Dia De Muertos

Some families have Halloween celebrations, we celebrate Day of the Dead, All Souls Day. We take advantage of that time in between where the door between earth and heaven open just a sliver, just enough to tell opur loved ones how much we miss them.

We celebrate with favorite foods and stories, tales of past celebrations, back when All Souls Day was something we read about. There were so few that I mourned, Grandparents, a cousin gone too soon. Then the death of a close friend, then my Dad, and then Sean. All within a year, three of my closest friends/family. Now it is a day for pause and remeberance.

I have become friends with many parents who have lost kids, I grieve for them too. We collectively grieve our kids on birthdays and “angel days” We talk about them. Because if you haven’t noticed, people don’t like us talking about our dead kids. The think we are stuck in our grief. There is even a name for it “Complicated Grief” stuck somewhere far from Acceptance, that final stage that announces “We are done!!” Yes that is where everyone wants us to be..moved on. When I post a photo of myself having fun, the world cheers me on.. Having fun gets more likes and comments than any post about my son or Dad or Jill. The world wants me to be happy.

I just take note, write in my journal or share with my friends of loss. They get it. You can have fun and celebrate life and enjoy all you have and still think about the one’s you’ve lost without being pulled under. You can” have it all”. The messy, sad terrible grief and the joy and laughter too. We aren’t just one or the other. Some type of a chimera of love and loss, all bound together in one being.

Celebrate your loved ones on a windy fall day, sing some songs, have a nice meal.

What does abortion have to do with substance use?

I started this blog to highlight need for harm reduction with regard to substance use disorders. I hoped to show the value of human life, even for people who use drugs. They may have a substance use disorder, a mental health condition or just enjoy substances. Using drugs shouldn’t be a death sentence.

I show many letters and poems my son, Sean Blake wrote over the years. To personalize his struggle. He tried to stop, he even went to jail, thinking he could stop by being incarcerated. He did stop, for about a year, he was sober. However, he returned to using and didn’t want help. While having alcohol and marijuana at a party, he inadvertently used fentanyl. We don’t know what he thought he was using…It ended his life. People were outside the bathroom door, they would have helped if they knew, they thought he was taking a shower.

With the nomination of Amy Coney Barrett to our supreme court, I worry we may go back to the dark ages of septic abortion. As a practicing Ob/Gyn, I was trained to fear the history of pregnancy termination in the US. My wise mentors would get a look on their face, describing the horror of losing young women to infections from a “coat hanger or back door” termination. These were, by and large, conservative white men. Staid men, who wouldn’t vote republican for fear of overturning Roe V. Wade.

I took my oral boards in 1996, the final exam question was how to treat gas gangrene of the uterus. This infection was commonplace before 1972. Once the infection gets into the myometrium (the uterine muscle), a hysterectomy is necessary. The examiners tried to get me to try to just give some antibiotics. They said “She wants to have children” I said “She can’t have kids if she’s dead” Needless to say I passed. This is the closest Xray photo I can find to the picture on my board exam.

The uterus is outlined in gas from the infection. The gas makes the uterus look black. I sincerely hope, for our country we don’t have to turn to doing hysterectomies on 22 year olds because they had an illegal termination.

Termination is going to happen. Whether you like it or not. You don’t have to be prochoice or prolife to be a harm reductionist. It seems pretty prolife to me. Just like substance use is going to happen, abortion is going to occur. Let’s make it safe. Let’s not make criminals out of patients.

World Mental Health Day 10/10/20

In this chaotic world of a pandemic, a divided nation, stressors such as the economy and climate change seem to rule the headlines. What maybe isn’t so apparent is the crisis of our mental health. Mental health disorders are often hidden, silent killers and quiet dream snatchers. We don’t get the treatment we need, the insurance coverage or the empathy of our community.

I hope that the crisis of our mental health gets the attention it deserves, not just today but, in the near future, everyday. “It’s Ok to not be OK” (thank you, Demi Lovato)

How can we start.. implore our governments to support treatment and insurance coverage, and in the workplace. We are losing far to many young people to suicide and substance use. We need treatment available 24/7. We need parity with insurance. Finally, most of all we need support from our community, our workplace and our friends and family.

Advocacy can make a difference. Small voices together can create the change we need now.

For substance use, follow Recovery Advocacy Project, “Vote Recovery”. https://www.recoveryvoices.com/

Follow your local NAMI chapter and finally, write your representatives.

Kim Blake (Sean’s Mom)

Reflection on Overdose Awareness Day 2020

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.


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.