Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
AFTER A TWO-day absence from the unit, I’m greeted at the nursing station by a very busy and preoccupied Yugoslavian. I feel as if I’m interrupting her in the middle of something more important.
“Angry?” I ask.
“What are you talking about?” she says. “I’m busy.”
“Frustrated? Come on. I sense it.”
Alexi handles a lot of work, aggravation, and complaining, and she does much of it thanklessly. Not that she’s looking for thanks for her everyday work—making sure that everyone is going to group, that detoxes are going as they should, that paperwork is completed. She does all that for many of the same reasons I do. We have to. We’re compelled by a force that we probably don’t understand as clearly as we should.
Alexi isn’t prone to dramatizing her frustration, but this time I can tell she needs to release some of her frustration. She’s turned inward; she doesn’t want to trade idle conversation the way we usually do at the start of the day. I take a seat on the counter, roll up my sleeves, and let her know that I’m ready to listen.
She starts with Mark.
“How bad did he get?” I ask.
It’s not him, she says. He was his usual self. After his encounter with me, he made it to his first group. The next day, as he woke up a bit more, he took it over.
“Mr. Know-It-All,” she says, rolling her eyes, bored.
“As he always is,” I say.
“Holding court,” Alexi says. “He told all the other patients about their problems and what they needed to do.”
“He’s so program-savvy. He’s knows it all cognitively, like he’s memorized a part in a play. But emotionally he hasn’t grasped a thing. He’s never addressed his own issues.”
“Not only that,” Alexi says. “Last night he left.”
“He did what?”
“He checked himself out, muttering something about everyone being full of shit.”
“That’s the pot calling the kettle black, isn’t it?”
“Usually he stays longer,” Alexi says. “For some reason, though, it really bothered me this time. I’m worried, because he seemed sicker.”
“I’m sure we haven’t seen the last of him.”
I try to lighten her mood, joking around with her a bit, but after a minute or two she waves her hand, telling me enough.
Time for the next problem—Amber.
“You wouldn’t believe that one,” she says. “Dr. Bloom had to completely snow her with phenobarbital. She was absolutely bouncing off the walls. Carrying on like that. Screaming, crying, throwing herself around the unit. She got all the other patients involved in her drama.”
“How’s she this morning?”
“She’s better today. But only because she’s still out of it.”
“Let’s get a look at her.”
As we head to her room, I’m a half-step ahead of Alexi, who is still relaying the highlights of Amber’s antics. She was at the med window, demanding more pills, falling all over herself when the nurses said no, growing more and more desperate. Predictable, I think.
We get to Amber’s room, listen for something to clue us into what we are in for, and trade a look that says, “Okay, here it comes.”
Inside, Amber is curled up on her bed, dressed in blue jeans and a T-shirt. It’s dark inside. The curtains are drawn, preventing sunlight from entering. It might as well be nighttime. It is for Amber, anyway; unable to venture beyond the cocoon of her painful detox, she’s trying to hide out from the stimuli of the outside world.
She makes eye contact as soon as we enter, turning on her side as if inviting conversation.
“How are you today?” I ask softly.
“Not good,” she says, as if she’s talking in slow motion. “Alexi won’t give me anything for the pain.”
Alexi interjects, “She’s getting all her PRNs.”
For the first time Amber looks directly into my eyes, with such clarity I can’t miss it: She’s trying to make a connection.
“I don’t know why you won’t give me more,” she says. “Nobody believes the pain I’m in. If you believed me, you’d give me more meds.”
“Pain is a normal part of withdrawal,” I say. “It will end soon.”
And then maybe she’ll turn down the frigging heat in the room. It feels like the Mojave in here. But of course I don’t say anything about that.
“We’re giving you everything we can possibly, safely give you,” I add, which is something I find myself saying to patients all day long.
Amber couldn’t care less. She’s already past me, and on to her next tactic. There is almost a coquettishness to her body language, a slight curve to her back as she lays on the bed, her chest arching ever so openly, which I understand is the way someone like Amber is accustomed to dealing with men. I read the invitation—and feel invaded by her. It is scary and uncomfortable as I feel my body reacting, and I think, I have to put a stop to this. Get going, I tell myself. Get to business.
Quickly, I listen to her heart and chest, making sure nothing medical is going on. She is okay. I give Alexi a look that says, “Let’s go.”
In retrospect, I have missed an opportunity for tuning more into the painful source of her behavior. But I could not get past the way she made me feel.
Out in the hall, Alexi cracks up. “You better be careful of that one,” she says.
“What do you mean?”
“Oh my God!” Alexi laughs. “Did you see how she looked at you?”
I did, but I’m not admitting it. Neither am I finding the situation as funny as Alexi is. I stick to business.
“She’s clearly oversedated from all the phenobarb,” I say. “In fact, the medicine only seems to be escalating her. Let’s taper her off and then see what we’ve got. Only give her the PRN phenobarbital. Decrease the Neurontin to one hundred milligrams TID for three days, and then stop. Push the alpha 2 agents if you see any objective signs of opiate withdrawal.”
