Suicide… It’s Not About Dying !

Tonight we learned  that Robin Williams is dead, and the consistent information is that he took his own life.  Social media being what it is, there are many comments.  Most are of shock and acknowledging the incredible talent and genius of a brilliant actor and comedian; another  who is gone too soon.  There are some  comments that are just rude and clueless.  But there are also those who just don’t understand how someone could get to the point of feeling that it was just time to give up on life, that it was too painful.  That there is no hope in sight, and that the people closest to him/her would be better if he/she was just gone… Thank God most people don’t understand what it’s like to be so far down in a pit of ‘no hope’ that suicide makes sense.

Suicide isn’t as much about dying as it is about wanting the pain to stop.  The cause of the pain isn’t really that important, though addiction is often a component.  Alcohol, drugs, eating disorders, gambling, etc. are ALL ways to numb some sort of emotional pain.  I worked as an RN in drug/alcohol rehab and adolescent psych for years, and nobody ever listed death as the main reason they considered suicide.   I had a good friend (also a co-worker) who was so solid in his sobriety and recovery  when I knew him.  He became a well-known therapist in the city where we worked.  Recently, I found out that he killed himself a few years back , while  I  was searching for him online, hoping to reconnect.  He had great local resources about where to get help (including where he could get away from town for treatment).  He knew the warnings… and yet, he relapsed into drugs, and overdosed in an amount that was said to be inconsistent with an accident.   I was able to find a close friend of his who could help me fill in the blanks, enough to know that something happened to take him into that dark hole of depression and relapse. Those are never good together.

With Robin Williams, he had resources and had recently gone back to treatment for a ‘tune up’ of sorts, knowing that he was feeling a need to protect his sobriety, not that he’d relapsed  (common knowledge).  He was getting help.  None of us know what his pain was from.  We look at the professional aspect of the man and can’t make sense of what could have been so bad in his life that he decided to give up.  But even if we knew the ‘reasons’, for most, the decision to end one’s own life will never make sense.

In 1982, I was battling an eating disorder, and got to the point of feeling very overwhelmed and unable to see that things were going to get better.  I don’t remember wanting to die.  I overdosed and was in a coma for 3 days.   I was lucky to have survived, and was able to get past those feelings of just wanting to go to sleep so I didn’t hurt (in my situation, nutritional ‘rehab’ was a huge part of clearing up my thinking).  I remember taking the sleeping pills, but don’t remember ‘death’ being my goal.  I don’t remember taking the 50 antidepressants.  I don’t remember the ambulance trip, or anything else until  I woke up in ICU three days later.  At other times, always when dealing with eating disorders, I would find myself in a mindset that didn’t see an end to the overwhelming hopelessness I felt.  I would feel myself on the edge, and yet I didn’t ever want to die.  I just didn’t want to feel so much pain.  It’s an incredibly dark place to be… and there’s a feeling of loneliness that has no words to adequately describe it.  Even with people in my life, they didn’t understand what was going on in my head, and the surrounding circumstances made things more isolating.

For those that don’t understand, please be thankful that you have no frame of reference for that kind of despair.  Please look around and see if there is someone who might need a quick phone call or note to say that they matter, and to just check in to see if they’re OK.  If someone you know has changed and either seems really down, OR suddenly ‘up’ after a period of severe depression, see if they’re really OK.  When someone makes the decision to give up, sometimes they are so relieved at making the decision, that their mood improves.  That type of ‘improved’ mood (sudden) is an alarming sign.  Gradual improvement is more likely due to good treatment ( medication for the biochemical issues, and/or psychotherapy to resolve emotional pain).  Don’t be afraid to ask direct questions.   When someone approaches from concern, it’s unlikely that it will make a situation worse.

