"How to Use Narcan" by Bonnie E. Carlson
Jessa sits in the noisy yellow school bus, her eight-year-old brother Gabe at her side on the cracked brown vinyl seat. They jounce their way to the library over potholed roads in the hilly, barren, southern Ohio countryside. The older boys in back punch and poke at each other while they argue about some girl. Other kids sing and dance in their seats to music blaring from somebody’s phone on speaker, arms waving in the air to the hip-hop beat.
Jessa pulls her wavy chestnut hair back in a scrunchy. “Have you got your homework in your backpack?”
“’Course,” Gabe says. He smiles at his older sister’s pale, open face and upturned nose and takes off his gloves.
Jessa ruffles the messy, dark-brown curls that tumble out below his knitted hat, grateful the bus stops at the public library each day after school. Small for his age and thin, Gabe’s ADHD makes school a challenge. The tranquility and order of the library help. Getting back home afterward to the mobile home park where they live is another story though. If they can’t find a ride, the mile and a half walk after dark will be dicey on rural roads with no sidewalks.
At the library, a bunch of kids, mostly teenagers, tumble off in heavy winter coats, laden with backpacks and other gear. Jessa and Gabe enter their haven, greeted by the library’s clean, open spaces and the enticing smell of books. Passing the displays of used books and donations for sale, Jessa tries to imagine owning so many books you can give them away because you don’t want them anymore. People speak in hushed tones. Jessa craves the quiet of the library after the chaos at school and the uncertainty of what they’ll find at home. This is the only place sane enough for them to focus on homework.
Walking in, Jessa noticed the county public health van in the parking lot. A librarian is scheduled to present with a county drug prevention educator on how to administer Narcan to reverse a drug overdose. A bunch of kids have showed up. Jessa and her pals on the town Youth Council insisted the school should have these sessions, but their stupid, head-in-the-sands school board nixed the idea.
Last month, the Youth Council appeared before the school board the night this issue was on their agenda. Some moron had argued it wasn’t “appropriate content” for kids. That it would be too “traumatic.” Right. They were in total denial about how many parents were addicted. Jessa had prepared a speech but ended up going off-script after she heard their ridiculous arguments. “If you think administering Narcan is traumatic, what do you think it’s like to come home and find one of your relatives lying on the floor ’cause they’re not breathing, a needle sticking out of their arm?”
That shut them up, but after she left, those idiots still voted no.
The county resorted to other locations that allowed them to conduct their seminars, even a McDonald's that had found customers OD'ed on the floor of their restrooms. The library, too, had found evidence of drug use on-site, and they knew patrons often used their Wi-Fi to seek out drug treatment sites. That’s why the presentation is here today.
Jessa wants Gabe to attend even though he’s only in third grade and the idea scares him. But not as much as seeing one of their parents on the floor after an overdose would.
The kids file into a conference room with a large table, now so packed they need to haul in extra chairs. Four large, flat, boxes sit in the center of the table, and the aroma of pizza fills the room. The drug prevention lady, Susan Marshall, is already there with the children’s librarian, Emily Harrison.
“Hi, Miss Harrison,” Gabe says, flashing a shy smile at the pretty young woman he’s spent so much time with at the library. He adores the red-haired librarian who brims with enthusiasm about books. Sometimes Jessa thinks of the library as his home away from home. Both have spent lots of Saturdays here reading and using computers and free Wi-Fi. With no money for books—hell, sometimes they have trouble paying rent on time or run out of food stamps before the end of the month—the only chances to read are at school and here.
Ms. Harrison pushes her glasses up on her head. "Hi, Gabe. Good to see you here this afternoon. Hey, Jessa, how’s it going?”
“Okay, I guess. Things at home are about the same. No worse than usual. I wasn’t sure Gabe was old enough to learn how to use Narcan, but I decided it wouldn’t hurt.”
Ms. Harrison nods, her chin-length red hair swishing.
“Before we get started today,” says Susan, the tall, heavy-set health educator, “I thought maybe some of you would be hungry.”
The kids laugh. It’s four-thirty, and lunch for most had been before noon. They’re starved.
