Detox Day Nine

I am more than halfway done my detox, thank goodness. The first week was rough, and at times I REALLY felt like quiting. It's never good when I start falling asleep during counselling sessions. I feel horrible because I actually cut one short simply because I could not keep my eyes open and I thought it would be better if we had a short session rather than me fall asleep. I don't know if it was from caffeine withdrawal, lack of gluten, or just overall exhaustion from all the yoga, but it was pretty rough. This week I started with a B12 shot at the naturopath though, so hopefully that makes a difference as well.

Looking at this week, things seem to be going pretty well. I did a good grocery shop (complete with a grocery list!) on Saturday, so that I had the food I would need for the week. On Sunday afternoon I sat down and cut up a whole bunch of vegetables so it would be easy to put them into things - I also boiled some beets so they would be ready to eat. After yoga Sunday night I cooked a big pot of lemon/chili soup with lentils, brown rice and a whole bunch of vegetables. Despite the fact that lentils are NOT my favourite food, it's actually pretty good.

In terms of yoga, I did a restorative practice on Sunday, and yesterday's flow class felt AMAZING. I really feel as though I do have more energy and that my body has gotten stronger, which I find pretty wonderful. When I did my 30 day challenge I was having to modify a lot because my ankle was still quite injured and my elbow was bothering me. This time my body seems fairly free of aches and pains. In fact, I find myself pushing myself fairly hard in yoga and not having the sore muscles the next day I might have in the past. Now this could be because I'm in better shape, or, as I suspect, it might have something to do with the difference in my eating. It will be interesting to see as I add foods back in what kind of a difference things make.

Speaking on adding foods back in, Tuesday I get to add my first food back in and I have yet to decide what it will be. Most people expect me to pick coffee as number one, but I'm not sure. While I really like coffee and I miss it, it might be good to be coffee free for a while. It's certainly cheaper and it makes life easier not having to think about fitting coffee into my life. Gluten will be nice to add back in as well, but finding gluten that doesn't contain eggs, milk etc... will make it harder. I'll add dairy back in as well, but I know you have to do that slowly or it can really upset your stomach. SO, I'm thinking the first thing I add back will be tomatoes!!! I really, really, miss tomatoes. I can't wait to have tomato sauce, tomatoes, salsa etc...

It's SUMMER (almost)

You know, it's a big stereotype that Canada is cold all year round. However, my city has certainly lived up to that this spring. It has been so, so, so cold. Snow in May! So not fair. Anyway though, today was gorgeous. It was our church picnic and it couldn't have been a more beautiful day.

The picnic was great fun. Worship and communion and barbecue and games and games and candy and friends and FUN! Unfortunately however despite my sunscreen efforts I "missed" a couple places and now have a rather wierd "stripy" burn. Not cool. I pride myself on not getting sun burns and the use of appropriate sun protection. I had to go out and by some after sun lotion to try and calm things down a bit where I am burnt.

In other news, the dreamer is doing okay. Worked at the shelter last evening; another detox shift. This one was MUCH better than the last one. I quite enjoyed myself in fact! I really like seeing the clients. I miss them. I popped into the shelter today to bring the leftovers from our church picnic and some of them were quite disappointed that I wasn't staying to work a shift (I actually got offered one, but there is NO way I could ahve worked tonight).

My sister is working on my house. She's done some odd things, but overall, progressing. Actually, right now my house looks worse then it did before. There is stuff everywhere which boggles my mind seeing as I feel like I've thrown out SO much stuff! But, she organized my kitchen today and is working on the linen closet now so I really have nothing to complain about.

And now, I'm going to get some ice cream :)

just a bit frustrated

I'm not sure where this post is going to go, so I apologize in advance if I offend anyone.  I'm tired.  I'm a bit grumpy.  And a bit pissed off.  

So, I worked at the shelter today, in the detox unit.  I haven't worked there in ages, so it was kind of nice.  

