Bart Simpson is in his parent’s Subaru parked to the side of a gas station in Hartford, Ct near the highway ramps. The car is running, in drive, his foot is on the brake. He is slumped forward against the wheel. This has aroused the attention of passerbys who have called 911. An ambulance arrives within minutes. The paramedic and EMT get out and try to open the doors which are locked. The EMT bangs hard against the window, while the paramedic, who has gone to the passenger side, bangs on that window. He also notices through the tinted windows a second person in the passenger seat, also slumped over. The banging causes Bart to stir. He opens his eyes, and appears frightened. He moves his hand to the drive control, but then realizes he is already in drive. He tries to go forward, but a bus is blocking the intersection and now a police officer is also there yelling and banging against the car. “Stop the car! Stop the car!”
Bart puts the car in park, and freezes a moment. The people are shouting and banging against the car. He looks like a trapped animal. Finally, slowly, he surrenders. He unlocks the door. The responders open it quickly and yank him out of the car. The police officer has him put his arms behind his back. There is shouting. “Where’s your sharp? Where’s your sharp!”
The paramedic opens the passenger door now, which unlocked when the driver’s door opened. The man slumped in the passenger seat, looks up slowly. His face is hardened and weathered. His pupils are pinpoint, drowsy. The medic recognizes him as an addict who he has seen humping up and down the streets and through the parks of the city. Another officer is there and hails the man by name. “Hey, Charlie, what are you doing in this car? Who’s your friend?”
“Bart,” he says. “Bart.”
“Bart? Really. What are you giving Bart a tour of the city, huh? You a tour guide, showing him all the neighborhoods? Is he buying your heroin for you?”
The paramedic sees the needle on the floor of the car and reaches in and picks it up. He takes it back to the ambulance, and disposes of it in the sharps box. Both passengers are out of the car now and being frisked.
Bart is a short, skinny, pale faced boy of 19 from a suburb. He is wearing blue Flintstones pajama bottoms, a New York Giants t-shirt and sneakers without socks. His hair is dirty and matted. He is crying as the officer shouts at at him. He finally admits to their doing two bags of heroin. On the floor of the car are two torn bags. One says SONY, the other is red and possibly says The Flash, although the stamp is faded.
Charlie is trying to persuade the officer to let him retrieve his backpack from the car because it contains all he owns in the world. He says he doesn’t need to go to the hospital.
Amidst the chaos, Bart ends up in the back of the ambulance, his car gets hooked to a tow truck, and his passenger takes off down the street. No one is arrested.
In the ambulance, the paramedic tries to console Bart. His parents are going to be so disappointed in him, Bart says. He was doing so well. He was on Suboxone and hadn’t used in months. If only Charlie hadnt called him.
The medic finds out how Bart knows Charlie. Bart happened to be in a car in Hartford another time also at a gas station after having bought a couple bags of heroin from a contact a classmate had told him about. Charlie saw Bart sniffing the drug so he came over and suggested that Bart might want to try injecting. The high is much better he told him. Soon the two of them were meeting. Charlie would provide the drug. Bart would pay for them, and Charlie would help Bart inject to make certain he found a vein. Today Bart paid Charlie $25 for half a bundle. A bundle is typically $35-$40 and contains 10 bags, each about 0.1 gram of heroin (cut with various amounts of other products such as fentanyl, baby formula, rat poison, sugar, and who knows what else). The medic tries to do the math for Bart.
“So you guys did two bags? You paid him $25? Where are the other three bags?”
Bart looks confused.
“And let me ask you something,” the medic asks. “You both injected right?”
Bart confirms.
“But I only found one syringe,” the medic says.
There is silence.
“Tell me you didn’t,” the medic says.
More silence.
“You two shared the same needle?”
Bart nods glumly.
“Jesus Christ!” the medic says. “You can’t do that.”
“He only had one needle.”
The medic wants to say what were you thinking, but he knows addicts don’t think. The wiring in their brains has gone haywire. They lack the ability to judge risk. “Do you have Narcan at home?” the medic asks.
“No.”
“You need to have Narcan with you wherever you go. Your parents need to have it in your house.”
“But I was in recovery. I wasn’t going to do heroin anymore.”
“That doesn’t matter. People relapse despite best intentions. You need to get it and your parents need to have it. And you need to use clean needles. Your pal Charlie in all likelihood has Hepatitis C and maybe HIV. He has been around the block. Addiction is hard, but you need to protect yourself.”
Bart returns to sobbing and the medic hands him a Kleenex and feels bad for upsetting him. At the same time he believes the young man needs serious counseling. He has no doubt that Bart’s parents love him, and he knows that Bart and his parents face a long road ahead.
“You can’t recover if you’re dead,” he says. “We need to get you help.”
The medic asks Bart, as he asks all of his addicted patients, how he got started on his path.
“I tore my ACL skateboarding three years ago,” Bart says.
“Your doctor prescribed you pain meds?”
“I got hooked on them.”
“You took more than you should?”
Bart nods. “They made me feel better.”
The path he traveled others had tread. Buying pain meds was expensive. He was introduced to heroin, which he could snort, and which was cheaper. He started coming in to Hartford. Then he met Charlie and his habit became serious. His family put him into rehab and when he got out he was on Suboxone. Suboxone is a opiate that lasts much longer than heroin. It moderates the cravings, and can be helpful to many people to keep them away from the much deadly opiate. He said he was doing real well. Just the day before, he had helped his grandfather paint his garage. Then Charlie called, and Bart slipped up. He couldn’t resist the thought of getting that heroin high again. Now he was in the ambulance, his parent’s car was on the back of a tow truck, and when they found out, they were going to be so disappointed in him.
Bart blubbered. A nineteen year old boy in blue Flintstones pajama bottoms, paint still on his hands from helping his grandfather.
The medic and his partner help get Bart into a room in the ED, and find him a blanket and pillow, and wish him well. They remind him about the need to have Narcan available, and to use clean needles, and to never shoot up alone.
The medic tells the ED nurse that Bart has no Narcan at home and that he shared a needle with a known IV drug abuser, who may in fact be Bart himself ten years down the road. The medic asks that the messages about Narcan and the need for clean needles be reinforced by the ED team. The young nurse, who is very busy, says “That’s rehab’s job. And he should know better.” She later apologizes to them for her comments (overheard by a supervisor), saying she was under stress.
The crew is worried that Bart will simply be observed and then discharged, but he is admitted to the substance abuse wing. While he is being admitted, he tries to escape. He flees the hospital shirtless wearing just his blue pajama bottoms. But it is very cold out on this November day, and he has nowhere to go. He turns around, and knocks on the ED door. They take him back in.
