Chapter 26 (advocate for comprehensive community withdrawal management)

I readied myself and got out the door in record time. A nice part of living in a small town was the six-minute commute. The office was empty when I arrived. I wasn’t sure if that was a good omen or a bad omen. In general, Fridays were a busy day. First, the emerg was busier because people left worrisome pains and complaints until the end of the week, probably hoping they might go away. Second, we tended to overbook our follow-ups so that we could connect with folks we were worried about over the weekend. We were lucky to have some excellent relief crisis workers who covered the weekend shifts. They were very good at recreating what we ‘regular’ weekday crisis workers would do with folks we were following. Nevertheless, we often sent emails or put ‘flags’ on a file to alert them to risks or remind them of strategies that worked. Amy Brixton was one person for whom this system of inclusion has been very helpful. Since we started comparing our notes and systematically putting the work back on her and her peer supporter Sandy, Amy and Jordon have been managing their typical mother-son conflicts much better and Amy herself has been coping exceptionally well. She joined a Recovery Group that the peer supporters facilitate on Saturdays. Adding that with her other consistent support has really turned the table for her.

Jenn was probably at lunch so I could easily slide into my chair as though I had arrived early. When I logged into the computer I faced 87 emails, among which was a request from Rudy to meet up at some point this afternoon. Last year, we had a summer student in the program who taught me how to code my emails so any message from Rudy came in with a purple dot. That way I could see immediately all communication from my commander. My schedule was jammed so I typed back asking for a ‘drop-by’ if I could manage it, or suggested my breaktime at around 1630, right about the time he would be out the door. If I was losing my break, surely he could delay his departure, I thought wickedly. Such requests from Rudy were not unusual. Because we worked shifts that covered the program from 0700 to 1900 hours many times our overlap didn’t match his schedule. Rather than send out emails or memos Rudy was good at hooking up and telling us what we needed to know face-to-face, which was up my alley in terms of supervision.

Jenn resumed her duties after lunch and I went though my expected appointments with her. Then I settled into a three-hour series of scheduled sessions; three follow-ups and one new assessment. After my break, I had both Lowell and Bridie booked in before I blitzed emerg for new crises. The first fella was a nice young man who was going through a difficult separation and not handling it well. He’d called the crisis line two days ago and after a quick telephone assessment it was decided he was okay until today. Face-to-face, he really was a nice young man but clearly at a loss to understand why he and his girlfriend were separating and not really invested in talking with her about it. It felt like I was giving more of a pep-talk than counseling, so I put that out there. “I’m missing something here. I need a little more detail so I can understand your experience. I feel like I’m just pitching you ideas and you are giving them back to me.” This was an easy trap to fall into in our line of work.

His response was partially productive “I don’t know what happened…all I know for sure is she is moving out. I think she might be seeing someone else but I’m not sure.” I kept pushing, hoping to find an edge to grab. The couple had been together only a few months. They hadn’t known each other well. Sounds like they didn’t talk much to start with. Maybe they just ran out of gas. I posed a few other questions, embedding my risk scales in as insidious a way as possible but when I still couldn’t get very far I started asking more obvious questions related to self-harm and safety. As it turned out, the most pressing issue for my guy right now was housing. Go figure. There were resources for that and after helping him make a plan to negotiate staying in their apartment until he found something else, he left happy. I did agree to call back in a week and see how things transpired.

