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.
Wednesday, July 11, 2012
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…”
Thursday, June 28, 2012
The Vietnam Vet
Jonathan was one of our regulars; he had well over fifty admissions since coming home from Vietnam in 1970. He was another casualty from a war that we are still trying to understand and heal from. When he came back he had gotten married to his High School sweetheart who was a nurse at a local hospital, and had tried to settle down.
After a couple of years of heavy drinking and bouncing from job to job his life began to fall apart. First his wife left him, then his drinking burned out his family and he ended up homeless, living in the shelters around Boston.
He was a quiet, polite guy who always helped out around the detox. One of our counselors at the time was a Vietnam Vet who had also served in the Marine Corps, “In Country,” as Jonathan had.
Jonathan would talk to him often. However, if the topic of Vietnam came up he would give a little smile then walk away. He would refuse to discuss any aftercare plans that included programs with the VA. There were benefits available to him, but he wanted nothing to do with them. So he lived back and forth from the shelter to the detox.
At this point in my career I often worked overnight shifts a couple of times a month. On one of these nights I had just come back upstairs from doing patient laundry in the basement. Jonathan was sitting at a desk where we often did admissions having a cup of coffee and a cigarette. It was about 3’ in the morning. Patients often who were detoxing would get up in the middle of the night for coffee and a smoke. We never shoo’d them back to bed like many facilities would do.
There is something to be said for sitting with a patient at this time of the morning. They have just gotten up and the alcoholic defenses one would normally encounter in the daytime were not present. This was the first time that I had such an experience, but it would not be the last.
As I sat there with him, I watched as he stared off into the distance, swirls of blue smoke drifting towards the ceiling. After several minutes, I made the remark to him, “Geez Jon, it feels like you are not even here.” He took another long drag from his cigarette and slowly exhaled. “No, you’re right, I’m far, far away.” I thought for a moment and deciding to take a chance, and said to him, “Are you back over there?” I waited with a knot in my gut for the response. He kept looking straight ahead as he extinguished his smoke he had just used to light another one up.
“Yea, I’m over there,” he responded. “A lot of good men were killed for nothing…I should have been one of them.” “I’m not sure I understand what you mean?” “I don’t know if you or anyone can ever understand,” he said without changing his distant gaze.
Next there was a pause that felt like an eternity. Then he went on, “my platoon had been In Country for three or four days when we were involved in a heavy firefight with the VC.” He paused for a moment then went on, ‘we called for air support to get us out. I jumped onto one of the helicopters with four of my buddies and we started to lift off the ground. When we were about twenty feet off the ground we were hit by rocket fire. As we started to crash I was thrown clear.’
For the first time since sitting with him he faced me, “I was the only one that survived.” I felt goose-flesh take over my body; I was speechless.
As he finished that statement he began to uncontrollably sob, wretch, and rock back and forth in his chair.
It was type of sobbing that comes from a person’s soul and one feels like it will never end. I knew right away that this was probably the first time he had ever told this story to another human being.
Over the years I have had the privilege of people bearing their souls to me. Others have told me that I have something that allows people to open up and tell their tales. I do not know why this is so, but, I don’t need to know I guess. This is and can be both a blessing and a curse. I thank God every day for my sense of humor. Without it, I would be a “Dead Man Walking.”
Jon did go on to get services at the VA after that night, and yes, we did see him once and awhile back at the detox; not with his previous frequency however.
After a couple of years of heavy drinking and bouncing from job to job his life began to fall apart. First his wife left him, then his drinking burned out his family and he ended up homeless, living in the shelters around Boston.
He was a quiet, polite guy who always helped out around the detox. One of our counselors at the time was a Vietnam Vet who had also served in the Marine Corps, “In Country,” as Jonathan had.
Jonathan would talk to him often. However, if the topic of Vietnam came up he would give a little smile then walk away. He would refuse to discuss any aftercare plans that included programs with the VA. There were benefits available to him, but he wanted nothing to do with them. So he lived back and forth from the shelter to the detox.
At this point in my career I often worked overnight shifts a couple of times a month. On one of these nights I had just come back upstairs from doing patient laundry in the basement. Jonathan was sitting at a desk where we often did admissions having a cup of coffee and a cigarette. It was about 3’ in the morning. Patients often who were detoxing would get up in the middle of the night for coffee and a smoke. We never shoo’d them back to bed like many facilities would do.
There is something to be said for sitting with a patient at this time of the morning. They have just gotten up and the alcoholic defenses one would normally encounter in the daytime were not present. This was the first time that I had such an experience, but it would not be the last.
As I sat there with him, I watched as he stared off into the distance, swirls of blue smoke drifting towards the ceiling. After several minutes, I made the remark to him, “Geez Jon, it feels like you are not even here.” He took another long drag from his cigarette and slowly exhaled. “No, you’re right, I’m far, far away.” I thought for a moment and deciding to take a chance, and said to him, “Are you back over there?” I waited with a knot in my gut for the response. He kept looking straight ahead as he extinguished his smoke he had just used to light another one up.
