3:58

One morning last year, when Bryan Bashin sat down to check his email, a peculiarly short note caught his attention.

“A businessman has passed away. I think you might want to talk to us,” it read.

Bashin directs a nonprofit in San Francisco called the LightHouse for the Blind and Visually Impaired, so he gets a lot of email about donations. But this one felt different. It came from a group of lawyers handling the estate of a Seattle businessman who had died, Donald Sirkin.

When Bashin and the LightHouse’s Director of Development, Jennifer Sachs, checked the LightHouse’s donor database, they found no record of him. Don Sirkin had never donated to the LightHouse for the Blind and Visually Impaired before, or used its services.

And yet, in his will, Don Sirkin had left almost his entire estate to the LightHouse, with no explanation.

In the end, the gift totaled over $125 million, more than 15 times the LightHouse’s annual budget. Bashin believes it’s the largest single gift ever given to a blindness organization.

“It’s one of those experiences where time stands still, where you know that every little bit of what you’re experiencing will be engraved in your memory,” Bashin says. “This is the moment that everything is going to change.”

He’s 60 years old, tall and almost always smiling. His eyes are cloudy; he walks with a cane. He gives off the impression of being an entirely functional, confident blind person.

But this Bryan Bashin is a relatively recent incarnation, because for a long time, Bashin didn’t identify as blind at all.

“I didn’t say the “B” word,” Bashin says. “Instead I used euphemisms if I had to. I used the lingo of the day: ‘visual impairment,’ ‘low vision,’ ‘visual challenge,’ that kind of thing.”

Bashin’s vision began to falter when he was in his teens, and gradually got worse. By his 20s, he was legally blind. Today, he says, he sees the world “as if through wax paper.” He can make out some light and color, but not faces or words.

Yet through his 20s and most of his 30s, Bashin squeezed by on the little vision he had, relying on magnifiers and special lamps to read what he could. He memorized the map of his daily route so as to not get lost. He only went out during daylight, to avoid the confusion of navigating in complete darkness.

Bashin says that a lot of blind Americans use work-arounds like these.

“Most never use a cane, or a dog, or Braille or any of the things that are identifiably blind,” he says. “In the blind community we say we’re in the closet, and it is just like being in the closet in the gay community. You try to pass and you try to be somebody that you’re not.”

But as Bashin’s vision declined, these work-arounds became harder to pull off. They were time-consuming and exhausting. Finally, when Bashin was 38, with his vision at about 10 percent of normal, he realized he couldn’t hide anymore. He decided to learn to be a blind person in public.

A friend took Bashin to a local blindness agency that Bashin found dishearteningly shabby. Stuffing was coming out of the chairs. The air conditioners buzzed. The office hadn’t been painted in decades.

For Bashin all of this was symbolic. The place lacked dignity. “None of that period made me feel like I could be a cool blind person and do stuff in the future,” Bashin said. “I felt ashamed. I felt confirmed in my suspicion that blindness would be a diminishment of my potential.”

But he did get something out of it. He learned how to navigate with a cane. He started learning the technologies that make life vastly simpler for blind people than it was a generation ago: the smart phone, text readers and pocket recorders.

And suddenly, everything got easier. For example, using text-to-speech was “vastly quicker” than trying to make out giant letters on a screen.

Since then, Bashin has made it his life’s mission to help other blind people make the leap he did. He got a job at the agency with the ripped up couches. And in 2010, he became the Executive Director of the LightHouse for the Blind and Visually Impaired in San Francisco.

Bashin says that with the right tools and training, blindness can be reduced to the level of inconvenience. “Don’t just hide,” Bashin said. “This is not a tragedy or shame. This is not some kind of deep loss. This is just another side of being human.”

Despite enormous technological gains that have made life vastly easier for blind people in the last decade, there are still significant obstacles to independence. The unemployment rate among working-age blind people is 50 percent — ten times the national average. Job training is expensive, and learning to live independently as a blind person takes time and resources. It’s often easier to get disability checks than to find and pay for necessary training.

To really master walking around using a white cane, Bashin says, requires 200 to 400 hours of training with somebody who is being paid to work with you. Learning to use a computer requires that same kind of training.

Through constant fundraising, Bashin’s organization has the resources to provide basic services to their clients.

But what Bashin wants is bigger than that: a change in how blindness is perceived. He wants to to encourage more blind people to come “out of the closet,” to embrace and celebrate blindness as a difference, and get the skills they need to pursue their ambitions.

Now, suddenly, thanks to this mysterious businessman in Seattle, Bashin and the LightHouse are looking at a different scale of ambition.

“When you get right down to it, the Sirkin bequest is about … feeling like we can dream and have options and be proud of who we are,” Bashin says.