We had a client in the office tonight who was ready to discharge because I would let her break the rules.  Apparently other staff let her break this rule and she couldn't believe I wouldn't.  I tell my coworker, that with the letter already on my file, I really can't afford to break any rules and that I'm documenting this all SUPER well so that it doesn't come back and haunt me later if the client reports me.  So then, I go do some laundry, and when I come back, the staff member tells me that she explained to the client that I was in trouble over something else and couldn't risk it.  I was NOT impressed.  That's my business and the client does NOT need to know that.  Hardly professional.  

self determination

I've noticed an interesting trend since I started working at the shelter.  I suppose in reality I understood the theory of this, but I never really understood just how true it can be until I started working.  

People need to make their own decisions.  

That sounds like such a simple thing, but it is HARD when you're watching people circling the drain, so to speak.  We can encourage, provide, talk etc... but when people are ready to change, they're going to do it.  

It's like this.  We have a detox program.  Many of our regular shelter clients have gone through it time and time again.  It's easy for them to get into, and because it's in the building it's not necessarily a step out of their comfort zone.  They come in, take a break from using, sleeping in a bed and eat real food for a while and then after their ten days are up it's back to the street and the substances.  This can be a good thing, and it's an important part of harm reduction, but it can be frustrating to watch.  

The thing is though, when the clients really want to change, when they want to stop, they do.  Without any detox at all!  Yesterday one of my clients was very excited to show me that he had tremors, this showed he was in withdrawl, and he did it all on his own.  

Another example is housing.  We try very hard to encourage people to find housing, we have a special staff person who'll help them find it, we have housing resources etc...  when people want a place, they find it.  If they don't, nothing we do will help.  I think people are generally a lot more resourceful then we want to give them credit for!  

So, the lesson to be learned?  Don't beat yourself up when people won't change the way we want them to.  If it's right for them, they'll get there. 

it's almost over

Well, Christmas is over now, and my five in a row work week is almost over. That may sound pretty normal to most people, but because of the nature of my job, we almost never work more then four in a row. I can't remember the last time I worked a five actually. And of course it's just been a little crazy, being Christmas and all.

I'm tired, just plain tired, and can't wait to go to sleep. After this, I get five days off, and I'm quite excited. The drunk tank has been hoping, and due to short staff I've had to be shift manager twice (well, one is tonight, so it hasn't happened yet). Apparently, I have seniority, what that gives me is a whole ton of responsibility and almost no extra money. Oh well, there are good people working tonight.

The drunk tank has been filling up every single night as people drink their way through the holiday season. Detox is surprisingly full, I had predicted it would empty out during the holidays, but it hasn't seemed to. The shelter's been full every night too, but i certainly wouldn't call that unexpected. It sucks having to turn people away on Christmas though.

I have so many stories and have had NO time to write, with church and family stuff I've been super busy for the past two weeks. They're coming though! Really!

less then healed but definitely better

I'm finally almost better! Actually, I've gotten over whatever this was very quickly, and today I'm not even taking decongestants. As long as it doesn't settle in my chest I'm free! Considering it was just three days ago I was lying across three chairs in the emergency room crying, I've made an incredible recovery (I will give complete credit to the 2 liter bottle of ginger ail I drank).

Work yesterday was the pits though. I had a couple really great conversations with clients, but it was marred by staffing issues and the fact I felt feverish. I will be SO glad when I don't have to work the evening shift any more. We had 20+ people in detox, which is a lot. It also means a lot more laundry and a lot more dishes. We also did two intakes. Fine. Problem is, my supervisor left me basically on my own for the second half of my shift (there's supposed to be always two staff back there when we're more then 10 clients. On a day where I was healthy I could have done it no problem, but because I was feeling crappy, I just wasn't in the mood.

Mr. nice guy tried to help, which was sweet, but he was training a new staff at the front, so really couldn't. Best quote ever though. I answered the phone in detox to record a new intake from the front and he says "what's wrong with you?". Because I know him, I knew what he meant and answer "I have a flu/cold thing which is screwing up my voice", but I found his bluntness and choice of words amusing.

