Waste of Time???

The patient came to our partial hospitalization program with a history of bouncing from shelter to shelter; short term program to short term program. He was admitted to our free male dorm to attend the program and I initially felt concerned that he might attempt “squatters rights” when the time came to discharge.

When case managing such a patient, one needs’ to be careful not to assume this will be the case again; even though it would understandably, be easy to do so.

Having this ‘history’ in mind I was a bit taken back when the first day he asked if I had lists of half-way houses and transitional programs for the Boston area. ‘I don’t want to wait until last second,’ he told me. Sure I said, and provided him with the lists feeling slightly perplexed.

For the next two weeks he could be found on the patient phone before groups started in the morning, in between groups, and after the group day making calls to various programs. He would then come to me to make the follow-up calls to see what information I needed to fax them (usually the bio/psych/social, TB test results, etc.).

Usually most mornings I head into work early so as to be able to ease into the day, have a second cup of coffee, do some writing (such as this blog for instance).

Well, on many of these mornings I would arrive and this patient would be waiting for me to call programs that he had spoken with the day before, after I had left for the day. I would have to explain to him that most programs would not have someone to ‘chat’ with at six-thirty; maybe we should wait until around nine o’clock or so.

Several times I would have to catch myself from getting annoyed with him; geez, he was doing the footwork on his aftercare, right?

He had never attended a half-way house. We had applied to five and were waiting to hear back from them. Late one afternoon I received a call from one of them stating he was accepted and that they would have a bed for him the following week. I needed to call the insurance company and seriously advocate that he be allowed to continue our program till the following week – which I gladly did and secured the time for him.

When I informed the patient he seemed happy, yet a bit frightened by this prospect of change. I explained to him that I would be more concerned if he did not feel nervous and apprehensive; after all he had been up to that point in a safe, secure, environment.

At the time I truly believed I had allayed his fears.

The patient was four days from what would have been his discharge date to enter the half-way house – and he took off! Someone on staff at the morning interdisciplinary rounds when hearing of this said, ‘that was a waste of time, huh?’

Actually, I do not see it that way; disappointing, yea, of course; but a waste of time?

Absolutely Not.

How so? This patient took his treatment to a new level when he came into our program and started calling programs to advocate for himself. He had never done that before. Although he did not ‘close the deal,’ maybe next time he will.

I’ve heard over the years it is about, “Progress not Perfection.”