LightHouse for the Blind and Visually Impaired is just beginning its strategic planning process, to decide how to spend the Sirkin money, but Bashin has some ideas.

One major project — which had begun well before the Sirkin grant – is a new headquarters in San Francisco. The building will have expanded facilities, including a dormitory where blind people can stay while they receive training in blind tech, cane navigation, and other necessary skills.

There’s also the idea of an award for blind people who do extraordinary things — say, travel around the world independently, or invent some kind of game-changing tool for blind accessibility.

For now, Bashin wants to understand the man behind the donation: This mysterious Seattle businessman, Donald Sirkin, left $125 million to an organization that had never heard of him, with no explanation — just a few legal sentences in a three-page will.

Last year, to try to reconstruct this man from the dead, Bashin made a trip to Seattle, where Don Sirkin had lived. He took a tape recorder and interviewed everyone he could find who had known Sirkin, including Sirkin’s ex-girlfriend, a half dozen of his colleagues and good friends.

The interviews reveal a charismatic, idiosyncratic businessman. Sirkin built a hugely successful insurance company from the ground up. He was on a caloric-restriction diet that consisted of large quantities of pomegranate juice and seaweed. He refused to eat in public. His ex-girlfriend Sue Tripp remembers going on a trip to New York with him. But while Sue went to see the Statue of Liberty, Sirkin stayed in the hotel and exercised for hours.

Don Sirkin commanded attention. If left too long in a waiting room, he would walk around on his hands to catch the eye of the receptionist, as change and keys flew out of his pockets. He loved a big gesture, handing out $100-bills to his staff after closing on a big client.

The interviews also reveal a man estranged from his family. Missing from Bashin’s tapes are Don Sirkin’s children. He had two – a daughter and son. Neither of them wanted to be interviewed. The kids received relatively little from his will: $250,000 apiece, compared to the LightHouse’s $125 million.

In May, Sirkin’s daughter Anna sued her father’s estate. Her complaint says that her father hit her and touched her sexually. She says this happened dozens of times. If she wins, she could get a small percentage of what would otherwise go to the LightHouse. Anna Sirkin told us through her lawyer that she didn’t want to talk to us for this story.

As part of the Sirkin bequest, the LightHouse inherited Sirkin’s private residence on the edge of the Puget Sound. Last year Bashin and Jennifer Sachs, the LightHouse’s Director of Development, went to see it.

Sachs recalls that the house was in disrepair. Crows had pecked away at the shingles. The roof was crumbling. And inside, it was packed with stuff: thousands of books suggesting a vast range of interests; piles of old papers; paintings; plastic clocks stacked on top of each other.

What Bashin wanted, of course, were clues. And pretty quickly, he found them.

“As we wandered through [Sirkin’s] house,” Bashin said, “we saw all these gadgets: giant light boxes, magnifiers, enormous plasma TVs in his kitchen and throughout his house.” Bashin recognized these clues because he’d used them himself, back when he was trying to hide his blindness.

It appeared that Sirkin, too, had lost his sight. He kept it a secret from almost everyone he knew.

Instead of getting help, or learning to use a cane, it seems he’d tried to bring his eyes back with special diets, the pomegranate juice and the caloric restriction.

Sirkin’s colleagues said that in his final years, he became more reclusive than ever. He holed up in his house — in a little room off the side of his kitchen.

In that room, Sirkin’s heart gave out on him. His body wasn’t discovered for days.

To Bryan Bashin, Don Sirkin is a black box, a mystery. Estranged from his family, reclusive, even to those who worked with him. A guy who also made this dramatic, final gesture – this extravagant gift– to people he had never met.

What Bashin found in Sirkin’s home reminded him of his own difficulty in “coming out” as blind. Sirkin couldn’t make the leap Bashin did. Instead, he hid. But he also did something else. He left his entire inheritance to a group of people who could have helped him, but didn’t get the chance.

This story was produced for KQED’s new podcast The Leap, co-hosted by Amy Standen and Judy Campbell. You can subscribe to the podcast through iTunes or Stitcher.

7:22

Opioids have a stranglehold on parts of the U.S. And where addictive pain medicines are the drug of choice, clinics for addiction treatment often follow.

Sometime these are doctor’s offices where patients can get painkiller-replacement drugs, such as Subutex and Suboxone.

These medicines, brand-name forms of buprenorphine, can ease withdrawal symptoms and cravings for opiates. They can be prescribed in an office setting, unlike methadone. And the drugs, also mild narcotics, can block the pleasurable effects of opioids if people fall off the wagon and take them, which can help reduce relapses.

The drugs are intended to be used as steppingstones to getting clean.

“I use the medication as fishing bait,” says John Fisher, a self-taught counselor who runs Addiction Recovery Center of East Tennessee in rural Blountville. The sign out front says the clinic specializes in “addictionology.”

