The Woman on the Line

September 20, 2023 10:16 AM

Every day, the calls come. She can tell quickly who might die. CW: descriptions of drug use and overdoses

The Call, This American Life

posted by Etrigan (15 comments total)

The This American Life episode is so very good. I love that it is an incredibly nuanced and human portrait of complex and real people. I have a few friends who volunteer with the hotline regularly, and I’ve been the sitter with a handful of people and I just really hope people begin to understand and really appreciate the value of harm reduction. As she says - we just want people to be alive.
posted by Bottlecap at 10:27 AM on September 20, 2023 [18 favorites]

Thank you.

The "Never Use Alone" number is 800-484-3731 and their website is https://neverusealone.com/
posted by bolix at 10:40 AM on September 20, 2023 [14 favorites]

I caught much of this TAL episode. Very worth the listen.
posted by obfuscation at 10:48 AM on September 20, 2023 [1 favorite]

I was absolutely gripped by this thing when I listened to it. So interesting (and lucky!) to get all those perspectives later.
posted by Glinn at 10:50 AM on September 20, 2023 [2 favorites]

I read the article on Slate the other day and genuinely teared up. The pain that brought her to her harm-reduction calling is just heartbreaking.
posted by uncleozzy at 11:06 AM on September 20, 2023 [3 favorites]

I hadn’t listened to TAL in years, but this one absolutely brought me in.
posted by samthemander at 12:14 PM on September 20, 2023 [1 favorite]

What you said.
posted by y2karl at 12:22 PM on September 20, 2023

What a person. I honestly think if I called anyone at all, for any reason, right now and someone as sweet and caring and capable and practical as this answered I would probably burst immediately into tears?
posted by We put our faith in Blast Hardcheese at 1:30 PM on September 20, 2023 [6 favorites]

I thought the code switching the volunteer did was really amazing. Both while on the call with the person injecting and when she called the paramedics. Shows not only how deep her compassion is but also her professionalism.

For sure this is one of the top 20 TAL of all time.
posted by Senescence at 4:56 PM on September 20, 2023 [2 favorites]

The people who do this work are truly angels. That they have to be volunteers is an absolute disgrace.
posted by dg at 7:16 PM on September 20, 2023 [2 favorites]

Thanks for this. I am going to listen to the TAL episode tomorrow. This issue is really close to my heart. In my free time, I help operate a small harm reduction program with my neighborhood mutual aid, and one of the things we provide folks with is naloxone. This has me thinking it will be a good idea to start putting a flyer or card with the Never Use Alone hotline number into our kits, too.

I don't know why the concept of harm reduction is so hard for many people to understand... It just seems so obvious to me, but some people are so virulently opposed to it, and those people seem to dominate any political conversations around drug use. I hope that the more these stories can be told, the more the folks with a counterproductive punitive mindset will start to actually get it.

I had to call 911 on the street for someone who was (probably) overdosing a couple weeks ago, and take care of him until the medics arrived. It was really scary and sad. I came a gentleman collapsed on the side of the bike path, twisted up into weird, uncomfortable shape, with his face crammed into a blanket in a way that looked like he couldn't possibly breathe well. I had a bad feeling that it wasn't just someone taking a nap, and I pulled over and leaned my bike on a tree.

I asked him if he was okay, then again louder. "Hey buddy." "Sir, can you hear me?" No response. I tapped his shoulder. No response. I shook his shoulder. I gave him a sternal rub with my knuckles. Still no response. I called 911. They had me shout and shake him and rub my knuckles on his sternum again. I told them he wasn't really breathing, except maybe a couple rattling agonal breaths per minute. I didn't have Narcan or a pocket mask on me. The 911 operator instructed me to do chest compressions and kept me on track with my pacing.

