by Wilson M. Sims
I’m doing the work of mental health and substance abuse consultation in pandemic isolation, and I’m in my bedroom wearing nothing but gym shorts while suggesting, assessing, and directing. There’s a full moon tonight and its white light is profiling the holly bushes and fence posts outside my window. It’s not supposed to be winter but Nashville is cold. In my bedroom that has become a sleep-in office, a lavender-scented candle sweeps a cone of gold across the wall behind my desk and red lights blink along the secure, work-issued phone. Each light represents a call in a queue of need-seeking.
Callers have been arrested and are dialing from jail. Callers have parents who take too many pills. Callers are case managers for patients in the psych unit of This Hospital or That Hospital. Callers have severe anxiety, manic episodes, personality disorders, substance use disorders, suicidal ideations and attempts.
We call these social indictments “diagnosis” and callers have combinations of them, collections of them, nothing to show for them. Callers are trying to speak to a DirecTV associate or a plumber but have the wrong number. Callers say everything without being asked anything. Callers say nothing when it’s essential that they say something and callers accidentally mute themselves with fumbling fingers or expressive cheeks. Callers are asking to speak to their Loved One who is already in treatment, but their Loved One does not wish to speak back. Callers are asking how much treatment costs, how long the wait list is, how the food tastes. Callers are asking why their son won’t look in mirrors, why their mom won’t leave her room, why insurance won’t pay. Callers want to know why I do or don’t ask for pronouns, why I do or don’t ask for race, age, weight. Callers want to know why we do or don’t have queer-specific programming, why their loved one’s therapist is or isn’t a person of color, and why we do or don’t send clients to church on Sunday. Callers want horses, massages, wifi, the Type of Therapy They Saw on Dr. Phil, their weed pen, cigarettes and conjugal visits but callers also have horse allergies, haphephobia, severe ADHD, a Different Disorder Than Dr. Phil’s Guest, THC addictions, oxygen tanks, and lovers who smuggle heroin.
Callers have mounting debts. Callers have fragmented relationships. Callers have fear, consequences, and no more chances. Callers are calling from varied geographic locations, sexual orientations, political persuasions, gender identities, and religious beliefs, but Callers will all be categorized by the resources they possess and identified by the demons they are possessed by. Callers have a gun they will not put down, a box cutter they keep picking up, and a phone that only works on wifi. Callers have a rope and a ladder, and “yes,” they do “have a plan.”
I press the button beside one of the blinking lights on the telephone, and the call goes something like this:
Transcript #: 96414
Call: 22:10:44 – 22:19:12
Admission Specialist: Wilson Sims
AS: Hey there, thanks for calling %%%%%%%%. I’m Wilson. How can I help?
CALLER: You have any beds?
AS: Well, let me check. Just one sec. May I ask who I’m speaking with?
CALLER: Yeah, Taylor. Taylor Stober It’s just I need to go somewhere right now. As soon as possible. I’ve already called some help but nowhere can take me and I really want to go this time. I’m ready, know what I mean? Over ready. Things have gotten… I just need to get cleared up. Get straight. I’ve had some time before, I know what I need to do. I do. But… I – my mom fell in May and I’ve been having to stay here with her. She needs someone to take of her and my sister said she would give me rides to work and that’s all I needed her to do but she just called one day and said she wouldn’t do it anymore and my mom has a car but my sister has the keys for it and for no reason she called one day and said she wouldn’t be driving me and wouldn’t give me the keys to mom’s car either. She’s got all kinda shit, too. I know she does. She acts like I’m the only one but I know how she does. And she has kids. I don’t have kids. I’d never be doing this with kids. Kids are – life. Gotta be careful with kids, know what I mean? But I know about her and she’s giving me this shit and all I need the car for is to get mamma’s stuff from the store. Errands, know what I mean? I’m the one who showed up when mom fell hell I’m the one who was-
AS: Okay, Taylor?
