Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
IT’S A LOVELY afternoon, several months later, and I step up to the front of the line at the bookstore and watch with pride as the woman behind the register rings up a few new pieces of summer reading for me. It is Hannah, one of my former patients. Working in a small town like Pasadena, I run into my former patients all the time. Hannah is pleased to see me.
“Oh my god, I love this stuff,” she says, gesturing to one of the novels I’d picked up. “Have you read him before?”
Hannah looks great. I don’t sense the emotional chaos that seemed to accompany her before. She is well groomed and seemingly together.
“I’m so glad to have a job,” she says, dropping my receipt in the bag. “You should stop by the café next door on the way out. Everything there is delicious. You can see that by the pounds I’ve put on.”
“You look terrific,” I say.
“I’m sober,” she beams. “I’m so grateful.”
Hannah goes on about the regular work she does with her sponsor. She sounds genuinely pleased. She seems stronger. But what about her daughter? Hannah sighs. That has been tough. Her daughter has been terribly angry with her, but she has started to attend Alateen meetings, which she hopes will help temper those feelings.
“I can’t blame her for hating me some,” she says. “After all, she has a right to be angry at me.”
“You’re right,” I say. “She’s trying to come to terms with her own life, and no one can change her reality. She needs a chance to deal with it. The better you do, the better chance she has.”
Before I leave, Hannah leans over the counter. Her fingers tap the glass top.
“Is it kosher for me to ask what’s happened to some of the others who were in treatment with me?” she says. “You get so close to some people, and then they disappear. I really hope they’re doing okay.”
“Who do you want to know about?”
“Well, Wendy. She was a wild one.”
“Unfortunately, I don’t know what happened to her. After two months in Sober Living, she got into an all-women’s program. That’s the last I heard.”
“What about Linsey?”
“Not good. After two weeks at a facility in Florida, she returned to L.A. One of the counselors ran into her at a meeting. She’s been struggling with her sobriety.”
“What about that real pretty girl? She was kind of weird. Kind of quiet. I don’t remember her name.”
“That’s her. What happened to Amber?”
I look across the bookstore, through the window, and onto the street where a woman in running clothes is pushing a baby stroller in the crosswalk. For the next few minutes I provide Hannah with the sad details. She interrupts several times to ask questions, including several having to do with Amber’s insurance, and as she talks, she picks at a plate holding tiny sample pieces of blueberry, cranberry, and bran muffins.
“The poor thing,” she says, before doing something completely unexpected. She asks, “How are you doing?”
Good question. Several months have gone by, and I have calmed down. Calm might not be a typical reaction to the death of another, but since that tragic incident I have felt calmer. It took a while. I had to live through the emotional mess that followed her death. But as time passed, I acquired a sort of clarity. That, and I became more accepting of my role in the events as they transpired. As I told Hannah, I did everything I could.
Once I was able to figure out what I had gone through, I felt relief. I felt release. I felt open, whole, and calm.
Calm is a new feeling for me. Ever since my episode with the man with the crosses in his eyes, I have spent my entire life focused on the well-being of the people around me, struggling to prevent bad things from happening to them. If I kept them well, everything would turn out all right, and I would be okay. I would ward off the sense that a catastrophe was always around the corner.
I was a resident the first time I had to confront the fact that reality didn’t always cooperate. It was in 1982, and I was on call at County General. It was past midnight, well past, and the cardiologist on duty asked me to taper a seventy-five-year-old woman patient off life-sustaining pressors—medication that maintained her blood pressure and kept her heart muscles pumping.
I looked at him as he gave the instructions, hoping on one hand that he wouldn’t notice the beads of sweat appearing on my forehead, while on the other hand thinking perhaps he would see the question marks in my eyes and explain why now, at this moment, with traffic in the halls at a minimum and beds plentiful, he decided to have me end this woman’s life simply by turning a knob. But he barely glanced up from his clipboard before walking away.
“Got it,” I said.
