Putting My Business In the Street

“Life can be only what you make it. When you’re feeling down, you should never fake it….”

Mary J. Blige-My Life

I haven’t written anything for a few months. Multiple reasons come to mind, but the most basic explanation is this: I didn’t feel like it. I mean, it’s not like I get paid to do this and on average only 50 people will read this. But I had to really look at my situation and realized that I was approaching burn out.

There are articles that talk about provider burn out. Meaning we get so overwhelmed by our jobs that some of us lose our passion and motivation for the work, become depressed, anxious and suicidal in some cases (NOT ME, thank goodness). Providing direct services is what I enjoy most, but I was thinking about going back into a management position (LOL). I had to figure out how to deal with several issues that were making me feel the way I felt.

1. I got tired of being Black. No, I haven’t lost my mind. When you’re only one of a few at your place of employment it can be tiring. I’m the only Black person who performs a certain function at my job, so when people request a Black provider it’s me. And most days I’m okay with it, it’s one of the reasons I chose to work in mental health. I LOVE MY PEOPLE. But every now and again it saddens and angers me that people continue to experience multiple forms of discrimination on a daily basis, especially since I deal with it myself (dog whistles are LOUD AS HELL!!!). I laugh at an interaction that happened during a meeting which I attend on a regular basis. After one year I was appointed as chairperson of a subcommittee, which meant that I became a co-chair of the larger group meeting. When I was being introduced in this role a woman interrupted with a voice full of excitement, she asked if I was the new administrative assistant. Of course I smiled really big and giggled as her face turned fire engine red when she received the correct information. But back to the care experience. A lack of training on ways to actually use cultural competency information sometimes results in Black people being misdiagnosed or having delays in treatment, so I have to work with people to repair their lack of trust in the system. The other “fun” scenario, I get cussed out for not helping my people. I’ve called a racist because I wouldn't approve an unnecessary treatment. So yeah, I was tired of these aspects of being Black.

2. I’m human. I got tired of being disrespected. Providers are people too. It sometimes seems that our patients and colleagues forget that. On an almost daily basis I receive e-mails from people who call me incompetent, unprofessional, and uncaring. Typically this come in response to my not doing something that they want. I’m blamed for medications not working. My education and expertise is questioned/challenged by patients and colleagues. Some assume that I don’t have many years of experience based on my appearance (I look younger than I am). For example, the patient who requested a new provider and specified wanting someone with more than 5 years of experience (I guess 14 years wasn’t the right number either because that’s what I have. HAHAHA!). Then my dear colleagues whose mission is to exclude NPs. They send me condescending messages, talk to me like I’m stupid, or feel more comfortable discussing my patients with my colleagues instead of speaking to me directly. For whatever reason there’s the belief that as healthcare professionals, especially mental health professionals, somehow wear a shield of armor that protects us from being affected by this type of treatment. God forbid we respond to it at the risk of someone filing a complaint. Every 2 weeks hush money is direct deposited on time into my bank account. So I take a deep breath and keep on pushing. But one can only imagine what types of responses run through my mind. How would you feel if this was part of your job on an almost daily basis? When a patient simply says thank you, it goes a LOOOONG way.

3. Disorganized systems. “Just Do It” is not a slogan for all situations. Where is the implementation plan ? How will changes affect workflow? What is being tracked? Is there a quality improvement process going on? Etcetera, so on and so forth. I stopped biting my tongue and found ways to give constructive feedback.

My “simple” approach to fixing all of this:

1. Thank You Jesus! Yes, “I curse a little but I love the Lord”. Prayer and spirituality keeps me sane. I truly believe that I am doing what I was born to do. Nursing is my calling. Seriously, my license saves lives in more ways than one.

2. My Life is Good:.Thankfully my life outside of work is solid. I have people who love me, and catch me when I feel like I’m falling. I have positive things to keep me busy. When all else fails, cleaning like a tweaker gives me a sense of calm. Taking vacations and mental health days with good people make a difference.

