!Wrong --- agk's diary 17 Sep 2022 @ 20:58 UTC --- written on GPD Win 1 in puTTY with tmux and nano in bed with my just fell asleep napping baby on my little brother's birthday --- Content warning: Morphine overdose death. One of my capacities is I'm a community health worker. Look up Barefoot Doctors in the Chinese Cultural Revolution. Like that, but not state-spon- sored, unfortunately. In 21 years I've trained hundreds more of us, dozens of whom practice. A few call me for advice sometimes. A friend in another state who attended one of my trainings seven years ago called last night. His neighbor got bad news about her son, drank the oral morphine sulfate she'd hung on to after her dad's hospice death. Her guy was with her. She was responsive only to pain, breathing 13 times a minute. My friend got narcan, went over. I called the neighbor guy. Everyone in his life, five all told, died in the last year, except her. He'd been with her since she started heading into stupor, about 3 hours. She'd been breathing about the same the whole time. Oral morphine's half-life's about 4 hours. I gave him the poison control number, said they're better to call than me. He was angry and hurt and scared. He didn't want hospital bills. Their home, small business, finan- cial life's falling apart. They're uninsured. I educated him about the poison control centers, how morphine works, how an overdose of it kills (resp- iratory arrest), narcan and rescue breathing (if she drops below 12 breaths per minute). I used to overdose on morphine. My priorities for this family: stay awake and with her til she emer- ges from stupor, prepare to resuscitate and trans- port; support his psychosocial needs possibly with accompaniment to an Al-Anon family group meeting; neuro assessment of her in a few days for any evident residual anoxic brain injury. I called and consulted two people in my network, a fire department medic in eastern Kentucky who resp- onds to at least one overdose every shift and a nurse practitioner in Chicago who consults when hospital patients are drug-involved. They said my priorities were good. I called my friend, told him to also count her breaths, check her capillary refill time (he had no pulse oximeter to get her oxygen saturation directly), and check her pupils (if they're slugg- ishly responding pinpricks, that's good. If one's blown, that's brain damage). Then I finished writing a paper on tens of thousands of deaths caused by private equity buying nursing homes and degrading care for quick profit. My friend called me in the morning. The neighbor guy had called him: "She isn't breathing!" My friend told him to narcan her and breathe for her, drove over. The neighbor guy hadn't called my friend to keep vigil when he fell asleep. She'd been dead some time. My friend stayed while the ambulance, police, etc. did what they do. The tragedy isn't how I felt, or feel. "Kill one person and you're a murderer, kill a dozen and you're a professional." My advice was bad. Maybe if the people I consulted or I had been there our spidey-sense would have told us this needed to be a hospital trip. Maybe not. I wonder what poison control would have said. My advice was consistent with what I teach to staff in the facility where I work in a nursing capacity. Has my advice killed anyone else? Where was it wrong? I needed her medication history. I kept asking if she took anything else, and he clearly thought I meant drugs of abuse. I wish I'd asked specifically about alcohol, prescription drugs she routinely takes, over-the-counters like paracetamol. More importantly, we all treated this as if she was an addict and chronic overdoser. She wasn't. I need to explicitly triage overdoses like seizures. If this is your first, go to the hospital. My friend will help you get the charity care paperwork, fill it out, and fight for it. It's really sad. She was alive. Now she's dead. I played a part in that. Maybe she would have died in the hospital. There's no way to know. I feel more culpable and torn-up than when a patient dies in hospital. I called my sponsor and told her. I wrote this here in my diary. What a waste. At least the neighbor didn't have to go through it alone.