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He Survived an Overdose. Now What? An Overdose Left Him With Brain Damage. Now What?
(1 day later)
It was a Sunday afternoon, and in the cozy house at the end of the street, Andrew Foote sat in his usual chair while a movie played on the television. NORTH ANDOVER, Mass. — It was a Sunday afternoon, and in the cozy house at the end of the street, Andrew Foote sat in his usual chair while a movie played on the television.
The young man’s hands rested on two pillows, wrists bent and fingers contracted into fists. From time to time, he rocked forward as if to stand but then collapsed backward, into the chair. His few words were slow and slurred.The young man’s hands rested on two pillows, wrists bent and fingers contracted into fists. From time to time, he rocked forward as if to stand but then collapsed backward, into the chair. His few words were slow and slurred.
The simple fact that Andrew was living at home is somewhat miraculous. Heroin and fentanyl caused him to stop breathing, but he learned to breathe on his own again. His kidneys failed and then recovered. But Andrew’s brain, starved of oxygen too long, was left severely damaged.The simple fact that Andrew was living at home is somewhat miraculous. Heroin and fentanyl caused him to stop breathing, but he learned to breathe on his own again. His kidneys failed and then recovered. But Andrew’s brain, starved of oxygen too long, was left severely damaged.
More than four years have passed since the overdose. For Andrew’s parents, the fear that their son will die has now been replaced by a new set of realities and unanswerable questions: Is this a good life? Is he happy? What will happen to him when they grow old?More than four years have passed since the overdose. For Andrew’s parents, the fear that their son will die has now been replaced by a new set of realities and unanswerable questions: Is this a good life? Is he happy? What will happen to him when they grow old?
In the opioid epidemic, outcomes like Andrew’s are a largely unseen casualty. “People think that if you overdose on drugs, you either die or you’re O.K.,” his mother, Linda Foote, told me. “But that’s not true.”In the opioid epidemic, outcomes like Andrew’s are a largely unseen casualty. “People think that if you overdose on drugs, you either die or you’re O.K.,” his mother, Linda Foote, told me. “But that’s not true.”
Andrew was a golden child. He was the oldest of four, a high school football star who remained humble despite the trophies that decorated his room — now alongside a urinary catheter, pill boxes and equipment for his feeding tube.Andrew was a golden child. He was the oldest of four, a high school football star who remained humble despite the trophies that decorated his room — now alongside a urinary catheter, pill boxes and equipment for his feeding tube.
“How many touchdowns did you make in high school?” his mother prompted. His long-term memory had remained relatively preserved, though it was hard for him to call up the words.“How many touchdowns did you make in high school?” his mother prompted. His long-term memory had remained relatively preserved, though it was hard for him to call up the words.
As we waited, my gaze traveled to a framed collage of family photos. There was Andrew in his letterman’s jacket, blond hair cut short, lips curled upward in a shy smile. He was still a handsome guy. Mrs. Foote took pride in this, but his expression had dimmed.As we waited, my gaze traveled to a framed collage of family photos. There was Andrew in his letterman’s jacket, blond hair cut short, lips curled upward in a shy smile. He was still a handsome guy. Mrs. Foote took pride in this, but his expression had dimmed.
“Seventy?” his mother asked again. “Seventy-what?” It was hard to understand Andrew’s speech, but he gave what sounded like the answer. Seventy-eight touchdowns. (Then the eighth highest in Massachusetts history, his father, Lenny Foote, interjected.)“Seventy?” his mother asked again. “Seventy-what?” It was hard to understand Andrew’s speech, but he gave what sounded like the answer. Seventy-eight touchdowns. (Then the eighth highest in Massachusetts history, his father, Lenny Foote, interjected.)
Things started to fall apart when Andrew left for college. His parents tried. But Andrew took pain pills, which slid into heroin. And nothing his parents did, not the counseling or inpatient detox, promises or rehab, methadone or an intervention, could stop their son’s descent. “We just thought that if we were good enough parents, if we just loved him enough, we could fix it,” Mrs. Foote said. “But we couldn’t.”Things started to fall apart when Andrew left for college. His parents tried. But Andrew took pain pills, which slid into heroin. And nothing his parents did, not the counseling or inpatient detox, promises or rehab, methadone or an intervention, could stop their son’s descent. “We just thought that if we were good enough parents, if we just loved him enough, we could fix it,” Mrs. Foote said. “But we couldn’t.”