I'm sure today will be equally "pleasing". I'm hoping for a good partner, cause I'm sure I will be working detox again. It should be nice, as I'll get some good client time in which I always appreciate, and since it seems like everyone got their "one load of laundry while in detox" laundry done yesterday and there were only a couple scheduled discharges there shouldn't be too too much laundry!

detox , it's not like the movies!

I've spent the past six evening shifts working in our chemical withdrawal unit. Technically that's not supposed to happen, but because I'm not a permanent staff until August 10th, they can do what they want with me. And honestly, it's all good. When I worked that double on Saturday I got my adrenaline rushes and everything was good again. It's actually been pretty good spending so much time in detox because I'm able to get to know people on a much deeper level then when I rotate through there, something which I find really valuable. I actually wouldn't mind having a job that was strictly detox, just not yet. I enjoy doing intakes, I enjoy the one on one time I get to spend with people, I enjoy the relative calm. That being said, I miss out on my favourite things, which are van patrol and hanging out with the homeless. Detox clients come from all walks of life, and while some of them are homeless, most of them aren't.

I don't know how much I've written about detox, but here's the scoop. Detox is a 10 day program. It's NOT a treatment program. It's supervised chemical withdrawal. It's also not a medical unit. All clients must be medically cleared by a doctor, have all their prescriptions detailed by the doctor and bring them all with them. We keep their meds, and make sure they take them at the right time, and that no one OD's on them.

Basically, detox is a place to sleep and go to a lot of twelve step meetings (AA, CA, NA). Most clients come in and sleep for the first 3 days at least! It's not like those movies, where you see people moaning and groaning and puking over the sides of their beds. People do get nauseous, and their is pain involved, but most people aren't that dramatic. Some clients get the shakes, but other then that... and I've seen only one seizure thus far.

People are coming off everything under the sun. Well, not everything. Not heroin. We accept people on methadone, but we don't do heroin withdrawal, that's dangerous! But we do alcohol, crack, cocaine, non beverage alcohols, sniff, prescription drugs, crystal meth (although most don't make it coming of crystal meth).

My role is counselor, laundress, dishwasher, advocate, voice of reason, mediator, intake counselor, med giver outer, reassurer, information provider, referral source, and many other things. I love just getting to sit and talk with people. About whatever. Their addiction, their kids, their housing situation, their hopes, their fears, whatever... I can provide them with support and with referalls to our resources and community resources because detox is only a 10 day program.

Ideally, a person going to detox would go detox, treatment program, transition housing and support, own accomidations and own employment... of course, it doesn't work that way, but that's a post for another time.

writers block

I had an awesome night last night. I had a couple clients just really open up. It was hard to hear in some cases; hearing dealers talk about the young people, mothers, pregnant women they've sold to. But it was good. Good for them especially.

Now I'm lying here in a sunbeam having writers block. I need a sermon for Sunday. I've already picked out my scripture; way ahead of time, so I need to preach about that. Weeds among wheat. I just can't think of anything all that exciting or meaningful or new to say. Maybe I won't. Maybe I'll stick with plain and simple. I dunno... writers block.

freaky

I had a kind of freaky day at work today. I really wish we had proper debrief! It just seems sort of...expected... that we won't have issues with the stuff that happens there, and I just don't get that. However, with some of the newer staff, I'm feeling able to form a bond so that maybe some of that debrief can take place, just informally, amongst ourselves. Because, maybe it takes place informally amongst the others, and I just don't fit in yet.

Anyway, not long before shift change one of my detox clients had a really bad seizure. At first I didn't know what was going on, I thought she was just joking around. She started gasping for air and stiffening and falling over. One of the other clients caught her. Mr. nice guy and I ran over to her and the three of us lowered her to the ground where she continued to seize. She started vomit a little, so we quickly got her on her side. Not a long seizure, but then a long period of unconsciousness with no rousability and odd twitches/eye movements. As she started coming out of it, Mr. nice guy left to check on the status of the ambulance and I stayed with her.

