Shandi Hopkins was admitted to the residential treatment program, Smithers Alcoholism and Rehabilitation Center, at Roosevelt Hospital on 4/18/01 and discharged 5/27/01. He was in touch with me regularly, sometimes twice a day while in the program. I obtained an 800 number to enable him to stay in touch with me when I moved from New York last July to begin teaching at Illinois State University. Shandi had been a heroin addict for approximately five years, and had been on methadone since 1998. He also used cocaine and had been getting benzodiazepines on the street. In the past few months before he got into Smithers, with a doctor’s help, he stopped using cocaine, and was on prescribed psych meds instead, including clonipin. The following are events I can document that occurred immediately prior to Shandi being admitted to Smithers and while he was a patient there. Mon. 4/16-9:35--Shandi called to say that he just gotten out of the welfare office on 14th Street. They said that they had already given him food stamps and that he was not up again for 45days until May 10, but gave him a date for applying for Medicaid. He said to me and to them, “OK, it’s good bye.” He said he spent most of the night at Bellevue emergency. “They checked on my head stitches and my tongue. (He had been severely beaten up on the streets.) They gave me a shower and pants and shoes, three sizes too big. At least I have a date for Medicaid.” Wed. 4/18--Shandi called collect from Smithers to tell me he got in. He was so happy. He said, “there’s so much light in this place, it’s the best. I’m waiting for the admissions person. ”Shandi and I spoke frequently, once or twice a day, usually. Although he was happy to finally be in treatment, he began having trouble with the staff immediately. He kept saying he didn’t feel well and no one seemed to know what was wrong. He said he was being asked to do a lot of writing, which was very hard for him, but he was trying. His counselor kept complaining that he wasn’t getting his assignments in on time. He finally handed in twelve pages of a writing assignment and his counselor gave it back to him saying he did it wrong. Apparently he wrote a narrative about what had happened to him, but he didn’t put it into the form his counselor wanted. She just wanted a list from him and demanded that he do it over. Another incident he mentioned was asking a nurse for deodorant. Her response was that he didn’t need deodorant because he had been homeless. Apparently, she eventually apologized for saying that. He also said that the head nurse kept yelling at him to get away from her and the desk whenever he asked to see the doctor. Apparently, he had to go through her to see his doctor and frequently requested to see him. Shandi asked me to send him clothes and complained about always being cold.
Sun., April 22--Shandi was given a behavior contract by his counselor on 4/22. The contract said he disrespected staff and was being verbally abusive and using profanity. Shandi had to sign a contract saying “I will respect the staff and my peers. I will not argue with staff. I will obey all the rules.” Behavior contracts ended with : “I understand that my failure to adhere to this contract may result in my discharge from the program.” Tues. 4/24, 4:40 p.m.--Shandi left a message for me. He said, “I’m getting some very interesting results here.” That’s when he found out that instead of giving him 80 mgs of methadone and bringing him down slowly as they were supposed to do, they apparently made a mistake and took him down to 20 mgs almost immediately. This explained why he had been so sick. Wed. 4/25--Shandi said he’s now on Trazadone to help him sleep. I sent out a clothing package, but I put the wrong floor on the package and they didn’t deliver it until the following week. Thursday, 5/3--Shandi called to say he is in total withdrawal. He’s on 10 or 15 mgs of methadone. Since they took him down so quickly, he didn’t want them to up his dosage again because he wants to get off methadone. Thursday, 5/3--The staff members keep ignoring his medical condition. Shandi was given another behavior contract for not attending his small group. He wrote, I will: “Attend all of my groups, lectures and return assignments on time. I will follow all rules and regulations of the Rehab.” He told me he couldn’t even get out of bed, and that the doctor told him he didn’t have to attend his group meeting, but his counselor wrote him up anyway. Friday, 5/4, 8:08--Shandi called in new phone numbers: 265-0893, 265-0838, 256-1512. He wanted to know if Rafi, his brother, had picked up his mail from where he used to live on E. 97th St. Not sure of date: I spoke to a staff member at Smithers who mentioned a fiasco that occurred in relation to discharge planning for Shandi. I don’t know exactly what happened. Shandi told me something about the staff saying that because he had been homeless, that he probably would not be able to get into a halfway house. His counselor had made an appointment for him with a representative from Atlantic/Pacific Halfway House, looking at a release date of 6/1. Shandi was not happy about that program. He was worried about it being located in a heavy crack neighborhood and a community in which he didn’t feel welcome or safe. (He had been severely beaten up in a similar neighborhood several months earlier.) The program had no recreational activities and didn’t seem to him like the kind of program that would work for him. The staff member said that he was trying to find a program that was more consistent with Shandi’s history and background. He thought Brandon House looked possible. Smithers collapsed as an option (not clear to me why), but the staff member said it wasn’t ideal either. He thought
