What if Emergency Rooms Treated Opioid-Addicted Patients?

Imagine this:

Your adult son/daughter lives in your home and you know they inject heroin on a regular basis.  You're fully aware that each injection could kill them even before they pull the needle out of their arm, leg, neck, face or on rare occasion, butt.[1]  Or perhaps she/he is on the street, homeless and yet, from time to time, reaches out to you by phone when a phone is available.  Something happens within him/her one day and they turn to you for guidance on how to separate themselves from this entity named "Addict.". 

This is your big opportunity to guide your child, your flesh of your flesh, your bone of your bone, your extension of you into a better and healthier life.  He/She has stepped away ever so briefly from the torment of "Addict" and wants a complete separation and divorce from it.

You know from past experience that your local emergency room will not provide any substantial treatment so you turn to Facebook and an online support group.  You pose the following question and receive a dizzying array of answers:[2]

*********************

Mom: My son wants to go away, as soon as possible to a 30-day program. Is there any help for him? Where can I take him?

Comments:

I think 30 days is not enough time but god bless him

Mom: You are right, I just meant not a 5 day, 60-90 day program.

Try and get him to Eagleville.

Call Eagleville or Malvern

The Phoenix Recovery Project

Take him to the Net at 5th and Spring Garden.  They will treat him while they find a bed for him.

Horsham Clinic 

You should try to take him out of your area.

Florida is the best thing I did for myself.

No please don't send him to Florida!!!!! There was just a post about Florida please stop saying Florida its not for everybody and a lot of body brokers out there keeping them high.....

Try Eagleville, keep him close!

I am not sure what body brokers are I just know for me it was the best thing.

Teen Challenge

Teen Challenge is for adults and teens.

Mom: He is an adult.

That is fine it is for adults also. Great program

Mom:  (He has city) and state insurance

Call Teen Challenge (in your city)

Try Eagleville they're a walk in.

So is Horsham Clinic.

See if your ins will pay for the Retreat at Lancaster County

Look at Horsham or Malvern, or Eagleville and while he’s there look for extended care PHPs or IOPs going down in levels of care each step, it’s really up to your son to take advantage wherever he goes, but the more TREATMENT he gets the more of a chance he has.

Teen Challenge seems like they have all those things including detox.

 They don’t I’ve been there.

Pennsylvania Adult & Teen Challenge is a leading drug and alcohol addiction rehabilitation treatment center that provides highly specialized treatment by offering medically-monitored inpatient detoxification, 30-day inpatient clinic…

Kirkbride

Recovery Centers of America in Devon is an incredible place. 1 800 recovery is the phone number.

He can't get medical clearance for treatment so he goes ROUND & ROUND UGH

Mom: Thank you all.  It does go around and around.

Pyramid, white deer run, Eagleville, valley forge, colonial house, fire tree, Malvern, treatment trends

Valley Forge and White Deer Run knew me by my first name

Net 5th n Spring Garden usually places within 48 hrs food, warm n comfort meds

Get him somewhere asap no time to Waste.

Malvern. There’s one in willow grove and one in Malvern

Self Help 215-677-7778

****************

As the clock ticks and you are trying to sort this out so as to try to save your child's life, you're aware that at a minimum, she/he will inject 1 to 4 (or more) bags of heroin approximately every four hours so as not to become dope sick.  From their perspective, even though they truly want to get away from this entity named Addict, they must continue to consume their "medicine" so as to avoid the horrendous symptoms that come with dope sickness.

Depending on where he/she buys these bags, the price per bag will be $5.00 to $10.00 each.  Do the math.  That's $5.00 to $40.00 per injection every four hours around the clock until treatment can begin. 

For your son, that's a lot of panhandling at a local intersection or hauling of scrap metal to the local junkyard or theft or, in rare cases, some aspect of drug distribution itself.   

For your daughter, at $10.00 to $30.00 per "date,"[3] that's a lot of sexual activity the awareness of which breaks your heart and that often brings her to heavy tears as she's trying to apply her makeup while gazing into a random piece of broken mirror or at her reflection in the side window of a parked van.