Clinical depression isn’t sadness.  It’s not about ‘reactive’ grief that many people will feel during their life when they lose a friend or family member to death, or the loss of a job, pet, or if someone moves away who had been a part of daily life.  Clinical depression is often a biochemical disruption to normal thinking and feelings.  Hopelessness and helplessness become so pervasive that the ‘normal’ way of seeing solutions to problems just doesn’t work.  While suicide is a permanent solution to temporary despair, it doesn’t feel that way to someone who finds it  worth considering.  It doesn’t feel temporary.  It’s kind of like being too far underwater after falling off of a boat, and wondering if getting to the surface is ever going to happen… like there’s no air left in life, and no ability to feel that the surface could be reached with just a couple of kicks to reach the air that restores hope. Even if getting back on the boat is a ways off, at least there would be air.  It’s like treading water UNDER water, and never getting closer to the surface.  It’s hard to withstand that type of hopelessness and helplessness for a long time, and each person has their own threshold for how long they can hold on.

People can’t snap out of it.  They can’t just go pop in a funny movie and everything is OK.  It’s a disease, that needs treatment, and  support of friends and family that understand that the person is doing the best that they can.  And when the ones who are depressed are finding themselves going further from their normal way of looking at life, they need someone who can help them hang on…

But sometimes, it just isn’t enough.   And those left to make sense of the loss  will never have a good reason to satisfy the ‘why’ questions that inevitably come up.  It definitely isn’t fair to those left behind.  And while it’s something they have to live with for the rest of their lives, it really wasn’t about them.  Sometimes, there is nothing that will redirect a tragedy.  But nothing can take away the good memories the person leaves behind… always remember the good.

Advertisements

Intervention and Treatment Memories

I gained a lot of weight during the time I was on chemo for leukemia.  It’s been very hard to get rid of it, as I’m also perimenopausal, and limited physically as far as what activity I can safely do.  Add a history of eating disorders, and the idea of losing weight is actually rather frightening at times.  I guess in some ways that’s good, since I don’t take for granted how bad things got the last time I relapsed in 1995-1996.  It took years to put my life back together so I could eat normally, and longer than that before I could accept my body without being disgusted by it.  My oncologist told me just to be thankful I’m alive (which I am), and don’t focus so much on the weight.   Easier said than done.

The last time I started to relapse coincided with being diagnosed as diabetic, and suddenly having to account for everything that passed by my lips. I lost about 50 pounds over several months prior to, and after being diagnosed (not noticeably abnormal ), and was holding my own without any eating disorder behaviors (purging- laxatives were my vice, restricting, excessive exercise, etc).  I ended up with pneumonia later that year (November 1995), and lost quite a bit of weight in a few days, and the sensation of being ’empty’ and seeing the scale numbers drop was enough to trigger the old eating disorder stuff that started when I was in my late teens and twenties (early 80s).  I’d been free of the anorexic end of things for many, many years.  It didn’t take long for being around food to cause anxiety, and for numbers on the scale, calorie books, and blood sugar meters to drive my entire life.  I lost another 50 pounds in about three months.  Other people noticed.

I worked at a drug and alcohol treatment center as a detox RN (and weekend charge nurse of sorts- if anything was wacky on campus, I had the last word if it was OK or not, though with serious stuff, I had plenty of folks to call for feedback and input) , so my coworkers were very aware of what addictive behavior looked like.  And denial.  And refusal to listen to rational feedback.  I coasted for a bit, but by the time a formal intervention was done, I was in bad shape.  Eating anything was excruciating.  Every night, I was asking God to just let me wake up in the morning.  And I literally crawled up the stairs to and inside my apartment.  Chunks of skin fell off of my heels.  Things weren’t good.

The day of the intervention was on the day after having worked a double shift.  I got off at 7 a.m. and went to rest for a while in one of the cabins my coworker had (she lived a few counties away and stayed on campus when she worked- we worked weekends and Mondays) while she went to do some discharge summaries, which I planned to do as well once I got some rest.  She came and got me at around noon, and asked me to come with her to get something to drink, and also drop off something in the Operations Director’s office.

