“Good Looking Creatures”

By

Carol Schaye

  The sound of helicopters was a disruption but a welcome one in the skies above. A group of registered nurses was gathered in a counseling center room to continue their weekly group treatment toward recovery from alcohol and other drugs.

  The center was an outpatient treatment program for registered nurses who had developed a substance use disorder.

  Good-looking creatures get preferential treatment in our culture. Jackie, the center’s counselor, was a giveaway when Jacob visited the treatment center for his initial interview. After years of working as a drug and alcohol counselor, she developed the ability to hide initial responses based on the client’s looks. He was so good-looking it briefly shook her long-worked mask of indifference.   Not a movie star’s blonde hair, blue eyes, and looks, but rather this calm, wise-cracking, very smart, I can protect you if you need me, and I will.

  The female clients later remarked that he looked like Bradley Cooper, with an alpha male sense of himself going against why he had been referred to an outpatient treatment center.

  Jacob was late for the group this evening, making the other participants uneasy. He was that guy that everyone wanted to hear from. Initially distant, he had become supportive with an easy answer for others. Nurses learned professional behavior as part of their training. It was no easy task for a Counselor to convince nurses to show their true feelings publicly. Jacob, who was great at supporting others, rarely revealed anything other than superficial feelings.

  It wasn’t until the opiate epidemic came crashing into their children’s bedrooms that the middle- /upper-class parents’ beliefs changed. Substance Use Disorders were diagnosable, treatable, billable illnesses. Perhaps there was a chance for recovery after all. Suddenly Jackie was in great demand.

  Previously Jackie had begun to challenge her own beliefs. Was she Hickey in Eugene O’Neil’s play “The Iceman Cometh.”   She had seen so much relapse, back to substance use, she wondered if she was selling her clients a false promise. Had it not been for the opiate epidemic, Jackie would have returned to hospital nursing (she was both a nurse and a counselor), tired of the struggle to convince other healthcare providers that her clients could get better while seeing so much death, crime, broken families, ruined lives. She was not even certain that there was hope.

  Jackie’s argument had always been that we under-treat and under-finance the opiate problem because it was for the poor. But like a lightning strike from above, the pharmaceutical companies and many physicians saw a great opportunity in the upper wealthier classes. We were now all in this together; Jackie was the go-to girl because Registered nurses were needed for treating other people, not to be treated themselves.

  Desperate wealthy guilt-ridden family members participated in a drama with a possible positive outcome.

  When Jacob began group counseling, it became apparent that he could work the house. Once a cop back east, that cop thing wasn’t gone. He just combined it with his special nurse thing. Handsome, even though she was twenty years his senior, it continued to unnerve Jackie. It wasn’t only the handsome thing; it was the witty, “I’m listening to you” close attention to what women were saying.

  Wearing khaki shorts and a blue oxford shirt matching his shocking blue eyes, he was wearing a slight grin, presenting as though all was well with the world. The counselor needed to be more at ease, not the client. He had his drink with him and didn’t need anything.

  Jacob’s seat of choice was sitting right next to Jackie.

  The State Board for Nursing was impressed with Jackie’s credentials and signed a contract to refer nurses to her, believing that her background as a registered nurse would make her a standout amongst counselors. Groups were filled to overflowing soon after opening. The word had gotten out that a counselor in town knew the hardship of being a Registered nurse; costs were kept low, and there was plenty of empathy for clients.

  Nursing was feeling the same pressure as other workers. Corporate was everywhere; all medical entities were on the stock market. Health Care was becoming a “Growth financial industry.” One hospital gave its registered nurses the gift of a pair of socks with the hospital’s emblem for Nurses’ Day. Insulting, degrading, and condescending, nurses were trapped between their love of their work, their knowledge that nursing was their way out of poverty, and their desire to respond to injustice. The managers could divide nurses one from the other so effectively that a saying about nurses, “Nurses eat their young,” became almost true.

