In 2017, 692 people died of opioid overdoses in Baltimore. One city resident says that number might have been 693 were it not for her doctor, Michael Fingerhood.
After years of recovery, the death of two close relatives left the woman reeling. She relapsed and overdosed on heroin seven times between June and August 2017. Several of those overdoses, she says, were nearly fatal. “Dr. Fingerhood helped me through the most difficult time in my life,” says Amy (not her real name). “He just never gives up on me.”
Amy is just one of thousands of patients whose lives have been transformed by the Comprehensive Care Practice that Fingerhood established at Johns Hopkins Bayview Medical Center back in 1994. Launched at a time when there were few health care options for Baltimoreans struggling with HIV and addiction, the practice has provided judgment-free support to people fighting dependence on drugs or alcohol for the past 25 years.
Heroin, fentanyl and other opioids are the most common substances Fingerhood and his team see, but the practice also treats patients with alcohol, cocaine and other substance use problems. More than 6,000 people, many of whom have been sober or off drugs for years, rely on the practice for routine medical care.
“Addiction certainly doesn’t define the people who come to our practice,” says Fingerhood. “But it does need to inform the care we provide them.”
In the accounts that follow, four people whose lives are closely bound up in the work of the Comprehensive Care Practice — a patient, a doctor, a community health worker and a pastor — talk candidly about their own experiences with the CCP and their continued commitment to stemming the tide of addiction in Baltimore.
Monaye Gethers, 57, started using heroin in her late teens and discovered she was HIV-positive at 27. She quit using — not just heroin, but alcohol, marijuana and any other substance that might cross her path — when she was 29. She went back to school, bought a house and car, launched a career in substance use counseling, and has maintained her recovery despite all she would continue to endure, including the death of her only child in an accidental shooting just after his 21st birthday. For all she’d been through, she’d never had a doctor she trusted. And then someone told her about Michael Fingerhood…
“When I was diagnosed as being HIV-positive in 1989, I was so ashamed, and I just assumed it was a death sentence. I had been in recovery a long time when I finally told a friend I was HIV-positive. My friend asked if I had a doctor, and I said no. All the doctors I’d met prior knew nothing about an African American woman in recovery with HIV. They didn’t even want to touch you, and everything that was wrong with you — even if you came in with a backache — had to be the HIV. Or, when I was using, it was the drugs. My friend said he knew this doctor who was not only a really good doctor, he treated people real good. So I called the number and made an appointment, and that’s how I met Dr. Fingerhood. And we just hit it off.
“He wanted to know everything about me — we sat in his office and talked for 45 minutes — before he even put a stethoscope to my chest. And then he examined me, and I showed him a rash and said it was probably the HIV, and he said, ‘No, that’s just topical dermatitis.’ When I came back for a follow-up to talk about my bloodwork, he said I was in great health. Yes, I was HIV-positive, and if the time came when I’d have to go on medication, he’d let me know. Well, that time did come, and he said I should think about it because it would be for the rest of my life. But I knew he had my back, so that’s what we did.
“And in 30 years, I’ve never been sick from the HIV. But one thing no one knew anything about at the time was hepatitis C, which affected a lot of IV drug users, and I started getting real sick, and my liver was failing. I was dying, it was affecting my brain, I couldn’t walk, and Dr. Fingerhood sent me to a friend of his at Johns Hopkins who was doing a study where they were going to transplant organs into people with HIV. It was quite a process, but I got better, and I now have this liver from a 20-year-old whose mother wrote to tell me what a wonderful son he was. And I wrote back to tell her about my son and how I plan to spend the rest of my life being the best person I can possibly be because I am so grateful. It was like a spiritual awakening.”
The Community Health Worker
Lisa Brown, 57, grew up quite literally in the shadow of Johns Hopkins. From her home on Chase Street in East Baltimore, she could look up at the hospital and medical school complex on Monument Street. And she and her girlfriends would climb that hill, strap on their roller skates, join hands and ride all the way back down in one great adrenaline rush. It would be years — a twisty road of addiction, of eventual recovery and discovery — before she’d walk into those looming buildings as a member of a medical team. She is now in her seventh year as a community health worker at the Comprehensive Care Practice.
“I was 24 when I started using heroin, and I used for 18-and-a-half years. Only when I got into recovery did I face the roots of my behavior. I had been molested, beginning at age 7, and the drugs suppressed feelings I didn’t understand. By the time I could no longer afford them, I was already in the grips. There were arrests, I was in and out of treatment. Then one day I was on my way home with a heroin pill, and something stopped me in my tracks. It was like gravity pushing me backward. And I threw up my hands and said, ‘Lord, God, I don’t want to live like this.’
“I was due in court, and I told the judge I wanted to go to Baltimore Behavioral Health. It was intensive therapy, all day, every day. In the 15 years since, I’ve never even thought about using. They saw something in me I didn’t see in myself because after 30 days, they made me house manager, then residential monitor, then shelter supervisor. I worked there for seven years, until they had financial problems and I lost my job.
