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

Chapter 5

I GET TO the unit at about eleven o’clock, happy to be back. Some days are like that. It simply feels good to be in the corridors, doing the work and going through the routines. The familiarity works for me. I feel connected to something real, as opposed to the chaotic lives of my patients, although today the hallways are empty. In fact, the entire unit is unusually quiet. A counselor tells me that everyone has gone to their groups, following directions as they’re supposed to. “Freakish, isn’t it?” she muses.

I’m at the nursing station, setting down my briefcase, when Alexi comes in with a cup of coffee.

“I love that one in four-twenty-one,” she says.

That’s Amber’s room. I make her my first stop. She’s sitting on the bed, dressed and cleaned up. Her hair is brushed, and there’s a hint of color in her face. She hasn’t finished detoxing. There’ll be many hard times ahead. But for now these are good signs. Leafing through an old Elle magazine, she turns to an advertisement for a beauty product and tells me she used to know the girl in the picture. They’d worked together several times as teenage models, but, as Amber explains, they lived on separate coasts and their lives went down separate paths.

“She’s making ten G’s a day, and I’m here,” she says.

“You don’t model anymore?” I ask, implying that I think she still could.

“No, not for a long time. I was a kid. It’s different now. Like, duh. Look at me here.”

There are places that could be much worse, but I refrain from saying so. Responding to the intense sugar cravings of early withdrawal, Amber has littered the nightstand with half-eaten Butterfinger and Snickers bars. The floor is strewn with Bobby Brown makeup canisters and undergarments, signs of withdrawal, frustration, and struggle as she tries to write the next chapter in her life. She stares at me with large brown eyes, no longer interested in her magazine.

“You need to start going to groups,” I say.

She doesn’t pay attention. “I think you’re better-looking in person than you are on television.”

I take a defensive step backward, then recover, smiling slightly. I’m flattered, but I ignore her flirtation. Hey, I’m not immune to the notion of a very attractive young woman flirting with me. I’m only human. But I know Amber’s come-on is a ploy to get what she wants—drugs—using the only tool sexually abused women like her know how to use with men. If it works, she’s victimized again. If it doesn’t, she’s exposed to shame.

Needless to say, she’s frustrated. That prompts her to complain angrily about the nursing staff for being unresponsive to her needs.

“In what way are you not being cared for?” I ask.

“I’m in too much pain,” she says. “They won’t give me any more medication.”

“As the doctor responsible for your medical treatment, I know you’re getting what you need.”

“Then you’re doing a shitty job,” she says. “I need more. At least something to help me sleep.”

“According to the night nurse, you do sleep. It just doesn’t feel like it because of your withdrawal.”

“Look, I’m serious. You want honest, I’m giving you honest. Here it is: I can get drugs without any problem. Anything I want. Don’t make me walk out of here and do something I don’t want to do. I can’t fucking stand the way I feel, and if I can’t get a little help here I’ll go elsewhere.”

The look she gives me now is much different than the one a few minutes earlier. I respond by doing nothing and absorbing her anger. Soon she’s picking at the frayed ends of her blue jeans.

“This is always a miserable experience,” I say. “It’s been six days. We’re doing everything medically safe to make it tolerable.”

“Can’t you just put me out till it’s over?”

“No. You have to trust that we’re doing everything that should be done.”

Quiet, she shakes her head. It’s easy to read the disgust on her face.

“How can you trust somebody when your own father—”

Pausing, she leans back and reaches over her shoulder to turn off the lamp. I get a good look at her pierced belly button as her short T-shirt hikes up on her stomach. Given her come-on earlier, it strikes me as staged. Her eyes are filling with tears, but she won’t let them go. She grabs her teddy bear and strokes one of his legs.

“You know men never say no to me,” she says. “I can get anything I want.”

“I understand,” I reply, getting up from the chair. “But here you’ll be hearing no. It’s difficult for us to see you suffering. It would be much easier to give you everything you ask for. But it’s not about what you want. We say no to your demands because it’s what you need.”

