The Nomadic Social Worker

I have worked in many settings during my social work career and have enjoyed certain aspects of nearly all of them. As an outpatient child and adolescent therapist I became accustomed to spending my days in an office I had outfitted to be as comfortable for my clients as possible. The dim secondary lighting, the beanbag chair, and all of the hands-on games and objects present had the desirable added bonus of providing me with my own safe and comfortable environment.

When I went to work as a hospital social worker I appreciated the freedom to move around the campus as much as I needed or wanted. The facility was like its own little city, filled with different and seemingly unrelated departments and units that were, in fact, shot through with the common thread of the hospital’s personnel. Previously an incurable introvert, the hospital helped me develop a healthy and robust extroverted side as I had such a high volume of contact with so many different people. I came to thrive on these relationships and am still pleasantly surprised to see so many nurses and social workers that I know when I visit the hospital for various reasons, work or otherwise.

Performing social work at an inpatient dialysis clinic was a completely different experience and probably my least favorite setting. I relished having access to my patients on such a regular basis, but it was difficult to be in the building hour upon hour every day with not enough work to keep me busy. The atmosphere on the floor of the clinic, where the patients received their treatments, was thick with the boredom and frustration that emanated from the people that viewed dialysis as a life sentence rather than a life-saving medical intervention. I found the overall experience rather depressing.

So I enjoyed being in an office as long as I had my own space and plenty of clients and work to keep me busy, but my restless side yearned for the freedom to wander from room to room and floor to floor that the hospital provided. Surely there was some sort of compromise.

Enter hospice social work. There I found a job that might have eaten me alive had I not been a seasoned veteran by the time I entered the realm, but that happened to come along at the perfect time. I have the luxury of an office, but probably spend less than five hours per week there. The rest of my time is spent doing two of my favorite things: driving and talking to people. I am simply given a caseload and geographical territory and am responsible for managing them. My office is a 2013 Camaro SS with satellite radio and my computer is my iPhone, the bare essentials I need to perform my work. I subsist on protein bars, coffee, and loud music as I cruise from nursing homes to hospitals to assisted living facilities to patients’ homes, all the while practicing a very specialized and complex form of social work that melds clinical skills with medical knowledge and appropriate care planning and documentation. I feel like one of Jack Kerouac’s “Dharma Bums”, a modern day nomadic social worker delivering hope and compassion. This suits me perfectly and I am profoundly grateful that such a possibility exists.

In short, everything I have done career-wise has prepared me for this particular niche, and my great fortune is not lost on me. I wish all of you a similar path as you toil in the trenches. Until next time.



Reefer Madness: The Flip Side of Marijuana Legalization

I am by no means a moralist when it comes to the subject of drugs, illicit or otherwise. I would like to preface this post by stating a few things:

  1. I am an addict. While I am in recovery, I personally believe that addicts are physiologically different from non-addicts and have a propensity for drug/alcohol addiction not found in the general population. Even though I am sober, I will always have this biological make-up and the only option for me is complete abstinence as I cannot successfully moderate drug or alcohol intake.
  2. While my relationship with alcohol started at a very young age, my drug of choice ended up being marijuana. I have since learned that I enjoyed it so much because it was very effective in masking my anxiety (which is considerable and disordered).
  3. There are people who use drugs and alcohol recreationally and seem to be able to do so without suffering the effects as me.

That being said, with all of the attention that marijuana legalization and decriminalization has received in the media, I would like to weigh in with my own opinion based on personal experiences. I did not begin regular use of pot until I was 19 years old. I had smoked during high school, but seemed to be one of those people that was not really affected by it. Perhaps that’s because I was usually already drunk before I partook. I remember the exact moment my love affair with the drug began. I was attending community college and had given a fellow student a ride home after an evening class when he invited me into his place to smoke a joint. This time it had it’s intended effect–I was seriously HIGH! I felt the body euphoria and a beautiful release from stress and anxiety. I immediately knew I had found the answer, though I didn’t even realize I’d been seeking one.

For the next five years or so I smoked weed as much as I could. As drug addiction is a progressive phenomenon, I could say no to it at first if I thought I needed to stay sober, but that ability diminished rather quickly as I degenerated into little more than a lab rat tapping the lever that administers drugs even though they would be accompanied by an electric shock. As my addiction grew out of control, I began to work my way through different groups of friends, finding new ones when the old tired of me. An addict will eventually find a way to drive away everyone that does not share his/her enthusiasm for and dedication to the desired substance. I was left with a few people in my life that enabled me to continue my use.

