Drug Trip in the E.R. - Good Old Special K

By Expat98 · Jun 13, 2008 · ·
  1. Expat98
    Drug Trip in the E.R. - Good Old Special K

    Wednesday December 12, 2007
    By Scott Haig, TIME

    "Oh, Mommy, I like this cartoon world!" From the lips of this perfect little 9-year-old Russian boy, these were welcome words. I was doing something so painful to him yet he was quite comfortable — I was happy to be getting my job done. But soul-chilling doubt attacked as soon as I looked up from his broken arm into the young, innocent, and oh-so-stoned face of my patient.

    Sasha was not a normal kid. His parents told me he was a genuine child genius. Spoke three languages, did 12th-grade math, played violin and piano — if you read Orson Scott Card's Ender's Game or saw Little Man Tate, you know the type.

    Before I gave him the drugs, I explained to Sasha what was going on, why this fracture through the growth plate in his wrist had to be put back in place right away. I told him that the nerve going to his strangely numb fingers was wrapped tightly around a jagged edge of broken bone, that every minute it stayed there increased the likelihood of permanent damage, maybe a palsied hand. His brilliant dark eyes understood immediately. He understood the time pressure, the risks and why I had to treat him right away, in the emergency room. Sasha nodded and said O.K. Then, so did Mom and Dad. I marveled at how these parents deferred to Sasha's judgment. They knew who he was.

    The ER doc with me that night was also exceptional, one of the best there is. She knew a lot about "conscious sedation," that is, knocking patients out just enough to do short emergency procedures without pain or writhing — but also without stopping the patient's heart or lungs. (Emergency rooms are not operating rooms; sedation can be risky, and Sasha had a full stomach, another danger.) But Melissa was her usual cheerful, omnicompetent self: "Don't worry, we can fix up that arm right here. We'll just use a touch of atropine, a little Versed for the nightmares and then the best drug there is for this sort of thing — good old Special K."

    Special K, or ketamine, is in fact an old drug. Available since the early '60's, it has enjoyed something of a rebirth in the past few years in hospitals, in-patient psych facilities and — illegally, of course — in nightclubs (the sweaty-techno-mosh-pit kinds, not the ones with elegant ladies at small tables). Though it's listed as one, ketamine is not really an anesthetic; it's not even an analgesic. It doesn't actually stop pain. On Special K, you'll still feel pain — you just won't care. Patients I have seen on ketamine become nonchalant about what's going on with their bodies, as if they're not really in there: "Out of body" is how users say they feel on it.

    Many patients, like Sasha, seem to be fascinated by the Special K high. This is what mortified me that night when I realized how much he liked what ketamine was doing to his amazing brain. I was afraid that Sasha had tasted a forbidden fruit, peeked into a place he might never forget, one he might long for. Into a 9-year-old mind already struggling with so much adult turmoil, we had loosed a psychedelic snake proffering an alternative and apparently pleasant reality.

    What scared me more was that I had never taken a bite of that apple myself. Put another way: I can describe my wife's chocolate cake. On a good day I could probably write 1,000 words about it. And you could read them all. But unless you had a bite (with coffee) you would never know how good it is. You wouldn't know it like I do. I've never been on ketamine, so I know it only as well as a reader would know my wife's cake — secondhand. I wondered how could I warn Sasha about this drug. Without firsthand experience, could I still reason effectively with him about it? I wondered if there was anyone who could, who could say something like "Look here, son, when I was in fourth grade, reading Crime and Punishment and doing analytic geometry, I tried getting high on ketamine and it seemed great, but let me tell you why it really wasn't"? I held Sasha's arm and watched his face as the plaster cast hardened. He was tripping, staring into the mystical middle distance, breathing deep and easy. Was this the face of the next Timothy Leary or Aldous Huxley? Was it my fault?

    "Please don't let this mess him up." Formed silently on my lips.

    A different set of eyes turned. We waited.

    And then it was over. Boy, was I happy to see that first grimace of pain. The plaster was hard, the X-ray was good and the child prodigy was back. He was still a little groggy from the Versed, but there's a world of difference between the sleepy-drunk effects of that drug (it's in the valium family) and the floating, hallucinating, who-am-I? mystical effects of ketamine. As Sasha returned to normal I tested the nerve to his hand. "Do you feel me touching your fingers now?" I asked.

    "Yes, but I won't be able to practice in this cast," he answered, and I knew, at least for the moment, that Sasha's big brain had won it's fight with Special K.

    And, yes, he was the model patient when he came to the office for follow-up. He claimed (perhaps a tiny bit evasively) that he didn't have nightmares and that he couldn't recall anything weird about the night we fixed his arm. Versed does cause amnesia — sometimes. But I like to think it was something already in there, more mysterious and far more powerful, that brought Sasha's head back to earth.

