Twelve Patients: Life and Death at Bellevue Hospital (17 page)

Over the month Octavio lived with his family, through the phone calls and email messages and the conversations with his caretakers at Bellevue, I thought often about what it meant to so many people to have him make it back to his home. Octavio had threaded the needle in this brave new world. He had survived the human traffickers, the desert, terrible loneliness, and extreme working conditions to send a few dollars home to his family. His hope was to someday have his own concrete-bunker-like home with a couple of rooms on the empty lot next to his parents’ house. A rogue cell had not obeyed molecular signals to stop unbridled DNA replication. Everyone had been moved by the spectacle of a young man made totally vulnerable. He had become dependent on the kindness of strangers.

From our perch in the inpatient building at 27th Street and First Avenue, recessed down a long walk toward the East River, on the high floors of Bellevue you can see for miles in a 360-degree arc that covers the lives of nearly twenty million people. As many people as in Mexico City. Within a few generations everyone within this broad radius has come from someplace else. Everyone has stories of leaving a homeland because of political persecution, economic collapse, civil wars, or the need to break out of the social grip of a traditional society that is too tight or too restrictive. In his attempt to create a modest better life, Octavio risked the little that he had. Reconnecting him with his home and family was a reaffirmation of life at its most elemental. In a
world that is increasingly stressful and less predictable, more economically challenging and politically less governable, medicine is still about looking after the individual who seeks care.

The return to Mexico for a dying young man and his young wife was our opportunity to take the caring as far as we could. How people die and how we participate in their deaths is as much about us as about them. Our own humanity is at stake. In a society that is increasingly mesmerized by efficiency, measurement by numbers and a bottom-line mentality that extols profit and wealth over any other human value, the risk is clear to everyone I work with. When health care is now measured by a “medical loss ratio,” and the percentage of spending on health care is considered a “loss,” then we are really lost.

The email was not exceptional.
Can you come to my next AA meeting tomorrow night. It is my 4th Step qualification. Would like you to be there. Sorry for short notice.—Arnie ps St Lukes in the Field West Village 7pm.
That was it, cryptic but crystal clear.

The invitation opened wide an entire emotional strongbox that had been dormant for at least four years. I was not the only one to witness Arnie skidding into the ditch. Watching a person slide into a deep hole and not knowing where it would end was slightly pornographic or schadenfreudesque as the bodies piled up. Deep wells of anger and sadness, families on fire, kids in crisis, broken marriages, and broken lives would pour out over a long time. The outcomes were prewritten; only the small print still needed to be filled in.

And now this email.

I was running late at work the next day, so I decided to take a cab to the AA meeting on Jane Street in the West Village. There was no time to decompress from a long day of listening to the
drip-drip
of cuts to funding health care for the most vulnerable. I asked the turbaned black-bearded Sikh cabdriver to let me off a few blocks from Hudson Street to walk the final ten minutes west along Christopher Street. The street was filled with cafés and bakeries, pet stores (“$300 Dollars Off All Puppies”), and trendy hipster bars and restaurants. Every other person on the street seemed to have a shih tzu, no matter how big and tattooed the guy. The evening was hot and steamy; by the time I came within sight of the Hudson River, my shirt was stuck to my back, with blotches of sweat everywhere. An electric storm was coming. A taxi was stopped at the red light when I got to the curb, all four windows
wide open. A Pakistani cabbie nodded ever so slightly to the relentless syncopated sound of Qawwali music rolling out over the street onto the sidewalk. He looked at me, still nodding, and did not miss a beat as he swished north through the thick damp air. I wished he had stayed there until the end of the song. It brought me back to Peshawar and another time in my life for a few brief seconds. The music was soothing and pulsated at the same rate as an internal pacemaker in my primitive limbic brain.

I was just on time, two minutes before seven. People were walking through the two gates to the grounds and filtering into the lovely brick building on the idyllic urban grounds of the Episcopal church. The large room was two-thirds full and I found a metal chair in a far corner between a bird-like woman in a white dress whose leg bobbed through the entire meeting and a middle-aged man with a short buzz cut and neat goatee dressed completely in gray from shoes to necktie. A thin woman of thirty-five to forty with frizzy brown hair was clutching the lectern while repeatedly looking at her watch, ready to begin the session on time. Precisely at seven p.m. she hushed the group, then asked for volunteers to man the clock when she started running through the AA mantra of mutual respect and asked for the 12 Steps and 12 Traditions to be read by the membership. A plastic-coated white sheet of paper was passed from person to person, each reading aloud one step and handing the sheet to the next person. It was “step night,” the third Thursday of every month. Members who had reached an important milestone in their progress “celebrated” the occasion with a meeting in which they could share their journey; they received a coin with the number of their years in AA. One day at a time.

