by Bill White

Created on: April 29, 2009   Last Updated: April 30, 2009

So I answered the phone and the details were tough to hear. Yes, one of those cases that requires a gut-check before making the scene. Seems a woman, seven months pregnant no less, was about to inject her daily heroin fix when her fiance intervened and called the police. Out they came to the house, arrested the woman, and stopped by the E.R. for a medical assessment before taking her in for booking. By the way, I found out later that one of my colleagues got the first call; however, she asked that I be contacted because she was so angered by the report she didn't feel comfortable handling the case. Kudos to her, passing the baton was the right thing to do.

Upon arrival at the E.R. I was briefed on the case by the woman's attending physician. I also talked with one of the two police officers that were waiting outside of her room. According to all parties the circumstances were pretty much as I'd heard on the phone. And, of course, I had to listen to all sorts of editorial remarks from the E.D. staff regarding what an awful woman and mother the woman was. Now, I'm not condoning her behavior by any means; however we're in the helping professions right? As I entered the woman's room, I saw a patient in her mid-20s dressed in a hospital gown with an I.V. in her arm. She was visibly agitated, crying profusely, and pacing as much as her I.V. line would allow. She greeted me with a desperate expression, intense weeping, statements of great fear and sorrow, a face scarred by running mascara, and a good deal of nausea and G.I. distress. In spite of everything else with which she was dealing, it was obvious she was in the beginning stages of heroin withdrawal, which could certainly account for a large portion of her presenting physical and emotional symptoms.

Not surprisingly, the woman formed an immediate emotional attachment to me. And all things considered that's not so hard to understand. Let's see - she's frightened to death, seven months pregnant, withdrawing from heroin, knows she's the object of contempt, may well have a deformed baby inside of her, may lose this baby and her family, and believes she may well be incarcerated. Wow, huh? But in spite of recognizing and understanding her attachment I had to keep it in check. No doubt, she needed support; however, my immediate task was to get answers in an effort to formulate a psychiatric disposition in her best interest. This wasn't the time to be toasting marshmallows and singing "Kum Ba Ya." But it also wasn't the

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