Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
THE NEXT DAY is Saturday, and I stop at the unit before meeting my wife and kids at a birthday party at the park. The sky is a dull gray blanket of clouds bringing cool air from the ocean. I cross paths with Finley walking toward his office. He says something about the two of us working weekends, as if we were kids out of graduate school. I smile, though it doesn’t feel like work; it’s just what I do.
“I sent you a couple of adolescents who called my office looking for a therapist,” I tell him.
“I know,” he says. “I talked to one, saw the other. The moms are nuts. It’s never just the kids. Both dad are alcoholics, completely checked out of their lives. The moms are compensating by hyper-achieving and acting out their needs through the kids. Don’t worry, though. I’ll get them.”
“Great,” I tell him. “See ya later.”
I cut through the patio behind the unit, interrupting two squirrels and a crow picking over the remainder of a breakfast tray left out on a table among the ashtrays.
“Sorry,” I say to the animals.
Inside, I see Alexi at the nursing station. I am surprised. She is supposed to be off. She says the same about me, and we laugh. She explains that Jane, her weekend counterpart, came down with the flu. She wants to know why I’m standing in front of her when she knows I am supposed to be at one of my kids’ events.
“I got a call last night that Debra came back,” I say. “I wanted to check on her.”
Debra is the wisecracking junior TV executive who was in a few months ago for a Vicodin and Soma addiction. Rather than go to Sober Living, she insisted on going back to work immediately and attending an evening outpatient program. For the past five days, though, she’s been missing from both. Now she is here.
“I thought she might do okay,” I say. “She was a little self-willed, but she had a ton of resources.”
“Opiates. You know what they need. It never takes if they go back too soon.”
“In any event, she’s back. We have her keys. We got a urine from her and it came back dirty.”
I spend five minutes with Debra, who cracks that she’s back for the sequel. I do a quick exam, then go over the plan. She needs to detox and then go into Sober Living.
“If not, we’re just wasting our time,” I say. “My time. Your life.”
She closes her eyes and groans.
By the time I get to the park, the sun is straining to come out from behind the gray clouds. I throw a Frisbee with the kids for a bit, and then sit down with the adults and discuss the disintegration of public schools, the cost of private education, and how we’re all going to end up broke after paying for college. The conversation is easy, light—and depressing as hell when we get around to the high cost of medicine, the lack of old age care, and the strange diseases traveling around the globe.
“Isn’t he fun?” says Susan, making fun of me to one of our friends.
“Is he always so upbeat?”
“You know Drew,” she says. “The other day one of the boys had a deep cough. I called Drew, described the symptoms, and he said, ‘It could be anthrax.’”
“I just wanted to grab her attention,” I explain.
Then my attention is distracted by a guy sitting on a bench near the basketball court. I’ve already noticed him staring at me a few times, and now he’s doing it again. I wonder whether I know him, and if so, from where. Then it comes to me. I excuse myself from the table, get up, and walk over to him. As I get closer, my memory becomes clearer. His hair is longer now, black dreads replacing the close-cropped look he had when he was in the unit. He’s also cleaned up.
“Earle?” I say reaching out to shake his hand.
“Dr. Pinsky.” He smiles.
I might as well be staring at a dead man. When he got on his bike and left the unit for the last time a few months earlier, I feared for Earle. I thought he was a sure bet to go back to using, that he’d end up another fatality. He had no inner self. He had no support system. His only way to cope, his only relationship, his only love, was drugs. He had nothing other than our feedback, and the experience of actually feeling better each day he spent in the unit.
“How are you?” I ask.
“Still sober,” he says in a soft but clear voice.
“What happened to you?”
After leaving the unit, Earle explains, he went to Sober Living, where he met a woman who was also in recovery. When she transferred to another Sober facility across town, he found someone to arrange it so he could move there as well. Eventually he got a job in a homeless shelter. That led to a job with the Salvation Army, where, he says, he continues to work. He goes to twelve-step meetings at least twice and often three times a day. He also helps others get to meetings.
“I’m all about service,” he says.
And in the process he is helping himself. He has gone beyond the terrible trauma of his past. He’s no longer a victim whose life is about finding relief from constant pain and suffering. He has changed by thriving in a highly structured environment, where he has gotten the courage to trust and connect with other people. Those relationships have given him the chance he never had. He has a life.
“How’d you do it?” I ask.
“I don’t know,” he says.
This is the mystery of recovery. It is why so many patients attribute the change to God. I don’t argue with them. I merely want an explanation of how they finally got it, and why, so I can give it to others.
