Janus In Euphoria: Weed And Branches

The story begins with branches. It always does. If things happen slightly differently, it could all end a billion different ways. Here, we want to attempt to follow the branches. 

Origin - First exposure

There are three ways this starts. One, a party or a casual experimental visit to that club. Lag asks for the stuff, whatever it is, loud, monkey tail, pure coke, meth, ecstasy, whatever. One shot up her arm, one sniff, one lick, one sip. The high never arrives. Instead, she arrives in black, unaware of anything. Or she arrives in distress. 

Two, Lag is stressed, depressed, scared, anxious, tired, weak, lost, or suicidal. She wants to quit, to end it. She says no,  God hates quitters. Still, it doesn't get any easier to cope. A good friend recommends a little transparent sachet of brown powdered stuff, says it's sugar, it'll sweeten life up. She's in a room, or in a hotel on a work or vacation trip, or at work in an office. She's found spasming away or gasping for breath. Whatever it is, she isn't feeling happy. None of the promised euphoria.

The third option. Lag visits or is visited, it's an innocent meet-up. They said they just came to say hi. Lag excuses herself, gets back, a few bites or sips in, everything's fuzzy. They mutter conspiratorially, apologizing or uncomfortably reading out incantations from their small itel, or worse they're undressing. Whichever it is, they stop once they notice Lag stiffening, midsection jerking and oscillating, or throwing up, then choking on vomit as eyes water and breath becomes a struggle.

Immediate Post Exposure 

The branches narrow here to two outcomes:

In outcome branch 1, scenario 1 skips to all the other 'experienced' dosers present holding our patient down while she seizures, gasps, or screams. They have seen it all before. As far as they're concerned, soon she'll come off it, and tell them just like they did at their first time, that she wants another shot or sniff or sip. She doesn't. For her, the room doesn't spin, it fades to pitch. Her body doesn't grow warm and fuzzy, instead, it goes cold. She doesn't feel high and light like her body is weightless. Rather, she sees her heavy body held down by confused addicts. As her soul or whatever dissolves, they'll mutter about how they didn't sign up to kill anybody. And how they can't take her to the hospital, so they won't have to explain the circumstances. They'll wait and watch, the golden minutes of first aid will ebb away. When she's undoubtedly gone, they'll pass the doobie or blunt or syringe around one more time, agree to toss her body where they tossed the many more one-in-a-thousand others who just couldn't join their ascended and enlightened vice. If the other person in scenario 3 is vile enough, this branch is also the end of the road for scenario 3's Lag. 

In outcome branch 2, the branches start again. She's able to call the receptionist at the hotel, or the neighbors hear the screaming from her house. Maybe her coworkers come for a coffee break and meet her face planted on the table while incontinence wracks her lower body with fluids as she foams at the mouth or mumbles incoherently from a stroke. They swing into immediate action, she's in a car speeding to a hospital. This same outcome occurs if the criminal in scenario three is conscientious enough to brave the risk of coming clean or worse, packaging a lie. After all, it's a hospital, not a police station. They drive by, dump Lag, and disappear on the pretext of buying drugs or something like that.

Intervention

For the sake of relativity and perception, understand that the .... Puts the estimate of hard drug users in Nigeria at about 1 in every seven people. So walk down the street and for every seven you count, one of them is on drugs. Hence, one of them could easily facilitate one of these scenarios.

Now, the patient is in the hospital. The branches don't stop. Branch 1 and many others, have Lag dead before she can get to a hospital. Her rescuers may spend too much time trying to intervene rather than rushing to a hospital straight away. Her rescuers may call the police anonymously, they don't want to be jailed for crimes they do not know of. Her rescuers could be stopped by the police. When some clean-looking young chaps in a nice car have an unresponsive young lady who turns out to be overdosed on hard substances in the back seat, they don't get away with "We are taking her to the hospital, officer". The rescuers might simply not have the means to afford transport to any good health care facilities. The rescuers might be puritans who even condemn her to "deserving the suffering" when they notice the powder all over the table she fell from. They could be rapists who take advantage, ritualists who take the opportunity. Or too unconcerned for her own good. Long story, she dies before she comes across the scent of a hospital's septic air

In Branch 2, she meets one of Nigeria's most numerous medical products, quacks. Nigeria, with all its brain drain, is a hotspot for quack clinics. If Lag is taken to one of those clinics that make up Lagos' 50-60% of quack clinics, she'll be hooked up to a drip and some other unspeakables will be done to her. Their uninformed and uneducated attempts at intervention, whether as intravenous fluids or palm oil in the mouth to stop the seizures, will kill the patient. These are just two of many possible scenarios. 

