Massachusetts General Hospital, Substance Use Disorders Initiative, Boston, MA
This summer I had the privilege of returning to Massachusetts General Hospital to work under Dr. Sarah Wakeman and the Addiction Consult Team. Dr. Wakeman is the head of the ACT team at MGH, which was created as a part of the hospital’s substance use disorders initiative and serves any patients that might be struggling with a substance use disorder. Under ACT, I served two specific clinics within MGH: the Bridge Clinic and the HOPE Clinic. The Bridge Clinic is a transitional Buprenorphine clinic in which patients can be treated with Suboxone, attend group therapy sessions, and work with a team of doctors, social workers, nurses, psychologists, and service coordinators to transition into more convenient treatment providers, transitional homes, and any other services patients may need in their medically assisted recovery. The HOPE Clinic is a new substance use disorders clinic servicing pregnant/postpartum women and their families at MGH, assisting mothers and their families with the treatment of their substance use disorder in the context of their pregnancy and the first 24 months after delivery.
Last summer I received an ASIP grant to work with ACT and the Bridge Clinic, during which I conducted chart review to assess the clinical effectiveness of recovery coaches (an individual who has a substance use disorder who has been in remission for at least two years who, in laymen’s terms, works as a clinical AA sponsor, ensuring that patients are empathically connected during their recovery and assisting with court, housing, treatment, and treatment difficulties.) The work chart review that I conducted contributed to a paper that is in development. Through the generosity of the Kraft Family, I was fortunate enough to return to MGH for another summer of work but in a more clinical setting.
This summer, I helped the ACT team conduct an overall assessment of their success in the context of 30-day readmission rates. The hospital noticed that the number of patients consulted by ACT who were readmitted within 30 days of their discharge had started to increase over the last few quarters. One of my projects for the summer therefore was to conduct a thorough chart review of patients who had been consulted by ACT and had been readmitted within 30 days in conjunction with an equal sample size of those consulted but not readmitted. The purpose of my review was to assess the nature of their substance use disorder (alcohol use disorder, opiate use disorder, cocaine use disorder, etc.), the providers they saw, the treatment they were prescribed, and the context of their subsequent admission (was it related to their substance use disorder). The results of this research are meant to discern whether or not the 30-day readmissions are the result of errors on the part of the ACT team or whether or not the patients that are seen are, for lack of a better term, simply sicker.
The other two main projects I worked on this summer were with the HOPE Clinic, one of which was to compose a resource guide for patients and clinicians to utilize. Having only opened its doors in March of 2018, the HOPE Clinic was just beginning to blossom and needed to get their barring. To assist them in their founding, I developed a resource guide of all the potential treatment, recovery, housing, parenting, pregnant, and financial resources that patients of the HOPE Clinic might utilize.
In order to put together the resource guide, I was taken under the wing of the clinic’s recovery coach, a mother of two who had been on sustained buprenorphine treatment for several years. I traveled with her to many different resource sites and centers, as she hoped for me to gain firsthand experience with what recovery options in the city looked, smelled, and felt like. The most profound experience I had was at Boston Health Care for the Homeless Program, located on Albany Street in the South End right next to Boston Medical Center, a street known as “Methadone Mile” because of its large number of shelters and methadone clinics. The purpose of our visit was to go to a presentation on safe injection sites. While nations such as Germany and Canada have passed legislation to legally allow the safe injection of opiates and other drugs for those suffering with opiate use disorder, the United States has refused to budge on any legislation that would weaken its “grip on crime,” even in the midst of an opiate crisis that claims lives every day. Safe injection sites provide spaces for individuals to inject drugs safely while a medical professional is ready to administer Narcan, immediately stopping an overdose. Insite, a safe injection site in Vancouver, has been open since 2003, has had zero reported deaths. For perspective, the state of Maine has made Narcan illegal, as they claim the overdose stopping medication encourages drug use.
While I was at Boston Health Care for the Homeless, I witnessed my first overdose. A patient had used heroin safely in a bathroom but had lost consciousness. Though relieved quickly through an administration of Narcan, the experience was jarring for me as this seemed relatively out of the ordinary at such a clinic, shedding a small amount of light on the daily clinical hazards that occur in the treatment of substance use disorders.
After completing my resource guide, I was asked to consult with specific HOPE Clinic patients and compile detailed lists with specific resources for a patient’s needs. This provided me with incredible clinical experience, as I was allowed to sit and work with patients to help them access the care that they required. My second project with the HOPE Clinic also put me in direct contact with patients as I helped develop a qualitative measurement of patient experience at the HOPE Clinic. Hoping to incorporate a semblance of evaluation in their development, I worked closely with one of the directors of the clinic to develop an interview questionnaire to assess the value of the HOPE Clinic. The experience taught me a great deal about qualitative measurements in the healthcare field, but it also taught me that I sincerely love talking and working with patients. Getting to try out a sample interview with some of the patients in the clinic was by far one of the best parts of my experience. Working behind a desk can be fruitful, but working directly with patients is truly rewarding.
I have tremendous appreciation for the Alumni Sponsored Internship Program for exposing me to such empathic care. While my current plan for life after Williams is to become an addiction internist, even if that is not the case, I believe that I have started out my medical journey in the most compassionate setting of care.