“Have a good day at School Max…don’t get shot”

“I love you Max,” I say, as my son leaves for high school this morning. He does his usual quick knock on the sliding glass door. Saying “I love you too” is communicated back to me in his unique “Max” way. Our parent-child morning ritual. That quick knock means the world to me, it means more than I can really express. The love for our children, with most parents, transcends a place so deep in our souls that it defies description.

Parents waking up today in Florida, having lost their children in the current school massacre—and I say “current” because I have little faith that it will not happen again—their pain I cannot fathom. I do not pretend to know their pain, but I am deeply sorry they are going through such a senseless loss.

“What did you do at school today Max?” I ask, in my usual after-school banter.

“We hid in the closet.”

“We hid in the closet”—his words swirl in my mind, taking me back to second grade. Tornado drills in the panhandle of Texas. The alarm sounded and we quickly got under our desks.

“A disaster drill for when the mass murderer shows up,” he adds.

Not “if,” but “when,” is his inner dialog to himself. The reality that our children live with this sort of distorted, brutal reality that has happened to their “own” is causing their developing minds to be affected with potential mental health disturbances and myriad psychological symptoms. Perhaps even taking a vulnerable teen and turning him or her into the next murderer.

A cycle. A cycle that will continue to spin unless an obstruction is lodged in the wheel.

A closet will not protect a huddled mass of kids from an assault rifle. In fact, with them all clustered together, it would be like shooting ducks on a pond.

Let’s have some gun-adept teachers, trained and armed, was our president’s remark yesterday. Lesson planning and teaching is their job, and they are woefully underpaid for the important job of preparing our youths for the future. Now we are suggesting they pack a gun. But maybe only 20 percent will be in the battalion of teacher protectors being thrown out as a solution to gun violence.

How long does it take to fire rounds of bullets from a war gun, slaughtering some kids, before Ed the shop teacher manages to run down the hall with his one-bullet pistol hidden in the back of his pants to disarm a deranged murderer? Might the murderer’s lightning-speed gun machine kill Ed first? Or maybe Ed keeps an assault rifle in a secure closet. How long before a twisted student’s mind breaches that closet, is my thought. Keeping guns at school seems unpredictable. As the bullets are heard, Ed is wondering where he left the key to the gun locker.

If it were not so politically incorrect, it would make a laughable skit for Saturday Night Live.

My blogs are on addiction, so let me tell you this: If I was a kid in school today, dealing with the  possibility of being murdered there, daydreaming during a class lecture what I would do if bullets started to fly, then numbing out with pot in the bathroom or a snort of heroin would become way more appealing. Addiction, when it expresses itself in an individual, always has a psychological trigger that pushes its pathology into presenting itself. Anxiety is one of the common triggers I see. Post-traumatic stress is another.

The stress our youths increasingly are made to deal with surely affect their minds.

Get the guns off the streets. Stop selling them. Politicians stop sucking at the NRA’s tits. It is a follow-the-money game hiding behind the Second Amendment.

Times change and constitutions need to change and keep up with modern times and realities. I believe our founding fathers would agree.

Max walks in the door from school. “Hey Buddy, how was school?”

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A Day Trip with Heroin

Disheveled and encumbered with unpacked cloths on her lap, my new patient, to be transported to a Southern rehab, shows up curbside at the local airport in her mom’s car, passenger side.

I open the door. “Hello,” I say, and my greeting hangs in the air, apparently like a nuclear bomb. The patient yells, “Get away from me, you f – – – ing c – – t.”

Inwardly, I laugh. Heroin is angry with me today. I’m on his turf, and he is fighting hard to hold onto his signature death grip. But I don’t scare easily, nor back down. He and I meet often. I don’t even see the girl nor take it personally. She is no longer present. Linda Blair is glowering at me.

OK, maybe Lucy, my little dog, will help. “Lucy would like to meet you,” I say, as I plunk Lucy in her lap. “Get that f – – – – – – rat away from me. Turning to her exasperated mom , she screams, “I am not going anywhere with that b – – – – . Just take me to jail.”

She is jammed up. It is jail or rehab. Bluffing is my middle name.

“OK, then,” I say. “Detox sucks in jail—you know, no meds—but good luck, goodbye.”

As the girl picks her clothes up from the car floor, I motion silently to the mom to loop her around the airport. And I turn my back and walk away.

It works. Only one loop and she decides I am the better option.

But it’s like she has gotten a restraining order against me. She orders me to stay so many yards away from her. I trail behind, just keeping a close eye out. She shot dope in the car, the mom told me on the phone. I carry naloxone, the antidote drug used for heroin overdose, which I feel is hanging around my neck like a clove of garlic, but my gut is telling me I won’t need it.

Every once in a while, her tough veneer breaks and she glances at me for direction. But then, getting her footing, she demeans me again.

“Disgraceful you are, making money off people like me. You are f – – – – – – unethical!

That, I admit, bugs me. I am not unethical, uncaring, uneducated, inexperienced, or overpriced. I do not take advantage of vulnerable families. But I stay quiet. No arguing with the devil.