I never saw it coming.  Inside the Operations Director’s office were my boss, her husband (who also worked there with the clinical staff), the medical director, day charge nurse, and several other people, including clinical staff who I worked with as well. There were 8-10 people there.  When I saw them all in the office, I knew what was going on.  I was terrified, but also wanted to stop fighting the wars in my head over something as ‘stupid’ as food.  It’s never about food, but that was what was going on mentally.  I was told of the plan to take me directly to my apartment to pack (supervised), then driven to the San Antonio International Airport to be put on a plane.  Someone would take care of my dog (that’s a whole different story), and my car could stay on campus where it could be monitored.  I’d fly to Houston, where an outreach employee would meet me, and be sure I got on the flight to Los Angeles.  That was the only way I’d be allowed to come back to work. What I hadn’t told them was that my primary doc had told me that I probably wouldn’t last a month, tops, if I continued as I was.  Their timing was perfect.  I wouldn’t have been ready before then.

So, off to Los Angeles I went.  Scared to death… I knew they made people EAT in eating disorder treatment.   But, I figured the sooner I got with the program, the sooner I’d get out of there.  So, in a feeble way, I’d begun to surrender on the plane.  By the time I got there, I was so exhausted from the double shift, then the intervention, traveling, etc, that the guy who picked me up thought I’d OD’d on something that made me semi-coherent.   I was just flat-out tired, and told him I was there for not eating (I never looked like I was starving as much as I was- curds of cottage cheese were something I worried about).  I was also exhausted from the battle fatigue from what had been going on in my head for months.  I’d been ‘confronted’ a couple of weeks earlier by a former coworker from another place I worked, about my weight (she was dropping off her child for treatment), and she asked if there was anything wrong with me.  I didn’t know how to answer.  It didn’t register that losing fifty pounds would be visible to anyone.  Seriously.  That jarred me a bit, but the intervention had the biggest impact.

I went to the treatment center in California (they no longer ‘do’  eating disorder treatment, thank God), and it was horrible.  The facilities were pleasant, and the food was really good (which amazed me, since I didn’t like much of anything, but all of the fresh produce ALL THE TIME was great) !  A few of the staff were decent, but eating disorder treatment it was not.  And the primary ‘assigned’ therapist I had was bad news… I was not allowed to speak about some things that seemed therapy-worthy to me. The ED patients had a table segregated from other patients in the dining room (and we were often like an exhibit in a zoo for the other patients who wanted to see if we ate), and one OA meeting a week (otherwise we went to AA).  That was the ED program. They may have been great for chemical dependency and/or dual diagnosis, but I was a generic eating disorder NOS (not otherwise specified) patient.  They didn’t get that right either.

When I first got there, I was so weak that when I went on the ‘beach walk’, I could barely make it.  Walking in the sand was exhausting, and I was having a lot of trouble even keeping a visual on the rest of the bunch who opted to do that activity.  My jeans were falling off, so they gave me a trash bag to tie two belt loops together, then trimmed the excess so it didn’t violate the safety rules about plastic bags.

The day before I was sent there, I’d packed up a detox patient to go there for more dual diagnosis issues than we generally dealt with at our facility, and then I showed up as a patient. Surprised her !   We sort of stuck like glue together, trying to make sense of the place.  Then another patient, AND person who worked where I worked showed up… They were both dumbfounded about the detox and treatment  process (so had a lot of questions), but come to find out one hadn’t told them all of the things she’d been taking. I told her she needed to fess up for her own safety.  They’d come to me (their former nurse) before talking to the staff there.  I wasn’t licensed in CA, and I was off the clock out there- but I was glad to be of some support.  We all needed each other out there.

There were a few of us ED patients, and we stuck together between groups, wondering where the ED services in the brochure were.  But, I managed to survive 36 days out there. The last 10 days, I had a virus of some sort, and wasn’t allowed to participate in any groups or meetings (but wasn’t sent home). They’d taken me to an ER, where they had me pee in a cup, and then decided I had a BLOOD virus- from a pee test…  The group would literally come to my room at the end of the session to say hello.  I could go outside and sit in the sun (or smoke), but no activities anyone else was doing. I could go to the dining room with everyone else, so it wasn’t like they were worried about me giving bugs to someone… but whatever.   I had a few roommates, some ED and one alcoholic,  (at different times) who were nice enough.  But I left there feeling totally unprepared for going home and making it OK.  I had no aftercare.  I was more scared leaving than when I got there.  But it was a great motivator to not want to ever end up in another situation like that was.