I had seen the patient before. She was sick beyond repair or hope, after more than a decade of physical decline, and both she and her family had issued clear instructions not to prolong the end if her basic quality of life could not be guaranteed. Wise, sensible, matter-of-fact. The patient and her kin had already come to terms with death.
I had a harder time. I went into her room, where it was just the two of us, along with several machines that were turned off, and a tall IV stand holding several bags of life-sustaining fluids connected by long clear tubes to her thin arms. I don’t know if she was conscious, or floating through a more pleasant place in a faraway dreamlike state of mind, but her eyes were open, and I swear to God she was looking directly at me. I stood at the end of her bed, thinking about it all, until I realized I was only spooking myself.
The woman’s breathing was weak and mechanical. After summoning my nerve by taking a deep breath myself, I performed the assigned task. I reduced the pressors and watched the reaction in the patient. It was instantaneous. The life drained out of her. Her breathing grew faint, her eyes sank, and her gaze became fixed.
I had an immediate reaction, too. I got scared. Oh shit, I’ve just killed this woman.
Then, as if on impulse, I turned up the medication, and watched the patient come right back, just as she’d been when I walked in the room. For a moment, I felt relieved. I asked myself how the cardiologist could have been so nonchalant in his instructions to me. Then I realized I knew the answer already. She was sick beyond repair, someone who would never have any more than the most tenuous grasp on life as long as she was given these drugs. Was this living?
I reduced the pressors again. But as soon as she began to die, I turned them on again.
Finally, I went back to check with the cardiologist once more. “She needs to be allowed to die,” he said.
That was it, then. I went back and watched the patient drift away. It ran counter to every sensibility I had. I thought doctors were supposed to save people from dying. But in this case I actually had to help one die. The experience might have made me quit medicine, but instead it made me a better doctor. I discovered that some deaths were good deaths. As I moved on, I found that I focused more and more on the pain and suffering in the lives of my patients. I defined myself by what I could do for others, which was alleviating pain and lessening suffering in my patients. They, in turn, just had to listen to me. And if they didn’t? Well, they had to. If I did my job well, other people wouldn’t have any other choice except to cooperate with me.
Of course it’s unreal to think I should be able to save everyone or that everyone should listen to me or both. How dare I insist all my patients cooperate with my need to rescue? But that’s exactly what I did.
As a result, I became so preoccupied with everyone else’s needs that I neglected my own. I was like many of my patients, closed off to the emotional nourishment I needed to develop a healthy self, I became unable to regulate my feelings, and so I turned to rescuing other people the same way my patients turn to drugs and alcohol. But my feelings about Amber pressed my face to the mirror. It was my bottom. I had to change.
I did so without being fully aware that the plates of my consciousness were slowly shifting. My healing process began with my run along the Arroyo, then continued with talks with Finley and Alexi and my wife and my patients, people who in their different ways caused me to recognize the fallacy of my omnipotent self-image. But I was not really conscious of the way those talks have percolated in me until I spoke to Hector, a former patient who approached me after one of my weekly medical lectures and asked for a moment in private.
Of course I’m happy to talk with him, and he waits patiently while I answer questions from a handful of other current and former patients. When I’m done, I suggest we talk while walking back toward the unit, because I have to pick up my daughter at the ice skating rink.
“How old is she?” Hector asks as we fall into step.
“My daughters are ten, too,” he says.
That’s right. I remember now: Hector has twin girls. The twenty-six-year-old ex-gangbanger is a devoted father. When I first came into his room and asked why he was there, he said, “I don’t want my girls to be like me.”
Hector had been surrounded by death his whole life; it was a miracle he was alive. The youngest of three boys born and raised in the roughest section of East Los Angeles, he barely knew his parents. His father was sent to prison when he was five, and his mother died of a heroin overdose when he was nine. His two brothers were both gunned down in gang fights. Growing up alone, Hector managed to escape the neighborhood when he somehow lucked into a job as a pharmacy tech.
But his break wasn’t totally clean. A heroin user since his teens, he was unable to resist easy access to drugs at the pharmacy. He started with Vicodin. He controlled his habit for a while with periodic blasts of naltrexone, an opiate blocker that shocks the body into a rapid withdrawal. Then he found Dilaudid, and that was that. After his boss discovered him semiconscious in the back room with blood trickling from his forearm vein, he ended up in rehab.
