Dereck Merrill survives drug overdose, vegetative state

Dereck Merrill was severely injured by a drug overdose. Some doctors suggested it was time to pull the plug, but his family saw something.

Kim Muncy’s 25-year-old son lay on an emergency room table, unresponsive and unconscious. A drug addict who had overdosed on opiates and benzodiazepines, Dereck Merrill was not likely to make it out of a vegetative state.
If he lived at all.
Muncy did not want her son to die alone among strangers at LewisGale Hospital Pulaski. She was so determined that she tried to talk her way back to the room where they were trying to stabilize him.
“I’m a nurse. I can stay out of the way,” she pleaded. “If he’s not going to make it, I want to be there to hold his hand.”
That was March 24, 2012. The mild-mannered nurse has given up a lot to remain at her son’s side in the time since — her job, her home, most of her free time.
She’s been through the five stages of grief, finally landing on acceptance as the best path for caring for her family and making the perils of drug addiction known. She’s also joined an effort to create a law in Virginia that provides legal immunity for those who call for medical help when a person overdoses.
“Being a family of faith, I think God picked me for this journey because he knew I was a nurse, and he knew I was a blabbermouth,” the 48-year-old mother said.
“He knew I had the ability to spread the word from coast to coast about what substance abuse has done to my child.”
Glassy eyes and SpaghettiOs
Muncy has told her story to area high schools, to youth groups and to recovery program participants. She begins with her son’s troubled primary and secondary school years — Merrill’s severe ADHD and poor school performance; the legal wrangles he got into when he got caught selling his Ritalin and other ADHD drugs for money to buy stronger drugs like Xanax, Valium and Loratab.
The first time Muncy suspected her son was getting high? He came home glassy-eyed, reeking of marijuana and tried to eat everything in sight. He was 14.
“He’d wolf down a can of ravioli then get a can of spaghetti and meatballs. He’d leave the fork in the can, and throw the whole fork with the can away,” she said.
Drug counseling, family counseling — they tried everything they could afford. She was in court so often for Merrill’s drug-related offenses that a Montgomery County bailiff made a crack about reserving Muncy her own seat in the courtroom.
At 17, Merrill was ordered to intensive drug rehab after a conviction for drug possession — his third — and intent to distribute. His crime? He’d stolen the painkillers prescribed for his mother, who was recovering from back surgery. She’d locked them up, but Merrill and a friend figured out how to open the safe.
Merrill had been doing better after a year of drug treatment, or so his mother thought. He was working some and living with a girlfriend in Pulaski County.
After the death of Muncy’s mother, however, Merrill became distraught. He’d been raised with the help of his grandmother, who baby-sat while Muncy put herself through nursing school. Merrill’s father was absent most of his life and died when he was just 15.
When she first learned of Merrill’s “injury,” as Muncy calls it, she and her new husband, Doug Muncy, had just sat down to supper. Merrill’s frantic girlfriend called to say she’d come home from work to find him vomiting, struggling to breathe and white as a ghost.
They’d been to a party the night before, and she’d gone to work that morning, thinking he was just asleep, she told Kim Muncy. She divulged no information about which drugs he’d been taking or even where the party was, family members say. Tests confirmed he had marijuana, benzodiazepines, opiates and alcohol in his system.
“The effects were parallel to what you might see in a heroin overdose,” said Carilion Clinic neurologist Jay Ferrara. The nerve coatings on his brain were so damaged that an outright hole had developed, with fluid replacing what was once been white matter. “He was as profoundly brain-injured as one can be.”
His heart, kidneys and liver were also failing.
Praying for a miracle
Doctors had little hope that Merrill would ever awaken from his vegetative state. They tried one drug after another, but nothing worked. At the long-term acute care facility he was transferred to in Lynchburg, a neurologist held up the Karen Ann Quinlan case as an example of why Kim Muncy should consider pulling the plug on her comatose son. The famous right-to-die case culminated with the young woman living on in a persistent vegetative state for nearly a decade — while a legal battle raged around her.
“They wanted us to discontinue tube feeding and just let him go,” Muncy said.
She and Merrill’s little sister, Deanna Farley, sensed something perking behind his dull stare. Muncy called it “a kind of flicker.” Farley saw it as “a little smirk.”
Neither one of them was sleeping well from driving between Christiansburg and Lynchburg. When the Lynchburg doctor persisted with talk of letting her son die a dignified death — he’d been lying in bed with contracted muscles, and he was beginning to get bedsores — Muncy finally snapped.
“What part of this don’t you understand? I’m not stopping the feeding, period,” she said.
The doctor relented, but the hospital could not keep Merrill much longer. Muncy spent the next week calling 75 rehab and nursing facilities from Wytheville to Richmond, offering to personally provide all his nursing care.
Merrill was too young, too needy and too likely to trigger scrutiny from state long-term care inspectors, Muncy said. The more complicated a patient is, the more likely surveyors are to dive into their care to make sure every decision is backed up with paperwork.
“Patients like Dereck are risky,” Muncy said. “The philosophy is, if it’s not documented, it’s not done.”
Muncy and her husband, a Roanoke mail carrier, prayed for a miracle — for a facility in the region to take Merrill so they wouldn’t have to move.
Only one was willing to take him on.
Magic number eight
