My interior landscape has undergone a lot of remodeling lately, and I think I just fully recognized the extent of the changes during the course of this week. Wednesday was the big day– since then I’ve just been kind of wandering the new paths and trying to get used to the differences.

I am tired, tired, tired of my job. I am tired of dealing with people and their problems. I’m tired of dreading my next argument with Joe about his money, or the next day that someone walks in to tell me they have no place to sleep that night. I’m tired of ending conversations with "Hang in there– it will get better", even though I usually believe that it’s the truth.

One of our ex-clients didn’t make it to the part where it gets better this week. I heard that she died on Wednesday. I don’t know anything about it– how or why she died, what she had been doing since we discharged her, where or how she had been living. I can’t even remember her last name, and this bothers me a lot for some reason. I remember her quite clearly. She had the dual diagnosis with the worst prognosis: crack addiction with schizophrenia, and she was not on medication, because she was pregnant. She was pregnant for the eleventh time, and she did not have custody of any of her previous children.

She was discharged from our agency over a run-in with our ex-nurse practitioner, and this is also troublesome. I wonder if, with a different staff, with different actions, we could have managed her case better and prevented this particular death. These kind of thoughts are generally useless, serve to feed depression and nothing helpful, and need to get cut off and replaced with more positive thoughts right away. Usually, when clients die, I’m able to take a more realistic perspective, along the lines of : "our work matters because the diseases– mental illnesses and addictions– are fatal. If no one ever died from them, then what we did wouldn’t be as important. We save as many as we can, but people will keep dying from fatal diseases. If we continue to work, the death probably won’t end, but fewer people will die." It is not our fault, that is. Everything we do helps some people survive, who wouldn’t otherwise. An occasional death is sad, but not an indictment, not our failure– just another proof of the strength of our opponent. Sometimes, though, the "I wonder if there was more that we could have done?" voice gets a little loud. It has been a little loud in this case. Our N.P. couldn’t work with the client, because she refused to get pre-natal care. She probably refused to get pre-natal care, because an obstetrician would discover the cocaine in her system, so she would lose custody of another baby, and she didn’t want to lose the baby. She had choices, and she was unable to make good ones. Such a sad little life, and now it’s over. Over for her, that is– but she leaves eleven motherless children behind.

You can see why I usually can’t let these thoughts get very far.

This time, however, on the day that I heard of this client’s death, one of our colleagues also died. Laura Quinn Marquandt was the Mental Health Liaison for the Nashville jails. She was 36 years old, in perfect health, and died of an aneurism while working out at the gym. She was the person who sent me an e-mail each morning listing all of the arrests from the previous 24 hours, so that I could identify any of our clients among the names and get help to them while they were incarcerated. On her side, she would try to see that our clients got a visit with the clinic and some medications while they were in jail. She also conducted training classes so that people involved with the mental health system could better understand the criminal justice system, and so that people in the criminal justice system could better understand the mentally ill. This is a terribly important job, in a country which still provides a big chunk of the treatment for mental illness through the jails and prisons. Laura tackled it with an energy and enthusiasm which were infectious, never betraying how little appreciated her efforts were in the larger scheme of things. She dedicated her time to trying to get help to these least-valued members of society, while higher up in the government, all of the work is directed towards reducing the cost of providing these kinds of services.  I saw her hearse go by as I drove home yesterday evening– escorted by more than a dozen vehicles from the Sheriff’s department (which manages our jails).

The very same Wednesday of these deaths was the first day of my Kant seminar. How lovely to return to the ivory tower after a day of too much ugly particularity! How nice to imagine a life spent teaching philosophy to bright, young, healthy, beautiful people! But, not only this– philosophy has always been my first love. I went into social work out of necessity, not choice, exactly. I’ve known for more than a year that I don’t really have the temperament of an excellent therapist or social worker. I’m too introspective, introverted, too inclined towards depression, myself, to excel in this field for very long. On the other hand, I love philosophy so much that I found myself, on my vacation, thinking that I should really get started on reading Heidegger’s Being and Time, which is not the way most people choose to look for fun in their free time.

So I took a small step, on Wednesday, from a painful world where even the simpler parts of my job require a struggle against my natural inclinations to a beautiful place where I fit right in and have fun, besides. It’s been hard to step back. I doubt my heart will be fully in my social work again. I’ll keep doing it, because I can’t afford to stop, but for these and other reasons that I can’t discuss here, my attitude will be different; I’ll keep a little more of myself out of the work. I’ve crossed a line, and I can’t get back to the other side.

3:52:37 PM    comments? []