I worked the inpatient psych/addiction scene for close to fourteen years before re-entering the detox and day treatment scene. This story is from those inpatient days.
Phil was a guy that would come in a couple of times a year. He would go off his anti-psychotic medication (stelazine) and then go on a two, three day bender drinking; which would cause him to lapse back into a state of paranoid schizophrenia.
This last time I worked with him was no different. It had been a beautiful summer and Phil thought it was too nice not to have a couple of beers. Well, this couple of beers escalated in a day or so, to drinking around the clock. We are talking a case a day plus. Per usual he had stopped his medication from day one of this episode.
By the time he came in he was in an ever increasing state of paranoia. He was convinced that the F.B.I. was watching him and they had tapped his phone; that is what the voices were telling him anyway. As was typical with a patient in this state of mind they cannot be convinced otherwise. I would acknowledge to him that I believed he was hearing voices; but that I was not.
I had built a good rapport with him over the years and he would seek me out on the unit when in the throes of another extreme episode of feeling paranoid.
Phil had been assigned to one of the new psychiatrists on the unit at the time. One that had been schooled in all the “new” anti-psychotic medications; hence he started Phil on one of these newer medications. When that first one did not work he tried another and after several days with no effect, a third.
In the meantime, Phil’s state of paranoia was ever increasing without relief. I could sense his agony going through this process. He had asked the doctor several times to go back on stelazine and the doctor kept putting him off on that being an option.
Finally after a week or so of this ‘experimentation,’ Phil was ready to explode.
I went to the doctor with this info and his response was, ‘if we need to, we will have a ‘show of force,’ and then restrain him if necessary.’ After this compassionate statement I let him know that those of us working the unit referred to a ‘show of force,’ as a ‘show of support,’ rather the arcane, negative, ‘show of force.’ He seemed put-off by my remark, too bad I thought. I am there for the patient, not for some pompous ass, using Phil as a guinea pig.
The next day Phil came to me, ‘please Willy tell him just to put me back on stelazine.’
So once again I went to the doctor to tell him of Phil’s desire to be started back on stelazine. He responded to my statement by saying, ‘stelazine had a lot of possible side-effects.’ Side effects doc, he has been on stelazine for ten years now, don’t you think he would have experienced them by now?
His first remark back to me was, ‘my name is Doctor XYZ, which I would appreciate if you would use in the future when addressing me. I made no comment back. The rest of the “doc’s” except this one wanted us to call them by their first names; they respected our observations, counselors and nurses alike. We were a ‘team’ that looked out for each other on the unit; we watched each other’s backs.
He went on to say that “he” knew what was best for Phil.
I had had enough. O.k. “Doctor XYZ,” let me tell you what is going to happen. Phil is riding the edge right now and it is only a matter of time before he goes off. I’m pretty sure you have noticed that he is quite a large man. Say, what, about six-foot four, roughly two hundred and sixty pounds. I’m fairly certain that when I go back and inform him that you do not plan on putting him back on stelazine, he is going to go after you…and you know, by the time we can get the Code team together…
“All right,” he said, “I will talk with him now about the ‘possibility’ of going back on stelazine.” He was perturbed at me; I didn’t care.
Well, he put Phil back on stelazine and he stabilized enough in three days to return home.
Listen to the patient…
Monday, July 30, 2012
Friday, July 20, 2012
“When You Leave Work – Leave Work.”
I am into my twenty-fifth year working in the psych/addiction field. Early on in my career, the title of this blog was not always easy to accomplish. As a matter of fact, it took several years before I was able to accomplish this on a regular basis. Even now, there are days that can be difficult to disengage from when I leave work at the end of the day; particularly if the transference/counter-transference game had been in play. Sometimes I will call my therapist on an exceptionally trying day to see if he has an open slot. The last thing I want to do is take the ‘day’ home with me.
In the early days of my career I would take it home every night. I would share the ‘joy’ of the day with my wife and her usual response would be, “I don’t know how you do it.” I would blame it on my parochial education with its emphasis on the ‘Seven Works of Mercy.’ (Bury the dead, visit the imprisoned, feed the hungry, shelter the homeless, clothe the naked, visit the sick, give drink to the thirsty). Damn those Nuns! I bought into the whole empathy, compassion deal. Oh well, guess there are worse things to espouse.
If I am not taking care of myself, how can I help others, to help themselves (do as I say, not as I do?) Keep taking work home with you and it is only a matter of time before ‘burn-out’ creeps in. I have seen this occur many times over the course of my years in the field; instances where really good clinicians have, well, ‘hit the wall’ and burned out.
I have especially seen this happen when the clinician is in recovery themselves. Slowly and insidiously the line becomes obscured between being in a professional relationship with the patient, and the relationship becoming a mutual one.
What they do for work becomes their ‘program.’ Good luck to those that are on this path. Burnout is more than likely right around the corner. I have heard clinicians say to a patient about to discharge, “I better see you at the meeting this Saturday!” Yup, I smell burn out coming; only a matter of time. Not to mention the line into co-dependency begins to rear its pervasive head.
“Well what am I supposed to do? There are always former patients at the meetings I go to." How about starting a ‘two-hat’ meeting? A ‘two-hat’ meeting is one that is attended only by those who work in the field and are in recovery themselves. These meetings are not listed. If you go to meetings that former patients attend, how can you maintain a professional role if they need to re-enter treatment? You cannot realistically do so.