Shandi would have been very liable to be ostracized as different there, the way he would be in the rehab. It is a narrow and strict program based on a conformist culture. It would be hard for him not to be viewed as a little provocative there. The staff member said he at least wanted to keep him on the unit long enough to get him on naltrexone, an opiate blocker. He could begin taking it 7 days past his last dose of methadone. Sunday, 5/27--Shandi is kicked out of Smithers. I called 20 minutes after he had been kicked out. A resident who answered the phone when I called, told me that something happened with another resident there. A guy came out and made a comment, called him names, and yelled at Shandi. Shandi yelled back. They discharged both of them. There was no physical contact. The resident said that she couldn’t say anything in support of Shandi, because they would have kicked her out too. (Patients are told not to get involved with each other. Shandi would often say something when he saw others being treated unfairly. This was another reason staff members got angry with him.) She said that Shandi and she had talked a lot. He was very sick. She told me to speak to the nurse in charge. I called back and the nurse told me that security needed to be called and that both patients had to be restrained. Three security guards came up. She said that the situation was getting out of control and escalating to violence. When I asked her if Shandi could come back if I could find him, she said that Smithers might take him back in 30 days. When he was discharged he was given a plastic bag for his stuff, some prescriptions, and a list of shelters. I was very angry when I called the nurse to ask what had happened and probably said something about suing Smithers and them saving his life and then trying to kill Shandi. Sunday, 5/27--Shandi didn’t call me until that night. He was discharged in the early afternoon. He was feeling devastated. The day before he said he had just started leading meetings and felt very good about his progress. He felt very good about most of the people in his program and had made some good friends there. What happened that morning is that one of the men in the program, who was going to be discharged in two days, swore at him when he came out of the room where he got his meds. He told me that this guy had been giving a lot of people there a hard time. He called Shandi names like “pussy” and “faggot,” and said, “it’s because of people like you that I can’t smoke.” Shandi said he tried to explain to the guy that it wasn’t his fault, that other people who got meds in that room were also smokers and had to wait for their meds in order to smoke. But, the guy wouldn’t listen and Shandi started yelling back. They threw both of them out. Shandi had four plastic bags of his stuff, which he was barely able to carry, with no place to go. He called me from the Lower East Side that night. I put him up at the YMCA on E. 47th St. Friends moved him to the Y on 63 St. the next day, where he could get food and be near the Smithers Day Program, which a staff member got him into. The staff member also said he wanted to hook Shandi up with a psychologist on a regular basis. Shandi had been requesting individual counseling for a long time. Wed., 5/30--Shandi said he had good news and bad. He liked the day program a Smithers very much. He had also met the new director of Brandon House, who had only been there
for two weeks. The head of Brandon House told him he would be part of a nine person staff and would scrub pots and cook meals for the residents in the building. The rehab was run by Volunteers of America. He said he would have a bunk in a room that had four beds. Shandi said the room wasn’t full though because they couldn’t get people who wanted to be there. He said he would have to live in a basement, next to the boiler room, and was disappointed that they didn’t even have computers. Shandi loves working on computers. This is how he supported himself, in addition to teaching chess, before he became debilitated with drugs. He wasn’t happy about this rehab because the person in charge was inexperienced and ignorant about drug problems, he thought the work schedule would prevent him from attending the Smithers day program, and he didn’t think that he could scrub pots 40/hrs/wk because he had a serious arm and shoulder injury. Thurday, 5/31—The staff person at Smithers told me that he was concerned about Shandi’s behavior. “He was having trouble