The client started coming around, but was behaving oddly. After getting no verbal response, I took her hands and asked her to squeeze them. The client squeezed, but instead of just squeezing she kept trying to put them in her mouth, and she was STRONG. I called for Mr. nice guy and he helped me wrestle myself away from her. Anyway, first response took a looooong time to get there, and my client was freakishly altered. No sense of where she was, how she got there, and asking very strange questions. Her voice was different and so were her mannerisms. Firefighters arrived, and did all her vitals and stuff, and then we waited, and waited, and waited for the paramedics. A consious female, even a very altered one, just doesn't take priority.

My client was SO altered though. And just odd. Every time a guy walked near us, she FREAKED out. She grabbed me really hard one time and freaked me out too. And she was freaking out all the other clients, because they wanted reassurance she was okay, and she didn't know who they were. She told me that the one man "had beat everyone up" (nope) and another had been kicking her purse (nope). She still didn't know where she lived, or where she was or anything like that. Strong denial about having a seizure.

Finally paramedics came and she was able to walk out with them. She wanted me to go the hospital with her, and I was quite sad that I couldn't. It's hard when you're with someone through something like that, and even though they have no clue who you are, they realize that you're someone safe and then you have to leave them. She'll be okay though. The paramedics were nice, and she's a white well groomed female.

But yeah, after that, shift change was over and it was time to go home. I thanked mr. nice guy for saving me from being eaten, but that was it, he didn't seem to want to talk, and one of my favourite staff just said, yeah, people have a post seizure period of alterdness. But, it freaked me out! I'm okay now, but yeah, it would have been really nice for someone to acknowledge that it had been a bit traumatic for me! Maybe I need to speak up more. Or maybe everyone at work is just so used to it now they don't even thinking about it. I mean, I've seen a few seizures already and I've only been there 3 months.

it's a brutal cycle

I'm having a hard time empathizing with people who come into detox who really aren't interested in breaking the cycle of addiction. I mean I get it, and I don't. Of course, the first question you're probably asking while reading this is "well why are they in detox if they don't want to get clean?" That at least, I can explain.

At work we definitely work towards harm reduction. And I'm all for that. I really am, and that's the thing with detox; harm reduction. We encourage some of our regulars (or any/all of them) to come into detox to give their bodies a 10 day break for the realities of their addictions and street life. The get a bed to sleep in, nutrious food, milk and their meds on time each day. At any given time we have a couple of our regulars in their doing this. And some of them do move on to periods of sobriety. I haven't been there long enough to know if we've ever seen anyone do a complete one eighty and wide up a working individual with an apartment, phone, and cable.

Now a lot of our regulars are older, and have been doing this for a long time. Many of them have brains which either started out damaged (FASD, PDD, etc...) or have been damaged through use of drugs, alcohol and solvents. Drinking hairspray has long lasting consequences! I have a fairly easy time empathizing with them. Whatever their initial reasons for winding up on the street were, they've lived a hard life, and I really feel for them. I feel like we need to protect them.

But then, we have some younger people, people my age and a little bit older. People with SO much potential. Their brains haven't yet been destroyed, they're literate and able to function (in some cases at least), but they have no desire to stop the drugs and get off the streets. That, I have a hard time with. I just don't get it. How can you WANT to live on a mat, on the floor, sniff solvents, and wind up passed out in random places. One guy came in because he badly hurt himself while high/drunk/out of it, and was in danger of losing his leg from an infection. Once his leg was better, off he went. Harm reduction though. He's pretty sure he's going to stop injecting things and stick with sniffing and drinking.

