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Death and Ecstasy 

It's hard to kill a 20-year-old. Trust me, I've seen them try. I've had a guy shot in the stomach who left the ER before getting treated because he "had some things to take care of." I've had a guy with a switchblade buried to the hilt in his brain ask me if he can step outside for a smoke, and I've had nearly every overdose known to man. Most patients, after a couple of hours in the ER, were no worse for the wear. Chances are if you're sick, stabbed or stoned and you make it to the hospital alive you're going to be OK. It's hard to kill a 20 year old ... but it can be done.

It was a typical Friday evening when the paramedics brought her to me. They'd been called because she passed out while dancing at a party. Who knows how long she'd been dead? It didn't seem possible that a girl wearing 9 West boots and a denim skirt from the Gap had a heart that was no longer beating. She was perfectly healthy except for her temperature of 108. We never got her back.

I went to have The Talk with her family, but she was from out of town and no one was there but her friends. Through the tears and the sobs they kept asking me, begging me--"What happened? ... She can't have died, it was just Ecstasy ... She never does anything hard ... She doesn't even drink ... "--as if, if they could just convince me that she was a good kid and not some junkie, she'd be any less dead.

Pointlessly I try to explain the hyperthermia as a consequence of overexertion and a blunted pain response from the Ecstasy, and they interrupt me shouting the precautions they have taken, the safe drug use guide they downloaded. I can't stop myself, holding back tears as the family room is dissolving into despair; I talk of fatal water intoxication, they counter with how they use sports drinks and nutritional supplements. Even looking death in the face, they cannot accept that at 20 years old they just don't know it all.

Emergency physicians are the world's greatest realists. There is nothing that you can do to your own body or someone else's that we haven't seen done before, usually with more panache. People are going to get in fights, have sex and use drugs as long as there is air to breathe. But if you're going to take Ecstasy, crystal meth, or anything cooked up by a second-rate biochem student, don't lie to yourself--and more importantly don't lie to your friends. You're not doing something safe and harmless.

Just like when you ride your motorcycle drunk or play Russian roulette, most of the time you'll get away with it. But when your luck runs out, nothing your friends can say will bring you back.

Certain details of this case have been changed to protect the privacy of those involved.

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