Coming To

Somebody in the media contacted me and wants to film a segment about the effects of Narcan. My recent OP/ED in The Providence Journal warned against widespread distribution of the drug, which in my opinion will serve to take the fear of overdosing away from those vulnerable to addiction and lead to more deaths than lives saved. It is only my opinion, and I’ve been wrong before, but anyway, here’s something about overdosing and responding:

From the book, Rescuing Providence, (Paladin Press, 2007)

addictionI keyed the mike on the truck radio. “Rescue 1 is in service.” We were at the mercy of the dispatchers. Before we made it back to the station, the truck radio came to life.

0840 hrs. (8:40 a.m.)

“Rescue 1 and Engine 9, a still alarm.” cracked the radio.
When somebody picks up the phone and calls the fire department it is called a still alarm. A box alarm means a mechanized alarm has been activated, a still box usually indicates there is a fire.
“Rescue 1 and Engine 9, respond to the corner of Wickenden and Benefit Streets in a silver Saab for a possible overdose.”
“Rescue 1 on the way,” I said into the mike.
We headed toward the East Side, about four miles from Allen’s Avenue. Rescue 5 from the North Main Street station should have been first due there but they must have been on another call. When one rescue is busy, the next closest one is called. Sometimes things get crazy and the closest rescue is three towns away.
The East Side of Providence has a distinct personality, different from the rest of the city in a lot of ways; money, and lots of it being the biggest. Brown University dominates the area. Many of the historic homes that line the residential streets are owned by the university and rented to students, professors and support staff. While contributing greatly to the city’s cultural and academic status, the college contributes next to nothing to the tax base.
We drove over the Point Street Bridge toward Wickenden Street. Engine 9 was already there, no silver Saab in sight. The officer in charge of Engine 9 signaled with a shrug of his shoulders, the universal communication. This happens a lot. Somebody takes too many drugs, overdoses and becomes unresponsive, their friends panic and call for help, then realize the trouble they have brought upon themselves and drive away, hoping the problem goes away. Sometimes it does, sometimes not. I have found numerous addicts dead where their friends left them.
I informed the dispatchers through a radio transmission, “Rescue 1 to fire alarm, nobody on scene at Brook and Wickenden, we’re going to look around the area.”
We drove up Wickenden, the street was full of people even at this early hour. Antique shops displayed their wares in store windows, restaurants were full with the breakfast crowd and traffic had picked up. A homeless man stood at the end of a highway off ramp holding a sign saying “Homeless Vietnam Vet.” Some cars stopped and put something in the can he held. A few hours later he cashed his earnings in at a local package store. Later still one of the city’s rescues responded to the area to help a man found lying in the street. They found the “Homeless Vietnam Vet” drunk and hostile. He was taken to an Emergency Room for treatment.
The air was crisp; early spring in New England doesn’t offer much relief from winters’ grasp, yet after months of bitter cold, a forty-five degree day on a sun filled morning fills the most jaded pessimist with hopes of warmth. A brave few drank their coffee while sitting at sidewalk tables the coffee shops provide, warming their hands with steam rising from their cups. As the temperature rose, the tables filled.
On the way back to the station I spotted a silver Saab stopped in an intersection. The passenger seat occupant was kneeling backwards on the seat leaning into the back. His pants had drooped, exposing half of his ass.
“Mike, look, someone is smiling at you!” I said, pointing at the car. He spotted the buttocks.
Grinning, he said, “I thought the moon was gone for the day.”
The car pulled behind us, horn blaring as we made our way onto the Point Street Bridge. I brought the radio to life.
to the car. I saw a “Rescue 1 to fire alarm, we have the overdose, have Engine 9 meet us at Point and Richmond.
“Engine 9 received.”
The car followed us over the bridge and into a parking lot at Point and Richmond. I got out and walked man leaning over the front seat, his pants worn gangsta’ style has slipped to his knees. He was trying to help a young girl in the back. She was barely breathing, her skin ashen.
“What’s going on?” I asked the driver. I put on some rubber gloves, the pale purple latex free material stretching over my hands, giving me minimal protection should I be exposed to bodily fluids. Slowly, the rest of the crew followed suit.
“I don’t know, she just stopped breathing,” he responded.
The man was reluctant to admit to illegal drug use, but saw the seriousness of the situation. The girl in the back of the car was in respiratory distress. She had overdosed, and would die in minutes without intervention. With help from the three members of Engine 9 we pulled the unconscious girl from the rear of the Saab and into the back of the rescue. As soon as we were done, I saw the silver Saab speed away.
