Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
PAT’S COMMENTS MAKE me toss and turn through the night. He’s probably right. I’m not perfect. No matter how much I want to care for her, Amber has to navigate the straits and narrows of this disease for herself. She has to summon the strength to pull herself through. Rather than rescue her, which just perpetuates her dependency, my job is to help Amber find a way to manage her feelings and engage in the program.
I stare at the walls all night, hoping to find that clarity within myself. A part like that is easier written than put into practice. At the first sign of daylight, I get out of bed feeling anxious. On my way to work I remind myself to be more vigilant, to pay more attention to my limitations.
I put my hand on the door leading into the unit and take a deep breath. Sometimes I wish I could rearrange my emotions the way I would clothes in my dresser. But I can’t. Once inside, everything I vowed to keep in the forefront of my mind blends in with the daily activity; soon I can’t even remember a sleepness night, never mind a promise to be more attuned.
“Oh boy, wait till you get a load of this new one,” says Alexi, dropping a chart in front of me. “She’s wacky.”
“I can’t wait,” I say. “Wacky. Is that a new diagnostic category?”
On the walk to her room, Alexi fills me in about Wendy, a brunette in her mid-twenties. She’s a stripper, says Alexi, adding with a wink, “She said she was stripping to make cash so she could go to school.”
“Fantastic,” I sigh. “Another one with an original plan.”
“I wonder if I should start stripping to pay for my daughter’s violin lessons?” she says.
Alexi goes on to hint that Wendy’s going to be one of those patients whose mere presence will upset the unit’s fragile balance of personalities. She’s outspoken, given to big gestures and loud outbursts, and sexually provocative, which means that her interaction with male patients will be a problem.
As for her medical problem, Alexi explains, “She’s been using Vicodin, taking twenty to thirty pills a day for the last couple months. Prior to that, it was much less. But she’s been on it for about a year, ever since a knee injury. There’s some question about recent benzos. If so, it was likely an effort to get off the opiates. This all came out when she was caught shoplifting.”
“Hmmm,” I say, raising my eyebrows.
“I know, it sounds familiar,” she says.
“When opiate addicts try to stop, their brains drive them to seek other thrills. Shoplifting is a common manifestation.”
“Tell it to the jury,” jokes Alexi.
“Pain?” I ask.
“She says it’s a ten on the scale. But there’s nothing to suggest a source for the pain. She’s also complained of hearing loss.”
“Interesting,” I say. “I saw a report from the Ear Institute that even in normal doses Vicodin can cause hearing loss. Sometimes it’s progressive after they stop. So far there’s no treatment available for this. Let’s watch for that carefully.”
Wendy was brought in by a concerned girlfriend after she passed out at a birthday party for the woman’s two-year-old daughter. Apparently Wendy had a few drinks—following the shoplifting incident, her drinking probably spiraled out of control—and passed out at the party, hitting her head on the corner of a table. There’s a bandage on her forehead; the wound beneath it needed eight stitches. When we enter her room, Wendy is devouring a large bag of M&Ms: she’s eating “the greens first,” she says, “followed by the blues, and then it doesn’t matter.”
Her room looks like it’s been ravaged by a cyclone. Clothes and belongings are everywhere. On the other hand, she’s taken some care to place two personal photographs on her nightstand. One shows her with what I assume is her family, her middle-aged mother and an older brother; the other is of her as a kid at Disneyland. Her idealized self, I imagine.
Wendy no longer resembles that little girl in any significant way. Her tongue is pierced. I notice a couple of tattoos. And fake boobs. She’s dressed in a barely-there tank top and low-slung sweat pants that reveal a leopard G-string around her hips. I have a hard time not feeling embarrassed as I look at her. This is how she chooses to relate to others, yet she has no conscious appreciation of how she affects them.
“I know who you are,” she says. “Sometimes I listen to you on the radio.”
She’s already testing the boundaries, trying to manipulate to her advantage. I don’t want to give any signals that could be interpreted by her as familiar. I keep Alexi close by while taking a step or two back myself. Suddenly I couldn’t be more aware of every thought and action I have. Be present; don’t get sucked in. Just stand there and take down her medical history.
“When was your last use?” I ask.
“Last night, I think,” she says. “Before I passed out.”
“Do you remember where you were?”
“At work. I’m a dancer,” she says. “My girlfriend was having a birthday party for her little girl.”
“At a club?”
“In the dressing room,” she says, and then adds, “I know. It’s pretty fucked up for the kid.”
To say the least. I glance at Alexi, who makes a note reminding us to investigate a little further, maybe alert Child Services.
“Have you been taking Valium, Xanax, anything like that?”
“I had some Klonopin last week,” says Wendy. “And, sure, Xanax whenever it’s around.”
“How much in the last week?”
“Mostly Klonopin this week,” she says. “The blue ones. Maybe six or ten, or, you know, I really can’t remember.”
When asked about her family’s medical history, Wendy paints a loving picture of her mother. Her father, she explains, left when she was nine. There hasn’t been much contact since then. He’s a druggie, she says, an alcoholic. She also admits that he sexually abused her. She offers some details, but without any trace of emotion. I’m just about able to contain my outrage at the constant outpouring of stories like this; it’s all I can do not to lose it front of Wendy, who’s only the latest in the long parade of victims who have crossed my path. No doubt her dad was only the first of many perpetrators. In an attempt to regain control and power in her relationship to men, Wendy fetishized her body. The pierced tongue, the fake breasts, the tattoos, the provocative clothes, the job. While she believes she dealt with the abuse long ago, the reality is different: She may not be preoccupied by her memories, but deep-seated feelings about the way she was treated have imprinted themselves on her brain in a way that affects every aspect of how she relates to herself and others.