During this time I also dabbled with “harder” drugs and found that, while I enjoyed them, my constants were pretty much pot and alcohol. I needed one or the other (or both) to sleep every night. I flunked out of college twice and dropped out another two times. Smoking pot robbed me of any ambition except wanting to do it as often as possible. My life and soul were empty. I was a bottomless pit of want.

When I was just shy of 24 years old I had my first panic attack. It happened after I got high one night after work and was the most awful thing I’d experienced up to that point. I remember going to my girlfriend’s house and rolling up into a ball on her bed, not understanding what was happening. I swore I would never get high again. That was September 3, 1998 and was the last time I touched marijuana. I quit drinking later that month for good.

If the story ended there I might not be writing this today, but it doesn’t. For the next three weeks I grew in confidence as I found it easy to leave pot alone. I had gotten back into school and was working on my B.A. at McKendree University. I was sitting in class one night, staring out the window, when my mind began to race uncontrollably. I was sweating and completely overwhelmed by a sense of impending doom. I was having a sober panic attack, the first of many to come. In fact, I spent the first four years of my sobriety in a state of near-constant panic. Sixteen years later I still deal with suffocating anxiety on an occasional basis, but it is much more manageable. I feel as though I wrecked something in my brain due to a genetic predisposition mixed with repeated, heavy drug use. I will likely be dealing with the repercussions for the rest of my life.

This brings me to my point: I support the medical use of marijuana as well as legalization for people that are able to use recreationally. I would be remiss, however, to keep my experience to myself when I hear people tout the safety of smoking pot. One of the most common arguments is that it is “safer than alcohol.” I agree with this for people that are not alcoholics or addicts, but the plain fact is that POT IS JUST AS ADDICTIVE AS ANY DRUG TO SOMEONE THAT IS A POTENTIAL ADDICT. As the saying goes with drug addiction, genetics load the gun and environment pulls the trigger.

I wholeheartedly believe that marijuana is dangerous to addicts. It will alter their brain chemistries and has the potential to prematurely trigger any biological predisposition for mental illnesses. It can take over their lives and leave them with no ambitions or dreams. It can dull their thinking and be potentially fatal for anyone that drives under the influence. While it may not be inherently fatal (such as alcohol, heroin, or cocaine), it can rob people of their lives slowly.

With the inevitable legalization of marijuana looming large in the near future, I would urge anyone who thinks they might be at risk for addiction to think about the dangers of the drug. Again, I am not a moralist or a prude when it comes to drugs, but I feel a certain responsibility as someone that has been there and still carries the emotional and psychological scars to help anyone that will listen to avoid learning the hard way. Please do not take this as a lecture. It is meant only in the spirit of helpfulness.



On-call: To Be or Not To Be

One enormous factor to consider when seeking a social work position is whether or not you will have to be on call. While most recent graduates will take one of the first jobs they are offered, it is important to contemplate how having to be on call (usually after-hours and weekends) can have a considerable effect on your life. I have had several jobs where I have had to take call and several where I have not and feel qualified to comment on the topic from my own experiences. I will include specific and detailed examples of exactly what being on call entailed with different jobs as the expectations and realities can and will vary in each work setting.

My first post-Master’s job was at the community mental health center in a program called SASS (Screening, Assessment, and Support Services). Every county in Illinois was mandated to run this service and my agency had the contract for St. Clair County. The duties included responding on-site to incidents where children and adolescents posed a risk of physical harm to themselves or others, providing three months of follow-up therapy when appropriate, and linking children to long-term services after their three months in the program. This job was unique in that it combined in-office therapy with emergency calls in the community and, as such, it was possible to be called out in the middle of a workday rather than just after hours or weekends. I received a flat fee of $500 per month to be on call with no further compensation for being called out on a case. As SASS consisted of exactly two people (my supervisor and I), I was on primary call half of the time and backup call the other half. While this may sound rigorous, it was actually the easiest money I ever made as almost all of our calls occurred during work hours. I did, however, learn the concept of being available even when I wasn’t at work, something that is a constant whenever you take call.

During this time I discovered that there were two factors I did not have to worry about while on call that affected many others:

  1. I do not have children.
  2. I don’t drink.

I have, over the years, seen and heard several people struggle with these two factors, primarily the former. My closest parallel is my pets, but I can put them in their crates and be out for hours without worrying about finding a babysitter or coordinating with my spouse. I consider myself fortunate to be in a position where being on call doesn’t have such far-reaching implications as these.

