Chapter 1 - Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold

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

Chapter 1

IT’S THE SECOND week of a warm August. Early morning. The first one in my family to rise from bed, I shuffle into the kitchen, start the coffee, and get the newspaper at the end of the driveway. We live in a ranch-style home perched on the edge of a canyon in the hills above Pasadena, with deer and coyotes on the prowl, and it’s so lovely and quiet at this hour I might as well be five hundred miles from the harshness of the city.

The headlines snap me back to reality. I read the Los Angeles Times sports section, sip coffee between box scores, and enjoy the quiet. Soon my wife, Susan, joins me, followed by the triplets, age ten, who gobble down breakfast, give us kisses, and go off to summer camp.

Outside, the sun begins its climb into a clear blue sky, and I know it’s going to be, in the words of Randy Newman, “another perfect day” in L.A.

Perfect for some, perhaps. But not for my patients in the chemical dependency unit at Las Encinas Hospital, a no-frills, twenty-two-bed facility popularly known as “rehab.” The truth? For many who occupy those beds, it’s their last chance before death. To me, it encompasses everything from desperation to the miracle of giving someone a second or third chance at life, at a better life, actually, than they ever dreamed of being able to have.

From the time I back out of my driveway, it takes me twenty minutes to get there. Once I enter the unit, the warm sun is replaced by the low-voltage hum of fluorescent lights. The perfect L.A. day disappears like a song fading from the radio. I step on linoleum, not grass. And when I look up, instead of endless blue sky, I see Ernesto from Operations staring back down at me from inside the ceiling, where he’s fixing the air conditioning.

“Good morning, Dr. Pinsky,” he says warmly.

“How’s it going?” I wave. Then, as I do at the start of each day, I grab my stethoscope, get an opthalmoscope from under the med cart, and pick up the list of patients I need to see.

Today’s list is topped by Mark Mitchell, a good-looking thirty-five-year-old in his third day of detox. Mark has been in and out of our care numerous times. His father is a former pro football player turned car dealer, a local celebrity who shows up in gossip columns, has his photographs hanging in restaurants, and seems like a great guy. The truth? He couldn’t give a shit about his son. Mark’s been hospitalized here at least five times—I can’t remember exactly—but he’s familiar enough that we’ve nicknamed him “Mitch.” Each time he comes in he looks older, his face creased, grayer beneath his eyes, moving slower.

At the moment, fortunately for me, Mitch isn’t as bad as when he was brought in—smelling of vomit and urine, and barely conscious.

But he’s still a wreck. Sprawled on his bed—imagine the pieces of a jigsaw puzzle before it’s put together—he’s tremulous, paranoid, and disorganized. It’s normal, all part of the withdrawal from alcohol. The early shift, which admitted Mitch, has already put him on heavy-duty medication to prevent his withdrawal from turning into the DTs, a potentially fatal syndrome where the outflow from the central nervous system is so disorganized that breathing, blood pressure, and other vital functions fail.

Good morning—yeah, right.

Not for Mitch. I stand there for a moment, observing his condition. It takes him several moments to notice I have entered the room. Once he sees me, Mitch jumps to his feet and grabs a piece of paper from the top of his dresser, shoving it toward me as if it were a weapon.

“I’m pissed off,” he says angrily, jabbing his finger at a paragraph. “What’s this?”

“Wait a minute,” I say. “Calm down and let me read.”

He’s showing me the treatment contract every patient signs on admission. I know what it says without reading it. These are the rules every patient agrees to follow. They include not using drugs, not selling drugs, attending daily group therapy sessions, submitting to urine tests, using the phone only during prescribed hours, and so on. Standard material for someone getting sober. I wrote the contract years ago, and have amended it many times since then. It’s nonthreatening to anyone, except those who fear relinquishing control.

Like Mitch. He doesn’t know what the hell he’s doing or saying. He’s out of his mind. His brain is screaming at him to get drunk. Biologically, he craves alcohol more than he wants to breathe. It’s driving him crazy. It’s hard for him to pay attention to anything else but the urge, and that urge is translated into a scream:

“This is bogus! This is bullshit! You know it. My cousin is a lawyer, and I know it’ll never hold up.”