  During his first group session, Jacob relaxed briefly as he told his story. Before moving out West, he had been a Deputy in another state back east, where his family of origin remained. His older brother was also a cop in a small town in New Jersey. Currently, he is married to a third-grade teacher. He had decided to go to Nursing School after retiring from the police force. Making a mental note, Jackie wanted to inquire, in the future, why Jacob moved three thousand miles away from his family of origin.

  The Nursing Board had not only suspended his license, but they had also taken it away for one year, and he would have to reapply after one year of total abstinence from all mood-altering substances. He had been accused of taking Fentanyl from the supply in the unit where he worked. Fentanyl, an opiate primarily used for pre-operation sedation, was not in the category of opiates highlighted in the press at the time. He had denied taking the Fentanyl, so without actual proof but rather another nurse’s suspicion, the nursing board put him on a monitoring contract. The details stated that he could continue to work as a registered nurse so long as he had regularly observed urine drug screens which were negative for all mood-altering substances. It didn’t take long for him to begin taking Fentanyl, a controlled substance from the workplace again. Eventually, he found himself as a patient in the hospital’s emergency room where he was working. He had taken so much Fentanyl that he passed out at work.

  Without a nursing license, he found himself looking for jobs that would allow him to contribute to the finances of his young family, which by now included a six-month-old daughter. Unlike ordinary citizens with Substance Use Disorder, Registered nurses face extreme lifestyle consequences during this crisis, without a nursing job; they have no health insurance to seek treatment for their Substance Use Disorder and no income to pay the middle-class payments they had accrued as registered nurses. Almost to a person, the nurses were in deep financial debt with student loans.  Nursing is known as a stepping-stone profession, allowing lower economic bracket kids to move into the middle class.

  Several nurses treated for medical issues had become addicted to post-operative opiates given to them freely and loosely by physicians, who ultimately should bear some responsibility for our current crisis. By its very nature, the nursing job involves hours of physical activity, often leaving nurses with residual physical issues. Recent years have brought a change in health care focus. Patient satisfaction surveys asked patients to rate their nurses not on the quality of care for their medical problems but rather to place them on personality issues. Leaving a fantastic nurse who attended to patient medical needs impeccably, scoring low on satisfaction if the uninformed patient didn’t care for that nurse’s professional but distant personal style. The saying in the hospital was, “Hit a physician, you get discharged; hit a registered nurse, you get treatment.” Whether quantifiable or not, nurses perceived patients as entitled, often feeling like the nurse was a waiter and the patient was in a hotel.

  Very aware of and having done the nursing stroll herself, Jackie remembered the exhaustion at the end of the day, standing in the nurse’s station with her shift exchange report, ready to go home.

  The comfort for her had been alcohol. In all fairness, she had been working as a registered nurse before the opiate crisis, when alcohol was a nurse’s go-to relief. Somewhere along the continuum, she realized she was drinking too much, drinking alone, and not wanting to go to parties without alcohol. So, she stopped drinking. Some people can do that. Others don’t know how or don’t want to until the consequences force them. Jacobs’s reasons for using Substances were far more complicated and disturbing than initially thought. 

  The person contracted with the treatment center to test the client’s urine drug screens were as good as they got.  Degrading as it is, the observer must see the urine stream coming directly out of the client’s urethra. Not out of criminality but rather illness, clients have strapped baby urine to their inner thigh, emptied their bladders with a foley catheter, and injected someone else’s clean urine before being tested.

  Some clients were asked to introduce themselves while summarizing what had gotten them referred to treatment. Allowing Jacob to hear to understand that he was not alone and could improve.

  Sydney, a female nurse around 56 years old, told her story. She had multiple medical issues, including status post uterine cancer. Her physician gave her oxycontin post-operatively. She woke up feeling all was well with the world; she was even attractive, so long as she took the oxycontin. A caretaker of others her entire adult life, all she ever wanted to be was a registered nurse. She worked as a cashier at Walmart, attended nursing school, and graduated Suma Cum Laude while working at Walmart full-time. Then one day, a nursing supervisor opened a bathroom door to find Sydney injecting Dilaudid (an opiate) into a thigh muscle. The Dilaudid belonged to the hospital; it was not prescribed for Sydney. Deferring is the euphemism used when nurses steal controlled substances. To sustain her increasing tolerance, Sydney had begun deferring.

