Hullaballoooooo!!!!

The other day at work I had a crazy day. It started out kind of bad because I didn't sleep well the night before and I woke up early and it was cold and dark and I didn't feel very upbeat. I drove to work and sat through report with a coffee in my hand. I didn't finish my coffee until 3 in the afternoon, which is probably why things went the way they did. We were short staffed: the social worker was sick and I had a student to help me with things, but otherwise I was on my own.
There are many different types of people who come through detox, but if I was to divide them into the two most general categories, it would be alcoholics and opiate users. Alcoholics of course can be anyone from any walk of life and there is no real typical example. Opiate users, however, are usually working through quite a bit of pain. Physical pain issues underlying their addiction are often things like car accidents or work accidents that left them with excrutiating back pain or chronic migraines, so they started with prescription painkillers and things spiralled down from there. Emotional pain issues are often childhood sexual or physical abuse, loss of close loved ones, bad marriages, etc.
Whatever the cause, when you remove a painkiller from someone, their pain surfaces at an even greater level than before. As a very general rule, people withdrawing from opiates (heroin, morphine, etc.) are in a LOT of pain; thus they complain a lot and are very needy. Coupled with the fact that many of them have subsequently ended up in pretty crummy life situations, many of them have very poor coping skills and very difficult behaviors. Not to mention a high rate of mental illness (depression, bipolar, multiple suicide attempts, OCD, etc.)
A busy day in detox would be 5-6 alcoholics and 2-3 opiate users. I say this all to explain why my day was so busy: when I got to work I had 9 patients; 8 of whom were opiate users.
Some of them were very sick. One young woman named Karen (not her real name) was scheduled to leave that morning. She had made plans with a young guy named Mark to go to his home for a couple of days before heading to a treatment center. Staff tried in vain to dissuade them. She had complex issues that we weren't really able to tell Mark about because of confidentiality. She had multiple suicide attempts and was drinking everything from listerine to glue to methadone and anything in between. Mark was a gentle-hearteded guy and the alternative of her going to a women's shelter for two days roused his protective instincts. The morning was spent on the phone with her parents and his mom and trying to convince him to leave without her. Mark finally confessed that he felt trapped; although he wanted to help her, he didn't really want to take her home with him, but when he tried to tell her she couldn't, she sobbed and cried that she had nowhere to go and wanted to kill herself.
Meanwhile an older man, Jason, had taken his medication for hepatitis and was growing weaker by the minute. I wondered if he had a drug reaction going on. Another lady, Beatrice, was sitting on the floor in the hallway crying and swearing.
The fire alarm went off. My manager came bursting out of the office yelling for me to get everybody out and evacuate. She called 911. I grabbed the census sheet and rounded up all my patients out the door and into the parking lot. It was freezing. We huddled together in the cold waiting for the firetruck to arrive. Jason had a blanket wrapped around himself and he curled up in the dirt, covering his head. Some of the girls were crying. I didn't have a coat and I stamped my feet to keep warm and told them it wouldn't take too long, everything was going to be okay.
The main boiler had exploded and it didn't take the firefighters long to check it out and let us back in the building. But there was no heat now, and no hot water. Me and the student helped Jason up from the dirt and I began filling hot water bottles and getting extra blankets for everyone.
Mark's mom arrived to pick him up and we quickly pulled her into the nursing station and explained what was going on. Karen was such a basketcase that we felt the easiest solution for Mark was to sneak out quietly and we'd deal with Karen after he left. The student distracted Karen; my manager got Mark ready to leave.
Beatrice was still crying. Her room was near the nursing station and she was huddled on the floor under a blanket with an electric heater under it. Her roomate was distressed. "She's going to light the place on fire!"
"Beatrice?" I tried to coax her out from her tent. She jumped out, knocking a glass of orange juice to the floor. She began to cry, sitting down in the juice with her blanket.
"I feel so awful! I'm spilling everything!"
"It's okay." I reassured her. "I'll clean it up. Why don't you go have a cigarette, and then I'll give you something for the pain?"
I hate to recommend smoking, but for people in that much distress it went a long way to calm jangled nerves.
She got up and went out the room. Her roomate, lying on the bed, told me:
"Beatrice asked me for some money because she wanted to get a friend to smuggle some dilaudid in here for her. I don't even know what dilaudid is."
And so my day went. Karen yelled and cried for 3 hours before leaving. We phoned ahead to the women's shelter and asked them to put her on suicide alert. The crowing glory was just after dinner, I heard someone shout my name, and I raced out of the nursing station to find the night attendent holding Jason against the wall. He was white as a sheet and tried to throw an arm around my neck as he slipped to the floor. He was a big guy, about 250 lbs, and I ducked out of his grasp and instead pushed him against the wall as I helped him collapse slowly. Then I got my stethoscope and listen to his falling blood pressure, managed to get him into a wheelchair and then into bed, and then called 911.
The detox center is not an acute medical facility, so anyone that turns critical we have to send to emergency. The paramedics came and put him in a stretcher and whisked him away. As I was trying to finish my charting, Beatrice came in crying and saying that the night attendant had been rude to her in front of the otehr patients and she wanted to make a complaint.
I went home feeling a little stressed. Sometimes people say, "Oh, I could never do a job like that!" My answer is that I couldn't either, if I had to do it full-time. I'm sure I would burn out. Some days are laid-back and easy-going, others are just one giant hullaballoo.