John Smith is 41 years old and has suffered from severe kidney, bladder and urinary tract infections for many years. He’s also suffered from severe depression. He has been unable to work due to the medical issues, and his depression would keep him shut in at home with no desire to do anything, and often with no desire to live.
I first made John’s acquaintance on May 20, 2004. John was angry, sad, depressed, physically broken down, in terrible and constant pain, and just plain miserable over the course his life had taken. I spent a long time on the phone with him that day, and on many days since, developing a trusting relationship with John and helping him to prioritize and address all his issues. I helped him sort out his medical and mental health appointments, understand his medications, understand how the hospital system works, and how to get the best possible care. I helped him make appointments and reschedule them when he missed them. I helped him find providers close to his home and learn how to get to those that were not. With his permission, I spoke to his providers for him, and about him.
John came to trust me as someone who was there for him and who would do anything to help him. He came to rely on my assistance when he needed it and on my advice about not only health matters but also other issues, like how to deal with his 10-year-old daughter. This happens sometimes between a case manager and a member, but I don’t think either of us knew that this developing relationship would one day save John’s life.
You see, although we were making progress, John Smith was not getting better. His physical condition was deteriorating, because his depression prevented him from following the course of treatment prescribed for him. And as his physical condition worsened so did his depression, and he simply didn’t have the motivation to keep appointments, take medications, and do all the tough mental work that’s necessary to pull out of depression. And as much as we spoke, it was not enough to turn the tide. John started talking more and more about ending his life.
As a case manager, I have to be very careful in this situation. I have to judge when I think a member is truly a danger to him/herself, and take very serious steps if that’s the case. I tried everything I could to offer him support. It was an up-and-down battle. One day, he would sound better; the next day he sounded horrible. I spent many hours on the phone with him, and talking to his therapist and psychiatrist, monitoring him as best I could to keep him moving in the right direction.
On March 31, 2005, John Smith attempted suicide. I had spoken to him earlier in the day, after he had gone to the ER for a medical reason. He sounded okay. But later on that day, I picked up one of the scariest voice mail messages I have ever received. On it, John was crying, and said he was calling to say goodbye. He thanked me for all that I had done for him over the last year, and ended the message by saying, “There was just no other way, Sam, I didn’t have a choice.” Fearing the worst, I immediately called his home and got his answering machine, which I knew he monitored, but there was no answer. With no choice, I called 911. I was patched through directly to EMS, and an ambulance was dispatched.
I found out the next day that EMS had found John in his apartment, crying and holding a large knife. There was a superficial cut on his arm and a suicide note prepared. He claimed that he was not trying to kill himself, and refused to go to the hospital, which he was forced to do against his will.
As his case manager and as a licensed social worker in New York, I had done what I needed to do (and what the law required of me) by calling 911 and ultimately saving his life. But I knew that John would see my actions as a betrayal of our trust. Sure enough, the first contact I had from John after the incident was a middle-of-the-night message he left me, saying he was extremely disappointed in me, and that he wouldn’t have given me the courtesy of the goodbye call had he known what I was going to do. I spent the next month trying to reach John, and we finally resumed talking on April 29, 2005. By that point, John had had time to think over what had happened. To his credit, he realized that I had done the right thing, and he was now extremely grateful to me. And a good sign was that John asked me to continue helping him get into treatment.
I am still John’s case manager to this day. There have been tremendous ups and downs. But he always turns to me for help, and allows me to help by talking to him and by getting him to see his therapist and psychiatrist. And always, John refers back to the darkest moment of his life and showers me with gratitude, saying that he knows that he would not be around if not for me. And I always respond by telling him that whatever success he’s had is due to the hard work he’s done in helping himself.
Today, John Smith is in a much better place. After years of battling depression, of staying in his home and suffering, and of having almost no quality of life, he has recently taken a part-time job as a clerk in a college bookstore. And, equally surprising and impressive, he has enrolled in a Kaplan’s course to prepare himself for the LSAT, in anticipation of gaining entry to law school. When I speak to him today, as I still do but less often, he sounds well. He is happier than ever, though still not where he wants be. But he has interests, he has plans, he has hope, and most importantly, he has a future.
