A matter of days

Tuesday was one of my worst days to date as a Case Manager. It was only exacerbated by my anxiety being in full flare. The stars collided perfectly and tragically, as it were.

Case Management in Addiction is a numbers game. Simply put, while there is never an expectation of 100%, if the successes outnumber the losses (we don’t use the word failures) then it is a rewarding use of your time. Even a ratio of 51/49 is fairly aggressive. For the sake of this conversation, success is a patient who buys in, makes an effort to dedicate themselves to healing, or at least surrenders (addiction treatment is about relinquishing control above all else) themselves to the process and completes all or most of the recommended continuum of care. We have ZERO control over what happens after they leave us but the numbers support that a full stay tends to lead to a more positive likelihood of positive outcome.
Tuesday I myself seemed to have ZERO control of ANYTHING. I was pushed to my absolute emotional limit. I went home questioning everything. Fortunately, I didn’t go home alone. I had Miss Anxiety with me and she was piling on.
You should quit!
No, I love my job.
Then why are you so upset?
Because I have no control.
Like your patients?
They have to be there…
You think you do too. Maybe you don’t?
I can handle it. I think.
Can you?
Fuck you, I have skills.
Not today you didn’t.
You’re right…
Of course I am, I’m always right. Especially when I tell you that you suck.
Tomorrow will be better. LEAVE ME ALONE BITCH!

I questioned everything and argued with myself for hours. I was low, lower than I’ve been for a while and it bothered me. Then it came to me. Late of course, as it always does.
Change your mindset. Do what you tell your clients. Worry about what you can control, put behind you what you can’t. Stop trying to save the world, help the ones that let you.

For the last 2 days I managed to keep the duct tape over the mouth of Miss Anxiety and focused on positivity. It must have oozed out of every pore of my aura because the last 3 days were so much better. I came home tonight knowing that I did some good and at the very least did nobody harm. Perhaps most importantly, I know that I did the absolute best that I could. And that, on a anxiety-free day, is all that matters to me.

Angels and Demons

I was warned when I started my job as a Case Manager in addiction, that there will be times when my entire client list would catch fire.

The addiction patient comes in several forms, ranging from first-time in recovery, young or older (sometimes in their 70’s) to the “readmit” who has been in multiple times (I have one young man in his 30’s who has been in rehab 41 times). Some are very motivated and others are counting the days. They come to us for many reasons. Some are court-ordered and others made the brave choice to change their lives and are willing to make bold moves to do so. One thing I have learned is that there is no room for assumptions about outcomes (that is obviously way beyond our scope) and there is no connection between willingness, enthusiasm and cooperation and stability during treatment.
There is no such thing as a stable patient.
Any patient can turn on a dime in one day, often defying every expectation. The addiction patient is dealing with a plethora of internal forces that pull and tug at them. One day there are doing fine; motivated, encouraged, and on course. The next day they may decide that it’s too hard, that they are needed at home, that they can deal with their addiction on their own, that getting back to work is the key, and my personal favorite…they think they are ready. Even when they are not. It is the mental push/pull that comes with making major change against a force that is larger than them. I attribute it to the dichotomy of human nature. Think of it as the scene in the Flintstones when Fred has a little devil Fred on one side and a little angel Fred on the other.

When this occurs, the adrenalin kicks in and the push to keep them from leaving begins. I know it sounds awful, but we know what is good for them even when they don’t. We have at our disposal the research to support it, compiled over millions of patients worldwide. We are trained, and we have the additional resource of many co-workers who have been through recovery themselves. We are armed with every tool, backed by sheer good intentions to help them recover. When we tackle this obstacle, it is exhausting. At least to the new guy, which I am, and my more experienced colleagues are more able to cope with it than I. While these waves of change occur in nearly all patients, it happened with too many of mine this week.

I approach my position as I do my own matters. aggressively and with passion. I challenge, poke and prod, tell the truth, and insist on reciprocation. While I am not a clinician, I get the information we need and I learn the ins and outs of the person in front of me. I invest, and I am here acknowledging that I do so at the sake of my well-being, of myself into my clients. I know it sounds corny as hell, but I care about people and despite my best efforts to dial it down, I can’t. Sue me, I give a shit. I need to know at the end of each day/week/month that I did the absolute fucking best that I could for those in my charge.

And it is taking its pound of flesh.

the day after Christmas

It was the day after Christmas and my youngest daughter and I were nursing our morning coffee after a late night of junk food and binging Netflix. My phone rang its distinctive Duck call ring tone and I walked over to the counter to see who it was. It was my ex. It was a dick move but I chose to let it go to voice mail. I do that a lot. I’m not proud of it. I don’t hate her but I have been conditioned to feel a sense of foreboding when she calls.

Too many years. Too many bad phone calls. Too many uncomfortable associations.

2 minutes later she texted me. Please call me it’s an emergency!

I called her right away. Her boyfriend Glenn was missing. He had been since Christmas Eve.

Do you remember Glenn? I wrote a blog about him a while back. He is the boyfriend that moved in with my ex and caused a family brouhaha. With a history of drug problems, still married with a shit ton of baggage some of us were less than thrilled that they were shacking up. It blew over, like most things do. I met him on Thanksgiving. He was a nice enough guy and I accepted him, if not the situation. My only problem was that I knew, as did my ex, that it would end badly.

It ended worse than anyone could imagine.

He’s dead.

My ex saw his car at a rest stop several hours later. She found his lifeless body in the back seat curled under a blanket. We’re waiting for the autopsy results but we know it was an overdose. The only unknown was how much of what he took.

She is a hot mess right now and I feel terrible. The memory of finding his lifeless body will be burned in her brain forever. Despite all of my animosity towards her I find myself perplexed and frustrated because I want to help. There’s nothing that I, or anyone can do.

She had told him, and herself as if in an effort to convince herself, that if he used drugs while with her that she would throw him out. Several months later, when he was still there, I assumed that he was clean. I now know that he wasn’t. He relapsed several times, disappeared for a few days at a time on benders and then showed up begging for forgiveness. She caved each time. I guess that’s what you do when you love someone.

I drove two hours yesterday to see her. To comfort her. I put everything aside to give her a hug. It was the first time we had hugged, even touched each other since my father’s funeral in 2013. I told her that I would never in a million years want such a thing to befall her. Then I left and drove another 2 hours.

I checked my FB at a gas station on the way up. She had posted a meme about how her life would never be the same and added her own commentary about how no one had ever made her feel as he did and that her life was changed forever by his love and that she will never feel again about another man. As concerned as I was about her I was stung a bit by her post. I spent half of my life with this woman, nearly killed myself trying to support and love her and this is what I see? Part of me wondered if she ever loved me that much.

I quickly reminded myself that it wasn’t about me.

Still, it stings. I guess I will just pile that onto an already heaping shit pile of things that I will never understand. Again, it’s not about me.

Addiction is a powerful thing. More powerful than many, including my ex, will ever understand. Like suicide, it’s the ones around and left behind that get hurt. I take no satisfaction in the fact that I told her she would end up being hurt. Being right doesn’t matter. The damage is done. The pain is palpable. The struggle continues.

All that is left is the cleanup.