                        

Wouldn't it be better for everyone involved if your daughter or son could enter any emergency room or urgent care facility and say "I need detox and rehab."  The professionals in these facilities would then have the opportunity to fully live up to their Hippocratic Oath:

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

What if Emergency Rooms Treated Opioid-Addicted Patients?

---

[1] Typical when all veins have been used to the point that they don't accept needles without collapsing.

[2] This is an actual discussion with all identifying references removed.

[3] Sometimes more and often less when the 'man' doesn't pay her anything

The Two Worlds of Addiction Recovery

I'm living in two worlds these days. 

My employment for the past couple of months has been as a driver for Recovery Centers of America (RCA) in Devon Pa.  It is a privilege to be involved in the transportation of people coming to RCA.[1]  These individuals have varying stories as to how addiction entered their lives.   The one thing they all have in common is that they have decided to face their addiction and get on the path toward a healthy life.

People coming to RCA have called 1-800-RECOVERY, had a discussion with a caring person at that number, had their insurance verified and been medically cleared.   Not everyone who does so needs transportation from us.  Some come to RCA thanks to a family member or friend.  For those who do need a ride, we pick them up in one of four vehicles.  It might be one of our two Lincoln Continentals, a Lincoln Navigator or a Ford Explorer.  All are black unmarked vehicles that demonstrate dignity and respect toward the man or woman who is being transported to their five-star experience in detox and rehab.[2] 

These people begin their treatment almost as soon as they arrive at RCA.  This minimizes the discomfort of the withdraw symptoms common to ending their relationship with alcohol or drug usage.

That's one of the worlds in which I live…

Here's my second world as I have described in several recent blogs:

I have described in "I Need My Medicine" the reason people don't just stop using their drugs.

In An Entity Named "Addict", I've provided a description of what addiction does to an addicted person and their family.

In Let's imagine… and Dear Emergency Room and Urgent Care Staff, I've urged professionals on the front line of medicine to take the initiative in not simply encouraging addicted people to seek help but to actively initiate that help for those who want it.

In A Tale of Addiction, One Set of Fraternal Twins And Two Sets of Simulated Hardwood Floors I present a look at two very different paths to treatment for this horrendous disease.  One path is for those with private insurance and one path is for those people who do not have private insurance.

And that is the point of this blog! 

People who have private insurance and people who do not have private insurance are all human beings made in the image of God and worthy of dignity, honor, respect, and love.  All deserve our societal best to walk alongside them as they do the work of putting their addictions behind them. 

People who do what they can for addicted and underinsured folks have told me that "This is just the way it is.  If they want help, they just need to tough it out."  To this, I say that far too many of our nation's sons and daughters and their families are being destroyed and the system must change.  A sense of urgency blanketed in an environment of dignity and respect must be provided to the underinsured.

Trauma-Informed Care

Please take the next couple of minutes to watch this video for a professional's description of one small but essential part of what needs to change within the care system of our nation's underinsured daughters and sons.

Finally, I don't pretend to have all the answers for how to smoothen the path toward addiction recovery for the underinsured.  I just know in my heart that change is needed.  Let's work together and learn from the model presented by RCA to present dignity, honor, respect, and love for all persons suffering from addiction.

---

[1] We also transport people back to their home and to outside appointments while they are a patient at RCA.

[2] I have transported people from their homes right down the street from RCA, southern New England(!) and within walking distance of Emerald City.

The Power of Addiction: Does Anybody Hear?

Please Pray for "Teresa."

************************

Does Anybody Hear Her

Casting Crowns

She is running
A hundred miles an hour
In the wrong direction
She is trying
But the canyon is ever widening
In the depths of her cold heart
So she sets out on another misadventure just to find
She's another two years older and she's three more steps behind

Does anybody hear her?
Can anybody see?
Or does anybody even know she's going down today?
Under the shadow of our steeple
With all the lost and lonely people
Searching for the hope that's tucked away in you and me
Does anybody hear her?
Can anybody see?

