Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
FOR THE NEXT two days, I am useless. I stay home from the hospital and let the fact sink in, let it fester: I’ve lost a patient.
I know exactly what to do for someone else who’s suffering. But the magic escapes me as it applies to myself in this hazy time. My wife and children sense the struggle and leave me alone. Several times, when she can no longer stand the sight of me lost in our own home, Susan asks what’s wrong.
“Nothing’s wrong,” I say, and both of us know I’m lying.
I wallow in it. The children come in and out of the room and I don’t hear them. I can’t sit still in front of the television. I don’t want to go for a walk or out to dinner, and when I do I’m not aware of it. Nothing can penetrate the stone wall of depression around me.
On the second night, Susan can’t take it any longer. After dinner, she confronts me in the den. I’m in a chair, holding a book on my lap without reading, when she puts her face right in front of mine.
“What’s up?” she demands.
I don’t want to talk.
She won’t let me get away with it.
“I lost a patient.”
She strokes the side of my face with her hand.
“I am consumed by thoughts of failure and futility,” I say.
I know everyone has a day at work now and then that they want to forget. For me, a bad day isn’t a mistake on a spreadsheet, a case that went the wrong way or a missed sale. I had a patient die. A woman in her prime, who should have enjoyed a long and fruitful life, died. Less than a month earlier, I had told her she didn’t have to die. I thought she had a chance. I believed it with everything I had. All I wanted was for her to share that belief.
“You’re good at what you do,” Susan says. “You did your best. It’s not like it would have turned out better if you had done something different, or if someone else had been taking care of her.”
How can she say that?
I disagree, silently, but vehemently.
She sees that. “Drew, you can’t save everybody.”
“It’s not about that,” I explain. “It goes beyond that. Every day I challenge my patients to get better by trusting the program and connecting to other people. They ask how they’re supposed to trust, and I tell them to have faith. They want to know, faith in what? Faith in a higher power, I tell them. Where was that higher power when my patient needed it? Where is it now when I need it?”
“I don’t know,” she says. “Either you have to find it…or it will find you. Or else you’re in for one long bummer.”
Later that evening, as the sun is setting, I go for a run in the Arroyo, an ancient river basin that runs through Pasadena. In the cool twilight air, amid the long grass and purple flowers on the canyon’s walls, I listen to my feet pound the earth and my heart pound inside my chest. I think about the earth and how it continues despite the plunder of humans, beautiful, nourishing, forgiving. I run to avoid defeat, to prove myself, to show I can. Step by step, I conquer boredom, push beyond pain, accomplish something.
Gradually, as I find my stride along the trail, I fall into a meditative state where I am able to open up and search my soul, questioning everything from my own actions to the inaction of the system. I have so much to go over. My thoughts drift from Amber to the pain of so many of my other patients to my place in their lives. What’s my purpose in this drama? What’s the point, I wonder.
I can’t make much sense of anything, but the run feels good.
By the time I return home, I have worked up a healthy, cathartic, cleansing sweat. Susan asks, “Good run?”
“Yeah, good,” I say.
“Maybe. I need to shower.”
After cleaning up, I walk in on the kids as they watch television. They are completely absorbed by The Simpsons; I am taken away by a phone call—Finley calling to check up on me. It’s perfect timing on his part. If he had called a day earlier, I would not have been ready to get into it with him. Even a few hours earlier would have been wrong. But now I am ready to talk. Hearing his voice unlocks the door to the vaulted emotions that have paralyzed me for the past forty-eight hours. After listening to me, he offers another slant on the situation.
“Blame yourself if you want. Feel sorry for yourself if you want,” he says. “But why don’t you also blame her?”
“You know why? She had no control over the disease. We didn’t provide enough help.”
“We did what we could,” he argues.
“I don’t know,” I say. “We knew what we needed to do. We needed to nurture a trusting connection and maintain it. We really didn’t do that.”
“Was there willingness on her part?”
“I believe so. Only a month ago she admitted that she didn’t want to die. She was in tears as she said it. It was as if she had a premonition. But that’s not the point. The point is that I had gained Amber’s trust, but to what end? To suffer one more abandonment and set her up for an even bigger and more tragic collapse?”
“Maybe you’re right. But the fact is, sometimes you don’t get the breaks. You can’t be the hero every time.”
He makes his point and then changes the subject to something lighter. The Dodgers are always good for a few minutes of distraction. After hanging up, I am still confused. There is no simple or easy resolution. I read for a few hours and then slide into bed next to my wife. Though she’s already sleeping, Susan’s leg touches mine, and that feels good.
The next morning it’s time to go back to work, something I can feel in my bones. I step back into the morning routine of getting the paper, making coffee and conversation with my wife and kids. All of this is a tremendous source of comfort. Returning to work isn’t as smooth. I walk in with a certain amount of dread.
The unit is quieter than normal. Like me, everyone is still dealing with Amber’s death. Whenever something like this happens, whether it’s someone getting caught with dope or someone dying, there are repercussions. Usually patients get their shit together for a little while. They settle down like a restless population after a public beheading.
