Shortly after five, the hospital called. More precisely, the emergency room phoned to ask if Ray had a bed. Ray pretended to consult his admission log, just as he always did. The nightly hospital call meant one of three things: the chemical dependency floor was full (highly unlikely), the individual in question had fallen under the hospital’s “one treatment episode every three months” sanction (also known as the Black List, and only moderately unlikely), or the prospective client had no insurance (in Ray’s experience, very likely).
The folks at the hospital knew, as did Ray, that federal law prohibited him from turning away individuals requesting detoxification services if he had an open bed. The hospital was generous enough to spring for a cab voucher for the intoxicate.
In Ray’s experience as well, overnight admissions were less interested in detox than in free food, a free bed and complimentary meds. For his two hour paperwork investment and aggravation, he would receive the benefit of knowing the client slept until noon then slipped out the side door and into another binge. Any bills for service generated for the brief stay would return in a week or so stamped “No Such Address” or simply “Return to Sender”. On average, the clients of addictions services managed to muster a raging 25% of them who would ever pay a dime toward their bill. The night shift admission payment percentages were a quarter of that quarter in good years.
Thus, the frequent calls from the hospital. They had little better luck in getting good addresses (or even with those, a client who stayed sober long enough to give a shit).
No one relished treating the uninsured and uninsurable. It was fiscal suicide. The hospital was perfectly willing to let the local experts in deadbeats handle the workload.
Tonight, Ray could tell them no. He liked telling them no, especially when it was the truth. It did not bother him that the hospital’s backup treatment was a one milligram shot of Ativan to control the client’s shakes and get them through the night until the liquor stores opened, then a security escort out the door and to the edge of the parking lot.
The reality was that overnight admissions, Ray’s or the hospital’s, would not and did not stay to complete programming nine times out of ten. The hospital’s backup treatment modality was simply an accelerated route to the same end. Whether the client chose to end up back on the street or the hospital chose for him, chose the time or the hospital chose for him, really made little difference in the grand scheme.
Ray hummed into the receiver, put his feet up on the desk and played the game.
“What’s the name?” he said.
The voice on the other end—Ray knew it, but could never remember the name—was black, sly, experienced.
“Uh-uh, man. If I tell you, you’re gonna say you’re full.”
“I might say that anyway.”
“He’s not one of the bad ones.”
“They never are,” Ray said. “At least from your perspective. The last guy you sent me had a gun.”
“No shit, man!”
Actually, the last guy had said he had a gun, which Ray had not bothered believing because a) he knew the client too well, and b) knew the client would hock a gun had he ever owned one for snort rather than use it to hold up night shift techs. Ray had threatened the guy with an aluminum ball bat until he ran away.
Ray continued, “What’s his DOC?”
“Alcohol.”
“BAC?”
“Point one oh two. Just barely legal even. Coherent.”
“And undoubtedly on the verge of DT’s by the time he would get here. Sorry, guy, I’m full.”
“Aw, we’ll give him Ativan before he comes over.”
“You’ll give him Ativan, anyway. We’re full.”
“You’re just being a lazy bastard.”
“Sure, and you’re not. Call my supervisor.”
“Whatever.” There was nothing acrid in the response. The guy just made the calls; he didn’t have to handle the client. Most of the time, he gave up a long time before Ray did. “We’ll do something with him. Probably just piss him off so we can call the cops, have him arrested for PI or DD.”
“It’s a place to sleep,” Ray said by way of encouragement.
“Night, man.”
“Talk to you tomorrow.”
*
Predictably, the doorbell rang twenty minutes later. The hospital was, after all, only eight blocks off and all down hill. That any prospective client would choose hospitalization over the efforts of the local mental health center was not particularly offensive. The outward appearance of Ray’s facility was not designed to inspire confidence in its medical capability (nor was the fact that it had no doctors except the one on call, and an assurance that you were not going to get any medication you wanted when you wanted it). The appearance, in turn, of a largely twenty something staff further exacerbated the lack of esteem. This was, Ray believed, the way it should be.
It was the others, the regulars, the ones who willingly chose a ramshackle alternative who worried him. There was something of desperation in that decision, or surrender to the inevitable. It was like the ultimate manifestation of the internalization of the shame of addiction. They had ceased to believe they were worth the hospital’s time. They had fallen too far from grace to be saved, which meant they weren’t worth saving, which meant, of course, that there was ultimately no motivation for them to stop drinking because they had already pissed away everything of value in their lives. The decision to choose CAT was a little sad, a little scary.