“So, help yourselves to pizza, grab a water, and we’ll get started after you’re done.”
“Eat as much as you can,” Jessa whispers to Gabe. “Who knows what’s at home for dinner.”
Fifteen minutes later, Susan asks if they know what addiction is. Several hands shoot up. She calls on a sandy-haired boy who looks about ten. “It’s when people do too many drugs and can’t stop.”
“That’s right,” Susan says. “And what happens when they take way too much—”
“They can overdose,” interrupts a teenage girl with curly hair and freckles. “Like my mom last Christmas.”
“I’m so sorry to hear that. Is she okay?”
The girl shrugs. “She went to the hospital afterward and now she’s home.”
“How many of the rest of you know someone who’s addicted or using drugs?” asks Susan.
Gabe and Jessa raise their hands. In fact, every hand in the room shoots up. No one bothers to look around first to see how many other kids raise their hands. Jessa shakes her head in disgust. She hates this rinky-dink town.
Susan takes a deep breath. “Wow. There’s so many of you. I’m sorry you’ve all had this experience.
So, Ms. Harrison and I are here today to tell you about something called Narcan. It’s a nasal spray, a medication that comes in a little injector that can be used to reverse a drug overdose, which unfortunately can kill someone.”
Heads nods, kids already familiar with Narcan.
Ms. Harrison clears the pizza boxes away while Susan takes out several small blue canvas bags with white lettering. She unzips one and pours out its contents, some funny looking white plastic things with a point at the end.
“Today you’re going to learn how to use Narcan,” Ms. Harrison says, “so if you’re ever in a situation where you’re with someone who overdoses on drugs and stops breathing, you can give it to them and maybe save their life.”
Every kid now has their eyes focused on Susan, watching with rapt attention, the room silent.Jessa has already been trained in how to use Narcan, months ago with the other kids on the Youth Council. Gabe needs to know, too. She avoids leaving him at home by himself with Mom or his dad, Billy, but sometimes she has stuff to do, like a volleyball game, and can’t take him with her.
“If someone looks like they’re not breathing, you think they might have overdosed and you can’t wake them up,” Ms. Harrison said, “Narcan could save their life.”
Susan holds up a white plastic device. “It works kind of like a squirt gun,” she says. “You put the device in either side of the person’s nose and squeeze it. Here’s how it works.
“First, gently pull their head back. Then, holding the device with your thumb on the bottom and your first and middle fingers on the tabs on either side of the nozzle, insert the nozzle into one side of their nose until your fingers are against the bottom of their nose.” She demonstrates. “Then press the plunger all the way and spray the whole dose of Narcan into one nostril. You only have to do one side. They should revive and start to breathe pretty quickly.”
Jessa looks down at Gabe, the smallest kid there. He looks scared. She takes his sweaty hand and whispers, “You okay?”
He nods solemnly.
She looks around the room at the faces of the other kids. Some look confused, their eyebrows furrowed.
“Can I have a volunteer to pretend they’ve overdosed?” Susan asks. “We won’t use any actual Narcan while we practice,” she reassures the group.
Jessa raises her hand.Susan shows how to open the cellophane packaging and, holding Jessa’s head back, pushes the pointed end of the empty device into one nostril, and presses the plunger. “It’s that easy.”
Then it’s time to pass out the empty Narcan devices and give the kids a chance to practice on each other. “I want each of you to try pushing the plunger, so you know what it feels like to squirt the spray even though we won’t be using actual medicine today.”
Jessa likes that she calls it “medicine.”
The kids pair up and practice on each other. There’s some giggling among the younger kids. “I know this feels weird and uncomfortable,” Susan says, “and hopefully you’ll never have to do this. But since all of you know someone who’s used drugs, you might need to do this at some point, to get someone you love to start breathing again.”The nervous laughter stops, and they spend five minutes practicing on one another.
“After you do this,” Ms. Harrison asks, “who knows what to do next?”
A bunch of hands go up. She calls on a blond-haired boy from Jessa’s ninth-grade class.
“You need to call 9-1-1 right away.”
