Having a non-judgmental approach and accepting that
abstinence from drugs is often not a viable option
for the population in this drug-saturated entrenched environment.

And we may as well start with the one that will likely seem obvious to you and yet causes more confusion that all the others put together: respect.
We have been asked: are we arguing for respect for the rights of the patient? Or the lifestyle? The ability of the patient to endure? Does our idea of respect imply endorsement?
We would like to have a clever answer to this. Some turn of phrase that would sum up our meaning of the word respect. So far, no luck.
So we break it down, throw in some stories.
Does it mean respect for the rights of the patient? Yes, of course. Absolutely. Each of the residents of DTES are residents of all the larger communities as well. Vancouver, BC, Canada. As residents of these communities, they have every reason to expect the services to which any resident is entitled.

This is not a question of compassionate care. Sympathy does not have to come into play. If these folks lived in a tonier neighbourhood, we wouldn't even have to make the point. A drug addict in a million-dollar home will get our services delivered in exactly the manner they request. While there are obvious differences between that well-off user of our services and the patient in DTES, those differences do not - or at least on paper should not - enter into our equation. The respect, then, is not some feel-good respect for the sensitive soul that lies within us all or some such. The respect is that due the office. In this case, the office of resident of Canada and BC and Vancouver. Period. All other factors: what you and I think of the person or the behavior of that person, has nothing to do with it. Residency equals service. Equals equal service.

No value judgment need come into play here. But, for the sake of clarity, ask yourself who is a more appropriate client for our services, the multidx shattered body and spirit of DTES or the mansioned millionaire who expects and receives - as is their right - free, nonjudgmental services. So, that's part one of respect: nonjudgemental care.

It's easy for us to say it that absolutely. And we expect most of you will agree without giving it much thought. In a few minute we'll get to the details of watching as a person destroys himself and your efforts time and time again. Respect for the person, respect for the position, respect for your abilities, respect for any aspect of the situation, will be hard-tested.

In the meantime, consider the idea of respect for the circumstances. For "being there, where they are." This is not how we are trained. We are trained to "fix it", to deal with the problem right "now". That's what you are trained for, that's what you're here for. You know the problem, know the solution and you're standing in the hall, knocking on the door. If they are not ready for you when you get there, they are labeled "not interested", "busy", "non-compliant" - "high". In most communities, this equals "services not required." Since other communities usually have alternate resources with which to address the problem, there is no absolute risk in you simply writing them off. Here, there are more subtle situations afoot. You have to understand that the concept of personal health is lower on their priority totem pole. You will know by the second "fuck off!' that it's "no" for today.

Weather it. It's important to pursue what you came for, even if it means another rescheduled visit. You have to know that your services are ultimately important - this is where that self respect is so important. The fact is that other priorities are currently in first place: maybe the person's getting evicted in two hours, or a close friend has just overdosed, etc. so understand we are not a priority. Think of the investor too intense on a trade to stop for a moment. Or a mountaineer too intent on the goal to deal with frostbitten toes. Don't let it get to you, don't let it turn you off. So today's schedule is now tomorrow's. Maybe tomorrow the priorities will be different. By the way, this is yet another advantage to two-nurse visits; it's unlikely you will both be equally frustrated by the rebuff. Second brain, second look: it's important.

We are saying the nurse must not judge, but the patient continues to judge the nurse and system. The nurse is caught in the middle of prejudices from patient and the care structure. Take the myth that the nurse knows all, is problem oriented, and will "solve" the problem and eventually discharge will happen. And you're out of there! What do you need a relationship with the patient for? The wound, break, disease - whatever - well, all that's history now. You've fixed it: move on! The very structure works against forming relationships over time. They serve no purpose, move on!

And, you know, for most of the people in the normal world that might at one time or another need a nurse, for them this makes sense. The pressure to discharge for them makes sense. But for the people of DTES it's not that way. The pain is chronic. The disease is chronic. The drug addiction is chronic. DTES itself is chronic. DTES wherever it may be. Life in DTES, life like this... is chronic.

These folks struggle up and crash down. Up and down. Sometimes the cycle takes weeks or months, sometimes hours. But it is always there. Wrapped in a swirling sea of mental confusion, paranoia and doubt. If you walk away from someone, the next time you have to deal with that person you are going to have to start all over again. And it will be harder. They remember that you were there and then not there. It's far easier, far more efficient, far more effective to just keep up the relationship. A few minutes here, a few there; next time something happens you're already on it. They cooperate, they trust to the extent they can. But, most importantly, you can get the work done.

Easing up on judgment of the person can help you make good decisions. Your view of the person isn't obscured by foggy layers of opinion. Here's an example and something you really need a clear head to think about: how willing are you to overstep your boundaries? Both professional and personal?

What if you don't do it? What if you know -- you know! -- that if you don't do it he will never get to that appointment? That he will tell himself you weren't there when he needed you?
How do you balance all this out?

One of the hardest things about trying to be non-judgmental is remembering to include yourself, your own actions and decisions. Action Based Care applies to you, too. So think things over, make a decision - often as not, going with your instincts will serve you well - and then live with it. Think over what you did, decide whether the action worked - skip "right" or "wrong", those are just judgements and serve you poorly - and decide on how you will handle it next time. Make notes, tell your partner. And let it go.