  Sydney, the first nurse to tell her story, had never been arrested, had always been a good citizen, had paid her taxes, and had given outstanding care to her patients.  Fired from her nursing job immediately, facing a brutal inquisition by the Board for Nursing, that presented as punitive and not caring, she opened the gun case at home and sat with her pistol on her lap. Her husband walked into the bedroom, snagging the gun from his sobbing wife, demanding to know  in a less than empathetic why she wasn’t at work. When she told him the story, he looked down at her.

  He said, “You are a fucking junky,” walked out of the room, called 911, and did not visit her during her month-long stay in the Psychiatric/ Chemical dependency unit where she was initially placed on a Legal restraint for ideas of suicide. Most recently, she was abstinent with three years under her belt and working as a registered nurse; her story was meant to reassure the new client that there was hope. Leaning forward in his chair, attentive to the story, his expression never changed. He was establishing himself as a viewer, as an outsider with his physical posture.

  Although the culture was becoming more accepting of Substance Use Disorder in the general public, the pressure on Registered Nurses to maintain the “Angel of Mercy” image was still very much in place. Despite the changing job, requiring nurses to do procedures that had once been doctors’ jobs exclusively, the role included more patients per nurse, as dictated by corporate headquarters, who deemed nurses a necessary but expensive commodity. If corporate types saw what was coming, that registered nurses were not only not immune to Substance Use Disorder but were meeting many of the criteria for it, they should have done more proactively in the way of prevention. Historically State Nursing Boards were given the mission to “Protect the public,” so even if the staff was empathetic, their written mission was to protect patients from these nurses.

  Known as a group for their caretaker personalities, nurses have easily been manipulated into over-extending themselves for “The sake of their patients.” The question “Who will care for the caretaker?” was not a consideration.

  Jackie felt a sense of purpose herself. Working with the Registered Nurses was essential for her; they remained Angels of Mercy, but ones whose wings had been clipped.

  After Sydney, the first nurse shared her story, Jackie asked Ellen to tell her story.  

  Ellen said she had been a nurse anesthetist in the past.  Most recently, she was a registered nurse doing chart reviews at a local hospital. Ellen had successfully remained abstinent from mood-altering drugs for five years. Nursing Board contracts often demanded two to five years of care and observation for contracts. About to complete her contract and move on, she presented as the wholesome all-American woman she had been raised to appear to be. Her father, a Physician, had died of a morphine overdose. Her mother was currently in the end stages of Alcohol Use Disorder, with liver failure, but Ellen could do nothing to help her mother. The only person she could rescue was Ellen. That concept was very foreign to nurses, it had taken five years of counseling for Ellen to grasp this idea, but like an evil devil, it sat on her shoulder, waiting to take her down. Fentanyl, used as a preoperative induction medication, lay at the head of the table among other drugs to be used during the procedure.

   Responsible for the care of these drugs, Ellen had begun signing out more than was necessary for the surgical case she was participating in. Initially used as a weekend party drug, Ellen had increased frequency and amount and had begun putting atropine eye drops in her eyes so her pupils would not look pinpoint as a result of Fentanyl which is a synthetic opiate. (Atropine dilates the pupil). Her last surgical case before being fired was a Lobotomy. Ellen taped a ten-cc syringe to her calf, injected a butterfly needle into a vein, and several times,though scratching her leg, injecting Fentanyl. Ellen’s employer had not reported her to the Board or the police; the hospital dismissed her after noticing she was making too many medication errors. Ellen did what she had to; she began buying heroin on the street, eventually passing out in the stairway of her apartment building, where her stunned but loving husband found her. Ellen had been seeing a psychiatrist for one year before being terminated from work. She said that she would shoot intravenous fentanyl and cocaine (a speedball) before her doctor’s sessions, but her doctor never picked up that she was using drugs. They were addressing what he diagnosed as her “Depressive Disorder.” When Ellen’s husband found her passed out in the stairwell, he immediately contacted the Hazelden/Betty Ford Treatment Center in Minnesota. He arranged a thirty-day inpatient treatment that specialized in impaired nurses. Ellen injected cocaine and heroin in the airplane bathroom on her way to therapy because she said, “I knew it was finally over.”  The nurses who shared their stories with Jacob shared some necessary recovery tools. Taking an honest look inward, they engaged in the group process sooner or later, sometimes resistant, initially finally accepting that no one else could wave a magic wand, making them normal again. They would always remain subject to the possibility that Fentanyl or any other drug was waiting for them to make a slip. Ellen, like Sydney, had avoided legal consequences for her illegal use of a controlled substance. As that first group slowly ended, Jacob remained behind to speak with Jackie.