“Exactly right. Because Narcan doesn't last forever,” Ms. Harrison says. “The person needs to go the emergency room quickly in case they stop breathing again. And so someone can talk to them about getting help so they don’t keep using drugs. And by the way, if you forget how to use the Narcan, YouTube has the instructions.”
That won’t help us, Jessa thinks, with no Wi-Fi at home.
“So, how are you feeling about this right now?” Susan asks.
Not one kid speaks.
“Is anyone worried you might not be able to do this right, to squirt the Narcan into somebody’s nose if they’re not breathing?”
A few nervous nods.
“I know, it’s pretty scary. So, another thing you can do is just dial 9-1-1 directly. On your cellphone if you have one or your house phone. Tell them what’s happened, that you’re with someone who’s taken drugs and stopped breathing and have some Narcan. They’ll be able to walk you through it.”Somber looks all around.“You can do this, kids, you can,” Ms. Harrison says. “But I hope you never have to.”
Susan passes out the blue bags containing two Narcan-filled devices, one for every kid. They put them away into their already heavy backpacks.
The presentation ends and kids file out of the conference room. When she and Gabe are the only ones left, Jessa approaches Ms. Harrison. “If Gabe and I stay until closing, is there any chance you could drop us off at the end of our street on your way home?”
“Sure, Jessa. I’m going straight home tonight so that won’t be a problem. Meet me at my desk at eight and we’ll walk out together.”
Jessa flashes her a relieved smile. “Thanks a million. Come on, Gabe, let’s go do our homework.”
Ms. Harrison drives Jessa and Gabe home in her familiar old silver Nissan. It smells like her dog, Wags, that she’s talked about on previous rides home.
“Just drop us off at the end of our road,” Jessa says. “It’s only a short walk from there.”
“At night?” Ms. Harrison asks. She looks concerned “I’d be happy to take you right to your door,”
“That’s okay,” Jessa insists.
Ten minutes later, Ms. Harrison drops off Jessa and Gabe at the corner of Stabley Road and Route 67. On the short walk to the trailer, Gabe asks, "How come you didn't let her drop us out front?"
“’Cause I didn’t want Mom and Billy asking any questions or giving us a hard time.”
Shivering against the cold, they don’t speak again until they arrive at the shabby blue trailer home they rent at the Shady Grove Mobile Home Park. She can smell somebody’s trash before the get to their door.
Their old beat-up Chevy isn’t in front of the trailer. Nobody’s home.
Gabe pulls off his hat and gloves. Jessa opens the rickety storm door, holds it with her foot, and unlocks the metal door. It sticks so she has to kick it to get it open. Once inside she turns on the lights and a troop of huge black roaches tap dances across the linoleum floor, skittering to safety. Gabe yelps. “I can hear their little feet!”
Jessa puts her arm around him. “It’s okay, buddy.” She wouldn’t have believed anything could be worse than the Section 8 housing they got booted from ’cause of her mom’s drug use. Then they moved here.
She tosses her backpack on the gray Formica kitchen table, the top peeling back from the rotting particle board, and plops down in the battered old upholstered chair she’d rescued from the neighbor’s trash pile. A stale stink rises off a glass ashtray on the table overflowing with cigarette butts. Her mom and stepdad sleep on a pullout couch they never bother to put away, so the living room’s always a crowded mess.
Gabe shuffles down the hallway from the living room to the bedroom in back and tosses his school stuff on the dresser before returning to the living room. “Where Momma and Daddy?”
“I have no idea. Do you need a shower tonight?”
“Nope, took one last night. Remember?” He sits at the table.
“Oh, that’s right. My turn tonight.”
“Is there any ice cream?”
“Doubtful, but I’ll look.” She’s grateful they got to eat pizza earlier at the presentation. In the kitchen she opens the freezer where a thick coat of frost covers the walls. No way Mom’s going to defrost it. A couple of frozen pizzas and store-brand frozen dinners are its only occupants.
“Why don’t you brush your teeth and get into your PJs. We can see what’s on TV, or I’ll read another chapter of Harry Potter.”
“But I really wanted ice cream . . .”
