Tuesday, April 21, 2009

Alcohol and Accident Free Days

Alcohol – Accident free days
By William Hay

“Bill told me that you’re a shrink but that you’re different.” He started the conversation. He was a big man in a kacki camouflage jacket wearing wool slacks and workboots. He had big hands. His face wore a days stubble. About mid 50’s, I guessed. He could be older and look younger.

He leaned his Muskavera rifle against the pack, spout pointing away.

“Mind if I join, you.” He said.

“Sure,” I was still trying to digest his first statement.

“I work over at the mill with Bill. That’s one of the reasons my son and I wanted to come hunting with you two this weekend. The other one as you probably know, is Bill always gets game.” He laughed.

I laughed with him. While I was new to these parts I’d already heard enough of Bill’s legendary hunting skills. Never came home empty handed. Spent years hunting as a teen ager to feed his brothers and sisters after his father died leaving his sick mother alone to fend through the northern winters of the dirty thirties. Later a hunting and fishing guide. My friend now as the result of a chance encounter in the woods when he was having a heart attack and I just happened to be a doctor. His way of repaying me had been to take me hunting with him and teaching me as he did the ways of these woods and the game that inhabited them.

“We don’t take much to the psychiatrist in the mills around here.” He went on to say. I was a little taken aback. He was being even more direct than I was used to. A lot of people have a lot against psychiatrists mostly for the same reasons as they do against judges. Psychiatrists are commonly required to give an opinion that goes a bit counter to the persons own opinion especially in matters of family disputes. Somehow this didn’t seem to be the case.

We were sitting at the campsite we’d chosen. It was mid afternoon. We’d all hunted in the morning without luck and planned to go out for the evening hunt in a few hours. It was a time to nap, shoot the breeze and drink coffee. We were a dry camp. No one drank. It was better that way. I also hunted with a group in a wet camp and more often than not we didn’t make the evening hunt and more often than not we came back empty handed. I preferred hunting with Bill.

“I’m with the union on the safety committee for a number of the mills. The union got concerned a few years back about the number of accidents. It’s one thing to have a good job with good pay but it’s another to see a bunch of guys losing hands in machinery or dying because they’re crushed .” He said.

I was listening. Looking out at the lake, watching the trees that were turning from green to yellow.

“We noticed that most of the accidents were happening around the same few guys. Always at the sight of an accident there was a guy with an alcohol or drug problem. It’s pretty overwhelming when you care to look into it and you and your friends lives depend on your finding out what’s going wrong. “

Bill and the man’s son had settled in near us without much comment. They respected this guy and weren’t going to interrupt him.
A whiskey jack had already joined the camp and all we’d done is take out the coolers and set up a lean too over the wood picnic table. This was a non official private site but the company took out the garbage and kept an eye on the outhouse. Black bears could be a problem.

The whiskey jack was a little grey bird about the size of a robin but known all through the north for his courage in taking food right out of your hands and his uncanny ability to find a camp the minute it was being set up. Always ready for a hand out he was wilderness’s best beggar.

“Management and the union got together and identified these guys and we’d keep a close eye on them. We have a policy about missed work and showing up with alcohol on your breath or being drunk on the job. After a certain number of times you’re required to go for alcohol treatment or you’re let go. It took us all a while to get this in. The companies just wanted the guys fired at first but we figured it could happen to anyone and as the union we wanted what was best for the guys. The guys who went to treatment came back and attended AA and did really well. Some of our best men in the union and even management went that route. The trouble started up again when this psychiatrist came to town.”

I saw that he was wearing a red shirt under his jacket too. This whole group hunted camouflage but most of us had something red underneath in case we actually wanted someone to see us. Mostly we felt it was safest if no one saw us.

