Clearly, it was an overdose. The EMTs we intercepted with said that they treated the same lady yesterday, at the same house in the same spot, with the same presentation and, likely, the same drug in her veins. The woman was hypoventillating at a rate of about eight, and her pupils were so small I had to check twice to make sure they were even there.
The call was so easy, so routine that I relaxed more than I normally would. We didn't move slowly, but certainly didn't rush. We where deliberate with our actions, and didn't make any mistakes. Nothing got tangled, nothing got in the way. One of the EMTs managed the airway with a bag-valve mask and an OPA, while the rest of us walked on the side of the stretcher towards the ambulance. Everyone, having been there before, was completely calm and comforted in the transparency of the situation. She'll be up in no time, a little vitamin N and we'll be cooking with gas.
We were right. 0.8 milligrams in the muscle, and then 0.8 more though the line and she was breathing well on her own, satting at 100% with just a nonrebreather mask and dreamily enjoying the ride to the hospital. It was the perfect amount of Narcan: that sweet spot between respiratory function and a pleasant patient. We hit a bullseye.
One might imagine that at this point I would, as I have many times before, launch into a lengthy discussion about the perils of overconfidence. ...Perhaps this patient might turn out to have something else going on, some terribly elusive pathology that I might've missed weren't it for some stroke of luck or moment of brilliance. I could write about myself being embarrassed by the hospital staff for a simple mistake, or relieved by a close call and reeling from the experience. All of these things have happened before, and it would be easy to weave these experiences into this story to make the point that I have made many times before.
Not this patient, though. Nope. She looked like an overdose, she presented like an overdose, and - lo and behold - she was an overdose. The drug worked, and all was well.
Sometimes its really nice to have things cut so cleanly. I probably can't expect the same from my next patient - and part of that is what I love about this job - but every once in a while, it ain't so bad to catch an easy touchdown.