He was the middleman — the man that took the crack cocaine from the main guy, the drug dealer and then sold it to his “clients” and kept a percentage of the money for himself and the rest to the dealer. It was a fine-tuned operation. You could make a lot of money. But you had to be precise, or else. The patient was a tall, slim 20-something man. He had a fistful of crack cocaine rocks to sell. Before selling it, he decided he’d sample some of the crack. So he smoked it. And then he could feel his heart rate go rapidly. He got short of breath. Told his mom he didn’t feel well and that his heart was beating really fast. Mom called 911. He had sickle cell, which, apparently, doesn’t like samples of crack cocaine. The medics hooked him up to their EKG monitor. Heart rate 180s. The medics sped to the ER, starting an IV and applying O2. He was in SVT. Oxygen was applied, and adenosine was given, quickly, IVP. He was transferred to the ICU step-down unit. After one night in the step-down unit, he was getting nervous. He had to get out of that hospital. He had a job to do. He had to sell this crack. He cut his IV line with a razor blade. The nurses were suspicious, and they called the public safety officers (PSOs) to the patient’s room. In his hospital room, PSO’s found razor blades and other drug paraphernalia, including crack cocaine pipes. The nurse and PSOs were quite suspicious. So the PSOs hung around as the nurse restarted his IV. The PSOs did a visual check of his room, and he got scared. He was afraid they would find his crack. He had to leave that hospital soon, and he could not let them find the crack — that was money. That was his money, his dealer’s money and product for his clients. He was a dead man if he didn’t get out of there soon. So making sure they wouldn’t take crack from him, he ingested a large clear lunch bag with crack cocaine rocks in front of the nurse and the PSOs. What he swallowed was the size of a large round Christmas ornament. And then I got the call. I was on call for ICU. Come in, stat. “You have a patient coming to you who just ingested a large bag of crack cocaine.” This was a first. Should the bag burst in the patient’s GI tract, he could have a sudden cardiac arrest., seizures or brain bleed. The crash cart was pulled up to the patient’s new room in the ICU. I explained to the patient why he had to have an IV, why he had to be on an EKG monitor and why he had to have a crash cart in front of his room. That what he just did was a recipe for disaster and sudden death. Per poison control, I started a bicarbonate drip to potentially neutralize this lethal dose should it burst inside of him. We also gave the patient kayexalate, hoping that the crack cocaine would increase motility through this induced diarrhea and have crack come out while he excreted. Everything we did, we explained extensively to him. We now had to attempt to save his life. During this course of this regimen of care, we frequently had to change the patient’s bed sheets. Sometimes the patient would put his fingers up his rectum. Unsure of exactly what was happening, I sensed that the kayexalate was working its magic. And there it was: A plastic baggy partially hanging out of his rectum. “There it is,” a fellow nurse yelled. And with that, the patient jumped out of his ICU bed, tore off his gown, tore his IV out and ripped off his EKG electrodes. He was naked, and he took off running out of the ICU. I chased after him, along with another ICU nurse and a CNA to follow. A “code gray” was repeatedly called overhead. Code gray is a call for all PSOs, stat. The potential danger, assault, aggression is why we call a code gray. Our ICU is on the same floor as the walkway to our orthopedic hospital. A clear glass walkway where cars could drive underneath this bridge/walkway. A large oversized banner proclaimed, “Excellence in care. Excellence in medicine,” right where all of the motorists could see. The patient almost made it to that walkway. This tall, thin, naked man with a baggy of crack cocaine halfway hanging out of his rectum. And the PSOs finally grabbed him and pulled him to the floor. He was a strong man. It took four PSOs to tackle him to the ground. And there it was. A lunch-sized bag, intact and filled with light gray colored crack cocaine rocks. With my latex gloves on, I pulled the bag of rocks out of the patient’s rectum and handed the bag to the PSOs. The patient was wheeled back to his ICU room. Two days later, during our busy visiting hours, the patient put his civilian clothes on and slipped out, looking like one of the many family member visitors. He slipped out, and no one noticed he was gone. He slipped out somewhere into this large city, most likely hoping not to be found by his dealer or by his clients. We’ll never know his outcome, but we can’t imagine it was a good outcome. Though this story is a decade old, it is repeated by nurses and doctors as if it were folklore. But it is, most likely, a one-time-only true story. Source
