Please Know...

As I come to know these fine people, they share with me more of their personal and sensitive stories. Their collective story is what I am trying to share with you as my way of breaking the stereotypical beliefs that exist. "Blog names" have occasionally been given to me by the person whose story I am telling. Names are never their actual names and wherever I can do so, I might use the opposite pronoun (his/her, etc.) just to help increase their privacy.


Monday, November 23, 2020

Dear Mom and Dad, …A Letter That Touched Souls

Every once in a while, I find a writing, something other than a song to hand out as part of my 'song sheet' collection.  The following letter which was written by Lorelie Rozzano[1] is one such example.  But before you read the letter itself, allow me to set the scene...

With the trunk lid open as I sat on the back bumper of my aging Nissan Altima at the intersection of Kensington and Somerset (Click on the link in the footnote to see the exact location in Google Maps[2]), a man, a bit older than most addicted patients of Substance Use Disorder who live in Kensington rode up to me on his old Schwinn Bike.  He asked for my usual stuff: bananas, water, and a song sheet.  I told him that along with my typical song sheet, I had a second handout, a letter written to Mom and Dad from the perspective of a person who did not survive an overdose.  He accepted it and began to read right then and there.  Tears started to flow from this man.  He stopped reading wiped his eyes and cheeks as he said he would need to finish the rest when he got home because he didn't want to be crying out in the street.

An hour or so later, a woman accepted the letter, saw "Dear Mom and Dad," at the top, and started to shake with whatever emotion was trying to break free from within her soul.  "I'll definitely read this later." She told me. 

Another hour passed.  By now I was outside Prevention Point.  She called out to me.  "Banana Man!"[3]  I turned around and found her sitting on the step right here (Follow the link in this footnote.[4]), noticeably emotional over what she was reading.  "I don't recall her exact words but I know that her heart was being touched in some way specific to her life journey.

In all, I handed out about forty of these letters.  If such a letter touches the soul of any person trapped in addiction and homelessness and inspires them to consider a new path, so be it.  We cannot force anyone to stop using their substances.  That decision must come from them when they are ready.  We can touch souls and in so doing connect to the healing that is silently begging to burst forth and begin the process of creating a new life.

Here's the letter:

Dear Mom and Dad,

Words can’t begin to describe how sorry I am.  I’ve put you in a position that no parent should ever face.  I left – before you.  It wasn’t supposed to be this way.  The natural order of things was skewed by my addiction.  I can only imagine the agony you must be in.  I know you’re angry, enraged, and sad, all at the same time.  If only you could reach back in time and pluck me from the path I’d chosen, but you can’t.  You never could.  God knows, you tried.  I wasn’t completely oblivious, to all that was being done for me.  I always believed I had time and the truth is – I was too dammed smart for my own good.

I underestimated the power of my disease.

I know you tried to tell me this.  But I wouldn’t listen.  After I began using drugs I became desensitized.  I thought I was immortal.  I liked living on the edge.  I felt so alive!  Drugs filled a place in me that nothing else could.  With them I was King.  Without them, I was just, well, me.

Maybe that was part of the problem.

I never did feel right, about being me.  I always needed something more.  At first, it was candy, and then video games and eventually, teenage love.  I idolized money.  I felt entitled to nice clothes and nice things.  I wanted the best.  I hated waiting for anything.  When I wanted something, it was all I could think about – until I got it, and then, I wanted something else.  There were times I felt guilty for the stress I created in our family.  But it was fleeting.  The burning need inside of me was stronger than anything else.  This need had no conscience, integrity, or morals.

This need – was my addiction.

I know I hurt you.  I rejected your love.  I rolled my eyes at you.  I called you names.  I stole from you.  I lied to you.  I avoided you and finally, I left you – for good.

I was so smug.

There wasn’t anything you could have said, or done, to prevent this from happening.  I thought I knew it all.  Death by overdose was something that happened to other people: Foolish people – people who didn’t know shit about using.  It wasn’t going to happen to me, no way, no how, not ever.

You begged me to stop.  I tuned you out.  Your words were like angry wasps in my ears.  Although they stung, they were nothing more than an annoying buzz.  When you cried, I cringed.  When you put your arms around me.  I wanted, away from you.    And now – I want back.

But there is no back. There is only forward.

