Drowning minute by minute

On the stand Monday in the federal courthouse, Jeanmarie Perrone told a hushed crowd, minute by minute, what happens to the body during an opioid overdose.
From the patients she sees in her job as an emergency physician at the Hospital of the University of Pennsylvania, two or three a week, who have a 10% chance of dying in the next two years. To the people she revives on the streets of Kensington and on the Market-Frankford El, just going about her day.
It was what everyone needed to hear first, in the first wave of testimony in U.S. v. Safehouse, the civil case that will determine whether Philadelphia becomes the first city in the country to open a supervised injection site. A fitting first for a city with perhaps the nation’s worst urban opioid crisis, the tide of deaths it has engendered, and the response that has grown to match it despite the best efforts of U.S. Attorney William McSwain, who sat at the prosecutor’s desk Monday.
Really, it was McSwain whom Perrone was speaking to. The crowd in the courtroom was filled with people who already know what an overdose looks like — because they’ve lost someone to it, or revived someone, or work with people in addiction every day. Like Jose Benitez, the executive director of Prevention Point, the public health organization in Kensington that began as a needle exchange, and now treats 15,000 people a year. He’s also the president of Safehouse. To recap: The person tasked with saving the lives of so many in this city was sitting behind the defendant’s table Monday.
Perrone went on to describe what so many in this city have experienced: what death looks like at the height of a health catastrophe. From the respiratory depression that sets in within 30 seconds to one minute after a dose of fentanyl. It’s like drowning, she told the courtroom.
How respiration can stop in one minute. How fentanyl and heroin and other opioids can keep the brain from realizing that the body is not breathing.
By a minute and a half or two minutes, the face loses color, turns blue, turns gray. Injury to all tissues around three minutes.
By four minutes, brain death. Cardiac arrest.
And then Perrone is walking down a hospital hallway, to tell a family “once again devastated by a preventable death.”
She talked of saving someone on the El, the young man who screamed through the subway cars for naloxone, the overdose-reversing drug, who pulled her to another young man on the floor, blue in the face, surrounded by a crowd desperate to help, but having no means to do so. How, after two doses of naloxone, a man who moments ago had been without a pulse took “one tiny breath.”
As the doctor testified, dozens gathered on the sidewalk — people who wished their loved ones could have had the opportunity to take that tiny breath. Like Rachel Graves, who held a photo of her younger brother, Jake, who passed away at 21 in 2015. The resident physician in emergency medicine at Penn works with Perrone, and advocates for a supervised injection site because “it’s what I can do for him now.”
And Marissa Perrone, Jeanmarie’s sister, was there, because what the doctor knows of addiction does not end at the hospital doors or on the El.
Marissa’s son, Antonio, Jeanmarie’s nephew, is 2½ years into recovery. “I had the benefit of a sister to guide us through,” Marissa said. “So many families don’t know where to turn.”
But she counts herself as one of the lucky ones: Her child is still alive.
On the stand, her sister did her best to bolster that argument. Perrone skillfully parried questions from a prosecutor, coming back again and again to a simple point, one that represents a direct line of this city’s journey in the last two years — from a city that barely acknowledged a crisis to one leading the response. This is an effort to save lives that deserve to be saved. And this is an effort long since due.
“There’s a tremendous kind of feeling,” she said, “that we can do better than kneeling on the subway floor resuscitating a 25-year-old.”
Mike Newall is a columnist at the Philadelphia Inquirer. He can be reached at mnewall@phillynews.com