At this rate, I think, neither will he.

I take a deep breath and think of what to say. I could ask if he would like a drink—a vodka tonic? A Heineken? God, that’s twisted—though Mitch wouldn’t think so. I could try to reason with him, but there’s no reasoning with someone this sick. I could call his cousin and threaten to countersue. (Good thing I’m not a lawyer.) I could slap him across the face, the way they used to do in Three Stooges movies, and hope it startles him into sanity. Or I could just listen and nod.

Actually, my fantasy would be to zap him with something—a laying-on of hands, a magic shot or electric shock—and have him all better, sober, clean, with no desire to drink again. That’s my sickness. I want to rescue everyone. I don’t need to turn water into wine or walk on water, but healing the sick would be dandy. Better still, I’d like everyone to be okay. I’d like to stop the suffering and discomfort in the world. Not too much to ask, right?

But that’s what makes me feel good.

I’m a realist, though. Mitch is more adversarial than most patients, but he’s hardly the worst of those making their temporary home at Las Encinas. The unit is a single-story bungalow. It’s part of an old-fashioned psychiatric hospital, on thirty rolling acres, that was used many times as a backdrop in old Hollywood movies. Stars from the golden era came here to dry out. W. C. Fields actually died here.

Las Encinas isn’t posh enough to make People magazine, though. It doesn’t have ocean views, like the rehabs catering to the current crop of troubled celebrities. Neither does it have any Oscar contenders. My patients tend to be more like Mitch than like Robert Downey Jr., though we do admit individuals representing every possible facet of society, from the rich to the destitute to the socially prominent to the disconnected.

What do they have in common?

Heroin. Cocaine. Vicodin. Crystal meth. Alcohol. Klonopin. Pot. Combinations of all of the above.

They’re addicts.

They’re desperate.

They’re in retreat from the world.

They’re brought by spouses, parents, friends, or ambulances.

Each one has a different story, but they all arrive for the same basic reason: Their lives are out of control.

Mitch was brought two mornings earlier by paramedics from a nearby hospital after he’d been found in a semiconscious, delirious state in an alley behind a bar. He has no idea how close he came to dying.

“Do you know why you’re here?” I ask.

After a second or two of staring at me blankly, he picks up a pencil and scribbles a note on the back of his contract. Then he hands it to me.

It says, “Who are you?”

I don’t have the time for this. Nor do I like this guy much. But I’m willing to play along. I take out my pen.

“I am Dr. Pinsky,” I write.

Some part of him knows this. He allows me to examine him. I listen to his heart and lungs. It’s a cursory checkup, takes a minute or two. Some patients draw you in; others have the opposite effect. As he gets through withdrawal, Mitch can be downright charming—I know this from previous stays. He treats the staff with the familiarity of a regular. At the moment, though, he’s anything but approachable. My challenge, as well as the staff’s, is to stay emotionally attuned without getting overtaken by the intensity of his needs and emotions.

Challenge Number 1: Get him to begin managing his urges.

“I want you to start going to group,” I say.

He writes another note and hands it to me.

It says, “And I want you to go to hell.”

Instead I go to Room 421—which, as it turns out, might be the same thing.

The room is occupied by a new patient described to me by the charge nurse, Alexi, as “a total mess.”

Alexi is the field general among the nurses, attendants, and counselors who comprise the unit’s staff. Most of the staff works in the daytime; only a few nurses remain at night. All are highly skilled, insightful, dedicated individuals with a range of experience that gives them unique perspective into the patients. Some of the counselors are former patients. Others have done this type of work longer than I have. Our patients are manipulative, secretive, frightened, paranoid, and unstable, but very few things happen on the floor without one of our team of staffers being aware of it.

Alexi is the best of them all. As the charge nurse, she supervises everything that happens in the unit from admissions to discharge. She is the Radar O’Reilly of our MASH unit: knowledgeable, levelheaded, firm, unflappable, with a great sense of humor. Aside from being a great nurse, she has an uncanny ability to anticipate everything that happens here, and knows exactly how to react.

