The Mule

Revised version as it appears in Nursing 2012, November 2012 edition.



1993, New York.

The elderly Filipino woman was shaking when she was brought by the EMS paramedic to Triage. She clutched my hand, pleading in silence.

The EMS paramedic bypassed the other triage nurse and zeroed in on me, correctly guessing that his patient and I share the same ethnicity.

“We picked her up at the airport,” he told me. “Her plane had just arrived fromBrazil. The flight attendants noticed that she was very agitated and crying uncontrollably. It seems she’s traveling alone, but she won’t talk to us.”

Anybody’s grandma

She was in her late 60s, with gray hair and a stooped posture; she looked like anybody’s grandma. In fact, she looked a lot like my own departed grandma. She held tightly to her purse and her eyes filled with tears. My initial reaction was to pat her shoulder in a gesture of comfort. As I rubbed her back, I felt her tremble.

At that moment, two men in suits appeared and handcuffed “Grandma” to the stretcher. The narcotics agents informed us that she was suspected of swallowing condoms of cocaine and she had to be isolated from the general population. They planned to wait for her to pass the condoms. I hoped that the cocaine packets would remain intact. Rupture of the packets would result in severe intoxication, seizures, and death.

Her story was all too familiar. She was a drug courier—or, in the colloquial term, a “drug mule.” But she was much older than the couriers who’d come to our ED in the past. None of the other couriers I’d seen looked like “Grandma.”

In my naiveté, I wasn’t prepared to think of the possibility of my patient as a drug mule. As I looked at her in disbelief and disappointment, she averted her eyes. Thrown off by my preconceived notions of what a drug mule should look like, I couldn’t help but ask, “Why?” She kept her eyes closed, but tears ran down her cheeks.

The agents were frustrated with the lack of information. “We need to find the people who contracted her to carry the drugs,” they told me. Their interviews with the patient were met with silence. She looked afraid; she provided all the demographic data for the registrar but refused to give any contact information. Maybe she didn’t want to give any information for fear of repercussions.

Taking a turn for the worse

Suddenly she grimaced in pain as she pressed on her stomach with her free hand. Alarmed, I yelled for the physician STAT. The patient’s BP was rising and her heart rate was racing. I was afraid that the cocaine packets had burst inside her.

“How many packets did you swallow? Tell us, please!” The patient hesitated, but as she squirmed in pain again, she mumbled, “Ten.”

The next few minutes were frantic as we prepared to send her to the OR for exploratory surgery. We were racing against time.

As she was wheeled out of the room, she turned to me and said, “I did it for my family.”

No room for preconceptions

“Grandma” didn’t survive the surgery. As we later learned, she died because she needed money to pay for her daughter’s cancer treatment back home.

Although we’d expected it, the news of her death affected the ED nurses who knew about her story. Our stereotypical image of a drug mule shattered, we were also touched by her sacrifice for her daughter.

To what extent would you go to help a loved one? we asked ourselves. How tragic that our patient felt trapped by her circumstances and fell prey to the drug lords who took advantage of her need.

I learned an important lesson that day: No patient is stereotypical; as unique as we all are, we respond differently to the chaos in our lives. There’s no place for preconceptions in nursing. We should be able to rise above our personal feelings and take care of each patient the best we know how, without passing judgment.