A Mother Lifts Her Son, Slowly, From Heroin's Abyss

Sparta, New Jersey: When Gail Morris came home late one night after taking her daughter to college, she saw her teenage son, Alex, asleep on the sofa in the family room. Nothing seemed amiss. An unfinished glass of apple juice sat on the table. She tucked him in under a blanket and went to bed.

The next morning, he would not wake up. He was stiff and was hardly breathing. Over the next several hours, Morris was shocked to learn that her son had overdosed on heroin. She was told he would not survive.

He did survive, but barely. He was in a coma for six weeks. He went blind and had no function in his arms or legs. He could not speak or swallow. Hospitalized for 14 months, Alex, who is 6-foot-1, dropped to 90 pounds. One of his doctors said that Alex had come as close to dying as anyone he knew who had not actually died.

Most people who overdose on heroin either die or fully recover. But Alex plunged into a state that was neither dead nor functional.

There are no national statistics on how often opioid overdose leads to cases like Alex's, but doctors say they worry that with the dramatic increase in heroin abuse and overdoses, they will see more such outcomes.

"I would expect that we will," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. "They are starting to report isolated cases like this. And I would not be surprised if you have more intermediate cases with more subtle impairment."

More than 660,000 Americans used heroin in 2012, the federal government says, double the number of five years earlier. Officials attribute much of the increase to a crackdown on prescription painkillers, prompting many users to turn to heroin, which is cheaper and easier to get than other opioids.

Heroin deaths across the country have soared: from 2011 to 2012, they rose 200 percent in Louisiana, 60 percent in Ohio and 300 percent in Maine. On Long Island, east of New York City, more than 220 people died from heroin in 2012 and 2013, the most ever.

"Everyone focuses on death because it's so dramatic," Volkow said. "And so attention hasn't been paid to the follow-up consequences that may emerge when someone actually survives."

Alex overdosed in 2001, when he was just 17. Today, after 13 difficult years, he has regained some cognition, but still cannot get out of bed, bathe or dress without help. His mother, who is divorced, has become his full-time caretaker. And her life - she was an executive for Citibank and traveled the world - has become circumscribed by his needs

Still, one of the doctors who treated Alex early said he was lucky.

"The ones who survive that I have taken care of - many are in a minimally conscious state or a vegetative state," said Dr. Caroline O.

McCagg, who is associate medical director of rehabilitation medicine at the JFK Medical Center in Edison, New Jersey, and oversees patients with brain trauma. "Some get better, but cognitively they are so impaired that their communication is limited and their ability to live in the community is unlikely."

She calls their condition "a living death."

"They don't always come back all the way," she said. "I've had patients for 10 or 15 years who are just in limbo. But the family can't let them go. Death would be kind, in some instances."

Alex has made more progress than anyone predicted. While he still cannot stand on his own and must use a wheelchair, he no longer requires a specialized chair with restraints. His left hand works. He has regained some vision. He can swallow and even speak; in fact his cognitive functioning is fairly high, considering what he has been through, and he communicates well enough to reveal a quick intelligence and flashes of humor.

But the promise of his young life - he excelled at math and loved to play guitar - appears dashed. He once dreamed of playing in a band; he now dreams of being able to walk.

Alex had learned his multiplication tables when he was three and scored 700 on his math SATs. Today he can hardly add, though he occasionally recalls his calculus and watches television programs on topics like string theory.

"His brain is Swiss cheese," his mother said. "It is full of holes."

One of those holes is the time immediately before he overdosed, in April 2001, at his home here.

Alex has no recollection of it. His mother said she thought this must have been his first time. He had an after-school job that required him to take a drug test, and only three months before the overdose, his drug test had been clean.

But after his overdose, the police found heroin packs hidden under a false bottom in his bedroom dresser, along with packets of marijuana and pills. They found no needles, leading police to surmise he had snorted the powder.

Morris and Alex no longer ask why he turned to drugs. She offers theories that he cannot corroborate: He was an introvert and had been bullied at school; he was moody and wanted to ease the pain; he thought heroin would expand his music appreciation.

In the emergency room, he received two rounds of an antidote, probably naloxone, which can reverse the effects of an opioid overdose. It is now being widely distributed to emergency medical workers and even family members and has saved thousands of lives. In Alex's case, he received it too late and it did not work.

