In which Nadja is a bit of a mess.

Sorry for the late post, I had an… interesting day yesterday. As you all know, I’m a case manager, and I work with the mentally ill population. I an intensive case manager, which means I have a small caseload (only 20 people) who are severely mentally ill and usually pretty risky. I’ve also been with my current agency for 3 1/2 years, so many of my caseload I’ve had that long, and I know all of them really well. When I get a new client, the first couple months can be a bit rocky, because I do not yet know them and they don’t know me, so the therapeutic alliance has yet to be. I got a new client about a month ago, and while he has a lot of needs, I figured he would be easy enough to handle.

Yesterday, he lunged at me when I told him something he didn’t want to hear, and later threatened to “come up here and take care of” me in front of the two police officers who were taking him out on a psychiatric hold. I was a bit shaken, but I managed to make it through the rest of the day. I definitely went to bed as soon as I got home, though. That was the first time I’ve been threatened by one of my clients and wholeheartedly believed it was going to happen. (I get threatened from time to time, it’s part of the job. I usually don’t believe they’re capable of it.)

Tomorrow he will be released from the hospital. We’ll see what happens then.

Needless to say, I hadn’t yet written a post for today, and that little incident put my blog pretty far from my mind. I’m actually surprised at how well I’ve handled this so far. I was shaking and crying initially, but so was the doctor who wrote the hold. She’d only been there for half of the event and missed when he came at me, which was honestly scarier than the verbal threat, because if one of my coworkers hadn’t walked by my office when he initially came at me and gone for help, I might not be here today to post this. And this all happened not a half hour after our site manager had been commenting on “we ought to keep our doors closed for client’s privacy,” to which my answer was, “The reason we keep our doors open is for our safety.” She then said it was up to ‘our discretion.’ (I don’t think she was terribly thrilled with being argued with, but I’ll take it. Usually she just shoots people down and declares that it is her way or the highway.) My discretion is my damn door stays open, because with my caseload? You never know what’ll happen. Even though I know most of them very well, things can turn ugly very quickly. I felt bad for this guy and his hard-knocks story until he threatened my life. He no longer is going to be working with sympathetic Nadja. It’s time for tough love Nadja.

It’s hard to do what I do, because I get it more than my clients will ever know. I sometimes am too empathic for my own good and have difficulty separating myself from the situation and seeing it from the clinical perspective and doing what I’ve been hired to do. Sometimes I get frustrated, too, especially when I work with non-intensive clients, who sometimes are less sick than I and yet they’re on disability and here I am, working my ass off trying to make a difference. Sometimes I resent those clients, which also makes it difficult to do my job in a professional, clinical manner. Sometimes, my job sucks. But as my supervisor said after it was all said and done, “Why don’t you call up one of your clients that loves them some Nadja, and go remind yourself why you do the job you do, and why you enjoy it.” Even when a client threatened my life, I was able to keep going, because I do have clients that love them some Nadja, and whose lives I have made a positive difference in. I just hope I can keep helping people, one way or another. Let’s hope that “or another” just doesn’t include dead. I have a vested interest in not being dead. I have worked too damn hard not to kill myself, to get strangled by a pissed-off client.

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