All About Me

There’s absolutely no humility in this photo. In July of 2020, I turned my life upside down with a big move from B.C. to Saskatchewan. Since then, I’ve felt disorganized, sometimes falling apart and have had too much time living with me. Getting to know myself more than I ever have. Last winter, I was invited to go snowshoeing with friends. I was unable to at that time. That’s where the debilitation interfered. That is also when I set myself a goal to go snowshoeing this winter. Until I actually walked in the snow, following the trail set by my two new friends, I wasn’t sure that I could actually do it. With each step, I knew that I could. 

Recovering from anything means a lot of things. For me today, it was deep snow and funny flat things strapped to my feet, laughter with friends and a still, calm winter day.

“We are all apprentices in a craft where no one ever becomes a master.”

~ Ernest Hemingway, The Wild Years

Author's note: June 2024 - I have had to give snowshoeing a pass! Further tries at snowshoeing were unsuccessful. A long story, just suffice it to say I loved the experience I did have and will forever 

cherish the memory.

With Gratitude

Purposely, for this last nine months, I have limited my contact with the staff I worked with for so many years in Detox. On November 5, one of my colleagues asked if I’d like to attend the staff party. And so I did with gratitude and delight. There have been so many staff changes in the short time since my retirement, but there were enough of my past colleagues present to satisfy my feelings of ‘homesickness’ that pop in every now and then. Some folks that I would have loved to see and visit with, were faithfully working their shifts, missing out on the noisy laughter and friendliness that was definitely a welcome balm to my soul. 

Working in addictions, in Detox and in recovery facilities ~ those fragile, early stages of lifting individuals out of active addiction ~ are not easy jobs. Guiding lives broken and destroyed by the rocky paths and the uncertain marshes of recovery takes its own toll. Yet there are many dedicated groups of people, like the wonderful folks I shared supper with last night, willing to step up and step into this sadly funded fray. Thank you all for keeping up and keeping on.

“You is kind. You is smart. You is important.”

~ Kathryn Stockett, The Help

Attitude Changes Stigma

I’m thinking about stigma this morning. On a bright summer day when the wind is calm and the sky is blue complete with two swallow tail butterflies flitting past to the next flower. So how does that work? Sweeping my patio of all the debris the wind of the last few weeks has blown in, I let my thoughts wander. The winds had also spread some of the mulch for the gardens into the cracks and corners of the patio blocks. Spider homes webbed behind my storage bin. You see, my wandering thoughts were also about the stigmas towards a variety of chronic diseases and conditions ~ addiction, epilepsy, diabetes, cancer, mental illness, etc. and on and on ~ burdened by the attitudes of stigma. Recovering from or living with any chronic condition is enough of a challenge in and of itself. Especially if it is very fragile and difficult to manage while trying to enjoy an interesting and rewarding life at the same time.

The attitudes of stigma are like the crusted leaves, fine dirt, crumpled bits of paper and even dry discarded flower petals nestled on my patio. These attitudes, much like my patio debris, have come from somewhere, piling up in corners and crevices to be ignored until a broom comes along and sweeps it all up. But is stigma that neat? Can we just sweep stigma up and toss it in the garbage heap, in the compost or under the hedge? I don’t think so. 

Stigma resides in the cracks and crevices of our minds and heart. Where has it come from? Our own experiences with watching someone live with chronic disease? From the sometimes dubious lessons learned on the playground without challenge by any other knowledge? From gossip and conjecture in ordinary conversation? Certainly from many more people, places and situations I can suggest here. No, banishing such long held beliefs and attitudes is not as easy as sweeping a patio. Recognition of the attitude of stigma and deciding if there is any value to nurturing it any longer begins this very personal journey. With willingness of heart, changing even a long held attitude can be done.

“…the issue becomes not whether a person has experience 

with a stigma of his own, because he has, but rather 

how many varieties he has had his own experience with.”

~ Erving Goffman, Stigma: Notes on the Management of Spoiled Identity

Only a Hop, Skip and. a Jump - On Skates

All the way to this fall. Am I talking about hockey too soon? Maybe, if it was only a hockey game. I have enjoyed hockey games from minor to major leagues. The cut of blades on ice. The whistle of the referee. The slap of hockey sticks against the boards. But I’ve never been a fan of the muscle that is unleashed on ice in the middle of a game. Helmets off and fists flying.

I’m also not a fan of active addiction, whether to alcohol, prescription drugs or illicit drugs, untreated or poorly managed mental health. Unfortunately, what is unleashed is not only muscle but much more serious and life threatening issues. Families shattered, depression, suicide……..I could go on, but you get the picture.

