Emerald City

She took the Dilaudid pill a friend offered her twelve years ago when she was sixteen.  Her sister had recently died and her young life, filled with depression and anxiety, had lost its only source of light.  The pill made her feel well in a way she had never felt before.  She liked who she was when she was on opioids. She had friends. She felt joy again.  Four years later she tried heroin for the first time because it was so cheaper and more accessible.  Two years later she graduated to injecting.  She’s been to rehab five times with no success. She’s tried methadone and suboxone.  No luck.  She is on Vivitrol now, but as the monthly shot wanes, she always finds her way back to the city.  She injects herself with heroin because it soothes her anxiety and cushions her in a cloud of calm.  She injects cocaine because it makes her feel invincible.

The guy she was with in the hotel room called 911 when he came out of the bathroom and found her unresponsive on the carpet with the two syringes on the bureau and the torn heroin bags branded “Emerald City” and the small plastic bag with some cocaine powder still in it.  

She was blue and agonal with vomit on the rug next to her.  With some stimulation, bagging and a small titrated amount of naloxone, we brought her around.  She didn’t want to go to the hospital at first, but we convinced her of the need to be evaluated.  Her heart was racing in the 140’s and her oxygen saturation was only in the high 80’s.  We were concerned she may have aspirated.

The now silent man fetched her purse and slippers and we put them on the back of the stretcher.  With a blanket I covered up her tattooed back and shoulders, but not before complimenting her on her artwork.  The artist had drawn a magnificent mountain top with elaborate etchings of trees, eagles, deer, and stars, along with the words: “The journey to the top is my soul.”

This is the third time she has overdosed, but the first in three years.  I give her my harm reduction talk about the dangers of fentanyl, how it mixes poorly so you never know how much you are actually getting in each $3 bag.  None, a regular dose or a lethal one.  It was a good she was not alone.

We talk more. She answers my question about how she got started, and she tells why it is so hard to quit. When I ask her who the man in the room was, she just shrugs.  Some guy.  I get her demographics.  She lives in a small town forty minutes from the city.  She asks if she has to give me her emergency contact.

“No,” I say.  “Not if you don’t want to give it.”

“I don’t want my parents to know.”

“They don’t have to.  It’s your choice.”

“I don’t want them to lose faith in me.”

I ask her about her relationship with them and she begins crying.  “They love me,” she says.

She tells me how supportive of her they have been, how much they care for her and want her to win her battle.

At the hospital, I tell the girl’s story to the nurse but the nurse just rolls her eyes.  It is busy in the ER and she has no time beyond a basic report.

I wonder where the girl is tonight.  Is she home with her parents?  What will they think when she asks to go out?  Will she just walk the quiet small town streets, struggling for the strength to stay the sober course, to keep her journey on the straight and narrow.   Or is she back here in the city, at another hotel with a nameless man?  The needle in her arm, the heroin easing her skittishness, keeping the darkness at bay, the cocaine rush making her feel invincible — up on the mountaintop now, her soul dancing under the stars? 

.

Hoop Dreams

 

I am sixty-three years old, six foot eight.  I used to be six nine and a half, but life has beaten me down.  Over thirty years in EMS has flattened my spine to the point that some days I can barely feel my legs.  I have no business being back on a basketball court, but I eagerly lace up my new Lou Williams’s size 14s, put on my Washington Generals tank top and head to the park where I will play a pickup game with men half and even one third my age.  I don’t have a lot going for me except my height.  I am slow, not just in speed, but reaction time.  The youngers have found they can attack me with jukes and jives and I am too slow to block their shots when they come at me, and if I go out to challenge their outside shots, they fake me and drive around me, rising to the rim before I even get turned back toward the basket. My balance has already caused me to fall once chasing a ball, scraping my knee, elbow and shoulder and nearly falling another time except for a helping hand of another player to grab me and steady me. I can’t jump.  Once I could dunk.  Now while I stand and can hold onto the bottom of the net with both hands, I can’t jump high enough to touch the rim, while the diminutive point guard on the other team does pull ups on it.  And while I may be in okay shape for sixty-three, I need to sub out frequently because I don’t have the lungs of a thirty-year old.  But I am not completely without value.  If I find the right spot I can hit a jumper.  While slow, no one can block my hook shot and sometimes if I run the court on a fast break, while my defender slacks, I can get open for a pass with an easy layup.

