I found out yesterday that one of my patients died on Easter Sunday by a drug overdose. It's never easy when someone you know dies, but it seems so much worse when that person was in your care and you could have virtually predicted his death.
This 30 year old man came for his third treatment episode last month. He was well-known within the institution where I work because he had been treated a few times there and had always come back following another of his frequent relapses. When I first saw him I felt strongly that this was going to be a tough case. He was a gentle and kind man without bitterness toward anyone, who always seemed to have something good to say about his relationship with you. Yet, deep down, there were signs of trouble and my antennae were vibrating the first day I saw him.
He had little trouble grasping the intellectual parts of a program of recovery. He knew he was biologically addicted to heroin and benzodiazepines, and he knew he was going to go through a range of physical withdrawal symptoms in the early part of his recovery. He also believed in the 12 Step program, but there was a tragic flaw in this belief system: He felt strongly that the 12 Step program works to help some people stay clean and sober, but somehow it would never work for him. And, he had a sadness about him due to this despair. On the last day we met for a private session on March 30 we worked hard for more than an hour to identify the sources of this negative belief system where he told himself he could never get well. We labored over his thoughts and beliefs about the events that happened in his life. We challenged those false beliefs with the truth. We identified that he felt sad and hopeless when he would cling to ideas about how he might never get clean and sober, and, while he wanted to remove these negative feelings from his life, he could not feel a change in his emotions for the better when he thought about changing these negative beliefs. In other words, he had a belief that no matter what he said or did, nothing would get better.
He also proved to himself that he was an excitement junkie...he loved the thrill of the chase to get his drugs and he loved the pleasure his heroin gave him. He even admitted to me that he loved the idea that this might someday kill him...there was an exhilaration that he felt every time he thought about using. No matter how hard we tried that day, he could not remove this from his mind or see a way to neutralize the tremendously damaging effects of such thinking.
At that moment, I knew he was in deep trouble. I asked him to review his anti-depression medications with his psychiatrist and he said he would. I asked him to surround himself with positive recovering people who had been where he was and turned themselves around. He said he would. And, I asked him to talk about this to anyone he knew who might help him shed the weight of this negative, self-destructive thought. He said he would.
He didn't do any of those things after leaving me that day. Instead, a few days later, he started to use again and he overdosed on Easter Sunday morning at his home.
I resist the temptation to think of what more I could have done to help him. I understand that there is only so much another person can do when you are confronted with the disease as strongly as he presented. But...I know what I felt that day when he left my office and, as unreasonable as it sounds, I wanted to hold him there that day, arrange for him to go back into primary treatment, and protect him from himself by wrapping my arms around him and assuring him it was going to be OK. I wanted to jump up and down and tell him that this negative thinking was only going to end one, bad way. And, because a man's life was at stake and I did not do any of that, I am left with regret, remorse, and anger.
Of course, over the span of 24 years as a counselor, it is not the first time one of my patients has died while in my care. I know this will all pass as I focus on the future and the people still in my care who may be at just as much risk for dying of the disease of addiction. But, it doesn't get any easier each time it happens. I immediately think of Chris, Wendell, Becky, Rose, Bob, and, most of all, Kristine whenever this happens.
I have also become a lot more rigid in my thinking about how to treat this illness. I vow to react more aggressively toward the obvious signs of relapse, and to not allow a person to lull me into believing that extreme sadness and hopelessness will somehow work itself out. And, I plan to do more meditating and praying for guidance in how to deal with this kind of case.
So long as I follow that way, I have nothing to fear.
Roger W.
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