Tag Archives: messy

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Messy

Everyone I get to know and really become friends with, has a messy life with difficulties. I think we are terribly afraid to admit it, with the curated lives on the place that is not a book but has lots of Faces. I write that all of my patients are smart and they are. I had my own rural family practice for eleven years. My goals were more time with patients and to do good medicine. I succeeded at both. With more time, I could learn a little more about my peoples’ lives. People that I would never suspect of having very messy lives still have them. Does everyone in our culture have estrangements, family that they don’t talk to, parents that they find difficult, friends that they have gotten upset at and abandoned?

In high school my daughter says, “Most of the fights are stupid. Usually someone says something without thinking, even in passing. Person B takes it personally, gets upset, talks about it to others and then person C or D says something back to person A or shuns them. Person A has no idea what is going on and is hurt and upset. It is stupid.”

Adults do this too. I had a friend where I would think about something for a week and then go back to him. “You said this. What did you mean?” Usually he didn’t mean anything or meant something very far from what I was thinking. At least I went to him and did not add person C or D or E to the mix. He said, “You think about it for a WEEK.” Well, that was his own fault, actually, because he can’t tolerate anger. Even if I was upset or hurt, it was still interpreted as anger. Raised in an alcohol household and trained by medicine, I can hide feelings. After a while he could tell when I was chewing on something.

We grow up physically by our mid twenties, but often we don’t grow up emotionally. Especially if relationships are interrupted and colored by drugs and/or alcohol. People miss developmental stages. Everyone is trying to cope as best they can, but I do wish our culture celebrated mature calmness and quiet adulthood, rather than just the wild youth. Wouldn’t that be a change?

If you were to curate your life for something like the site that is not a book and has Faces, what would your ideal be? What do you aspire to? Kindness? Emotional maturity? Peace? My feed has friends, insects, birds, rocks, fossils, funny animal videos and music. I get almost no politics in it. I have not blocked anyone or anything. I try not to friend people I do not know. It is peaceful and a celebration of nature and yes, that is what I would like to curate.

Blessings.

For the Ragtag Daily Prompt: curate.

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Getting rid of stuff

This is not my forte. I was raised by pack rats and I have genes from both sides. My OCD tendencies are confined to patient charts and keeping shoes in their original shoe boxes. Otherwise my house is piler pack rat. Piler, not filer. Filing is boring. My office managers have to be Queen Filers to keep me in line. Both of them were, too.

Cleaning out the clinic was difficult. I found stuff I didn’t know I had, of course. What to do with the metal speculums? Keep for posterity or in case we run out of oil? I don’t actually know where the speculums went, they went off with a friend who is helping.

In retrospect, I think my mother would have made paper mache ducks with speculums as beaks and wish I’d kept one. Ah, well.

Weird shelves, microwave and printer.

Someone bought the weird shelves. The microwave’s owner picked it up. We had three printers running at any one time except when one would die and we’d only have two. This printer went home with me. New and old computers went home with me because one has to wreck the hard drive because HIPAA. My house currently looks like a computer/printer/scanner/file cabinet graveyard. It’s annoying.

Home office guest bedroom.

Besides this messy room, there are also 8-10 more boxes of stuff moved down to the basement. I have to keep patient charts for ten years or until they are 21 for minors. I have paid a company Big Bucks to take that over. I have to keep business records for 7-10 years depending on if it’s state or feds.

Well, I’ll sort it before I’m dead, or else my kids will.

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Reducing recidivism: Snohomish County Sheriff’s Office and Human Services Program

The last two days have been at the 20th Annual Fundamentals of Addiction Medicine Conference in Washington State, 15 lectures. Everything from science trying to understand addiction via studying dopamine in ratbrains to the last presentation: Snohomish County started a program two years ago that pairs a social worker with a county sheriff or deputy to work with the homeless.

The county is trying to stop the revolving door of homeless to arrested to jail to homeless. 95% of the county homeless are addicted to heroin and some to methamphetamines. They don’t access services when they are “dope sick”. They describe heroin as being 10x worse than the worst influenza. I think of withdrawal from opioids as having all the pain receptors turned as high as they can go and screaming at once.

The sheriff and social worker go to the camps. They get to know people and offer services. They have helped over 100 people get their identification replaced. When someone is arrested, their homeless encampment is often stolen. No honor among thieves, you say? The rat studies address that: in addiction the brain puts the drug first, in front of food, water, sex. Some rats will access the drug until they die, just like people. I think of it as the person losing their boundaries to the drug. The conference used the phrase “incentive salience” — dopamine is released when the person or rat is cued that the drug is now available and again when the drug arrives. More on that in another write up.

At any rate, the clients do not get to appointments. So the deputy and social work start at the beginning: they make the appointment, go knock on the tent that morning, remind the person to get dressed, take them to get food and coffee and then take them to the appointment. Then they return them to their camp.

After two months, the first sheriff and social worker were so successful that the program was expanded.

They have 206 chemical dependency evaluations.
232 have gone to detox. The detox is 3-5 days. They are taken straight from there to inpatient treatment, 30 day minimum, but ranging from 30-90 days. After treatment, clients are taken straight to sober housing, with a 6 month supported stay and intensive outpatient treatment.
85% get through the detox.
59% graduate from the treatment
50% go on to sober housing and intensive outpatient.
Their first clean and sober client is two years out.

50% of the homeless who agree to the program getting to sober housing is huge. Recidivism and incarceration drop, so it is making a true difference.

The program is expanding. They have a Community Court set up, much like Juvenile Drug Court, modeled after a program in Spokane. If the person agrees to drug treatment, they can do that instead of jail. This is for minor offenders. The sheriff says that once the homeless person is incarcerated, everything is stolen. They then steal food and supplies for a new camp when released and it happens again. If the client completes the program, low level charges may be dropped. They are setting up a service center right by the court where the clients are sent immediately to talk to a chemical dependency person, to get medical treatment, dental emergencies, centralized services because these people do not have transportation.

The social worker is in kevlar and heavy clothes as well and is never to go in the encampments without the law enforcement officers: it’s usually private land so it would be trespassing anyway.

This was an absolutely inspiring presentation. It starts with outreach and intervention, and gives people choices. They will soon be opening a temporary site, up to 15 days with medical support and beds, for when a client is ready but the social worker needs to arrange the detox, the treatment, the housing. Sometimes when a client is finally ready, there are no beds. And they don’t want to send them to detox and then back to the streets. The sheriff says that he was “volutold” for the program, but he, the deputy and the social worker are all clearly inspired by the program and enjoy their work and that it is making a difference.

 

Any write up on addiction fits today’s Daily Prompt: messy.