Overdose

Again, we're called on an overdose. Female, unconscious, breathing. Alcohol and heroin. Police responding as well.

My partner snorts as I manuver the ambulance down narrow streets with cars on either side, strobes reflecting from windows. "Unconscious? We'll see. Nothing a little narcan won't fix, in any case." She sighs. "I don't want to fight with someone, we just started the shift..."

The fire engine arrives a few moments ahead of us. I turn a corner and thump the steering wheel. "Go get 'em, boys! Make me proud!"

But when we arrive, parking in the middle of the street, one of the firemen sticks his head out the door before we're halfway up the stairs. "Grab your suction, we're working a code."

Oh, dammit.

She's sprawled out in a tiny living room. Nice enough house. A firefighter pumps on her chest; another squeezes a bag-mask. Two other people, friends of hers, I suppose, sit on a couch. They're arguing about responsibility, and who should or shouldn't have called 911, and so on and so forth. I try to tune them out.

My partner and I jump in. She starts an IV, remarking that she's surprised a drug user has such good veins. I get set up for the tube; take a look, pull back, confronted by a mouth much too small for the grandview blade. I stand up to swap blades. A couple of cops are standing at the door now, dark blue uniforms almost black in the poor light.

One of the friends is asking the firemen over and over, "What's happening? What's her condition?!" They've already told him that his friend's heart is stopped, that we're doing everything we can, please let us work on her.

Now he fixates on me. "Why don't you give her some narcan?" he asks, accusingly. "Come on, she was just breathing until right before you guys got here."

I look at him, look down at our patient. She's cool, mottled. She's been down for a while. Look back at him. "Narcan only works if her heart is beating, sir." I pop the old blade off, snap the new one on, click it open to test the light. "Which it hasn't been, since we got here."

"But, come on, she was just breathing, jesus, do something ... I mean, she's been like this for an hour, but she was breathing, come on, guys ...."

I look over at the cops, toss my head at the friends. "Them. Out of here. We need room to work." I turn my ball cap around backwards and nudge the fireman at the head out of the way, kneeling again, scope in hand.

The cops take the friend by the arms, out the front door, down onto the sidewalk, firmly but not unkindly. As he steps out the door I glance over. The lifepak faces me, yellow on black display glowing softly. The three lines are flat as the surface of a pond.

Empathy

We're called on an overdose. Wait for police. We sit around the corner from the apartment complex, fire engine and ambulance idling in the night. Before long the dispatcher came on the air -- "Engine 44, Medic 38, cleared in by police."

The man sits in a chair, nodding off. A few cops stand around, arms crossed.

"What's up?" I ask after introducing myself. One of the firemen wraps a blood pressure cuff around his arm.

"Nothin'," he says, slurring his words a bit. "'m fine."

"Then," I ask, a bit of sarcasm tinging my voice, spreading my arms to encompass myself, my partner, the firemen and cops, "why are we all here tonight?"

"I dunno," he said, obstinately. "Nothin' wrong w' me."

I sigh, put my hand on his forehead, flick my light into his eyes. Pupils tiny constricted dots, even in the dark room. I glance down at the monitor, showing the normal blood pressure and heart rate. I wave to the firemen. "Have a good night, guys."

As they filed out, I look down at the man again. "Okay," I tell him, not kindly. "We know why I'm here. What did you do tonight?"

He looks sullen. "Nothin'."

"Fine," I say, patience evaporating. "You can either go with me, or go with the cops. Which do you want?"

He mumbles something. I lean in. "What's that?"

"I said, I'll go with you."

In the ambulance, we get him out of his jacket. Track marks dot his arms. My partner looks the man in the eye, and says that if he has to stop the ambulance to come back and deal with any problems, he'll be angry; there aren't going to be any problems, right?

The man shakes his head. Tha ambulance jerks into gear. I take a deep breath, try to be less irritated with him, this stupid junkie who's wasting all our time, and lying about it to boot.

"Okay, friend. No cops here now. Just me, and I just want to take care of you. Can you tell me what you did tonight?"

A long pause. "Yeah, I did a speedball." A bit of shame in his eyes.

Alright. "Thank you. Coke and heroin, right?" He nods, and, the dam broken, readily answers the other questions I have. There aren't many, and presently I'm sitting writing my chart while he stares out the back window at the city lights.

Abruptly, he says, "I'm getting too old for this, man."

I look up from the paperwork. "I'm sorry?"

He looks over at me, obviously unhappy through the sleepy heroin high, and for the first time I really see him -- a man past 40, who hasn't been spared much, either by life or by himself.

A screwup junkie, yeah, but it takes a long time to get there. A lot of bad times, bad choices. There but for the grace of god ... Hell, and I'm not even a believer.

"I'm too old to be getting loaded," he says sadly. "I was trying to quit, man."

I set my clipboard aside, lean closer to him a bit, and smile. "And that's a good thing, trying to quit. So what happened tonight?"

And so he starts talking, telling me about his night, about how he's been clean, about how he fought with his wife, how he stormed out, about how he thought, well, everything sucks already, might as well get high. He tells me about how he wants to get clean, get into a program, but the lines are long, and if you relapse you lose your place.

By the time he's done talking we're at the hospital. I put my hand on his shoulder, tell him that he needs to keep trying, and that he'll get there. We put him in a bed in the ED. I shake his hand when we're leaving the room, tell him good luck.

Ten minutes later he walks out, AMA.