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Tales From the Front Lines

Police officers, surgeons, firefighters, BART cleanup workers, and others talk about the often-harrowing realities of dealing with an epidemic.

SLIDESHOW

Clinton Bailey

(1 of 7)

Terry Morris

(2 of 7)

Dr. Christopher Colwell

(3 of 7)

Bryan Jackson

(4 of 7)

Pauli Gray

(5 of 7)

Joseph Pace

(6 of 7) 

Lennart Moller

(7 of 7) 

 

This story is part of our special report on the private tragedies and public toll of our injection drug epidemic. Read more of One City, Under the Syringe here.

 

Clinton Bailey, 53
BART system service worker, Powell Street station

Back in the day 10 years ago, you didn’t have this. Like, a needle? We’d all be shocked. “Look at what we found, look at what we found!” But now it’s like, “Eh—add it to the pile.” It’s crazy. We have a worker downstairs in the station at Civic Center, which is one of the worst spots for needles, and she’ll fill up a sharps container a day of needles.

You watch ’em shoot up. You watch the dealers sit down and sell them the dope right in the station, and watch them shoot up. All day. We have to call 911. We see ’em overdose, we see ’em throwing up, people passing out all the time. That’s why frontline workers don’t get the credit, but they’re there doing everything.

We have people that sit there and they’re high—and I don’t know what the hell on—and they jump up all in your face. And here you are, a worker, and you’re scared to death. As you notice, most of these stations are three-block stations. So there’s times as a worker you’re by yourself way out there. Civic Center, the end of the platform, is where they love to shoot up at. We go down there every 20 to 30 minutes to check it, and that’s when you get cursed out, threatened.

This one guy I witnessed had the needle in his arm, pants down, he was dead as a doorknob. They almost had to break him to straighten him out to get him in the bag. Needle just hanging out of the arm. You start just to feel sorry for folks. As you work and you start talking to folks and you get to know ’em, you come to find out that hey, some of these people—you could be in their shoes if you were to lose your job or have no family to fall back on.

January, I think it was, I went through with [BART police] because I work this station. There were two guys tapping, shooting up, one guy had already tied him up, tapped him off, and then BART police, we walk up and we were standing right here. The cat just looked up at us and continued to shoot his buddy up. The BART police said, “What are you doing? You see me right here, what are you doing?” He said, “What are you going to do? You’re going to put us out anyway, at least let us get high before we go.” That’s how it simply was for him.

 

Terry Morris, 48
Director, 6th Street Harm Reduction Center, San Francisco AIDS Foundation

San Francisco has a fairly ginormous number of overdoses and reversals. On my commute home, I found someone OD’ed on the stairs at Civic Center BART. I had given my Narcan to someone I thought needed it more than me, [though] I always carry it in my bag. I started giving rescue breathing and yelled, “I need Narcan! I need Narcan!” Six people who were homeless and used drugs came and helped me, and then a business guy called 911. We laid the guy out, he was on a stairwell and we put him on a flatter part of the stairway in the BART station. I gave him rescue breathing for about five minutes, and the guy that came to assist me administered two doses of Narcan. We saved the guy’s life.

 

Dr. Christopher Colwell, 52
Chief of emergency medicine, Zuckerberg San Francisco General Hospital

In college, I had a sense of what I thought of as an IV drug user. But now I’ve seen everybody from the down-and-out that I’d always assumed was an IV drug user to the highest-functioning people in business, medicine, law—whatever you consider high-functioning society. They’ve all come to the hospital, and they’ve all succumbed to injection drug use.

It’s so hard because we see overdoses literally every day. During my shift on Monday, we had two people die from having an overdose. One was a 28-year-old from overdosing on heroin. We couldn’t get there to give him the Narcan in time. At the same time, we had three that we did give the Narcan to on time, and we brought them in for evaluation, and they’re sitting there going, “When can I leave?” And we keep saying, “You took an overdose that would have killed you had no one gotten you the Narcan in time. You really need to understand the seriousness of this.” And none of the three gave it any real credence.

