There are three loaves of bread sticking out of a paper bag in the passenger seat of the car.  I recognized them from the bakery on Park Street where people pick up fresh long loaves of the crusty pan de agua (water) bread hot out of the ovens when the shop opens at six.  It is now eleven on this brisk November day and the bread is cold. We pulled the young man who bought them out of the parked car and laid him down on the pavement in the apartment building’s isolated rear lot. Now a woman screams when she recognizes the man. People come out of the back door of the building.  The older onlookers try to shield the children’s view. We work the man for thirty minutes and then five more on the short trip to the hospital, but the straight line on the monitor never changes.

“He cut them down in droves–the corpse fires burned on, night and day, no end in sight.” – The Illiad -Homer (Robert Fagles translation).

In 2017, for a powerpoint presentation on the opioid epidemic, I made a slide that showed a graph of annual nationwide fatal ODs (about 15,000) from when I started as a paramedic in Hartford in 1995 to 2016, when the number had reached 65,000 a year.  I put a picture of myself at each stage.  Now four years later the annual death toll has reached 100,000.  

I went from being a medic who told my patients to just say no to drugs or they would end up dead or in jail to being an advocate for harm reduction (community naloxone, needle exchange, safe consumption sites) to now being adamant that the only way out of this is to end the war on drugs through decriminalization and regulation of a safe medicinal supply of opioids.  Clearly what we have been doing is not working and the problem continues to get worse.

Nearly everyone recognizes that this is a public health...

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“You’re covering the city,” dispatch says to us, when we clear Saint Francis after an early morning cardiac arrest. 

We park on Albany Avenue. The sun isn’t up yet, but the black birds are stirring.  We’re on for another ten hours.  By midday, we’ll have twenty ambulances on, but right now it is only us.  The others are calls-an asthma on Martin Street, a diabetic on South Whitney, and two early dialysis runs.  Another ambulance is at the base doing a crew change.  The rest sit parked in neat rows in the cavernous garage, waiting for their crews, still asleep, to rise and slowly make their way back in.

The avenue is quiet.  A cop sits across the way waiting like us.   From Park Street where the coffee at Cubanitos is being put on to brew and the days bread just starting to come out of the oven north to the Bloomfield line, where early workers are trodding to the bus stop along Blue Hills Avenue; from Prospect Ave where the governor sleeps in mansion East to Interstate 91 that runs along the...

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(This is an excerpt from a fictional work-in-progress.)

Frank Anastacio walked out of the brick building with a small paper bag in his hand. His work boots trudged forward, each step taking him deeper into a world he no longer wanted to live in.

The autopsy report said she had died of asphyxia from tying the bed sheet around her neck and jumping off the top bunk of her cell. EMS had transported her to the hospital and the run form said they had briefly restored a heartbeat, but the coroner told him that her brain had died within minutes. He tried to get out of his mind the thought of his daughter kicking the air, fighting against the sheet. He wondered if she might have regretted it at the last second, or had her despair been so deep that nothing mattered?

The last time he saw her, he’d had to talk to her through glass. She’d cried and said she was ashamed. She said that, no matter what, she loved him. He had to know that.

“We’re going to get through it,” he had told her. “We’re going to get...

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When I started as a paramedic in Hartford, many of my coworkers referred to the city as a shit hole. They said this as they put on or took off their bullet proof vests at our base and swapped stories about the populace they encountered in the inner city, drunks and deadbeats, and addicts and criminals. For someone from the suburbs, being thrown into an inner city of crumbling public housing complexes and high crime rates can be startling. Your eye is drawn to the outlandish and it takes awhile for you to see the normal — the hardworking, the family loving, the dreaming –who make up the bulk of the city that I have come to love.

Hartford has done a great job over the years, tearing down the crumbling public housing complexes and replacing them with new beautified developments with yards, flower beds and while in 2021 the city is facing one of its highest murder rates in years, the city seems to me to be in renaissance. From the new Parkville Market, where many of the city’s local restaurants have food...