“I was so scared. I must have applied for 100 jobs, and I’d get to the second or third interview, and they’d say, ‘There’s a hiccup in your background, and we do apologize, but we can’t use you.’ Then I ran across an ad that said all you needed was two years sober, a vehicle and a driver’s license. And I thought, ‘I have that!’ I was in the grocery store with just $5 left, trying to figure out what I could get to eat, and I got a call from a Ms. Dawson at Johns Hopkins HealthCare. ‘I see you put in an application for the community health worker position.’ And I said, ‘Ma’am, let me say this. I’ve got a filthy background. I’ve been in recovery for nine years. Either you want me or you don’t.’ And there was a pause and she said, ‘Can you come in on such-and-such a date?’
“It’s my ideal job. I do home, hospital and nursing home visits, volunteer at the food pantry because volunteering is part of the job. I help my members apply for assistance, advocate for them. Sometimes I’ll be in conversation with someone who is in the struggle, and they’ll say, ‘Ms. Lisa, you sure you ain’t never used before?’ And I’ll just smile. But I always say my past does not define my future, and neither does theirs.”
Jarratt Pytell is the first-ever fellow in addiction medicine at Johns Hopkins. The 33-year-old former math teacher earned his medical degree at Louisiana State University Health Sciences Center New Orleans, and he fell in love with the work and philosophy of Michael Fingerhood and the Comprehensive Care Practice while completing his medical residency at Johns Hopkins Bayview Medical Center. Pytell plans to pursue a career as both a researcher and a physician focusing on the primary care treatment of substance use disorders.
“I came out of medical school wanting to be a primary care doctor, and one of the first places I worked during my residency was at CCP, and, for lack of a better word, I was smitten. Physicians like Dr. Fingerhood and Dr. Darius Rastegar meet patients where they are, and the feeling is more of a collaboration than a one-sided, talk-down, do-what-the-doctor-says type of relationship. Plus, the care really is comprehensive, with primary care physicians treating the whole spectrum of diseases, including conditions like HIV, hepatitis C and substance use disorders that have their roots in more social determinants of health.
“Dr. Fingerhood has shown that taking responsibility for the whole spectrum of care as a primary care doctor means better health outcomes for patients. Many CCP patients don’t have a lot of financial or social resources, so referring them to a handful of specialists is often setting them up to fail. Plus, patients with conditions that have been stigmatized are more likely to show up for a primary care appointment because it’s a nonstigmatizing care setting. Everybody has a primary care doctor. And CCP doctors treat substance use disorders the way they would any medical problem. There is no judgment. There is only compassion.
“My experience at CCP got me interested in studying addiction medicine, but still in the context of primary care. I love science and discovery, but I also love relationships and getting to know people on a very deep level, and primary care doctors get to think about the whole patient, not just an organ or an illness. It is very specific to the training and culture at CCP that getting to know patients as people, understanding how they think of themselves, is crucial to practicing good medicine.
“CCP does extraordinary things for patients. But it is also a fertile training ground. When I think about the incredible impact it has had on me, I can only begin to imagine its impact on every other resident who has trained here over the past 25 years and gone out into the world to revolutionize the way we practice medicine.”
Rev. Debra Hickman launched STAR (Sisters Together and Reaching) with pediatrician Dorothy Brewster-Lee in 1991. Since then, STAR has helped tens of thousands of HIV-infected and -affected men, women and children in Baltimore get the care they need. As a former nurse researcher and now assistant pastor at City Temple of Baltimore, a Baptist church, Hickman is highly regarded in Baltimore’s public health community: She has been a consultant to the Centers for Disease Control and Prevention and a member of the Baltimore City HIV Commission. She and STAR are now working with Michael Fingerhood and CCP to help the program improve its outreach into the community she knows so well.
“We have a collaboration with Johns Hopkins where we hire people from the community, train them as community health workers, then use a patient list [Johns Hopkins] gives us to intervene with people who overuse the Emergency Department. Overuse of emergency rooms is a serious problem among people without resources, and we reach out to these patients to help them cope with ‘social influencers’ of health, such as issues surrounding transportation to medical appointments and money for copays and utilities. We work diligently to stabilize their environment, which might mean anything from finding permanent housing, to establishing a good relationship with their primary care provider, to even coaching them in money management and healthy cooking.
“With the opioid epidemic, we have wanted to do more, so we have been meeting with Dr. Fingerhood about establishing a formal collaboration. STAR knows how to do outreach, and we now have 38 employees, many of them very experienced in working with the substance using community. People here on the East Side don’t really like to go outside of the community for care, and a lot of them don’t like going to Johns Hopkins because they’re not seeing people who look like them or who understand their cultural norms and values. The community also hasn’t emptied itself of the feeling that Hopkins is just about research, and that when the research is over, they’ll be abandoned.
“So, we are seeking to house Hopkins physicians within our community-based organization, where we are already offering direct services and care management and have a lot of foot traffic. We would offer a safe space where these physicians can be available to the community when people feel ready to stop using. Dr. Fingerhood is well-known in the substance using community, and people respect him. To me, he feels like fresh air. He is real, his heart is real and he really wants to stem this tide of addiction. At STAR, we look at the whole person, not just their addiction, and that is exactly what Dr. Fingerhood has been doing for 25 years.”