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.
Fuck you, I have skills.
Not today you didn’t.
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.
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.
For the almost 6 years that I spent sick and out of work, I missed a lot of things. One thing I missed most was working. For better or worse, my work was closely tied to my identity as well as my self-worth. I was always known as a hard worker, most of the time I was the best at what I did among my peers, and it wasn’t always about money. I actually got off on the feeling of accomplishment. My last great job before I got sick was a great opportunity for me. I got to be a part of the higher-level decisions, I made a good living and I was able to turn my role into one that actually helped people. I wish that the company never closed. I was busy as a one-armed paper hanger but I was comfortable and relaxed about my position and confident of my worth.
What I didn’t know was that in the series of unsuccessful jobs that followed, I would learn something about myself that I hadn’t realized before. I was a neurotic and paranoid knucklehead once taken out of my comfort zone.
I don’t know when it happened. I was always confident, cocky even. Then, suddenly I worried about what other people are doing, about perceived inequities, that I wasn’t getting treated fairly. I was never mean-spirited or petty, I just cared about things that previously had not occupied my mind. I suppose when my entire life was collapsing as I dealt with divorce, foreclosure, and kidney failure it naturally follows that I would be a little insecure, even paranoid. After all, when I go to a football game, I don’t think, I KNOW that they’re talking about me in the huddle.
Now that I’m healthy, relatively unconcerned about money, and too low on the totem pole at work to worry about being knocked off, I worry about the neurotic side that has emerged.
I am a Recovery Case Manager. I work with people trying to recover from addiction. There are no performance metrics other than documentation. The rest consists of managing your own caseload with empathy and efficiency. There is no competition, we all run our own affairs with adherence to general protocol and a lot of individual styles. Management is supportive and largely hands-off. And I am fucking good at it. My clients are well-served and have everything they need handled. So why do I care how many cases the woman who started after I did has? Why do I immediately assume the worst when my manager sends me a simple email telling me that they want to go over something with me? Why do I have to remind myself that by all accounts I am doing really well?
I can handle a lot, and my job gives me a lot of satisfaction. I sure don’t do it for the money. So why do I always wonder if I’m in trouble?
I hate this side of my personality. I love my job and I am really really good at it. I wish I knew where it came from so I can stick a stamp on it and send it the fuck back where it came from.
I’ve been away a while. When I get really involved in something I totally dive into it and I don’t allow time for other things. This includes Blogging. I really got into something and I just now feel that I have time to get back to putting my thoughts to paper (as it were).
The biggest change in my life of late is the confirmation that I am in good health and should be, depending on how diligent and committed I am to maintaining it, for a very long time. While this is to be rejoiced, it presents a new set of challenges. For one, my Disability Benefits are expiring and I have to return to work. I’ve known this for some time but it’s getting closer and closer to the day they cut me off. I look forward to going back to work, I’m not really a big “collecting” kinda guy. I’m excited actually because this time around I may be able to find something I want to do as opposed to a life of tolerating jobs because my family and finances required it. Fuck money, I’m never going to be rich and my overhead is a lot lower now. Satisfaction and the possibility of helping someone is the goal.
So I started interviewing.
Despite hiring a professional Resume service, with the specific request that my skillset acquired through years in the car business was presented in a more universal manner because I believe that the skills are transferable. Many hundreds of dollars and several weeks on job sites later…you guessed it. Car sales were what I was being offered. Double sigh.
Then I got a call from a recruiter who offered me an interview in a business that had always interested me, Insurance. So I interviewed. A good group of people with a lot of good products in a fairly friendly atmosphere. They offered to take me on, as a contractor. Agents are generally not salaried and benefitted employees. Again, at this point in my life, I can do something like that so I asked for the next step. I was told I couldn’t do anything until I got my State Insurance license.
Oh boy, testing. My favorite thing, with the possible exception of shaving my scrotum with a cheese grater. But I decided that an Insurance License would give me a tool for life to earn a living. There are so many possibilities. I was excited. So I signed up for the prep course.
For 3 weeks I lived, ate and breathed Life, Accident and Health Insurance and Annuities. I worked my ass off. All the while the agency checked in with me on my progress. I registered for the test on the following Monday and 2 excruciating hours later I passed with an 84. A 71 was the minimum score allowed. With one click of the mouse I received my license and producer number and I became a licensed Insurance Agent. My life was about to change.
I was born in July 1965, I weighed 8 lbs 2 oz…ok yeah maybe not that far back. Let’s go as far back as August of last year instead. It was a hot summer and, despite being increasingly sick on dialysis, I was making my best effort to maintain my side business of detailing cars. I was doing really well, making good money and, despite being weak and really struggling to keep up, doing a car a day if the weather allowed. It was a good gig, people in town like me and are happy to give me their business. It doesn’t hurt that I do a really good job I suppose. It’s not a brag, I really do professional quality work for a very reasonable rate. I have as much work as I want.