CALLER: -here when mom couldn’t get socks on or or and now she won’t let me drive the car that mom keeps here at the house, know what I mean it’s not even hers to be in charge of and Harper won’t let me just go to the store to-
CALLER: –get what’s needed. I’m the one who took it and given me shit because not having a job when-
AS: HEY. Taylor, hold up. Hold up, man. I’m sorry to jump in here, and it isn’t right. I know, I do. I’ve been there. Trying to do something good, but it goes to shit. And it’s not like you’re asking for a million dollars. You’re just asking for a ride. But I can’t do anything about your sister, right? Sounds like nobody can. But I might be able to help you. We’ll see. So I’m going to do my best to find out if we can help, and I’ll be quick, I know you’re in a hurry. Where are you calling from, Taylor?
CALLER: Yeah, yeah, she won’t listen to anything sensible. I’m trying. I really am. I’m in ******. Let’s do it. Do you have anything near there? Where are you? Y’all allow phones\
AS: I’m in Nashville, and I’ve got a place in mind that I think might be right for what you’re looking for, it’s not too far from where you are now. I know you’re in a hurry, so I’m going to run through some questions real quick with ya like I’m a machine, okay? And that will tell us if we can help or not. And even if we can’t, I’m gonna point you in a direction, okay? But do you have any kind of health insurance?
CALLER: . . .I did for a while, but when I was taking care of mom I missed work a couple times and I don’t work there anymore. I have my card still. I have it right here. Can I give you the numbers?
AS: Oh, Taylor I’m sorry to hear that. It’s tough without insurance. I’m sure you already know, but treatment will be expensive. They won’t let you in for free. When was the last month you were working at that job?
CALLER: It’s been a while. Maybe a year? Is there anything you can do? Are there any grant beds or scholarships or somethin? Or do y’all let people work while they’re there? I can work. I can do anything. I just need a chance.
AS: No, I’m sorry, but we don’t have any grants, scholarships or anything like that. Do you have any financial resources or maybe if you have only a little bit I might be able to find somewhere that can work with you.
CALLER: Sir, I’ve got nothin. My mom lives on her disability and even if my sister had some to give she wouldn’t. You know any place that’ll let me work or might have a grant bed?
AS: I got it, man. Like rule 1 of doing what we do is that we don’t have money laying around. God knows not for insurance. But I-
CALLER: I know, right? You aren’t the first call I’ve made, know what I mean? And the answer is “no,” I’m not calling in for help while I’ve still got money!
AS: Right. We wait till we owe someone we’re afraid of, then we call. I know man, I know. But look, I’ve got two numbers for ya, okay? The first one is my cell. You can call it but I may not answer because I’m on the work line. I’ll always answer texts, though. It’s 321-243-8983. The second number is for state sponsored substance abuse and mental health services, and I know what you’re thinkin, but they should at least put you on a list for the next available grant bed, okay? And this is real. You call 1-800-889-9789 and they’ll tell you how you can get on the list for a free spot. Tell them exactly what you told me and they’ll be able to help you.
CALLER: Nice. Oh, thank you so much. I mean, okay, I am gonna do it. I am. I’m gonna get my mom set with her stuff and then I’ll pack. Send me a list of what to bring and I’ll be packing. Just gotta set mom up, first with her stuff from the store but I’m so glad. Thank you.
Not helping is more tiring than helping and even though that was a quick one I pull the headset off and sigh. Lou is beneath the desk, asleep in exactly the space where it’d be most comfortable to plant my feet. If I’m not careful crossing one leg over the other, if I move too quickly or jostle her in my adjustment, she’ll think something good is about to happen when it really isn’t. She’ll think I’m about to walk to the kitchen, or to the ring where the leash hangs, or to the box of toys, and if she thinks I’m doing any of these things Lou will squirm from beneath the desk, shake her bony yellow bottom and stunted tail, and look at me like she’s lived her whole life just to experience this exact dog treat, this one walk, this particular stuffed zebra. And I just can’t handle that. When her almond eyes are excited and I can’t give her the thing she’s anticipating, the muscles in my back tense and my jaw sets. I press rage down into my stomach where it undoubtedly refines into cancer, and I resent her for wanting something I can’t give.
