I was talking to a colleague recently about the death of one of our clients, and we were saying how death is inevitable in the work we do and how much it sucks. This isn’t something I talk about a lot, really, because I don’t think the average Joe can fully understand what it’s like to work on the front lines of a crisis that has been going on for the better part of a decade and just keeps getting worse. Working in community, you’re not just patching someone up or prescribing them a medication and sending them on their way. You get to know people in a way that most people never experience. You’re often sitting with people at the very worst, most vulnerable times in their lives, but you’re also there for the small victories. I’ve been doing this work for the better part of a decade now, which is a long time to know people, support them, worry about them and hope that things will get better.
During this conversation, I told my colleague that doing this work has given me such an appreciation for my family and the people in my life because I know that many people in this world don’t have that. It has given me an appreciation for life, for spending time with the people I care about, and for never being afraid to tell people how I feel about them. I’ve experienced a lot of death, both personally and in my work, and I know that tomorrow isn’t promised to us. I don’t want to regret not letting someone know how amazing they are or how much I appreciate them when I had the chance.
Hearing that another one of your beloved clients has passed away is always such a trip. It’s not always overdoses that get them, like you might think. Sometimes it’s cancer, sometimes it’s murder, sometimes it’s heart problems or an injury, and sometimes the circumstances are more tragic than I can put into words. Some people were just dealt shitty cards in life, and no matter what they do, they always seem to end up further behind. I think about how many people were never given the kind of foundation they needed to get through life’s challenges in the first place. Maybe they never had stability, a safe home or people they could count on. Maybe one setback followed another until everything became a domino effect. That doesn’t mean people don’t have responsibility for their choices, but I think we sometimes forget that not everyone starts from the same place, and that getting back up is a whole lot harder when you’ve spent your life trying to do it alone.
Having said all of that, I wouldn’t change the way I do my job or the way I choose to see people beneath the exterior they put on for everyone else. Yes, it makes the heartbreak greater, but it has also made my life so much richer to get to know these people for who they really are. People let their guard down with me. They know they can be vulnerable, and I can’t tell you how many times I’ve thanked people for allowing me to witness that. It’s a privilege to have someone trust you enough to let you see the parts of themselves they might spend most of their lives trying to hide.
I have one client who comes to me regularly for wound care, and he recently said to me, “Stacy, you’re the best nurse for me. You’re always so optimistic, you can always find something about my wound to be positive about.” I laughed at the time, but the more I’ve thought about it, the more I’ve realized what that actually means. There are so many people who don’t seek help for their wounds because they’re embarrassed or ashamed. Maybe they didn’t come back when they were asked to, their wound smells, they have maggots in it, their socks or feet smell, or they’re wearing dirty clothes. Maybe they’re worried about being judged or think they’ve left things too long to be helped. Imagine being so embarrassed about your circumstances that you’d rather live with a wound that needs medical attention than ask someone to look at it. So when someone comes to see me, that’s something to celebrate. They showed up. I can address the wound without making them feel like they’re the problem, and we can figure out what needs to happen next. I might not be able to fix everything that’s going on in their life, but I can make sure they don’t have to feel ashamed while I’m helping them.
Today, I’m sitting here writing this while looking out at the rain, trying to distract myself from the provincial election happening today, knowing there’s a chance that big changes could be coming to my work and to the people I support. Services like mine, which are about as low-barrier as you can get, are already working with limited staff and funding. We know there is more potential to help people than we’re currently able to realize, but that takes resources, trained staff and time. I’m concerned about what happens when people decide that punishing people or forcing them into things is the way forward. I understand that people are frustrated. I see the impact this crisis has on our communities, too, and I want things to change just as much as anyone else. But I don’t believe punishment and coercion are substitutes for care. We have enough history to understand the harm that can come from systems that claim to help people while taking away their autonomy and ignoring their humanity. Surely we can recognize that forcing someone into something isn’t the same as giving them the support they need to move forward.
We need low-barrier services where people feel comfortable walking through the door, but what we don’t have enough of is robust, properly funded services and trained staff to help people figure out what comes next. Getting someone through the door is one thing. Helping them navigate the system once they’re there is another. Do you know how many people have given up trying to find a path forward because it was too hard, the wait was too long, they couldn’t get the right support, or they’d already experienced too many setbacks? I know a lot of people think we need more treatment beds, and they’re not wrong. But treatment is only one piece of the puzzle. What happens when someone completes a program and is discharged back to the street, a shelter or a supportive housing building where the people around them are still using substances? What happens when they have no stable housing, no support network and nobody to help them navigate the next steps? We can’t keep expecting people to make lasting changes in their lives without looking at the circumstances they’re returning to. We also need to look at the standards and oversight in treatment services so people know what they’re getting into and have access to appropriate care. We need more than a bed. We need a plan for what happens before, during and after treatment.
My colleague and I also talked about the lack of support and funding for those of us doing this work, and how often we take on tasks outside our scope just to get things done. When you see someone who needs help, it’s hard to stand back and say that’s not your job, especially when you know how difficult it can be for that person to find help elsewhere. Sometimes you make a few extra phone calls, chase down a service, try to connect someone with the right person or take on something that really should be handled by someone else. We do it because we care, but caring doesn’t create more hours in the day or give us the resources we need to do everything properly. There is a difference between being flexible and having a system that relies on frontline workers to fill the gaps. We can’t keep asking people to stretch themselves further while providing them with less and expecting better outcomes.
I don’t have all the answers, and I don’t think anyone working on the front lines would claim to. But I do think we need to listen to the people doing this work and the people trying to access these services. We need to be honest about what’s working, what’s not, and what we’re asking people to overcome just to get help. I know there will be more losses. That’s the reality of this work, and knowing that doesn’t make it any easier when someone you’ve come to know and care about dies. But I also know that I wouldn’t want to do this work any other way. I can’t undo what happened to someone before I met them, and I can’t fix every problem they’re facing. What I can do is meet them where they are, help with what I can, and try to make the next step a little easier. They don’t have to have everything figured out before they walk through my door, and they don’t have to be perfect for me to want to help them.
I keep thinking about that conversation with my colleague and how we can sit together and talk about losing people, knowing full well that we’ll probably have the same conversation again soon. There is something strange about how you can become accustomed to death being part of your work without ever really becoming comfortable with it. Maybe that’s part of what happens when you spend years getting to know people who are struggling. You learn to celebrate the small victories, you learn to appreciate the time you have with someone, and you learn that sometimes the things that seem insignificant to the rest of the world are anything but insignificant to the person living them.
I don’t have a neat conclusion to any of this. The work is hard, the system has some very real shortcomings, and there are days when the losses and the frustration are a lot to carry. But I still believe in showing up for people, meeting them where they are and treating them like they matter. I think about that client who told me I was the best nurse for him because I could always find something positive about his wound. Maybe he understood something about my approach that I hadn’t quite put into words myself. Or maybe it’s just that, after everything people have been through, sometimes they need someone who can see a little good when it’s hard for them to see any themselves.
And when one of them dies, it matters. Even if the rest of the world has already moved on.
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