Dispatch From a Clinician

“I just need to talk to somebody,” he said, slumping into the seat across from me. He was tall and thin and wore a tattered winter jacket though it was unseasonably warm and humid outside. His long hair was pulled back in a ponytail and his eyes were wide and tired. He looked down at the floor.

“What’s going on?” I asked.

“I’ve had the worst couple of days.”

He wasn’t lying. He proceeded to describe a series of events reminiscent of Job. His story concluded with a heartbreaking account of having been jumped at the subway station earlier that morning. They took everything he had left: his wallet, his phone, his breakfast. Tears welled up in the bottoms of his eyes, but he fought them off. I got the sense he had been fighting for quite some time.

We talked a little more. He came around to telling me his name: Alex. Alex had been through a lot, not just in those past few days, but extending far back into his childhood. He told me he drank when he got angry. He told me he was angry a lot. But Alex was also ambitious. He was spiritual. He just wanted to go back to work and to live a normal life.

I mentioned treatment. He was polite but hesitant. No one is ever thrilled about the idea of detox, and understandably so. The process is painful and difficult and requires dramatic lifestyle changes in order to maintain long term. We scheduled a follow up appointment for that Friday so we could talk about the idea some more. He said he’d think about it in the meantime.

I left the shelter that day encouraged by Alex’s ability to reach out for help but uneasy about the potential consequences of our conversation. Had we talked about too much too soon? Was the suggestion of treatment overwhelming? Did I miss something? It is always easy to second guess. After all, the phrase “I’ll think about it” does not exactly inspire confidence. But this dilemma is at the core of human services: to acknowledge the limitations of one’s role and trust those we work with to be that which they are capable of being. It is an ongoing practice.

That Friday, Alex didn’t show up. I was disappointed but not surprised. The uncertainty in the daily life of an outreach worker is only surpassed by the uncertainty in the lives of those we aim to serve. When my day came to an end on that Friday, I quietly wished him well and then turned off my work phone for the weekend.

The weekend was quiet. I got some much needed rest. The Patriots won. I did my best not to think about work. I didn’t look at my phone again until Monday morning as I rode the Red Line into the office. There was a voicemail waiting from me. It was Alex. He had left it Saturday morning. He wanted to apologize for missing our appointment and let me know that he “thought about it” and decided to enter treatment earlier than we had talked about. He said he’d see me soon and bring along his certificate of completion to show me and give me a copy to keep as a thank you.

Of course, he didn’t need to do that. But I am glad he did.


Brett Dixon is a clinician in the Boston area. We have not named his employer to protect his clients’ confidentiality.



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