“These guys started going to the psychiatrist when they were in trouble and he’d write them up as suffering from depression and work stress and deny that they had alcoholism. Then he’d keep them in the hospital for a month or two while they dried up and sometimes they’d even have friends bringing them joints and mickies there with no one caring. They’d come out and they’d be on these drugs and still drinking and the accidents would be increased but there was little we could do. It wasn’t like we could force the guy into treatment because it wasn’t up to us or him now but the psychiatrist who’d just take him in to hospital and cover up for him. “

“What about the drug and alcohol counselor.” I knew the town had one. They had a treatment centre too. I’d even met the doctor who ran it.

“He’s a drunk himself and he enables them.”

What about the doctor at the treatment centre. “

“He’s okay but he won’t do anything. He’s not going to argue with the specialist and he’s happy with the unit as it is. Mostly the alcohol treatment centre doesn’t have alcoholics just women who say they are to get a break from their abusive husbands or to get a rest from being single mothers. They don’t give him any problem. Not like real alcoholics do. We know these guys are tough characters. They’re out of control. But they go to the hospital and they get labeled depression and make up some horseshit about their childhood. Nothing is done about their alcoholism and they’re on more drugs and they have an excuse for their problems. It’s a real mess. “ He concluded with his hands on his knees. Kind of defeated. Also a bit like he wasn’t used to talking so long. Bill and his son just sat and listened.

“So why are you telling me.” I asked.

“ Bill said you were different. He said you might do something about it. That you understood these things and you weren’t like other psychiatrists.”

I never knew what to make of these back handed compliments. I had a lot of colleagues that I would have liked to have been like. Some of my teachers for sure. But I knew what he meant. This type of colleague was always a problem. Self interested and lazy and never seeing his role as more than helping the one patient and never willing to say anything the patient didn’t like because he was greedy. I knew the type. Being a psychiatrist could be a rich job if you just wrote feel good prescriptions but if you actually tried to practice psychiatry it was messy and complex and frustrating. You never made the money you’d like to because most of the real psychiatry work wasn’t paid for. Like this consultation in the woods with the head of the safety committees for the largest mills.

On Monday, my colleague was out of town at a conference and I was in charge of the psychiatry ward. We shared hospital patients when this happened. I walked around reviewed a half dozen charts and talked in depth to the men in question. I added the diagnosis of alcohol dependence in each case. I then advised them that they would be discharged with a recommendation to be followed up by the alcohol treatment center. None of them were suicidal and the nurse's notes showed all of them were anything but depressed. Amorous and frisky if anything.

Two of the men threatened me separately right there at the bed side. "I'm going to fucking kill you one night when you don't expect it. You're fucking dead, man." The other guy was subtler. "You'd better change that diagnosis right now or you're going to have a very serious accident. I'm the guy that makes accidents happen."
I told them both that depressives don’t threaten doctors but that drug addicts were notorious for that kind of behaviour so that I was reassured I'd made the right diagnosis and thanked them. They'd get the right kind of care in the right place for their principal illness. Other people would be a whole lot safer even if I wondered about the future state of my health. There’s a tough love policy in alcohol treatment. It’s not that we don’t care. It’s just that we know that once an alcoholic or addict goes over an invisible line he 's not really himself . It's usually months into sobriety before the real person surfaces.

The psychiatric nursing system fed into the problem because unlike nurses in treatment centres, they really were used to dealing with people who were affected by circumstances. Schizophrenics will remain stable unless their landlord starts to hassle them. Psychiatric nurses understand this and provided the nurturing care appropriate to these conditions. The job of the social worker in the traditional psychiatric unit is to try to change the patient's environment back to a more conducive one.
That’s the exact opposite for an alcoholic or addict. Things are never good enough for them. They blame and want everyone but themselves to change and then they're still dissatisfied. Unless they have their drug or drink of choice and then everything is just fine. The natural state of the untreated alcoholic or addict is “irritable, restless, and discontent”.
This is changed by stopping the drugs of abuse, associating with sober people, understanding and group therapies and spiritual and emotional development. If a drug were to be the answer they’d all be cured because mostly they’d tried almost every drug known to man. Medications are symptomatically adjunctive therapies but addiction is primary disease. Most recently it was the self prescribed “marijuana maintanance programs” that were most popular but in the past it was the barbiturates, the valiums and other benzodiazepines. They only postponed the crash and made for another addiction in addition to the primary addiction. That’s not something they’re ready to hear. Pills and booze have been their life solution so what they want is more drugs.

