A typical day in the life of a detox therapist…
Okay, so there really aren’t any days that are “typical” because I never really know what to expect when I walk through the door – that is the “thrill” of it, I guess (not). But I’ll try to paint a picture for you of what goes on in the world of addiction through my little window looking into it.
7:15am – I arrive, fight for a good parking spot, and walk to my unit. (FYI: A “good” spot in the parking garage is one closest to the stairs or elevators.)
7:30am – I slide my security badge over the sensor and walk in the door (yes, it is a locked psychiatric unit). Usually I’m greeted by several staggering patients who just crawled out of bed desperately in search of coffee, medication, food, or directions for “how to get out of here”. I’m also greeted by a variety of smells. Most mornings the smells remind me of those morning jogs I used to take down Bourbon Street at 6am on Saturday mornings…I’d have to hold my breath due to the leftover party funk: a mixture of urine, alcohol, and…I’ll leave the rest to your imagination.
7:30-8am – Initial to do list: Print out all necessary paperwork for the day. Meet with any doctors and nurses on the unit to get/give updates on patients’ progress. Sign all charts. Gather as much information on each patient (you might call this “ammunition” to throw at the denial) including: why they landed here, what/how much they were using (compare this to what their toxicology report says they were actually using), and check for past admissions to see if I’ve met the patient before (usually 1-2 patients or more are “repeat customers”).
8:00am – Medication time! The chaos begins…
I grew up living a couple of blocks from the beach. On weekends, our family would load up blankets, sodas, and a picnic lunch and head to the beach for a day together. I have a vivid memory of us going to a local Taco Bell drive-through and ordering lunch to go – lunch that we planned to eat at the beach. Little did we know that this was not the best idea that day. Why? Seagulls. Have you ever attempted to have a picnic on the beach surrounded by a huge flock of seagulls? They are relentless. I remember guarding my nachos with my life while screeching seagulls swarmed above me at what seemed like only a few inches above my head. Screaming “shoo!! shoo!!” repeatedly did nothing to quell their resolve to steal our yummy morsels. We ended up having to retreat to the safety of the mini-van to scarf down our lunch in the sweltering heat. This is what medication time in detox is like – swarming screeching seagulls.
8:05am – The fun starts. I must assess every new patient admitted the day before. I usually have to wake them up and ask them a ton of questions that they’ve already been asked 2-3 times. As you can imagine, they are thrilled.
Scenario 1: The patient pretends to be fast asleep – or actually is in a coma-like state – and refuses to wake up, even with earthquake-like shaking of the bed followed by their name being called out repeatedly at a high level. I’ll come back later.
Scenario 2: The patient is startled by a whisper and as I start to talk states: “I’ve already answered these questions a million times, don’t you guys compare notes?” I politely respond that some of the questions are indeed different and even if they’ve been asked before, I must gather this information again, more specifically. An angry “Fine” is followed by stern “yes” or “no” answers to what are open-ended questions requiring much more detailed information. I’ll come back later.
Scenario 3: I find a patient who is already awake and agrees (although reluctantly) to be interviewed. First question: “What brought you to the hospital; why did you seek help yesterday?” I’m trying to identify what painful source FORCED them to seek help, since rarely does a person set their alarm and wake up saying “today is a great day to get detoxed!”. Usually they respond: “drugs” or “alcohol” and I have to say, “yes, but what was going on that made you seek help at the emergency room? What was the straw that broke the camel’s back?” – Patient: “I was tired.” Therapist: “Why were you tired? What was different from every other day spent using?” Then I might get what may be close to the truth: “My family brought me here and won’t let me come home.” Or “I was arrested and they told me I had a choice, jail or the hospital.” Or “I ran out of money and ran out of stuff to use – couldn’t handle the withdrawal.” The list goes on from there. Each question goes on this way with me having to wade carefully through the denial to get at the truth. I realize that I am interviewing people who are used to lying to themselves so much that they don’t know what the truth is anymore and I have to help them dig it up. I am a detective in a missing-person case, talking to the person who is lost and doesn’t know it.
Scenario 4: The patient wants to talk. They are ready for help. They are willing to answer questions – and, although they still may have some denial going on – they are willing to reveal and examine the truth. They accept my challenges to their thinking – sometimes they seek further education on addiction and how it has changed their brain – and I’m thrilled to discuss it with them. My eyes light up, the air in the room becomes still and the noise outside the door settles, my focus becomes very sensitive and in-tune with this other person. Time passes very quickly in these moments – an hour feels like 5 minutes. I’m thinking of nothing else but this patient, what they need, and how to help them get it. They ask about how to go about finding further treatment. They agree that they really need it. These are rare gems. These moments are what make the day seem totally worthwhile. I will take the smells, the verbal abuse, the denial, and the despair…just give me these tiny gems.
11:00am – First psychotherapy group. I knock on each door and encourage attendance. At this point, I turn into a cheerleader. “Ho Ho! Hey Hey! We’re gonna treat your disease today!” “Two bits, four bits, six bits, a dollar! All for recovery, stand up and holler!” (I don’t really do these cheers, but sometimes I’d LOVE to do this to see what they would do). I may go into the room and give my best attempt at verbally dragging each patient out from behind their pillows. Some days a majority of them stay in their beds. Some days a majority of them make it to the session. Rarely are they ever very excited about it.