When I arrived earlier today, Alexi was bent over the counter at the nursing station, filling out a form while people waited. Too busy to say hello, she kicked up her leg in back and wiggled her foot at me. I was supposed to understand, and I did.

She’s indispensable. Now in her early forties, Alexi grew up in Yugoslavia during what she calls, acerbically, the Golden Age of Communism. She emigrated to the United States after marrying her scientist husband just after she turned twenty-one. They have one preteen daughter. She abhors women who have more than one child. “Breeders,” she scoffs. “I’d kill myself before I stayed home with three kids and drove an SUV.” She regularly complains that American culture has made kids way too soft. Sometimes she jokes that we should have boot camps instead of rehabs.

“There may be more sophisticated approaches,” I tell her.

“I know, I know,” she says. “Of course, if we just had plain old alcoholics, I’m telling you the boot camps would work.”


Today’s theme?

“Last night I got home and told my daughter to pick up a broom and hold it while she watched her television shows,” she says.

“Why?” I ask.

“She needs to get used to it. I told her she’ll be doing that if she doesn’t work harder at school,” she says.

Alexi loves the work as much as I do. On our way to Room 421, she gives me a rundown on the patient.

“What a mess this one is. She’s on cocaine, Oxycontin, pot, Klonopin, and maybe—”

“A real Girl Scout,” I interrupt.

“She’s going to be a handful. She’s totally borderline.” Then she pauses. “She’s so cute.”


If Alexi likes a patient, I’ve learned by now to get out the hammer and nails and board up the windows. She’s never met a drug-addicted sociopath she didn’t adore. It’s not that she loves down-and-out dirtballs. Rather, she’s entertained by the drama of the borderlines, the charm and charisma of the sociopaths.

Giggling, she covers her mouth, embarrassed by her own codependency shining through.

We hear screams from inside the room.

Alexi’s eyes light up. “See. Doesn’t she sound funny, all that carrying on?”

A moment later I’m staring at the patient—at least the little bit of her I can see clearly. She’s curled up on the floor in the far corner beside the bed. She reminds me of an animal trying to hide. Frightened, suffering pain, a biological mess, Amber lets us guide her into the bed. She quickly pulls the covers up to her chin, shaking and crying. It’s been about ten hours since she passed out. Her husband brought her into the hospital, then left for work. From what I see in these first few minutes, I’d say she’s fortunate to be alive.

“It’s impossible to tell what she’s really been doing,” says Alexi. “At first, she said she was taking fifteen Oxycontin a day. But then she changed her story—it was two a day. And then it was thirty, sometimes. She also said something about eight hundred milligrams of Valium.”

“Any IV drug use?” I ask.

“Hard to say. She denied it at first, but then she said she’d been doing speed. She doesn’t have any tracks.”

I make a fist, put it to my mouth, and blow on my hand in frustration.

At this point only Amber knows the intimate details of her use, the truth about the years of ugliness that have paved her road here. But I’ve seen enough young women like her to know what I’m dealing with, and it tears at my gut to confront this over and over again.

Amber is twenty-six, with a model’s lissome figure and dark coloring. Her father, I learn, was a terror who left her mother but periodically returned to harass his ex-wife and daughter. There are the first hot buttons of trauma—abandonment, helplessness, the rupture of attachment with someone they love and idealize. Amber’s relationships have been similarly chaotic. She has continued to be exploited by men, including her husband, whom I haven’t met and to be perfectly truthful might not want to. Her looks have always given her trouble. I start to say something profound about the burden of having perfect looks in our culture, but then I stop myself. It’s redundant. I see the twisted consequences in front of me.

“When did this all start for you?” I ask.

“What do you mean?” she says.

“When did you start smoking pot?” I ask, knowing marijuana or alcohol would have been her first drugs.


“Did you smoke every day?”


“Every other day?”


“How about five out of seven?”

“Yeah, I guess.”

First encounters like this are interesting. There’s a big, powerful dynamic at work in the room. Though she lets me ask about her medical and drug history, it’s not clear at this point that Amber even wants to get better. The only thing she really wants from me right now is relief—which means drugs. She wants a prescription. Not a relationship, not a savior. I’m just standing in her way, unless I can provide her with medication. To her, I’m a capsule on legs.

