Samantha came to us for support with her opioid use. Upon arrival, she felt limited in options to better her life but stated, “I know I need help with this first.” Her struggle with opioids heightened amidst the COVID-19 pandemic, as many individuals were limited in the supportive services and people that helped strengthen their recovery. We were fortunately able to engage her in our ED-Initatiated Buprenorphine study, where we target individuals seaking medication for opioid use. Upon receiving her first dose of buprenorphine with us, we noticed an immediate improvement; in both physical symptoms as well as restored optimism within our patient. She began sharing personal goals of getting more involved in acting again, after having been a theatre major in college while also being excited for warmer weather that she could now look forward to experiencing with her family. After checking in the following morning, Samantha answered the call with the same degree of optimism, stating that she was able to wake up early and grocery shop and get new shoes for herself. We commonly take for granted the simple daily chores and tasks that we all partake in, so for Samantha this was a feat she had not been able to do for many months prior to being engaged in care. A month later, Samantha is doing wonderful. She remains engaged in medication, has exercised a new-found support system, and she is taking it one step at a time as she states, “I am prioritizing my own well-being for the first time, in a long time.”
Maria came to our emergency department in search of assistance in stopping opioid use and reported that Suboxone had worked for her in the past. Before leaving the ED that day our CRS team worked with her clinician to discuss starting treatment with buprenorphine (Suboxone) and set up a follow up appointment with our Penn primary care office. Maria’s story did not end here. Recovery is a challenging journey filled with obstacles. Maria faced stigma within her recovery center as medications for opioid use are sometimes unfortunately viewed as a “lesser than” form of recovery. This lack of support was a leading trigger for Maria to return to use. Fortunately, Maria felt comfortable reaching back out to our CRS team and has since re-engaged in her Suboxone treatment plan. Maria now works full-time, regularly comes to her IOP and medication appointments, and has since enjoyed a well-deserved vacation with her family.
“I just want you to know how this initiative has helped my family personally.
Nicole is familiar with my brother and has answered texts and calls from myself and my brother at all times. She was able to get to his bedside at Presby when he presented off the street while staying at the Red Cross house after a total loss house fire back in November. He has been an opiate user for years and has never once voluntarily sought treatment. Never been to rehab or detox. He has only stopped cold turkey when he went to jail. It took me 5 days, while he was homeless, to get him to go to Presby’s ED. When he finally went, Nicole and Brian were there immediately, the process was seamless, and he was set up with IOP and the outpatient team. He has had slips along the way, as a matter of fact he sits in Presby’s ED right now, after leaving detox from a one-day slip on benzos. Brian was at his bedside to make sure he’s set up with the tools in-hand so he doesn’t go out and die.
That’s the reality of this disease. My mother and I, regardless of my brother’s slip, are eternally grateful for you keeping my brother alive during this epidemic.
In all of my personal and professional experience, which is very personal and dating back to working in detoxes, other rehabs and hospitals as a nurse in this city and other counties in Pennsylvania, I have never experienced such compassion towards anyone with Substance Use Disorder as I do with this Health system.
You never know who you might be helping.
I just wanted to recognize ALL OF YOU for what you do every day.”
A loving sister
Eddie came to our emergency department in February and was treated with buprenorphine-naloxone (Suboxone) and admitted to our inpatient unit at Penn Presbyterian Medical Center. He successfully completed his treatment program. Soon after discharge, Eddie had to travel to his home state of West Virginia to address a family emergency. Because of out-of-state insurance barriers, he was not able to continue his Suboxone care plan. Eddie found himself homeless and amidst a medical emergency that could not be addressed in West Virginia. He “panhandled” just enough money to get a bus ticket back to Philadelphia and returned to the same emergency department at Penn, knowing that he would again receive the care that he desperately needed. Eddie was in touch with his provider throughout his experiences in West Virginia, which demonstrates the longitudinal connection between our providers and our patients.
“To whom is reading this I hope it gets forwarded all the way to the highest level. My father is from Gettysburg, PA. He has been battling multiple melanoma for 2 years now. He was transferred by the grace of God to the oncology unit at UPENN via ambulance almost a month ago to receive treatment from a UPenn physician who has since been our biggest cheerleader even while we faced very grim obstacles. My father’s health took a turn, and we were told to prepare for the worse.
