Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
UNFORTUNATELY, AFTER ALL my attention to Amber, I’m in New York when she is finally discharged two days later. The timing was beyond my control. I had taken one day off to watch my daughter in an ice skating competition and help coach my boys on the ball field. Then I flew back east for a commitment on Good Morning America. While there I opened an e-mail from Alexi updating me on the day’s activity in the unit, and saw that Amber had left.
I e-mailed her back, asking for more information. Her response contained some unsettling details: Amber had been picked up by her husband, who said he was taking her to Sober Living, but she hadn’t checked in when Alexi called a few hours later. Neither was she there when Alexi called later that night.
Ugh. Reading this stirs all sorts of feelings in me, none of them good. Why couldn’t I have done more?
All of a sudden it seems as if I’ll be swallowed up by my hotel room walls if I don’t leave the building immediately. I need air and space. I end up taking a long walk. There’s no better place to lose yourself than the streets of New York City. By the afternoon I’m downtown, in roughly the same place I was about two weeks after the September 11 attacks against the World Trade Center and the Pentagon.
I remember that night. It was a Sunday, and I was walking around Greenwich Village. I was relieved to see the cafés full of people. I’d watched the attacks from three thousand miles away, but as soon as I’d arrived in the city I was on the streets, drawn by a need to participate in the healing process. I began in midtown and went to Ground Zero. I walked for hours, eager just to be around New Yorkers, who managed the trauma by talking and connecting with each other.
I wish I had that same feeling now, as I walk around thinking about Amber. I’m hard on myself at the best of times, and this might be one of the worst. One of the tenets of AA’s twelve steps is a spiritual awakening, a belief in a higher power, a general faith that life will work out the way it’s supposed to. When I run outdoors in the canyons near my home, I can sometimes connect with something greater than myself and give myself over to it. That’s my sense of spirituality.
But I struggle with the concept of faith. How can I have faith when every day I’m confronted by people in pain? How can I have faith when the system can be so coldhearted to someone as clearly in need as Amber? How can I have faith when I failed to help her improve? And if I struggle like this, it’s that much harder for my patients. They have a right to ask where God was when such horrible things happened to them. Why should they have faith that things will turn out?
I can dwell on this and get myself way down, but at the same time I know it just takes one patient given up for dead coming through the door with a brand-new healthy and sober life to restore my faith. It’s a miracle I witness over and over. In reality, it has very little to do with me. That change takes place entirely inside the person, and I have no idea why. I’ve heard it attributed to God. That could be right.
Nevertheless, my trip back east leaves me feeling weird, unsettled. The whole time I struggle with difficult emotions: a nagging sense of having been betrayed by the system for not working, by Amber for not getting better, and by myself for not making everything better. The time doesn’t pass quickly enough. I can’t wait to get back home, and I’m glad when the plane touches down.
Even back at work, I’m thrown slightly off-step by Amber’s absence. Until midday, I’m nagged by a sense of unfinished business. No one else is, though. Alexi, the only other staffer who had strong feelings for Amber, doesn’t even mention her. We discuss New York, a city she loves, and then the usual routine overtakes us. We have twenty additional patients in beds, all deserving—and needing—the same attention and concern I gave Amber. Not to mention the others who come in daily as outpatients.
What’s the old saying? The camel shits and the caravan moves on. That’s life in a hospital.
What’s life, after all, but a series of problems? And your life is defined by how you handle them.
Over the next three weeks I have plenty to handle. On the positive side, Linsey continues to make progress. One day I see her on the patio, drawing in a tablet. She’s quite good; her training as a graphic artist is evident. We get into a fun discussion about art, and trade stories about favorite museums and paintings. She prefers the Impressionists, especially Renoir’s The Boating Party, which she’d seen years earlier in San Francisco. My choice? Michelangelo’s masterwork on the ceiling of the Sistine Chapel.