Another way people ‘burn out’ is not taking care of themselves; nutrition, exercise, hobbies and outside interests.
Personally, I have been a roll the past several months preparing material for lecture, growing my social network, trying to finish up a book I have been writing, expanding my national contacts, writing this blog, etc.
Over the course of doing this I lost sight of nutrition and exercise. Before I knew it my weight shot up from 210 to 228, my waist went from 35’ to 40.’
I slammed the brakes on this a couple of weeks ago. I ‘make’ time in my schedule once again to hit the YMCA at least three times a week. As far as nutrition, I eat clean & healthy six days a week. Friday is my anything goes day. The reason for this is quite simple; I have no intention of going through the rest of my life without Italian pastries, pizza, ice cream, pasta, etc.
In the two weeks since re-starting a healthy regiment I have gone from 228 down to 220 and my waist is 37.’ Two, three weeks more, I should be back to my former self.
So long as I have been eating clean & healthy six out of the seven days of the week, and have been working out, this one day does not affect my weight.
Diet should be a way of eating for life; not a quick fix. Ask most people that have been on ‘quick’ weight loss diets and they will more often than not, tell of gaining back the original weight and then some once they stop the ‘diet.’
Another tool to help prevent burnout is having a therapist. I mentioned earlier that I have a therapist. Usually the first half of the session is about work; essentially a form of supervision. The second half is about my own issues that are outside the realm of work (not that I really have any, lol).
Once I leave work, I leave work. I am not my job. It is a ‘part’ of who I am, not the totality. Nor is it the ‘most’ important part of life, I reserve that designation for my family and friends.
Peace, Out
In the early days of my career I would take it home every night. I would share the ‘joy’ of the day with my wife and her usual response would be, “I don’t know how you do it.” I would blame it on my parochial education with its emphasis on the ‘Seven Works of Mercy.’ (Bury the dead, visit the imprisoned, feed the hungry, shelter the homeless, clothe the naked, visit the sick, give drink to the thirsty). Damn those Nuns! I bought into the whole empathy, compassion deal. Oh well, guess there are worse things to espouse.
If I am not taking care of myself, how can I help others, to help themselves (do as I say, not as I do?) Keep taking work home with you and it is only a matter of time before ‘burn-out’ creeps in. I have seen this occur many times over the course of my years in the field; instances where really good clinicians have, well, ‘hit the wall’ and burned out.
I have especially seen this happen when the clinician is in recovery themselves. Slowly and insidiously the line becomes obscured between being in a professional relationship with the patient, and the relationship becoming a mutual one.
What they do for work becomes their ‘program.’ Good luck to those that are on this path. Burnout is more than likely right around the corner. I have heard clinicians say to a patient about to discharge, “I better see you at the meeting this Saturday!” Yup, I smell burn out coming; only a matter of time. Not to mention the line into co-dependency begins to rear its pervasive head.
“Well what am I supposed to do? There are always former patients at the meetings I go to." How about starting a ‘two-hat’ meeting? A ‘two-hat’ meeting is one that is attended only by those who work in the field and are in recovery themselves. These meetings are not listed. If you go to meetings that former patients attend, how can you maintain a professional role if they need to re-enter treatment? You cannot realistically do so.
Another way people ‘burn out’ is not taking care of themselves; nutrition, exercise, hobbies and outside interests.
Personally, I have been a roll the past several months preparing material for lecture, growing my social network, trying to finish up a book I have been writing, expanding my national contacts, writing this blog, etc.
Over the course of doing this I lost sight of nutrition and exercise. Before I knew it my weight shot up from 210 to 228, my waist went from 35’ to 40.’
I slammed the brakes on this a couple of weeks ago. I ‘make’ time in my schedule once again to hit the YMCA at least three times a week. As far as nutrition, I eat clean & healthy six days a week. Friday is my anything goes day. The reason for this is quite simple; I have no intention of going through the rest of my life without Italian pastries, pizza, ice cream, pasta, etc.
In the two weeks since re-starting a healthy regiment I have gone from 228 down to 220 and my waist is 37.’ Two, three weeks more, I should be back to my former self.
So long as I have been eating clean & healthy six out of the seven days of the week, and have been working out, this one day does not affect my weight.
Diet should be a way of eating for life; not a quick fix. Ask most people that have been on ‘quick’ weight loss diets and they will more often than not, tell of gaining back the original weight and then some once they stop the ‘diet.’
Another tool to help prevent burnout is having a therapist. I mentioned earlier that I have a therapist. Usually the first half of the session is about work; essentially a form of supervision. The second half is about my own issues that are outside the realm of work (not that I really have any, lol).
Once I leave work, I leave work. I am not my job. It is a ‘part’ of who I am, not the totality. Nor is it the ‘most’ important part of life, I reserve that designation for my family and friends.
Peace, Out
Sunday, July 15, 2012
Thoughts on ‘Things’ I Find Maddening!
Many of you are aware of my “past life" as a comedy writer and stand-up comedian. My wife (of thirty-two years) occasionally reminds me when my comedic ego arises that “if you were that funny…you would still be doing it.”
Nice, real nice, lol. I hate her brutal honesty (not really).
I find it maddening when people say, “Have a nice day!” As George Carlin said, to paraphrase, ‘Maybe I have had ten nice days in a row and I just want to have a shitty one.’ Please, allow me to be in the space I am in, all right? It is up to me to determine what kind of a day I want to have. Am I not entitled to have the kind of day "I want?"
