| So I answered the phone and the details were tough | | | | Due to the woman’s ongoing crying, hyperactivity, |
| to hear. Yes, one of those cases that requires a | | | | and physical distress, this was no doubt a tough |
| gut-check before making the scene. Seems a woman, | | | | assessment. And making it all the more difficult was |
| seven-months pregnant no less, was about to inject | | | | the medical staff’s comings and goings as they |
| her daily heroin fix when her fiancé intervened and | | | | conducted a variety of procedures. I mean, I had to |
| called the police. Out they came to the house, arrested | | | | stay focused and on course, making sure I got the |
| the woman, and stopped by the E.R. for a medical | | | | answers I needed. And it was important that I went |
| assessment before taking her in for booking. By the | | | | beyond ascertaining the details of her substance |
| way, I found out later that one of my colleagues got | | | | abuse and dependence. I needed to assess her |
| the first call; however, she asked that I be contacted | | | | potential for self-harm and harm to others. And, oh by |
| because she was so angered by the report she | | | | the way, I needed to know who was going to care for |
| didn’t feel comfortable handling the case. Kudos to | | | | her two very young children should she be |
| her, passing the baton was the right thing to do. | | | | incarcerated or hospitalized. There was a ton on the |
| Upon arrival at the E.R. I was briefed on the case by | | | | line here and I had to keep moving forward and make |
| the woman’s attending physician. I also talked with | | | | sound decisions amidst the chaos. |
| one of the two police officers that were waiting | | | | Well, long before I completed the assessment I was |
| outside of her room. According to all parties the | | | | pretty sure there would be nothing from a psychiatric |
| circumstances were pretty much as I’d heard on | | | | perspective that would stand in the way of the |
| the phone. And, of course, I had to listen to all sorts of | | | | woman’s transport to the police station. And this |
| editorial remarks from the E.D. staff regarding what an | | | | supposition was confirmed as I finished the interview. |
| awful woman and mother the woman was. Now, | | | | At any rate, protocol mandates my touching base with |
| I’m not condoning her behavior by any means; | | | | the on-call psychiatrist. That I did, and she concurred |
| however we’re in the helping professions – | | | | that though the woman definitely required substance |
| right? | | | | dependence treatment, there were no criteria for |
| As I entered the woman’s room, I saw a patient in | | | | immediate hospitalization that would trump the coming |
| her mid-20’s dressed in a hospital gown with an I.V. | | | | legal proceedings. Of course, the psychiatrist reminded |
| in her arm. She was visibly agitated, crying profusely, | | | | me to notify Children and Family Services. |
| and pacing as much as her I.V. line would allow. She | | | | So off I went to give our disposition to the E.D. |
| greeted me with a desperate expression, intense | | | | attending and the police. Then I stopped by the |
| weeping, statements of great fear and sorrow, a face | | | | woman’s room to share the disposition, give her |
| scarred by running mascara, and a good deal of | | | | some referrals, and say good-bye. No doubt it was |
| nausea and G.I. distress. In spite of everything else with | | | | tough, as she hadn’t emotionally stabilized and was |
| which she was dealing, it was obvious she was in the | | | | still presenting with all sorts of desperation and the |
| beginning stages of heroin withdrawal, which could | | | | hope that I could somehow stay and talk for a while. |
| certainly account for a large portion of her presenting | | | | And as much as I might have liked to it just wasn’t |
| physical and emotional symptoms. | | | | the thing to do at the time. |
| Not surprisingly, the woman formed an immediate | | | | After saying good-bye I went to a near-by computer |
| emotional attachment to me. And all things considered | | | | station to enter my formal assessment. Out of the |
| that’s not so hard to understand. Let’s see - | | | | corner of my eye I caught a good bit of commotion in |
| she’s frightened to death, seven months pregnant, | | | | front of the patient’s room. Her mother dropped by |
| withdrawing from heroin, knows she’s the object of | | | | to see what had happened, and the police had to |
| contempt, may well have a deformed baby inside of | | | | intervene as her mother tried to get at her and inflict |
| her, may lose this baby and her family, and believes | | | | some physical harm. Amazing. But the upside of her |
| she may well be incarcerated. Wow, huh? But in spite | | | | mother’s visit was her commitment to care for her |
| of recognizing and understanding her attachment I had | | | | grandchildren. Oh – and when I spoke with Children |
| to keep it in check. No doubt, she needed support; | | | | and Family Services I found out that several parties |
| however, my immediate task was to get answers in | | | | had beaten me to the draw. |
| an effort to formulate a psychiatric disposition in her | | | | Interesting tale, don’t you think? I mean, I’m left |
| best interest. This wasn’t the time to be toasting | | | | with all sorts of feelings. Absolutely, I’m disgusted |
| marshmallows and singing “Kum Ba Ya.” But it | | | | by someone shooting heroin throughout her pregnancy. |
| also wasn’t the time to be an iceberg. Just the right | | | | And, indeed, what kind of mother would daily use |
| mix was the order of the day. | | | | heroin when she has two very young children at |
| As the interview commenced the woman confirmed | | | | home? But on the other side of the coin I know how |
| the circumstances of her arrest and transport to the | | | | devastating substance addiction is, and how its |
| E.R. And she confirmed that she’d been using | | | | biochemical foundation can make it almost impossible |
| heroin on a daily basis for the past nine months. And, | | | | to challenge. But yet, we all have our “stuff” and |
| remember, she’s seven months pregnant. She was | | | | it’s our responsibility to step up to the plate and |
| actually arrested for possession of drug paraphernalia | | | | manage it. |
| and possession of cannabis, a small amount found in | | | | These are the cases that help me grow as a person |
| her purse. Who knows what happened to the heroin. | | | | and a professional. |