Monday, October 24, 2005


Two of my patients who've been clean for many months are now using crack again. In times of stress, many of us turn to food, TV, slothfulness, and other addictions. In some lives, the lure of a cheap and fleeting high is too much to bear.

Last Friday, I called a patient that I haven't seen for a while and told her she'd been on my mind and I wanted to pay her a visit. She said that she'd been thinking of me at the moment that her phone rang and was not surprised to hear my voice. An hour later, I was at her apartment. After the usual pleasantries and inquiries about her health, I could tell that she had something to say but was having trouble forming the words. Due to her hesitancy and the way she looked at the floor and avoided my eyes, I knew that she had "picked up" again. I moved from the couch across the room, sat down next to her on the other couch, and put my arm around her shoulders. "Digame", I said. "Tell me". She admitted to using crack and I quickly assuaged her fear of judgement and reassured her that these things happen and we would work with her to find a way through to the other side. Her shame was a palpable presence in the room.

After giving her a flu shot and several hugs and words of encrouagement, I took my leave and moved on to other people, other places. Today I received a call that her heat wasn't working but she reassured me quickly that her bill was paid in full and it was just the fault of the landlord, not her drug use. But it's a sign that things are not as they should be. Again.

Addiction coils around the reptilian brain like a slithering blight, blocking out the light of reason. Ah, the failings and treachery of the human heart and mind.


daozenfox said...

Hey, the metaphors are getting a little thick my friend. Addiction may have a bit to do with the reptile brain, but nothing to do with the "failings and treachery of the heart and mind". Addicts in recovery are sick people getting better - not bad people becoming good. I have seen people in recovery relapse after decadeds of "clean-time". The basic tenet of any 12 step program is based on the idea that the addict has only a "daily reprieve" and take his/her life one day at a time. One has to get to the turning point of realizing the unmanagebility of living one's life as a drugged animal and must be shown that recovery is possible, most logically by others who have arrested their addiction. The addict must be taught that seeking oblivion is no longer the solution to their day to day problems, something that self-knowledge or willpower can overcome alone. Most addicts or alcoholics attend several meetings a week primarily because "Its the only thing that's worked!". As empathetic as folks in the health care and psychiactric industries may be, the "system" and the "client/patient" relationship will never achieve the success of one addict helping another. Good luck in the ongoing quest though, but refrain from reducing the patients to cattle with moral platitudes.

daozenfox said...

....typo- meant to say " something that self-knowledge or willpower CAN'T overcome alone. " Its okay to get pissed at the disease...I usta get pissed at people who can have just one beer. luv GXF

Anonymous said...

"Addiction coils around the reptilian brain like a slithering blight, blocking out the light of reason. Ah, the failings and treachery of the human heart and mind."

I would differ on this point, though the first part of this entry is well said. If an individual is experiencing an it truly a failing or an opportunity to learn, grow, and change? As a former addict, I would venture to say that my former addictions made me the person I am today, and I'm certainly no failure, and trust my heart implicitly.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Wow. I am very chastened and somewhat ashamed that my words are seen as platitudes and that it seems that I view my patients as cattle. I thought I was being very human by describing how I dealt with my patient on the human level in terms of non-judgement. I guess that didn't come across clearly enough. I in no way intended to communicate that addicts are failures, simply that the heart and mind are treacherous themselves.

This is food for thought and quite a lesson. It also shows me that I should be more careful when choosing to "wax poetic" about something so difficult and fraught with meaning for so many people.

It seems it would have been better for me to leave well enough alone and remove the final statement which mixed too many metaphors and was attempting to be eloquent but actually belied some feelings about addiction that I should examine more deeply. Flowery writing is often lazy writing.

I am embarrassed to be chastened so harshly, but I choose to learn from this experience and move on.

Thanks for your honesty, no matter how much it stings.

Anonymous said...

Keith~my words were not meant as chastisement, but merely to provide a different viewpoint on the topic. Don't buckle under perceived pressure to "change" your the reason I read your blog is for your insight and poetry. Your blog is one of the highlights of my morning because of your special ability to slice through the external and delve into the internal. That and the work that you do lends itself to your unique views.

[sings]Don't go changin' to try and please us...

thank you. thank you very much...

daozenfox said...

"We're all God's children, but there are sure a lotta sheep out there..."
They say only about 1 in 34 addicts/alcoholics maintain their sobriety thru the rest of their lives. The "wiring"(and brain chemistry) of the addict/alcoholic wether genetically predisposed or altered thru the progressive abuse is distinctly different from "normal" people. I have heard people complain about friends or relatives who are clinically depressed or manic-depressive saying "I'm so tired of so-and-so and all the excuses! Why can't they just be happy...Jeez, she can burst into tears over a broken shoelace!" You'll never know what its like unless you've been there. Although there are meds for mental illness - there are none for addiction. I have seen people lose many years of their lives being "clients" of the state in methadone programs.
You may have not judged your patient to her face - yet you judged her in mind by the very entry you present for us to read. I can only suggest you physically introduce her to another woman who is maintaining her recovery. Relapse is not a requirement for pursuing clean time. These things don't just happen.
Keith, I really enjoy your work here and I certainly believe your service to humankind is inspirational. Your self-examination and capacity for love and compassion is tempered with a self-deprcating tone that smacks of nobility. This can be dangerous. In closing, I apologize for my own psychosis by saying "get down off the cross- we need the wood...." GXF

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

This is why I love blogging. I can wear my heart on my sleeve, post my thoughts when they're raw and new and relatively unedited, and then receive almost instant feedback. It's like having people inside my head!

While I felt that GXF's comment about "patients as cattle" was stinging, the sting was only enough to cause some deep self-reflection and examinatiomn of beliefs. (For those of you not in the know, I have known GXF longer than any other person outside of my family--he is my oldest friend).

Regarding this patient, she is in touch with a number of people in varying stages of recovery, and I'll encourage her to go to the drop-in centers where she can talk and reflect with others.

As someone who struggles with major depression and takes medication for that disease, I acknowledge how there is no "magic bullet/pharmaceutical" for addiction, although evidence suggests, as GXF expounds, that the brain chemistry of addicted individuals is indeed different than others'.

In my work with addicts, I do try to carefully refrain from judgement---as I tried to do in my actions towards said patient---but it is also necessary to reflect on what is happening "behind my eyes". I, too, forget the disease model of addiction and sometimes need reminders.

A recent sobering reminder was embodied in a visit to the area beside some railroad tracks where my good friend's son died of a heroin overdose last year. One year ago, we prayed over his body in the back room of the funeral home (I'm professionally connected with the director) and I realized that the body lying there on that silver gurney is everyone's son, everyone's daughter, father or mother.

In the end, there's always room for more compassion.

Anonymous said...

okay, now i am in tears! you guys are so deep and honest and i love the vulnerability, support, wisdom and radical honesty i am witnessing here.