The "TIGER" Returns

By Richard C. Dillihunt, M.D., Retired Surgeon, Portland, Maine

DECADES AGO while I was in surgical training in New York, heroin was a terrible problem, a real tiger in New York City and now its back, worse than ever.  Maine`s annual opioid deaths now approach 400 as jails overflow and treatment and rehabilitation programs are inadequate in  bed numbers and funding, despite terrific work by police to accomplish results in  this area. Federal and State governments have joined in serious efforts to control this epidemic and bring funds forward in what is now obviously a domestic war.

Only now is the critical role and scope our profession has played in aiding and abetting the spread of this epidemic becoming apparent, with many accidental addictions attributable to faulty prescribing of opioids. Likewise, the very deep involvement of the drug industry in overproduction and overzealous pushing of such drugs to market for profit motives is showing some transparency.

Our Governor has chipped in by insisting that more DEA professional agents be added to the roster to increase the forces of interdiction.  Our Attorney General has also been a strong voice in spreading the word regarding the horrendous exponential growth of this uncontrolled epidemic. It is little wonder that we need to explore and utilize every avenue available to overcome this domestic problem, and bring the opioid epidemic under control. When we realize that fentanyl is manufactured in China and Mexico, and enters the US easily via borders that are wide open to its importation including from China to Canada to the U.S. Do we realize that a huge supply of fentanyl can reach us through birthday cards?

Have we thus done all we can? No Way. We have not done much at all to educate the young people of America to never start taking opioids. That a first try of an opioid may be their last. That late teens through twenties is an age of unreasonable reason, and virtually nobody can beat "The Tiger" alone.                                                                                     

Education of Millennials is a Critical Need

Bethany is a 19 year old first-time user tempted to try heroin by addicts who are skilled at making the experience appear attractive and safe, fueling their own addiction.  Her story is designed to deter temptation and emphasize the real danger and vivid results an overdose can cause, even with a first time experience.  

Bethany

Hello, I am Bethany!  I met Eric from Boston.  He gave me my first heroin.  Thrilling, warm, toasty, then I couldn’t breathe.  Down I went, next choked, next vomited even out my nose, then diarrhea up my back and hair!!  Eric slapped me, my eyes rolled back.  I could not see.  He went nuts.  His wig fell off, I was peeing out my $125 jean pockets and Eric was gone.  Then 3 guys show up with suitcases and Hell breaks out.  First it’s Narcan in my nose, twice, then in my arm.  Ribs are poppin.  One cleans french fries from my mouth and puts his on mine and blows.  God I thought, THIS IS AN OVERDOSE gone too far!  Eric did not tell it like this.  Down my windpipe goes a hose.  They pay these guys 50 bucks an hour?  They are heroes and should make more than doctors------where are the doctors?????  My heart is lights out.

Now it’s paddles and blast away, I jump right off the floor and my heart kicks in -- lub, dub.  Beat you sucker.  Beat!  Now in MEDCU -- full tilt, loud, hoggin the road.  Oh my God!!!  Mommy --- PLEASE!  At the hospital, doctors waited.  They pumped, beat, wired, catheterized me, then this guy actually cuts open my chest and squeezes my heart.  Blood everywhere, but blue.  Hope disappeared, but they tried so hard.  Even a doctor cried, but hid it---I felt bad for her.  But she felt worse for me.  I was dying!  Her face showed a range of emotions; horror, disbelief, compassion, grief, yet a burning resolve to return tomorrow to help in this epidemic.  Next I am “pronounced,” the ugliest word I ever heard.  All flat lines.  They pulled the sheet up, then down for my Mom, and she hit the floor.  Then up again.  Then, I’m in a refrigerator with huge clunky doors---the morgue, lying nearly naked on a “stainless” table with wheels      --, surrounded by six stiff and silent men on gurneys.  It seems nothing could top this for humiliation.  But there was more.  Much more.  An attendant came in, wheeled me out, and washed my back and hair.  Near freezing, no blanket not even a night light.  Then it was suddenly autopsy time, surrounded by hordes of gawking medical students sitting in like a theater taking notes on IPads.   Where is my IPad?  I am just a high school kid.  I am only 19.  Where are you Mom?  I can’t stand it.  It’s gone, my IPad is gone.  Someone is going to get it—with all my secrets.  I am naked and cooling and my muscles are tightening up, wicked.  Is this rigor mortis or something?  They saw my tattoo, but nobody else knows—especially my Mom.

They cut me stern to stern..?  All the parts of my inside body are now detached, like when I saw a deer that was shot and they say “gutted”.  Then---------I cannot bear to tell more….It’s private property…….even if I am dead.  Can this be a dream?  Please God, give me a chance---just one more.  I promise, I promise, anything.  Some guys said we only had one thing to fear----that is fear itself.  Well, I can say absolutely that there are now 2 things to be scared about.  2 fears, and I am peering into the second one.  I am so scared, it’s unimaginable.  I did not deserve this.  All I ever did was like my friends did, a little beer, some pot.  I was no sleaze-ball junkie, I was just Bethany.  I did not lead a bad life, I came from a good family, my Mom and Dad were average to others but royal to me and my sisters.  I thought they were prehistoric raising me, but now I see better, they were heroes, but I never got a chance to tell them that, and never will.  This is the depth of despair.

The quiet seems forever----maybe it really is.  It is black dark.  I know I am in a casket.  But then a strange thing happens.  A flicker of light.  So tiny it may just be a backfire from a firefly.  I know I must be having some kind of postmortem twinge of the brain.  I am trying to trick the grim reaper.  Yet, could that be finger tips under the lid?  Could this all have been a drug hallucination or a nightmare due to my overdosing?  IS THAT MY MOTHER’S FINGERS UNDER THE LID?  Have I been given another chance??  Is that you Mom??  I promise.  I PROMISE.  I MEAN IT.  Is it Mom or a gatekeeper or what??  It is pitch dark, I cannot tell.

I overheard they caught Eric on the turnpike -- a student said it.  One said he lost his wig and looked old and decrepit, shriveled up like a prune, and he faced 25 years in jail.  Another said the Governor already knew about this, and was steaming about “this killer costing Maine a million bucks to feed and house for 25 years.”  I never knew a thing about that stuff.  I wanted to be old before I got a chance to be young.

PLEASE CIRCULATE