I wedge my legs into the corner beneath the desk and rotate my torso in search of a back-crack that doesn’t come. My chair is from a kitchen set and would be better suited as a table than a seat, but I don’t wanna get too comfortable with quarantine. I prefer to imagine the end of the pandemic might manifest itself suddenly and unexpectedly, as a sign unto itself, like a rainbow or groundhog. I know it’s ridiculous; a recipe for daily disappointment. And I know the quality of my chair has nothing to do with the spread of the virus. But I explored depression for a decade (in an I-can’t-stop-drinking sort of way), and now I work in the industry meant to treat it, and hope is not the same thing on both sides of that horizon of health. When you’re really sick, hope sucks.
When oblivion is the aim, hope objects. When all we want is to be left alone, hope sends help. And when the bottle-top’s been twisted or the vein strobes for injection, it’s hope that intervenes. It’s hope, and not hopelessness, that agitates the addict. It’s hope, and not hopelessness that’s the enemy of the seriously ill.
Fortunately, even when you’re hell-bent on getting rid of it, eradicating hope is no easy task. It’s like dog hair on a cloth chair or a forgotten tissue woven through shirts and pants by the washing machine. Just when you think it’s all been picked out, your eye catches one more little bit, and while you’re using your fingernails to get at that piece, well, then you see there’s another fleck just to the side there, and this goes on and on until you accept that unless you torch your cushions or your clothes, there’s gonna be some of that hope in there.
I knew Taylor wouldn’t be glad to get handed to another helpline—there’s no comfort in calling 1-800 anything—but I gave the digits anyway because I want the end of hope to be at least one more call away. But if Taylor makes that call, the person who answers the phone will not give a name because the operators for the state-sponsored 24-hour helpline (“The Redline”) are anonymous. The operator will be someone who, like me, has been on the “need” end of these calls. The operator will be someone who believes they owe a debt, someone who is not only doing their best but maybe doing even better than that. Still, the operator will be underpaid, their call volume high, their tools limited, and their training a reflection of the region’s dominant ideologies.
The operator will accurately but improperly assume Taylor uses He/Him pronouns and identifies as male. If Taylor tells the anonymous operator he’s been using heroin for a long time but more recently fentanyl and meth, that he can’t stop, and that he doesn’t have any insurance or resources for private rehab, the operator will say, “Okay.” If Taylor tells the operator that Taylor is queer, the operator will say, “Okay.” If Taylor tells the operator that he’s black and would prefer to be in treatment where there might be other people of color, ideally counselors with similar experiences and perspectives, the operator will say, “Okay.” If Taylor tells the operator that he is a survivor of sexual assault, the operator will say, “Okay.” If Taylor tells the operator he is an Old Testament Prophet resurrected for the purpose of selling bicycle pumps, the operator will say, “Okay.” Then the operator will ask Taylor where he is from, and if Taylor says he’s from Small Town, Tennessee, the operator will then use this single fact and no others to curate a list of eight program names and phone numbers for Taylor to call. The operator will say, “I can give you the number for some places that have grant beds, and you can call them but sometimes there aren’t any spots available right away. You’ll probably have to go on a waitlist.”
Taylor might already know that three of the options, Samaritan Recovery Community, Place of Hope, and Safe Harbor, are what people commonly refer to as “homeless shelters.” Or he might see “Samaritan” or “Mission” in the name of these options and recoil because the sexual assault he suffered was in a religious context, or because he assumes a “Christian” place is a bad place to be queer. Taylor might love Jesus and prefer that option to the others, but Taylor is either learning or has already learned that he is not, as a person without resources, entitled to the privilege of choice. Taylor might call every single one of the phone numbers even though a phone call, he’s also learning, is not so simple as dialing ten digits and repeating his name and Social Security number. He might feel each call is a flaying of his privacy, a voyage into those internal spaces which both encourage his use of drugs and discourage his making these calls in the first place, but nonetheless, Taylor might be sick and plagued by a bit more hope than none. With some slight variation, each phone call will require a tax from Taylor in the form of answering questions like these:
- If you are admitted to our program, can you arrange for transportation to our facility?
