The Power of Words

“I am an addict. I fucking love shooting heroin. I love it. You would love it too if you tried it.” – My daughter, April 13, 2015, calling home from Arbor Hospital in N. Attleboro

Until I heard these words I had not fully believed she was an addict. I thought depression, anxiety, poor impulse control and the wrong crowd had led to a misuse of substances. But addiction? To heroin?

The next day she refused further treatment and checked out of the dual diagnosis facility the ambulance had transported her to just a few days prior. The power of her spoken words just a memory. How could they let her leave? Why would she choose to leave? She called once more explaining that she would be staying with an unnamed girlfriend in New Bedford: “There won’t be any problems. She will teach me to drive. There is a community college nearby. I will go to a Suboxone clinic.”

Who was this mystery person who would house my homeless daughter? How can you practice driving without a permit? How can you go to college when you dropped out of high school? How can you start a new life in hospital scrubs? All those motherly questions remained unanswered.

I wanted to believe this new friend was safe; but her last “safe” roomie was dead. Do addicts believe the yarns they spin?

Then my texted treatises begin. I had become as manic and as lost as my daughter. I warned that she couldn’t live a happy, healthy life on dope. I explained why “home is not an option,” and I begged her to reconsider treatment.  I feared her death and every morning I asked myself “will this be the day?”  I didn’t want her to leave this world hating me or not seeing a way out of the paper bag she had put herself in. I wanted to clear the mind debris; hers… and mine.

But my words got no response. Eventually I just texted that I loved her unconditionally…. even if she couldn’t kick this. Each time I wrote it I felt like I was signing a death warrant. But we all die. But not all of us die feeling loved.  I wanted her to know that her mother would always, always love her.

For weeks upon weeks I got no reply.

My daughter was a young adult of nineteen years. The law, the courts, the healthcare system all had decided that it was none of my business. My sick child was now the captain of her own ship.

After a month or two – I received a reply. She did not tell me where she was. But instead wrote, “you will always be the greatest mom in the whole wide world.”

I did not feel grateful. Instead, I felt sick. My daughter was now doing the equivalent of what I had been doing: making sure all of our interactions were kind because we may not have many left. I knew her words would save me if the worst came to pass. But I did not want to hear them.

This disease is so heart achingly difficult to process that sometimes silence gives more comfort than words. And how does a mother find comfort in that?

 

What Am I Here For?

 

My husband says it was to save our daughter. I have saved my child. At least twice she was within days of dying. But is this all I am here for? I can’t keep her alive if she doesn’t want to be. Hell, I couldn’t even keep her alive if she asked me too. In the end, the work necessary for survival is hers. I can’t do it for her. And saving your own child isn’t magnanimous. It is what most of us would do. And, more importantly, it is what we should do.

Doing what you should do can not be a life’s purpose.
And we are all bound to fail if the purpose is following some sort of moral script.

Sometimes I wish we could all be avengers and superheroes; performing spectacular feats of a magnitude that we never predicted on our little home radars. Why can’t the tiny ripples caused by good deeds be more like tsunamis?

There is an urgent need for a lot of saving to be done.
And sometimes I just feel plain powerless as I sit here eating my lunch.

What “War” on Drugs?

“We lost more people last year than the entire Vietnam War and Korean War combined.”

I received this text on a frosty Sunday morning from a friend who is a cardiologist. He can not ignore the obvious. Every emergency room bed is filled up and down the East coast. Patients line the corridors in gurney traffic jams.

So how are we addressing this home grown war of epic proportions?

JP Clark, West Point professor and author of “Emergence of the New Modern Army,” explains that the US military prepares for war by planning during peace time. Makes sense.

The US has spent a lot of money, and time, attempting to stem the flow of drugs and incarcerate dealers. I am not opposed to either effort – but it has been a one-pronged enforcement driven approach. Notably; the drugs have not been contained. They continue to cross the Mexican border, and be flown in from China and Afghanistan. But before preaching isolationism consider the role of American pharmaceutical companies and script writing doctors…

According the to the Nat’l Institute on Drug Abuse, 80% of all heroin users began their addiction with access to a legal opiate prescription. Let me say that again. 8 out of 10 American youth are shooting up, stealing, selling themselves and dying because they had access to a legal prescription. Prescription opioids such as OxyContin and Percocet ARE Heroin in pill form. The molecular structure of these opiates is nearly identical and are all derived from the poppy plant. All are extremely dangerous and highly addictive forms of pain relief.