After my rounds, I return to the nursing station and find a piece of paper placed upside down on my chair. I pick it up and turn it over. The top half of the page is a detailed drawing in black ink of a figure in jail, his hands gripping the bars. Beneath that is some writing done in a stylized script that must have taken some time to execute.

Question: Why are you still here?

Answer: I don’t fucking know.

Disease: Well, then, let’s split. Let’s go down guns blazin’.

Me: Get your hands off my throat.

Disease: Then accept me forever.

Me: Relapse is certain. This shit is going to kill me. How far down the rabbit hole must I go?

It’s a pretty accurate description of the struggle. I’m wondering which patient might have written this—which of them has shown any artistic ability?—when I hear Alexi raise her voice. This is a woman who doesn’t lose control easily. After the hardships of Eastern Europe, as she says, our troubles in the unit are a piece of cake.

That’s why it’s unsettling to hear her voice carry down the hall like a siren. I race toward the noise. I end up in the doorway to Amber’s room. Alexi is leading a significantly larger man out by his wrist, though if he wanted he could shake her off like a gnat. He’s about a foot taller than her and maybe a hundred pounds heavier. Like a football player. He looks to be in his early to mid-forties. He’s well dressed, in casual sports clothes. Before leaving the room, he turns to Amber and says, “Don’t worry, baby. I’ll get you what you want.”

“This is Amber’s husband,” says Alexi, looking relieved to see me.

“Jack,” he says.

“Dr. Pinsky,” I reply. “What’s the problem?”

“This nurse isn’t helping my wife. Look at her. She’s in pain. She’s suffering. I can’t bear to see it. I don’t know how this nurse can just stand there. She needs more medication.”

It’s not unusual for family members to react this way when seeing loved ones at the height of withdrawal. Understandably, they can’t stand seeing them in pain. But of course they don’t have any knowledge of the process. Jack’s a perfect example. I walk him down the hall, so Amber can’t hear the conversation. He’s steamed, and I need him to take it down a few notches. Sometimes addicts can intuit what’s going on in such situations and use it to their advantage.

“I want to assure you that everything is under control,” I say. “Amber is exactly where she’s supposed to be.”

“She looks a helluva lot worse than when she was strung out at home,” he says. “She sounds it, too. I’ve seen her bad, but never like this. She says she’s going to die from the pain.”

“You’re going to have to trust me,” I say. “And you’re going to have to trust my staff, whom you can’t abuse.”

“I’m not a trusting guy,” he says sternly.

“But you’re going to have to trust me,” I say. “She’s okay. She’s going through withdrawal. It’s not easy. She’s a pretty sick young woman.”

He runs his fingers through his hair and exhales. Suddenly his tone changes and he wants to be my friend, apologizing if he came off too angry. But dealing with Amber has been tough, he says. He’s in the hardware business, he explains, the co-owner with his cousin of several hardware stores. He works hard, and he likes to party hard. So did Amber, he says. Poor thing.

“She’s hot, though, isn’t she?” he says, a comment so inappropriate that I step back in disgust.

I don’t like this guy. I don’t know if he can tell, but I don’t care. I just want to get rid of him.

“Where’d you go to school?” he asks.

“USC for medicine,” I say.

“Sorry to hear that,” he says. “I played football at Washington. Do I have to say anymore?”

That’s my chance, and I seize it. “No, please don’t say anymore. I have to get back to work.”

Thank goodness he picks up on the cue. I don’t know if I could bear talking to him any longer without becoming overtly rude. As he got chummy, my dislike for him grew proportionately. I could tell the type of guy he was, and the sort of relationship he had with Amber. Granted, I’m quick to categorize; it goes with the job. But abused women are attracted to these types—athletes, cops, high-octane men—seeking safety and protection, but getting a severe power imbalance that breaks down into abuse.

As he leaves, Jack laughingly says, “Make her feel better, okay, Doc? I don’t want to have to yank her out of this place, too.”

After he’s gone, I enjoy the silence. I can feel the tension leave my body. Alexi and I share a look of relief. In the nursing station, she’s going through the same deep breathing exercise as I am. I shake my head and say, “He could be more difficult to deal with than Amber.”

“I can take the borderlines,” she says. “But please, don’t let their spouses in.”