- What is your drug of choice? How long have you been using it? When was the last time you used it? How much would you say you use on a daily/weekly basis? Do you use any other substances? How frequently and how recently?
- Have you ever been to treatment before? If so, where? Did you complete the program?
- Have you ever been hospitalized for psychiatric reasons? If so, why? What happened?
- Have you ever been given a mental health diagnosis?
- Have you ever experienced auditory or visual hallucinations? Are you now?
- Do you currently have a desire to harm yourself or anyone else? Have you ever?
- Have you ever attempted suicide? If so, how? What happened?
- Do you have a plan to harm yourself?
- Are you or have you ever been violent?
- How much do you weigh? How tall are you?
- Are you eating regularly?
- Have you ever been convicted of a crime? Are you on parole or probation?
- Are you the primary caretaker for children? Are you married? Do you live with anyone?
- Have you had any of the COVID vaccines? Which one?
- Have you been given any medical diagnosis we should know about? STD’s? Are you pregnant?
- What prescription medications are you on? Are you taking them as prescribed? Do you have them in your possession?
- Are you employed?
- Have you ever been convicted of a sexual crime?
- Have you experienced trauma? If so, of what nature and when?
Assessment questions such as these might be asked of anyone seeking residential treatment, but how the treatment center uses the answers is dependent upon the potential payout that patient represents. When these questions are asked of someone who has private insurance and their insurance will foot the hefty bill, the assessment answers will be used in constructing an individually specific treatment curriculum. A combination of modalities, accommodations, and nutrition to match the patient. The list of phone numbers texted to Taylor will not include private treatment programs, though. The text will include this listing: “Buffalo Valley, Inc. – Davidson County – Nashville – (Coed) – Call for more information: 1-800-447-2766,” and this is the most likely program to have a bed available because this is the largest program on the list. Anyone calling Tennessee’s 1-800 helpline has a greater chance of finding themselves at Buffalo Valley, Inc. than anywhere else. And due to this volume (in part), if Taylor calls Buffalo Valley the assessment questions will not be the basis of a unique treatment plan but instead will act as the net meant to prevent “inappropriate” admissions. Will Taylor complete the program if admitted? Does he pose medical or psychiatric liability concerns? Do Taylor’s medical, psychiatric or identity characteristics violate the parameters of the grant funding in any way? Bottom line: Will treating Taylor return too little revenue? While these determinations are being made, Taylor will wait a variable length of time—sometimes an hour, sometimes weeks—as his statistical chances of physical survival and his commitment to entering rehab diminish with each moment.
Where is Taylor, by the way? Are his feet in shoes? Is his body inside walls? And are there other bodies where his body is? Is his body warm? Is his body safe? Is his mind in his body? If he goes to the store to buy smokes, can he make it back? How often has he made it back from the store without first finding himself in the one place he begged himself to avoid? Has discussion of his traumas, diagnosis, treatment history, suicidal experiences and medical maladies encouraged Taylor to be still? Where is he charging the phone he’s using to make these calls? Is it his phone? Is it good that he has a phone? Will the prospect of treatment, the potential for thirty days without the ability to administer the only solution for his suffering that has ever worked, prompt Taylor to use immediately, more frequently, in greater quantities? Will the prospect of thirty days within the confines of a facility encourage Taylor to exit the boundaries of whatever confines he currently perceives? Instead of waiting will Taylor very reasonably conclude that there’s a better way to do this? Will he make a commitment to himself to suck on a Jolly Rancher instead of using whenever cravings hit? Will Taylor decide, as earnestly as any person is capable of, that he has had enough of the drugs and so all he needs to do is turn his phone off and eliminate the temptation to find them? What if Taylor “realizes” he need only use smaller and smaller doses over time and eventually, that way, he’ll be clean? What if he forgets that this plan has never worked? But Taylor’s probably not going to be accepted anywhere, anyway, right? I mean, even if he is, it’s not like Taylor hasn’t been clean before. He has. What would they even tell him at rehab that he hasn’t already heard? He knows what he needs to do. He just needs to do it…to try a little harder this time…
If Taylor survives his mind, his drug, his circumstances and time—meaning he is not jailed for symptoms of his disorder, not killed by the substance he uses, not displaced because of his impolite appearance or behavior—and he is accepted into a program, then it may occur to Taylor that he has questions of his own. Questions he’d like to ask of the treatment center where he will be going. But in Behavioral Health Treatment there are many questions, few answers, and less time. Spoken responses are short and lengthy or complicated explanations are often withheld. About like this:
Will it work?
