如果您在过去的十年中的任何时候告诉我，当我的兄弟杰里米（Jeremy）与阿片类药物成瘾作斗争时，它将在圣路易斯医院的一家蜂鸣器上聆听机器的蜂鸣声，学习诸如此类的术语缺氧性脑损伤和糖尿病急症当一个移植团队讨论器官捐赠时，我会坚持认为您是错误的。我会告诉你，他没有办法在30岁时死亡。
不过，这就是现实。
2020年11月11日，我接到妈妈的电话，告诉我一个女人发现我的兄弟昏迷不醒，在圣路易斯高速公路侧的卡车上没有脉搏。陌生人打电话给911，当医护人员到达现场时，他们花了八分钟的时间将他复活，然后将他运送到医院。在我知道自己在做什么之前，打了电话，输入了信用卡号，包装了行李，我当时正在租用五个州的租车赛车去找他。
世界仍然处于2019冠状病毒病大流行当我到达圣路易斯大学医院时，当我进入建筑物并填写接触示踪表格时，我必须检查温度，然后才能真正看到我的兄弟。当我终于到达他的房间时，我犹豫了在门外，专注于30岁男性附上的标签。没有名字或其他识别特征 - 可能是那扇门另一侧的任何人。这是我四年来第一次见到我的兄弟，那些在医院里的日子就是我和他在一起的最后时刻。
当我无所事事地站在房间里，他的护士在房间里结束了，问他们知道什么，那时并不多。All they said was that if Jeremy’s condition didn’t change rapidly (for better or worse), someone would have to make the decision to turn off his ventilator or move him to a long-term nursing facility, where the chances of him being in a vegetative state forever were high.
当护士终于在他的房间里结束时，我能够拉起椅子与他坐在一起，我两个人伸手去拿他的手，将目光固定在裸露的皮肤上的裸露的皮肤上纹身 - 他18岁之前获得的朋克摇滚风格的汇编，并试图想到对他说些什么。即使在他的创伤状态下，我也感到惊讶。他肮脏的金色头发朝着他的头侧面张开，他的胡须饱满了。他宽阔的肩膀填满了精致的黄色医院礼服。
“嗨，杰伊，是克里斯塔尔……我在这里...我现在需要你醒来。”在无菌空间中，我的声音听起来很大，发抖和外国。我觉得我失败了。在纽约这么远的地方，我被切断了他，我希望当我知道他清醒时，我能伸出更多东西，告诉他我为他感到骄傲并继续战斗。“我非常抱歉，这发生在你身上，”我一遍又一遍地小声说道。
杰里米五天后去世。死亡原因：芬太尼过量。
一种流行病，只是不断增长
The phrase阿片类药物危机在过去的几年中，人们逐渐进入我的意识 - 通过新闻报道，政治演讲和选举竞选活动的辩论一直在编织，围绕消耗整个社区的流行病进行辩论。现在，阿片类药物account for more than two-thirds of死亡人数从药物过量的药物中，这个数字只有合成阿片类药物的增加，例如芬太尼，是推动力。
When the COVID-19 pandemic hit the country, it only escalated the crisis, causing a spike in overdoses and leading some experts to预测2020年可能是阿片类药物相关死亡的最致命的一年。最近发布的临时数据显示，阿片类药物的死亡在2020年3月中旬猛增，就在该国锁定时，报道了14,895该年的三月至10月的死亡。
And while the whole world was locked down, individuals struggling with addiction were cut off from their jobs, friends, family, healthcare, and whole支持系统。整个社区都变得更加脆弱，同时又集中在其他地方。我不知道我的兄弟在为时已晚，以帮助他才沉浸在这场危机中。
Potential Cut Short by Pain Meds
回顾过去，很难确切地知道我的兄弟是如何从如此可预防的东西中垂死的。是的，我们的童年很麻烦，但是我不确定我会知道第一个撞击挡风玻璃并在杰里米（Jeremy）的生活中慢慢崩溃的卵石。为了梳理我对他的记忆，直到他首次清醒的尝试，才能面对如此多的潜力。
杰里米（Jeremy）在加利福尼亚州的赛普拉斯（Cypress）长大。他很聪明，聪明，我永远无法理解科学和数学，就像阅读一盒通心粉和奶酪上的说明一样。他不是一个超凡的成就，但是当他13岁时，我看到他拆开了一个VCR，然后将其放回原处，而无需手动。他也很受欢迎。我们高中的许多老师和管理人员甚至都以名字认识他，不是因为他是个麻烦制造者，而是因为他很有趣，富有魅力和外向。
杰里米（Jeremy）是我们家庭中唯一的男孩，有三个大姐妹和一个年轻的姐妹。他一生都被女孩包围，一直在寻找他从未有过的强大男性榜样。当我12岁和杰里米（Jeremy）9岁时，我们父亲在一次车祸中死亡。他的白色福特游骑兵（在杰里米（Jeremy）中发现了同样的制造和模特），从路上漂移，滚上山坡，颠倒过来，立即杀死了他。Jeremy spent most of his childhood being told how much he resembled him, and I can’t imagine what was going through his head when he decided to get the same truck as our dad or what sick joke the universe was playing when it decided that both their lives would end in a white Ford Ranger on the side of a freeway.