(This was its own confusing experience, because the patient was non-breathing but not completely pulseless, and what he really needed was naloxone and breaths... but I didn't have those things, and I guess the 911 operator felt compressions were the best option? I felt weird about it because CPR isn't harm-free. I've talked about it with a few medical friends and apparently not checking for a pulse and just starting compressions is the current bystander CPR protocol, but that seems like it's mostly targeted for cardiac arrests. But good compressions do also provide a tiny amount of ventilation... I don't know. Next time I'll tell them I'm CPR-BLS certified, and I'll also have Narcan and a mask with me so I can actually do something useful.)

When the two ambulances with four paramedics arrived, the patient still had a pulse. They told me, "Good work," and then ventilated him with a bag-valve mask and (I assume) gave him Narcan. I no longer had a role to play, and I left. I hope he woke up and was okay, and didn't lose any brain function from the time he was out. I also hope it was an opioid overdose and reversible with Narcan. Sometimes I sort of wished I stayed to see if he woke up okay, even though I felt out of place.

Since then I've started making absolutely sure I have a pocket mask and 2-4 nasal Narcan sprays on me at all times, plus some nicer, bigger one-way valve masks (peds and adult) when I'm on my bike. I mean, I help distribute Narcan, but before for some reason, I didn't always keep any around for myself before.

I'm glad I was there to help, and that the medics came quickly. But I'm sure at least several other cyclists rode past the collapsed person and weren't willing to approach him, or talk to him, or touch him, even though he was laying in a position clearly not conducive to breathing -- because he looked pretty clearly homeless. And that makes me pretty bummed about the world, too. But once I was doing CPR, at least 3 different people stopped to find out how they could help -- which makes me feel less shitty about the world? A bus driver parked his bus and ran over to see if we needed help, and two separate cyclists stopped and asked how they could help. One waved down the ambulances for me.

I wish that safe injection centers were just a normal, common thing. We could just have free, non-adultered government-provided drugs in a setting with safe and compassionate medical supervision. That definitely sounds way fucking better to me than our current system, which seem mostly composed of random bicyclists with Narcan, people's friends with Narcan, and amazing hotline volunteers with index cards and the ability to call EMS. These hotline folks are amazing but it's a crime that they're even necessary at all.
posted by cnidaria at 10:26 PM on September 20, 2023 [22 favorites]

Increasingly common not only in my neighborhood, but in the very wealthy neighborhood that abuts it, to see the same unhoused folks day to day in a particular spot. You get to know them a little (the folks who want to be known at least). Then one day you see not them, but a small scattering of medical waste and narcan packets in their spot. I am always at least relieved to see the narcan, as it means maybe they're still alive somewhere. It is so heartbreaking in its regularity.

Our local bars have started carrying fentanyl test strips and offering them for free to anyone who asks, but according to my bartender buddies people mostly don't take them up on it.
posted by We put our faith in Blast Hardcheese at 7:13 AM on September 21, 2023 [1 favorite]

We put our faith in Blast Hardcheese, that's cool to hear the bars are carrying test strips, but a bummer folks aren't interested.

Fentanyl test strips are definitely popular with people where I do outreach -- but we do package them with a cooker, instructions, and a paperclip (for holding the cooker), to make them simple to use.

The other issue is it seems like almost everything has fentanyl in it these days... A handful of local organizations I know of have actual mass spectrometers for people to test their drugs in a more useful way, which is kind of amazing. (But then folks have to physically get to the location.) I'll have to ask the groups how often their mass specs are getting used.
posted by cnidaria at 7:42 AM on September 21, 2023 [2 favorites]

I didn't have Narcan or a pocket mask on me.

Here they hand out the Narcan packaged with a mask. Something to think about for your program?
posted by praemunire at 8:12 AM on September 21, 2023 [1 favorite]

I'll look into it, praemunire! I'm mostly limited to supplies I can source for free (which are surprisingly significant), although the group is considering allocating a small budget for additonal harm reduction purchases. Currently a lot of our budget goes to things like propane fills, tents, propane heaters and adapter hoses, and water.
posted by cnidaria at 3:01 PM on September 21, 2023 [3 favorites]