Last evening I attended the AGM for the Umbrella Society for Addictions and Mental Health. The Umbrella Society is dedicated to longterm housing in recovery homes, as well as supporting recovery from these dreadful conditions. Acceptance, encouragement, paramount for these relapsing conditions, is unconditionally offered to scores of those working towards good health and happiness. While still in my nursing career in detox I had many opportunities to work alongside the many frontline staff from Umbrella in their outreach programs. Each one was and has been dedicated to their clients in their recovery. Retirement has meant that I’ll no longer work with them in that capacity, however gaining membership in the Society last night changes all that for me.

My words are minuscule, compared to the ripples that The Umbrella Society on Addictions and Mental Health has made in this community. They have elevated a community of individuals suffering from their various health conditions, whether addictions or mental health, to communities of healthy individuals that live, work and play with clarity and sobriety. These journeys are long and arduous. Yet the Umbrella Society has continued to believe in these folks who have not felt belief from themselves or anyone else for a very long time.

On that note: Come to a Charity Hockey Game in October! The Boston Bruins against the Greater Victoria Firefighters. I’m not a huge fan of hockey, even though I was born, raised and live in Canada. I am definitely a fan of The Umbrella Society for Addictions and Mental Health.

“Everyone has inside of him a piece of good news. The good news is 

that you don’t know how great you can be! How much you can love? 

What you can accomplish! And what your potential is!”

~ Anne Frank

Quite Necessary!

Quite necessary and very welcome in the domino effect - medical and psychiatric - of untreated active addiction. Six to eight week treatment for those suffering from active addictions and mental health issues. Homewood Ravensview is a branch of the Homewood Health in Guelph, Ontario where many have had to travel across Canada to acquire more focussed treatment for both of these conditions. Individuals do not have to have an addictions diagnosis as Homewood centres all treat mental health, including PTSD. As an adventure, I took the opportunity last evening to attend their presentation at the Mary Winspear Centre in Sidney, B.C. Robert de Clark, General Manager and a Masters in Social Work; Dr. Lyn McBeath, psychiatrist and addictions specialist and Dr. Michael Berry, psychologist, each shared personal histories as well as the long history of Homewood Health now extending to Vancouver Island. Their presentations provided insight into the workings of this very welcome resource opening May 22, 2019. A Q&A session following their presentations allowed the audience to ask questions from specific grassroots questions (including cycling in the area) to professional questions. All questions were answered appropriately, however if more in-depth was required, they followed up with the questioner(s) following the Q&A period. Paraphrasing from Robert de Clark’s words in his presentation -

We have a beautiful healing setting as well as an historic (old Dunsmuir site) and renovated building, but it is the team that is important. Their team is an interdisciplinary team to be able to share their knowledge and experience for the well being of the client. Access their website for more complete information at homewood.com, specifically the Ravensview site.  Welcome Homewood Ravensview and your team!

“In the longer run and for wide-reaching issues, more creative solutions 

tend to come from imaginative interdisciplinary collaboration.”

~ Robert J. Schiller

Tea Service

Reliable protection from the elements 

 ~ not always a shiny yellow slicker. 

Hearts bruise,

feelings get frayed and torn. 

souls disappear in the debris of the real world without scarlet drops or purple stains. 

Numbness hides the damage.

Elements of our lives 

 ~ emotional storms and turbulence

need buffers and wraps

to seek protection and shelter.

Warm service from others delivered

in a listening ear, a cup of tea or bowl of soup

offers the reliability of friendship for the long road to recovery.

“When friendships are real, they are not glass threads 

or frost work, but the solidest things we can know.”

~ Ralph Waldo Emerson, Essays: First Series

A Second Thank You Note

There are many nursing specialties. I mentioned a few of them in my blog post ‘A Thank You Note’ from yesterday. The specialty that I failed to mention is that of nurses working in Detox facilities. We seem to be a special breed. Our brand of nursing involves the neurobiological management of alcohol and substance withdrawal. That’s a mouthful! We are caring for an individual experiencing the rapid brain changes that occur due to withdrawal from long term alcohol and/or drug abuse. We collaborate with and care for clients from an extremely intoxicated or substance affected state, through an acute withdrawal period and into sobriety. Many, many times they do not remember that they had even been in a Detox.

Detox nurses monitor and manage extreme states of anxiety, work at preventing seizures and manage states of high blood pressure for these clients. We educate, or attempt to educate, our folks on how to eat. That sounds kind of odd, even as I write this, but many people in active addiction have very little interest in, and sometimes opportunity for, regular eating. Many unpleasant gastric effects with the various forms of substance withdrawal requires a finesse that allows Detox nurses to minimize the discomfort, averting medical emergencies. All of this in 24 to 48 hours for the most acute stages in a young and relatively healthy individual. The older the individual, more medically compromised or a longer period of active addiction can extend this short phase. 

