Medical Director, Front Range Clinic, Fort Collins, Colorado, and Assistant Clinical
Professor, University of Colorado School
of Medicine, Aurora, Colorado
“I work very long hours these days as medical director at the Front Range Clinic,
Colorado’s largest network of outpatient substance abuse treatment centers. I’m up
early and work into the evening. I answer emails and texts and put out two or three
fires before 8 a.m. Then I go downstairs and have an online meeting with staff to
game-plan the next 48 hours. We see up to 1,200 patients a week, in 19 brick-and-mortar
clinics, three mobile units and more than two dozen points of care embedded in homeless
shelters, syringe access centers and counseling clinics. … It’s crisis command from
my home, still seeking PPE, coordinating the delivery of essential medical services,
figuring out staffing. That’s our next contingency: what to do when the staff gets
sick. As of mid-April, we have two N95 masks for everyone. We had a stockpile, but
every day is a scramble. I’m in touch with vendors in more than 10 counties, tattoo
parlors, construction sites. … We still need testing for the virus. There is a lack
of a comprehensive testing infrastructure for COVID-19. This is hopefully improving.
We are looking now for antibody tests, and the scams have begun. It’s the Wild West
out here. … The severity of our patients has gone up significantly—with the fear of
sickness, isolation at home, getting laid off or furloughed, adapting to virtual healthcare
visits with providers. We’ve seen more relapses, more overdoses. One patient who’d
been stable for seven months just overdosed and passed away. … We do have patients
with COVID-19. Patients may use their COVID-19 diagnosis as an excuse not to come
in for treatment. We are keeping our antennae up. We make plans to meet in the middle.
We might ask: ‘How about you drop off a urine sample in 10 days and increase your
virtual visits?’ Stable patients get the benefit of the doubt. But it’s more challenging
for new or unstable patients. You need to do urine tests and see many of them in person.
We need to make sure they are taking the medicines we are prescribing to them and
to provide continued treatment accountability. We still have a robust urine collection
system, with heightened precautions. We have some patients who show up, pee, get their
vitals taken and then talk to us from their phone in the parking lot. … I am humbled
by the work my colleagues are doing in the ICUs and on the front lines. I’m now receiving
videos that teach outpatient physicians how to run ventilators, if everything goes
south. I’m board-certified in family practice and addiction. The last time I ran a
ventilator was in my residency 20 years ago. I’m quasi-terrified. But I’m watching
the videos. I’m learning again in case they call me in.”
As told to David McKay Wilson
April 18, 2020
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