Walking the Front Line
By Kerry J. Bickford, VOICES Editor
As overdose numbers soar and communities continue to grieve the loss of so many, the number of service providers walking the fragile line between life and death is also increasing. Sometimes they seem invisible, but they are there when you look behind the scenes. The toll that this work takes on their souls cannot and should not be underestimated, as they are fighting a war on drugs that, like any other war, includes innumerable human casualties—and not just the ones who have died.
Countless individuals perform miraculous work in the streets of our communities daily, in the name of harm reduction. This strategy incorporates safer methods to reduce the negative impacts of substance use, for individuals who are not quite ready to stop. Harm reduction is designed to do precisely what the phrase implies—it reduces harm while often building trusting relationships, which can sometimes result in the person’s treatment. Harm reductionists are committed to the well-being of their patients, so it is profoundly sad for them when someone dies after a committed investment in their physical and mental health. In the November issue of VOICES, Kim Powers said that she remembers the faces of her patients, and keeps a book of their names, anecdotes and sometimes their obituary. She does this so they are not forgotten, and it is a touchstone that keeps her moving forward in the darkest hours of her work.
Another line of defense against the addiction includes the hundreds of thousands of nurses—at all levels of care—who are often the ones who develop the closest relationships with their patients. They provide information, medical care and support, but even more than that, they become a lifeline in their patients' treatment plans. Justin Alves said that in this disease, loneliness is the enemy, and his dedication to his patients with substance use disorder inspired him to work both inside the walls of the Boston Medical Center and out on the streets. The vital knowledge he gains through this lens is shared with the staff he works with to help improve services, strengthen relationships and save lives. “Modern medicine has no value if a person feels forgotten or hopeless,” Alves said. In the 27 months I have served as editor, this is the most important message I’ve heard, perhaps because I have also lived it. As the parent of someone who died in a well of hopelessness, I get it, and it gives me so much hope to know that there are warriors on the street and in the hospitals and clinics who think as Justin does. Still, there is an impact on his soul when he loses someone he has worked with, and he firmly believes in the body-mind connection. Self-care is a practice he carries into the classroom with his nursing students, and one he exercises daily as he processes the highs and lows and pays attention to the lesson learned in each life and death. He believes this grounds him as he focuses on the lives in front of him—with one eye on the rearview mirror.
Every treatment plan includes at least one doctor, and communication is key to keeping team members on the same page. There are so many dedicated physicians out there, but there are always a few who could benefit from a deeper understanding of the whole person in front of them. In May 2021, we spoke to Dr. Laura Kehoe of Massachusetts General Hospital’s Bridge Clinic. Dr. Kehoe personifies compassion for each and every one of her patients, a result of lessons from childhood experiences when she was taught by her parents’ actions, her medical training and her own history of caring for the human being in front of her. “There is much hope if we keep the pressure on to expand immediately accessible, science-driven and patient-centered substance-use care, as we do for every other illness we treat in medicine,” Kehoe said. “People who use drugs deserve the same type of respect and care.” She practices this lesson daily with an incredibly devoted and competent team of like-minded providers. Still, even this level of devotion is not enough to protect her from the grief she feels when a patient dies, despite all heroic and practical efforts. “No medical education, training or years of practice could have prepared me for today,” said Kehoe as she eulogized a patient her team had worked hard with and lost. Her grief is genuine, and she says it motivates her to advocate for changes and policies that might help someone else. But she says it never gets easier.
Probably the most under-acknowledged, yet most important member of the frontline team is the family. Years of exhausting struggles to support their loved ones, searching for services and desperately reaching for anything that will help keep their loved ones alive, all combine into sheer devastation when the battle is lost. These families show up in peer grief support groups, shell-shocked and broken as they try to make sense of what happened. Other family members who have experienced a similar loss are there to witness their grief and provide any support they can.
These peer grief helpers have joined the front line, and their increasing numbers combine to wrap around the families whose journey they know all too well. This becomes part of their healing, and honors their loved ones and others who have died from substance use disorder by keeping the messages of love and hope front and center.
Editor’s Note:
As the founding editor, I took the opportunity to review some of the most powerful stories that have come across my heart and desk since VOICES debuted in April of 2020. I will soon be moving over to spearhead a new initiative with SADOD, and a new editorial team will continue the mission. I will continue to write from time to time, as I am very much invested in the many people and voices who are working hard to raise awareness and reduce the stigma of this epidemic, as well as the people who are walking the devastating trail of tears as they mourn their loved ones.
Thanks to all who have supported and encouraged me in this mission—dedicated to the memory of my son, Nathan.