Fun And Games · Overdoses · Protect and Serve

Commercial Quantities of Meds

Thanks to Aesop (https://raconteurreport.blogspot.com/) for the inspiration for this post. See his series of posts, July 10 2019 to July 12, 2019. I write this on 12 July 2019. He may have more: it appears that he is just warming up!

So, TINS©, TIWFDASL© as a midlevel in a county lock up. Our sheriff had a policy of no drugs (I.e, no euphoriants narcotics or sleepers) for inmates. I was told that the rationale was that he did not want inmates to “sleep their sentences away”. Cool story, there were very few occasions wherein I would consider prescribing scheduled meds (euphoriants, narcotics) anyhow.

I was working part time. One morning I came in, and an offecer invited me to step into his office. He showed me a dispenser pack of what looked to be 140 or more tablets, labeled “Methadone 10 mg”. The administration instructions read “take 9 tablets daily”. Holy cow! That’s 90 mg of methadone, equal in pain killing (or sedating) effect to around 1 000 mg of morphine every day. ONE THOUSAND MILLIGRAMS of morphine equivalent, every day! The medical history form related that this had been prescribed for debilitating arthritis.

The officer noted the department’s “No Narcotics” policy, and asked me, the medical authority (Hah!) present, for an opinion. I thought that placing this gentleman in the “detox”/observation cell, and obtaining and recording vitals every hour for the first 24 hours sounded prudent. I also provided a checklist of concerning symptoms to watch or. I provided my cell phone number, and directed that, if certain parameters of vitals or observation were exceeded, send him to ED by ambulance immediately. If any grey area, phone me at ny time of day or night.

So, the officers recorded vitals and made “nurse’s notes” on their guest. I came in early the next day, read the noted, and re assessed the gentleman myself. All nominal, no alarming findings. We repeated this process, now every 4 hours, and, again, the next day, I arrived early and re-re-assessed the inmate. Same nominal vitals, same unremarkable exam. This did not seem to all fit together as it had been presented.

Another day, another 24 hours of vitals and “nurse’s notes”, another benign exam.

After several days of this, the jail command suggested that , with nearly a week of normal vitals and normal exams, perhaps our guest could be moved into general population? It seemed alright to do do, and I seconded their initiative.

So, after nearly a week of no methadone, nearly a week of no abstinence symptoms, my attention wandered to other topics. One morning I arrived, and an officer beckoned me into his office. “Hey, I thought you’d want to see this!”, was his opening conversational gambit.

It turns out that there are surveillance camera throughout the jail. (Who knew?). One had captured the methadone-for-debilitating-arthritis fellow getting into an altercation with another inmate, and whupping same. That’s correct: the “debilitating arthritis” inmate, delivered a whupping onto the person of another inmate.

The officer turned to me, and observed, “I am beginning to think that that prescription is rather more of a commercial opportunity, instead of a medical intervention!”

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Overdoses

Marielle and The Upstairs Overdose.

So, TINS ©, TIWFDASL ©. This one time, Marielle and I were working Medic 7. Now, at this point, I’d been working the road a spell, and had, approximately, 2/3 of a clue. So, we caught a run for an overdose, and off we went.

It was my day to drive, and Marielle’s day to medic, so we arrived at the scene, notified dispatch, and beat upon the door, announcing ourselves. “Fire Department!” One of the occupants thundered down the stairs, and announced back up the stairs: “The ‘Mergency Mutha Fuckas is here!” Our host bade us follow. We followed.

Near the top of the stairs lay a gentleman, who appeared nearly completely disinterested in the goings on around him. Everybody else there appeared, themselves, disinterested in the named patient, but there were no threatening nonverbals, so, whatever, another day in Da City.

Our new friend was breathing, sort of. For bonus points, he did, indeed, posses a pulse, and was perfusing nearly all of his organs, as reflected in the presence and regularity of his radial (wrist) pulse. I was entirely happy to place this gentleman upon a stretcher, trot downstairs, and meander off to the hospital of my partner’s choice, but, NNOOOOO!, she felt the burning need to awaken him right there. She applied the BVM, and commenced to resuscitatin’.

Now, among my (small) fund of clue, was the insight that these citizens, who had expressly called the 911 EMERGENCY phone number, and requested an EMERGENCY ambulance, might, somehow, have determined that they were confronted with an EMERGENCY, and likely would be skeptical that said EMERGENCY could be resolved, satisfactorily, in their living room. Indeed, clinically, it occurred to me that, should Mr. Sleepy awaken, that his wakefulness likely had a half life shorter, in clinically significant terms, than the half life of his narcotic of choice. In either event, if did not seem that “customer satisfaction”, clinically satisfactory outcomes, or abbreviating our dwell time here, well within the potential hornets’ nest, would be promoted by awakening this soul, in the living room, and discussing with him his unhappiness at his pharmacologically induced bliss, being interrupted. Then, of course, there was the back injury eliciting potential of maneuvering an irate, dystaxic, nearly overdosed adult male down the stairs, without dropping him. I suggested as much.

Uh, Marielle? Wouldn’t this be simpler, in the truck?”

She looked up at me. “Stretcher Ape, I’ve brought half a dozen of them back this way!”