The call came early one fall morning in 2014. No one knew how long Andrew had been alone after the overdose, but by the time someone found him, he’d stopped breathing altogether. The doctors told the Footes that although their son’s heart was beating, they worried that he would not live. He would need to be transferred to Boston, to a bigger hospital. He might not even survive the helicopter ride.The call came early one fall morning in 2014. No one knew how long Andrew had been alone after the overdose, but by the time someone found him, he’d stopped breathing altogether. The doctors told the Footes that although their son’s heart was beating, they worried that he would not live. He would need to be transferred to Boston, to a bigger hospital. He might not even survive the helicopter ride.
At Andrew’s bedside each day, the Footes watched their son’s chest rise and fall with the ventilator, listening to the staccato of his heart-rate monitor and hoping for signs that he was in there somewhere. When he started to “storm” as a result of his injured brain’s inability to regulate his body — breathing rapidly, blood pressure and temperature soaring — they looked on helplessly. They could not yet wonder what the future might look like; all they could do was hope that their son would make it through the night.At Andrew’s bedside each day, the Footes watched their son’s chest rise and fall with the ventilator, listening to the staccato of his heart-rate monitor and hoping for signs that he was in there somewhere. When he started to “storm” as a result of his injured brain’s inability to regulate his body — breathing rapidly, blood pressure and temperature soaring — they looked on helplessly. They could not yet wonder what the future might look like; all they could do was hope that their son would make it through the night.
A few days in, the doctors explained to Mr. and Mrs. Foote that they had been feeding Andrew through a tube in his nose. His death was no longer an immediate threat, but he wasn’t going to get better any time soon either and his doctors needed to consider a more permanent method of nutrition. This would mean a surgery to place a feeding tube directly into Andrew’s stomach. This decision was meaningful, because it signaled a commitment to continuing aggressive care for a young man who might never again open his eyes. Andrew’s parents grasped onto faith and the hope, however slim, that their son might improve. And they gave the O.K.A few days in, the doctors explained to Mr. and Mrs. Foote that they had been feeding Andrew through a tube in his nose. His death was no longer an immediate threat, but he wasn’t going to get better any time soon either and his doctors needed to consider a more permanent method of nutrition. This would mean a surgery to place a feeding tube directly into Andrew’s stomach. This decision was meaningful, because it signaled a commitment to continuing aggressive care for a young man who might never again open his eyes. Andrew’s parents grasped onto faith and the hope, however slim, that their son might improve. And they gave the O.K.
Andrew did get better. By December, a month after the overdose, he had made it from the I.C.U. to a rehabilitation hospital. There were setbacks. The “storms” continued. He picked up a hospital-acquired diarrheal illness and a urinary tract infection. But slowly, he started to emerge. He began to talk, even to sing along with a music therapist who came into his room to play the guitar. He could stand with help and shuffle down the hall. His parents began to think there might be a day when he wouldn’t need a feeding tube after all. And then, five months after the overdose, it was time to take Andrew back home.Andrew did get better. By December, a month after the overdose, he had made it from the I.C.U. to a rehabilitation hospital. There were setbacks. The “storms” continued. He picked up a hospital-acquired diarrheal illness and a urinary tract infection. But slowly, he started to emerge. He began to talk, even to sing along with a music therapist who came into his room to play the guitar. He could stand with help and shuffle down the hall. His parents began to think there might be a day when he wouldn’t need a feeding tube after all. And then, five months after the overdose, it was time to take Andrew back home.
Mrs. Foote, who had worked in special education before the overdose, became Andrew’s 24-hour caregiver. “As long as he can stand and somewhat help me, I’m not putting him in a nursing home,” she said. “I wouldn’t even consider it.” Mr. Foote returned to his work in the city Parks Department. Though they knew their son would never be the same, they were optimistic. So they sent him to outpatient therapy, fought with their insurance company when they were told he no longer qualified and scrambled until they were able to find a new brain injury program near home.Mrs. Foote, who had worked in special education before the overdose, became Andrew’s 24-hour caregiver. “As long as he can stand and somewhat help me, I’m not putting him in a nursing home,” she said. “I wouldn’t even consider it.” Mr. Foote returned to his work in the city Parks Department. Though they knew their son would never be the same, they were optimistic. So they sent him to outpatient therapy, fought with their insurance company when they were told he no longer qualified and scrambled until they were able to find a new brain injury program near home.