One of my customers was a gentleman that I had never met until he called me on a referral. He was an ideal customer, he gave me 3 vehicles to detail and he was a big tipper. He was also fun to talk to and that mattered to me because he was my age, friends my age are hard to come by in this podunk little town. I immediately liked him. The day I returned the 3rd vehicle he mentioned to me in passing that he had just bought the local eyesore, a vacant convenience store. Everyone in town had hoped for someone to build something there and finally someone had. He told me all about his plans. In addition to having a full convenience store, he had plans to build a pizza, sandwich, and deli section as well. His plan was to serve New Haven, CT style “Apizza” (pronounced ahpeetz), a style of pizza that no restaurant in NH, never mind our local area, was serving. Thin crust, light cheese with a charred bottom. My favorite type of pie next to Boston North End style. It was exciting to hear him talk about it. I knew right away that he would be providing a unique product that people were going to love and travel for. His history of successfully flipping properties in town spoke for itself. This guy didn’t know how to fail.
He asked me if I knew anyone with food service experience. Impulsively, and in hindsight, regrettably, I told him that I did.
He told me that we needed to talk. I was looking forward to that conversation. But as fate would have it, the next day I got the call that saved my life. I was called to the hospital to receive a Kidney Transplant.
Bill Marshall stood at the tee on the 18th Hole. Not only had he had a decent day of business that should yield a boost in sales, he had also played the round of his life for 17 holes. There is a Cardinal rule in sales regarding Golf with clients. Always let them win. Fuck that was Bill’s answer to that. Despite his recent brushes with mediocrity, Bill was a winner at heart and firmly believed that there is no honor in laying down. He was ahead by 2 strokes and if his clients wanted to win then they were going to have to earn it. He knew people and he believed that his clients were not the types to respect laying down for the cause. They were also winners, by virtue of the success of their respective businesses. He lined up his shot and swung. He sliced it into the trees. That settles that, he thought. I didn’t fake losing, I legitimately fucked up this hole. He could live with that.
As they completed the 18th, they picked up their balls and headed to the bar. He had lost by one stroke. The Universe had settled that dilemma for him. No dishonor in that.
The cocktail lounge was full of chattering golfers. They had teed off late so it was no surprise to find cocktail hour in full swing. Bill ordered a round of drinks for the group. It was only his second drink of the day. His companions were several rounds ahead of him. Bill always imbibed carefully on company outings, there was no room for gaffes and embarrassing behavior while at work.
The day had really gone well. His three guests had enjoyed themselves and the hope of many hours of uninterrupted relationship building had come to fruition. One of his guests, Drew, was a regular customer who had been invited as a reward for his loyalty. The other two, Steve and John, were prospective clients with a lot of potential business. They seemed to like Bill and he was hopeful that their liking would convert to dollars and cents. Bill Marshall was a businessman first and foremost but in his heart of hearts he genuinely liked people. In sales, they buy you as well as your product and he believed that Steve and John were buying into him. As they sipped their drinks and made small talk with the other guests a young woman selling 50/50 tickets came around. Bill called her over and asked for 100 dollars in tickets.
“Big spender”, Drew chided.
“Hey, it’s company money, right?” His owner had given him 200 in petty cash for drinks and raffle tickets, he planned to use it.
“What will you do if you win?”, Steve inquired.
“Give it to the cause, of course”, Bill replied.
“I think I speak for all of us when I say Bullshit, Bill.”
“OK, it’s not like I’m going to win anyway.” Bill knew that he would donate it. He wasn’t on his dime for starters. And the tournament was being sponsored by one of his best customers. A local dealership owner whose passion was the Boys and Girls club of Holyoke. The owner only gave Bill some of his business, there was a lot more to be had, but he wasn’t there for that. He was there to support his client and his cause.
Dinnertime arrived and the 150 or so golfers filed into the dining room. As they ate, the host, Bill’s client grabbed the microphone and made his thank you’s and announcements. The event had been very successful and he expressed his gratitude. He then announced that he would do the drawing for the 50/50. The total take was 3000 dollars and the lucky winner would take 1500. He proceeded to announce the winning ticket, which happened to be in the hand of Bill Marshall. He was floored. He stood up and went to the podium to claim his prize. His client greeted him and announced Bill’s name and his company and acknowledged that they did business together. He then handed Bill the envelope of cash, to much applause and fanfare, and started to move on to other business. But Bill Marshall was still standing there. The host asked if there was something wrong.
“Yes”, Bill replied. “I’m here on the company dime to support a charity. So why am I leaving with an envelope of cash?” With that he handed the envelope back to the host. The room erupted. He glanced over at his table and his guests were smiling at him. He walked back to his table and sat down.
“You son of a bitch, you actually followed through,” Drew said. His other guests nodded in agreement.
