We get a lot of ideas about drug overdoses from the movies. Raves gone wrong, party girls with bloody noses convulsing on the linoleum. But most overdose deaths take place in quiet, everyday settings. Somebody will be going about their normal business until a horrific discovery breaks the mundanity.
The night three years ago when my brother, Matt, overdosed, for example, my stomach was filled with fountain soda and greasy, chain-restaurant breadsticks. My friend George was with me as I unlocked the front door to the Boston apartment my brother and I shared. We laughed about how full we felt. Has anyone ever eaten so much? Haha. It should be a crime to be this full. Ha.
The apartment was quiet, still, tidy. I filled water glasses, sent ice cubes clinking into whiskey tumblers. But as I breezed through the drink-fixing motions, I began to get a weird feeling. I thought of Matt that morning, loopy and disoriented before work. I realized I hadn’t heard from him all day.
“I wonder if my brother’s home,” I said to George in a forced casual tone. I started to feel prickly and sharp as I remembered Matt’s disorientation earlier that morning, how I had to remind him it was daylight, that it was time to go to work.
Matt was 26, and had been struggling with drugs and depression on and off for years. But lately, things seemed like they were on the up. He had completed a stint in Beth Israel’s psych ward. He had new meds, anti-depressants and anti-psychotics, and said he felt like they were working. He just got promoted at his 9-to-5 office job.
But something still wasn’t quite right, and although I didn’t know he was using heroin again, I should probably have been more suspicious.
All these little clues, these tiny details, race through your mind like you’re an animal.
Even though Matt usually seemed buoyant and happy, he was often confused. He’d tell me the same stories twice, sometimes within minutes. He’d wake up in the middle of the night and get in the shower, thinking he was late for work. His texts were riddled with slurry typos, the sort of super-obvious ones that you’d think someone would correct before hitting send.
The panic in my ribcage spread as I did a quick mental tally of Matt’s erratic recent behavior.
I headed downstairs to my brother’s bedroom on the garden level of our duplex apartment. What I saw next gave my panic a little spike: His door was closed completely. When Matt was home, his door was almost always open, at least a crack. He usually only closed his door when he’d gone out. (In retrospect, I think that was because Matt was worried about my dog getting in there and accidentally ingesting something dangerous.)
All these little clues, these tiny details, race through your mind like you’re an animal.
I opened the door. And then, a shift in space and time. There he is: my baby brother, blue and unconscious, splayed across the floor. He’s been sitting in a chair, and he must’ve passed out in it and then fallen backwards, because his limbs are still tangled up in it.
His mouth is open a little. His eyes are closed. It is silent. The air around us feels like a snow globe. The soundless moment of realization feels like it goes on forever.
After the Screaming
Once I start screaming, things move much faster.
I call 911, and the operator shows no whiff of emotion. “Is his body warm, ma’am?” she asks blandly, like a Burger King drive-thru attendant inquiring after my sauce preference. I don’t know why I expect her to be panicking, too, I think. It’s her job to be level-headed.
George used to be in the Marines. He snaps into crisis-management mode right away, and I’m lucky he’s with me. Together, we untangle Matt’s body from the cheapo office chair and lay him flat on his back.
George begins CPR. I watch my brother’s blue body react to the chest compressions like a crash-test dummy.
The dispatcher goes on with her tight little questions. “Is he breathing?” “How old is he?” “How long has he been unconscious?” I don’t know if she expects actual answers, or if it’s just an attempt to keep me focused.
I feel the strangeness of losing my shit while surrounded by people calmly going about their business.
Finally, the buzzer sounds from upstairs. The EMTs are at the front door. I rush up and fling it open. For some reason I expect to be greeted by anguished faces that match mine. But they are expressionless—level-headed. The first one says something like, “Hello.” The rest shuffle in behind him casually and go downstairs. I feel the strangeness of losing my shit while surrounded by people calmly going about their business.
There’s a cop in the crowd, too. He comes inside and I shrink from his presence. After a decade of dealing with cops in relation to my brother’s drug use, seeing one here, now makes me cringe.
Tall and broad-shouldered, the cop has tools, weapons and other shiny items hanging from his uniform. His eyes are round and sad, like a puppy on a greeting card. He walks over to me gingerly and introduces himself. His radio fuzzes, and he gives me a status update: The EMTs are still working, which is actually a good sign. It means Matt stands a chance.
“Say a little prayer,” he suggests, looking like he might cry himself. I can’t imagine how many of these he’s attended at this point. I feel sure it’s hundreds.
I watch the blue and red emergency lights swirl around my street, hitting the neighbors’ windows. I imagine them inside, peeking out through curtains, whispering to each other, asking what’s going on. Even now, when my thoughts should only be on my brother, I find myself worrying about the judgement of strangers.
I don’t remember how to pray, so I just try to focus on the blue and red lights and wish really, really hard that everything will be okay.
The EMT gets close to me. He looks at me and says, with a regretful head shake, “No.”
Five minutes go by. Maybe 10? Forty? Time bloats and contracts.
