This, too, shall pass.

This too, shall pass… as all crises do.

Big Pharma (once again, Purdue—though they are by no means the only purveyors of pain pills) just recently announced they are officially backing off on opioid production. I react to this as if it was a positive move, though by no means am I ready to suggest backslapping and cigars. Medical professionals are now conceding pain is an unhappy byproduct of illness and injury. We need to accept it and look for alternative methods of relief. In the eighties and nineties, the position taken was that pain, responsibly managed, could be eradicated. This is noble in thought, faulty in practice. This approach, in hindsight, comes across as modern medicine’s concession to not being able to eliminate death. If we can’t keep you alive forever, we can at least triumph over physical pain. Right-hearted, wrong-headed. On a bad day, this approach can be viewed as arrogant and naïve. On a good day, it reveals profound compassion and care. Humans aren’t as bad as I’d have you believe.

* * *

 

Opiates are the only substance that offer salvation and slavery in equal parts. A substance with the potential to swap one manner of pain for another. They offer the promise of relief from physical suffering, in exchange for the opportunity to exact emotional and mental agony.

Opiates are a substance that saves lives, providing food and shelter for countless millions born and raised in primitive agrarian societies. It can be argued the development of opioids came about only to keep Afghani peasants off the payroll. But, Big Pharma cannot preserve the effect and erase the pleasure, and therefore cannot insure the safety of all exposed to it from its most virulent side effect. Like it or not, opiates and all its imitators cannot be separated from its true self by mankind’s intervention or manipulation. It is a force of nature.

Human beings, try as we might, cannot conquer nature. We cannot conquer our own nature. People like to get fucked up, and will continue to do so no matter how hard we try to prevent it. While most of us do so in moderation, there will always be a percentage of us that, for whatever reason, will not have the capability to moderate. Mother Nature will do what She’s always done: thin the herd. Monuments will crumble. Levies will break. Wells will run dry. Addicts and alcoholics will find an early grave. This we will never control. This we can never control, try as we might.

But try, we do. Try and try and try, as well we should.

In our era, human response to these natures have been divided between combat and compassion. Education and eradication. Rehab or remand. When it comes to junkies and opioid addicts our society finds itself in a conundrum. With a life expectancy of ten years from the first taste of that sweet milk o’ the poppy, and a recidivism rate of over 80% for opiate/opioid addicts within 90 days of leaving rehab, we point to treatment as our best weapon in this war, yet mutter under our breath “Why bother?” Understandable. The casualty rate of this addiction is something only the purveyors of tobacco and booze would find acceptable. But panic serves no one.

The Press wants you to see a dealer on every corner, an irresponsible physician in every clinic, a Big Pharma executive who owns a crematory. The Press wants you to see a junkie in every house. They want to put an Opioid boogeyman under your bed. The rationale for such is their proclaimed duty to increase public awareness. How does “Hillbilly Heroin” and “One Nation, Overdosed” serve to elevate awareness? Sensationalism is not service. It is distraction, not information. This approach may serve in gaining the attention of the lowest common denominator or cause the comfortably unaffected to shake their heads at the sorry state of the nation—Damn kids!—but in truth its no better than scoring a chuckle or two on “open mic night.” They will offer stories of tragedy. Ruined lives coming to a wretched end or a life in prison. The orphaned and displaced children will be displayed. The will offer clips of dusty Mexican villages and cartel thugs sporting AKs. Mounds of packaged heroin and piles of pills will be put on display, with a stern DEA man posing next to it. Drink it in, folks. There will be stories of triumph, the single mom who struggled through treatment, got her kids back and is now reclaiming he life as a barrista. They won’t tell you her chances of being strung out again within a few months is over 80%.

Our government will promise: This, too, shall pass. Build a wall, jack up the DEA funding, promise to clamp down on Big Pharma and monitor physicians. Treatment, programs, education… They’d also reassure us that they’ve faced up to such crises in the past and resolved it with extreme prejudice, but their track record would suggest otherwise.

This, too, shall pass.

Information will help. Education will help. Treatment will help. Arresting thugs and dealers will help. Shaming Big Pharma will help (for a little while, anyway.) Compelling physicians to reign in prescriptions will help. They will all have an impact. The death rate will inevitably drop. But the biggest impact on the present crisis will come from . . . you guessed it! . . . Nature! Over less time than you’ll dare to believe, this epidemic will recede, level off, and we will accept a new “normal” with relief—and the assured determination to never let such things get this bad again. This resolution will be rooted in that facet of nature mankind can never control, that good ol’ Human Nature. The dealers—cartel backed or otherwise—will allow their greed to consume their market. They’ll kill off enough customers, or see them herded off to institutions—penal or medical—that the “market” will stabilize. Chances are, this market will still be better than it was fifteen years ago. They’ll have to settle with 2017/18 being a “boom time,” and adjust their projections for the next fiscal cycle.

 

Check out my ebook, a delightful compilation of previous— now unavailable !–posts: https://www.amazon.com/Lunacy-Death-perspective-developed-investigation-ebook/dp/B079DWFH9T/ref=redir_mobile_desktop?_encoding=UTF8&keywords=lunacy%20and%20death&qid=1520694997&ref_=mp_s_a_1_1&sr=1-1

All my friends are junkies… (that’s not really true…)

Thank God for the Government. The solution for the scourge of opioid addiction in my particular state-of-residence should allow us all to sleep easier. There is a proposal up for consideration that will levy a one-cent-per-milligram tax on opioids produced by Big Pharma and prescribed within the state. That’s hittin’ ‘em where it hurts. That’s boxcar loads of cash. This money is ostensibly earmarked as funding for law enforcement, education, intervention and treatment. My bet is Big Pharma will at first throw a tantrum, bring it to the cusp of a court battle, then humbly capitulate. They may even offer a show of contrition… and six months later start jacking the price of every other pill in the state to the tune of about a penny an mg. This’ll surely cover the tax, and easily recoup the cost of all that discount naxalone/Narcan they will selflessly offer to cops and medics to administer to OD victims.

The promise on tighter monitoring of prescriptions has gotten louder and louder as well, so now the friendly family doc is on alert and had better tighten up. Threats of suspended privileges and censure are no longer idle.

Glad we’re finally getting a handle on this thing. Not.

***

Human history has had its share of cataclysmic disaster. To believe this crisis is an anomaly or aberration is blissful ignorance and modern-day arrogance. I’m not specifying drug abuse/addiction in particular. Since the dawn of recorded history there have been epochs and eras where sudden spikes in wholesale death came to pass. And I’m taking warfare out of this equation. Pandemics and drought, plague and pestilence! Sure, there were a few folks who picked up the flails or rough timbered crosses and slogged around the countryside, making appeals to God’s mercy and demonstrating penitence, but most people reacted to widespread catastrophe by hunkering down and waiting for things to blow over. “Cryin’ won’t help ya, prayin’ won’t do ya no good…” Losing a few family members was a grim expectation in the best of times. When it didn’t rain for five years or a plague swept over civilization, the best one could do was hope—or pray—that whatever cosmic deity they believed to be in charge was more pissed off at the neighbors.