I find it maddening when I have to interact with people that are always ‘cheery.’ Everything is always “Wonderful!” In the meantime their house just burned down, a family member has an incurable disease, and they just learned that their son has a drug addiction. Ah, reality check please.
Jesus, what medication(s) are you on? I’ll have to contact my primary care physician that had sixteen hours in medical school on mental health and ‘get me some of that!’
If people do not want me to, or allow me to experience true sadness including downer days, how can I experience “True” happiness? Not the ‘plastic’ variety that our society often espouses as being correct & proper.
I find it maddening when the first question out of a patient’s mouth is, “How do I get on suboxone and SSDI/SSI?” On the same note, when patients are talking amongst themselves, coaching newbies on how to go about this, ‘you need to do this, this, and this.’ Then to compound this further, they brag about how they work under the ‘table’ to really maximize their profits!
I can remember when these ‘benefits’ were viewed as a temporary state of being and once a person had their substance abuse and mental health issues in order they would ‘get-off’ SSI or SSDI. It seems like this does not occur all that often anymore. Maddening, truly maddening.
I find it maddening when I see all the motivational books offered out there emphasizing how ‘their method’ is the answer to achieve “Happiness!” Especially a certain ‘Dr. DWD. If you know who I am talking about then you have probably bought one of his books; hence, making him really, really, happy (good work, lol).
Reminds me of all the “Self-help” books out there. To paraphrase another comedian, Steven Wright; ‘if you are into self-help, why would you feel the need to buy a book on self-help from SOMEONE ELSE?’
I find it maddening when people look at their therapist as almost a ‘status symbol.’ “Hey how long have you been seeing your therapist?” For ten years now. “Ten years, what are you working on?” Oh, nothing really, I just go there to talk about my week. “Talk about your week? What, you don’t have any close friends you could talk with?” Nice.
I find it maddening when people look down on alcoholics, addicts, and those with other mental health issues; well, until it is about one of their loved ones and their attitude suddenly changes to one of ‘caring.’
I find it maddening when people try to proselytize others to their religion and concept of “God.” I suggest they read Joseph Campbell’s “The Hero with a Thousand Faces,’ or, “The Power of Myth.” Then we can have dialogue. A person made the mistake the other day to ask me if, “I have found Jesus?” Being of comic bent my response was, “Wow, I didn’t realize he was missing! Have you called all the local area hospitals?”
Another time I kept having the same proselytizers’ ring my doorbell at least once a week for several months. Finally I had enough of this. The last time they came to my door…I answered it naked. Boy you should have seen them scamper off my porch in a hurry. “Hey, this is how God made, come back!”
Maybe my wife is right, good thing I left the comedy scene, huh?
I find it maddening when therapists and counselors believe that their method(s) are the only ones that a client or patient can benefit from; instead of individualizing treatment choices to meet their needs. Or, when a ‘Super’ counselor/therapist spends the whole session telling the patient/client what ‘worked’ for them. Good going, now you have set-up an ‘expectation within them that they have to do it your way. What happens if they can’t do it your way? Oh well, they have to keep trying I guess (Maybe you should be listening to “their” story, not telling yours).
These are a few of my maddening things (gosh, sounds like a line from a Julie Andrew’s song in the “Sound of Music” does it not? (Ah, for those of you old enough to remember the movie, lol).
So, I am just spouting off here and not being a part of the solution on these things I find maddening? No, I lecture, I teach, I advocate for change, I belong to organizations that foster change. That is what I do.
Oh, before I forget…
“Have A Nice Day!!!”
Peace, Out…for now
Thursday, July 12, 2012
"The Young Stripper"
From the moment I spotted her, something about her just did not fit in with our usual crowd at the detox. She looked, well, like a model, one that had come upon hard times that is. My guess based on her gaunt appearance was that she had been using cocaine and/or heroin (later my guess would be confirmed after reading her chart - both, plus alcohol). Most of the patients in our facility had multiple detoxes under their belts. If you averaged out the number of stays amongst the 28 patients that we held, usually the number would run between 10-20 stays per person.
She was young, nineteen I learned later that afternoon, and this was her first detox. Her name was Melissa and she had grown up in a wealthy, affluent suburb of Boston. After I checked in with the patients that I had been working with throughout the week, I decided to sit with her and listen to her story.
Melissa had attended a private high school in Boston and her father, a prominent Boston Physician, wanted her to go to an Ivy League School for either pre-law or pre-med. She was not interested in either however. Her passion was to found in the dramatic arts. As she expressed to me, the stage was everything to her. It made her feel alive and one with the world.
This caused great tension in her home as she finished her senior year in high school. Her mother was constantly caught between her and her father. She had applied to a University in New York for the Dramatic Arts and after receiving mail of her acceptance, was determined to attend. This increased the tension in the house with her father stating that he would not financially support her endeavor what-so-ever.
She told him that was fine by her. She had a half scholarship and would just get a part-time job once she was there for the remainder.
This is where the trouble began however.
Once she had settled into College that fall, she began to look for work. This proved not to be as easy as she had initially thought. After a month or so of looking with no luck, she began to get panicky. Her mother was sending her money behind her father’s back; this still did not cover all her expenses.
Then one day she happened to overhear a few of her new aspiring actress friends talking about dancing to help pay the bills. When she questioned them further, she realized that they were talking about exotic dancing, stripping. At first she was mortified but when they told her the type of money they were making, this faded away rather quickly with some rationalization on her part.