My husband and myself rented an apartment and have been pseudo-residents of Philly now for a month. During this time, family from Carolina and Virginia have come to pray, love and vigil for a miracle and embrace one another for a possible heavy loss. During this visit my brother ran out of his medication (Suboxone) that has kept him in heroin recovery for the last year. After a week of daily heartfelt emotions, of deep lows and small victories, my brothers’ inability to focus strayed due his lack of medication at this time. He purchased heroin from one of the many city pharmaceutical reps, and unknowingly due to his yearly sabbatical from addictio,n overdosed (unbeknownst to our family) not once at 10 am, where a meter attendant found him and had him placed into the hands of EMS and Narcanned and transferred to another hospital’s ED. At this time they didn’t bother with his lack of medication, withheld him for 90 min and released him. He returned to our father’s ICU room and spent the day with us. We had no idea what he had just endured or the struggle he was facing. Later that night at 11pm we found him lifeless and foaming at the mouth with a grey face and blue lips. Our sister performing CPR until, once again, EMS came to the rescue with Narcan. The same emergency department that failed him earlier, took him in again for his 2nd time. And although we asked for Suboxone, they did not help and suggested we simply carry Narcan with us. My mother dressed in an isolation gown and mask had to leave my father’s side while the ventilator breathed for him to weep for her son’s possible death. The charge nurse at UPenn, where our family remained at my father’s bedside at that time, was an angel placed to catch us. She helped us to therapeutically communicate and provide us with resources that could potentially help us during this time. The NP also helped us to find a few resources. Unfortunately, after many calls to social work they could not be reached. I called his insurance company, but because he has out-of-county Medicaid, no one in the great city of Philadelphia could help us to get a bridge of Suboxone, as we await our father’s possible passing or possible hope for what recovery we can pray for him to find.
After 4 hours in the Behavioral Health Crisis Center, they told us they couldn’t help us with any medication or outpatient therapy due to this darn tricky insurance snafu. So again out into a dark Philly night we walked out into. A sleepless night, fearful of what could be a death of a father fighting for his life and a death of my brother. I could only imagine what this could possibly destroy inside my mother. I set out on a new day. Suboxone clinics only open Mondays and others only open Tuesdays. The Dept. of Health turned me down since he didn’t have Philadelphia Medicaid.
Finally, I called Presby CORE which I was told was only open 9-5. I assumed it would be another dead end but with bankers hours. But with nothing to lose, besides a huge chunk of my family I, with all the hope left, called. Bryant Rivera picked up… another angel sent my way to save us. I told Bryant our misfortune. Bryant didn’t mince words or “okay ma’am” or “sorry ma’am” or, “well let me give you 5 numbers, or run to this other facility remove your shoes and belongings and sit another 4 fruitless hrs.” He said, “try this Ride bus, but if they don’t help you I WILL HAVE THIS FIXED FOR YOU TODAY”. Wait. What!? Someone sure they can help me? Not just sure, but that literally will allow us to sleep finally for fear of the tragedy that could happen if we don’t care for the father with cancer or brother searching for lifesaving medication. Although I did as he asked and Pete at the Ride program for help. He kindly said let me call around to see who can help you. Before I hung up Bryant called right back. He told me I am so sorry I sent you to yet another person, come to the Presby ED and I will meet you and we will fix this for your brother. A cab ride to hope. A walk through some pretty humorous security staff who asked if I needed help and Bryant met me just like he had promised. My heart was full and my eyes wept from my tired and anxious body finally finding a human at UPENN and all of Philly who was helping us not find but bring us the medication we needed to get us through this time. Meeting Bryant and Kelli was like a warm hug, a nod of affirmation and meeting an old comforting friend. They listened to the struggle of not being able to find a single person to help us. To the tragic suggestion of we’ll just carry Narcan. I am supposed to watch my brother do heroin and just Narcan him back so we can go pray for our father while his kidneys shut down and he is put on dialysis. Bryant got us through the ED literally by hand, the nurses listened, no one judged. A man with a year of recovery asked for a medicine that in fact contains Narcan and his cry heard that he does not want to do dope, but just get the medication he needs to return healthy. He helped us navigate our way through a complex system. He was a companion to my brother and a beacon of light and hope to myself and my family. My brother got Suboxone within 20-30 min and a 7 day bridge while we await our father’s body to repair or find rest.
My brother is sleeping soundly tonight; he isn’t sick anymore. My mother ate dinner for the first time with us as a family, not alone at the hospital and allowed me to sleep at my father’s side after sleeping in a chair for the past 7 straight nights while she rests in an actual bed. She can hold her son and we all now can focus on our father. We can pray and heal and support in a healthy way. If it wasn’t for Bryant Rivera and his confident personality, his passion and conviction to helping others, I am not sure if I would have lost my family, my heart, my soul to Philadelphia. Our family would be fractured and children would have lost a father. He simply got us the medication we needed. He did it with grace and he did it willingly as if we were his own family. I wept tears of what hope is and I know God brought him to help us. I have been a RN, BSN for 16 years I have my Masters degree in Nursing Education, and I have taught for 10 years. I have served in the Army for 19 years. I came home from Afghanistan 2 years ago missing this country and my family. I had the utmost challenging time navigating this system and finding someone to simply help or give me the resources I needed to be successful. In all of my experience as a nurse and soldier I have witnessed numerous acts of courage and selflessness. Bryant Rivera is for certain saving members of this community. He is salvaging families from a legacy of addiction. UPenn and Presby is not just lucky to have him walk along those providers who may give medicine and treatments to sick patients. The lack of MD behind his name means nothing because he in fact did what numerous MD’s did not; save a life with medicine. His invaluable priceless love and genuine caring make every moment I have spent in other countries caring for soldiers worth it to know my family is safe as long as he could be found. It didn’t matter our INSURANCE it mattered that we were HUMANS. I just hope he is recognized by the Behavioral Health Department that he represents. And I want him to know that our family will forever be grateful for what he did for us.”
-a sister, mother, brother, a child and a father
The “Smith” Family