Ray peered out through the thin slab of wire meshed glass in his steel framed back door. By the streetlights, he could see the man standing there in the pea gravel border between sidewalk and parking lot. Not large, not small. Definitely thin, possibly malnourished. Ascites belly bulge over his belt, a first trimester alcohol pregnancy. With nothing to lean on, the man swayed gently.
Unsteady on his feet, Ray began. Unkempt in appearance. Visibly flushed. Apparent motor skills impairment.
Ray pushed the door open, no more than eighteen inches and blocked the gap with his own body. He kept a firm grip on the bar.
“Can I help you?”
Slight pause. Flighty, disordered thoughts, possible disorientation. “I jus’ come to prove you was a liar. From the hossspital.”
Slurred speech. Disconnected or obsessive thought patterns. Individual seems to have forgotten the use of basic grammar rules learned in elementary school.
Ray sniffed, winced. Definite odor of alcohol. No tremors, though—he could thank the hospital and the makers of any number of depressants for that. Add also, no perceived immediate risk of DT’s or withdrawal related seizures.
Diaphoresis, agitation, fresh abrasions to the knees and heels of palms.
Preliminary assessment, acute alcohol intoxication.
Ray said, “Excuse me?”
“Liar.” The guy said it like one long word, a sigh of exhaustion.
“And how is that?”
“You said you got no bed. On the phone, to them guys at ‘mergency. You got a bed in there and I’m gonna find it.”
The man took a tentative step forward, but Ray was certain that he was not as physically threatening as he intended to be. The difficulty of re-establishing a firm and reliable connection between feet and ground which he was obviously experiencing tended to deflate his projection of peril.
Still, Ray stiffened, set his mouth, pulled just a bit on the door. Obvious and almost lugubrious gestures of resistance designed to penetrate a thick (normally) and drunken (currently, but also normally) head.
“I can’t let you do that, Tom. Confidentiality. You know the rules. They haven’t changed since last week.”
Tom stared, scratched absently at his ratty, two-week growth of beard. His shoulders seemed to fold, his whole body to shrink. He had given up any ideas of breaching the walls with force.
“I don’t have anywhere to go.”
Another tactic, an attempt to elicit sympathy. Tom knew better than to cry, because Ray hated that. He did a good impression of hopelessness, though.
Ray said, “I don’t have anywhere to put you.”
“The hospital wouldn’t take me, either.”
“Three strike rule, you know that. You’re blacklisted there until June. You can try again here tomorrow, if you’d like. I’ve got three I expect to walk out before noon.”
That seemed to perk him up (though it was a flagrant lie). “Can I jus’ wait here then? I won’t bother nobody.”
“No.”
“Come on. I’ll hide by the dumpsters where nobody can see.”
“No.”
“Why not?”
“Because you’re drunk and it’s my job to make sure you don’t corrupt my clients. Because you’re trespassing and it’s my job to make sure you don’t harm any of my clients. Because if you fall over and die on my doorstep that has nothing to do with the clients, but everything to do with liability for me personally. You need a longer list?”
“You can pretend you didn’t know I was here.”
“And you can pretend I’m not calling the cops if you don’t get going. You are publicly intoxicated, Tom. I’m giving you a break by even letting you walk away.”
He nodded involuntarily. “I know. I know.”
“Go down to the Waffle House, get some coffee. Hang out awhile. They won’t care.”
Tom’s head came up, giving a sidewise glance. “That sounds okay. I can come back later. You got any money, man? For the coffee? Three or four bucks is all I need.”
“Seventy five cents is all you need. For the coffee. Get the hell out of here before I stop being generous.”
The man threw his hands up, borderline aggressive again. Mood swings, rapid, Ray said to himself.
“Whatever, Ray. Motherfucker. Cocksucker.”
Muttering, cursing, weaving, Tom walked away. Ray watched him go down along the side of the building. When he hit the sidewalk, Ray closed the door. He picked up the phone and dialed the number for the city police night dispatcher.
If they bothered to pick him up, it would be at worst a PI (unless Tom did something stupid, which was not out of the question). At best, he’d have a place to sleep, minimal but adequate healthcare and a probation officer to pinch beneath his thumb until the city took charge of manhandling Tom’s passage into the detox and treatment program of his choice, all at the taxpayers’ expense.
For Ray, this scenario was preferable to believing he was just being an asshole.
*
Almost six. The sky was looking pink and flabby. Clear to the east, a cellulite bank of bruised clouds rolling in from the west. Ray pushed up the window by his desk and leaned his head out through the rent in the screen. The wind had picked up. It smelled like ozone, like more rain coming. He pushed the window back down and went to work on his charting notes.
