The man is trembling, sitting on the bed in the spare motel room down by the highway. Sometimes, these rooms are filled with the patient’s worldly belongings, but this room seems to only have the bed, a dresser, a chair and the TV. The man is in his late fifties, a portly man with white hair and liver spots on his hands. The Spanish woman in the room with him is of an indeterminate age. She wears a pink tank top and grey yoga pants with flip flops, even though it is cold and blustery out. She is the one who called. When I say she is of indeterminate age, I mean she could be anywhere from 30-50. It appears she is missing a fair number of teeth and her arms lack the tone of a younger woman. While he talks to us, she walks behind him and mimics a man shooting heroin. He says he is a diabetic and hasn't eaten or taken his insulin for a couple days. He says he got robbed last night and has no money. He is going to have some funds transferred up to him tomorrow. We check his sugar and it is 485. The normal range is 80-120. 485 is in the danger zone. If he doesn't take insulin soon, he could develop diabetic ketoacidosis and go into a coma. He wants to refuse, but we keep trying to persuade him to go. "No, no, I'm fine," he says. "I'll get some insulin tomorrow. I'm fine, really."
He doesn't look fine. “Listen, I say. "Look around this room. Do you want to die in this room? You have a couple hours and then your mind is going to get really fuzzy. You may fall asleep. In your sleep you'll lapse into a coma and we'll be here in the morning except you'll be long gone, only your body will be here. If the nice lady here is with you, she may notice you are awfully cold, and we wouldn't her to have to go through that would we?"
"You gotta go honey. I'll pay for your insulin," the woman says. "We have to take care of you."
His eyes blink and he looks from side to side. "Okay," he says, "I'll go."
Outside the room as we walk him to the stretcher, the woman tugs my sleeve and says something about his name. I take out a pen and pad and am prepared for her to tell me to his name and date of birth. "No, no,” she says. "I need to know what his name is. I just met him yesterday. They won't let me see him at the hospital unless I know his name."
Okay then.; I get his name for her.; She thanks me and says she'll be down in a little while. She sticks her head in the back of the ambulance before we shut the door and says, "Tell them, I'm your granddaughter."
Granddaughter, I am thinking, with the miles on her face she could easily have been his wife.
On the way to the hospital, I put in an IV line and start running in fluid. He finally admits to me that he did 20 bags of heroin last night. He says his wife threw him out of his home and he has been living in the hotel for the last week. I asked him how he got robbed, but he doesn't want to talk about it. I tell him he needs to have narcan with him if he is going to use heroin. I explain where he can get it. I give the whole rap about not using alone and doing tester shots.
When we get him in his ED room, he is very thankful to us. He makes eye contact as he shakes our hands. I can tell he is worried about his physical shape.
"They'll take good care of you here," I say.
At the triage desk, I tell nurse the story. I think about leaving out the part about the heroin, but I don't.
"I thought he was in alcohol withdrawal at first," I say, “but he denied it. Of course, he also denied drug use, but then copped to doing 20 bags last night."
"Winner," she says, while typing her notes in the computer, all the while on hold with the ICU about a patient she is trying to get transferred up there.
The next Sunday I am working with a different EMT as my partner is out. We are talking about the heroin epidemic and he tells me he did a presumption at the same motel by the highway on Saturday afternoon. Late 50ish man, just released from the hospital. Cops found a syringe and were treating it like a crime scene. They didn't find any heroin bags -- they said it looked like the room aside from the syringe which they found under the bed, had been cleaned before they got there. The man's wallet was empty. I queried about the room and the patient and it was the same man.
My partner mentions the patient was in an odd position. Found on the ground in a praying position against the bed.
I tell him that this actually is a common position for opioid overdose deaths to be found in.
A couple years back I did a call that really disturbed me. At eleven in the morning at a motel in town, a maid finds the door unlocked and goes in the room and screams. We arrive to find a naked man on the floor, his butt up in the air facing us. He is riggored cold, resting on all fours, stiff as can be, his head turned to the side.
On the table by the bed stand is a mobile phone that is vibrating. I look at it. Full of messages. "Honey are you okay? Honey when are you coming home? Is everything alright. I am worried."
My partners and I discuss our theories of how he may have died. Based on other evidence in the room, we speculate that he might have been having anal sex when he either suffocated or his neck snapped. We guess his partner at some point noticed he was dead and fled the scene without calling anyone; I run my six second strip of asystole. Presume him dead.
I kept expecting to see a report of the murder in the paper but there was nothing. The security footage from the hotel ought to have captured who was there with him. How could anyone leave another human being like that? I read nothing in the papers.
Several years later, I am attending a seminar on fentanyl and I find myself looking at a slide of a dead man's bottom up in the air.
The very same man.
I learn that he died of an opioid overdose. And that this praying frog position is a common one when people collapse from opioid overdose. We are shown eight more photos of dead people in similar positions, all are opioid deaths.
I try to picture now the man we took to the hospital with the high blood sugar. He gets his insulin, gets a wire transfer from his bank, and goes back to the hotel with the woman of indeterminate age. Either she or he buys the heroin. A half a stack. Party time. They shoot up, the only problem is the bags of heroin are not heroin, but fentanyl; One of the bags contains a hotspot, a clump of fentanyl. He injects and a moment later his breathing slowing, he goes dark and slowly slumps forward to his knees, his arms out before him.
When his friend awakes from her prolonged nod, she sees him there. She gives him a little shake, but he is already gone. She knows this because this is not the first man she has been with who has had heroin issues. She carefully takes the remaining bags of heroin, any paraphernalia, and then slips his wallet out of his pocket, takes the remaining green and puts the wallet back. She lets herself out into the night.
I wonder if she remembers his name.
I wonder how many other people are out there who have been in similar situations, finding; a companion dead, and then robbing them and slipping out the door.
It is a brutal world.
