Author: for-kindness

The day came and went with reflection on where we stand with treatment of substance use disorder and mental health conditions, during a pandemic no less. An awareness event scheduled for the summer was cancelled due to the pandemic. Our awareness events were mostly virtual. I put up some ribbons, as did my neighbors.  

Unfortunately, overdose deaths are spiking nationally. We are still facing barriers to treatment. In Vermont, there are still prior authorization requirements for buprenorphine, especially injectable forms. There are federally mandated requirements for methadone.  We have been unable to pass a bill to decriminalize buprenorphine without a prescription. There is still lack of access to treatment in Vermont, nothing much beyond a 21 to 28 day stay, even though experts agree on a 90 day step down treatment approach.  There is a lack of sober supportive housing, and no place to go (sometimes other than jail) if you are one of many evicted from sober living.

Other countries, like Switzerland have adopted strategies to care for people who use drugs. People who, like our son Sean, used sporadically and didn’t see MAT as a need (though I disagreed with him on that point) These aren’t outlandish ideas, Switzerland certainly is pretty conservative in many areas. It is sensible to promote harm reduction, lower barriers to treatment, focus law enforcement on big-time dealers, focus on treatment not criminalization of use.

I am certain that rapid access treatment will lower diversion. Allowing more liberal use of methadone, and treating people instead of putting them in jail will decrease use. Treatments have to support people, housing is an important part of that strategy. Law enforcement is part of the strategy as well.

If you haven’t read Fentanyl Inc, by Ben Westhoff, it is well researched and captivating look at how these chemicals are radically changing the substances used recreationally, with often lethal consequences.

Finally, we need to start with prevention. Mental health care for our kids is of upmost importance. The record numbers of suicides and substance use disorders is a symptom of our culture. Social media has not helped. Iceland has a great prevention model where substances aren’t promoted, sports and connection with pers and families are. There are few liquor outlets, no cannabis stores, and many teen recreation centers.

https://www.twentytwentyarts.com/weathered?pgid=kcxd8zq9-6e760cd8-8e81-42d1-b4ec-13baa3c78110

Type on the link to see this new exhibit to benefit safe consumption site in Toronto, ON

Sean’s nickname in jail was Shaggy, like the character from Scooby Do. He looked like Shaggy, the prison soap at Rikers made his curly hair,stiff and unkempt. He looked like he was very overdue for a haircut. I barely recognized him, that hot July day when I saw him, for the first time in four long months.

Sean was one of few white faces in jail in New York. He would joke ” the only white people in here are named Sean or Patrick”, oh the luck of the Irish. Sean stayed for three months at Rikers, partly because he wanted to stay on Methadone, partly because the public defender’s in Manhattan were quick to accept the DA’s terms. There wasn’t much justice happening.

Sean was well aware of the racial disparity. He was quick to note how he was able to shoplift because of his blond hair and blue eyes. He sold his goods to bodegas in the Bronx. His “gang” made him the gofer, he could get away with what they couldn’t, and (according to Sean) protected him when he did go to jail

One of Sean’s best friends, from jail in Vermont, noted that Sean was a unifying force in the jail. He was able to traverse the racial divides that are so common in our prisons. He truly was friends with everyone.

Visiting Riker’s was a jarring display of systemic racism. The numbers of prisoner’s of color far exceeded the number of “White, Non-Hispanics”. This was not a representation of the New York City population. It was probably about 90-95% people of color. Biased policing, prosecution and sentencing are all to blame.

Even in Vermont, where the population is lacking in diversity,African Americans in Vermont are incarcerated at a disparity that is 10 to 1 that of whites (Burlington Free Press 6/19/20) Even with the hard work of Vermont Public Defender’s who, in my opinion, like the “Bronx Defender’s”, the Bronx counterparts, made an effort to actually obtain justice for their clients.

Imagine the outrage if so many white, middle class youth were imprisoned?

If hundreds of kids like Sean were sentenced for stealing soap and toothpaste from CVS, there would be change.

As a physician, I am often frustrated by racial disparities in healthcare. The criminal justice system makes healthcare look like a beacon of racial equity……… (which it certainly is not).

Many of our institutions are in need of an overhaul. Racial equity is long overdue. The prisons are a great place to start, as are our schools, healthcare organizations. I would like to see some changes happen in our criminal justice system, just as much as Sean did.

Life often takes some very sudden turns. When Sean died, I was in shock. It didn’t seem real. He was on life support, no sign of life, at least in his brain. However, his body seemed in such good shape. He was fit, not underweight. He looked nothing like what I thought when I thought of substance use. Sure many times he had looked thin, gaunt, a hollowed out form of a human. This wasn’t one of those times. The image didn’t fit with the reality.

So, with this pandemic.. I should have been more expecting, more prepared. Sure, I ordered a few masks for my medical office. I even bought some face shields. I just never thought it would come to the dangerous fight that is happening across the country.

Life is like that often not what your expecting.

I have had so many patients fear ovarian cancer, only to neglect their diabetes and hypertension. I have had so many anxious Mom’s fear losing their children to stillbirth, or childhood cancer. Yet, when my son was dealing with life threatening illness, I couldn’t see it. Those episodes were behind him (us). He had survived the worst and was fine now. Well, maybe not fine but, at least in the improving category.

When it did happen, when Sean overdosed, I wasn’t on a trip, or at work. I was at a program meeting. Surrounded by friends. I was scheduled for vacation in 2 days. I hardly needed to take time off work.

Life is fragile and we often are the worst at seeing our own reality. Thank goodness for all those therapists and good friends out there. They can clue you in. Take your own inventory as they say.

