Coping in the Days of COVID19

My homemade masks

When I rolled into our opioid treatment program parking lot at 7 this morning, there was only one vehicle in the patient parking lot. When I got inside, the waiting room was empty.

It’s quiet at the opioid treatment program these days. We’ve already implemented accelerated take homes for most patients, which drastically reduced traffic through our lobby. Patients new to treatment on methadone are still coming daily, as are unstable patients, but many patients got anywhere from six to twenty-seven take homes, under the blanket exceptions we submitted to our state officials.

Our nurses wear protective gear and dose potentially infected patients in their cars, if they aren’t stable enough for take home doses. Our patients with severe immunosuppression or other conditions that place them at higher risk of death if they contract COVID19 are also dosed in their cars.

We have another group of patients, mostly older people with COPD, whom we dose in an expedited fashion, moving them to the front of the line to shorten their time of exposure to other people. That created resentment when we had wait times, but now that there’s practically no wait time (except for the last fifteen minutes of the day, because that’s always the busiest time), everyone gets dosed in an expedited way.

We are open for business as usual. I haven’t seen as many people seeking admission as usual, but there have been a handful this week. In accordance with SAMHSA (Substance Abuse and Mental Health Services Administration) and state guidelines for treatment in the age of COVID19, I’ve been trying to get new patients to agree to start on buprenorphine so that they can get take homes sooner. However, not all patients do well on buprenorphine, and some can’t tolerate it. A few patients, miserable on buprenorphine, wanted to switch to methadone this last week, and we did this. As good as buprenorphine products are when they work, they don’t work for everyone.

I’ve seen a handful of patients each day for various reasons but mainly for dose adjustments. I’ve helped the staff by wiping down doorknobs, computers, dosing counters and the like, taking turns with other staff.  I’ve had extra time to look at patients on our state’s prescription monitoring program. So far, no unpleasant surprises.

We made a bunch of decisions about take home doses very quickly, to try to prevent COVID19 spread in our community. I pray I’ve had the right decisions, and patients will be able to take their extra doses as prescribed.

Counselors are doing phone sessions to provide support for patients but are available to do in- person sessions as well, at six feet apart. We cancelled group sessions until the age of the COVID passes. I hate that, but we want everyone to be safe.

So, for now, at the opioid treatment program, I’m going to work each day. The time may come when I will need to telecommute, and that will be fine, too. I’m ready.

I see patients in my private office on Fridays, and most are people for whom I prescribe buprenorphine products. Tomorrow, instead of driving to my office, an hour away from my home, we are using telemedicine. Regular readers will remember I’m a bit of a dunce with technology, but my fiancé is a whiz. He has a computer program set up and showed me how to use it. I think I will like it. The sound and picture look great, and I’m hopeful it will work very well.

We’ve called all my patients to explain what they need to do to see me from the comfort of their home, via the computer. Most are younger than me and computer savvy.

We have one older gentleman, well over seventy, who doesn’t have the capability of getting on a computer. I completely understand. I plan to talk to him on the phone, see how he’s doing, and then send in his electronic prescription. Given his situation and that he’s been stable in his recovery for twelve years, I feel it’s reasonable to do phone sessions until COVID19 goes away.

The advantage to me is that I could go to work in my pajamas. I won’t, of course. But I could.

My home life hasn’t changed much. When I’m not working, there’s no place I’d rather be than home, so I’m an expert at “sheltering in place.” Since my fiancé, my dogs, and the cat are there with me, I’m happy. I have my hobbies: writing, weaving rugs, reading, and carving our backyard quartz into interesting shapes. We have several weeks of food at home, so we are more fortunate than most.

However, routine decisions can have big consequences. Over the weekend, I needed some little thing for cooking, and my fiancé was going to Lowes, so I asked him to stop by Walmart, which is nearby. While he was gone, I thought, “What have I done? There will be crowds at Walmart, and he could get infected and get sick.” I felt so guilty and worried. He laughed it off when he got home, but little decisions like that matter now.

To combat the feelings of unease, last weekend I did one of the most hopeful things I could think of: I planted a garden. I realize I might be pushing the season, and that we may get another frost, but I felt like I wanted to do something optimistic. I planted tomato seeds in little compartments, to grow into seedlings that I’ll plant later. Then I planted green and yellow squash, cucumbers, carrots, lettuce, and spinach into the ground. I do this every year, but usually not until mid-April.

Last weekend, I made cloth surgical masks for our nursing staff. I took tightly woven cotton cloth, cut it up and constructed the masks, then ran them through the high-temperature cycle with Clorox. Of course, being 100% cotton, they came out wrinkly as hell. I ironed them flat with a steam iron, perhaps further killing the little viral/bacterial bugs. I reasoned that most masks aren’t sterile, outside the operating room, so these may be of some help.  I’m not very fast at it, though. It took me three hours to make seven masks. Staff were very appreciative.

Twelve-step recovery continues to flourish. Though some groups have ceased to hold meetings for now, online meetings have opened. On a recent Narcotics Anonymous meeting held on Zoom, over forty recovering people shared their experience, strength and hope in the traditional manner. Participants shared one at a time, sharing their fears and challenges, and how they were coping with difficulties without using drugs to mask their fears. There was a real sense of comradery, every bit as real as in face-to-face meetings.

People who want to attend these meetings should contact Narcotics Anonymous or Alcoholics Anonymous in their area, to get times and meeting codes. These meetings can be excellent support during these difficult times.

Even though the evening news is a horror show, I plan to carry on with life as best I can, like everyone else. I’ll do the best I can to protect me and the people I love from COVID19. In my free time, I’ll continue making the arts & crafts that relax me. I’m going to try my best to have as normal a life as possible, and enjoy every moment.

8 responses to this post.

  1. Posted by bshug4u on March 26, 2020 at 11:28 pm

    Read this. I am glad I work for the state. This person is in their own office. You need to make masks in ur spare time. Do u want to use my sewing machine ?

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  2. Posted by Lee O Smith on March 26, 2020 at 11:37 pm

    Thank you so much for your blog, especially this last one. It is good to know that providers/Doctors have lives too.

    Reply

  3. Posted by Matt Holmes on March 27, 2020 at 12:25 am

    Jana enjoyed your update! Put pictures of quartz shapes for next time!

    Reply

  4. Posted by Kimberly smith on March 27, 2020 at 2:30 am

    I wish other methadone clinic would operate as you are!! I love your blog!!

    Reply

  5. Posted by Lynda M Summers on March 31, 2020 at 5:44 pm

    Ok, now I have to comment. You’re a weaver??!! Wonderful. I recently bought two frame looms and am very excited about learning to weave rugs. I have been reading your blog for a couple of years (can’t remember how long really) but I’ve been on “bupe” (as my first physician provider used to call it) since 2016. I am an RN (BSN) in recovery from alcohol and now pain pills. Keep writing this blog if you can, I enjoy you and your thoughts on Methadone Clinics and love hearing about your work. Every time you are outraged, so am I. So just know, when the bureaucracy messes with you again, I am still here and always on your side.

    Reply

    • Thank you for writing!!!
      Yes I love to weave. I use a 2′ by 3′ twining loom, mostly. I’m going to try to include a picture of my latest rug – I just finished it last night, woven from strips of leather reclaimed from old coats and jackets with spots/stains. I love to re-purpose.

      Reply

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