A crowd hovered over the man lying on the grass as his skin turned purple. Chera Kowalski crouched next to his limp body, a small syringe in her gloved hand. Squeeze. The antidote filled the man’s nostril. The purple faded. Then it came back. Kowalski’s heart raced.
“We only gave him one, and he needs another!” she called to a security guard in McPherson Square Park, a tranquil patch of green in one of Philadelphia’s roughest neighborhoods.
“He’s dying,” said a bystander as the tension mounted around lunchtime one weekday last summer.
“Where is the ambulance?” another woman begged.
Squeeze. As the mist entered the man’s nose, Kowalski dropped the second syringe and put her palm on his sternum. Knead. Knead. Knead.
Nothing. She switched to knuckles. Knead. Knead. Knead. Then a sound, like a breath. The heroin and methamphetamine overdose that had gripped the man’s body started to succumb to Kowalski’s double hit of the recovery drug Narcan. With help, the man sat up. Paramedics arrived with oxygen and more meds. Death had been held at bay, again.
Kowalski headed back across the park, toward the century-old cream-colored building where she works. “She’s not a paramedic,” the guard, Sterling Davis, says later. “She’s a teen-adult librarian, and she has saved six people since April. That’s a lot for a librarian.”
Long viewed as guardians of safe spaces for children, library staff members such as Kowalski have begun taking on the role of first responders in drug overdoses. In at least a handful of cities (Philadelphia, Denver, San Francisco, Salt Lake City, New Orleans, and others), library employees are trained to administer the drug naloxone—also known by its brand name, Narcan—which helps reverse overdoses. As opioid abuse has continued to afflict many parts of the country, libraries have frequently found themselves on the front lines, which is perhaps not surprising given that they often serve as daytime havens for homeless people and hubs of service in impoverished communities. In the past two years, libraries in Denver, San Francisco, suburban Chicago, and Reading, Pennsylvania, have been among the sites of fatal overdoses.
Narcan training has changed the odds. When a man overdosed in the bathroom at Denver Central Library in February 2017, security manager Bob Knowles rushed to revive him. The branch had received its first delivery of Narcan just hours earlier. Library workers had sought the drug after a fatal overdose at their branch, which is near Civic Center Park, a hangout for homeless people and a market for drugs. Knowles lost a brother 40 years ago to an overdose. “I wish somebody had had Narcan for him,” Knowles says.
Chera Kowalski is a somewhat unlikely rescue worker. The 34-year-old librarian wears oversize sweaters and big glasses. She reads nonfiction about World War II and zones out on Netflix. She chose to work at McPherson Square Library partly because of her personal history: Her parents had been heroin users. They’ve been clean for more than 20 years. Her mother earned a college degree in her 50s, and her father, a Vietnam veteran, worked as a truck driver until retiring, she says.
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But Kowalski knows what it’s like to live in the turmoil of addiction. “I understand the things the kids are seeing,” she says. “It’s not normal. It is, unfortunately, their normal.”
When a drug user overdoses at or near the McPherson library branch, Kowalski takes a minute to “switch the head-set” from librarian to medic, she says, then springs into action. When she got word that day about the man who had collapsed in the grass, Kowalski reached into a desk drawer and pulled out a blue zippered pouch containing Narcan and the components required to deliver it. As she dashed out of the library, she asked someone to call 911.
“You’re under a time limit,” Kowalski says. “It’s, ‘How fast can I do this?’” When she walked away a few minutes later, she felt relief. He would live.
“I understand where they’re coming from and why they’re doing it,” she says of heroin users. “I just keep faith and hope that one day they all get the chance to get clean. A lot of things have to line up perfectly for people to enter recovery long-term.”
According to the Centers for Disease Control and Prevention (CDC), deaths from overdoses of prescription drugs and heroin have quadrupled since 1999 and are the leading cause of unintentional death for Americans. From 2000 to 2016, more than 600,000 people died of drug overdoses. Some of those deaths resulted from abusing legal painkillers such as oxycodone or Percocet, and some were from heroin, the hard-core opioid that some people turn to when their legal pain prescription runs out or becomes too costly.
Opioids work by attaching themselves to the areas of the brain that control pain and emotions—the same way the body’s natural neurotransmitters such as endorphins do. When the body can’t fight off pain, the drugs help by driving up levels of the feel-good hormone dopamine, which can create a feeling of euphoria. Yet as the brain becomes accustomed to the good feelings, it often takes more and more drugs to produce them, leading to dependence and addiction.
Hailed as a miracle remedy, naloxone short-circuits the effect of opioids. More than 26,000 overdoses have been reversed since needle exchanges and other programs started distributing naloxone two decades ago, the CDC reports. Pharmacies sell it over the counter, and many insurers cover both the injectable and nasal-spray methods. The cost is about $150. Administering the nasal spray, as they do at McPherson, requires four steps: unscrew the vial, put it in the syringe, screw on the nasal mister, squeeze out the medicine.
McPherson Square Library has a wide, welcoming staircase punctuated by tall columns. It anchors the Kensington community, where residents drop in with questions about doctor visits and legal matters and children eat meals provided by staff and play with rockets in the Science, Technology, Engineering, Arts, and Mathematics (STEAM) program.
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In recent years, so-called drug tourists—people who travel from as far as Detroit and Wisconsin seeking heroin—started showing up in Kensington, which boasts perhaps the purest heroin in the country. Users would camp out in McPherson Square Park and shoot up in the library’s bathroom, where nearly a half dozen people overdosed in the past two years, says branch manager and children’s librarian Judith Moore.
The problem got so bad that the library was forced to close for three days in 2016 because needles clogged its sewer system. The staff discovered a man in the bathroom with a needle in his arm. He toppled over and started convulsing. “I heard his head hit the floor,” Moore recalls. A city employee had left a dose of Narcan at the library, but the staff didn’t know how to use it. After that, administrators set out to get them trained, says Marion Parkinson, who oversees McPherson and other libraries in North Philadelphia. (Patrons at McPherson now have to show ID to use the bathroom, Moore says, and overdoses have dropped dramatically.)
The American Library Association also created a sort of electronic digest for its members to help with visitors suffering from substance addiction. It directs librarians to advice on how to recognize opioid use (short of seeing someone with a needle), how to address it, and where to go for additional support. “We can be partners in the solution of this problem,” says Julie Todaro, PhD, a former president of the American Library Association.
Last year, opioids killed more than 1,200 people in Philadelphia, about 30 percent more than in 2016. Nearly half involved fentanyl, the powerful drug that killed Prince and Tom Petty. “It is among the worst public health problems we’ve ever seen, and we have not seen the worst of it yet,” says the city’s health commissioner, Thomas Farley, MD.
In fact, the situation is so dire that city officials are considering a radical experiment: establishing “injection sites,” where addicts can shoot up under medical supervision, in hopes that they won’t overdose before finally getting treatment. “The only way to get people to turn their lives around is to keep them alive long enough so they can do that,” says district attorney Larry Krasner. A handful of foreign countries have injection sites, but no American city has taken the controversial step of opening one.
So library employees keep an eye out for overdoses. When Davis, the security guard, spots one, he tries not to alert the children. Kowalski’s first save happened when a woman overdosed on a library bench after school. One dose of Narcan revived her: She got up and walked away. But when Kowalski turned around, several kids, all library regulars, were on the steps, watching.
“I got really upset because I know what they were seeing,” she says.
Weeks later, she revived a man who overdosed on fentanyl and fell off a bench in front of the library. “I might need to take a mental day tomorrow,” she said afterward. But then her regulars arrived. She played games with them and helped them on the computer. By the end of the day, Kowalski says, “I felt good again.”