That’s what I play for — to make the baskets.  I try to tell my daughter of the joy I feel when the ball rips through the net.  I know each basket I make could be my last.  I could fall and break my hip.  I could take an elbow to the chest and break my ribs,  I could fracture my hand grabbing a rebound.  I could die in any of a number of ways I have seen people die in my work as a paramedic.

I stopped playing basketball years ago because I did get injured.  I broke a finger going up for a rebound, and while I worked through it, it was painful and I had to develop a new way of holding the IV catheter when I tried to cannulate a vein.  Once, our company, which does standbys at the civic center was granted use of their court at noon one day.  We played a game between company divisions in front of 16,000 empty seats.  I scored twenty points, but took a headbutt to the chest in a scramble for a loose ball, which I believe may have cracked my sternum as I couldn’t sit up in bed for over a month without holding a pillow to my chest, and if I tried to do a pushup, I felt as if my chest would crack in two.  I also dislocated my pinky diving over the courtside chairs trying to save a ball from going out of bounds.  That was my last game for almost twenty years.  I couldn’t risk getting hurt at basketball and missing extended time at work. I had a family to feed.

But taking my daughter to her basketball games and practices in recent years has rekindled the fire.  It also helps that I have a desk job that provides most of my income with my street time now only 10 hours a week, I am no longer entirely dependent on my physical health to get my paycheck.  While my daughter practices with her team inside the gym, I shoot alone on the outside playground. In the rain.  Just like when I was a kid, I imagine myself in the NBA with the clock running down and the ball in my hands, and my teammates depending on me.

I should probably be doing something else with my time, like writing my next book or producing more blog posts or working on a work project or lifting weights, running, stretching or swimming, instead of dribbling a basketball, shooting 50 free throws and then 25 three point shots, but spending a good part of the time chasing after errant rebounds.

Sometimes my daughter will come out and shoot with me.  We had a free throw contest the other day.  First to 10. I missed my first shot, then she hit twelve in a row.  My daughter is 13 and really good.  Last Sunday, as the only 8th grader on a high school travel team, she knocked down three threes in just a few minutes time, where a year or so ago she could barely make the distance.  “Dad,” she tells me. “I love the weekends because I get to play basketball.”  She is talking about a game with officials on the floor of the Bristol Sports Armory and other local arenas where she and her older teammates will play against challenging teams, and win or lose, there will be moments of victory (as well as defeat), memorable moments of a great pass, a spin move to the hoop, or watching a three rip through the net.

I wonder what she will do when she grows up.  I hope she will find work that will bring her as much happiness as basketball does.  That’s why I have always loved being a paramedic.  Sometimes on calls, it is just like playing sports before a crowd  Pressures on, eyes are on you, you have to perform.  You can’t let the pressure get to you.  There is the same camaraderie with your crew or your partner as you had with your team.  I try to teach my daughter that sports is about life lessons, things you can use in the real world, but sports, I am realizing is also an end in itself, a pure joy.  Sixty-three, slow, old, hard of hearing, tired, weak legs,  a cough that rattles the earth itself, but I grab the rebound,  I dribble to the corner,  I turn and shoot. The ball arches through the air.   It rips through the net.

I am alive.

Dopesick

 

“Dopesick” is a new eight-episode series dramatizing the start of the opioid overdose epidemic that originated with Purdue Pharma’s marketing campaign for oxycodone .The series is populated with a fictional cast of characters, including a country doctor (Michael Keaton), a young woman injured in a coal mining accident and her parents who struggle to understand her addiction, an earnest young drug salesman, two US attorneys and a DEA agent (Rosario Dawson) who fight to combat the powerful drug company and Purdue’s bought and paid for allies in the FDA and Congress.  I’ve seen seven of the eight episodes, and I can tell you this is riveting TV that will move, startle and anger you, and I hope by the final episode, inspire you to help change this country’s approach to the epidemic.  The producers and writers did an amazing job taking the facts of the epidemic and turning them into compelling drama that should engage a wide audience.

What Purdue Pharma did was criminal, and it unleashed on this country a tragedy of epic proportions.  As a paramedic, with each corpse I stand over and run my six-second strip of asystole (flatline) before announcing the time of their death presumption, my own rage grows.  This series aims squarely at the Sackler family, in particular Richard Sackler (Michael Stuhlbarg), as the bad guys, but also directs its wrath at FDA and DEA officials who went easy on Purdue before joining Purdue in high paying private sector jobs.  Why no one from Purdue has ended up behind bars while users, who sell $3 bags to support their addiction, are locked away for years is stunning to me.  It is a testament to the power and the influence of money on our political system.

