"How are you?" is a typical, and often sterile, question we ask each other every day. It's become almost meaningless. Do we really care how the other person is?
I'm as guilty of it as anyone. When I first started getting to know the men and women living under a bridge in Kensington, I would say, "Hi, (first name), how are you today?" The most common answer I got was something like, "Not well. I'm sick. I need my medicine." And this is where my lack of understanding, because I've never been addicted myself, was a harsh reality.
I'd look at each person and ask what kind of cold they had—chest, head, allergies? With the politeness I've found in almost every person in this community, they would respond, "No. I'm dope sick and need my medicine." I still didn't truly understand what they meant until a couple of days ago when a community member explained it through words and example.
I sat down on the sidewalk with a person who was feeling dope sick. He told me it had been far too long since his last heroin injection. Dope sickness can manifest differently in different people. His was like allergies escalating into a full-blown flu. In the few minutes we sat together, I watched his symptoms progress from mild sniffles and watering eyes to a headache and nausea. He apologized in advance for a possible accident in his pants. "I'll be better as soon as I get my medicine."
He excused himself to go get his medicine. I saw him again not even half an hour later, and he was completely healed. All symptoms were gone.
"All I needed was my medicine."
I finally got it. At least to a small degree, I finally understood the desperate need of a person trapped in addiction—to "need their medicine" simply to keep from becoming outrageously physically sick.
“A heart at peace gives life to the body, but envy makes the bones rot.” - Proverbs 14:30 (NIV)
This is the very essence of a sickness of the soul, a spiritual and emotional rot that manifests itself in a physical need. When the soul is in turmoil, the body follows.
What's missing from the above description?
Nowhere did I mention getting high from their drug use. I sat down with another person on the opposite sidewalk as he prepared four or five packets of heroin for a single injection. As he worked with the skill of a seasoned R.N. preparing a shot for a hospital patient, he looked at me and said, "Chris, I've built up such an immunity that I don't get high anymore. I continue to do this just to keep from getting sick."
"I need my medicine."
For some, but not all, of the women in this community, their bodies are the source of income for their medicine. One woman told me that to keep from getting sick, she will stand on a street corner or walk along Kensington Avenue for hours as the dope sickness sets in, until some 'man' makes an offer.
"One was an important lawyer who picked me up in his Cadillac, took me to a hotel in Center City, 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."
With tears streaming down both our faces, I asked, "Why do you do this?"
"I need my medicine."
Chapter 2: The Compass of Shame
The phrase "I need my medicine" was a gut-punch of a lesson. It stripped away my last naïve assumptions, replacing them with a stark reality: addiction, in this context, wasn't a choice. It was a desperate, constant act of survival. But as I continued to sit under that bridge and on those sidewalks, I began to learn about another kind of sickness—one that couldn't be healed by a syringe or a pill.
I started to notice a deeper pattern in the stories, a theme that ran beyond the physical pain of withdrawal: the crushing weight of shame.
I saw it in the way people avoided eye contact, even when telling me their deepest truths. I saw it in the man who, after preparing his shot with surgical precision, lowered his head as he confessed, "I don't get high anymore." That line wasn't just about his tolerance; it was an apology, a defense against the judgment he expected from me. He was telling me, "I'm not doing this for pleasure, so please don't think less of me."
“For all have sinned and fall short of the glory of God.” - Romans 3:23 (NIV)
We are all in need of healing, and we are all broken in our own way. In a world with a high degree of brokenness, we are all alike in that we are all broken, each of us. We are all alike in that we all need to be healed. This is what Jesus meant when he said he was sent to heal the brokenhearted. Brokenness is a great unifier of all humanity, if we would only look at it that way. In brokenness, we are all alike.
I heard it in the woman's story, her tears a testament not just to the pain of her situation but to the self-humiliation of it. The lawyer's Cadillac symbolized a world she had once known, and the hotel room wasn't just a place of danger; it was a stage for a violation that stripped her of her dignity, leaving her with just enough change for a bus ride back to a reality filled with shame. When she told me, "I need my medicine," it was a physical necessity, but the tears in her eyes spoke to the deeper emotional wound that her medicine could never heal.
Shame is a compass that points inward, convincing you that you are fundamentally flawed, worthless, and undeserving of help. It’s the voice that whispers, "You are a bad person." And for so many in that community, it was shame that kept them from reaching out for help even when it was offered. It was shame that made them believe they weren't worthy of a bed, an ID, or a second chance. It was shame that told them the judgment they saw in my eyes was real, even when my heart ached with empathy.
“He has shown you, O mortal, what is good. And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God.” - Micah 6:8 (NIV)
This is what it means to be human: to love mercy. To be merciful, we must have empathy for another’s lot in life. This is the very essence of the life of a Christ-follower.
And so, as I continued to ask, "How are you?" I learned to listen for a different answer. I learned to look past the physical symptoms of dope sickness and see the deeper pain of a heart and soul in turmoil. I realized that to truly help, the first dose of medicine had to be a powerful and unconditional counterpoint to the shame—a simple, loving affirmation that their life matters, no matter what.
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