As much as I tried to avoid them, I found myself working at a ketamine clinic. I studied Biology with a Psychology minor and set out to be a Physician Assistant, thinking I'd be somewhere more clinical, taking blood pressures and giving flu shots. Instead, I found myself in a dark room with recliners and noise machines, next to people about to be dissociated.
They've been dubbing it a clinical position. It's so much more human.
It takes a lot of patience, which isn't just about politeness. It's about deep, painful patience which lets you embrace the terror and the sadness and the confusion that comes along with this experience. It can sometimes mean staying silent.
The routine can be soothing and the patients become familiar. They come in with their playlists and candy sorted in rainbow order and their blankets neatly folded, some begin to journal, some meditate, some do deep breathing to calm and prepare themselves to dissociate. The most common practice is to shake and tap the applicator because even though it doesn't do anything, it can help control the anxiety of the situation. Ultimately, they need to take a small, soft sniff. The dissociation then finally comes and some just slip into it.
People may thrash, rock, hum, or sing without awareness. I've walked in at 40 minutes to screams of anger because I am an intrusion in their world. I have witnessed people hallucinate with floating, flashing, and phantom figures and things and colors that don't exist. I have witnessed slow motion movements of people, intermixed with hands that appear to move through a space filled with sticky, thick air. Bright lights make it worse, hallucinations and movements better, different views worse.
The worst of it is sudden intense panic attacks. There's the unexpected fear and gasp, and the affected individual reaches out with a quivering hand for reassurance. It has happened too many times for me to count. I have given reassurance by counting and breathing with people until they stop trembling from the attacks. I have sat on the floor by the recliner because that was where someone needed me to be.
Vulnerability causes attachment and brings blurred boundaries. Some patients think they have intimacy with familiarity. It is common practice for patients to try to cross real and virtual boundaries by asking for my phone number and social networking contact as if it is their due. We lose our cool a little when we enforce 'doctor's orders' especially the 15 minute 'late to your own funeral' policy. One patient stole Spravato. Others used it to get high instead of to heal. The rest are the vast majority: they are good people, trying their best, fighting battles that I cannot understand.
None of my coworkers have lost control. We have an excellent training system and an even better learning group of colleagues. The providers are calm and steady. I have learned to act fast to count and to protect, to soothe.
Using vulnerability as my guide, I have taught myself how to be a person others trust when they are in their most vulnerable position. Patients share their pain with us. They come from other clinics. They tell us stories about staff behaving indifferently. They tell us about chaos in their dosing rooms and how they feel unsafe. They say our clinic feels safer. Kindness matters, and that really helps the staff of the clinic because we hear that everyday.
I have watched people grow. I have patients return after going on vacation. I have listened to them talk about going to the ocean. I have remembered their plans and asked them about it after. I have watched patients that come in anxious and leave feeling less anxious.
We have an overall treatment ritual. Spravato is more than just a medication, and patients experience a new kind of surrender as they go on a strange and beautiful yet frightening journey for two hours into themselves, which I was there to witness.
I by no means was a medical assistant. I was a witness.
Music is an almost constant element a patient brings into the treatment room. If you are about to go into a session, you can use our Spravato playlist to guide you. It was made by someone who has been through Spravato treatment.