Purdue Pharmaceutical, the maker of OxyContin, knew this. But profits were just too good to share that information. (Purdue has since paid $635 million in fines after pleading guilty to false marketing charges.)

Insurance companies happily complied. Pills provide an immediate short term solution for pain, and are more cost effective than lengthier physical and holistic therapies. Insurers then began to base doctor compensation on pain management. (If you are envisioning a noose around patient necks… you are seeing correctly.)

Recently the AMA, after a judicial wrangle, reluctantly agreed to limit first time prescriptions. But the war has not been won….victory does not include leaving the troops behind.

We need immediate investment in rehabilitating our sick youth and adults.

Medicine is a big, big business, right? According to B. Lee in Forbes Magazine, “seven of the top ten profitable hospitals in the US were non-profits.” (Your eyebrows should most definitely be raised.) He quotes, “the system is broken when nonprofit hospitals are raking in such high profits. The most profitable hospitals should either lower their prices or put those profits into other services within the community.” Well why not push for a large percentage of those profits to be spent on improving addiction services?

Being a foot soldier, I have suggestions.

1. Outpatient service; often the first line of treatment, is notoriously ineffective. Heroin is classified as the most addictive drug on the planet with 1/4 becoming instantly addicted. (It also creates real physical and physiological changes to the brain.) Outpatient might be a form of acceptable treatment for marijuana abusers or sex addicts… but certainly not for heroin addicts. Why do we accept this as a permissible form of care?

2. If you are lucky enough to advocate for inpatient care, two weeks is the average stay. Two weeks only reduces tolerance and increases risk of fatal overdose. 90 days is the minimum amount of time needed for treatment to “catch.” (A full year is required for normal brain functioning to return.)

3. Removing an addict from their environs is important for success. Addiction is a brain disease. Removing quick access to destructive behaviors and people makes rehabilitative sense. There should be a demand for quid pro quo arrangements with out of state insurers to benefit those with HMOs and medicaid plans. We must find a way to do this or else only the rich or those with premium insurance plans will benefit.

4. Spiritually based programs work. Addiction is a disease that requires a form of “spiritual surrender.” That doesn’t sit well with some because it seems to imply an inherent moral failing or belief in God. Neither is true. What it fosters is recognition that self reliance is not an option when you suffer from a mental illness like addiction.

5. An increase in MAT (medication assisted therapy). Some addicts need it – and right now the number of physicians licensed to prescribe it is too low.

6. Increase the number of physicians going into adolescent psychiatric care. (One reason there are so few is because they are paid much less by insurers for their work.)

If we don’t do these things we will continue to watch our youth die.

My daughter has lost many acquaintances. Twenty-two to be exact. One male friend I recall frequently. He had a “thing” for her and had stumbled all over himself buying her shoes, groceries, and red roses. The relationship didn’t last, and he texted me, desperate, that he was “heartbroken and would never love again.”

It all seemed so overly dramatic. But he was right; he never would love again.
A week later he was dead from an overdose. He was just 22.

Stone Heart.

“Too Long a Sacrifice Makes a Stone of the Heart”  – William Butler Yeats

This week I had cause to worry about my child’s commitment to her sobriety. I had been led to believe that she had traveled by train to our hometown to spend time with a friend who is an active alcoholic and was, or still is, a crack cocaine abuser. This friend has a boyfriend who regularly beats her. She is a petite blonde with glassy eyes and bird like bones – but he throws her against walls and routinely blackens her blue eyes. My child was to spend the entire evening with them in a Boston hotel. She did not share this news.

Why would she choose to do these things? What good could come of this?

I felt fear – and anger.  I had a hard time sleeping that night. I took a melatonin, but it didn’t offer much relief. I also turned the phone off. I didn’t want to be woken by what I assumed would be a midnight phone call from an overcrowded emergency room. Or the police demanding I pick her up at 2 am. I imagined changing out of my warm pajamas, programming my gps, and driving into yet another cold, fraught ridden night. And then to be greeted by a kicking, screaming addict, a disgusted police officer, and the mind numbing question: how do you want to handle this?

I am still so tired and it’s been over a year.

I never got that imagined phone call. A few days later I drove up to Maine to see her myself – and she appeared healthy, happy and whole. Which made me ask myself, “why would I turn off the phone when I had a sneaking suspicion that she would get into trouble?” Why would I put limitations on coming to her aid when she had worked so hard for so long? People make mistakes. People relapse. Is it because I didn’t want to look at that fact? Or because I didn’t want to be inconvenienced?

