Chapter 3 - Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold

Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)

Chapter 3

AS A CHILD, I feared the man with the red crosses in his eyes. Until I was five years old, I had a recurring nightmare in which a man with red crosses in his eyes chased after my mother and me. We would be stuck in traffic, the two of us huddled in the passenger seat, while this guy came to get us, walking up and down cars behind us the way a tank would roll over them.

As an adult, I deciphered the dream. It turned out my mother had a miscarriage when I was only a year old. She had hemorrhaged severely, and was taken away in an ambulance—which in the late 1950s was a large white van with red crosses on the side. The man with the red crosses in his eyes bore a close resemblance to a neighbor who had taken care of me while my parents were at the hospital.

I was terrorized by the situation, and the helpless feeling I experienced lingered as a constant fear that bad things were about to happen to me.

Traumas like that leave imprints on parts of the brain that don’t have a sense of time. The memory gives the sense that the trauma is always happening. As a result, I grew up with a feeling that there’s a catastrophe waiting around every corner. I can’t remember a time when I have not felt anxious. My response has been to try to control everything and everyone. I am a perfectionist. I rescue people. I have to make sure no one else gets carted away.

In reality, my childhood was pleasant and pain-free. The older of two children, I was raised in Pasadena by parents who valued stability and family. My father, Morton, was the son of a Chicago grocer who had escaped the pogroms in Russia, and then was nearly wiped out during the Great Depression. At eight, my dad got a job at a Chinese laundry to earn money for the family. As an adult, he became a doctor. He was a rescuer, too.

My mother, Helene, came from a highly Victorian upper-middle-class family in Philadelphia. She never saw her parents speak to each other. For instance, at the dinner table, her father would say to one of her sisters, “Please ask Mrs. Stansbury to pass the salt.” She came to Hollywood in the early 1950s, and became a movie actress in film noir features until she married my father and had me.

She treated motherhood as a new career. My first year of life was defined by a symbiotic attachment to my mother. I was the sole object of her attention, and I reciprocated loyally with coos and smiles. As soon as I began walking, saying no, and having thoughts of my own, however, the narcissistic bubble burst, and I was cast out of Eden. Between the ages of two and three, I could swear, I remember a sense of terror, perhaps a remnant of the trauma of my mother’s miscarriage. Eventually, though, we moved to a new house, and it was the good life. Things worked again.

But in those formative years, my brain was left with implicit wirings, structures that are literally like behavioral maps. In my case, I would grow up to be the perfect codependent, someone lured to the gratification of a fused relationship like the one I had with my mother at the start of my life.

As a teenager, I was a people pleaser. I had to be perfect for my parents out of fear of the old catastrophes that were subconsciously embedded in my brain. I couldn’t do anything wrong out of fear it would devastate my parents. At Polytechnic High, I was a top student, captain of the football team, and the lead in the school play. For as long as I can remember, I assumed I would follow my dad into medicine, and so did everyone else.

The high school headmaster steered me toward science. In 1976 I enrolled at Amherst, a small private liberal arts college in Massachusetts. I majored in biology. By the end of the first term, I was miserable. As soon as the weather turned cold, I was second-guessing my decision to go to school in the East. Why was I freezing my ass off in New England when all I wanted was to be surfing and chasing girls at U.C. Santa Barbara? And how did I know I truly wanted to pursue medicine, anyway?

I brought my confusion home. During Christmas break, I announced at the dinner table that I no longer wanted to be a doctor. It was a good place for a scene. My parents nearly disowned me. Their anxiety overwhelmed me. This was the first time I had attempted to assert my independence, and it upset everything. It created catastrophe, just as I had feared. At the same time my high school girlfriend, to whom I’d clung desperately from 2,500 miles away, told me she wanted to see other guys. I was crushed; my world had fallen to pieces.

Back at school, I became depressed. The whole idea of the future was too much for me to handle, and I started having panic attacks. The first one came when I was rehearsing a play at Mount Holyoke College; I went back to my room convinced I was having a seizure. I thought I was going crazy. I struggled through the night, hoping I wasn’t going to die, and in the morning I went to the student health center, where the psychologist appropriately recognized the signs of panic. He asked me to come back a few days later; I did. I was a lot better, but still anxious and complaining.