One really funny thing happened one evening, during my ‘banishment’ from groups, when I was outside  smoking.   One of the techs (fondly called the ‘clipboard jockeys’) came running around the corner asking if I’d seen the REST OF THE PATIENTS.  All of them !  😮  I told him no, and he was sure I must know something, even though I wasn’t allowed in groups. I really didn’t know. Come to find out that the rest of the patients were doing the evening community group, and after the tech checked everybody off of his clipboard, they went to another room to mess with him, and hide.  Eventually, all showed up, and the tech laughed, but I can imagine the thoughts going through his head about how he’d lost the entire lot of patients, except the puny one not allowed to go to groups.   That would have been a serious pile of incident reports and phone calls.

In the meantime I’d been told that I would NOT be allowed back to work where I’d been working at the time of the intervention until the director of nurses OK’d it (she had some serious boundary issues, and was also a neighbor of mine who had been in contact with my therapist in the treatment center- acting like some sort of information verifier.  The treatment center wouldn’t let me talk about being raped until my boss had reported to them that it had actually happened when she found the info and news clippings in my apartment when I was gone). Anyway,   I really liked that job, so that was a huge loss until I showed I was doing well enough to come back.   Eventually, I did get to go back, and stayed another couple of years until things started feeling unsafe with a huge increase in census, and no changes in detox/nursing staffing for several months.    But I’ll always be incredibly thankful that I got to work in that facility.  I learned a lot, and am a better nurse for my experiences there.  I still am in contact with several people I worked with there.

The intervention likely saved my butt, even though I had a lot of work to do ON MY OWN when I got back.  I got every professional book on EDs I could find, and did an ‘as if’ thing.   I looked at what I needed to do ‘as if’ I were carrying out orders for one of my patients.  I had to detach for a while.  Eventually, I was able to make it about me, and feel like I was doing OK. (The one OA meeting/group in town was ‘lead’ by someone who brought specific diets to show to the group- nothing 12-step about it, so I passed).  Whenever I see the show ‘Intervention’ or someone getting nailed on Dr. Phil, it brings back a lot.  Interventions are terrifying, but there was also a huge sense of relief at not having to go it alone any longer.

For those who think it might happen to them, just go with it.  Let everybody talk, and then be thankful that you don’t have to get well by yourself, and it doesn’t have to be perfect.  One step at a time, even if they’re baby steps.  A slip doesn’t have to become a relapse.  It beats being tied to an addiction that wants to kill you !  Things can get better, IF you are willing to let someone nudge you on your way (feels like an emotional sledge hammer, but in retrospect, it’s more of a send-off to the rest of your life 🙂 ).

Freak Magnet

Sometimes I’ve wondered if I’ve got a sign on my forehead that screams “ALL FREAKS, C’mon over” !  I’m sure that everybody has experienced the same sorts of people in different ways…and some days I’m not so sure.  Maybe some of it has to do with being a nurse. People see nurses as helpful and nurturing, when we’re just as weird as everybody else- we just get paid to take care of the lost and vulnerable. And then there are the folks who would fit nicely  on the side of ‘Criminal Minds’ that either gets shot or lengthy prison sentences. The spooky people.  Not all are dangerous to others, but the danger to self thing eeks in there. Regardless, they don’t fit well into a ‘normal’ life.

Let me start with a director of nurses (DON) who had been one in a line of them at a very nice nursing home after the ‘good’ DON had gone on maternity leave. He happened to come along during a time when a new administrator was also getting used to all of us.  Initially, he seemed a bit intense, but not pathological.  One of my duties when I was working on the weekends as the RN Supervisor was to log in the discontinued medications that did little but take up room in the storage cabinets in locked medication rooms. I counted each pill on each card of pills (packaged at the pharmacy for nursing home med carts), bottle of loose pills, or made sure injectable medication vials had a reasonable amount left for what the sign-out sheet said it should have.  Narcotics (or ‘scheduled’ drugs) had to be accounted for separately and documented on specific forms.  It was mundane, but necessary. At one point, the DON asked me for the keys to the file cabinet  in his office where we kept the ‘logged’ drugs.  He was the boss, so I handed them over- no problem.

