A Cast Now or Surgery Later

A couple of years ago, "Cecile" came up to me in Emerald City and shared with me how he had pulled someone out of the path of an out of control motorcycle.  The person was fine but he now had a broken arm. 

People on the streets do everything possible to avoid going to the E.R.[1]  Cecile had put a splint of his own making on his arm.  His arm was completely useless for a couple weeks as he tried to bring healing to it without professional care.  In time, his arm "healed" but had a noticeable bend in it.  He was told by a doctor who visited Emerald City that the day would come when surgery would be needed to correct the improperly healed break that could have been dealt with early on if proper care had just been provided when it was needed.

Melanie and Natalie are sitting in jail cells at RCF[2] as I write this blog.  Both ladies have been there for three to four months.  They have both detoxed from their "medicine" and have been in a holding pattern, living in a cell that can better be described as an oversized toilet stall with cots.  They have received no counseling nor therapy for their Substance Use Disorder issues. 

Their "broken arm" has been the addiction/homeless phase of their Substance Use Disorder.  Their time in a homemade splint has been these past months as they have sat waiting for the legal system to find them a medical bed in a facility to provide the care - the cast - that they should have had months ago.

As they sit and wait, they think.  They climb inside their own heads, talk to others who are in this similar holding pattern and develop their own -  largely unguided - understanding of what happened to get them where they are today and how they might correct their path.  In the absence of the placement of a proper cast at the time of injury, their soul may heal but with a bend that will require "surgery" since healing was not provided at the time of the injury.

Would it not be better for these ladies, - who represent thousands of other men and women in this same situation - if we as a society had the mechanisms firmly in place to provide the cast when it's needed and not wait to provide the surgery long after the injury? 

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[1] Mostly because they have come to know that most E.R.s treat them as something less than human.

[2] Riverside Correctional Facility

Comparative Studies in Addiction

Reliant on Medicaid to fund her healing, Melanie sits in a jail cell for 3, 4, or 5 months with all of the constraints of an imprisoned person while awaiting handcuffed transfer to a medical facility that is charged with the privilege of serving her in her healing from Substance Use Disorder.

Reliant on Private Insurance to fund his healing, Ralph sits in a plush luxury vehicle for his transfer to a medical facility that is charged with the privilege of serving him in his healing from Substance Use Disorder.

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An Imperfect Analogy:

If the use of insulin was considered wrong would medical patients who have been diagnosed with diabetes be living in tents under bridges or out in the open on city sidewalks?

Would they be unemployed, 'panhandle' and 'date' to raise funds to go to their street corner insulin dealer to buy their insulin to avoid 'insulin sickness?'

Would they be derogatorily described as "Diabetics?"

If the use of heroin was considered acceptable would medical patients who have been diagnosed with Substance Use Disorder be immediately treated upon request in emergency rooms, clinics or hospitals?

Would they survive and be employed to raise funds for their family instead of going to their street corner heroin dealer to buy their heroin to avoid 'dope sickness?'

Would they be derogatorily described as "Addicts?"

Patients who have been diagnosed with Diabetes and patients who have been diagnosed with Substance Use Disorder are all medical patients who have been diagnosed with a medical condition that results in its respective sickness if a 'medicine' is not provided to avoid that sickness.

One diagnosis is socially accepted.  The other is not.

You can't do this for me and yet the opposite of addiction is connection.

Earlier this week, I saw the following statement posted on Facebook on one of the outreach group sites that I follow.  I copied it into my word processor and then it happened…  My computer burped… I lost the original post and, in the absence of my morning coffee, could not recall where I had been reading it.

I wanted to know more about this disturbing statement that was making me wonder if I should stop doing what I do in Kensington.  I Googled the first sentence of it and found the statement in its entirety in this post from 2005.

I suddenly started wondering if I was reading something that is very accurate to today's current situation in Substance Use Disorder and addiction or was this something more along the lines of coming from an excellent but outdated textbook from two decades ago?  Here's the statement[1]:

"If you love me let me fall all by myself. Don't try to spread a net out to catch me, don't throw a pillow under my ass to cushion the pain so I don't have to feel it, don't stand in the place I am going to land so that you can break the fall (allowing yourself to get hurt instead of me) ... Let me fall as far down as my addiction is going to take me, let me walk the valley alone all by myself, let me reach the bottom of the pit ... trust that there is a bottom there somewhere even if you can't see it.

The sooner you stop saving me from myself, stop rescuing me, trying to fix my brokenness, trying to understand me to a fault, enabling me ... The sooner you allow me to feel the loss and consequences, the burden of my addiction on my shoulders and not yours ... the sooner I will arrive ... and on time ... just right where I need to be ... me, alone, all by myself in the rubble of the lifestyle I lead ... resist the urge to pull me out because that will only put me back at square one ...