Branch 3, Lag gets taken to an unscrupulous private hospital, they'd charge for typhoid and malaria, collect money for drips, and whatever else. They'll try to manage respiratory distress or seizures as best as they can, sucking whatever funds they can justify to the responders who brought Lag. When efforts prove abortive, the patient will be rushed to a tertiary center such as UCH, LASUTH, or OAUTH and dumped. This is where all pathways that do not lead to death due to skilled and timely intervention eventually come in the acute phase. Of course, there's a chance that one is taken to a top-notch private hospital. First of all, one pays through the nose for services in such areas. Second, clinical pharmacologists, chemical pathologists, toxicologists, and doctors of pharmacy are rare. To have access to one of these people, get them to show up in such time-scarce conditions, and have the drugs required and the means for all the tests is quite a series of possibilities.

So, Lag is in a competent center. There are spaces available in the Emergency Room. There's a good doctor who can derive a good and near-accurate working diagnosis on time. There are extremely few options for acute care before she can get professional help to know what drugs are in her system and what drugs to counteract their effects. So in the meantime, there are two options. 

1. They manage symptoms. In other words, check bp, fix bp. Check respiration, fix respiration. Check kidneys fix kidneys. Except "fix" is not really fixing, but more of a modulation to last till help arrives. This runs the risk of going wrong of course. Some things may not be so apparent. Any number of things could go wrong throughout the whole process. 

2. Dialysis. Some toxic substances can be dialyzed out of the system. Usually, methods like Continuous Renal Replacement Therapy are used in such cases. 

While all this is happening, the internal medicine resident is rushing her way, along with the doctor of pharmacology and chemical pathologist. If the patient's case is that complicated, a clinical pharmacologist will be consulted. At this point, any number of things can happen. Nigeria has so laughably few clinical pharmacologists, a Google search pegged the number at around 20-30 in the entire country. So, good luck reaching one. If they can though, Janus reappears, and she enters a new stage of branches. 

Post-acute intervention. For life or to live

Branch One has a skilled psychiatrist and good protocols in place, and psychological health care starts early. If it were a suicide attempt, an unintended exposure, a mistake, or an experiment, the gradual care required to ensure the patient does not lick the lion's palate and kiss death one more time will be administered. Patient leaves with regular clinic visits, lesson learnt for life. Of course, this assumes the patient is compliant with seeing a psychiatrist. It also assumes any pressures from well-meaning or just unpleasant people to stop going to a head doctor like a crazy woman do not prevail on Lag.

Branch 2: If there are no skilled psychological care personnel or protocols that ensure follow-up, the patient falls through. Maybe fights for some time and eventually goes for some lower down drug, before gradually growing up to be like one of those elders who would hold someone in his former shoes down and kill them. Maybe she just becomes one of the 6 out of 7, the experience remains a scar in her case note. Nothing to worry about. 

The judicial aspects of all these will remain buried under way too much of Nigeria's murky waters of course. So the cycle can't stop, the murderous elders or lustful assassins will continue to exist. They won't stop, probably. And unfortunately, here, our Len Biases never see justice. They are gone and they stay gone. Every single life lost to powders, injectables, smokables, and drinkables is never fought for, rarely sought for, and rarely bought back. Justice is not an option. The only option is grief for those who the deaths happen to, the relatives and family. 

Conclusion 

This article is an attempt to profile and cross-section the flow of an illicit substance toxicity case in a hospital. The problems a patient could be managed for include a myriad of mechanisms. From raised heart rates causing arrhythmias or strokes to raised ICP or aspiration and respiratory depression, there are many. And sadly, none of them can happen only the first time. All these acute cases will hover over any occurrences of drug use. The slightest draw beyond the usual, the tipping of that measuring spoon beyond the normal, the sniffing of a little too much to go just a little bit higher, they open the doors to all these, leaving fate and chance to guard the doors, flimsy, paper-thin sentinels that mean nothing. A background of complications like hepatitis and HIV, cirrhosis, endocarditis and a myriad of other conditions along with eventual drug dependence and addiction form the chronic backdrop against which these risks are taken per time.

The risks are more obvious here than anywhere else. And the Labyrinth of euphoric Januses is nigh unnavigable. So keep your noses and veins to perfumes and blood. Guard yourself. Your body is more precious standing next to someone else under the bright sun and under the rain clouds, than it is pushing up lilies where the sun doesn't shine. Remember, till death, every defeat is purely psychological. So dear friend, do not invite the final defeat because of something purely psychological. Leave the weed and its branches, or else you might get hung while getting high. Leave the high to the low, and stay safe in the between. Talk to someone when it all gets tough. And never stop being a winter bear, hibernate as long as you want, for the sun will shine again tomorrow. Peace.

Janus - Roman deity of beginnings, gates, transitions, time, passages, endings and duality.

Salami Wisdom