After that I kept an eye on her. I knew she was working on her second step—come to believe that a power greater than ourselves can restore us to sanity— and asking about others. We’d love to see patients get through the third step—make a decision to turn our will and our lives over to God as we understand him—but very few have the resources to cover the weeks of hospitalization that can take. The fourth and fifth steps—a searching and fearless moral inventory of ourselves, and admitting to God, to ourselves, and to another human being the exact nature of our wrongs— are so intense that some sponsors won’t allow their sponsees to begin work on them until they’ve been sober for six months. Until then they’re too fragile, still affected by the biology of their condition. We actually prefer that patients get right to it, as long as they take the time they need to get there.
Linsey’s doing just fine. From our brief chats and conversations with other staffers, I know she’s trying to deal honestly. One day, as I’m about to leave, she tells me to wait a minute; she has something to show me. She pulls an envelope from the top drawer of her nightstand. The letter, which she carefully unfolds, is from her grandfather in Ohio. She holds up the second page of the letter, and I see a beautiful drawing of a sunflower.
“He said he drew it for both of us,” she says.
“It’s beautiful,” I say.
While admiring the drawing, I see her watching me. When I turn my attention back to her, she maintains contact. That’s good. That’s what we want.
Why does she seem to get it and Amber didn’t? Both arrived in nearly the same condition. Both suffered terrible abuse in childhood. We treated both similarly. So what’s the difference?
A few days later, though, I hear that Linsey’s leaving. A red flare goes up. What’s going on?
Linsey’s mother has arranged for her to transfer into a treatment center in Florida that specializes in borderline personality disorders. This is the first I’ve heard of such a plan. I’m worried that the mother’s efforts to inject herself into the process are a subtle way of undermining our work. This sort of thing happens all the time. When a patient starts making progress, their significant others get anxious about the changes. They’re used to playing an important role in their loved one’s life, and they fear losing that role. Finley and I have a conversation with Linsey’s mother. She denies feeling scared or losing control. In fact, she lectures us about being intrusive.
“I’m her mother,” she says emphatically. “I only have her interests in mind.”
“What about participating in some therapy yourself?” suggests Finley. “If you join in the process, it could be very helpful.”
“Excuse me,” she says angrily. “I’ve been involved in the so-called process since she was born.”
In the end, we take her blows and lose the patient. Linsey seems to handle it with only minimal anxiety. Honestly, we expected more as she prepared for the discharge and transfer. I catch up with her as she’s packing her clothes in an expensive leather duffle bag. She seems somewhat detached and robotic. She explains that her mother has a second home in Florida, along with a sugar daddy and a few relatives there. Some of them are even tolerable, she admits with a smile. She makes a point of showing me that she’s taking her steps workbook and says she’ll continue listening to Loveline from her new home, as she has since she was a teenager. She’s actually telling me she wants to keep up the attachment we’d established. Another good sign.
Later that day, after she’s been discharged, Alexi hands me an envelope that she says Linsey left for me. I open it up, and find inside her grandfather’s drawing of a sunflower. Across the bottom of the stem she wrote, “ThanX.” I tack it on the bulletin board in the nursing station as a reminder.
It doesn’t hurt to have one, the way things go in the few days that follow. Alexi has begun to suspect two patients of using. Max and Russell started out as roommates, but we split them up as soon as they started to ignore curfews and other little rules. The guys are in their early twenties: Max is a white guy from the dot-com world, and Russell is a black music industry talent scout. Both are opiate addicts. We’ve had them six days, long enough for them to emerge from the misery of withdrawal and reveal themselves as frustrated, craving, desperate, and full of self-will.
“What worries you?” I ask Alexi.
“They’ve missed a few groups,” she says. “They’ve had excuses, but I see the pattern. All of a sudden, like the past two days, neither is participating.”
“Both have come back clean the past two days.”
Patients sneak drugs and get high during treatment all the time. We don’t tolerate it when it we know it’s going on, but it happens behind our backs from time to time when they’re out of our immediate supervision. Their friends bring stuff in, or they score in the field behind the unit. Desperate people do desperate things. The range of human cleverness and deceit is always impressive. Patients stash drugs in stuffed animals and pillows. There’s a huge black market for clean pee. Family members often smuggle in drugs. One patient’s husband brought in Oxycontin because he couldn’t tolerate her discomfort, which shows the power of the disease over the entire family.
