Appointments double at addiction clinic, says nurse practitioner
Updated: May 11, 2020
Ellie Titarenko is a Nurse Practitioner who works in two clinics in the Denver suburbs. One of the clinics is an addiction recovery center, and the other is a primary care doctor’s office. Both positions give her a wealth of insights into how Americans are coping with the Covid-19 crisis.
She kindly agreed to tell us some of what she’s been seeing - including, sadly, racism against African-American patients:
HOW ARE YOU GETTING BY? First, when Covid began to spread, I had to decide: do I continue working with patients, and risk bringing the virus home to my kids and husband? When I thought about NOT working, there was one patient at the addiction clinic who kept popping into my mind. Last fall, a gentleman came in who - until recently - had worked in a top management position. He had been in a very bad work-related accident, and was then hospitalized for a long time. When he was released from the hospital, he was on a high dose of opioid painkillers. After a few months, his doctors cut off his opioids. They didn’t taper the medications - they just cut them off, cold turkey. He was desperate, and he went out on the street to buy oxycodone illegally. Usually a month’s supply costs about three thousand dollars. That’s a lot of money, so after a while he had to switch to something cheaper. Whatever he could get his hands on. Cocaine, methamphetamines, heroin. It wasn’t to get high, but to control his pain - to prevent him from going into withdrawal. Patients say withdrawal is like hell. They describe it as wanting to crawl out of their skin. Puking, diarrhea. When he came in, he was devastated. Within six months, he had fallen from a perfect life with a high-level job, to buying meth on the street. Despite all his knowledge and intelligence, he couldn’t help himself. Ironically, it’s someone he was buying drugs from who told him about my clinic. He came in totally embarrassed, crying. He was so ashamed he couldn’t look me in the eyes.
It takes a ton of courage to take that first step.
Studies say you have a better chance of being cured of brain cancer, than being cured of an addiction like this.
That was in September. Today, he is my best patient. I can tell you hundreds of stories like this. My thought was, if I close my doors when the pandemic is starting, what will happen to people like him? So my husband and I made the decision that I would continue working with patients, and we would send our kids to live with my parents in Iowa until the worst of the pandemic is over.
On March 21st, my parents made the ten-hour drive to Denver and picked up the kids. Sophia is 12 and Andrew is nine. We were very worried about them traveling, because of concerns the state borders might close. We see the kids on FaceTime every day. But it’s not the same as being able to give them a hug, wash their hair, put them to bed. My mom is fantastic. Grandparents watching their kids, they are the unsung heroes right now. We talk about frontline workers, but we never talk about who’s watching their kids. I buy their groceries online and send little packages when I can. It’s such a small price to pay for what my parents are doing for me. At the primary care clinic, there are seven of us: a doctor, four of us nurse practitioners, one nurse, and a secretary.
The majority of our patients - about 75% - are Russian-speaking. Immigrants from Eastern Europe, Belarus, Russia, Ukraine. Most have a very high level of education in their home countries, but here they are working frontline jobs. Our nurse got Covid and so did our secretary. Fortunately they are both doing ok. We have plenty of PPE, and are very careful about changing masks and gowns between each patient we see. We get information about what’s happening at the hospitals, because we hear it directly from our patients. They tell us that the hospitals are overwhelmed, and that there are very strict parameters about who can be admitted. I have one patient - an African-American woman in her 50s - who had pneumonia and chest pains, and she ended up going to the hospital three times. They refused to admit her, and so then she would come to us. She was in tears. We gave her an IV and antibiotics. We called the hospital, and our doctor insisted that she needed to be hospitalized. And still, they would not take her. Well, of course she had Covid - and she ended up having to be hospitalized for a week.
I’m so angry about what happened to her. I grew up in Ukraine and moved to the U.S. in 1999. I used to think that America is free of racism. I work with such amazing colleagues, and I used to go to work thinking that race is just not an issue here. America is a country that loves you for who you are. It’s been such a shock to discover that’s not the case. I truly believe this woman was turned away because of her race. People say that in the U.S. some minorities don’t get the healthcare they need because they live in rural communities. But I’m seeing that it’s not a question of access. This woman lives in the city. She went to the hospital over and over. She has access to healthcare. The problem is that the hospital is denying access. As for the addiction clinic, since the pandemic started, a much higher volume of people are coming in. One explanation for this is that people who use illicit drugs can no longer get their drugs. That’s what the patients are telling us.
I don’t fully understand why - whether it’s because illegal dealers are no longer working, or because the supply has diminished. So some people who can’t get their fix, they start looking into getting treatment from us.
I have a few patients who recently started suboxone treatment - a medication to treat addiction to opioids and heroin. They’ve been telling me, I’m so glad I made the switch before the pandemic, because I can’t imagine how hard it is to get drugs on the street right now. I also see just a lot of general emotional turmoil. A lot of people are suffering from insomnia - much higher rates of that than we see during ordinary times.
And there’s also terrible suffering among folks who lost their jobs. I think that losing your job is - in many ways - as bad as getting sick. You end up worrying yourself crazy, not knowing if you can pay your mortgage, everything else. The unemployed don’t feel validated. They feel that they are supposed to feel lucky, saying ‘well, at least I didn’t get Covid.’ But their pain is very real and I have so much sympathy for them.