100447125-______, ______ – MR#-298720 Dr Patel jg
Gender: Male
Age: 21
Disposition: Short Term Hospital (2)
Admit Date: 11/09/2011
Disch Date: 11/14/2011
New York IP APR DRG
Information
812 POISONING
MEDICINAL AGENT
NY wt 2.5140 ALOS 3 SOI 4
MDC
021 POISON, TOXIC EFF & OTH INJURY
Severity of Illness
4 Extreme Severity of Illness
Risk of Mortality
4 Extreme Risk of Mortality
Admit Diagnosis
96509 Poisoning by
opiate/related narcotic
Present
On Admission: Y
Principal Diagnosis
*96509 Poisoning by
opiate/related narcotic
*SOI=P
Principal Diagnosis used for SOI calculation
*ROM=P
Principal Diagnosis used for ROM calculation
Present
On Admission: Y
Secondary Diagnoses
41071 Subendocardial infraction, initial episode of
care
*SOI=4
Extreme
*ROM=4
Extreme
Present
On Admission: Y
51881 Acute
Respiratory Failure
*SOI=4
Extreme
*ROM=4
Extreme
Present
On Admission: Y
570 Acute
and subacute necrosis of liver
*SOI=4
Extreme
*ROM=4
Extreme
Present
On Admission: Y
5849 Acute
kidney failure, unspecified
*SOI=4
Extreme
*ROM=3
Major
Present
On Admission: Y
5770 Acute
Pancreatitis
*SOI=4
Major
*ROM=2
Moderate
Present
On Admission: Y
2760 Hypersmolality and/or hypernatremia
*SOI=3 Major
*ROM=2
Moderate
Present
On Admission: Y
5070 Pneumonitis
due to inhalation of food or vomitus
*SOI=4
Extreme
*ROM=3
Major
Present
On Admission: Y
78065 Hypothermia not associated with low
environmental temp.
*SOI=1
Minor
*ROM=1
Minor
Present
On Admission: Y
4589 Hypotension
*SOI=2
Moderate
*ROM=2
Moderate
Present
On Admission: Y
78039 Convulsions
*SOI=3
Major
*ROM=2
Moderate
Present
On Admission: Y
72888 Rhabdomyolysis
SOI=2 Moderate
ROM=2
Moderate
Present
On Admission: Y
78060 Fever, unspecified
SOI=1
Minor
ROM=1
Minor
Present
On Admission: N
72981 Swelling
of Limb
SOI=1
Minor
ROM=1
Minor
Present
On Admission: N
7821 Rash or nonspecific skin eruption
SOI=1
Minor
ROM=1
Minor
Present
On Admission: N
73679 Deformity of ankle/foot
SOI=1
Minor
ROM=1
Minor
Present
On Admission: N
Principal Procedure
9671 Continuous
invasive mechanical ventilation for less than 96 consecutive hours
*SOI
*ROM
11/09/2011
06977
Other Procedures
9604 Insertion
of endotracheal tube
11/09/2011
06977
3893 Venous Catheterization
11/13/2011
I awoke out of my
drug-induced coma after five days on a respirator. I was put into a coma at the
hospital, where I was taken to be treated for my overdose. Upon my admission I
was unresponsive, so I was given Narcan, a drug that shuts down all of the
opiate receptors in the brain and has become the gold standard for treating
overdoses. I came to, or so I’m told. But then I needed to be sedated once more
because my oxygen saturation was below 65% when it should have been around 99%,
in order to intubated and so that I could be treated for my failing organs. I
remember my voice being raspy and my throat feeling as if someone had poured
sand down it. It occurred to me later
that this was from the breathing tube that had been implanted in me. My left
leg was swollen and I had a bizarre pecan shaped mark on top of my left foot.
My aunt, the nurse practitioner and family medical authority, had been summoned
by my mother to the Upstate New York hospital where I was being temporarily
housed. That’s how I felt, as if I was constantly being housed somewhere, in a
state of perpetual institutionalism. For a year, I had been arbitrarily bouncing
from psychiatric facility, to rehab, to emergency room in between bouts of
homelessness.
At this last rehab,
located in Ulster County, New York, I had befriended a young man who, unlike
the majority of the rehab population, was a local. After two weeks, he told me one day that he
had an appointment with a pain management doctor, and that he planned to have a
friend pick him up, sneak him out to the appointment and return with a filled
prescription for oxymorphone, commonly known as Opana, a powerful synthetic
opiate painkiller.