“We bring them in and try to taper them over time,” Fisher says, adding that no one comes truly seeking treatment. They’re looking for legal access to drugs. “One hundred percent of them are,” he says. “No one comes to sit in a group and hear the ‘Kumbaya’ story. So that’s fine.”

Fisher’s clinic has arrangements with two doctors who are able to prescribe buprenorphine to the patients. The treatment center isn’t licensed like a typical outpatient rehab facility. The physicians in charge say they haven’t seen the need.

The clinic, located in a Civil War-era cabin on a winding highway in northeast Tennessee, has roughly 120 patients. They are charged $500 for five weeks — cash only. The office doesn’t accept insurance, citing the burdens of red tape and the fact that few patients have coverage anyway.

Clinic participants must attend weekly group meetings with Fisher, who is a recovered addict himself. He says two decades on drugs were all the training he needed to do this work.

Clients are told to get off any other illegal drugs, such as heroin or methamphetamine. The clients are tested for drug use during treatment and can be dismissed from the program if they regularly show signs of using something other than what they were prescribed.

Some patients stick around clinics for years. This one has just a handful of success stories in which addicts weaned themselves completely, says Dr. Mack Hicks, who writes many of the prescriptions.

The spotty results lead some to question how committed some of the clinics are to seeing people through to recovery.

“You get this relationship built with them where they’re just really legit drug dealers in a sense, in my eyes,” says Heather Williams of Johnson City, Tenn. She has been clean for 11 months, after going through a cold-turkey program at a licensed drug treatment facility. But she spent a year and a half and $300 a month at a clinic that wasn’t licensed.

Ironically, buprenorphine itself can become a drug of abuse. And the medicine has street value. To pay for treatments, Williams says many people sell half their buprenorphine pills to get the money for the next doctor’s visit.

She’s skeptical about the motives at some of the clinics. “The relationship that I had with my doctor, it’s just really a money racket for some of them,” Williams says. “I think somewhere they might have started out caring about your well-being and whether you’re getting better or not. But he would go on vacation numerous times and show us pictures of him being in the Caribbean Islands, and I’m sitting there thinking the whole time, ‘I’m helping fund this.’ “

The local district attorney wants these kinds of operations reined in, but there’s not much he can do without changing state law.

And the need for treatment is growing. “If someone wanted to shut them all down — all the Suboxone clinics … what do you think that would do in terms of all the people that are addicted? You know that’s not going to cure the problem,” Hicks says.

Hicks is a former pain pill user, too. He got clean in the mid-’90s by going to an expensive inpatient treatment program that stepped him down off drugs in just a matter of days, though counseling continued for months.

Most people in this part of Appalachia can’t afford to take that much time off from work and get that kind of care, though Hicks says that approach would be ideal.

“They’ve got to keep working some way,” Hicks says. “The only way to do that is by giving them a substitute like we do.”

Drug-replacement therapy is a standard course of treatment for people hooked on opioids.

But getting on Subutex or a similar drug isn’t a silver bullet for pregnant women trying to minimize the drug dependency of their unborn child.

In Tennessee, which has seen a spike in births of drug-dependent babies in recent years, nearly three-quarters of all cases this year involved a woman who had a legal prescription.

“The babies withdraw just like an adult would,” says Tiffany Hall of Jonesborough, who gave birth to drug-dependent twins this year.

Hall was a nurse who worked in the neonatal intensive care unit and took care of babies with neonatal abstinence syndrome, the technical name for drug withdrawals.

Hall knew better. But she had a drug problem herself. And the NICU is where her twins spent the first weeks of life this summer.

“You stand there and you watch your own child go through something you’re not willing or wanting to go through yourself, and you have to stand there and watch that, knowing that you did that to them,” she says. “It’s awful.”

Tennessee has a relatively new and controversial law that allows drug-using mothers to be prosecuted for giving birth to a drug-dependent child. But any mother who has a prescription for the drugs in her system is safe, no matter what kind of doctor prescribed the medication.

“I ended up going to a Subutex clinic, and I thought, I’m OK now. I have a legal prescription. If the babies withdraw, it’s all right because it’s legal,” Hall says. “Still wasn’t thinking about anybody but myself.”

Hall got into a fully licensed program run by the nonprofit Families Free, which is focused on helping mothers kick their drug addiction. She’s headed toward recovery and rebuilding her life, though she points out that there are less scrupulous clinics everywhere, including a stone’s throw from the Families Free office in Johnson City.

But she accepts the temptation those clinics represent, since that’s what every day will be like after treatment. “I like having it there,” Hall says. “For me, it’s accountability. Yes, it would be easy to go next door and come up with some kind of story to get whatever I may want, but I have to be able to hold myself accountable and say no. I’m done with that. I don’t want to do that anymore.”