Max and Russell are now marked men. Once Alexi plants the seed, I watch them with a wariness that frequently makes the unit seem smaller than it is. Our paths start to cross more than ever. I ask how they’re doing, and they make chitchat. It’s all pleasant, but everyone can feel the buildup to something bad.
One night after dinner, as shifts change, a night nurse spots two women she knows from the main psychiatric hospital as they go into Max’s room. After Russell follows them in, she calls me on my cell phone while I’m driving to dinner before doing Loveline. I instruct her to get the girls out—she calls back later to say she’s done so—and the next day Alexi and I speak to the guys separately.
Both of them tell a similar story about the girls coming to their room to continue their AA meeting.
“Right,” I say to Alexi.
She laughs. “They’re so devoted.”
We confront them again. “Are you using?” I ask Russell.
“No,” he says.
“We have reason to believe there’s some drug use on the unit,” I say, hoping either to lead him into a confession or simply to scare him. “I want to give both of you a chance to be honest. You know that your treatment contract, which you signed on admission, stipulates immediate discharge for offering drugs to another patient. Relapse can be part of recovery. If you slipped there will be consequences, but you won’t be discharged. We want to help you. But we will not tolerate anyone infecting other patients.”
“I’m not using,” he says. “If you think it’s going on, it’s someone else. It ain’t me.”
I’m silent, as is Russell, who looks me straight in the eye with total sincerity. He might even believe it, but my gut tells me he’s lying.
Alexi has a similar experience.
Fine. We have no choice but to take their word, and wait to see if something turns up. If they’re using, we’ll know soon enough.
Later that night, at the radio station, Adam raises an interesting point after a sixteen-year-old girl calls and starts talking about an experience when she was “partying” too much. When did the word party evolve from a social celebration, he wonders, to a euphemism for getting fucked up? The phrase “hook up” has recently undergone a similar change. Once it meant to meet a friend; now it refers to indiscriminate, drunken, quickie sex.
“So I was partying too much,” the caller continues. “My boyfriend passed out in the living room, leaving me with two so-called friends.”
“Why are we so-calling them that?” asks Adam.
“They passed around the bong some more times,” she says.
“And you were with them?” I ask.
“Yes. And then one of the guys took me upstairs. I passed out on the bed, and I think he raped me.”
“You think he raped you?” I say.
“I sort of remember waking up with him on top of me,” she says.
“Did you call for help?” I ask.
“I couldn’t. He was so big he scared me.”
“Did you tell anyone about this?” I continue.
“No. I didn’t want my boyfriend to find out.”
She was too comfortable in the role of victim. She was playing the role too well. People don’t typically freeze so readily in the face of threat, unless something else has happened earlier in life to set this up. There had to be more.
“Had you ever been raped before?”
“No,” she says hesitantly, and then adds, “Well, when I was fourteen I had a boyfriend who did something to me. He was nineteen.”
“Listen, this may sound odd, but you seem very comfortable with this stuff that’s been happening to you—too comfortable,” I say. “Somebody must have done something to you before that. Were you ever sexually abused by someone? Did your parents ever abuse you in some way?”
“My family’s great,” she says. “I see my dad at least once a month. We have a good relationship now.”
“What do you mean now?”
“He left when I was about eleven and we didn’t get along so good.”
“Did he ever beat you?”
“He never hit you?”
“Sure, when I was bad I would get whooped. But you know, like everyone, it was just discipline for being bad. I deserved it. No biggie.”
There it is. Dad would beat her for her own good. Not only did she feel she’d deserved to be hit, she was cool with it. No biggie. She had just described what human beings do when they have been victimized. First they deal with the overwhelming threat by immediately believing it’s something they’ve caused. I’m wicked and I deserve this. At least that’s not as threatening as the reality of their safety being threatened by someone they rely upon for nurturance. Then they learn to detach. In their own minds, it’s as if they’ve ceased to exist—the ultimate disconnect.
“So we never, uh, got to your question,” I say. “What’d you want to ask?”
“I missed my period and I don’t know what to do.”
“You screwball,” says Adam.
I take a sip of coffee and tell her.
