Balloons of Hope



 

Ahmed Z Obeidat, MD, PhD; Nadia Al-Khun

Perm J 2018;22:18-024 [Full Citation]

https://doi.org/10.7812/TPP/18-024
E-pub: 07/19/2018

ABSTRACT

A neurology fellow describes an emotionally draining workday beginning with a long commute delayed by a scene of accidental death. During patient rounds, the day continued with misery as this physician watched and declared brain death in two patients. Opioids took away the life of a young, loving father from his growing family. Opioids robbed an unborn child from seeing her mother. Opioids made this physician feel helpless and caused him to think, Why is this happening? How to stop it? And when does it end? This narrative essay illustrates, with words and art, the need to stamp out the opioid epidemic.

INTRODUCTION: PERSONAL REFLECTIONS

As I (AZO) entered the room, a balloon exclaimed: “Come home soon.” Several other colorful balloons decorated the room and surrounded the young man in the intensive care unit bed. A heart-shaped, red balloon expressed endless love. A wrinkled blue balloon begged him to come back home. A small stuffed elephant carried a pink balloon gesturing, “Be well.” In the corner, a furrowed-flesh golden balloon glowed with remnants of the phrase “Recover soon.”

The harsh sound of the ventilator and the loud beeping of the monitors took me back in time to earlier that morning. I sat for hours behind the steering wheel on my way to work. Stop-and-go traffic was the theme. It was dark, cold, and wet. The lights of emergency vehicles filled the horizon. Erratic lightning dominated the sky. Sirens intermixed with thunder. A murder (flock) of crows overflowed the shivering trees of Ohio’s winter while paramedics tried to resuscitate a man found unresponsive in his vehicle. I made it through the traffic jam but arrived late to work. I was emotionally exhausted. The morning scene stuck in my mind. I rushed to the physician lounge, took off my coat, ignored my wrinkled suit, forgot my coffee, and proceeded to patient rounds.

As I walked my way through the balloons and prevailed over my distraction, I greeted the patient’s wife, who clutched her husband’s pale left hand. I introduced myself as the neurologist and asked for permission to start my neurologic assessment. A blue teddy bear in the corner looked at me while I tried to call our patient’s name. That same teddy bear held a colorful drawing of a happy family, signed by a young boy, who happened to be our patient’s 6-year-old son. Despite several attempts to call our patient’s name, I received no answer. While trying to call his name again, I noticed a small piece of paper next to the electroencephalogram decorated and warmly colored by the man’s 4-year-old daughter. As my soul continued its distraction, my mind attempted to draw my attention to the neurologic examination. I tried to elicit a pupillary response. However, the man’s eyes did not avoid the intense beam of light I shined at them. I took out a syringe filled with sterile saline from the cabinet next to his bed. His eyes did not blink to drain the falling drops of salty water away from his drying cornea. He could not cough or gag while I suctioned his copious secretions. He did not move an arm or a leg no matter how strongly I stimulated a hidden part of his sweaty back. Despite a beating heart, his body was cold, swollen, and limp. The mechanical ventilator drove air in and out of his 30-year-old lungs.

The sound of the ventilator accompanied me to the next room. There I could see a young woman lying in the hospital bed; next to her sat the patient’s mother, a gray-haired woman who was grasping her daughter’s pale left hand. After greeting them and introducing myself, I asked for permission to perform my neurologic assessment. Then I noticed the colorful “Get well soon” balloons all around the room. While I stared, my mind experienced déjà vu. Could it be another brain-death examination? I noticed that the patient was pregnant. I called the patient’s name but received no response. I then yelled her name. However, I noted that her mother was not as surprised by the lack of response as I was, so I took a deep breath and continued with the examination. I could feel the moving fetus deep inside the patient’s abdomen. Sadly, the patient herself was motionless, and she showed only limited signs of life. I overcame my distraction and continued my neurologic assessment. I elicited no pupillary response. I could not get her to blink when I tested the corneal reflexes. I failed to elicit any meaningful movement from her limbs. The only movements, other than those of her energetic fetus, were the brisk spinal reflexes. The baby girl was due in a few weeks, and her grandmother asked me to predict if the little one would ever meet her mom. My blank stare and a glistened tear on my face were apparent to her as I answered.

