It is a story I have struggled to tell. Because it is most definitely a hard story to tell, a hard story to make sense of…I’m still trying to wrap my head around it. My conclusion is this: her story has to be told, as a cautionary tale, as a warning to parents, as an education for all of us…and I believe that Ashley wants it told. I am not embarrassed by her story, for I could never be embarrassed by my precious daughter. We all make mistakes, we have all made poor choices. Tragically, her choices cost her this life. So, it is a heavy weight to accurately and clearly tell of her life…and of her death; I will do my best to honestly tell it. I’m still shaken to my core that I didn’t see this coming. This is not something I want to share, but it is on my terms, and it is time. As a parent and as a nurse, it is a responsibility.
Ashley’s story, though you know the ending, is unexpected. And it is in the unexpected that our lives change. It is in the unexpected that Ashley’s dance of life ceased, and the lives of myself, my husband, and our son have forever been altered. Just so you know…God was not absent that night; God is not absent now. He was with Ashley, and He has walked every step with me since that night.
How in the world do I put this into words?! Well, I will do my best. Let me tell you my daughter’s story…beautiful…tragic.
Ashley was born May 1st, 1992…May Day. A perfect birth date, for my Sunshine filled my life with light and joy. Oh, how I loved being her Mom!
She lived a good life, a blessed life…loved by her family, smart, an amazing writer, a Christian who loved God and wanted to be like Christ, a (mostly) good big sister 😉, beautiful beyond measure, funny, a truly caring heart that had compassion for the hurting, an animal lover, a coach, and a competitive swimmer for 15 years (from six years old until her senior year of college). She loved to make others laugh, and she loved to laugh. She loved being blonde and embraced her “blondeness,” because yes…there were many blonde moments in her short life. She loved all things medical, and loved to discuss medical things with her Mama. We were best friends and she shared so much of her life with me. I miss that talking…every day. She wanted to be a PA; she wanted a husband who adored her; she wanted children; she wanted to make a difference in this life. Oh, how I feel her absence! How grateful I am to have been her Mom!
Ashley sailed through most of her life, with a few bumps along the way. After graduating from college, she struggled, trying to find her way, trying to be an adult, to figure out what she wanted to do with her life. After college, she stopped swimming, and naturally her muscle mass decreased and so her right shoulder began dislocating. She had three major shoulder surgeries in the space of a year and a half, and yet, her shoulder continued to dislocate, no matter how careful she was. Each time, a bit of her bone would be chipped off, meaning there was little bone there to hold the humerus in place. We saw so many doctors, even seeing one to see if he would do a shoulder replacement (waste of time and money!) And, yes, she became addicted to hydrocodone. It took me a while to figure it out, but eventually I did.
We tried to get her into rehab, but at the time I figured it out, she was just ten days post-surgery, and she actually did need the pain meds. As long as she was taking pain meds, rehab facilities would not accept her. So, we set out to detox and wean her meds…the two of us…her PCP…and God…facing this giant of addiction. It was a battle, sometimes two steps forward, one step back…sometimes three steps back. It took quite some time, but she did it…we did it! And I was so very proud of her!! During this time period, she also suffered from depression (understandably!), and a suicide attempt. Her life was in a shambles, but God graciously allowed us to build her back up. She wasn’t there yet, but wow!, she had made such amazing progress! At the time of her death, she had held the same full-time job for over two years, and in the last few months, she was at peace. I love that!
We never did get her completely off of meds because her shoulder continued to dislocate, which was so painful! She saw her PCP regularly, and received her meds in 30-day allotments. At the time of her death, she was not addicted, but she was dependent…though she knew the risk of becoming readdicted, and she didn’t want that old Ashley. She fought hard to be free of the chains of addiction, and didn’t want to go back to that dark place. She was happy, at peace, recovering from a broken heart, cruelty, and a betrayal from a man she thought she was going to marry, and she was finally ready to move forward…as the Ashley God had created her to be.
On April 20th, 2019, a Saturday, Ashley texted me. I was working that day, and she texted me before work (she had just moved out on her own about three weeks earlier.) She was not feeling well, and we both knew it was strep. Ashley was asking if she could stop by to pick up my credit card to use for a doctor visit. I said “yes”, and would leave it for her.
I went to work and realised early that afternoon that I hadn’t heard from her, and so texted her…no answer. I’m a nurse, and don’t have much time to be on my phone. I called Bill to see if he had spoken with her. He hadn’t. I told him to try to call/text periodically and I would do the same. (Ashley worked as an ER scribe in the same hospital where I work, and had crazy shifts at all different times of the day and night, so it was not unusual for her to sleep at odd times. In addition, her connectivity in her new apartment was very spotty, though Bill had gone over the day before to hopefully fix that issue.)