A few weeks went by, and the nurses on the floors said that nobody had picked up the growing piles of discontinued cards and bottles of medication for a while; they wanted them out of the way. I asked the DON if he wanted me to log the meds in that coming weekend ( I think this was either a Thursday or Friday). He looked at me and closed the door behind me in his office.  Gulp.  He then pulled out a .44 semi-automatic handgun out of the desk. That alone was a huge, HUGE problem. Texas was pretty gun-friendly, but in 1994, guns and old folks weren’t a good pairing.  He pointed the barrel at me as I sat down (which I decided to do before I keeled over), and asked me if I was going to tell anybody about our little talk.  Nope. My lips were sealed. Everything was very cool (as I’m imagining my body being found after the weekend, ripe and smelling up the place).  He handed me the keys and told me to go ahead and log in the meds that were piling up.  NO problem. Happy to do so.  Can’t wait to get started. Did he want coffee with that?

But that weekend, I noticed that every last narcotic form I’d filled out had been rewritten in his handwriting, with no way to figure out what had been removed from the lists I’d been keeping. I had a very specific way of tying the bags when I was done, and how I kept the narcotic sheets separate.  It was a federal law that this all be done according to the rules. I liked following the rules 🙂   I didn’t like having my work screwed with by a gun-weilding nutjob of a boss.

I  didn’t like even knowing about the gun. But I was also initially scared enough that he would shoot me, run off with piles of drugs, and nobody know why I was found belly up until they start looking at the paperwork. By then, he’d be on some uncharted island in the South Pacific, in some hut powered by a bamboo bicycle generator and drinking coconut drinks. The new administrator didn’t know any of us that well, and I wasn’t super tight with the assistant DON, but I had to tell someone. The ADON ‘G’ was outside smoking late that next Monday afternoon after nearly everyone had gone home. I told her about the gun.   She knew me well enough to know I wouldn’t come up with some sordid story about someone.  We agreed that we’d both go to the new administrator in the morning, before the gunslinger got to work.  We did, and told the newbie administrator. By that time, the DON had turned in his resignation, and it was decided he need not complete the two-week notice. He was free as a bird.  I have no idea what else was done about reporting him to the board of nurses (not sure if mandatory reporting was in place at that time), but I was told (after he left)  that before he left, he’d taken it upon himself to just stop some lady’s order for morphine- pills and injectable- and they were never seen again.  That created a HUGE mess with calling the doctor and getting the stuff reordered from the pharmacy for the poor little lady who still needed the stuff. The floor nurses were going nuts counting everything that wasn’t nailed down, and making sure their names were clear (they were).  I’ll never forget the business end of that .44 charcoal gray gun ‘looking’ at me.  “Two in the chamber, ten in the clip”…. whatever that means, it didn’t sound good.

Another time at this same facility, there was a sweet certified nurses assistant who was noticeably quiet, but she got her work done and wasn’t an attendance issue. Those sorts tended to fly under the radar. She was probably in her early 20s, and a member of the ‘fashion isn’t my thing’ club (I also belonged to that club- no judgement from me). We all worse scrubs while working, so looked pretty much the same (in different colors and prints, depending on the department), but when she came to get her paycheck, she dressed ‘depressed’. That was my first clue. I’d talked to her several times, and we had a decent rapport. I could tell there were things going on, but didn’t have any reason to pry. Her work was acceptable. I was part of the nursing management bunch, but did patient assessments and staff training/infection control- not the hiring/firing/counseling stuff.  Anyway, I kept an eye on her.

One afternoon, I got a call from the next door emergency room. They had the CNA there. Her friend wanted to talk to me.  Seems this CNA had slit her wrists. I wasn’t sure why I was being called, but the friend asked if I could talk to the staffing nurse (ADON) and let her know that ‘L’ wasn’t going to be there for her next shift; ‘L’ didn’t want to talk to anybody. I asked where she was going when she was done at the ER (as in what psych facility is going to evaluate her?). She was being discharged home.  With sharp things. By herself.  I didn’t like that at all. I knew ‘L’ lived alone. She never mentioned any family or support system.  OK, not good.   When they left there, I needed to see ‘L’ with my own eyes, so asked them to come over to work, and I’d talk to her.  She agreed via her friend.