Thinking about it in terms of the stages of changes helps. This guy is in precontemplation, and that's okay. People go through precontemplation before they go through other stages. It's the way it works. And there are things we can use with precontemplation. I've been using a lot of motivational interviewing in cases like this, latching onto people's ambivilence, reflecting back the bad things about use (but not neglecting the good things), providing information, and having an unwavering belief that the person can change (which reminds me, I should post about that). It's the empathy I have a hard time with. And I'm not sure it's going to get any easier...

It's a small world

Blogger is being stupid and not letting me add a picture. Either that, or it's firefox. It could definitely be firefox, I've been having problems with it all day. In any case, here is a completely new ethical concern I never even thought about until it happened.

I recently did an intake for someone I knew. Only, I didn't realize I knew them till partway through the intake. How is this possible you say? I only knew them through an internet message board and msn. I'd seen pictures, but it was quarter to midnight and dark in the shelter where I went and got her to bring her to the intake room. So the thing is, I'm pretty open on this website, and so was she, and so we both know lots of deep, deep stuff about each other never expecting that we'd meet... and we met. awkward much?

And I was a bit unprofessional... sigh. Things we think of in retrospect. I recognized her and she didn't recognize me. It was late, she was very nervous, etc... And so I told her I knew her and where from, I was hoping it would help her nervousness, to know someone, you know? I totally shouldn't have done that... just kept it anonymous.

I reassured her that anything I knew about her from our past relationship I would keep out of our professional contact. My intake doesn't reflect anything she didn't say... I hope. Sometimes it's hard to keep those things out... I'll try and pass off her file each time I'm in detox. Maybe I should have passed off her intake once I realized it too, but I was the only one back there (nights), and it felt okay at the time. It's not like we were all that close on the internet, we hadn't talked at all in probably over a year. More like just a mutual message board knowledge of each other.

But, it also makes me feel kind of vulnerable. Because she knows tons of stuff about me that I would NOT want getting to the staff at work. I've barred my soul on that website. Not recently, but in the past.

The internet really changes things. It changes the way we think of friends, the way we think of relationships. It changes the way I think of conflict of interest situations. It also makes stop and think, and realize that I need to narrow this down for myself. My city's big, but not that big, when does my knowing someone become a conflict of interest? I've had the file of someone I played with when I was 6 and 7 at my dad's drop in center... That didn't seem like a conflict of interest to me, and I don't think it was, but this?

These are times when I regret taking a job that's not explicitly a social work job. No social work supervision. And really, the supervision sucks. Not enough debrief, not enough feedback, not enough time to talk ethics... and honestly, ethics just doesn't seem to be on the mind of most of these people. alas.

the benifits of boundaries

I recently had a client come into detox who I really liked. I like most of my clients, but this client was different, I could totally have been friends with her if we'd met in a different context. We're close in age, live very near each other, frequent the same places, are in similar income brackets, similar levels of education etc...

It was an interesting experience, because I got to see how beneficial good professional boundaries are. On a slow night in detox I sat down at a table with a few clients making beaded jewelry to try and talk to them in a non threatening context. The others cleared out and the client and I wound up having a really great talk. It started on the outer level and we were probably contributing about equally to the conversation. Suddenly it occurred to me; "shut up, it's about her". Best advice I could give myself. After I started really listening, reflecting, and asking some open ended questions the conversation began to move from the outer level to an inner level and we were able to talk about some deeper stuff. In fact, she came and found me in the office to talk more later, bringing up some other personal stuff. It was a really great reminder of paying attention to context and really listening.

It also made me think about my job. I spend a lot of time doing laundry, cleaning IPDA cells, and driving people around, oh, and I wash I lot of dishes. Further, a lot of my clients are pretty much permanent residents of the shelter and have no current desire to change. I have skills to help people make changes. I took a whole bunch of counseling classes as part of my BSW and while I use my "attending behaviours" all the time, I rarely get to use much theory working in the environment I do (I mean, theory is part of everything, but not). I like what I do. I like that I'm comfortable there. I just know that I could do so much more. Maybe that's a bad way to look at it though. Maybe I just need to figure out a way to use my gifts and skills with this population I so much want to work with. Thoughts for a day when I've had more sleep...

detoxing from what? and/or what doctors should talk to their patients

We run a "non medical" chemical detox unit. This means we don't have any medical professionals on staff. Before a clients comes in to detox they have to get medically cleared by a physician (or nurse practitioner) and have their medications listed on their medical clearance form. When they come to book their intake appointment they have to have all the meds on the form and enough to last them 10 days.