If I am allowed to stay at the bottom and live there for a while ... I am free to get sick of it on my own, free to begin to want out, free to look for a way out, and free to plan how I will climb back up to the top. In the beginning, as I start to climb out .. I just might slide back down, but don't worry I might have to hit bottom a couple more times before I make it out safe and sound ...

Don't you see ?? Don't you know ?? You can't do this for me ...

I have to do it for myself, but if you are always breaking the fall how am I ever supposed to feel the pain that is part of the driving force to want to get well. It is my burden to carry, not yours ... I know you love me and that you mean well and a lot of what you do is because you don't know what to do and you act from your heart not from knowledge of what is best for me ... but if you truly love me let me go my own way, make my own choices be they bad or good ... don't clip my wings before I can learn to fly ... Nudge me out of your safety net ... trust the process and pray for me ... that one day I will not only fly but maybe even soar."

If this statement is accurate to today's situation and we take it at face value, anyone who does anything for/with people on the streets and in the addiction phase of their officially recognized Substance Use Disorder, might as well go home and find something else to do with our time.

But wait! 

There is something for us to do even if the statement above is 100% accurate:

Develop and Maintain Connection for that time when our loved ones on the streets are "ready"!  I encourage you to watch the following video which addresses the importance of connecting with Substance Use Disorder patients who are in the addiction phase of their disease:[2]

Here's the takeaway statement from this video:

And what I've tried to do now, and I can't tell you I do it consistently and I can't tell you it's easy, is to say to the addicts in my life that I want to deepen the connection with them, to say to them, I love you whether you're using or you're not. I love you, whatever state you're in, and if you need me, I'll come and sit with you because I love you and I don't want you to be alone or to feel alone. 

And I think the core of that message -- you're not alone, we love you -- has to be at every level of how we respond to addicts, socially, politically and individually. For 100 years now, we've been singing war songs about addicts. I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection. 

So what do we do in our connection with our loved ones when they are "ready"? 

The answer is actually easy and yet our society can't seem to do it:  Connection may lead them to seek treatment.  Medical facilities must treat them and treat them without delay as a medical patient of their Substance Use Disorder!  Connect with and treat them in an environment of dignity and respect.

Patients of Substance Use Disorder who are reliant on Medicaid for financial coverage of their disease's expenses[3] face the requirement of climbing  "Medicaid Mountain."  Many of our nation's daughters and sons fall from and die as they hike in their weakened condition along the high and narrow cliff trails (that do not have guard rails of dignity and respect) that lead to the health care that they need and now want.

To better understand the differences in health care provision for people with private insurance and Medicaid, I invite you to read this linked  blog.

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[1] I've broken it down into separate paragraphs for easier reading.

[2] Clickhere for the video that includes a transcript.

[3] This is almost every homeless person.

Sitting in a Cell with SUD

Once again in my time of blogging, I find myself eating lunch at the Applebee’s on Aramingo Avenue following a wonderful visit at RCF with “Melanie,” my Delaware County neighbor.  As a patient of SUD, she sits in her jail cell minute after hour after day after week after month awaiting word that the legal system has found a bed for her within the medical system for her to go to that will meet her rehab needs.

She’s been sitting there waiting in a jail cell designed for criminals longer than your standard 30 days of typical private insurance rehab.  It’s a time for her to contemplate her navel or come to the conclusion that the system just does not care.  Rather than receive the emotional and spiritual healing that could be had within rehab,  this extended stay in jail only adds to the emotional trauma that she has experienced thus far in life. To the system, she’s just one more ‘case.’ 

To those of us who know and love “Melanie” for who she is with her fun, lighthearted and playful spirit, we mourn her prolonged and unnecessary suffering in a cell – an oversized toilet stall shared by previous strangers who now sleep in neighboring cots and share an exposed toilet.

Let us remember now and never forget, “Melanie” and the hundreds/thousands of other sons and daughters who are sitting in cells with SUD when they should be in rehab getting therapy. 

I don't know, go or care! Carry Narcan!!!

I don't know any addicted people.  I don't need to carry Narcan.

I don't go to any places where I might see an overdosing person.

I don't care if an overdosing person dies.  They chose to be an addict.

I don't know any addicted people.  I don't need to carry Narcan.

Substance Use Disorder patients are everywhere: in your neighborhoods, churches, shops, and highways.  You don't need to know a Substance Use Disorder patient to save their life if overdose tries to claim them.

Carry Narcan! 