He ended up in the same intensive care unit at the local community hospital as Karen Ann Quinlan, the young woman at the center of one of the nation's first major right-to-die debates in the mid-1970s.

Quinlan had fallen into a coma after a night of drugs and alcohol. After a year in which her doctors said she suffered from irreversible brain damage and was in a "persistent vegetative state," she was taken off her respirator. She lived for nine years before dying of natural causes.

Julia Quinlan, Karen Ann's mother, heard about Alex's overdose and called Morris.

"She was very helpful," Morris recalled.

Quinlan helped her think about her options and what might lie ahead. But mostly, Morris sat by her comatose son in the hospital, willing him to live by softly chanting what she calls the parent's prayer: "Take from me and give to him."

After emerging from his coma, Alex was transferred to the acute brain trauma unit at JFK Medical Center, where he stayed for three months, and then he spent 10 months in the medical center's extended brain trauma unit.

At the age when Alex had been expected to follow his sister into an Ivy League college, he instead could do little but breathe. Instead of becoming independent, he became completely dependent.

He is now 30 and his mother is 66. They are an inseparable pair, their lives intertwined in every way. She tends to the minutiae of his every waking moment.

Their symbiosis is reflected in their pas de deux when Morris helps Alex transfer from bed to wheelchair, from wheelchair to toilet, from wheelchair to sitting chair.

Her legs straddle his while she pulls him up and he grasps her arms. She is careful to position herself so that if his legs go into a spasm, they will not clutch her in a vise.

When she has him up, they stand for a moment as if in an embrace before she turns him to another chair.

And they seem to have a kind of mind meld. Morris was saying that introverts like her son often felt in high school like they were being "policed." But as she spoke, she knew that "policed" was not quite the word she wanted, and Alex, who was listening intently, sensed it too.

"Monitored?" he offered. That was the word she was looking for.

"Brain-injured people can't always find the right word," she said. "But sometimes, I feel like we've flipped, and Alex fills in the blanks for me."

He is also funny. At one point, Morris said she had despaired of researchers who like to note that more people die from smoking cigarettes than from using heroin. This prompted Alex to laugh and paraphrase the comedian George Burns, who constantly smoked a cigar: "My doctors who told me that smoking would kill me are all dead now."

In between exercises, therapies and trips to the doctor, Morris and Alex find time for a few activities that do not relate to his condition.

They traveled recently to Baltimore to see an exhibit on Archimedes, the Greek mathematician. They attend classes together at the Apple Store. They also go to a local Toastmasters club, where people learn public speaking and are critiqued by other members; Morris said it was "good therapy" for Alex "to see Mom get critiqued for a change."

In recent months, they developed a cooking project called "Helping Hands Chefs" to help people like Alex with hand-dexterity issues. Over the years, Morris has perfected many techniques, from putting peas in mashed potatoes so that they do not roll off a fork, to grinding cinnamon sugar onto bananas, making the pieces less slippery so Alex can pick them up.

Now, she is sharing those techniques through a blog, videos, a cookbook and by giving cooking lessons to others who take care of people who have difficulty feeding themselves.

Morris hopes the project will provide some financial security for Alex's future, which is constantly on her mind. He receives disability income now through his father's retirement.

Morris is healthy and strong but knows she will not live forever. Her immediate goal is for her son to be able to move from chair to chair by himself, and someday to walk with a cane.

"I hope that I hold out long enough that we can get him to be independent, and he's trying as hard as he can," she said. If he does not learn to walk, she said, he could end up in a nursing home. She is still searching for a way that he might become self-supporting.

Asked how he envisioned his future, Alex said quietly, "I don't have an answer for that."

People often think of taking heroin as like Russian roulette, Morris said, because you never know what you are going to get. But to her mind, taking heroin is more like being a suicide bomber.

"Not only are you affecting your own life, but the shrapnel that is produced goes to the people you love the most," she said.

"When you're thinking of getting high, you really should be thinking that you're taking a hot coal and putting it in your loved one's body," she said. "If you die, that pain will be with your loved one forever. But these other outcomes can also be incredibly painful and arduous for whoever has to deal with it."