The heroin hunch...

escaping from a harsh reality one “dope fiend lean” at a time

The world of a heroin addict is not linear — definitely equal parts catastrophic and cinematic. There he was. Partially hunched over, knees bent, peripherally coherent but definitely blurred beyond recognition. Not to say I didn’t recognize his 6’4 frame, but the gaze is what grabs you. Beautiful blue eyes peering through a fentanyl and methadone haze. He reminded me of someone desperately trying to gain access to something beyond the present while simultaneously retreating into the familiar.

me on the left, my brother on the right…

Maybe not co-conspirators but until his arrest in January we didn’t know what we have known for too many years for us not to be at least partially culpable in the persistent denial of his heroin addiction. I wouldn’t describe him as a functional addict although he does have a roof over his head and when working, is quite reliable and fulfilled. His marriage falling apart was a blessing as his wife was embezzling our mother’s money, one secret money order at a time. But I digress…

I arrived to my mother’s house somewhere between the initial wellness check by the police and the arrival of an additional 3 police cars and an ambulance. Apparently it depends whom you identify as a recipient of the wellness check as the police left once they could see mom alive and well although the addict was passed out in another room.

As the police cars begin to arrive for the second time, I vaguely recall my brother in the kitchen window washing something vigorously or more likely getting rid of something down the drain. He admits to keeping the little bags in his pockets to avoid my mom stumbling across them in his room or bathroom.

Patients on Medication Assisted Treatment (MAT) are notorious fentanyl users. MAT includes the use of methadone or buprenorphine to treat opioid use disorders (OUD) and often Naltrexone to manage overdosing.

Somehow my brother pulls it together and is answering questions in the back of the ambulance. The EMT is quite knowledgeable (put a pin in this) and instructs us to follow along after the ambulance. They will keep him for 8 hours of observation (because of the fentanyl) and informs us that the social worker at Robert Wood Johnson ED will help explain treatment options—my goal was for him to be admitted somewhere—and that only 2 of us would be allowed in the ED because of Covid restrictions. She added that taxi-fare is provided once they are discharged. Fair enough.

My adult son accompanied me the 5 or 6 miles to RWJ Emergency Department. I actually had completed my senior year internship here many moons ago while attending Rutgers University and even worked in the Radiology department for a time.

Not germane to the story but I remember filing away a baby’s patient folder under the name Velveeta. It stood out among the ‘baby boy «last name»’ or ‘baby girl «last name» folders waiting either for the baby to be deemed viable or the parent(s) to make a decision.

But on this particular evening, it was a shit show. Yes, I know people are helped every day and they serve an important community function but the dystopian reality had me tempted to volunteer as Tribute and hopefully get myself and others out of there alive.

Scan your eyes to the picture below, and the description on the website. Go pour a cup of tea and let me paint you the reality of 2022 emergency departments or at least this hell hole.

The website describes a hotel-like lobby but in their defense they didn’t clarify if it was a war-torn hotel in a developing country because this did not look like what you should anticipate in a country where healthcare is 20% of GDP and climbing. I have worked in hospitals on and off throughout my working life and this shocked me to my core.

This is even more alarming because whatever you might think, this is the portal of entry for many patients suffering severe Covid symptoms and this was a sick, sick gathering of people. Families of all ages sweating, sleeping, suffering, slumped and moaning taking up every amount of visible space. There was a pathway to these private areas they mention in the caption of the photo but it was mostly blocked by bodies slumped in wheelchairs or on stretchers. The picture below of the ED is missing the capacity seating that was there as I entered. Definitely edited for the picture. In reality, there was no place to stand so after being rebuked by the security desk we waited outside in the vestibule (visible in the right of photo). I can’t get the image of a profusely sweating woman slumped over the check-in desk. She was moaning and clawing at her layers of clothing.

“From the moment you walk through the revolving door into its hotel-like lobby, you know this isn’t like the Emergency Department you remember. Someone greets you at the door and asks your name and information about your condition. You spend the next few minutes meeting with a nurse in a private interview room to explain more about your symptoms. The nurse decides that your illness is not life-threatening and takes you to an Express Care area that’s just for patients with minor ailments. Instead of stretchers of patients separated by curtains, you find spacious private rooms with a TV and phone in each room. This area has its own doctors and nurses so you don’t have to wait to be seen until after doctors are finished caring for patients with more serious health problems. Laboratory and X-ray services just down the hall help doctors diagnose your problem quickly – and get you on your way quickly, too.”

I am filing this section above and below as the RWJ liar, liar, pants on fire section.

“The Robert Wood Johnson University Hospital Somerset Emergency Department has revolutionized the delivery of emergency care. At 40,000 square feet, making it one of the largest, best-equipped emergency departments in the state....”

A soft-spoken man with brusque demeanor although thankfully masked and behind plexi-glass, seemed incapable of understanding what we were trying to communicate. But was aces at repeating catatonically…

“The social worker has gone home.” “Drug-related patients are not permitted visitors”. “I am managing 100s of patients in front of you…”.

These are a few of the biggest hits of the evening. A steroid swollen tattooed police officer lounging in a chair at the back of the security area piped up, “I don’t know what you were told, but they don’t know what they are talking about” with his nose completely uncovered from his mask.

I am not saying I was behaving like my best citizen persona but I was civilized and inquisitive. Not once was there any interest in assisting us. There was no reply to the questions I had been told to ask and after about 30 minutes I was told my brother was being discharged.

“Ummm…what about the 8 hour observation?”

No response and as I voiced my concern over an afternoon that included 5 or 6 police vehicles and an ambulance at my mom’s home with a still visibly drug-addled grown man, a different security guard approached my right side. Clearly my propensity to speak loudly was triggering some sort of protocol where I was to be intimidated, ignored, and in charge of somehow navigating my brother to my vehicle in the parking garage up the hill.

The nurse barked at me that he was refusing treatment and that there was nothing she could do. Attempts to find out the treatment they were indeed offering were not addressed. It is important to know that many “treatment” facilities do not accept patients on MAT to their programs. By default, they were relying on an addict in active drug-use to make a decision to live or die because of course, their social worker has already punched out. It is also important to know that as I retold the story to my family later, my brother chimed up from his fugue state across the room—”yeah, that nurse was pretty rude.”

So here we are America. Oh. And by the way not only wasn’t there cab fare (they had no idea I was waiting out in the vestibule as I never signed in), to their knowledge they discharged him from care in a pair of socks, still high, into the rainy night…

I have a hunch this isn’t going to get better anytime soon.

It is not heroin or cocaine that makes one an addict, it is the need to escape from a harsh reality—Shirley Chisholm