Please bring me forward.  Tell my story.  Say my name.  Have conversations with me.  Include me in your celebrations.  Rejoice in the time we had together.  Cry, if you must, but not all the time.  I know you’re sad.  I know you miss me.  I know you love me.  I know you did your best.  But you were never stronger than the disease of addiction, and sadly, neither was I.

Please don’t blame yourself, or me.  It will only make things worse.  We all did the best we could.  You must believe this.  If you don’t, it will be like me dying all over again, each and every, day.  We will all stay stuck and that would be a tragedy.

I hope you take all the love you have for me, and put it into the rest of our family.  Every time you want to hug me, grab one of them.  Then it will be like I’m part of the hug.  Give them a great big squeeze and I promise, I’ll feel it, all the way up in heaven.

May you find peace in knowing I’m free, in a way, I never before was.  Up here, there is no addiction. There is only love, the kind of love that is greater than any of us will ever know, below.

You might tell yourself that I am gone. But you’re wrong. I’m right here.  I’m the wind on your face, and the stars in the sky.  I’m the raindrops, falling, outside your window.  I’m the song of a bird and the dawn of each new morning. I’m the rustle of a leaf. I’m the clouds and the sun, and the waves in the ocean.

We will never be truly be parted from one another.  For love breathes life, even, in death.

I am the flesh of your flesh.  Standstill – and you will feel me.

Love, Your Child This Day and Always...

 

Adapted from a writing by Lorelie Rozzano


[1] and adapted by me only to take out the male gender-specific pronouns and references and therefore make it apply to everyone. 

[3] For those who don't know, I've been handing out bananas as I do what I do in Kensington.  Soft fruit was requested by these wonderful people four years ago when I started doing this.  I kept bringing bananas with every visit.  One day, a man on the street called out "Here comes "Banana Man!"  The name stuck…  J

Tuesday, November 17, 2020

24 Hours

Nearly every day as a driver with Recovery Centers of America (RCA), I have the privilege of bringing in for detox and rehab a person who has decided enough is enough.  They want to be done with their substance use.  They want to heal and to reclaim life as they once knew it.

More often than not, this person will have consumed their substance just prior to getting in my company car so as to be comfortable for the trip.  Withdraw is nothing to smile at and they don't want to be going through it on the ride to RCA.

On rare occasion, I have brought in a person who had decided 24 hours earlier that they would no longer consume their substance.  For this discussion, I'm going to focus on patients with Substance Use Disorder who use heroin.  "Dope sickness" is the term for what patients experience when withdrawing from heroin use.  Here's some of what they go through…

The Symptoms of Withdrawal

Symptoms of dope sickness – and their intensity – can vary by person, the drug of choice, and the amount of drugs used on a regular basis. However, common signs of dope sickness include: 

Nausea, vomiting, diarrhea and/or constipation

Loss of appetite/huge return of appetite

Hot and cold flashes

Muscle aches and spasms

The sensation of bugs crawling on or under the skin

Hyper-awareness

Dry mouth

Headaches

Insomnia

Sweating

These physical effects are often accompanied by mental and emotional symptoms. Those who are dope sick may also experience: 

Agitation

Anxiety

Paranoia

Frustration

Depression

Despondency 

When a person I've just picked up tells me that they are dope sick, I call ahead and inform my coworkers in admissions that we will be arriving at a particular time and to please have nursing personnel at the door so as to alleviate our new patients' suffering as quickly and as much as possible upon arrival.  As with any illness or injury, total alleviation of suffering is not possible but much can be done to alleviate the worst of the pain and discomfort. 

These nurses are fulfilling their role as they declared to do when they took their Hippocratic Oath at the beginning of their careers.  Here's a modern version of that oath: (Red wording is most relevant to this discussion.)

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.

********** 

Such is not the case for patients with 

Substance Use Disorder 

who live on the streets of Kensington.  

Nearly all of these people are reliant on Medicaid and the Medicaid based system of health care provision for their alleviation of pain and suffering and reclaiming life. 