Sometimes my least favorite people are related to the patients I like the most. If I had my way, we’d treat the families alongside the patients. As it is, we do have family sessions several times a week, but they’re voluntary. They should be mandatory. I’m positive Jack beats the crap out of Amber, emotionally if not physically. He might do the same to us, too.

I’m doing paperwork in the nursing station when I notice Amber go outside for a smoke and coffee, and I wonder how she was affected by her husband’s visit. A few hours have gone by since he left, and she’s feeling a need to get outside, something she rarely does. What’s that about? I’m feeling protective as well as curious. (What’s that about? I also wonder.)

Every so often I glance outside to the patio, where there are several old picnic tables, chairs, and ashtrays piled with butts. We try to get the patients to stop smoking, but we are obliged to provide them with a space outdoors where they can indulge their habit. Three patients occupy one table, smoking and continuing a conversation from group. Then there’s Amber. Seated by herself, she might as well be in another country. She lights up a Marlboro, takes two puffs, and throws it away. She glances around. I can see she is agitated and unable to concentrate. She gets up and goes back to her room.

I send a nurse to check on her. After some time has passed, I follow up myself. She’s on top of her bed, her back against the wall, with a magazine and her teddy bear in her lap. Her eyelids are heavy, but she makes contact. In that instant, I come under her spell—the kind a beautiful woman casts on a man. I want to open the window shade, let in light, and tell Amber she’s beautiful.

I don’t. But I am so much more human and susceptible than I admit. I tell myself that my vulnerability and openness allow me to appreciate the opportunity I have to make contact, even the most fleeting contact, with someone who’s been disconnected from his or her humanity. But part of that, I know, is also BS, an attempt to rationalize my need to rescue.

Amber doesn’t care one way or the other. Whatever works for her is good. I know what she wants. “My husband says I should’ve gone to Cedars,” she says. “He says they would’ve given me more medication.”

“Your husband’s not a doctor,” I respond. “But I am going to change some of your meds. I’m going to give you some Seroquel for your agitation. I’m also going to give you something to help you sleep a little better. But I can’t give you anything more to help with the withdrawal.”

She reaches for the pink comforter at the end of the bed and pulls it up over her. Is she hiding or cold? Probably both.

“Your husband’s a big guy?” I say.

“Yeah. He’ll be back.”

“Will any other family be coming?”

“You’ve got to be kidding,” she says.

“Not close to them?”

“I love my mom,” says Amber. “She’s the only one I love.”

“What about your father?”

“Fucking freak,” she says without hesitation.

As I suspected. This will be helpful for me to hear: The more we know about a patient’s background, the better the treatment we’re able to provide. Amber isn’t very forthcoming, but neither does she refuse to talk. The details come slowly. She grew up middle class in Ontario, a city about sixty miles east of Los Angeles, the younger of two children (her brother’s in the military) of a mechanic father and salesclerk mother. She describes a home life that didn’t have much structure. There were no regular mealtimes; if she didn’t want to go to school, she stayed home in her room.

Most people probably thought they were a nice family, Amber says, but the reality was horrifying. Her father was terribly abusive to her mother. Amber would stand outside the bathroom door and hear everything: the cries, the slaps, the pleading. Things got even worse after Amber told her mother about what her father had been doing to her from age seven on.

“Do you think your mother was sexually abused, too?” I ask.

“She once said something about that,” says Amber. “Something about her dad being an alcoholic, too. I don’t know. It’s all shitty.”

The pattern is clear to me. It began with her grandparents, or earlier. Her mother married a man just like her father. Now Amber has done the same. She’s just like her mother, thinking she’s found a savior when in fact she’s just attached herself to a man who is going to repeat the cycle of abuse. I guarantee Jack is that person.

“Does your husband—”

She opens her magazine and looks down at the page. “I don’t want to talk anymore,” she says in a voice so cold I can feel the room temperature drop.

She’s done. The light in her eyes disappears. I glance out the open door, wishing someone would walk in, someone who would stimulate her to talk. This is frustrating for me, pure torture. If I could get her to talk more, I think, I might be able to make the connection she needs. But of course I also think, who needs this more—me or Amber?

