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'My Heart Still Beats' Part 5: Emergency Room (Transcript)

A drawn portrait of Dr. Javad Mashkuri with the text Emergency Room written next to the illustration.
Illustration: Janelle Sing | Design: Angela Evancie

"I think in the past, people would say, 'Look. People don’t want to talk about this.' ... And the truth is, people want to talk about this stuff, if you give them the right forum."

Note: These transcripts are provided for accessibility and reference. If you are able, we strongly recommend listening to this episode of My Heart Still Beats here. Please check the audio before quoting in print, as the transcript may contain minor errors.

My Heart Still Beats logo. Text says VPR My Heart Still Beats, a project of Writers for Recovery and has illustrations of six people.
Credit Janelle Sing


JAVAD MASHKURI: Part of our hesitance and our fear of all this is that we don’t understand this disease very well. We don’t talk a lot about it in medical school. We don’t get a lot of training about it. So we’re all coming to this late.

GARY MILLER, HOST: That’s Doctor Javad Mashkuri, emergency department director at Central Vermont Medical Center in Berlin. And he’s talking about the opioid epidemic, which has hit emergency rooms hard all over the country. They’ve seen more patients with serious problems, and they’ve struggled to find ways to help. Now they’ve discovered a new tool: trained recovery coaches who work alongside medical staff in the ER. Who are there to advocate, to sympathize. To comfort, and sometimes, to share stories of their own recoveries.

I’m Gary Miller. Welcome to My Heart Still Beats — a project from Writers for Recovery and Vermont Public Radio. My Heart Still Beats features conversation and original writing from the recovery community all around Vermont. People in recovery from substance use disorder. And people helping those in recovery rebuild their lives.

Here’s Dr. Maskkuri.

JAVAD MASHKURI: In late 2014 and 2015, we started to notice an uptick in opioid-related problems. Overdoses — which were things typically we’d see only a few during the year — started to happen more frequently. We noticed more people having trouble with pain medications that they had become addicted to. We noticed more people with infection problems like abscesses from shooting up, or infections of their heart valves, that we just didn’t typically see very frequently. And then as the epidemic developed, those numbers continued to increase.

A lot of us go into emergency medicine because we want to be able to fix things. We want to be able to fix a broken bone. We want to be able to fix a heart that’s beating too fast or someone that has fluid in their lungs. There’s a lot of things we can do acutely to provide relief. Addiction really is not one of those things. It’s such a complex disease process that has a lot of different factors that make it really, really hard to treat.

GARY MILLER: That’s changing, thanks to the new recovery coaching program in the Emergency Department. It started in July, 2018. It’s a partnership with the Vermont Recovery Network and the Turning Point Center of Central Vermont in Barre.

JAVAD MASHKURI: They come in, they talk to the patient, and what they do is, they, it’s very powerful. They forge a bond right there. They’ve got street credit already, by walking in, because they’ve lived the life that this patient is struggling with. And they also are now free of that, and they serve as a really great role model for someone to see that, “Yeah. There’s hope. You can do this. This is what can happen. You can get better.”

GARY MILLER: Recovery coaches are there when people are at their most vulnerable. They’re there to listen, and to offer resources that can help people take their next step toward sobriety. These coaches currently work in three Vermont Emergency Departments. Many of them are in recovery themselves.

Here’s Liz McDougal, one of the recovery coaches in the Emergency Department.

LIZ MCDOUGAL: I’m from Florida where they don’t have a lot available for recovery, period. I was addicted to opiates and I eventually lost everything. My house was burned down, I lost my children, in and out of jail, I almost died several times, homeless on the streets of a very dangerous city ... And it wasn’t until I realized how much it was affecting the people in my life that I wasn’t OK with it anymore.

GARY MILLER, ON TAPE: And so how did you connect with recovery? How did that happen for you?

LIZ MCDOUGAL: Coming to Vermont [laughs]. Vermont saved my life, you know? I shot up in the airport on my way here, like, I was completely strung out up until the day I came here. And all the amazing resources and how much they’re willing to try things like the recovery coach program is how I was able to dig my way out.

GARY MILLER, ON TAPE: When you went into recovery, was it — did it make a difference that the people that were helping you knew what you’d been through?

