Benzo Salvation.

I spent the better part of 6 hours last night with a friend who took too much. She had been told: "Here, take this, it's old and probably not so good anymore, so you'll have to take a couple..."

Half an hour later, she was curled up in her car, headed for the worst trip of her life.

Pupils the size of dinner plates, tachypneic, anxious, having visual and auditory disturbances, and begging to go home, my poor friend took little comfort from her boyfriend who was "...not feeling anything."

I heard she was sick, and stepped in with my labor & delivery skills to help calm her. My experiential toolkit is stocked with coping strategies and support techniques for anxious, pain-full laboring women - this situation wasn't all that dissimilar.

She started complaining about muscle cramps, and as observed her contorted lips and hands, the possiblity of malignant hyperthermia or some serotonergic syndrome popped into my head. She didn't feel particularly hot, and wasn't overly tachycardic, but was only 45 minutes into this ride, and who knew how long, or how deep this rabbit hole went. I talked her through some slower breathing, helping ground herself, focusing on not adding to the anxiety. It helped for a little while.

Two other medical professionals assessed her, one experienced in primary care, one in operating room protocol. I suggested a benzodiazepine that I had at home. That we should offer her an oral sedative, take her home and watch her closely until one drug or the other wore off. One agreed with me, the other thought she looked cyanotic, needed 100% O2 and an ER bed.

Here lies my dilemma.

Do I continue to support her, decrease stimuli, attend to her basic needs, assess her ABC's frequently, and keep feeling for rising temperature, or any other signs she might be decompensating? Do I take this responsibility for her healthcare, knowingly blur the lines between friend and nurse and give her an oral sedative? What about injectable? Can I rely on my experience and my 5 senses to tell me when something is wrong and she needs more help than I can give her?

Or do I withhold my skills as a nurse, protect myself, and deliver her to the ER, where she will be in a bright, loud, scary place; get an IV and a slot in the locked Psych room for the next 8 hours while she wrestles with a universe of demons. Would she be even further traumatized by that experience? What defines a safe place? A place where your vital signs can be monitored, or a place where your friend can help you fight your way back to reality.

Could I recognize the signs of MH, stroke, or cardiac arrest fast enough to save her from permanent damage?

Did my own experience with the very same drug color my assessment of the danger she might be in? (Neither of the other two professionals had had any experience with this particular recreational pharmaceutical)

In the absence of clear threats to her health, would an ER trip be a threat to her mental health in the long run?

When I worked in the ER, we did not sedate people on bad trips - the rationale being some possibility of adverse interaction between the recreational drug and the sedative, causing more harm than good. People on bad trips are very unhappy, but as long as they do not present a threat to themselves and the people around them, let 'em be uncomfortable.

I couldn't do that to my friend. I knew that if I stayed by her side, I could minimize her fear and anxiety. I could assess her constantly and recognize danger that was beyond my capability to manage. I could safely give her a medication to help calm her and trust that it would overtake the beast inside her and give her some peace. Lastly (least importantly, but still deserving of consideration) I could save this artist/student from the ER bills that could quickly mount into the thousands of dollars.

And so I did.

My partner in crime and healthcare professional extraordinaire helped me to give her sips of water, hold her hands from thrashing, keep a blanket under her head when she fell to the floor screaming. She became an animal, totally disconnected from reality, floridly psychotic.

But she was breathing. She was not hot, alarmingly tachycardic, or developing any focal deficits. The muscle spasms went away, and after a second dose of said benzodiazepine, she finally fell asleep.

She is well this morning. Still suffering the bruises of her thrashing, and echoes of visions still dance in her head, but my friend has returned; the beast within her gone.

Was I right? Was I wrong? What more could I have done? How do you draw the line between your job and your life? In your own conscience, which is the ethical decision - sterile Professional overkill where her health is more guaranteed, or the love of friends who watch over her with professional eyes? The outcome was good, but would it be next time? What if it had been different?

What if I had been wrong?