Arnie was in the front row, three seats down from the evening’s leader. After collecting the paper when the traditions had been read, she had some announcements about upcoming meetings, holidays, donations, and the need to be on time to respect the church’s contribution of the building. She announced that Arnie was celebrating his fourth step and would be qualifying tonight. She beckoned him to join her at the lectern, smiled, and took a seat as the group applauded enthusiastically. He was clearly a regular and known to the group.

He had seen me come in and nodded a greeting, expecting nothing in return. A small smile acknowledging that I had come at his request. Nothing more would be said between us.

My name is Arnie. I have just completed four years in AA. One year for every step so far. It has been a hard, long journey. I have not made a qualification before. I have had my two and three minutes sharing things with this group and the other groups I have attended over almost five years. They have all been fragments, bits and pieces from my life that were all responses to things other people had qualified or said about their lives and their personal experiences. It has taken me a long time to be able to stand here in front of you and tell you what I can about my shipwrecked life and my many attempts to put it back together.

He paused and sipped some water.

Arnie was a man in his early sixties, comfortably dressed in a blue linen blazer with matching buttondown cobalt-blue shirt and freshly pressed slacks with gray New Balance racing sneakers. His hair was thinning, and he had lost a good thirty pounds since the last time I’d seen him four years ago. He was trim and clean-shaven with an almost imperceptible hesitation in his presentation. You would only notice it if you knew him. The old aggressiveness was tempered, held in check, as if on a leash, without any strain. I sat back into my chair, crossed my legs, and blocked out the rustling in the room, the overhead fan giving a faint respite to the humidity and the heat from the other bodies. People idly fanned their faces with paper, books, a stray ancient
People
magazine, and 12 Step literature.

My story is not a pretty one. It is no better and no worse than the hundreds of stories I have heard over the years in several thousand AA and Al-Anon meetings here and wherever I have traveled. I am one of those guys who had to destroy everything I had. My sponsor first used the term with me
auto-da-fé
, a burning at the stake. They used to do that to Jews during the Spanish Inquisition, but I lit my own fire. I had to almost die to get a life, any kind of life. In fact I did kill myself in some way. I mean, I destroyed myself, or the remaining part of myself that had not been destroyed already by my addictions and bad judgments. My deceptions and lying were all that I had left by the time I nearly died in Bellevue Hospital. But to finally come around, to make it, to be here tonight, I had to go down a lot farther than I ever thought possible. I mean I had to let go of any remaining hidden pretenses that I was holding on to, or that held me in their grasp. Was the addiction mine to choose or was I in thrall of the addiction? It doesn’t matter really, two ways of looking at the same thing.

Listening to Arnie, I remembered the call a few years back about him from the Bellevue emergency room. “Eric. He’s back. He’s hallucinating and acting psychotic. I sent off a drug screen. There is a lot more going on here than you can imagine.” I got it right away and headed for the hospital.

Arnie relaxed some as he got into his story.

I was one of those guys who they make movies about.
Wall Street
with all of the lifestyle that went with it. Michael Douglas as the evil monster without values who used other people. When I first saw it I denied it to myself and to everyone around me as a fantasy and bad image of a profession that had a job to do in society even if we didn’t like how it was done. Like a garbageman, I said to myself. Not everything smelled good but it was necessary work. Capitalism wasn’t pretty up close but it was better than anything else that had come along. Creative destruction. You blow up businesses and lives and then get to crow as you pick up the pieces, scrape the pension funds into your balance sheet, and go on the prowl for other objects of your desire.

It first started with a back injury. I don’t even know what caused it and it’s immaterial, it does not matter now. My doctor saw me and did some X-rays and gave me some prescriptions for pain medications. Vicodin tablets. Though it is blurry, the beginning steps I mean, since by the time I was finished it was ten different kinds of prescription medication and hundreds of tablets every couple of days plus anything else I could get my hands on.

So Vicodin, little white tablets. Not the mother’s little helpers from the songs of the 1960s. Valium for stay-at-home moms who couldn’t bear the stress and boredom of being locked in their houses with two kids, the dog, and no one to talk to. Just some white tablets for pain. I was a regular heavy drinker at that time. Always had a bottle of wine with dinner and a drink or two over lunch. In fact, I had bought a wine cellar at an auction from Sotheby’s. I mean the entire wine cellar of a longtime collector who died with thousands of bottles in several carefully monitored and air-conditioned warehouses plus a thousand bottles in another apartment next to his filled with cases and racks of wines from France, Argentina, Chile, South Africa, and a huge bedroom filled with single-malt Scotches, collectibles, the best, most esoteric and delicious. There wasn’t a day I did not drink; it lubricated my work and helped me deal with the stress of the brinksmanship and the deal making. There was nothing unusual about it. We all did it and then went to private gyms and men’s clubs for a sauna and massage. Part of the executive compensation package.

