Nothing to lose.

"The most dangerous creation in any society is the man who has nothing to lose." 

~ James Baldwin (1924 - 1987)

You were shivering and covered with goose flesh. A slick film of sweat enveloped your skin and stayed that way no matter how many times you tried to wipe it away. Food particles floated on top of the murky liquid in your emesis basin, sloshing back and forth on your lap with every tremble of your rebellious body. You looked up at me with eyelids at half mast; you tried to speak but could only moan. With your torso still quaking you finally got a few words out: "I-I-I-I fee-fee-feel like I'm gonna d-d-die." And the look on your face when you said it made me believe you.

Damn. This wasn't what was intended. You were supposed to make it over to your friend who said he had some money. Once you got the money, things would be fine. You'd get what you needed before feeling like this set in. But you stepped off of that bus and walked those four blocks just as you said you would. Problem is, when you knocked on that flimsy screen door, the person who came to greet you wasn't your friend.

"He ain't here," the other person said. You could feel the urgency welling up inside of you. Your head cocked sideways as you studied the person on the other side of that screen. He had you by at least fifty pounds but that didn't stop you from making a quick assessment about whether or not you could take him down.

"He supposed to have some money for me. Did he leave it?"

The other person just laughed out loud when you said that. Then, intuitively he stopped and said, "Don't even think about getting froggy and trying to leap on nobody neither 'cause it won't end pretty for you." That urgency turned to desperation when he slammed the wooden door shut in front of that screen. You started to knock, begging for something, anything he might have in there but the minute you heard that loud click you stepped away. Was it a deadbolt or a glock? You weren't sticking around to find out. 

Light became dusk. And dusk became dark. That urgency and desperation evolved into physical sickness. Innards threatening to hurl and bones feeling like each one was being broken from the inside out. And this? This wasn't what was intended.

Calmly, I took your medical history. I asked you about your story and listened as you told me what happened through your chattering teeth and glistening face. But honestly? The explosion of red confetti dots covering your left hand and forearm explained it all. Well, not all of it. But at least it explained your immediate clinical picture.

"How did this happen?" I asked.

Somehow you got what I meant by that question. You knew that I wanted to know how this happened. All of this. You spending your days roaming around and hoping to get what you need to not feel like you feel now. At what point you even stepped into the threshold of this shitty existence. And I am thinking of that adjective to describe it because this just could not have been what was intended for you life.

"I got in an accident. A bad one. They gave me some pain pills and they gave me a couple of refills. Next thing I knew, I was hooked."

"Dang." You offered me up this lopsided shrug when I said that and something about that gesture made me sad. I squinted my eyes as I tried to sift my brain to get the course of events. Then it clicked and I nodded slowly. "First the pills . . .then. . I guess you turned to heroin because it was easier to get?"

"That and way, way cheaper. It hits you harder, too." You winced between sentences and then went on. "Nobody get on this stuff like they did in the old days. Just about everybody I know that shoot up or snort heroin started off on pills. First they was prescribed by a doctor and then all hell broke loose. Like I don't know nobody that just chose heroin to get blowed right off the rip. No way. It's just the way to keep from getting sick."

I just stared at you when you told me that part. My body filled up with these complex emotions that were hard to get my mind around. Pissed that the medical profession was now a new part of an old problem. Intrigued by this suggestion that shooting up heroin just for the sake of getting high was as played out as Tab soda. Pills had become the Coke Zero, and for many it was on accident. In other words, it wasn't what was intended. By the patients or by their doctors when they acquiesced and gave "just a little" of "something strong."

"So you don't know folks who just decide to give it a shot? I mean, no pun intended."

"Naaah. Not really. Not no more. Maybe some really stupid rich kids. But most folks I know start with pills. For real. The needles don't come until they go broke from buying pills. Then, as for the other drugs, once you all caught up in the life, you just in it. So you'll try whatever, you know? Meth, heroin, speedballs, all that."

Again, I said nothing. I mean, what could I say? Instead I just sat there pondering this quote from James Baldwin because that's what that last sentence made me think about.


"The most dangerous creation of any society is the man who has nothing to lose."

~ James Baldwin

Let me tell you. Some of the deepest truths I've learned about addiction have come from simply listening to the voices of my patients. Patients who have lived it or who are living through it. People like my Uncle Woody or like my patient who explained to me the real truth about how a crack addiction develops. And every time it is nothing like what I'd seen on television or heard through urban lore; the common thread being that this--the wretched monkey now perched upon their backs--was never, ever what was intended.

No it was not.

The sad truth is that there was little we could do for you without resources. I couldn't carefully place you into the open arms of an inpatient rehab facility nor could I hospitalize you until I could. Instead, the ball was placed into your court forcing you in your broken state to dribble down a full court and shoot.

You left before I could wish you luck. That ball before you turned out to be an airball. Your sheets were empty before I could even get back down to you.

I guess in my Pollyanna-ness I imagined this brief encounter as something more pivotal than it was. I pictured us plotting your comeback and me running into you somewhere looking robust and strong someday. And I swear to you, I believed that this could be your story. I did.

But as of today? This wasn't what was intended. The magnetic pull of your own back alley hospitals was greater than me and my scattered words of encouragement. In your mind, you had nothing to lose at this point--and maybe you were right.

I guess I just wish I could have convinced you of all you had to gain.

***
Hump Day, it is.

And now I'm crying because writing this made me think of a Grady angel who left in August of 2009--and now is making me hope this one won't be joining her in August of 2014.

Addiction sucks, man.

Stuck in reverse.

When you try your best but you don't succeed
When you get what you want but not what you need
When you feel so tired but you can't sleep
Stuck in reverse

~ Coldplay

__________________________________

"Miss Manning! Miss Manning!"