“It’s hard,” says Earle. “Every day I wake up and have to get over my shit.”
“How do you do that?” I ask.
“I just look at it,” he says. “I talk about it in meetings. And I help other people get through their shit. That helps me.”
“How does it help you?”
“It makes me feel good.”
“What do you do when they don’t listen? When they screw up?”
“I tell them to try again. I give them another chance. People are hard enough on themselves. My hand is always out for my brother.”
After a few more minutes of catching up, I rejoin my family at the birthday party. The festivities are in full swing, with kids running around while the birthday boy swings a bat at a large piñata. I take a lemonade and mingle with the other parents, knowing my conversation with Earle has lifted my mood. Like so many of my patients, I am in awe of him and grateful for the gifts of insight and awareness he gives me in return.
Why do I love what I do? Besides the day-to-day medical challenges of treatment, I actually see patients decide to keep living. How can you fail to be inspired by the resiliency of human beings like Earle, by what they reveal about the resiliency of the human spirit? In so many areas of medicine, doctors and patients generally adapt to chronic illnesses, without necessarily getting better than they were before. But I see people get better than they ever thought they could be. And that is the rule, not the exception.
“Your next victim is in three-twenty-two,” Alexi says, slapping a new chart in my hands.
It is afternoon, and I have returned from a heady lunch with Adam Carolla and our agent, at which we celebrated Loveline’s expansion into several new markets. Alexi has perked up since earlier this morning, when she complained about being bored by run-of-the-mill addicts and alcoholics following directions.
“You’re happy,” I say. “This can’t be good.”
“What a mess this one is.” She smiles.
“She is cocaine, Oxycontin, cannabis, Valium, and Klonopin.”
“A total garbage bag,” I say, mocking her.
“My kind of girl,” Alexi chimes.
We enter the room, and immediately I see at the foot of the bed a surefire sign of trouble: a stuffed dog with long floppy ears. Alexi, having noticed where my eyes go, covers her mouth with her hand to stifle a laugh. I also note the usual collection of half-eaten candy bars on the night table. But wait. Look at that. The patient—I glance at the chart and see her name is Carol—has also put several framed pictures of herself as a child on the nightstand.
She’s resting with her back against the wall, her knees pulled up to her chest, exposing rips in both legs of her blue jeans. She is knotted as tightly she can make herself. She looks miserable. And she sounds it, too.
“Are you going to give me something?” she asks. “I need something. My back is fucking killing me, and I want to jump out of my fucking skin.”
I glance back at Alexi, who gives me a look that says, I told you this was going to be fun. I roll my eyes. Let’s get on with it.
I proceed to her physical exam. Her heart and lungs are sound. Next I need to look at her head and neck. I ask her to open her mouth. And then I see the same thing I saw in Amber and so many other women with histories of sexual abuse. It is that peculiar pharyngeal relaxation, the submissive manner in which they put their head back and open their mouths. See it once, you’ll never forget it.
“Did you have any trauma growing up?” I ask.
She looks surprised, her expression a mixture of How dare you? and How do you know? Mine, I hope, is passive, clinical, and empathetic, though inside I cringe. Confronting someone who has been afflicted by childhood abuse makes me feel something is dreadfully wrong. I believe everything, all of us, are interconnected in some way, our actions provoking reactions, and nothing beneficial results from this type of behavior. The opposite is true.
“I was four,” she says, looking down at the blanket. “Routine stuff. My dad. He warned me against telling anyone. It was our secret. He was fucked up.”
“Was he an addict?”
“Does the moon come out at night?”
“Pot? Coke? Alcohol?”
“All of that, and more,” she says. “He was silly on pot. I actually have pleasant memories of that. But he was a mean asshole on coke. I remember times when my dad acted like a little boy, letting us ride him around like a horse, making funny faces, and letting us sit on his lap when he drove. But then one day when I didn’t finish my oatmeal, he picked up the dining room table—the entire table—and threw it out the window, shattering the glass, the dishes, everything. If my mom said something, he’d smack her. Sometimes he hit all of us. Mostly we were scared shitless. But I learned to deal.”
“My dad left when I was eleven,” she says, grabbing the stuffed dog at the end of the bed. “Life went on.”
I wince when I think of the pain of the little girl traumatized at the hands of someone she loves and idealizes. When it’s the father, it always affects her relationships.
“Do you have a boyfriend now?” I ask.
“I know what you’re getting at,” she says. “I’ve seen therapists.”
“I was just asking if you have a boyfriend.”
