The Central City Concern.
Portland has an overabundance of nicknames-- just to name a few: p-town, bridgetown, stumptown, rip city, the rose city... it goes on and on. There's one name to add to this list. Central City.

During this month I have had the opportunity to learn more about Central City Concern as a resident. The intersection between homeless Process group meeting today at Central City. Today one of the members of the group, "Kevin*" (*names substituted) graduated. I was touched by how complex his story was, as he relayed it to our group leader, "Roger*," who stood at the white board writing every milestone between his addiction (age 14- runaway/homeless) and to today. In between was a cycle of addiction, run-ins with the law, labeling of the dirty 30" (which i learned is a portland term for a group who constantly got arrested and released), homelessness, failed treatment groups and homes, and repeating the cycle over and over again. The way that the group leader facilitated this meeting was impressive. The end product after multiple cycles of relapse and denial? Several months of being clean. On the surface, that doesn't seem much. The odds are against this now 30 yo man. But after hearing his story, his words, I came away touched.

The stories that are heard in those walls on Burnside are similar. The power of the story is to hear that story in that group, with others who are in the similar situation. When Roger asked others in the group to comment on Kevin's story, the support was clear. Appreciation for those struggles; the observation that Kevin had worked hard in groups and outside of group to stay clean and to avoid those temptations that led him back in the cycle. I finally was asked to comment. I knew it was coming. What does one say? Several things cross my mind:

that A.), I could not empathize w/ Kevin's story. I doubt many physicians could really picture themselves in a similar scenario, of growing up w/ little opportunities to succeed, and multiple opportunities to fail; of growing up w/ addiction to crack, that led to petty crime/theft, harm to others. We may have experimented in the past, but in the end, I had opportunity to attend good schools and college, and had the support of my parents to attend medical school. Unfortunately this day in age, such education is not a right, but a privilege that a few get.

That B.) that there is a perception that the medical community is "fighting" against the addicted community. That physicians believe that addicts just want pain meds, or opiates to abuse; on the flip side, those afflicted w/ addiction believe the physician treat them differently from the elderly lady from the nursing home w/ chest pain, or that there is mistrust that the physician really understands the nature of addiction.

All I could really say then, was that I felt fortunate for the opportunities I did have, and that I would try to use that opportunity to help those less fortunate than me, including those w/ addiction. And that I would do my best as a physician to understand addiction, and by understanding, not forget that those struggling w/ addiction are humans that are touched by disease, and fighting a disease that is not well described in texts books and not well taught in our medical curriculum. That though I did not know Kevin but 1 hour ago into the group session, I was extremely touched by his story.

I felt lucky to have that opportunity to learn about addiction that morning. We can all watch "trainspotting" several times, or read about it in UpToDate or Harrison's, but it was much more educational spending that 1 hour w/ this group. Who knows, perhaps "Kevin," by the time I write this will have relapsed to using crack again, homeless, and on the streets. But I like to think not.

"Life happens when you make plans."

Hello All-

To my loyal readers (of which there are few), I apologize for the long hiatus. Intern year has flown by quickly. It has been an extremely busy but rewarding year. Sometimes the only way to get through it is to consume yourself in it, live and breath it, with all its long hours, the off days, the reading. During the doldrums that accompany the winter, the rain, and the inevitable burnout, I have survived possibly by plowing through the months, commiserating the days and hours with my fellow cohorts and the few friends I have been fortunate to meet outside of work. However, several big events have prompted me to further self-reflect and that leads to this. One, is that I finally had a vacation-- the first since my Thanksgiving vacation. In retrospect, it was too long a wait for vacation-- though I managed to survive the winter relatively intact, I too, was running on fumes by the time it had come around. Vacation itself was spent with friends, family. While relaxing, also led to anxiety and self-doubt about my actual progression through the year. Two, is that my cousin Viv was married last weekend, prompting a trip (not on vacation) to Vancouver and family reunion. The fact that it was first one on that side of the family and involved my eldest cousin made it of even more significance. Three, a close and special friend will be leaving Portland soon; a person who to me has shaped my first year in Portland significantly outside the hospital. And Four, tonight was a celebration of Dr. Cooney, our venerated program director who stepped down after 20+ years as the leader of the OHSU residency program.

Why these milestones in my life have all occurred at once, I have no idea. For several weeks I have been pondering the significance of the fact that life is happening all around us, despite our best efforts (misguided) to separate it out of our medicine work, especially intern year. Dr. Cooney summed up my personal feelings and questions best tonight w/ a remark "Life happens when you make plans." Dr. Cooney's dinner tonight brought it all together; the celebration of a person's academic achievements cannot be separated from the personal achievements. His work as program director touched so many people from colleagues, to residents, and of course, his patients. As one of the residents who probably know Dr. Cooney the least in terms of years knowing him, I can still say that he's already influenced me in so many ways, as a teacher, a role model physician, a leader, and a mentor and friend. Lofty descriptions but these are all apt. A living legend who continues to exude energy and passion that is extremely motivating and inspirational for a young physician trying to make a mark. Its a feeling that excites me about medicine and why I love this career.