On Peanuts and Therapists

I haven't done much hands on patient care recently and forgot what it was like to be thrust into the action early in the morning, before tea, and half asleep.  It used to be before the second cup of coffee but since I gave up caffeine, there is no first let alone second cup to be had.

I volunteered to help with intakes since we are perpetually short handed.  When you work in substance abuse services, doing intakes can mean a lot of things can go wrong really fast depending on how many drugs were available the night (or even a few minutes) before a client comes in for treatment.  My intake was a youngish dude who was just released from the hospital, which means he probably wasn't high, and had been hospitalized to treat some medical condition related to his drug use.

I really wasn't that interested in why he went to the hospital.  I was more concerned with remembering everything I needed to get done during the admission.  Unfortunately, dude broke my concentration by asking me if I had a pillow in my office he could sit on.  He was in one of our plastic hospital issue chairs sitting in the hallway with a pained look on his face.   I noticed dude was squirming around in his seat and his hands were hovering over his balls.  His pants were tented out in the crotch, and I randomly thought and discarded the idea that he had a hard on.  He looked really uncomfortable, he wasn't high, and he wasn't trying to hide the bulge.  My assessment skills are so good I figured that out before consciously thinking how gross that sounded. Apparently I have mad assessment skills honed from years of doing my best therapeutic work in my sleep.

FYI hospitals use plastic chairs cause they're easy to clean, and bed bugs can't hide in them.  The chair in my office has a cushion, very conducive to bed bugs, and guys who are having some sort of ball pain as yet to be determined...Dude sat down gingerly in the chair and proceeded to ask me if I had read his medical records yet.  Now let me just say how nervous I suddenly got cause when someone wants you to read about their medical condition, especially substance users, no good will come of it.  Especially not at 7am.

 I decided to leave my office door open cause some instinct was warning me that dude really wanted me to check out the situation in his pants.  Sure enough, he starts describing the state of his penis.  He tells me he has a wound on it that really hurts and that he left his pain medicine at home.  he also tells me there is no dressing on said appendage and that the wound is just hanging out... Mad assessment skills in full force I turn toward my computer as he is reaching for the fly of his pants and tell him we need to get on with the interview.  Time for penis assessment later please.

Those of you in the know bear with me while I explain to everyone else just how desperate IV drug users can get looking for a good vein to shoot up in. Especially after they have blown most of them in their arms and legs.  Yep they get that desperate.

Another funny thing about addicts is that they seem to want to show people how they are wrecking their bodies one fix at a time.  I can't remember how often people have come into my office and yanked their shirts up or their pants down to expose the tragic wounds they have received from their personal war on drugs.  Addiction destroys a person one pound of flesh at a time.


 The morning went swiftly down hill as he proceeded to describe his penis shooting up ritual in great detail.  Having been trained in the latest therapeutic techniques, I thought and discarded most of them.  Dude didn't really need me using motivational interviewing open ended questions like "can you describe the rush you get from..."  Or  paraphrasing like " I heard you say that after your penis gets hard..." No I was leaning more along the lines of "do not touch anything in my office, I know where your hands have been."

So instead I used my dazzling therapeutic training to say, "so you been shooting up in your penis?"


To which he replied, "yep, I don't know what I was thinking."

"I do. You were thinking you needed to find a good vein."

"yeah," he agreed

In retrospect, the most therapeutic part of my morning was that dude managed to keep his pants on in my office and I managed to keep my wayward thoughts to myself.