“How are things?” I ask Alexi as she brings a fresh cup of coffee to the nursing station.
“It’s slow,” she says. “I’m bored.”
She makes no mention of my two days off. Neither do I. We go on as if nothing has happened.
My first patient is Esther, the older woman I had been examining when the episode with Amber started. Because we were interrupted in midexam, I want to go back and reestablish contact with her. I find her in her room shortly after she has been brought back in a wheelchair after a short stint sitting in the morning sun on the patio. I ask if she knows how many days she has been in the unit.
“Too many,” she says.
“You’ve been here three days,” I say.
She is lethargic, thick-tongued, and unstable (hence the wheelchair) from the Librium we have given her to suppress the alcohol withdrawal. For older people with other medical problems, withdrawal is really dicey. They can easily lapse into a potentially fatal state of delirium tremens and quickly slip away.
But Esther, for all her problems, is hanging in there. She is even thinking fairly coherently through the medication.
“I heard what happened to that girl,” she says.
“What’s a matter with kids today?”
I shrug. What am I supposed to say? That they’re overstimulated, bored, drugged out, and disconnected from each other?
That they’re fucked by pop culture?
That they’re lost?
I don’t have to say anything. Esther can’t identify with the kind of turmoil and chaos of young women like Amber. She tells me that women of her generation facing adversity got their shit together. End of story.
“I don’t get it,” she says. “We drank at lunch. But we didn’t get tattooed or stick pins in our tongue or our eyes.”
“I don’t know what to say,” I tell her.
“It’s okay if you don’t want to talk about it.”
“The girl that died.”
“I don’t know if I do or I don’t.”
“You did the best you could,” she says. “You guys work so hard. I see how you and the others go all around and help everyone.”
“You can’t save them all.”
“What do you mean?” I ask in a slightly mocking tone.
She taps a finger on her chest as if to say, “Look at me. Here’s another one you aren’t going to save.”
Enough about me. We need to readdress Esther’s treatment more than we need to discuss my needs. Glancing at notes on her chart, I see her daughter was here the night before—merely to visit, though, not to participate in family group or any other aspect of treatment. I get it. She just wants Esther fixed. She doesn’t want to do anything that would require examining herself.
That’s normal among families. All too often family members don’t really want the patient well. They want them the way they were before the addiction got out of control. Fundamental emotional change is too scary; it can often require family members to look at their own emotional issues, which can be a major stumbling block.
“How was your daughter?” I ask.
Esther shrugs. “I asked her to take me home. She said no. Then I asked her not to talk while I watched television. She left.”
“I can see you’re feeling better,” I say.
She shrugs again, but it’s the truth. Three days of good food, rest, medication, and no drinking have improved her health. Granted, we’re letting her smoke outside, so she’s happy. She lets me know she could be happier.
“When can I go home?” she asks.
“I don’t know,” I say.
“Doctor,” she says, pointing her trembling hand at me. “What’s the point? What are you going to do for me—really?”
“We’re going to make you feel better.”
“That young one—you might have been able to do something for her. But she’s dead. So for me? I’m seventy-two years old. I’ve got how many years at most—eight? Ten? What’s being sober going to do for me?”
Her logic kind of staggers me. A part of me wants to admit she has a point. It’s a little like the situation I sometimes face when I argue against withholding morphine from an opiate addict with cancer, though I have found that frequently addicts with a strong connection to sobriety will want to go through as much pain as they can stand without drugs. It’s their choice. Esther’s giving me the same message. Whether she has two years or ten, she wants to live them with her friend and lover, alcohol.
“Could you be happier sober?” I say. “I honestly think you would. Would you benefit medically? Yes. Would it prolong your life? Probably.”
“And your point?”
“You’d have a fuller, more complete life experience.”
She brushes aside my argument with a shake of her head and announces that she’s going outside to smoke a cigarette. “I would prefer it with a cocktail.”
I might as well have tried selling Esther on ginseng tea, or asked to her to reconsider the feng shui of her apartment. We are on different planets.
I step into the hall, realizing that, though Esther has no more use for me, she has in fact caused me to ask a serious question.
What am I really doing here?
What’s the point?
I once had a discussion with an aquaintance about mental health. This guy was a brilliant businessman involved in the entertainment industry. We were having dinner at a mutual friend’s house, celebrating one of his latest multimillion-dollar deals. At some point he turned his attention to my work. After listening to a few stories about my work with patients, he said he could improve the results I got by developing a “happiness scale.”
“You have these troubled individuals who can’t really express their suffering or their joy,” he said. “But if you created a scale, you would be able to quantify their feelings. Instead of pain, you could be measuring happiness.”
“How do you figure out the scale?” I asked. “What’s a one? What’s a ten?”
He needed only a moment to formulate his spreadsheet logic.
“Well, take me, for instance. I guarantee you that I’m way up on the happiness scale. I have a beautiful wife. Two kids. And I just sold one of my businesses. I couldn’t be better.”