Bill Marshall just smiled. Doing the right thing is easy, and it doesn’t matter who is watching.
It was a 3 hour drive from the house to the location of the golf tournament. Bill Marshall was in a decent mood this morning. Relatively speaking, he was at peace. Things had been quiet at home overall. The kids were doing well and the wife has been fairly calm. He knew that the next shitstorm was close by but he still welcomed the reprieve. He had decided months ago that his marriage was a lost cause and that he was there for the kids. He suspected that she would make access to his children difficult should he try to leave and he wasn’t having any of it. His kids meant everything to him and if that meant sacrificing his own happiness then so be it. Bill was raised by an old-fashioned man. He was taught that when you have family, your happiness is secondary to the welfare of those that depend on you. In that vein, it was a no-brainer. Thus, a few quiet, albeit tense evenings of silence at home was worth the quality time with the kids. As he ran those thoughts through his head, he recognized and accepted that he already knew that he was going to leave her. The only question was when. Alone in the car, with the radio volume down, he absorbed that revelation and let out an audible “holy shit”.
Traffic was heavy but moving. He turned the radio volume down and focused on the day ahead. He was excited about the tournament. It wasn’t lost on him what a luxury it was to play Golf on the company dime. He had played Golf many times under the umbrella of work, it was an excellent and effective sales tool. It was very difficult to conduct business when visiting clients at their place of work. They are constantly interrupted by coworkers, the phone or one of many crises that always come up. On the Golf course, your only real enemy to productive business talk is the cell phone. Most of his clients have the manners and common courtesy to put the phone away. If they didn’t? Well, Bill would just have to deal with it. A bad day of golf still beats a good day at work, he mused.
Bill pulled into the Country Club parking lot at 9 AM sharp. He had 30 minutes to gather up his clients/guests and check in. He walked into the clubhouse and through the doorway he could see two of his guests at the bar, Bloody Mary’s in front of them. Bill considered himself a respectable functional alcoholic but he wasn’t ready to go down that road this early. He needed to be sharp. He waved to them as he checked in and dialed his 3rd guest. He was in the parking lot. So far so good. He walked into the cleverly named lounge “The 19th hole” and greeted his clients. They were cheerful and eager to play. It felt right, he felt on top of his game. He paid for their drinks and went out to meet his other guest.
He glanced to the sky, the morning haze was burning off. It was going to be a great day all around. Little did he know how right he was.
As they entered the Hospital Foyer, Bill made one last attempt to get his manager to leave him. He was having none of it.
The check-in process was fairly quick. It was early afternoon, the ER wasn’t busy. Being in an affluent community didn’t hurt as well. Bill’s home hospital was often flooded with drunks and victims of violent crimes. There wasn’t a lot of that in this sleepy Massachusetts town, he mused. Within 15 minutes Bill was seen by the ER physician. He was asked a bunch of questions about his health history. They did a run-up of blood work. The ER doctor was clueless regarding the episode. Bill was not surprised, no one else had ever figured out why he had these attacks either. The Doctor scribbled on his board, muttered something to his attending Nurse and went on to another patient. Bill was left to make small talk with his GM until someone came back.
To his encouragement, his manager didn’t talk about the events of the previous hours. He instead shifted gears to talking about some of the business matters that he wanted to review in the now cancelled meeting. It was a relaxed conversation and they actually accomplished something. Before long the ER Doctor poked his head in.
“Are you aware…” time stopped for Bill, he knew exactly what was coming…3,2,1 BOOM
“that you have serious kidney failure?” Bill high-fived himself mentally, just as he had called it.
“Yes, I am aware” he replied as he looked over at the furrowed brow of his boss.
“Are you being actively treated for it”? the doctor asked.
“Not as actively as I should, perhaps” Bill replied. “But here’s the thing, is it related to why I’m here?”
“Not that I know of” he replied. “I can’t identify the source of your episode.”
“Then we’re done here unless you have some suggestions.”
“See your Nephrologist. If you give me his contact information I’ll have your labs forwarded.”
He gave him what he asked for and they left.
It was a quiet car ride back to the office. Bill decided to just get it over with.
“I have Kidney Disease” he offered. “Now you know.”
“Well something has to be wrong with you, you were flopping around on the conference room floor like an epileptic Carp.”
They shared a laugh. Then Bill asked, “Does it change anything?”
“Like what, you mean your employment status?”
“No.” Bill rephrased his question. “Is this something that I should have told you when you hired me?”
His manager didn’t flinch. “That’s why we have health insurance, you dumbass. How long have you had it?”
“Since I was a teenager. It’s unpredictable in its progression. I think it’s getting worse.”
“Do you think you should have told me on the interview?”
Bill stroked his goatee, stalling.
“Yes and no. It really hasn’t affected my work that I know of. I don’t have a crystal ball so I don’t think about the what-if’s. When I met you, I wanted you to see the man for the job, not some sick guy. Does that make sense?”
