WhiteCoat

Buffy the Lifeguard

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.

13 Responses to “Buffy the Lifeguard”

  1. SeaSpray says:

    I’m so sorry for her and her family. And for you …even though you did all you could to help her.

    A daughter of a close friend of mine became addicted to heroin. (She had gone through some great emotional upheaval in her young life prior to that and then got in with the wrong kids)By the time she was 17 all hell began to break lose. I don’t know how long she was using before that. This girl was soooo beautiful ..did modeling in the city when younger and could’ve continued but she didn’t like it and it was demanding on my then newly divorced friend’s schedule.

    However, this young girl was so hooked ..her beautiful skin was pale, she was breaking out and frighteningly thin. Her mother said she didn’t even look like her daughter anymore. She did all the horrible things you hear stories of addicts doing …stealing from family, arrested, etc. It got to the point that my friend said she was relieved when she knew she was in jail because at least she knew she’d be alive for the night. And for her own sanity she had to use tough love and kick her out… which also ripped my friend’s heart out, but she had another daughter at home. Three rehabs …until the last one helped her. But …they said that heroin is the most difficult substance to stop and she will always crave it.

    That being said …at least for a decade ..she returned to being her beautiful, vivacious self, enjoys her work and totally committed to healthy eating and exercise, etc. Thankfully their story had a happy ending.

    There are certain towns in our county known to be Meccas for heroin. I guess it’s everywhere and we just have to do our best maintain good communication and trust with our kids, to instill critical thinking into our kids, a sense of independence from their peers, know what they are doing and the company they keep and pray a lot.

  2. Ann Onymous says:

    It’d sure be nice if detox was the happily ever after. I can see why people think that. Occasionally it’s the beginning of the end, but usually it’s just the beginning of at least a few more stops and starts.

    Addiction is a family disease. If the addict gets well but the family doesn’t, over time it becomes more difficult for the addict to participate in the family relationships and stay sober. Ultimately the family goes or the sobriety goes. Sometimes it’s short – a year or less – and other times it’s a slower process. All roads tend to lead to Rome, though.

    Of course there are exceptions – some recovered addicts find a way to maintain their family relationships under new terms that don’t threaten their sobriety. Some recovered addicts switch addictions to compensate for the strain of staying in a sick system – eating disorders, workaholism, whatever. Others end up “divorcing” their families because they can’t compromise.

    I haven’t yet seen a family unit seek recovery alongside an addict. There’s a lot of unsavory bullsh!t required to get well/change behavior/do 12-steps/be BFFs with Jesus/get right-side-up/whatever and most won’t bother unless faced with life-or-death consequences. Maybe these happily recovered family/recovered addict combos exist somewhere; I’ve just not seen any.

    Addiction is insane. Lots of paradoxes but after a while you tend to see the same formulas repeat (and repeat and repeat). And none of it is truly quantifiable, which makes it a bad candidate for any med school curriculum. Hard to fault doctors for not intuitively understanding….

    Thanks for steering the general conversation away from the usual aggravation and disdain. Not that I’m defending addicts – they’re a miserable bunch, and typically obnoxious to boot, but it’s nice to see sincere discussion once in a while.

    • Birdstrike says:

      As said by Ann Onymous: “Addiction is insane. Lots of paradoxes but after a while you tend to see the same formulas repeat (and repeat and repeat). And none of it is truly quantifiable, which makes it a bad candidate for any med school curriculum. Hard to fault doctors for not intuitively understanding….”

      Like many, I didn’t always think addiction was a disease, until it was explained to me what you mention, “the same formulas repeat (and repeat and repeat).” The course is as predictable as any other true disease, with onset, symptoms, prevalence, etiology, pathophysiology, treatments with various success rates, morbidity and mortality. This actually is exactly what DOES makes it perfect for medical curriculum. Where it gets off track is when people say that the “disease” takes responsibility for the behavior, not the person with the disease. A diabetic isn’t to blame for his disease, yet still must take responsibility for his disease and its treatment, administering his own insulin and so on. The same applies to those with the disease of addiction. They may not be “at fault” for having the disease, but still must take responsibility for it, its treatment, going to meetings, rehabilitation, and so on.

      At certain teachable moments, educating someone that, “It is not your ‘fault’ that you have this disease (addiction), but it is yours, and getting better means giving up on fighting it and blaming yourself and instead focusing on getting treated for the disease just like you would any other potentially terminal disease like breast cancer, diabetes, or COPD.”

      Addiction is a disease. It is treatable, but you have to accept the treatment. Of course, this is the hardest part.

      • Dr. Mongo Lloyd says:

        The problem is the “treatment” seems to be one-size-fits-all, and doesn’t seem to work for the vast majority of addicts.

      • hellzfireice says:

        Problem is that it’s also a lifelong disease, much like diabetes.
        Treatment does not stop once someone is done with the formal inpatient/outpatient programs. Families also sometimes struggle with understanding or coping with the fact that their loved ones need lots of support for the rest of their lives, very much like diabetics and family members checking in, helping with diet issues etc.

  3. Birdstrike says:

    It seems you were touched by a similar tragedy. Many seasoned Emergency Physicians have an unusually cynical worldview and “gallows” sense of humor that would make most laypeople cringe. Unless you have lived something similar, day in day out, it can seem very out of place. When routinely encountering what is rare and tragic to most people, but commonplace in the ED, it is much easier to “think” a sardonic joke and just keep moving, than to stop and “feel” what you’ve seen. As said much more eloquently by a man with a much smarter and elegant sounding name than my own:

    “Life is a tragedy for those who feel, and a comedy for those who think.”
    ― Jean de La Bruyère (1645-1696)

    • Birdstrike says:

      (This reply to SeaSpray)

      • SeaSpray says:

        I’m just so happy she did finally get past all of that. There were times my friend was sure her daughter would die. It was that bad. She did end up with hepatitis C though. But, like previously stated …she is doing so well now and is living a very full, happy, healthy life now …thank God.

        Having worked in ED registration/Pt Access for 20 years …I am not unfamiliar with gallows humor. It’s a coping mechanism. I loved that job and often joked I’d pay to do it. I worked with a terrific group of physicians, nurses and ancillary staff. Fortunately – not all gallows humor. My joke was …when it’s busy – they work like crazy and when it’s not ..it’s like they’re crazy …like on M*A*S*H…with all exquisite humor and pranks. :)

        “Life is a tragedy for those who feel, and a comedy for those who think.”
        ― Jean de La Bruyère (1645-1696)”

        I really like that quote! True too.

  4. girlvet says:

    After a lot of years in ER, it never ceases to amaze me what people come up with in regard to drugs – how they use them, the goofy way they use them.

  5. davidhowardojai says:

    Typical. If you’d been around persciption opiate addicts as long as I have, however, you’d have known why all the cars were outside the house without even asking.

  6. FormerTeach says:

    The suburbs are full of drugs. As a former teacher, I have learned the richer the school population the harder the drug. The wealthiest suburban streets are like polk-a-dotted sheets of papers, when a cop shows me his drug maps. High-income parents living in gated communities, rarely know their child. The nannies might know the kids, but mom or dad is just in the once a year family picture.

  7. Anony says:

    No matter how fictional it is or non-fictional, I can bet that the incident described here has already happened.

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