It’s very frustrating. Especially the realization that, somehow, our message is not getting through and that the message of the impact of the drug is more powerful. And I’ve had them tell me that. I’ve had patients tell me, “Look, doc. I get what you’re saying, I know what you’re saying, and I agree with it. But the feeling is too intense. My life focus is on getting back to that feeling again.” And the hardest part of all of this is when they’ll tell you, “That may have been death, but it was fantastic.” The difference between the ultimate euphoria and death is very narrow.

 

Meaghan McMilton, early 30s
SFPD officer; did Homeless Outreach for six months

We start every day—and it’s how we spend the rest of our day—with injection drug users. The women always stick out the most. I have a really close family member who’s an addict who is a woman. For me it feels personal. Any of these women could be her. Most cops are pretty good about compartmentalizing. Because otherwise I think it would be impossible to not be sad all the time.

You are essentially watching people slowly drown. We can’t just kidnap people and make them get help. You have to remember that addiction is not a choice. Maybe not seeking help is a choice, but who gets addicted and who doesn’t is not a choice. I think the way to stay not judgmental is to remember that these are people’s kids. They mean something to people, even if they don’t feel like they mean anything to themselves anymore. I don’t think that I ever feel judgmental about the decisions they made that led them to that point because I’m sure that the vast majority are dealing with all sorts of trauma and ghosts.

I’ve had one really good successful story. She’s my age. I met her five or six years ago when she was just starting her decline. My regular partner and I would see her all the time. We were on a first-name basis. And I’d say over the course of three years, she looked like she had aged 20. The only way that we felt like we could help her was to arrest her, because she wouldn’t do anything willingly—that was back when possession was a felony, so then they’re getting booked and they have the opportunity to detox. But then I didn’t see her for like two years, and I thought she had died. And then my old work partner ran into her on Market Street. She looked great, she was pregnant, she was clean for a year and a half, and she had a job at a coffee shop. She was really happy to see my partner. It was a lot of oh-my-Gods. My partner sent me a selfie of the two of them. I was working midnights at the time, maybe five or six months ago, and I woke up to that picture and it made me so happy because maybe two days earlier I’d checked her mug shots to see if she had been booked recently. And she had no booking photos for two years, and I was worried. I just assumed the worst, I thought maybe she had died out here. And then I woke up to that happy smiling selfie. It made me very happy.

 

Bryan Jackson, 61
Community program manager, Opiate Treatment Outpatient Program, Zuckerberg San Francisco General Hospital; S.F. General Methadone Van

A lot of people in the Bayview need treatment. If you go over to the plaza there, you’ll see people using drugs. We have space for 120 people, and we’ve only got about 80. I’ve been putting out flyers, letting people know we’re available. But I think a lot of people out there are saying, “Why should I go get on methadone when I have heroin?” Sometimes it’s easier to get the heroin than it is the methadone. There’s no shortage of heroin out there. And some don’t come in because of the stigma of using methadone. They think, “Why should I get on methadone? That’s just as addictive as heroin.” If a person who’s getting high every day has got a place to live, and it’s a comfortable place, what reason is he going to have to want to stop? They’ll just continue to use. I try to get them to understand that change is a part of their recovery. They might have to change their friends. They might have to change their environment. I try to take them through the stages.

There’s a young woman I started working with in 2012. She’s been with us on and off for those six years. When she first came in, she had been prostituting herself, she had gotten arrested, and she wound up going to jail. The jail brought her in and we put her on methadone. She did the whole program, got clean, and even went to a residential treatment program for a while. But she still hasn’t stopped using drugs and now she’s back with us. This time she called us and said she wanted to get back on the program. I keep asking myself, what makes you want to keep going out there? Doing the same thing over and over and over again, when you know what’s gonna happen? You’re gonna go back to jail, wind up in the hospital, and you’ve got two children that your mother and father have adopted. We’re just trying to see if she’s gonna get any better this time. And hopefully she will.