She is yearning
For shelter and affection
That she never found at home
She is searching
For a hero to ride in,
To ride in and save the day
And then walks in her prince charming
And he knows just what to say
A momentary lapse of reason
And she gives herself away

Does anybody hear her?
Can anybody see?
Or does anybody even know she's going down today?
Under the shadow of our steeple
With all the lost and lonely people
Searching for the hope that's tucked away in you and me
Does anybody hear her?
Can anybody see?

If judgment looms under every steeple
If lofty glances from lofty people
Who can't see past her scarlet letter
And we never even met her

If judgment looms under every steeple
If lofty glances from lofty people
Who can't see past her scarlet letter
And we never even met her
Never even met her

Does anybody hear her?
Can anybody see?
Or does anybody even know she's going down today?
Under the shadow of our steeple
With all the lost and lonely people
Searching for the hope that's tucked away in you and me
Does anybody hear her?
Can anybody see?

Does anybody hear her?
Can anybody see?
Or does anybody even know she's going down today?
Under the shadow of our steeple
With all the lost and lonely people
Searching for the hope that's tucked away in you and me
Does anybody hear her?
Can anybody see?

He is running a hundred miles an hour in the wrong direction

Songwriters: Mark Hall

Does Anybody Hear Her lyrics © Sony/ATV Music Publishing LLC, Essential Music Publishing, Capitol Christian Music Group

Suicide by Deliberate Overdose Averted and Two Tiramisus To Go

One of the privileges of relational ministry is to walk alongside another human being in their darkest times.  I've had such privileges several times since visiting the good people of the streets of Kensington over this past couple of years.  This only happens in depth when trust has been realized and that only comes with time.

One of these experiences happened recently when I was contacted by a resident of the streets who has been doing everything they can possibly think of to find detox and healing.[1] 

I won’t even go into the details of all that this person has tried to do to find healing.  Those details are actually already mentioned in general terms throughout this blog series.

Imagine if you will, being required by your body to inject a drug that you are well aware may kill you before you can even remove the needle from your being.  If you are a lady on the street, imagine knowing that your only source of income to buy that drug that may kill you is to rent out your body to a guy who may be kind to you or who may kill you.  Imagine being called every conceivable harsh term often used to describe a woman who walks the street in this way. 

Are you getting the idea?

I’m not done…

Imagine knowing that your children have been taken away from you permanently, your family has turned their back on you, you have several STDs, blisters, abscesses, and, most recently, a doctor has told you that your organs are failing due to your drug use that you’d like to stop but can’t because you can’t get into a detox unit without jumping through so many hoops that your mind blows just thinking about it.

Multiply all of that by a factor of 10 or more and add on top of that the torment that you feel in your soul because, in reality, you are a very committed Christian who knows that all of this is wrong and you’d like to stop but can’t.

Are you starting to understand?

Now hold those thoughts for a moment…

What is a heroin overdose?

An overdose occurs when a person consumes more heroin in one injection than their body can handle.  That’s really all an overdose is…

Just as you might ‘overdose’ on pizza and end up with indigestion, any drug addicted person could end up with death by injecting to much drug in one dose.  It’s just that simple…

Now let’s combine these two topics…

If my life is a living hell from which I can not find my way out and no one around me seems to know or care what to do then all I need to do is inject more heroin than my body can handle in one injection.  My obvious solution to this misery is literally at my fingertips with far more ease than using a gun or rope or stepping into traffic.  I’ll simply fade away and never know I’ve died.

This is the place in which one of my street friends found themselves a few weeks ago.  Well, actually, my description is a faded shadow of their reality over those days.

I was deeply concerned and sought prayers and professional guidance on what to do.  With the seemingly guaranteed day of earthly departure come and gone, when I received a text the following morning indicating he was still with us, I sighed and cried in relief.  