Alas, I can’t force her to trust me with her innermost thoughts, any more than I can make it rain or snow.

Patients don’t have to open up to me or anyone else on staff. There are no rules stipulating that patients must share the details of their lives, the abuses they suffered, their fears, and their mistakes. The mistakes can often be the hardest. I know of a patient who has been in and out of rehab a dozen times over the last decade, and he can’t get past the fourth and fifth steps, which require a fearless moral inventory of all one’s wrongdoings. It’s just too painful.

Of course, some patients can’t wait to unload. They’ll talk nonstop if we give them the chance. We don’t have the time. Others are only comfortable discussing their most painful and private moments among peers or with their sponsors. We emphasize only one thing: The more patients talk honestly about their feelings, the better their chances at recovery.

The opposite is also true. Those who don’t talk don’t succeed. They don’t make connections and grow beyond their old hurts. That’s true of the man I mentioned who can’t get beyond the fourth and fifth steps. Despite all his treatment, he’s never been able to stay sober for more than a few months.

Amber, I can see, is on the fence. She might open up, she might not. I can’t tell, and it’s too early to make any predictions. She clearly has a lot to say, though. Volumes. I may never learn all or any of the details, but I know enough about the blueprints to make me sick. As a child, Amber was violated by the same grown-ups she loved and believed would give her the nourishment she needed to grow and thrive. Instead she was left helpless, defensive, and struggling to survive. She could never allow herself to trust anyone again, lest it leave her feeling threatened again.

Love? It’s not in her vocabulary.

What of her looks, those looks that make men fall in love in a heartbeat? She’s been blessed, and yet she can’t feel it. Can I make her understand that connecting with others is the only way to help that frightened seven-year-old inside her discover more joy than pain? Will she ever be able to trust enough to take that risk?

For all my training, I can only do so much to treat her, or any addict, for that matter. I can take them through withdrawal. I can administer medications to help them get through detox. But actual long-term recovery is up to them. It’s one of the challenges of this type of medicine. A surgeon can put in a new heart or liver and the patient improves. An orthopedist can reset a broken leg and the patient will eventually walk again, whether he works at it or not. But I can’t make one of my patients better on my own. I wish I could.

I can provide help while their body chemistry readjusts to a drug-free life. I can talk to them about AA’s twelve-step program, encourage them to attend meetings, and arrange for admission into a Sober Living program, where they can receive the structure they need to support their effort to stay clean. I can put in the time and do everything they need to start the healing process. I can be the first real human being they can trust. But that’s it.

At a certain point, they just have to want to get it.

The light has to go on inside.

The rest of the night passes, and before I know it I’m on my way home from the radio station after three hours of Loveline with Adam Carolla. It’s close to 1:00 A.M. The freeways are an absolute pleasure to drive when they’re this empty. If I weren’t so tired, I would enjoy the drive. As I pull into the driveway at home, my beeper goes off. It’s the hospital.

I call in and get Diana, the night nurse. Like Alexi, she’s wired to remain calm in any situation. She works nights, so I don’t see much of her, but Diana and I talk all the time. Her voice never varies in tone. She’s always on top of things, quick and efficient. Tonight’s emergency is Amber.

“She banged on the medication window for hours,” she reports. “She demanded something to help her sleep, and got very frustrated when we said no. She insisted you promised her different meds.”

“They were changed,” I said. “Alexi took care of that before I left.”

“It didn’t calm her down. She’s been up all night. Agitated. Threatening to leave.”

Why the drastic change in her behavior? I believe it’s a reaction to the discussion we had. Talking about abuse that way can often open the floodgates to emotions that are difficult to control. At best, she’s overwhelmed. Now she’s still in an altered chemical state that’s got her reeling and confused.

If she wanted to leave, we couldn’t do anything to stop her, though we try very hard to talk patients through the situation and hope they stay.

“And now?”

“We worked hard to deescalate her. I had two people stay with her. She hasn’t left. That’s the best I can say.”

“Let’s keep it that way,” I say. “Thanks for the update.”