Unfortunately, exposing and damming Purdue Pharma doesn’t end this epidemic.  The dead remain in their graves with countless more ghosts joining them with no end in sight, souls lost forever to the living world.  There are more parts of this epidemic to follow, the rise of heroin after Purdue comes out with a tamper-resistant oxycontin, and the current and most dangerous wave of fentanyl poisoning the drug supply and turning each hit into a game of Russian roulette with the reaper.

Dopesick should convince those who watch and hopefully those in power that most of those affected by this crisis were afflicted through no fault of their own.  They got hurt or sick and trusted their doctors and trusted their regulators and elected officials to protect them, but instead they suffered addiction, stigma, jail, failed rehabs and death.

We have a chance in America to fix this and end the deaths if we pursue the scientifically evidence based avenues of decriminalization, safe injection sites, medical opioids, and a safe legal drug supply.  Instead we are likely to get more arrests, more jail time, and more deaths by following old and failed, but politically expedient policies of the past.

Watch Dope Sick.  Follow Michael Keaton’s journey, feel the heartache of parents, witness the  Richard Sackler dark villany, cheer for Rosario’s passion.  Then commit yourself to educate your neighbors and community about stigma, harm reduction and call for a shift in resources from the criminal war on drugs to a humane public health approach based on science.

Dopesick premiers on Hulu on October 13, 2021.  It is loosely based on the book Dopesick by the journalist Beth Macy.

https://youtu.be/JYU1kzGn4rk.

origin Story

 

For many of us in EMS, our origin story began with watching the TV show Emergency. The decent paramedics Johnny and Roy, the wise Drs. Brackett and Early, and the beautiful unflappable nurse, Dixie McCall. Together they stood for all that was good in the world. They were role models for us in showing us a path to lead our lives as rescuers.

When we entered the workforce, or at later times, contemplated the other work we were doing, and wondered if there was something more meaningful, the example of Emergency was always there for us.

I came to EMS later than most. I was in my early thirties. I had been working in government/politics for a United States Senator, and with his defeat in 1988, I was at a crossroads. I liked the man I worked for – US Senator Lowell Weicker. He was a liberal Republican who was not afraid to buck his own party if he thought his actions would benefit the people of his state and country. He was a member of a group of moderate Republicans like Charles Mathias of Maryland, Jacob Javits of New York, and Ed Brooke of Massachusetts who crafted compromises both parties could live with. Sadly today, as William Butler Yeats warned in his poem “The Second Coming,” the middle did not hold.

“Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,”

Politics today is no longer about making good policy, it is about making political points in a battle for personal power. Everyone is partisan. Weicker was defeated by Joseph Lieberman, a Democrat who ran attack ads that distorted Weicker’s record, while Weicker preferred positive ads believing the people understood he was their champion. We didn’t know it then, but the world was changing. There was no FOX cable news channel then. No MSNBC. No internet. No Facebook or Twitter, but the seeds of the future were already being sown.

I never really cared for the political life. I could have stayed in Washington and became an aide to another Senator or joined an interest group or lobbying firm. Instead, I (full of beer and passion) announced at a going away party for the Weicker staff that I was going to become an EMT, and then having said it aloud, I had to follow up on it. And so began my EMS odyssey. Even when Weicker ran for and was elected governor and I worked on his campaign and served as a speechwriter and executive assistant at the state health department for his four year term, I continued to work as an EMT at night, while thinking about going to paramedic school.

The other day I came across a collection of quotes I had put together at that time (1992). The quotes represented what I thought about life at the time. They contained song lyrics, passages from books, poetry and culture, along with illustrations. I saw one quote I had forgotten about, one that I remembered finding in a book by the great oral historian Studs Terkel.

“The fuckin’ world’s so fucked up, the country’s fucked up. But the fireman, you actually see them produce. You see them put out a fire. You see them come out with babies in their hands. You see them give mouth to mouth when a guy’s dying. You can’t get around that shit. That’s real. To me that’s what I want to be.”

I worked in a bank. You know, it’s just paper. It’s not real. Nine to five and its shit. You’re looking at numbers. But I can look back and say, “I helped put out a fire. I helped save someone.’ It shows something I did on this earth.”

-Tom Patrick, Brooklyn firefighter quoted in Studs Terkel’s Working.

I believe that quotation, as much as all the episodes of Emergency, set me on my ultimate life’s path as an emergency medical responder. When Weicker left office in January of 1995, the next day I was on the streets of Hartford with a paramedic patch on one shoulder and an American flag on the other.