He left for the
appointment but the staff somehow caught on to the fact that he was
missing. The rehab was woefully
understaffed, only two of them for a patient population of 150. This was a
state-run therapeutic community, so they had little funds, and few resources. My
friend returned and quickly slipped the pills to me. I took them up to my room
and went into the bathroom, a place that had become very familiar to me
primarily for the consumption of drugs. Whether it was a public restroom or a
private one, I would often lock myself inside and douse myself with whatever I
had obtained.
I took a piece of
paper and placed one of the pills in the folded paper, and folded it a few more
times. I took a lighter and smashed the pill into a fine white powder. With no
money to roll up, I took another piece of paper and ripped it so that I had a
strip roughly three inches tall, and rolled it up. I then dumped the powder
onto a book, and went through the traditional ritual of chopping the powder up
with an empty metro card I was still hanging onto. Once I had made a nice rail
out of the powder (I preferred them short and fat), I sniffed it, inhaling the
bitter tasting powder through my nostril. I felt my throat fill with the powdery
gook and I coughed at the bitterness. I bent down to the sink and drank some
water out of the faucet. I waited about 20 minutes, and I began to feel very
light and warm, everything felt light except my eyelids, which were becoming
increasingly heavy. I decided to go for round two, so I repeated the earlier
process, this time with less diligence, so the powder was chunkier than I
preferred. I remember being so high that I was filled with the fear that the staff
was going to catch me. So rather than staying in my room, or my bed, I chose to
take a walk. I began to walk off the campus like facility, and down a country road.
The last thing I remember is falling down in the tall grass.
I woke up in the
hospital, to my mother and aunt, and my swollen left leg. My aunt came up to me
and gave me a friendly little whack on the side of my head. At this point I was
oblivious to the fact that I had been on a respirator, and had OD’d. I do
however remember a brief phase of semi-consciousness where I had a nurse
cleaning me; the drugs had made me incontinent of both feces and urine. But
this must have been a day or two prior.
My aunt decided to
flaunt her medical connections and have me transferred down to Montefiore
Hospital in the Bronx, where I would ideally receive better medical care. I
arrived late one evening. I remember the long ride down Interstate 87 in the
back of this ambulance, waiting for my next destination, filled with fearful
uncertainty. The past few days still an unclear blur. I remember crossing the
Tappan Zee Bridge, and feeling the cold November air fill the ambulance through
an opened window at the toll. I arrived at Montefiore Moses late that evening,
at roughly 10 pm. I was wheeled through the maze of hallways, floors, elevators
and corridors until I finally arrived at my bed on an ICU unit. I was received
by a team of nurses, who strapped me up to all kinds of monitors, took blood
and cleaned me. I had not yet regained continence. As one of the nurses was
wiping me, I stared at her. She gave me a smile and said in her thick West Indian
accent, “Boy dun worry none, I done seen a whole lotta asses in me day. Enuff
to fill upta sky.” I gave her a smile back. The care seemed excessive, but I
suppose given the circumstances, it wasn’t.
The next morning a vascular surgeon came in to
look at my leg. He took one look and rushed me into surgery. Forty-five minutes after he saw my very
swollen and now discolored lower left leg, I was in the OR under
anesthesia. Apparently when I fell, I must
have been leaning on my leg in a way that caused me to develop compartment
syndrome, which is when all the muscles in the leg come under so much pressure
that the muscle begins die. Most likely in my case, due to a cutoff of circulation,
when the circulation returned rapidly, the pressure began to build. So the
doctors had to perform a fasciotomy.
They sliced my leg open about 12 inches long, three inches wide and dug
a quarter inch deep in order to relieve the pressure and remove dead muscle
tissue. I again awoke in an opiate induced daze to find my mother, my aunt and
a very swollen, bandaged leg.
After about a week
on the post-op floor at Montefiore Moses, I was transferred to Montefiore
Einstein, for a brief stint of physical therapy. I had, due to the surgery,
developed a foot drop, which meant I couldn’t lift my foot up on my own, and
when I walked my foot automatically dropped down.
I was sharing a
room with an older gentleman named Benny who had his knee replaced. It was here
that a psychiatrist came to see me. He asked me about my history, which
included cocaine addiction and suicidal ideation, although only when I was under
the influence of cocaine. He asked me if my overdose was the result of a suicide
attempt. I told him that no it wasn’t, I took what I thought was a “get high”
dose, and that it probably occurred because I had no opiate tolerance. I
assured him that the only times I had ever been suicidal in the past was after
long multi-day cocaine binges, when I was coming down, or crashing. In my opinion, anyone under those
circumstances would think about killing themselves. He didn’t believe me, and
then told me that Benny, my roommate, had told him that I had said that I was
going to try to kill myself again as soon as I got out of the hospital. Benny
and I shared a standard hospital room with curtains around the bed. I told the
doctor to open the curtain and confronted Benny right there. I said, “Benny is
it true that you told them that once I get out of the hospital I plan on
killing myself?” Benny denied it, and never brought it up again. I still wonder
to this day whether or not Benny did say what the psychiatrist claimed.
