Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
ON THE DAY Amber returns to the unit, I’m treating what Alexi would describe as an old-fashioned alcoholic. Esther, in her mid-sixties, came in during the night. Her daughter brought her. When I enter her room, she’s seated on the bed, and she couldn’t look thinner or more frail. In her heyday she could never have been more than slight, but now she has no muscle or soft tissue. She’s skin and bones covered in a faded orange housedress. I notice she has beautiful coral earrings, though; a hint of life in the past. One of Pasadena’s finest.
I pull up a chair and sit down and glance at the few notes on her chart: Passed out in her apartment. Lives in SQUALOR. Daughter thought she was dead. Smoker. Bad cough. Probably emphysema. When I take another closer look at Esther, I see she’s bruised and banged from falls and accidents, like an old doll. She’s also trembling.
“I understand you’ve been drinking,” I say.
“My family would have you believe that,” she replies in a weak but coarse and defiant voice.
“Those bruises on your arms—have you fallen recently?”
“A couple times,” she says. “It’s nothing.” She turns toward the window, purses her lips, and gently blows air. “You people won’t let me smoke in here.”
As if on cue, she rips a big wet cough. I place a hand on her shoulder to steady her.
“I’m fine,” she says.
“Those cigarettes need to go, too,” I say.
She dismisses me with a simple wave of her fragile hand. For a moment, I can picture her fifty years earlier, a spry young woman at a cocktail party holding a martini glass and a cigarette. The early 1950s. A whole generation of women like her defined themselves by their freedom to smoke and drink. The next generation would partake of drugs and sex. If a show like Sex and the City is any indication, the current generation is defined by a desperate inability to maintain a genuine relationship. I’m reminded of the old Virginia Slims cigarette slogan: You’ve come a long way, baby. But is this progress?
Esther coughs into a tissue that was wadded up in her hand.
“Listen, I don’t know what all this is about. I’m fine. My daughter gets a fear about me, and the next thing I know I’m in this jail. I want to go home.”
“Do you have any medical problems?” I ask.
“No, I told you. I’m fine.”
“Have you been in the hospital anytime recently?”
“I don’t remember.”
“What about for pneumonia? On your chart, I see it says you were pretty sick about a month ago.”
“Everyone got all excited about nothing.”
Esther is in denial. She’s an old woman who totters through her apartment all day with a drink and a cigarette, and when she runs out of booze she shuffles to the nearby restaurant, stumbling up and down the building’s stairwell. This is her life. This is how she defines herself. She is a self-reliant woman who drinks and smokes, and her social life revolves around people who do the same.
Denial; reality. It doesn’t matter. Nothing I saw will change that picture.
It’s futile for me to argue with Esther. She won’t accept any sense of herself that doesn’t meet with her approval. The uninformed wonder how people like her can continue to drink when they see what they’re doing to themselves. That’s the point. You can show them everything from a toxicology report to their reflection in the mirror to their own distraught relatives, but they don’t accept it. You’ve heard of rose-colored glasses? Hers are the color of booze.
According to what her daughter told the night nurse, Esther’s drinking picked up in a serious way after her husband died two years ago.
“Ancient history,” says Esther when I raise the issue. “Can I go now?”
“This is not a jail,” I say. “You can leave any time you want.”
“Then call my daughter,” she says, her whole body trembling in withdrawal.
She reminds me of a piece of china about to fall off a shelf. She would be in a full-on seizure right now if not for the withdrawal medication we gave her. Extending a steadying hand, I coax her to lie back on the bed and explain that I’ll be back to examine her in a little bit. Then I slip out of the room for an appointment having to do with administrative business. Hopefully Esther will sleep for a few hours. Letting her go home would be absurd. We will help her immensely even if we only have her a few days by attending to her medical and nutritional needs. Unfortunately, it’s not against the law in this country to drink yourself to death.
I spend the next hour on the phone. It’s one of those necessary duties of running a unit within a hospital, like pulling over to get gas when you’re in a hurry. It’s too boring to go into. During the conference call, though, I see a familiar face through the door. It’s Amber. She passes by, walking next to Alexi.
When I get off the phone, I immediately find Alexi. She confirms it: That was Amber. Though scattered, she came for a meeting.
“For group?” I ask. “She’s hours late for any scheduled outpatient groups.”
“I tried telling her,” she says. “She couldn’t follow. I just sat her down in the group that’s meeting now.”
“Is she high?”
“She shook her head no.”
“I’m worried. But at least she’s here.”
Before checking on Amber, I have to finish examining Esther. Her condition, it turns out, is pretty much what I expect. Her bruises, the falls aside, are due to her alcoholic liver’s failure to produce normal amounts of blood-clotting mechanism. Her legs are swollen, perhaps from heart failure or the added pressure put on her heart by the emphysema. Her lungs are barely functional after years of chain smoking. She has no patience for my poking and prodding. After a few minutes, she squirms free and scoots to the back of the bed.
“I’m too old for this,” she snaps.
“Esther, you need to stay here for a while,” I say. “If you leave, I think there’s a high probability you’ll die fairly soon. If you stay, you can feel better.”
She isn’t happy.