If you work at it.
What do you mean when you say, “work?” What is your metric for success? If your challenge is depression and addiction, then is treatment a success if the symptoms of depression are eliminated? Or if you manage drug abstinence for one year? Three years? Six months? Your whole life? What if in the absence of drinking you find you’re unable to sleep? Or horrified by the prospect of entering any room with more than one person in it? What if your symptoms of depression are eliminated, but so too is your capacity for joy—would that be a success? What if you retain the ability to sense joy and your sadness is limited to levels clinically deemed “reasonable,” but for the most part you feel like a mug that’s been wrapped in hundreds of layers of tissue paper? How familiar do you need to feel to be you and how different do you need to feel to survive? What if your spouse or partner committed to a person who drinks, or more specifically, the version of you that drank with some moderation?
What happens after rehab?
Let’s worry about getting
you here, first.
After rehab will you have zero dollars, no job, and a phone full of people you shouldn’t call? What if your medication is essential to your sobriety but to collect your daily dose you must spend four hours of each day sitting on or waiting for buses? And how many hours on buses can you manage while also seeking or maintaining employment? If, in the hours you’re not sitting at a bus stop, you do procure employment, will that employer allow you “mental health” days if needed? Will they resent you for asking? Can you afford your rent if taking a mental health day means forfeiting wages? If there is a viral pandemic, will your employment remain unaffected? What about your home life? How many family emergencies do you plan on having? Does a therapist specialize in your required modality anywhere near where you live? Do you speak English? The same version of English as your clinician? Are you able bodied? Are you technologically literate? Are you housed?
Is there any free help?
A.A. is free and more likely to be geographically accessible than any alternatives. And if substance abstinence is the goal, A.A. is the most successful of many unsuccessful modalities. But the population of A.A. is 90% white people, and the vast majority are men. Are you a white man? Had good experiences with white men? How about white men who talk about God?
What’s the success rate?
Better than the streets?
Let’s say success is sobriety and stability. Then how are we collecting that data that we don’t share publicly? Is it through phone calls to our alumni who then self-report whether or not they are “sober” or “stable”? And if so, does sobriety include weed? Or moderated drinking? What if someone accidentally ate one of those chocolates that has bourbon inside of them? Or double-dosed on their cough syrup? What if someone is drinking but describes themself as stable? Or if someone describes themself as stable and during that phone call screams desperately for whoever else is in the room to “KEEP THE GODDAMN DOOR CLOSED. KEEP IT CLOSED, KEEP IT CLOSED, KEEP IT CLOSED.” Is someone stable if they’re “really sad really often”? What about if they’re “kinda numb,” having trouble eating, but “hanging in there”? What if these reports given by folks with historical substance abuse or mood disorders are clinically inaccurate? Have you ever asked someone who has a drinking problem whether or not they’ve been drinking? Have you ever questioned the veracity of their answer? When an alumni never answers the phone, is that factored as a successful or unsuccessful outcome? Do we offer a voluntary analysis program in which participants are randomly drug tested for twelve months following treatment? Would you like to be in that program? Have you ever managed to “pass” a random drug test shortly after using or drinking? Have you ever known someone to scream “I’M FINE” when they seemed to be less than?
Then what’s the point?
Well, you probably don’t
have much of a choice.
