The Cardinal

 Scars are a gift. They allow us to show the world that not only have we been hurt, we have healed. The deepest wounds are the ones that fester inside our minds. They are allowed no healing light. No escape. There is no salve that can relieve that suffering. Temporary respite can found with the addition of a distraction. A drink, a drug, an obessive behavior can turn the pain down to an almost manageable level. Yet, It is always present. 

         I enjoyed working with clients that other providers in the community found difficult. Why? I am not entirely sure. I think more than anything, I believed everyone deserved to be healthy and perhaps even happy. Not a new concept. The people who come here have had lives before addiction that I found to be quite fascinating. I didn’t see my goal as trying to fix them. I saw my role as being a mirror to the solutions inside of them. For one brief moment in time, we build a connection. Then life moves on. 

There was a growing pool of individuals that would get what society deems as “clean and sober”, taper off their medications. Others would be what were commonly called “lifers”. They experienced a tremendous amount of stigma for staying on the clinic when really how was this medication different from heart medication, insulin, or any other life saving drug? I found the rules related to methadone to be limiting to the grow of patients to the point I felt like I did my best to work around them. A new competitor in opioid treatment has entered the ring- bupephrenorphine. This medication was given at a doctors office. There was no constantly demeaning lines. Meds could be picked up at a drug store. Within a short period, many of those (mostly white, mostly well off) patients were getting two weeks of take homes at a time. Our clients, in a best case scenario, had to wait two years for the same schedule. It did not provide much hope of normalcy. 

          There were also big changes in my life over the past year. In terms of the job, my work site and duties had changed. I had moved into an experimental program run in cooperation with the clinic and the city called the mobile methadone van. The van allowed for a dosing nurse to give out medication in a community setting five days a week. The other two days, that site would be closed allowing the majority of the clients to receive automatic two weekend take home doses, a luxury of epic proportions. It also made it easier for folks with limited mobility that lived in the area. The little victory of having found an exception to stifling federal rules boosted the spirits of both the patients and myself. I had to smile when I saw those little brown lunchbags head out into the world on a Friday morning. 

       In other news, I had a miscarriage at ten weeks. I felt sick one morning when I held my calls to walk a block to the drug store for a pregancy test. I went into the shared client bathroom to get the results. I felt so self conscious, I took the stick with me in the backpack. I didn’t want the person who came after to find in in the tiny trash can.  I waited all day to show it to my boyfriend. But that happiness was short lived. In true circle of life fashion, I started bleeding a month later in that same bathroom. A trip to the hospital followed. My faith in the universe was broken. I didn’t realize how much I had wanted this pregnancy until it was taken away. For months after, it was hard to walk through the door knowing that this event that had made me so profoundly sad had started in this place. I would sit in my office in the darkness and wonder why the fuck I even bothered to come here. I was walking in a haze where my life seemed to have lost its purpose. 

       Whenever I took a few days off, the clients liked to grill me about what I had been doing. I had just gotten back from my four day Honeymoon in Hawaii. It was a shotgun wedding of sorts, we agreed to get married when I was pregnant. We dedicated to go ahead with the wedding after the miscarriage. It was an exorcism of sorts. A chance to shake off the bad spirits that circled around our relationship since that horrible day. I was sunburned more than any kind of tan, exhausted from days of hiking. I had poured myself into an adventure hoping to clear my head for a few minutes. 

     “You look like a bloated lobster…” only the happiest of mornings with this crew. 

      “Good morning to you my friend! So glad to be home again.” 

      As I walked over to open up my office, one of my older clients called to me from across the street “Are you open yet?” 

       I shook my head and gave him the hand sign for five minutes. In the time it took for me to lock up my purse, turn on the lights, and open up doors the client had taken a dump next to the garbage can. He was in the process of scooping up the cardboard he did his business on and throwing it in the trash when I walking back out to get him. While this sounds disgusting 1. This client had a medical condition that made his waste a biohazard. The level of consideration on his part was remarkable. 2. It was my fault. An absolute rookie mistake on my part. If a client asks if I am open, from that day forward I always ask them if they needed to use the bathroom. There are medications and medical conditions that made it immpossible to wait. So, when I say this started out to be a shitty day, I meant it. 

