Grade A

The man kneels in the grass next the pickup truck that has its door open. He vomits.  The fire department is standing over him.  “Citizen Narcan found him in the truck passed out, squirted him with two doses and then took off when we got here,” a firefighter tells me. I see the two 4 mg nasal devices in the grass.

“Thank goodness for community narcan,” I say.

The vomiting man, who looks to be in his early fifties, rouses enough that my partner and our paramedic student are able to get him on our stretcher. I do a quick check of the truck to look for bags, but don’t find any. I do find a used syringe under the center fold down console. I find that odd as the fire department told me they also found a syringe. I do another look in the grass and then I see the bags – three fresh white bags sitting on top of the grass. The brand is a new one. “Grade A” stamped in blue.

On the way to the hospital I learn the man is a house painter. He hurt his back a few years ago when he fell off a ladder. He got hooked on the pain pills. Now he does heroin.

I ask him if he just got out of jail or treatment or if he just ended a period of abstinence.

He shakes his head.

“Did you use more than your regular amount?”

“No, the same.”

“You used Grade A before?”

“No, the guy who sold it to me said it was good.”

“Apparently. You need to be careful. All the fentanyl out there, you can catch a hot spot. You were lucky some dude came along and found you and had narcan.”

He doesn’t seem to understand what I am saying.

“Let this be a lesson,” I say. “Never use alone.”

“I wasn’t alone,” he says.

“Huh?”

“My buddy was with me.”

“Your buddy?”  That explains the second syringe.  

“He wasn’t there?”

“No, a passerby found you. He had Narcan. You should always have Narcan with you.”

“I do. I keep it in the console.”

I am beginning to get the picture now. The alleged passerby was his buddy.

“Where’s my wallet?” he asks.  He pats his pants.  “Shit.” He shakes his head.

“At least he called 911,” I say.

***

I see Mark walking along the sidewalk. No doubt he just came out of the bushes at the corner of Park Terrace and Park. There is a dirt circle in the middle of the bushes that is beaten smooth and covered with empty heroin bags, saline vials, and assorted trash. The users sit on milk cartons and shoot up, before reemerging. Mark’s got that light airy walk going and I can tell he’s feeling pretty good. I met him on a 911 call. He was on the nod at a bus stop, and while I was able to wake him up with just stimulation and ended up not transporting him, we had a long talk that morning.  He was in a car accident his first year in college,  and got hooked on pain pills.  Heroin was an easy transition.  He remembers me as saving his life at the bus station that day, which I didn’t do. At least I haven’t yet. He is still using. A couple weeks ago, he told me he has a plan to detox himself  this winter.  He has some suboxone stashed to help him through it, he says.  My partner pulls the ambulance to the side of the road, and Mark comes over to talk.

“There’s a new brand,” he says. “I just tried it. Grade A. Its white powder, fentanyl. Its best shit I’ve had in weeks.”

“We did an OD with it yesterday. Be careful. You still have your Narcan with you.”

“In my bag always,” he says.

“Very good,” I say. “Peace be with you.”

My partner and I laugh as we watch him make his way down the street with the two other users he is with. The three of them look like Monty Python cast members doing slow motion silly walks.

***

A fellow paramedic tells me he did an OD in a neighboring town. Two dudes in a car, out cold in the middle of the road right by the commuter lot on route 4. The cops arrested the driver who the medic was able to wake up with stimulation. The passenger was unresponsive with agonal breathing. He had to bag him and give 2 mg of naloxone. They brought him to the hospital. I ask about the bags, and he shows me a picture he took of them. Three bags of Grade A.

“Popular brand,” I say.

***

I find Grade A wrappers in various spots about town that week, by the pavilion at Pope Park, in the port-o-potty in Putnam Park, outside an apartment on Vine Street where we are responding for a 19-year-old with chest pain when he coughs. Sunday morning, I check the bushes where Mark and the other users like to shoot up. I make noise as I walk down there so I don’t take anyone by surprise. As I expected, Sunday morning with the sun just coming up, there is no one there.  There are many  grade A wrappers, and Rolex and then fewer of others like Back off, Reaper, Spartan Helmet, Coca-Cola and Diesel. I feel like an archaeologist going back in time, weeks are like years in heron users lives. There are other bags there too faded to read.

**

The next week, I see Mark sitting out in front of the Seven-Eleven. I nod to him as I go in. He smiles at me, but he looks miserable. I get myself a green tea with honey and lemon and a package of blueberry Bell Vita crackers. I stop outside.

“How are you this morning?”

“Struggling,” he says.

I give him the crackers and my change from the register. Maybe a dollar-fifty.  “Buy yourself some coffee.”

“You didn’t have to.”

“You refusing?”

“No, I’m just saying.”

“I’m just saying too.” I stand looking out at the gray storm clouds rolling. “It’s going to rain all day.”

“Sucks,” he says.

“What’s good out there this week?”

“Nothing,” he says.

“Not even Grade A.”

“No, barely got me high this morning. They increase the cut till its shit. Wasn’t worth my four dollars.”

“Sucks,” I say.

“Teddy got blue New Worlds on Zion Street, but they charged him $5. He said it was worth it.  And he’s a cheap mother.”

“Is that your plan for the day?”

“I only have 30 cents and what you gave me.”

“Wish you luck.”

“Thanks, man.”

“You stay safe now.”

“You, too.”

***

He lays curled in fetal position on my stretcher. Fifty-one years old, but he looks seventy.  This is his first time in rehab and the facility is concerned his extremities are cold and his pulse sat is unobtainable. (We get a 100%).   The man tells me he got cancer ten years ago, and while he beat it – he has been in remission for five years — he ended up addicted to fentanyl. His doctor lost his license two years ago and he has been unable to find another doctor who will write him scripts for his pain. He snorts a bundle (ten bags) of fentanyl a day now. He knows where to go to get fentanyl – he can tell the difference. Heroin doesn’t do anything for him. The brand he was buying last week was Grade A. The week before Rolex. He has a family, but hasn’t seen them for over year. He says he left so they wouldn’t see this side of him. He knows he has to quit if he wants to be a part of their lives again.

I think about asking him more questions, but it seems like just speaking is an effort for him. I dim the ambulance light and let him try to sleep.

***

The next day, I see Mark and he is happy again. “New World is banging, man,” he tells me.  “I just got five and some change for my cans at Stop and Shop.”  Ten thirty in the morning and it is already seventy degrees.  The sky is blue and the leaves in the trees are orange, red, and yellow.  A perfect day in Hartford.  Winter seems a long way off.

“Stay safe,” I say, as he walks off, headed toward Park Street.

 

 

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