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Category Archives: Harm Reduction

Tumult

I don’t even know where to begin. I feel like my brain has been rolled through a paper shredder on high speed with a magazine mixed in for confusion.

Last night I got the news that one of my close friends got the phone call she has been waiting for. However, this is not the type of call that any healthy 23-year young woman should be waiting for. She has been waiting for a small bowel transplant after having gastric bypass surgery just over a year ago, losing well over a hundred pounds and nearly reaching her ideal body weight through a combination of healthier living and exercise. Then, severe and sharp pains to her abdominal region complicated her course. Her gallbladder and 26 gallstones were removed, which unfortunately didn’t go far to solve any problems. Without writing a novel, or giving away any personal information, it was soon discovered that nearly her entire intestinal tract was rotten.

Suffice to say, her outcome was poor to dreadful. But through a combination of incredible strength, excellent medical care and a whole lot of love, support and luck, she somehow stabilized after having her entire bowel removed, save a few inches on either end. She was stable, but certainly not out of the woods. To say nothing of the struggle with insurance or malpractice suits, her life has been blown to smithereens for the past 5 months, and it is only recently that she was finally cleared for transplant. And yesterday she got the call.

The organ was in the Midwest, so at 3am, a team went out to harvest it. I was in contact with her via a few brief phone calls and a piddling of texts. She is on edge, and I am on pins and needles – I can only imagine how much more difficult it is for her. She is so incredibly strong, yet how much can a person really take? While in my afternoon classes, I got news that she was being taken in. The transplant would go forward: the organ was viable. After clinic this evening, I got a text from her mom. About an hour ago, the bowel had been successfully placed and she was stable. She would still be in the OR for a few more hours. So that’s one piece, the most important piece, of this whirlwind that is stealing my breath and messing with my mind. But it’s not all.

I have recently started volunteering with a Harm Reduction Clinic and needle exchange. Initially, the idea was to participate with the student-run clinic, which operates every other week, on one weekday evening. But more recently we have been working closely with the program coordinator and toying with the idea of starting a program that offers services strictly to their female participants. These participants are sex workers, IV drug users, or both. The idea is to offer a support group, maybe some case management, definitely health education, and hopefully women’s health services and point-of-care testing. This is all still a nascent dream, but it has already gotten minimally underway with a survey tool that we have developed to use in conjunction with a focus group. More on that to come.

Today we spent time at the needle exchange in the morning and the evening just to start getting to know a few of the participants and the general “flow.” The morning was mellow and this evening we were able to watch and observe the clinic in action. I shadowed a medical student with a patient who we’ll call Arnie.* Obviously it would be crazy to claim that I didn’t have a single stereotype or preconceived notion of what a (past) drug user, current panhandler and intermittently homeless man would be like. And being myself, I at least give myself credit for expecting and seeing these incorrect assumptions disproved within seconds.

This was a fairly well educated man with typical but exacerbated health problems: many of which that he understood far better than your typical layperson. Better than me, in fact, in some cases. He was agitated when he sat down, and rightly so. He felt like he was being seen by a medical student and a nursing student and he wanted to see the real doctor right away. He asked smart questions and he made a lucid point about unequal medical care, comparing his own care to that of former Mayor Giuliani’s daughter’s care. I had to agree that they didn’t quite match up. Then we got down to business. I was at once impressed by the second year med student’s knowledge and overwhelmed by my vast lack of knowledge. But I have to remind myself that knowledge isn’t a secret elixir-I will attain it too, someday, and at least my social skills are intact.

Arnie and I made a connection. I recognized it, and I think he did too. In trying to compliment me at the end of the history-taking, he told me that I should really go to med school too because I would make a better doctor. I could have hotly informed him all about nursing and why I chose it as my profession instead but….Argh, sigh. We’ll tackle that topic another day.

(Reflecting on how astute and intelligent I found him to be, I do want to mention that in one of his many rants, he speculated on how silly it was that doctors didn’t have to become nurses first. He said that nurses do all the work, they provide the majority of the hands on care, and they are the most well informed individuals in firsthand experience and that they should be the ones to go onto med school and become the best doctors one day. His words, not mine. I swear.)

His problems aren’t insurmountable, but they did seem enormous to me tonight. It wasn’t the diabetes, the infection, the mysterious skin condition, or even the coronary artery disease. It wasn’t the arthritis or the peripheral neuropathy. It was more the fact that he was in a downward spiral and unlikely to climb his way out, despite our best effort. This really put a story to the faces that I see in the subway. The panhandlers, the singers, the dancers, the vendors. They all work in this gray market – one that isn’t very visible but very much exists. Arnie is an a cappella singer. I heard his baritone when he opened his mouth for us to examine his throat. I got a vivid image of one day seeing him on the subway in my daily commute. It’s not unlikely. It made me squirm and feel desperately sad for a moment.

When I left that evening, late, well past 10pm, I sighed when I looked  outside and saw pouring rain. I turned back inside and mentioned to one of the clinic’s participants that it was raining. “Bummer,” I said. And she looked at me and said, “Yeah, that really is. That just about ruins my night.” I sucked in a breath. It was too true. And it hit me hard. Our program coordinator told me that volunteers here hope to get their “feet wet” in the complex world of harm reduction. But she said she always laughs a little bit inside, because the reality is, that if you really want to help, you’re not going to just get wet. You’ll get soaked.

So, saying goodnight, I jogged out into the rain without another self-pitying thought. I took the subway. And then I biked home from the train station, barely even glancing at the tempting taxis. I got soaked, and as melodramatic as it might sound, it felt right.

* Name changed

 

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