We should never have gotten involved with this guy.
First of all, Donald Lee* (name changed to protect privacy) was, in my humble opinion, much too young for assisted living. A short, compact man with salt-and-pepper hair, he was barely three years older than I, and experience had taught me that Baby Boomers thrown into a communal living situation with seniors old enough to be their parents generally don't do well. Then there was the pesky fact that he was a formerly homeless, family-less, friendless alcoholic with multiple psychiatric diagnoses whose mere presence would probably frighten the living daylights out of our customary population. He had just failed his second adult foster-care placement when his Medicaid caseworker came to my executive director, pleading for a "favor" and offering the moon and stars if we would just keep him off the streets temporarily until she found more suitable housing for him.
That was almost a year ago. In the weeks and months that followed, Don consumed more of our time and resources than all of our other 85 residents combined, with repeated ER visits for suicide threats and ongoing behavioral issues such as burning himself with matches and stealing employees' cell phones from the break room. We careplanned and careplanned again; he continued to be disruptive and contemptuous of our efforts to help him manage his outbursts. We encouraged him to keep his counseling appointments, to no avail. We advocated for mental hospital admission, and learned that not one such facility in the entire state would admit him unless he actually tried to kill himself or someone else.
Even his primary-care physician didn't really want to have anything to do with him. As was my duty, I called and faxed the office with updates and suggestions on a weekly, and sometimes daily basis until one day he faxed me back with this terse reply: "This patient has been in my care for the past 10 years. He is beyond help. You need to stop trying---he's not worth it."
In late August, Don's state funding dried up, essentially granting our secret petitions to God that something would force him to move. He was viewed as a pathetic, freakish loser who couldn't be trusted as far as you could throw him, and he was certainly not adjusting to living among the older generation as he rarely, if ever, came to meals or even spoke with other residents. He was also demanding, abrasive, and verbally abusive to staff on top of everything else......the sooner we were rid of him, the better!
In early September, he had a heart attack. This hospital admission was swiftly followed by another for complications relating to the MI.
The ED and I fought hard and long to get Don admitted to a skilled-nursing facility for some rehab, but with no insurance and no funds to pay privately, he boomeranged right back to us as soon as the hospital could discharge him. Fortunately, some of his psych meds had been changed while he was hospitalized, and for a time after he returned he was better than we'd ever seen him. He no longer screamed at staff or hid out in his room; as he told me one day, the MI had scared him sufficiently to make him realize that he really did want to live after all, and he was willing to do whatever it took to stick around. Meanwhile, the ED worked with Don to organize his finances and stay afloat until we could find him a better placement, because he would literally become homeless again once we "kicked him out" and then he'd be society's problem.
Some of the staff said, "Better society's problem out there, than our problem in here." I could only disagree half-heartedly; he'd cost me vast amounts of time, effort, worry, and mental gymnastics ever since his admission, and there'd been absolutely NO reward in any of it. Despite recent efforts in the right direction, we waited for the other shoe to drop, and I often thought his PCP was right about his being beyond help. And if truth be told, I didn't think he was worth it either.
Then, in early October, the drinking started. After a self-reported five years of sobriety, he'd fallen off the wagon, and now all bets were off.
Now he really WAS a headline-in-the-making. Mental illness, antipsychotic meds, and alcohol were a disaster waiting to happen, and we all knew it. Sure enough, the suicide threats started again; he appeared in common areas overtly intoxicated at all hours of the day; and now he began to threaten physical harm to others: "I'm gonna set my room on fire one of these nights," he was overheard telling a staff member one evening, "and we're ALL gonna burn, even those sweet little old ladies who're nice to me sometimes."
Out of all the crazy-sounding statements the man had ever made, this one scared me. I'm no expert, but as a recovering alcoholic myself, I sensed that he'd reached critical mass and feared that he no longer even cared if he took innocent people with him when he finally decided to end it. But there wasn't a blessed thing I could do about it, for the ER sent him right back to us after we shipped him out for a psych eval. His PCP didn't care, the state had washed its hands of him, and the police refused to take him into custody for his own protection. Now, each night when I left the building for home, I wondered if it would be there the next morning.....if my son, the night-shift med aide, would be OK.......if there was anyone who could, or would, help Don and save us all from becoming the featured story on the five o'clock news.
What happened the Monday after his last ambulance trip to the ER for visual and auditory hallucinations that were telling him to "end it now!" is still up in the air as to its ultimate significance, for no one knows what lies ahead. But I am firmly convinced that somebody much wiser and greater than I brought Don to my office door that morning.
Now, I had never had a huge communication problem with him, and he knew the ED and I were his only real advocates---his Medicaid case manager having dropped him like a hot potato---but I didn't relish the prospect of hearing any of his sob stories and wild delusions. I was worried for my other residents and my staff, and I really wasn't in a mood to deal with him; however, it's part of my job, so I invited him inside and inquired as to what I could do for him. That's when I got a really good look at him.
He was stone. cold. sober. His gray eyes, recently so bloodshot, were as clear as I'd ever seen them, and so was the voice that had been so slurred as to be unintelligible. He told me he was scared to pieces of being "thrown out of this place" and winding up back at the homeless shelter, or worse. He said he knew he'd "screwed up royally" and probably deserved eviction, but also that this was his last chance at having some sort of life and if he became homeless again, he didn't think he'd make it because no one would be there to make sure he got his meds.......or had something to eat......or even got into a warm bed when he fell asleep on the floor late at night.
That's when I told him I understood more than he knew about being an alcoholic, but I couldn't help him unless he was willing to admit he was drinking again. After all, I said, you can't BS another BS'er.
And he did.
He admitted everything. He told me exactly when he'd bought that first case of beer and why (losing his state support and being threatened with the prospect of homelessness had sent him over the edge, he said), and that he hadn't had a drink in the previous 48 hours because that last ER trip had really scared him. And I believed it, because he was as sober as a judge and thinking as clearly as he was able, given his psychiatric issues.
I don't know why I broke my personal rule about disclosing my own history to patients, but it obviously had an impact. Suddenly words he hadn't known how to say for God knows how long came tumbling out in a rush. I won't share them here because of confidentiality and space considerations, but it was amazing how much Don opened up to me in those forty-five minutes. He repeatedly verbalized astonishment at the fact that I'd been fighting the same disease for nearly two decades, and never let my guard down because I still crave alcohol (at times) just as badly as I ever did---"You can still taste the booze after all those years? How in the hell do you stand it when the cravings get that bad?" He reminisced about his days as a sponsor in AA and quoted familiar passages from the Big Book as I looked up local meeting times online and urged him to get to one ASAP.
Well, it's too early to tell, but in that brief meeting of two addictive personalities, I felt that a connection had been made......if only for a few moments. But even if it doesn't last, I'm feeling a little easier in my soul for having reached out to this sad, sick man yearning---like everyone else---to belong.
As to whether he's 'worth it'........that's a story which has yet to be written, but in my heart of hearts, I already know the answer.