     As an absolute workaholic, sliding back into work was natural to me. Instead of drugs, these days I buried my discomfort in staying busy. I knew this could be at my own peril. The person that was hired the same day as me had already relapsed and requested to come back as a client. He was referred to another clinic to avoid an awkwardness. I completely understood. A few weeks prior, I had found a full syringe of heroin. I am not going to lie, I was tempted more that I was disgusted. Squirting that into the toilet felt like a waste. 

       Before I turned to my other work for the day, I did my morning wake up call for The Cardinal. The Cardinal had been a thorn in the side of the clinic for years. He was on the no show leaderboard each and every month. A client would get discharged if they did not show up for their medication for fourteen days. After missing five days in a row, they would have to see a medical professional to assess if they could receive their full dose. Month after month, The Cardinal would float in at closing time slowing up the gears of progress. Having to wait would anger The Cardinal. He would start yelling at whoever got in his way. 

“Why are you making me wait! You know I am sick!” By this point The Cardinal would be frothing at the mouth. He had part of his jaw removed after a bought with cancer. When I part beggged/part dragged him into get his follow up, there were quite a few shocked looks. Not at his appearance. They were used to comple cases. The fact that he was still alive and kicking. 

The Cardinal had been a farm boy that enjoyed traveling over to the wrong side of the tracks. While he enjoyed the occasional snowstorm, opioids were not a big part of his life until his late twenties. According to him, the back breaking work and stress of raising a child born when he was only 18 pushed him farther and farther into opioids. 

        “Wait wait- The Cardinal has children?” Brandice stopped me mid sentence. 

        “That’s what he said. And a grandchild too.  He said he wants to go visit them.” He talked in a way where he frequently had to repeat himself which would work him up even more. 

“I promised him a take home to go visit if he could write up a letter.” (I wrote the letter). He did go. He always swore the family just wanted him for “His money.”

“What money?” I laughed with him a bit. I had not forgotten the time he had brought me a plastic bag with $512 in it. He had a habit of wandering into places where he was not supposed to be. Apparently, this was hidden under the carpet in an apartment remodel. 

The Cardinal asked me “Will you hold this for me? In your desk?”

First of all, no. Second of all, hell no. I could picture this man banging on the door at all hours of the night saying I “took” his money. Plus “I am not a well person.” Not to say I didn’t trust myself. There was a tiny piece of me that made me wonder. 

I hung up the phone. The Cardinal was leaving his nest. 

Mr. Batt was back with a vengeance after a brief stint in rehab.

“Trace,” he reached across my desk to grab his bottle for his urine test.  “That place was just not for me. They told me every single day that I was not clean because I was on methadone. I fell asleep for two seconds in a group. The counselor shook my shoulders. He pointed to me saying look he is high. Motherfucker have you ever considered that these groups are boring? I’ve been listening to the same thing all day long. So I went to smoke and never went back in.  By the way, I think we might have a winner. I think I can finally hit all of ‘em” He darted off in the direction of the bathroom. 

The clinic tested for a little bit of everything. Heroin, cocaine, benzos, methamphetamine, other opioids, and we tested for the presence of both methadone and methadone metabolites. Clients occasionally tried to “cheek” or hold part their dose back in their mouths to share with a friend outside. The nurses were on to this and made small talk at the dosing window. Still, I’d be lying if I said I haven’t bought a dose of mouthadone outside of this place when I was using drugs. Desperate times call for desperate measures. 

He dropped his sample into my collection box. 

“Where are you staying now?” I spun my chair around to follow Mr. Batt. He had now parked himself on my couch. When I switched office locations, it came with a few upgrades including occasional moments of silence and a sofa that magically appeared. 

He kicked his shoes off. He must of changed his socks before he left the rehab because they didn’t have that familiar smell of corn chips that come from stinky feet

“I’m staying right here until you kick me out.” And there went another hour of my morning. How do I record that in the case notes? I had to eventually evict Mr. Batt when a scheduled client arrived. 