Even so, as the years passed, the Footes watched their son lose gains he had made in the early days at rehab. Though they were told that this was the natural progression of his injury, it was hard to scale back and realize that this was it — he most likely would never eat on his own without a feeding tube, never be able to use his hands or to talk clearly.Even so, as the years passed, the Footes watched their son lose gains he had made in the early days at rehab. Though they were told that this was the natural progression of his injury, it was hard to scale back and realize that this was it — he most likely would never eat on his own without a feeding tube, never be able to use his hands or to talk clearly.
He had turned 29 a few days before I met him, a bittersweet milestone. He no longer had friends to celebrate a birthday with and though he didn’t seem to mind, it was hard for Mrs. Foote to be reminded of time passing. Mr. Foote had recently stopped by a nursing facility, just to take a look. He was almost 60 with a new diagnosis of advanced melanoma. He knew that he and Linda wouldn’t be able to take care of Andrew forever. They’d promised each other that the responsibility would not fall to his siblings.He had turned 29 a few days before I met him, a bittersweet milestone. He no longer had friends to celebrate a birthday with and though he didn’t seem to mind, it was hard for Mrs. Foote to be reminded of time passing. Mr. Foote had recently stopped by a nursing facility, just to take a look. He was almost 60 with a new diagnosis of advanced melanoma. He knew that he and Linda wouldn’t be able to take care of Andrew forever. They’d promised each other that the responsibility would not fall to his siblings.
But for the moment, their son was home. “I remember driving into Boston and crying and crying and begging just to say one more word to him. I basically sold my soul,” Mr. Foote said. “And to me, this is my wish. I got my wish. So now I just have to do what I have to do.”But for the moment, their son was home. “I remember driving into Boston and crying and crying and begging just to say one more word to him. I basically sold my soul,” Mr. Foote said. “And to me, this is my wish. I got my wish. So now I just have to do what I have to do.”
When I visited them it was still cooler out, and they were looking forward to when the weather would turn warm again. Linda and Lenny Foote would help their son onto the tandem bike they had bought, and maybe his father would ride with him or maybe one of his siblings would come over. He and his family could all watch television together, and Andrew still laughed at Adam Sandler, this great big belly laugh that made everyone around him smile. Though he occasionally grew frustrated by things he could not do, he appeared unaware of the magnitude of what he had lost.When I visited them it was still cooler out, and they were looking forward to when the weather would turn warm again. Linda and Lenny Foote would help their son onto the tandem bike they had bought, and maybe his father would ride with him or maybe one of his siblings would come over. He and his family could all watch television together, and Andrew still laughed at Adam Sandler, this great big belly laugh that made everyone around him smile. Though he occasionally grew frustrated by things he could not do, he appeared unaware of the magnitude of what he had lost.
As our conversation wound to a close, Mrs. Foote sat down next to her son. She had a few questions for him, and she wanted me to hear his responses.As our conversation wound to a close, Mrs. Foote sat down next to her son. She had a few questions for him, and she wanted me to hear his responses.
“Are you happy?” she asked Andrew.“Are you happy?” she asked Andrew.
“Yeah,” he said, slowly, drawing out the syllable.“Yeah,” he said, slowly, drawing out the syllable.
“You’re happy that you’re still here?”“You’re happy that you’re still here?”
“Yeah,” he repeated.“Yeah,” he repeated.
“Are there things you miss that you used to do?”“Are there things you miss that you used to do?”
This was a more complicated question. Andrew paused, looked around him. He did not seem to know how to answer. He moved a bit in his chair. And he was quiet.This was a more complicated question. Andrew paused, looked around him. He did not seem to know how to answer. He moved a bit in his chair. And he was quiet.
Daniela J. Lamas, a pulmonary and critical care doctor at Brigham and Women’s Hospital in Boston and an instructor in medicine at Harvard Medical School, is the author of “You Can Stop Humming Now.”Daniela J. Lamas, a pulmonary and critical care doctor at Brigham and Women’s Hospital in Boston and an instructor in medicine at Harvard Medical School, is the author of “You Can Stop Humming Now.”
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