Introduction - Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold

Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)


FROM THE ROAR of the crowd in the bleachers, I know I’ve missed something good. It’s Sunday afternoon, and I am being torn apart. Actually, I’m tearing myself away from the Little League field, where my ten-year-old sons, Douglas and Jordan, are in a tight spot in the middle of a game. Just a few moments ago I was yelling hitting tips to the boys as my wife, Susan, and my daughter, Paulina, gave me what-are-you-doing-type looks. Then, with Douglas on first and Jordan at bat, my beeper went off. Now I’m headed to the hospital, a medical problem in front of me and a ballgame left behind.

Welcome to my life. Sure, I’m happily married, the father of triplets to whom I’m devoted. But I’m also chief doctor at a chemical dependency unit. So as much as I love watching my sons play ball, and probably could have done so today without risking anyone’s life, I know I would’ve been on my cell phone the whole time—or at least long enough for Susan to say, “Just go.”

That’s why I’m weaving through traffic, grim-faced, while talking to Kathy, the evening charge nurse. Though she’s normally even-tempered and in control, I can hear she’s pissed, anxious, and overwhelmed. That alone tells me a lot about the patient: She’s a borderline, a trauma survivor, someone who’s projecting her pain onto everyone around her, including the nurse.

“It’s wild over here,” says Kathy, almost chuckling; she realizes she’s deflecting the patient’s chaos onto me. “Sorry.”

“It’s okay,” I say. “I’m in the car now, though; I can hear you. Run me through it me again.”

“I just took in a new patient. She’s a twenty-eight-year-old female. Taking thirty to fifty Vicodin a day. Nine milligrams of Ativan. She says that’s it. I placed a clonidine patch. She started the narcotic protocol.”

“Add in the phenobarb protocol starting at two hundred and forty milligrams. With sixty Q6 PRN. Routine labs. Pregnancy test if you think it’s appropriate. Any IV drug history?”

“No. But I have a problem.”

“What’s that?” I ask.

“Her mother is here. She’s hysterical—she wants to talk to the doctor right away. Like it’s not soon enough, if you know what I mean.”

“I hope you set some limits with her.”

“I tried, but she’s really out there. She’s beyond wanting to know what’s going to happen during treatment. She’s major drama.”

Indeed she is. When I get to the hospital, I find the woman in mid-flipout. I take her away from her daughter and put her in an empty office. Did I smell alcohol on her breath? Do I have another patient here? She doesn’t seem to be impaired, but I wonder if she’s going to be a problem later on. I wonder if I should let her drive.

As these and other questions run through my mind, she continues on the attack. “What’s going to happen to my baby?” she asks.

“We’ll finish detoxing to let her brain settle down so she can begin to think more clearly and engage in the emotional experience of recovery. There are lots of group meetings. She’ll get a sponsor. She’ll learn how to develop genuine relationships and meaningful connections with other people. And she’ll—”

“No, this is not right,” she says. “This is typical of how you people have treated my daughter since we arrived. It’s all talk, excuses, and explanations. But you saw my baby. Did you see my baby?”

“I did.”

“She’s in pain. She can barely stand it. No one has said a thing about medication, treatment, maybe physical therapy. We’ve been here an hour. What are you doing to help her?”

I see more than impatience in this woman’s eyes. Feeling abandoned without her daughter to prop her up, she’s brought her here under the illusion that treatment will be no different than taking her car into the shop. Unfortunately, she can’t just pick her daughter up at four o’clock, overhauled and ready for another five thousand miles. Like most people, this mother doesn’t understand what we do. Besides the patients, doctors, and nurses, few people ever get a glimpse of what treatment is really all about. You have to be there, present and involved, because it’s not something that can be explained cognitively. It’s an experiential process of growth—indeed, of brain change.

“I can’t tell you when she’ll be better,” I say. “Treatment takes time. If I told you anything different, it would be a lie.”

But that isn’t good enough for her. Midway through my explanation she loses her temper, bursts out of the office, finds her drug-addicted daughter, and drags her down the hall toward the exit. There’s chaos and confusion. Everything is crazy for a few moments. “This is all bullshit!” she yells. “You people don’t know what you’re doing!” Then the two of them screech out of the parking lot, leaving Kathy and me standing in front of the unit.

I just shake my head and go back inside.