Unfortunately, like many women that initially enter the dancing profession, (I know some will question my choice of calling it a profession), she began to get caught up in the after-work lifestyle. She frowned upon having sexual relations with the customers which several of the ‘dancers’ did; partying with them was o.k. to make additional money however.
For Melissa it began innocently enough, (or so she thought), a couple of lines, a couple of drinks, that should help in keeping them coming back. She told me how she loved the attention of the men that watched her dance: she was in control, (or so she thought she later stated to me). These men were so different from her father. He was always criticizing her, always questioning her judgment. She felt like she could never do anything right in his eyes. Although these men looked at her lustily, it was positive attention in her eyes.
The lifestyle began to catch up with her. After several months of dancing she was finding it more difficult to get up in the morning for classes after late night partying.
Her studies began to suffer and the calls from her mother trying to persuade her to come home and re-think her future were beginning to wear on her. She understood without being told that her father was pressuring her mother to make these calls.
The stress and strain of school, dancing and partying at night, and the family issues were beginning to wear her down. At this point she began to snort heroin... When I asked her why heroin, she told me that people had told her that when you use heroin, you haven’t a care in the world, well, except getting more heroin that is.
She told me that she realized that booting heroin would be the next step in her addiction and she wanted to put the brakes on before hitting that level. She had taken a leave of absence from school and would live with a couple of girlfriends from High School while trying to put her life back together. She entertained thoughts of returning to college after some sobriety time.
The only person that knew she was at the detox was her mother, (or so she thought). I was working a Saturday night when there was a knock at our front door. It was a couple in their late forties. As I let them in the man turned to me and stated, “I am Doctor such-and-such, from the xyz hospital in Boston, and I demand that you bring my daughter Melissa out to me now!”
I looked at him directly and said, “Well, first of all, this isn’t xyz hospital in Boston. Secondly, all the people admitted here have to be of legal age to make the decision to be here. Thirdly, it’s their choice if they want to see or not see someone.”
“Therefore, before you further make an ass of yourself with your condescending attitude and bravado, I suggest you calm down and have a seat. Another outburst and I will have the police here in less than two minutes to escort you out.”
I looked at his wife who was crying at this point then back to him. “If your daughter is here, I will have to ask her first if she wants to see you.” He was about to speak and before he could do so, I spoke, “This is not a two way dialogue, think of it as a lecture, you are a guest in my house right now and my rules apply, not yours, understand?”
He gave me a slight head-nod while gritting his teeth.
I left them at the front desk and entered the main door of the unit to find Melissa. She had been near a window that allowed her to hear the whole conversation that we had been having by the front door. “What should I do”, she asked me. “Well, you may as well confront him here and get it over with. Besides, I will be right by your side and once the ‘chat’ is over, they will be leaving.” “Just don’t leave me with him to talk, O.K.?” “O.K.,” I replied back to her.
I brought her out to meet them, immediately she went to her mother and hugged her. She then turned towards to her father and gave him a downward eye nod. The father looked at me and asked for a room to meet with his daughter alone. I told him that Melissa did not want that. His affect began to grow angry, I reminded him that he was a guest in my house and to remember my previous offer to call the police.
He began by telling her he knew this would happen, if she had only listened to him, she wouldn’t be in her current predicament. She stood there eye-to-eye with him. When he finished, she started to speak.
If you had really cared about me and not your God-damn image, you might have supported me in whatever endeavor I chose. Yes, this predicament is of my own making, and you know what, the solution will also be of my own making, not yours! The father went on to tell her how he gave her everything a girl could possibly want. When he finished, she said, yes everything, except your time and your understanding, but then again, I guess you save that for your patients huh? Then she went on to wrap up the conversation by saying, “You know what, I really don’t care how my present situation has affected you and your image; I do feel horrible by how it has affected Mom though.
Melissa began to turn away but before doing so, she told her mother the visiting hour times and that she would prefer next time if she came alone. She then went through the main doors back into the detox unit.
The father went storming out of the detox while the mother stayed behind with me. She asked me, “How is Melissa doing?” I told her, “so far, so good.” The easy part is the physical detox I told her, the difficult part for Melissa will be to change the thinking and patterns of behavior that had made it seem o.k. to “use” as a solution for life’s issues.
A car horn outside started to beep several times. Melissa’s mother said, “I better be going or there will be a price to pay.” I told her, “Take It Easy, call me if you would like updates.” She gave me a smile of resignation and said, “Thank You,” then walked down the stairs and out the door to the waiting car.
Melissa decided to go to a half-way house rather than move in with friends from high school. She was determined and motivated to get back to life on a healthy track.
She was young, nineteen I learned later that afternoon, and this was her first detox. Her name was Melissa and she had grown up in a wealthy, affluent suburb of Boston. After I checked in with the patients that I had been working with throughout the week, I decided to sit with her and listen to her story.
Melissa had attended a private high school in Boston and her father, a prominent Boston Physician, wanted her to go to an Ivy League School for either pre-law or pre-med. She was not interested in either however. Her passion was to found in the dramatic arts. As she expressed to me, the stage was everything to her. It made her feel alive and one with the world.
This caused great tension in her home as she finished her senior year in high school. Her mother was constantly caught between her and her father. She had applied to a University in New York for the Dramatic Arts and after receiving mail of her acceptance, was determined to attend. This increased the tension in the house with her father stating that he would not financially support her endeavor what-so-ever.
She told him that was fine by her. She had a half scholarship and would just get a part-time job once she was there for the remainder.