“I want you to see a doctor,” he said.

I saw a doctor. He checked me out and told me to take a walk. He didn’t know squat about depression, and he missed the whole thing.

For the next year and a half, I struggled without support, searching myself as best I could, and during that time I decided for myself to pursue science. The lack of structure in my life bothered me; so did the lack of purpose. I realized I needed both. I didn’t know it, but that’s where my need to make a difference began. I threw myself into my books, and responded to the challenges of an outstanding group of professors. I rededicated myself to becoming a doctor. This time, though, the decision was all mine.

In 1980 I entered medical school at USC, where my zeal as an overachiever paid off. For two years, I worked my ass off. The real learning began in year three, with practical experience. During my first rotation in the Neurological ICU, for instance, the resident led me and several other students into the unit early in the morning and issued a complex list of instructions. “This patient needs a Swan. That one an A-line. The next patient gets a ventriculostomy…” Then he departed, explaining, “I’ll be in surgery all day. See you at seven.”

I had no idea what he was talking about. None of us did. But we opened packages. We read the instruction manuals. We figured it out.

Other lessons were harder to figure out. One day, while I was working in the general hospital ward at County General, the city’s dumping ground for the sick and destitute, I saw a black woman in her twenties who’d been shot through her abdomen. Sitting up in bed, she was suffering through a terrible, unimaginable pain in total silence, writhing, waiting for someone to help her. I had stopped by her bed, hoping to alleviate her pain, when the supervising surgical resident said, “Leave her. We’ve got cases that are more urgent than hers.”

I put down her chart. He was right. A bullet through the abdomen wasn’t the worst case. It was nothing. Something that would wait till morning. There were people who were worse, people who had been run over by cars or stabbed in gang fights, people with multiple gunshot wounds, people who wouldn’t survive if they didn’t get immediate attention. And this was the judgment residents had to develop in a MASH unit like this.

As we walked away, he said, “You’ll get used to it. You’ll learn to do it.”

I thought, No, I won’t.

I was wrong. I very quickly saw more than I ever imagined, and came to realize that doctors are basically biological repairmen, especially in inner-city hospitals on violence-riddled Saturday nights. On my first night at County General, I treated a guy with a penis the size of a football. It turned out he’d been shot in the ass, and the bullet had exited through his penis. After a few Saturdays, though, I learned that two things could be predicted with 100 percent accuracy: If you asked anyone with a knife wound what happened, they’d say, “I don’t know.” And if a person had something stuck up their butt—which in my experience included lightbulbs, broomsticks, and grapefruits—they’d explain, “It was an accident. I sat on it.”

For a while, I was headed toward a specialty in orthopedics. If you had an athletic background, which I did, the ortho team drafted you. I liked the physicality of it. As it turned out, though, ortho was where I treated my first addicts and alcoholics. They are generally thrill-seekers who like motorcycles and fast cars and extreme sports. They also like to experience these things while they’re loaded. They get into accidents. I remember in particular one biker whose leg had been mangled below his knee in a crash. He had a pin through his tibia, and he was in traction—his leg was up on a pulley. But what you saw was a bone with a foot on the end, and his calf muscle hanging down from the leg. Every day we chipped a bit of dead bone off his leg. The whole spectacle was revolting.

I saw on his chart that he was a heroin addict. One day I told him he should quit.

“You’re right,” he said sincerely. “But I’m in excruciating pain. Can I get some more morphine?”

He genuinely needed it. He was a mess. “Let me see what I can do,” I said.

I got him more, and seeing it do its job was equally satisfying for me. Early in your training as a doctor, you don’t have a lot of skills. One thing you can do is take away pain with opiates. I was very gratified.

In the early 1980s, there wasn’t much knowledge about treating addicts, and though my training routinely exposed me to hundreds of junkies, dopers, meth freaks, pill-poppers, and alcoholics, I would end up advising addicts that what they needed was a new set of friends. I told dozens of alcoholics to just stop drinking.

