This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.
Skin and soft-tissue abscesses, a common problem among injection drug users (IDUs), result in serious morbidity for the patient and costly hospitalizations for incision and drainage; however, there has been little etiologic or preventive epidemiologic research on this problem.
Subcutaneous or intramuscular, instead of intravenous, injection is a major risk factor for abscess among IDUs. The injection of a cocaine and heroin mixture, or "speedball," may predispose patients to develop abscess by inducing soft-tissue ischemia. Cleaning the skin with alcohol before injection was found to have a protective effect. ¹
Sarah: Hunts Point, Bronx. Courtesy of Chris Arnade.
A cigarette case operates as a drug use kit. The flat metal box opens to reveal order: sealed syringes in plastic wrappers, silver cap, plastic water dropper -- things supplied by the harm reduction van that drives by at night. The silver case lays on a mirrored dresser top. The silver takes over in reflection and in the real world.
Users in the flat henpeck at supplies. Someone needs the dropper and clean water. (Fine, she'll make do without the water.) Someone else needs a crack stem.
Because of certain tools' singularity, a procession unfolds: one person smokes crack while waiting for the heroin cap. Another holds a lighter, staring, awaiting both.
Few inject quick. Roller veins, once-there-now-gone veins. Many need help.
It's hard not to miss. Veins, dried, leave behind branched shadows. New ones are tried -- in the foot or neck -- some not thick enough to support a passage of drugs.
It's a waste to hit the skin or muscle. A huge fucking waste. $10, 20, 30...
On some skin, sores peek out beneath hand-torn capri pants and spandex tops. If you squeeze an abscess, pus and fluid leak out, requiring a cloth or napkin to soak up the water-like clear.
Care of such, based on rumor, varies. Keep the area dry or moist? One method's tried one day, another the next. Group-share antibiotics (if someone's been to an ER lately).
No matter how big the abscesses are, theirs aren't too bad, not like their friend Millie's, the one who died. It was Millie's fault she shot drugs (cocaine and heroin "speedballs") into her open wound repeatedly. She should have known the infection would spread from her skin to her blood to her heart.
But an easy gaping mark is a window for a needle in an expanse of closed skin, and things are different when shaking from withdrawal.
Clear fluid mop-up meets dates and kisses and drugs and an increasingly distanced hope for the wound's openness to be made smaller, hope authorized by the oxygen bubbles of stolen hydrogen peroxide.
Love in the Time of Heroin: Hunts Point, Bronx. Courtesy of Chris Arnade.
Why worry? The hospital just digs the bad out, after all. Why can't they conduct private practice, squeezing over incision?