“One more thing,” I add. “Stop looking at that Victoria’s Secret catalog I saw on your desk. It’s clouding your judgment.”
I have a better rapport with Debra, a twenty-eight-year-old working in marketing at one of the television networks. She is preppie-style pretty. Slender. Short brown hair. Tiny glasses that probably cost $350. I picture her five years earlier as a bookish partier at an East Coast college like Sarah Lawrence or Wesleyan.
Debra has made a good impression on the staff. Aside from a trendy Fred Segal wardrobe—she dresses stylishly rather than provocatively—she is earnest, insightful, bright, and polite, which goes a long way among a staff used to belligerence and difficulty. I notice she is writing diligently in a journal. Seeing me, she looks up and says she is working on the first of AA’s twelve steps, admitting her powerlessness over drugs and the way it’s made her life unmanageable.
“I caught you on GMA,” she says.
“You’re great. Mr. Media. I never watch GMA, but I’m boycotting the Today show until Matt Lauer’s hair grows back.”
“How are you doing?”
“Uh,” she says, shrugging. Then she turns serious. “I’m jonesing for my BlackBerry.”
Missing a small computer should be her biggest problem. Debra is in her third week as a patient. For the first ten days, she went through utter hell withdrawing from Soma, a muscle relaxer the liver converts into the old-fashioned Miltown. She also suffered from akathesia, an extreme agitation that caused her to constantly pace and rock, wringing her hands and rubbing her arms in response to a vague pain. Unable to recall all but the last of those miserable days, Debra simply knows she doesn’t want to go through any of that ever again.
“You’re so much better,” I say. “I’m so pleased.”
She shakes her head.
“Words don’t even describe what I went through,” she says.
Indeed. But there was more. A few days earlier, she’d been talking to another patient in the lounge. This guy, whose name was Harold, was asking about her childhood. It began as a normal conversation; he was interested in her. But in the course of answering, Debra revealed that her brother had sexually abused her as a child. She had never spoken about the incident before. As she revealed this, Harold, in his desire to help, pushed her to confess more and more details.
All of a sudden Debra was in the position of a victim needing rescue, and Harold was ready to oblige. It made him feel worthwhile to be her rescuer, but it left Debra helpless again, powerless and frightened. She needed to learn to manage her feelings on her own.
Instead she was seized by a full-blown post-traumatic stress attack. Heated up by the biology of her withdrawal, she collapsed in a ball, crying and gasping for air.
Fortunately, Alexi and I had been right there for her. We were present and calm. We talked her through it. She got better.
Later, I explained what had happened, and advised her that she shouldn’t try to deal with all that trauma until she was in a more solid biological state and more secure. Don’t worry about it, I advised. First she needed to get detoxed, and then to start working on her ability to attach to people and reconnect with the world—everything that drugs allowed her to avoid.
Once she was further along in recovery, she could start to deal with the fallout of this long-ago trauma.
“You mean I’m going to have to get into this someday?” she asked.
“We don’t believe anymore that you have to reexperience the trauma,” I say, struggling to put complicated new theory into a few simple words. “The trauma left you feeling you couldn’t trust people. As a result, you never learned how to use interpersonal connection to help you regulate your feelings. That’s what you’ll develop over time.”
“Okay. Can we schedule that in by tomorrow?” she jokes.
“The slower you go, the faster you get there,” I say, borrowing a phrase I once read. “We’re talking about rewiring your brain.”
Since that incident, Debra has continued to do better. She interacts with the staff. She takes direction. She converses with peers. Her progress is most apparent in her eyes, which are clear, present, and searching for connections. I can sense her aching for a chance to feel good.
“You know what else I miss?” she says.
“My bed, my morning Starbucks, lunch at the Ivy…”“Is that all? You mean sixteen days here isn’t the Ritz Carlton?”
“I also miss my assistant. I wish he could’ve gone through all this for me. Then again, he’s so tortured, he would’ve enjoyed it too much.”
Through her malaise, Debra entertains me by poking fun at my favorite target, the media.
“This is where they should shoot a season of Survivor,” she says. “I can see the two tribes. The stoners versus the tweakers.” Translation: the pot addicts versus the amphetamine addicts.
“You’re right,” I laugh. “It has all the elements. Drugs. Drama. Fighting. Sex. Winners and losers.”
“But do you think rehab is too five minutes ago?” she wonders. “Is my being here as passé as a Van Halen comeback?”
“I don’t think you have to worry,” I say. “As far as I’m concerned, the people who create the culture tend to be sick and have no idea what’s real or healthy.”
A vision bubbles through my head: the unmistakable voice of Robert Evans, the legendary Hollywood producer. Not long ago I listened to the audio edition of his celebrated autobiography, The Kid Stays in the Picture, and my reaction was a constant Oh my God. Evans was talented, to be sure. But a whole generation was influenced by him and his kind.
“I am surprised I haven’t bumped into anyone I know,” she says. “I thought all of Hollywood would be here.”
