Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
THE WAIT ISN’T long. A few days later, Max is caught by the night shift on the corner in front of the hospital doing what we had suspected. I get the news from Alexi the next morning. According to her, Max had convinced the night nursing supervisor to get his wallet out of the safe. He had broken unit restrictions by going outside. There was no doubt why he needed his money. Unable to get me on the phone, the staff contacted Finley, who gave the go-ahead to discharge Max on the spot.
“He was picked up by a friend,” Alexi says, putting away his file.
“He wasn’t ready,” I say. “Too bad. How’s his pal?”
“Russell is hanging in,” she says.
This will be hard on him. He’ll have a lot of mixed feelings, and fear, and he’ll have to rely on his peers to help him process Max’s sudden departure.
Toward the end of the day Alexi comes into the nursing station from her rounds of the unit. She can’t hide her frustration.
“What is it?” I ask.
“You know what I want?” she asks, slapping her palm on the counter.
“A good old-fashioned alcoholic,” she says.
“Where’s our friend Mark Mitchell when you want him?”
But our next patient is transferred from the psych unit. Earle, in his thirties and dressed in a white T-shirt and baggy black pants, is a crack cocaine addict who’s out of his mind despite the brief stay in the locked ward. He is sped up, manic, like an airplane bucking out of control. Everything from his movements to his speech is tangential and wild. He keeps insisting to the staff that he and I are friends from childhood. In fact, he even mentions some guys I had known since fourth grade.
I have no idea how he knew those names, not to this day. I had never seen him in my life.
I put Earle on Depakote and Seroquel to calm his mania, and about five days later he finally starts to land. A few days after that we get him to do a first step—and it overflows with atrocities. He says his mother was a heroin addict, and in a monotone voice frightening for its lack of feeling he describes how he came home every day from school wondering if he’d find her alive or dead. Once or twice a month, he would see a fire engine or an ambulance out in front of his house as he walked home from school.
“It got to the point where I changed my pace as I went inside,” he tells me one day. “I’d slow it way down. I didn’t want to feel a thing. I just asked, ‘Is she dead?’”
He saw them cart his mother off while she was frothing at the mouth and covered in shit and pee.
“How old were you?” I ask.
When his mother wasn’t incapacitated, she was abusive. She opened their home up to drug addicts willing to trade heroin for a place to crash. He can’t remember who did it—it could’ve been his mother—but someone gave him pot when he was ten. Around the same time he discovered beer. Both made him feel better. He quickly graduated to harder drugs. As much as he thought he was handling his painful life, he was extremely disconnected. He just grew more addicted.
“How’d you get by?” I ask.
“I ate my Cheerios,” he says. “That’s all I did. That’s all I liked. That bowl of Cheerios.”
I find myself drawn to Earle for the wrong reasons. I seek him out for snatches of conversation so that I can look into his eyes.
He also tells me that if need be, he could kill another human being and go back to eating his cereal without a second thought. How could someone get to that point? Think about it. After experiencing one atrocity on top of another, he could no longer trust anyone, no longer connect with anyone; as a result, he could no longer have any of the interactive experiences that would allow him to relate to others, to measure himself against the rest of us.
Why is he able to talk about killing this way, without any hesitation or remorse? Because other people really don’t exist to him. One of the higher and later levels of human development is the capacity for empathy. He needs to use other people to survive, but he’s a million miles away from recognizing that.
“Why is he here?” asks Pat, one of the counselors, in the team meeting.
“Because of a fuckup, really,” says Finley. “He was taken to County Jail, somehow transferred to the hospital, and they shuttled him here.”
“He’s lucky, in a way,” says Pat.
“Drew, how long do you give him?” asks Finley.
“Best case, I’m afraid he’s dead in six months to a year,” I say. “I can see his pain. I can feel it. I’m not sure he can feel it as much as I can.”
“He’s completely dissociated when he talks about his life,” says Finley. “When he talks about his life, he sounds like he’s a narrating a film.”
“Only less involved,” adds Alexi.
“I think that’s how he’s been able to survive,” says Finley. “He’s the modern-day version of Ellison’s Invisible Man.”
“I see someone like this kid and I get angry,” I say. “A part of me wants to know why the world can’t come to grips with this disease and the causes. Another part of me is grateful to be treating him. Addicts are strong people. They are serious survivors. If you think about it, the whole nature of addiction is about survival in the face of horrible circumstances. It’s unusual for an addict not to have some internal resource he can call upon, no matter how horrible the trauma. Apparently Earle’s mother was somewhat available to him until she got too strung out, when he was seven or eight. Some of the newer research suggests that a stable attachment in infancy may be enough for someone like this to call upon to rebuild.”
“I don’t know,” Finley says, shaking his head. “Abandonment, chaos, years of opiates. That’s a powerful combination to overcome.”