This is where the trouble began however.
Once she had settled into College that fall, she began to look for work. This proved not to be as easy as she had initially thought. After a month or so of looking with no luck, she began to get panicky. Her mother was sending her money behind her father’s back; this still did not cover all her expenses.
Then one day she happened to overhear a few of her new aspiring actress friends talking about dancing to help pay the bills. When she questioned them further, she realized that they were talking about exotic dancing, stripping. At first she was mortified but when they told her the type of money they were making, this faded away rather quickly with some rationalization on her part.
Unfortunately, like many women that initially enter the dancing profession, (I know some will question my choice of calling it a profession), she began to get caught up in the after-work lifestyle. She frowned upon having sexual relations with the customers which several of the ‘dancers’ did; partying with them was o.k. to make additional money however.
For Melissa it began innocently enough, (or so she thought), a couple of lines, a couple of drinks, that should help in keeping them coming back. She told me how she loved the attention of the men that watched her dance: she was in control, (or so she thought she later stated to me). These men were so different from her father. He was always criticizing her, always questioning her judgment. She felt like she could never do anything right in his eyes. Although these men looked at her lustily, it was positive attention in her eyes.
The lifestyle began to catch up with her. After several months of dancing she was finding it more difficult to get up in the morning for classes after late night partying.
Her studies began to suffer and the calls from her mother trying to persuade her to come home and re-think her future were beginning to wear on her. She understood without being told that her father was pressuring her mother to make these calls.
The stress and strain of school, dancing and partying at night, and the family issues were beginning to wear her down. At this point she began to snort heroin... When I asked her why heroin, she told me that people had told her that when you use heroin, you haven’t a care in the world, well, except getting more heroin that is.
She told me that she realized that booting heroin would be the next step in her addiction and she wanted to put the brakes on before hitting that level. She had taken a leave of absence from school and would live with a couple of girlfriends from High School while trying to put her life back together. She entertained thoughts of returning to college after some sobriety time.
The only person that knew she was at the detox was her mother, (or so she thought). I was working a Saturday night when there was a knock at our front door. It was a couple in their late forties. As I let them in the man turned to me and stated, “I am Doctor such-and-such, from the xyz hospital in Boston, and I demand that you bring my daughter Melissa out to me now!”
I looked at him directly and said, “Well, first of all, this isn’t xyz hospital in Boston. Secondly, all the people admitted here have to be of legal age to make the decision to be here. Thirdly, it’s their choice if they want to see or not see someone.”
“Therefore, before you further make an ass of yourself with your condescending attitude and bravado, I suggest you calm down and have a seat. Another outburst and I will have the police here in less than two minutes to escort you out.”
I looked at his wife who was crying at this point then back to him. “If your daughter is here, I will have to ask her first if she wants to see you.” He was about to speak and before he could do so, I spoke, “This is not a two way dialogue, think of it as a lecture, you are a guest in my house right now and my rules apply, not yours, understand?”
He gave me a slight head-nod while gritting his teeth.
I left them at the front desk and entered the main door of the unit to find Melissa. She had been near a window that allowed her to hear the whole conversation that we had been having by the front door. “What should I do”, she asked me. “Well, you may as well confront him here and get it over with. Besides, I will be right by your side and once the ‘chat’ is over, they will be leaving.” “Just don’t leave me with him to talk, O.K.?” “O.K.,” I replied back to her.
I brought her out to meet them, immediately she went to her mother and hugged her. She then turned towards to her father and gave him a downward eye nod. The father looked at me and asked for a room to meet with his daughter alone. I told him that Melissa did not want that. His affect began to grow angry, I reminded him that he was a guest in my house and to remember my previous offer to call the police.
He began by telling her he knew this would happen, if she had only listened to him, she wouldn’t be in her current predicament. She stood there eye-to-eye with him. When he finished, she started to speak.
If you had really cared about me and not your God-damn image, you might have supported me in whatever endeavor I chose. Yes, this predicament is of my own making, and you know what, the solution will also be of my own making, not yours! The father went on to tell her how he gave her everything a girl could possibly want. When he finished, she said, yes everything, except your time and your understanding, but then again, I guess you save that for your patients huh? Then she went on to wrap up the conversation by saying, “You know what, I really don’t care how my present situation has affected you and your image; I do feel horrible by how it has affected Mom though.
Melissa began to turn away but before doing so, she told her mother the visiting hour times and that she would prefer next time if she came alone. She then went through the main doors back into the detox unit.
The father went storming out of the detox while the mother stayed behind with me. She asked me, “How is Melissa doing?” I told her, “so far, so good.” The easy part is the physical detox I told her, the difficult part for Melissa will be to change the thinking and patterns of behavior that had made it seem o.k. to “use” as a solution for life’s issues.
A car horn outside started to beep several times. Melissa’s mother said, “I better be going or there will be a price to pay.” I told her, “Take It Easy, call me if you would like updates.” She gave me a smile of resignation and said, “Thank You,” then walked down the stairs and out the door to the waiting car.
Melissa decided to go to a half-way house rather than move in with friends from high school. She was determined and motivated to get back to life on a healthy track.
Wednesday, July 11, 2012
"Stand Off At The Detox"
Weekends were usually laid back at the detox and this one was no exception. It had been a warm, beautiful, summer day when I came in to work the evening shift. After listening to report until around 3:30, it was time to check everything out around the detox.
