If you had told me at any point in the last ten years while my brother, Jeremy, was battling his opioid addiction, that it would end in a St. Louis hospital listening to the beeping of machines, learning terms like anoxic brain injury and diabetes insipidus while a transplant team discussed organ donation, I would have insisted you were mistaken. I would have told you there was no way he would be brain dead by 30 years old.
This was the reality, though.
On November 11, 2020, I got a call from my mom telling me that a woman found my brother unconscious and without a pulse in his truck on the side of a highway in St. Louis. The stranger had called 911, and when paramedics arrived on the scene, they spent eight minutes resuscitating him before transporting him to the hospital. Before I knew what I was doing, calls were made, credit card numbers were entered, bags were packed, and I was in a rental car racing through five states to get to him.
The world was still at the height of the COVID-19 pandemic when I arrived at St. Louis University Hospital, so I had to get my temperature checked when I entered the building and fill out contact tracing forms before I could actually see my brother. When I finally reached his room, I hesitated outside the door, intently focused on the 30 year old male label attached to it. There was no name or other identifying characteristics — it could have been anyone on the other side of that door. It was the first time I had seen my brother in four years, and those days in the hospital that followed would be the last moments I’d get with him.
His nurse was finishing up in the room as I stood idly by, asking what they knew, which at that point wasn’t much. All they said was that if Jeremy’s condition didn’t change rapidly (for better or worse), someone would have to make the decision to turn off his ventilator or move him to a long-term nursing facility, where the chances of him being in a vegetative state forever were high.
When the nurse finally finished in his room and I was able to pull up a chair to sit with him, just the two of us, I reached for his hand, fixed my gaze on the exposed patch of skin on his arm covered with his first tattoo — a compilation of punk-rock-style stars he got before he turned 18 — and tried to think of what to say to him. I was surprised how strong he looked, even in his traumatic state. His dirty blond hair matted to the sides of his head, and he had a full, well-groomed beard. His broad shoulders filled out the delicate yellow hospital gown.
“Hi, Jay Man, it’s Krystal … I’m here … I need you to wake up now.” My voice sounded loud, shaky, and foreign in the sterile space. I felt like I had failed him. I was cut off from him so far away in New York, and I wished I had reached out more when I knew he was sober, to tell him I was proud of him and to keep fighting. “I’m so so so sorry this happened to you,” I whispered, over and over.
Jeremy died five days later. Cause of death: fentanyl overdose.
An Epidemic That Just Keeps Growing
The phrase opioid crisis has slowly made its way into my consciousness in the past few years — there’s been a constant thread weaving through news stories, political speeches, and election campaign debates around what to do about the epidemic that’s consuming whole communities. Currently, opioids account for more than two-thirds of deaths from drug overdoses and that number is only rising, with synthetic opioids, like fentanyl, being the driving force.
When the COVID-19 pandemic hit the country, it only escalated the crisis, causing a spike in overdoses and leading some experts to predict that 2020 would likely be the deadliest year recorded for opioid-related deaths. Provisional data recently released shows opioid deaths skyrocketed in mid-March 2020, right when the country went into lockdown, reporting 14,895 deaths from just March to October of that year.
And while the whole world was locked down, individuals struggling with addiction were cut off from their jobs, friends, family, healthcare, and whole support systems. The entire community became more vulnerable at the same time the national attention focused elsewhere. I had no idea just how immersed in this crisis my brother was until it was too late to help him.
Potential Cut Short by Pain Meds
Looking back, it’s difficult to know exactly how my brother ended up dying so young from something so preventable. Yes, our childhood was troubled, but I’m not sure I'll ever quite know the first pebble that struck the windshield and slowly shattered its way through Jeremy’s life. To comb back through the memories I have of him, up until the first attempt he made to get sober, is to be confronted with so much lost potential.
Growing up in Cypress, California, Jeremy was well liked by everybody. He was smart, intelligent in a way that I could never be, understanding science and math as easily as reading the instructions on a box of macaroni and cheese. He wasn’t an overachiever, but when he was 13, I saw him take apart a VCR and put it back together without so much as a manual. He was popular, too. A lot of the teachers and administrators at our high school even knew him by name, not because he was a troublemaker, but because he was funny, charismatic, and outgoing.