editing himself at times.” He was heard talking on the phone to residents he knew at Smithers making statements about “those bastards on the 9th floor (the treatment floor he was kicked out of).” He also greeted the psychiatrist disrespectfully one day when he saw him in the hallway. Shandi stayed at the Y until Friday, June 1, and then went to his brother’s house, where he would stay until he got into Brandon House. I saw him and his brother for dinner Friday night when I got into town. Earlier in the day Shandi thought his bags had been stolen from the Y, when actually his brother had picked them up the evening before. Shandi was not very present at dinner, he ate very little, barely communicated, and fell asleep sitting on the couch at my friend’s house. Friday, 6/1—The director of Brandon House said he could give Shandi a work schedule that would not interfere with his treatment. He would have Shandi operate an elevator from 3-11 p.m. Even though Shandi still seemed worried, and unsure he could operate an elevator for 40 hours/wk, the Smithers staff member thought it would be better than the St. Luke’s Halfway House for him. The staff member explained to Shandi that his first jobs would be early recovery jobs in which he wouldn’t have to assume a great deal of responsibility. He also said that he would set up Shandi with regular psychotherapy through Smithers as well. Monday, 6/4--My partner and I, picked up Shandi at Smithers in the afternoon after his day program to take him to Brandon House. Shandi said he wasn’t feeling well. The staff person at Smithers explained that Shandi was uncomfortable due to his withdrawal. We also thought that Shandi was just scared of going to Brandon House. Shandi said that the director of Brandon House didn’t know much about drugs. He had called his counselor in the day program at Smithers in the morning concerned that Shandi might sell his Paxil in the street. The staff person explained to us that this was absurd because Paxil takes too long to kick in. No one could use it as a street drug. Shandi acted erratically on the way over to Brandon House. He kept saying he was very tired. He said he should be in a hospital. Then at one point he yelled fuck you at some
diplomatic cars coming down the street that were blocking traffic for a long time. We finally met up with Shandi’s brother, Rafi and took a cab together over to Brandon House. Shandi just said he was very tired. I thought we would be able to help him get set up, but the director at Brandon House said we had to leave right away because Shandi needed to attend a meeting that was already in progress. He said I could see Shandi one more time before I left town in a couple of days. I did not feel happy about how this administrator was dealing with the transition. Apparently, Shandi went to the meeting for a little while, then went back to his room to sleep. He was supposed to have gotten up to go to another meeting, but he said he was too tired. When his roommate came back to the room during a break to get his cigarettes he found Shandi on the floor with his belt around his neck and the wardrobe he tried to hang himself from on the floor on top of him. He supposedly was brought to the hospital at St. Luke’s brain dead. They resuscitated him, but couldonly keep him breathing on life support. He went into cardiac arrest 3 times, before we signed the DNR. Because it was a suicide, his body went to the medical examiner and I asked for a toxicology report which would be ready within 120 days. Meanwhile, in a urine sample Smithers took before Shandi went to Brandon House on Monday, they found new methadone and heroin in his system. Shandi said that they gave him medications before he left Smithers. I’m assuming it was Paxil, Trazodone, and Loperamide. I don’t know if they gave him prescriptions for anything else. He was also supposed to be on Clonipin, but I did not find any in his bag. His old prescription bottles were empty. The following are the prescription bottles I found in his Shandi’s bag that he brought withhim to Brandon House:• Paxil, 30 mg, 1 per day—5/27/01• Trazodone, 100 mg, 2 _ tablets at bedtime (75 left)• Loperamide, 2 mg, 1 capsule every 6 hours as needed (7 left)• Serzone, 150 mg, 2 times per day— (46 left)• Clonazepam, 1 mg, 2 tablets 3 times per day for anxiety (empty)• Clonazepam, 1 tablet, 3 times a day. (empty).
MESSAGE FROM PROFESSOR A BRECKENRIDGE, CHAIRMAN OF COMMITTEE ON SAFETY OF MEDICINES ZYBAN- MODIFIED DOSAGE AND SAFETY PRECAUTIONS I am writing to advise you of a modified dosage schedule and new safety precautions for Zyban (bupropion /amfebutamone), a drug licensed as an aid to smoking cessation in nicotine addicted patients. Since its marketing at least 419,000 patients are estimated to have
II CONGRESO DE LA SOCIEDAD ESPAÑOLA DE FISIOTERAPIA EN PEDIATRIA Organiza: “La Fisioterapia Pediátrica basada en la Evidencia Científica. Perspectivas Internacionales” Barcelona, 8, 9 y 10 de Noviembre de 2007 AUTORES: Pablo Herrero Gallego, Orlando Mayoral del Moral, Ángel Luis Ventura Álvarez, Javier Trenado Molina. TÍTULO: Utilización de la técnica