This was the call that broke me.
I was training to cover as an intake nurse at work — taking calls from outside hospitals that need to seek care for kids that they can’t provide care for. The call came from a community hospital. The police had brought in a teen who had threatened his mother because she was trying to keep him from getting drugs. The teen had reported using opioids and had a toxicology screen that showed cocaine. He was now under control. The mother spoke no English, and the patient had no insurance or medical assistance coverage. It was an odd call because the patient had no acute medical problem.
Trying to better understand, I asked the doctor what her goal was in calling. The doctor at the community hospital was trying to get the patient placed into some kind of inpatient setting because she was convinced that the patient was at great risk of overdosing if she discharged him. The doctor told me, “He said he’s using ‘30s’ [30 mg tablets of oxycodone] that he’s buying on the street. Almost all of those are fakes and are fentanyl.”
I stopped just short of saying, “Yeah, no sh--, lady.” That’s what we found in my son Sam’s room after he died from an overdose. They look like commercially produced oxycodone tablets and, one presumes, are claimed to be such by dealers.
The doctor went on, “If I discharge him, he’s going to end up back here dead.”
I believed her, and she was probably right. I wanted desperately to help. Unfortunately, we didn’t have the service the teen needed. Barring a medical or psychological problem, we had no means for admitting him. I contacted our attending who confirmed this. Finding an inpatient drug rehab that would take an adolescent without insurance is basically impossible. We contacted our social worker who was at least able to give us contact information for a couple of places that offer outpatient drug rehab services to the indigent. I gave those to the doctor at the community hospital in hopes that they might have a tie-in with some resources. It was the best I could do and that was the end of my involvement.
I don’t know the outcome, but I suspect we all can presume how this will likely end.
After nearly 30 years of working in emergency and critical care, that was the call that broke me. A patient I never touched or saw. After three decades of close contact with every manner of human physical and emotional suffering and tragedy, this was too much. In my world, where I’ve seen every awful thing that can happen to a child, this was more than I could bear.
If that kid had been hit by a car walking across a street in near that hospital, an emergency rescue team would have responded. We would have flown him in an $11 million helicopter to a trauma center where resuscitation teams, surgeons and operating rooms — all maintained on standby at great expense — were waiting. We would have thrown everything we had into saving him, then pass him to inpatient care and physical rehabilitation. We built all of this, also at great expense, because in the 1960s that person hit by a car stood a great chance of dying there in the street or in the afterthought emergency ward of a local hospital. We decided that lives were worth saving and all we had to do was care.
You can’t tell me that kid, if left to his own devices, stands less of a chance of dying than if he’d been hit by a car. I’ve seen it over and over again in my working life, and, once, in my home. We can save these people from this created ill of modern society just like we’ve saved so many from death and disability from accidental injury.
All we have to do is care.
Pete Fitzpatrick (email@example.com) is a registered nurse and paramedic.