I was driving home on a sunny Sunday afternoon, cruising along Leary Way in Seattle, when I saw a woman sitting on a stretch of grass several feet from the street. She was digging frantically through a pile of garbage and debris, the excess forming a multi-colored ring of filth around her. Pieces of rotten food, shredded clothing, and broken toys glistened in the sun. As she writhed and twisted through the garbage, her eyes darted around her surroundings, and she resembled a hungry or angry animal.  

I work with patients with heroin addiction, and my clinic is surrounded by dense layers of homeless people. Many of my patients also use other drugs, most commonly methamphetamine. Seeing people who are using and recovering from drug use is exceedingly common for me.  And her state was consistent with acute methamphetamine intoxication—a condition that I frequently see.

Drug-induced behavior is one of the saddest and most distressing things a person may witness. I have seen many examples of it: at a Tacoma gas station, I saw a young woman who appeared to have dropped an entire pie on the ground. She seemed obsessed with cleaning up large splatters of pie. She went back and forth from the pie-drop site to the containers of cleaning liquid next to the gas pumps, where she’d moisten paper towels, then walk back to the pie area, get down on her hands and knees and start scrubbing. She did this over and over, back and forth.

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After driving by the woman in Seattle, I felt upset and unsure of what to do. It seemed clear, however, that she was intoxicated, at risk of harming herself, and in need of help.

I looped back around and parked approximately 20 ft from where she sat, continuing with her manic and senseless rooting. She was talking, singing, yelling, and making unhuman noises, and her head spun from side-to-side repeatedly. She spotted me, and her gaze reminded me of a dog gnawing on a bone while eyeballing all who approached.

I sat in my car and called for an ambulance. The operator came on the line and flatly asked, “What is your emergency?” As I tried to explain what I was witnessing, I was surprised at my emotion. My voice cracked as I tried to tell the operator about my concern.

She sounded annoyed, and asked, “Is she bleeding?” I was floored by this question. I paused, noting, “Well, no, I don’t think so. She has a lot of clothing on, but I don’t see any blood.”

“Does she appear injured?” she flatly countered. I paused again, unsure about how to better describe my concerns. “Well, I guess that depends on how you define injury,” I replied. “People who are severely intoxicated from alcohol are considered ill and are often transported to facility to detox. This woman appears either severely intoxicated from something like methamphetamine or is in the midst of severe psychiatric decompensation. Both of which I would consider severe illness.”

The operator paused. “Sir, how do you know this?” she asked.

I replied and stated that I am a physician assistant and work in an addiction clinic. I included that I often treat patients in many states of methamphetamine intoxication. ,

She paused again, and noted in closing, “Sir, if she is not bleeding, and if she appears to be breathing, and if she is not sitting in traffic, then I don’t think there’s much we can do. I will notify the emergency medical technicians.”

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And that was that. I drove away feeling hopeless and sad. I wonder what it will take for our society to recognize that people with addiction are ill and need help—even if they are not bleeding.