The "Little Baby"

 *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.”