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Finding hope in the darkest times

BY Dr Max Pemberton

26th Jul 2023 Life

Finding hope in the darkest times

Two people struggling with drug addiction surprise Dr Max with a friendship that helps them to overcome hardship together 

As a doctor, I have become accustomed to making judgements based on evidence. On a rudimentary level, much of medicine appears to operate on the premise that what is observed in one individual can be extrapolated and applied wholesale. But the more I work as a doctor, the more I realise that this does not always do the patient justice. The exciting thing about working with people is their ability to constantly surprise, so that even in the bleakest of human terrains there is hope.

When I met them, Fergal and Anthony had been living on the streets, sleeping in a disused shed on an allotment, for over a year. Fergal had been homeless for longer. He used to be a waiter but had begun drinking heavily after his mother died. He was fired from the restaurant where he worked and was eventually evicted from his flat.

"The exciting thing about working with people is their ability to constantly surprise"

He started going to local parks during the day to drink until, one day, sitting with a group of fellow alcoholics and worrying about where he was going to sleep that night, someone offered him something to smoke. He smoked it and for the next half an hour nothing seemed to matter. It was heroin. After a few weeks of smoking it every day he was not only addicted, but also had started injecting it.

When I worked in an outreach project for homeless people I met many drug addicts and many started injecting heroin this way—they started off by smoking it, then as the addiction took hold and they needed more in their system, they progressed to injecting. It was certainly easier and cheaper for Fergal to get wasted on heroin everyday rather than alcohol.

Homeless man on the street

Life on the street can be harsh and brutal

But the success rate for getting people in treatment off heroin is about 5 per cent a year. That’s pretty poor. There are numerous factors that make people more likely to succeed: good family support networks, stable accommodation, using only one substance, motivation and drive. Fergal and Anthony didn’t tick any of these boxes.

In fact, both he and Anthony were injecting two packets of heroin a day and occasionally using crack. Neither of them had been in treatment for their addiction before, and both of them seemed rather indifferent to the idea. They had only come to see me because they had been arrested for possession of heroin. "The courts said we had to come, so we did," said Fergal, shrugging his shoulders. I sighed.

A friendship that blossomed against the odds

But something about their story did make them stand out. He had met Anthony a year ago while sitting on a park bench, and they struck up a friendship. Life on the streets is harsh and brutal. There is no honour amongst thieves, or drug addicts, and allegiances that are formed on the street are fragile and transient—they only existing as long as they served the interest of the individual. But Fergal and Anthony were different; they were like brothers.

They were inseparable, looking after and protecting each other, sharing their food and money. They funded their addiction by stealing things, mainly copper wiring but also tools and sheet-metal from building sites and selling it to scrap merchants. Despite operating outside of the law, they had their own strict moral code of conduct which involved no burglary from people’s homes, no mugging and no begging.

"Fergal and Anthony were inseparable, looking after and protecting each other, sharing their food and money"

They reasoned that stealing from businesses was ok because they were wasteful and had insurance anyway. While I couldn’t condone this, it is at least a change from the usual ways my patients made their money. In an environment where the only currency given any importance is drugs, it was heartening to see two people place value on their friendship.

But this didn’t take away from the fact that they had not attended under their own volition, and to date, no one who had come to the clinic under a court order had returned for a follow up appointment. Instead, they vanished back into the seedy underworld of life as a drug addict. I knew that they would never return—all the evidence pointed towards it. I signed the form, prescribed them both the starting dose of methadone and they left the unit.

To my great surprise, Fergal and Anthony did return. While many of the patients I had thought would be able to kick the habit relapsed, they stuck with it. In fact, a year on, they were no longer dependant on drugs and both had jobs. However uncertain the world may seem at times, one of the things you learn in medicine is that people have the capacity to surprise you, and because of this there is always hope.

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