To most of them I was threatening their jobs. They didn't care I was saving their lives. When my colleague returned from the conference we had a meeting. He tried to get me back on line but I explained that in good conscience as a doctor I would be remiss in not making the diagnosis as I saw it. After the meeting he was kind enough to say, “watch yourself. You’re right. I’ve got children so I wasn’t ready to confront them.” I knew that was only part of it. He was a real play it safe political sort and maybe favours were being exchanged.

The other thing that had really been a motivation for me had been how mother’s didn’t want their daughters to be admitted to the psychiatry ward because of the ‘reputation…"you know the men….the drinking”. What really upset me most was when the suicidal elderly lady said she couldn’t go to hospital because all those dangerous men were there. It wasn’t a forensic unit but the smell of a psychiatry unit rife with drugs and alcohol is rank.

That night friends were over at my house when the sound of pinging on glass caught our attention. When we investigated we found holes through the windows on the ground floor . It looked like 22 bullet holes or BB’s. There was no one in the place where the bullets appeared to have come from. Just some cigarette butts and a couple of beer bottles.

I’ve been asked when I tell this story why I didn’t phone the police. The simple question is what would they do. My girlfriend complained the next week to the police when her windshield was smashed in and her car filled with empty beer bottles and cans. When I explained about the hospital the police just smiled in that certain way. They're not going to make work for themselves.

“It’s probably just kids.”

For a couple of weeks I’d come home to broken beer bottles on my doorstep or in the back yard. At night I’d get death threats on the phone. Eventually I figured it had gone on enough.

There was this wet group I hunted with on occasion. We’d grown up together and gone our separate ways. They rode Harleys and partied with a group of guys called the Hell’s Angels. I invited them to come hunting for the weekend.

Four of them drove through town on their Hogs, rifle cases slung to their bikes plain as day and for some reason just enjoying tearing round the town throttling so everyone seemed to know they were there. They drove up to the psychiatrists house and came in to spend the night. The next two days we hunted north of town. I slept well. I didn’t know I’d not been sleeping that well till I had the companions and the comparison.

After that the harassment stopped. I think it had something to do with that weekend. After that the problem stopped too. No more drunks on the psychiatry ward. They couldn’t be certain I wouldn’t be on so it was better to work it out with the emergency doctors and go to the treatment centre than try to do it the psychiatric route because if they did it that way they were on medications that had to be monitored and they still couldn’t drink. In the past the medications hadn’t been monitored and they took them when they wanted but in drug and alcohol treatment with urine testing being done it’s just as easy to check for psychiatric medications. They ‘d liked the valiums, clonzepams and ativans but the other psychiatric drugs they’d chucked. Who wants to take antidepressants or antipsychotics when you'd rather have a drink or do some real drugs.

The psychiatric ward got quieter. The depressed weren't just conning and the young women and old people felt safe again. The treatment centre filled up with men while the women moved down the street to the new woman’s shelter because they didn’t much like the kind of clients that were now showing up in their treatment centre.

“Things are better at the mill. Our accident free days are way way up. Morale is better than ever because the majority of guys don’t have to work with guys drunk or stoned or hungover. “ he told me that one day in the coffee shop when we met again. He had introduced me to the president of the largest corporation who wanted to thank me personally. So there I was with management and the union leader.

“Thanks, “ I said. It was the nothern way. An honest request and an honest solution.

“Tell Bill, my boy and I’d like to go hunting with you two again sometime.”

“I will", I said as I left for an afternoon clinic.

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