Today I find myself sitting in a coffee shop across the street from St Paul’s Hospital in Vancouver, Canada waiting for my mother to have a procedure on her heart.  I just admitted her through the emergency room that has the insurmountable challenge of helping the people of our downtown Eastside caught in the epidemic of our opioid crisis.  It was an eye opening experience that inspired me to write this post and think further on the topic that I know is plaguing my city.  I am a healthcare professional that deals with people in various levels of pain all day.  I am also a person that due to a freak accident has found himself in the emergency room, in the operating room, given OxyContin, morphine and other drugs to try and help my immediate pain on a cycle of over three months.  My experience talking to Lance today in the St Paul’s ER has made me reflect on my experience and realize how slippery of a slope it can be for a person to go from a normal life, to an injury, to being a homeless drug addict living among throngs of others living out their own journeys on the street.

We arrived at the ER at 8:45am on a Saturday morning to a relatively quiet waiting room for downtown Vancouver’s only hospital.  There was one very talkative man being processed by the nurse.  He was seemingly a drug addict in withdraw and his father was quietly waiting in the chair looking like he had been through this before.  The dad was about my mother’s age and the talkative man was about my age.  I made sure my mom was taken care of at the admitting desk and then I was told to wait for about twenty minutes while the nurses processed her.  They took my mom in right away and told me to wait in the waiting room where there was one quiet well-kept woman in her late twenties, me, and Lance.  Lance’s father tried to express to him that he was going to deal with the parking meter, a concept that had no meaning in the world that Lance was currently in, so he saddled up beside me and started talking.  I spent the next thirty minutes listening to him tell me his story, going in and out of conspiracy theories, but I could tell there was a genuine person under the fog of drugs.  The quiet girl watched us and listened the whole time.  I have no idea why she came to the emergency room that day, but my brain somehow placed her there for being suicidal and she was waiting for help.

I realized quickly that Lance was going to talk as long as I listened and that he wasn’t really capable of a two way conversation, so I sat and listened, only making occasional comments to show that I was paying attention.  I had nothing but time waiting for my mother and Lance seemed like he needed a fresh ear so I engaged him in a non-judgemental way and let him vent to me.  It was a fascinatingly sad window into the life of a real person living in the terrifying alternate reality of psychosis, withdraw, poverty, loss and hopelessness.  I have no way of knowing if any of what he told me is true, but he was a passionate man that left an impact on me.  He told me that this all started on a construction site when his boss told him to climb a ladder or he was fired and long story short, he fell off the ladder and badly injured his back.  He was taken to the hospital and given Oxycontin and morphine to deal with the pain and ended up becoming a drug addict living in the downtown Eastside.

Lance perceived the world to be against him and had all sorts of conspiracy theories, but there seemed to be an underlying truth and genuine need for help in his ramblings.  He talked about these people that were watching him and studying him and he didn’t know why or how they knew his name or other personal information about him.  It became evident that his lasting perception of the social workers and nurses around him was that his life was part of some sort of horrible experiment.  He was in an endless cycle of trying to get some relief that started with Oxycontin and progressed to crystal meth and fentanyl.  He has seen his friends die from five dollars’ worth of fentanyl, but himself survived taking fifty dollars worth because he claims the methadone he is prescribed increases his tolerance.  He has revived fentanyl addicts with narcan and occasionally admits to playing Russian roulette with drugs because he thinks death may be a better option.

Lance grew increasingly agitated with the fact ‘they’ were making him wait in the waiting room because he had missed his previous two doses of methadone and he just needed some relief.  After listening to him talk for about thirty minutes I asked my first question “what do you want them to do for you?”  He didn’t really have an answer but the question calmed him down.  He had nothing but bad things to say about all drugs, especially crystal meth and methadone.  He had a lot of complaints about his body, but none of them were really pain centered.  He literally just needed to escape his own mind so I wanted to know how he felt the people he was waiting for could help him if he hated drugs.  He paused to think for a few seconds then refocused on how long he had been waiting for and insisted he was going to harm himself if he didn’t get some help soon.  At this point, I needed to go check on my mother so I asked him to come with me and talk to the nurses again.  We walked back to the admitting area and he said ‘thank you, this was helpful, my name is Lance- remember me,” and shook my hand.

I don’t think I will ever forget him.  I went into the emergency room and spoke with my mother about her issues and told her about my experience while we were surrounded by numerous other addicts in various levels of consciousness.  My mom ended up being OK and I have spent all day reflecting on my talk with Lance.  It brought me back to my experiences with my eye injury when all I was craving was some relief for days, weeks and months at a time.  I remembered dragging myself into the eye care center looking like a drug addict to get the doctor to stick a needle in my eye and reduce the pressure.  I remembered them giving me drugs that didn’t help the pain, but completely messed with my brain.  I lost thirty pounds, had multiple surgeries, hallucinated on Oxycontin, passed out on morphine and now realize how easily I could have been Lance.  It makes me sad for him and scared for what could have been.

My new normal is varying levels of pain in my eye and head every day that don’t particularly relate to my physical movements or activities.  It’s just there; sometimes it’s better and sometimes it’s worse, but it seems to be a part of me now and I have learned to cope with it.  I understand that most likely some of it is physical and some of it is perceived; by that I mean, I know that I have a silicone band wrapped around my eye, a piece of mesh holding it up, scar tissue in the muscles, and a damaged cornea that all have the potential to tell my brain “hey something sucks over here.”  I also know that none of those things are inflamed or infected or need to be telling my brain to perceive them as painful stimuli anymore, but that’s what happens.  Pain is a perception that starts with sensory nerves, but can become much more than that over time.  Drugs alter our perceptions and our levels of consciousness and as such they can be an effective tool in dealing with pain, but the danger lies in trying to treat the person’s physical symptoms without taking their emotional well-being into consideration.  It is a dangerous thing to give someone a pill or injection that makes a negative physical perception, that has all sorts of emotion wrapped around it, disappear for a short period of time.  It is the recipe to create addiction.

We know that pain is a perception more than a tangible, physical thing given the fact that doctors can do nerve blocks or sedate a person then cut them open and do major surgeries with no experience of pain by the individual.  The trouble is that people need to be in control of their own perceptions, not doctors, and people’s ability to feel pain is an important feedback loop to keep their bodies safe and healthy.  When susceptible people go through a traumatic experience they deserve relief from pain just as much as the next person, but what they really need is a support network around them to help them beyond day one.  I can’t imagine what would have become of me if I didn’t have my family, friends and team of doctors around me for the disorienting, pain filled, months in bed.  Lance and many others like him congregate together as a dysfunctional group of addicts on Vancouver’s downtown Eastside, each one has a story and each one needs some support.

Lance called me “a normal” and himself “an addict.”  As a physio, I work with “normals” in pain that are taking various ‘drugs’ to help them cope.  I now more than ever understand the importance of my job in helping people understand their body, their mind and their pain to give them some mental control of their situation because it can be a slippery slope to becoming an addict when constant pain wears you down.  Lance was an addict, but also a person that taught me a lesson and for that I am grateful for my St. Paul’s ER experience.

I don't have answers for our downtown Eastside in Vancouver, but I do have a new level of empathy and support for all those people involved in the chaos.  I hope the story of my experience will inspire more people to increase their awareness and level of support.

Sincerely,

Brent