Skittles

How do you end up with a bullet wound in your foot that travels through the back of your heel down several inches of plantar fascia and out the bottom of your foot, leaving shattered bones and cauterized tissue in its wake? If you ask a doctor, they might tell you that the bullet passed through the calcaneus, or “calc”, which is an important weight bearing bone in the heel that, if left untouched, might heal (heel?) on its own, but due to its presence now being an absence, scans and surgery would likely be needed. A socio-economist might say something discussing the circumstances that led to this, economic disparity and poverty resulting in the normalization of crime and gun violence. A gun owner might discuss the importance of gun safety courses and how everyone that owns a firearm needs to take safety lessons and not flag people or wave the gun around randomly. The EMTs that brought the patient to the hospital might talk about how it was a drug deal gone wrong, and how the patient should have been more careful before trying to sell to or buy drugs from the wrong people. The nurses would agree with them before pumping the patient full of opioids, which won’t work on him anyway because he’s a chronic Percocet user.

“Skittles”, he called them. “Do you like Skittles?”, I asked. He tried to clarify. The pain meds they gave were like Skittles to him, they weren’t effective as pain meds. “Do you like Skittles though?”

“Yea, I guess, but not right now.” Fair enough, bro has a foot that’s been blown to bits. I’m sure the bone shards aren’t helping much with the pain either.

The doctors ask if he has any allergies and medications and past medical history. “No allergies or medications, no conditions”. The picture of perfect health, except he’s lying in front of me on a hospital bed with a hole in his leg. They ask if he smokes cigarettes. “Nah, I smoke weed.” Do you drink alcohol? “Nah, just weed. And Percocets.” Good to know. “Atlanta has a big Percocet problem.” Really? I didn’t know. Amidst the screaming, the nurses say that’s why the opioids they gave him aren’t working. The doctors already ordered ketamine though, so no worries.

Ketamine. Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a treatment for depression and in pain management. Ketamine is an NMDA receptor antagonist which accounts for most of its psychoactive effects. Ketamine produces hallucinations. It distorts perceptions of sight and sound and makes the user feel disconnected and not in control. In a hospital setting, ketamine is given at low doses for slight pain relief and at higher doses for its dissociative properties. In practicality, ketamine makes you trip. Hard.

I’m worried about saying the name of the drug aloud in front of him, in case he tries to find it again after his treatment. The healthcare providers have no such reservations. The name of the drug is thrown around a few times. At least they inform him of the drug and its effects before they give it to him.

“Like shrooms?” He sounds scared. I wonder if he’s ever done shrooms before. The nurses say yea, similar to shrooms. I wonder if they’ve ever done shrooms or ketamine before. Probably not. The doctors ask him what music he’d like to listen to. It’s important that he’s in a good headspace. He knows what that means. He knows exactly what he needs. He asks for a specific artist, and asks the doctor to scroll through the songs until he finds one that he likes. Finally, with the vibes right, he lays back and lets the process happen.

Within seconds he’s in the clouds. He keeps looking at his hands, as if he can’t believe they are there. I get it. I understand the feeling of dissociating. That’s a telltale sign. I do it a lot too. At least he’s enjoying the music. And he’s no longer feeling the pain. The doctors pick his foot up by the toes and begin washing it with saline, a movement that would have been excruciating for him 3 seconds earlier. As they’re washing it out, he looks around at us, incredulous. “Is that my foot?” Yes. “This should be hurting right?” I nod, it should be hurting. I am amazed at how powerful this drug is.

Not even a week earlier, I saw a lady who I would have guessed had no prior experience with drugs also undergo a treatment including ketamine. She was a solely Spanish speaker and the doctors weren’t able to communicate with her effectively about her treatment. The translator was there but I don’t know if drugs were part of the conversation they had. Two and a half milliliters of fluid had been pushed into her knee joint to ensure that it wasn’t penetrated by a cut. She screamed so viscerally that I had to write a poem about it to cope. It shook me to my core. Yet, here is a patient undergoing a treatment just as painful and looking completely relieved, at peace even. The doctors continue their work, cleaning and wrapping and casting and wrapping again. They finish up as the patient starts to come down. He is speaking more fully now, and understands what just happened to him.

“Y’all had me on Pluto”. I laugh. We did have him on Pluto. “Y’all should not be just giving that to people. That’s messed up.” Mentally, I agree. If he comes back in a few months for a ketamine overdose, that’s on us, isn’t it? According to the healthcare staff that gave it to him, it isn’t. We don’t control what people do outside the hospital. Plus, what’s the better alternative? I don’t know.

Doesn’t the Hippocratic Oath say to do no harm? What constitutes harm? Are we hurting the few to save the many? Are we hurting the future to save the present? And at the end of the day, who wins? Because I don’t think it’s humanity.

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[Joss Jeffrey]

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