I don't go to any places where I might see an overdosing person.

Substance use knows no boundaries nor borders.  Whether you live in a gated community or a housing project, heroin is hovering nearby.  If you're a high society individual who only goes to high society places, heroin is there and hiding in more pockets and purses than you can possibly imagine. 

When that day comes that you excuse yourself to use the restroom in your high society restaurant and you find a person lying on the floor or gasping for breath from inside a closed stall, you'll wish you carried some Narcan. 

1, 116 people died of an overdose in 2018 within the Philadelphia city limits.  Over 68,000 people died nationwide in 2018.  Many more than that were saved by Narcan, a stunning miracle drug that is reducing the number of parents who bury their children and reducing the number of children who have lost both parents from entering the foster care system.

Carry Narcan! 

                                                                                                                                                     

I don't care if an overdosing person dies.  They chose to be an addict.

It's shocking to me that some people feel this way. 

The topic of "choosing to be an addict" is an incredible error in understanding the issue. 

If you really don't care if that human being dies, even after you see them turning blue in your favorite restaurant's bathroom stall, I guarantee you that in the days to follow, you'll wake up at night wishing you'd carried Narcan: that simple to administer miracle drug that would have prevented you from carrying the emotional baggage of knowing that your ignorance contributed to the preventable ending of a life and that you could have been some person's and family's lifesaver hero.

Carry Narcan! 

The Grassroots Hospital: A Call for Overdose Prevention Sites

The Grassroots Hospital: 

A Call for Overdose Prevention Sites

Click here for an audio version of this document. It runs 3:41.

The Current Crisis

Until the time when we as a nation have evolved to accepting Substance Use Disorder patients as patients and not as outcasts, we must open Safe Injection Sites and Overdose Prevention Sites NOW.

As I sit here in my suburban apartment, I am acutely aware that many of my Philadelphia friends are gathering at the Federal Courthouse. They are making their voices heard on the issue of Overdose Prevention Sites. My work schedule today prevents me from being there in person, so I wanted to share these thoughts from home.

The Hidden History of Community Care

Grassroots versions of Safe Injection Sites have existed for years—and likely decades. One could argue they have existed throughout the two and a half centuries of our nation's history.

Years ago, our nation's sons and daughters gathered in "The Tracks" to inject their "medicine." It wasn't a perfect system, but it was a community. About three years ago, when the city of Philadelphia closed The Tracks, those residents were displaced. Many of these daughters and sons created new communities under four Conrail overpasses along Lehigh Avenue. The largest of these was known as "Emerald City."

The Miracle of Emerald City

Emerald City and the distribution of Narcan gained attention at roughly the same time. During its height, between 80 to 100 people lived under one of those four bridges. Narcan was distributed as widely as possible among the residents.

The result was an incredible lack of deaths by overdose.

This does not mean there weren't overdoses; it means that nearly every person on death’s door was witnessed by someone else. Narcan was administered by fellow residents, often accompanied by resuscitative efforts and CPR. I witnessed five such events during my visits to Emerald City. Of those five nearly dead people, ALL were saved by members of that community: homeless patients in the grip of full addiction.

Street Level Community: The Actual First Responders

How did these saves happen? The answer is simple and controversial: Street Level Community.

By allowing our nation’s homeless Substance Use Disorder patients to gather in community—under bridges or along sidewalks—lives are saved. They come to know each other. They look out for each other. They become each other’s actual first responders in a life-or-death crisis.

These communities give a human being the opportunity to eventually choose recovery. They prevent parents from the agony of burying a child. They reduce the number of orphans left behind and traumatized for life.

A Failure of Compassion

These are human beings. No one should be forced to live under a bridge or on a public sidewalk because they have an officially recognized disease that society refuses to understand.

While it would make far more sense to treat Substance Use Disorder as a medical condition rather than a societal disgrace, our culture isn't there yet. We aren't opening our hospital doors to these intelligent people—most of whom rely on Medicaid—to give them the treatment they deserve.

The Next Best Option

Public injection, the physical toll of the disease, and the loss of dignity on our streets are not pleasant for anyone to observe. Therefore, the next best option is to create officially sanctioned Overdose Prevention Sites. In these sites, residents can inject the "medicine" their bodies demand while being supervised by professionals who can keep them safe. These professionals can then guide patients into services that have the potential to reunite them with their families and lead them down a path of healing.

The Ultimate Answer

Are Overdose Prevention Sites the ultimate answer to this horrific issue?

No. The ultimate answer is to create a culture that plows down the barriers preventing patients from getting care in an environment that recognizes their humanity.

