A Pitiful Sanctuary

By Jessie M. Gaeta, MD: For More Info, Go Here…

Inever anticipated spending so much of my clinical time in bathrooms. But drug overdose is the leading cause of death among the homeless individuals I take care of at a health center in Boston—and without homes or access to supervised consumption sites, people who are homeless frequently inject drugs behind the closed doors of public bathrooms, including ours.

Despite the housekeeping staff’s relentless efforts to keep them clean, these bathrooms can be desolate spaces. I try to imagine what it might be like for a person as he or she approaches the restroom; it’s painful to think that this bleak space could be a person’s only sanctuary. A trail of desperate attempts at patient education and clinician preparation lines the hallway: a fentanyl alert poster several doors down; an overdose prevention fact sheet a little closer; another sheet asking, “Do you know what to do if a friend overdoses?” I imagine people shuffling past these warnings and pleas. As they enter, the bathroom door clicks decisively behind them. Escaping from the bustling clinic lobby, they are alone, finally hidden to do what their mind and body are demanding: dissolve the pain and stem the symptoms of withdrawal.

An alarm sits on the wall above the bathroom door. When a person in the restroom does not move for 2 minutes and 50 seconds (an amount of time we have gradually titrated down in the fentanyl era), the alarm sounds loudly throughout the building, alerting us to a possible overdose. One foot from the door is a naloxone kit on the wall and a bag-valve mask.

Compared with the chaotic street corner outside our front doors or the clinic’s busy waiting room, the bathroom is hushed. This sanctuary, however, is a dreary one. Fluorescent light falls upon teal, bare walls, and drab floors. Stains darken the wall and stray hairs cling to the sink. A metal sharps container with a hefty lock is secured to the wall, but the cotton and cooker from someone else’s fix may be seen discarded atop the garbage lid. A sour smell permeates the air.

The person takes the only seat: on the toilet.

A few minutes later, when the alarm echoes through our building, we know what has happened. A team of clinicians rapidly coalesces outside the bathroom and security staff swing open the door after knocking and receiving no response.

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