I nodded. Dr. Laughlin was the most gregarious doctor on the Emergency Room staff, with a relentless sense of humor.
Sam continued, “I know Dr. Laughlin very well, we talk about everything. He was asking me about products to enhance his physique. I told him that you were very well educated on that subject, and you may be able to help him. He is cool. I hope you don’t mind.”
“That’s fine,” I acquiesced. This wasn’t new. I had sold to medical doctors before. Shit, I had sold to doctors, lawyers, and cops. A cop was one of my best clients at one point. The desire to look the part of a predominant male figure showed no discrimination.
As I turned and walked away, I realized that I hadn’t even gotten in the door of the hospital yet and I already made more money from that transaction than I would for the entire eight-hour shift.
I strode in to the Emergency Room on my way to discover which section I was working today, when I was immediately waylaid. “Ryan, I have been looking for you! I need your help really quick!”, exclaimed a fellow Emergency Room tech. I quickly turned to follow her into a room. “I told you I had a really strong guy that was perfect for this job!”, she stated to an overweight, elderly patient as we walked into the room. This was common. Overweight patients would slide down on their elevated hospital beds, and because they could not shift their bodies upward, we frequently had to lift them using a draw sheet to adjust their position.
“Oh my god! He’s huge!” the patient exclaimed when I walked into the room. One of the cons to being a juicehead was that people were always asking me to lift heavy things.
Variations of this experience were common. At the time, I was running twelve-hundred milligrams of Andropen per week, four-hundred milligrams of nandrolone phenyl propionate per week, three hundred milligrams of trenbolone acetate per week, and between fifty and one-hundred milligrams of Dbol per day. I was also on five to ten international units of human growth hormone per day. If you don’t know what any of that means, it was a very large amount of anabolic substances, to an abusive level. But I was big, and I was a sight to see. The hospital gave us T-shirts to wear. I intentionally ordered mine a size to small to accentuate every striation and every bulge.
Coincidentally, I worked in Dr. Laughlin’s section that day. I was passing by on my way to a work computer, and he stopped to chat. He gave the tell-tale signal by looking both ways. No one was around. “I have been thinking about using something to help me get into shape. What do you know about Human Growth Hormone? It won’t make me too big will it?” asked Dr. Laughlin.
I launched into an almost programmed response. I get asked this question quite frequently. “HGH is very moderately anabolic, and will not dramatically increase your strength or size. HGH binds to growth hormone receptors on your adipose tissue, or fat cells, triggering lipolysis. Because of this, your body will begin using its fat stores as a primary source of energy, instead of glucose, which is your body’s normal primary source of energy. Moreover, because your body is no longer using as much glucose, your insulin sensitivity may increase, so it is important to watch your sugar intake. HGH does not dramatically increase your mass and strength, like some believe, but because of its immense fat burning capabilities, it acts a fine tuner for your physique. It will strip away your fat so that every muscle striation and cord is clearly defined. I eat triple cheeseburgers from Wendy’s almost every day, and I am so lean that you can see veins in my abs. It makes people look like they are chiseled out of marble.”
“What do you know about Human Growth Hormone? It won’t make me too big will it?” asked Dr. Laughlin.
What surprises most people is that, with merely a bachelor’s degree in Biochemistry, I know more about these compounds than a medical doctor. The medical community as a whole, even endocrinologists, broadly study their field of specialty and do not focus on anabolic hormones or how they react within the human body. They rely on books with outdated information on anabolic hormones. They rely on a couple outdated and poorly run studies. Being medical doctors, it is expected that they know everything, and their egos force them to expound on recondite matters as if they know everything, despite not having a clear picture of anabolic hormones and their biochemical reactions within the human body. Because of this, the medical community holds on to these antiquated notions and dogma that is decades old, creating a negative stigma. They refuse to enlighten themselves with new evidence that testosterone and its derivatives are not as dangerous as previously thought, and help hundreds of millions of people worldwide. At this point, in 2011, I had focused for approximately ten years on these specific hormones and their biochemical reactions within the body. Additionally, as men of science, it is well understood that empirical evidence is the only way to truly comprehend a field of study. I am uniquely positioned in this industry because I have empirically studied a vast array of people using hormones. I had coached countless people through their cycles to achieve the desired results. Therefore, I had studied, on a more prominent and vast level than most medical doctors, the effects of these hormones on a myriad of people, and at a bigger sample size than almost anyone. With my knowledge and empirical understanding of these hormones, I would unabashedly go toe to toe with any endocrinologist or urologist in a battle of practical understanding – and win.
