Chapter 7 - Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold

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

Chapter 7

“HOW IS SHE?” I ask Alexi.

I have been updated on everyone but Amber. I think Alexi purposely saved her for last. She must sense I’m developing a special interest. She liked her instantly, but that was her rising to the challenge of a difficult patient. Now that she’s spent more time with Amber, I can tell, she’s growing very fond of her.

As in any hospital, we like some patients more than others. At first, we try not to make any judgments. Everyone here is out of it when they first check in, and many are downright miserable from the pain and discomfort. As they come through withdrawal, though, they reveal more of themselves.

Addiction doesn’t discriminate. I see every type, from celebrities to bag people. One of my favorite patients was a fundamentalist Christian who managed a religious bookstore and read at Sunday school. Three times a day, she slammed heroin through a tiny vein hidden between her thumb and forefinger. They found her passed out in the bathroom of the bookstore. She was the single most polite person I have ever seen go through withdrawal.

Some patients—no, many patients—are at the other extreme. I see quite a few who are totally despicable. But part of my job is to find something worthwhile about every patient, and even when dealing with the most despicable I have to try to understand the feelings behind the behavior. Generally, the worst-behaved patients are the ones in the most pain. They tend to be people who can’t tolerate overwhelming feelings, and when they experience dread, shame, rage, and envy, they project them onto other people.

If I am standing in front of them, they project them onto me. They perceive me as the source and container of their horrible feelings. If you aren’t aware of the exchange taking place, they will make you feel horrible. They are great at it. That is their goal. There are others who are capable of being awful, but they have much better skills when it comes to manipulating people, and they make you feel great. Alexi loves these patients. But they’re only interested in themselves and their own needs.

Amber is still too profoundly affected by her withdrawal for me to draw any conclusions about her tendencies. Despite her complaints and manipulations, something about this young woman appeals to the staff. Part of it is the way she looks. It’s human nature to gravitate toward good-looking people. But Alexi doesn’t care about that. She reacts to a more human side that has broken through the storm clouds. Earlier this morning she asked Alexi a few questions that made her seem like a real person.

“I don’t like her husband, though,” says Alexi.

“I know what you mean,” I say. “Is she communicating? Sharing? Saying anything?”

“No. She’s in group, but she’s still too out of it to even consider doing her first step.”

At this stage I’m primarily focused on the biological grip the patient is in, but I also try to start educating them about how that relates to the powerlessness of their addiction. The messages are direct. We introduce the ideas of the twelve steps, powerlessness, and the behavioral goals we want them to achieve. We repeat these things over and over, since in the delirium of withdrawal very little sticks.

Then again, I don’t know what makes patients admit they’re powerless over their addiction.

I don’t know what makes a patient stop using.

Or what finally makes them get it.

I have searched long and hard for the answer. I don’t think anyone knows, those in AA with longtime sobriety included. A particular woman comes to mind. She had struggled through three previous hospitalizations during which she never made any progress. As soon as she left, she relapsed. But this latest admission was very different. She was attending groups, participating actively, and following directions. Then, at my weekly medical lecture, she suddenly stood up as I was discussing the biology of addiction and said she had something to share.

“I heard you go over all this biology stuff that last time I was here,” she said. “But I didn’t get it. I just want you and everyone else to know that now I feel completely different about everything you’re telling us. Now I get it.” She hit her head. “The message got through my thick skull. I get it. But let me ask you a question. What took so long? How do you give someone ‘get it’?

The room was quiet, and I could feel the room turn its attention from her back toward me. I was suddenly at a loss. I didn’t know what to say. I was dazzled by the simplicity and clarity of her question. After all, it was thequestion every addict has to address. The same with me. I think about it with every single patient. How can I make him or her get it?

How do you get people to follow directions, make connections, and trust when they’ve never done it before?

How do you make them understand that they didn’t deserve the abuse they suffered as children?

How do you make them whole again?

It is a complex and mysterious process, so much so that most of my patients who get it attribute it to divine intervention. They say God steps into their lives, which explains the spiritual component of recovery.

“You want to know how to give someone ‘get it’?” I asked.

“Yeah,” she said.

“Well, if you figure that one out, let me know. We’ll bottle it and share the Nobel Prize.”

Here’s the truth I tell my patients: I don’t always have the answer. It drives me nuts. I have no idea why some people get it and others don’t. You can’t bet on anyone. Those who seem like sure bets often relapse, and those who you think are going to walk out and score sometimes get sober for the rest of their life. Take another former patient, Nancy, a forty-eight-year-old biker living in the high desert. She was a longtime speed and heroin addict who was close to death when paramedics brought her into the unit.

I remember telling Alexi that she wasn’t going to make it. Then, when it looked like she would survive, I figured she’d split as soon as she detoxed, and start using again at home. Actually, I suspected the only reason she had checked in in the first place was to escape her abusive, morphine-addicted Vietnam vet boyfriend.