Scenario 1: I’m greeted with “My goodness, we have another group???” This is usually followed by loud sighs and statements about needing more coffee. I start the session off by asking an open-ended question. The only responses are blinking and breathing. Much of the session continues on this way. Sometimes I push and prod until they are forced to speak. Sometimes I am forced to just hear myself talk and hope that some of it will sink in through osmosis. Sometimes I have to nudge and ask a patient to leave because their snoring is disrupting the group (they are on phenobarbital and it is tough to stay awake on that stuff). Half of the time I am amazed that they agree to get out of bed. Our groups are voluntary.
Scenario 2: When I walk in the room I feel it. Have you ever walked into a room full of people who strongly despise you? It is palpable. Sometimes the disease is alive, well, and thriving among the group and they are convinced that I am the enemy – perhaps because I tell them what they hate to hear most – the truth? These sessions are tough because it can feel very personal. Sometimes patients will cuss me out. Sometimes they will do their best to try to discredit me: “Well are YOU an addict? Have YOU ever used heroin? I am not going to listen to anyone who hasn’t been through this themselves!” They make assumptions about me – and I tell them that. My response is this: “I choose not to share my personal life at work – however, I will tell you that addiction has been a part of my life for my entire life – and, if you are open-minded, you can learn from anyone. Openness is key to the recovery process.” That usually shuts them up. Sometimes they storm out, slamming the door as hard and loud as they can. Sometimes they try to speak for the group and form a coup: patients vs therapist. I’ve been through these battles a million times and I know exactly what to do to disarm them. Usually, I use the 12-steps in some way, but oftentimes remaining calm and letting them see that I am not the enemy – I am there to help them – is the best antidote.
Scenario 3: I walk in and begin the session. They are attentive, ask questions, nod their head, engage in the discussion, share about their own struggle in an attempt to gain understanding of themselves, of the disease. There is a cohesiveness among the group…we are working together as one. Again, time passes quickly and we don’t notice – we don’t think about lunch or what we’d rather be doing. There is an energy flowing through the room. The light comes on in their eyes; they sit up and lean forward in their seats. Risks are taken. Tears are shed. Truth is revealed. Everything comes out and it is heard, understood, accepted, protected. This is a place where steel trap doors are creaked open; dams are broken; battles are agreed to be fought with intensity instead of simply surrendering to misery and death. It is these moments of true vulnerability that are so very precious. Being a part of a group session like this is a rare privilege and everyone in the room knows it. The end of that hour comes and I close the session. It feels like being awakened from a pleasant dream. The patients appear to be in awe of each other; sometimes they are in awe of me – but I didn’t do anything – they did.
12:00 – Lunch. I leave the unit and spend lunch time getting as many laughs in as I can with my colleagues – a group of 16 other therapists. It is what refuels me for the second half of my day.
1:00pm – I return phone calls to family members who are often as sick, if not sicker, than the patients. Usually they have been major enablers who have repeatedly misunderstood that by helping their loved one while they are using means helping them to keep using. I give them a quick dose of honest education about addiction, the brain disease, how to seek help for themselves. I encourage them to send a clear message to their loved one: “We will ONLY support healthy recovery decisions – we will NOT support unhealthy decisions that negatively impact your recovery.” I give them information about Alanon, Aftercare, books to read, websites to visit, and other resources. Sometimes they aren’t interested in anything I have to say and just want to know when they can picked their loved one up from detox.
1:30pm – Education group…a repeat of the scenarios listed above.
2:30pm – Write notes on each patient until my eyeballs cross, my vision becomes blurry, my hand cramps, and my brain turns to mush.
3:15pm – Meet individually with patients who have requested information about treatment. Try to help them understand the need for doing THE MOST that they can do to treat this deadly illness. Usually I’m faced with a variety of excuses for not going to further treatment: “I have a job.” (Well, if you keep drinking you won’t!), “I have a family” (If you die, you won’t! Your family wants you to stay alive.), “I can’t afford treatment” (How did you find money for a $200/day habit? Plus, free or low cost treatment is available to you.), “I’m going to go home first and think about it” (Translation: I do not want to tell you that I am not going to go, so I’ll make you think that I’ll go later.), “But I don’t have enough clothes to go to treatment” (Since when do you care what you look or smell like?), “I have some things to take care of first” (Um…like using?), “I just need to go back to meetings” (What you need to do and what you actually will do are two different things). The excuses can be very creative. I’ve actually considered making a list of the top ten excuses that are given by patients so that instead of responding, I can just point to a list and say “read excuse number 5, I’ve heard it before.”
3:59pm – Gather my belongings, my fatigued compassion, and what is left of my brain…and walk out the door.
4:15pm – I try to remember where I parked my car in the parking deck – sometimes I climb flights of stairs and remember that I actually parked on the ground level (I blame it on a tired brain). I kick myself for waisting needed time and energy climbing stairs that I didn’t have to. I fight the traffic home.
4:30pm – Collapse from exhaustion – and prepare for the next day.