In case you wondered

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What a detox nurse does…  I work for two different types of detox programs, one is hospital-run and one is a subacute rapid detox serving basically anyone that comes in the door.  It’s run by an agency that serves the homeless and disenfranchised of Metropolis.  This agency provides housing and all kinds of other assistance; detox is just one of the many services they have.

I haven’t really gotten a good feel for who comes to the hospital-run program and why, or how, or who pays for it.  Nor am I really sure who pays for the subacute rapid detox either, except that they request insurance information from anyone who has it.  One must also be a resident of Metropolis or at least of its state, or else pony up nearly a grand up front.

Let’s just imagine a day in rapid detox, shall we?

Firstly, if you want to avail yourself of the detox you must begin by appearing in its lobby at an appointed early hour each morning, consecutively.  It is considered a measure of your motivation that you continue to appear, day after day, until you get in.  This may take a few days, or may occur very quickly if you meet certain magical parameters: you are more than a little sick from detox (dopesick, they call it, for the opiate users, or going into DT’s if you are an alcoholic), you have nowhere safe to go, you are prone to seizures or DT’s.  I have attended this call and seen a few very twitchy people in the lobby, as well as the huddled masses that mostly just look tired and like they don’t feel that great. I have seen others taken away in ambulances to be stabilized before they can come back to their bed at the detox.

Say you make the magic cut, and finally you are in.  You are taken back to an assessment room and if you are quite ill, once you sign the consent form you may be medicated immediately.  Otherwise you are assessed, a history is taken, vital signs, urine drug screen.  You are asked what exactly you are detoxing from and how often/how much you have been using, as well as when  you had your last fix/drink/whatever.  You are given several opportunities to get rid of any substances of abuse that you might have on you; should you fail to do so and it is found among your things back in the unit, you will be escorted out immediately and may not be permitted back in the future.  Once you are finished with the assessment process, you are taken to a shower and given clean scrubs to wear.  Your clothing is laundered while you are in the program so you can leave wearing clean clothes.  For some of the clients this is a nice luxury.

On the unit you are expected to participate in groups, although you may be excused from them if you are too sick to attend, as many people are in the first couple of days.  This program utilizes acupuncture and it is mandatory for all clients, which I find very interesting.  Otherwise the day goes like so:  your vitals are taken at 8am or so, and based on an assessment of your symptoms you may be medicated according to a protocol.  Alcohol detox is done via Librium dosing, while opiates are detoxed using Suboxone.  Depending on your dosage, you may be re-assessed in as little as one hour.  All day the assessments take place and the medication is handed out accordingly.  Meals are provided as are all toiletries and basic needs.  The beds are in large dorms, all the men in one room and all the women in the other, no real privacy.  It’s not luxurious but it’s quiet and it’s clean.

Lest you consider that this is cushy for the addict, let me tell you: this just rounds the corners off the detox.  It’s still miserable.  They sweat, they shake, they are nauseous and vomit and have diarrhea.  They get monster headaches and high anxiety.  It would be easier for them to go out and use, that would take all of this away, but they are here trying to kick it.

I have met people who have been drinking a fifth of hard alcohol a day for years, who have been shooting up heroin for months, who slept last night in a dumpster and apologize for stinking; who have lost their homes and their children and their spouses and their jobs and their health.   Some of them try to pursue every medication we can offer and argue with us, others just look tired.  Most of them have  a little spark of hope.  Some will go on to inpatient programs or outpatient programs.  Some are trying to get their kids back from the state.  Some of them are just young kids who made some bad decisions and are not too far into it yet, others are older and more beaten down — but they still have hope.  It’s amazing, they still have hope.  They have guilt, and shame, and fear, and sorrow, and depression, and hope.

My job is to be kind, with an eye for fairness, to assess and to medicate and to monitor and to keep them safe.  I don’t have to judge them for being addicts, although a healthy dose of reality is not considered to be out of bounds.  I heard a young, hipster heroin addict tell another nurse she should not eat meat, “It’s, like, so not healthy for your body.”  “Oh,” she responded, “but injecting heroin into your body is okay?  Yeah, I thought so.”

Many of the staff, from nurses to techs to janitors to clerks, are in recovery themselves, from alcohol, from drugs, from gambling, from some combination of these things.  They speak of it frankly and without shame.  I feel almost at a disadvantage sometimes, because I grew up pretty sheltered and pretty disinterested in drugs and alcohol aside from some (occasionally rather spectacular, it must be admitted) social drinking.  Hell, I don’t even smoke.

Once you’ve made it through the protocol for your particular substance you are considered stable and will have met with a counselor to consider your options from here.  Those counselors do their best to line the clients up with services of some kind after they leave the detox.  Most clients don’t make it all the way through the program on their first shot; most will leave once they feel better, but many of them will return several times, each time staying longer, each time staying clean longer after leaving.  Some will never stay clean and will return occasionally when their misery exceeds their ability to medicate it away on their own.   The clients are almost without exception very polite and grateful to be there in detox.

Am I  a real nurse?  Well, I’m helping people who need help.  You be the judge.

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