Welfare check. The superintendent lets us in. The apartment is a poor man's hoarderville, open boxes and dirty clothes stacked as high as the unwashed dishes in the sink. The man is sitting at a table with his head in his hands; a chess board in front of him. For a moment, I fear he is not breathing, but when I nudge him he moves. He turns slowly and stares blankly at me. I ask if he is okay, but he doesn't answer. I nudge him again but he is out of it. I try to get him to squeeze my hands, but he doesn't follow any commands. Still, he has a decent pulse and his breathing while a bit slow is even.
His medications are on the table alongside the chessboard. I read the labels. Metoprolol and HCTZ for hypertension, furosemide for congestive heart failure, simvastatin for high cholesterol, coumadin for atrial fibrillation and blood clots, allopurinol for gout, metformin for diabetes, oxycodone for pain, colace to soften his stool. As I reach for each bottle, I can't help but admire the antique chessboard; the pieces are large and carved from wood. No idle purchase.
I always wonder about my patients' lives. On the wall there is a picture of a strong man in military uniform and another with the same man with a large family around him. There are many pictures of younger children. The pictures are old and faded.
We pick him up, me with my hands under his arms, and a firefighter grabbing his legs. It is then I see the torn heroin bag on the floor below the chair. I check his eyes once we have him strapped in on the stretcher. His pupils are pinpoint, but he is breathing well enough that I don't need to give him any naloxone. This is a dose, not an overdose. All he needs is a little shake to keep his breathing up when he nods off.
I wonder how many years has he been using and where did he get the heroin from? By the door there is a walker, the kind with tennis balls on the ends to make for smoother rolling. Did he push his walker all the way down to Park Street to get his $4 bag or does his dealer knock on the door with a regular delivery?
Was he once one of those who played chess in the park for a dollar a game? When was the last time he played a fellow human, relegated now to playing against himself in this dim apartment? I wonder if he replays lost games from his past, like many chess masters do, studying them to see where he went wrong. Maybe the heroin helps him play better, relaxing him and letting his mind see patterns that reveal to him the proper move.
I pick up my gear as we prepare to head down to the ambulance. I take a last look at the chessboard. I am new to the game, but it looks like if he is playing black, he is in a losing position. White's pawns are advancing on his king and his two rooks are about to be forked by the opposing knight. Soon his pieces will join those already taken, standing helpless now on the sidelines, among his battalion of prescription pill bottles. The battle will come to an end. As it will one day for us all.