       “Mr. Slaughter would like to see you,” I get a call over the walkie talkie. My new office is located in the belly of a building owned by a corporate rehab facility. The front of the building is a mixture of people coming in for intake to the program and day treatment. I rarely see those people because I leave this location at 9:00am. The back section is a payee program for folks on disability benefits. The patrons get money either once a week or even small increments once per day. While I am here to open at 6am, that office doesn’t open for a few more hours. Yet many mornings, I get anxious individuals ringing the bell over and over and over. 

      “Is Mary here?” It’s dark as hell outside. I’m not opening the door to anyone I don’t know. This person, Mr. Williams, he’s a regular. He is here for his daily $10. “Not yet Mr. Williams. You have to turn your clock back. It’s daylight savings time. It’s only 7:45 am.” Mr. Williams shuffles off but I know he is just going around the block and will be back again in ten minutes. 

      I am here alone or with one other counselor many mornings. The Methadone Van with it’s armed security guard is parked in the lot behind the building. The initial thought was that only “highly functioning” stable folks would be assigned to this location since there is only a brief period per day when the van is open before the rehab people arrive. The rehab thought it would be great to create a system where a handful of their clients could get on the van site and detox off methadone while in their center. Quickly, that fallacy was revealed. As the saying goes, life finds a way. Clients are smart. They began to sign up just to get those coveted slots then drop out of treatment. In addition, the clients that stayed would decide they did not want to taper off. I received many angry phone calls. 

      “Hi I’d like to speak to you about Brenda Morris. I’m from Fairmont Treatment” 

      I’d ask if they had a release of information, a form that provides consent for the two health organizations to talk. 

      “No but…”

       Okay well call back when you get that. Click. 

       Later it would be “Listen Tracey Helton. This is Jack Wright. I know you from NA. I want to talk to you about Brenda and her methadone dose. I know you know who I am.”

       Sir, I thought it was an anonymous program. Click, bye. 

       Mr. Slaughter was inherited from another counselor. He had requested to transfer to the van because he did “security” for a construction site which meant he was up all night, slept most of the day. I don’t think it was a formal agreement of any sort. He was an easy person to get along with, quite personable, when he wasn’t drinking. He swore he had stopped. “My kidneys can’t take it…” 

It was him and his two rescue pit bulls. The first dog Baby was a notorious pigeon killer. I am not sure what it was about pigeons that set her off. Maybe it took its job as a protector a bit too seriously. Or maybe pigeons looked like squeaky toys it always carried around in her mouth. I’m not entirely sure but I believe it was up to pigeon number four. The other dog, a male named Prince, had been a bait dog. Mr. Slaughter had found the dog bloodied with injuries one morning where it had been dumped. He successfully nursed him back to health. The two were now inseparable. Timmy Slaughter was not going anywhere his dog could not go, which meant showers were extremely rare. There weren't many places that allowed a 6’4” man with scraggly hair, broken teeth, and dirt from head to toe with two scarred up dogs in their establishment. 

      Prince was easily one of my favorite dogs, so much so that Timmy brought me a picture to hang on my shelf. Soon, there was a competition among the clients to fill my space with cute pics of their own animals. These sat next to the Teddy Bear Mr. Batts had given me, a sharps container that mysteriously would get filled and replaced, and a laminated card the staff had made for me when I got married. 

       “Congrats on getting married. I was married once.” Mr. Slaughter threw a toy to Prince. Baby was chugging water I had put out for her. They had to walk a few miles to get here. “I was married. I had a child too- a daughter. I spent all my time working out in the oil fields in Texas. I worked 70-80 hours a week. One day they pulled me out. They say there had been an accident. Both of them were killed. Asked me when I was going to come back to work. I started drinking then. Never went back. Heroin was later. Hell I used to go to church. I spent all that time believing in the dreams of other people when everything I needed was right there at home.” 

     The loud SQUEAK of the toy broke the tension. The dog rammed itself against Timmy’s leg searching for a pet. I searched for the right words. They never came. There were mornings when I hugged the clients or cried with them. This morning, it seemed more appropriate to sit in silence. There was no comfort I could provide. There was no lemon tree. No performative words of condolences would be adequate. Just silence.