I am continually amazed at how many medications my detoxing clients are on. And yet really, it makes sense. Long term substance use creates medical problems. These require medication. Psychiatric problems and substance use goes hand in hand, these require medications. And many nice doctors will prescribe a benzodiazapine to help with the detox process. Again, pretty normal. But it still surprises me.

What makes me mad however is the number of clients who have no idea what they're taking or why their taking it. We dispense client medication as per their prescriptions, and I can never get over how many clients are clueless about their meds. Many of them only take their meds on a regular basis when they're in detox, but still, it bothers me (and reminds me of another subject which is the starting and stopping of psych meds).

A couple days ago a young woman and her mother came in to get the girl into detox. She had a prescription (not yet filled) for olanzipine. Olanzipine is a fairly heavy duty antipsychotic. From what I know and have observed, it's generally not prescribed first...especially when the patient is not psychotic. But whatever, I'm not a doctor and have no medical training. What bugged me, is that this girl and her mom had NO idea what the medication was. None at all. Her mom thought it "might be like valium". And that was it. I can't imagine going to the doctor, getting a prescription and then taking a medication without knowing what it was supposed to do! And with all the potential side effect of olanzipine, starting it while detoxing has got to be hard. The two asked me if I knew what it was, and i started to explain, but realized I shouldn't be explaining this, I'm not a doctor, I'm not a pharmacist, they need to be talking to someone who knows.

Bah. I have so many clients like that. We have this program where I live called "It's safe to ask", which is supposed to encourage doctors and patients to talk to each other; in particular about medications. I guess it didn't work in this case!

ps. just cause someone uses crack doesn't mean they're psychotic when they're not on it!

sober v drunk

Sobriety is an interesting thing. So is intoxication. As is the difference between the two of them. I find it especially interesting the different decisions people make when they're sober vs when they're intoxicated and how this is different for different people.

At work, we have rules about sobriety and detox. Basically, you have to be sober for every step of the process but it doesn't matter if you're intox in between. You pick up your medical form while sober. You bring it back and book an appointment while sober. You go to your intake appointment sober. Plain and simple. Some people are so caught up in their addictions that this is very hard for them.

The reasoning behind it, is of course that you can't make rational potentially life altering decisions while you're intoxicated, which makes sense. On the other hand, some of the people I work with really aren't ever fully sober until they've been in detox a couple days. It takes a long time to dry them out of the almost constant supply of alcohol and solvents. I had a woman in IPDA once for eight hours, and she said it was the most sober she'd been in 3 years. I'm fairly sure she was heading home to drink.

Another interesting thing, is that some people only want detox when they're drunk. When they're drunk they're saying "give me a form, give me a form", which we don't, but once they're sober they're like "oh no, forget it".

Really, what is intoxication anyway. Is it a blood alcohol level of .08? Or is it different. Is the client who is partially intoxication all the time really intoxicated? Or is that just who they are. Or is that a very cynical way of looking at the world. One of our regulars, who I really don't think I've ever seen sober, was supposed to be heading into detox tonight (he's more excited about the free meals then detox at this point though I think). I'm very interesting to see if he sticks it out and what he'll be like in a few days if he does. I'm sure he's been there many times, but I've never seen it, and I'm interested to.

I'm too sleepy to be blogging, I bet this doesn't make much sense at all... sometimes I just need to write though.

random

It's 2AM and I'm not sleepy, but I couldn't think of anything to blog about. So I google image searched the word "random" and decided I would blog about something on the first page. So here goes.

