The man is on the nod, the only thing keeping him up is the fence he is leaning against. When the police officer tries to extricate him from the fence, he falls back and the officer has to lower him to the ground. I set my red bag down to get out my ambu-bag, but I can see the man is still breathing regularly. I shake his shoulder. He opens his eyes. No need to get out the Naloxone. I lift him up under his arms, while my partner grabs his legs. We get him on the stretcher. He nods back out. We find an orange capped syringe in his left front pocket, and some white powdered residue in a small plastic baggie in the right front pocket. The officer gets the man’s ID out of the wallet he finds in the man’s back pocket. He says he’s going to run his name for warrants.
We wheel the patient over to the ambulance and load him in the back. He is SATing at 97% and his ETCO2 is 48. The ETCO2 slowly climbs into the 50’s as he starts to hypoventilate, but with a little shake, I stimulate him enough to get it back down into the 40’s. While waiting for the officer to return with the man’s ID, I look through the backpack for medical information. There is an embossed certificate for successful completion of a 30 day residential treatment program with the man’s name on it, and an accompanying letter that attests to his meeting all the demands. There is a sheet of paper with his medical history which simply lists broken bones. There is an empty prescription vial for Suboxone. 42 count. Take three strips once a day. I count the days from his release from his treatment program when the prescription was filled until today. He ran out yesterday.
The officer comes back and says he got a hit on the warrants. He takes out his cuffs, and I look at him with a look that says, “Really?”
He says you never know with these people. He has to at least put something on. He cuffs one wrist to the stretcher. The man doesn’t even notice he is being cuffed. I don’t really blame the cop. We all have procedures we have to follow that don’t always seem to make the most sense. Once I did a transport out of a correctional facility for a man with no legs. They still had to put the chains on.
I monitor the patient’s breathing on the way to the hospital. I like talking to my opioid patients to learn their stories, but there is no conversation between us. He is too much on the nod to talk, but still ventilating well enough to not get Naloxone. I’d like to know more about how he came to be leaning against that fence, to hear his story of how he became a statistic in this great opioid war. The only things I know about him are he has suffered broken bones, he graduated from a 30 day treatment program, he was proud enough of himself that he kept his diploma, he appears to have been on Suboxone for 17 days, and then this morning, he injected heroin, and while it wasn’t enough to stop his breathing, it was enough to incapacitate him against a fence. When he comes out of his high, he is going to jail. 30 days or 90 days or a year or however long he’ll be locked up for, he’ll get out and have to start all over again.
I hope he can find a better support system than he had this time.
