“24 year old female, found down. GCS 3, CPR in progress. ETA 5 min.”
The radio crackled off and I immediately started running towards the resuscitation bay to meet the EMS crew.
I methodically slid on the vibrant blue nitrile gloves, carefully placed my face shield on and prepared my intubation kit.
All codes are the same. The fundamentals of medicine kick in. Airway. Breathing. Circulation. A. B. C. In emergency medicine, we train to maintain composure in chaotic situations. I take a deep breath and prepare to take charge.
When EMS arrived, one crew member was performing chest compressions, sweat dripping down his face. The other crew members carefully transported her from their stretcher to our bed. The medic immediately briefed us, “No improvement, 1 round of Epi given, no shockable rhythm en route.”
“Ok everyone, continue chest compressions and administer the next round of Epi” I said.
Multiple rounds of chest compressions and medications were given. I placed an ultrasound over her chest during the pulse check. Her heart was still. The room was still. We all knew her fate.
“Time of death 1437.” I stripped off the face shield, removed the gloves and glanced at her family through the window.
Often times in the moment, emergency physicians are focused on the task at hand. What can I do to bring her pulse back? Is there a shockable rhythm? Is there a reversible cause for her death?
A lot of times, we can’t get them back, as hard as we might try. I once had an attending tell me, “They’re already dead. You can’t make them deader. Do your best to bring them back and be there for the people who are left behind.”
I walked over to the family and gave the speech I was used to giving over the years. I watched the color drain out of their faces; guttural moans filled the room with despair. The questions flooded of “Why her? Why this? Why now?”
I couldn’t answer those questions. As I covered her body with a bright clean white hospital sheet, I glanced at her arms. Scars from the needle sticks searching for a viable vein for the heroin. Evidence of the long battle she had been through.
Colleagues, friends and family have all questioned why Dr. Khalsa and I felt a need to advocate for medical cannabis. Anyone who has been affected by the opiate crisis has never asked us why we do it, they simply thank us.
When you have firsthand experience with the gruesome toll of opiates, it is easy to advocate for safer treatment options. Physicians agree at this point that opiates are not the answer. However, patients are left with no other alternatives. As physicians, we cannot simply ignore pain control or defer it to the next doctor to worry about.
We understand the hesitancy both in the medical community and general population. For many years, cannabis has been stigmatized with both physicians and patients abusing the system. In the medical community, cannabis physicians are sometimes viewed as lesser-trained doctors, who frequently did not become board-certified in a specialty. In other words, this was just a way to “make a quick buck.” Another barrier is that medical education certainly does not include a section on medical cannabis. Physicians have to go out of their way to gain additional training and expertise in this area.
Dr. Khalsa and I want to change this perception. We are board certified physicians in emergency medicine and still practice on a regular basis. After working for many years in Colorado, we saw the good and bad of cannabis legalization and we readily discuss these risks and benefits with our patients.
No medication is perfect and we encourage the medical community and our patients to always maintain a guarded perspective on any novel treatment. Just look at the drug commercials on TV that subtly try to list over fifty various life-threatening side effects. These are commonly followed by large lawsuit advertisements for the previously mentioned side effects. No medication is taken without risks and this includes medical cannabis.
Yet, medical cannabis does show promise. We continually review the most recent literature on cannabis. But, we also listen to our patients. A common theme that comes up is that patients enjoy having control over their own health. They appreciate having an active role in determining strains, dosing and frequency of this medication. With any chronic illness, control is something that disappears over time. They feel mainstream medicine only contributes to their lack of control and medical cannabis helps them regain some balance.
Patients tell us about how they were able to cut out opiates from their lives, how they head into their chemotherapy sessions without enduring weeks of nausea and vomiting, how they enjoy their lives again without having to worry about daily intractable seizures. We listen to their success stories.
Medical cannabis is not the right choice for everyone, but we are here to start the discussion about whom it can help.
Radhika Ratnabalasuriar MD