They are not hard to miss. There is just a look about them – haggard and emaciated. Besides, they carry the stigmata of their affliction like badges.
Their hair is often stringy and unkempt. Their faces bear marks of acne, scratches, cuts… The eyes are sunken into the sockets like there is nothing to hold them in place.
When they open their mouths, the dentition is always a dead giveaway. Terrible! The teeth are broken, carious, missing or loose.
Their lips are often parched and look whitish and cracked.
Their skinny limbs jut out of their emaciated bodies like those of a stick-figure drawn by a child and those arms often betray the horrible habit – track marks. Those unmistakable marks left by needle sticks hint at an addiction that has ruined the life that often lies before a caregiver. Those track marks are often everywhere on their arms and legs, even between their fingers and toes, armpits or even breasts in women and the penis in men.
The hands may be busy, twirling around aimlessly or maybe scratching.
There are also the ever-present sores or abscesses from dirty stick sites.
If one watches their chest, one can see the heart, pounding through that bony thorax.
Yes, intravenous drug addicts look pitiful. Regardless of what they use, be it heroin or prescription opioids or methamphetamine, their sorry state is difficult to miss.
However, what always gets me is the look in their eyes. There are two main looks. There is a hollow and vacant look that betrays a certain soullessness and then there is the one I call the look of craving. The latter is a wild look of want. The first time I saw it I attributed it to a craving for a fix; a need for a shot. Over the years, any time I have been in the presence of an addict and seen that look of craving, it has haunted me for days. Then somewhere in me, I have a feeling that the look was way more than a sign of a craving for drugs.
This past weekend, I cared for an addict. As she lay on the stretcher before me, I looked at her face and saw that look in her eyes – that look of craving. She was hurting and so I initially attributed it to that. However, even after making her comfortable – a gigantic feat in a drug addict – that look persisted. That is when I remembered a conversation I had with another addict a year ago. She told me how tough it was to go a day without a fix. She told me how she wished she could die so she did not have to go through the pain and torture of going a day without. How she wished she had never taken up the habit. Then it hit me. Was the look in their eyes a cry for help? A cry for someone to save them from themselves? A craving for another life?
A Khat addict on the street of East Africa
Addiction has many causes but one of them is an emptiness in one’s life. Getting high gives one the false impression that, that emptiness does not matter or that one can deal with that emptiness. So maybe both looks – the hollow and vacant look as well as the look of craving are stark reminders of this emptiness. An emptiness that results in that hollowness. An emptiness that makes one crave. An emptiness that cannot be filled by getting high. An emptiness that just gets worse and is evident in those eyes that are sunken into the sockets.
Addicts are very manipulative individuals. They can tell the best sob stories and will do anything, even kill, for a fix. Yet, even with them, the eyes still remain gateways to the soul and they cannot mask the pain in their lives that is so evident in those eyes.
With the raging drug epidemic that is afflicting the US, all healthcare providers are seeing more addicts in the hospital setting. Their afflictions range from abscesses of the skin to infections of the heart valves. Not being addiction specialists, all my colleagues and I can do is give them the best preoperative care that we can and hope that they can find the strength to get the help they need. We can only hope that the broken system we call healthcare can give them a chance. Then that might be the first steps to filling that empty space.
Nana Dadzie Ghansah is an anesthesiologist who practices in Lexington, Kentucky