Ah, times were simpler then. The local liege-lord didn’t step out onto the balcony and assure the serfs and peons of his understanding of how serious this situation was. He didn’t inform them he and his staff were hard at work in finding solutions. He didn’t offer pep talks centered on courage and unity. He sure as hell didn’t make promises about “programs” or “special committees” being put into place to alleviate the suffering or finding a means to combat it. In those dark days before mass media, the town crier didn’t march up and down the square barking statistics and bemoaning the fate of “the children.” Nobody expected as much, either. Everybody knew they were in the same boat and equally fucked, whether they lived in a castle or a mud-walled hovel.

Ah, how times have changed. We no longer lack for information. Panic can now be spread and fed in nanoseconds. The upside of this we have instant access to statistics and whatever agenda they’re put forth to prove, and we now enjoy regular updates on the welfare of “the children.” We’ve progressed beyond primitive belief and simple mindedness We’ve outgrown and “out-sophisticated” a thing so silly as accepting the Will of God, and supplanted it with the more enlightened and humanistic approach of assigning blame. Who needs a cleric when we’ve got lawyers and politicians? No better place to seek counsel when it comes to determining where fault should lie. We’re so advanced that we don’t even blame Mother Nature when it doesn’t rain or the tsunami hits. It’s no longer a natural occurrence, but the result of greedy and selfish fuckers who are destroying the Earth Our Mother from both within and without.

Now is when you should ask: “What the hell does this have to do with opioid addiction?”

And now is when I answer: “Everything.”

Despite our modern knowledge and sophistication, we are just as stupid and oblivious as we were in the Middle Ages. We have convinced ourselves that this knowledge and sophistication imbues us with control. We are convinced we have power over conditions that were once universally accepted as forces humankind was powerless against. We can well delude ourselves that we’ve come to the point where Mother Nature is a force we can play with—for good or ill—but won’t accept there is another nature we can’t do shit about: Human Nature.

People like to get fucked up.

Now that we’ve all outgrown the notion that God runs the Show, we’ve chosen to elect (for those who enjoy democracy) people who’ve determined themselves capable in doing His work. Those not living in a democracy are stuck with people who’ve decided to play God. Either way, the people affected by pandemic addiction and death ultimately aren’t going to fare any better. In many ways, we’ve worked very hard and very long to go nowhere.

Since my middle school days, I’ve been told by the powers that be that education was our greatest weapon in the battle against addiction. That’s been the line adopted by those in our nation we’ve put in charge of determining what’s good for us. Folks, we’re educated. If there’s one person in this country that hasn’t had the dangers of opiates and opioids pounded into their heads since elementary school, then that person lives in a cave or a culvert—well “off the grid” in any case. We have all been schooled on the dangers of tobacco, drugs and alcohol . . . and sugar, caffeine, genetically modified chickens and anything “supersized.” Put ten schoolkids in front of a steel post in sub-freezing weather. Tell them not to put their tongue on it. Tell them why it’s a bad thing to do. Stress and re-stress what consequences they could face in performing such an act. Provide evidence, show them pictures, recite testimonials, get an expert opinion. Repeat it over and over until you get every kid in the group to assert licking a frozen pole is a dreadful thing to do. Repeat, repeat, repeat… I’ve not a doubt whatsoever that, despite all this good intent and information, at least one of those little shits will find himself glued to a stop sign within the week.

More by Friday, the end of all this, in fact, guaranteeeeeeed. I’m getting back on track, but it’s taking longer than I’d thought it would. Why is this so? Here’s why: https://www.amazon.com/Lunacy-Death-perspective-developed-investigation-ebook/dp/B079DWFH9T/ref=sr_1_1?ie=UTF8&qid=1519665668&sr=8-1&keywords=lunacy+and+death+book

Whose junk is this, anyway?

Addiction is an awful game of diminishing returns. The longer you live within it, the more it demands. There is no breaking even. There is no “levelling off.” “Jim’s” fiscal relief by switching from pharmaceuticals to street candy will be short-lived. The money he saved by opting for heroin will be recouped by his supplier in a very short time, and then some. He may be spending the cash, but his dealer is the true investor. Such is the economy of addiction. It’s ass-backwards

“Junk is the ideal product… the ultimate merchandise. No sales talk necessary. The client will crawl through a sewer and beg to buy.”—William S. Burroughs.

Before you know it, Jim will soon be spending as much for smack as he was trying to avoid spending for quality-controlled and consistent dosages of Oxycodone. Move down the road a wee bit, he’ll be spending more. If Jim should enjoy a long life as a junky, he’ll let that life rob him of every asset he has, every one. His material possessions, like the house, car, electronics; the emotional, family, wife, friends, kids. Gone, too, will be even his ethereal credit, job, self-esteem, reputation. Not enough? Should his drug of choice-but-no-choice finally deprive him of life itself, his dealer still benefits. Overdoses are good for business. Having a client knock himself off on a product is great advertising. It’s proof of high quality. Lose one customer, gain three. Outrageous as it seems this is not baloney. Find anybody you can who works on either side of the drug trade, and they’ll confirm it. Ass-backwards.

Big Pharma didn’t throw in the towel after OxyContin generated some bad press. Fentanyl came right behind it. The exposure I’ve had to Fentanyl is in its “Duragesic” form; transdermal, time release patches. I’ve seen this in both ODs and suicides.

Fentanyl isn’t new. It’s been around for a long time, and in manifestations other than the patches. A powder/pill form has been around since the 60s and started showing up on the street in the 70s—“China White,” then subsequently “Apache,” “China Girl,” “ Dancing Girl,” “ White China,” “ Jackpot” and whatever name change suits the current market. The street name was co-opted from a sixties term for pure, white heroin, turning up as one of the first bigtime “designer drugs.” This form is almost universally manufactured in guerilla laboratories. It is a wonderful chemical that can be produced in over a dozen analogues, making it handy in evading FDA bans with a simple, chemical tweak. Ban analogue one, adjust the formula and analogue two is technically legal until the law figures it out. The big reason my Office hasn’t seen a lot is that high demand means it get gobbled up on the coasts. The supply gets sold out “right off the boat.” The patches are unique in that the dosage is spread out over three days with a single application. The really cool thing about the patches is that, while the prescribed therapeutic level is cited as three days, there’s still plenty buzz left in a patch after those three days, if you’re willing to work for it. You can wring ‘em dry by chewing them. I’ve seen more than a few corpses with a “dead” patch tucked between the cheek and gum. Yum. I’ve also heard you can jack up its effect by putting what should be a spent patch up your butt. Haven’t seen it, myself, but it wouldn’t surprise me. The problem—again—is this: Sticking something like that between your teeth or up your ass negates the dose/delivery system equation, just like snorting or shooting.

If OxyContin is to Oxycodone like whiskey is to beer, then Fentanyl is what pure grain alcohol with a couple of horse tranquilizers dropped in is to a near-beer. Therapeutic Fentanyl dosages are measured in micrograms—one-thousandth of a milligram, the amount anything with Oxy or Hydro is measured in. So, you may ask: “Are you saying Fentanyl is a thousand times stronger than Oxycodone?” Yes. “Really?” You heard me the first time.

Here’s the fun part: Those who’ve made the switch from pharmaceuticals to street products have essentially put a blindfold on and thrown all their trust—as well as their cash—into the hands of a scumbag. That heroin they think they’re buying might not contain one smidgen of heroin. Throw a “mic” or two of Fentanyl into anything and you can deliver a narcotic effect that’ll pass for heroin. “Is it really that close?” Junkies aren’t known to be picky.