But until we reach that evolution, we must open these sites now. Until they are open, we must recognize that street communities are the actual reality of grassroots Safe Injection Sites. They are, in essence, hospital wards where the patients are also the medical overseers.

The Last Stop's Sidewalk as a Hospital Ward

The Intersection of Kensington and Somerset as a Hospital Ward

 

Streets Outside Prevention Point as a Hospital Ward

Street In Front of the Kensington StoreFront as a Hospital Ward

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[1] It was called this because it was at the corner of Lehigh Avenue and Emerald Street.

[2] The total number of people under all four bridges was thought to be in the range of 300.

[3] Three of those five were saved by the same woman whose latest save count is pushing one hundred and fifty as of last week.

[4] Neither of which provides bathroom facilities.

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

In my role as a driver for RCA[1], I have had the privilege of bringing in one person at a time for the beginnings of their detox/rehab experience and to be relieved of their often years-long relationship with their drug of choice.  Very often, they did not know when they woke up that morning that they would be concluding their day at RCA.  It took one decision to call 1-800-RECOVERY to get the proverbial ball rolling.  Within a very few hours of making that call, I pick this person up in a fully loaded black Ford Explorer.  Upon arrival at RCA, this person is receiving the care that they deserve and in an environment of dignity and respect.

Recently, as I was preparing to go get one of these people, I was hearing by way of Facebook messenger, from a person I've known for a couple of years who lives on the streets of Kensington.  They had been admitted to the Temple Episcopal Hospital Emergency Room for withdrawal-related seizures.[2]  Once the seizure issue was resolved, this person was discharged with instructions to go to the NET or Hall Mercer, two different crisis centers that serve Medicaid reliant Substance Use Disorder patients.

Let's look at this incident more closely:

This homeless person, a woman reliant on ‘dating’ to raise funds for anything and everything, was discharged to walk ‘home’  - a piece of sidewalk on Kensington Avenue - and/or make her way by foot having recovered from seizures and still experiencing dope sickness - to one of two places many blocks away. 

Here's a visual of her three options:

It's an hour and 3 minutes
for a strong and healthy person to make this walk.

It's an hour and 20 minutes
for a strong and healthy person to make this walk.

Even walking at half speed due to dope sickness,
it's a 16-minute walk to find a 'date' and relief.

Once at either of these crisis centers, if she was to arrive there at all, she would be required to go through the same experience that 'George' did in this blog that I wrote contrasting Substance Use Disorder health care providers depending on your insurance: private or Medicaid.[3]

Now put yourself in her shoes for a moment:  She's convinced after all these years that she's a worthless piece of garbage, not even worth the breath she breathes.  Nothing matters and death in inconsequential.  Which is easier:  

1. Dope sick and potential seizure filled walking an hour and 20 minutes to reach Hall-Mercer or
2. the same walking an hour and 4 minutes to reach the Net so as to wait at either place for many more hours and MAYBE be admitted for her much needed services or 
3. walking 8 to 16 minutes so as to be in the general area where she can find a guy or two with whom to provide some degree of sexual service so as to 'earn' the very few dollars[4] that are needed to buy the 'medicine' that she must have to relieve her dope sickness?

Each person I bring to RCA is a human being made in the image of God and is worthy of dignity, honor, respect, and love.  They receive the care they need and deserve.

My friend from the streets of Kensington who is also a human being made in the image of God and worthy of dignity, honor, respect, and love, upon discharge from that emergency room is probably doing a dope sick date to raise funds for her next dose of ‘medicine.’

RCA is doing everything right and nothing wrong in providing high-quality care to their private insurance patients of Substance Use Disorder.

Temple Episcopal Hospital committed a grave error in violation of each medical professional's Hippocratic oath by discharging a Medicaid reliant patient in their care to the streets, an error that could very well send this person who is equally worthy of and in the need of care to their premature grave.

It's time to Plow Down Medicaid Mountain! << Click to read more.

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[1] Recovery Centers of America in Devon PA.

[2] Withdraw related symptoms on the street occur in two basic ways.  The person has either not been able to get the 'medicine' they need or they are trying to self-detox.  This second choice is extremely uncomfortable and dangerous.  What I know of this particular person, I believe that they were trying to self-detox since she had been told by Hall-Mercer a couple weeks ago to leave since there were no beds available.

[3] If you've not already read that blog, I encourage you to do so.  'George' is a fictitious man.  The description of the crisis center that he goes to is Hall-Mercer.

[4] If she's paid at all, it may be $5.00 to $20.00 per "customer."  One bag of 'medicine' is $5.00 and this is all it will take to relieve her of her dope sickness (and potentially kill her).

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.