In the meantime, I tracked down the social worker (from hell, normally) who was still there; I needed help with this one. And she got nice about it all, which I was thankful for. She got on the phone and started making calls re: acute psychiatric facilities who would do an impromptu assessment as soon as we got ‘L’ over to their facility.  I don’t remember who the DON was at that time, but I think she was gone for the day (it wasn’t gun-boy).  ‘L’ got over to the nursing home in a little while (wrists wrapped in gauze), and agreed to go with the social worker and me to the psych hospital, just to see ‘what her options were’.  I was hoping they’d keep her for a few days, so she’d be safe.  She was worried about losing her job if she checked in to a psych facility, but I told her that being checked out, and getting help was going to help her keep her job. Our administrator (before the one with gun-boy) was very compassionate.  ‘L’  agreed, and the psych facility did decide to admit her. She was in and out of there over the next few months (once after I sent the police looking for her as she had uncharacteristically not shown up for work), and ended up getting shock treatments.  She came back to work eventually, and while a bit subdued, she was doing better.  I learned more about her past, and she had reason to feel overwhelmed and hopeless.  Everybody has a history…

Another coworker (an LVN at an acute care hospital working on the neuro floor) had some ‘issues’.  At work, she was fine.  Not employee-of-the-month, but she did OK when she was there. We were both fairly ‘young’ nurses- as far as time out of school, and also just plain young, in our early 20s.  ‘A’ had all sorts of respiratory problems- mostly asthma. She had some attendance issues as a result, and the hospital had a ruthless attendance policy. She could be admitted in the hospital on oxygen, and it counted against her attendance record.  Anyway, a few months after I’d been raped and beaten in a very publicized case, ‘A’ calls me and says she had been attacked overnight by a former boyfriend, and needed help getting her dog to the vet. Fido had been cut by the boyfriend’s knife per her report.  I immediately agreed and went to pick them up.  Something seemed ‘off’.  Fido was frisky and happy to see me (his  usual goofy, non-traumatized behavior). There was a tiny cut  on his paw (more worthy of a bandaid than a trip to the vet), and ‘A’ had some odd looking cuts on her neck…the depth wasn’t something I’d expect from someone who had been seriously sliced by a rabid ex-boyfriend, and the way it went from deeper to more shallow from left to right looked kinda self-inflicted to me (she was right handed). But I didn’t want to believe that.

‘A’ told me she’d been whacked in the head, and felt horrible, but after going to the vet, how about we go get some lunch and maybe do some shopping.  😮 Everyone deals with stress differently…but another piece of the puzzle wasn’t fitting well. But, I agreed.  We spent most of the day together, and during that time she told me that the police had asked her for this guy’s photo- but she didn’t feel like getting it for them. WHAT? Not helping to apprehend this guy?  I had no ability to understand that ‘reasoning’ at all.  I’d been held in my apartment for 6 hours, finally escaped and called 911, and police ended up shooting the guy in my bedroom when I’d been attacked less than 7 months earlier. Why was she doing this?

I decided I needed to get home, and she suddenly begins to have symptoms of a concussion.  Puking, head pounding, vision a bit blurry…. so she now needs a ride to the ER for a CT scan and neuro evaluation.  The day was getting so very long (and more and more weird). She ended up being cleared for any sort of head injury, and told that basically she was fine.  I dropped her off at her apartment, drove like a bat out of hell to get home, and turned my answering machine off when I got there. She could dial 911 in a real emergency when she was going to cooperate with an investigation.  I was done.  I was no longer working at the same hospital by that time, so rarely saw her… I’ll never think that she was telling me the whole story- OR stop wondering if the police had ever actually been notified of the ‘attack’.  What made me even more mad was that the dog had been involved.