“I know, bud. Maybe the next time we go food shopping. Want some cereal and milk, instead?” If there is any.
He shakes his head and disappears into the bathroom. He comes out and slips into the trailer’s only bedroom to change into his PJs. “Let’s see what’s on TV.”
They sit cross-legged on the sofa bed and Jessa turns on the TV. She flips through the channels—just four, they can’t afford cable—but there’s nothing that grabs Gabe’s attention.
“How ’bout we read another chapter of Harry Potter?” They retire to the tiny bedroom and climb into Jessa’s bottom bunk where she opens Harry Potter and the Goblet of Fire. When Gabe falls asleep, she carefully tucks him into his top bunk.
Back in the living room, she empties the smelly ashtray into the overflowing trash bag, fills the kitchen sink with soapy water, and drops it in. It joins the breakfast dishes Mom hadn’t bothered to wash after Jessa and Gabe left for school. She scrubs at bowls still encrusted with cereal and glasses sticky with juice. No wonder we have roaches, Jessa thinks. She’ll have to remind the landlord to call the exterminator again.
She hears them before they open the trailer door, their noisy old Malibu pulling into the dirt driveway. “Dammit!” a neighbor yells. “If you wake me up again, I’m gonna complain to the landlord. I gotta work tomorrow, unlike you scummy junkies!”
“I do work!” Billy hollers back. “Fuck you.”
Mom and Billy burst in the door, fighting again, tension crackling around them like static electricity. “Where am I gonna come up with three hundred bucks to replace the damned muffler?” Billy asks. He’s short, no taller than Jessa, and wiry. Wears his black hair long and messy and has a scraggly beard ’cause he’s too lazy to shave. Tats cover his arms. The dagger on his neck, just under his ear is the one Jessa hates most.
If they get kicked out of this place, Jessa has no idea where they’d go. Too scary to think about. Billy works off-books at a gas station convenience store, part-time, paid in cash. Usually, he pays the $259 trailer rent first thing. Her mom . . . well, Desiree’s such a friggin’ mess no one will hire her now, even off-books. Her only household contributions are Medicaid and SNAP—food stamps—which only covers actual food, not things like toilet paper, toothpaste, and dish soap. Sometimes Billy swipes toothpaste from the convenience store. Embarrassed to admit it, Jessa often sneaks TP into her backpack from school or the library, telling herself it won’t be missed.She can’t wait until she’s sixteen next year and can get a job that pays more than babysitting.Billy and her mom continue their argument without so much as a hello. Jessa thinks about moving out of their orbit, in case punches begin to fly. When that happens . . . well, she and Gabe need to take cover or get out. Billy usually doesn’t hit Gabe, mainly because Jessa warned him that if he does, she’ll call the cops.
Desiree throws off her jacket, grabs a cigarette, and lights it. “When you looked at that stupid skank with those goo-goo eyes—”
“I can look at a girl any way I want to! Especially when you look like shit. You need to clean yourself up. Crystal was one thing. When you graduated to smack . . . Well, now you really look like total crap.”
“Look who’s talking, dickhead.”
Okay, now they’re on a roll. Sure enough, Billy raises his hand to hit her.
Desiree scoots out the way and yells, “Don’t you ever raise your hand to me again. I’ll be outta here with these kids faster than—”
“All right, all right. Chill.” He puts his arm around her and tries to kiss her, but she turns her head away.
Desiree’s favorite thing, after getting high, is pouring gasoline onto a fire, mouthing off at Billy and getting her licks in when he’s already pissed at her for something. Once they get all boozed up or are coming down from something and all itchy and twitchy, fur flies.
Her once-pretty mother looks like crap. Dark bags under her gray eyes, her faced pallid, skin all ashy. She’s skinny now from the meth, her mousy brown hair dull and tangled. Even the green dragon tat adorning one shoulder is faded. Jessa’s seen photos of her mom back when she still looked good, when she and Billy first got together before drugs and booze ravaged them both. Billy was gorgeous in those days, looked like a rock musician with his long wavy dark hair, sparkling white teeth, and huge smile. Gabe looked just like him.