It occasionally happens to the people on the streets that they don't have the money to buy their "medicine" and end up going 24 hours very unintentionally without it.  Sources of income vary and all have periods when they are not as lucrative.  Examples include: 

  • Standing on a street corner with a cardboard sign…
  • Hauling metal to the local junk yard for cash
  • Trash picking and selling the items on the street
  • Shoplifting and selling the items on the street
  • Relying on your regulars with whom to do a "date"
  • Standing on a street corner in hopes that some guy will want to do a "date" with you.
  • Asking for money from family and non-street bound friends 

These people will not be picked up in a company car and brought to an awaiting nurse for their nearly immediate alleviation of pain and suffering. 

Here is a firsthand account of an all too familiar scenario at the intersection of Substance Use Disorder and Medicaid: 

I have personally been to several crisis centers in Philadelphia. A few months ago, I went to one and sat for about 13 hours in a waiting room so very sick shaking and sweating and vomiting everywhere and all for them to come out and tell me that there were no beds and said to come back the next day to try again. 

Mind you I was very very sick and when they told me that, I asked them what should I do as I was laying on their bathroom floor vomiting everywhere and it looked like someone had sprayed a hose on me because I was dripping wet. My clothes were soaked and I was flopping on the floor like a fish out of water. 

The doctor said to me "I don't know what to do." She said she cannot give me anything because I am not admitted and there are no beds. So they asked me where would I like to go to because they will call a cab for me. As I was waiting for the cab, security and a nurse came outside to me and asked me what I was doing and I said "You told me you are calling a cab." The nurse said, "We did not call one and you have to get off of the property!" 

Mind you I had no money and I was so sick so I ended up walking to the EL. The SEPTA personnel told me I cannot go through without money and I told them that I just came from the hospital. I showed them paperwork and they still said "No" so I ended up jumping the train and the SEPTA personnel hit the alarm! 

So thank God the train came before any cops got there so I was fine. As I was on the train I dropped to the floor and had a seizure. When I woke up people were standing around me and they were waiting for the ambulance but I jumped up and said no and got back on the next train and got off at Somerset station and had to find a way to get well... 

My experience that day with the crisis center made me so sick to my stomach thinking that I really wanted to get clean and I really wanted help and nobody helped. 

 **********

RCA and similar private insurance facilities are modeling for all of us what health care providers to patients of Substance Use Disorder should be doing.  Patients in these places are treated with dignity and respect.  They are warmly greeted at the door upon arrival.  The process of healing begins right away. 

The person who decided 24 hours prior to getting into my company car that they would never use again and the street bound person who is unintentionally in that same 24 hour period unable to buy their "medicine" are equally human.  Neither is better than the other.  All or worthy of dignity and respect.  

24 Hours

Monday, November 2, 2020

Agony Upon Agony

She was conceived and born addicted.

Agony Upon Agony

She was fed drugs through childhood and "played with" by her several uncles.

Agony Upon Agony

Her dad told her that in his eyes she was not his daughter but rather a piece of meat to use for his own sexual pleasure.

Agony Upon Agony

Bullied and beaten in grade school and middle school and never getting to high school.

Agony Upon Agony

Verbal and physical and sexual abuse from family and "friends"

Agony Upon Agony

Addiction follows her with every event and every turn of life's path.

Agony Upon Agony

Homeless and rained on as she tries to sleep under a set of steps near her family home.

Agony Upon Agony

Time and time again, raped[1] on dates that she does only to provide funding for her addiction.[2]

Agony Upon Agony

Screamed at by a street preacher that she better change her sinful ways or risk burning in Hell.

Agony Upon Agony

Fed slop called a good dinner by a well-meaning visiting church who tells her that God is her Father who loves her[3].

Agony Upon Agony

Being rained on, doing 'dates' and occasionally being raped continues year after year as she grows up on the streets and alternates between coherent and high.

Agony Upon Agony

She makes a friend who really cares.  A moment of joy…  While walking together one day, he's assassinated in front of her, shot in the head in an apparent drug war dispute.

Agony Upon Agony

Bullet-ridden Nightmares persist for months as do the dates and occasional rapes.

Agony Upon Agony

An injection of something other than heroin causes an almost fatal overdose.

Agony Upon Agony[4]

Having been injecting for so many years, her veins no longer work as they did.  It now takes hours of trying to do the shot, hours of multiple needle sticks to her own hands, arms, feet, legs, neck and body using the same needle.

Agony Upon Agony

Some time ago, her brain began a war with itself.  One side of her brain begged "Stop doing this!"  The other side of her brain screamed louder than loud "You love the drug!"