Jeremy was the only boy in our family, with three older sisters and one younger. He spent his life surrounded by girls, always looking for the strong male role model he never had. When I was 12 and Jeremy was 9, our dad died in a car accident. His white Ford Ranger — the same exact make and model Jeremy was found in — drifted off the road, rolled up a hill, and turned upside down, killing him instantly. Jeremy spent most of his childhood being told how much he resembled him, and I can’t imagine what was going through his head when he decided to get the same truck as our dad or what sick joke the universe was playing when it decided that both their lives would end in a white Ford Ranger on the side of a freeway.
Jeremy and I became close when I was about 16 and he was 14. We would go for jogs in our neighborhood, vent to each other about our crazy grandma we were living with, and borrow one another's CDs. By the time I was approaching my high school graduation with my eyes set on college, Jeremy’s relationship with our grandma had worsened, causing him to drop out of school and disappear into the massive void that is Corona, California, where my mom’s side of the family lived and where drug use was a common way to pass the time. It didn’t take long for Jeremy to start experimenting with different drugs until he became addicted to opiates.
Jeremy tried to get clean a few times, to no avail. His first attempt, in 2011, had him out on foot for days, walking to different outpatient rehabilitation centers and detox clinics throughout Corona, trying to find a place that would take him. He had limited resources, no money, and wasn’t a convicted criminal, so he could not be court ordered to rehab. That’s when he called me and asked for help.
Jeremy had just become a father — my niece was only a few months old — and he told me that had been the motivation he needed to get clean. On my drive to see him I passed the high school we attended together and the same spot on the 91 freeway that took our dad from us 12 years earlier. When I finally reached Jeremy, he looked embarrassed to see me. He wasn’t the same guy I remembered, smiling from the inside of a high school football jersey or singing along to Taking Back Sunday with me in my first car, but he wasn’t completely gone either. The jeans and zip-up hoodie he was wearing were clean enough, and it didn’t look like it had been that many days since his last shower. His dirty blonde hair naturally spiked out around his head, but it was longer than I had seen it in a while. His honey-brown eyes, exact replicas of my dad’s, looked at me pleading and desperate.
After I agreed to help him, I had no idea where to start. I had never actively participated in someone’s attempt at sobriety before. I wasn’t even sure I could figure it out, but when my brother looked at me, eyes watery, shaky hands holding out folded-up papers of information on free clinics and rehabs, I knew I couldn’t let him go at it alone. With help from a friend, I was able to get in touch with someone who advised me to get him into a detox center.
He had been living in Riverside County, California, at the time, and I lived in Orange County. The distance between the counties was only about 30 miles, but I was told to choose a detox center in Orange County, in order to make it harder for Jeremy to just walk off the premises and back into his familiar territory. I called the numbers I was given, inquired about available space, and finally found a place that would take him. Once it was all lined up, we headed to The Roque detox center in Stanton.
I remember the sky that day being an unnatural shade of blue, without a single speck of white. Southern California has a funny way of providing a backdrop that can completely contradict the mood. In the car we were silent. I could feel the strange mixture of hope, desperation, and raw fear radiating from him. He fidgeted a lot — changing the position of the air vents in my car and tapping the sides of his legs.
Jeremy was in that facility for 10 days. On his last day, I picked him up and drove him to a sober living house. He relapsed a few days later. That was the moment we started drifting further apart. By the time he ended up in the hospital in St. Louis, I hadn’t spoken to him at all in a few years. I had heard only secondhand information about what had been happening with his life and sobriety attempts from one of my sisters and from what I could piece together from his social media accounts. He had moved around the country multiple times — to Oregon, Illinois, and back home to California — trying to get a fresh start in a fresh location and had been on the brink of starting up a tiny-house business in Oregon right after his second child was born in July 2018.
His addiction always caught up to him, though.