Nurses in other nursing areas also see withdrawal on a far too regular basis. From the Emergency Room to the Operating and Recovery rooms and all the nursing units in between. Not to be forgotten are the Neonatal Intensive Care units with the wee tiny babes sadly born into withdrawal. To wade through the stigma of addiction, to push past it to evaluate, assess and collaborate with all these clients is an extremely difficult part of this job. To encounter violence and yet offer kindness is another extremely difficult part of this job. 

We are often the last bastion of care to be offered and accepted willingly. Establishing an individual’s physical and mental health allows them to take the next step into the foreign land of recovery. In this continuum, Detox is relatively easy yet often the most physically painful, compared to ongoing recovery from active addiction. So far, to my knowledge there is not a formal Addictions Nursing Specialty in Canada, so I say to all nurses, thank you for your good care of those individuals of any age and in any state of health to arrest active addiction and provide respite from an extremely chaotic world. Thank you for seeing the person beneath active addiction.

“The future depends on what you do today.”

~ Mahatma Ghandi

It's Personal ~ 2

This is my signed copy of Father Martin's book.

Puzzling over what I would write today, I thought to myself: I have nothing in my head, no story to tell….wait... I do have a story to tell. It really is kind of a combination of stories. A story about personal belief.

It was June 1989. I was in Hobbs, New Mexico with friends listening to Father Joseph C. Martin, a Roman Catholic priest who presented the topic of alcoholism in a humorous but serious manner. He was presenting a ‘Chalk Talk’ on Alcoholism, dubbed Chalk Talks because he always used a green chalk board and chalk to outline his points. My understanding was that he originated these talks for the military, but they became so popular that they were expanded to other audiences and treatment centres. Father Martin has since passed away, but I found a series of these Chalk Talks on Alcoholism on You-tube this afternoon. In the talk that I chose, he reviewed the similarities between being anaesthetized before surgery, the behaviours because of the sedatives and the serious risks that are present with sedation. Even for minor surgeries. 

Now I’ll back up a few years. It was still in the eighties, long before I was considering a career in Addiction Nursing. Actually I didn’t even know that there was a specialty for addictions nursing. I was working on a medical unit in Regina at the time so my patients were admitted for medical reasons. Many were actually there for alcohol withdrawal. It was while I was caring for these clients that I began to consider that it was like someone coming out of surgery. The more I thought about it, the more I believed that the nursing care for withdrawal from alcohol would be similar to the nursing care for someone coming out of anaesthetic. I have maintained that belief since that time. Today, I can include in that belief, opiates as they are often part of the drug cocktail that is used in anaesthesia. The opiates, however, continue in use for pain control in a longer term recovery period and may continue once discharged home.

This Chalk Talk I listened to today restored my belief in my own belief! Alcohol and drugs affect the brain as an organ. Alcohol and drugs alter behaviour. Not everyone becomes addicted to either, but it does occur to some. Why? I have no idea. Anymore than I know why I have epilepsy, a brother had epilepsy and the rest of my siblings do not. What I do know for sure is that withdrawal management for alcohol and or drugs, outside of any political hot potato issues, is critical to recovery and should not be taken lightly. Brain damage is brain damage and should be recognized as a critical issue for those who wish to get that monkey permanently off their back. In nursing and in medicine, the care that we take with our patients can support their opportunity to recover, or can deal a too heavy blow.

“My belief is you have one chance to make a first impression.”

~ Kevin McCarthy

Homecoming

Homecoming

He opened the door to find her standing there, crying. Quietly crying, poised and well-dressed.

“I was so afraid that you wouldn’t be home. Is mom here? Do you even want me here?”

Her father hadn’t said a word. Just stared at her.

“I’ve made such a mess of my life. Of your lives. And I’m so very, very sorry. I wouldn’t blame you if you asked me to leave.”

Manley just stood frozen while this woman cried and talked. He had heard it all before as had Genevieve,  his wife of 40 years. He had cut Cassandra out of his heart a long time ago, but the scar had never really healed. Today, the aching started again. They had not seen or heard from Cassie for several years and believed her dead or dying in some dirty back alley. But there she was….his Cassie-girl. Shivering and cold and crying. Manley felt soft warm hands on his shoulders.

“Manley? Who is it? Cassandra!! Oh my dear sweet daughter, come here to me! Let me get you warm. Manley, it’s ok. You come in here too and stop looking so shocked.”

