Near Death

She was slumped against the wall. Her hands were purple. No pulse, no breathing, no vital signs.

Fentanyl overdose.

My response to overdose has changed over the years. In the early days of this work, it caused me panic.

My fingers trembled as I engaged in the cumbersome process of preparing a syringe with a dose of Naloxone (the drug that can reverse an opioid overdose). One time I cut myself while breaking the glass ampule containing the chemical agent.

Often, the faces of clients near death would stick with me - the sight of their skin turning blue from lack of circulation and the awkward positions of their bodies frozen as their life force moved further away.

These days, the experience of bringing a person back from the edge of overdose death has become somewhat normalized. I still feel the pressure of the moment, but my response is more detached and methodical, more like a seasoned paramedic.

I go through the steps…

First - look for signs of overdose: the tiny pupils, blue skin (especially the lips and under fingernails), cold clammy flesh, limp body, lack of response, shallow breathing, gurgling/snoring sounds…

You try to rouse the person, calling their name.

“Sandy. Can you hear me?”

On this day, Sandy’s street buddy is there. He shakes her at the shoulders and splashes cold water on her face. He is trying to stimulate her into waking, but it doesn’t work.

Sometimes, nothing does.

Naloxone is administered into thigh, with an inch long 25 gauge needle that is strong enough to puncture Sandy’s jeans. It is a strangely intimate experience jabbing a needle into someone, penetrating their barriers of clothing and flesh.

I feel that intimacy with the syringe in my hand.

911 is called.

I notice that Sandy only has one shoe on; the other somehow kicked off during the episode. The smell of dirty feet fills my nostrils - a scent that remains there until I’m able to cleanse my nasal passages with a neti later that evening.

Sandy’s street buddy begins to panic. Even with the Naloxone, she isn’t responding.

“COME ON WOMAN! WAKE UP. NOW!”

Her skin has become the darkest blue. A thought of my brother in law, Steve, climbs up from the void into my awareness.

Steve died of a heroin overdose in a shooting gallery when I was a teenager, back in Detroit.

The dealer and a couple of addicts dragged Steve out of the house into the alley, leaving his body in a dumpster to be found later.

I breathe through that image, not trying to fight it away, noticing as it dissipates.

The 911 dispatcher calls my attention back to my phone set on speaker mode. She is talking me through the steps of keeping someone alive.

In this moment, it is impossible to communicate to the dispatcher how commonplace this has become in this work, in an environment where drugs (both illicit and “safe supply”) are easier to get than treatment.

Sirens can be heard in the distance. Sandy’s street buddy takes off.

Finally, the Naloxone is taking effect. Sandy’s chest rises and falls, slowly, as her breathing returns.

The colour of death withdraws.

Sandy’s eye lids open-her pupils are dilated. She is smiling.

In a volume just above a whisper words come out of her mouth:

“That was even better than the last time I died.” she says, referring to the near fatal OD she had, a couple weeks back.