From Bagby to Bixby

Late 90's in Portland, where the dream of the 90's persisted in spite of the last and fast sinking sun of that millenium swiftly approaching, was a place where the encroaching and soon to be overwhelming influx of people was still a dull roar. A time where I was a high school graduate and working odd jobs, still skateboarding and engaged in the urban adventures that go along with being a skate rat. One day three friends and I packed into a car just like this Honda Hatchback and headed to Bagby Hotsprings, an hour or two outside of Portland and that is snowed in a good part of the winter.

Bagby Hot Springs is a place deep in the woods, located in the Mt Hood Forest about 70 or so miles southeast of Portland and sits at nearly 3000ft of elevation in the Cascade Mountain Range. Undoubtedly a place of renown to the Native Americans for who knows how long before the immigrants came from the West and by ship to Portland. It is named for Bob Bagby, a prospector and hunter who "settled" the site in 1880.

In 1913 the United States Forest Service built a small guard station used to house fire patrol crews. In the 1920s a bath house was built but burnt to the ground in 1979, from unattended candles. A volunteer group Friends Of Bagby formed and swooped in to rebuild the bath houses. In the early 1980's there were three bath houses built. There are three major springs at the site, the largest flowing at 24 gallons/minute at 138 degrees Fahrenheit, the two others at 15 gallons/minute with a temperature of 136 degrees, the other much slower and cooler with three gallons/minute at 120 degrees.

The weekends are always busy, and in the early nineties there were stories of shenanigans going down, assaults, drunken debauchery and intimidation, and cars being broken into at the lot. There is a 1.5 mile hike into the area from the parking lot, leaving cars vulnerable to the whims of the unscrupulous and dishonest characters.

Anyway, if my memory serves correctly it was a late autumn Friday evening but the snow had yet to come. The little Honda that could took the 4 of us and a dog up into the hills for a little rest and relaxation in the tubs. I'm fairly sure these pictures are from that very night. Realize this was before everyone had cell phones, and I don't think one of us had a cell phone. Not sure who's camera these pictures come from.

Sausage party, sure, but good times nevertheless. 

It may have early morning by the time we hiked out back to the car and made our way down out of the windy, precarious backroads and down to the highway, coming back into Estacada with the Clackamas River on the left. I think I may have been in the front seat, and as we came around a broad, sweeping curve in the 4 lane highway there was a embankment on the right that had maybe 50 feet of a shallow decline before the land met the mountain base; tall grass covered the road grading embankment. There was a car at the bottom of the large ditch, in essence, and with its lights on. We approached it and the driver slowed down. We ran down the hill and the car was full of people, 4 young people, who looked to be just about our age. They were nearly unarousable. We checked to make sure that all of them were alive and then we decided to continue into Estacada and keep an eye out for a pay phone.

We eventually found one, called 911. We drove back towards the car, maybe a few miles back, and I believe the police and or paramedics flew by us, and we decided not to stop and bother them once we saw the other kids being attended to. I've not thought of this story in awhile, and I'm not sure why it came to my mind today, but I was reflecting on whether or not I had any more insight as a doctor vs back then, when I had no intentions of even earning a bachelor's degree.

The car was resting at the bottom of a long shallow hill, with no evidence of damage to the front, or any part of the care indicating a traumatic precipitating event, or even a velocity of any significant amount as they went off the road and down the hill. In no way would this have been an ideal place to pull off the highway, to chill, drink a beer or whatever kids might be up to on a desolate forest road. I think the car was still running, and the headlight were on.

So, I conclude that whatever insult happened to the mental faculties of all members of the car occurred while the car was on the highway, and it was something that took all of them out at, or nearly at, the same time. Interesting. What could do this? Common intoxicants being common, let us talk through them. Okay, first remember that all four of the kids were sitting in their seats, unconscious and not easily arousable. I wish I would have been paying attention to respiratory rate, but I don't remember any of them having vomitus obvious  around their mouth or on their shirts, I doubt any of them soiled themselves, or at least I didn't smell anything like that. After vigorously shaking one of them he mumbled something incoherent and I don't think he opened his eyes. I remember we checked the pulses of the others and ran back to the car as it was obvious these people were in trouble, it was clearly apparent to even us, some skater dudes who were walking around in the dark, deep forests of the ancient old growth timber, enjoying the fruits of the volcanically heated spring waters.

Alcohol? Doubtful. While passing out from EtOH intoxication is obviously possible, it seems unlikely that all four of them would have been in a place where they were able to get in the car, and then at the same time all pass out and then to gently drive off the road, causing no apparent injury to car or body. I don't remember smelling booze, either.

Uppers, like methamphetamine, or cocaine? Again, unlikely -- of course people who go on speed benders and are up for days, or a week or two at a time eventually crash and sleep. But there is no way that all these kids became unconscious from something like this. However, if they thought they were snorting, smoking or shooting cocaine, or meth and it was dirty, at a unexpected concentration or something else altogether, this could be one possible explanation. And that leads us into my primary suspect...

Downers; specifically kinds that are injected into veins, as acute, coordinated overdoses are seen more frequently from direct intravenous introduction versus smoking or snorting, but nevertheless, I suspect heroin overdose. These kids, if I had to bet, shot heroin into their veins, and they probably all did it together. Most likely it was too concentrated and they, whether experienced users or neophytes, received too much and their respiratory drive in their brainstem was suppressed insomuch that they faded out and slowly drove off the road and came to rest at the bottom of the ditch, waiting for us to come and rescue them. These days, people are falling all around us because of fentanyl that is added to what is sold as street heroin. Fentanyl is waaaay strong and people stop breathing and die. What abou benzos, or other things like GHB, or ketamine? Definitely possible, but again, the scenario which has all 4 people incapacitated at the same time indicates, in my mind, a very acute onset intoxicant which was administered in a manner in which metabolism variances in passengers of care have minimal impact. That is, things that are not eaten or ingested in any way. That means smoking, snorting and shooting are most probable. Benzodiazepines are generally eaten in pill form. I'm not sure about ketamine, I think it is in pill form. Still, heroin injection is suspecto primarius.

If I were on the paramedics rig that responded to that call, I would have hit them with narcan and, probably, would have watched them come to with a rage and anger rarely seen outside of a person reversed out of a blissful celestial passage on the USS Opioid Princess bound for the deep water dock in the sky.

Hope they're okay. I'm sure they're upstanding citizens of rural Oregon, dedicated to the progression of society yet mindful of the unfortunate among us.