I ask her to lay down so I can examine her. I also ask Alexi to help—not that I need any, but I have other, obvious reasons.
I work quickly and in silence. It’s all about maintaining distance, and yet, as happens with so many female patients, I find myself imagining what kind of horrors were inflicted upon this woman when she was an innocent young girl. Soon I’m agonizing for her. Then Wendy experiences some pain when I press on the lower left quadrant of her abdomen. Upon further questioning, she takes my hand and presses it more firmly into the spot, saying, “Right there.”
“Any changes in your period?” I ask.
She shakes her head no. That surprises me. Opiates cause changes in the dopamine levels in the hypothalamus that suppress ovulation.
She shrugs. She must have been somewhat constipated from all the opiates. The diarrhea will hit with the withdrawal.
She’s also in pain from withdrawal. She mentions that quite a few times. In general, though, Wendy is in fairly good health. Before leaving her room, I can’t resist commenting on her habit of clicking the little barbell in her tongue against her teeth. Since there aren’t any rules against it, I can’t tell her to stop, but it annoys the hell out of me. “I’ve seen a ton of chipped teeth from those things,” I say.
She shrugs. “I don’t get too many complaints from it,” she says. “But weren’t you going to give me something for the pain?”
I tell Wendy to prepare herself to feel a lot worse before getting better, and not to expect us to be her new drug dealers. She’s going to need to start paying attention, and learn to follow the staff’s directions. We treat thousands of addicts, I tell her; we know what it takes to get better.
Outside, Alexi rolls her eyes. “Did you see the way she held your hand on her abdomen?” she says. “Oh my God, I thought she was going to pull you right down into bed with her.”
“Sorry, I didn’t notice,” I lie.
“She’s a mess,” Alexi says. “We’ve got to get her meds going or she’s going to put us through hell.”
She does anyway. The rest of the day and on through the next, Wendy complains in the worst way about excruciating pain in her knee. She calls us every hour till we could set our watch by her. All of a sudden we’ll hear her scream, “Holy fucking shit! When are you going to give me something for my goddamn leg?”
Her leg is fine. The opiate withdrawal is her problem. Despite the medication we’re giving her, she’s still in terrible pain. Everyone knows it, too. They can’t help but know it. Wendy makes sure everyone knows she’s miserable. Some patients burrow into an invisible hole as they go through withdrawal, hiding under the covers in their beds, their drapes pulled down and the lights off. They want to be left alone.
Not Wendy, who is dramatic, expansive, and intrusive.
On her third day in the unit, she has managed to burn out Alexi. “I’ve had enough,” she says upon seeing me that day.
“What do you mean?”
“Follow me,” she says. “Let’s go.”
She takes me to Wendy’s room and we walk in. Wendy is on her bed, holding onto the headboard while raising her torso and legs straight into the air. Total exhibitionism, total ridiculousness. Groaning, she says, “This is the only way I can be comfortable.” I look at Alexi and the two of us crack up. Neither of us comments, though. “Come on, Wendy, let’s go to group,” I say. “Get your mind off the pain.”
Amber is affected by Wendy’s behavior. As I am about to leave, she asks if she can speak to me for a moment. At first, she asks how Wendy is doing. A patient as brittle as Amber would much rather focus on someone else’s pain. But it’s hard. With her empty emotional landscape, she’s easily invaded by other people’s intense feelings. Still, I encourage her to focus on her own treatment.
“But did you notice that girl’s eyes?” she asks.
Yes, I have. “What about them?” I ask.
“They’re wild and crazy,” she says.
“Kaleidoscopic is the word that occurs to me,” I say.
“Am I as fucked up as she is?” she asks.
I nod and raise my shoulders, metabolizing that reality for her and reflecting it back in a way she can tolerate. If she could read my eyes, they’d say, “This is a bad disease you have.” She takes something from me that allows her to continue reflecting on Wendy.
“I don’t even remember coming here,” she says. “Isn’t that freakish?”
“Not really,” I say. “Most patients go through such intense withdrawal that they don’t remember their first few days or even the whole first week.”
“I remember feeling like shit,” she says. “I still feel like shit. But I remember being hit by wave after wave of pain.” Amber looks up at me with big eyes awash in tears. Given her typical disconnect and periodic dissociative flashbacks, it’s a rare moment of real connection for her. My instinct is to hug her, the way it would be for any caring person, but that would cross the very boundaries I’m trying to define with Amber. Instead I compliment her on getting through the worst of her withdrawal, and on embracing her feelings. I tell her I’m proud of her strength, and I urge her to share that story in her next group.
Later, I find I’m still thinking about that encounter. You never know for sure, but I believe Amber and I had one of those significant moments when a patient takes a completely honest look at their past, present, and future, and decides—maybe without knowing or articulating it—to reconnect with humanity after years of being cut off. If her recovery happens, she’ll need years to get entrenched and feel the full effect. It was one brief moment in which she allowed herself to accept connectedness and experience herself as reflected by another person. She will need thousands more such moments, and with luck they’ll happen between her and her sponsor, and with her peers.
I won’t be a part of that process. But I love being present for the moment it all turns around.