*I have written this blog for another publication but since I can never seem to get 2 separate blogs written, I am posting it here... It's not a feel-good, positive post, but it is very raw and real. Enjoy.
While the Covid “Delta” variant
wave recedes and positive cases become fewer and farther between, another
pandemic rages on. For those of us in the ER, we see evidence of a global
disease almost every day. Some regions of the world seem to be less affected,
but some areas, like my area, is consumed by this disease called addiction. We
see patients daily who are struggling with addictions to opioids,
methamphetamines, cocaine, alcohol, and spice. Many of them are marched,
kicking and screaming, into the ER in handcuffs by 2 or 3 law enforcement
officers. The opioid users are often found blue, unresponsive, and not
breathing. They are given Narcan, an opioid antagonist, on-scene by EMS
personnel and brought to us, angry and yelling obscenities, because EMS just
ruined their “high.” I can’t count all the times anymore that people have
driven their vehicles, wheels squealing, into the ambulance bay, and begged us
to help their loved one or friend who lies passed out in the passenger seat,
barely breathing. It’s become almost habit just to yell for Narcan on the way
to the trauma room.
Several months
ago, when I was sitting at the nurse’s station in Pod 1 and heard someone
banging frantically on the ambulance bay doors…We opened the doors, and a young
man ran through yelling for help. He was carrying an older man in his arms
whose face was a very ominous shade of gray. We all scrambled to grab a
stretcher and supplies and shortly, the patient was in a room with IV access
and was immediately given Narcan. Within 2 minutes, the patient was awake,
breathing normally and starting to talk. He vehemently denied taking any
substances, even when we told him that we had used Narcan, and he soon tried to
leave the hospital. The young man who had saved the patient’s life turned out
to be his son. He was so disappointed in his father that he turned and walked
away, leaving his father at the hospital to find his own way home. He told us
that his father was an addict that had recently gotten sober. Apparently, this
was one of many relapses. He, the son, had gone against his own better
judgement and given his father a job with the condition that he remain clean.
He said this time, he was done. He promised to never speak to his father again
and walked away.
Several times,
EMS have brought young mothers that have overdosed with their children in the
house. EMS brings the children and the patient, and we, the nursing staff,
double as babysitters until the Department of Children and Families (DCF) can
come for the children. Once, a 5-year-old told our ER nurse that she had called
9-1-1 when her Mommy passed out.
Amphetamine and
spice users are in a class of their own. They come to the ER complaining of
“bugs crawling out my skin” and have an almost superhuman strength at times.
These people often are so convinced that everyone is trying to harm them that
they become very aggressive and combative. It will often take 4-5 people just
to hold them down long enough to place them in restraints. The restraints keep
the patient from harming the nursing staff and themselves until they can be
medicated. Here is a typical scenario in the ER, sometimes repeated multiple
times in one day: EMS wheels the patient in on a stretcher, escorted by
multiple law enforcement officers. The patient is cuffed to the stretcher and
may be actively trying to jump off the stretcher or spit and bite the people around
them. Once in an ER room, the patient is taken off the EMS stretcher and cuffed
to the ER bed. We will put them in 4-point restraints and put a mask over their
mouth to avoid the spit. It will take multiple people to get a simple set of
vital signs and to remove their clothes. Side note: I have learned to be very
careful when assisting with this process. We have found drugs, syringes with
needles, and weapons in pockets and shoes. I recently emptied a patient’s
pocket and pulled out a broken “crack pipe” with the broken edge against my
fingers, but, thankfully, no cut. Usually, the doctor will take a quick look at
the patient, get the story from law enforcement and EMS, and then tell us to “B52”
the patient. “B52” stands for Benadryl, Haldol, and Ativan. Haldol is a powerful
antipsychotic and Ativan is a sedative used for anxiety. The combined effect of
all three of these medications will usually “snow” the patient for a few hours
and allow them to return to their mental baseline. Sometimes, if the patient
has been awake for several days, they will sleep for 10-12 hours straight. Almost
always, the patient will wake up hours later and have no memory of their
behavior. They will be humble and cooperative and quietly ask why their throat
is sore and their arms hurt. They will be escorted to the Behavioral Medicine
Unit for a psych evaluation and a referral to rehab before being released to
start the whole cycle over again.
Alcohol
addiction is the worst of all because an alcoholic who can’t get their “fix” can
die. Patients with an alcohol addiction will present to the ER sweating
profusely, nauseated, and often confused. The longer they go without alcohol,
the more confused they become. They have uncontrollable tremors and hallucinations.
If they are not treated with medication, they can have a seizure and suffer
permanent damage. So often, the patients we see suffering from alcohol
withdrawal symptoms are the homeless population, especially homeless veterans.
They use the effects of alcohol to treat their PTSD and to keep them warm in
the winter, but when their “stash” gets stolen or they can’t get their hands on
any alcohol, they become very ill. A few months ago, I triaged a patient picked
up by EMS after someone called for help for a “burned man.” This poor homeless
soul had picked the wrong place to pass out drunk and someone had poured
lighter fluid on him and tossed a match, then stole all his belongings and
left. He ended up being transferred to our local burn unit. Also recently, I had
a patient who had been released from rehab. She was unable to walk due to hip
or knee issues and had been released to the care of her “boyfriend.” He had
taken her home and given her alcohol. Several days later, when the patient’s
sisters were unable to reach her on the phone, they sent law enforcement for a
welfare check. The officer found the patient lying in a pool of alcoholic
vomit. She had been lying there for so long that the skin on her left arm and
torso had been severely burned. She also was transferred to the burn unit. One
of my nurse friends knew this lady years ago. She had once been married to a
physician and lived the “high life.”
As an ER nurse,
I find that I often lose my compassion for these people, especially in the heat
of the moment when they are screaming curse words at you or loosing their
bodily functions on the bed and on the floor. The stench of days old urine and
feces is almost unbearable even with a healthy layer of essential oil in my
mask. Sometimes they have been in the rain for days and their feet are
beginning to rot. That is an indescribable smell. And all because of their life
choices…
Then, almost
every time, as I drive home from work, I imagine those patients as newborn
babies, small and helpless. I imagine them as toddlers, already learning that there
is no one in the world that they can really trust. They may have been beaten, yelled
at, molested, and abused. They were probably told that they were “stupid” and made
to feel worthless. They grew up believing that they didn’t deserve to be happy.
Then when they were a teenager and given drugs at a party, well, they found the
“numbness” they craved. I think of the veterans and the atrocities they saw and
how there are still so few resources for them today. One thing I know for sure;
these people who choose addiction over and over are not happy to be addicts.
They are always ashamed and angry at themselves and the world. But the alternative
is just too difficult. They are unable to face the demons in their life when
they are sober, so they turn to substances. I always feel reproved when I could
have spoke a word for Jesus and I don’t… when I give way to irritation and disgust
instead of seeing that “little baby” in my patient.
The truth is, we
are all given trials to bear in life, some greater than others, but you and I
have been given the Greatest Gift of all. In this Thanksgiving season, say a
prayer for the millions around you struggling with addiction and for their
families and don’t be afraid to say a word for the Lord or a word of
encouragement the next time someone asks for money at the gas station or begs
on the street corner. Think of the “little baby.”