“We’re going to focus on getting you stronger,” I continue. “You obviously haven’t been eating too well. We’ll get you on a better diet. I’ll also be giving you some medications and vitamin shots, because—”
Just then we’re interrupted by a crash, loud enough for everyone in the unit to hear. Both Esther and I stop and turn toward the door. I hear voices down the hall. Advising Esther to lie back down and wait for me, I rush outside just in time to see the end of an altercation at the nursing station between a nurse named Kathy and Amber, who’s screaming, “Give me my fucking car keys!”
Amber flails at the countertop. Papers and books fly everywhere. A metal chair falls over, making another crash. I grab a phone on the wall next to me and ask the operator to sound a Code White to the Briar Unit. As soon as Amber hears the alarm sounding through the P.A. system, she sprints down the opposite end of the building, toward the patients’ rooms. My first stop is Kathy, who’s shaken and breathing hard. She says she’s okay.
“What was that all about?” I ask.
“Earlier, I smelled alcohol on her breath,” she says. “I was sure she’d been drinking, so I asked for her car keys. I didn’t want her driving in that condition. I was going to call her husband to come get her if she refused evaluation to come back as an inpatient. But I didn’t even get that far.”
“And just now?”
“I’d called the admissions staff to come evaluate her. But they were taking a while, like they always do, and the next thing I know she practically breaks down the door.”
“Okay. You did everything right. You’re okay?”
We have to find Amber. Staff have poured into the nursing station in response to the code announcement. In addition to Kathy, Alexi, and myself, there are six people, all practiced in these sort of events. They happen almost daily throughout the hospital, particularly on the adolescent and locked psych units. Believe it or not, they don’t happen as dramatically or as frequently on our unit.
I send two guys outside to look around back in case she’s already out the door, and I lead the others down the hall. Kathy thinks she was heading toward her old room. Glancing past the open doors of other rooms as we hurry down the hall, my head fills with the same nagging concerns I had before she was discharged. I’m already jumping to dark conclusions. Then we get to 421. The door is open. The room is empty and tidy. The bed is neat. No signs of anything.
“What about the bathroom?” asks Sean, one of the orderlies. “I smell something burning in there.”
The door is shut.
“Yeah, try it,” I say.
Sean knocks. Because of Patient’s Rights, we can’t just burst into a room even when there’s a potential danger. After the second quick knock, we hear the sound of breaking glass. It’s followed by a thud. He immediately tries the door, but something on the other side prevents it from opening more than a crack. That’s enough for us to see Amber lying on the floor, wedged between the door and the toilet. Sean pushes harder, and the door opens.
The first thing I see is a crack pipe on the floor, which I kick to the side. We pick up Amber and quickly carry her to the bed. I bark instructions: “Call a Code Blue. Get a crash cart.” I look down at Amber. Her eyes appear to be fixed on a point three feet above her head. They’re gray and detached. She swallows once and it’s followed by a loud, snapping sound, a shudder deep inside her chest, and a guttural moan. Suddenly I can’t get a pulse.
“Get an IV going in that arm,” I snap. “Bring me the defibrillator and charge it up to a hundred joules. Set it for Cardioversion.”
Nothing happens. I look up at the waiting crew. “Jesus, where’s the crash cart?”
Can’t waste time. I drop my fist against her chest, hoping to jumpstart her heart. I press on her carotid artery. Nothing. I start mouth to mouth.
“Sean, start chest compressions,” I say between breaths.
Finally, the cart arrives. According to the monitor her heart rate has risen to 240, with wide complexes. I have Kathy get the EKG pads ready. Someone else gets the Amboo bag and starts running O2. One part of my brain operates on automatic, while the other is pissed off at the insurance company that forced her out and prevented me from doing the tests my instinct and training told me were necessary. Damn. How can we live with a system where people who don’t give a shit make medical decisions?
None of the emergency procedures are working on Amber. Not more adenosine. Not the paddles. Not CPR. Not epinephrine.
She’s lying perfectly still, now only a body without life.
“Give her another amp of Narcan,” I say. “Charge the paddles again. Three hundred joules.”
I hold the paddles to her chest.
Amber’s body jumps off the bed as the electricity is delivered; no change. Just as I consider what, if any, last-ditch options are available, the paramedics arrive and take over. Information floods out of me. Amber was probably smoking crack in the bathroom, I tell them. She probably had a flial mitrial valve. I think she had a massive MI, and must have ruptured her ventricle or some other total catastrophe. More…
The paramedic nods coolly, never looking up from his clipboard.
They resume CPR, but each squeeze of the respirator bag sprays vomit in every direction. All of us turn away, not from disgust as much as defeat. It is never easy watching someone die. The little room is silent and still and suddenly very claustrophobic. Alexi stands in the doorway. Feeling sick, I hurry past her and into the bathroom. I barely make it to the sink.
I’m there for a while, cleaning up my mess and crying. Finally, sometime later, there’s a knock on the bathroom door. It’s Alexi.
“Drew, are you all right?” she asks.
“Yeah,” I say, lying.
“I couldn’t reach Amber’s husband,” she says. “But her mother’s on the phone.”
I splash some cold water on my face, take a deep breath, and say, “All right, just a minute.”