I got much more jaded when crises came up with some coworkers.  I had my own stuff to deal with, and had also become much better at sorting through when someone needed  help that was appropriate for a friend or coworker to handle.  I had times when coworkers helped me through some lousy times, and most of that was when they offered; I didn’t seek them out.  I was always very thankful for their time.  But,  I got careful about that as well, as crises junkies also like to be on the ‘helper’ end, not just the ‘helpee’.  One in particular had been a huge support system during some eating disorder stuff that was pretty serious, but when I got better, she wanted nothing to do with me. That hurt a lot.  There are a lot of people out there who are taking care of people who need keepers themselves.  Or who help to fulfill their own self worth needs.  There’s nothing wrong with finding satisfaction with helping people (professionally or on a friendship level), as long as the needs of  those being helped are the first consideration- not some twisted need for being needed.  Sometimes it’s a fine line.

I can think of others… these just stood out tonight.  Stay tuned for the continued saga of the  wacky side of nursing, and whacked nurses. :/

Working Drug and Alcohol Rehab…Voluntarily !

I worked at a great drug and alcohol rehab facility for about 2 1/2 years (minus a few months when I was sent for eating disorder treatment).   When I tell people I worked with drunks and junkies, I get a look that hollers ‘Ew’.  But it was great!  We had people from all over the country and several other countries come there for treatment. One arrived by limo after landing in a private plane, most came through a nearby large airport on commercial flights, and one person arrived on a bike with a backpack and everything they owned.  Addiction doesn’t discriminate.  Doctors, lawyers, nurses, construction workers, homeless, wealthy… didn’t matter. They all needed help. Many were really nice people and quite enjoyable to get to know, even during a really hard time in their lives.

People who end up addicted to drugs and/or alcohol are just folks.  I’d be really surprised if there are any people out there who don’t have someone in their family who is addicted to something, or know of someone by name who has addiction issues (my family has had its share).  Nobody decides to become an alcoholic or addict.  It’s not a lifelong goal they set out to achieve when they’re kids.  It’s a disease.  That doesn’t excuse them from their behavior- but it does give a reason. And the addict/alcoholic is still responsible for their actions, and consequences of what they do when loaded.  They’re also responsible for the decision to get help.

To the average person, the amounts of substances that were ingested by our patients sound unbelievable.  I admitted many people who took 70-80 Vicodin a day, or drank 36 beers in 24 hours, a quart of vodka in a day.  Their admitting blood alcohols (breath tests and blood samples) were often .300 and higher, and they were talking fairly well.  I remember one youngish patient who blew a .500+, and while not doing well, had stable enough vital signs to not ship him/her to the medical hospital; he/she was that used to being bombed at that level.   (I can’t give anything away that is identifiable about a specific patient).

The doses of stuff we gave these folks (depending on what they were primarily detoxing off of) were generous.  We didn’t want them to suffer any more than they already did. If they were willing to come for help, we wanted to help them.  Many people say let them suffer.  What that does is send them back to the bottle or pills (or needle) because the symptoms of detox are just too much.  It keeps them sicker longer. The most cruel detox I ever saw (repeatedly) was from methadone.  The medication meant to get someone off of heroin is worse for detoxing than heroin, which is bad enough.  I remember one patient who spent three weeks in active detox; the acute phase of heroin detox is a few days.  There’s no comparison.  They’re all miserable, but looking at all of them  from the outside, methadone is the worst, hands down.  I’ve been given methadone for chronic pain, and it scares me to death.  I never take it two days in a row, and generally only once every few months.  I wait until I know that I can’t get by with something less potent.

Many addicts started out with pain medications for legitimate physical pain.  But addicts generally have a different reaction to drugs.  Most non-addict people get sleepy from opiates (narcotics) and alcohol; addicts and alcoholics often report feeling energized.  So, they use them for non-pain related reasons.  There’s the problem. Pain medications aren’t ‘bad’…it’s when they are misused that they are an issue. People taking legitimate prescriptions by the label instructions aren’t likely to get addicted (less than %6).   There may be some tolerance that builds requiring increased doses to be prescribed, but that’s not addiction.  Addiction happens when someone is using something for a reason other than its intended use, has negative consequences for using that substance, not stopping when they have negative consequences, denial, and the inability to stop on their own.  There’s also the psychological need for the substance to help deal with emotional pain.   It’s not ‘just’ someone who wants pain relief for physical disorders.  I have never met an addict that didn’t have emotional pain that was deeply rooted, and they didn’t have any other coping skills with which to handle them.

