by Robert Lanz, LCSW
(Most of us ER social workers wish that Narcan was an over-the-counter drug.)
“Get me a blanket man. I’m freezing my ass off.”
A simple request. I went to the blanket warmer and brought a toasty one back to the young man who had been complaining of being cold but couldn’t get any of the nursing staff to respond. Too busy. When the paramedics brought him in, they said he had overdosed and had responded well to Narcan, an opiate antagonist that has the strength to bring a junkie back from death. By binding onto neuron receptor sites, the Narcan blocks the uptake of any opiate in the bloodstream in a few seconds with dramatic results. Often the junkies don’t like this rude awakening, even when that rude awakening is from death. Magic medicine, Narcan turns an OD from the blue of breathlessness to the pink of withdrawal in about ten seconds. That’s dramatic.
This guy may have had a flair for the dramatic at some point but if he had, I didn’t know about it. All I knew for sure, was that he was shivering, and I thought he was just another junkie kicking his habit, going through withdrawal. Since we had effectively taken all the opiates from his blood, I brought the blanket. I’m not overly fond of junkies because, like everybody who lives in LA, I’ve been ripped off on more than one occasion to support somebody’s bad habit. But right then, that junkie was a patient, so I could afford to be a little empathetic and besides, he did look like he was freezing his ass off.
“Thanks man,” he said as I wrapped him up and started to leave.
“Hey, no problem,” I responded and went about my business. I’d be returning to see him later, before his discharge to discuss the obligatory “Are you sure you want to be a heroin addict, do you know where to go for help?” pitch. It was an old and tired pitch, about as old and tired as the junkies that have to sit through it and then tell me lies. No fresh news here. If getting caught stealing color TVs, going to jail, watching their friends die and the fear of AIDS don’t dissuade them from their addiction, I’m hard pressed to say something that will make the point much clearer or provide the motivation for rehabilitation. That’s a different story altogether.
A few minutes later, I passed the patient’s bed again and he asked for another blanket.
“My ass is still freezing,” he observed.
Given the severity of his shaking, I could only sympathize and bring a fresh blanket from the warmer. Another couple of rounds of this, and he would either be crushed in white cotton or start looking like the Pillsbury Doughboy. I was wishing the doctor would come in and tend to this guy so we could get his freezing ass out of there and get on with taking care of patients who weren’t practicing their death dance again.
“I’ll check on you in a few minutes. The doc should be right in,” I said as I walked out of the room.
Junkies. They have no tolerance for pain. It might be why they become junkies in the first place. Life’s raw edges were too raw for them, or their coping skills were too weak. Or they learned about drug escapes from their parents, from TV, from their gangs or somewhere else early on and never developed the skills to get past pain. Who knows? There must be something that makes it hard for some people to stop being a junkies, because the physical withdrawal isn’t that bad, and the alternatives, like death or prison, don’t seem to have the preventive effect they would on most rationally thinking and acting people. Junkies will rob another 7-11 and take a chance on a few years in jail rather than go through a few days of withdrawal and calm down a little. Go figure.
The next time I passed the junkie’s room, just a few minutes later, he hailed me again.
“Man, my balls are fucking ice. Can you get me another one of those warm blankets?”
“Sure,” I answered as I went to the blanket warmer again. Definitely starting to have the doughboy look, I thought, as I piled on the third one. By now I could barely see him under all that cotton.
“Is that any better?” I asked.
“No, man I feel like I got ice in my shorts.”
Ice in the shorts? What the hell was this guy talking about? I looked down and there was a small puddle starting to form under his bed. At first I thought he had wet his pants but it the liquid looked too clear for that. I could see a big water mark on the side of the bed where the dripping had started.
“Put your hand right here and tell me what you feel,” I said as I guided the junkie’s hand to the wet spot. I sure as hell wasn’t going to be the first to touch it.
“Feels like ice water.”
“Pull those blankets back and let’s take a look,” I said.
The bed was soaked. His pants were soaked. I felt the wet spot, quickly, gently. Jesus
Christ, it was ice water.
“Take off your pants,” I said with authority.
He did. His jockeys were soaked through and through and there were small corners poking out in several spots. Judging from the temperature of the water I knew immediately it wasn’t the guy’s anatomy that was frigid.
“Stand up and drop those Jockeys,” I told him.
He slid over to the edge of the bed and eased himself into a standing position, holding onto the safety bar to steady himself. As soon as he stood straight up and dropped his shorts, about twenty little ice cubes fell out onto the floor and slid all over the room, under all of the other patients’ beds. I could see now that this guy hadn’t been speaking metaphorically when he used the expressions about his ass and balls. They were freezing off, or at least in danger of frostbite, hanging lifeless and purple.
Junkies don’t like to come to the hospital. Junkies hate to take other junkies to the hospital for overdosing because it brings on too much attention to their own junkie condition. They never seem to know about our drug, Narcan, or they would be out stealing it like they did everything else. Then they wouldn’t have to come to the ER in the first place. But they do know about home cures and opiate addict lore, such as, if you keep them walking after an overdose they won’t die. Sure. They die walking. And if you put an OD into a tub of ice water he won’t die. Sure. They die cold.
Tonight’s OD lived in a funky little apartment without the amenities that you or I might have in our homes. If the residents of that apartment had those amenities, they would have sold them a long time ago and bought drugs and then ended up with just the bare essentials. This junkie apartment was no exception, lacking the luxury of a bathtub, just a shower, and a cold shower isn’t cold enough to keep a junkie alive, at least that’s what they think. But hey, there was an icebox and it did have a freezer and the freezer did have two trays of ice in it and because they couldn’t take the junkie to the ice they took the ice to the junkie. Since he was nearly naked, the only place big enough to hold two trays of ice was his Jockeys, so that’s where it went. Right up the old wazoo.
Of course, the ice didn’t save his life, we did. It did keep him awake though, but I’m not sure that would have happened without the Narcan. And in the end, it may have even done some damage to his private parts. Frostbite in the worst way. Junkies. You probably think this would teach him some kind of a lesson, and if it had happened to you or me, that would probably be the case. That’s why we’re not junkies and he still is. I’ll keep the blanket warmer full. He’ll be back.