Erin Baringer, our most recent podcast guest, is the writer of this piece. In it Erin discusses dealing with an overdose while on the job and the similarities he found between that experience and the experience with his brother. The views expressed are not necessarily shared with OD. Open Discussion Apparel is committed to further the dialogue on addiction.
Pinpoint fixed pupils. Loss of consciousness. Decreasing heart rate. Breathing slows to a halt and what follows next is surely death. The National Institute on Drug Abuse states that of the over 60,000 overdose fatalities in 2016, 42,249 involved opioids. That year approximately 175 people died every day from drug poisoning. How can the human body endure traumatic events such as rocket launches, the shock of warfare, and aggressive disease – but a seemingly small amount of chemical can shut it all down?
I’m an EMT working another event, as I sometimes do, to pick up extra hours. At events like football games and arena performances I’m the first to respond in a medical emergency. Someone’s unconscious, people around him say he may or may not have been taking drugs. The moment that follows equate to a desperate struggle to bring back life. Underneath his eyelids, pinpoint pupils, an indication of possible drug interaction.
After radioing in paramedics, I assess my patient. He isn’t breathing. His heart is barely beating. I throw a device in his mouth to keep his tongue down. I place a mask over his mouth to deliver oxygen by manually squeezing a bag. This attempt fails and my patient is not getting air to his lungs. Plan-B is a tube down throat that proves to work, and now I’m able to ventilate with my bag and mask. Next on my to-do list, spray a shot of Narcan up his nose to temporarily stop any effects these drugs may have caused. Narcan is a drug that blocks the opiate receptors in the brain, reversing the effects of powerful narcotics such as heroin and morphine. His heart rate rises from a snail’s pace to a very fast snail’s pace. A few more doses of Narcan, like magic, he wakes up in a world of confusion.
This is the fascinating reality of my job. On one hand it leaves me satisfied, hungry for more. On the other, it leaves me begging for an answer to the question, why did this happen? This man was a stone’s throw from death. How can we better understand the epidemic of overdoses in the US or even the world? He escaped becoming a statistic. Others, like my brother, don’t escape. I search for answers.
In June of 2016, CBS reports an alarming twenty-year high in the amount of Heroin users in the US, with deaths related to Heroin up five fold since 2000. The crackdown on prescription medications highlight theories surrounding this sharp increase in use and loss of life. It makes sense that someone with a dependency on prescription narcotics would seek a cheaper, more readily available alternative.
To you or me, putting life on hold to obtain a high may seem like madness. Why put our lives in jeopardy to chase the dragon? If the answer was simple, so too would be the solution. Individuals who relapse after treatment for addiction range from 40-60% with the relapse rate for opiate addicts being around 90%. Astonishing figures if you’re focused on just those people. However, those treated for high blood pressure and asthma exceed those numbers for relapse. No, it’s not crazy to think we should attack drug addiction in the same manner we treat other chronic illnesses. Sit through any 12-step program and you’ll likely hear words like “disease” or “illness”. I found it hard to fathom that the need to get high was somehow in the same ballpark as cancer or heart problems.
After I intervened in this man’s overdose, I felt relief that I was able to prolong his life. Maybe the world granted him a second chance. He lived to see the next day only because he was in the right place at the right time. Had this occurred in a bathroom stall or on his living room couch, there is no telling how long until someone noticed his lifeless body. The fact he was able to receive medical attention within minutes is the sole reason for his survival.
My brother was older than me and had seen more in life. To many of us older siblings, especially at a young age, often resemble gurus or wise prophets. What do I have to be afraid of? He’s been through it, I will never walk into a situation blindfolded because my big brother would never leave me to be caught off guard. We laughed, cried, fought, and we forgave each other. This was my best friend. On July 18th, 2016 Dean passed away from a lethal combination of Heroin and Fentanyl toxicity.
I just poured my first glass of wine and was enjoying the beautiful summer afternoon in my backyard when his roommate called to say he found my brother on the couch that morning pale, cold, and lifeless. Infuriated, this seemed like a cruel and sick joke, I threw my glass of wine which shattered against the wooden fence. After a brief moment, I let the news sink in. I jumped in my car, bound for Detroit. After countless trips in the past, I may have broke a personal record getting there this time. He was being hauled off in the coroner’s van as I pulled into the driveway.
It would be weeks until we found out the cause. I was confused and anxious to know what took him. He was only 31, what could have taken his life at such a young age? When we finally read his death certificate and the autopsy results, we were all in a state of disbelief. If he had a drug problem, I’d thought I would have noticed prior to overdose. I just spent the past weekend with him. He appeared to be his usual self, aside from a minor cold or flu. Nothing out of the ordinary at the time, but now it feels like a sign I brushed aside.
So it was to be, my big brother just passed away and there was nothing I nor anyone could do about it. I spend the next few months racking my brain as to how I could have missed any preceding indications to what just happened. Was he in such a bad mindset he needed to escape through hard drugs? What could have I done differently in the weekend prior that could have changed the course of history? The notion that I could have prevented it weighs heavily on my mind to this day.