In the mean time, stay aware, flexible and kind…you never know when you’ll need that kindness coming back to you.

A few weeks ago, my dog, Yves, was attacked in the woods by another dog. Yves is a grey standard poodle; he is thirteen years old and not in the best of health. We were just finishing our walk. I felt very calm and peaceful, typical after a nice walk in the woods. It was snowing lightly; the woods were beautiful.  I felt refreshed, ready to start my workday. Suddenly, out of nowhere a neighborhood dog came down the path and brutally attacked Yves. Going for his neck in a vicious way. I struggled to kick the dog off Yves. The owners walked by me and lended no aid or even attempted to get their dog. After several screams and kicks, I fell down in the snow. I looked up at the dog and rolled over, ready for it to attack me. Luckily, the dog left and rejoined his owners. I don’t know why it stopped; I was just very grateful that it did.

Yves was bitten in several areas, not enough to need stiches. The owners eventually came to our home to apologize, I had already had to go into work, my jeans still damp, so I never got to hear them out. It’s ok, I wouldn’t have believed anything they had to say. Actions speak louder than words.

I was terrified. It brought back all the distress of helplessness that I encountered with Sean. Trying to fend off something evil and vicious with no assistance at all. Trying to argue with an insurance company, trying to get him off the streets and into treatment. Trying to cope with the sleepless nights when he was missing yet again. Convincing colleagues, that people with substance use disorders and mental health conditions deserve respect and care.

I’ve become less forgiving. I used to give everyone the benefit of the doubt, always willing to believe in the good of our community. No, not so much anymore. I have seen the injustice of the world, even in Vermont, and I won’t back down. It’s a good thing, I was way too nice.

The injustice of our criminal justice system. The all-out greed of the Purdue Pharma.

Don’t get me wrong, there are many people who are good out there. Lawyers, doctors, pharmacists, police officers, writers, treatment providers all doing their best.  At least knowing you’re not alone helps the vulnerability.

No the PTSD won’t get erased, and Sean won’t come back to life. However, his life won’t be in vain, that I am very sure of.

So the website is for-kindness, which is meant for the world to have more kindness.  I choose the name because Sean was “for kindness”

Dear Mom.

I love you. You brought me into this world, gave me everything I ever needed and most of what I wanted for years. I’ve abused and manipulated your kindness and love. I never did treatment, I wasted your money. I tried to steal from you. I’m just a lech on everyone. I have been nice and kind and loving like you but, it was an act to get what I want.I am right where I need to be and will be for years.I don’t want to fight anymore….I’m not going to get what I want and that is a lesson I need to learn, you don’t always get what you want.I wanted you to post bail, I was really ready for change..I will not fight anymore, I will sit in prison and do nothing.I want to blame the police, the bullying and PTSD but, they only play a small role. At the end of the day we make our own beds, our own luck, and I will try and be the best man I can be.I want to be like you, successive (sic), loving, hardworking and have a true purpose.

THANK YOU for being my role model and my friend.

Your son, Sean

(Excerpts from a letter from Sean, I edited out some more personal pieces from the letter, I don’t think he would want them published. I am very sad reading this, how down on himself he was. He was worn out and tired, angry at himself. He had recently broken into our home and threatened his brother and myself. I doubt he would have really hurt us. He picked up his belongs and moved into a friends. Unfortunately, the friend was admitted to the hospital for psychiatric reasons and the young man’s family not knowing Sean had permission to stay at his place, called the police for trespassing. We didn’t post bail and Sean stayed in jail until he could get to treatment a month or so later. My most significant regrets involve not working harder to get better psychiatric treatment and less jail time. Our family was just completely worn out)

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I recently returned from Vieques, Puerto Rico. I have had the blessing of being able to travel there for a week every year, a vacation with my sister, Dawn, sometimes with my niece and/or Mom. We have been heading there for the last 10 years. A treasure, as travel had been a challenge with Sean’s illness, my husband staying home so I could get away for a short time.

It is a beautiful place, lovely beaches, horses roaming free, it is as if time stood still for a few years or decades.

I thought Sean would love it here. Relaxed and carefree, I suspect he could have gotten along pretty well, at least for a while. The geographic cure can work, sometimes for a week, sometimes for years. Usually, though life and it’s complications catch up.

I once worked with a physician in New York, who after struggling with personal issues, made it to Vieques. He tended bar and made a new beginning. Life caught up with him there as well, his adventures now the subject of a book (autobiography)

One morning, our little gang (Mom, Dawn, niece and I) arrived at a remote beach. You have to travel a pretty challenging road, with a four- wheel drive to get to Navio beach. It is one of our favorites. An exposed beach, plenty of surf and caves to explore. One time, we met a young man, doing yoga on the beach. His beat- up van was nearby, likely his camp for the night. He was getting ready for the day, yoga and a swim. He had long hair, no clothing on, and seemed very relaxed and happy. My Mom said, “Wow, he is a great swimmer”.  My sister and I looked at each other, smiled and thought “Sean”.

I didn’t want to bring Sean to Vieques, I thought he would be lost forever. A vagabond for good. I knew the medical facilities weren’t great, especially the mental health care. Sean spoke some Spanish, maybe enough to get around, I don’t know.

The idea of him being lost was terrifying. It was something I worked through in therapy, I could cope with him being out of contact with our family, if I knew he was well. I knew some people with substance use and mental health struggles needed to be away from their family of origin to become well.  A chance to find a chosen family.  It certainly was preferable to an overdose death.

So Sean lives on, in our hearts and minds, and in some, their real-life organs (his heart, liver and kidneys). A vagabond forever.