No Refills Remaining

[P14]: Paramedic 14 to Dispatch, on scene with unidentified female, approximately mid to late forties, suspected overdose. Found unresponsive by bystander out front of St. Kingsley shelter. Pulse 51 and weak, BP 78 over 45. Shallow respirations, bag valve mask in use. Requesting hospital direction.

[DP]: Copy Paramedic 14, standby for directions. Medication administration?

[P14]: 0.4 mg naloxone IV push given two minutes ago. No response, prepping D50.

[DP]: Havenfield Community Hospital accepting. ETA?

[P14]: Nine minutes out.

[DP]: Copy, ER informed. Keep us updated.

[P14]: Understood dispatch, Paramedic 14 out.

“Everyone stop your talking so we can finish up the shift report, I have one more patient to go over, ” Marie called out to the oncoming nurses, waiting a few moments to gain back their attention. “It’s been nothing but a shit show tonight, and I swear to Asclepius himself I never want to set foot in this ED again.”

“That’s what everyone says until another overtime shift pops up. We all know you can’t resist them,” Lydia teased, wagging a finger at Marie. “Pretty sure this is your third double shift this month.”

“You better watch it, Lydia, or else the oncoming charge nurse might assign you Grace Bennett again,” Cheryl warned.

“Grace is back already? It’s only been, what–three weeks since she was last here?” Lydia snatched the assignment sheet while Cheryl and Marie exchanged snickers.

“Not even,” Cheryl chimed. “I had her last week when you were off. An absolute delight, as usual.”

“I’m sure she was,” Lydia grumbled, having found her name written next to Grace in the assignment sheet. “Let me guess, more opioid use? How many times can one person overdose and still be alive?”

“Forty-eight times, give or take,” Cheryl stated. “Had a slow night, so I dug around her file. Forty-eight ED visits for overdose, thirteen of those visits lead to an inpatient admission.”

“Forty-eight times?” Lydia asked in disbelief. “I know we see her a lot, but that seems a bit excessive. Are you serious?”

“First visit dating back to 2004. Apparently her kids called EMS after finding her unresponsive from an overdose," Cheryl reported while receiving surprised looks from her fellow nurses. “Social work got involved real quick, and she ended up losing custody of her kids. She has a really juicy history if you go back far enough; divorce, parole–you name it, she did it.”

“Stop your pouting, Lydia,” Marie spoke up. “She is basically good to go. Just get the attendant to sign off and hand her a naloxone kit on the way out.” Lydia let out one last whine, before she left the report room. After settling into her desk and reading over her full assignment, Lydia grabbed the rolling vitals machine, pulling it towards room B13. She slipped on her professional smile just before pulling back the curtain.

“Welcome back, Gracie,” Foster smirked as Grace stumbled into the apartment, collapsing onto one of the kitchen bar stools. Her fingers twisted into the loose fabric of her shirt, a poor attempt at easing the shaking of her hands. Foster moved to stand on the opposite side of the kitchen counter. Foster caught Grace’s gaze before his eyes drift down to her wrist. The hospital band stood out against her skin, stark and wrinkled. “Nice bracelet. Another one for your collection. You’re close to the double digits.”

Grace looped her fingers under the wristband and pulled hard, a futile attempt to rip it off. Foster turned away, rifling through a drawer. He returned with a pair of scissors, cutting the band off with ease.

“Do you have any more?” Grace rasped, throat still sore from when the tube that had been down her throat yesterday. “I’ve got money.”

Foster tilted his head, a grin playing at the edge of his mouth. “It’s all business with you, that's why you're one of my favorite customers. Pick your poison.”

Foster opened a cabinet below the kitchen counter, bringing a small clear box out and placing it just out of Grace’s reach. Through the plastic she could see the collection of small orange bottles. “I’ve got a good supply of Percocet. Or we could spice things up with some vicodin? I’ll give you the whole bottle for two hundred. Typically I’d charge two-fifty, but I’ll give you a loyal customer discount.” He plucked out one of the bottles and set it in front of her.