Jeremy and I became close when I was about 16 and he was 14. We would go for jogs in our neighborhood, vent to each other about our crazy grandma we were living with, and borrow one another's CDs. By the time I was approaching my high school graduation with my eyes set on college, Jeremy’s relationship with our grandma had worsened, causing him to drop out of school and disappear into the massive void that is Corona, California, where my mom’s side of the family lived and where drug use was a common way to pass the time. It didn’t take long for Jeremy to start experimenting with different drugs until he became addicted to opiates.
杰里米（Jeremy）试图几次清洁，无济于事。他在2011年的第一次尝试使他步行了几天，步行到不同的门诊康复中心和排毒整个Corona的诊所，试图找到一个可以带他的地方。他的资源有限，没有钱，也不是被定罪的罪犯，因此他不能被命令康复。那是他打电话给我并寻求帮助的时候。
Jeremy had just become a father — my niece was only a few months old — and he told me that had been the motivation he needed to get clean. On my drive to see him I passed the high school we attended together and the same spot on the 91 freeway that took our dad from us 12 years earlier. When I finally reached Jeremy, he looked embarrassed to see me. He wasn’t the same guy I remembered, smiling from the inside of a high school football jersey or singing along to Taking Back Sunday with me in my first car, but he wasn’t completely gone either. The jeans and zip-up hoodie he was wearing were clean enough, and it didn’t look like it had been that many days since his last shower. His dirty blonde hair naturally spiked out around his head, but it was longer than I had seen it in a while. His honey-brown eyes, exact replicas of my dad’s, looked at me pleading and desperate.
在我同意帮助他之后，我不知道从哪里开始。我以前从未积极参加过某人的清醒尝试。I wasn’t even sure I could figure it out, but when my brother looked at me, eyes watery, shaky hands holding out folded-up papers of information on free clinics and rehabs, I knew I couldn’t let him go at it alone. With help from a friend, I was able to get in touch with someone who advised me to get him into a detox center.
当时他一直住在加利福尼亚的河滨县，我住在奥兰治县。县之间的距离仅约30英里，但我被告知要在奥兰治县选择一个排毒中心，以使杰里米更难走出房屋并返回他熟悉的领土。我打电话给我被给予的数字，询问可用空间，最后找到了一个带他的地方。一旦整理好了，我们就去了斯坦顿的罗克排毒中心。
我记得那天天空是一种不自然的蓝色阴影，没有一片白色的斑点。南加州有一种有趣的方式来提供一个可以完全与心情相矛盾的背景。在车里，我们保持沉默。我能感觉到希望，绝望和原始恐惧的奇怪混合。他烦躁不安 - 改变了我的汽车中通风孔的位置，并敲打了双腿的侧面。
杰里米（Jeremy）在该设施中呆了10天。在他的最后一天，我接他，开车把他带到一个清醒的住所。几天后，他复发了。那是我们开始进一步分开的那一刻。到他最终去了圣路易斯的医院时，几年来我都没有和他说话。我只听到了有关他的一位姐妹的生活和清醒尝试的二手信息，以及从他的社交媒体帐户中可以拼凑的东西。他多次在全国各地搬到伊利诺伊州的俄勒冈州，回到加利福尼亚 - 试图在新的地点开始新的起点，并在第二次后在俄勒冈州开设一家小房子业务孩子出生于2018年7月。
不过，他的成瘾总是赶上他。
学习危机的真正范围
Having this crisis hit so close to home made me search for the one thing I could latch on to, to unleash all my anger and frustration. I still don’t know exactly where to direct it all. At my mother or dead father for not setting a good example? At the greedy pharmaceutical companies for over-marketing and misrepresenting addictive opioids? At the lack of government oversight over large medical distributors? Or the flawed treatment programs and stigma associated with drug abuse? I believe that all of these things had failed Jeremy and every other person like him.