Upon arrival at our destination, she can barely walk, she is so weighed down with stuff: dope fatigue, carry-ons, and luggage.

I repeatedly offer to help her. “I’ll ask you if I need help, just shut up,” she retorts.

She is shuffling so slowly and labored, I offer to get a wheelchair. Any second now, I expect her head to spin around.

Finally she asks for help. “I can’t go on, I have to have something to drink.”

Alcohol is not her deal, so I say, “OK, Coke?”

“No, Sprite.”

She has no money. I buy her a soft drink and place the straw in the cup. She grabs it from me with unexpected strength and continues seething. Her needing me has not made her any nicer.

Her bag on the ground, I pick it up because she is now even more labored with a drink.

“Put it down!” she spits at me. I put it down. She juggles everything for a minute, and we carry on.

On the tram now to take us to the baggage claim, where  I am to hand her off to the rehab, I take out my card..I slip it into her bag. “There is my card. Come find me in the future.”

She glares, and we have a staring contest that lasts maybe three minutes.

“I will never come looking for you,” she says. I have zero respect for you.”

“OK,” is my simple response.

Heroin hates me today for attempting and possibly winning the battle. One person at a time.

I hope Lisa comes and finds me one day.

Why are Lucy and I effective at doing Interventions.

Lately I have pondered this question: Why am I so often effective at reaching my goal of getting a person who has substance use disorder, who is resistant to treatment, into rehab?

First, I think, it is my 13 years of performing this job that is helpful.

Like all professions, most people hone their skills by working in their chosen profession.

But I believe it is more than that. 

From the moment I get a call from a family member or loved one about the person in need of an intervention, I carry that person inside of me until we meet. I silently internalize all I am learning about the patient, both through extensive interviews with the family about the patient and also (and this is where I believe a big part of my success comes from) because I am walking with the patient and working out in my mind the best way to approach him or her. This is done on a gut—an instinctual—level if you will.

I grew up in a family where I was enveloped by substance-use disorder and became sick with the disease as well. That experience has been invaluable to me in understanding the dynamics taking place in the family, giving me the skills to deal with the group. This, I believe, is where my instincts were born out of that I now use for the good of other families suffering from substance-use disorder.

For me personally, there is no greater passion then taking something dark in my past life and using those challenges to bring hope and light to another family. 

Then there are the pragmatics that aid me in my skill as an interventionist. As a former registered nurse in an alcohol and drug rehab, I have the ability to make sure the patient is physically capable of being admitted to a rehab instead of a hospital first. 

Then there is little Lucy, my five-pound Chihuahua. If appropriate, she is with me. Lucy transmits unconditional love to people who internally have no love left for themselves. I have literally seen people’s despair blossom to a place of hope with little Lucy sitting in their lap on the way to rehab. 

My attitude as I approach an intervention, first with the family, then with the patient, is one of hope and celebration. An intervention is a time of hopeful renewal and change—not gloom and doom or threats. 

An intervention is about new beginnings with a solid plan on how and where to go to get help. And above all else, an intervention is facilitated in a nonjudgmental manner, transmitted with respect and love.

Why are Lucy and I effective at Interventions

I have pondered this question: Why am I so often effective at reaching my goal of getting a person who has substance use disorder, who is resistant to treatment, into rehab?

First, I think, it is my 13 years of performing this job that is helpful.

Like all professions, most people hone their skills by working in their chosen profession.

But I believe it is more than that. 

From the moment I get a call from a family member or loved one about the person in need of an intervention, I carry that person inside of me until we meet. I silently internalize all I am learning about the patient, both through extensive interviews with the family about the patient and also (and this is where I believe a big part of my success comes from) because I am walking with the patient and working out in my mind the best way to approach him or her. This is done on a gut—an instinctual—level if you will.

I grew up in a family where I was enveloped by substance-use disorder and became sick with the disease as well. That experience has been invaluable to me in understanding the dynamics taking place in the family, giving me the skills to deal with the group. This, I believe, is where my instincts were born out of that I now use for the good of other families suffering from substance-use disorder.

For me personally, there is no greater passion then taking something dark in my past life and using those challenges to bring hope and light to another family. 

Then there are the pragmatics that aid me in my skill as an interventionist. As a former registered nurse in an alcohol and drug rehab, I have the ability to make sure the patient is physically capable of being admitted to a rehab instead of a hospital first. 

Then there is little Lucy, my five-pound Chihuahua. If appropriate, she is with me. Lucy transmits unconditional love to people who internally have no love left for themselves. I have literally seen people’s despair blossom to a place of hope with little Lucy sitting in their lap on the way to rehab. 

My attitude as I approach an intervention, first with the family, then with the patient, is one of hope and celebration. An intervention is a time of hopeful renewal and change—not gloom and doom or threats. 

An intervention is about new beginnings with a solid plan on how and where to go to get help. And above all else, an intervention is facilitated in a nonjudgmental manner, transmitted with respect and love.

“I hope you’ll join me as a #FacingAddiction Activist by visiting the link below! One simple action step each week – it’s the least we can do combat this public health epidemic.”

https://www.facingaddiction.org/activist_program

Dope/Smack/Carfentanil

“Don’t bother coming; he is dead.”