“Where does it come from?” Dr. Laughlin asked.
“It comes from China. I have been getting HGH from this company for many years, and I have tested it many times as well. The results from this company are always very good,” I cooed.
This was accurate. I used to pay someone to take ten international units, fast, and have their blood tested, all at the proper timing, for HGH levels to make sure this product maintained good quality.
“How much are they?”
This was different than my friend Sam. Dr. Laughlin knew nothing about black market HGH, and did not know anything about its cost. Therefore, I had to give him a figure. “HGH is a long-term commitment. You need to take it for at least six months to notice peak results. I can get it for you at twenty-three-hundred for ten kits.” I was getting these kits for about one-hundred dollars apiece, so this was a thirteen-hundred-dollar profit. I had never made close to that on one sale before, and would never normally present such a large order; but, he was a medical doctor – he was in a position to make this type of investment.
Dr. Laughlin said he would get back to me, and sidled off to work on some patients. I moved to my station behind a computer, and began to look at my patients and their vitals. It was a moderately busy day in the ER. Suddenly, the ER doors kicked open. There was an old man with long grey hair, and it looked like EMTs were trying to put an oxygen mask on his face. He was being rushed on a gurney to a room in my section. He was being followed by a middle-aged blonde-haired woman in obvious destress. I jumped from my seat. I was still pretty new to working here, so I tended to go into a mild state of shock when an emergency was taking place. Probably not a good quality for someone who worked in and Emergency Room. The patient was placed into a room, followed closely by a nurse and Dr. Laughlin. I rushed over and stood before the room, wide eyed, and without a clue of what to do based on what I saw inside.
The nurse and Dr. Laughlin were desperately trying to put an oxygen mask on the elder gentleman, as the EMTs explained that he would not allow them to put the mask on. I could now see that the man was emphatically rebuking any attempt to don an oxygen mask by pushing it away violently, with more force than you expect from someone whose mortality was evidently in jeopardy. The nurse had managed to slide an oxygen sensor onto the man’s finger, which was now beeping and blinking red on the monitor, indicating an oxygen saturation of fifty one percent. Normal saturation is one-hundred percent, and humans cannot survive long at fifty one percent. It hit me. This man was tired of living, and wanted to die – right now.
“Does he have any advanced directives; does he have a DNR in place?” Dr. Laughlin asked the female accompanying the elderly man. She shook her head no. “Get me an intubation kit!” commanded Dr. Laughlin. I turned and darted to the supply room. I didn’t even know what the hell an intubation kit was! I burst into the supply room, and luckily, a nurse in there. I asked her if she knew where we kept the intubation kits, her eyes popped open, indicating that it sounded serious, and she quickly handed me a pre-packaged bag full of tubes, what looked like a shoe horn, and some lubricant. I was getting it. Because the elder man refused an oxygen mask, we were going to shove a tube down his throat and force oxygen into his lungs. I returned and handed Dr. Laughlin the kit, and he promptly opened it and stood at the patient’s head. While preparing for insertion, the elderly man started violently shaking his head to avoid the tube! This man was trying to commit suicide in front of all of us!
The nurse asked the middle-aged blonde-haired woman about her relation to the elder patient. She was the elder patient’s daughter. “What do you want us to do?”, the nurse questioned the patient’s daughter loudly, clearly, and directly.
The patient’s daughter had not said anything to this point. She was obviously concerned and distraught, but she seemed content letting this play out without her input. “He doesn’t want any oxygen because he wants to die,” she replied. She had a Polish accent.
The nurse began pointing furiously to the red blinking fifty one percent oxygen saturation warning while stating “He is not of sound mind and cannot make that decision! You have to make that decision!” When a patient’s oxygen saturation is below a certain point, it can retard their decision-making ability. Therefore, the hospital will not allow people to make life altering, or, in this case, life ending, decisions while their mental state is impaired. A fifty-one percent oxygen saturation level was well below the point of mental impairment. Imagine having that dumped into your lap. The elder man’s daughter was just here to support and pray for her father, and suddenly she was thrust into making the decision of whether to give an order to save her father’s life, or honor her father’s wishes by letting him die.
“It doesn’t matter, we don’t have a DNR form in place. We are going to have to hold him down,” said Dr. Laughlin flatly.