This is actually a very cute story. Part of doing a detox intake includes searching the client's possessions (and person, if we think it's necessary). This means that I get to put on blue nitrile gloves and dig through client's stuff sort of like I work in airport security! To make it less awkward I try to do it while they are filing out a form or something, so they're not just sitting there staring at me. And I always ask the "is there anything I should know about" question. We don't have a lot of IV drug users, but I really don't want to come across a dirty needle!

In anycase, as I was searching this particular males stuff I came across a stuff animal. He said oh, that's my lucky lion (or something, I can't actually remember what it was). He bought it from a friend in preparation for detox, because the last time he had a successful treatment program and stayed sober for quite a while he had a lucky stuffed animal. Okay, that's kind of cool, whatever. As I keep searching, I pull out a far more raged animal. Turns out, it's the first one. He still has it. It's gone with him through tons of ups and downs, crack binges, oxycontin highs, moving, evictions etc... and it looks like it got the worst of it. But it's still there, and coming with him to detox once again.

I thought it was really cool, that this man could carry those with him. I mean, this is no "wuss". He's tattooed, done his time, and used just about every drug in every kind of way. Sort of makes you realize how we're all the same, and how we all have a human side.

NOT

I am NOT a maid.
I am NOT a servant.
I am NOT a gopher.
I am NOT a dishwasher.
I am NOT a stair master.

I am however, a university educated social worker with experience in the fields of addictions, mental health, domestic violence and homelessness.


Unfortunately, that stuff doesn't matter at work. None of it. I mean, I kind of knew what I was getting into, but kind of not.

I did 8 loads of laundry tonight. The laundry is in the basement. I washed dishes, dishes and more dishes. I filled buckets with clean water, I emptied buckets of dirty water. I folded those 8 loads of laundry. I bought junk food from the vending machine for people in the shelter who aren't allowed to go to the vending machine in detox (just this once, i said, trying to get on their good side). I opened client's lockers. I gave client's towels, pajamas, soap etc... I woke people up for group, I counted heads, I made notes. Did I have time to actually TALK to anyone?

I did 1 intake. I managed to spend 30 uninterpreted minutes with my intake. It was awesome. That stuff, is why I'm a social worker, and that stuff is why I have my job. The poor guy was scared out of his mind. From a small town, first time doing this, he's worried his addiction is going to kill him. To get to detox, you have to come in through the shelter. It's a pretty freaky place if you've never been in a shelter before. He was very intimidated. Talking to him, reassuring him, listening to him. That stuff is the good stuff.

Unfortunately, in this work environment, we don't have people to do all the crappy stuff for us. Which is good, in a way, it eliminates hierarchy to an extent. But really, if only I could have spent all the time I spent on the laundry with the people in detox.

panic attacks

One of the things I'm really nervous about is that someone is going to have a seizure in detox when I'm there by myself. This is actually quite likely to happen, and I'm sure I'll learn to deal with it soon enough. I thought it happened today, but thankfully, I wasn't dealing with a seizure, just a panic attack.

I got called into the dorm by a client yelling for "staff". Being me, I of course left my radio in the office. I found the client lying on the ground with a couple people around him. I asked what happened, no one knew, the person just collapsed. Asked a couple questions though and ascertained it was a panic attack. I helped the person calm down and take deep breaths before getting them to come to the office with me to talk things out further.

Panic attacks are freaky, I know, I've had a couple although not for quite a long time. I'm not sure how long in fact, 2 years maybe? Maybe more like a year and a half. Either way though, I've never had them as bad as this poor person. They were quite shaken. Most people who come through detox sleep A LOT and they hadn't slept in two days. Plus, they had restarted all their meds after a binge. I can only begin to imagine what that must do to your body. Binging, quiting meds, and then detoxing and starting them again. Wow.