Heroin/Fentanyl combos have been cut with anything from confectioner’s sugar to powdered baby formula to—get this—powdered feces. Whether this final by-product is simply used in whimsy— “I got some really good shit here, man,” or for some other esoteric purpose, I cannot say. Nevertheless, it’s “here we go again.” Whether the supplier is mixing heroin with doughnut sugar or Fentanyl with shit, the user is the one vulnerable to the consequences.

***

Somebody needs to do something. Yep. Really needs to do something. Anything. Sure. Uh-huh.

Big Pharma can sit back and hold the same line: We produce this shit, but don’t prescribe it. We market the fuck out of it, but don’t put it in people’s hands. We offer bonuses, incentives and even kickbacks to prescribers, but we can’t control how those prescriptions are used or abused. They, too, have no problem pointing the finger at cartels and renegades co-opting their work and keeping all that cash for themselves. (I’ve always wanted to see Big Pharma try to sue the “criminals” for patent/trademark/and copyright theft. This could be the answer, you know…)

For now, doctors are taking most of the beatings. Monitoring systems are popping up all over the place, analyzing duration of prescriptions and the amounts prescribed. A lot of wrist slaps and “time-outs” are being levied. Lawyers are doing their bit, throwing lawsuits in all directions. Law enforcement—BIG picture Law Enforcement—are making the usual speeches and declarations. (Mo’ money, mo’ money.) Street level law enforcement, the types I’m familiar with, are essentially asked to piss in the face of a tornado and told to leave a puddle. They do what they can, knowing it’s not much. This brings us to Big Brother, the Babysitter and Caretaker of the Nation. I offer this, an arguably different subject altogether, but one that certainly is consistent in theme and attitude:

“Good people don’t smoke marijuana.” Thus spake our Attorney General, Jefferson Sessions. Wonder how he feels about opioid addicts and junkies? No better way to express how the current administration intends to address addiction. I know I take comfort in seeing those in charge are bold enough to assert this is a character issue after all.

I’ll leave you with that. I shall return with one last rant, and promise I’ll have insights, answers and solutions just as effective when addressing this problem as those history has provided already.

***

Lunacy and Death Ebook available at Amazon, Barnes and Noble and Apple Ibooks.

 

I’m a fleabit peanut monkey…

“One Nation, Overdosed”. That’s NBC’s catchphrase for this mess. Clever, isn’t it? The nation sits in the easy chair and shakes the collective head—those of us that aren’t piled on the street corner waiting for the body-wagon. “Bring out your dead!”

After OxyContin was relegated for use on patients that were essentially “goners”, the huge numbers it created dwindled almost overnight. I’ve haven’t seen an OxyContin OD in well over ten years, probably longer. “Hillbilly Heroin” became an archaic term in my part of the world. But, as said in the previous post, the roster of Opioid deaths did not diminish. From that point on, overdose casualties were easily the most predictable COD (cause of death) in our Office for anybody under forty-five years old. It became such that when the cops called in a death and you were given a date of birth that was in the 1960s or more recent, you automatically thought, “Hells bells, another one.” It became trite. Passé. Boring. Annoying. “Can’t these people find another way to kack?” A traffic death became manna from Heaven. You delighted in a good ol’ gunshot and wanted to shake a man’s hand for hanging himself. If your partner was going out to pick up an old lady who’d taken an unfortunate tumble into the basement, you were jealous, because you knew fucking well the next phone call would be a thirty-year old, unemployed brick layer with a pillar of foam rising out of his mouth.

After a while, it wasn’t just the standard opiates and their derivatives, but any substance that’s origins could be traced to a poppy field. Methadone, for crying out loud, the stuff that’s supposed to get you off the “hard stuff,” had become a popular conveyance to the graveyard. Then another, rather well-known substance was added to the list. “Smack,” “skag,” “H,” “horse,” “tar,” “brown sugar.” Heroin, man… The Grandaddy. Big Pharma had an old-but-new competitor, and with it a distributorship that didn’t have the FDA fucking with the product. Can’t blame the hippies this time around.

My first honest-to-god heroin OD was something of a hippie, a man in in his early thirties, living in a loft-style apartment, walls covered with his own artwork and a few guitars lying about. This was back in the OxyContin days, and was perceived as something of an anomaly. He was found on the floor next to his couch, insulin syringe still sticking out of his left forearm, a spoon and a candle on the coffee table. He hadn’t even gotten the tourniquet (a bandana) off his bicep. Old School, ya dig? But, there was something decidedly un-Old School sitting on his kitchen table. It was a FedEx envelope, addressed from a town near San Diego. The PD investigator told me that was “a new one on him.” He added “this stuff has been showing up, but it’s pretty rare.” When I brought the decedent back to the Office, it caused a bit of a stir. It had been the first one we’d seen in years, long before I’d shown up. Since then, the cases were heroin was the culprit have increased exponentially. One of the last ones I’d picked up, less than a year ago, was no hippie. He was barely into his twenties, discharged the day before from his third inpatient rehab stint, and hadn’t spent a minute away from his parents since they’d picked him up. The only time he was out of sight was in his bedroom. His kissed his mom g’night the evening he was home again, and was found dead in his basement bathroom the next morning. He’d never left the house, because his father had sat up all night fearing he’d sneak out and score, like he had the last time. There was a bindle of gritty brown powder in the key pocket of his jeans. Where’d he get it? That question triggered a little brainwork. He’d been strip searched when he was admitted to the facility, and spent the first week in a scrub suit. His clothing had been searched, then washed in an industrial/ commercial machine—one that would destroy any contraband no matter how well hidden or packaged. It was searched again once he’d earned them back. The only place he could have copped had to have been the facility itself, and just before he was discharged. I’ve heard that this has been an incident that’s not uncommon. Cartels and other bigtime organizations have been seeding treatment facilities for years. I’ve gotten word that treatment centers have clamped down on how much cash a client was allowed to have. Foolproof? A stopgap at the very least? Great on paper, bad in practice. I know a guy that sells weed who takes credit and debit cards.

“Why heroin?”, you may ask. Great question. Unlike those in the market for stimulants, thousands of opioid addicts didn’t acquire a dependence by seeking out a thrill. They got it by ending up in an emergency room or a doctor’s office. It’s a story everybody knows by now. Jim shatters his wrist after slipping on the ice. Jeanie’s back is knocked all to shit when she gets rear-ended coming home from the grocery store. Both go home with a bag from the pharmacy. Two months later, they’re back in the office or the ER, trying to convince a doctor that physical pain is still unbearable and they need that Percocet or Vicodin just to lead a normal life. This game works for a while, but eventually Jim’s doctor says “No more,” and Jeanie has found herself on the “professional patient list” at the local emergency room. The Doc giveth, and the Doc taketh away. Now they have something in common with the crackheads and tweakers. They have to find an alternate supplier.

They can get the same stuff, quality controlled, legitimate lab produced pills on the street, but their insurance company’s not about to help in footing the bill. A few years back, I was informed a single, 5 milligram tablet of Oxycodone sold on the street for anywhere from ten to twenty-five dollars. That much for a dose that has long been inadequate for your average abuser. An addict is taking three to five times that much—and not just once a day. Crushing and snorting, dissolving and injecting (needles and syringes require a prescription as well), and smoking it were an unpleasant and risky means of keeping the cost down. It doesn’t do much for enhancing a person’s self-image, either. Enter heroin.