The white pills took away an edge of anxiety, stress, and some other dimension I hadn’t even fathomed at the time. My life was becoming unwound, though I didn’t see that, either. I had been through several marriages, failed relationships, extramarital affairs, and the latest trophy marriage was coming apart slowly but surely. I treated her like my other acquisitions. The cost, the benefit. A wife as an ROI, a return on investment. My life was like the morning after, the feeling of desultory emptiness that slowly lifts and then you get on with things. But it never lifted; I was living in a perpetual, terminal phase of the morning after. That is, until the white pills took it away. I was free now of that nagging feeling of incompleteness and a deeper fear that I didn’t want to approach at all. That would come much later, when things fell apart.

I sat there listening to Arnie tell his story to seventy-plus people in a room on a hot humid New York night with lightning flashes coming in the windows like spasms from another universe, but the air still heavy and dead. The thunder would arrive later. His chauffeur had steered toward Bellevue four years earlier, when he turned ashen and complained of nausea. When I got to the emergency room, he had been thrashing about and hallucinating about hearing voices that wanted to kill him. He was drenched in sweat, and a nurse was wiping him down with a wet towel. He was now heavily sedated with morphine for his chest pain and tranquilizers plus a shot of Seroquel, an anti-psychotic medication for the hallucinations and agitation. The attending in our psychiatric emergency room had come down the hall to advise on the situation. The patient’s initial EKG showed an inferior myocardial infarct in progress and a tachycardia at a steady 120, his pulse racing under the stress and need to keep up his cardiac output. Now with his agitation and delirium/hallucinations, it was clear that his heart would be at much greater risk—and that there was something else going on. He had no previous psychiatric history. One of our doctors had Arnie’s wife on the line, and we were getting phone numbers of his family doctor, specialists, and key contacts to put the puzzle together.

There was something about the narcotics that gave me a release from a distress I hadn’t even identified to myself until it was gone. But I went back to my doctor a few times and got new prescriptions since the pain was not better. I went through the usual CT scan and MRI scan rituals plus the obligatory referrals to multiple specialists who couldn’t find anything but bone spurs and degenerative spine disease. Half the docs offered surgery and half prescriptions and half said, “Do nothing.” An enlightened non-interventionist even recommended rest, acupuncture, tai chi, the finest spas and massage therapists available, and of course to cut down my schedule, relax, and take a vacation. She cautioned about the medications. I did all of that except the rest and relaxation and cutting down of meds. The opposite. I accumulated at least fifteen more doctors that year, who all prescribed not only the Vicodin but Oxy-Contin in increasing dosages plus benzodiazepines like Valium, Ativan, Xanax, and Klonopin. I had an elaborate schedule to see them in rotation. At work I made up fake appointments every week that looked like I was busy going to meetings around the city. I took the prescriptions to different pharmacies and paid cash every time to avoid the insurance company inquiries and computer-driven letters to my physicians. Within a year’s time I was a regular user. A regular Dr. House or Nurse Jackie on Wall Street. I took my pills every few hours, had them hoarded away, and had my dealer doctors scattered around the city all cleverly hidden from one another. I arranged it like I was planning a merger or acquisition with military precision and took care of all the details. Nothing was left to chance. Except I forgot one thing. The alcohol and the medications interacted. I had memory losses. Minutes were gone. Then hours. Then entire days were gone. They weren’t blackouts in a drunken stupor. They were chemically induced erasures of parts of my memory banks in my brain. Everyone noticed it and discreetly wrote it off or covered for me and assumed it was too much work, stress, pushing myself too hard, maybe a little aging thrown in. I was like that guy in
Memento
who had to write down his life on his skin.

By this time I had branched out to other drugs, other medications. Since I was who I was, the doctors gave me samples and other prescriptions for tranquilizers, benzos, sleeping pills, anti-epileptic medications, and anti-depressants. I had so many prescription medications, I couldn’t keep track of them or remember what they were for. I had bags of prescription medications stashed in my apartment, my office, my weekend house, and suitcases I used on trips. I couldn’t keep track of the drugs. During a business trip to Europe, I ran out of Oxy and got into real trouble for the first time. I got sweaty, very anxious, and had a craving that was burning a hole in my head and my insides. I faked a kidney stone and got some narcotics in the emergency room and a prescription. That was Paris, France. I was an international drug operator by this time in my new “career.” By day an international financier and by night desperate to make sure I had my supply of drugs. I was increasingly doing stupid things, more careless. Lying became a habit. Then it became a normal way of living. It became living.