A letter to K.

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    Recently I took care of a new mom postpartum after her second baby who took methadone for heroin addiction. She and her family taught me so much. I wrote her this letter; I'll never send it to her, but I did want to share in hopes that someone else may get something from it.

    Dear K,

    I will not lie. When the powers that be told me you, a patient taking methadone for heroin addiction, were being assigned to me postpartum, I wasn’t happy. “Oh, great,” I thought. “A druggie.”

    I was wrong, and I’m sorry. You shattered every perception I had, and I‘m grateful for that. I thought I was going to be getting a whiny, self-absorbed, annoying, demanding patient.

    What I got was a sweet young lady who’d had a hard life. I saw someone who would make different choices if she had things to do over again. I saw someone who maybe didn’t have all the tools in her proverbial tool box that I have. I saw someone who realized her mistakes and was trying to right them. I saw someone who didn’t want to be separated from her baby, which is more than I can say for a lot of my patients. I saw someone who was really trying to do the right thing and realizing that sometimes the right thing is very hard.

    You and I had an eventful night. For starters, you fell. When you later asked for pain medication for your back, I gave you two Percocets. That didn’t work; no surprise for either one of us. I called your doc and she was not willing to give you anything else because “she’s already had enough.” Forget that your opiate receptors were just a little occupied already. Maybe if she had seen the tears in your eyes she would have sung a different tune. Maybe if she’d tried to massage your pain away, or made you a heating pad, or just sat with you for a few minutes holding your hand, she’d have been moved to practice better pain control. But to her, you were “a heroin addict.” And I’m so sorry. I believed you, and I wish she had too.

    You and your family were a complete joy to meet and care for. I am glad that you felt comfortable enough with me to ask honest questions about your baby. I’m glad that we were able to talk openly about circumcision, vaccines, the baby’s methadone withdrawal process, and your own past. Thank you for trusting me with such precious information, and thank you for trusting me to tell you the truth.

    No, when I looked at you I did not see a heroin addict. I saw the human being that you are. Thank you for being willing to let me see her. You changed me. I became a nurse to help others; but you helped me and cared for me. Thank you, from the bottom of my heart.
    Last edit by Joe V on Dec 28, '07
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    21 Comments

  3. by   ukstudent
    Yes they are people too. However, the methadone system does not work well. It should be used for a short time only with a weaning process. If that baby can go through the weaning process of getting off methadone so can the mother. This way if she has another baby that one will be born methadone free. I am not saying that her continued methadone use is this mothers fault, she did not devise the system that she is under, that allows years of methadone use.
  4. by   ElvishDNP
    That wasn't really the point.
  5. by   danissa
    Arwen, thats such a heartfelt letter. Can relate to it so! not all the methadone mammies are tarred with the same brush. I once loked after a NAS baby, whose mother had become addicted to heroin after her three children died in a house fire. I never forget that woman, and her guilt, over the fact she hadn't died with her three angels, and over the way her newborn was suffering. She tried so hard, and she was on a minimal amount of methadone, compared to others, didnt abuse anything else, but the baby withdrew badly. This was a woman who had once had a normal life, a job, a family....she was a human being like you and me.

    good for you babe,that letter says so much.
  6. by   ElvishDNP
    Thanks danissa. It's so easy to group people together because of one thing they have in common...so easy, and so wrong!

    And is it just me, or have you found too that sometimes Mom can be on a minimal dose of methadone but baby just has a horrid withdrawal, and other moms can be on giant doses and baby seemingly is perfectly fine??
    Last edit by ElvishDNP on Dec 5, '07
  7. by   danissa
    Arwen, that is so true. Its so unpredictable, sometimes you check the history and think, oh no! But the wee one copes better and faster than the one whose mammy had the smallest maintenence dose of Methadone! Cant quite figure it out yet, but it facinates me. Am going to look further into this, we have a lot of babies withdrawing, seem to get them in clumps....(wonder, is that a factor, have they all been using bad doses of heroin, cut up with the same substance initially?)

    Arwen, anyway doll, I salute a fellow nurse, who does not bunch people together! If you find out anything that may further our practice, please let me know, as I will you!
  8. by   SuesquatchRN
    Arwen, thank you.

    For those I know and love who abuse drugs,
    for my heroin-addicted-trying-to-get-clean beautiful wonderful lying using niece,
    and for all of those people trying to self-medicate their pain and themselves away.
  9. by   leslie :-D
    it's just so darned easy, to stereotype various populations.
    but actually, it's just as easy, to get to know your pt.
    yes, many are demanding and self-absorbed.
    but even then, it is usually small but meaningful interventions, that will make them feel heard and noticed.
    it just takes genuine concern/interest in understanding the root of your pt's woes.
    once established, it's usually win/win.
    thanks for a wonderful post, arwen.

    leslie
  10. by   Grace Oz
    Beautifully written!
  11. by   MrsCannibal
    Very thought provoking, and touching. I'm crying at work, dammit, for my little brother: 20 years of addiction, 2 1/2 years clean and sober, living his life in quiet terror that he might fall down that slippery slope again...
  12. by   DutchgirlRN
    Quote from Arwen_U
    No, when I looked at you I did not see a heroin addict. I saw the human being that you are. Thank you for being willing to let me see her. You changed me. I became a nurse to help others; but you helped me and cared for me. Thank you, from the bottom of my heart.
    Wow Arwen...just wow
  13. by   lifesacomedy
    Yes, thank you. I am not a nurse yet, but I have often wondered about what it must be like in the L&D department. I'm interested in that work. At the same time, I can imagine seeing a lot of judgment from nurses because a new mother has an addiction (another medically treated condition). We don't begrudge a woman for cancer. We hope that she is making the best decisions that she can and we care for the person as they come to us.

    Thank you so much for sharing this important letter.
  14. by   cmo421
    What a great job you have done. Learning is an everyday thing and listening is an art. You have accomplished more then most medical people do in their whole profession!

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