  “Can’t I just see you on an individual basis?”

  Feeling unique, different, or special goes with the territory of Substance Use Disorder. Jacob’s desire to be unique was routine.

  “Let me walk you to your car,” He said as she turned off the lights, closing the center. The parking lot was dark, and the treatment center was in an industrial area. ‘That cop thing again.’ ‘Damn,’ she thought as she drove off, he will be a challenge.’

  During the following weeks, groups were considerably more relaxed. Slowly, Jacob became an important part of the process.

  Other nurses left the seat next to Jackie empty if he was late to the group. The group support seemed to work. Jacobs’s car had broken down, and he shared with the group how frustrating and impotent he felt; his low-paying job at Office Depot made it difficult for him to afford repairs. Family issues began to emerge, often speaking of his wife’s frequent fear that he was going to or had already used drugs again. The more he engaged with the other nurses, the more they all began to like and adore him. He had a witty sense of humor and was eager to listen to other nurses’ daily struggles with abstinence and their financial and relationship problems.

  On occasion, he would tell cop stories, which everyone liked hearing.

“I can’t tell you how many women had called the police for assistance because their husbands were beating them, were hanging on my back punching me, screaming at me not to take him off to jail.”

   “You can’t imagine how much heroin I have held on drug arrests and never thought twice about it.”

   A family session with his wife was scheduled. As pretty as he had described her, she was madly in love with him. She knew nothing about substance use disorders and was a willing participant in the session. Jacob brought up the ongoing worry on her part that he was about to or had used drugs again. He had been using drugs for years without her knowledge before treatment, so how would she know? Although she was given a referral to a 12-step program for family members, Jackie gave her some urine drug tests to take home, and they all agreed that if she got distraught, she could conduct a test on Jacob. She was also invited to attend other couples counseling with Jackie, but she declined. Their schedules were overbooked already. Jacobs’s wife had never even smoked cannabis. Jacob’s wife knew nothing about Drugs. Terrified and at first not believing what she heard, she had worshiped her handsome, smart ex-cop husband. Uncertain of what an opiate was, she asked questions when she met with Jackie and Jacob

  The issue of Jacob’s wife’s worry over his possibly using substances again kept coming up in the group. He told the group how she called him into the bathroom during a family holiday at her parent’s house to confront him about what she thought was blood on the sink.

  “Where are my rigs? What are you talking about?” Animated and agitated as he told his story to the other nurses, several responded that they had similar family or loved ones who were often afraid they might have relapsed.

  Any ex-cop, now a registered nurse, would have certainly been the best candidate to figure out how to use drugs and still present with a negative drug screen.

  “Perhaps your wife might attend some meetings with you.” One nurse suggested.

  “It just takes time,”

  Maintaining total abstinence for almost one year, he was getting close to applying for his nursing license on a limited contract basis.

  Unexpectedly, quietly and without warning, the sky collapsed during an individual session with Jackie, and the world would never be the same again.

 Cautiously and after a previous discussion directly with his psychiatrist regarding how to address the topic of his family of origin, who lived back in New Jersey, Jackie had been curious why he was so distant from them, why he had moved so far away, starting a new life out west. Still, she had waited for close to one year of documented abstinence on Jake’s part and allowed him to lead the way.

