Suffering and Dying with Heroin

I recently worked a shift in the Emergency Room. After a few years, you certainly assume a patina or shield to protect you from the wear and tear inflicted upon you mentally. Even non-medical personnel have heard of ‘hardened attitudes’ and the incredible sense of humor (dark and otherwise!) that we develop in this business. However, even that is sometimes not enough. At times, I struggle to keep perspective, to remember that all of us make our choices about which path we take, what steps come next. I struggle to remain as nonjudgmental as I humanly can. Yet, I continue to fail and to struggle.

A young man (mid 20’s) came into the ER for an abscess on his foot (gender, names, places have either been omitted or changed to protect confidentiality). Open and honest, he informed us during triage that he is addicted to heroin, has been for three years and is using 3 grams a day. Hence the abscess and his own attempt to lance it having failed, his journey to the hospital. He was one of the nicest patients I have ever dealt with and everyone in the ER took a liking to this guy. He was unfailingly polite, nice, soft-spoken, apologetic and understanding. We caused him considerable pain when we lanced the abscess (despite numbing agents and pain medication), yet he did his best to remain calm. I held his hands during that time and I think it helped – he said it did. Pain medication is a difficult issue with people who are so used to it. A normal dose is anything but normal when dealing with nerve endings that are so saturated.

After draining the abscess, we packed it with sterile gauze. He had an IV established immediately after being admitted to the ER and continued to receive antibiotics (Vancomycin, a real heavy hitter) and any pain meds through the IV. Almost every vein and artery was useless. I told a nurse I would call her goddess for the rest of the day if she got access within two trys (and she is one of the best!). She did it on the second try and we all cheered (and as promised, I called her goddess for the rest of her shift). We also started him on Methadone because he indicated that he would like to try to ‘kick’ the habit once again (having failed previously). Once we had a bed open in Med/Surg, we took him down and got him settled.

This could be any of us. We all have our weaknesses, setbacks, chance encounters with fate and just plain bad luck. This one got to me though, it just broke my heart to see him in that much pain, so young and (looking 40 at least) flirting with death. He has avoided AIDS and Hepatitis by using clean needles and never sharing. He looks like hell, filthy, disheveled and obviously not taking care of himself. The heroin is taking care of itself and cares for nothing. I think that all else falls into nothing, the center cannot hold and this kid, this young man, this human . . . is into that downward spiral from which there is either no return or a very difficult one.

I will never forget this one. I wish the best for him. What I would like is for him to be happy – but he is not and may not ever be. I would like to meet him again some day, to see what he has made of himself and the promise that I told him I thought I could see . . . somewhere, some capacity to know, feel and understand the pain and suffering of others. I told him that I think we, as humans, have a duty and responsibility to lessen the pain and suffering of others in whatever ways we can.

For him though, only one thing is paramount. To feed the monkey, keep it off his back. To survive and try to heal.

I don't want to lose that ability to empathize, to care. But I got angry at myself for the sadness and anger that I felt. I retreated to the 5 x 10 closet we call our 'break' room, sat in a chair and cried. I can be a real tough guy at times, angry and mean when I have to be, but this was not one of those times. Somehow I am finding that balance, be it ever so precarious.

I am grateful.