His job was to stretch the word “fine” into a minimum of four lines of informative text, preferably without obvious obfuscations. Anything less than four lines made the RN suspicious of your attention to the client’s condition. This was not difficult when Ray had clients who were actually in need of his attention.
This group was not. They were mostly half a day away from successful graduation from the detox portion of programming, and ready to begin the intensive group therapy that would occupy the rest of their ten day to two week stay until they were ready to go on to state hospitals, halfway houses or simply home to wives, children, families who knew damned well that it was only a temporary surcease. Everyone would, of course, pretend to be hopeful (when really, despite themselves, they were bitter and spiteful). Except for those families who had been through the whole treatment followed by failure and relapse cycle too many times before—they would just pretend to be bitter and spiteful (when really, despite themselves, they were hopeful). It was that kind of profession.
Knowing this did not make Ray’s task any easier. It wasn’t his job to make a prognosis on their recovery. Only to encapsulate all the truth he had gleaned in the three to five minutes he had seen them awake in the last few hours in one all encompassing note. He was not, when it was absolutely necessary, above making shit up.
In treatment lingo, FINE was an acronym. Fucked-up. Insecure. Neurotic. Emotional. All the time people said to him while he was checking their vitals or giving them meds, “I’m fine.” Ray was invariably able to agree. In such spirits, he could write actual charting notes, accurate notes, for the RN to review. “Client stated he was feeling emotionally off-balance, moody and overly sensitive to the comments and actions of others.”
Bob was fine.
Very much true, chuckles from the gallery. FINE. He-he. On the other hand, a bad display of professionalism if you hinted in any way that you knew about the acronym. The rule of thumb, of course, was that each note should be written in such a way that it could be viewed in court and easily understood should a client’s chart at any time come under a subpoena. So you added more words, more layers, each round of the onion skin further insulated from the true kernel of fineness. Each succeeding layer a little less true, each word creating a bit more obscurity so that by the end the actual experience was unrecognizable. A billowy white sheet over a moth-eaten sofa. Bob was no longer a sick, puking, manipulating, bitching fuck trying to scam medication, but a highly agitated client requesting increased medical intervention for vomiting, anxiety and general malaise. Bob sounded like a decent guy, a guy who had made a few mistakes and now just needed a helping hand to get himself back on track.
Ray knew very well that charting was a form of mythmaking, disguising the kernel of truth with abstract and metaphorical lies that no one would fully understand. Or maybe not mythmaking itself, but definitely contributing to the whole treatment and recovery myth of sincere and generous mental health professionals extending the warm hand of help to a noble class of the chemically addicted willing to work for a better life. Addicts who had said “Give me the tools and I’ll build a monument out of the raw materials of my life.”
Except the reality was that they were all fine. They really meant “Give me the fucking tools and I’ll dig a pit so deep with your psychobabble, inner child, disease concept bullshit that I’ll have a whole lifetime of rationalizations for why I’m such a stupid, lazy bastard.”
Of course, that was another myth. The jaded myth, the treatment Qillipoth myth. The one that said the problem with addicts who fail at sobriety is that they expect us to do the work for them. They want a magic pill, magic cure, magic bullet. Sobriety as something that happens as a result of what is done to them rather than what they do.
One day at a time doing first things first—the top agenda item being to climb upon somebody else’s shoulders so they can drag your dead ass.
That wasn’t true, either. It was the treatment worker’s rationalization for the thirty who don’t make it, come back, die. Believing anything else is codependency. We don’t fail. They fail. All we can do is give them the tools—they have to use them or not. We have no blame.
Right.
Except, try to convince any product manufacturer in any industry you choose to name that every item which rolls off the assembly line works perfectly. That the same techniques used on every problem with every machine yields acceptable results. Convince them that the day Annie B. came in so hung over after her husband had beat the living shit out of her, when her eyes were so swollen up and puffy, when she was bearing those stupid, fat, broken fingers and that throbbing head…on that day, all of those factors didn’t take one percentage point of performance potential away from her accurate tightening of whatever bolt she’s been assigned to for twenty years. Annie is just as up to it and focused and giving a goddamn about quality assurance as ever, right? Pride in workmanship. Quality control. The whole cookie cutter approach, assembly line argument for increased production works just as well on a day like that as on a day when everybody gets big, fat bonus checks. Right?
All our staff is fine. Whatever the conditions, the headaches, the intrusions. The staff is always fine.
Yup.
The phone rang, and Ray picked it up before it could ring — or not — a second time.