Office in the Spring

 

Rain. Partly cloudy. Rain. Mostly cloudy. Snow. All cloudy. Rain.

Spring has come in fits and starts to the North Countryas usual, but this usual serving of ornery weather spares us for the most part from the drastic climatic events plaguing the rest of the country.

Despite the weather, or maybe because of it, things bloom. At Spruce this means lilacs; old bushes, almost tree height, with delicate white flowers at the second story level. Anyone who has supervised the growth of these persistent, hardy, memory-jostling  presences knows they demand only two things: pruning or not pruning. Take your pick. If you prune the main trunks by a third as advised to make them “bushy,” you get more suckers around the base. If you prune only the suckers, you need a ladder to smell the flowers because the trunks have a mind of their own.

Of the lilacs outside my office, none has been allowed to sucker, and one has been pruned to permit passage on the path around it. The cutting is purposeful and I found myself wondering as I waited between resident visits last week, who’s in charge of pruning at Spruce, and is there some kind of botanical grand plan involved?  The first person I thought of, our course, was Candace. As the founder and director of SMI her steady hand guides this ship even when she isn’t at the wheel. It is an effective and admirable skippering style. But what does she know about lilacs? There must be a secret lilac guru I haven’t yet met.

I mentally go through the staff list trying to align each name with his or her assigned job. There are plenty of possibilities.Those of us who chose to live in Vermont have an affinity for the natural world and some skills in making our way through it. I know there is a saw in the tool shed. Can anyone at any time just decide “oh well I guess it’s time to hack a limb off that old lilac?”

I hope you see where I am going. This isn’t really about lilacs. And pruning is too harsh a word for the work we do with residents at Spruce. But the implied parallel to helping young adults bloom by paying attention to natural processes is much to the point. And while there is a master gardener, her greatest skill is not in telling the staff how to shape the growing stock, but in how to work collaboratively to facilitate the growth that has been thwarted in those who come to SMI seeking help.

Interrupted. That describes most of the lives of our residents. As I listen to and read their stories, again and again I am impressed by the kinds of hurdles put in their paths, starting at an early age: anxiety, mood changes, learning problems, addictions. And the history of their attempts to move ahead despite these obstacles; therapy, medications, hospitalizations, resident placement. When we consider all the developmental tasks that need to be finished by society’s “grown up” gateway, twenty-one, the courage of these folks, our residents, to still want to fit in becomes all the more remarkable.

In my last column I wrote about “Emily McDonald” from Denver who had been hospitalized following a suicide attempt and was hoping to come to Spruce but was not quite ready. The clinical vignette was intended to identify questions that arise frequently in the admission process: What kind of potential resident will get the most out of being here and when should s/he come?

The skill and experience of the referring clinicians in recognizing when a person is ready for residential treatment is the key starting element. Their familiarity with SMI and/or the SMI admission team’s assessment that the proposed resident would be a “good fit” for our program is next. The intervening administrative details feel endless on both sides, but, in fact, the clunkiness of the process allows an opportunity to evaluate the timeliness of the referral.

When can my son/daughter come to SMI? How long will s/he have to stay? Is there a set time for them to start working? I hope they can be living independently by the end of the summer. Will they stay on the same medication the whole time? When can we talk to them on the phone? These are all questions relevant to time, but are on a different order of scale than the larger questions of treatment timeliness, a concept something akin in complexity to pruning lilacs.

It will be high summer when you hear from me next. In the meantime I will be thinking about how to describe for you the calculus of timing treatment in a residential setting. Perhaps you will be surprised to hear that it is not so much what the intervention is, as when it occurs, and less who does what to whom, than how consistent the resident’s internal experience feels with the external reality.

If there is in the above a blossom of hope for those of you who trust us with your loved ones, please take it. If not, blame it on the rain and I will try to do better.

(Dr. Richard Bernstein is the consulting psychiatrist at Spruce Mountain Inn.)