“There are DNR forms at the Nurse’s Station,” stated the attending nurse. The Nurses Station was only about thirty yards away.
This whole situation was existentially beleaguering. I felt horrible for this woman who had to make this decision. It was evident from her body language that this was an ongoing embodiment of their daily lives. She loved her father and wanted him to live – forever if that was possible. However, he was diurnally in pain, depression, and stress. The elder patient’s actions were unassailably premeditated, thought out, and planned. He would fight to die. I understood what that was like. Stress, anguish, and depression will lead to some dark days. This elderly patient was done. He had enough. Is it fair for us to prolong this man’s suffering because some paperwork is not properly in place, or should we bless him and let him rest in peace?
“I will get the DNR form!” It blurted out of my mouth, and surprised even me. I locked eyes with the attending nurse, and she ostentatiously nodded, echoing her support. I broke into a dead run to the Nurse’s Station. I had no idea where the DNR forms were. “Do you know where the DNR forms are?”, I asked the first nurse I saw in a hurried, panicked manner.
“Yeah. I will get one for you in just a second…”. I don’t have a god damn second! I didn’t want to be rude, but, read my voice, face and body language! I don’t have a god damn second!
“Do you know about where they are? I will look for them,” I asked quickly. She indicated that the DNR forms were somewhere in a huge, waist high, wooden filing cabinet that took up the entire back wall of the Nurse’s Station. I opened a few drawers and began feverishly sifting through papers. This filing cabinet was huge! I didn’t even know what a DNR form looked like! Dr. Laughlin is going to have to intubate, and without me there, that was going to get messy.
“Nichole, do you know where the DNR forms are?”, yelled the nurse I was just speaking with. Oh my God! You have all worked here for years, in an Emergency Room, and nobody knew where the DNR forms were? “I thought they were here somewhere- “, she stated as she began sifting through papers near where I had been looking. “Here they are!”, she exclaimed as she held one up to her face looking at it, and handed it to me.
“Thank you!”, I said as I bolted back to the room with the dying elderly patient.
The attending nurse of the elderly patient quickly grabbed the DNR form and brought it to the patient’s daughter. “If you want to sign this, the DNR form is right here.” The nurse put the form on a table next to the blonde-haired woman. The elder man’s daughter was sitting at her father’s bedside with an extremely pained look on her face.
“If I don’t see a signed DNR form, then I have to intubate! I need a decision now!”, stated Dr. Laughlin definitively. Her face was screwed up with immense pain and emotion. The elderly patient wasn’t moving much anymore. The daughter was perturbed, but not making a decision.
“Ryan, hold him. We have to intubate,” commanded Dr. Laughlin. I moved to hold this man down so he was unable to fight, and could be intubated.
“Let him die!” cried the woman, the daughter of the elder man, whose fate she just sealed. She grabbed the DNR form in front of her, and signed it, officially making it a death warrant.
Dr. Laughlin set the intubating tools down, and left the room. The attending nurse turned off the head lamp, dimmed the lights, closed the curtain and gave the daughter time alone with her passing father.
“How long will it take?” I asked the nurse as she exited the room.
“It will only be a matter of minutes, if he isn’t gone already,” she said solemnly.
I could see through a slit in the curtain. I saw his arm move one more time. The elderly patient’s daughter was slumped over her father. I couldn’t take my eyes away. I wanted to, but I couldn’t. I had never watched anyone die before.
This event would stick with me for the rest of my life. As time elapsed, on multiple occasions, I would perform CPR on patients who were rushed into the emergency room. All of those patients died, or more accurately, were dead before I started CPR; but those deaths were inevitable – out of my control. This death somehow seemed controlled by the nurse and myself. The nurse and I clearly believed it was time to let this man die, and that mentality shined through in our actions. Had the nurse decided to let Dr. Laughlin intubate, and not mention the location of the DNR forms; had I not decided to rushed to get said forms; and had the nurse not slammed the DNR form on the desk in front of the elderly patient’s daughter to sign – he would have lived to see another day. For how long? How much more suffering would he have experienced? I don’t know. Maybe we did the right thing. Even to this day, I can’t help but lament, feeling like I issued some subtle manipulations, and that maybe I had a hand in that man’s death.
Next >>: Episode 09 (Monitoring the Competition)
Memoirs of a Steroid Kingpin (Table of Contents)
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