LIZ MCDOUGAL: Absolutely. There’s a lot of shame attached with addiction. And when you know that the people who are helping you aren’t looking at you with judgement at all, and it’s complete acceptance … When I met my sponsor that I have now, there was an immediate connection because [there was] no judgement at all within him. And, um, my story does have a lot of crazy things that I was not comfortable talking about at first that now, through working through things with him and knowing that there was no judgement, I can freely talk about with pretty much anybody and know that I don’t have to feel ashamed anymore.

GARY MILLER, ON TAPE: How does that play out in your recovery coaching? That idea that, you know, you can go and talk to someone and say, “Maybe I don’t know exactly where you’ve been, but I know the kind of things that you’ve experienced.”

LIZ MCDOUGAL: So, pretty much every time it’s somebody who’s in the throes of withdrawal. And the clinical staff can only relate in a medical sense. And they’re just so desperate and somebody walks in that’s been there and can hold their hand and say, “Listen. I know exactly what you’re going through. Let me get you a blanket and some ginger ale until they can bring you your meds, and let’s talk about what’s next.” The look of relief on their face.

GARY MILLER, ON TAPE: Can you tell me a story of a specific person and what happened?

LIZ MCDOUGAL: Um, I came in the room recently and there was somebody who was in withdrawal very very badly, and they had recently, clinically, been dead. And I could visibly see that they were very uncomfortable. And he told me how he had just died, and how he was sick of living this way.

And I remember saying to them that we could help them. And I chased that medical staff all over that ER, [laughs], “Let’s get them their meds now because I’m not gonna be able to have a clear conversation with the way they are now.”

And just seeing that I cared enough to do that, opened him up to tell me more. And to be more willing to hear me out and listen to what I had to offer. And we were able to get him everything he needed by the end of the day. I mean, not everything he needed for his life, but everything he needed to get him out of that desperate situation where he was willing to start taking the next steps.

GARY MILLER, ON TAPE: What is it like for you on an emotional level when you really feel like you make that connection and you’re gonna be able to help somebody in the ER?

LIZ MCDOUGAL: So, um, having any role at all, and being able to see somebody that’s living a miserable life start to come out of it and start to be happy and start to have a reason to live and start to smile. ‘Cause we meet with these people regularly afterwards. We talk to them every day, and to be able to see them go from what they were like when you saw them in the ER to even just a few weeks later, almost a completely different person. And being able to do that over and over and over again, it really, um, it makes my life more worth living.

JAVAD MASHKURI: I think in the past, people would say, “Look, people don’t want to talk about this. They’re not gonna tell you truthfully what they’re doing, how they’re doing it." And the truth is, people want to talk about this stuff, if you give them the right forum and the time to do it, which in the ED, you have time if you’re waiting for an X-ray to get done or you’re waiting for blood results.

And quite often they go, “I can’t believe you people want to do this and actually help us.” And we’re like, “That’s what we’re supposed to be doing. That is what we want to do.”

GARY MILLER: The tough part, says Mashkuri, is that not everyone is able to make that change.

JAVAD MASHKURI: I mean, there are, at this point, unfortunately, there's a lot of stories, and not all of them have happy endings. And what people don’t realize is that someone who shows up in the Emergency Department with an opioid overdose has a 1-in-5 to 1-in-10 chance of showing up dead in 90 days.

So there is a certain urgency to getting this started. And the better we can either erase barriers or make them — make this treatment more accessible, the better we’re gonna do.

LIZ MCDOUGAL: Every story’s got something that you’re gonna feel ashamed about because we all do things we regret in our addiction. If I can tell you my story and I don’t feel shame, it makes you feel like I’m probably not gonna judge you. And, guess what? I’m not. At all.

It’s such an amazing feeling to be able to literally walk back into hell and go, “Hey, I can help you. I figured this out. I know the way. Let me show you.”

GARY MILLER: My Heart Still Beats is a production of Writers for Recovery, made possible with support from Vermont Public Radio and the VPR Innovation Fund. In the show, you heard from Dr. Javad Mashkuri of the Central Vermont Medical Center and recovery coach Liz McDougal. Producers for this series are Bess O’Brien and me, Gary Miller. Erica Heilman edited the series and Angela Evancie is VPR's managing editor for podcasts. The music in this episode was by Brian Clark. Writers for Recovery is made possible through major underwriting from the Vermont Department of Corrections, The Rona Jaffe Foundation and Nat and Martha Winthrop.

For more information about Writers for Recovery and how to join a workshop go to

If you like what you heard here, please take a minute and review us on Apple Podcasts. This helps new listeners to find the show. I'm Gary Miller. Thanks for listening.

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