Patient Name: Benson, Tessa

Rx#: 2431874

Prescriber: Dr. Andrew Kolchek, M.D.

Drug: Hydrocodone/APAP 5-500 mg

Qty: 40 tablets

Sig: Take 1 to 2 tablets by mouth every 4 to 6 hours as needed for pain. Do not exceed 8 tablets in 24 hours.

“I’ll take it,” Grace answered, pulling cash out of her pocket. “Who is Tessa?”

“My girlfriend's sister. Told her doctor she pulled something in her back—walked out with three refills.” Foster took the money before moving further into the kitchen, grabbing an empty glass and filling it with tap water.

“She doesn’t need them anymore?” Grace asked.

“She never needed them to begin with.” Foster slid the glass of water across the counter. She wasted no time opening the bottle to take two of the pills. “Doc didn’t even do a proper assessment. Five minutes in and out. She’s seeing someone new today—hoping lightning strikes twice.”

A small ringing emanated from his phone. Foster flipped it open, and grinned at the name on the screen. He looked back at Grace, amused. “Well speak of the devil, let’s see if Tessa was successful once again,” Foster commented before bringing the phone to his ear.

“Hi Dr. Nguyen, this is Dr. Patel, resident for Dr. Kone in the Emerge. I’m calling to give a report on a patient being transferred to the ICU — Grace Bennett, date of birth September 22, 1958.”

“Let me just pull up her chart. She is currently in ED R02?”

“Yes, that is her. She is going to ICU A3.”

“I have her chart up, go ahead with the report.”

“Bennett was brought in at 02:34 with EMS after a suspected opioid overdose. She’s post ROSC, but remains comatose. She is currently intubated on mechanical ventilation, FiO₂ at 30% with stable sats. Neurologically, she has minimal brainstem reflexes and is non-responsive to pain. CT head shows cerebral edema, no signs of herniation.”

“I see a pending order for an EEG, has that been completed yet?”

“The techs are with her right now, plan is to send her up once she is done.”

“Understood. What are the arrest details?”

“She had an unwitnessed collapse, found unresponsive by a staff member at the Hillside Outreach Shelter around 01:55. CPR was initiated by shelter staff guided by dispatch. EMS took over at 02:17. She had a return of spontaneous circulation around 02:22, so about 27 minutes of CPR. The exact down time is unknown. Shelter staff had given 3 rounds of IM naloxone prior to EMS arrival with no response.”

“Thanks, good report Dr. Patel, I’ll review her lab results before she arrives. Sounds like an anoxic brain injury. Let’s get social work to contact next of kin — check if Cindy’s in, she knows Grace well. Ask her to reach out to Grace’s son.”

“Sounds good. What's the name for the son?”

“Jacob?” a quiet voice called out from the top of the basement stairs.

“Go away Annie, I’m busy,” Jacob grumbled, eyes not leaving the screen. “You got to play on the N64 this morning, it’s my turn.”

“I need your help.” Floorboards creaked as Annie made her way down the stairs.

“Can’t you ask mom? I’m in the middle of a boss fight.”

“Mommy fell down, and now she won’t wake up.”

Jacob paused his game and turned to see his sister. Annie’s face glistened with tears. “What do you mean she isn’t waking up?”

“I shook her arm a bunch but she is still sleeping.”

“Okay,” Jacob said as he pulled himself from the cushion on the floor and headed towards the stairs. Annie followed closely behind him as they traveled up the stairs to the main floor. Laying on the living room floor was their mother, motionless.

“Mom!” Jacob yelled, quickly dropping to his knees, grabbing onto her arm and squeezed it hard. She didn’t move. She didn’t even flinch. Heart pumping, Jacob got up and ran to the kitchen to grab the phone from the stand. Next to it on the fridge was the sticky note of important phone numbers.

Call 911 for an emergency if Mom or Dad aren’t home

He never had to call 911 before. He didn’t know what he was supposed to say when they answered. He dialed the number, a shaking hand brought the phone to his ear. A soft yet firm voice answered the call.