My next gigs that involved on-call were at two different hospitals over the next three years. Hospital social work is considerably different from clinical jobs in that it mostly involves helping patients access resources and getting them ready for discharge. While most of this can be accomplished during the workday, there was always the odd doctor that didn’t make rounds and discharge his patients until after-hours. Even then the plan was usually in place, but there were always exceptions where the discharge was unexpected. I also had to take call on Sundays for any social service needs on those days. Receiving an after-hours call at the hospital was much different for two reasons. First, most requests could be taken care of from home via telephone. Secondly, responding to a call in person merely meant showing up to the hospital. This was not a problem as I lived approximately ten minutes from the first hospital (where I worked for two years) and I never received a call to which I had to respond in person from the second hospital. The main similarity between these jobs and SASS was that I rarely, if ever, was called after hours. My structured schedule at the hospital also enabled me to anticipate potential “future emergencies” and head them off before they required a late night phone call.

My current job with hospice has provided me with my most challenging on call experiences. Our patients have to have access to us 24/7 with no exceptions. This necessitates the constant availability of an administrator, a nurse, and a psychosocial person (either a chaplain or a social worker). As I am part of the psychosocial team I split call with two other social workers and our two chaplains. The tricky part is that our psychosocial team always has a backup. The reasoning is sound: if a social worker is primary and the family would rather have a chaplain, there has to be one ready to go at a moment’s notice. Therefore, our schedule always consists of a primary-secondary tandem of social worker an chaplain (in either order). This requires excellent communication and coordination of services based on the needs of each specific patient and family. I receive far more calls working for hospice than in any previous job. The bonus is that calls are fee-for-service, so you are compensated for your work as well as your “waiting” time.

Having gone over some of my experiences, I would like to share some things I have learned from being on-call:

  1. It’s as bad as it sounds. You can be lulled into a false sense of security by going through a cycle or two with very few calls, then get slammed when you aren’t expecting it. Remember that, if you do make plans, you have to assume that you are going to be working just to be on the safe side. Take your own car, make sure you have any work materials you might need, and have appropriate attire with you. For instance, I have two full sleeves (tattoos) and carry something like a long-sleeved shirt or a jacket with me in case I get called. Most of my patients and families are pretty lax about my tattoos, but I am often meeting a family for the first time when I get called to provide them with information regarding hospice and it is not the first impression I want to make.
  2. The extra money is nice. There are likely very few jobs that don’t provide at least some additional compensation for taking call and it can be a nice surprise at the end of a busy call cycle when you get that paycheck. For instance, the on call pay I earned in the SASS program amounted to an extra $6,000 per year guaranteed, making a low-paying first job into a relatively more lucrative proposal. Furthermore, extra pay earned on call is great to put in savings because it is just that–unexpected income.
  3. It is useless to act like a baby when you get called. You signed up for the gig knowing what it would potentially entail. You have to go anyway, so it doesn’t do any good to voice your displeasure. This is way easier said than done as I know many people (myself included) that are seasoned veterans and still do this to some extent. No one is perfect. I do much better when I view call as an opportunity to serve rather than as a nuisance.
  4. Call can be where some of your most meaningful work will occur. Your patients/clients will, by definition, be in crisis and will, therefore, present you with great opportunities to connect with them and build trust and rapport. Although it is your job, they will still express gratitude that you are giving up your time to help them when it is inconvenient.
  5. You will learn to plan your life around it. For all of the times I have been called out, I would estimate that 95% of the time I’ve ever been on call I was collecting money for doing nothing. I still plan coffee with friends and go to recovery meetings knowing that I could be called, but my friends always know in advance so that they can have the option to decline an invitation when I may have to leave after a half hour. While I cannot speak to planning for your children while you are on call, I see nurses and other social workers do so with minimal disruption every day.
  6. Lastly, as I write this blog entry I am relaxing in my office at home with my laptop, a giant mug of good coffee, and my pug–and I’m on call.

In short, do not shy away from a job just because you will have to be on call. You will likely gain some valuable experience through responding to emergencies and it will make you appreciate your truly free time even more. Until next time.



I Need You to Kill People–Think You Can?

Quick, here’s your assignment–design a way to kill someone. It should be efficient, effective, and virtually unstoppable. Time is not a factor. It can be a swift death or a long one, drawn out over many years (the more suffering the better). It should be painful, its very name inspiring terror  amongst even the bravest. It must present itself to the medical community as an unsolvable puzzle. It should affect every person in a completely different and unique way, spreading throughout their systems with complete unpredictability. The progression may vary, but the end result will be a literal wasting away from the inside out. It must not be contagious as that would allow scientists and physicians to monitor its spread. There will be much speculation as to its causes, but you need to be extremely wily and keep these hidden from the intense scrutiny of the most brilliant minds.