This is the third and final story in a series that was produced by All Things Considered in collaboration with Nashville Public Radio reporter Blake Farmer.

5:16

Tennessee’s “fetal assault” law is designed to push pregnant women into drug treatment programs. But there are not enough of those programs available for the people who need them.

6:54

In the United States, a baby is born dependent on opiates every 30 minutes. In Tennessee, the rate is three times the national average.

The drug withdrawal in newborns is called neonatal abstinence syndrome, or NAS, which can occur when women take opiates during their pregnancies.

In the spring of 2014, Tennessee passed a controversial law that would allow the mothers of NAS babies to be charged with a crime the state calls “fetal assault.” Alabama and Wisconsin have prosecuted new mothers under similar laws, and now other states are also considering legislation.

Supporters of the laws say they can provide wake-up calls to women dependent on drugs and encourage them to get help. The Tennessee law says that getting treatment for drug use is a valid defense against fetal assault charges. But critics say criminalizing the effects of a woman’s drug dependence on her newborn child makes it less likely for her to seek help when it could do the most good.

The problem of NAS is growing nationwide. Nearly 6 in 1,000 babies born in the U.S. in 2012 were diagnosed with NAS, according to a study published in the Journal of Perinatology in August. That’s nearly double the level seen in 2009.

In Tennessee, billboards on the side of highways declare, “Your baby’s life shouldn’t begin with detox,” with an image of a newborn baby’s foot attached to a medical monitor. The signs are strategically placed in areas with the biggest substance abuse problems, like Oak Ridge — a town surrounded by poor, rural communities in northeastern Tennessee.

On a drizzly Monday afternoon in Oak Ridge, a group of women sits in a circle in a low brick building. Some of these women have their babies — bouncing on their knees or rocking gently in car carriers. These women are all in recovery, and some are recently out of prison for fetal assault. The group is called Mothers and Infants Sober Together, or MIST, and provides outpatient treatment for mothers addicted to drugs.

Each woman takes her turn checking in with Michelle Jones, who runs the MIST program. The women talk about their challenges and triumphs, their cravings. One pregnant woman admits to feeling guilty for being on a medicine prescribed by her doctor to ease her cravings for opiates.

“Can I say something? Don’t feel guilty,” another woman pipes up, “because it’s going to help you right now.”

Jones sits in the circle with them, week after week, asking questions and prompting them to open up. It’s not an easy task. Many of them were afraid to talk at first.

Avoiding Prenatal Care Out Of Fear

Brittany Crowe used to be one of those women. Now, she shares her story.

“I could have gone [to] a baby doctor at first, but I was scared because of the new law,” Crowe tells the group. When she was pregnant with her youngest son, she was addicted to prescription drugs and knew that if she went to a doctor, a drug test would come back positive. So she stayed away. She had no prenatal care through her entire pregnancy. She was so afraid of going to jail and losing custody of her children that she considered giving birth at home.

“I worry about that a lot now,” she told us later. “I wonder how many babies are not known about because the mothers are afraid to get help, and then they’re born at home and nobody ever knows about these babies. If they’re going through withdrawal so bad, they’re going to pass away.”

Crowe finally went to the hospital 10 minutes before she gave birth. Her son was born with neonatal abstinence syndrome. The Department of Children’s Services took him and her older children away and put them in foster care. Crowe enrolled in the MIST program to get clean.

Crowe’s experience points to one reason medical professionals and social workers oppose the fetal assault law: They worry that the law will keep women from getting medical care. Dr. Jessica Young, an OB-GYN at Vanderbilt University who specializes in addiction during pregnancy, says the law has made her patients afraid.

“So now they’re making decisions on medical care out of fear rather than out of science or what is best for them and their baby’s health,” she says. “Fear makes people make rash unsafe decisions without the consultation or guidance of a physician.”

State Rep. Terri Lynn Weaver, a Republican who co-sponsored the bill, argues that critics misunderstand its intent.

“We want to get these women help,” she says. They “weren’t getting help — not going to prenatal care anyway. Their mindset is not on prenatal care. The mindset is on the next drug.” She hopes the law can act as a wake-up call to addicted women that will motivate them to seek help.

Some of the mothers at MIST told us the law did scare them into getting help. When Jessica Roberts got pregnant, the law drove her to enroll in rehab twice, but it didn’t make her quit. She relapsed both times, injecting herself with opiates.

“What finally broke me was, I was 31 weeks. I had tied off to hit myself. And I put my arm on my stomach. And [the baby] kicked my arm off. And that broke me,” she says. “To me, it was like my baby saying ‘Mom, you can’t do this anymore. I need you.’ And it hurt.”

