Our unconscious patient’s chest heaves again and he coughs up another gob of high flying trapeze pink froth that splats on the ambulance bench seat where seconds before my partner’s knee had been. As he secures the IV, I check the patient’s pupils. Midsize, unreactive. No one home.
Ten minutes before, bystanders who found the man slumped forward in the car, gave him narcan and pulled him out onto the pavement. They weren’t certain if he was breathing, but his pupils were pinpoint, he was cyanotic and there were syringes on the seat. He is a big man and was difficult to lift up onto the stretcher, dead weight. We don’t need to ventilate him anymore with the bag-valve mask as he is breathing fourteen times a minute, and he has pinked up considerably. His Sat is 92% so I put him on an oxygen mask, periodically removing it to suction the froth.
No one knew how long he was parked there. He no doubt bought his fentanyl on Park Street, then headed west, pulling into this shopping plaza and parking in the first available spot — a spot where I have done several overdoses in the past. When he went out, his glottis, the opening between his vocal chords likely closed and his body trying to breath against his now occluded airway created extra pressure that damaged the alveoli in his lungs, causing this noncardiogenic pulmonary edema, the pink froth that is filling the bottom of our suction canister. Pulmonary edema is not uncommon in opioid overdoses. Many of the dead we find have pink foam cones on their mouths.
His driver’s license says he is from a Connecticut town down by the shore, but when we put his name in the computer, an address of a transient motel on the Berlin Turnpike comes up, the kind of motel where we routinely call the time on residents found dead by the motel staff. In his wallet there are school photos of a young boy, each of the three photos are of the same kid, one year older than the last, maybe third, fourth and fifth grade, guessing. No pictures of a mom. Business cards for a methadone clinic and a probation officer.
I wonder who will get calls from the hospital telling them what is going on? Will anyone sit in the ICU waiting room for updates as he lays in a bed intubated and sedated? And how many others like him today are in the same situation? Alveoli burst under the stress of trying to breath against a closed airway. Naloxone rushing to the brain. Bubbling pink froth flying through the air to be wiped away or end up in soon to be discarded suction canisters after they have been wheeled into another ED. Meanwhile, broken families try to go about their lives. Telephones on the wall that no longer carry the voices they want to hear.
Still no end in sight.