Supply and demand, folks. Smack is back, and supplied by people with no regard for the consumer’s safety, or a concern for consistency in the quality or potency for the product. All it had to be was cheap. Here’s the breakdown. Jim now needs five Oxy’s to sufficiently “feed the monkey.” That’s gonna cost anywhere from fifty to one hundred twenty-five dollars every time that monkey gets hungry. A milligram of heroin—a reasonable, if not better, substitute for five mgs of oxy or hydrocodone—sets him back only five to ten bucks. That makes for one stuffed monkey. And you didn’t need to have it flown in from San Diego, either.

***

More, oh, much more, in a couple days. Big Pharma hasn’t been asleep at the wheel. And I’ve yet to give you my take on how I see the gov’t is handling this from my particular seat at this show.

 

Lunacy and Death Ebook now available on Amazon, Amazon Kindle, Barnes and Noble and I-books. Have a look, buy the book. Currently at a discount price. Amazon link:Link to sale page.

Somebody better clean up this junk!

Facebook flagged me as a degenerate pornographer for my display in the previous post: a nekkid woman in an opium den, circa 1928. Shame on me. I’ve learned my lesson. Say hello to ‘Sailor Moon!’  As wholesome as it gets.

Repeating myself: OxyContin is Oxycodone. The difference in nomenclature steams from it being nothing but Oxycodone, just in a different “presentation’” if you will. The name is just a portmanteau of “Oxycodone” and “continuous.” No acetaminophen or aspirin mixed in. OxyContin, in the prescribed amount, also contains more Oxycodone that the dose found in Percodan or Percoset. Why? Because it’s buffered, it’s time-release, and in the process of making it so, the oh-so-attractive secondary effect had been negated. It’ll cure what ails ya, but only physically—when taken as prescribed. The promise of euphoria has been removed, and thus its temptations.

That’s the key, folks. Take these pills as directed and once the pain has been resolved, you won’t want to take any more of them. Do as your told, and you won’t get into trouble. Life wouldn’t be so difficult for us human beings had we heeded that statement the first time we heard it, and adhered to it for the rest of our time on this planet. If that line of thinking was all that was needed, we wouldn’t have this problem in the first place. This is right where doctors, Big Pharma, the press, and yes, the Government (note the big “G”) prove themselves as helpless and befuddled as those they care for, serve and ostensibly protect. This where they fail, and fail miserably.

Firstly, directing a junky to obey a prescription order is a conversation just as effectively held with the cat. Addicts aren’t heedful. If that approach had the slightest shred of merit, there wouldn’t be a problem. Secondly, telling an addict—or anyone else, for that matter—that what you most greatly desire in life has been put in a package that you can no longer open is a challenge, not a deterrent. How did the afflicted meet this challenge? It didn’t take long. Turns out that if you wanted open the package oxycodone now came in, all you had to do was crush it up and snort it. Or crush it up and inject it. Or crush it up and smoke it.

Curses, foiled again.

When OxyContin was released for public consumption and could be scribbled on a prescription pad, we at the office saw the effect almost immediately. We collected a shitload of dead people who were in possession of little blue-green pills. It blew past the “traditionals” on the first turn and entered the backstretch, going away. One could wonder why this spike in drug specific ODs would make such a leap. It was essentially the same drug that was snuffing people at a lower rate just weeks before, so why should this stuff—believed to be overdose-proof to the overly optimistic—pile up to what became at that time record numbers. Part of it was that it was suddenly the “new toy”. “You ain’t hip ‘til you take this trip.” Sad but true. What was ignored was that, while the same chemical, the dose was being served up three times stronger. Your previous therapeutic dose was intended to be effective for about four hours. OxyContin was meant to do three times the job, i.e. twelve hours. Therapeutic levels don’t fit the parameters of abuse. Opioid addicts I’d encountered typically abused their Percosets, Percodans and Vicodins orally. Crushing, then snorting or injecting it was the exception rather than the rule. Oxycodone is an “immediate effect” opioid. You gulp ‘em down and the narcotic effect initiates in minutes. Taking it this way was factored into the overall intended effect the medication. A reasonable example of abuse would be taking three pills when one was recommended. Snorting or shooting it up bypassed the digestive system, a natural buffer, and provided a straight shot into the bloodstream and hence the brain. People I’ve known with opioid addiction told me they didn’t like to snort or mainline because the initial rush was too intense. This massive hit usually resulted in a sudden and overwhelming physical reaction. They either vomited – “an instant punch-in-the-gut, projectile puke”– or passed out. “You’re out before you can even exhale,” I was told. “And when you come to, you can’t even fuckin’ move, like you’re nailed to the floor. Your whole day is pretty much done.” While you didn’t need as much if snorting or injecting, it was still seen as a “last resort”. “You only go that route if you’re running out and you don’t know when you’ll get a chance to resupply,” or if “You’re hooked so bad and in so deep it’s the only way you can get high any more. If you’re in that bad, about the only way you’ll get out is when you OD.”

Because it was so much stronger, and the only way you could access its narcotic effect was by snorting or injection, it wasn’t uncommon that the first time OxyContin was used to get wasted it was also the last.

I won’t believe for an instant those geniuses at Big Pharma (in this case, Purdue) didn’t have a clue their latest safety barrier could be breached by any fifteen-year-old in the habit of stealing Grandma’s hip medicine. Oh, well… The great thing for Big Pharma—and physicians and the Gumma-mint— is they have a ready-made scapegoat in such cases. The junky himself. Can’t blame them for the reckless and wanton behavior of the weak-willed and self-destructive. The Press did their bit to raise public awareness while at the same time assuring us ‘Merica’s Best and Brightest weren’t being thinned out. Due to its popularity among white males and the first widespread OD’s showing up in Appalachia, OxyContin was dubbed “Hillbilly Heroin.” Fuckin’ hilarious.

Big Pharma as well as the other powers-that-be didn’t take this shit lying down—nobody wants to take the blame for knocking off scads of rednecks. After a few months, those little aquamarine pills stopped showing up on my desk. OxyContin wasn’t banned—as other pharmaceuticals of the same era, like Fen-Phen (weight loss) and Seldane (allergies) and a whole lot more—but it lost its place as the newest and improved-est painkiller on the general market. Prescriptions were limited to those with a terminal illness or elderly folk with chronic pain issues primarily associated with other significant medical conditions. This clientele wasn’t in the habit of tinkering with their medications. Besides, their time on Earth was finite in anyone’s book. If they suddenly kacked, there were plenty of other places to point a finger before anyone got around to snooping in the medicine cabinet.

So… we could all take a deep breath and find assurance that this big bullet had been effectively dodged, yes? Uh . . . no. Funny thing; while the main culprit had been effectively caged up, the OD rate didn’t decline. Percoset, Percodan and Vicodin reclaimed their spot on the list, and stronger than ever. Disclaimer here: My theory follows, and I’ve not seen any “academic” support for it. Here goes: Those folk who abused OxyContin and managed to avoid the undertaker had been effectively hooked. They had to find another way to catch that dragon, and find it fast. They had to resort to what was available, and during this brief but intense crisis, they old stand-by’s hadn’t gone anywhere. Just sittin’ back and bidin’ their time…

This was hardly newsworthy. But, take heart folks. Big Pharma wasn’t about to take a break from coming up with the latest answer to pain, and addicts weren’t about to give up in gettingwhat they needed. Changes were acomin’. And those involved in freelance pharmaceutical supply weren’t about to stand by and watch the “legitimate” pushers rake in all that cash.