Those words, a week later, still haunt my world. They echo in my head, roaming my mind and refusing to stay still. I am working through the grief.

It is early morning. The day’s usual routine plays itself out. My son is sleepily wandering the kitchen getting ready for school. The smell of coffee is in the air. I had locked and loaded the coffeemaker the night before. I am sleepy, too, and all I can manage first thing in the morning is to push a button. I can hear the sound of cereal hitting a bowl.

“Max, don’t forget to brush your teeth before you leave,” I yell from my room as I dress.

“Mom, why do you tell me that every day?” Max laments.

I reply, as usual, “It is my job as your Mom to help take care of you; that includes your teeth!”

Max and I have had this conversation over a dozen times. Maybe I should stop reminding him, I think, fleetingly. Am I enabling him, not allowing him to take responsibility for his own teeth, or am I loving and protecting him? As I tell my patients, it is a fine line that separates caring for our loved ones from enabling them. But I have no time this morning to really contemplate my parenting style.

I hear the front door. “I love you Max, make it a great day.” I hear a muffled grunt, which I translate as, “Bye, best mom in the whole world, I love you too.” Ok, maybe I am stretching the meaning of my son’s grunt, but it works for me.

I pull my dress over my head. The dress feels too conservative for my style, but I am working today, transporting a young man who has willingly said he will go to rehab.

Two years earlier, I did an intervention with Todd for his family. Todd was addicted to heroin at the time.

He went on from rehab to attend college for two years in a sober dorm, housing designated for kids that have had treatment for addiction. He went on to be a counselor to other, newly sober students.

He returned for a brief time and visited with an old friend—an old friend still using heroin. And with a speed I know all too well from personal experience, Todd used his old enemy, heroin—an enemy disguised as your best friend, a friend that has the ability to manipulate your memory in a way that is incomprehensible, telling you, “We will visit just this one time,” when, in reality, and with rare exception, that “one” visit will end up being a road trip to hell as you once again become addicted.

Todd’s quality sobriety has not been a failure or waste of time, though. He asked for help quickly, within a week of his disease coming out of remission. This is an important point. Addiction/alcoholism is a lifelong chronic illness.

Our success, many times, is when the illness recurs coming out of remission; the addictive stage of addiction becomes much shorter. Addicts who have learned about their disease in treatment and achieved periods of sobriety are armed with facts about the illness coupled with positive experiences of sobriety. These two factors combine and result in the addict seeking help sooner for a relapse.

This is what Todd did—he asked for help quickly—but these days, with strong heroin on the streets, addicts are too frequently passing on before getting the help they need.

That is when I got a text from Todd’s mom, asking for my help in placement and transport to treatment for her youngest son, a son asking for help.

But I was just hours late. The devil beat me to the finish line, and Todd died sometime in the night of a heroin overdose.

Unfortunately, Todd’s death is not unique. Two factors were working against him, increasing his odds of an overdose death.

One, his tolerance for the drug had changed, Having not used heroin for a few years, he needed less of it than he had used previously to obtain the same high. Returning addicts make this mistake all too often, seeking the same old warm euphoria they remember from their previous days of addiction. Simply said, they use a dose of heroin that is too strong for their bodies, which have been abstinent for a period of time. They overshoot the mark and use too much of the opioid; this affects their vital bodily functions, mainly breathing, and they drift off to death.

Two, the heroin of yesteryear is not the heroin of today. The countries that send us illegal heroin are sending America a “weak,” or watered-down, product. Why? Ask them, but I suspect this skimming of the heroin is to save money or make more money. This precious and lucrative commodity comes from countries where a big part of their economy is the illegal export of heroin.

Enter the United States. Drug addicts don’t want to buy a weak product anymore than a person with alcoholism wants to drink .2 beer. So dealers are beefing up the product with fentanyl, a potent synthetic opioid . Fentanyl is also being imported into our country. Where from? Depends on the day. The last big shipment of Fentanyl seized came through Quebec, our northern border. It came into Quebec by ship from a far away port. The point of origin is still debated. The Fentanyl changes hands many times before hitting the US. Currency flows among dealers like the death the drug will bleed down on our citizens. Then there is Carfentanil, a clone of Fentanyl, if you will. I hugely strong form of Fentanyl , originally used to bring down a large animal, like a elephant or lion as a anesthetic.

Amateur chemists add the Fentanyl forms but can’t seem to regulate the strength , and strong batches of heroin laced with it hit the street. Heroin addicts use their usual amount, but that dose has morphed into many times its previous strength, becoming lethal, and the addict dies.

My phone alerts me to a call as I am putting on my shoes to go pick up Todd.

“Don’t bother coming; he is dead.”

I sit on the side of the bed, numb. My first thoughts turn toward Todd’s parents. Their grief is beyond my ability to truly appreciate.

I think of Max, my son, minutes ago slamming the door as he rushed to catch the bus to school.

“God, please watch over my son today, and bring him home to me.”

I will continue my “war on drugs,” as an interventionist, one person, one family at a time. It is my mission as I chase the devil away from the families I am privileged to serve.