From Crying to Consuming

This was a tough week.  Two people who I know lost their lives to an inanimate powder.

This blog is about one of those people and the reaction that his friends who knew him from the street had upon hearing of his death.

One person who has moved on gloriously from their own street days described Alexander as follows:

Today one of my favorite people in the world left this earth.

My friend (Real Name) was one of very few people who didn’t let drugs take over their soul or their heart and no matter how f’d up he was, there was always a glimpse of who he really was showing. He was so charismatic. He was literally one of the smartest people I’ve ever known, we would spend hours talking about books, music, theology, philosophy, you name it- he could talk about it (with intelligence). I never knew a person so full of useFUL information. We had some bad times too, we suffered together, but it was the good stuff that made us close.

I wish so badly that his suffering ended before he left this earth.

**********

I did not know Alexander to that depth but I knew him to be a true gentleman on the streets of Kensington.

Another friend of mine who is no longer on the streets described him as "my only true friend who lived on those streets with me."

Several people asked this question in these past few days:  

"Why did this happen to Alexander?"

Alexander and hundreds of other people in Kensington, multiple times each day, play the opioid version of Russian Rolette.  In the original version of the 'game,' Russian Rolette is "the practice of loading a bullet into one chamber of a revolver, spinning the cylinder, and then pulling the trigger while pointing the gun at one's own head."

In this 'game', there are as few as five empty chambers in the gun.  The person spins the cylinder, aims, and fires the gun at their own head.

On the streets of Kensington, our loved ones unwittingly participate in this dangerous activity that closely resembles Russian Rolette.  There is one difference.  There are more empty chambers in the 'gun' of the Substance Use Disorder patient than there are in the actual gun of the one playing this dangerous 'game.'  The heroin version of Russian Rolette can, in theory, go on for quite some time before the 'bullet is in the firing chamber.'

Our Substance Use Disorder medical patient/loved ones 'pull the trigger' multiple times each and every day.  Eventually, the bullet is in the firing chamber and our loved one overdoses.  If they are in the presence of other people, there's a chance they will be saved by Narcan and, in the absence of prompt dignity and respect-filled care, live to continue to play the 'game'.

My friends cried and asked, 

"Why did this happen to Alexander?"  

The all too simple answer is that 

"The bullet was in the firing chamber."

How did my friends who are still consuming respond to Alexander's death?

There was crying and then, sadly, they continued to seek funding for their 'bullet.'  

They bought their 'bullet.'  

They loaded their 'gun.'  

They pulled the 'trigger.'

And that is the power of addiction for the patient with Substance Use Disorder.

From Crying to Consuming…

Let's pray that the title of my next blog will not be 

"From Tears to Toe Tags"

Footprints On The Steps

I was out of water, running low on bananas and my song sheet supply was nearing depletion.  It was time to go home.  As I took one last glance around my surroundings on this warm sunny day, I was parked at East Indiana Street at Kensington Ave.  I saw April, dosing/dipping at the base of the steps that lead up the hill to the McPherson Branch of the Philadelphia Free Library.[1]  I knew I needed to go and offer all that I had left, a banana and a song sheet.

Instead, she gave me what she had left.  By the time I said "Goodbye" probably 30 minutes later, she had walked with me - no, led me - into the pure presence of God.  This moment was far better than any worship service I've ever attended - and that includes Easter at the National Cathedral!

As she dosed/dipped she began to read out loud from this song sheet, pausing only as the dip[2] did what it could to derail the moment.

She read:

Footprints In The Sand

One night I  had a dream. I dreamed

I was walking along the beach with the LORD.

Across the sky flashed scenes from my life.

For each scene, I noticed two sets of 

footprints in the sand: one belonging

to me, and the other to the LORD.

When the last scene of my life

flashed before me,
I looked back at the footprints in the sand.

I noticed that many times along the path of
my life there was only one set of footprints.

I also noticed that it happened at the very
lowest and saddest times of my life.

This really bothered me and so I
questioned the LORD about it:

"LORD, you said that once I decided to follow
you, you'd walk with me all the way.
But I have noticed that during the most
troublesome times in my life,
there is only one set of footprints.
I don't understand why when
I needed you most you would leave me."

The LORD replied:

"My child, my precious child,
I love you and I would never leave you.
During your times of trial and suffering,
when you see only one set of footprints,
it was then that I carried you."