“It’s my mom,” Jacob told the woman over the phone. “My little sister saw her fall a few minutes ago, and now she isn't waking up,” Annie gripped tight on the side of his shirt. He tried his best to keep his voice steady as he looked at his mother. The woman on the line kept her voice soft and clear. She reminded him to breathe, told him help was on the way, that he was doing great.

“Jacob?” Annie’s muffled voice said through the fabric of his shirt. He could feel wet spots from her tears, but he didn’t care. “When is mommy going to wake up?”

“I don’t think she is waking up this time,” Jacob said quietly, eyes fixed on their mother. She lay motionless in the hospital bed, connected to machines by IV lines and a thick tube threaded down her throat. He was too familiar with this place–the bright lights, and the smell of sanitizer. “The doctor said she was brain dead, there is no coming back from that.”

“She can’t be gone,” Annie sniffled, Jacob handed her another tissue. The nurse placed a new box in the room before the two of them had been brought in. Jacob arrived first, having already been briefed by the ICU physician.

“She said she was going to get better, she was attending the meetings!” Jacob pulled her into a hug. He didn’t say anything at first. Their mother had said a lot of things over the years. Annie still believed her. Jacob hadn’t in a long time.

“I know,” Jacob rubbed her back as she clung tighter.

“She can’t be gone,” Annie repeated, voice cracking. “I want my mother back.”

“Me too,” Jacob said back. They sat in silence for a while, holding each other close. When they finally pulled apart, they took seats in the quiet room. It wasn’t long before the nurse returned, another box of tissues in hand.

“Hello Annie, I’m glad you were able to come,” the nurse offered a small smile as she placed the box on the table in front of them. “The doctor wanted to talk to both of you. Shall I grab him now?”

“Yes, please,” Annie replied, her voice small but steady. Jacob gave a quiet nod. The nurse left the room, returning shortly after with the same doctor that spoke with him earlier. Annie dabbed her eyes one last time, bracing herself, as the doctor stepped into the room.

“What brings you back in to the clinic today, Mrs. Bennett?” Dr. Raman asked as he entered the small exam room. Grace sat stiffly on the examination table, the thin paper beneath her crinkling as she shifted.

“I’m still having a lot of back pain,” she said. “I can hardly move without sharp, stabbing pain. It hasn’t improved at all since last week. I’ve been taking the muscle relaxants you prescribed—they help me sleep through the pain—but I can’t take them during the day. I’ve got two kids to look after, I can’t be stuck laying in bed all day.”

“Cyclobenzaprine can definitely make you groggy.” Dr. Raman nodded, flipping through the chart. “I see you went for the X-ray. That’s good—nothing skeletal going on, just soft tissue strain. Have you started physiotherapy yet?”

“Yes, I had my first appointment on Friday. I’ve got another one tomorrow. I’ve been trying to do the stretches they gave me, but it’s hard when it hurts this much.”

Dr. Raman reached for a prescription pad, clicking his pen. “Let’s go ahead and order a CT to take a closer look, just in case. In the meantime, I’m going to give you something a little stronger for pain to help you stick with the physio.” Grace took the paper from the doctor, taking a moment to read the messy writing.

Patient name: Bennett, Grace

Rx: Hydrocodone 5 mg / Acetaminophen 500 mg

Sig: Take 1–2 tablets by mouth every 4 to 6 hours as needed for pain

Disp: #30 tablets

Refills: 2

Prescriber: Dr. Elliot Raman, MD

“Hydrocodone?” Grace asked. “I’ve never heard of it before, what is it?”

“It’s an opioid,” Dr. Raman explained. “Stronger than what you'd get over-the-counter, but not long-term. You can use it during the day for breakthrough pain and continue with the cyclobenzaprine at night.”

“Thank you Dr. Raman,” Grace winced slightly while getting off of the exam table. “How long do you think it will take for my back to improve with the medication?”

“With proper rest and physio, a few weeks,” he said. “The medication should help get you over the worst of it. Don’t worry—you’ll be back on your feet before you know it.”