One and done: a heroin and fentanyl cocktail

Originally published on KevinMD

There was her 28-year-old daughter lifeless in an ICU bed.

Her name was Tricia, and she had dabbled with drugs since she was 15. As a child, she was artistic, adventurous, and always found excitement with other kids who tended to do risky things. She’d justify their behavior and say they were more fun and had better personalities.

Eventually, her mom and dad moved to a small town thinking it would be a safer environment. But when Tricia started middle school, she again sought friendships with those “bad kids” on the edge.

It was as if she was heading down a path of destruction her whole life.

But her unsavory friendships didn’t keep her from excelling scholastically. Tricia was quite the student: she was smart, absorbed information in a flash and had a mind like a computer that was always on. And she was especially good at biology and chemistry. In fact, she obtained a bachelor’s degree in chemistry — she was that smart.

After college, she landed a decent job. A job that paid the bills and her drug habit.

Heroin costs less than Percocet pills on the street. But there was also a new way to get high in town. The “ultimate high.”

The combo: Heroin laced with fentanyl.

ER docs and nurses call this mixture “one and done.”

But that didn’t matter to Tricia or the crowd she hung out with. Even though they heard that this combination killed, they were willing to take a chance. They knew it wouldn’t happen to them.

After all, weren’t they invincible?

Apparently, they weren’t.

A car sped up to the ER entrance, and Tricia was pushed out right before her “friends” put the pedal to the metal and took off. Workers later said it was too late to capture the license plate. All they knew was that it was a red Mustang. Other than that, the occupants of the vehicle were a mystery.

There was her body on the cold pavement. No pulse. No breathing.

“Code Blue” blared throughout the hospital.

CPR, intubation, central line, loads of normal saline, Levophed, and vasopressin — it took over 20 minutes to gain a pulse on Tricia. They found opiates in her blood.

Her “friends” had thrown her wallet out when they dumped the body. That’s how the hospital identified her.

But her mother already knew something was up. It was a week since she last heard from her daughter, and Tricia usually called every other day. After dealing with Tricia’s friends who “knew nothing,” mom called the police who heard of the dump and referred her to the hospital.

The ICU nurses understood she was dead. It was just a matter of time after so many hours of ineffective “Code Cool” protocols. We lowered her temperature to preserve her vital organs, but it was too late. She was down for too long.

Her mom rushed in, shook her beloved daughter’s arms and screamed, “Wake up, Tricia! Wake up!” The only movement was a decerebrate response.

Tricia moved her mom thought.

“She’s moving!” her excited mom yelled to the nurses. But we had to explain to her that movement from decerebrate response is one of the worse signs of neurological damage.

Tricia’s body was rigid with head and neck arched backward.

After EEGs, MRIs, cold caloric tests and failing “Code Cool,” the promising, smart, adventurous woman with a chemistry degree was pronounced brain dead.

Another one down.

One and done — the ultimate high.


Was it really worth it, Tricia?

Heroin and fentanyl. They call it “Theraflu,” “Bud Ice” or “Income Tax.” And it’s happening across the country in cities and town big and small. Some are lucky. Some get to the ER in time. Naloxone (Narcan) IV push can reverse heroin. But when it’s laced with fentanyl the chances are much slimmer like Tricia’s case.

Should you know someone or YOU are that someone, get help. Get treatment. Go to rehab. You can start over.

Do something or accept and expect that you might be six feet under.

Remember, it’s one and done.

We have no answers to these unbearable algorithms in life

Originally published on KevinMD

Jim Morrison of the Doors once sang, “Petition the Lord with prayer … You cannot petition the Lord with prayer.”

But we did that. We petitioned.

On one side of the ICU, we had an 18-year-old girl, upper middle-class family, had everything. Beauty, brains, money, supportive parents, and she was off into this new bright world, choosing her college of choice. A simple surgery led to sepsis, severe sepsis that raged through her body.

Mom and dad at her side. Dad collapsing over her body, wishing for a miracle. We were all wishing for that miracle. Cheering on every better blood pressure and better temperature and better vent settings.

And then there was Sue. 21 years old, overdose, mom and dad deserted her, and she lead a life of despair, neglect and abuse. She could remember verbal and physical abuse as far back as 4 years old. She tried and she tried to climb that mountain of hope.

But it never came, and through defeat, she overdosed on her anti-depressant meds. She did a good job with her overdose. She was found down at her home, by a friend visiting her. 911 and CPR couldn’t bring her back. And with a slight faint pulse, she was intubated and placed in the ICU. Comatose, non-responsive.

We, the ICU nurses and MDs placed our “petition the Lord on Cee-Cee, the glamorous college student. Though we provided excellence in critical care to both young ladies. The bet was on.

And we lost. And with our loss, we knew we had to evaluate. Cee-Cee coded many times, until there was nothing left. Dad draped his body over his daughter, and sobbed and sobbed, and we all became defeated. We lost, we questioned, we had petitioned. And we lost.

Sue started to rouse. Started to give handgrips and grimace and squirm. ABGs improved significantly to where she was able to be extubated. There was no family member or friend to cheer her on. But after we, the nurses, realized that you can’t will one person to live and let the other person go, we rallied Sue on.

Sometimes, this job, this costume we wear, this stethoscope we wear, becomes unbearable. Tears of sadness for Cee-Cee, tears of unbelievable happiness for Sue. And Sue made it. Not only did she make it out alive, a year later, she sent us a postcard. She was standing on a mountaintop. Accomplished with inner peace. And she thanked us for believing in her.

Sue became a counselor, master’s degree, counseling people just like her. People who had met a dead-end in life. She wanted to share her life and give hope to others. And she did. Triumph.

Lesson learned: We can’t petition, we can’t bet. But we must be steadfast in what we do. And as the nuns once taught me in Catholic school as a little girl: “Thy will be done.”

We have no answers to these unbearable algorithms in life.

We have no answers.