Author: Carolyn Joyce Carty

And then she continued to read and concluded with this final blessing to and of herself:

I am an inspirational human being made in the image of God

and I am worthy of dignity, honor, respect and love.

No time of worship in any church could ever begin to compare to the Glory in this moment.  This woman who, undoubtedly had been on multiple "dates" in the last 24 hours,[3] consumed heroin - or whatever it is these days - been under-fed, under-housed and now exhausted on these steps read to herself about a God who she may or may not know.  That reading, completed by her own determination planted a seed of Heavenly Fatherly Love within her soul. 

I said "Goodbye.  Be safe."  She drowsily thanked me and fell asleep right there on those steps.  One banana served as a paperweight for her printed and divinely read poem.

Footprints on the Steps

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[1] See the location here:   https://www.google.com/maps/@39.9939477,-75.1181706,3a,67.6y,329.29h,93.34t/data=!3m7!1e1!3m5!1sl9qX5Fv7et5T3B5qatfpyQ!2e0!5s20181101T000000!7i16384!8i8192?hl=en&authuser=0

[2] A behavior associated with current drug use… Part of the experience of being high.

[3] Times all the days, weeks, months, and maybe years that she's been out there

She moved Home.

As the sun set on this date 2 years ago, she was looking forward to going to detox in the morning. She just needed to get through the night with one maybe two "get wells."

Morning never came. She moved Home to her Savior sometime in the night and we miss her. 

It's all well and good to have a security presence at this and other train stations along "The Ave." It would be all the better to have a medical presence made up of professionals who have vowed their careers to the ideals of Hippocrates and who will welcome each and every patient with prompt kindness, dignity, and respect.

As I sat on the open trunked back bumper of my car and conversed with Christine as if on a park bench on a warm and sunny day, we agreed about the true nature of the crisis in Kensington.  Across the street, a newly assigned uniformed Transit Police officer was handcuffing and firmly guiding a woman to a location out of sight from our vantage point.

At that moment, I could not help but think of how miss-assigned that officer is as he interacted in his official capacity with this patient with Substance Use Disorder.  I thought back to previous ponderings of how this section of Kensington is more of a patient waiting room where patients of Substance Use Disorder do what they need do to stay 'well' while they are waiting for that moment of 'rock bottom' or intellectual decision to invite sobriety back into their lives.

Speaking in general terms here[1], that handcuffed patient with Substance Use Disorder most likely comes from a childhood of some form of abuse.  She may have been 'played with' in ways that would make your heart bleed with tears if you knew the details.  She has sought detox and been treated hideously as was "George" in this blog.

One day, she overdosed on the steps of this same train station.  She was revived by Narcan.  She was taken to a very local hospital.  She was told by the Registered Nurse to "Get out of my Emergency Room!"   She's now dealing with Krokodil.

Family atrocities and professional neglect by representatives of Hippocrates are the foundations of why so many of these street-bound patients with Substance Use Disorder remain where we find them.   

Christine herself told me in our hour-long conversation that if she could just go to a health care facility and get the care she needs promptly and respectfully, she would have gone long ago.  But she knows as does this newly handcuffed patient that the system is broken and it's far easier to keep consuming and dating and risking all manner of health crisis than it is to seek help.

It's all well and good to have a security presence at this and other train stations along "The Ave."  It would be all the better to have a medical presence made up of professionals who have vowed their careers to the ideals of Hippocrates and who will welcome each and every patient with prompt kindness, dignity, and respect. 

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[1] I am combining stories here to make a point.

[2] Kensington Avenue

Amputations During the Civil War

Amputations During the Civil War in the 1860s were very common and saved lives.  Here's a video that looks at this topic.

Arms and legs were lost from one's body as a consequence of battle.  Artillery penetrated the limb and the result was often the loss of that extremity.

 **********

What does this have to do with Substance Use Disorder on the streets of Kensington?

As I've already written, there is a Civil War in the Mind occurring within patients with Substance Use Disorder.  This civil war's conflict within the patient causes this person to battle between wanting healing and wanting drug.

There is a drug making itself known more and more in Kensington.  It is called "Krokodil."  You can read about it here.  Look in the endnotes of this blog for the most critical part of this article.[i]

Unlike the artillery of our National Civil War of the 1860s where the bullets and cannon balls (etc.) claimed limbs in an instant, Krokodil claims limbs slowly by rotting it's victim's arms and legs from the inside (Warning: Graphic imagery!).  

