Two brothers, two opioid ODs at the same time

Gray Matters

The Cruelest Déjà Vu

As the opioid epidemic continues to evolve, so too must our concept of a first responder

BY BRITTANY ERVIN (M.D. CANDIDATE 2020)
Fall 2017
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Whenever possible I make the outdoors my office, which on this balmy, August afternoon was the patio of a coffee shop in downtown Ann Arbor. I laid claim to a corner table with a decisive thud of my computer bag. The aesthetics of this concrete cubicle did not disappoint — a garden view and stunningly vaulted ceilings architected by the trees above. Time to work! The wicker chair creaked to a slow halt underneath me — giving way just enough to be comfortable and yet sufficiently sturdy to bear the weight of my uncertainty as I pored through another dataset I was not completely convinced I knew how to code. This was the backdrop to the summer after my first year of medical school, with much of it spent as the apologetic novice assisting the seasoned clinicians and researchers of Michigan-OPEN (Michigan Opioid Prescribing Engagement Network). Working with this team was my first in-depth introduction to the shattering realities of the opioid epidemic. I could not have imagined, during that peaceful moment at the coffee shop, that the life-and-death questions driving our research were about to play out right in front of me. 

My initial haste to get to work made it easy to disregard the odd interactions of a man and woman seated two tables from me. A private conversation, perhaps? All the more reason for me to retreat into my spreadsheets. Not more than a minute later, I surfaced from my work to find the man alone and slumped forward in his chair. A chilling picture started to unfold as I realized those had not been the clandestine tones of an intimate exchange but rather the hushed pleas of the man’s companion trying to rouse him from unconsciousness. Being a medical student in the infancy of my training, this moment of unsupervised emergency was one I had not expected to confront so early — at least, not outside standardized patient exercises or carefully written cases in which the casualties of my indecision were easily rescued by additional studying. 

Diving in with what I knew, I dialed 911 and worked my way through the ABCDE assessment — reciting the steps of “airway, breathing, circulation, disability, and exposure” like a verbal lifeline. Moments later, the flashing lights of the ambulance came into view but stopped, inexplicably, two blocks short of our location. 

I was torn. I didn’t want to leave the man’s side, but, luckily, a passerby — who was also a visiting ED physician — stepped in to help. I ran, full-sprint, to the EMTs and breathlessly relayed that the patient was farther up the street. They shared a quizzical look and pointed to the flowerbed below as evidence of my apparent error. There lay an unconscious man bearing a striking resemblance to the one I had just left. This was the cruelest déjà vu — the second victim was my patient’s brother. They were overdosing at the exact same time. 

Looking back, I have reflected on the day’s events many times. One realization is that, in a crisis that can strike anyone, anywhere, our concept of the first responder deserves reevaluation. Joining the ranks of police officers, firefighters, and EMTs are librarians, baristas, and other non-medical personnel who are increasingly being trained to administer lifesaving Narcan (a medication that reverses fatal central nervous system depression induced by opioids). Contemplating my own place in the changing landscape of first response, the easy story to tell would be that of the green medical student turned decisive heroine amid the serendipity of “right place, right time.” But the reality was not in the knowledge I crammed away this year; it was in the simple, here-and-now of being present. 

Practically, the action of being present is to embrace the vulnerability of what it means to be genuinely affected by another’s experience such that we can see ourselves in this patient, his brother, or in the countless others affected by this epidemic. Although I do not know the outcome of the two brothers, their story leaves me to ponder optimistically: How much more could we accomplish together if we allowed ourselves to have more “inelastic collisions” — inviting our life spheres to overlap, connect, and conflict in ways that shift our social kinetic energy toward our shared humanity? 

For those wondering what they should do in the event of a suspected overdose, I won’t transcribe a first-response manual here. I will say that, as we debate paths forward, await policy to roll out, and weather losses together, we can take solace in and be inspired to action by the fact that presence has no prerequisite that would disqualify any of us from responding.

Illustration by Rebecca Mock