In retrospect I should have made sure my phone was fully charged. I should have had a type written list of detoxes to call when the sun rose. And if her relapse had been fatal (as it often is after having significant clean time) I should have rushed to the emergency room to hold her.

I have a beautiful child. Despite it all she is caring, funny, hard working… and mine. Why had I allowed the past to make a stone of my heart?

Some Words Stick.

Two quotes have been bouncing around my head recently. I read them voluntarily but didn’t invite them to stick around. The fact that they have is disconcerting. A lot of the stuff I read, or hear, vanishes pretty quickly from the old memory bank. A story twice-told can still provide a surprise ending. Sometimes, half way through a movie, I ask myself, “have I seen this before?”

But Carrie Fisher’s description of addiction has parked itself inside my drive-through brain. She writes, “It was a kind of desire to abbreviate myself. To present the Cliff Notes of the emotional me, as opposed to the twelve-column read. I used to refer to my drug use as putting the monster in the box. I wanted to be less, so I took more – it’s as simple as that.”

Unlike Carrie; when I drink I want to become more. Her explanation is so contrary to my own that it gives me pause. When I drink each sip is like a loosening of some inner bind; a freeing of my emotional gatekeeper.

Why is our response to substances so dissimilar? Carrie speaks of a daily struggle to suppress the beast. She claims her substance misuse was an attempt to quiet a constant state of emotional overload. Does the non-addict control their inner monster by subconsciously cramming it down (and employing the weekend safety valve of a couple of “harmless drinks” to avoid explosion)? If so does this mean that the addict is more conscious of emotional dis-regulation? Or are they incapable of the “cramming” part? Are they incapable because they feel more? Or because they have less free space within which to cram the over wrought monster?

Which leads me to the other quote that has taken up residence in my brain.  In The Folded Clock Heidi Julavitz confesses to carrying around a small water tap handle which she found between the studs of her newly demo-ed wall. She imagined the prior owner put it there because they didn’t want to throw it away, yet they didn’t want to keep it laying around because its daily usefulness was long gone. She contemplates what is stored between the “studs of the walls of herself…. who knows what I have hidden in there because I could make no sense of it at the time, and found nowhere else to put it.”

Which makes me wonder: what have I placed inside my interior walls? Are things taking up unnecessary space because I refuse to look at them? Or am sentimentally attached to their expired value? Should I create a little larger space inside for my inner beast to slumber or should I wake my monster and face the consequences? (Hey – is this what meditation is for? Will it both clear the mind debris and shrink my emotional beast?)

Do we have to look at all this stuff? Isn’t it annoying to have to look behind every wall? In some respects our “tap handles” are a record of a life lived. And our inner beast a barometer of our capacity to feel. The tap handle and inner beast may also represent the sum total of all of those emotional traumas we have absorbed but failed to assimilate. Funny, but when my daughter first started on her 12 step program she suggested that my husband and I pursue it as well – not because we are addicts but because it would allow a peek at our own hidden spaces.

For most of us, a certain point surely comes when the walls become overstuffed and the well over flows. Those conditions don’t just magically resolve themselves nor are they swept away by some outside force. Intimately seeing the path of a recovering addict has taught me the hard lesson that change can only come through painstaking self-analysis. Time for exploring this old house. Time to wake the monster.

Here I come 2017.

The Boy Outside of the Gym.

Today I saw a boy outside of my gym. He had his grey hood up and appeared to be waiting for a ride. It was 22 degrees outside. He was smoking a cigarette. Funny that; a cigarette outside of a gym. And then it occurred to me that he was in recovery. I have no proof of this random rush to judgement – just a hunch. I gave him a big smile and, contradictory to his rather unapproachable affect, he smiled back.

I felt like we had bridged, in some small way, a rather momentous divide. This may have been another rush to judgement on my part – but clearly we had plenty that separated us. Age, sex, income level and life experience for one. Most likely also politics, education, hobbies, and the content of our daydreams.

Once inside I focused on maintaining my speed on the treadmill. This is more challenging then it sounds because the desire to slow down is surprisingly strong with me – and it only takes the push of one sweaty button. Sometimes I bait myself with my daughter’s struggles… if she had the inner strength to quit drugs then you can certainly run for fifteen more minutes. (Maybe you could even, God forbid, kick up the speed.) It was then that I noticed the boy. I guess, unable to get that ride, he had returned to the warmth of the gym. He had removed his hoodie – and he was covered in tattoos. Not a tribal bracelet, soft green shamrock or the name of a lost family member. No, these were the scary kind. They traveled up his arms, his neck, his brow. They were dark and fresh and it would be hard to accept the challenge to look directly at them. I wondered if he had been a dealer. I wondered what kind of trouble he had gotten into in his brief life.