Permission to photograph
was obtained from
Mr. Croquette Potato Head.

The tiramisus did not
want to be photographed.
Out of respect,
I've used this very similar
photo from the web.

We met for lunch.  Both of us ordered French Onion Soup.  He had a chocolate milkshake and I had the happiest chicken croquettes with mashed potatoes and gravy that I’ve ever seen!

On the way out, there was one more temptation to overcome and fall victim too:

Those gorgeous desserts in the display case right at the cash register!!!

It didn’t take long to identify what we were getting…

“Two tiramisus[2] to go, please.”

---

[1] To say that the medical system is so outrageously incapable of providing care for those who need it at the volume it is needed these days in this current crisis is one of the understatements of the century. 

[2] an Italian dessert made with layers of sponge cake soaked in espresso coffee, Marsala, mascarpone cheese, and chocolate

Dear Emergency Room and Urgent Care Staff,

Dear Emergency Room and Urgent Care Staff,

More than once, I have sat with a man or woman as they have been treated in your facility. On occasion, these good people have been admitted to your hospital for the primary cause of their visit.  Almost always, that cause has as its underlying issue, the addiction for which they suffer and the lifestyle that this addiction brings.  Pneumonia[1], acute diarrhea[2], bruises and breaks, slashes to the face, black eyes and torn ligaments from being hit by cars, motorcycles and abusive 'dates' are a few examples.   Pre-existing conditions made worse by life on the streets include diabetes[3], epilepsy[4], multiple sclerosis[5], arthritis[6] and more. 

For the many who come to you for service and don't need to be admitted for their presenting medical issues, far too often, I've seen you say "Have a good day."   Occasionally, and far less than most of the time, I've seen you hand them a sheet of paper with names and phone numbers "of places that might be able to help you (tomorrow or on Monday when they reopen) with your addiction."

As they leave patched up but still emotionally/spiritually bleeding to death from their addiction of which you were fully aware and did not apply your medical training, you are setting them up for additional crisis of which you may not be aware.

When you say "Have a good day." to that man you've treated, he leaves to continue his day, not feeling well from whatever brought him to you but on the mend thanks to whatever treatment you've provided.  He will go to his local street corner to 'fly a sign' that says "Hungry".  His increasingly emaciated appearance will actually help prove his case to folks who get stuck at his red light and are forced to consider this man for a minute.  Some may actually give him some change or random food item that they happen to have.  Others may yell or spit at him.  Some who know they won't get stuck at that light will throw things at him as they pass by.

When you say "Have a good day." to that woman you've treated, she leaves to continue her day, not feeling well from whatever brought her to you but on the mend thanks to whatever treatment you've provided. 

She will go to her local street corner to stand there well dressed seemingly waiting for a specific person to pick her up for a meeting when in fact she's standing there well dressed waiting for that random male to pick her up to use her for his own purposes.

Her increasingly emaciated appearance will actually hinder her ability to find a "safe date."  Through her own experiences and those of other ladies on the street, she will begin to realize that her natural physical beauty has faded to the point where "the only dates I can get are with guys who want to hurt ugly girls like me."

Some guy will stop to scan her and decide "She'll do."[7]  With fear, she gets into his broken down car or classy high end vehicle and they drive away. 

Half a day after being in your health care facility and four hours after hearing in a phone conversation the above bold red highlighted quote, the author thereof was assaulted by such a guy and would have been raped if she had not "kicked the shit out of him to get away from that car parked in a back alley many blocks away."  She continued:  "I walked those many blocks back to the bridge and he followed me in his car most of the way shouting horrible things at me the entire time."

Realizing that finding safe dates due to her declined physical beauty, women of the street may be tempted to turn to a pimp[8] who will arrange for dates to come to her.  Such is the case with one woman who has shared these thoughts with me.  Again, to drive home my point with you, this woman was in your health care facility not long before starting to consider this option.