Without using him as a specific example, I took exception to his theory.
“What the fuck are you trying to say?” he eventually asked, unable to reckon a world where numbers weren’t primary.
“I’m saying that I don’t think happiness should be the goal.”
Esther, I think as I walk from her room, is happy when she has a bottle close by. No one is happier than my heroin addicts when they first get going with their drug of choice. Pot addicts are the same when they’re lighting up. In that moment they have found the solution, and everything is okay. You can’t find folks who are happier.
I’m aware that I’m pondering this question at a time when I am at a low point of my own, feeling inadequate and unworthy. I am definitely not happy. I’m not walking around with a smile on my face. I am not offering high fives to friends, neighbors, and co-workers, going, “Hey, let’s hear it for being happy.”
But “happy” is such a ruse. I deal with actors and rock stars and Hollywood executives who have wealth, fame, drugs, sex, great homes, the best tables in the finest restaurants, five-star vacations in exotic locales…they have everything—including the misery, pain, and suffering of addiction. Kurt Cobain…
(Fill in your own list of celebrity ODs)
1. 1. ______________________________________________
2. 2. ______________________________________________
3. 3. ______________________________________________
They aren’t happy people.
If not happiness, then, what?
Better that we start at a more basic level: mental health.
Mental health is defined by one’s ability to be fully present and integrated in reality. Of course, that reality may not always be happy. There might be negative experiences. In fact, there will be negative experiences, days that are downright crappy, moments or even years so painful you’ll ask why such shit is happening to you. But if you are mentally healthy, you will be able to tolerate such experiences, regulate your emotions. And in the end you will be nourished by something more real than merely “feeling good.”
Later that afternoon Alexi and I are due at one of our regular staff meetings across the grounds. As always we take the walk together, enjoying the moments outdoors. The path, snaking across a parklike stretch of grass, is lined with flower-filled gardens. It is empty and serene. We see several squirrels, a lizard, and an array of birds. One patch of grass in the shade is full of enormous black crows.
“What do they know?” I wonder, motioning toward the birds.
“They know where the worms are,” Alexi says, laughing.
We move on for several moments in silence, until I catch Alexi looking up at me as we walk. We stop and I ask, “What?”
“Are you okay?” she asks.
I know what she is talking about. I have been absent from work, troubled, distracted, irritable, depressed, quiet, and confused, and she has read me like a menu.
Still, I am not forthcoming. “What do you mean?”
“How are you doing with all of this?”
“I’m okay,” I say, surprised to hear those words coming out of my mouth.
“I don’t believe it,” she says. “No, you can’t be. Not without me mothering you a little bit.”
I chuckle. We get into a brief discussion about medical responsibility.
“I hope you don’t feel mistakes were made,” she says. “Or there was something more you could have done.”
“The system sucks. That’s not our fault. She shouldn’t have died. That’s the reality. And I’m not sure we couldn’t have done things a little different. But”—I sigh—“I’m okay.”
“What do you mean you’re okay? You seem upset.”
“I am upset. It’s painful. But I’m dealing. What about you? You loved your little pain in the ass.”
“Well, I cried,” Alexi says. “I cried that first night. My husband and child wanted to know what was wrong. I told them. We talked about it. I cried some more and then I didn’t have to anymore. Now I’m nervous.”
“I’m nervous we should be doing more. I’m nervous that if we don’t do more someone else will die.”
“You know what? Someone else is going to die. Eventually. But our treatments are good. Our program is right. We know what we’re doing. We can help people. We have to keep doing the best we can.”
We start to walk again, but as I replay my last comment I hear my inner voice say, Wait a minute. You have to do better than that for Alexi. Everything I’d just said was uttered on autopilot. Obviously I’m still a little vulnerable, and I was feeling invaded by Alexi’s feelings. But Alexi is in this, too, and shifting into neutral that way was no good or fair or helpful for either of us. I need to mark her feelings and listen, acknowledge her concern and pain. I need to connect. So I stop and look straight into her green eyes, and ask her to go on.
After a few moments of conversation, Alexi calms down. To my surprise, I didn’t have to rescue her from her feelings. I just had to be there, and she calmed down. My empathy was enough. I felt more secure. This is new to me, a small but significant change in awareness.
I realize we can’t save each other. But we can be there for each other. We can be open, empathetic, present.
And I was still there for me.
“How are the kids?” she asks, turning it back on me.
“They’re great,” I say. “They’re playing baseball and ice skating, they’re doing well.”
We start walking again. We have to get to the meeting. As it is, we’re going to be late. I wish I could stay in the moment a little longer, because I sense that it’s some kind of breakthrough, a door Amber has opened, a debt I will owe her. A slight breeze picks up. I have a small tear in my eye and a warm spot in my heart. Before entering the administration building, I tell Alexi that I’m grateful for her friendship, for her health, and for her partnership.
She shakes her head. I’m sure she wants to make some crack: “What kind of dope are you on?”
But she doesn’t say anything, and we go into the meeting.