The residents and the attendings threw up their hands; they just got frustrated with the addicts, and after a while they gave up even telling them they should stop. They wouldn’t even address it. I hated being ineffectual. I saw young alcoholics returning again and again after we had told them they would die if they didn’t quit. They didn’t care about stopping. They wanted more meds. Why didn’t they listen to what we said?

Then I started moonlighting at Las Encinas. Though it was located in the heart of old Pasadena, somehow I had never heard of it. But I came to know it very quickly. As a young internist, I performed all the basic medical care for the psychiatric patients, and soon I discovered that the patients with the most medical needs were the addicts.

Las Encinas was unique among hospitals. It had a detox protocol and program for treatment of the addict. Dr. Mike Meyers, a trailblazer in addiction medicine, had established one of California’s first comprehensive chemical dependency units at the hospital. Meyers was able to withdraw addicts systematically. He had turned detox into a clinical discipline. Up to this time, detoxing patients had been very haphazard and often just plain dangerous.

The more I observed, the more I wanted to know. Steadily and naturally, I gravitated toward the chemical dependency unit. After a year and half of moonlighting, I began to feel adept at helping patients through withdrawal. In the beginning, though, it was difficult. I dubbed myself (none too proudly, I might add) Dr. Pushover for how easily I was manipulated by addicts, who I soon realized are the smartest and shrewdest patients in a hospital when it comes to getting what they want. No patients were better at it than Anna and Elena Petrovic, sisters and longtime opiate addicts from Greece. They were in their mid-twenties. Anna was an opiate addict, and Elena was a speed addict. They loved me. I was their favorite doctor. Every time they had an ache or pain, anxiety, or trouble sleeping, they could count on me to help them out. “Don’t worry,” I said. “I’ll get you something.”

Elena came and left without ever having a breakthrough. Anna struggled. She kept relapsing but coming back. Finally, on her third time, she declared herself done with drugs. By this time I knew her pretty well and saw that something about her was different. It was all in her eyes. They struck me as depleted, frightened, and from what I could discern, either she was truly done, or she’d soon be dead.

I asked what happened.

Sobbing uncontrollably, Anna described how less than twenty-four hours earlier she had been scoring heroin at her dealer’s house when a gunfight had broken out. The dealer had given her a gun and told her to shoot anyone who came into the room. Instead, Anna had rolled beneath abed and put the gun in her mouth. Scared, crying, and desperately intent on removing herself from this nightmare, she had tried summoning the nerve to pull the trigger, but she couldn’t do it.

That was the end of the line, the point at which she had two choices: death or recovery. She saw it and felt it. That was her bottom.

“I took it as far as I could,” she later told me. “If I don’t want to die, I have to get better.”

About ten years later, I bumped into Anna at the store. She had two kids, drove a minivan, and had married an engineer. Her sister was still out.

I couldn’t help but ask what the difference was that allowed her to change and not her sister.

“I just got it,” she said, and then shrugged. “I don’t know how else to explain it.”

Neither do I.

One of the toughest lessons I learned in those early days came from the person who taught me more about addicts than almost anyone. Betty was one of the unit’s star counselors, a former heroin addict who’d been through treatment numerous times, including several stints before Dr. Meyers created the chemical dependency unit, and she had a magical touch when it came to working with other addicts. Not only did she know all the tricks, she had a sixth sense that I envied.

“Count your blessings,” she said one day when I wished I knew what she did. “You got your knowledge from medical school, not from shooting up in bathrooms like me.”

Then she told me a story from the days when she was trying to get sober before she got in the program. Like all heroin addicts, she was convinced all she had to do to get well was to get off the heroin. She hatched a plan to “explore her roots” in Czechoslovakia. She was convinced that would keep her sober. (In drug treatment circles, this is what’s known as “a geographic”—moving away from the physical scene of your drug use.)

It never works. On her way to Prague, Betty had a short stopover in London. She decided to spend the downtime at the National Gallery, taking in an exhibition. As Betty told me, she felt terrific on the flight over. She was on her way to the promised land. She wasn’t even thinking about drugs. Yet within an hour of getting to the museum she was slamming heroin in a bathroom with a security guard she spotted in the main gallery. She didn’t even introduce herself. She just went up to him and said, “Let’s go.”