I knew that the other firefighters had been through this ritual numerous times, and I imagine the victim has as well. Without a word from me, the girl is placed on high flow oxygen, a firefighter assisting ventilations with a device called a bag-valve mask. Her vital signs were assessed and an IV was started. While the crew did their thing, I drew up some Narcan, which counteracts the effects of narcotics. It is our most utilized drug.
“Pulsox eighty-two %, Blood pressure 60/40, respiration’s 6, she’s in respiratory arrest,” said Mike. The syringe was ready.
“Watch out,” I said to the guys. Sometimes the patient vomits violently when they regain consciousness. Narcan gives instant withdrawal.
I pinched off the line, pushed the drug then flushed. The medication was on the way. The five of us sat back and waited Slowly her color returned and she began breathing on her own.
“You are in a rescue with the fire department,” I told her as she woke up. Her look of confusion turned into anger as she realized what was going on.
“What happened, where are my friends?” she asked.
Mark, one of the firefighters from Engine 9 let her have it.
“You and your asshole junkie friends were shooting some shit, you did too much and they left you for dead. If we didn’t come along when we did instead of asking us what’s going on, the Medical Examiner would be cutting open your chest looking for the cause of death. Have a nice day.” With that rebuke, the crew of Engine 9 left the truck and took off.
I usually don’t get mad at the drug-addicted patients we care for. I understand addiction. The girl in my care was a living, breathing twenty-six year old. One wrong turn and she would have been dead in the back of an old Saab. She looked as though she lived a tough life; her skin was pale and blotched, her hair damaged by too many treatments. She may have been pretty at one time, and could be again. She was slightly overweight, not from living well, probably from abusing alcohol. If she continues on this path the extra weight will slowly fade and she will become haggard. For now, she has youth on her side. She was lucky. Sometime we arrive too late, either they took too many drugs, or it was just their time and all we can do isn’t enough. Sometimes the overdose victims that didn’t make it reappear in my mind, their faces still and pale with the grip of death as we work on them, trying to squeeze more life out of their tired bodies. We do our best for them, breathe for them by filling their lungs with oxygen, pump their hearts for them and fill their veins with drugs to counteract the poison they’ve ingested. Their peaceful ride that started with a little heroin and turned drastically wrong ends in our truck, and they never know it. Sometimes they make it back, sometimes not.
I looked at the girl sitting on the stretcher in the back of my truck and marveled at the miracle of life. I was quietly thankful I don’t have to add her face to the others that haunt my memories.
“How are you feeling?” I asked.
“Like an idiot. What happened to me?”
“You were with some friends. They say you overdosed on heroin.”
“I’d been clean for two and a half months. I hurt my back at work and got a prescription for Vicodin. I guess that was a big mistake.” She said.
“You were lucky, you could have died. Almost did actually. Don’t give up on yourself; sometimes something like this can be what you need to keep you from having another relapse.”
“It’s so hard.”
“I know.”
She was back to normal for now, but the narcan has a short life and would be out of her system soon. We transported her to the ER for observation. There was a chance that she could go back into respiratory arrest. After checking her in at the triage desk, I went back to the treatment area to wash my hands. Two sinks located at the center of the room gave a great vantage point while washing. Patients filled the twenty ten-by-six foot treatment areas, separated only by curtains. Doctors and nurses converged in the middle of the room with the treatment areas circling the perimeter. The patients have nothing to do while waiting to be treated so the center of the room becomes something like a stage, the doctors and nurses, and sometimes rescue guys providing entertainment for the bored audience.
There is not an overabundance of privacy in the ER. While drying my hands I saw another addict waving at me. I brought her here last week because she was complaining of abdominal pain. She was living in a halfway house and working for the Salvation Army. While at work she called for a rescue because of her pain. While transporting her she told me that she had been clean for six months and her life was really going well. She needed to get to the hospital because her stomach hurt so badly that she needed painkillers. I tried to talk her out of her plan, knowing that she was fooling herself into thinking a few harmless prescription painkillers wouldn’t set her back. My talk didn’t do much good. She told me she was here because she overdosed on heroin yesterday and got kicked out of her treatment program. Hands clean, I headed back to the truck

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