Table 2. Themes Identified from Data Analysis of Transcripts
Major ThemeSubthemeExemplar Quotation
Emotional impactTragedy 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 mechanismsAdaptation 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.”