Cassandra melted, sobbing, into her mother’s arms. Manley slowly stepped back into the front hall, quietly shutting out the cold, his hand lingered on the shiny brass door knob. He felt the need to do something. To get something. Go to the kitchen for some tea? He couldn’t really have seen Cassie. Is she really home?

“Manley, come in here a minute, honey. Cassie has something she wants to tell us.”

“Now, Cassie, your grandparents will be here any moment. Do you want to wait to give them your news? They will be so excited for you. Oh, honey, you’re scared. It’s ok. Maybe it would be easier to tell your dad and I first with just the three of us.”

Cassandra took a deep breath, held on to her mug of tea like it was the only thing keeping her still. She looked in her dad’s eyes. So suspicious, confused and ready to be hurt again. She had planned this day for the last year. Not by herself, but with her new friends, and with her counsellor.

“Well. Oh, this is so hard.” Cassandra  hesitated, tears slid slowly from her clear, green eyes. Then her words tumbled out without warning.

“You haven’t heard from me for so long because I have been doing a lot of work. I was in the hospital for quite awhile - that’s another story - I wouldn’t let them call you. I went through detox there then the social worker got me to a long term treatment center down east. I’ve been out from there for a year now and have my own apartment. I’ve kept a job at one of the thrift stores on the other side of the city since moving into my apartment. You also have a grandson. Caleb is two years old now. I have shown him your pictures. I would like him to meet his grandparents but will understand if you don’t want to.”

Manley’s voice had returned to him. Gruff and defensive.

“Cassie, this is quite a lot to take in when Christmas is just a day away. Sounds to me that you’re just creating your usual Christmas crisis. And where is this grandson anyway?”

“Dad, I’m not going to beg and I’m not going to fight either of you. I’m telling you all this for my son, your grandson. Right now, he is with his babysitter. I won’t wait for Grandma and Grandpa, but will go now. Please tell them I love them and hope to see them soon.”

Cassandra got up to leave, still wearing her coat and pulled her gloves from her pockets. Genevieve, always the placater of the family, turned to Manley. 

“Manley, it is Christmas. I know, that’s not an excuse and sometimes not even a good reason. Why don’t we have Cassie and little Caleb over for Christmas dinner tomorrow? In fact, Cassie, could you stay here a bit longer to help me get some of the salads ready for tomorrow.”

“I don’t know, mom. I’d love to but dad is pretty worried. We need to listen to him too.”

“Well, it might be alright. But it might be better if we went and picked up - Caleb? A good family name. Your mom could come too, but she needs to be here if your grandparents get here. I’d do it by myself but Caleb won’t know who I am. Do you think we could take a ride together?”

“Thank you dad. Mom, is that ok? I don’t live that far away so we’ll be right back.”

Genevieve felt such relief and joy at having her daughter back with her. The old niggle of fear, ever present, felt much more distant than it had for a long time.

“Every traveler has a home of his own, and he learns 

to appreciate it the more from his wandering.”

~  Charles Dickens

*Opening line from writingexercises.co.uk

Career Moves

I might have been 
An operating room nurse
I liked the strict order 
But couldn’t see the patient
For sheets and drapes

I might have been
A paediatric nurse
I love children
But couldn’t tolerate
Their pain and bravery

I might have been
An orthopaedic nurse
I loved the mechanics
But couldn’t fix the reasons
Behind injuries caused.

I might have been
A physical rehabilitation nurse
And that was closer to my heart
Because I could support recovery
From all kinds damaging events

I might have been
A nurse specializing
In any other health care field
Because I saw the needs of many
But I saw one cause roaming throughout each specialty

I did decide to become
An addictions nurse
Specializing in withdrawal management
- not just detox - not just sobering up
But the priniciples of basic nursing care in all areas of nursing.

I occasionally am honoured to be
A nurse educator of these principles ~
A mentor to a nursing student
As they pass a day or maybe more
Learning about the beginnings of recovery.

“I’ve learned that making a ‘living’ is not the same thing as ‘making a life’.”

~ Maya Angelou

Nursing Against Stigma

Intuition whispers goals and dreams. Such a lovely sentiment, and one that describes the center of a passionate belief. A belief that may or may not blossom into change. For me, that change has been reflected only in my personal nursing career. My disappointment is that I haven't known how to take this belief out of my personal career. I believe it is an idea that could affect nurses in their comfort and ability to do their jobs.