I am often looked at with skepticism when I report pain (I haven’t had a pain-free day in about 17 years).  SO I stopped, except when I see the board certified pain management doctor I  see – who doesn’t prescribe over the phone, never changes doses without an exam and face-to-face discussion, and who has the right to obtain random drug tests or no longer see me, should I refuse (which I wouldn’t do).  I like it that way. In the days of some people misusing narcotics, it leaves those with legitimate pain diagnoses hurting, which is to make the %94 who won’t become addicted suffering unnecessarily because of the %6 who misuse the prescriptions, and seek illegal or bogus ways to get the drugs.  But that’s a whole ‘nother blog. 🙂

Sometimes things went badly either during detox, or during their last hurrah on the way to the facility. I sent a couple of patients by ambulance before they even started their admission paperwork because they couldn’t stay awake enough to get basic information and give ‘informed consent’.   One person showed up dead on a different shift.  Glad I missed that.   Another patient  forgot to let us know that sleep apnea was one of their diagnoses.  That person woke up to paramedics grinding their knuckles into their breastbone.  I’d tried waking that person up in various ‘deep’ ways, and got nothing.  That person refused to go to the ER.   If  they were awake enough to complain, I felt better.   Another patient ended up septic from IV drug use infecting the lining of his/her heart. The night nurse (a temporary weekend nurse; the regular guy was good) didn’t know that a decrease in fever to a sub-normal level, after having a significant fever, was a BAD sign and said that the body was decompensating into septic shock, which is lethal if not treated.  I couldn’t get out of report fast enough to go see that patient, who was seriously ill. The local hospital really disliked the detox patients (I worked there, also; it wasn’t a bad place by any means, but detox wasn’t their thing, like septic patients weren’t going to get the proper treatment at a detox center), but they got that patient  for a couple of weeks.  More IV antibiotics were required after he/she returned to complete treatment with us.  Another blew the blood vessels in their esophagus, hemorrhaging blood all over the place; he/she survived and it scared him/her into taking things more seriously.

The facility I worked at had a good rate of recovery, but many addicts/alcoholics from any treatment center go through relapses. Sometimes they make it back to rehab, and sometimes they die in their disease.  That’s sad.  I got the call one weekend from one of the guys who arranges admissions to go get the medical record for a young person who had been in the facility before and was coming back, only didn’t figure that one last fling in the hotel before readmission would be fatal.   The admissions guy needed the kid’s (20’s) parents’ phone number so he could notify them.  That was really sad.  We got news about the deaths of other former patients as well.

I had a neighbor  (no confidentiality issues) who could have benefitted from alcohol rehab.  He lived directly next door to me; our front doors faced each other in the apartment complex.  He was stupid drunk at least 4-5 times a week.  I saw some lady walking him home one afternoon; he’d wet his pants. Another night, the police were at his front door.  Through the peek hole, I could see he was naked as a jaybird, just standing there talking to the officers until one of them suggested he go get some clothes.  It didn’t occur to my neighbor that standing in  his open front door, naked, was inappropriate.  I got tired of talking to him when he was drunk.  He always had the same conversation over and over again.  He asked me one night when he wasn’t drunk if I was mad at him.  I told him no.  But when he was drunk, I wasn’t really talking to him- I was talking to the booze, and if that’s what I wanted to do, I could go to the convenience store on the corner, and chat with the Bud Light in the cooler.  That stopped him cold, but it did nothing for his drinking.  I moved away, and have no idea what happened to him.  I left him a ‘Big Book’ from Alcoholics Anonymous and the phone number for the local chapter in his door when I left  before dawn, that morning I moved.

Addictions nursing is actually really rewarding.  All specialties of nursing have sad aspects, but watching someone get their life back in order and work through the pain that go them to the point they reached in their addictions was pretty cool.  They’d come in broken and deeply hurting, and leave with hope and a support system of any alcoholic or addict that they encountered in the 12-step meetings they had been attending. The actual steps they were working on were giving them a second chance at life, and even the early changes were amazing, and an honor to watch.