We’ll both make choices and we’ll both make mistakes and it’s likely you’ll relapse. Most people do. And every relapse is a courtship with death. But it’s also possible you endure sustained, unspeakable discomfort while simultaneously getting very lucky and one day you’ll be pumping gas at a Circle K and you’ll see a handoff right there beside the ice cooler. The guy dropping the dope will catch your eye and flick his chin up. You’ll smile and shake your head, replace the nozzle of the gas pump and when you’re back in your car and buckling your seatbelt your hands will shake and your vision will blur and you will be flooded with what you can only assume is called “joy.” You’ll remember that it’s a miracle to wake up and find your legs automatically moving to the floor in anticipation of the day. To watch the leaves of a poinsettia brush one another, to feel wind swirling at the backs of your legs as you walk your dog, to hold your steady hand out so your partner can grasp it. You’ll see yourself from a removed perspective making your bed in the morning, folding laundry in refracted sunlight, writing a “thank you” note to the baristas of your favorite coffee shop. You will pray, manifest, or hope-with-fullness for more of the peaceful eternities between an inhale and exhale and your exit from the gas station will be propelled not by fear but by the charming and urgent purpose of being exactly who you are.
I flip a plastic lighter over and under the fingers of my left hand, from thumb to pinky and then back. I scan and then minimize the inbox on one of my monitors, exit the secure server and open a browser. There’s not a rainbow or a groundhog, but a “Death Toll” ticker that tabulates the total number of Americans to have died from COVID-related causes. The figure is in the hundreds of thousands, and increasing, but both the accuracy and significance of the toll are debated. Our grief seems to demand explanation by relative situation, so we triage tragedy by creating a hierarchy of calamities, a pyramid of personal and social ailments, and then we weaponize that shit. One source says the number of casualties is equal to “eighty times the amount that died in 9/11,” and another source says the number of dead “is a fraction of those killed by mosquitos,” but in comparing these great sums of loss we lose our capacity to hear the small figure; a son who says, “I lost my mom.”
And while “At least it’s not…” and “thankfully I …” are all the beginnings of thoughts that might help us sense something like gratitude, the maintenance of this hierarchy eventually costs everyone. Whether it’s the loss of a job, the addition of a pimple or the inability to help someone who asks for it, no wound is healed by the presence of another. Suffering is a gas, not a solid or liquid. It assumes the shape and volume of its container, whether crevice or cavern.
You’d think empathy would be the same, some sort of limitless commodity that we can all get a little more of by watching a dog sneeze or wriggling our toes in the grass, but I just gave a person a 1-800 number that leads to a list of 1-800 numbers that likely all lead to nowhere. I prefer Taylor not to be discarded, I appreciate the vastness and wonder of Taylor’s humanity, but I am about to go for a walk with my dog.
Maybe empathy the feeling is as abundant as articles on the internet, but empathy the action is more complicated in construction. Maybe it’s two-parts altruism and one-part self-preservation, or maybe, despite wishing I were someone who cares, I am someone who is selfish, and maybe suggesting I’m both is a way for me to abide the dying around my living. Maybe “empathy” is a word we made to patch the gap of inaction between suffering and knowledge.
I drop my chin to my chest and inhale through my nose until my eyes are facing the monitors, then exhale through my mouth. Sometimes there is an irreconcilable disparity between the gratitude expressed by callers and the service I’ve provided them, and sometimes callers suggest particular tools or topographical features they’d like me to fuck myself with. Sometimes I care very much, but sometimes it’s hard to care at all, so I shame, delude, and motivate myself as needed.
I listen to the saved voicemails from parents without children, partners without a partner, and callers who made their last. I use their words and pain to hurt my own feelings, to whip myself into action, and I redouble my efforts. I hold and harbor the details dismissed by insurance agencies, I gently receive the fallacies relayed as facts, and I imagine I am the help that’s just a phone call away.
I carefully detangle and recross my legs, shifting the weight in my chair. Red lights blink along the secure, work-issued phone, and each light represents a call in a queue of need-seeking.
Editorial note: The conversation featured in this essay is a composite based on hundreds of similar calls. The specifics have been fictionalised to protect the privacy of individuals. No identification with actual persons (living or deceased) should be inferred.
Wilson M. Sims is a Behavioral Health Worker based between Nashville and South Florida. His work can be found at Longreads and The Florida Review, and he is the winner of The Lascaux Prize in Creative Nonfiction. @wilsonmsims / wilsonmsims.com