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.
Neurologists and emergency department physicians are frequently involved in the comprehensive evaluation of a first generalized seizure. An important aspect of this evaluation is a detailed history which can identify a provoked seizure secondary to drug toxicity and hence avoid unnecessary treatment with antiepileptic drugs. “Spice” is an umbrella term for a variety of synthetic cannabinoid products whose inhalation has been associated with an increasing number of toxic side effects resulting in emergency department visits. These side effects (including psychosis, tachyarrhythmia, and seizures) are not typically seen with marijuana (Cannabis sativa) use. We report 2 patients with no prior history of neurological disease that experienced their first generalized tonic–clonic seizure after smoking Spice. The mechanism behind the possible proconvulsant effect of synthetic cannabinoids is not known, but it may be due to their effects at the cannabinoid receptor CB1. Although the US Drug Enforcement Administration placed 5 synthetic cannabinoids into schedule 1 for a 12-month period beginning March 2011, new Spice products containing different synthetic cannabinoids continue to emerge. Because synthetic cannabinoids are not detectable on commercial drug screens it is important that neurologists and emergency department physicians consider Spice inhalation in their differential diagnosis of a first generalized seizure.¹
Beauty cried whenever someone she loved entered the room. Physical disbelief that someone could find her, could know where to look, could care enough to visit, when she disappeared.
This time, there were two sets of people who cared: her new boyfriend, Gary, who felt her attack, the way her body stiffened and shook, when she was in bed next to him; and the ones who follow her story.
Her disappearance, the void she left in the course of a day, was marked as before by a bare concrete wall in Hunts Point, but now the absence meant a hospital, not jail, nor a couples' shelter in Harlem.
It was a woman slurring and staggering from heroin who told. The woman who rifled through her purse on the street, and when prompted several times, said she heard that Beauty was in the hospital.
Two calls to different hospitals across the Bronx, Beauty's full name (both given and what the system misspelled it to be) and date of birth.
In her hospital bed, she tried to talk through the emotion, but the sounds were wide and unrecognizable. She pointed from one person to the other by way of introduction and gratitude.
Her man, Gary, wore a backwards hat and a teardrop tattoo under his eye. When she woke the first time, hours after the attack, he was there.
It happened like this: she and Gary crashed at a friend's place (they live homeless, or here and there). She stretched in the early morning and went into a seizure that wouldn't end. It lasted and lasted, and Gary sat there watching while the ambulance took forever. "You know how 911 is."
Later in the day, in the ICU, she slept. Visitors were given pink slips, like tickets, and were allowed 10 minutes. The Green Ward had staff everywhere. Beauty laid on her side, softly snoring. Louder than most people in the ward.
A nurse's aide sat near the foot of the bed, seeking curtained privacy while on hold on a cell phone, and said the women snoring in the bed is rousable.
She did not appear to be rousable by kind measures.
Beauty's body appeared unharmed-- the abscess she had a few weeks ago had shrunken to a mark. In the ICU, she was allowed one visitor at a time, but she doesn't remember.
Visitors that were allowed in -- few she knew had valid state ID or driver's license -- walked back and forth across the hospital, down corridors, looking. Misinformation spanned nine floors and led to empty beds. Down and up and back again.
A friend who lived in a nearby shelter sat in the lobby to charge his phone. Without ID, he could go no further.
When she was lucid, on her in-patient floor, wide-mouthed sounds gave way to explanations. Her tongue was swollen on the sides where she bit down before Gary had helped her breathe. She hadn't seen a doctor; she didn't know what was happening. Could someone find one?
911 is a Joke, Lincoln Hospital. Courtesy of Chris Arnade.
Signs above her bed read SEIZURE PRECAUTION and NADA POR BOCA and ASPIRATION PRECAUTION, nothing by mouth. It was all the information anyone had.
The wing has one attending physician, so the wait was long.
In the meantime, a Pepsi was bought from a machine, money for a TV, bites of meat solid and mashed potatoes from a tray.
The doctor came, asked for one person with consent to hear about Beauty's condition, a person who was then led into the hallway:
Beauty's blood has traces of K2, which likely caused her seizure. She is advised to discontinue use of K2. Her kidneys suffered in that event, so she needs hydration. She has pneumonia in her lungs, so she's being treated with antibiotics. Pneumonia from somewhere else. The hospital would like to keep her another day.
Returning, the person plead the facts to Beauty, as if facts could be what convinces.
"I'm gonna calm down with it. You know if I don't do a little bit, I'm gonna go crazy on it one day and really OD and get messed up. For real, I'm gonna calm down."