Stay tuned!

 

 

 

 

Show me your junk.

Flip on the news. On any given broadcast these days, some talking head will bring you a story focused on America’s current scourge. This isn’t about the most recent social media head scratcher put forth by Dear Leader, but a real, bona fide and honest-to-God scourge, one that’s sweeping the nation. I’m talkin’ ‘bout the newest, latest and greatest of American Tragedies—The Opioid Epidemic. Every time I hunker down in front of the television and Lester Holt warns of the disturbing story his network is about to lay on me, I want to holler back at the tube: “Where the fuck were you guys fifteen years ago?”

***

There was a time when I’d joke that if it wasn’t for alcohol and firearms, I’d be unemployed. It wasn’t long before I came to realize this clever bon mot didn’t provide for me that sharp, short and sweet summation of life as a medico-legal death investigator as concisely as I wanted it to. Sure, it stood on its own and produced a few dry chuckles from those I graced with it, but this was not enough. It’s true that alcohol plays a huge role in providing me with food and shelter. It wouldn’t be unfair to assert ballistic mayhem has done its bit in making Game of Thrones and Boardwalk Empire a part of my life. Without it, I could well have to endure a life of TV entertainment limited to a “basic” package. The problem I had was that my little pet phrase was lacking. It didn’t encompass a full view of my employment. It omitted a very important facet of my career when it came to percentages regarding how I spent my time at work. It truth, it was an aspect of death investigation that provided me with more job security than the consequences of drunkenness or gunplay—combined.

Lengthening this slice of morbid humor to “If it wasn’t for alcohol and firearms and prescription painkillers and all derivatives of opium, I’d be unemployed,” just wouldn’t do. It didn’t “sing.” This from a guy you all know has one dickens of a time “keeping it short.” So, I dropped it altogether. I dropped it well over fifteen years ago. The media had nothing to do with this decision. They were still jerking themselves raw over 9/11 in those days. I was in no danger of being considered passé due to pop-culture oversaturation.

To be truthful, fifteen years ago the number of opioid/opiate overdoses weren’t as overwhelming as they are now. But… the signs were there, and that’s not hindsight. When I first started as an investigator, the types of overdose fatalities reported to us were spread more across the board, so to speak. The pharmacological spectrum of drug use that resulted in fatalities, both intentional and accidental, was more varied and consistent in those days. Opioids, i.e. prescription painkillers concocted in a lab, not a poppy field in Turkey, held a notable but not overwhelming share of this spectrum. Psychotropics – often cocktails of benzodiazepines and tricyclics combined with alcohol– were “popular”. Non-benzo sleep aids like zolpidem and Lunesta, and antipsychotics like quetiapine (Seroquel), clozapine, risperidone also held a notable place. This spectrum also included overdoses that involved gulping down any and every pill available, prescription or OTC (over the counter), with suicidal intent and relying on the theory that too much of anything ought to kill you.

The primary opioid culprits back in those days were the pharmaceutical products of Percodan or Percocet (oxycodone and aspirin and oxycodone acetominophen, respectively) and Vicodin (hydrocodone and acetominophen.) These medications are highly effective, both at relieving pain and killing people. In my first year or so as an investigator, these meds were almost exclusive in opioid fatalities. We’d encounter the occasional morphine or methadone death, and there were folks who either had too little respect for its position of power in the opiate spectrum, or too much regard for the opinion of it as a wimp on that same spectrum, and wound up dead for taking a generous handful of Tylenol 3s (acetaminophen and codeine.) Once in a great while we’d catch an honest-to-god heroin OD, but in the waning 1990s that was a genuine eyebrow raiser. Then along came a medication that was heralded as an answer to the problem of folks abusing their pain medication: Oxycontin.

Oxycontin is just oxycodone; oxycodone with a twist. Big Pharma was tired of being associated with the over-prescription and subsequent abuse of painkillers. Just because they made the shit didn’t mean they were handing it out to anyone who wanted to cop a buzz. They preferred the blame being directed at the middle man. Doctors, on the other hand, had no problem with Big Pharma sharing the heat. When it came to patients who’d been on a regular diet of opioids going on three years after an ankle surgery, and whose next need of medical intervention took place in a morgue, the argument was made, “If this is all you have to offer for pain control, don’t scold us for prescribing it.” Big Pharma’s answer to this was oxycontin. (I heard this from a doctor, a friend of mine who was doing an emergency medicine rotation through his residency. He stated this was more of an ongoing gripe than an any sort of official dialogue between pharmaceutical companies and physicians, though he asserted this had been an ongoing debate for decades.)

Like I said, oxycontin was just oxycodone, “new and improved.” To diminish—if not wholly eradicate—this drug’s appeal as a pharmaceutical joyride, they did some chemical tinkering. It was made “slow/time release” and “buffered.” This resulted in a painkiller that was just as effective when it came to dulling the “ouch”, but eliminated the “aaaahhhh…” associated with the parent medication. Voila! This’ll take care of that abuse/addiction headache. Who’d want to get hooked on a pill that won’t give you a buzz? Problem solved.

A couple years after I became an investigator, this new and improved painkiller started showing up in overdose cases. We weren’t given much info about this stuff. You might find that odd, but, as I’ve learned over the last couple of decades, the medical and pharmaceutical communities aren’t in the habit of handing out updates to medical examiner’s offices. I suppose, after all the testing, studies, cross testing and cross studies and whatever, they don’t expect the latest FDA approved pharmaceutical advance will be sending us any business. (This isn’t the sole bailiwick of pain control. Remember “Fen-Phen”? Pharmaceuticals are equally adept at killing overweight folk as those in pain.)

When the oxycontin started showing up, and at an alarming rate, if I dare use such cliché, we were a little taken aback. We’d heard of this stuff, but that’s about as far as it went. A little research and a few pointed inquiries shed a ton of light on this latest puzzle. The answer was should have been obvious, but we, least of all, hadn’t figured it out.

Stay tuned. I’m about to tell.

 

 

 

Ya doan wanna f*ck widda JuJu, mon.

New, not previously published. This is a brand-spanking new BLOGPOST!This is not a retread or rehash. This is all shiny an’ new. For reals.

In regard to my months-long self absorption I realize I’ve been dreadfully negligent. Shame on me. But, I’m reunited with my baby now, the band is back together and we’re about to tear up the casino circuit until a new record deal is on the table. Here goes…

***

In my early days I’d made a few comments in regard to how I felt about satisfying prurience and appeasing morbid curiosity. If memory serves, I was a bit haughty when it came to such gratification. On this, my “second incarnation,” I’ve decided to eschew all semblance of moral integrity and get right down to serving the lowest common denominator in whatever way I can. Gotta knock the rust off somehow.

