Between the Lines of Care

I have gone back and forth about writing publicly for a long time. I have written plenty in private, in charts, in policy drafts, in meeting notes, and in the quiet margins of my own thinking. What has held me back has never been a lack of things to say, but a deep awareness of responsibility. I work with people whose lives are often reduced to headlines, soundbites, or assumptions, and I take confidentiality and respect seriously. Stories are powerful, and once they leave your hands, you no longer control how they are understood.

And yet, I feel a growing pull to start sharing what I see.

I have spent the past decade working across housing, outreach, supervised consumption services,  inpatient psychiatry, tertiary care, pharmacy, private psychotherapy, and local government. I have worked inside systems and alongside them. I have sat at policy tables and on concrete floors. I have supported people in moments of crisis and watched them navigate the long, unglamorous work of surviving day to day. What ties all of this together is not ideology, but proximity.

I am also, by nature, an observer. I pay attention to patterns, to energy, to what is said and what is avoided. I am interested in why people behave the way they do, whether they are clients, colleagues, administrators, or well-intentioned members of the public. I do not believe people are simply good or bad. I believe they are shaped by their experiences, their environments, and the stories they have learned to tell themselves.

Much of my work exists in the space between harm reduction and accountability, between compassion and challenge. Over the years, I have watched stigma around substance use be rightfully named and pushed back against. Language has shifted. Overdose has been reframed as poisoning. Services have expanded in an effort to keep people alive in the face of a toxic drug supply. All of that matters.

What I also see, every day, is complexity that does not fit neatly into any single narrative.

I see people who use drugs to escape pain, and people who seek out the most potent supply available. I see people desperate for housing, and people who are housed but deeply unwell. I see systems stretched thin, and I see boundaries put in place not to punish, but to prevent harm. I see how progress stalls when we stop asking hard questions, or when only one lens is allowed to inform decisions that affect many lives.

This blog is not about quick fixes or virtue signaling. It is not about exposing individuals or simplifying problems that are anything but simple. It is about sharing observations from the ground, naming uncomfortable realities, and exploring where our well-meaning efforts sometimes fall short.

I want to write about the gaps between policy and practice, about what actually helps and what unintentionally harms, about the difference between doing something and doing something that works. I want to write about boundaries, about accountability, about why care without structure can backfire, and why challenge, when done properly, is not cruelty.

Mostly, I want to write to add nuance to conversations that have become increasingly polarized. People deserve care that is thoughtful, skilled, and honest. They deserve systems that are evaluated, not just defended. And they deserve to be seen as whole human beings, capable of change, not frozen in the roles we assign them.

I am starting here, not because I have all the answers, but because I have been paying attention for a long time.