And then I saw him grab free weights – and he used them like a ballerina. Slow beautiful, deliberate arcs. Others grunted and watched themselves in the mirror. Some walked around more than they lifted. But he was lost in an interior world. At one point he looked like a Christ child; his arms impossibly spread, his posture shamelessly on display. I couldn’t help but imagine what he had suffered for his addiction. What avenues had he gone down to feed his fix? How could ones desire for something be so strong that they would risk destroying the beautiful body that they had been given?

Making yet another mad rush to judgement I decided that this is what we shared in common. A desire to both understand and to forget. And shouldn’t our interior worlds bind us more than our exterior ones?  It is unfortunate that they aren’t as obvious as race or culture.   Our interior worlds are often fiercely private and often lonely.  If only they glowed like some sort of mood ring – I am green I am working on liking myself, I am blue I am working on liking others, I am red I am working on controlling my moods, I am purple I am working on forgiving.  How cool would that be?  Then we could help each other, guide each other, or at least recognize a commonality:  I am not alone.

I have a strong feeling that me and this very different boy had lived through something regrettable and were working hard to reinvent it. A personal resurrection or rebirth of sorts. And it made sense to me, it was Christmas week after all.

I See You Mr. Double Standard.

I know many people believe that healthcare dollars should not be spent on those who choose to use street drugs. I get it. It’s about personal responsibility. Healthcare dollars are stretched enough caring for those who aren’t the agents of their own destruction.

However, I ask you to consider the following:

We cure cancer in those who continue to smoke cigarettes.
We staple the stomachs of those who ignore the food pyramid.
We perform heart surgery on those who have never seen the inside of a gym.
We given insulin to those who knowingly eat donuts.
We fix the broken limbs of those who practice extreme sports.
We pay for the delivery  of babies conceived by high risk mothers.
We stitch back the bodies of those who crash speeding cars.
We treat melanoma in those who refuse to stop sun worshipping.
We treat venereal diseases in sexually promiscuous people.

The costs incurred for treating these examples of “irresponsible behavior” are staggering: According to the Centers for Disease Control and Prevention, smoking is the number one preventable cause of disease in the United States and it costs $170 billion dollars a year in direct medical costs. According to the American Diabetes Association one in three medicare dollars are spent on treating diabetes at a cost of $322 billion dollars a year. And, “American use of tanning beds may lead to upwards of 400,000 cases of skin cancer annually.” (American Academy of Dermatology).

But you know what?  Those individuals receive treatment with care, efficiency, and efficacy. The same can not be said for those with substance use disorder. This time a year ago my nineteen-year old was turned away from a detox center because there were no beds. She then walked to Boston City Hospital’s emergency room, sweating and trembling, for help. They too turned her away. Desperate, she spent that evening trolling Mass Ave looking for the drug she needed to tide her over for one more day. The next morning she returned to both the detox center and the emergency room. And once again she was refused admittance. She called crying; “could I please, please help?”

Help should have been as simple as a request.

I spoke with the ER doctor. He explained, “we don’t treat drug addicts here.” He then explained that he would also not admit her for mental health reasons because he didn’t believe she “would kill herself.”

I felt weak at the knees. How does one mount a spirited defense when powerless?

“My daughter is only nineteen years of age. She is not yet a hardened street addict. She is high on a drug that is killing people at an unprecedented rate. She is asking for help. You are that help.”

Silence.

“We are not asking for charity. She is insured by two separate policies.”

His reply: “Hospital rules do not permit admittance.”

“Surely,” I argued, “it is time for hospital rules to change. This is an epidemic. Turn her away and there is a strong possibility that she will die tonight.”

Silence.

“Why wait for the hospital to change it’s policies in response to a dead child and a lawsuit?”

Silence

“You took the Hippocratic Oath.”

Silence.

“You could lie about the reason for her admission…”

Do you know how it feels to beg when you shouldn’t have too? Begging when the stakes are so ridiculously high?  It feels like swimming against the tide while trying to reach your drowning child. Swimming and swimming…and then the dorsal fin appears.  But hope is not lost: a lobster boat comes into view!  You yell for a rope. But they don’t throw one.   No, they don’t.  Instead, they sit back and watch.  Because, you know, she shouldn’t have been swimming in those waters.

I know I sound angry. That’s because I am.  I spend $1500 a month out of pocket for health insurance – and I have had to beg for life saving services.  Addiction is classified as an illness by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).   But the double standard most assuredly remains.