Physicians and nurses of the E.R. and Urgent Care, each one of you have, upon your graduation pledged your career to some version of the Hippocratic Oath.  While your version may have been slightly different, the following is, I'm sure, a reasonable representation thereof.  I have made bold and red, the points therein that most apply to this open letter to you:

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Finally E.R. and Urgent Care Staff:  The next time any man or woman comes to your facility, please inquire into what your organization can do in the here and now for them to combat their addiction.

Sincerely,

Chris 

---

[1] an inflammation of one or both lungs, usually caused by infection from a bacterium or virus or, less commonly, by a chemical or physical irritant

[2] frequent and excessive discharging of the bowels producing thin watery feces, usually as a symptom of gastrointestinal upset or infection

[3] a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine.

[4] a medical disorder involving episodes of irregular electrical discharge in the brain and characterized by the periodic sudden loss or impairment of consciousness, often accompanied by convulsions

[5] a serious progressive disease of the central nervous system, occurring mainly in young adults and thought to be caused by a malfunction of the immune system. It leads to the loss of myelin in the brain or spinal cord and causes muscle weakness, poor eyesight, slow speech, and some inability to move.

[6] a medical condition affecting a joint or joints, causing pain, swelling, and stiffness

[7] This is, of course, after multiple guys have stopped to scan her and then tell her to her face that she's far too ugly for "this line of service." 

[8] somebody, usually a man, who finds customers for a prostitute in return for a portion of the prostitute's earnings

A Tale of Fraternal Twins And Simulated Hardwood Floors

Nearly 100% of the people whose stories I anonymously share here 

are reliant on Medicaid to cover their health care costs.  

In recent months, I have become increasingly aware of the lack of care, compassion, and competence on the part of Medicaid level providers as compared to their private insurance counterparts.  

Medicaid patients are losing their lives as a result of these differences.  

It is time for those of us who care to 

"Plow Down Medicaid Mountain!"

George and John, in the following story, are fictitious characters.  What they experience, however, is factually based on what I have witnessed in the worlds of Substance Use Disorder Health care provision in the two insurance realms.

Please consider joining us in making changes to this system.  A private Facebook Group is forming for us to share stories, compare notes and support each other as we seek solutions.  

**********

On the Day that George and John were born, their parents, in a fog of addiction, gave them up at local safe drop off stations, George on one day at one such station and John on another day at another station.  As fraternal twins, they looked nothing alike.  They bore no identical traits other than the propensity for addiction that lingered quietly within them. 

George and John were placed in loving homes through adoption. 

George's home was one of considerable financial wellbeing, mostly through his parent's many real estate holdings.  George went to the finest schools as a child.  In 2008, finances dried up for George's family and times got tough.  His Dad and Mom moved their family of three into the basement of a family friend who had a dark side.  This friend introduced George to aspects of life that no child should ever know.  The resulting pain and confusion within the soul of George awakened the inner demon of addiction.  Heroin became his only and best friend.

                                                       

John was adopted into a hard-working family.  Mom and Dad were both tradespeople.  Dad was a plumber and Mom an electrician.  Mom and Dad loved athletics and as John grew, they encouraged him to find a sport that he enjoyed.  John was awesome at high school baseball.  On one fateful day, he slid into third base and shattered his leg.  Surgeries lasted for months.  During this time, to manage his pain, John was put on opioid-based pain relievers which handled his pain and awakened his inner demon of addiction.  In time, heroin became his only and best friend.          

Twins separated at or near birth and who know nothing of each other have been shown to often do the same things throughout their separated lives.  George and John are examples of this phenomenon. 

On the same exact day toward the end of 2018, George and John made the same decision...

George woke up in his tent in a "homeless people's encampment."  He glanced over at his tent mate, a young lady in her twenties.  She lay there blue and lifeless with a noticeable facial injury, the result of a date gone bad just hours before.  This, combined with other recent street deaths of friends by overdose, pneumonia and one out of control car and his own multiple overdoses saved by Narcan in recent months watered a seed of rational thinking that had laid dormant for years within George. 