While destruction of the physical body is of utmost importance, your task does not end there. It is equally vital that your creation be absolutely soul-crushing in the cruelest possible ways. Its development should be possible from the earliest ages through the entire life span. No one should feel totally safe. There will be no guaranteed prevention, immunization, or inoculation. You might even decide to divide it into hundreds of different forms so that those in the medical community will be even more confounded. That way their time and resources will have to be allocated to just those strands that they feel are the most perplexing and destructive. The cost of your project on society at large will number in the hundreds of billions of dollars. It will divide doctors and legislators against one another as they will be constantly scrambling to make sure they are following the latest trends as one form gets more media attention and, therefore, more public outcry for effective treatments. It will eventually affect everyone in some way, with no exceptions.

The only treatments available will be just as brutal as the illness itself. People afflicted will endure being cut upon, burned, and even poisoned in desperate, vain attempts to rid their bodies of the dreaded malady, all to little or no avail. Some people undergoing such procedures will be informed that they are cured, only to find several years later that the doctors were mistaken and did not completely eradicate the root cause, thus beginning the terrible cycle all over again. Parents will tear out their hair, screaming at God and cursing a world where their young child could incomprehensibly be diagnosed and condemned to such cruelty and suffering in what should be the innocence of their youth. Your creation will be so powerful that it will stretch people to the limits of their faith and cause some to abandon it entirely. The fallout will be tremendous.

Lastly, but most importantly, is the component of emotional suffering. If this illness were all-encompassing, if there was never any light at the end of the tunnel, people would at least be able to accept fate and embrace their suffering. The most crucial component, therefore, is hope. Everyone afflicted and affected must have ample reassurances that they should expect that things will get better–that they or their loved one can be cured. In fact, a select few should be able to beat it completely, but only after they have suffered sufficiently. This will perpetuate the belief that it can be conquered by most. Precious hope must be given and taken away so many times that it tortures people to madness and beyond. Sufferers should be days from death and still clinging to the fantasy that everything will be okay. In short, your method should entail the prolonged and absolute obliteration of the body, mind, and spirit.

Think you can handle that? Oh, you already have something there? Let me see it. Hmm, I like it.

Let’s call it cancer.


A Sad Vigil

People exemplify ideals–that is, all people do, at one time or another, exhibit behavior that represents the best humanity has to offer.  And what might that include?  Courage; compassion; unwavering devotion; perseverance; empathy; understanding; selflessness; and, humility.  In the vernacular of the eternally optimistic every person has, at some time in his/her life, been perfect.  Not perfect in all aspects, but perfect in their expression of one valuable, timely, and unmarred gesture of altruism toward another person or persons.  We don’t always recognize these displays at the time (or sometimes not at all).  After all, the most effective and inherently beautiful examples are often the least obvious or the seemingly smallest.  One day I was honored with the opportunity to glimpse unmatched compassion and empathy in action–the most distinctive and perhaps the only way such qualities materialize.

The old man lay in bed, propped up on his right side, nearly catatonic from his most recent stroke.  His sister-in-law Emily, the widow of a brother that had preceded the man in death by over two decades, sat in a green vinyl chair at the bedside.  I hesitated at the doorway of the darkened room with a measure of vigilance born from enough experience in such situations to know that every patient is different and every family has unique circumstances and dynamics.  Nothing is guaranteed and you cannot assume that you are following a paint-by-numbers formula that is effective with everyone.  The best you can do is take a deep breath, say a little prayer, and dive in, hoping that your presence will be enough and that something magical and cathartic might happen if you surrender to the moment and conduct yourself with genuine sincerity, an open heart, and a few kind words.  Emily’s hands, fingers misshapen from years of arthritis, were clasped across her lap, her jacket gently rippling in the cold air blasting from the buzzing air conditioner.  She leaned toward the bed, furrowed brow indicating deep concentration, and studied Cliff’s frozen face.  This gesture was instantly recognizable and one of the only things that you could bank on in any similar situation–the careful scrutiny of a loved one searching, usually in vain, for any sign of consciousness, something to indicate that, while the end is certainly imminent, there are still a few moments to be stolen.  As I crossed the threshold, propelling myself out of my semi-distant surveillance from the relative safety of the hallway, Emily raised her head to greet me with a faint smile and warm, weary eyes.  She was, by now, hours into what might optimistically be referred to as an “angel watch”–a heavy-hearted vigil marked by a potpourri of conflicted emotions including misguided and illogical hope, a sincere desire for the patient’s deliverance from suffering, and camaraderie among those present forged in the crucible of mourning, fond memories, and anticipated grief.  It is in this atmosphere and these instances that I have experienced some of the most intimate moments of my professional and personal life.  In a matter of hours an outsider like myself can come to be accepted as a member of the fold, equal parts fellow-sufferer and caring friend.  Death is truly the great equalizer, and not just for the dying.