Narcan At The Gate

Editor’s Note: This is the third in an on-going series of articles on the realities of the War on Drugs as seen by a New York City paramedic. Previous articles are here and here, and I highly recommend anyone who wants to understand the human toll this incredibly destructive and utterly ineffective War has taken read them.

On this blog we’ve spoken a lot about harm reduction alternatives to the war on drugs, but here we go from abstraction to actual: just the other day a young engineering student from one of the best schools in the country went to celebrate with a bag of cocaine, wound up with an overdose of heroin instead, and went into respiratory arrest. Not that the best school part matters, because all overdose stories start with potential lost or recovered.

It should not be necessary to humanize an overdose victim like this, but my experience has been that, say, Phillip Seymour Hoffman will get attention: the outrage and grief needed to uproot a status quo, that an everyday OD victim will not. This is not entirely perverse: Phillip Seymour Hoffman is not an “other.” He humanized abstractions beginning on paper, characters in the script, and made them specific humans in particular.

Since this is a story about a specific, living engineering student, we will call him Nah. Imagine him as the Asian actor Stephen Yeun in “The Walking Dead.” Bring Nah to specificity in your minds’ eye. Please, try hard. If you are thinking that he is some criminal junkie parasite on the medical dole of the taxpayer, please, try harder. This is how the war on drugs has been fought so popularly so far: by doing what all wars do; dehumanizing the war-target.

So, the other day one of my partners, Daniel, stopped Nah from dying, and it was an amazingly close-run thing. I’m going to lay out all his lucky breaks, where either the universe decided it did not want Nah to depart our particular planet-plane for his folly, or he just got extraordinarily lucky where the stakes are the utmost.

As a new buyer of illegal drugs, Nah is particularly at risk. The dealer will not be cultivating a long term trade situation, and will sell whatever fills his greed or entertains his whimsy. It’s like telling a grocer “Fill this brown sack with something I can eat, I can’t see it, I will know what it is after I eat it, you will never see me again.” A funny story I know first-hand has two neophyte LSD “psychonauts” buying a bottle of Pepto Bismol from a drug-dealer. They drank the bottle and waited around saying “Do you feel anything yet?” They wondered if the fluorescent lights always looked so silver. No chemical adventure, but a very placid belly. It makes for a great lifetime laugh, but had the dealer lacked a sense of humor, or felt that his stock of heroin was selling too slowly that night there would have been no lifetime for our psychonauts to to laugh in.

Imagine Nah’s future in that moment of hovering, not breathing; the heroin blocking the body’s imperative to breathe, Wile E Coyote over the cliff. Nah hovers at the the apex of an upside down time-pyramid of the directions of his ordinary or extra-ordinary future. Think of his future family tree, think about what they would look like, probably very fine like he is. Try to make them pop like spent Champagne bubbles, out of existence, out of your imagination.

The cocaine/heroin dealer also stands at a pyramid of the moment: the legal status quo behind him, all of the blind spots of drug policy bull-headed non-adaptivity creating the situation where Nah buys his mystery powder. It is very unlikely that this was a mistake: drug dealers bear awful consequences for losing bags of product. It’s possible that the dealer sized up Nah, elite written all over him, decided he didn’t like his face, and scratched some long-felt itch of a grudge. I’ve long suspected that lots of druggies are murdered in this way; they are very often annoying people.

The dealer is at the apex of an evolutionary eco-system which selects for cunning and efficient predation. His prey are the most compromised people on the planet, “disciples of the molecule,” who are almost all mentally ill to varying degrees. Or, like our young Nah, simply a youngster possessing a brain that has not even finished growing all its parts.

It’s been said that the culture of India’s democracy was positively informed by the methods used to bring it about: Gandhi wanted non violent resistance partly for the character developed in the leaders of ethical resistance, knowing that the men who stand at the apex of a violent evolution will not be fit to lead a nation. How our political system selects for negative traits in its leaders is a Blog log of another day. The sorts of evolutions required by a system matters, a lot.

Lucky break number one was that he snorted his heroin at the right time of the evening: around ten o’clock at night with plenty of people around.

Lucky break number two was that he was felled in a very public place, in public view, on the subway platform on 96 street. Had he managed to sit down on a bench in the station “to rest” for example, God only knows if he would have noticed in time. Technically, what happened next was that the heroin suppressed Nah’s respiratory drive, he passed out from lack of oxygen, and started to die after that. It was then a matter of how long his body, and his brain, could “hold their breath.”

Lucky break number three was that the right, that is, high functioning and thoughtful, person saw him go down. After calling 911, he sussed out that the responders would have to find the right part of the platform, not so simple, it’s a large subway station. The caller was upstairs on the street, frantically waving, waiting to rush the paramedics right to the spot. Sorry to say, but MTA transit workers are rarely this diligent, in my experience. Maybe Nah’s Good Samaritan knew that.

Lucky break number four was that there was a paramedic team within a reasonable distance. Some of the distances we have to cover nowadays can count as an odyssey. The other day we were sent to an emergency from West 110 Street down to Union Square.

Daniel flopped down on the subway platform and started breathing for Nah with a respirator squeeze bag as Nah’s head turned the color of a grape. At that moment Nah did not have five minutes more of life left in him. The medics were able to get an IV in, and started getting the Narcan on board. They continued to mechanically breathe for Nah, since it takes a while for the Narcan to do its work at the cellular level. For it to work at a cellular level, there has to be metabolism and cellular activity. Where was Nah’s breath-holding clock? Just starting, or like a world record chasing free diver fathoms down?

Nah was a collegiate athlete, so maybe that gave him the last little lucky reserve. A fire engine company arrived to help. They placed him on a aluminum pallet stretcher called a scoop, and carried him out of the subway. They continued to breathe for him with the Ambu bag as the Narcan started to work. Nah was breathing more and more on his own, getting better. By the time they carried him up to the street he was breathing OK on his own and starting to murmur.

Nah regained consciousness in the ambulance. I’ve seen this happen hundreds of times and it always looks like a magic trick to me, like a time lapse film of a tulip opening. “Welcome back,” I often say.

Nah remembered buying the heroin (cocaine) but he didn’t remember anything else. It took Daniel quite a long time to convince Nah that he had been circling the drain-eternal. If I ever get a free hand in a call like this it might be useful to make an iPhone video to show the proof of it, the OD patients are so often in denial. (But, we could also be fired for violating patient confidentiality, and who wants to take their chances in Human Resources Court?)

Nah fought a follow-up trip to the hospital, despite it being imperative. He was concerned about his folks getting his hospital bill. They run several dry cleaners, do nothing but work, and who can imagine what they’d say on hearing their gifted son needed to be whisked from death from a heroin overdose? Daniel told him that wrangling his parents was his problem, but the heroin would outlast the Narcan, and he could very well stop breathing again, “Which is a bad thing, from an engineering perspective.” Daniel added, sarcasm being a prerogative when the rescued person breaks balls, and acts the ass. They fought on a little while longer, with Daniel threatening to get the cops involved, until Nah started to cry, and decided to submit to the truth and to the hospital trip.