Stuffers

Working in an urban ER exposes you to all aspects of drug use, marketing, and abuse. I’ve had patients shooting up heroin in the ER, dealers are always hanging around outside ERs offering their products, and every other patient has a substance abuse problem. Body packers or “mules” are brought in by border patrol after they are discovered smuggling drugs into the United States in their stomachs. These patients are usually from South America, Central America, or Mexico, and they have swallowed many latex packets the size of large grapes that are filled with heroin or cocaine. After arriving in the US they are picked up by their contacts and the drugs are collected when they exit the body with the assistance of laxatives. Our job in the ER usually is to perform whole bowel irrigation which is a fancy way of saying we give them Go-lytely which is an osmotic agent they causes watery diarrhea to evacuate the bowel of all its contents. The border patrol agent usually handcuffs the patient to their bedside commode and nature takes its course. The real problems arise when one of these packets rupture and spill their contents into the bowel where it is rapidly absorbed into the blood stream leading to a massive overdose. A similar phenomenon occurs more commonly with body stuffers (as opposed to packers). These patients have swallowed their goods as they were being arrested by police to avoid charges of possession. They are usually under the assumption that since their crack or crystal is in a baggie they can save it and will be able to retrieve it later. Unfortunately simple sandwich baggies are rarely air-tight and the drug can still be absorbed - often with disastrous results. I had a 25 year-old patient brought to the ER by medics after he swallowed a baggie of unknown contents while trying to evade the police. The patient initially appeared well to the medics, but his heart and blood pressure became quite elevated enroute to the ER. He then began seizing as his body responded to a massive influx of amphetamines that he had swallowed. The patient was still seizing when he arrived in the ER and I gave him large doses of benzodiazepines as well as sedatives to control the seizures. I also quickly paralyzed and intubated him meaning I placed a tube was in his windpipe and put him on a breathing machine to protect his airway and ensure oxygen delivery to his brain and other organs. This young patient was admitted to the ICU and monitored carefully. After 2 days he was extubated (the tube was removed) and he was taken off the ventilator. He was able to breathe for himself, but unfortunately due this patient’s prolonged seizures he had suffered an anoxic brain injury – he basically had a stroke from not getting enough oxygen to his brain while he was seizing. He was what people call “a vegetable”. He had intact primitive functions such as breathing and respond to painful stimuli, but he had no higher brain function and couldn’t perform any meaningful activity. At 25 years old a young, otherwise healthy man had effectively committed suicide when he ingested that baggie of drugs to avoid what probably would have been a short incarceration for possession. The patient was eventually transferred to a long-term care facility specializing in patients with neurological problems ,and he will probably spend many years, the rest of his life, receiving care and therapy with minimal progress.
How's that for depressing? sorry but it was a long week...