The Emergency room came to life as a female voice repeated the words “Code orange” over the intercom. Nurses in scrubs communicated in nervous whispers with palpable anticipation. I flipped my ID card over to look up what the hell code orange meant. My heart sank as I scanned down to the orange block: “Code Orange: Mass Casualty Event”. I wondered when my life became a scene out of Gray’s Anatomy.
I was there that day to connect with two individuals who’d overdosed. We call them heroin overdoses but most likely it was fentanyl. Fentanyl is a powdery substance primarily created in Chinese labs, crossing oceans to arrive smack dab in the middle of our Opioid epidemic. It’s mixed with, or sold as heroin, frequently causing overdose due to the astronomically higher potency.
Sometimes people realize it’s fentanyl when they fill their syringes and the liquid inside does not turn a familiar brown. The problem is by then they’re starting to feel their insides churning. Their body has grown frigid and clammy, skin crawling in a papery dread. Their legs have started to kick and jerk on their own, possessed and endlessly restless. Their eyes flood with tears, not from emotion but an unseen force that commands fluids to pour out, needlessly purging nothing. The nose gets a cue from the eyes and commences to stream watery mucus obliging them to sniffle and snort. The pupils dilate mercilessly from an opiate induced speck to eclipsing all color, turning the eyes a demonic black. There is no relief. There’s no remedy like one would turn to if this were a garden variety ill. They could swallow 7 Ibuprofen, wash it down with Nyquil and Xanax and still be tossing and turning in misery. The ONLY thing on earth that can relieve them from this infinite suffer-fest is an opiate. So the excruciating morning is spent stealing a family heirloom from a relative, selling it at a pawn shop for 1/10th of the value and pacing the block in 10 degree weather waiting hours for the dealer. Next comes standing in line at the Pharmacy dripping in sweat as they fork over their last 4 bucks to purchase a bag of hypodermic needles since this is the only instrument that will deliver them from their nightmare.
After these humiliating, guilt dripping gut wrenching activities they must find a public restroom, search for a vein to the ambiance of someone pounding on the door while they drip blood on their only clean hoodie. In the midst of this glamorous experience, they notice the loaded needle is too clear. It’s probably fentanyl. The fear of imminent death is silenced by the need to end suffering.
They awaken on the bathroom floor projectile vomiting; a warm, sticky feeling in their pants that they’re hoping isn’t what they think it is, surrounded by wrinkled judgy faces. A select few agree to hospital transport, aware that the shot of breath enabling Narcan could wear off, sending their body back into respiratory failure. Their lips will again turn blue, foam gathering on the sides of their mouths as breath is replaced with a “death rattle” as they slowly drown. I once asked a guy what it felt like, having been spared the experience myself. His answer was “Ya know when you’re standing on the beach with your feet in the sand right next to the ocean and a wave comes and sucks the sand out from under your feet? It feels like that.” He said. I can pretty much guarantee that no one living this way planned to end up there. The brain, once dependent on opioids is chemically altered, shifting what was once a choice to a necessity.
My title was Peer Specialist; which meant I had found recovery and tried to help others find it too. Without connection to people like me, OD patients are discharged within hours with no follow up or aftercare, likely to relive the event like Groundhog Day.
I asked one of the nurses where I could find the two patients. Her reply made my heart sink and my blood boil “Oh we discharged them to make way for the REAL medical emergencies en route”. The “real” emergencies never came. The Code Orange, which beckoned every available surgeon, nurse, and x-ray tech down to the ER, was the report that there’d been an explosion at a nearby nail polish factory. The problem is that the nail polish factory survivors were fictional. The explosion was real having only seriously injured one individual who was being treated elsewhere. “They wanted to leave she said, so we discharged them”. What she and all the other staff fail to understand is that yes, when told they’re free to go, they will most likely run. At the same time, if they are kindly offered help they are often just as likely to receive it. If every hospital in America were to treat the people recovering from overdose as REAL medical emergencies, offering help instead of judgment, stigma, guilt and shame, this epidemic could end overnight.
The stigma is alive and well in this Emergency room and others like it all over the country, putting a huge brick wall between people who are suffering and the help they so desperately need from the medical community.
A recent study published in The Journal Of Addiction Medicine titled An Exploration of Emergency Physicians’ Attitudes Toward Patients with Substance Use Disorder reported “A significant portion of our study population had low regard for patients with substance use.”
Until we treat the disease of Substance Use Disorder with the same compassion and urgency as diabetes, heart disease, cancer and burn victims, we will continue to bury an entire generation.