Connecting with a Drug Overdose Patient

Freehold-Heroin-Possession-Offense (1)She’s only 20 years old*. 15 years younger than me. Laid out on the ground in front of the house. It’s 40 degrees outside at 1am here in Texas. Her boyfriend woke up and found her not breathing and did CPR on her while waiting for us to show up. The police showed up first and she woke up. They started their investigation before Fire and EMS even made it to the scene, and proudly declared to me that they had discovered heroin and drug paraphernalia inside the house. All around me are public safety employees shouting at this young woman, “what did you take?” and “what are you on?” and “whose drugs are inside the house?”

Meanwhile, I walk up to her and say, “Hi, I’m Dave, I’m a paramedic, what’s your name?” She stares at me with the same blank, glassy, pinpoint eyes I’ve seen over and over again. I know she’s high on opiates as sure as the sun will rise again in the morning, but she denies it. Her boyfriend says maybe she took too much of her prescribed seizure medication. He’s visibly shaken from finding her apparently dead, and doing CPR on her. I talk to him for a moment, thank him for the information he can provide, and tell him he did a good job keeping her alive until we got there to help her. We pick her up off the cold, dark ground. Carry her to the stretcher. Move to the ambulance.

My firefighter brothers, normally compassionate, caring souls, have turned into callous, questioning, judges. More cries of “what did you take?” and “you stopped breathing” and “if you don’t tell us what you took you could die.” She looks at me. Tears forming in her eyes. I clear out the ambulance. She’s breathing. She’s stable. She has a pulse and a blood pressure and her other vital signs can wait. She doesn’t want me to start an IV. She doesn’t want me to expose her any further to obtain a 12-lead EKG. I tell her that’s fine, it can all wait until we get to the hospital. We talk while PD continues to pop in and out of the ambulance. She wants to talk to her boyfriend, but he’s already been detained and arrested and can’t come see her in the back of the ambulance. She tells me she has a job interview in the morning, and cries when I tell her I don’t think she’s in the right state of mind to go to a job interview right now.

On the way to the hospital, she admits that she was clean for almost a whole year, and then went back to her old boyfriend, and he convinced her to start using again. I tell her it’s ok. I’ve never used before, but I’ve been told that drugs are like a bad relationship, you just want to keep going back again and again, even though you know it’s not right. She nods. I hold her hand on the way to the hospital. We arrive at the ER. The nurses and the doctor are surprised I haven’t given narcan. Why would I? She’s breathing, she’s awake, she’s maintaining her airway…. am I supposed to use it punitively? To punish her and wake her up faster from the high that almost killed her?

I haven’t had a lot of run-ins with heroin use since I moved to Texas. I got so used to seeing overdoses like this in Kentucky that I became numb to the callous, harsh nature that we handle drug addicts there sometimes. It was shocking to see it here, years later, as I was trying to form a personal connection with my patient, to form a rapport so that I could better treat her, better understand her, support her, and help her get the help she needs. We can do better for our patients. They deserve better from us, regardless of the reason why they ended up in the back of our ambulance.

*Patient information changed for privacy.

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