Treatment Slots Hard To Find

When Roberts wanted help quitting cold turkey, she had a hard time finding it. Not many rehab clinics will detox a pregnant woman, and the few that do have long waiting lists. Doctors disagree on whether detoxing a pregnant woman is really best for mothers and their babies. Instead, most physicians recommend a gradual tapering of less harmful medications like methadone, paired with a comprehensive addiction treatment program. Those programs are scarce, however, and often have long waiting lists of their own.

Young’s clinic at Vanderbilt, for instance, has a waiting list of up to eight weeks, and the majority of her patients have to drive over an hour to see her.

At the state Department of Children’s Services, Connie Gardner says it feels like Tennessee is “drowning in the drug problem,” and nobody has thrown the state a life preserver. She understands why mothers view her office with distrust and fear. The department makes the decision about when babies should be taken from a mother and put into foster care.

“None of these mothers wakes up and says, ‘I’m going to abuse my child today,’ ” Gardner says. “None of them wakes up and says, ‘I’m going to be a bad mother.’ What I have to remember is that they do. They can get better. What’s frustrating, what’s disappointing is that we don’t have the tools to help them get better.”

Even the law’s advocates acknowledge that there isn’t enough help for the women who want it. Barry Staubus, the district attorney for Sullivan County in the northeast corner of Tennessee, has prosecuted more than 20 drug-using mothers this year.

“Of course I’m for funding programs and making those programs available,” he says. “There’s always the call for more funding, but we can’t let that get in the way of a good idea … or an effective program.”

Staubus believes that there need to be real consequences to women who chronically abuse powerful prescription drugs while pregnant. He says the threat of jail time would scare even the most defiant women, who had been previously unwilling to get into a program.

The Tennessee law is set to expire next year, unless state legislators renew it. So its effectiveness is under close scrutiny.

Births Of Addicted Babies Up In Nashville

At Vanderbilt Hospital’s Neonatal Intensive Care Unit in Nashville, the persistent squealing cry of newborns going through drug withdrawal provides an audible reminder that this problem is far from solved. In the year and a half since this law took effect, the numbers of NAS babies have not gone down, says Dr. Stephen Patrick, who researches neonatal abstinence syndrome at the hospital. He saw 100 cases last year, and the hospital is on track to see at least that many this year. He doesn’t think punishment is the right way to solve this problem.

NAS is a treatable condition in newborns, he says, and there isn’t enough research to know what its long-term effects on a child might be. “There was a lot of concern about the cocaine epidemic and Time magazine calling it a ‘lost generation.’ I think we should be really cautious in how we frame this moving forward,” he says. “The evidence really doesn’t support that for neonatal abstinence syndrome. And, in fact, we know that other substances, legal substances such as alcohol, are far more harmful long-term to infants.”

On a warm fall afternoon, Crowe and her children are at the park. Her older kids play in a stream as she holds her youngest on her hip. He’s 9 months old, with big blue eyes and a tuft of blond hair.

One of her boys runs up to her, a mischievous smile on his face.

“Don’t you splash me,” she warns, but there’s amusement in her voice.

He giggles and Mom gets a faceful of muddy water. She laughs as she wipes it from her eyes. He splashes her again.

Is she having second thoughts about having her children back?

“I think it’s a little too late,” she says, laughing. “I can honestly say a year ago I wouldn’t have been here.” She’s grateful to be here now. Free of drugs, and finally reunited with her children.

This is the first story in a series that was produced by All Things Considered in collaboration with Nashville Public Radio reporter Blake Farmer.

4:48

NPR’s Robert Siegel talks to an emergency doctor who was on the front line of dealing with casualties from the Paris attacks. He says on a normal weekend his ER will usually handle injuries from a car crash, and maybe once a year they will handle a gunshot victim. Friday night, he had 27 patients with gunshot wounds. All of his patients survived that evening.

Transcript

ARI SHAPIRO, HOST:

Our colleague Robert Siegel is in Paris. He has been talking with people there as they take stock of what they’ve been through. Now we’re going to hear his conversation with a doctor who take care of some of those who were shot in the attacks.

ROBERT SIEGEL, BYLINE: Right next to the sight of several of the shootings on Friday night in Paris is the Hopital Saint Louis – the Saint Louis Hospital. And the head of the emergency department here, Dr. Jean-Paul Fontaine, was working Friday night when this emergency room saw more gunshot victims than any French hospital could ever expect to see on a single night.

JEAN-PAUL FONTAINE: Usually in the emergency department in France, you may have a car crash. Sometime, one gun but not that type of number of patients was of gun.

SIEGEL: Normally, here, just one gun shot on the weekend, or…

FONTAINE: One per year.

SIEGEL: Per year?