“How’d you know to seek out the guard?” I asked. “You were in a room in a museum—why would you walk up to a guy with a gun? In a uniform?” I was mystified.

“If you’re an addict,” she said, “you just know. The drive to use is so powerful, you develop an extrasensory ability.”

After that relapse, she got into the program, listened to direction, and became a star in the treatment field. Still, though she was a counselor for years, her disease eventually came back for her. The first sign was trouble at work. After years of dependable, consistent, and conscientious work, she changed. She started splitting people, pitting one against the other. She complained about her superiors. She became erratic. She may not have been using then; it might just have been time for her to get a new job. It was clear that she was no longer happy; she needed a change. But the whole process of leaving resurrected feelings of abandonment and loss that overwhelmed her.

I, of course, defended her, made excuses for her, ever the good codependent. I could see her emotional chaos emerging, but I thought it was just the difficulty she was having leaving a place and a team to which she’d felt so connected. She had worked with us all ever since she got sober; I knew it was painful for her to contemplate moving on.

One day Betty called me as I sat completing some paperwork in my office. She sounded breathless and desperate. “I need to see you right away.”

Alarmed by the distress in her voice, I told her to come right over. She flew into my office, closed the door, and dropped into a chair. I had become used to her complaining to me about how others were to blame for how she was feeling. I figured she was going to go off about one of the nurses who was nearby. But today she seemed different. I was immediately anxious.

Then she leaned forward, in a manner that made me uncomfortable and blurted out, “I need to have you—right now.”

Almost reflexively I shot back, “That is just not possible.” And, strangely, I felt a flood of guilt and confusion.

“You see,” she said. “I know that about you. That’s what makes you so great. That’s what makes me want you.”

I just sat there shaking my head, feeling incredibly uncomfortable, not knowing what else to do but apologize. At that point in my career it was difficult for me to set limits. I felt guilty and apologetic for exposing her to shame. I was uncomfortable not being able to comply with someone else’s needs, even when they were completely out of line. And yet, of course, I could do nothing to answer them.

A few pleasantries followed. She tried to joke away the discomfort. She was clearly somewhat ashamed, but like most addicts, she wouldn’t stay with that feeling long. She slipped out as quickly as she blew in.

In retrospect, I didn’t think it all the way through. I followed my own human reaction, rather than recognizing an addict’s behavior for what it was.

Two months later, still in the throes of her bad behavior, she approached me in the parking lot and showed me a picture of her naked ass with welts all over it.

“You should check this out,” she said. “A riding crop. That will really pin your pupils.”

Such behavior was so far out of character for the Betty I knew—the consummate professional she had been for years. Today, such conduct would never get past me. I know too much about this disease and its cunning ways. At that point, though, I was still mystified. I tried talking to her, but she wouldn’t open the door to any honest communication. Within six months, she left and found a job at a different facility, where she got involved with a man early in his recovery. (Another common pattern: People with long-term sobriety who relapse usually do so after a bad relationship choice.) A few months after she took her new job, I got a call from her father. Betty was dead; according to him, she had shot herself in the chest with her boyfriend’s gun.

I must admit that I’ve never quite been able to accept that story; the Betty I knew was never suicidal, never self-destructive. Even today, it seems more likely to me that someone turned a gun on her. The boyfriend also ended up in the hospital with self-inflicted gunshot wounds. What are we supposed to believe—that it was a double suicide? Whether it was a case of foul play or not, however, this much is true: Ultimately the disease was the true cause of death.

Betty was the first addict I had become close to and then lost, and the news shook me in a profound way. My job was to save people, to prevent catastrophe, and here one had occurred to someone close to me. But it was too painful for me to accept the full force of the situation. And so I carried on, returning to my role at Las Encinas, still trying to pull people away from death and toward a place where they might start to felt better again. Even in the face of evidence that I might not be good enough, I still had to believe I could prevent bad things from happening.