An EMT emerges from downstairs. He must be in charge, I deduce, just based on his age and elder-statesman aura.
He scans the room and our eyes meet. His brow furrows apologetically. My heart starts to slam. My mind starts making excuses: Maybe Matt’s just brain dead, maybe he’ll just need his arm sawed off, maybe anything other than what I already know. The EMT gets close to me. He looks at me and says, with a regretful head shake, “No.”
I collapse. George picks me up off the floor. He takes me into the living room and I sit in there and wail for a while. The EMTs shuffle around in the background, zipping bags, rustling supplies.
I think about the “no.” I almost laugh about it. It’s a no—after all that!
More time passes. A new man enters the apartment. His hair is slicked back. He’s wearing a black leather trench-type jacket with a flowy, lavender-hued shirt underneath, like some extra from The Sopranos.
He does not greet me or identify himself. Instead, he barks with a head-nod, “You tha sistah?”
He asks me a bunch of timeline-related questions and inquires after Matt’s supplier. “I mean, there’s a lot of drugs down there,” he says to me with what seems almost, I think, like a laugh.
I just keep saying, “I don’t know,” and I’m upset and of course I’m white and dressed nice, so the guy ends the conversation there. After he leaves, I realize he’s the detective on the case. I never hear from him again.
People start to pack up, they have sidebar conversations. I step out on the back deck. I have to call my parents.
I’m waiting for someone to hand me paperwork, or to say, “I’m so sorry, how terrible.” But this all feels like a business transaction. People start to pack up, they have sidebar conversations about other things. No one’s looking at me.
I step out on the back deck. I have to call my parents. It’s weird to already be living in the reality where Matt’s dead while they are not. I dial their landline, the same phone number we’ve had since Matt and I were children. My mother answers pleasantly.
I breathe into the receiver. ‘“It’s Jess,” I eke out. She hears the strain and her tone comes down several octaves.
“What…” she starts.
My voice twists thickly as I start to cry. I build my brother’s name into the noises. I say, “Matt.”
She drops the phone and screams. My father’s screams join hers. I hear it all in booming echoes from their cordless phone’s position on the floor.
Drug Combinations and Drug-Induced Homicide
My brother’s death is, of course, emblematic of so many others before and since; there were 72,000 fatal overdoses in 2017 alone. In the large majority of these cases, combinations of drugs were involved, rather than a single substance—something people need to know.
Matt’s toxicology report showed heroin plus benzodiazepines, a pairing shown by one study to increase the risk of death five-fold compared with using opioids only.
The cop was symbolic, too. My first thought when he came through my front door was, “I have to go to jail now for killing my brother.” That was irrational, based in guilt, but there’s a nugget of truth to it.
If that bloused detective had decided that I seemed shifty, high, like I could have possibly been doing drugs with my brother—or worse, that I gave them to him—I could have found myself in a mighty different circumstance. Drug-induced homicide prosecutions are all the rage these days.
For all the talk of compassion and public health in the past few years, little has significantly or systemically changed around law enforcement’s responses to drugs and overdose. And the rising death toll has many prosecutors leaning harder on these responses.
That’s how friends, relatives, and loved ones get sucked into the mess. With an adequately harsh interpretation of drug homicide laws, a person who happens to wake up after a hit of heroin when their fellow user doesn’t could be charged with murder. And nobody feels any better. No risk is reduced, no future deaths prevented.
In the eyes of the law, once someone dies from an overdose, they become a victim. Someone worthy of avenging. Even though when they were alive and breathing and capable of being helped, they were vermin. Apparently, the difference between someone who mattered and someone who doesn’t is a pulse.
“I Didn’t Know What Naloxone Was”
My little brother always appropriated gonzo depictions of drug use to laugh off his troubles. See? Here I am in a bucket hat, playing the recorder at 4 am. See? Here I am smoking a cigarette while standing in the middle of a fern. Take a picture, put it on Facebook, tag me! I’m the one who’s always getting into it. I’m the one who can take a good joke.
But it’s not funny anymore. I wish it still was. It’d still be funny if he were here, if all of this gave way to health, happiness, to overshare-y anecdotes he’d tell to cringing nieces and nephews at holiday dinners. Instead, the anecdotes swallowed him up. But they didn’t have to.
At the time of Matt’s death, I didn’t know what naloxone was. I didn’t know it was a miracle medicine that can reverse an opioid overdose in minutes. I think about that every single day.
What if there had been Narcan in my medicine cabinet? Would I be buying my brother a Christmas present this year?
When we relegate drug overdoses to the world of fantastical fiction, they feel as likely to happen to us as, say, a gangland shootout. They feel sensational, made-up. And when we consider them made-up, we don’t think about rational responses to overdose situations. We don’t prepare.
The past few years have shown many more of us that drug overdose scenes unfold around real-life people and real-life things—not in a comical party panic, nor a place where dirty criminals get what they had comin’ or a moustache-twirling dealer poisons an innocent victim.
It’s a quiet and ruinous place. It’s a place where someone who was once small and loved could die for no reason. It’s a real place. We should all be more prepared to face it.