By BirdStrike, MD
Taking a break from my main job at the trauma center, I was covering an odd night shift at the “Little ER”, an 8 bed glorified “urgent care” type ED that actually takes ambulances, but probably shouldn’t. Susie the nurse walks calmly out of room 4 and says, “We’ve got a heroin overdose in there.” Being that the EMS radio hadn’t gone off and no crew wheeled by bagging anyone blue, I was a little surprised. “Her friend dropped her off, and we pulled her out of the car. There are syringes all over the car floor.”
I sauntered over to the room, knowing that my very experienced nurse Susie would have yanked me into the room immediately if the patient wasn’t at least somewhat stable. I walked into the room expecting to see one thing, but what I saw was quite another. Lying there on the stretcher was a tanned 19 year old, buxom blond female lifeguard that easily could have been a Victoria’s Secret model for her day job, in her bikini, breathing slowly. RR 14, HR 55, BP 100/60, O2 sat 95%.
I call out her name, “Buffy…Buffy!” There was no response. With a sternal rub, “Buffy. Buffy! What did you take? Did you shoot heroin, cocaine, what did you take?” “Leave me….leave…me…. alo…..” she trailed off. With a much harder sternal rub and the old supraorbital notch trick, I asked again, “Buffy, what did you take?” “Percocet, you d—–bag”, she muttered and fell right back asleep. A little surprised that a user advanced enough to be regularly injecting narcotics, would make the rookie mistake of injecting oxycodone with Tylenol, I asked again with a much required sternal rub, “Don’t you know Percocet has Tylenol in it? Don’t you know that if the Oxycodone doesn’t kill you, the Tylenol will if you inject enough of it?” Her answer, barely able to keep her eyes open was, “No s—t Sherlock, I used the cold water dilution technique. You think I’m stupid enough to kill my liver for a little high? Google it Einstein”, and eyes closing, she quickly fell back into her euphoric opiate twilight.
Fortunately for me, this tiny 8-bed “Emergency Department” (if you could call it that) in addition to having invested in such technologies as the “wheel”, the “pencil”, “running water” and “sterile technique”, actually did have access to “Google”, believe it or not. Feeling a little like an idiot for not knowing this particular piece of street lingo, I Google-searched, “Cold water dilution technique percocet”. Let’s just say that Google needed no more than a nanosecond to educate me on the very quick and easy technique for removing the acetaminophen from oxycodone/apap, and making freshly sterilized and purified oxycodone-water ready for injection or drinking.
Buffy’s very concerned father arrived and received the same education that I received that night. He also explained to me that she had always his “perfect child”, a straight A student, and that he was learning a few things about his “little girl” tonight that he hadn’t expected to learn. Buffy the buxom lifeguard was correct that she was smart enough to protect her liver, as her initial and repeat acetaminophen levels were zero, with normal LFTs. She came very close, but never required Narcan as she remained stable on oxygen and happy to go to detox as long as we let her sleep it off and dream her beautiful opiate dreams.
After she rolled out the door in the ambulance stretcher to be transferred to detox with her loyal father trailing, I looked at the demographic sheet and to my shock, she and her father were neighbors of mine and lived in a home I drive by every day. (I know, I should know better than to be shocked that my precious upscale community could suffer the same scourge of untreated addiction that afflicts all other less affluent and less plasticized neighborhoods.)
I had no concrete follow up for about a year, though rumor had it that she left rehab clean and sober and remained so for the past year. I took solace in that likely I had saved the life of a young person with great potential. A few days ago, I drove by their house and saw dozens of cars lining the street. I assumed that there was some sort of family celebration, party or reunion. When I ran into one of my other neighbors I was asked, “Did you hear about Buffy Smith, that gorgeous blond beauty that lives down the street?” “No,” I said, “what happened?” “She died last night. Her parent found her dead. The cops think it was an overdose. Isn’t that sad?”
“Yes,” I said. “Yes. It really is.”
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.