The second fella had shown up in emerg a few days ago, intoxicated and rambunctious. When he sobered up enough and agreed to this meeting, we sprung him. Here was where I expected my no-show. I just finished my note on fella number one when Jenn rang to say “Duncan is here for his 1:30 appointment”. When I walked into the waiting room to fetch him I was shocked to see his condition. He looked like he hadn’t slept since he walked out our door. His hair was messy and I wondered if he had showered. Inwardly I suspected he had continued his bender. I was happy to learn however that he had not had a drink since the police hauled him into emerg. His family had stepped in and pointed out to him that he was on the wrong train and had to change his ways or else. His presentation might be indicative of alcohol withdrawal so I had another series of questions to ask to assess that risk. Yes Duncan was experiencing physical illness, nausea, vomiting and diarrhea. He had ‘the shakes’. He felt confused and had tightness in his chest. Duncan revealed quite a heavy history of alcohol abuse that confirmed for me he was very likely in withdrawal. The next question was the extent of the withdrawal and what the best response was. There was no detox centre in Carter but we had a back-door phone number to the detox in Kempenfelt, the larger town further South. I explained to Duncan that we needed to check this out and he sat with me while I called my colleague.

The detox counselor took my information then asked to talk to Duncan directly. He took the phone and I could hear him answering questions that resembled the scales I had already asked him. The answers remained the same. I wasn’t sure where the next questions were headed but I heard Duncan saying “yes, that’s right, OK. And OK.” Then he handed the phone back to me and the counselor informed me that Duncan was a good candidate for transfer. Duncan agreed. “Let me work on it and I will get right back to you.” I hung up the phone and Duncan and I considered options to drive him to detox.

“How did you get here today?”

“My mom drove me.”

Is she waiting for you? Could she drive you to detox? Is there someone else who can drive you?”

Duncan made a call and several texts. Finally, his mother returned a text saying she would be back there to get him in 15 minutes and yes, she would drive him to Kempenfelt. He gave her a quick call asking for some basic supplies like toothbrush, shampoo, a change of clothes. Hearing him now, I realized this was part of his instruction from the detox counselor, given how he rattled them off in a way I thought was beyond his current cognitive ability.

Detox was a good start for folks sometimes. It can make for a smoother referral to a rehab program but it can also scare people off a bit. One sees some wild things in detox, this I knew for sure. But Duncan was serious about changing so I validated his worries and bolstered his hopes. I wrote out some phone numbers and on-line links to local and regional rehab programs but suggested he follow the advice of the detox staff, they would know the quickest referral and the best match for him. I gave him a card with a follow-up appointment with me for next week, letting him know he could call and reschedule it if his treatment got in the way.

Duncan’s phone dinged indicating a text that his mother was on her way. As I walked with him to the back exit, I gave him the stock ‘you can do this’ routine but I also thanked him for his honesty. Honesty is the biggest hurdle for people with addiction. They spend so much time hiding, covering up and lying that being efforts to be straight about their use and their struggles to quit get lost in the weeds. Duncan’s hand was shaking as he held it out to shake mine. I took it in one hand and covered it with my other hand. “I’ll be thinking of you; stay in touch.” He crawled into his mother’s car, they both waved and he was gone.

My new assessment was the no-show. I called both numbers listed in the package. I figured the first number was her cell phone because she stated her name. With this identifier, I left a message identifying myself by name, saying I was calling from ‘the hospital’ and I left her my number. The second number did not convince me this was her own line so I left a vague message for her saying I already left a message for her on her other line and asked if she could she call me back. I checked the information I had about her. It was vague. She reported some risk of self-harm but not immediate; some misuse of drugs and alcohol and a history of childhood sexual abuse. I couldn’t tell about her treatment history. Complicated.

Sometimes once the crisis has subsided folks with this pattern back away, either in fear because revealing or re-telling their story is too painful or because they want to believe the calm after the storm is the end of their problems. Either way, it wasn’t unusual to have a push me-pull you engagement in these situations. I wasn’t worried yet and I was glad to have the chance now to dig up Rudy. When I checked my emails quickly for purple dots, I found that Rudy was in meetings the rest of the afternoon. He would be swinging through the office at the end of the day and see me if I was available.

