"The Silence of a Client's Death"

November 25, 2019

By, Heather Black-Coyne

I have worked in addiction treatment for 10 years now. My journey working in the treatment industry began early in sobriety and like many, I wanted to help others find recovery just as I had.  A topic much talked about but not really talked about is the death of our clients. The news coverage speaks to the number of opioid overdoses and the stark increase of deaths over the years. The opioid epidemic is well underway, and tens of thousands die each year because of opioid use. Today’s reality is that someone is now more likely to die of an opioid overdose than a motor vehicle accident. The unfortunate news is methamphetamine use and alcohol use also take thousands of lives, but their toll is overshadowed by the opioid crisis; that’s a topic for another day.

Despite the staggering statistics, in all of my classes, clinical team meetings, and new employee orientations, the fact that one of my clients might die was never discussed. Sure, we covered self-care, hear of and grieve the third-party news that a former client has passed. Sure, I have learned that certain standards, regulations, risk management and compliance measures need to be in place to safeguard organizational liability in case of sentinel events. I have participated in the silence, and I am sad to say that over time, my cognitive sensitivity to death by overdose has decreased. 

 

Today, I’m very aware of the cumulative effect these losses have had on my soul. I am sad. I am confused. I am preoccupied with images of my late client. My thoughts vacillate between my recent client’s death and the loss of past clients. I see past clients sitting in my office talking about their dreams. I hear their longing to be a part of. I imagine them at my doorway, smiling, telling me about their latest achievements. I replay moments where I had this keen sense of them flirting with the afterlife and their weighted connection with death. My process then flips to my recent loss. I feel guilt when I hear others express they thought ‘this one would make it.’ The guilt is rooted in retrospect. I knew a barrier existed between her and true joy. I knew she was just existing, despite the smile she flashed the world. The guilt is rooted in knowing, at times, I operated from a place of defense, “I am here for you AND I am protecting myself.” A sense of protecting myself from the overwhelming feeling of grief, even before you passed away. Though at the time, I truly didn’t know that would be the outcome. 

I am grounded and rooted in emotional health. I don’t beat myself up, I don’t ruminate on what I did or did not do. I do not assign myself unnecessary blame. I have and my guess is, others have too. My guess is, that especially for newer counselors, there is some unshakable sense of responsibility. I want to validate that normal human process for anyone who has experienced the death of clients. I want to validate the enormous pull to help save someone’s live and the disappointment of that endeavor not being realized. I want to validate the disparity between seeing someone thrive and then learning of their passing. I want to talk about the fact that if you work in addiction treatment, for any length of time, losing a client is not only a possibility but a probability. When this happens, the loss is staggering. The world silences while your heart sinks. Our thoughts attempt to reconcile the feelings that can’t be explained.

 

 We do this work because we are called to help others, and the need is clear. We do this work, because we believe in the gift of life. We keep doing this work despite the heartache for these reasons. The number of individuals I have seen achieve successful recovery far outweighs the number of individuals I have seen die from this disease. Every story holds a special place in my heart. Every story teaches me something I didn’t know I needed to know. If you are like me, if this subject wasn’t talked about with you, know you are not alone. I am with you, we are with you, let’s talk about it.

 

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