But never underestimate the resiliency of the human spirit. I glimpse Earle’s inner resources one day following a group. He stops me in the hall and tells me he wants to get better. I have another appointment, but decide this is more important than being on time. I have never sensed anything like this in Earle. I ask some questions, and I get the impression that his mania has settled down. When he first arrived, that’s what we had been treating. As he felt better, he began trusting us. He doesn’t have family, or a job, or anything else he can look forward to—other than feeling better.
“So what do you want to do?” I ask.
“I want to get the new Radiohead CD,” he says.
“No,” I say, smiling. “I mean with your life. What do you want to do? What’s next for you?”
“I don’t know,” he shrugs. “You tell me.”
Without plans or a place to go, he is asking for guidance. This sounds like a small matter, but it’s nothing short of miraculous to me, if he means it. If he’s willing to turn to others—and, moreover, others in authority—for solutions. He’s lived a life completely without hope of anything but getting through the moment without pain, and suddenly he’s been asked something new—he’s taken notice of the future. There’s no resistance coming off him; he seems to be accepting that his way wasn’t working. He seems open to an alternative.
About two weeks later, Earle has completed his behavioral goal: He’s gotten a sponsor, completed his first step, and with help drawn up a discharge plan: calling Sober Living, setting up an interview and a move-in date, and creating a schedule of attending groups at the unit as an outpatient.
“You have to be responsible for your own disease and recovery,” I explain.
Earle nods and scratches his head. I pat his back. It’s not that complicated. It starts with a phone call. Then I leave him to do his thing with the Sober Living intake coordinator. I don’t have any idea whether Earle is simply doing what we tell him to, or actually drawing upon an instinct to survive and just looking for a place to crash. What would possibly keep him from using again?
If our roles were reversed, could I make it? I’d like to think I have that strength in reserve. But who the hell knows? I don’t know if I could’ve made it as far as Earle has.
My last interaction with Earle is when I write his discharge order. I shake his hand, wish him good luck, and watch him walk through the doors. He drags a large army surplus canvas bag of used clothes some of the staff rounded up for him. The plan is to see him at eight the next morning for group. He nods affirmatively. A van takes him to Bishop Gooden, a Sober Living facility about ten minutes away.
I give him the thumbs-up sign through the glass door just as Finley passes on his way to his office. I catch up with my colleague a moment later.
“How can you be so matter-of-fact about something like that?” I ask.
“I don’t give him a chance,” he says. “It’s a miracle he’s out on the streets and not in jail where guys like him usually end up. How’d that happen anyway?”
“He called and set up the interview yesterday.” I shrug. “Whatever we say, he does.”
“Maybe he doesn’t have any other options.”
“I don’t think he does. But you know as well as I if these guys haven’t capitulated, they’ll find ways to keep using.”
Sure enough, Earle shows up the next morning at eight. He pedals up on a used mountain bike. Someone at Bishop Gooden had given it to him for transportation. Huffing and sweaty from the long ride, he parks it inside the hall, not even asking if it’s okay. I suppose it is. As far as I know, no one’s ever ridden up on a bike. Inside, he takes a long breath, gives me a parting nod, and then we walk off in separate directions to do our work.
The same thing happens the next day. And the next. It keeps happening. For reasons I can’t explain, he continues to ride to the hospital, always on his bike, and always on time. We don’t always cross paths, but I see his bike parked in the entry or I hear about him, and it fills me with encouragement, the type of feeling that fuels hope. We chase so many people out the door, reminding them of their commitment, begging them to return. We don’t even have to ask Earle, who just seems to get it.
But then one day he doesn’t show up. He comes the next day without explaining his absence. Then he misses the next few. Finally, he stops altogether. He also leaves Sober Living. When we follow up, they tell us that he followed a girl to another facility. Or so they said. Neither left their name.
“I feel betrayed,” I tell Finley and Alexi.
“Personally?” he asks.
“No, not personally,” I say. “It’s a professional failure. First it’s Amber. Now him.”
“How long have you been doing this?” asks Alexi. “You know how many people don’t get the first time.”
“Or the second or third,” adds Finley.
“Maybe I’m having a crisis of faith,” I say. “I don’t want to hear this.”
“It’s the truth, though,” he argues. “You can’t question Earle. You can’t change him, either. What do we tell our patients? They have to take responsibility for their disease and their recovery. If he’s going to change—which would be a miracle—it’s going to have to come from inside him. I think you’re putting too much of yourself into this.”
“Maybe I’m not putting enough of myself in,” I say, raising my eye brows.
“No,” he says. “You’re doing as much as the system allows.”
“You know what?” I extend my arms in a broad gesture. “I haven’t said this since college. But fuck the system.”
“I don’t know,” says Alexi. “The system brought us Earle. The system probably saved his life.”
“The system also kicked Amber out. So fuck the system.”