Learning the True Scope of the Crisis
Having this crisis hit so close to home made me search for the one thing I could latch on to, to unleash all my anger and frustration. I still don’t know exactly where to direct it all. At my mother or dead father for not setting a good example? At the greedy pharmaceutical companies for over-marketing and misrepresenting addictive opioids? At the lack of government oversight over large medical distributors? Or the flawed treatment programs and stigma associated with drug abuse? I believe that all of these things had failed Jeremy and every other person like him.
The things I’ve learned about opioids since I never wanted to know. I didn’t want to know that Jeremy’s almost yearlong sobriety before he was found in his truck could have contributed to his death — that relapsing on opioids is more dangerous than the addiction itself, due to the brain's ability to lose tolerance for a drug over time, making a dose an addict is used to taking much more deadly. I didn’t want to know that so many fentanyl overdoses are caused by a rapid use of synthetic opioids laced in many illicit drugs and that so often victims don’t even know that they’re taking it. I didn’t want to learn that the pharmaceutical companies that pushed the use of fentanyl through bribery campaigns and other aggressive marketing strategies are the same companies now making millions off naloxone, the nasal spray used to prevent opioid overdose deaths.
On November 17, 2020, I stood in a hospital room as a team of nurses, doctors, and assistants packed up Jeremy’s hospital bed and wheeled him out of the room to perform the final test that would confirm what so many doctors already knew and tried to prepare me for — that his brain had gone without oxygen for too long, it had swelled too much, it was slipping, crushing his brain stem, and there was nothing they could do to stop it.
That afternoon, I watched as everything in the room became unanchored: The plastic pouches full of dripping liquids were wound up and attached to new stands with wheels; the machine hooked up to his ventilator was detached and replaced with a portable one; switches were flipped; cords were removed and inserted into new plugs; things I couldn’t identify clicked shut and locked tight until it seemed that nothing in the room was bolted down. And then it was all just gone, like the door to the hospital room became a massive void that everything got sucked into — including my brother, along with all of the questions I still needed to ask him. I stayed behind, assaulted by the quiet, no longer able to rely on the beeping of machines and the buzzing of motors to breathe life into the little bubble we had been sharing. The silence burst through, and I braced for everything that was coming next.
While the doctors were conducting that final test, I was pulled into a conference room with two women from a transplant team, with my mom on speakerphone, while they asked detailed questions about Jeremy’s life and habits. We knew he was positive for hepatitis C from being an intravenous heroin user, and that it complicated the organ donation process. They assured us, though, that there were still plenty of ways he could help others.
In the end, he saved five lives through organ donations. “I hope this brings you and your family some comfort in this difficult time,” one of the women texted me when I was back home in New York, along with a list of the gender, age, and state of each of his organ recipients. As strange as it was to receive that message, I was comforted knowing that the Jeremy I knew would have selflessly given anything he had to someone less fortunate — and in some way he will live on through the people he helped save.
After I left the hospital for the last time, I drove the 45 minutes to where Jeremy had been living in Highland, Illinois, in an attempt to find a connection to him. He had a nice apartment, clean and uncluttered. He had a separate room with weights set up and an empty bottle of Crown Royal on a kitchen shelf. Most of the pictures I found lying around were of his kids, who were still living with their maternal grandparents and probably would be for the foreseeable future.
I looked around the three-bedroom space and tried to soak up as much of my brother as I could. I grazed through his hat collection and the contents of his refrigerator. I looked through his closet and picked up a red McDonald’s staff T-shirt and held it close to me. I took that shirt home with me.
When I stepped out of my brother’s apartment for the last time, I remembered the final conversation I had in the hospital with a woman who was sent down from an administrative office to have me sign the papers they needed in order to move Jeremy’s body. We stood only a few feet away from each other as she held the signed forms in her hand, and I hesitated, not wanting to leave the hospital and never see my brother again. She leaned in to hug me, tears threatening to spill over the corners of her eyes, but stopped herself — COVID preventing any opportunity for comfort from a stranger.
“Is there anything I can get you?” she asked me once it was all over.
“A ten-year time machine,” I choked through tears. “You don’t happen to have one of those, do you?”