“Yea, I’m over there,” he responded. “A lot of good men were killed for nothing…I should have been one of them.” “I’m not sure I understand what you mean?” “I don’t know if you or anyone can ever understand,” he said without changing his distant gaze.
Next there was a pause that felt like an eternity. Then he went on, “my platoon had been In Country for three or four days when we were involved in a heavy firefight with the VC.” He paused for a moment then went on, ‘we called for air support to get us out. I jumped onto one of the helicopters with four of my buddies and we started to lift off the ground. When we were about twenty feet off the ground we were hit by rocket fire. As we started to crash I was thrown clear.’
For the first time since sitting with him he faced me, “I was the only one that survived.” I felt goose-flesh take over my body; I was speechless.
As he finished that statement he began to uncontrollably sob, wretch, and rock back and forth in his chair.
It was type of sobbing that comes from a person’s soul and one feels like it will never end. I knew right away that this was probably the first time he had ever told this story to another human being.
Over the years I have had the privilege of people bearing their souls to me. Others have told me that I have something that allows people to open up and tell their tales. I do not know why this is so, but, I don’t need to know I guess. This is and can be both a blessing and a curse. I thank God every day for my sense of humor. Without it, I would be a “Dead Man Walking.”
Jon did go on to get services at the VA after that night, and yes, we did see him once and awhile back at the detox; not with his previous frequency however.
Tuesday, June 26, 2012
The Dead Father
He had been on the unit, or I should say in bed for the first three days he was with us. Usually when a patient is unable to get out of bed for two or three days it can be attributed to chronic alcohol use or, a really bad cocaine crash (awake for days using). In this case it was the result of alcohol.
Since stays at the detox lasted three to five days only, I decided to go to his room and maybe bedside I could begin to do his paperwork.
He was in his early forties but the years of chronic alcohol abuse gave him the look of a haggard man in his late sixties. After asking him if it would be o.k. to sit by his bed and ask him a few questions, I took a seat.
As I was asking him various questions to complete the Bio-Psych-Social I could sense an intense sadness permeating from his being.
I asked him, “Have you ever had any sober time?” He replied “yes” he had a year once. I then queried him further, “what was it about that year that you were able to stay sober?”
His look became distant; all expression was gone from his face. It took him several minutes for him to look back at me. Then he responded, “well, we found out that my father was terminally ill…I was sober for the six months leading up to his death, then for six more months after.”
He then looked down at his bed and began to uncontrollably sob and rock back and forth. Through his lamentations one had the sense the agony was coming from the depths of his soul. This went on for a period of a couple of minutes (though when you are with someone going through this, it can feel like hours).
I then asked him when his father had passed away. Next, the shocker when he told me the year and it was thirteen years prior! There I had been thinking it was probably a fairly recent event and it was thirteen years ago.
He then went on to tell me that this was the first time that he had ever talked about it to anyone. In a way I felt privileged that this person had allowed me into his being.
He had not been able to maintain sobriety for more than a couple of days when he broke after a year clean. The issue of his father’s passing was on his mind every day; all day.
Part of his aftercare plan was to hook him up with a therapist that works in the area of unresolved grief issues. No longer did he want to live with the belief that men don’t cry, men don’t grieve.
Since stays at the detox lasted three to five days only, I decided to go to his room and maybe bedside I could begin to do his paperwork.
He was in his early forties but the years of chronic alcohol abuse gave him the look of a haggard man in his late sixties. After asking him if it would be o.k. to sit by his bed and ask him a few questions, I took a seat.
As I was asking him various questions to complete the Bio-Psych-Social I could sense an intense sadness permeating from his being.
I asked him, “Have you ever had any sober time?” He replied “yes” he had a year once. I then queried him further, “what was it about that year that you were able to stay sober?”
His look became distant; all expression was gone from his face. It took him several minutes for him to look back at me. Then he responded, “well, we found out that my father was terminally ill…I was sober for the six months leading up to his death, then for six more months after.”
He then looked down at his bed and began to uncontrollably sob and rock back and forth. Through his lamentations one had the sense the agony was coming from the depths of his soul. This went on for a period of a couple of minutes (though when you are with someone going through this, it can feel like hours).
I then asked him when his father had passed away. Next, the shocker when he told me the year and it was thirteen years prior! There I had been thinking it was probably a fairly recent event and it was thirteen years ago.
He then went on to tell me that this was the first time that he had ever talked about it to anyone. In a way I felt privileged that this person had allowed me into his being.
He had not been able to maintain sobriety for more than a couple of days when he broke after a year clean. The issue of his father’s passing was on his mind every day; all day.
Part of his aftercare plan was to hook him up with a therapist that works in the area of unresolved grief issues. No longer did he want to live with the belief that men don’t cry, men don’t grieve.
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