December 25, 2015
After the patient has been brought back from near-death with Narcan, amid the whooshes, clicks and beeps of the monitors in the emergency department room, Dr. Joshua Lynch comes in, closes the glass door and takes a seat on the flat top of the room’s trash bin.
There he employs a time-tested medical technique in the fight to save lives amid the heroin epidemic: He talks to the patient.
Lynch – a tall young man with tousled hair and an easy smile – asks how the patient started using drugs, when addiction gripped him or her, and how he or she wound up near death that day. He asks all of the patients he talks to where they plan to go – not just figuratively, but literally: “Are you going home? What are you going to do when you get there? And what about tomorrow?” Those are questions most addicts haven’t considered much, because getting the drug that allows them to feel normal and not sick consumes all their time and energy.
Lynch knows it’s his one chance – maybe anybody’s one chance – to make a difference at a critical point.
“This is a patient population that most likely will never touch the system any other way,” he said. “They won’t go to rehab. They won’t go to counseling. But that doesn’t mean they don’t want to get better. They just aren’t ready to do that. So they come to me, and usually they don’t come to me by choice.”
Through these conversations, Lynch not only works to help the person sitting in front of him, but he gathers information he will use as part of a countywide team devising a response to the opiate overdose crisis that has claimed 188 lives in Erie County this year.
“This is such an evolving problem that we are all trying to figure out what is going on, and he’s flat-out asking the source,” said Cheryll Moore, a medical care administrator with the county Health Department.
She teaches the county’s Narcan use classes, sometimes with Lynch.
“We are learning so much,” Moore said. “These individual case studies that he is looking at are putting together the larger picture.”
Lynch brings the information and insights he gathers from his patients to meetings with others in the medical and legal fields who are crafting policy to try and save the lives of drug users and slow the spread of addiction. “When we’re talking to Josh, we say, ‘What have you learned recently?’ ” said Moore. “And he’s talking with many other people, too.”
Moore called Lynch “extremely committed to this.”
He has taken a leadership role, Moore said.
“Whatever ideas we all come up with together, Josh is right in there with us,” she said. “He’s really hitting all angles, probably because he’s seeing it firsthand.”
His conversations with patients are pointed but not accusatory, Lynch said.
“I try to hold them reasonably accountable, but as soon as you start lecturing people, they don’t want to talk to you anymore,” he said. “It’s really more like a reality check.”
Lynch did not start out intending to develop this approach with addicts, but he was always interested in people’s behavior as well as their physical well-being. He earned a bachelor’s degree in psychology from the University at Buffalo, and then a medical degree at Lake Erie College of Osteopathic Medicine in Florida, followed by a subspecialty in emergency medical services and residency at UB.
Lynch, 33, worked as an East Amherst volunteer firefighter and emergency medical technician from 2001 to 2012. He now serves as the medical director of the fire company and several others. He’s still a paramedic. He worked on ambulances for Rural/Metro from 2001 to 2004. He and his wife, Michele, have two children.
The Williamsville North graduate, whose family “moved all around New York State” while he was growing up, credits his parents’ example for helping him meet people on their own level.
“My parents introduced us to people in all walks of life,” he said. “I don’t care what somebody does for a living, that doesn’t really matter to me. I treat very, very wealthy people, and I treat the homeless, people who come in from the jail or the prison. What matters to me is that you are here and you need my help.”
Lynch, an emergency room doctor at Millard Fillmore Suburban Hospital, also works at DeGraff Memorial Hospital in North Tonawanda, Erie County Medical Center and United Memorial Medical Center in Batavia. He finds that emergency medicine fits well with his personality. Accepting people, he said, “goes to the heart of emergency medicine. You meet a stranger, get their total trust and have them tell you their deepest secrets all within about 90 seconds.”
The longer he practiced medicine, the more he learned. Lynch recalls that early in his medical career, a patient told him she had smoked the fentanyl from a drug-impregnated patch. “I just remember, totally disinhibited, saying, ‘How do you even do that? Do you just light it on fire?’ She explained to me how she did it. I will never forget that. I thought, ‘These people should be teaching me.’ ”
Simply asking a patient to explain how they wound up in the emergency room can be a turning point, Lynch said.
“Maybe what they are doing is normal in their group of friends, and maybe they need me being the theoretical slap in the face,” he said. “Maybe for a lot of people it doesn’t make any difference, but maybe some will remember me saying, ‘What are you doing?’ I’m not judging the person. I’m not calling them out. And I’m not asking them to rationalize or justify. I’m just asking them to explain their thought process in getting into the situation that led to them coming to see me.”
So far, Lynch has seen some small successes. He has urged his patients who just survived an overdose to go to the class that enables them to get Narcan, and a couple have done that. So far, nobody has come back to tell him they are now drug-free. But none have come back in dead, either.
“Now, I’m just one ER doctor working in a couple of hospitals,” he said. “But thankfully that has not happened.”
“It probably will happen.”
Telling the dirty details
When talking with patients, Lynch does not hesitate to make the point, bluntly if necessary, that their behavior is dangerous.
“I thought I probably shouldn’t waste this opportunity while I have these people pinned down in a room, usually not literally,” Lynch said.
It might be the only time a drug user gets to talk to somebody about it and hear a physician tell him or her that he cares.
“For some people, this is their first freaked-out moment of ‘Oh, my God! I can die from this,’ ” Lynch said. “But others are used to being dismissed, being degraded, hearing ‘Get him out of here,’ or ‘What a waste of Narcan.’ I disagree strongly.”
Seeing his patients as people is important, and Lynch is careful to separate the person from the behavior.
“I ask them, ‘How did you get yourself into this situation?’ Most of them are very willing to explain, in dirty detail, how this started and what happened. I usually will tell them, ‘This is for my own knowledge. I can help you and other people like you and maybe try to fix this big problem.’ ”
When they hear that, most people struggling with addiction welcome a chance to provide information. One theme runs through their stories, Lynch said.
“Nobody wants to be doing this. Everybody wants to stop. They understand that the risk of them dying is pretty high. Most of them really are terrified. None of them predicted that they would overdose. That’s how the discussion starts. Some … don’t want to talk to me, but I just sit there and stare at them for a while, and we usually end up talking.”
Lynch emphasizes that just having Narcan won’t save a person who uses street drugs like heroin, which could be unexpectedly strong or spiked with powerful fentanyl.
“They don’t think Narcan is a safety net,” Lynch said. “It’s not like, ‘I can use because Narcan is around.’ People die all the time when they use by themselves, with Narcan in their pocket or on their desk. You can’t give it to yourself.”
People who don’t know anyone who struggles with addiction may find it easy to judge and blame addicts because of the element of choice in drug use, at least early on, Lynch said.
“Whether it’s your choice, or your doctor’s choice, and that is really unfortunate, it’s still a choice,” he said. “In fact, it’s a couple of choices, and then you’re stuck. No one chooses to be addicted, but there are a couple of irresponsible choices along the way. That’s not to say that the person who has knee surgery and goes to his doctor and gets a script for 50 hydrocodones, that’s sort of a different problem. However, some of those people choose to take three tablets instead of one, or to run out of their prescription and need a few more, so they go out and buy some.
But once the person winds up in the emergency department after a brush with death, confronted by a plain-talking doctor, all that is just the past. What matters is the present and future.
Lynch delivers this message: “No one else is going to do this for you. And if you don’t do this, the chances are that you are going to die.”