Tales from the ER # 1

“County we are incoming from the airport with a 54-year old Hispanic male, likely drug mule, complaining of abdominal and chest pain. He’s awake and alert, heart rate of 120, BP of 85/40, ‘sating 96% on 100% O2 via non-rebreather. We got an 18-gauge established in his right AC with a liter of fluid going wide open. We’ll be at your back door in 10 minutes, over.”

Tuesday night just got exciting. A “mula de drogas” patient is not very common. Drug traffickers fly poor, desperate human beings stuffed full of packets filled with coke, heroin, or whatever else needs to be smuggled to airports all over the country. Whether professionally sealed like a laundry detergent pod, or shoddily wrapped in a condom, drug mules swallow dozens of packets in the hopes of a grand payday, while praying to God they don’t burst.

But those packets can burst, and when they do it’s almost always fatal. A large surge of cocaine, heroin, or fentanyl is unleashed in the intestines and absorbed into the circulation. That massive overdose typically ends in cardiac arrest. Yet this patient was still alive enough for EMS to sound nonchalant while radioing our ER a heads-up.

When EMS says their ETA is 10 minutes that either means 1 minute or 1 hour. In this case it was the former and before I could turn the oxygen port on in the critical care room the medics were wheeling in the patient. He was not awake or alert, the man looked grey and half-dead. I’d treated one drug mule before - a thin, young woman who was undoubtedly being sex trafficked too. This man was older and incredibly obese. Maybe he owed the cartel money, and this was how he was paying them back?

Whatever, I could gossip with the nurses later about motives. The patient had agonal breathing and his pulses were thready. My colleague put in a central line and started a noradrenaline drip while I squirted Narcan up the patient’s nose and intubated him. My former med school classmate was the surgeon on-call. Like any great surgeon he never missed the opportunity for dark humor. He appeared in just a few minutes, took one look at the patient, and said, “too many paquetes tonight?”

The surgeon whisked off with the patient, accompanied by the gaggle of nurses and respiratory therapists that escort a sick, intubated patient whenever they’re moved from one part of the hospital to another. Fortunately the OR was on the same floor as the ER – in fact we shared the same break room. I went back to seeing ER patients until the night settled down.

At 4 am I went for my last coffee of the shift – the one I need to stay conscious until 7 am sign out and the drive home. I swiped my badge to enter the break room and found the surgeon talking to three police officers. In his gloved hand the surgeon was holding a green vomit bag filled with drug packets. The cops looked pretty good for a night shift with their cleanly pressed uniforms, shiny badges, and Glock 17s.

“Jesus, you guys have to do this here?” I said.

The cops laughed.

The surgeon replied, “This kills two birds with one stone, we give the cops their evidence and a cup of coffee at the same time.”

I’d seen stranger things happen at our county hospital, so I poured my cup of coffee while the surgeon handed over the vomit bag filled with drugs, which the cops promptly put in a much more official looking evidence bag.

The cops thanked us and left. I asked the surgeon how it went in the OR.

“Tons of cocaine packets, as you could see. Several had burst. The guy never had a chance.”

We parted ways and I went back to my workstation which faced the ambulance entrance. Around 6 am a police cruiser pulled up blaring its sirens. Two scruffy-looking detectives exited the cruiser and entered the ER flashing their badges.

“Excuse me, are you the ER doctor on duty?”

Yes, I am, I replied.

“We’re here about the drug mule from earlier, we’ve come to collect any drugs that were recovered as evidence.”

In my sleep deprived state all I could do was stare blankly at them while I wondered if I had hallucinated the entire break room incident from a couple hours earlier.

“Uh, there were already police here…they took the packets from the surgeon.”

Now the detectives looked like they were hallucinating.

“Were they officers in uniform?”

Yes, I replied, badges and guns and everything.

“Those weren’t our officers…”