“Marcos is dead!”

Her son. My wife got the call, his girlfriend screaming hysterically from Palm Springs. His body was in the morgue by the time we drove down from Los Angeles. Between choking sobs, his girlfriend said that after a night out together, Marcos woke at four AM complaining of chest pain and sneezing; jittery and not feeling well. Thinking it was an allergy, she went out to Walgreen’s for Benadryl. He took them and went to bed. His loud snores woke her up around 7:30. She described him taking a long gurgling, gasping breath and then he rolled over and didn’t breathe or move again. She tried to wake him over and over but he was unresponsive. Lifeless.

The paramedics started CPR and Advanced Cardiac Life Support, but they couldn’t get any response. They rushed him to Desert Regional and at 8:35 he was pronounced dead. Dead at forty-five years old! Heart failure. He was a lifelong basketball player. No health issues as far as we knew. How could he possibly die so suddenly and what could cause his heart to fail so suddenly and so young?

The Coroner’s Sheriff ordered an autopsy and tox screen. With case backlogs and budget cuts we didn’t get the results until nine months later. Cause of death: “Acute cocaine and cocaethyloene intoxication.” “Administered illicit drugs to self.” I’d assumed for years that Marcos did ecstasy at parties and probably cocaine when he could afford it. Party drugs. But dying from cocaine? News to me. How did the Coroner figure cocaine as the cause of his death? And what was this “cocaethylene” stuff? Where did it come from? Some strange new street drug? The answer came in an internet minute.

The druggie chat rooms call it “Drinking With Charlie.” They say that drinking alcohol  while doing cocaine boosts and prolongs the high and makes a stronger and longer-lasting high than either alone. Alcohol and cocaine both go to the liver, but the liver metabolizes alcohol faster. The  cocaine breaks down in the presence of alcohol, then it recombines with the ethanol to make an entirely new chemical: cocaethylene – more potent and dangerous than either coke or alcohol. And when you do it steadily, the cocaethylene builds up in the liver and stays there.

The effects of coke wear off faster and faster the more you do. But cocaethylene takes twice as long to be processed by the body than alcohol and cocaine alone. Instead of being flushed out in the urine, the cocaethylene gets back into the bloodstream, to the brain, to the autonomic nervous center that maintains heart rate and breathing. Cocaethylene makes the heart rate skyrocket and for far longer  than coke alone, subjecting the heart and liver to a prolonged period of stress. Even while sleeping. The heart can take only just so much stimulation and the system suddenly shuts down. Completely. The effects of cocaethylene last so long, your heart can stop even twelve hours later in your sleep.

Paramedics can’t resuscitate, ER declares “heart failure” and there it stays. Without a full autopsy, there is no record of why a young, otherwise healthy heart fails. Like most parents, we probably wouldn’t have had an autopsy done on Marcos, but the Sheriff ordered it.

I told this to a friend who scoffed, “Every time I did cocaine i drank booze and nothing ever happened to me.” But when Marcos’ father  died recently  and left him in charge of his business, Marcos had unlimited access to cash – probably the worst thing for a cocaine addiction. At the end he must have been doing it every day and drinking, judging by the whiskey and vodka bottles left under his desk.

In the US we don’t have National Health, so we have no central database that includes all medical-related records: ER, paramedic, police reports, Coroner’s autopsies, tox screens, primary care docs, etc. In the UK and Sweden that do have National Health, they maintain central data bases so all this information is factored into cause of death. In the UK – a famously boozing nation – cocaine has become fashionable whilst binge-boozing in pubs. Drinking With Charlie has caused an epidemic of sudden death in young people from cocaethylene. In the UK the epidemic of sudden heart failure from Drinking With Charlie is a accepted medical fact. In the US it’s considered an unproven rumour.

Marcos’s death from cocaethylene isn’t a rumor and these words won’t bring him back. Hopefully, this might help someone think twice. It’s been a year since that phone call. His mother put up an altar for Dia de Los Muertos with his picture at the center. We’ll take it down soon, just not yet.

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