We are all in this together

If my fans want to do something for me when that time comes, I say, don’t waste your money on me. Help the homeless. Help the needy… people who don’t have no food… Instead of some big funeral, where they come from here and there and all over. Save it.

B. B. King

 

Two things I’ve encountered recently have made me consider more than usual the tragic things that plague our society, like homelessness and addiction.

 

One of them was a reflective piece written by my daughter, Cate, which I’d like to share momentarily. The other came when someone I was having a conversation with recently said, in an apologetic way, “ Oh my family is totally messed up. It would be hard for you to imagine.”

 

I almost laughed out loud, not that it was a funny topic or that I felt their discomfort amusing but that my immediate thought was, “ Oh Honey, you don’t know the half of it.”

 

Funny, that on more occasions than I can probably count, someone has said or inferred that their collective history in this messed up world is so complicated that no one else can begin to comprehend it and yet it seems, we all imagine ours to be the worst.

 

We are all flawed humans, messed up family histories and members we’d rather leave in locked closets, we have all had our heartaches and challenges and moments in time that have shaped us. We all had parents, or at least “biological donors” who have influenced who we are. Nature and nurture then play their competitive roles in our development, our relationships, and our worldview. This is not exactly rocket science; I just know this to be true. Love them or hate them, whoever brought us in to this world and whoever cared for us until we reached independence, we cannot turn back time or rewrite history.

 

Certainly my family, like everyone else’s I know, has dark secrets and a not so stellar history of dealing with that darkness. I am not really focusing on the particulars of my own background though, just the collective feeling we all have, the shame I suppose, that we have such trouble divulging and which we carry with us.

 

Why, I wonder, is it human nature to be controlled by something over which you had no control in the first place? Why do some of us struggle to keep ourselves above this collective hurt and why do some of us grow stronger?

 

Homelessness and addiction, at least drug addiction, are not topics I confess I am very familiar with. Alcoholism has plagued some people to whom I am very close, so I feel like in that am at least entitled to have some opinions. I am, I confess, loath to confront the issues of drug addiction and homelessness head-on because it feels so overwhelming to me. I am actually a psych major and should be better equipped to deal with such things but find words and action escape me. My daughters’ words and my discussions with her recently are making my self-imposed ignorance harder to preserve, it is making me look at the issue, however ugly, with a fresh perspective.

 

 

Cate is in third year Med and is currently on her Clinical Rotation with a GP. I should note that she is not in Canada, where there is Universal healthcare (at least that’s what we’re led to believe despite the regional differences in access); she is in a country with public and private health care systems. I had imagined this would be a few months of vaccinations, childhood illness, maybe mild depression and normal disease processes. I thought it would be comparatively one of her less stressful rotations. I was very wrong and naïve in that assumption. She has been working with an extraordinaire GP in a rather extraordinaire clinical setting. The clients are overwhelmingly those hat most of society ignores, avoids, even fears. These are the homeless, the mentally ill, people on probation recently released from prison, people from violent backgrounds and poverty. Refugees from places where children are bought and sold, violence is normal and families are broken. There are also people who do not fit into this lost segment of society, people who somehow manage to maintain jobs and homes and “ normalcy” but harbor secret addictions. It is a methadone clinic and here is a segment of what Cate has experienced.

 

 

 

 

 

“Honestly, doc, I would rather be back in prison than be where I’m at right now.” This is a phrase I’ve heard so many times now it has started to feel if not reasonable, then at least not absurd. I have begun recording some of the quotes from patients at the methadone clinic I’m training at, because I never want to forget how their words make me feel – the first time I heard a patient express the desire to be picked up for jail, I felt like I’d been punched in the stomach. I grew up in a household where there was never enough money for many ‘flashy extras’, but my parents worked very hard to ensure my sister and I were well-fed, educated and happy. By the time I was born my parents had ceased smoking and drinking alcohol, and I had never considered jail as anything other than a nightmare, a worst-case scenario. Becoming homeless, I have learned, opens a door to a dark world of desperate choices, hopelessness – and eventually despair. Whether people are homeless because of drug use, or because they have been forced from their homes due to family violence or lack of finances, or pre-existing mental instability or (oftentimes) a mix of these factors, it is hard to judge people for breaking the law to gain access to jail. Once on the inside, they have a stable routine, room and board, the possibility for training and other education – and most importantly, they become incorporated into a rigorous social system that cuts them off from the street drugs they use to manage the sometimes-lethal indifference of the world on the outside.

