Today I was assigned a case about an hour away from home.
I had time to drive to the job, so I was already quite introspective, listening to my favorite Pandora station, ready to take on the day.
I'll be the first to admit I didn't really know what I was driving into, or to what extent "taking a few blood pressures, and giving injections" really meant.
I shadowed a few nurses to see how everything was done to get "my feet wet".
On the way to one of the clients houses I was given the run down that I was going to probably see some "bad stuff".
I smiled, and nodded because I think after 4 years of experience in this field- I've seen my share.
Wrong again.
Patient one:
We drove into a what seemed to be, deserted bottom of the barrel trailer park. I say it this way, because frankly, not all trailer parks are necessarily bottom of the barrel...this one was though. We circled a few blocks, looking for the right number plastered on the side of the aluminum siding, or whatever they make them with.
We pulled to the curb, and I got a bit of a nervous feeling because I wasn't sure what to expect with the first "client". I adjusted my polo shirt and straightened my dress pants to look as professional as I could in this situation, as we walked up the unsteady, uneven weathered and rotted wooden steps at the side of the house. The nurse I was with knocked loudly, 3 times as practiced. The door flew open.
I hadn't expected someone young.

The mentally ill and unstable drug abusers are generally, in my mind in their mid 50's- unshaven, unwashed, waiting on the corner for someone to toss a dollar or two at them. Now, I know this is a pretty politically incorrect way of thinking, but come on... I'm not the only one thinking this way. Not to say it's right.
He had a shaved head, shaved face, a 
tattooed tear drop at the bottom lid of his right eye and tattoos scattered haphazardly on both of his arms. He had a white cut off shirt on, and black jeans- sagging of coarse to his knees, but he was thoughtful enough to pull them up after we walked in the door.
He stood close. He was one of those close talkers. He shifted a few times uncomfortably, not quite sure how to act socially. He chuckled to himself a few times, of which reminded me of a few stoners I have known in my day, laughing at an inside joke...inside his own head.
We asked if he'd had some food, and enough money to get him by until the next pay day, he said yes.
And when we asked if he had been hearing voices, questioning his odd behavior- he said no. . . but the answer seemed rehearsed.
He didn't make eye contact except for when he heard one of us talking, but couldn't pin in his brain, which one of us actually said the words. He looked uneasily at me, knowing he was taking a gamble on who had asked him the question. I eased his nerve by glancing sideways at the other nurse I was with, as to hint to what direction he should be responding in, he followed the trail well.
We set up the injection, an antipsychotic mixture that most of the clients were on either monthly, weekly or twice weekly- he moved his arm so to prepare for the poke, scrunched up his nose as the needle went in- rubbed his shoulder after the damage was done- and readjusted his feet as to show he was tough enough to handle a little needle. I smiled a little.
This tough guy- straight out of jail- still nervous and anxious at the needle topic.
We left, and climbed back into the van. I asked, as I'd been wondering, "What's his story?".
The nurse explained to me that he was in and out of jail, schizophrenic and a habitual offender for alcohol and marijuana use. The nurse sighed a bit, said he'll probably end up back in jail.
I stared out the window, sad for him, knowing that he won't ever know any better than his situation right now.
Patient Two
More prepared for the next client, I walked in, confidently to the house with the other nurse. It was one of those old victorian style houses, that they'd split up to make a bunch of little mini-apartments out of that was now doubling as an adult foster care (AFC) home. We poked our head in the front door, as no one answered the first few hard knocks, we walked into the entry way where there appeared to be no one home, though there were four doors to choose from in the entry way...so it was questionable about who was actually there.
The nurse I was with walked more confident than me, she walked forward, opened one of the doors- searching for our client. The home helper looked to be some form of alternatively dressed, punk-rocker, hippie girl with gauged ears and a bandana tying back her dread locks...
These are the the people we hold responsible for these people who are "incompetent"? 
She hastily said she'd go find him, since his roommate might wonder why we were there.
Down clamored a mid-forty something man with baggy khaki pants, and wiry curly blonde, receding hair. He seemed harmless enough. I smiled politely and introduced myself. He responded appropriately, so I breathed a little sigh of relief.
Too soon.
As the nurse knelt down to prepare the injection (another anti-psychotic drug), he started talking to me so I listed quietly. He had a manic rush in his voice, urgently getting out his words as fast as they came into his brain. Racing through sentences faster than I could keep up. Talking about aliens, and his abusive father, portals or vortexes that could be opened up for more help, talking of viruses that exist in the universe that we do not know what to do with, children that he did not have (but believed that he did), and of his anger for his roommate that he was trying desperately to control.
This was too much for me. Not in the "I can't handle this" sense, but in the "if he doesn't stop talking nonsense, acting like I know what the hell he's talking about- I'm going to LOSE it, and laugh in his face types of losing it".
We left there relatively quickly. The nurse didn't seem to be bothered much by his behavior. I looked back at the house wondering what was going on in his head, and what a burden it must be to have that much flying around at once.
The Final Patient
In an end to my day, we went to one more house. This was yet another surprise to me as the door slowly opened. There stood a short, fit black girl with her hair tightly pulled back- capri shorts and a tank top on. She was the most put together one yet.
We sat down at the table and got right to it. She talked openly about going to Detox this week for five days. My eyes widened a bit, but I kept my confusion to a minimum, so not to be noticed. The male nurse I was with talked comfortably with her, asking him his assessment questions.
When did you last use? 
Last night, she said. 
What was it that you used, Heroin?
Yes, she said. 
As we got up to leave, I felt like I was leaving someone I'd known before. She was easy to talk to, down to earth and comfortable in a social situation. She was picking up her pack of cigarettes to start smoking as we left, and said thank you to us for coming to check on her meds and give her, her injection.
I climbed into the car, and looked at the nurse and asked him how old she was.
25. My age.
He said, she's been a long term heroin user, has lost her two young kids to CPS and will likely relapse from her treatment after Detox as it usually takes at least a few times to kick into the "long termers".

She mentioned she wanted to start college in the Fall. Hopefully she makes it there.
I drove away feeling a bit defeated with that patient. Another instance of a wasted life. Someone caught in a situation of bad timing, bad people, and bad choices. I found myself feeling bad for her too...though, I don't think she'd appreciate the sympathy.
She seemed to be very well aware of her circumstances that led her to where she was today.
Probably worse to be 
aware of the bad, then be content in your own delusions...