Anyway, as the day wore on, I knew something was wrong, and told Bill to pick me up when I got off work (7:15pm). As an aside, Bill and I had gone over exactly one week before in a very similar situation. When she answered the door, she had been fine (sleeping due to her schedule and connection issues so not getting my calls/texts.) When you love someone who has had addiction issues, you are never completely at ease. But knowing what had happened the week before, and that Ashley was an adult, I didn’t want to overreact. So many could’ve/should’ve/would’ve’s. But the past cannot be undone.
We got to her place…no answer. I had a key, but it was bolted from the inside, so we knew that she was home. We banged on the door, and called her phone. No answer. Silence. Ashley lived on the second floor and around the corner was a fire station. I had often looked down at it, but had never seen anyone. This night, I went around the corner, and they had just pulled in. I called down to them that I needed a “wellness check”, and I would need them to break the lock.
They got up to us as quickly as they could, and it took just seconds to break the lock. Bill and the firemen/woman went in, while I followed slowly behind, afraid of what I’d find. I heard Bill say, “Ashley”, and I knew she was still alive. I rushed to her room, and she was just falling into Bill’s arms, locking her gaze with mine over Bill’s shoulder. (He told me later that she was lying in bed, and got up when they came in the room.) She looked so confused. Bill laid her down on the bed, and I laid next to her, holding her, telling her how much I love her, and that it was going to be ok. Time is weird that night, but it was less than ten minutes, and I realised she wasn’t breathing, and told the paramedics. While I had been holding Ashley, the fire fighters/paramedics had been getting vitals and starting an IV. At that point, I got off the bed, and they started CPR.
In my head, everything was ok…we had gotten there in time…she had been alive…we had professionals with her who were giving her high-quality CPR, which literally started the moment she stopped breathing. She would be ok!! But you already know…she wasn’t. It took an hour to get to the hospital…every time they’d get her heart back, they’d move her a few feet and lose her again, and CPR would start all over again. I am grateful I did not have to do CPR on Ashley, but the trauma of seeing it done over and over and over and over and over and over and over, and again multiple times in the ED…well, that is a traumatic thing to have in your head. It doesn’t go away. Memories which I try to push down; bu they will not be silent. Sometimes I can quiet them for awhile, but they claw and clamour to be remembered, to be relived, to change the outcome. Often, those times come in the stillness before sleep, when my mind and my unconscious join forces to bring up the continuing echoes of grief and pain, and the unchangeableness of Ashley’s absence.
I had called ahead to the ED, the ED where she worked, because I wanted to know which doctor was going to be caring for my baby, and I wanted them prepared for my Ashley. They allowed me to stay in the room that night, and I am so grateful for that gift. Horrible images, but I had to be with her, had to know that they were doing everything possible to bring her back to me. How very difficult it must be to work on someone you know. But I’m so thankful she was worked on by people who knew and loved her. They were all very professional, but I saw more than a few tears in their eyes. She had a brain CT, and when Dr. Ali got the results back, he explained that there was nothing they could do. Ashley’s brain was swelling from anoxia (lack of oxygen), she was on max support with both meds and the vent…there was nothing more to be done.
We went to ICU, where we were able to say our goodbyes. I watched the monitor, noting that all of her vitals were slowly decreasing, and praying they would go the other way. They did not. I laid my head on her chest to hear her heart beat one more time…the heart that had beat in my very body, the heart that made Ashley so very special. I wish I had laid there and held her in those last moments, but I didn’t even think of it at the time. Really, I believe Ashley left me at the moment her heart first stopped in her apartment when I was holding her, so I suppose it doesn’t really matter. Just one of the many things I wish I had done differently that night, and the day before. But we don’t get a do-over on some things, often on the most important things.
And so, at 4:38am on Easter Sunday, Ashley was resurrected with her beloved Savior, to spend eternity in heaven. We were in shock, and I would say stayed in that state of shock for over a year. We left her behind, something no Mother should ever have to do, walking down a dimly-lit corridor, holding Bill’s hand, with everything in me screaming to go back, to not leave Ashley behind. Moving into a life without Ashley, coming home to a house ready for Easter lunch, an Easter lunch that was not to be held that day…though I’ve no doubt Ashley had an amazing Easter celebration that day!!! Leaving her physical body behind was one of the hardest things I’ve ever done, but that doesn’t mean I left her behind; she remains with me…Ashley will always be a part of me.
Everyone was under the assumption that Ashley died from an overdose, though not intentional. The people she worked with did not know of Ashley’s past, but of course I had to tell the Paramedics and ED doctor of Ashley’s past history. Ashley never did descend to harder drugs; it was always hydrocodone, so everyone thought it was an overdose from her prescription meds. Ashley had been given numerous doses of Naloxone (an opioid reversal), in her apartment and also in the ED; this did nothing fo her. My nurse brain noted it, but didn’t understand it. I would have to wait almost two months to find what caused Ashley’s death.
