She took the Dilaudid pill a friend offered her twelve years ago when she was sixteen. Her sister had recently died and her young life, filled with depression and anxiety, had lost its only source of light. The pill made her feel well in a way she had never felt before. She liked who she was when she was on opioids. She had friends. She felt joy again. Four years later she tried heroin for the first time because it was so cheaper and more accessible. Two years later she graduated to injecting. She’s been to rehab five times with no success. She’s tried methadone and suboxone. No luck. She is on Vivitrol now, but as the monthly shot wanes, she always finds her way back to the city. She injects herself with heroin because it soothes her anxiety and cushions her in a cloud of calm. She injects cocaine because it makes her feel invincible.
The guy she was with in the hotel room called 911 when he came out of the bathroom and found her unresponsive on the carpet with the two syringes on the bureau and the torn heroin bags branded “Emerald City” and the small plastic bag with some cocaine powder still in it.
She was blue and agonal with vomit on the rug next to her. With some stimulation, bagging and a small titrated amount of naloxone, we brought her around. She didn’t want to go to the hospital at first, but we convinced her of the need to be evaluated. Her heart was racing in the 140’s and her oxygen saturation was only in the high 80’s. We were concerned she may have aspirated.
The now silent man fetched her purse and slippers and we put them on the back of the stretcher. With a blanket I covered up her tattooed back and shoulders, but not before complimenting her on her artwork. The artist had drawn a magnificent mountain top with elaborate etchings of trees, eagles, deer, and stars, along with the words: “The journey to the top is my soul.”
This is the third time she has overdosed, but the first in three years. I give her my harm reduction talk about the dangers of fentanyl, how it mixes poorly so you never know how much you are actually getting in each $3 bag. None, a regular dose or a lethal one. It was a good she was not alone.
We talk more. She answers my question about how she got started, and she tells why it is so hard to quit. When I ask her who the man in the room was, she just shrugs. Some guy. I get her demographics. She lives in a small town forty minutes from the city. She asks if she has to give me her emergency contact.
“No,” I say. “Not if you don’t want to give it.”
“I don’t want my parents to know.”
“They don’t have to. It’s your choice.”
“I don’t want them to lose faith in me.”
I ask her about her relationship with them and she begins crying. “They love me,” she says.
She tells me how supportive of her they have been, how much they care for her and want her to win her battle.
At the hospital, I tell the girl’s story to the nurse but the nurse just rolls her eyes. It is busy in the ER and she has no time beyond a basic report.
I wonder where the girl is tonight. Is she home with her parents? What will they think when she asks to go out? Will she just walk the quiet small town streets, struggling for the strength to stay the sober course, to keep her journey on the straight and narrow. Or is she back here in the city, at another hotel with a nameless man? The needle in her arm, the heroin easing her skittishness, keeping the darkness at bay, the cocaine rush making her feel invincible — up on the mountaintop now, her soul dancing under the stars?