It's interesting how many things run through your head when a crisis is happening. All sorts of thoughts, ideas, issues, things you should be doing. And yet, at least for me, I manage to keep everything in check and still concentrate on the situation... I don't know. I like crisis, but there's too much documentation involved :P

sick? i'm not sick. whose sick?

Tonight was a busy night, I didn't have time to think really, and yet at times there were lulls. I had a good chat with a co worker, talked to some clients, and handed out meds...

When working in detox, one person is in charge of laundry, the other is in charge of meds. I was in charge of meds tonight. It's a really... annoying... job in some ways. Our shift coordinator and I talked about the fact that people are "detoxing" but they're on tons and tons of meds! And when I say meds, I mean meds for everything under the sun, plus lots and lots of psych meds and painkillers. Most of the people in there are on at least one benzodiazapine and at least one anti depressant. A lot are on anti psychotics too.

I'm definitely feeling more comfortable in my job, but tonight I made at least one med error. And I'm really not pleased about it. A guy is on an anti psychotic at supper and bedtime and I totally missed the supper one. Knowing what I know, the dose could probably have been consolidated, but you really can't do that. I'm not a doctor or a pharmacist. I had noted that on my sheet and yet I was busy with a guy having a panic attack and then stuff just kept happening. I feel horrible and stupid, and I had to fill out an incident report. Missing the one med won't have a huge affect on the man, it is something that accumulates in your system somewhat, so he should be fine, but still... I am going to have to be even more careful from now on. And I'm sure I will improve as well and get better at catching things like that!

Really, I can do this laundry

Tonight was my first evening shift, and my first time working in our "Chemical Detoxification Unit" (Detox). It was...interesting, to say the least. The work itself is easy and fairly self explanatory complete with it's multiple redundant sets of paper. The staff I worked with tonight though...not sure I really quite fit in with them...

Detox is a fairly basis service. We're none medical detox, which means we don't have any medical professionals on staff and anyone who needs medical supervision has to detox at the hospital, not with us. We do accept people with a wide variety of disorders and on a wide variety of meds though.

Clients make appointments for intakes through our front desk. We usually do four a day (based on the number of beds available and expected discharges). The clients much be medically cleared and have all their current medications with them, in the correct bottles and on their medical clearance forms. Clients usually enter within 24 hours of their inquiry, space and forms permitting. If there's something wonky with their meds, we can't let them in. Clients fill out and intake form which gets brought to their intake interview.

As a crisis worker I get to do intakes. We have a form to fill out (as I said, the job is very self explanatory), and then we take their vital signs, search their stuff and go over the rules. The person I was with tonight did what I would consider to be a bare bones intake. I mean, it was pretty basic and if I was the client I would not have felt heard or understood. But, each staff has their own style. The other staff I was with tonight did a really long intake; I wasn't in with her though, so I can't judge the clients feelings. We get the final decision, based on this interview, about whether the client gets to come in our not.

The detox area is made up of three dormitories. There are 15 mens beds (all in one room), 6 women's beds and 4 "assessment" beds. These beds can be used as extra women's beds (or extra mens) or for people with special needs of some sort. My orientation day they were using that room for a couple people with seizure disorders so they could keep an eye on them. The clients have to attend to groups a day, one is a group run by the transition team and one is either AA/CA/NA (I think there's a couple days when there's two 12 step meetings...I'm not sure). Other than that though, their time is theirs. There's a couple computers, a TV, and tons of board games, and a lot of people sleep, especially at the beginning.

Each crisis worker gets half the files and is responsible to check in with those clients. We don't need to do much, just make sure they're doing okay and see if there's any pressing concerns. One cw is in charge of meds and gets the keys to the med cabinet, they're held responsible if anythings missing at the end of shift. (The shift coordinators have to count all narcotics and mood altering drugs at the end/beginning of each shift). The other cw does laundry; fun, fun...

The best thing perhaps, is that they drive you home at the end of the evening shift because it doesn't end till 12 or should I say 2400 hours. That was REALLY nice at the end of the day!