The victim who is a patient with Substance Use Disorder is torn between desiring detox and craving drug.  Rotting of flesh, muscle and bone progresses while the patient intellectually understands the consequences of a rotting extremity - potential amputation - and yet hears with stunning clarity the inaudible call of the opioid.

I've recently interacted with two people who I love from those streets who are facing this issue.  One's battle with Krokodil is very advanced with self reports of seeing their own bone.  The other's battle has only just begun with a dime sized black hole and a whole bunch of localized infection and swelling. 

For anyone else facing such a critical situation, the answer for entering healing would be simple:  Go to a doctor, clinic or emergency room!

For patients with Substance Use Disorder who are reliant on Medicaid, it's not that simple. 

Unlike the soldier on the Civil War battlefield who just happened to be in the wrong place in that moment the enemy artillery came calling, the patient dealing with Substance Use Disorder and now Krokodil can make the decision to go for health care before amputation becomes the only viable avenue to renewed health.  Sadly, there are unreasonable, and medically neglectful[ii] hoops created by far too many medical professionals who had dedicated their careers to the ideals of Hippocrates that must be jumped through while each patient is dealing with their own internal psychological civil war of healing vs. drug.  One side of their brain cries in literal agony for healing while the other side of the brain makes arrangements for income and then acquisition and consumption of their next drug supply. 

Rotting of flesh, muscle and bone continues while the mental battle plays itself out to a possible conclusion of amputation.

Krokodil, just like heroin, is an inanimate substance.  As an inanimate substance, Krokodil is incapable of creating the massive crisis that exists right now on the streets of Kensington.  It is just being what it is, nothing more and nothing less.  The Medicaid healthcare system adds to the crisis with its lack of prompt dignity and respect filled connectional medical care.

We can do better for our loved ones on the streets of Kensington.  To that end, I invite you to continue reading "Kensington Does Not Have an Opioid Crisis!"

 

End Notes:

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[i] Krokodil side effects

The most recognized side effect of krokodil is scaly green and black skin that develops shortly after injecting the drug.

Based on reports, people don’t need to use the drug for long to experience permanent and serious tissue damage that extends as deep as the bone.

Let’s take a closer look at the side effects responsible for the drug’s street name as well as its other side effects.

Skin necrosis

According to reports Trusted Source, people develop significant swelling and pain in the area where the drug is injected. This is followed by skin discoloration and scaling. Eventually large areas of ulceration occur where the tissue dies.

The damage is believed to be at least partly caused by the toxic effect of the additives used to make the drug, most of which are erosive to skin.

The drug is also not purified before injection. This may explain why the skin irritation happens almost immediately after injection.

Muscle and cartilage damage

The ulcerated skin often progresses to severe muscle and cartilage damage. The skin continues to ulcerate, eventually sloughing off and exposing the bone underneath.

Krokodil is 10 times Trusted Source more potent than morphine. Because of its pain-relieving effects, many people who use the drug ignore these side effects and put off treatment until extensive damage has been done, including gangrene.

Blood vessel damage

Krokodil can damage the blood vessels that prevent the body’s tissues from getting the blood it needs. Blood vessel damage associated with the drug can cause gangrene. It can also lead to thrombophlebitis, which is inflammation of a vein caused by a blood clot.

Bone damage

Bone infections (osteomyelitis) and bone death (osteonecrosis) in parts of the body separate from the injection site have also been reported.

Bacteria are able to enter the bone through the deep tissue wounds, causing infection. Bone death occurs when blood flow to the bone slows or is stopped.

Amputation is sometimes needed to treat this type of damage.

Use of krokodil has been associated with a number of other serious side effects and complications, including:

·         pneumonia

·         meningitis

·         sepsis, also referred to as blood poisoning

·         kidney failure

·         liver damage

·         brain damage

·         drug overdose

·         death

Takeaway

Krokodil (desomorphine) is a dangerous and potentially fatal drug that causes a number of side effects.

Its toxic effects are experienced immediately after injecting it and progress very quickly.

If you or someone you know is using krokodil or misusing other opioids, here’s how to get help.

Last medically reviewed on August 6, 2019 

 

[ii] neglect

1. Failure of a health care provider or caregiver to observe due care and diligence in performing services or delivering medicine or other products so as to avoid harming a patient.

2. Generally, indifference or inadequate attention to one's responsibilities in regard to self-care, care of others, or other aspects of one's personal or professional life.