3. Music soothes a savage beast. It all depends on my mood. It may be Coltrane, the Winans, Brian McKnight, Lenny Kravitz Snoop or Bishop Bullwinkle that gets the job done for me. Last week I wore out Lil Duval. Just had to smile, couldn’t go back and forth with ……….!

War. What is it Good For?

“The older I got the more I realized that grandma wasn't just full of Christmas cheer, she wasn't just happy: Grandma was high! Seeing her medicine cabinet as a teenager was like discovering Shangri-La".

DISCLAIMER: THE MAJORITY OF THIS IS NOT PERTAINING TO PEOPLE RECEIVING TREATMENT FOR PAIN.

The so called War on Drugs wasn’t successful at accomplishing much except for the incarceration of black and brown people in disproportionate numbers. “Just say no”, wear a red ribbon for a week and focus on telling kids how bad drugs are, and run ads about your brain on drugs. Whatever, people kept using drugs and getting high. I once had someone tell me that they didn’t sell drugs, “drugs sell themselves”. People are abusing Immodium for crying out loud because they want to get high. And why was it dubbed a war on drugs? Why the adversarial stance against people using drugs? Society traditionally viewed people who use substances as outcasts, but now demonstrates compassion for people "forced" into addiction by clinical providers. This started in the 1980s, yet the US is still trying to figure out ways to prevent drugs from crossing our borders. It seems that it would’ve been more helpful to declare war on the lack of resources to treat underlying conditions that make people want to use drugs. 

Opioid crisis, #crisisnextdoor. The current US Surgeon General speaks to the need for increased funding for services to provide integrated treatment, including mental health services. Yet it seems that his sound logic is being overshadowed by the emphasis on the Opioid Crisis and access to Naloxone (Narcan). Please don’t misunderstand me, increased access to Narcan for overdose prevention is necessary. But let’s not loose sight of the real issue: prevention (and reduction) of use and overdose to begin with. In my experience, over 90% of the people I’ve treated for substance use had a diagnosable mental health condition;  people self-medicate in an attempt to feel better or to block out painful memories. This is where the word “treatment” becomes hazy. When they mention increased access to treatment as part of the solution to the current crisis, what exactly do they mean? True, many substance abuse programs provide mental and physical health services, but there are still some that don’t. And how are we increasing access to services amidst an attempt to cut funding for healthcare for those who have difficulty affording care?

And why are we wasting money trying to sue Big Pharma. "Why are they still making these drugs?" Because some people actually take them as prescribed to treat pain. People like to throw the term Big Pharma around in a negative manner without looking at the full story: they have been attempting to make medications that work as intended but with safeguards to prevent inappropriate use. Take Oxycontin for example. The manufacturer developed a version with a coating that couldn’t easily be crushed or dissolved for snorting or injecting. People tried it anyway, experienced adverse effects, and then wanted to blame the manufacturer. I’ll provide a more basic example:Tylenol. People took more than the recommended dose and experienced problems with their livers. You can’t buy the 650 mg strength anymore (part of the reason Vicodin is dead, Norco has less Acetaminophen/Tylenol). So is this Big Pharma’s fault or do people need to be held accountable for using medications incorrectly?

I encourage people to read about the Sunshine Act and Anti Kickback statutes regarding monetary incentives for prescribing (sorta boring but good information). It’s been over a decade since companies were able to provide items with logos or drug names on them. So I really need people to stop acting like all medical providers are so easily swayed by lunch or a few free trinkets that we are able to get at conferences. The overwhelming majority of us don't get paid for prescribing drugs. Or did they put my million dollar check in someone else's box? Anyway, when drugs are taken off of the market we end up with synthetic drugs which are more lethal in most cases.  And clutch my pearls! Suburban use of heroin is on the rise (I guess it’s a gentrification proof drug). Let’s pay attention to it now because people with money are using poor people’s drugs. But with most of the focus being on opiates and ads against underage use of tobacco, is everyone else unimportant? What about alcohol, cocaine (powder is popular again), meth, marijuana, nitrous oxide, ghb, shrooms, etcetera so on and so forth? Oh yeah, FLOTUS is on her job to help children Be Best by telling them to not use drugs and be resilient.