On the weekends we ran with one counselor and one nurse (for 28 beds). Usually by late Friday afternoons we would have a full-house so additional staff would not be needed to do admissions. Once in a while we would have an open bed or two and we would do a couple of admissions however.
After getting supper out with the aid of a couple of patients that were waiting to get their beds at a half-way house, I kicked back in the main area of the detox to chat with a couple of them and watch the BoSox on the tube.
After a while I went down to the basement to check on the patient laundry. The counselors and the nurses were responsible for everything around the detox; from admissions, to doing the laundry, to making the beds, helping to serve meals, aftercare placement, etc.
When I came up from the basement, Margaret my nurse partner for the evening was nowhere to be found. I figured she was probably in the woman’s dorm chatting with the new female patient.
That morning we had gotten a new woman patient in from the local emergency room that had asked for detox. We had two rooms for the women; one was a four person room, the other, a two person room. This new admission was solo in the two person room.
These two women’s dorms were inside a larger dorm room that housed six of the sickest male patients and was overlooked by the med room window.
I went back to the main room and hung-out with several of the patients. It had not occurred to me to take a stroll through the detox to check-up on Margaret. We were an open-unit, meaning that a patient could ask to leave at any time. We would grant their request, after a chat to try and get them to re-consider their decision.
So there I was in the main room playing cards when Ray, one of our male patients came stumbling towards the table where I was. He was one of our patients that would be with us every other week from the local shelter. When he came in we would wait for him to sober up before doing his admission; usually the next day.
Ray had just come in that afternoon from the local shelter and was still exhaling the cheap vodka that he drank when hanging out with other alcoholics down by Harvard Square. “Hey, what’s up Ray,” I said as he came near the table.
He was trying to tell me something, but his speech was slurred and almost incoherent. He said something about Margaret. I said yea Ray, Margaret is working tonight, and he shook his head.
“What you don’t believe me?” I asked him. “No, no, no,” he said back to me.
Then what is it Ray? “Maagareeet wants meeee to get yoooou!” Suddenly, I noticed the seriousness of his eyes. Oh Christ I thought, “Where is she Ray?” “Sheeee’s in the Dooooorm.”
As I raced into the dorm that housed the women’s rooms I began to wonder how long had it been since I had last seen Margaret; probably a good hour or so.
Margaret called out to me in a firm, controlled voice, “Willy, can you come in here please.”
As I entered the dorm room Margaret had our new female admission from that morning pinned to the wall. I could see that Margaret’s left hand and arm were pinning the patient’s right arm and hand high up on the wall. In the hand of the patient was a razor blade.
I raced over to relieve Margaret’s hold on the woman’s arm. As I took over the pin, Margaret was able to carefully pry the blade away from her without any of us getting cut.
“Jesus Margaret, how long have you been in here holding her?” She figured it had been roughly an hour or so. "I kept calling out to you, but between the door of the room being almost closed, and the main door of the dorm being closed you couldn’t hear me." "I was finally able to get Ray up after yelling to him numerous times and told him to find you and get you in here."
"I came in here to give Sarah her medication and found her about to cut herself, she jumped up and told me not to try and stop her or she would cut me also. That’s when I pinned her to the wall."
Margaret was a strong woman, but this patient was also. As Margaret came down from her adrenaline rush, she was exhausted. We became much closer after this incident. We also started to check in with each other much more frequently when working shifts together, about every ten to fifteen minutes.
We called the hospital we were affiliated with and Sarah was transferred to their inpatient psych unit. Being an open unit we would not have been able to provide her with the supervision and help that a case like hers required.
This could have turned into a really ugly incident. Thank God for my little stumbling buddy Ray. Drunk or not, he knew he had to get me to help Margaret.
On the weekends we ran with one counselor and one nurse (for 28 beds). Usually by late Friday afternoons we would have a full-house so additional staff would not be needed to do admissions. Once in a while we would have an open bed or two and we would do a couple of admissions however.
After getting supper out with the aid of a couple of patients that were waiting to get their beds at a half-way house, I kicked back in the main area of the detox to chat with a couple of them and watch the BoSox on the tube.
After a while I went down to the basement to check on the patient laundry. The counselors and the nurses were responsible for everything around the detox; from admissions, to doing the laundry, to making the beds, helping to serve meals, aftercare placement, etc.
When I came up from the basement, Margaret my nurse partner for the evening was nowhere to be found. I figured she was probably in the woman’s dorm chatting with the new female patient.
That morning we had gotten a new woman patient in from the local emergency room that had asked for detox. We had two rooms for the women; one was a four person room, the other, a two person room. This new admission was solo in the two person room.
These two women’s dorms were inside a larger dorm room that housed six of the sickest male patients and was overlooked by the med room window.
I went back to the main room and hung-out with several of the patients. It had not occurred to me to take a stroll through the detox to check-up on Margaret. We were an open-unit, meaning that a patient could ask to leave at any time. We would grant their request, after a chat to try and get them to re-consider their decision.
So there I was in the main room playing cards when Ray, one of our male patients came stumbling towards the table where I was. He was one of our patients that would be with us every other week from the local shelter. When he came in we would wait for him to sober up before doing his admission; usually the next day.
Ray had just come in that afternoon from the local shelter and was still exhaling the cheap vodka that he drank when hanging out with other alcoholics down by Harvard Square. “Hey, what’s up Ray,” I said as he came near the table.
He was trying to tell me something, but his speech was slurred and almost incoherent. He said something about Margaret. I said yea Ray, Margaret is working tonight, and he shook his head.