Now at sixty-three, in a world that seems to be threatening to fall apart, from the hateful politics of the our times, to the roof of my house, to my battered 200,000 mile plus sedan, to my own health no longer that of a young man, here I stand, still putting on my uniform and going in to work to answer the call.

I did seventeen 911 responses in a ten hour shift last Friday, and when I came home I just sat in front of the TV with my wife and daughter and ate a late dinner before going to bed to sleep the sleep of the weary.

I wish all jobs were like ours, where the oath is to do no harm, to help others, to make the world a better place.

Xylazone- Mind F

 Xylazine, a horse tranquilizer, has been increasingly found as an adulterant in the East Coast street supply of fentanyl.    In 2019 in Connecticut, xylazine and fentanyl were found together in 71 overdose deaths.  There were 141 deaths of this combination in 2020, and in 2021, through August with still many cases outstanding, the number has risen to 172.

In Puerto Rico dealers began mixing xylazine with heroin in the early 2000s. While xylazine has not been the subject of much human research and is definitely not approved for human use, it is believed to produce prolonged sedation and likely works synergistically with opioids to create a longer high.  This is significant because fentanyl has largely replaced heroin along much of the east coast, due to its economic advantages for dealers.  Fentanyl typically lasts 4-6 hours while heroin lasts 6-8 hours.  Fentanyl’s shorter duration requires people to use more often to fight off withdrawal.  It is speculated that xylazine’s longer sedative effects may help fight off withdrawal, and enable users to go longer between doses.  The high produced by xylazine with fentanyl also, according to some users, more closely produces the nod associated with heroin, which some users prefer to the potent fentanyl rush. Other users, however, seek to avoid it because it makes them feel like zombies, trapped in a haze that lasts for hours.

There are significant drawbacks to xylazine.  Most commonly xylazine, which may depress cells’ ability to handle oxygen, has been known to cause bad skin ulcers, as well as hypotension and bradycardia.  Xylazine may potentiate the respiratory depression of fentanyl and make someone more likely to die from overdose.  In other words, the xylazine may be enough to make someone severely respiratory depressed from fentanyl, completely stop breathing (not that fentanyl needs much help in this department), which will mean death if someone doesn’t arrive soon with naloxone to resolve the fentanyl induced respiratory depression. Some have said xylazine makes the user naloxone resistant, but I don’t buy that. Naloxone will still work on the fentanyl, enabling the person to breathe on their own, while still leaving them tranquilized with the xylazine.

If you are buying a bag of heroin/fentanyl on the street in Hartford, the guy taking your 4 dollars is unlikely to know whether or not there is xylazine in the powder.  An experienced user may be able to detect the presence of xylazine based on how it makes them feel.  It has been reported in Philadelphia that some dealers advertise the xylazine adulterated mix as “tranq dope,” but I have not heard that is the case here in Hartford based on my limited connections with users and harm reduction advocates. I recently asked a friend who now works as a bagger for a local dealer (in return for coffee, beverages, snacks, along with a low wage and discount on his fentanyl ($20 a bundle of ten instead of $30)), and he told me that his dealer does not use xylazine in his recipe.  He said that he has previously purchased bags from other dealers that he thinks likely had xylazine because they caused him to suffer severe ulcerations and also made him feel excessively tired and out of it.

His account squares with what we have seen on the street, and what we had previously believed might have been PCP mixed with fentanyl. (PCP while making some users crazed, leaves others catatonic.) One user called the fentanyl mix she was using “mind fuck” because it made her feel like she was trapped in her own body. Not being able to test the drugs they used, these instances could have been xylazine or they could have been some other unknown additive.

The bottom line is the drug supply is increasingly more dangerous, not just causing more deaths, but significantly harming users’ health as well.

While we offer users health services, naloxone and syringe exchange, if we are serious about lessening the deaths, we need to address the biggest culprit behind the slaughter — our toxic drug supply.  It is time to consider controlled legalization of pharmaceutical opioids.  Get rid of the poisons like xylazine and poorly mixed fentanyl batches, bring users in from the cold and allow them to use in safe injection facilities with medical and social services who can offer avenues to recovery.  If we truly believe our rhetoric that addiction is a medical and not a criminal problem, and we want to save lives, this is the logical next step.   

The Emerging of Xylazine as a New Drug of Abuse and its Health Consequences among Drug Users in Puerto Rico

Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature

Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010–2019

This Horse Tranquilizer Keeps Showing Up in Human Drug Overdoses