It wasn’t quite a flicker, but Stephanie Mangan thought she spotted something behind Merrill’s blue eyes the first time she saw him, four months after his overdose. An occupational therapist at Raleigh Court Health & Rehabilitation Center in Roanoke, she saw in his limp body and faraway stare “some form of drive, some kind of yearning to participate or move,” she recalled recently.
One day in July 2012, she was doing her usual range-of-motion exercises, bending Merrill’s arms and counting softly as she worked to keep his muscles limber.
“Four … five … six … seven,” she said, flexing his elbow as she counted.
“Eight,” Merrill said softly.
He hadn’t spoken in four months. Hadn’t communicated at all. Couldn’t move beyond blinking his eyes.
Now he was not just speaking a word, but saying the correct word in a sequence.
Mangan ran through the facility hallway, telling everyone she saw, “Dereck just spoke!”
The Raleigh Court therapy staff shepherded his gradual awakening, first teaching him to blink for yes or no, helping him put sound behind his mostly mouthed words and teaching him to eat.
His sister shocked everyone, including his doctors, when she described how Merrill happily mouthed the words to the entire Justin Bieber song, “Baby.”
No one believed her that he really knew the song, but Farley recorded the entire performance on her cellphone.
“We had to show the video to the doctors to prove that he was really all there,” said Farley, 21, who helps care for Merrill in the Grandin Court ranch house the family moved to so they could be near him. Farley said she postponed college to help him, and she wants eventually to be a rehabilitation therapist of some kind.
Once the Raleigh Court rehab staff got Merrill speaking and participating more fully in his recovery, he was transferred to the Shepherd Center in Atlanta for a month of intensive rehabilitative training. Though he’s technically still a quadriplegic, he now has limited use of one arm and can feed himself with help.
Certified nursing assistant Andrea Trenor at Raleigh Court became so close to the family that she accompanied Farley to visit Merrill in Atlanta.
“I’m so proud of you, Dereck,” she told him during a recent social visit to the Raleigh Court facility. Muncy took the staff a giant sheet cake that said, “Thank you, Raleigh Court,” and the therapists and aides cooed over how much Merrill had progressed.
“When he first came in he was stiff, and he couldn’t bend or talk. Then he started whispering, then speaking, then making jokes,” Trenor said.
“Many of them inappropriate,” Farley said, laughing.
Not long ago, from the other room, his mother heard him whisper “Hey, baby” while watching a female weather broadcaster on TV. “His new love is Kristina Montuori,” Muncy explained of the WSLS (Channel 10) meteorologist.
When Muncy asked whom he was talking to, Merrill brightened and explained: “I’m saying hi to my girl on TV. Mom, she’s so hot, she’s making the temperature go up in the 70s.”
From acceptance to activist
She’s given up about $60,000 in nursing salary to care of Merrill, working only part-time on weekends for a local hospice company. Initial hospital bills were covered by Muncy’s insurance, followed by Medicaid once Merrill was rendered fully disabled.
The newlywed life she and Doug were enjoying pre-injury — going to church, fishing and going to auctions — has all come to a halt.
Family members say their goal now is to tell Merrill’s story as far and wide as they can, in person and through a social media campaign they call U Turn for LIFE. Muncy is teaming up with Robin Roth, the Roanoke County mother who lost her 21-year-old son, Scott, to a heroin overdose four years ago.
They hope to resurrect a 911 Good Samaritan bill that would provide legal immunity to people who call for medical assistance when someone overdoses, rather than flee the scene for fear of legal trouble. HB 557 was introduced by Del. Betsy Carr, D-Richmond, but was tabled in the 2014 Virginia General Assembly session.
According to the Drug Policy Alliance, 23 states already have enacted similar legislation.
Carr said she plans to introduce another version of the bill next year, recrafted to address opponents’ concerns. Fear of prosecution was a factor in the cases of Scott Roth and Merrill, both of whom could have benefited from earlier interventions, their mothers believe.
Merrill’s friends “took him home and put him to bed when he was passing out,” Muncy said. “Later, at the hospital, they were afraid to tell what he’d done at the party. The doctors wanted to know so they could help him, but everybody played dumb,” she added.
In both men’s cases, smoking marijuana led eventually to much harder drugs, which is why both Muncy and Roth hope to stop efforts to legalize marijuana in Virginia. Roanoke County prevention coordinator Nancy Hans agrees with that strategy, citing Harvard Medical School professor Bertha Madras, whose research underscores how addictive and harmful the drug can be, especially to developing adolescent brains.
“Marijuana is definitely a gateway drug,” Hans said. “In Dereck’s case, it led to not just a drastic change in his life but to his whole family and beyond.”
A new purpose
Ferrara marvels at Merrill’s high quality of life, calling him an inspiration to his doctors and to other brain injury patients. He credits his mother for her remarkable care and advocacy.
“Although he has trouble learning the date and other things going on in the world, and certainly needs help in terms of [daily activities], I do think his family life is rich. He has a great sense of humor and is really a charming guy,” Ferrara said.
That charm was on quiet display during a recent visit to Hidden Valley High School, where Farley pushed him in his wheelchair, and Muncy showed the video Farley made to help spread the word about U Turn for LIFE.
“You can ask us anything,” Farley said at the start of the Q&A session, and slowly and shyly the students did open up: Why are drugs so accessible? What does the future hold? How do you deal with the stress of it?
Asked by one student what his goal is now, “If you don’t do drugs, I will have achieved my goal,” Merrill said.
“That’s why I lived,” he added. “It’s my purpose now.”

Source: roanoke.com  Story by Beth Macy

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