“What you don’t believe me?” I asked him. “No, no, no,” he said back to me.
Then what is it Ray? “Maagareeet wants meeee to get yoooou!” Suddenly, I noticed the seriousness of his eyes. Oh Christ I thought, “Where is she Ray?” “Sheeee’s in the Dooooorm.”
As I raced into the dorm that housed the women’s rooms I began to wonder how long had it been since I had last seen Margaret; probably a good hour or so.
Margaret called out to me in a firm, controlled voice, “Willy, can you come in here please.”
As I entered the dorm room Margaret had our new female admission from that morning pinned to the wall. I could see that Margaret’s left hand and arm were pinning the patient’s right arm and hand high up on the wall. In the hand of the patient was a razor blade.
I raced over to relieve Margaret’s hold on the woman’s arm. As I took over the pin, Margaret was able to carefully pry the blade away from her without any of us getting cut.
“Jesus Margaret, how long have you been in here holding her?” She figured it had been roughly an hour or so. "I kept calling out to you, but between the door of the room being almost closed, and the main door of the dorm being closed you couldn’t hear me." "I was finally able to get Ray up after yelling to him numerous times and told him to find you and get you in here."
"I came in here to give Sarah her medication and found her about to cut herself, she jumped up and told me not to try and stop her or she would cut me also. That’s when I pinned her to the wall."
Margaret was a strong woman, but this patient was also. As Margaret came down from her adrenaline rush, she was exhausted. We became much closer after this incident. We also started to check in with each other much more frequently when working shifts together, about every ten to fifteen minutes.
We called the hospital we were affiliated with and Sarah was transferred to their inpatient psych unit. Being an open unit we would not have been able to provide her with the supervision and help that a case like hers required.
This could have turned into a really ugly incident. Thank God for my little stumbling buddy Ray. Drunk or not, he knew he had to get me to help Margaret.
Friday, July 6, 2012
The Young Iron Worker
This case is back from when I was beginning in the field of addiction in the early nineties.
Paul (as I shall call him throughout this story) was a twenty-five year old iron worker that had picked up a nasty cocaine/alcohol habit. He came to us in need of detox and had been referred by his E.A.P. (employee assistance program).
This combination was quite common at the time. I had observed many of my friends on the comedy scene with this combo back in the eighties; coke, do your set, come off stage, drink your way down. This would go on some nights two or three times; especially weekend gigs with multiple shows. We would joke that the last one to do coke would be the designated driver (not that funny when I look back now).
I digress however, back to my story.
Paul at the time was one of the younger patients. In the early nineties it was extremely rare to have a patient under Paul’s age. Most of the patients in those days were in their thirties; old timers were people in their mid to late forties (my how times have changed).
During the course of his assessment it was decided that I would be his counselor.
He was upset for many reasons; his job was on the line, his family was upset with him, his wife of three years told him to leave and was undecided if she would allow him back.
So here he was, in the detox, not knowing what lay ahead of him, and feeling totally despondent about his current plight.
My main theme with him was that by coming into detox he had slammed the brakes on his addictions and that little by little he could work his way out of his predicament. I told him to “Hang in there.”
Paul was the type of patient that as his counselor I never had to prompt him in groups to participate or ask questions. He was open to any and all suggestions. When AA commitments came in the evening he could be found chatting with the group before and after the meetings. He spent his free time reading the “Big Book” of AA and calling the people he had met from the commitments that had come in to speak.
Then one day the ‘boom’ dropped on him. The bell rang down at the front door of the detox. As I opened the door there in front of me was a constable (not too hard to tell by his badge on the front of his shirt). “Good afternoon fine Sir,” I said, “how may I help you?”
“I’m here to serve a restraining order to a Mr. XYZ” (my patient Paul).
“May I come in? He asked. I responded, “Actually, no you can’t.” He seemed a bit put-off, by my remark. “We have to protect the privacy of our patients; I can’t even tell you if he is here or not.”
“His wife told me he was here,” he informed me. I responded, “Well that is interesting but the fact is, he could be here, he could have been here and left, I just don’t know.”
Before he could respond I fired back at him, “look, this is what I can do. I will go back inside and if that person is here, which I will have to check on first to see if he is, I will tell him of your presence here at the front door and suggest he meet with you.”
“Is this o.k. with you?” He looked at me and muttered, “Do I have a choice?” I responded with, “ah, no you don’t.”
Going back inside I found Paul and explained the situation to him. He went into shock, “a restraining order…how could she?”
I suggested before we try to tackle that question why don’t we go to the front door together and get the restraining order; which we did.
Essentially, the restraining order was based on her fear of him when he was using. He admitted that often times especially when coming down from cocaine he could become verbally abusive and start throwing stuff around.
Try to look at this as a chance, an opportunity, to work on yourself I suggested to him. He did not like hearing that but accepted that it was probably the best thing for him to do.
The next day he came to me after he had made a phone call to a new AA friend. Have you heard of the XYZ halfway house? I told him yes and that it had a great reputation. He said, “Well, I would like to get an interview there.” I told him I would gladly make the phone call to set-up an interview.
He went on the interview the following week and was accepted. He was on a two week wait list. In those days we had four beds at the detox that people could use while waiting for their placement (those days are long gone unfortunately), as long as they helped out around the detox.
During the wait he went to court to see if his wife would file to have the restraining order extended. Upon her learning of his plans to attend a six month program she decided not to request a continuance of the restraining order.