Of course I would never fully admit that to myself. To acknowledge not existing in her eyes would be too painful for me. I have to matter. Why? Because to me, witnessing the collapse of those who were abused and molested as children is almost too much to bear. The emotional fallout is profound. In a way, it’s part of my own pathology; I feel the presence of the developmentally arrested traumatized child within patients like Amber, and I let that child invade me. I need to help her so that both of us can feel better.

“When was the last time you used?” I ask.

Amber bites her lip and grimaces.

“It hurts so bad,” she says. “Can you just put me to sleep?”

I turn to Alexi for the answer.

“She said she hasn’t used since last night, but I think she’s got something on board now. Her belongings were clean. If you ask me, though, she still seems loaded.”

I agree.

As that wears off, Amber will feel even worse.

“She’s going to be detoxing soon, so have the med nurse get a clonidine TTS-3 patch on her right now,” I say. “You can also give her Neurontin four hundred milligrams QID, since we really don’t know how much benzodiazepine she’s been exposed to. No doubt she’s going to need a loading dose of phenobarbital. Let’s also give her the usual Robaxin, Bentyl, and Motrin per the protocol. Then call the lab and order an HIV and hepatitis screen on the blood they drew this morning. Make sure we get a pregnancy test, too.”

We spend a little more time with her, but there’s not much else to do except step back and wait for a moment during her withdrawal when we can let her know that we can help her feel better, as long as she listens and does what we say. That moment is clearly not now. Amber is locked in a biological prison. She’s so neurobiologically impaired that her responses to our requests are meaningless. Later, she won’t remember them anyway.

She clutches a little worn-out teddy bear she’s brought from home. The bear is missing an eye and part of an ear, I notice, and its fur has been picked bare in spots, but the red stitching at the mouth still forms a cute smile. I pray that Amber will hold up as well.

But I don’t know. Right now she’s gripped by pain and fear, and without any of her usual escapes, she yells and moans in agony.

“It’s going to get worse,” I say. “It’s going to be miserable. But we’re going to make it tolerable.”

“Can I have something right now?”

“Alexi’s on it.”

When Alexi and I are in the hall, she starts to giggle again.

“I told you she was something,” Alexi says.

“Yup, we’re going to be in for it,” I say. “I hope she’ll stick around long enough to wake up and want to get better.” But I don’t know.

A moment later, I’m down the hall when Amber screams. “Alexi! I can’t take this! Get in here. I need something!”

“What the hell is that?” asks Dr. Peter Finley, the unit’s program director.

Finley, a stocky man with curly black hair, a moustache, and glasses, is basically my counterpart. Whereas I manage the medical care, he handles the psychological. Together, we make sure the patient gets what he or she needs during treatment. Finley has an amazing grasp of the psychological syndromes that affect addicts; he also has exceptional judgment—and there are lots of doctors with great knowledge and shitty judgment. On top of all this he’s a first-class storyteller, with a tale for every situation.

“She’s a new patient,” I say, referring to Amber’s plea for help.

“Makes me think of a woman I worked for when I was an assistant at an insurance company during college,” he says. “I’ll have to tell you about that sometime. But you need to deal with the woman in three-oh-two.”

He doesn’t need to say much more. The woman in 302, an opiate addict in her late thirties with a difficult personality disorder, has been horrible lately. For the past week, she’s driven the staff crazy with her constant demands. She lies and manipulates, and when that’s not enough she yells and lashes out.

“She’s a pain in the ass,” I say.

“We’ll just have to build a better cage,” says Finley, and launches into the story of one of his dogs that kept escaping until he finally constructed a better fence around his backyard.

I go into 302. Her name is Katherine, and she’s been acting like a member of the British royal family, ordering staff around and insisting on a variety of privileges—particularly unrestricted use of her cell phone. We allow phone calls between 7:00 and 10:00 P.M., but she has been demanding unrestricted calling privileges because, as she has told everyone within earshot, her nine-year-old son, the youngest of her three children, is chronically ill. According to her, he’s liable to die at any minute.