FONTAINE: In Paris, that’s not like in the USA, you know?

SIEGEL: And Friday night?

FONTAINE: Twenty-seven patients. The first patients we had – members of emergency team who took stretcher.

SIEGEL: You mean by foot. They took a stretcher…

FONTAINE: Yeah.

SIEGEL: …And ran around…

FONTAINE: Yeah.

SIEGEL: …Outside the hospital walls. And what were you thinking during all this? What were you – what was going through your mind as the emergency doctor?

FONTAINE: I can tell you, you don’t think. I can tell you that you don’t see the end of it. That was very strange. When will it all stop? Patients, stretchers, patients, stretchers, surgeon – you don’t know the intensity of it, the number of it.

SIEGEL: Did all of the patients who came here to this hospital – did they all survive the night?

FONTAINE: Yeah.

SIEGEL: Were they all gunshot wounds?

FONTAINE: All – all of them.

SIEGEL: I assume this was unlike any other night you’ve had…

FONTAINE: Sure.

SIEGEL: …As an emergency doctor in Paris.

FONTAINE: Sure, sure.

SIEGEL: Now that you’ve had a day or two to digest what went on and not as a doctor, but as a Parisian, as a French citizen, what do you make of what happened?

FONTAINE: They’re on different levels. First of all is, what I could not imagine before was the silence on the Friday night in an emergency department with that kind of event, and especially from the patients.

SIEGEL: Silence.

FONTAINE: Yeah – no scream, no cry, no shout, like if the patients were shocked, deftly shocked – first. Second, if you had the time to speak with them, every one of them were able to tell you their special story of the event. And I explained this silence from them like, sure, I got a gun wound, but I’m still alive. And I think of one of these image I will keep will be that silence.

After that, as a Parisian or citizen, the trouble is when you have kids. You can’t imagine your kids could be there. But if you are near, you don’t know what it’s out. You don’t listen to your phone. You have something other to do. After that, the next day, you see the number of message, the number of names. Is it fine? Are the kids OK and all that.

SIEGEL: Do you think it changes the way you think about everyday life in Paris or in this neighborhood?

FONTAINE: No.

SIEGEL: No.

FONTAINE: No, no. And I hope that it will be the same for the Parisian people. Paris is a living city. You can’t imagine there were no football game, no movies, no concerts, no music, no bars. That’s impossible. And you have to keep on having this atmosphere. So we are not afraid.

SIEGEL: Well, Dr. Fontaine, thank you very much for talking with us.

FONTAINE: Au revoir.

SHAPIRO: That’s our colleague Robert Siegel in Paris speaking with Jean-Paul Fontaine, head of the emergency department at Saint Louis Hospital.

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3:34

The Supreme Court has agreed to hear a challenge to a Texas law that requires abortion providers to have admitting privileges at a nearby hospital and requires abortion clinics to have the facilities of an outpatient surgical center.

Transcript

KELLY MCEVERS, HOST:

The U.S. Supreme Court is once again entering the debate over abortion. The court said today it will hear arguments later this term testing the constitutionality of a sweeping abortion law in Texas. If upheld, it would allow the kind of major abortion restrictions not permitted in more than 40 years. NPR legal affairs correspondent, Nina Totenberg, reports.

NINA TOTENBERG, BYLINE: Texas set the gold standard for tough abortion statutes two years ago. And this summer, the Fifth Circuit Court of Appeals, based in New Orleans, upheld the law. The Supreme Court by a 5 to 4 vote temporarily blocked the ruling from going into effect. But if the High Court follows suit, the number of clinics in Texas would drop from the 40 that existed when the law was passed to just nine or 10 clinics in major cities. That would leave some 900,000 women of childbearing age to drive more than 300 miles round-trip to get an abortion. And nationally, it would give the go-ahead to dozens of similar provisions that until now have been blocked by the lower courts. The Texas law has two key provisions. First, it requires that all doctors who perform abortions have admitting privileges at a hospital within 30 miles of where the abortion takes place. But because the complication rate from abortion is so miniscule, most abortion providers cannot meet the minimum number of admittances that hospitals require in order to grant privileges. Second, the law requires that abortion clinics be retrofitted to meet elaborate hospital-grade standards that do not apply to all other outpatient facilities, where procedures like liposuction and colonoscopies take place. The provision also applies to doctors who provide medication abortions, which involve giving patients two pills and sending them home. The state of Texas defends the statute, containing it was enacted to protect women’s health and safety. That assertion is disputed by the American Medical Association, which does not usually take a position in abortion cases, and the American Association of Obstetricians and Gynecologists, as well as other major medical groups. In a brief filed in the case, they contend the law not only fails to enhance safety, it impedes it. The Texas case represents the most comprehensive challenge to the court’s rulings on abortions since 1993, when the justices cut back on their 1973 Roe versus Wade decision and allowed states greater leeway in regulating abortion. Back then, the court said states could try to persuade women not to have an abortion by requiring a 24-hour waiting period and counseling before an abortion. But at the end of the day, the High Court said states may not place an undue burden on a woman’s right to terminate a pregnancy. And on the subject of health care regulation specifically, the court said that unnecessary regulations that present a substantial obstacle to a woman exercising her abortion right amount to an undue burden. The Fifth Circuit in upholding the Texas law said it did not consider a 300-mile roundtrip for nearly a million women of childbearing age to be a substantial burden because that number of women potentially affected was nowhere near a large fraction of the state’s 5.4 million women of childbearing age. It also said that under the Supreme Court’s prior decisions, it was required to defer to the state’s asserted rational justification for the law – protecting women’s health – even if that assertion is not supported by empirical evidence. Nina Totenberg, NPR News, Washington.

