The Vices Among Us

It's not uncommon in a month to have a patient that is on CIWA protocol. CIWA stands for Clinical Institute Withdrawal System or Canadian International Wrestling Association - depending on who you are asking. The CIWA protocol is put into place if a patient is currently withdrawing from alcohol or if there is a potential that they might during their stay with us. As nurses, we have to watch for signs/symptoms and then respond appropriately whether it be with medication, increased monitoring, etc. I am more apprehensive when I see this as an order because I am never quite sure what I am walking into. It can be an order placed as a precaution and the patient never does experience significant withdrawal OR it can be very, very messy. Awhile back I had one that fell more into the latter category.

In addition to alcohol withdrawal, we see people who are withdrawing from drugs or who are struggling because they can't get their nicotine fix while in the hospital and the patch isn't cutting it. Usually I leave a shift where one of my patients is going through withdrawal with a firm "don't do drugs" message for my kids. They are getting a little tired of it. But, here's the thing....the more I am around it, my feelings have shifted a bit. As ugly as the withdrawal can be, there is often a story that goes with it. When you look deeper into the situation there may be a spouse with cancer, a recent widow, joblessness. A hard situation. Really hard. My guess is that in some of these situations, the addiction started because life got messier.

Messy can be hard. We all have various ways we deal with hard things - some ways healthier than others. Some of these habits probably didn't start as addictions but they were a way to temporarily make some of the difficult times just a little easier. Maybe going to the bar for a drink rather than home to an empty house didn't start as a problem but as a way of coping.

A few days a week I am fantastic at coping. I can totally manage my life when I wake up in the morning on a day off, Michael has work and the kids have school. I am home alone with the dog. I find this quite manageable. I can go 8 hours without talking to anyone. My time is often filled with errands, running, walking Annie and paying bills but it's on my own schedule. On those days, I am a rock start with coping - even the dog says so. It's when the kids get home from school that things get a little more complicated and my patience isn't quite as amazing. Last week, the kids had been home for 10 minutes and I had to take the dog for a walk to get out of the house before I said something less than kind to my teenager. 

Relationships, work, school...they are CRAZY hard. Some of us have vices that take the edge off at times. My vices usually involve coffee and running but I understand the other ones. If I didn't have such a history of alcoholism in my family, my vice might have been alcohol. I do enjoy a glass of wine but it ends at a glass. Too risky for me. But...I get it. Numbing the pain can be very attractive in the short term.

So, when I have a patient who is struggling with an addiction, I TRY to consider the bigger picture. I'm not perfect. Instead of just talking to my kids about not doing drugs, I need to talk to them about coping strategies, the importance of people you can talk to you in your life and taking care of yourself. I need to look at my patients AND the people in my life with a different perspective. Is the vice hiding something else? More often than not, I imagine it is.