    Dr. Scott Haig is an Assistant Clinical Professor of Orthopedic Surgery at Columbia University College of Physicians and Surgeons. He has a private practice in the New York City area.

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  1. cra$h
    hmm.... glad to see that people are going to respect k more than they do with oxy's. and versed is used to enduce amensia. swim has experienced it 2x, and both times swim forgot the surgery, but suposedly was still concious and "aware" of the world. but if versed was used to help for pain, why was k even involved?
  2. AquafinaOrbit
    Glad to see it getting some medical recognition. Personally think the article is terribly written however
  3. Expat98
    ^^I thought the writing was ok, but I find this doctor's stance to be ridiculous:

    Without firsthand experience of the drug's effects, what makes him so confident that Sasha needs to be "warned" about it? [​IMG]
  4. Paracelsus
    You don't need any first-hand experience to know that some people get addicted to ketamine and that such addictions can turn out very ugly. The man was just trying to be a responsible doctor, I think. Nice article.
  5. Expat98
    I think if you read the article carefully you will see that his concern is not addiction, but that this drug experience opened the child's eyes to the fact that drugs can affect the mind in profound ways. The doctor's attitude is that this is inherently a bad thing, and that's an attitude that I just do not agree with.
  6. Paracelsus
    His concern was more that Sasha's fascination fascination may result in a longing for the experience. Which is neither unrealistic, nor surprising for someone who doesn't do drugs.
  7. Expat98
    Right. He was afraid that, "we had loosed a psychedelic snake proffering an alternative and apparently pleasant reality." Implicit in these comments is the misguided notion that this is inherently a bad thing. As you note, this attitude is not surprising coming from someone who's never tried ketamine or psychedelic drugs themselves.
  8. cra$h
    but why was k used in the 1st place, if he's so scared of a potential addiction?
  9. Ontherooftops
    I don't think we have any evidence that the doctor had never taken drugs himself, he seems fairly level headed about the whole business, and familiar with the power of a psychedelic experience, he simply stated that he had never taken ketamine.

    No matter what you feel about the psychedelic experience and drug use, most swimmers found these substances themselves, through their own curiosity, not out of medical necessity.

    At the age of nine, one hasn't fully formulated their own reality no matter how prodigal, its simply a matter of the time it takes to aquire life experience. The doctor likely is aware of this and knows how an interest in other realities could interfere with the boy's current exploration of his own mind in its natural state and the things that it can do.
  10. Expat98
    I would agree that a medical procedure is not the ideal situation in which to be introduced to mind-altering drugs and that 9 years old is probably too young for a first experience. But we are talking about a single experience here, not a recreational habit.

    The way I would look at this is that this child prodigy had been exposed at an early age to a profound experience at which he would most likely look back on later with appreciation.

    But the doctor seems to have no appreciation for it at all. Just look at the words he uses:

    "I knew, at least for the moment, that Sasha's big brain had won it's fight with Special K."

    "I held Sasha's arm and watched his face... Was this the face of the next Timothy Leary or Aldous Huxley? Was it my fault?"

    The world should be so lucky as to have another Aldous Huxley!
  11. Paracelsus
    I'll try not to continue arguing for too long, but the doctor's attitude, despite the ignorance behind it, was the only responsible one in such a situation. Doctors aren't there to glorify drug experiences.

    P.S.: I'm pretty confident that the world will do just fine without a new John C. Lilly...
  12. Expat98
    Your thoughts are appreciated. I hope that nobody looks at my posts in this thread as argument in the negative sense of the word. They are intended as debate or discussion. I thought this article was interesting for a number of reasons, and I was hoping when I posted it that it would generate some discussion.

    I have no problem with the doctor acting in a medically responsible manner in the E.R. It is publishing this (in my view) misguided article in one of the U.S.'s most widely read magazines that I don't like.
  13. Panthers007
    Once upon a time, ketamine was used as a short-term anesthetic in quick procedures in US hospitals. As well as being widely used in MASH units in Viet~Nam. But it fell into disfavor in the US because of "emergence reactions." This is where your Dad would emerge from the anesthesia saying he met God and was shown the inner-workings of the Universe. And DAD was an atheist! This didn't go over too well.

    So it's use was rolled back in US medicine. It would/could be used in young children. They might emerge talking about cartoons. Or, even, God. But they were kids, so it was "cute." No one really gave a shit. Unless the kid turned into a Playground-Preacher (such has happened - accusing teachers of being "Fornicators!" - but it has never been linked to ketamine. Might have been insane parents). This might make the hospital liable for legal damages. So it's use was scaled back further. Today it is near zilch.