Unspoken was the Paul Harvey Moment. As in, what was The Rest Of The Story? Like, once you had, indeed, awakened this soul, and then had to implement a follow on plan of care. Would this newly reanimated patient, breathing spontaneously, feel motivated to deliver a soliloquy on your mother’s poor life choices and unusual tastes in romantic partner(s)? Or, perhaps, seek to kinetically provide dissuasion of repeating this Dreamus Interruptus upon himself, or another similarly situated child of God? Or, once the recently dreaming person was woke, might the companions now take an interest in his life circumstances, and feel that, notwithstanding his protestations to the contrary, you HAD to “snatch him on up, and carry him on down to the hossipal!”? Tangential to that, just how do you negotiate with 4-8 angry inebriates? (Please provide a syllabus of your tutorial in the comments!)

I realize that this was not a Teachable Moment for her, nor for me, and handed her the handie talkie, and loped down the stairs in hopes of moving him before he became too animated and restless.

Sigh.

Of course, he WAS animated, and WAS restless. On the way down the stairs, it was a near thing whether he would roll off the stretcher, one, the other, or both of us would tweak our back(s), or some combination of the above.

Well, that day The Patron Saint Of Emergency Motherfuckers smiled upon us, and Mr Formerly Somnolent was safely tucked away on our stretcher, in the ambulance, and he was delivered to TSBTCIDC. After a brief prayer at the Altar of The Ghawd Narcan, he dashed out of the department, before Marielle had completed her trip sheet.

And THAT, boys and girls, is why I am blessed to be doing Ghawd’s Work, fighting Disease and Saving Lives.

Life in Da City! · Overdoses

War Story The First

27 July 2017.

Taking an Overdose to The Second Best Trauma Hospital in Da City (SBTHIDC): “Breathe!”

Let’s see if I understand this “blog” thing. In addition, I suppose we’ll see if I can translate my Tales Of The Dark Side narrative style to a screen. Let me know, OK?

So, this is No Shit ©, There I was, Fighting Disease and Saving Lives In Da Big City ©. As was not uncommon at that point in Da City’s history, EMS received a call for an overdose. Shocker, right? Further compounding the shock, my partner, Doug (Not His Real Name), and I caught that run. So, fleet of accelerator and steely eyed for Clovers in their natural habitat {(a) on the road, and (b) in front, or on a collision course with the Battlestar Galactica that was a Big City Ambulance}, we arrived on the scene.

In some regards, heroin overdoses were rather adult-adult transactions, with a minimum (generally) of drama and hidden agendas. It typically ran along the lines of “He’s too high, he’s fucking up our party, y’all snatch him on up, and carry him on down to the hospital!” (translated from Street into more easily transcribed neo-English). Conveniently enough, said action plan would minimize our time on scene, with a couple of beneficial effects. First, (OF COURSE!) was expeditious transport of this ill soul to higher medical care, and a life changing resuscitation courtesy of The Ghawd Narcan, and, secondly, enabling my partner and I to elope from the free fire zone that such a scene had potential to develop into, and do so in a time frame calculated to have us safely away before said fireworks unfolded.

Well, on this particular day, Doug was driving and I was medic-ing. We announced ourselves (“Fire Department!”), were admitted, and found Mr. Hypoxic inert, supine, but, par miracle’!, breathing. Well, sorta. He was breathing every 15 seconds or so. Doug handed me the BVM*, and skedaddled to the truck to retrieve the cot.

While I waited, I noted that Mr. Hypoxic seemed to move air OK, when he remembered that this was sorta important. I wondered if reminding him of this little chore would be productive, and so bellowed “BREATHE!” into his ear.

He breathed.

I wondered if this was a “one of”, or a replicable experiment in assisted respirations, and so, again, bellowed “BREATHE!” into his ear.

Again, he breathed.

I love it when a random thought produces an actionable plan.

When Doug returned with the pole stretcher, we rolled Mr. Hypoxic onto it and trundled out into the street, onto the cot, and into the ambulance, me hollering, “Breathe!” every 5-10 seconds or so. He continued to breathe.

Doug radioed dispatch, advising them of our priority two transport to The Second Best Trauma Hospital in Da City (SBTHIDC), and then dialed up said SBTHIDBC on the hospital alert radio (in those days called “the HEARN”, for Hospital Emergency Alert Radio Network, and on VHF. Ah, yes! The days before 800 mhz!). He supplied the abbreviated version of Mr. Hypoxic’s story, and then focused on driving a near-code through city streets. (I did mention The Clovers, right? They’re everywhere!)

Once we arrived, Doug and I debussed Mr. Hypoxic, and we strolled into the triage area of TSBTHIDBC, where Mallory the triage nurse, and my then-current girlfriend, awaited us. She looked puzzled when I wasn’t ventilating my patient, and that puzzlement only grew when I commanded, “BREATHE!”, for, like, the 1200th time. He breathed, again, of course.

So, what happens when you don’t yell at him like that?”

Uh, he kinda doesn’t breathe……BREATHE!…..See?”

She looked unpuzzled. “Uh-huh…(pivot, poke head into resident’s room) I need a doctor in here, right stat like!” (pivot to me and Doug) “Put him in the trauma room!”

Some people don’t really seem to appreciate whimsy, very much.

*BVM: bag-valve-mask. A device for introducing room air into the lungs of a nonbreathing person, by compressing a bag, pushing the air from that bag through a one way valve into the mouth (and therefore airway) of said person via a mask. Releasing the bag allows it to self inflate, and the patient to exhale, so you can repeat the whole process again. And again. And again…