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This week I have been reading/listening to Sam Quinones new book “The Least of Us”  about the changes in the opioid epidemic caused by the shift from heroin to fentanyl and the shift from ephedrine-based methamphetamine to a more dangerous type he calls P2P meth.  A federal drug agent told me a few years ago that drugs go in historic cycles from sedatives to stimulants and back.  We have been expecting our opioid/sedative cycle to switch to stimulants here in Connecticut, but it hasn’t happened in a significant way yet as it appears to be happening in other states.  The crazy meth that Quinones writes about instead of turning people into extroverts seems to turn them inward and antisocial, banging their heads against walls.  Due to the idiosyncrasies of the drug market, Connecticut fortunately has been spared this so far.  We have always seen very little meth in our state.  The stimulant used here is cocaine, which comes through established drug routes run by Puerto Ricans and Dominicans.  We...

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This week I was asked by the Connecticut Alcohol Drug Policy Treatment SubCommittee to comment on the new FDA approved high dose 8 mg naloxone product, Kloxxado, from the EMS perspective,   Here’s what I told them:

Three Points

1. High dose naloxone has no place in EMS/First Responder arsenal.

2. It has not been proven that higher doses of naloxone are needed to reverse fentanyl overdoses.

3. High dose naloxone is more likely to cause precipitated withdrawal than traditional doses.

Point 1: 

We in EMS are taught to assist ventilations and administer naloxone at the lowest dose possible to achieve spontaneous ventilation/oxygenation.  The goal is not to fully wake the person up, but simply to restore their ability to ventilate/oxygenate themselves.  I typically administer naloxone at 0.1 mg/min when I have an IV or 0.4 -1.2 IM if I don’t.  I give 1.2 mg for patients who are blue and apneic.  0.4 if their breathing is agonal.  I rarely ever give more than 0.4 IV and rarely need a second...

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Thirty three years I’ve been in EMS now and if there is one line of advice I have for people starting out in the field, or just for life in general for that matter it is:

Don’t Be an Asshole

EMS is stressful and we are constantly in situations that may put us in conflict with others.  I sit in EMS rooms and listen to people bitch about coworkers, patients, patient’s families, dispatchers, nurses, doctors, police, fire, bystanders, management, the union, their spouses, the government, their sports teams, their health, the weather, etc.  Serious negativity.

Sure some of it is blowing off steam, but when everybody does it, expected conversation comes to be about who is having the worst day, who can be more negative about life.  You carry that attitude onto a scene and someone gives you a hard time, and it can quickly becomes about standing up for yourself by putting others down.  I told that nurse where to go.  I gave it right back to that patient’s family.  I told that addict to stop using drugs and...

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(An excerpt from a fictional work in progress.)

Prologue

Hernando already had a 200-gram bag of heroin on the table, as well as a smaller baggie of fentanyl, a canister of baby formula, four packages of Benadryl, and several small open cardboard boxes, each holding 600 of the glassine envelopes they would be putting their product into. Enrique helped Hernando package the heroin to be distributed to the dealers Hernando had below him. In return, Enrique got a break on his own supply.

Hernando used to do a 40/60 cut of the heroin with the baby formula, but Enrique had convinced him to do a 50/50. The better the product, the quicker they would sell out, and the faster their brands and reps would grow. There was so much quality on the streets these days, no one wanted to buy shit. Now that Hernando was also getting a few grams of fentanyl to mix in, their brands were banging, although Hernando always urged caution, and resisted all of Enrique’s attempts to move to an even bigger fentanyl presence....

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A firefighter has already bandaged the patient’s head by the time I arrive in the fly car.  The man sits on the front stoop looking like the fifer in the revolutionary war painting of the three marching wounded soldiers the way his head is wrapped.  The firefighter points out the puddle of blood in the road and explains how witnesses say the man tripped on the curb and hit his head.  “He has a pretty deep gash.”

“How’s his mental status.  Is he all there?”

“No, he’s out of his mind.  He’s on PCP.”

I nod.  That would explain why the man mutters to himself and grabs at invisible bugs in the air.

“She’s on PCP, too.” A short woman in the pink dress stands next to the man.  She opens his tattered wallet that she has fished out of his pants pocket.  She takes out the only cash – a dollar bill—and puts it in her bra. 

“Is that his wallet?”

She looks at me like she is not certain I am standing there — like maybe I am a seven foot lizard, or more reasonably just a...

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