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

Chapter 6

EARLY THE NEXT morning I go online and check my e-mail. Among the junk I find a report informing me that Amber made it through the night, eventually falling into a fitful sleep, and as of 6:00 A.M. she was continuing to rest with her eyes shut. “Still quiet, thank God,” the note finishes.

By 10:00 A.M. I’m sitting in the South Pasadena office where I maintain the private practice my father started in the early 1950s. The call is on behalf of Gladys, an elderly patient who began with my dad shortly after I was born. Gladys is fighting a bronchial infection and claims she needs stronger medication. She is one of a few patients I have left who compare me to my father, and usually she gives me good marks.

I do enough comparing on my own. For several years my dad and I worked side by side, the old-fashioned family doctor and his hotshot son fresh out of medical school. It wasn’t an easy situation: He struggled to maintain a business-as-usual environment while I scurried around modernizing his office and expanding the number of patients we treated.

There was a time when I thought I wanted to leave my father’s practice. After he retired in 1998, though, many of his longtime patients worried out loud that I would abandon them, too. Though I had more lucrative opportunities, I took my commitment to them seriously, and I chose to stay. No regrets here. I enjoy the challenge of diagnosing abnormal biology and figuring out the treatment, and the exposure helps me keep up my skills. Yes, most of my patients are elderly, but old people are the ones who get sick. Anyone who wants to see pathology is going to see an older population. They end up teaching me as much as I help them.

Gladys, my first patient of the morning, is a sixty-seven-year-old grandmother. When I ask how she’s been doing, she responds with a deep sigh.

“I almost died this morning when I put on my stockings,” she says. “That’s how little strength I have.”

As I learned from my father, patients often come in simply to talk, and Gladys is one of those. Over the past few years, she has dealt with kidney failure, diabetes, and hypertension. Despite the long list of maladies, she has hung in with impressive resilience. As she says, she doesn’t plan on checking out anytime soon. No, she would rather nag. Hence today’s appointment. Besides the reassurance that comes from a visit, she wants to know if I agree that her pharmacist is gouging her.

“The charges sound about right,” I say, disappointing her. “You can shop around, but you need those pills.”

“It’s getting so only the rich can afford to get sick or old,” she scoffs.

After checking up on several other patients, all routine, I meet Beverly and Richard Norton, a married couple in their mid-eighties. Their visit is a pleasure. He was a successful scrap metal salesman whose winning personality is still evident. Beverly and Richard have a bunch of grandchildren; until recently, they’ve been avid world travelers. They’re adorable, always watching out for each other, always bundled up in sweaters and scarves, even in the summer. They still hold hands. I like them very much.

But Richard is beginning to fail. Age plays no favorites. Beverly is still coughing up sputum. I thought she would be somewhat better, but the stress and fear of what’s happening to her husband is taking its toll. After battling heart failure for years, Richard is starting to poop out. His mind is sharp, but his body is simply yielding to age. Richard is exceptional. He seemed to accept the infirmities of aging as a part of life. This sets him apart from most Americans. In this country, we don’t care for the aged and diseased. We keep them hidden away in hospitals and institutions, never to dirty our hands with their care, while we inundate ourselves with images of youth and unrealistic messages about optimum health. As a result, most of us are shocked when we age. We expect eternal youth and health. And because we have no sense of our biology, we are bewildered when a medical problem emerges. I’m always amused when a seventy-or eighty-year-old patient with a new medical problem reacts in disbelief. “How could this be? I’ve never been sick before.” The next question is usually, “What did I do to cause this?” Usually, it’s just the biological process of aging. And I try to get them to understand that aging beats the alternative.

Addicts in early recovery can be funny this way, too. Soon after they detox, many patients who’ve spent years killing themselves with alcohol and drugs start worrying over every little symptom. Now that they’re waking up and feeling again, every hangnail becomes a potential crisis.

“Dr. Pinsky,” Richard says. “I have a question for you.”

“Go ahead.”

“What do you call an eighty-four-year-old man with a bad heart?”

“I don’t know. What?”

“Old.”

Richard, always ready with a corny joke or line straight out of the Saturday Evening Post, loses his breath laughing at this one. After he recovers, I listen to his chest. His ejection fraction, the percentage of blood pumped out of his heart with each beat, is only 19 percent. It should be around 60. Dip below 20, things aren’t good. On previous visits I’ve suggested that they think about a nursing home, but Richard has always refused, explaining that he’s comfortable at home. “I know where the TV clicker is,” he always says.

The two of them accepted their health problems a while ago, but Richard’s severely weak heart has me very concerned. I suggest checking into a hospital. But he turns me down.

“I’m past worrying about making the grade,” he says, coughing. “It’s difficult enough getting here. I want to be at home. I like my home.”

I hear the subtext of his response and nod, appearing to agree. Then our discussion takes a turn that makes this appointment different from the others. I don’t know whether Richard decided ahead of time, but he acknowledges that the end is near, and tells me, “When the time comes, I don’t want any machines.”

“I understand,” I say.

“I want to go out of this world as gently as I came in.”

This is a turning point in our relationship as doctor and patient. I want to think our longtime relationship has contributed to this openness. Richard has had a good life, so why shouldn’t he attempt the same when he dies? Later, I write out his instructions in his file. If there is any dispute among family members—something I don’t expect—such a notation can have the power of a contract. I agree with Richard. As a doctor, I don’t believe in sustaining life in a strictly clinical sense. There has to be quality, not just form.

This is the key point in everything I do and believe. My elderly patients constantly reaffirm it. Through them, I have developed a sense about what matters in life. When people have a finite amount of time left, they focus on what’s most important, and 99.9 percent of the time it is the same thing—other people. People are not solo acts. Saying “everyone is interconnected” isn’t just a cliché. At the end of our lives, it’s all about the connections we have made with other people. Filling our memories, they give our lives substance and meaning.

But guess what? Addicts don’t make those connections. That ingredient is absent from their lives. They don’t connect with other people in ways that create genuine relationships of meaning and depth. Where other people have trust, they have only feelings of fear, hurt, and violation. No matter what’s going on in their lives, they are alone, isolated, scared. It is the reason I can say I have seen many people die in peace, but no addicts who live without a lot of pain.