Coast Emergency

The emergency room is a place that by definition you don't want to go to. A week or so ago, I was stricken with food poisoning or something heinous and mysterious. I was taken (first time in one) in an ambulance to this place that stands for desperation.

For those of you who want to cruelly admonish your children to not be irresponsible slackers lest dire consequences be their appointed lot, I suggest that one very powerful image that you could bash them with would be the emergency room. You don't want to end up there do you, sonny? And you could, you know, if you are sufficiently disenfranchised and have no other option. Without health insurance and a responsible attendance to ones own interests the ER just might be all you have. It is all a lot of people do have and woe is them.

The emergency room serves several community functions. Certainly and principally, as it were by definition, it is there for the treatment of trauma.

In that it is a kind of equalizer, a place of democratic leveling when the blood is flowing. Here they handle car crashes and broken bones, all of the horrible incidents of circumstance for which no one can really prepare. For those grim inevitabilities be glad that an emergency room does exist. You might not want to go, but when you are badly hurt it is where you are going, no matter who you are.

It is also historically the place that you go if you are uninsured. They are innovating on that one. As I will relate.

It is also the preeminent spot where you can get drugs. There are other ways to acquire the hard stuff, arguably better, nicer, less stressful ways. With not much difficulty anyone can find a private medical hack who will fill your prescriptions easy as pie in Mendocino.

But that of course takes a little time and a tiny bit of planning. The hustle on the street is not tolerant of either. The emergency room is known to be at one unvarying location, easily manipulable, and conveniently open at any hour. Naturally this ease of public access, coupled to the demand driven and insatiable appetite for drugs on the street has made the dispensation of opioids a principal, perhaps the principle function of the Fort Bragg ER.

The people who work there do not like it.

The sweeping national epidemic of opioid addiction is changing our small local community in ways that are evident to every one of us. It is as if something atmospherically dismal had descended in an invisible cloud on the whole region. Reluctantly and gradually we have discovered a sadness and futility that grinds at us in ways variously subtle and egregious. It is not a mystery, not any more. We have become involuntarily adept at recognizing clear symptoms and obvious signs.

We know anecdotally, personally and through the range of our experience what an addict is, and what addiction means to them, and what it means to those who love them. It made itself a part of many, many lives. Really it hits us all. Directly or indirectly but unavoidably opioids are now a part of the texture of our lives.

Heroin has always been in the culture of my time, throughout the ascendancy and reign of the baby boomer. A gateway drug, if I correctly understand the propagandists, is a drug with which it is hard to find fault with in itself, but which with sinister inevitability leads to something more dire.

That would be heroin.

Over the decades, the anti-drug establishment spent so much energy in the defamation of heroin and her sister opioids that for that specific drug to be the default recourse to virtually any patient who quivers quibbles or complains is passing strange. But then so much is. I suppose that the bow tie wearing doctors with their obtuse professional inscrutability would sneer at me that Oxycontin is not actually heroin. But it is, you know. It really is.

A few months ago, I attended a seminal seminar on the effects of opioid addiction in the local community. I arrived a few minutes late (as I usually do somehow) and who of all people is there but the estimable publisher of the Advocate, Sharon Dimuro, handing out cookies in the back of a packed hall. She made sure that I got a couple and a seat. She is always nice and keeps her long knives in her purse. I have been (almost) utterly blacklisted from her paper for a decade now.

The panel of experts was there to give the community the rundown and the facts and the stories about the opioid epidemic that everybody knows about. But this time all the stories were officially told to a packed audience.

One of the panelists (not a doctor) marveled that when her daughter had gone in for a tooth ache to her considerable surprise her daughter, was given 35 oxycontins, enough to change a life.

A contemptible nerd (excuse my expression) doctor on the panel explained to the audience that doctors are limited by their exhaustive schedules to spending only a few minutes with each patient and that such a brief allotment of their valuable time was not enough to get to the bottom of anything. Neither saith he by law could a doctor withhold medication from a patient that stated in plain terms that they were suffering pain. The volumes of addicting pills that they sent home with every customer (35) was also set by law.

Having told us this in smiling good humor he seemed to feel the matter had been thoroughly addressed.

Someone disclosed that there were 1200 addictive pain pills issued for every one thousand residents of the county. Or it might be the other way around.

Up spoke the spokesman for our state representative, James Wood, (a dentist) had tried to stop it all, she said. He really tried hard but the backlash was fierce and he had to give it up. She smiled blandly. What backlash, from whom, why? I silently raged. Everyone seemed to know that but me.

No real outrage was expressed by anyone. I wanted some talk about ruined lives and dead children. I wanted it all to matter. Foolishly, I came to the seminar expecting contention, confrontation, outrage, indignation, but no, the panel of experts was there apparently to reassure us that a social epidemic of staggering consequence was being properly addressed and that the doctors themselves were as innocent as lambs.

There were no hard questions taken from the audience. We were asked to write our questions on cards, but they did not actually read more than one or two of them. There was patently no audience participation. Afterwards, there was no press. Sharon of the Advocate seemed to have an organizing role in the seminar and a direct responsibility for the cookies, but not one word about any of it ever appeared in her paper.

The whole seminar was conducted in a kind of open secrecy. It was intended to be (I guess) reassuring that someone was thinking about things, and reassuring also that a panel of “experts” had been convened. Unto this opportunity they had come to make us understand that medical doctors were safely in charge and bad as we might think that it is, we were in the hands of professionals.

I left the seminar thinking that I understood things a bit better. Some people (not a few) have learned to use the automatic dispensation of addicting drugs as a convenient means of paying of the rent. I understood now how that worked. I understood now about the number of pills dispensed, which is enough to hook you but not necessarily enough to happily live the rest of your life on.

The bumping of people off their medically proscribed pain meds provides an opportunity for them to make the formal transition into (street) heroin, which with a little application is even easier to get and actually cheaper than oxycontin. Watch out for the phenol. And have a good life.

The doctors just follow the law. The seminar made that much very clear.

The actual dispensing of drugs, if it is not done in an official visit to an actual doctor's office, is taken care of for the masses at the ER.

When I showed up there on my gurney, I was in no shape to make judgments. So they made them for me.

To say that the ER personnel that I encountered were jaded is hardly adequate. To say that they were hostile, prejudiced and vicious is less than the situation merited. These were people who were fully expecting to be played and cunningly savvy to any game, even when one did not have one. They do not take any shit. An encouraging or gentle bedside manner is nowhere on their radar.

Predictably, a doctor strolled through and asked me the pain question. I knew from the seminar that they had to. I told them that I was horribly nauseous and that I had a terrible suspicion that I might be dying, but that in terms of getting dosed I was not actually in pain. It did not go well.

Some days later, I talked to the comparatively new hospital administrator, Mr. Edwards, and his assistant Julie, the administrator for customer satisfaction.

They were very nice. They struck me as smart and professional. They knew there was a problem. They were dismayed that I thought that I had been handled roughly and sorry that I felt bigotry and hostility were standard at the ER. It had been that way for me. I told them I thought the personnel were burned out from being made to be drug pushers and continually gamed by the desperate. The administrators thought so too. Julie explained to me that now they have Immediate Care which is a way for anybody even the uninsured to bypass the ER altogether. She told me that she had a new cellphone ap to monitor customer satisfaction at the ER, which was on the threshold of being implemented. I thought that was a good idea.