Trigger Warning: This content discusses topics related to drug overdose and death, which may be distressing for some individuals. Please proceed with care and prioritize your well-being.

Submitted by a Dr. Darren Markland, Nephrology and Critical Care MD FRCPC - Edmonton, AB.

“I am really sorry that I need to do this, please grab my hand.” And though I’ve told her son why I need to rub my knuckles against her ribs I see him recoil. It’s hard to imagine him being more horrified than he already was when I called him three days ago. He’s technically her decision maker.

This man child. She’s raised him well despite her demons. He’s never known the shadows that set her on a long path to my care unit. Yet all his posturing and rage melts away when he sees her convulsing on the bed. His jaw slackens & quivers. Fighting back the tears only makes his nose run.

He’s that snot nosed 12 year old who needed his mom to make it better when he was told he was too small for football. And she comforted him, bought him shoes for afterschool basketball and cheered for him when he made the team.

At 72 hours she’s not making purposeful movements. You’d think in this day and age we would have a machine that would predict if someone is going to make it out of hospital if they stop breathing, but is all clinical. Testing the pathways. It’s a bad sign. It prompts me to repeat her head ct.

“It’s all gotta connect.” The story, the tox screen, the images and the exam. I need to repeat the CT brain. The first one looked normal. “Was there fentanyl in her blood?” “Yes, and ketamine and xylazine, there’s a really bad batch on the streets. She wouldn’t have had time to call out.”

She’s biting the breathing tube and her tongue. The ventilator protests as it tried to deliver breaths. The monitors ring out as if to testify. I need to put her back under. Her brain is a mass of short circuits now. I see his face harden and the rage returns. A wave of unfocused anger.

The new CT is horrible. Showing the ravages of just 5 minutes of oxygen deprivation the scan connects the last of the dots. The damage is clear to the untrained eye. And though he refutes it, he shrinks back down in front of my eyes. His eyes drop as do his shoulders. “Mom, why? …. Mommy?”

I put my hand on his shoulder. There’s no air in the room, and so I hold my breath. He thinks she was clean, but despite trying she would falter. The supply was so dangerous, but there were no other options. No testing, no mitigation, no way back home.

“I will talk with you tomorrow, you can sleep by her bedside if you like.” He’s pulled the hoodie over his head now, to hide the tears, but I can see his cheeks glistening.

I bow out of the room, and walk down to the family room, where another family has been waiting to talk to me.

“I am so sorry about what happened to your son. There’s a really bad batch out there right now.”