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4:28

A street drug made of various chemicals sprayed on tea leaves, grass clippings and other plant material continues to send thousands of people suffering from psychotic episodes and seizures to emergency rooms around the country.

In 2015, calls to poison control regarding the drug already have almost doubled, compared to last year’s total, and health professionals and lawmakers are struggling to keep up with the problem.

Some call the drug K2, or spice. It’s also widely known as “synthetic marijuana,” because the key chemicals in the spray are often man-made versions of cannabinoids, a family of psychoactive substances found in marijuana.

But the ingredients and concentrations used in this street drug vary widely, and it can be very different from marijuana in its effects.

At a drug rehabilitation center a short drive north of Syracuse University, where 52-year-old Edwin Santana has come for treatment, they call the drug “spike.”

Santana, who was born in the Bronx, is a few weeks into his detox program at Syracuse Behavioral Healthcare. A longtime heroin user, he became homeless after multiple run-ins with the law. Then, he says, a couple years ago he developed a problem with spike.

“It was getting out of hand,” Santana says. “I was starting to smoke every day. And you know, spike is a drug I respect, because you don’t know what you’re getting.”

The drug also inspires fear in him.

“Not a little bit of fear. A lot of fear,” he adds.

It’s hard to guess what will happen after you smoke or ingest spike, users and drug enforcement officials say, because the chemists who make it are constantly changing the main ingredients — tweaking a cannabinoid’s chemical structure, or mixing it with other substances entirely, which can change its effects.

“You get stuck when you’re on spike,” Santana says. “And it makes you do all kinds of crazy things, man. I’ve seen people roll around on the floor and stuff like that.” Smoking the drug landed him in the hospital.

Angel Stanley, a psychiatric nurse at the rehab center, ticks off the symptoms she’s seen in patients who have smoked spike: “Auditory hallucinations, visual hallucinations, disorganized thinking, delusional thinking. Paranoia is a big one.”

Many of these patients, she says, expected that smoking spike would be just like smoking regular pot, because the drug was sold as “synthetic marijuana.” The drug first became popular with teens, who were looking for a new way to get high for just a few dollars.

But now, Stanley says, she’s seeing older users, too.

“They’ve gone from using some marijuana in the past, a little bit of alcohol use over the years, and now all of a sudden, they’re in their 50s and they’re addicted to spike,” she says.

Often users are also homeless.

“A lot of people who use it, their reality is pretty bleak, so they use spike to escape that reality,” explains Matthew, who asked that we not use his last name. He just finished an inpatient program at Syracuse Behavioral Healthcare to help him stop using spike and cocaine, and doesn’t want future employers to find out about his past.

“The main thing with spike,” Matthew explains, “is this: It is the cheapest, most effective high in Syracuse right now. Is it the most enjoyable high? Probably not. But it’s the cheapest, hands down.”

The question facing workers at rehab centers and emergency rooms is how to effectively treat users of a drug that’s essentially an unknown mixture.

“We know how to treat an alcoholic,” says Jeremy Klemanski, who heads Syracuse Behavioral Healthcare. “We know how to treat an opiate patient. We know how to treat somebody’s who’s using cocaine. But, when we say we know how to treat somebody who is using synthetics — to a certain extent we do.”

Health professionals faced with such a patient are usually flying blind, Klemanski says. Some types of spike can be detected in drug tests, but not all.

“Until we get to a point where the treatment system has as sophisticated testing as the labs that are inventing and creating these things, we’ll struggle,” he says.

Lawmakers are paying attention. The federal government has permanently banned more than a dozen types of synthetic cannabinoids.

But packets of “spike” and “K2” and “spice” are still sold in many mom-and-pop convenience stores, because they contain versions of cannabinoids not covered by the ban, says Matt Strait of the Drug Enforcement Administration.

