A toddler, his dad, and the unthinkable

Originally published on KevinMD

The toddler was a curious, rambunctious, talkative three-year-old who loved to explore.

Every week, he’d wait for Sunday to come, because Sunday was he and his dad’s special day. Mikey and his father adored each other.

Whether Mikey and his dad were doing “horseback rides,” playing basketball, or just sitting on the rocking chair for story time, whenever they were together there was fun, love and a forever bond.

Mom called them “the twins.”

One particular Sunday, “the twins” packed a picnic lunch with a bag full of breadcrumbs for the ducks. And Mikey couldn’t wait to feed those ducks! Dad loaded up the truck, and he and Mikey set off for their favorite park.

They sang their favorite song on the way: “This little light of mine … I’m gonna let it shine.”

When they arrive, it was a beautiful riot of spring: flowers reached for the sun, the air seemed to pierce through the fluffy clouds and the ducks waddled over and ate the bread crumbs Mikey had tossed to them.

Dad spread out a quilt on the grassy area under a tree where he and Mikey ate peanut butter and jelly sandwiches as they talked about the clouds and, of course, the ducks.

When lunch was over, Dad turned on the radio, and they listened to music. Tammy Wynette, Patsy Cline, Hank Williams, Johnny Cash and old gospel tunes — the good stuff.

Dad closed his eyes, but only for only a second. Mikey saw dad sleeping. Dad had such a beautiful smile, he thought.

Curious Mikey heard the ducks quacking and wanted to pet them. So he went down to the pond and got very close to the water. Then, one of his little feet slipped on a slick, wet rock.

At the hospital, things were quiet in the ER. The nurses were snacking on treats their families brought them after church. Sunday was always a good day for the nurses and staff. Church folk stopped by to visit loved ones and sometimes brought treats for the workers.

This particular day was eerily quiet, though. One of those “quiet days” that was almost unbearable. It was such a tranquil and peaceful Sunday that it almost “warned” us that something bad was going to happen. Amid the snacking and the chatting, there was a sense of doom.

A truck sped up to the Emergency Room doors. A frantic father carried his three-year-old son out of his truck and screamed, “My son, my son, help my son!”

Mikey was blue and lifeless as he lay on the ER stretcher. “Code Blue, Code Blue,” paged loudly and quickly throughout the hospital. Surgical nurses on their break ran out to the ER; respiratory therapists reported STAT to the ER. This small country hospital had only two MDs that day, and they dashed down the stairwell to the ground floor ER.

Mikey’s dad told the story gasping and hyperventilating.

“I fell asleep. I fell asleep … it was only seconds.”

Mikey had roamed off, and he slipped on a rock and fell into four inches of water. He couldn’t get up, and his mouth filled with pond water as he desperately gasped for air vomiting and aspirating until he was unconscious.

When Dad woke up, all he could hear was silence, but Mikey was never silent — until then.

We performed rapid CPR compressions between oxygenating him. Mikey was in pulseless electrical activity (PEA).

No pulse. No heart rate. No breathing.

Dad leaned over the ER sink, hung his head and began vomiting while he cried, “My son! My son!”

Despite our IV doses of epinephrine, rapid CPR, pleading with God and despite wanting to pretend this nightmare never happened — Mikey did not come back to life.

There he was blue and lifeless with vomit on his little T-shirt that read, “I love daddy.”

This was over twenty years ago, and the vision is ingrained forever in my brain.

Some things we cannot erase — ever.

This is what heroin addiction looks like

Originally published on KevinMD

What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration.

Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were destined to hell.

So when Pam graduated from high school with top honors, she was set free and off to college. While there, she learned a lot about different cultures, different religions and different languages. She learned that not everyone was white, Christian and middle-class. This was a whole new world to her. And she loved it.

After several parties she learned some non-academic things one learns about in college. With her discovery of alcohol, pills and cocaine — she was ready to conquer anything. She had her wings and was ready to fly. And fly she did. Even with the partying through four years of college, she walked across the graduation dais with a diploma in her hand.

Then she found an amazing job in Manhattan far away from her provincial life. New York City: Bright lights, big promises and John.

John was Pam’s handsome, smart and, well, perfect manager at work.

Boy, did they have fun. There was dance, dinner and drugs … and even more drugs.

The fun went on for months, and then John proposed. Together they shared a taste for adventure, travel, exotic food, music and sex …

Eventually, they had a baby boy with blue eyes and blonde hair just like John. Pam’s family was complete, and Baby Jack was the apple of here eye. He was perfect in every way — except for his colic which made him cry and cry as Pam would rock him and rub his back. But what really calmed this baby down was warm baths — he loved them!

One day, John came home early. And he had a surprise for Pam. Although it was inexpensive, only around 80 bucks, it was precisely what the couple needed — a new high. The gift was black tar heroin and gave them the hit they were looking for after oxy and coke lost their lustre.

John tied his belt around Pam’s upper arm. The syringe was full, and he interested the needle into her vein and pushed. The rush was on. Pink clouds danced along side of puppies, kitties, unicorns and cotton candy. And life became painless.

Pam’s memories of her mother screaming, “Come home, you don’t know what you’re doing! You’re damned to hell,” her father’s rejection of her, the taunts, the damnation, the screams were all gone.

Pam was comfortably numb and free. It was pure euphoria.

Her head flopped down as she fell into the abyss.

She couldn’t wait to have more, she was rapacious and desperate for that feeling. But she knew she couldn’t keep doing this. Pam stopped eating and taking care of herself. Jack ran around in dirty diapers, and John came home later and later — Pam’s life was spinning out of control.

In a lucid moment, Pam knew she had to stop. Heroin took over her mind and body. So, she stopped using — cold turkey. She told herself that she could do it without help. 18 hours later, without the drug in her body, she started to sweat profusely, her body shook, her muscles ached, her legs were restless and the stomach cramps and vomiting were excruciating.

She wanted to feel good … to be normal. She just wanted the pain to go away. And her son just wanted to be held, to be fed. So he cried and cried.

Pam needed to fix this — to fix everything.

She knew she could calm Jack with a warm bath. So she put him in his baby seat, placed him in the bathtub, poured in bubbles, and turned the faucet on as she sat on the toilet seat and tightened up her belt. She injected deep into her vein and watched the bubbles rise … those beautiful bubbles.

John was out of town. He tried calling multiple times, and Pam wouldn’t answer.

When the police arrived, the door was locked, and they tore it down.

After two weeks, Pam roused but didn’t know where she was. She was in a strange bed in a strange place with a voice hoarse from an endotracheal tube.

She squeezed my hand and asked where she was.

I told her she was in the intensive care unit.

She didn’t remember a thing.

How do I tell her that she stopped breathing? How do I tell her that CPR was started on her? How do I tell her that she had a needle sticking out of her arm? How do I tell her that her bathtub water was overflowing onto the floor?

How do I tell her that her little boy is dead? How do I tell her that he drowned in the tub while his mommy shot up?