5 Questions for Chris Zebley, Nurse Practitioner

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Chris Zebley
Job: Nurse Practitioner
Time with BCI: 4 years

1. What is your job at BCI?
I’m a board certified adult nurse practitioner and HIV specialist. I actually work for Christiana Care Health System. My department is the Community HIV Program. I collaborate with Dr. Szabo, who’s an infectious disease physician, and we run an HIV clinic here at the Lancaster site every Tuesday morning. The whole idea was to allow a one stop shop to get your mental health, your substance abuse treatment, and if you’re HIV positive, to get your HIV medical care under one roof. We call it “nested services.”

2. What services do you provide to BCI clients?
A nurse practitioner can treat acute and chronic illnesses throughout the lifespan, along with having prescribing privileges. I can practice independently, whereas a physician assistant must have supervision.

The services I provide include case management and treating acute illnesses. The clients who come in to see me generally present with maybe a tooth abscess, bronchitis, a skin infection, sprains or strains. The client may be unable to see their primary care physician, or worse yet, because of their addiction, might not see it to be a priority to take care of their health. I make referrals to dentists, PCP’s, foot and eye appointments. On occasion I’ll refer them to the ER, and I can call people that I know in the emergency room. There’s many, many things that I’ve done for people as part of referrals and such.

In my HIV clinic I have around 35 clients. I get referrals from my department, from NSAFE upstairs, Outreach, or by word of mouth. The medical management of these clients is very intense, because the majority have “advanced disease,” so it’s my duty to assist them in maintaining optimal health. We treat patients with very, very heavy co-morbid conditions - Hepatitis C, heart failure, vascular problems. I may do pill planners to aid in the adherence of their medicines, treat any acute illnesses that may arise, and also provide health maintenance by making sure they have their necessary screenings, such as a colonoscopy, Pap smear, or mammogram.

On Fridays I usually do annual physicals for Dr. Glick, as well as intake physicals for methadone, Suboxone or Revia. I do part time work with the Medical Maintenance Level 2 program at Newark where the people come in once a month for their methadone.

I’ll be working hand in hand with Outreach on Safety Net Services. I’ll be providing case management, HIV medical care, and psychotropic medication management.

3. What drew you into a career in the addiction treatment field?
This is something that I grew into. In the hospital we’d always have people that were disadvantaged, and stigmatized in society - IV drug users, the homeless, HIV infected individuals. These were real people with real illnesses who never asked for anything, and were very appreciative of the care they received. And I always thought, I’d like to work with these individuals, because they had a lot of needs, simple needs, that could be fulfilled.

This was a job posting with Christiana Care. I was working in employee health as a nurse practitioner at the time. I happened to see this posting, and it was for the Riverfront. An HIV clinic, but you would be working in a methadone clinic. I didn’t even know what a methadone clinic was, really. I didn’t realize how many people actually go to these places.

There were many people telling me, “You’re not gonna like it. You’re gonna regret taking that job.” You can’t go on hearsay. If I’d really listened to people, I might not be here today. I would not even have taken the position. I had to experience that for myself. And from day one, it was fine, it was nothing like what people told me it was going to be. I enjoyed it from day one. Because we’re able to meet the people’s needs, that’s a big thing.

4. If you had $30,000 to donate to BCI, what would you do with it?
Certainly the Outreach. They’re the ones that get people in here. They do so much good, whether it’s the food closet, or the clothes closet, and to help for that needle exchange to grow. As we see the research and the data come down, I’m sure the federal government and the state will allow us to expand. But that’s been a plus here for Brandywine Counseling. I’ve done intakes and I asked them, “Well, how did you know to come here?” And they said, “Well, it was the needle exchange.” That’s an indicator that it’s working.

I’d also open more transitional housing, because recently the CDC announced that homelessness is now the single largest contributor to HIV infectivity.

5. What is it like to work with these clients?
You’ve really got to like people in their worst condition, and in their good condition. And that’s what nursing is about, the human response to illness.

These people are survivors. They’re very, very smart. They could be executives if they could put their mind to more positive things. Some of these people could have been very, very wealthy and rich, the way they’ve been able to hustle, to get money for drugs. People have written about, if we could only find out how these people, the disenfranchised, tick, and how they’ve been able to survive these harsh illnesses, without a lot of medicine, then we could treat a lot of other illnesses cost effectively without using medications.

My first patient that I ever saw [now] comes here for take-homes twice a week, so they’ve been drug free for almost two years. I have them come in for support, and they’re part of my HIV clinic too. To me that’s a success story, because they know that they can come in at any time, whether they can see their counselor or not. To really see this person get out of the deepest, darkest abyss, where they were constantly using, and she’s not now, so she’ll continue in her recovery. That was pretty cool, to actually see that.