自从我从不想知道以来，我学到的关于阿片类药物的知识。I didn’t want to know that Jeremy’s almost yearlong sobriety before he was found in his truck could have contributed to his death — that relapsing on opioids is more dangerous than the addiction itself, due to the brain's ability to lose tolerance for a drug over time, making a dose an addict is used to taking much more deadly. I didn’t want to know that so many fentanyl overdoses are caused by a rapid use of synthetic opioids laced in many illicit drugs and that so often victims don’t even know that they’re taking it. I didn’t want to learn that the pharmaceutical companies that pushed the use of fentanyl through受贿广告系列和其他积极的营销策略与现在相同的公司相同naloxone，用于防止阿片类药物过量死亡的鼻喷雾。
说再见
On November 17, 2020, I stood in a hospital room as a team of nurses, doctors, and assistants packed up Jeremy’s hospital bed and wheeled him out of the room to perform the final test that would confirm what so many doctors already knew and tried to prepare me for — that his brain had gone without oxygen for too long, it had swelled too much, it was slipping, crushing his brain stem, and there was nothing they could do to stop it.
那天下午，我看着房间里的所有东西都变得未经锚：装满滴水液体的塑料袋被缠绕，并用轮子固定在新的架子上。挂在他的呼吸机上的机器被脱离，并用便携式呼吸机代替。开关翻转；将绳索卸下并插入新的插头；我无法识别出点击的关闭并紧紧锁定的东西，直到房间里没有任何东西都没有螺栓固定为止。然后一切都消失了，就像通往医院室的门变成了一个巨大的空白，一切都吸引着 - 包括我的兄弟，以及我仍然需要问他的所有问题。我呆在后面，遭到安静的袭击，不再能够依靠机器的哔哔声和电动机的嗡嗡声将生命呼吸到我们一直在分享的小泡沫中。沉默突然爆发，我为接下来的一切都做好了准备。
当医生进行最终测试时，我被带到了一个来自移植团队的两名女性的会议室，我的妈妈在扬声器上，而他们询问了有关杰里米的生活和习惯的详细问题。我们知道他对丙型肝炎从成为静脉注射海洛因使用者，并且使器官捐赠过程变得复杂。不过，他们向我们保证，他仍然有很多方法可以帮助他人。
最后，他通过器官捐赠挽救了五个生命。“我希望这能在这个艰难时期带您和您的家人安慰，，，，” one of the women texted me when I was back home in New York, along with a list of the gender, age, and state of each of his organ recipients. As strange as it was to receive that message, I was comforted knowing that the Jeremy I knew would have selflessly given anything he had to someone less fortunate — and in some way he will live on through the people he helped save.
After I left the hospital for the last time, I drove the 45 minutes to where Jeremy had been living in Highland, Illinois, in an attempt to find a connection to him. He had a nice apartment, clean and uncluttered. He had a separate room with weights set up and an empty bottle of Crown Royal on a kitchen shelf. Most of the pictures I found lying around were of his kids, who were still living with their maternal grandparents and probably would be for the foreseeable future.
I looked around the three-bedroom space and tried to soak up as much of my brother as I could. I grazed through his hat collection and the contents of his refrigerator. I looked through his closet and picked up a red McDonald’s staff T-shirt and held it close to me. I took that shirt home with me.
当我最后一次走出哥哥的公寓时，我想起了我在医院与一名妇女进行的最后一次对话，该妇女被从行政办公室送往行政办公室，让我签署了他们所需的论文以移动杰里米的尸体。当她手里拿着签名的表格时，我们彼此之间只站了几英尺，我犹豫了一下，不想离开医院，再也见不到我的兄弟。她俯身拥抱我，泪水威胁要溅到眼角，但阻止了自己 - 库维德阻止了一个陌生人的安慰机会。
“Is there anything I can get you?” she asked me once it was all over.
“一台十年的机器，”我哭了起来。“你碰巧没有其中之一，对吗？”
重要的：本文中表达的观点和观点是作者而非日常健康的观点。