She made it through treatment, but then I heard nothing from her for a year and a half. Then one day I walked into the unit, and she was there. I didn’t recognize her. She looked great. I thought she was a visitor; then I did a double-take and realized who she was. After treatment, she had gone through Sober Living for a few months, left her boyfriend, and started over. I asked all sorts of questions. From her answers, I could tell she’d found a way to do it: She was managing her feelings without feeling overwhelmed, or giving in and getting high. She was making one healthy decision after another. The way she described it, her new life was happening almost spontaneously, as if she couldn’t help it.

“What happened?” I asked. “What made the difference?”

“I don’t know,” she said. “I just got it.”

Amber could have the same thing. The turning point could come at any time. There’s no way I can predict what could be the catalyst. But when Alexi and I stop in her room during our rounds, my first thought is not positive. She gives me the impression it might take a bomb exploding beneath her to snap her into a state resembling consciousness. She’s lying on her bed in jeans and a T-shirt cropped below her breasts. It’s so short my instinct is to turn away. She looks wasted, and she is. Her body chemistry is still a mess from the drugs she’s coming down from, and from the meds we’re giving her.

Alexi hangs by the door. I pull a chair next to her bed and sit down.

“How’s it going?” I ask.

“I still feel like shit.”

“It’s going to be a while,” I say.

Our conversation is run-of-the-mill. Amber doesn’t have any significant memory of her first few days in treatment. She doesn’t remember whether she has slept. “It doesn’t feel like it,” she says, repositioning herself on the bed with a long, slow groan that sounds like it has worked through her entire body. “God, I hate this,” she adds, before telling me she doesn’t recall her constant demands for more drugs or complaints about being mistreated by the staff. She has attended groups, where she has taken the same seat in the back each time, but she hasn’t participated. She hasn’t done any work.

There’s a magazine beside her. Vogue. I pick it up, riffle through the pages, and set it back down.

“Anything interesting in here?” I ask.

“I don’t know,” she says. “I don’t have the energy to look. I’m not sleeping. I could use some better sleepers.”

She has already picked up the jargon for nighttime pills. It doesn’t take long before patients start sounding like residents, throwing around the lingo: sleepers, meds, benzos. Like good addicts, they might not be able to keep track of meals and meetings, but within minutes they sound as if they’ve memorized the Physicians’ Desk Reference.

“You’re getting all the medication you can take safely.”

Amber shuts her eyes. Moments pass.

“I feel like crap. When’s this going to be over?” she sighs.

I slowly describe the process of withdrawal, treatment, Sober Living, and long-term recovery. Rather than think about a lifetime of sobriety, I urge her to concentrate on one day at a time. She has to make herself whole again, and that’s a long, slow, often painful progression of baby steps. Amber rolls her eyes. She wants me to give her drugs. Nothing else will satisfy her.

“I know you don’t trust anyone,” I say. “And I know you don’t have any faith. But those are the two things you need.”

“How can I trust?” she says, her voice tinged with disbelief and scorn. “What do you know about trust? My father raped me when I was seven. I’ve had the crap beat out of me so many times.” Her voice trails off. “My husband—”

Amber closes her eyes and tears slide down her face. My stomach tightens. I can feel her misery crawling under my skin. I wish it weren’t so, but I can’t help it. The more Amber makes her awful feelings tangible and real, the more I feel them, too. Patients think they go through it alone. They don’t. Why do you think there’s so much stress on caregivers? Doctors and nurses, too. Bill Clinton gave the phrase “I feel your pain” a bad name, but we doctors do. It’s inescapable. It is the toughest part of treatment for me, the most draining, and yet it’s also the part I connect with, the part that makes me feel like a rescuer.

My job isn’t to rescue anyone, though. My job is to help Amber help herself. Am I doing that as best I can? I don’t know. That sort of awareness is lost in the moment.

“I’d be better off dead,” she says.

“I know why you say that,” I reply. “But no one your age is better off dead.”

“Then what can you do for me?” she asks.

“I’m doing everything I can. You have to pitch in, too.”

“I just want to go to sleep. Or, like, get the hell out of this place.”

“You can get better. I see it happen over and over to people who feel a lot worse than you. You have to have faith.”

She rolls over and faces the wall. “Yeah. Right.”

I exhale and glance back at Alexi, who knows but doesn’t share my frustration. She finds it easier to accept the process the patient goes through. She goes with the current. She waits for openings, and finds amusement when there are none. I have to work at it a lot harder. Conclusions like this one leave me unsatisfied, angry, feeling as if I haven’t done all that I can. Not that I can do anything about it. I can’t magically change the patient, though I wish I could. I wish Amber would respond in a way that made me feel better. The rescuer in me wants results that make me feel good. But that’s my problem, not hers.