“So is she,” Alexi mutters under her breath every time.

I suspect Katherine has been calling dealers, though she hasn’t tested positive—at least not yet.

Katherine is one of those personality types who make you feel their awful feelings right along with them. She gets under your skin. That’s a good way to spot a borderline: They defend against their own miserable feelings by projecting them onto other people. Trouble is, I’m a perfect receptacle. I don’t need her feelings on top of my own.

None of us do.

I want Katherine off the phone and complying with the rules. As a compromise, I suggest keeping her phone at the nursing station. If it rings, I tell her, we’ll get her immediately. That’s impossible, she says, angry and dismissive. So I clamp down entirely. If the rules aren’t followed to the letter, I tell her, she will get kicked out. After digesting the consequences, she barrages me with all kinds of crazy excuses, accusing me of being cruel and unfair.

“My child is going to die,” she says. “He’s connected to tubes. They get badly infected. You’re a doctor. What about that don’t you understand?”

“What is it about checking in between seven and ten that’s so unreasonable?” I respond. “If there’s a problem at another time, we’ll get you.”

“My husband and children live back East. Isn’t it enough I’m out here? With the time difference, I’ll wake everyone up. It’ll be the middle of the night.”

I stand my ground, but that only encourages her to act like an animal beating against a cage. At the same time, though, I know I can’t ignore the issue of her son. After giving it some thought, I telephone her husband (which I should’ve done long before, of course) and ask about their son’s condition. Turns out the boy hasn’t had a health problem in four years. He is, her husband tells me, perfectly stable.

“And his lines?” I ask.

“Not a problem. We haven’t had an emergency since I can remember.”

My decision about the phone will stand: Katherine will have to deal with containment, and she’ll likely do better for it. Borderlines challenge boundaries, but they actually feel safer when they’re held. Precisely like little children.

In the meantime, as Katherine and I talk, I take a fresh look at her. What’s really going on inside her?

This is a woman who’s just transferred from another hospital after going through a rapid opiate detox, a highly controversial procedure in which the system is flooded with medication that blocks the body’s receptors for opiates and induces a profound state of withdrawal. The detox so profound it could kill a person if she weren’t held under general anesthesia for about eight hours.

The people promoting such treatment believe they’re accelerating a withdrawal that would normally take a week or two into a convenient eight hours. Hooked on heroin? Popping 40 Vicodin a day? Don’t worry. You can schedule your withdrawal between business appointments. Don’t believe it. The very idea betrays the fundamental misunderstanding most people share—mistaking detox for treatment.

Katherine is a perfect example of a user who thinks all she needs to do is get off the drugs. Getting off is the necessary first step, of course. It’s dramatic, and interesting. But it’s only the first step in treating the disease. It’s like getting into position to do the work.

Katherine is falling apart all over the place. Having hid the truth about what she’d been using—a common tactic among addicts—now, in addition to her opiate withdrawal, she’s dealing with a Valium habit, too. She’s a mess in every way. She has discovered that there aren’t any quick fixes. How can there be, when the patient has used drugs to regulate emotions she can’t manage normally? Generally, these overwhelming emotions are related to childhood traumas—pain, abuse, neglect, abandonment, and overall feelings of powerlessness. There aren’t any simple eight-hour cures for that.

I don’t go all the way into Katherine’s room. You don’t want to mess with a dangerous angry borderline—that anger is too easily projected directly onto you. Everything becomes your fault; filled with hostility, they’re liable to start accusing you of things, from simple neglect to sexual misconduct.

So I stand in the doorway. Seeing me alone with a dangerous patient, Alexi stops and stands behind me.

“We made a decision. There will be no phone,” I say with finality.

The stake has been put in the ground.

I feel a tightening in my stomach, preparing for Katherine’s angry onslaught, and I get it. She comes at me from a completely different direction. “Have you called my real doctor, Dr. Smith, who did my detox?” she says, her jaw so tight it barely moves. “He told me I would get much more medication than you’re giving me.”