I liked him immediately. His honesty was raw, right out there on the surface. He was motivated. He didn’t play games. His employer, a middle-aged man who ran a mom-and-pop pharmacy, stuck by him. Hector reached out to others in group, and found that people responded to him. He seemed to get it. Now, eighteen months later, he was wrestling with a problem that could destroy his sober life.
We stop walking and Hector looks straight into me. I see the anguish in his eyes.
“I keep thinking I’m going to die soon,” he says.
This strong young man covered with tattoos is trembling with fear and nerves. I put a hand on his shoulder.
“Like your mother?” I ask.
“Like everyone I know,” he says. “I’m no different than her, or my brothers, or all the kids I grew up with. I’m just waiting, man. I can hear the bomb ticking. I can’t sleep. I can’t concentrate on anything. The feeling never goes away. I don’t know how to make it go away. I just keep thinking it’s going to happen any moment.”
I don’t tell him, but I know too well what it’s like to think that catastrophe is around the corner. Still, I can’t help pushing Hector a little bit: I know he’s stronger than this.
“I guess you’re already dead then, right?” I say. “You’re not worth it. It doesn’t matter anyway what you do. It’s hopeless, right? So just fuck it.”
“Yeah, fuck it. I might as well get high.”
“How does it feel to be dead?” I ask.
He bristles with anger and aggression. “What are you talking about?”
“I want to know how that feels. Tell me.”
He struggles against the challenge. I see his frustration and fear as he bumps into feelings the human mind loathes.
“How does it feel? It feels fucking empty, man.” Suddenly Hector is in my face, nose to nose, angry and aggressive. He yells, “Are you really interested in fucked-up feelings, doc?”
I am, but not at this close range. Suddenly the whole outdoors seems too cramped. “Hey, Hector,” I say, “you’re standing so close I can’t make things out clearly. I’m not only getting old, I guess I’m also going blind. Would you mind taking a step back?”
Hector pulls back and smiles. Casting his eyes downward, he shakes his head. My playful response forced him to connect momentarily and see the experience from my perspective. For a moment I truly existed for him as a separate being with my own feelings. I wasn’t angry with him for letting out a little aggression toward me. Equally important, I wasn’t ashamed for having triggered them. Nor was I inclined to be responsible for soothing him and rescuing him from his feelings.
“Hector, you’re not dead,” I say, seizing the opportunity to open up his feelings to him a little bit. “That emptiness is something people escape into when they have no other escape. When you were a kid and your dad beat the shit out of you and your mother died, you survived by dying emotionally.”
“Whenever you’re scared or anxious, you go there. It doesn’t matter if you make a mistake at work, get in an argument with your wife, think about your kids, or feel like you might want to use again. It’s anything and everything you can’t control. You imagine yourself dying. You see death. It’s really emptiness, but it can feel like death.”
“Yeah.” He nods.
“But it’s not real. In fact, it’s as unreal as thinking you can control everything and everyone.” As I hear my voice, I realize I might as well be talking about myself. Or to myself. “You know, real recovery is about accepting powerlessness. It’s about accepting that you were traumatized, and while that was intensely, seriously wrong, you survived. Appreciate that. You got a chance. Your life can be okay. You can’t be perfect. You can’t ever be pain-free. But things can be okay.”
“How do I know that?” he asks.
“You work hard, you do what you’re supposed to do, and you have faith.”
“Yes, have a little faith. It’s the thinnest strand and it holds all of us together. You have to trust me and have a little faith. Eventually, over time—I can’t say when—you’ll have a sense that something profound has happened. Everything will be the same, and yet something will be different.”
“What’s that?” he asks.
“You won’t feel dead.”
“How will I feel?”
Good question. I think for a moment.
“You will feel whole.”
I don’t expect Hector to understand at this stage. I barely do myself. But he walks back to the unit. I get in my car. And I think both of us feel better.