The Rural Opioid Tragedy in One Story

One of many stories

Photo by Sean Foster on Unsplash

She was 55 years old, shooting up with friends; well, with people. I have no idea if they were friends, or if they were simply bound together by addiction and convenience. Maybe, to that extent, a kind of family knit together by pain, loneliness and despair. I never saw them. No surprise. Why would they show up when the police might ask questions?

She took that last hit, her arm bound by a cheap, probably dirty tourniquet. A needle that was probably used. It was probably a very good hit. The heroin, or more likely fentanyl, flowed up her scarred arm and into her heart and on to her brain where it unleashed a tsunami of dopamine. A warm, relaxing, euphoric and probably transcendent tsunami that coincidentally caused the basic parts of her brain to stop telling her body to breathe.

This is what it looks like. The pause in breaths, maybe a gasp, and then shallower breaths less often. We call them agonal. Even the lay person watching knows that something is wrong.

And then the heart…also…..slows………..and………………..stops…………..……..beating. The regular impulse of electricity that traveled since the sixth week of gestation in her mother’s womb, through day and night, through sickness and health, richer and poorer, suddenly shut off like a broken breaker, a snapped wire in an ice-storm, because the oxygen is no longer arriving. The lub-dub of atrium and ventricle contracting becoming still, blood that would have carried oxygen and glucose pooling in small, warm caverns.

Someone, we think, gave her narcan but it wasn’t enough. Someone did call 911. A call went out as her friends, family or whomever they were tried to do CPR.

The story set at night, on a cold, windswept West Virginia mountain. The ambulance made its way up narrow roads, and the paramedics began their work. Narcan again, more CPR, epinephrine, intubated with a plastic tube down the trachea.

A LUCAS Device, a sort of robotic CPR machine, continued the work. And from that mountain in the dark, she was brought to the hospital over more dark, windswept roads in the shadow of ancient Appalachia, stars high in the night.

When she came to me it was 90 minutes since the drugs were pushed. (Maybe more. Times are always hard to estimate.) 90 minutes since she had felt that last wonderful moment, that last rush. 90 minutes since the people with her had the awful realization that the evening would result in tragedy.

With lights and sirens on, despite the hard work of dedicated, cold, anxious paramedics, CPR and medication, despite truly heroic effort, the blood congealed and the breaths never returned and the heart never beat again.

That’s a long time. When she arrived we stopped the machine, looked at the heart monitor, examined her. The blue marks of lividity lying under the skin of her flanks, a sign to a doctor that ‘this is all; there is no more.’ The monitor that classic green, flat line that we have known since the television show ‘Emergency’ brought it to us for public consumption.

I look at pupils, of course, and hers showed no activity. But I look at eyelids too. It’s a thing I’ve realized. In death they are rubbery, the do not stay open or closed, but sit in a half state.

We stopped.

Unlike other deaths, there was nobody present to tell. There was no scream, no ‘why God why?’ No necessary explanation, no calming words to say ‘this isn’t your fault.’ No chaplain to pray. No priest for someone desiring last rights. Her sacrament, I suppose, her path to what she thought was ineffable had already been pushed into her body. 90 minutes before.

The police were notified. The coroner was notified. The body prepared and taken.

And that is just one image of the rural opioid epidemic.