With my new-found free time, I started the phone calls to people I wanted to connect with before the weekend. I checked the schedule to see which of the weekend crisis workers was working this weekend. I saw it was Tom. He is a new social work grad but he has fallen into this work as though he’s been doing it for years. I sent him a brief email noting Duncan’s name as a person to keep an eye out for, on the off chance detox sent him back our way Saturday or Sunday. Karen, the crisis worker who usually worked the opposite shift to me, arrived in the office, carrying four referral packages, a paper cup likely filled with flavored coffee and a white, waxed bag concealing a cookie from the snack bar. “Hoo, hoo!” I sang out when I saw her. “You look like you had a busy day.”

“Ya figure! I earned my cookie today.”

“I’ve had a no-show. What can I do to help you out?”

“This is my first sit-down.” Karen sighed as she dropped cautiously into the rollie chair by her cubby and took a long swig of her coffee. “Your manic gal…” Karen canvassed her files. “…Jill, Jill Marshall. Remember her?”

“Yup. She’s living with Craig Betts, n’est pas?” I could love the French too.

“Was living with Craig Betts. From what I can gather, the Team found out he was crashing there, saw him as a threat to her wellness and put enough screws in their life that he skedaddled.”

I joined Karen in the adjacent rollie chair. “And?”

“And…Jill has fired the Team, in a big show-down outside her building.”

“Have you talked to anyone in the Team?”

“Aren’t you the Rhode scholar”! Karen laughed at me mockingly. “If I’d had six minutes, that might have been the third call I have made today.” She waved her free hand over the stack of packages she had placed on her desktop. “Actually, as it turned out, one of them arrived in the department right after she did but having them together seemed to stoke the fire rather than calm her down. The guy from the team backed out before I could find out more.”

“Gimme.” I motioned, wriggling my fingers in her direction.

“Gladly!” Karen responded, handing me the folder I presumed was related to Jill. “She’s still down in emerg. They’re trying to decide if she needs an admission.”

“I’m all over it.” I smiled at her. “You reinforce yourself with caffeine and sugar. I’ll let you know what’s up.”

I read the information from emerg. The name of the support worker was not noted so I had to call the general number. I did so, found out that the guy involved in the showdown with Jill’s landlord was Jeff Palonski. I knew Jeff. Not well but we’d shared some work in the past. According to the admin person on the phone, he had likely returned to emerg now. I could hear Karen talking on the other line and it sounded like she was explaining a medication to someone. When she hung up I let her know Jeff from the Team was back to see his gal Jill.

“I can go down and meet him but you’ve got your fingers on this pulse. I have someone else coming in about 20 minutes. Give me something else to do while you get at it. I’m here ‘til 1900, though so load me up.”

“Shit, shit, shit” Karen jammed a hunk of ginger cookie into her ready maw and washed it down with the cooling coffee. Her usual hippie-calm evaporating. “If you can connect with these last two referrals it would be great. If they need more, or if they can wait, Tom can see them on the weekend. I just need to do up the notes. I’m on my own with that. But thanks for the offer…and thanks for calling the Team, it gave me the cookie break I needed.” Karen hauled herself to her feet, retrieved Jill’s folder from me and strode back out the door.

I finished my note to Tom and readied myself for Bridie. She was a little early, so we had a head start.

Bridie wasted no time diving in after she sat down. “I had my conversation with Doug…the conversation about dying in hospital; that I don’t want the kids to be there.” She seemed relieved to have gotten those words off her chest and continuing seemed a bit easier for her. “I know I’ve been shutting him out but I don’t want to burden him with more to think about. And its hard to get a private moment these days, there’s so much going on.”

“How did it go?”

She smiled to herself as she paused to consider her answer. “It started off kinda rocky.” She chuckled out loud.

 

“Not the emotion I expected in this description.” I was certainly curious about where this was headed.

“It is funny to me now. It wasn’t so much at the time. I introduced the idea of him remarrying…” She caught the movement as my eyebrows shot up and my lips disappeared. “I know. It was risky but when I explained it all it made sense.”

“I’m listening…” I managed to match her smile. “Sometimes this job can amuse me.” Bridie laughed out loud.

