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ADVANCE Perspective: Nurses

What Do I Say to You When You Wake Up?

Published November 12, 2015 2:42 PM by Guest Blogger
Guest editorial by Debbie Moore-Black, RN, ADN, charge nurse/staff nurse at Pineville Medical, Charlotte, NC, and Devin Black, BA, at the Center for Behavioral Health, North Charleston, SC.
She came rolling into the ICU. Intubated, chest tube, restraints, propofol, fentanyl and Levophed drips infusing through her veins. Her blood pressure is low, we pour normal saline IV into her veins as fast as possible. She's only 28 years old.

She crossed the median of the highway int the oncoming traffic. Barreled into four vehicles, randomly. She sent three people to the ED. One young father is dead. Her hair is filled with shattered glass; her face has lacerations. She has a tension pneumo.

The ED nurses and doctors are on high alert, and she is emergently intubated, a chest tube is inserted. The nurses give her drugs to slow her respirations, restrain her to make sure she doesn't pull out her endo-tracheal tube.

She was a young mother, not ready for the real world. Had minimal support. A boyfriend that drifted in and out of her life. When her little boy was 4, she picked him up when he was crying, he jerked out of her arms, and she pulled a sciatic nerve in her back. Severe back spasms set in.

She moved furniture, hurt her back again, and a period of strange "events" kept happening, where her back "gave out." So she went to her physician. She said her pain was a "10". He wrote her a prescription: hydrocodone. It worked pretty well, but not good enough. Then she graduated to oxycodone. Oxy was good. Drifting off on the couch, pink clouds, angels, rainbows, and the pain was gone, emotionally and physically. It didn't matter that Timmy was in his crib crying because he was hungry, it didn't matter that the sink was piled high to the ceiling, it didn't matter that she missed several days of work. Two tablets every day, grew to three tablets a day. And it was never enough. She needed more.  After a year, Jen needed more. But her MD said he was unable to write her any more prescriptions. And so after one year of chewing down her oxycodones, she was without for 18 hours. Her boyfriend would supplement her with drugs being sold on the street, but it was $30 a pill. Jen ran out of money, and she ran out of pills.

Covered in sweat, stomach churning, goose flesh skin, restless legs. She was in withdrawals. She haphazardly roamed the streets and there it was. Magic. Black. Black tar.  He said half a gram of heroin is $80. That was cheaper than the $120 it took to get Jen through the day.

She wrapped the belt around her upper arm. The syringe was loaded. He inserted the needle in her arm, and pushed. Suddenly, she was wrapped in a warm hug in the clouds of heaven, suddenly everything was OK. There was no pain, no sadness. Jen was euphoric.

And Jen did this whenever she could. Whenever she had the money, or "found" the money.

But this time, after shooting up, she jumped into her car. Driving, on the highway, her head tilted back as she felt that rush go through her veins. And she drove, unaware of driving ... and she plowed into four cars. Four cars totaled, three people sent to the ED, one man dead. Blue lights, red lights, ambulances, police, fire department, people gawking on the sidelines.

And you wake up in the ICU; several weeks have gone by. You are out of your coma, chest tube pulled, breathing tube gone. And you squeeze my hand, and ask where you are.

How do I tell you that you put three people in the hospital? How do I tell you that Social Services has your little boy? How do I tell you, you no longer have an apartment? How do I tell you that you killed a man? An innocent man, driving home from work to his wife and three children.

Could she even put these pieces back together again? Rock bottom.

With the assistance from her doctors, nurses, counselors, rehab, Jen slowly, painfully pulled her life back together.

Not everyone makes it.

Three months later, Jen came back to the ED. DOA. Body bagged. Famous deaths by heroin: River Phoenix, John Belushi, Janis Joplin, Jim Morrison, Sid Vicious, Cory Monteith, Dee Dee Ramone, Philip Seymour Hoffman, Chris Farley.

Non-famous deaths: Over 8,200 deaths in 2013 per the CDC. Every day, 44 people in the U.S. die from overdose of prescription painkillers, and many more become addicted. 

Greatest risk: prescription opiods, painkillers such as codeine, fentanyl, hydrocodone, Demerol, morphine, methadone, oxycodone and dilaudid.

Treatment: Recognize and acknowledge your problem. The WILL to quit. Drug treatment centers. Psycho-therapy. Drug rehab. Methadone clinics. 24/7 hotline: "Narcotics Anonymous: 1.888.827.7180. Educate yourselves, give out this number. If "they" don't quit heroin, the alternative is death.

posted by Guest Blogger


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