A few days later, Alexi decides to ruin the afternoon. Not purposely. She’s going through the previous night’s drug tests, and reads that neither Max nor Russell provided urine specimens within the sixty-minute time period we allow. That’s bullshit. It would seem to confirm our suspicions. Then something occurs to me: Max’s withdrawal has been too easy.
“I bet he’s been chipping,” I say. Alexi goes to hunt him down. I’ll talk to Russell later. We never confront two patients together; each conversation is confidential and we don’t share the information with either individual.
Max acts as if he’s surprised I would even want to speak to him. His body language tells a different story.
“You failed to give a urine specimen yesterday in the time period you agreed on in the treatment contract,” I say.
“We consider that a positive,” I continue.
“They didn’t tell me I only had sixty minutes,” says Max. “I’d just gone and—”
“As I said, it’s in your treatment contract. You’ve been doing it for a week. You should know. I believe you do know. What I’d like is for you to tell me the truth.”
He doesn’t; neither does Russell when I talk with him next. They both deny everything. Russell’s much smarter than Max, making me think they may have bonded more out of a desire to use than mutual respect. Russell changes the subject; curious to learn more about him, I decide to see where he takes the conversation. Very often you get the information you want through a path you didn’t see at the start.
“It’s not that I’m against returning to the hood in theory,” he says. “But I don’t have to worry about gangs or gunshots where I live now.”
I sympathize. Listening to Russell talk about his family—a cousin who was killed outside a high school, an uncle in prison, his father abandoning him and his two sisters when they were small—and his friends, only a few of whom made it into college, I feel more than just his pain and suffering. If abuse, neglect, and abandonment were viruses, we’d be battling an epidemic so large the country would be engaged in a national emergency. It’s in the inner cities, the suburbs…it’s everywhere.
For some reason, Russell suddenly decides to confess. Something makes him tell the truth.
“Max found some heroin in one of his socks a few days ago,” he says, looking away as soon as he finishes.
“Have you used lately?”
“We—I mean I—both of us chipped a couple times yesterday. I wanted to say no, but I couldn’t. It was like I didn’t have any control.”
“I want to get better. I don’t want to be one of those guys who run out of chances. That’s why I’m here. I need help.”
“Then follow our directions,” I say. “We know what we’re doing. We’ve treated hundreds like you. We know what it takes.”
We look at each other in silence. I can see his desperation. That’s not necessarily a bad thing. I warn him that he might be experiencing withdrawal again. He’ll also need to sign another treatment contract, which will include a provision that he’ll agree to write about and discuss his relapse in group.
“I don’t want any confusion,” I say.
“There won’t be,” he promises.
“If there’s any deviation from the contract, even the slightest, you’ll be escorted off the grounds immediately.”
My next discussion with Max is different. I don’t have to reveal what I know. He is aware that information has been passed. This is a bed he made himself, and I wonder how much he will allow himself to get in it. Partway, it turns out. He admits to using, even to getting high earlier that morning, but I can still see his face is a puzzle. He is continuing to maneuver, trying to find a way out. No one is comfortable in these situations. At the same time, they can be an opportunity for a patient to capitulate to treatment at last.
But Max isn’t there yet. He says, “I want help,” and it’s true. Yet I don’t see the calm and resignation that come over a patient who means it. Max is continuing to shuck and jive. That tells me it’s not over.
“What’s going to happen?” he wants to know.
“First, I need to know if you were bringing drugs into the unit.”
“No,” he says. “Except for what I found in my sock.”
“What about the heroin you did this morning?”
“I had a friend come visit. He had some shit. When he offered, I said okay. I couldn’t resist. Neither could Russell.”
I’m not clear on the biggest issue: whether or not Max gave drugs to anyone. If he did, the punishment is immediate dismissal, no questions asked. He’d be treated like an infecting agent. But I don’t know for sure. An addict isn’t expected to be able to resist drugs. Max responds like a typical sociopath, trying to make me feel great. He compliments the program and says how much he’s getting out of it. He praises me. He seems genuinely sorry. He’s suddenly a real people pleaser.
I wish I knew more. Because I don’t, I say, “I’m going to give you another chance. The same as Russell.”
I believe it’s only a matter of time before he screws up and makes the decision for me.