How many times?

How many times in our own life or the lives of our loved ones have we heard that a particular surgical procedure is being scheduled for a date several days or weeks into the future? Most of the time, the future-dated surgical procedure is future-dated because it simply cannot be done sooner than that date. There's a whole bunch of reasons as to why. 

When a person is waiting for a particular surgical procedure they continue to deal with the medical situation as best as they can. A person awaiting a knee replacement, for example, will continue to use their cane. Someone waiting for a bladder procedure might continue to use a catheter. The examples are pretty much endless. In all of these procedures that people engage in while waiting for their surgical procedure, nobody is engaged in a life-threatening or immoral, or illegal activity.

This is not the case for someone who is waiting for a bed in a detox unit so as to begin methadone maintenance or any other form of MAT treatment for their substance use disorder. The person may be 100% committed to the idea of getting off their drugs and starting a methadone or other program. They will be told that the wait for a bed to begin this procedure is in the range of 5 days. During those five days, that individual will be reliant on continuing their illegal drug use and risking overdose. If they live on the streets, they may need to continue their prostitution to raise money for their illegal drugs. They may need to shoplift to raise money for their illegal drug use while waiting for that bed to open.

There is something incredibly wrong with this system of medical care provision. I'm not saying that I have the answers as to how to solve this situation. But it does strike me as horrendous and immoral and illegal and inappropriate that our society requires patients who are seeking care for an officially DSM-5 recognized disease process known as substance use disorder to continue to engage in various aspects of illegal activity while they are waiting for a bed to open up so that they can begin the life-saving procedure 5 days after the fact of being ready for that procedure and getting them away from the drugs they despise.  (My mother would not be at all happy with that run-on sentence. :-))

So my point is this. How can we change this aspect of healthcare provision to the men and women on the streets of Kensington and other places who are 100% ready for detox care and must continue to prostitute themselves or shoplift to raise money for drugs they would rather not take while waiting for a bed to open?

I'm dying over here.

I'm dying over here.

Your male patient on our co-ed floor put me in a chokehold which triggered my trauma from years ago.

I'm dying over here.

I happened to glance into the room across the hall from my own only to see a male patient on this co-ed floor masturbating. That also triggered my trauma from years ago.

I'm dying over here.

I was given Suboxone far too early by your staff person. I was thrown into precipitated withdrawal. You said there was nothing that you could do about it. You told me that I got myself into this situation and now I just need to deal with it. I signed out to find my own relief. You called it signing out ama. I called it trying to relieve my agony since you could not and to survive.

I'm dying over here.

You wouldn't give me anything to eat while I sat in your emergency room waiting 8 hours to be evaluated for admission into your detox. You told me that I could not be cleared for something to eat until the doctor saw me. I was so hungry. I finally left just to find something to eat. I had no money and so I had to do a date. That date exposed me to my first ever sexually transmitted disease that I will have for the remainder of my days on this earth. With no hope of receiving detox care, I immediately went back to the drugs from which I was trying to escape by trusting you for care.

I'm dying over here.

I trusted you to provide a drug-free environment. The patients on my unit all had drugs. Some of those drugs were brought in by one of your staff members. Others were brought in by an incoming patient who buried them under a bush in the smoking area which is easily accessible from your public parking lot. I couldn't resist and so I got high (which, by the way, is the most basic definition of addiction). I knew that wasn't what I wanted and so I signed out. You considered me to be signing out ama. I considered myself to be signing out to run from the drugs that you did nothing to keep out of your building and to try to survive.

I'm dying over here.

I trusted your facility a second time. I went through the admissions process. Another incoming patient saw that I was not feeling well. They offered me one bag of dope imprinted with a label I did not recognize that they had on them. You never discovered this because you didn't search any of us. I went into the bathroom unaccompanied and consumed that one little bag. I left the ladies' room, continued the paperwork to enter your facility, and overdosed. You gave me three Narcans. The medics who arrived informed you that that was far too much for such a situation. You explained to the medics that I would need Narcan once every 25 minutes for the foreseeable future. The medics tried to correct your lack of knowledge. You sent me to the emergency room and, with that, my battle to survive was over for this day because I couldn't see myself returning to your facility. 

I'm dying over here.

Knowing what the reward would be if I could survive your facility, I gave you one more round of trust. I acknowledge that I did a get well about 3 hours before this incident happened. Again, I was going through all the paperwork and answering all your questions. I was dipping out a bit from my get-well. I acknowledge that. But I also tell you, I was very aware that you stuck Narcan up my nose. I tried to stop you from doing it and you squirted that Narcan up my nose twice. You said "You're not alert enough for us." You then told me that now that I've received Narcan, I was a liability to your facility and that I had to go to the emergency room. I've never felt such heartbreak in my life because I knew that this day would be different. I would be putting my drug use behind me once and for all. I was truly heartbroken beyond my ability to explain when I realized that you had Narcaned me when Narcan was not necessary. You violated my trust. How could I return to any place that had done so?

I'm dying over here.

I don't need your derogatory comments about my situation. I don't need your inappropriate nicknames such as 'junkie' or 'whore' often applied to people in my situation. I don't need you to talk about how aspects of my body don't work the way they should. I have heard all these nicknames and I know all my bodily malfunctions. 

I need your encouragement to take the next healthy step. I need you to celebrate that I have volunteered to come into your care. I need you to be a professional caregiver in my world. I need you so very much to fulfill your training. I need you to know something. In the absence of that, you must understand…

I'm dying over here.

In the past 5 months, I've tried 10 times to seek medical care for my substance use issues. I want to heal more than I can possibly explain. I've tried and tried and tried and tried and tried and tried and tried and tried. I'm going to keep trying as much as I possibly can but I want you to know something. In the midst of my battle, I want a healthy life. My strength is waning and I don't know how much I can keep going but I'm going to try. In the absence of continuing to try,

I'm dying over here.

Finally, I want you to know this even though I struggle with this idea myself. I am an inspirational human being. I am made in the image of God. I am worthy of the highest dignity and honor and respect and love. I need you to know this. Through your words and actions and interactions with me, I need you to remind me of this. In so doing, I will be able to break from my current path and one day look at you and my family and all of my loved ones and proudly say… 

I'm living over here!