I looked over my shoulder and saw you coming toward me and waving your hand. I waved back. I figured you were just saying hello so I kept walking toward the hospital.

"Miss Manning! Miss Manning! Wait! Wait! Wait!"

Your feet were shuffling quickly behind me. There was urgency in your voice. Once you reached me you repeated my name, more to catch your breath than get my attention because I'd already stopped to wait.

"Miss Manning," you panted and you reached out to shake my hand.

"Hey there, sir."  I squeezed it tight and covered it with my other hand. "What's up?"

Your eyes were dancing and your face had a film of sweat over it.  Your clothes were unkempt and pasted to you with sweat. There was a nervousness in your disposition that made me worry about you immediately.

"Miss Manning, I'm hungry. I'm hungry. I need some money to get some food."

I was going upstairs to round. But that wasn't the issue.

Something was up with you. Something wasn't right. Your voice was staccato. Your hands were waving and shaking so I could see the burns on your thumbs.  The erratic behavior, the jumpiness, and even the pressure in your walk suggested that something else was up with you.

And you weren't a stranger to me, so this wasn't the same as being presented with this request by someone I didn't know.  I decided to keep it simple in the interest of time.

"I don't have money. Let me speak to a social worker. Let me--"

"Miss Manning! Miss Manning! I'll wait for you to go get some money, okay? Okay? I don't have my medicine either. I need it. I'm sick. I don't feel good. Please."  Your feet kept shuffling. Your eyes bouncing wildly and that film of sweat now coalescing into beads on your brow.

"I won't give you money. You know I won't."

"Miss Manning! No, it's not. . . I mean. . . Listen I promise . . .I promise that I--"

"I don't know what's going on with you. This is making me feel nervous." I registered the security officer standing several feet away from me even though I felt pretty sure that you'd never harm me. But something was up with you that might turn you into a puppet on a string with actions you don't see or want or mean. "Sir? Are you using again?"

"The thing, Miss Manning, is that it's hard. You know it's hard."

"Sir. It makes me sad that you're telling me you want money for food and medicine if that's not what you really are looking for. What happened when you left us?"

I was referring to you leaving the hospital earlier in the month. You shrugged.

So we just stood there staring at each other. I was already late for rounds. It was like standing in front of a giant mountain that needed to be torn down brick by brick. All I was doing was yanking on one, somehow hoping this would cascade the whole thing down.

But deep down I knew. I knew I couldn't fix this in five minutes before rounds. Just like I couldn't fix you in those five days. And we both realize that the only one who can fix you is you.

That made me feel sad. And helpless.

I think you saw that in my eyes.

"It's hard, Miss Manning. Hard to break free." You wiped your face with your hand and shook your head. Then your feet started walking backwards away from me. Like a puppet on a string. "Be blessed, okay? I got to go. I know you care about me, Miss Manning. I do. I'm gon' keep trying to break free. I'm gon' keep trying, okay?'

Keep trying. To break free.

The last thing I saw was you diagonally crossing the street, disjointed like the marionette that you still are.

Still erratic. Still anxious. Still stuck in reverse and not quite ready or able to break free.



***
Welcome to Tuesday.


Now playing on my mental iPod. . . . . haunting words, haunting lyrics. . . please listen.

Everybody has a story. . . .

Ever drive down a major street in a large metropolitan city and witnessed someone erratically walking by with that dazed, drug-addicted look in their eyes? Or better yet, have you ever encountered someone who was giving you this long, drawn out story about how their car broke down, etc. and if only you could give them $5, it would be okay. . . .yet you know from the vacant look on their face that it is likely drugs? Yeah, well if you haven't then just take a trip to downtown Atlanta.

I see so, so many people whose lives have been ruined by drugs, particularly crack cocaine. The most disturbing part about it is that the majority of them look like me- black and female. It really, really sucks. . .and it can be really frustrating at times. But every now and then, I am reminded that every single one of the people I have met or cared for who uses crack cocaine has their very own story.

I was rounding recently and one of my patients, hospitalized for multiple things all of which were complicated by the fact that she was homeless and addicted to crack, had a sad look on her face that morning. When I asked her what was wrong, she gave me a half-hearted smile with a shoulder shrug and told me, "Today is my 30th birthday." Then I noticed this yellow legal pad on the tray table. She had scribbled down all about what she wished this day could be like instead and how much she wished her life could be different. We talked for a while, and I learned a lot about her. Then I thought about my 30th birthday. . . .a fabulous weekend laughing on South Beach with two of my good friends. . . .riding around in a convertible, basking in the Miami sun and sipping mojitos. . . .meeting my best friend, Lisa, in Atlanta afterward for even more celebrating. It was unforgettable.

As soon as I walked out of her room, I burst into tears. That happens to me more often than I should probably admit. (I keep waiting for this point in my career where I will become stoic and unaffected.) Crack cocaine is awful. It is a horrible, ruthless thief that robs young and gifted people of so much promise. And I see it every single day at work. Be glad if it has never occurred to you to try crack, and feel thankful if your family cherished you growing up. If that's your story, count yourself blessed. A lot of folks never even get a fighting chance- and if only they did, they might have gone on to do such great things. The late Keith Haring immortalized this truth in his art (pictured above), and Whitney Houston said it best in her latenight chat with Diane Sawyer- "Crack is wack." Talk about an understatement.


Anyways. . .the next time you see someone who clearly looks like they are "on something" just take a minute to ask yourself. . . "What's her story? How'd he end up like that? What are her talents? What did he want to be when he grew up?" And then, if that's your thing. . . .say a little prayer just for them. I know I do all the time. . . . . .


Like many of my unstably housed patients, this one went back to a downtown homeless shelter when she was discharged. . . . .where a large number of the folks there use crack. Damn.

*patient permission obtained to be subject of blog