BY: LAURA McKINNIS, APNP
I am working in the front hallway of our emergency department, and I hear an overhead page from triage for help in the waiting room — there is an unresponsive patient. We run out there and find a triage nurse, a tech and a security officer struggling to load a 20-something, white male into a wheelchair. His eyes are rolled back in his head, his mouth gapes, he makes occasional, grunting respirations. He is moments from death. This is a heroin overdose.
We know how to save him: Get him to the back of the ER, give him Narcan — an antidote to opiates — save his life. We all have seen these symptoms before. The nurse is calling for Narcan all the way from the waiting room.
Usually within minutes of receiving Narcan, the patient revives, becomes completely lucid and often proves to be a real pain in the neck. So it was with this particular kid. He started demanding food, then complained about what we gave him. He became disruptive and was verbally abusive to the nursing staff. He left the hospital, against medical advice, within an hour of being carried through the door half dead. We treated two overdoses that day.
I hate heroin.
Once, after we got an overdose patient to the back for treatment, I quickly returned to my other patients and responsibilities. I turned around to discuss moving some patients with my triage nurse — for privacy purposes, I'll call him "Greg." He was leaning over the computer desk, head in his hands.
"Greg, what's going on?" I asked.
"Oh, didn't you know? My kid overdosed last year," Greg said. "I was the one who found him and started CPR. I've seen dozens of kids like this since — this one just got to me. I need a minute."
Everything just stopped. We talked. Then I left him alone to catch his breath.
I hate heroin.
My emotions are equal parts anger, frustration, sadness and fear. I hate this drug. I hate what it does to people. I feel hatred towards those who use it. I feel hopeless and afraid. I feel afraid of myself and how easily I become jaded. I can't speak for my co-workers, but the angry thought in my mind as we save one of these overdose patients is something like this: "You stupid kid! Maybe we shouldn't give the Narcan and just let this whole problem end a little more quickly."
I hate heroin.
There is a heroin epidemic in our country. U.S. government statistics say heroin use nearly tripled between 2007 and 2014. Deaths involving heroin use more than tripled between 2010 and 2014.1
How did we get here? How do we get out? I know next to nothing of public health, alcohol and other substance abuse management or law enforcement. I only know emergency medicine. I know how weird it is to save somebody's life and then immediately want to punch them in the face. I know the grief in a parent's eyes that tells the story of a tragedy.
Where do we go from here? I have no idea. As clinicians, we definitely need to rein in our narcotic prescribing. I think we need to show young people what heroin overdose looks like — it's really scary. I want to tell my story and how this epidemic affects us every day in the emergency room. I want to explain the complicated and conflicting emotions that come with caring for these people who have overdosed. I want the problem to go away. I hate heroin.
The only way I know to search for answers is from a Christian worldview. I hope that even if the Bible is not your language of spirituality, you will at least find some truth in a story that tells us what Jesus would do. What he did do.
What comes to my mind is the story is from Mark 5:1-17 about the wild, demon-possessed man, "a man from the tombs who had an unclean spirit ... and no one could restrain him any longer, even with a chain." The guy was running around naked, living in a graveyard. People had tried to chain him up because he was so wild. He just broke the chains.
Jesus said, "Unclean spirit, come out of the man!" And then he asked, "What is your name?"
The demon answered, "Legion is my name. There are many of us."
I pause here. I wonder if the demon is who Jesus was talking to. Maybe he actually was talking to the man, not the demon. Maybe Jesus looked this pitiful, wild human being in the eyes and asked, "What is your name?"
This makes sense to me. Jesus called out to the human heart in that tormented man.
What do we name these people who come through our emergency room doors, half dead from narcotics? I have named them addict, idiot, stupid kid, loser. But those are not their names.
Maybe we need to look through the crazy, manic, frightening behavior and ask, "What is your name?" Maybe that is a way through this epidemic. Maybe we need to look these people in the eyes and ask, "Who are you? Who is the real you? What is your name? What is your real identity?"
Maybe they've been struggling for so long that they forgot. Maybe we, as health care providers, forgot that this frightening, disruptive pain in the backside is a deeply wounded human being.
"What is your name?" we should ask. "No, really, what is your name?" Because his or her name is not stupid kid or pain in the backside. It's Kyle, or Demontre, or Andrea. Real names of real people with moms and dads, friends, kids, jobs and broken hearts.
I'm not saying this is easy. Jesus was brave and bold and so tender and compassionate. That's certainly not how I feel during the frantic moments of trying to revive someone who is nearly dead from a heroin overdose.
But I want to learn that way, and maybe it starts with getting to know the person's name. Maybe that will give him or her hope. Maybe it will give us all hope.
LAURA MCKINNIS is a nurse practitioner specializing in emergency medicine. She has worked in emergency departments in Milwaukee, Wisconsin, and surrounding areas for 17 years. Her website is www.medicineasministry.com
- DEA Strategic Intelligence Section, National Heroin Threat Assessment Summary — Updated (June 2016), www.dea.gov/divisions/hq/2016/hq062716_attach.pdf.
QUESTIONS FOR DISCUSSION
Laura McKinnis, an ED nurse practitioner, repeatedly states "I hate heroin."
- How would you describe your own emotions on this subject?
- How can the author's question "What is your name?" become helpful to the patient and the clinician? What is risky about asking those questions? How can they give hope?
- Do you know a health care worker who is highly competent and motivated to work with heroin or other addicts? How does that person uphold the dignity of individuals who are addicted?