  While generally speaking about growing up in a significantly competitive family, Jacob mentioned a second brother he had not spoken of before.

  “You have two brothers?” she responded, staring at him inquisitively.

  “Yep,” he repeated. “I had two brothers, not just the one you know about.”

  “Ok,” she nodded, wondering why he had misled her on his initial intake assessment.

  “My oldest brother was twelve years older than me.  I was the youngest. It began, I think, when I was about four years old.”  His pause seemed forever. “I thought he was playing with me when he first climbed above me from behind. We were wrestling kids’ stuff.” Jacob described in excruciating detail a history of childhood rape by his eldest brother, which went on for years, and how he had come to dread the nights alone when his parents left him in his brother’s care. Threatened that he would kill both their parents by his older brother, he was caught.

  As he continued with the details of the trauma, which so many people with substance use disorder have suffered in one form or another, Jackie sat still; she was one tough cookie; she had heard it all over the years, but as Jacob, the cop protector of women and critical care nurse, the most handsome most intelligent guy in any room continued speaking he began quietly crying.  As he continued to tell the most violent details about years of terror and abuse, she wrapped her arms around him as a nurturing Parent. She heard herself saying, “It’s over now.”

  Almost finished with his story, he said he had told his mother what was happening after the first few months. According to him, his mother drove him to church and made him go to confession. Nothing was ever said, and the sexual assaults continued, as well as the trips to church for Jacob, until his brother left home to go off to the military. His brother was killed in a helicopter crash during a training session in Afghanistan; no one was left to bear witness to his story.

  Jacob had told his wife the story but no one else ever. Without the benefit of Fentanyl to medicate his reality, it was all pouring out.

  Jackie made sure he was seeing his psychiatrist in town. Early childhood trauma like this needed a more sophisticated, informed treatment provider.

  At first, he had said, “Nope,” he said, no-shrink, “I’m okay now; I just needed to be honest with you.”

  “Nope,” she said, “No choice here; you have to see someone else about this.”

  Together they called to schedule an appointment with the best psychiatrist.

  Jacob complied.

  Perhaps a month later, he appeared at her office door without a prior appointment. Seeming agitated.

“I need to speak with you.”

“So, sit; I’m with another client; I’ll be right back.”

  “No, it’s okay,” he said as he turned right around, leaving” I just wanted to tell you I called my mother and confronted her; I asked her why she never stopped what was happening.” Jackie, the psychiatrist, and Jacob had agreed he would not take that action until all involved felt he was stable enough. Then they might outline a strategic approach.

 “I’m Okay, really,” he said, leaving for his evening shift at Office Depot.

  “She said it was my sister’s fault and mine; she said God would forgive me. She said the confession was what we needed to confess our sins to god.”

  Following him into the parking lot, Jacob was gone before Jackie could stop him.

  Jackie could not get him on the telephone. Jacob’s wife phoned Jackie, crying that she had just returned home from a brief shopping trip with the baby to find what she thought was a suicide note.  Jacob’s wallet and cell phone were on the counter. He had taken a gun from the safe

  Having contacted the local police, she felt the police department was not taking her seriously. So, she emphasized that he was an ex-cop.

  That evening as the other registered nurses came to the group, they could hear the helicopters overhead.

  The sound from the helicopters continued throughout the night.

 The following day a newspaper headline reported that a man had been found with what was thought to be a self-inflicted gunshot wound to the head.  A police dog had located a man slumped over in his car.

The End

 *All characters in this story are fictional, any resemblance to real people is unintentional.

*Understanding Child Trauma/Substance Abuse and Mental Health Services Agency (contact for assistance)

Trauma is a risk factor for nearly all behavioral health and substance use disorders.

There is hope. Children can and do recover from traumatic events, and you can play an important role in their recovery.

A critical part of children’s recovery is having a supportive caregiving system, access to effective treatments, and service systems that are trauma informed.

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