Destiny. Kismet. Karma. All strong, powerful words in and of themselves. In some individuals, they carry deep connotations in how they view their place in the universe. Outside of the obvious– i.e. I decide to give mugging passersby a try as a part-time job and end up getting shot in the face– I don’t give them much credence  when it comes to cause and effect in regard to meeting one’s maker. No “butterfly effect” in my view of the Cosmos. I would be a liar, however, if I were to say I’ve never borne witness to a few tragic events that one could ascribe “destiny,” “kismet,” or “karma” powerful roles in the chain of events that sent some poor soul to the Other Side. Here goes.

“Don’t dare God:” I was summoned to a death scene which involved traumatic injury incurred in the performance of service to humanity. It happened in a small, rented warehouse from which a church operated a busy food-shelf. Every aspect of its operation was based in donations. The food, pallets and bags were provided gratis by congregants and local businesses. Congregants also were generous in providing time and specialized skills to the cause.

This charity had benefited from the donation of a pair of forklifts, provided gratis by a shipping company. These labor saving implements were not in “fresh-off-the-assembly-line” condition. They’d seen many hours of hard service and were in need of a little fixin’ up. No problem. One of the church members was an industrial mechanic. Tuning up such equipment was right in his wheelhouse.

This warehouse was just a barebones grocery store. It didn’t have a machine shop. There were no industrial hoists or grease monkey pits to facilitate the repair and maintenance of contraptions like a forklift. One of the lifts– per the pastor– had some sort of problem “underneath it.”  Where there’s a will, there’s a way, and the mechanically oriented congregant was a “can do” sorta guy.  He came up with a plan.  The other forklift had been deemed mechanically sound in all regards. There was nothing wrong underneath that one.  The solution to access the “underneath” of the problematic machine was to utilize the operational forklift as a hoist. The forks were slipped under the counterweight at the rear of the defective one and raised about two feet from the floor. The forks of the malfunctioning machine were fully operational. They were raised to the same height, and a stack of sawn off railroad ties were placed underneath them. Those forks were then lowered until the implement was a level twenty-four inches from the floor. Its normal ground clearance was about three inches.

The congregant found this a sound solution, and took no further steps in terms of safety or common sense. The pastor, who was present, thought otherwise and voiced his concerns. The philanthropic congregant disagreed. “I told him I wasn’t  comfortable with him crawling under there without further blocking the forklift,” the undertandably stunned reverend related to me.  “‘We’re doing God’s work here, pastor,’ he said. ‘I’ll let Him worry about it.’ Then he slid under it with a flashlight.”

The “good” forklift had been more than adequate when used to move a pallet laden with potatoes and such. Supporting over a ton and a half of steel well exceeded this function. The hydraulic hoses used to raise and lower its forks weren’t up to the job. The pastor reported that the man had just finished asserting his faith in the Lord and slid under the machine when one of the hoses blew, showering the entire area with hydraulic fluid. The forks dropped and so did the load it was bearing. The railroad ties supporting the front end of the damaged forlift, in reaction to the sudden change of angle and pressure, shot out from beneath the forks they were supporting. In less than a second the implement was resting on its wheels, as well as the congregant’s head and shoulders. I mentioned its ground clearance was three inches, did I not?

***

“It’s the clothes that make the man:” I went out to pick up a middle aged fellow who’d taken a headlong tumble down the steps leading to his basement. Throughout the day, he’d been hard at work, emptying several canned twelve ounce beverages from the refrigerator in his kitchen. This had been his normal Saturday routine for over twenty years.  His wife told me it’d been at least a twelve pack.  When the kitchen supply had run out he was still thirsty, so he headed downstairs to tap into the reserve supply. His wife had been in the living room watching television when she heard the basement door open. An instant later she heard a terrible noise that she correctly interpreted as her husband bouncing down the steps.

When I arrived he was still at the bottom of the stairway.  The medics had been there and left, of course. They reported to the cop who’d called it in to us that, when they arrived, the man’s shoulders were flush with the wall opposite the bottom step. His head was folded tight to his chest. When they rolled him to his back they reported his head was “kinda floppy.” They put the heart monitor pads on, saw the telemetry, and called it quits right then and there. So, I did my part, took my pictures, talked to the cop, spoke with the wife. It was as we were putting him into the body bag before hauling him back upstairs that I took a moment to read what was on the front of his T-shirt. Emblazoned over an artistic rendition of a brimming mug was printed: “There’s no such thing as a fatal beer!”

***

“If you read it somewhere, it must be true:” I got a call from an outstate county we serve as Medical Examiner. The deputy reported they’d be sending the young victim of a truly spectacular traffic accident. This young man had enjoyed a meal at the local Chinese restaurant with some friends– the last people who saw him alive. He was rushing through his dinner, explaining he was going to a party after eating and there would be a certain lady attending he’d been dying to “have a crack at.” He did stick around long enough for a fortune cookie, and these friends reported he tucked the little strip of paper into his wallet before heading out to test his luck in love.

It was a late autumn/early winter night. It had been dark over an hour before this lad left the restaurant. His route to the party covered several miles of county roads. A freezing drizzle had just begun to fall. About halfway to the party his shot at getting laid was foiled forever. The deputy reported his estimated speed at the point of the crash was at least twenty miles an hour in excess of the posted speed, which was fifty MPH. It was on a long, left breaking curve. The curve grew tighter as the roadway progressed. The deputy further reported this road bordered a ditch, sizable  both in depth and width. About a quarter mile before the road straightened out, the young man lost control of his vehicle (a pickup truck) and slammed into the massive, ultra heavy duty guardrail that protected this ditch from guys like him. The deputy added that this stretch of road and that ditch had a long, long history of gobbling up vehicles. The cost of removing those vehicles and their occupants was substantial. To prevent this type of cost,  this whopper of a guardrail was put up three years prior and had paid for itself several times over. On this occasion, however, this stalwart line of defense had proved itself only partially insurmountable. The truck remained on the pavement. The driver did not remain in the cab. He was unbelted (regard for personal safety is ever the casualty of eager anticipation,) and the impact launched him straight through the windshield. He was recovered from the other side of the ditch, twelve feet off the ground and in the branches of a tree. Impressive.

When he arrived at our Office, he was routinely processed, just like everybody who shows up that doesn’t die under suspicious circumstances. In the course of this, his wallet was emptied and the contents were sorted and documented. Tucked in with his legal tender, a small strip of paper was discovered. It was the contents of the fortune cookie that had topped off his last meal. It read: “You will soon take a short but exciting journey to a peaceful place.”

 

Well, then…

 

 

 

 

 

 

 

The end in order to begin again… let’s hope

As a bonus to my preferred customers, I offer this, another stopgap in the process of getting the ol’ book finished and available to a thirsting Public. This is the last section of said publication, and has never been presented for open consumption.

That said, the time draws near for my masterpiece to be put out there. Once done, I assure you I’ll be back on a weekly basis, in more or less the same fashion you’re all accustomed to.