“They are in a legal grey area,” Strait explains, “because they’re not specifically named in the statute.”

That keeps makers and dealers of spike one step ahead of state and federal laws. Congress is weighing how to streamline the process of regulating new versions. Meanwhile, the Drug Enforcement Administration has been investigating and temporarily banning some new forms of the drug.

But back in Syracuse, some health professionals and spike users say the government can’t move fast enough to keep up with new varieties hitting the streets.

11:18

Every Thursday night you can find Nathan Fields making the rounds of Baltimore’s red light district, known to locals as The Block.

An outreach worker with the Baltimore City Health Department, Fields, 55, is a welcome sight outside strip clubs like Circus, Club Harem and Jewel Box.

In the early evening before the clubs get busy, he talks with dancers, bouncers and anyone else passing by about preventing drug overdoses and how to stop the spread of HIV and other sexually transmitted diseases.

Later on, he’ll drop into the clubs to check on the dancers who aren’t able to come outside, finding out what they might need.

Fields has credibility on The Block that people higher up in the health department don’t. “I watch him walk down any street in Baltimore city, and people come up to him, and they know that he is there to serve them,” says his boss, Health Commissioner Dr. Leana Wen.

It wasn’t always so easy.

Seven years ago, Fields was working with the city’s needle exchange program. After a spate of drug overdoses at the strip clubs, the health department brought its needle exchange van to The Block one night a week.

There were hardly any takers at first. People were skeptical.

“They were under the impression that we were giving their information to the police,” Fields says. “So that’s when I came on board. You know, I’m a great negotiator. Donald Trump can’t beat me out.”

Fields started with the bouncers. Though a Baltimore native, Fields is a huge fan of the New England Patriots and would often show up in head-to-toe Pats gear. The Baltimore Ravens-loving bouncers hated his get-up, and the football rivalry broke the ice.

Eventually, the sports talk turned more personal. Fields learned that some of the men had girlfriends dancing in the clubs who needed help – everything from condoms to drug treatment. Some women needed copies of birth certificates and other forms of ID in order to get into treatment.

Fields leaned on colleagues in the health department to get the problems solved.

Soon, the clubs doors opened for him. Once inside, Fields saw people needed even more.

“We went into one club, and there were three girls in different stages of pregnancy that were still dancing,” he recalls. “We started running it up the chain: ‘Hey, we need health care down here — reproductive health care.’ “

So in addition to the needle exchange van, the city brought a second van to The Block, one with an exam table and a nurse. Now, every Thursday night, health workers offer needles for exchange, training in the anti-overdose drug naloxone, HIV tests, reproductive health exams, pregnancy tests, flu shots and more other basic health care services.

Fields treats each person coming into the vans like family. He remembers babies and boyfriends and other small details of people’s lives.

“The Block is like living,” he says. “These relationships, you’ve got to keep them flourishing.”

Quietly, Fields also hands out pamphlets with information about drug treatment. Every so often, he’ll mention a new option and encourage someone to check it out. But, it’s a soft sell. He doesn’t want to drive people away.

“I don’t beat a person over the head,” he says. “I never badger anybody for fear of them looking at me like, ‘Oh, he’s an elitist. He forgot where he came from.’ I could never forget where I come from.”

For nearly 20 years, Fields was a heroin addict. He sold drugs to support his habit and did time in the Baltimore City jail. “I was a predator to my community,” he says.

After getting clean in the mid-1990s, he got a job as a recovery counselor. In 2004, he went to work with the Baltimore City Health Department. “The job just gives me a sense that I’m helping to build back what I tore down,” he says. “You know, every time I can get somebody to even thinking different or even consider going into treatment, I feel as though I had a successful day.”

In spite of those small victories, it’s been a particularly difficult year for Baltimore and for Nathan Fields.

Over Memorial Day weekend, the outbreak of violence following the death of Freddie Gray claimed the life of his youngest child, 20-year-old Hassan Fields. He was shot and killed on the west side of Baltimore. His death remains an open case.

Nathan Fields struggles to understand how this could happen to him, given all he’s done for the community. He had thoughts of reverting to the person he once was. Then, he came to a quieter place.

“I’m sorry. I can’t let this destroy me,” he says. “I can’t let this turn what my thoughts are about human nature — some good people with some bad people. I believe the bad people have a little bit of good in them too. It’s just got to come out.”

Thinking about Hassan’s death has led him to reflect on his own past.

“I just have to look back on myself and say, I’ve caused pain. No, I’ve never done anything as violent as that, but I’ve got to keep working. I can cherish his memory, I sit down, I look at his picture and think about it, and it just makes me work harder.”

NPR and All Things Considered will continue reporting from Baltimore in the coming months, checking in with Leana Wen and her team. Stay tuned for future stories.