My next stop was
the Montefiore North Division Psychiatric unit.
Again, I traveled by ambulance late one night at roughly 11 pm. At this
point I had a wound-vac, which is a negative pressure wound therapy machine,
designed to pump out and help close the wound. It’s a portable round apparatus,
about half the size of a basketball that is attached to your wound via a hose
and a dressing. It is also equipped with a shoulder strap, so it can be easily
carried. Upon arriving on 7-South, being wheeled through the locked steel door,
and hearing it slam shut behind me, into that gray corridor I felt for a moment
as if this recently acquired wound reached beyond just my lower left leg, and
into my identity. I felt it its openness, its nakedness. I felt as exposed, as
sliced open and vulnerable as the flesh of my lower leg. At first they parked
me just outside the nurse’s station. A large black man came up to me and
introduced himself and asked me if the wound vac that was resting on the floor
was a turtle, and then began to mumble incomprehensibly. I was assigned a “one-on-one” since I was
deemed a suicide risk. A “one on one” is someone, or different people at
different times, that is constantly by your side, 24 hours a day.
My roommate’s name
was Calvin, an 18 year-old black man, who had apparently attacked one of his
supervisors at his group home. He was ranting about something or other and
making threats, like “I am going to punch her in the face”, when I was brought to
my room. One of the nurses came in and gave him an intramuscular injection that
quickly calmed him to sleep. The next morning I awoke to two things: one of the
staff screaming, or so it seemed, that breakfast was there, and the smell of
urine. Calvin had wet the bed; probably from the drugs he was given. Calvin and
I both had one-on-ones. So my one-on-one confronted him about it, asking
jokingly, “Calvin what did you do?” She was met with Calvin’s defensiveness,
and out of embarrassment he told her to, “Shut the fuck up.” I got up and
started to walk to the dining room, forgetting that I was attached to the
wound-vac, which had temporarily become part of my being. It came crashing down
from the nightstand, where I had planted it before going to sleep. I picked it
up, and saw that the pressure reading on the small LED display screen was
unchanged and carried it on to the dining room.
In the dining room
that morning, I was unofficially introduced to those I would be sharing my
meals and time with for the next few weeks. There was Figueroa, a morbidly
obese and occasionally violent man in his twenties. Then there was Trombetti, a
sixty-something manic-depressive Italian man, who made these loud and angry
outbursts, which often included the words “cunt” and “nigger”, which he
directed at our predominately black and female staff. He would also try to
drink as much water as possible in an effort to “wash” the Lithium out of his
system. The staff would try to restrict his water intake, with little or no
success. There was Myra, a young woman, probably schizophrenic; during this
first meal she took her serving of oatmeal and threw it at another one of the
patients. It landed on the patient’s side, and sent her tray crashing to the
floor. Shocked, she did nothing, and Myra was escorted back to her room while
she was pounding her fist into her forehead. She had on two hospital gowns, and
I noticed her hairy, unshaven legs as she left. I looked down at the various
foods splattered on the linoleum floor, the powdered “scrambled” eggs, some
potatoes, a spilled juice, and stared at how it obstructed the fluorescent
light’s reflection on the linoleum tiles.
Luckily for me, my
mother came to see me everyday at lunch, and she brought food, real food in
comparison to the grotesqueries they served at the hospital. Dad came too, but
always in the evening. One night he brought me pizza, and as he was walking
down the long corridor to the dining room, one of the patients screamed,
“Pizza!”
There was always a
lot to talk about when they came. We talked about my leg and whether I was
receiving proper care for it, which for the majority of my stay I did not. We
talked about the hospital, the other patients, the food but very rarely did we
ever talk about me. Perhaps what we should have been talking about was the
state of my life, and plans for the future. But we weren’t.