 

Afterword:

What This Was About

Thirty years, and that’s it? A fair question, but the only answer I can give is: Yeah, that’s it. Flashes and glimpses, singular situations. That’s all you get, and it’s what you work with. Both places are where the frailty and folly of human existence come to their most wretched realizations. A person does not get admitted to a locked psychiatric unit by living a quiet, well ordered life. You don’t end up in a morgue by dying with dignity. Working in such places, you’re not privy to the full story. You may get the particulars of what brought somebody to either place, pertinent details strictly related to what got them through the door, but that’s it. In the psych ward, it’s often just re-reading the same chapter in a life. In the morgue, all you get is the ending. There is no well plotted, flowing narrative, complete with a thrilling climax and satisfying denouement. Through these thirty years, I’ve never encountered a Frances Farmer or an Elvis Aaron Presley, though I’ve encountered dozens—if not hundreds—of people whose lives could have been parallel but for the absence of fame and notoriety. Fate has provided me no fodder, nothing I could write that would be sensational or titillating enough for viral, mass consumption. Nope. All I’ve ever encountered  were   . . . people.

Without a TMZ bio or a resume’ of headlines and lead stories, it’s hard, if not impossible, to view them as no more interesting than extras in a film. Incidental characters, filler with no significance in the real story.

I was called out to pick up dead man lying in the middle of the street. He’d hopped from the curb into traffic. The first vehicle swerved around him. The next vehicle could not. The driver didn’t have enough time or space to react. The entire incident probably lasted no more than three seconds. The first driver got a wicked scare. The second driver killed a man. The guy I was standing over got what he was after.

It was a cold night, but not dead winter cold. It was just above freezing. Our guy in the street was wearing layers; three pairs of pants, three or four shirts, a coat. Tucked in all of this were a couple pairs of socks, some underwear, a T-shirt. The impact had knocked him out of his shoes. They appeared new, but were cheap, the kind you might find in a drugstore bargain basket. We went through the pockets of his outside layers looking for some identification. All that was found were rolled up wads of public restroom toilet paper. When he was moved to the cot one of these wads dropped out of his coat. One of the cops wanted to know if I needed to take it with me. I didn’t, and did not.

It wasn’t a careless assumption on my or the cops’ part in believing this guy to be homeless. To assign him some degree of mental illness was a reasonable postulation as well. He was certainly suicidal. It is also not unreasonable to assume this man’s life had been miserable, miserable enough to throw himself and everything he owned into traffic. To take it further, I’ll assert that anybody who encountered this man in the months, weeks, days, even hours before he made the decision to let a stranger end his life, perceived him as miserable in any and every way you could define it. At a glance, in a snap judgement, his presence would not be welcome in your place of business, in your home or sitting beside you on a bus. He was one of society’s rejects. In turn, he rejected society by forcing an anonymous citizen to kill him.

Incontrovertible respect is the divine right of every human being. Society promulgates and preaches this but often fails to deliver. I won’t even qualify it as an assumption to state this man hadn’t enjoyed much incontrovertible respect. Those days, however, were over. From the moment he was transported from the middle of the street to our cooler, he would be the recipient of honest and unmitigated respect. It’s too bad he had to die to get it.

Right, wrong or anything in between, this sort of thing will go on forever. For some reason, this incident stuck with me longer than others. I’ve long since learned that allowing such occasions to linger in the head too long isn’t much different than adding sand to your pockets every time you’re involved in one. Over time you’ll end up so weighed down and sluggish you’ll quit moving. But this one dragged me back over twenty years, and wouldn’t let go until it made some sense… in my head anyway.

Of all assumptions that may have been made at the scene, by me, the cops and the driver of the rig, I was probably the only one who could add this one: This dead man, this machine the ghost had voluntarily fled, had surely strolled on that treadmill as those same people I’d left behind in the psych ward. Unlike most of them, this man had literally leapt off it. Why? I rarely bother with “why?” It’s a waste of time in that you rarely get a satisfactory answer. But the “why” that popped up this time was different. It wasn’t why this guy jumped off, but why did the others stay on it? I can’t give you a satisfactory answer, either. But I’ll give you what satisfies me.

Those that remained were not about to allow someone else determine the quality of their lives. Despite its agonies, they valued the life they were given enough to be determined to get every ounce of good they could get out of it. If society has a rough time handling their existence, and the manner with which it is dealt allows little consideration in regard for dignity, self-determination and respect, it’s hard to blame them for telling that society to fuck themselves on occasion. They didn’t ask for it, but are still trying to make what they can of it. That satisfies me. It tells me that whatever miseries I find in my own existence are mostly piddling by comparison. Those patients I worked with never hesitated to tell me they’d gladly swap their problems for mine and feel blessed.

That’s what this was about. What a privilege it is to witness such things from the viewpoint of a life intact. What it means to be blessed.

Thanks for reading this.

 

Feline-O-Cide and death with dignity.

September 13th, 2016.

 

This last Sunday I killed my cat. That is, I paid someone to kill my cat, a professional. This was not a “contract hit”, of course, but a run-of-the-mill euthanizing of a kitty whose time had come. She went out like cats often do. She was obviously not herself about five days ago and at some point went and hid somewhere in the house like no animal but a cat can. I looked for her over three days with no success, and then she just finally appeared that morning near her water dish so sick and weak she couldn’t raise her head. I’d seen this before. “I can’t heal up, I won’t heal up. It’s up to you to do the right thing. I’m ready.” So I did.

This also occurred on the same day our nation, fifteen years ago, suffered its greatest shock since Pearl Harbor. I’m not about to compare the putting down of a pet to that catastrophe. But, it did bring about some curious juxtapositions in my head about what it means to choose one’s manner of death, if that choice is ever presented in one’s life. I don’t want to prattle on right now about suicide– which is of course an obvious subject when it comes to the argument about opting for one’s own demise. Most of those I see are either years in the making, a long history of depression with previous attempts or gestures, sort of sad, foregone conclusions, or an impulse seen through with the help of a handy means (gun, rope, or easy access to a river or an elevation sufficient enough to do the job) and consuming enough alcohol to make it seem like a good idea. That day will come, trust me, and I’ve no choice but to brush over it today, but that’s not what I want to put a microscope on.

Taking my cat to the vet was nothing more that putting a quick and supposedly comfortable end to her misery. Her age was the biggest factor in not pursuing another option. She’d never been sick in her life, was well into her life expectancy range and what I saw, from past experience as well as knowing my own cat, was that any treatment option wasn’t going to give her much more and most likely was going to be just as bad as what was hurting her at the present time. The vet backed me up, but I didn’t need reassurance. I knew, and the cat knew. There are those that believe you ought to be able to do the same with grandma or old Uncle Pete. Hmmm… Another time, perhaps…

After kitty’s passing it became just another Sunday. Football, crappy food eaten in front of the TV, a beer or two and I gave myself permission to sulk for the rest of the day. In the evening while channel surfing I came across a documentary on the World Trade Center attacks. The focus of this program was on a photograph of a man falling to his death from the North Tower. He has since been widely referred to as “The Falling Man.” It was believed he jumped from the Windows on the World restaurant. This man was one of an estimated two hundred that fell or jumped from both towers that day. I recalled other documentaries from varying perspectives and points of view. One particular program I remember was a French film crew that had been following a FDNY station on an entirely different project. The sharpest memory I have of that piece was the firefighters and the film crew in the vestibule of one of the towers. Through the shouting, the chaos and confusion, you heard an unsettling noise, like a single, heavy drumbeat that was more of a “bang” than a “thud.” One of the film crew, in a voiceover, said it took of few moments before, all at once, the film crew and the firefighters realized it was the sound of people hitting the roof above them. Each sound was a life coming to an end, a life that not thirty minutes before was engaged in normal, daily existence. My thought at the time was “better to jump than suffocate or burn.” Watching the show on “The Falling Man” and the efforts made to identify him, I was surprised– astounded, actually– at the negative reaction people had regarding those who’d chosen to leap rather than burn. (Not to be gruesome, but the fact is that “burning” may have been too mild a term. Several floors above the inferno– estimated at 1000 degrees F in both towers– “roasting” would be more apropos.) To me, jumping made sense on several levels. I’d go as far as to say it wasn’t even a choice. Why would I stand, with several floors beneath my feet being consumed by flames, cutting off any possibility of escape or rescue,  and know I’m certain to suffer horribly until the darkness falls for good? Why would I gasp and choke for minutes that will seem like hours, blinded, choking, knowing how it was going to end? And, finally, why would I let whoever did this to me, put me in this horrid, hopeless situation, have this kind of say in how my life ends? I saw jumping as defiance– a final gesture of self-determination.