John lived with his addiction and his family and kept distant from them but not from it in his basement apartment.  He began to realize that life was not going in the direction it needed to go.  One night, upstairs, around his parent's kitchen table, John confessed his sadness and self-loathing to his Mom and Dad.  The three of them through a lot of tears and a tiny bit of yelling decided on a course of action to address John's addiction.  With private insurance cards in hand, phone calls and arrangements were made for John to enter detox and rehab.  Later that same day, John injected one last dose of his needed medicine, was picked up by a driver from his rehab home of the next 28 to 30 days, arrived and was met by men and women who treated him with the dignity and respect deserving of any human being. 

From the moment John entered the building and on his walk to the admissions office and then to his detox room, John walked through tastefully decorated halls lined with portraits of famous strugglers of addiction and inspiring quotes from people throughout the decades.  He could not help but notice the brightly lit lounge areas with their electronic fireplaces and large screen TVs.  Under his shoed feet, every step of the way, he walked on well maintained simulated hardwood floors.

George knew what he needed to do to enter detox.  For the next few days, as he continued his normal routine of living in a tent and 'flying a sign' at street corners that read "Hungry," George connived to survive and hustled to pull together an extra $60.00 so as to buy extra dope to hide on him during his expected one day wait in the Crisis Center several blocks away.

With enough money in hand, he bought the extra dope, and then walked to the Crisis Center, pushed the button on the brick wall next to the secured ill painted metal door with the wire laced security window located in the middle of its upper half.  After a couple pushes of the button, a security guard opened the door and asked why he was there.  After explanations, the guard told George to come in and strip down in public to one layer of outer clothing, to empty all of his pockets, remove his shoes, allow himself to be frisked and to walk through a metal detector.  With growing fear and trepidation and a fading determination in his heart, George complied.  With socked feet, he walked across the worn and tattered simulated hardwood floors that ran throughout the facility to the awaiting receptionist; was handed a clipboard with papers to be filled out and told to "Sit over there and fill these out."  Once filled out, he handed the papers back along with his Medicaid insurance card.

As George sat down, he glanced around the room of grey chairs each attached to the one next to it.  Three other people were in some stage of being processed.  All were asleep.  One was a woman whose 'one layer of outer clothing' had obviously been her only clothing for quite some time.  A man, asleep and draped across two chairs and covered with a blanket, lay motionless representing the hours of waiting he had endured thus far.  The other waiting room resident and only Caucasian of the three looked suspiciously familiar to George.  As George looked at him, asleep in his chair, he wondered if this was the same man he's seen in a recent "Has anyone seen my son?" flyer posted up and down the avenue.

One urine sample, one medical exam, one interview and six hours of room observation later, George was starting to experience dope sickness and needed to use the bathroom.  From observing, he knew that anyone who asked to be allowed into the locked bathroom would be checked on after a very short period of time.  George knew that he could not, during that short interval of privacy, prepare and inject the dope that he had smuggled in and stored on him where nothing to be consumed should ever be stored.

With an onset of diarrhea from dope sickness nearly guaranteed any minute, George requested to use the only bathroom.  He entered it and saw one toilet and two urinals against one wall none of which had any hint of current privacy provided except for the small holes in the wall that suggested that privacy enclosures once existed.  All pipes typical of bathroom fixtures were boxed in so as not to be used in combination with one's belt for the purposes of hanging and ending the misery.  But what did that matter?  By requirement, George had surrendered his belt hours ago.

It was more than George could take.  He walked out of the bathroom without feeling better, politely told the nurse that he was leaving, was reintroduced to his belongings, left and found a back alley nearby to use as his bathroom. 

John's road to recovery is well underway. 

George is living in a tent.

The one thing both facilities have in common:  Simulated Hardwood Floors

For further reading on this topic, I invite you to read these blogs.

It's Time to Plow Down Medicaid Mountain!

This Week with Tabitha and Melanie

Calling ALL Bulldozers! It's time to Plow Down Medicaid Mountain!