The wound-vac was
attached to my wound by a dressing which consisted of a piece of foam, cut to
the shape of the wound, and then a layer of clear plastic that had a strong
adhesive on one side that kept it stuck to the leg. This dressing had to be
changed every three days. On day five I became enraged that the vascular
surgeons hadn’t come up to change it yet. The vac had become full, so I had to
manually shut it off and disconnect it myself. Full of the wound’s discharge,
it was made thick by a teabag-like insert inside of the transparent storage
canister. The remaining piece of foam became soaked, and had begun to leak this
blood-like fluid, dripping out of small pathways in the clear plastic lining, and
onto my pajama pants and bed sheets and into my socks. From being stagnant and
unchanged, the wound had developed an odor, one similar, but not as potent, as
provolone cheese. Finally a rather young vascular resident came up to change
it. Out of a lack of available space, we went into the Quiet Room so he could change my dressing. Being inside was
spectral, the padded beige walls, the barrenness of it all. The glooming
reinforced steel door with its small wire-glass window. It was as if for that
brief ten minutes or so I joined every man and woman who had ever been locked
in that room. I stared at the walls, the padded walls, where some of the paint
had been peeled back. I pictured someone locked in here for hours, amusing
themselves by peeling back as much paint as they could. There were even the letters
“F-M-L”, fuck my life etched into the
wall with I don’t know what. The resident brought a new dressing, packaged by
the makers of the wound-vac, some sterile gauze, and some towels that he had
one of the nurses fetch from the linen closet. Once he peeled back the dressing,
fluid instantly began to pour out of my leg, and onto the floor. As if he was
in a rush, he abruptly yanked the soaked piece of foam off of my leg, which
hurt since the clear plastic was attached to my leg by a strong adhesive, and began
to cut the new piece so that it would fit the wound. He then picked up a towel
that had been resting on the floor and dabbed my open wound. Shocked at his
negligence, and filled with a feeling of voicelessness, a combination of being
institutionalized and the drugs they had me on, I politely requested that he
use sterile gauze, when in fact, I was teeming with anger inside. I loathed
him, and this place where I was. I imagined the dusty and bacteria ridden shelf
that that towel had just come off of. But in my request I was reserved and
cordial.
Three days later
my leg developed a strange color, an even stranger odor and ultimately a staph
infection. I was taken off the psychiatric unit, and placed once more on a
post-op floor where I was treated with broad-range IV anti-biotics for 14 days.
I was frustrated that even when arriving at the medical floor, rather than
changing the infected dressing right away, no one looked at my leg until the
next day at 3 pm.
I shared the room
with an older Spanish man, who had apparently begun vomiting and couldn’t stop
for several days. He didn’t speak a word of English, and was on a water and
food restriction. I would listen to him cry out for “agua.” When I would get up
to use the restroom, he would reach out to me and wriggle his fingers with long
yellowed fingernails, and repeat these cries for “agua.” As politely as I could
I told him, “No puedo ayudar”, “I cannot
help.” At this point I had regained
continence, which was mirrored by his lack of. He would make bowel movements in
his bed, and the nurses would leave him there to sit in it, sometimes for hours.
And then they would come in and say to him, “What happened, Papi?” They were
always referring to him as “Papi” It really bothered me, I found it to be
condescending and demeaning. One day I almost said to them, “Call the man by
his first name!” But I never did, I was dependent on and didn’t want to cause
any problems for them. I was the one some of the nurses and all of the “one on
ones” fought over. Perhaps because I was so easy, I didn’t get out of bed, my
only requests were for more pain medication, which provided no sort of high or
even relief of the mild physical pain I was in, but I had to have it every four
hours. After two weeks on this quiet
post-op floor, I was thrown back into the madness of 7-South.
It took several
more weeks on the floor, before it came time for me to leave. I was stable, as
stable as I was when I first walked in the door. But my psychiatrist was very
insistent that I be supervised once I left. He feared for me, or so he claimed,
that I would start using again and kill myself either voluntarily or
accidentally. So he had arranged for me to receive a court ordered AOT. Which
stands for “Assisted Outpatient Treatment”. It’s a legally binding document
that required me to receive some kind of supervised treatment on the outside,
or in the “community” as they call it in the mental health world.
Finally, two
months after I was first taken to that Upstate New York hospital, I was
released to the care and supervision of an ACT team. This is a team of social
workers that come to visit you, and check up on you 6 times a month. I didn’t mind
them, but I cringed inside when they asked me, and they never failed to ask, every
time they came to see me, if I had any suicidal or homicidal ideation. What
kills me about the whole thing is that I have never been homicidal or even
violent. And when I was suicidal, it was always after a cocaine binge. But I had
legally binding orders to see them so I did. If I failed to see them, they
could have me taken by the police to a psychiatric emergency room, where I
would be admitted if deemed necessary by a psychiatrist. So even though I was out
of the hospital, or in “the community” as they put it, I am not yet that far
removed from it all.