    Any doctor who admitted to his patients/family to having tried what is, in effect, an hallucinogenic could expect to be avoided like the plague. Would you approach a patient you were going to operate on and say: "Hi! I'm Dr. Zorpensteen. I've been to the Clear-Light of the Void! And I'll be cutting you open today!" I thought not.
  14. Heretic.Ape.
    Interesting article. I wonder if he would have had such fears and reservations in using the ketamine on a kid who wasn't a genius. Is his fear of people enjoying drugs or of feeling a certain accountability in potentially playing a part in turning the kid toward interests that are not socially condoned? Lord knows we all want young Sasha to grow up to be a good successful doctor or lawyer rather than a kooky revolutionary or philosopher.
    Not sure what I think yet. Have to read it again when I've had some coffee.
  15. enquirewithin
    Interesting that a genius child would have such a positive reaction to ketamine, which he might have found frightening. Any professional should worry about his patients. (Ketamine addiction as such is not that common amongst users, I suspect.)
  16. Expat98
    ^^I don't understand. Sasha was clearly not having a bad reaction to the drug, so what is it that you think the doctor should have been worrying about? It seems to me that what he was worried about was that Sasha would become interested in altered states of consciousness because of this experience. Do you think that is a legitimate worry?
  17. Bajeda
    Language proficiency has nothing to do with intelligence at such a young age. In fact, any child is a genius when it comes to languages, as they have essentially equal ability to learn any language. It just depends on how much exposure you have to other languages at a young age, so not surprising at all the kid can speak several, particularly if he is an immigrant or travels outside his country frequently.

    Playing violin and piano doesn't mean jack either. He could play them really shittily and the doctor wouldn't know. Not to mention that research suggests that musical prodigy doesn't really exist, and its just a ton of practice starting at a very young age that allows younger people to excel at music. Even Mozart's first compositions were pretty crap, and he had one of the most famed music teachers in Europe for a father.

    Same thing for the kid doing "12th grade math". Just because its usually taught then doesn't mean you can't learn it earlier. I'm assuming the kid's parents make sure he studies and works hard and he has put in much effort to get to that level. Doesn't make him a genius.

    Ender's Game and Little Man Tate are fiction. Go figure. Sort of like the concept of little geniuses.

    You can just see the doctor perpetuating his own value judgements in his own mind.

    A little kid, scared or not, gets a medical explanation concerning the necessity of the procedure, nods his head ok, and the doctor assumes he understood it all because of a simple 'ok'?

    What about all the other kids he deals with and has to explain reasoning too. Does he just assume they don't understand him when they nod and say 'ok' because their parents didn't tell him he was dealing with a little child genius?

    And about the parents, maybe they just want to reinforce their son's optimism. Who says they are deferring to his judgment? They obviously had the procedure explained to them beforehand and would have objected to it if they didn't agree, so I see this as yet another instance of the doctor reinforcing his perception of the boy as a child genius, a 'different' sort of patient who for some reason should be treated and perceived differently than others.

    I think that explains alot of the article right there.

    This just pisses me off. I don't care for Timothy Leary much, but Aldous Huxley?

    As HereticApe mentioned, society wants little Sasha to grow up to be a nice doctor or lawyer, but fuck that. He should grow up and choose for himself what road he wants to go down. If he turns out to be the next Aldous Huxley, it would pain me all the more to think that the fine doctor/author considers it to be a waste. As if lawyers are any more fucking useful.

    His "big brain"? Who says his brain is any bigger than average, even if he does possess above average intelligence?

    And won its fight with Special-K? Is this guy actually a doctor? Not only is he using the slang, he is expressing the pharmacologic aspects of the drug in an utterly retarded manner.

    Again, this guy is a doctor? Sasha didn't go to outer space. His mind simply came under the influence of a dissociative psychedelic with a short duration of action.

    What a worthless article.
  18. Panthers007
    What explains this reaction/action on the part of the doctor? One word:

  19. Bajeda
    And where does the fear come from, aside from it possibly being a generalized response to the unknown?

    Two possibilities:

    1. The doctor is afraid that this nine year old boy is somehow going to like Ketamine enough that he will go out on the street to get some and then get addicted. [​IMG]

    2. The doctor is afraid that the boy will discover the unfathomable mystical world that exists outside what he currently knows, and that he could end up in a non-typical profession, causing all that intelligence to go to waste, oh noes! :eek:

    More about the 'reading description of cake' vs. 'eating cake' thing.

    Maybe your body is still experiencing pain, but on a subjective level you won't feel it, so the doctor seems to have used a poor choice of words.

    My monkey will tell you that he couldn't feel shit while on Ketamine, and that you could have taken a baseball bat to his arm and he wouldn't have felt it. Its not that he wouldn't have cared about it, but that he couldn't feel it in the first place. Maybe the nerves were still firing off pain signals to his brain, but his brain wasn't taking any note of them.

    Me thinks this doctor could do with trying a psychedelic once to get some of the BS stereotypes and misconceptions out of his head.

    "Poor Sasha! One trip and he'll spend the rest of his life hugging trees!"
  20. Panthers007
    Find the doctor's address. Send him a Ficus, FedEx.
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