“Remember I told you about making those cards for the kids, so they would have messages from me later on? Well the social worker at St. Germaine told me they have a studio there where I could record some messages and I liked the sounds of that. But then I got to worrying about whether Doug’s new wife would be ok with the kids getting them. She’d have to be part of their support and comfort if the messages upset them….I know, I know…” She waved off my questioning look. “It all worked out. He understands what was bothering me. Anyway, he’s convinced me that he won’t remarry anyone who doesn’t accept that my kids will get messages from me.”

“Good grief! I wish I’d been a fly on that wall!”

“It felt so good Hattie to get all that off my chest. Its like it freed up space for me to get moving on other things. And now I am ready to share more with Doug. I’ve been carrying this burden on my own because I didn’t want to hurt him more but it turns out he’s been doing the same. He even had the same thought as me about protecting the boys from….” Bridie drew a deep breath and held it. “…from the end; watching me die.” She exhaled with a sigh.

“Sounds like it was a relief to you both to talk these things through. It is also Doug’s pain to bear, so he shares its weight.”

“That’s what I realized. I can’t do this alone, as much as I want to shield everyone.” She settled back in her chair and gingerly crossed her long legs. “It also struck me, while we were talking, how much of Doug I’ll miss. Until now I’ve been re-running all the moments I will not have with my kids. But as I sat there, running my fingers through his hair, I realized I wouldn’t see him go grey…” her attention faltered. “…or even bald. I knew Bridie well enough by now to appreciate that when she felt overwhelmed she moved quickly to lighten the subject.

“I won’t see him get a little paunchy…or help him with a hip replacement.” She smiled meekly, knowing I understood her motivation. “Busted.” She acknowledged. “I can’t stay with it too long or I will cry.”

“You wanna cry? Cry. You said it. You and Doug are bearing this pain but as your witness, I can also share some of its weight.”

“Thanks Hattie. It means so much to me just to have another person, someone who’s not … not so tangled up in this mess, to talk to. I feel like I can be myself here. I don’t need to protect you from my worries and my fears. I think I’m getting close to that point now with Doug but I had to iron it out here. This disease is consuming me, one bite at a time. Chewing on my soul from the inside out. It takes all my emotional gumption just to put one foot ahead of the other. So, I pack it away as much as I can. But Hattie, I’m afraid I’ve made the mistake of thinking I had more time. There are basics I need to get done. Now, while I have the physical strength.”

“Deal.” I nodded. “What’s next?”

“I’ll make those videos. I’ve been thinking a lot about what to say. I already started the cards, so I won’t repeat all that. I think I’ll just let things roll without a lot of preparation. I don’t want it to look rehearsed. Maybe I can include Doug in a couple….that way his next wife can’t say no.”

“Rascal!”

“I know.” She laughed. But her laugh also produced a cough and she hovered her hand over her right side.

“You OK?”

“I’m good.” She replied but I noticed that as she answered her head was shaking what without words would mean ‘no’. I took her at her word but I was skeptical.

She abruptly changed the subject. “Did I tell you we have Blue Jays tickets for Jamie’s birthday. They weren’t home on May 16th but we were able to get really good seats for all of us on the 14th. We are even taking Lynne. Doug will take lots of pictures and videos. He won’t explain why all the paparazzi to the kids, but we know why.”

“Well I want to see those pictures!” I didn’t feel it was a good time to prod about her health.

Author: hopeisinfectious.ca

My writing experience comprises, almost exclusively, academic papers and technical/ professional reports. However, I have lost faith in these methods as paths to real change. My doctorate is in Education, specifically transformative education and through my research and my work, I have come to the conclusion that people learn more through stories than journal articles. Therefore, instead of investing in the usual strategies for pedagogy, I am leaning toward fiction as a way to change minds about social issues and dilemmas. I believe stories can un-other social interpretations in a way I feel I have failed to in all my academic and professional writing. I hope to convey some alternate ideas about the work I have done for 35 years, as a mental health nurse, psychometrist, educator and administrator.

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