When I received the autopsy results, probably the most horrific thing I will ever read, her cause of death was listed as: “Acute Complications of Loperamide Toxicity”. I sat in stunned silence for a moment, then heard primal screaming and realised it was me. (There were no opioids in her system, and all of her other prescription meds were within normal ranges.)
As a nurse, I knew what loperamide was. And I was angry…furious…with Ashley, with me, with the medical community, with the drug makers, with God, with the media for not informing me. How could this be Ashley’s cause of death? Imodium. A medication for diarrhea?! Something I could get over the counter…Walgreens, CVS, the grocery store…anywhere…everywhere. How was this possible/ How could this be a cause of death?! How could I not have known?!?! A “benign” drug!! No prescription necessary. Not a drug most of us would give a second thought to taking!
Of course I began researching it. What I found shocked me. People who abuse drugs know that loperamide can be used as an opioid. It is known as a “poor man’s methadone”.
I put the pieces together: Ashley’s shoulder had dislocated 10 days prior. I knew that when her shoulder dislocated, she would take more Narco to deal with the additional pain, which meant 2-5 days before the end of the month, she would have run out of meds. I knew she would start detoxing during that time, and would take Imodium to help with those side effects. In addition, she and her Dad had done a lot of work in her apartment the day before, which meant she would have been in additional pain. And, that stupid strep throat meant more pain on top of that. So, I think she needed the pain control, and she knew it would work for that. I don’t know if she knew about the risks of taking it. I suspect she lost track of how many she took, and just kept taking them, trying to take away the pain.
Unlike most opioids, loperamide has an effect on the heart. So, her heart stopped…her life stopped. And, Naloxone, which they had tried giving to her, reverses respiratory depression, not cardiac complications.
I find meaning that Ashley’s life began on May Day, a day celebrating beauty, and spring, and life…and ended on Resurrection Sunday, a day celebrating New Life and life everlasting.
I want Ashley’s story told because, like me, there are too many parents who are unaware of the risks. They know that there’s an opioid epidemic, but would never think to put an OTC med, like Imodium, on that list. I want them to be aware of its potential danger, especially if their child has had a drug addiction or dependency. I want to encourage those parents to not give up. Keep fighting the battle with your child. They need you. I also want Ashley’s story told to educate healthcare professionals. Her PCP did not know Loperamide was used for this purpose, the firemen I spoke with did not know, I never heard anyone in the ED ask if this could be a loperamide overdose…too many of us don’t know about this use/abuse. And just so you know, you have to take a LOT of these to cause this effect. I also want Ashley’s story told because we need tighter controls on loperamide. It should NOT be available on the pharmacy shelf (I have been to about ten pharmacies where I have asked the pharmacist if there are any risks with taking Lopermaide…they all said no. Just take it as directed.) There are no limits on the number of boxes one can purchase, and it is on the aisle, not controlled behind a counter, and it is cheap. Only Costco has a limit of one box, and it is kept behind the counter. The FDA added a box warning in 2016, but any restrictions are voluntary. Our legislators need to take action, for the drug makers will not do it. They know of the problems, yet continue to do nothing. And we cannot do nothing. We must…we must do something!! Ashley’s story matters. Her beautiful life, and the tragedy of her death matter. The lives lost to Loperamide matter! The data on this is slim, and many Medical Examiners do not even know to test for this. I’m so thankful that the Harris County ME was aware enough to check Ashley’s levels. I cannot be silent. Our children’s lives are too precious. Lie is too precious. Silence is not an option. My beautiful girl should still be here. She is gone. My sunshine is gone from this life, and my heart is forever broken, my life forever altered. All of her dreams left unfulfilled…this beautiful life…gone. Yes, I will see her again. And I am so grateful for the many promises of eternal life with my Savior. But that does not make her absence and the pain of her absence any less of a reality, a reality to be lived every day. All because of a drug that is used daily with little awareness of the damage it can cause, and the lives it can destroy.
So, Moms and Dads, know the dangers of loperamide. Doctors and nurses and PA’s and NP’s and EMS/paramedics…please know the dangers of this drug. If Naloxone isn’t working, think about Loperamide. Pharmacists, lead the change…put it behind the counter! Legislators, enact legislation. News media/reporters…help me get the facts out there. We can all let others know of the dangers of this drug! Please help me make that happen!!
Medical Info: The Poison Control Center database (National Poison Data System) reported a 91% increase from 2010-2016, which in 2015 included 916 exposures and two deaths. The majority used extremely high doses of loperamide, the equivalent of 50 to 100 two-milligram pills per day, necessary to cross the blood brain barrier. https://www.forbes.com/sites/brucelee/2018/03/31/another-overdose-of-an-anti-diarrhea-drug-this-time-a-death-from-loperamide/?sh=19594f854202
Treatment: overdrive pacing, magnesium, lidocaine, amiodarone (American College of Medical Toxicology www.acmt.net; JoAn Laes, M.D.) https://www.acmt.net/2020_Opioid_Symposium_Online.html