 

Pauli Gray, 50s
Senior harm reduction specialist, San Francisco AIDS Foundation; San Francisco Hepatitis C Task Force

I do a lot of hep C work. We’re trying to get treatment for hep C at needle exchange sites. It used to be you had to be clean and sober for three to six months before you could get treatment. Now we know the people infecting other people are active users, so we have to treat them.

I had hep C for 32 years. It’s a devastating disease. It’s crippling fatigue and depression. People are like, “I’ve been exhausted before,” but it’s different, it’s crippling. I didn’t have enough energy to go to work or go to school or have a career or follow my bliss and play music again. Drugs will steal your bliss. But I can tell you one thing: If you were out there homeless on the street, you would want to be high too. I’d like to see you try it. It’s brutally hard out there, but I’ve seen astonishing acts of kindness too.

My dog is my best harm reduction worker. I put a hep C shirt on him and people come up to pet him and ask me about hep C. He got me two of my first three clients that I got cured when we started this new program.

 

Dr. Corinna Gamez, 51
Medical director, Office-Based Buprenorphine Induction Clinic, UCSF

My goal is to make patients feel more comfortable from opiate withdrawal. When they’re uncomfortable, they want to use, and that’s a big trigger for relapse. And I don’t want that to happen. We tell them to come in here slightly sick and uncomfortable—I know that’s really hard for the patients, but we have to instruct them that way so that when we give them the buprenorphine, all the buprenorphine does is help them with the withdrawal symptoms. When they’re bouncing around, really agitated, irritable, throwing up, and really uncomfortable from their withdrawal symptoms, when you give them the medication you can see a visible difference in their behavior and how they’re doing. When they feel like the medication is working out, they’re more inclined to follow up and stick with the program and do the rest of the treatment, like counseling, other interventions, and things like that.

A few years ago, we had a patient we were concerned about because he was an injection drug user. He was injecting in his right groin because he couldn’t find any more veins in his arms or his legs. When I did the physical examination, you could actually hear that the blood vessel was weakened—it was making a hissing sound. It sounded like it was an emergency that anytime could pop. You know when you have a hose that bubbles up? That can explode.

So we called to transport him to the emergency room. We had our people at the general hospital ready to receive him, they walked him to the ER, and the ER people saw him and called surgery. With this chain of providers wanting to help him, they repaired the blood vessel and he was doing well.

A few months later, he came back to my clinic and I said, “How are you doing? I’m so glad to see that you’re doing well and you’re alive! But why are you back here?” And he said, “Oh, I’m using…but now it’s on the left side.” This, truly, is addiction. After everything—where we all tried to pull together to help him—he stayed clean for a little bit. But after that, he was injecting on the other side. That was the sad reality. So we helped him again.

 

Danny Gracia, 48
San Francisco firefighter

In the ’90s, when we would respond to heroin overdoses in the Tenderloin, it would be mostly people inside their SRO units, hallways, basements. You didn’t see nearly as much of it in the wide open, all day every day, out on the streets and sidewalks. I would say 70 percent was behind closed doors, and now you see the opposite of that: I think it’s probably 70 percent out in the open and 30 percent is indoors, because there are a lot more people living on the streets now.

We do what we need to do, whether it’s outside or inside. We start working on them—oxygen, CPR, et cetera, and then the medics come and inject Narcan. In a few minutes, a person will sit up and start talking to you. Sometimes they complain that you ruined their high and you should have left them be. Sometimes they throw up on you and complain. You try to help them, and you do what you can for them, but you might come back the next day and the same person did the same thing.

 

Dr. Joseph Pace, 45
Director of primary care homeless services, San Francisco Department of Public Health

A lot of the people that we care for have lived pretty tumultuous and traumatic lives. You talk to some people about their substance of choice, and they often will talk about it as if they have a relationship to it. It’s their friend, it’s their companion, it’s the person that gets them through rough periods of time.

If you think about how long it took for these coping mechanisms to develop, to reverse that, or help people find new coping strategies, can take quite a bit of time and persistence. We as medical providers want people to be as healthy as they can be; ultimately, that is up to what the person is ready for. If that means they want to stop using drugs, great, we’ll get them on that path; if that means they’re not ready to stop using drugs, well, how can we reduce the harm? And then we try to move people along a spectrum of change toward something. We try to hold out hope that things can be different for people.

