The Sum of its Parts
The setting: A Men’s Co-Occurring Therapy Group takes place in an 80+ bed rural addiction facility, in a small, snow covered state, in the freshly painted almost-purple, “Wild Wisteria” office of the psychiatric nurse practitioner who at the moment is screaming silently in her head. Her brains are still bouncing from an hour long commute while listening to NPR. Having the radio on the whole time was probably a mistake. She is feeling most things are a mistake, currently jealous of the Facebook posts she read this morning over coffee from soon to be ex-pats getting out of harm’s way, or friends with various inheritances, retirements, better luck. But there’s no time for that. She has more pressing issues: a full folder of psych referrals and right now a roomful of addicts for whom she is paid reasonably well to deal with.
The purple office sits smack in the intersection of two men’s units. A banner hangs on one wall: “Be the change you want to see in the world.” She looks at it so much that she barely sees it anymore. Sometimes she is so preoccupied she doesn’t realize her dress is inside out until lunchtime.
The stats, 1: At least 80 % of the men who meet criteria for addiction here are from the criminal justice system. 99% are white, the sons of loggers, of farmers, of drunks, of teachers. No one really has time to follow the numbers or interpret the data. That they are mostly white could be significant although she wishes it didn’t matter. Sometimes the sheriff comes to shackle someone and take him away. There’s a tendency to make metaphors here and the psychiatric nurse practitioner resists the temptation. But today one group member uses the word “comfort” when addressing another who says, and means it, “You’re like wrapping me in a blanket.” He uses this to describe how it feels to be in treatment in the facility, where shame is neutralized and maybe one can imagine something beyond. She eventually uses the word “metaphor” to describe the process but is unsure if they know what it means.
The atmosphere: The purple office hums with the foot-stomping rhythm of post-acute withdrawal. Of anxiety/fatigue/nausea/delirium. Of sweat. Of neurotransmitters struggling to flow across pathways destroyed by opioids and alcohol and crack and weed. The thrum of trauma. The scent of many men. An absence of despair, at least for today.
This absence speaks to a presence of its own. The walls sigh with relief. She gives the members each a piece of chocolate and asks them to read the messages printed inside the foil wrapper. “Draw yourself a warm bath.” “Smell the roses.” “Take the day off!” “Dance party!” “Tell someone you love them!” The men get into these lady-like memes, laughingly tell us how they would apply them to today, in the treatment facility, four to a room. Not a rose or bathtub in sight. But the chocolate is sweet and rituals are essential.
A group member says he’s never fit in, why would these guys like him after all he’s done. He says maybe he should try an antidepressant. He asks for help. His face is open and upturned, a small ray of sun seems to land on him for a moment. The psychiatric nurse practitioner comments on this.
The process: These guys are alive even as their livers turn to mush, veins harden into old garden hoses. Brain arboretum snipped and snapped.
Lines have been crossed or they wouldn’t be here. Even so, they are gentle with each other. She bounces back and forth between these worlds.
The stats, 2: In their small state, 2015 claimed 75 dead from opioid overdose. The nurse practitioner had known one of the victims since they were a child. Another was a young woman who had been in and out of treatment since pubescence. Another a sweet, sweet man from her first group years ago. She had a photo he sent from a hike he took with some of the other men, before he died. He was terrified of heights. They hoisted him up at the end and gathered round for the selfie. Familiarity gives these numbers a taste, a smell. Texture. In 2016 the number jumped to 105. And these numbers don’t even account for the DUI deaths or the Emergency Room visits or the Department for Children and Families files or the Probation and Parole numbers.
2015: 33,091 dead nationwide from opioids alone.¹ 52,404 all told.² And did she just hear, again with the local radio on, that 2016 data jumped 38%?³ The prognosis for 2017 is worse.
The metaphor: She is tempted on a bad day to call this spitting in the wind. On a day like today, she “comforts” herself with platitudes. “Recovery is a journey, not a destination.” “Keep it simple.” “One day at a time.”
She thinks she should contact the company that makes the chocolates and give them a whole bunch of ideas for their wrappers. She’d do it for free.
Her role today is as much ambassador as border guard. There was a time long before this when she never would have imagined it.
A large man, nodding precariously from his morning maintenance dose, is propped back up in his seat by his neighbor. He usually doesn’t talk much and fights the recommendation that his meds be reduced. He opens his eyes to the blanket metaphor. He adds his own.
He tells us, “This here, this is a safe neighborhood. I can walk the streets at night.” He smiles around the purple room, bright and alert before he tips forward again. Murmurings abound. Many neighborhoods are populated by inhospitable guests. The psychiatric nurse practitioner is no stranger to this.
As immigrants, all of us, maybe a sweet minute or two of humanity. She stays put, having shaken off the regret for now. They all have.
³ Vermont Public Radio, 2-16-17
Nina Gaby has been represented in numerous journals and anthologies, and currently focuses on the shorter form, using composites to illustrate the face of addiction and mental illness from an intimate perspective. Gaby is also a psychiatric nurse practitioner and a widely exhibited visual artist.
*** This is the author’s first literary award. ***