She’s attacking me personally.

“I will certainly notify Dr. Smith of our treatment plan once we get to know you better. Right now you’re getting enough medication to detox safely.”

No way around it—Katherine is going to take us for a ride. I can’t predict where that might end up. “Jesus Christ,” I say to Alexi and several of the counseling staff at the nursing station. “We have so many sick patients. Do you think anyone here is interested in recovery?” My job is to evaluate these people at the beginning of their journey, and to be honest, the success rate is mixed. It’s easy to get frustrated by patients. They don’t follow directions. They’re paranoid and distrustful. They see me as a drugstore, if they acknowledge me at all.

“I have a patient who just presented a courageous first step this morning in my group,” one counselor says.

“That patient of mine, Joan Bayturn, went to Sober Living,” another adds.

“So there’s some recovery going on?” I ask. “You mean we’re actually having an effect here?”

I know we help. At times it just gets hard to see it.

Some days the beds at Las Encinas are filled with somatically preoccupied heroin addicts, there because their families dragged them in. They aren’t the least bit interested in getting better. They’re usually manipulative, angry, and hostile. Those are times that try even the unit’s most dedicated staffers. Other days I find the biological effects of drugs playing out in the brains of my patients in interesting, not always predictable ways. When these people are also motivated, I can sometimes have the almost spiritual experience of helping return near-dead human beings to life.

If I get angry, it’s at the bigger picture. In general, our culture offers us solutions that only intensify our problems. I’m prone to rant about this, I know—but after all, surgeons are permitted to rage against cigarettes and fatty foods, psychologists about poor communication skills. So why shouldn’t I go off on the culture?

I have plenty of reasons to call the culture up on charges. Katherine. Amber. Mitch. And hundreds more just like them. The culture is like a living, breathing beast that feeds its own need to exist and grow at the expense of the individual. Our world is full of people with narcissistic problems who look to escape those feelings and be gratified—and the culture steps right up to meet those needs. Many of those contributing to the culture are sick themselves. It doesn’t take a shrink to count the number of celebrities who end up in rehab, getting into fights, or posing for mug shots. The media has become an instant-response machine, ratcheting our tolerance ever upward in cycles of arousal and gratification. All of this can be arresting, fun, sexy; most of all, it sells. But it doesn’t heal.

What our culture lacks are honest messages about what it really means to be a healthy human being. Or how you make humans grow. These are sort-of-boring topics that won’t sell Budweiser or Nikes. Cervantes, writing in Don Quixote, goes on a rant like this about theater of the early 1600s. He has the same complaint. Just because people gravitate to something doesn’t make it good or right. I want more messages about how healthy humans are created, and as much as I want them, others need them.

Amber is laying on her bed when I see her again. A few hours have passed since I saw her last. Her room is still as dark as she can make it. She also has the heat turned uncomfortably high, to counter the chilling effect of opiate withdrawal. Even so, she still complains about being cold.

I look at her chart again. She’s twenty-six, married to an older man, and employed as a receptionist at an advertising company in Hollywood.

What’s the longest she’s been clean? I don’t know.

Does she want to get sober? I don’t know t hat either.

What I do know for sure is that Amber has begun to detox. In simple terms, she’s in utter hell. She is sick and getting sicker. Why? Her body is in a state of hyperstimulation, her nervous system overwhelmed and reacting to every little sensation. If not for the central nervous system depressants we’ve given her, Amber would be screaming for us to put her out of her misery.

She might do that anyway. It goes with the territory.

I pull a chair up next to her bed and sit down. I want to give her some reassurance, establish rapport, and check on the alchemy of what we’re doing. Amber looks at me from a thousand miles away. All I see is a young woman in misery. She’s craving drugs, and that deeply physical craving hurts worse than a normal healthy human being can imagine.

“Help me,” she says.

I know what that means. “We’re giving you everything you can safely take,” I say.

“I need something now.” She moans. “It hurts so badly.”

I believe her, but I sit there unmoved. I’m not being callous. This sort of pain is just part of the process of withdrawal. It’s a necessary evil. But it’s surface stuff. Eventually it goes away. The difficult part is the unexpressed pain that’s buried far beneath the surface, the original hurt around which everything else is structured.

