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.