“Yeah, but I’ll tell you what you want to know. All my relationships have been shit. I have trouble, okay? What do you expect? Actually, I know what you expect. But my question is this: What about me?”
“What do you mean?” I ask.
“If I answer your questions, are you going to give me something to make my back stop hurting? I have such goddamn pain, and you want to know if I’m dating anyone. What the—”
“I have to ask these questions,” I say. “They help me understand you better. We just met. You’re loaded. You’re starting withdrawal. It helps if I know more about you.”
“All right. My love life has been in the crapper. Can you call it a love life if there’s no love? I had the dependent relationship, where I freaked out as soon as I started feeling close to the guy. I had relationships that were ruined because I convinced myself he was going to leave me, so I couldn’t stand if he even left the room. And I’ve had times when I just fought and argued long enough to cause the breakup I convinced myself was going to happen anyway. I don’t know. Just pick a guy and I screwed it up.”
“Better you should push him away first?”
She looks away. “Whatever.”
I know the sound of such indifference. It’s the same helplessness I’ve seen in so many other patients, Amber included. If a girl like Carol pushes her boyfriend away first, then she feels like she’s taking some measure of control, staving off the intolerable feeling of helplessness. A real connection with someone could expose her to the trauma of abandonment she first experienced with her father, and she can’t handle that uncertainty.
I glance again at one of the photographs on Carol’s nightstand. It shows her as a child of around five, playing outdoors with her older brother, who looks about seven. He is attempting to kiss her, and he looks secretly satisfied by his efforts to annoy her. She looks brilliant; her eyes sparkle with life. Laying on the bed in front of me is the broken remnant of that self, disconnected and addicted.
I don’t want to imagine what happened to that little girl’s lost innocence and the joy she should have experienced, but I can’t help thinking about the terror, the fear, and the dismantling of her sense of life. Why aren’t people protesting this kind of evil? We protest pollution of rivers and oceans, the cutting of tall trees, the loss of wilderness. We march against racism and hate crimes. We rail against films and TV series that are too violent or too sexy.
My stomach tightens at the thought that the little girl in the photographs is lost forever. She can never be recovered. My mind drifts to Amber. She is gone, too. She and Carol are similar, even down to physical resemblance. Carol may not be as stunning, but she is long and lithe and beautiful. She has large eyes and a small nose. Then I notice that the fingernails on one of her hands are polished pink. The other is natural.
“What’s with the fingernails?” I ask.
“Oh, that,” she says, comparing the two hands. “I got bored. Didn’t finish. The story of my life.”
Right about now is when I would usually start hoping for signs that Carol wants to cast me in the role of rescuer. In the past, I would have connected so strongly with the picture of the injured little girl that I would have taken her recovery on as a personal responsibility. I would have stepped in as a way of gratifying my own need to save her. But this time I simply stay with the reality of Carol as an adult. She is a woman of strength and resources. She has to learn to manage her feelings. My job is to help her on the road to acquiring those skills, without relying on primitive defenses like drug use or dissociation. In the face of the overwhelming stress of addiction and its consequences, she must find what she needs within herself.
Silence fills the room. I can sense something welling up within her. Here is where she expects me to step in to relieve her suffering, or attack or invade her with criticism. But I remain silent, as does Alexi in the background. This time the move is not mine. It is hers, and I am willing to wait.
About thirty seconds pass. Then I see tears flowing down Carol’s cheeks. Soon she is sobbing hard.
“I am so ashamed,” she says.
I reach for a handful of tissues from the box next to her pictures.
Finally, sensing that I might get a real answer, I ask, “Why are you here?”
“I am here,” she says between sobs, “because I am such a fuckin’ whore. I do this to myself.”
My instinct is to swoop in and tell her that she’s not not a whore, that she’s not bad. Instead I keep quiet. I stay with her. I am there for her.
“I cheated on my boyfriend,” she continues. “He wants to take my son away. I’m so fucked up. My life is so fucked up.”
For a few minutes I try to imagine what it must be like to be Carol. The trauma she suffered as a child instilled the tendency to freeze and dissociate. This tends to make women like her perpetual victims. The usual story that follows involves rape during adolescence. She has continued to re-create the traumas over and over in her adult relationships for reasons she can’t understand, and so she blames herself.
Suddenly her eyes lock onto mine. She looks angry, confused.
“Don’t you guys ever say anything?” she asks. “Don’t you want to tell me I’m fucked up?”
“Whatever you are, that’s okay with us,” I say calmly. “I’m just grateful you have come to us for help.”
And I am.