Missing from my career is the development of this principle in a much deeper sense. My career was born in hospitals where I continued for twenty years. I floated from unit to unit, hospital to hospital. Besides illness, recovery and death there was one condition becoming increasingly obvious. Active addiction. Alcohol. Prescription drugs. Illicit drugs. And many, many combinations. For the last 19 years I have worked in detox facilities in the critical area of withdrawal management. The beginning of recovery.

Now, towards the end of my career, that intuitive thought - that kernel of an idea - has never gone away. My belief has never diminished. Those with alcoholism are living longer, yet with more severe medical effects. Those with drug addiction are susceptible to more and more powerful drugs. More simply, anyone - any age - any gender - any economic bracket - anyone affected at even the lowest levels by drugs and/or alcohol will be in the care of a nurse. Nurses in any area of our health care systems, focused on the individual, their needs and their abilities, can support that very important part of recovery. The beginning. Just as we support the recovery of those with heart conditions, cancer, diabetes and epilepsy - other ‘socially acceptable’ conditions and diseases. 

Nurses have replaced their stethoscopes and manual blood pressure machines with digital up to date machines that record more than just blood pressure. Today, to the best of my ability, I practice my patient care with the intuitive belief residing in my heart that nurses, and the education about basic health they provide in times of illness, are an incredibly important key for addictions care.

“Reality is that which, when you stop believing in it, doesn’t go away.”

~ Philip K. Dick, I Hope I Shall Arrive Soon

Crisis of Care

In 1966, I stood in a linen closet crying because I was just too scared to do a bed bath…..on a man….kind of old - probably about 40. That was the crisis I had to deal with. 

Telling my dad that I was quitting nursing was the alternative. Just over twenty years later, there was another critical point in my nursing career. Yes, I continued in nursing. That crisis was on a medical unit in Regina. I wanted to know how, with nursing process, to care for patients in alcohol withdrawal. So I moved to Texas. There was no nursing education specific to alcoholism, however I did get experience in a treatment center. Nurses were in treatment centers, not hospitals. And yet, alcoholics and those with drug addiction frequently require medical care for the medical effects of alcoholism and/or drug addiction.

Today, there is another crisis in the world of nursing. In the world of health care workers at any level.  On the streets, in the ambulances, in emergency rooms. Fentanyl, prescription opiate and illicit opiate abuse. I’m not sensationalizing when I say the people are dying out there. Withdrawal management, better known as detox, is alive and well whether in hospitals or detox facilities. I have told many patients over these last many years that I will take care of them as many times as is needed. I have told them that relapse is not a shame but part of the process of addiction. This brings me to the next crisis in the world of active addiction. It has become so much bigger than that first bed bath. And it really is not my crisis.

We, within health care, have the knowledge, tools and abilities to treat the medical effects of this dreadful condition that spirals into so many other medical conditions. We are saving lives…..over and over again. For those that still have loving families, employment and community support systems there is some hope. Hope that a new life, a good life, is a possibility. And then there are those whose bridges have all been burned or are at least severely damaged. Those that are homeless, jobless, with no family. And yet we save lives.

I am reminded of Ebenezer Scrooge when he relegates them to ‘work houses and prisons’ and ‘if they would rather die then let them’. Is that where we are now? And yet we still ‘save lives’. And where do these lives go? The ones that are homeless, jobless, and with no family. Has society even thought about the personal addiction treatment that is needed alongside valuable medical management? In five decades, my limited view of how we have progressed past the stigma, to identify the chronicity of this condition, is that we are still blinded by the brilliance of controlling substances. We seem to have completely forgotten the individuals, the families that have been devastated by the conditions of alcoholism and addiction. 

To begin to mend this crisis, treatment centers, outpatient clinics and more importantly affordable homes are required. Housing and funding. For those that have housing, their ability to maintain clean and sober time increases, the quality of recovery is improved. Is this an easy task? No. It will require a complete restructuring of our attitudes and our ways of thinking in our increasingly complex system of health care.

“Sometimes you need a little crisis to get your adrenaline 

flowing and help you realize your potential.”

~ Jeannette Walls, The Glass Castle

A Special Quiet

This Christmas was quiet
mostly calm and settled ~
despite folks away
estranged from families
always hoping to 
get better
be better
recover from active addictions
find a life
that was or
that could be
pulling away from addiction’s grasp
struggling to believe where
belief had been lost
smiles and tears
for all that has been.

“It is not true that everyone is special. It is true that everyone was 

once special and still possesses the ability to recover it.”

~ Criss Jami, Killosophy

Against All Odds

Determination ~

a word too big for a haiku

~ but not for recovery.

“There is no pride when it comes to survival, only determination.”

~ Anthony Liccione