Just Here for Detox

Abstract

To the Editor: It started off as a normal evening on my night shift in the emergence department (ED). As a psychiatry intern, this was an off-service month for me, so I spent most of my time seeing a range of patients with chief complaints ranging from abdominal pain to sore throats. This evening was a bit different than usual, as we had a number of patients with psychiatric and substance use disorders. So, when the attending asked if I wanted to see the patient with a substance use disorder in room 3, I said, “Sure thing.” “He’s just here for detox,” he said. What he meant was that this patient had come to our ED reporting a history of substance use and was in withdrawal and had brought himself to the EDwith a goal of being admitted to our hospital’s detoxification unit. The ED is the gatekeeper for these patients, where they are cleared medically before being sent upstairs. The admissions to detox were generally straightforward. I knew the drill. I knocked on the door and entered, barely pausing before launching into my well-worn introduction, but when his eyes met mine, I was thrown offbeat by an immediate and vibrant sense of recognition. I could tell that he remembered me as well. We had met a year prior, when I was still a medical student on an addiction medicine rotation. Different from the majority of my rotations as a medical student, I had not done physical exams, written health and physical examination notes, or admitted patients on this rotation. Instead, I had spent the month with a group of patients going through chemical dependency treatment. I had attended all their groups, listened to their stories, and participated in group therapy. Mostly, I listened. The group I was assigned to had shared with me their vulnerable moments and their hopes and fears for the future. By the end of the month, I had felt the power of the group, the power of the camaraderie, and the power of listening. When a group member graduated, the tradition had called for each person in the circle to share their words of encouragement for that member. As I became more familiar with each group member, they had invited me to participate in this tradition. When I entered room 3, I was transported back to that group room. I could see the rickety folding chairs all positioned in a circle, smell the burned coffee growing lukewarm down the hallway and the scent of cigarettes on the jackets of the group members as they came inside from their break, and hear this patient sitting at the edge of the circle, sharing his story. I started off, “I don’t know if you remember me, but...” “I do,” he said. He started to tell me his story again. This time, the folding chair was exchanged for a hospital bed, the smell of coffee and cigarettes replaced by the acrid scent of hand sanitizer. His voice was the same, gravelly and questioning, and it brought me back to the present. How he had been sober for 8 months and putting his life back together. How he had reconnected with his daughter and started working again. How he was on opioid maintenance treatment, and it was working for him. How he tried to wean himself off methadone/buprenorphine, but then he used meth and alcohol again, and his life had come crashing down. How he had been spiraling and spiraling. How disappointed he was to have relapsed again. “You don’t know how hard it was to get myself through those doors,” he said, gesturing vaguely toward the entrance to the hospital. He started to cry. And when the tears felt heavy behind my own eyes, I did something I have never done in front of a patient before. I let them fall. There is a dichotomy in medical education in how we are taught to deal with emotion. We are told to be patient-centered, but not too patient-centered. Be empathetic and caring, but not too emotional. And never cry in front of a patient. To do so is to * Amelia Wendt [email protected]