“That’s Malibu,” I say.
Seeing her laugh reminds me why I am obsessed about my work, why I am on the radio five nights a week when I could be at home with my wife, why I speak at colleges, and why I’m so committed to making a difference in the quality of people’s lives. I am not interested in telling people what to do. But I want to make them think about what’s healthy and what’s not, and perhaps encourage them to make better choices.
Sick people can feel better than they ever thought. Debra could be one of those people whom I’m able to draw back in from the abyss of pain and trouble. I can’t predict her outcome. I guarantee she had no conscious idea that dealing with her drug habit would require a fearless confrontation with the trauma of past sexual abuse and other family problems. But she isn’t flinching as she starts the journey.
“I have a question for you,” she says.
“When am I going to feel normal? When is all this crap inside me—this buzzing and dullness and pain and anxiety and the can’t-sleep shit—going to stop?”
“It could take up to a year,” I say.
Her eyes widen. “A whole fucking year?”
“And then you have the dysregulation of emotions from your past to deal with,” I add.
“I should sue the fucking doctors who prescribed me those goddamn Vicodins and Somas in the first place.”
“They thought they were helping you,” I say. “Very few people understand this disease. From now on, it’s going to be your responsibility.”
About three hours later I walk out of a meeting with Dr. Finley, and he persuades me to take a brief stroll with him outside to take in the nice warm weather. Nothing is brief with Finley, though. He and his wife recently had their third child. This one, he says, is sleeping well, “so we’re going to keep her.”
He congratulates me on how much better contained Katherine is since I took away her cell phone, and then admits he switched his own cell phone to her plan.
We round a corner and I can’t believe what I see ten yards in front of us.
Alexi is seated on a bench, smoking a cigarette.
We head right to her. I see her drop her hand with the cigarette behind her back, and when she brings it back up the cigarette is gone. Her shame is so great she won’t even acknowledge that we caught her smoking. This is truly funny.
“I can’t believe you smoke!” I say.
“I don’t,” she replies.
“But we just saw you.”
“I have two cigarettes a day. That’s not smoking.”
“What is it, then?” Finley asks.
“Could you relax in a different manner?” he asks, grinning.
Alexi sticks out her tongue and walks off.
That gets Finley and I talking about what motivates people to change their behavior. Finley reveals that he was once a two-pack-a-day smoker.
“You?” I say. “I’m shocked.”
“Yeah. Then one day I just decided it was enough. I was going to stop.”
“Like that? So abruptly?”
“Actually, I woke up one day and sent my wife out to get a pack of cigarettes. I was sick from not having them. While I waited for her to get back from the store, it occurred to me that this stuff had control over me, and nothing was going to have control over me.”
“Then you stopped?”
“But wait. A lot of addicts realize things have control over them, and what do they do? They use more. As both of us know, even when addicts acknowledge something has control over them, they don’t all of a sudden stop. It doesn’t happen that way.”
“I know,” he says. “But I just decided nothing was going to control me.”
We start walking back to the unit. For a moment or two I’m silent, thinking about what he’s said.
“Wait a minute,” I say. “You work with addicts all the time. You work with people who are controlled by drugs. People just don’t decide to stop using drugs unless something really gets their attention. How were you able to make this massive change in your behavior?”
“I don’t know,” he says. “I just didn’t want anything controlling me.”
I’m confused and frustrated by his response. He knows better, I think to myself. There has to be something more, yet he’s being so dismissive. I expect that kind of obfuscation from our patients, not from Finley.
We walk on in silence for a while. He doesn’t seem to notice my frustration; he seems to be thinking about something. I’m reluctant to probe any further. Suddenly, as though thinking out loud, he begins telling me about his boyhood in Portugal. “When I was six years old my mother used to send me to the store by myself. I’d have to walk by the wharf, and the wharf was a hangout for alcoholics. As I’d go by, they’d reach out for me, yell things, threaten to throw me in a bag, and take me away.”
“That sounds awful,” I say.
“They scared the crap out of me,” he continues. “We all heard stories about these drunks supposedly throwing sacks over kids, taking them away, and selling them into slavery. The poor kids would never see their parents again.” He pauses a beat as if paralyzed by the memory of that fear. “These were scary guys, and alcohol seemed to make them that way. I came away from those experiences with an intense feeling that nothing would ever control me like that. So when I saw the cigarettes controlling me…”
“Not only that, but you aren’t going to let it control anyone else. So now you have to cure all the alcoholics and addicts.”
“Fascinating, isn’t it?” he says. “I don’t know what it is with human beings. Say a dog bites you when you’re a child. Some people grow up avoiding dogs forever. But another side of the population becomes veterinarians.”
“True,” I say.
“Here’s a thought, though. You didn’t grow up in Portugal with drunks grabbing at you, and you’re more into rescuing these patients than I am. Explain that?”
We are back at the unit. I put my hand on the door.
“Well?” he says. “No one has deeper need to rescue people than you. What’s the story?”
“The man with the crosses in his eyes,” I say.