When something doesn’t go as planned on the ambulance, you don’t spend the rest of the day sobbing over what happened. You get back on the horse and go about business as usual. There are plenty more people in need of help, plenty more opportunities for better outcomes. You care for each patient equally and to the best of your ability. When emotion gets in the way, it hinders your ability to think and make accurate decisions. So you push it away, letting it pass. As EMS providers, this is the general mindset that allows us to perform on the job. We may provide the type of care we hope our loved ones would receive, but the patients are rarely our actual brother, sister, aunt, uncle, or parents.
Losing these individuals does not impact us in the same way as losing our own family would. Not because we care less, but rather because emotions are set aside. The dynamic relationship between siblings or mother and child develops over time. The time we spend through good and bad together seems to form a bond unlike any other. Much like treating a sword through extremely high temperatures, cooling, and repeating this process will strengthen it, so too will the relationship between loved ones. The time spent with my brother may not seem to be any more significant than time with these patients, but the loss of it was devastating.
After treating the overdose I carried on my event shift as usual. On my way back from evaluating another, far less critical patient on the other side of the building, I was stopped by someone working the concession stand. “So what happened with that guy earlier who collapsed?” Of course, I couldn’t say anything. There are laws in place to protect the identities of those treated. “I’m sorry but I can’t give out any information.” Come to find out, the person asking me is his brother. We crossed paths later on that night, now that I know he is a family member – he paints a picture of events preceding his brother’s near-fatal episode.
He was surprisingly calm and seemed untouched by what his sibling just endured. This is not to say he was actually unaffected, but that was my first impression. He explained that his brother has battled with addiction for quite some time and was showed no signs of letting up. Have you ever watched that TV show, Intervention? Family of the addict often times hit their breaking point long before taping occurs, and what is left mimics indifference. They seem so familiar to the behavior and watching this downward spiral has become the norm. It was hard for me to understand how he was still at work, let alone calm and collected. Most folks would probably find the nearest exit after hearing their sibling nearly died and was being carted off to the hospital.
We exchange words and he thanked me for what we were able to do. Afterwards I couldn’t help but draw similarities between my own personal experience and the patient I had that day. This wasn’t the first time I had this type of patient. There was very little about this call that stood out from any other incident, but for some reason I think of Dean when this one comes to mind.
It was almost as if I was angry at him for being able to talk so nonchalant, like it was an nothing more than an inconvenience. If the person I was talking to was not his family member, it wouldn’t have taken me by surprise. It was not long ago I was in his shoes, but Dean didn’t make it to the hospital. Perhaps it would be different if there was a long dark road that brought us to that day. We would have seen it coming and it was this realization that gave me understanding of his cool composure. There was no doubt his family was expecting a phone call some day, like the one I received.
It drove me crazy. I could never stand idle while my best friend was killing himself. Did they really do absolutely everything in their power to prevent it? The pieces came together as time went on but never seemed to fit perfectly. I remembered a conversation with Dean a couple weeks before his passing when he explained in so many words that he was not happy with where he was in life financially, professionally or otherwise. It was clear he desired change but did not know where to start. I was thinking the rough patch he was going through may have led him to party too hard that day.
Common sense tells me drug addiction sprouts from traumatic experiences, depression, and any number of personal issues. It’s not like you walk in to the grocery store, get a heroin sample at the kiosk and become hooked. Every disease is a disorder but as a society we don’t consider every disorder a disease. We don’t think think of the student who has trouble paying attention as diseased. No, he has attention deficit disorder. What many substance abuse counselors will tell the addict is that it isn’t their fault because what they are combating is an attack on the otherwise normal function of their body.
Experience has shown me that I can most effectively tackle an issue after I know what it is. If my car fails to start, I’ll skip checking the tires. I know where not to look, and maybe that is the problem. We rule out what we instantaneously believe the cause is not. My brother went through a lot of hard times in his life and most often came out on top. He was able to get through many difficult situations after all these years, so why would I stop and think that this time it was any different? At the end of our conversation, he said something I will never forget. “Erin, everyone tells me I should be worried about how you are doing, but honestly you are the one person I never had to worry about. I know you’ll be okay.” I felt the same way about him. This tough guy never needed a leg up because he would somehow find his way out.
I take what good I can from that moment, but I regret putting my full trust in his ability to cope. Obviously something triggered actions he never would have performed under “normal” circumstances. I live an hour and a half away from where he did and have my own endeavors in life, but I can guarantee he would still be alive had I been there listening to more of what he had to say. I didn’t go checking what I was convinced didn’t need checking. What I’m left with is neither guilt nor anger. The end result was out of my hands. I just wish now that I worried more.
Dedicated in memory of
Dean Richard Boulton
10/24/1984 – 7/18/2016