We try to employ a strengths-based approach. Someone has survived all this adversity and they have picked and chosen things that they have needed to get them through the day, and through the years. But they’ve done something that’s allowed them to survive, so they must have some strengths they’ve brought to the table. So how can we identify those strengths and use those to help someone find a way forward? Some of it is a little bit of a discovery for the client. They might not see themselves as having strengths. For us it’s about identifying that for them and saying, “Hey, you’re really good at this. You get your needs met, or you know how to focus when you really want to, so let’s find ways to build on those strengths.”

 

Christopher Dixon, 31
Paramedic
It wasn’t until we started administering Narcan that would see results. San Francisco has done a pretty good job [giving] SFPD and people that do use heroin out on the streets Narcan. A lot of times, when we get dispatched they’ve already gotten their first dose of Narcan. Before, we’d show up and the patients would be blue. Sometimes now when we get there, the patients will just be starting to come out of it. We assist with ventilation and make sure that they are alert and going to the hospital. Narcan wears off over a period of time, so in a lot of overdoses, when they get Narcan initially, they don’t want to go to the hospital. We have to explain that Narcan has a short lifespan and that they could go back into an OD. We prefer them to be seen at the ER. They’re like, “Oh I don’t want to go.” But because they’re alert and altered, we have to take them. We’re under oath that we have to take the patient if they’re altered, so they start fighting with us. There have been times when a patient has snapped on a dime and you’re back there wrestling. The only thing that we can do is restrain them the best we can and give them Versed, which will chemically sedate them. There have been instances where people have wrestled with the patient and got kicked in the face. There’s just a lot of things that aren’t really said with EMS [training].

 

Lennart Moller, 54
Medical Director, Ohlhoff Recovery Programs
We have an acute 30-day program. I mostly work with those clients. They sometimes want to have one last hurrah, so we don’t end up seeing them for a few days after they said they would be here. That’s very common. By the time they come in, it might be that they have lost everything—their job, housing, all their money. A lot of times they use up the last money they had for their last fix. They come in here, and the first week is inevitably hard. For most substances, detox is the opposite of what the intoxication is, only more intense. If a person did heroin, the withdrawal might start to come on about eight hours after they last used it. It might consist of feeling achy in joints and bones. Any sort of [previous] injury they had, they’re going to feel that injury now. They’ll feel restless, like they have to move their legs. They’ll feel anxious, they’ll have trouble sleeping. Their blood pressure and pulse will go up somewhat. Interesting thing, a lot of them will have runny nose or watery eyes. Some might get the hairs on their body standing up. That sometimes happens, if it gets bad enough. They will also get diarrhea. A lot of times it might be hard to tease out [if] the depression that they’re experiencing at that point is actually a withdrawal symptom or an underlying problem. The first three days are especially hard for most people. After that, they realize they’re with nice staff working with them, and their peers are nice people. Some patients when they finish, if they have been an especially tight group, I have heard that the group will continue to meet up and support each other, and encourage each other, and go to AA and NA meetings together. That’s really nice to hear. There are certain situations in life where it is possible to form these intense bonds rather quickly.

 

Phillip Coffin, 40s
Head of Substance Use Research at the San Francisco Department of Public Health
Four years ago, we started a Naloxone co-prescribing program for people who are prescribed opiates for chronic pain or at risk for opiate overdose. When we looked at the mortality data, we saw that most of the overdose mortality was prescription opiates that were prescribed. Even if the patient isn’t at risk of overdose, their boyfriend, girlfriend, wife, husband, child might use their opiate medications. We wanted to get Naloxone into the places where opioids are. In fact, we did have one patient, who lives in an SRO, who had his room burgled, and all of his opiate medications were stolen, and his Naloxone was stolen. That to me—that’s a successful Naloxone prescription, because the Naloxone stayed with the opiates.

 

Originally published in the October issue of San Francisco 

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