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Precision has always been a challenge for me.

After hanging out with a friend, my wife will ask, “How’s Bill?”

“He’s good…”

“…yeah? What’d you guys talk about?”

“……I dunno…”

“How could you not know!? You just hung out for 3 hours!?”

It’s not that I willingly forget, it’s just that I can’t remember. I’m not the Blackbox on a downed airplane! To me, let bygones be bygones and if it happened in the past, then it’s over. Of course, my hakuna-matata attitude is a far from ideal fit in the healthcare industry. They want meticulousness and documentation. To answer the question “How’s Bill?” we are given the DSM-5, a thick medical tome filled with every possible mental health diagnosis you could imagine. We have a one-hour conversation with Bill and he is given a nice little diagnostic code to describe his recent experience of life – like Generalized Anxiety Disorder or Major depressive disorder, single episode, severe w/o psychotic features. We then fill out records of our conversation to a level of detail that would make my wife purr with satisfaction.

There’s nothing wrong with this, it’s just that I’m bad at it, because as I mentioned above precision has always been a challenge for me.

I tend to be totally in the moment with clients. I become engrossed in their stories and their lives. I feel their pain as they describe it. The love I feel for them is authentic and deep.

But by necessity I must forget. You can’t carry around hours and hours of people’s anguish and sadness. To do so would spell the quick demise of any trained therapist. You’d lose your mind, start to see the world through the lens of despair. Time only flows in one direction and so I cannot go back again. But for the sake of documentation I am ordered to travel back in time and record the details of my journey!

***

Precision is a real challenge, but so is a procrastination rooted in administrative despair.

If you can believe it, until very recently the clinic I was working at used paper records for all behavioral health patients and I’d spend hours stacking and stapling papers Dunder Mifflin style. We had this filing room with client reports and paper folders stacked from floor to ceiling. Every dirty secret the town was holding was written down somewhere in that room. Some long-term clients had files thicker than the King James Bible and the musk of rotting paper made the room feel like you’d been sent back in time to the 1970s. All therapists at the practice shared the room and because it was an open space, you could generally see who was behind on their paperwork and who was right on top of their notes. I would often glance at other counselors’ mailboxes and cabinets and feel a strong mixture of shame and jealousy.

Paperwork feels to me like mowing your yard, it needs to be consistently done or it will become overgrown. Next to mine sat the file drawer of Sandra Lee LPC – an immaculate lawn, richly green, finely trimmed, with sweet scents of freshly mown sheaves. A bit further down was Dr. Denise Willup, a cabinet to be featured on the cover of Better Homes and Gardens, so sparklingly organized you could play golf on it.

Then there’s my cabinet, my file drawer, my mailbox. I’m that guy on the block…. You know? The one where it’s not clear if they’re having a yard sale or that’s just how their lawn looks? I’m the guy with the canoe in the front yard, weeds so overgrown neighbor kids refer to it as “Jumanji”, the guy who they gossip about at the Home Owners Association meetings. The one getting citations from the city.

Oh sure, sometimes I do something about it. I’ll stumble out of the house with a weed whacker and beat back the wild overgrowth, making the yard look like one of those haircuts they give you in the ER when you need stitches. Examples of this include writing the discharge report that should have been done months ago or bunching progress notes into stacks. My lawn appears a bit more cleaned up, but look closely and you’ll see the old tractor tire laying on its side, covered in weeds.

I don’t want to be this way, but my existential turmoil hinders me from action. And there’s so much working against me. The counseling profession is weird in that you have no set hours, but rather get paid for each client you see. This means you don’t have to stick around when sessions are done. You’re not technically on the clock because there is no clock. Obviously, there is something dangerously unmotivating about keeping on top of paperwork when you could otherwise leave immediately and go get ice cream at The Dairy Barn.

Near the end of my time, we joined civilization and switched to electronic medical records. It was then that I began to make real progress.

By the time I left, I was all caught up, my lawn a pristine display for all to marvel at. (or rather an empty file drawer)

But it wasn’t easy. I wrestled within my soul and from somewhere deep inside of me, the voice of my blue-collar ancestors, the ones who worked in Detroit factories and stayed in the same career for decades shouted at me “DO! YOUR! JOB!!!”

So, I sat down to fill out a client progress note:

Question 1: “How’s Bill?”

Answer: “He’s good.”

Question 2: “…yeah? What’d you guys talk about?”

Answer: “……I dunno….”

How Could You Not Know!?