His manager nodded. “So now we know,” he said. They drove the rest of the way in relative silence. They passed through the security gate and as a courtesy he was dropped off at the door. It was 4:30. Bill was thankful and he got out with the intention of going in, grabbing his bag and calling it a day. As he nodded a thank you for the ride his manager asked,
“Where does stress fit into all of this, you know, with the kidneys?”
“I don’t think it helps, I know that much. Why?”
“Because you’re wrapped tighter than a convenience store sandwich. You try to do too much. You’re the first one in, last one out. I’m not asking for that. Take it easy on yourself. You’re getting the job done.”
“Thanks, but you might as well tell water not to be wet. It’s how I’m wired.”
“No, that’s how Superman is wired. Your name is Bill, not Clark. Smarten up.” With that, he put the car in gear and drove to his reserved spot.
“What can I get you, Bill?” the bartender asked. She had startled him. Despite the fact that a drink was all that he had wanted for the last 2 hours, he had been distracted by the Sox game on the corner TV.“Good evening, Liz. What are the beer specials this evening?” God, how he hated to ask that question. The Crown Royal bottle on the top shelf was waving and calling his name but he was on a copper budget. His gold tastes would have to deal with it.
“Coors Light and Bud Light draft are $2.50 each.” She seemed to be on edge tonight, not as friendly as usual. He would know, he was as regular as Norm from Cheers.
“Bud Light, please.”
“You got it”
Within seconds, a tall mug of cold, GMO-infused, foamy piss water was in front of him accompanied by a basket of tortilla chips with Salsa. For anyone else, that’s another $2.50 but Liz always took care of him. He took a long sip of his beer and scanned the bar. He wasn’t looking for anything in particular. Maybe a new face or something to indulge in his favorite past-time, people-watching. His scan was nearly complete as he turned his gaze back to the Sox game.
As he did so he inadvertently caught the gaze of the guy sitting beneath the TV. He was careful to not stare back but instead focused on the TV. He occasionally found himself darting his glance at the man and each time his gaze was met. This annoyed him. Why does every dickwad sitting under the TV think I’m looking at them? Where the fuck else am I supposed to look? He glanced over again and the fellow looked particularly hostile. Bill was not in the mood for a confrontation, it was the very last thing he wanted after today. So, he chose to look straight ahead at the mirror behind the bottle rack. As cranky and depressed as he was when he came in, it was now worse. He was disgusted by the round face and bloodshot eyes that stared back at him.
Relax, Bill. The mirror adds 15 pounds.
Yeah, but how many mirrors am I in right now?
He decided that he had to do what he hated most, play with his phone like “one of those” people. Bill Marshall was opinionated and old-fashioned and the phone thing conflicted him. He needed it and hated it at the same time. He saw the cell phone as an Orwellian nightmare, he refused to be glued to it and he had open disdain for those who were. But in this case, drinking alone at 3:45 on a Tuesday afternoon really was no time to stand on principle. As he pulled the phone from his pocket he saw that he had missed 3 calls. 1 from his boss and 2 from home. He made a mental note to call his boss back. He chugged the remainder of his beer and motioned to Liz for another. She was there with a fresh one immediately.
“Nice hat.” Bill had forgotten that he was wearing his Red Sox Scally cap. He loved the hat and got a lot of feedback whenever he wore it.
“Thanks Liz. I like it a lot.”
“Get it at Fenway?” she asked.
“Yup, thieving bastards got me good on it.” He had, on a whim gone into the gift shop at Fenway Park, home of his beloved Red Sox while on business in Boston looking for that very hat and paid stupid money for it.
“It looks good on you. It’s a keeper.” She smiled at him, there was a sadness behind it. As she walked away she said, “My brother would love it.”
The comment seemed odd to Bill, almost forced. Less conversational and with intention. Whatever. Remembering that he had to return his boss’s call he pushed his stool back and stepped outside. He walked to the end of the concrete walkway to escape any noise from the patrons entering and leaving. Bill knew from experience that this was the best spot to call his boss and lie to him about his whereabouts and productivity that day. The nature of the call would dictate how big the lie will be. He hated this part, and it was of no comfort that he had done it a lot lately.
He was in a rut at work. His customers weren’t busy, so consequently, his portfolio was suffering. His competition was killing him and Bill was worn down by the constant “No’s” from his customers by about noon each day. Deep down he knew that he was a great salesman. But he had lost faith in his product, his managers, and most importantly, in himself. He hated going to work as much as he hated going home lately. Whenever he could knock off early he did. Without permission, of course, which is why he was dreading making the call. If asked where he was, what would he say? He wasn’t where he was supposed to be so whatever he said it will be a lie, a lousy fucking lie that he thought he was above. He took a deep breath and dialed his boss.