I sat in the vet’s office for over an hour with my lethargic, quasi comatose cat curled up in a towel on my lap . It was busy. Every time somebody popped in, to do the paperwork, for me to hand them a credit card or, “to see how you guys are doing,” they always left with the question: “Do you need a little more time with her?” I understand and appreciate the sentiment. However, she was suffering. I was not there to extend it. My time was the time I’d spent over the last fifteen years. Now that time was over and I couldn’t understand why I would want her to remain in this condition for any longer than she had to–closure?

In our American manner of striving to sanitize death, “dying with dignity” is inevitably mentioned. In a nutshell, you have a say in whether or not someone shoves a hose down your throat and lets a machine breathe for you until your heart stops… unless they can get a machine to do that work as well. Then you can lay there and wait for the rest of your organs to ultimately fail. You are no longer required to put up that kind of fight any more. It took a couple of generations for us to realize that all of the wondrous advances we’d made didn’t necessarily mean you were going to enjoy your final days. We spent two generations thinking we could kick death out of our lives with science. And for anybody not to embrace this and cling to the very last breath by whatever means was a quitter. You can die at home now. You can stop the chemo, the radiation, the surgery. You can state your ideals and follow through with them and take you last breath where and whenever it comes and no one will think less of you. On the contrary, you will be anointed as courageous, noble and… dignified. I’ve no argument with this. I’ve lived it myself with people I loved. It’s how it should be. We’ve finally come to accept that hospital sheets and sterilized implements won’t make the end of a life better– or less final, for that matter. You can concede that the end of your life is inevitable, and to face it on your own terms is nobody’s business but your own.

That is, of course, only if you let it happen. Taking matters into your own hands is another story.

The Medical Examiner’s Office in New York listed every death caused by falling or jumping as a homicide. I see no problem with this, though technically it is not true. But there is in fact a loophole, and they used it. One problem is that most of the people who jumped, or fell, were not only pulverized by hitting the pavement, most of them were buried by the debris– tons beyond comprehension– after the buildings collapsed. Many were unrecovered and simply declared dead when they were never heard from again. Another was there were no living eyewitnesses from the floors they’d fallen from to provide any “history.” There were witnesses, yes, but none of them in a proximity that they could be asked “did they intend to jump?” though the circumstances made it pretty obvious. Some did fall. Some on the floors that were in close proximity to where the planes struck were possibly pushed through broken windows by panicked and disoriented people behind them, moving toward fresh and smoke-free air. Some were seen to fall after attempting to climb to another floor. But others, a couple holding hands, a woman holding her skirt down to prevent it being blown up by the velocity of her fall, or the well documented and photographed positions of the “Falling Man” indicate a jump. The loophole? Homicide can be listed as a cause of death if it is “loss of life resultant of an action initiated by another party.” This was clearly, unarguably, the truth. But the public perception in these cases is undeniably divided. You can put whatever you want down on a death certificate, but what many people saw was suicide, pure and simple. Even from families, who, as in the case of the “Falling Man”, did not want them positively identified. Suicide was simply too much of a load to add to the agonizing weight already dropped upon them by this unthinkable event. Be it their core beliefs, their upbringing, or imagining someone they loved being so terrified, desperate and hopeless they were forced to take their own lives is more than they can emotionally accommodate–more than anyone should– and more than anyone has the right to judge. Other people, those who’d not lost anybody that day, most whose only connection was the television or other media and thousands of miles away, perceived it as “giving up,” “not fighting to the last,” even cowardly. They could accept the other victims as heroic, but prefer not to even acknowledge those that fell rather than endure the smoke and flames. (There were some that complained the media had no business showing people falling.)

The other side of this issue was that those people on that day who opted to make that choice had to answer to nobody but themselves. Their choice was to burn and suffocate or take the only matter they had left in their lives into their own hands. Did this make them any less “heroic?” Does a coward or morally shallow person opt for a ten second fall rather than die in agony and disorientation? Or do they say “I won’t die the way madmen intended me to. I won’t accept that I have to take this.” That, too, is beyond anybody else’s scope of judgement.

My cat lived her cat life with an “attitude.” She was anything but docile. She bit me regularly, even when I wasn’t asking for it. She never– well, rarely– drew blood, but it was a solid chomp, nonetheless. One you felt. She wasn’t de-clawed, either, and she wasn’t shy when it came to utilizing all the weapons she had at her disposal. I actually preferred the bites. One of my friends dubbed her “Evil Orange Kitty” when he, against my strong and repeated advice against it, reached for her while assuring me that “all cats love me”. He snatched her from the floor abruptly and brought her up to his face. Less than a second later he had a shredded lower lip and “Evil Orange” was a streaking toward the basement. Sucking on his lower lip, my friend managed to say “All cats but one love me.” The only condolence I could offer was “Don’t take it personally.”

There was none of that on her last day. She couldn’t even hold her head up, much less offer a bite or a full blown, claws out swipe. When they finally put a portal cath in her foreleg to administer the cocktail, she didn’t even twitch. She sat in my lap for over twenty minutes with a tube in her leg and three layers of tape securing it, when two weeks prior she wouldn’t tolerate my dropping a napkin on her back. She ignored it, and the veterinarian, who at last showed up with the loaded syringe. When the vet reached for her, the cat didn’t make a move, not a twitch. And as I watched the pink fluid disappear from the syringe, “Evil Orange Kitty” was silent. A few seconds letter she grew rigid in my lap, loosed a sharp yowl and took a full body swipe, claws visible, at the gap of air separating us and the vet. Then she went completely limp. The vet was startled. She said, “She must have been very dehydrated and it took that long to reach her heart. The fluid can ‘burn’ somewhat. I’m sorry. That must have been difficult.” But it wasn’t. On the contrary, it was comforting. I hated the idea that she may have felt one flash of pain, but at the same time she still had one vigorous and assertive swipe left in her, and she took it.

Please don’t think I minimize the horror and grief of what happened fifteen years ago. What happens to a pet no matter how beloved, is beyond microscopic in comparison. No, there is not a shred of comparison. It was just a moment that, in its timing, pried my eyes open a little wider than they’d been in too many years. When a choice as difficult as how to meet death is put up, when the outcome is inevitable and unavoidable, but along with it is the unfathomable option to alter the means of accepting it, and having the incomprehensible capability to alter the means and manner, it is a moment inviolate by something as trivial as an opinion.