Agony Upon Agony

Exhausted by it all, she sits on the steps leading to the El[5].  Local police without getting out of their car and with flashing lights and blaring bullhorns tell her to stop sitting on public property.

Agony Upon Agony


But one day, a brief window of opportunity opens.  The quieter side of her brain screams Louder than ever before.  

"STOP!!!"

With every available fear filled ounce of determination focused on this mission, she walks to the nearest crisis center a very long walk away.  She knocks on the locked security door.  The guard opens the heavy metal door and asks "Why are you here?"

"I'm an addict here for detox." She confesses as if speaking to her childhood priest.

The guard tells you to come in.  "Strip down to one layer of outer clothing and put everything else in this trash bag.  I'm going to frisk you……  OK… Now walk through this metal detector."

Agony Upon Agony in the midst of hoping for healing.

You're greeted by a burned-out registered nurse who simply says "Fill out this form and give it back to me."

Agony Upon Agony in the midst of hoping for healing

You comply as you sit next to a passed out man who is a bit further ahead in this process and who smells like the alcohol he's been consuming and the urine he's been peeing on himself and multiple days of unwashed sweat.

Agony Upon Agony in the midst of hoping for healing.

Hours go by as you sit in worn out chairs purchased decades ago and inhale the fumes of sweat and urine of people in various stages of this same process of Medicaid funded healing.

Agony Upon Agony in the midst of hoping for healing.

After hours of sitting, dope sickness[6] is taking over.  You beg to use the locked bathroom and the guard uncaringly lets you in.  You enter and pull one bag of heroin out of your vagina - placed there so as not to be found in the search by the guard.  You snort it in the absence of your normal needle.

Agony Upon Agony in the midst of hoping for healing.

More hours go by and the "nurse" tells you there are no beds available anywhere in the city and to come back tomorrow.

Agony Upon Agony in the midst of hoping for healing.

You beg and plead for help.  The guard tells you to get off their property.

Agony Upon Agony in the midst of hoping for healing.

 You're aware that dope sickness is trying to take over again.  You have no more dope and no more money.  You need quick money now and so you manage in the midst of your dope sickness to get to your preferred street corner and stand there with a glued on smile as if waiting for a specific friend.  You hop in the car of a random man…  You tell me later that

 "One was an important lawyer who picked me up in his Cadillac, took me to a center city hotel, tied me to the bed, had his way with me, got dressed, untied me and left the room.  I had to use some of the money he gave me for public transit just to get back here to buy my medicine."  

Agony Upon Agony

You're starving, literally starving, worn out and exhausted. 

Agony Upon Agony

You try to sleep under that step near your family home as rain pours on you on those bad weather nights. 

Agony Upon Agony

From time to time, you continue to be raped on those dates that you do as your only available source of income.

Agony Upon Agony

These examples of agonies upon agonies could continue for page after page of this blog.  Suffice it to say that:

The Medicaid bound medical representatives of Hippocrates have had multiple opportunities to end the agony upon agony and failed miserably each and every day multiple times a day with men and women whose brains have screamed   "STOP!!!."

When will the leaders of our society look at the failings of the intake process within its system of Medicaid based medical provision, make improvements and begin to save lives?



[1] People have occasionally asked me how rape exists in a setting where sexual activity is the purpose of the interaction.  The man and woman may have agreed to a certain "level" of sexual activity such as only oral.  If the man forces intercourse, that's rape.

[2] given to her by her mother at the moment of her conception

[3] While her only understanding of "father" is "rapist."

[4] with a dose of blessing by the random person nearby who had Narcan and saved her.

[5] Elevated train line that runs the length of the street for many blocks

[6] Symptoms of dope sickness – and their intensity – can vary by person, drug of choice, and the amount of drugs used on a regular basis. However, common signs of dope sickness include: Nausea, vomiting, diarrhea and/or constipation, Loss of appetite/huge return of appetite, Hot and cold flashes, Muscle aches and spasms, The sensation of bugs crawling on or under the skin, Hyper-awareness, Dry mouth, Headaches, Insomnia, Sweating…

These physical effects are often accompanied by mental and emotional symptoms. Those who are dope sick may also experience: Agitation, Anxiety, Paranoia, Frustration, Depression, Despondency