 

All of the patients I see are not homeless; and many of the homeless people I do see do not use drugs. That said, the two seem to be highly affiliated, and one patient sticks in my mind when I think of this: 29-year-old Mr. CH. Born in 1988 to alcoholic parents, he lost his mother early in life and like most of his first and second-degree relatives, began using drugs before he reached high school. He ended up in prison, and on release he went straight back to the heroin that had caused his arrest (and allowed him to dissociate from the memories of abuse in his early childhood) in the first place. A tall, athletic young man prior to developing his habit, he retains a handsome face but it now has sunken cheekbones and sad eyes, and his clothing has the frayed, cigarette-smoke sweatshirt esthetic common to many heroin users. He apologized for his appearance to me on entering the room, murmuring “Sorry Miss, I usually take care to look nice when I’m clean.” The ‘Miss’ was my first hint at his background – many ex-inmates employ these otherwise outdated formalities when opening conversation. He was brought into clinic by a relative after two unsuccessful suicide attempts in the past week, and this is where the shocking part of inequality in healthcare provision truly stood out to me – he was discharged from the emergency department of a major  hospital without so much as a referral for psychiatric follow-up care.

 

The man who brought him in to see my supervising doctor is a patient of hers as well, and he provided much of the background and revealed it was only on his insistence that his cousin had agreed to come for this appointment. A former heroin addict himself; the cousin had been successfully recovering from his addiction on the ‘Program’ with my supervisor for several years. How, he wondered angrily, could the psychiatrists at the hospital have possibly thought his cousin was fit for discharge after two intentional overdoses in less than a week? He was obviously the one motivated to have Mr. CH start on the suboxone program, for when questioned by my supervisor Mr. CH muttered that “Life seems pretty much pointless now,” and when questioned further on his goals for treatment, he expressed his desire for the aforementioned prison sentence.

I am an empathetic person by nature, and while sitting there for some reason I could not stand the sadness I saw in his eyes. While the doctor had her back to the patient writing notes I blurted out the only thing I could think of, “Did you see that dog out in the waiting room?!” Another patient had come in with a dog, and I thought maybe talking about animals would make him feel better in the same way it does for me. He smiled and replied that yes, he had seen the dog, and would one day like to adopt one like it (a ‘staffy’) from the RSPCA. “But it has to, you know, be abandoned and a bit messed up. Some dog other people would pass over. Like me.” Again, an unremarkable statement from the outset, but heartbreaking when you analyze it a bit further.

 

This man had attempted to take his life twice in the past week, and he had been ‘kicked out’ of the hospital without so much as an opioid treatment plan. His cousin, a similarly troubled and formerly homeless recovering heroin addict, had been forced to take matters into his own hands and take the day off work to bring Mr. CH to our clinic and convince my supervisor to add him to the Program. This in itself even proved to be more difficult than usual, as we had to call three pharmacies before we could find one to take him. I have nothing but praise and appreciation for the pharmacists in this city who agree to open their doors to the high-risk population of former addicts needing methadone and suboxone to survive their days.

 

The lenses of social inequality, gender and culture all feature in Mr. CH’s life and treatment to date. He is a young male from a relatively poor socioeconomic background, who throughout his life has suppressed his emotions and dealt with stress the only way he was taught – by shooting up into his arms. He was arrested, recovered while in jail, and then relapsed as soon as he was ejected back into the comparatively stressful, uncaring and even cruel world that  society can be when it comes to ‘homeless people.’ He is on the ‘dole’, but the money from the government presumably goes largely straight towards feeding his habit. This is inarguably a poor choice on his part, but addiction is a disease. A disease which at its worst is punishable by homelessness, jail and death. Somehow, his two attempts at suicide didn’t raise enough red flags for him to be ‘sectioned’ under the mental healthcare act. As a student , I have good reason to suspect that similar attempts at suicide would raise more intervention and ongoing help if he had been under treatment by a  psychiatrist at a private hospital. There is nothing my GP could do for him further, though, except to refer Mr. CH to the social worker affiliated with her practice, and arrange follow-up appointment and urine drug screens as well as standard bloodwork for Hep C and other common illnesses of the addicted.

 

In the future, I have learned enough from my time here to know there is no magic ‘fix’ for addiction and homelessness. Sadly, often people relapse or are lost to follow-up, and the GPs willing to own and operate methadone clinics are severely overworked and underfinanced, so there is never enough time to spend with people. I only hope that I can actively listen to future patients, continue to empathize with people like Mr. CH, and hopefully find ways to work together to find some reason to want to stay alive (a future staffy?) in what can be a very cruel and inequitable world.

 

 

So it is with a different lens I now see the complexities of the issues around addictions, mental health and homelessness. There are no simple solutions and there are surely not enough resources directed towards this. I think there is a need to focus on the early years of development and to creating family supports to help bring entire families healing and understanding of the issues that lead them to trouble. I think we need to better prepare people who have been incarcerated for their re-entry into society and offer them better supports. We need better housing opportunities for people with low incomes so that they may create their own safe havens and find purpose and optimism for a better future. We need to remove the stigma around mental health issues and support people who battle depression or anxiety the same way we might support someone with cancer or MS. Mostly I guess we need to remember to see people, of all races, ages, genders, affiliations and socio-economic situations as people who need our compassion, our help and our attention. Cate has told me she will never give a homeless person money again because it may end up in their veins. She says she will feed them; offer them a hot coffee or a sweater and a kind word whenever she can. I will try to do the same.

 

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