Neurologic diseases deprive us of the many things we take for granted; they hinder our natural capacity to move, walk, and talk. They rob our memories, hamper our thinking, and attenuate our abilities to see, hear, smell, taste, and touch. Sometimes brain death happens and takes us away from our loved ones. Opioid overdose puts the human body into a hypoxic state of cessation. Neurons are particularly susceptible, and brain damage or death may follow. Sometimes, lives are taken away in a matter of a few hours or days.

Earlier that day, paramedics failed to resuscitate the man who had reportedly overdosed in his car. Both my patients, according to their family members, had just relapsed after years of sobriety. The father of the young family had started a new job and a new chapter of a healthy, productive life. However, it was not long until he relapsed. He used a similar amount of heroin as he had before sobriety. Because he lost his opioid tolerance, the amount was too much and resulted in an accidental overdose. The young woman was living a sober life. She started a family and had a toddler boy at home waiting anxiously to meet his little sister. Unfortunately, the mother relapsed and accidentally overdosed. She sustained a massive anoxic brain injury, which ultimately led to her death only a few weeks after I met her. Luckily, she delivered safely, and the grandmother decided to raise the boy and his newborn sister.

DISCUSSION: THE EPIDEMIC

Ninety-one Americans die every day of opioid overdose, the Centers for Disease Control and Prevention report.1 The incidence is outrageous and continues to increase despite the availability of naloxone. Although deaths associated with prescription opioids steadily rose over the past 2 decades, heroin and fentanyl-related deaths have recently risen out of proportion.2 In 2016, fatalities attributed to fentanyl increased 540% compared with 2013.3 Public health experts suggest that prescription opioid misusers later make a transition to cheaper and more potent alternatives such as heroin.4 Sales of prescribed opioids have increased by 300% during the past 2 decades. Specialists suggest a combination of intertwined factors behind the current opioid crisis. Such risk factors include race (white), younger age, male sex, poverty, lower education, psychiatric comorbidities, and prior use of prescription opioids.5 

In addition to proper regulations and altering the practice of prescribing opioids, a comprehensive plan is necessary to combat the opioid abuse epidemic. Community efforts and targeted education can play an integral role together with legislation in fighting this epidemic. Teaching about the dreadful consequences of substance abuse should be discussed as early as possible in school curricula, at community gatherings, and in homes. Improved efforts such as raising awareness about the harmful effects of substance abuse, identifying individuals at risk and those in need of treatment, and promoting alternative methods of managing and coping with chronic pain are desperately needed. A dedicated team of teachers, community leaders, physicians, nurses, paramedics, police officers, parents, and caregivers should work together to plant balloons of hope in the community, alongside the path to recovery from the current opioid crisis.

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CONCLUSION

The balloons in the hospital rooms were of false hope—balloons of despair—signaling love, health, and joy but masking suffering and death. The furrowed balloons narrated lengthy tales of intensive care unit stays owing to accidental opioid overdoses. One day, I hope, balloons will mark the end of the opioid epidemic.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Acknowledgments

Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.

How to Cite this Article

Obeidat AZ, Al-Khun N. Balloons of hope. Perm J 2018;22:18-024. DOI: https://doi.org/10.7812/TPP/18-024

References
1.    CDC. Opioid overdose: Understanding the epidemic [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; updated 2017 Aug 30 [cited 2018 May 19]. Available from: www.cdc.gov/drugoverdose/epidemic/index.html.
    2.    Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016 Dec 30;65(5051):1445-52. DOI: https://doi.org/10.15585/mmwr.mm655051e1.
    3.    Katz J. The first count of fentanyl deaths in 2016: Up 540% in three years. New York, NY: The New York Times; 2017 Sep 2 [cited 2018 May 19]. Available from: www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html.
    4.    Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med 2016 Jan 14;374(2):154-63. DOI: https://doi.org/10.1056/nejmra1508490.
    5.    Martins SS, Sarvet A, Santaella-Tenorio J, Saha T, Grant BF, Hasin DS. Changes in US lifetime heroin use and heroin use disorder: Prevalence from the 2001-2002 to 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry 2017 May 1;74(5):445-55. DOI: https://doi.org/10.1001/jamapsychiatry.2017.0113.

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