17 October, 2020
11 years today since I last used heroin.
11 years today (17th October 2020) since I last used heroin. About 8.30am on the 17th October 2009 was my final time. There’d been many last times over the years. At the time I didn’t know this was really the last time.
It was a Saturday and from memory, much like today weather wise. The previous few days had been a struggle. Years of injecting had wrecked my veins. For the previous couple of years I'd been injecting into my legs; my groin veins were very inaccessible (my arteries too essay to it) so I was going into smaller veins.
At that point it was probably a combination of intramuscular, venous and skin popping (you don't want to know). I had large infected open wounds on both legs, think of bad burns. The left was so bad that, 11 years later, I still have an open wound on it. I also had another problem...
A few days previously I'd felt something when I injected into the left leg. I remember thinking 'uh oh, that's not good'. It was a blood clot (DVT). The pain was excruciating. By Saturday I'd had a few days of shuffling round on my backside unable to walk, blagging lifts to score.
I was now barely able to move. I got myself downstairs and somehow the day passed. I'd left heroin upstairs but was physically incapable of getting back up. I was also feeling hot then cold & having bouts of uncontrollable shivering. I obviously wasn't well (& withdrawing).
Somehow, the day passed. Eventually, that evening, I phoned for an ambulance. I remember a triage call back and they sent a non emergency ambulance. And, so, the journey round the hospital system commenced.
A&E. I should mention that the infected tissue on my legs didn't smell great. I think I'd become inured to it but I could hear the smell being talked about. That, and what followed immediately made me wonder what was going to happen.
An initial attempt to get an IV line in my hand to give me some fluids failed. I was accused of removing it myself. ‘We can’t help you if you don’t help yourself’. It actually fell out. I was told I was probably going to lose my legs. ‘And how do you feel about your legs?’ The left one I'd kind of written off. I still felt attached (emotionally as well as physically) to the right
It got better. I was wheeled to the Emergency Assessment Unit. It was quieter and calmer there. The Dr was lovely. I was given something to ease my agitation (diazepam?) and fully assessed. Turns out they weren't too bothered about the DVT. The raging infection on the other hand...
I was taken to Intensive Care. I needed IV antibiotics, blood (I needed 3 units: 'Have you experienced any blood loss over the last few days Mark?' I hadn't). I was also withdrawing quite badly. I requested Methadone (I also requested diamorphine; I figured they might have some lying around)
My agitation was hindering getting an IV (neck) line in. I was trying not to be a nuisance but was very twitchy. A keyholder was found for the controlled drugs cupboard and I was given methadone. After what felt like hours by a lovely Polish anaesthetist the neckline was in.
The line had 5 separate lines and they started me on IV antibiotics x 2, paracetamol and the 1st unit of blood. I was given some (oral) dihydrocodeine. Arterial line in left arm for regular bloods. My CRP (measure of infection) was impressively high. 'We can't figure out how you're not delirious'
I was asked if I was hungry. Turns out I was. I was given tea (black, lots of sugar) and toast (both orally) and, as the sun rose over Hardwick on the 18th October I started to feel, not well, certainly not that but that I had the capacity to be well. I washed myself, cleaned my teeth. I started to think...
The Dr who had seen me on AEU came to see me and wish me well. 'That was nice of him' said the sister looking after me. It was. It was nice when she came to see me on the ward a few days later too. ‘You’re still here then? I just wanted to check something in your notes.’
I was seen by the surgical team. One of them came over. He was a vascular surgeon but on the general rotation. 'Your legs, they're in a bad way but I've seen legs like that get better. It’s going to take a long time but they can and they will. You need to start looking after yourself, let people look after you'.
I remember that. I occasionally help with student medics and nurses and try to remind them that sometimes the words are as important as the treatment. Even surgeons (nearly all medical students appear to want to be surgeons) need those softer speaking skills.
The next couple of weeks were very up and down. I was moved to a ward, room on my own as on top of everything else I had MRSA. IV antibiotics 4 times a day. Lots of time to think and some long dark nights. The self-haircut with disposable scissors was probably ill advised. Some other moments I won't share today.
But, two and a half weeks after being wheeled in, I left my crutches on the bed and, with my discharge papers and a large sack of meds, walked back into the world. I had some work to do, a life to reclaim.