Tuesday, January 25, 2005


It's 11:30pm and I'm exhausted. Mary is in that sweet state between waking and sleeping, and the dogs are on their way to that canine dream-land which we can only imagine. I will join them soon, but my brain is still spinning from the day.

The nature of my work can lend itself to mental, physical, and emotional exhaustion, with current loads of 80-90 patients each, my current roster numbering 83 individuals.

Imagine for a moment that you are a 60-year-old Puerto Rican woman with HIV, diabetes, hypothyroidism, major depression with psychotic features, and asthma. You speak no English and have a 2nd-grade education. Your family members also speak no English. How would you navigate the healthcare system? Or imagine you are a 35-year-old Latina woman with advanced AIDS, Hepatitis C, asthma, a seizure disorder, a history of trauma and physical abuse by your mother who burned your skin with hot oil and water for fun, and this caused you to pursue a life of self-medication with street drugs? How would you manage to take care of yourself and your children? How would you stay clean and do the right thing? How would you stay focused on your health when your history of trauma effects your every waking moment and decision?

These are just snippets to allow you to see the complexity and tragedy of some of the lives of which I am priviledged to be a part, welcomed into homes, confided in, and relied upon. I say it is a priviledge because it actually is an honor to be embraced by these individuals and their families. Yes, we see our share of death, of failure, of self-destruction and chaos, yet we see enough success and self-preserving valor in the face of grim odds that we feel it is worth our time and effort (and at times our mental health, frankly) to work in this community.

Tomorrow I go to visit a white gentleman in his late forties who is an alcoholic. I recently facilitated his admission to the hospital for alcoholic hepatitis. He came to see me and his liver was in such acute distress that his eyes were as yellow as a flourescent highlighter marker, his face a cadaverous pale yellow, and his ankles filled with fluid, almost the size of his thighs. After a 9-day stay in the hospital, delirium tremens (DTs) from alcohol withdrawal, and a general "tune-up", he is now back at home, hanging out at a local bar and drinking again. In his condition, drinking alcohol is like pouring gasoline on a fire. I don't know his whole history, but I imagine it's rife with abuse, abandonment, or worse. How do I convince him to stop drinking? How do I help him to see that he is slowly committing suicide? I guess I will do my best, and then rent "Leaving Las Vegas" and be reminded that some people will choose to self-destruct no matter what kindness is bestowed upon them. My meeting with him tomorrow may lead to little or no change, but I will remind him once again that help is their for the asking, and I will meet him half-way if he reaches out for it.

Consider this quote from Cracked, a book about addiction by Dr. Drew Pinsky: “We define ourselves by the way we relate to other people. We get deep, lasting, and meaningful satisfaction from giving selflessly to, and being present with, others. My patients can’t do that. They’re struggling with the effects of trauma suffered early in life when they were still developing the brain mechanisms that allow them to relate to other people and the world in general. Unable to trust, they grow up without a sense of self. They’re overwhelmed by feelings, unable to cope, always out of control. Their brains tell them to manage pain by getting loaded. Then, when they find their way to us, we ask them to go back and experience that powerlessness, the very thing that sent them off the rails in the first place. No wonder they resist.”

There are so many stories, so many struggles, countless people out there who deserve more, who deserve better, who have been dealt a bad hand either through genetics, poor choices, mental illness, or plain bad luck. If we think we can save them, we're wrong, and sometimes in our earnest efforts to effect change in the lives of those whom we seek to help, we lose sight of our own self-care. Thus, here I sit, just short of midnight on a Tuesday evening, pouring my heart out on this keyboard, with the realization that I will get up tomorrow and do it again. I don't write this out of a need for congratulations, praise, or moral kudos, I write it to share that this reality, this daily vision of the underbelly of urban America, greets my eyes each day and informs my own personal version of reality. I share it here as an exercise, an exorcism, a description, a way to loosen the hold of that troubling reality on my psyche as I prepare for the sweet forgetfulness of sleep which sometimes seems too brief.

Good night.
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