On any given day, I completely and utterly love my job. The work is hard, mentally and emotionally. Nothing is really easy in the mental health field – people don’t seek out treatment because they have sunshine shooting out of their ass, that’s for sure. Even so, I truly love the work because I get to be there and hold space for people when they are at their lowest lows. I get to be the ear they may have never had. I get to shine a light they might not have believed existed.
But then there are days like today when it’s hard. Days when something about the person or the circumstances is too close and touches a nerve I didn’t know was quite so raw. It’s always my goal to find a way to engage the people I work with on their path to healing. That might mean simply showing up for an intake somewhere or it might mean agreeing to inpatient psychiatric or substance abuse treatment. Giving the person the opportunity to have autonomy and make choices empowers them to go in the right direction. Usually.
And then there was today and a situation where the balance between keeping someone safe and maintaining their autonomy and personhood felt impossible to achieve. All the risk factors were there. But the willingness to get treatment wasn’t. Every time I’m put in the position of having to take a person’s rights away in order to keep them safe, I take it very very seriously. Today was harder than usual. I spent hours back and forth between talking to the patient, talking to the people who care about him, talking to my supervisor, talking to our psychiatrist and talking to the ER doctor. I was looking for a foothold, something that would teeter the balance heavily in the direction of safely allowing the patient to do what they wanted to do, which was go home.
In the end, I couldn’t. In the end I convinced the patient to meet with a psychiatrist face to face, to get a second opinion of sorts. In the end I put the decision in the hands of someone with a few extra, more expensive letters after their name. In the end, even though the decision was never just up to me, I simply couldn’t tell another human that they were going to lose their right to choose.
Autonomy has become a very big theme for me spiritually in the last week or so. It cropped up when I was writing about my dad. It came up in therapy and I made some connections that, while uncomfortable, were spot on. I have never been, and continue to be, not allowed any autonomy when it comes to my relationship with my father. Because I have been wrestling with such ferocity in the last couple of years to simply be okay with and accept who I am, when that autonomy is challenged by anyone else, I react immediately. It’s no surprise that today, when I was charged with deciding whether or not a person got to keep their autonomy, I had a fairly significant reaction.
I came back to the office where my coworkers were joyous and gregarious – I on the other hand was bristling and short. I hated that they were unaware of the storm raging in me. I hated that I had been stuck with this case while they sat enjoying each other’s company. I set my things down at a desk that is far away from the normal cluster of cubicles and I started to cry. All the torment I was feeling came leaking out. I was rather shocked. But also not. What was really going on hit me as the tears came – I was identifying with this person, I was tormented by the decision I was part of, and I was feeling my own loss of autonomy at the same time.
I didn’t, couldn’t, let it last. I quickly wiped my tears – there was no way I could explain why I was this upset over an average case. I got my long overdue lunch. I sliced my perfect avocado and scooped it into my salad. I set to work doing what I do – telling another person’s story, getting it ready for that psychiatrist so that he or she could see what I saw and hopefully make the decision I couldn’t. The right one. Whatever that means.