!Wrong
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agk's diary
17 Sep 2022 @ 20:58 UTC
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written on GPD Win 1 in puTTY with tmux and nano
in bed with my just fell asleep napping baby
on my little brother's birthday
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Content warning: Morphine overdose death.
One of my capacities is I'm a community health
worker. Look up Barefoot Doctors in the Chinese
Cultural Revolution. Like that, but not state-spon-
sored, unfortunately. In 21 years I've trained
hundreds more of us, dozens of whom practice. A few
call me for advice sometimes.
A friend in another state who attended one of my
trainings seven years ago called last night. His
neighbor got bad news about her son, drank the
oral morphine sulfate she'd hung on to after her
dad's hospice death. Her guy was with her. She was
responsive only to pain, breathing 13 times a
minute.
My friend got narcan, went over. I called the
neighbor guy. Everyone in his life, five all told,
died in the last year, except her. He'd been with
her since she started heading into stupor, about 3
hours. She'd been breathing about the same the
whole time. Oral morphine's half-life's about 4
hours. I gave him the poison control number, said
they're better to call than me.
He was angry and hurt and scared. He didn't want
hospital bills. Their home, small business, finan-
cial life's falling apart. They're uninsured. I
educated him about the poison control centers, how
morphine works, how an overdose of it kills (resp-
iratory arrest), narcan and rescue breathing (if
she drops below 12 breaths per minute).
I used to overdose on morphine. My priorities for
this family: stay awake and with her til she emer-
ges from stupor, prepare to resuscitate and trans-
port; support his psychosocial needs possibly with
accompaniment to an Al-Anon family group meeting;
neuro assessment of her in a few days for any
evident residual anoxic brain injury.
I called and consulted two people in my network, a
fire department medic in eastern Kentucky who resp-
onds to at least one overdose every shift and a
nurse practitioner in Chicago who consults when
hospital patients are drug-involved. They said my
priorities were good.
I called my friend, told him to also count her
breaths, check her capillary refill time (he had
no pulse oximeter to get her oxygen saturation
directly), and check her pupils (if they're slugg-
ishly responding pinpricks, that's good. If one's
blown, that's brain damage). Then I finished
writing a paper on tens of thousands of deaths
caused by private equity buying nursing homes and
degrading care for quick profit.
My friend called me in the morning. The neighbor
guy had called him: "She isn't breathing!" My
friend told him to narcan her and breathe for her,
drove over. The neighbor guy hadn't called my
friend to keep vigil when he fell asleep. She'd
been dead some time. My friend stayed while the
ambulance, police, etc. did what they do.
The tragedy isn't how I felt, or feel. "Kill one
person and you're a murderer, kill a dozen and
you're a professional." My advice was bad. Maybe if
the people I consulted or I had been there our
spidey-sense would have told us this needed to be a
hospital trip. Maybe not. I wonder what poison
control would have said.
My advice was consistent with what I teach to staff
in the facility where I work in a nursing capacity.
Has my advice killed anyone else? Where was it
wrong?
I needed her medication history. I kept asking if
she took anything else, and he clearly thought I
meant drugs of abuse. I wish I'd asked specifically
about alcohol, prescription drugs she routinely
takes, over-the-counters like paracetamol.
More importantly, we all treated this as if she was
an addict and chronic overdoser. She wasn't. I need
to explicitly triage overdoses like seizures. If
this is your first, go to the hospital. My friend
will help you get the charity care paperwork, fill
it out, and fight for it.
It's really sad. She was alive. Now she's dead. I
played a part in that. Maybe she would have died in
the hospital. There's no way to know. I feel more
culpable and torn-up than when a patient dies in
hospital. I called my sponsor and told her. I wrote
this here in my diary.
What a waste. At least the neighbor didn't have to
go through it alone.
