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Making it Human

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.- Leo Buscaglia

Avenue of the Giants

Humboldt County, like so many other Northern California counties is breathtakingly beautiful. There are redwoods, wildlife, waters, good food, art, architecture, and history. Coming from San Francisco, there's a notable slowing of pace and a quiet in the air.

But there's trouble. Big trouble.

Humboldt County is plagued with an ever increasing homeless population, many of whom are people who inject drugs (PWIDs). The county runs neck and neck with Lake County as having the highest rate of hepatitis C (HCV) in the state of California. It's a community, rightfully, up in arms about the degradation of what was once, their slice of heaven. The local entities are very aware of the problems and are working diligently within their individual scopes to find solutions. But solutions have been hard to find, and the problems only seem to worsen.

I've been in Humboldt County, living in the HepCarestream, about 2 weeks. During that time, I've met with a lot of folks in the community- public health, healthcare providers, local merchants and community members, law enforcement, and homeless people who inject drugs. I even went to a City Council Meeting where I witnessed civil, but definite frustration over the trouble related to syringe litter. In the upcoming weeks, I have appointments with even more people. I'm taking a pulse.

The work I am doing withUCSF's Project ECHO brings me to Humboldt County to recruit primary care healthcare providers (MDs, DOs, NPs, and PAs) to participate in ongoing clinical education specific to treating and curing hepatitis C (HCV) right in their own communities. Through this remote education model, sustainable capacity to treat is established. It's a win-win.

These days, we must talk about IV drug use when we talk about HCV. There's a new cohort of HCV infections- no longer does the disease belong to the baby-boomers. In recent years, there's been a 55% increase in young males and a 37% increase in young females (ages 20-29). The CDC reports 2/3 of new HCV infections are injection drug use-related.

I'm looking for ways to potentiate the efforts that are already underway by community organizations that are already addressing these issues. The problems associated with homelessness and addiction have been going on long enough for strong opinions have been solidified. Tolerance is low, and people are vocal about acting on their strong convictions. Residents are angry and tired of finding used needles, likely contaminated with HCV, strewn in the bushes and along public pathways. Some people have even reported finding them in their private yards and on their front porches. They are tired of thieves and beggars and all the other things that are so significantly impacting their community's wellbeing, economic and otherwise. They are tired of the constant reminders of the underbelly of Eureka.

It's hard to maintain compassion and empathy for people who appear to be apathetic about their very existence. But, decrepitude doesn't happen overnight. It's a slow-burn; a series of things- an addiction that leads to loss of job, loss of home, loss of relationship, loss of support, loss of self-worth & purpose, all of which are oppressive (even when not using drugs) and require herculean inner-strength to surmount. If actively using, after a certain point they are no longer of sound mind. Ravaged by the demon of the drug that steals souls, they are only interested in one thing; the next fix. The soul that once occupied that body, is no longer in residence. Without help, there will likely be no retrieval. Thing is, these humans are someone's son, daughter, mother, father. They cannot simply be disposed of.

What is true, is that the years always come to collect.

When people get to the state of decline that so many of the homeless in Eureka find themselves, they become the outcasts of society and even begin to be parasitical. There doesn't seem to be any solution. Unless the use of empathy as a theoretical framework could be employed. But how?

Making it Human

While attending a meeting at Humboldt Area Center for Harm Reduction (HACHR), this week, the opportunity to put a face to the issue walked right through the front door. A young man, dirty, disheveled and clearly in distress, hobbled into the center. He had walked several miles in the rain, desperately looking for help for an infection in his leg that was spreading rapidly and causing him unbearable pain. I examined his leg and he had what appeared to be an aggressive case of cellulitis. This condition is often seen in people who inject drugs (PWIDs), and if not treated can lead to systemic infection (sepsis) and even death. I do not have prescriptive privileges, therefore I can't diagnose or treat him. I can only treat his symptoms and perform triage.

Only a few weeks earlier, he had signed up for Medi-Cal but was unaware he had a primary care doctor. I was able to get him a same day appointment and drove him to the office and dropped him off, leaving my phone number. He called me a few hours later and said the doctor suggested he go to the emergency room. The infection had advanced to the point where he needed IV antibiotics and possibly, surgery to drain the infection. Without this, he was warned, he could die of sepsis. He was making his way toward the hospital, which was at least 5 miles away. It was cold, and pouring rain. He didn't ask me to pick him up, but how could I not? I made my way to where he was walking, and took him the rest of the way where I again dropped him off at the emergency room, this time hugging him.

During the car ride, he shared with me how just a year ago he was engaged to a young woman and running a successful business. After a stint of sobriety, his brother was killed in an accident. The grief sent him back into the abyss that is IV heroin. As he spoke, he was tearful, and grateful, and shared with me that he had just learned he'd been accepted into an 8 month rehab program. He said he was done. I asked him when the last time he used was, and he said a few hours earlier and that his body would tell him when he needed more. He was lightheaded, running a fever, achy, and in my nursing judgment looking like someone in the early stages of sepsis.

When I dropped him off, I wanted to tell him to call me but I knew I had already crossed a certain boundary and it was out of my personal and professional scope to intervene any further. Curious about his disposition, I called the emergency department the next morning with hopes they'd tell me he had been admitted. Instead, they said he left before they saw him. My guess is, as he predicted, his body started telling him it was time for more and even his severe pain and life threatening infection couldn't make him stay to care for himself.

My mind has been filled with thoughts of this young man. Days away from his 30th birthday, I wonder if he will survive until then. Somewhere, someone loves him. I thought about my own son who is working hard, being a husband and father, and living a healthy and happy life. And my heart exploded. That young man could have been my son, your son. I treated him as I would have treated my own, hoping that my seeing him instead of judging him may have been the thing to have turned his life around.

Treating others as our own and approaching these significant issues with empathy and compassion, alongside well defined boundaries and strong and fair policy is, I believe, the way we will find the fine and balanced approach to providing humane care to these souls who are in such need.

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