She made no promises however that they would get back together again upon his completion of the program. He understood. “Regardless of what happens between us, I need to take care of business.”
The time came for him to leave for the halfway house. I bade him farewell and good luck, emphasizing how much he had worked on himself and suggested he keep working as hard on himself as he did during his stay with us.
He thanked me and the rest of the staff and left to a waiting taxi.
Usually, after people leave the detox we seldom know what happens to them unless they return again for our services.
Several years after Paul left us I was with my wife at a city wide block party when I noticed three people walking towards us; a young couple and an older woman.
The man spoke first, “Willy, how are you man!” I took a closer look, “Paul, how the heck are you?” He was beaming, “doing great.” He had graduated from the halfway house, and was in good standing with his union. “Willy, I would like you to meet my wife and mother-in-law.” Now I found myself ‘beaming.’
We spoke a couple of minutes longer and then parted ways. As they turned and started to walk away I could hear his wife ask him, “Who was that?” He told her, “That was the guy who told me to hang in there…”
Paul (as I shall call him throughout this story) was a twenty-five year old iron worker that had picked up a nasty cocaine/alcohol habit. He came to us in need of detox and had been referred by his E.A.P. (employee assistance program).
This combination was quite common at the time. I had observed many of my friends on the comedy scene with this combo back in the eighties; coke, do your set, come off stage, drink your way down. This would go on some nights two or three times; especially weekend gigs with multiple shows. We would joke that the last one to do coke would be the designated driver (not that funny when I look back now).
I digress however, back to my story.
Paul at the time was one of the younger patients. In the early nineties it was extremely rare to have a patient under Paul’s age. Most of the patients in those days were in their thirties; old timers were people in their mid to late forties (my how times have changed).
During the course of his assessment it was decided that I would be his counselor.
He was upset for many reasons; his job was on the line, his family was upset with him, his wife of three years told him to leave and was undecided if she would allow him back.
So here he was, in the detox, not knowing what lay ahead of him, and feeling totally despondent about his current plight.
My main theme with him was that by coming into detox he had slammed the brakes on his addictions and that little by little he could work his way out of his predicament. I told him to “Hang in there.”
Paul was the type of patient that as his counselor I never had to prompt him in groups to participate or ask questions. He was open to any and all suggestions. When AA commitments came in the evening he could be found chatting with the group before and after the meetings. He spent his free time reading the “Big Book” of AA and calling the people he had met from the commitments that had come in to speak.
Then one day the ‘boom’ dropped on him. The bell rang down at the front door of the detox. As I opened the door there in front of me was a constable (not too hard to tell by his badge on the front of his shirt). “Good afternoon fine Sir,” I said, “how may I help you?”
“I’m here to serve a restraining order to a Mr. XYZ” (my patient Paul).
“May I come in? He asked. I responded, “Actually, no you can’t.” He seemed a bit put-off, by my remark. “We have to protect the privacy of our patients; I can’t even tell you if he is here or not.”
“His wife told me he was here,” he informed me. I responded, “Well that is interesting but the fact is, he could be here, he could have been here and left, I just don’t know.”
Before he could respond I fired back at him, “look, this is what I can do. I will go back inside and if that person is here, which I will have to check on first to see if he is, I will tell him of your presence here at the front door and suggest he meet with you.”
“Is this o.k. with you?” He looked at me and muttered, “Do I have a choice?” I responded with, “ah, no you don’t.”
Going back inside I found Paul and explained the situation to him. He went into shock, “a restraining order…how could she?”
I suggested before we try to tackle that question why don’t we go to the front door together and get the restraining order; which we did.
Essentially, the restraining order was based on her fear of him when he was using. He admitted that often times especially when coming down from cocaine he could become verbally abusive and start throwing stuff around.
Try to look at this as a chance, an opportunity, to work on yourself I suggested to him. He did not like hearing that but accepted that it was probably the best thing for him to do.
The next day he came to me after he had made a phone call to a new AA friend. Have you heard of the XYZ halfway house? I told him yes and that it had a great reputation. He said, “Well, I would like to get an interview there.” I told him I would gladly make the phone call to set-up an interview.
He went on the interview the following week and was accepted. He was on a two week wait list. In those days we had four beds at the detox that people could use while waiting for their placement (those days are long gone unfortunately), as long as they helped out around the detox.
During the wait he went to court to see if his wife would file to have the restraining order extended. Upon her learning of his plans to attend a six month program she decided not to request a continuance of the restraining order.
She made no promises however that they would get back together again upon his completion of the program. He understood. “Regardless of what happens between us, I need to take care of business.”
The time came for him to leave for the halfway house. I bade him farewell and good luck, emphasizing how much he had worked on himself and suggested he keep working as hard on himself as he did during his stay with us.
He thanked me and the rest of the staff and left to a waiting taxi.
Usually, after people leave the detox we seldom know what happens to them unless they return again for our services.
Several years after Paul left us I was with my wife at a city wide block party when I noticed three people walking towards us; a young couple and an older woman.
The man spoke first, “Willy, how are you man!” I took a closer look, “Paul, how the heck are you?” He was beaming, “doing great.” He had graduated from the halfway house, and was in good standing with his union. “Willy, I would like you to meet my wife and mother-in-law.” Now I found myself ‘beaming.’
We spoke a couple of minutes longer and then parted ways. As they turned and started to walk away I could hear his wife ask him, “Who was that?” He told her, “That was the guy who told me to hang in there…”
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