I fish around for something positive. Though it might not appear so, she is doing better. She’s calmer, and that calms me down.

“Why are you here?” I ask. It’s my standard opening line. “You’ve been doing this for years. Why are you here today?”

The purpose is to find out the source of the patient’s motivation to get sober. The initial response, I know, will be some obfuscating bullshit. No one ever comes right out and says, “The court sent me.” Nor do they say, “I lost my job and my girlfriend is leaving me.” Eventually we get to that. For the most part, they say, “I just got tired of living like this.” Which is true. But they’ve been tired of it for a long time. I want to know why today. What got you here at this moment?

Sometimes they have to think about it. Even when the court actually did send them.

Other times, I have to dig for it.

I don’t know why it’s so hard for patients to give me a real answer. Amber is typical. “I don’t know why I’m here,” she says.

“You don’t know?”

She rolls her eyes and lets me know she has no patience for this.

“Okay. I can’t keep living like this. I’m sick of being sick.”

Nice try. She’s heard that line before, and maybe before it’s worked. But I let it sit there. I want something honest.

“I can’t go on like this,” she continues. “I got a DUI. My husband is pissed at me. I’m tried of all the crap.”

“There we go,” I say. “Keep going. Drugs have been ruining your life for a long time. I imagine your husband didn’t all of a sudden get pissed off for the first time. Why are in you treatment now?

“I told you,” she says faintly. “I can’t go on like this.”

“But why today? I’ve never met an addict who woke up one day and decided to get sober. It doesn’t happen like that. There has to be a whole lot of shit coming down for you to want to stop. What happened?”

“My family has had it with me,” she says, dragging a tear across her cheek with the back of her hand. “If I don’t get it together this time, I’m going to end up on the street. I know it. They’re fed up with me. It’s like, either I get help or they’re out.” She suddenly winces. “Can’t you give me something?”

Not now.

Despite her discomfort, Amber complies when I tell her to lay back so I can give her a cursory physical. Like anyone in her condition, she complains of extreme pain. But discomfort may be a closer description of what she’s feeling. She is agitated, craving, feeling like she wants to jump out of her skin. Every place on her body hurts—her joints, her muscles, her arms and legs, her back and neck especially. If I could see her brain, it would be throbbing, too.

That’s withdrawal.

All in all, though, Amber is in fair shape. Her youth gives her some resiliency. It has also provided her with a few tattoos; several piercings, including one to the side of her nose; and a few strands of blue and red highlights in her otherwise brown hair. She is a very pretty girl. I think Truman Capote once said something like, Beauty makes its own rules. I might add from experience that beauty also suffers its own tragedies. From Marilyn Monroe to the various Hollywood stars I’ve treated, I wonder why is it that so many beautiful young women suffer. There’s no reason Amber has to be another tragedy.

“Am I going to die?” she asks.

“No,” I say.

“I feel like it.”

“Yeah, I’m sure you do. It’s got to be awful. But we’re going to get through this. We’re going to help you.”

I leave the room. She’s given me a few positive morsels. Katherine has been a bummer, but I have hope for Amber. I want to have hope.

I ask Alexi if I’m needed for anything else.

“Go,” she says. “Get out of here.”

I take a step and then stop and turn back to her. I have a last-minute feeling to get rid of before going home.

“You know something? I hate the feeling I get from patients like Amber. I’m trying to help, but she looks at me like I’m a perpetrator. Just one more person in her life who’s going to take advantage, abuse, or let her down.”

“You have to start building from somewhere,” says Alexi. “How much is she complaining?”

“She really wants some more meds,” I say.

“She asked every minute or so?”

“She insisted something was wrong with her back or her neck. But I examined her, and it’s just the withdrawal. God knows how long she’s been numbing and neglecting her central nervous system with drugs, and now it’s crackling like an exposed wire.”

“Luckily for us, it’s just the start.” Alexi smiles. “I have a feeling about this one.”

“Good or bad?”

“Just a feeling. Let’s see how she is in a few days.”