Welcome! I finally learned how to setup WordPress. It’s a lot different than what it use to be 3 years ago. The user interface has definitely gotten a lot fancier! This is also why I hardly update my phone since sometimes the layout changes and I get confused. Is my grandma side showing yet?
Anyways, it took me an hour to set this thing up and I’m due to be in clinic tomorrow early morning so keep tuned! In the meantime, here’s a writeup for the current elective rotation I am on right now. More details on the next post- enjoy!
- “It was just a part of my routine”
- “False relationships are hard on [substance] use”
- “ We all have the same wheelbarrow, but we put different things into it”
The VA Puget Sound’s Addiction Treatment Center is a multi-resource avenue for veterans undergoing substance abuse and addiction. It is regarded in high esteem as a center of excellence for its compassionate and respectful care and patient advocacy. How patients get to the center depends on their circumstances. Some come in with their walls down, feeling defeated, and ready for change after having their lives “controlled” by their substance. Some come in with mild resistance, unsure and skeptical, referred by primary care providers and family members. And some come in more than familiar with the program after having multiple relapses but remaining optimistic that this time around, it will be different.
Every day is a busy one at the ATC. Without knowing the clinic’s location, one would walk by the entrance without a second thought. But upon entering, you are greeted by a bustling lobby filled with patients waiting to give urine samples, pick up their methadone, see their case manager or waiting for an admit. During admit days (Tuesdays and Thursdays), patients first meet with Nancy, a no-nonsense irrepressibly charming nurse that does the morning triage. During these 10-15 minutes, a brief history and physical is done and with some quick judgement based upon 30+ years of experience of working with this particular population of patients, she formulates a treatment outline. The morning then proceeds with an introduction to ATC, a tutorial on opioid rescue kits, a meeting with a social worker for a complete assessment of their substance use history, and then depending on the patient’s needs, a meeting with a medical professional to finalize their treatment plan. I had the opportunity to follow a gentleman for an entire morning as he and the team worked on a plan to help wean him off multiple substances and keep him in his stable housing. With a complicated history consisting of depression, PTSD, and chronic pain, there were multiple reasons for his substance use. The discussions were centered around what his goals were (e.g. to reach abstinence for a hip replacement) and what incremental steps were needed to reach that goal. Things at the ATC are done in a patient-centered manner.
On Mondays, Wednesdays, and Fridays, I sat in on the ATC’s Intensive Stabilization Services (ISS), an intensive outpatient program (IOP) consisting of three hour-long sessions per day, three days a week. Sessions consisted of checking in, a focus group, and an education hour. These sessions were facilitated by a rotating group of medical professionals, social workers, and a chaplain. They served as a support group to discuss life experiences and different techniques and strategies to help with the recovery process. At the end of the three week program, patients can opt to continue in a treatment facility or be discharged with outpatient follow-up.
The core amount of my time at ATC was spent attending ISS sessions. I appreciated how inclusive the group was to my presence. They were a jovial group with a broad variety of experiences. Some had been through ISS before and for some, it was their first time. In one hour chunks, I slowly understood the extent these addictive substances could penetrate the human psyche and the relentless control it had on the body and mind. In many ways, addiction is similar to depression: a diagnosis that never completely goes away. However, I also witnessed the resilience of humans and the power of human connection during these sessions. Through generous listening and a rule of “no cross talk” and “I statements only”, patients shared stories of relapses and cravings and received feedback from others. There was always something said that could be related by another person. This leads to validation and feelings of “you are not alone”, a very simple but important concept in addiction treatment.
During my time at the ATC, my emotional capacity for empathy has grown ten-fold as I am given an opportunity to hear these intimate stories. I sat with the group during lunch one day and asked what they felt was most important to them in a physician-patient relationship. I also wanted to know how their interactions with the medical system have gone in the past. Positive experiences boiled down to several key factors: the physician’s ability to be non-judgmental, honest, and understanding. Many of them had past encounters where they felt let down, dismissed, or worse, shamed by the medical community. It was a candid conversation that reinforced my biggest takeaway from my experience at ATC- the only way to help others is to always keep your door open and be willing to listen.