| Emotional impact | Tragedy and death | “Some of them are so troubled … how fleeting their relief from suffering is … I try not to go through those roller-coaster rides with people.” |
| “… You're traumatized by them.” |
| “… when they talk about a sex trade worker being killed and it's splashed across the front page of the papers, we check … to see if it was someone who was known to us …” |
| “… the people who seem to be my dearest clients—like they've just been dropping. … And now that many of those people are gone it's been hard to … build through the grief … to recreate those connections with people. … I can think of a couple of people who I have … held onto who have stayed alive, I still just wait for the call that they're dead.” |
| Difficult behaviors | “… sometimes the interactions can be incredibly brutal. … There can be racial slurs … clients have had to be barred… .” |
| “… when you get death threats from patients … or when somebody steals your prescription pad … sometimes I have to fire people.” |
| “… there have been a couple of times when you can feel really unsafe; and that's scary, right? And then you can come home and your partner … they get really mad. And then you end up calming them down.” |
| “… it's very frustrating when people try to take advantage of me to get drugs.” |
| Isolation from mainstream medical community | “I even had someone say: ‘Couldn't you do any better'? So, I mean, just by the fact of having chosen to work here, in many people's eyes, makes me seem quite fringe… .” |
| “When you talk about the challenges that you're dealing with. … People's eyes glaze over. They have no idea. … They're very focused on things that are superficial … that can be somewhat isolating.” |
| “… while I might perceive myself as an outsider to [the] … medical community at large, I work in a really supportive environment.” |
| Coping mechanisms | Adaptation and evolution | “It's a subtle shift … where you go from ‘What's wrong with this person? … Why won't they just do what I tell them to do?' To understanding that is not where they're at.” |
| “When somebody is in crisis, meeting the immediate needs but not putting everything I have into that, so that when they leave at the end of the day I'm not in a heap … a mess.'” |
| Teamwork | “We … have regular team meetings where we'll discuss cases. … It's very practical case management. But other times it's just for psychological support for the caregivers… .” |
| “[feeling] not so isolated … I'm kind of part of some group that would support each other… .” |
| Modification of expectations | “So you set your sights on an achievable level and you don't expect somebody to suddenly stop using them [drugs], go get a PhD and work and live happily ever after.” |
| “Her sugars are coming down from 30 to 15. In my practice here in [middle class area] 15 would be intolerable as a glucose. I'd want to get from 15 to 7. With her [woman patient using drugs] I'm thrilled because it's down from 30 to 15.” |