For the past couple days, I’ve been attending a conference in Boston, where I lived for just over five years in the late 1980′s. My family and I have periodically visited New England since then, primarily for conferences on Cape Cod, but I haven’t been back in the area for eight years.
My, how things change.
My cab ride from Logan Airport that took me through the South Harbor area of the city was completely mystifying: where did all this come from? There before me were all the fruits of the “Big Dig” that had been gearing up around the time of my last visit, the road project of road projects that took part of Boston’s famous “Central Artery” of I-93 underground. Good Lord, how do you spell gentrify?
And then I get to my hotel, right off Chinatown, in the Theater District, and, like, where am I? Although this area was cleaning up when I was living here, still there were remnants of the old “Combat Zone,” Boston’s red-light district here and there. I kid you not, there’s a W Hotel down there. A “W”! I see the South End from my hotel window, a conclave of row houses formerly on the godforsaken side, though, true, getting trendy even twenty-five years ago, but–I mean, that’s the South End?! Verily, God hath returned. In quite the glory, I might add.
But then I walk up Tremont Street, and the Boston that has always been Boston greets me: there’s a great breeze coming off the Commons; Park Street Station remains abuzz, even at this quite early hour; Park Street Church continues its Calvinist, stern watch over the whole scene, the Statehouse just up the hill. I end up at Government Center, with the ornate Courthouse, where I did part of my child psychiatry training, just out of my view. And I’m sitting under the famous Steaming Tea Pot of Government Center.
But under that Tea Pot, where I’m typing? Instead of the eatery of old that had once stood at the heart of all Bostonian–it’s now a Starbucks. I just finished a cinnamon chip scone that I could have snarfed down just as easily in Indianapolis.
Life does, indeed, move on.
And as I remember and readjust, I recall: when I lived here, I was the age of most of the men and women whom I’m now serving. My worst memories at age twenty-seven were of this bizarre anesthesiology resident I had to endure as a medical student.
But even with him, the bodies I saw woke up.
Today I also recall a patient whom I’ve talked about before. His story does not differ markedly from those of others. He was blown away. His buddies were blown away. He lived, in a manner of speaking. They didn’t, period.
His struggle with opiate dependence has been a hard one. It has only become harder as we have begun working together. Although one might think that one should feel better when working with a psychiatrist, in my combat trauma line of business, sadly I cannot guarantee (initially) such a course.
He has relapsed on both pain pills and heroin, more than once. He always tells me when he has done so. He is terrified that I’m going to kick him out of the Suboxone program, send him back to the streets until he finally decides to “get serious about his recovery.”
He is a challenge.
I’d forgotten how much Boston is a city of the “fit young,” something so very noticeable in the minimalist clothing of summer. He could easily have been one of these young men I now see at this early morning hour, he on the slender side, true, but he still with a gymnast’s physique, striding before me, backpack in place, button-down Oxford open-collared, heading off to the Financial District, dreaming of a one-day corner office.
Instead he’s just grateful to modern medicine that he has a body to drape anything over.
I had to be honest with him: I found myself in a quandary. I told him that I was not going to stop his Suboxone (I can’t be deterred that easily). Yet both he and I knew that with every prescription he took (and, no, I don’t think he’s selling it), he was taking from me a flaming torch that he could add to the fire of painkillers in his bloodstrem to end up with a grand finale conflagration of respiratory failure.
We’d been here before in my office, post-relapse, post-confession, his gaze averted.
“It’s as if a part of me is getting stronger,” he told me, “but another part of me is determined not to change.”
Hmm, have I heard that story before?
He’d been having girlfriend problems. It was complex (isn’t it always?) It’d reached a point, however, at which I’d had to ask him to consider that both he and his girlfriend were trapped in a cycle of recriminatory despair that didn’t appear to be benefitting either of them, shall we say.
“I just can’t stand to see her sad,” he said. “I love her so much, but we’ve got to be away from each other for a while. But she gets so sad. I can’t stand to see people hurting. It hurts me so much, I keep on doing what ends up hurting me even more, even when I know I shouldn’t.”
I’d heard this story before as well. From him.
It was an old story for him, one that long predated his combat experiences. Clearly he’d been a sensitive kid who’d nonetheless managed to grow into a kind of cool kid as well. Had he gone to college, he’d have been invited to one of the cooler fraternities on campus, no doubt, and then he’d have become the guy who was always laid back, funny, loyal–the quintessential “decent guy,” the one you tell your darkest secrets to when you’re drunk, the one you even admit the same secrets to once you’ve sobered up.
But he wanted to go into the military. He wanted to prove himself. He was well-liked by his peers, well-liked by his superiors. He rose up the ranks quickly. He ended up in some impressive spots–and I mean, impressive.
He took that decent-guy heart of his to the Middle East. He was devoted to his buddies, his men. The man who had always felt deeply felt over there even more deeply, more intensely than he had ever imagined. Those guys were his life. He just knew what they needed.
He is one of only a handful of survivors.
“Have you ever noticed,” I asked him, “that whenever you start feeling better about yourself, you get this incredible urge to use?”
He looked down.
“I just don’t get it. I know that I can do more with my life. I really feel that, deep down. But it’s just so hard, my girlfriend, all these feelings. It’s just so hard.”
I decide it’s time to return to the story.
“It’s so hard, isn’t it, to feel hopeful, strong, when all of them are dead.”
He looked back up at me, eyeball to eyeball. He said nothing. He didn’t appear angry, anxious. His look wasn’t a blank one, though. It was as if both of us were suspended in time, staring at each other, without feeling, yet with every feeling imaginable.
The first tear trickled down.
“You have to understand,” I told him. “For all you guys, you had never felt closer to anyone than you did to the men around you. You were in each other’s souls. And when one of you died, he took a part of your soul with him. But for you–it was even harder. You feel the hearts of others so much more naturally than most. When you entered a guy’s soul, you entered it. You’d do anything for him, would have done anything for him. But he died. And you’re alive, in better shape than anyone who had seen you on that Med-evac would have ever imagined.”
He was still looking at me, several tears having already followed the first, quiet, his whole demeanor floating almost, on a sea of sadness.
“It hurts so much, you know,” he whispered through a swallow. “Sometimes I don’t think I can make it.”
I had to ask.
“Any thoughts of hurting yourself?”
He shook his head, though not vigorously.
“I mean, I can’t say it doesn’t cross my mind sometimes. But . . .I could never hurt my family like that, my Mom and Dad, my siblings. That would be too awful.”
So I decided to go for it.
“You do realize, don’t you, that in trying so desperately to rescue your girlfriend from her pain, a part of you is trying to rescue those guys? It’s as if your body can’t let go of trying to get it right this time, make sure no one around you ever hurts like that again. So that you don’t have to hurt like that again.”
He looked down. Very slightly, he nodded.
“We’ve got to face this together,” I continued. “It’s not going to be helpful in the least to deny it. As you begin to feel stronger, more solid, a part of your body is going to demand that you get back to those drugs. Yes, you’re going to want to use initially to reduce the tension. But you know as well as I do that within minutes, you’ll just be hurting, loathing yourself, one more time, one more crummy time. No, you don’t want to feel that way, be that way. But you’ve got to face that a part of your body is demanding you never have what those men could not have.”
For a few seconds, silence, then a quiet “I do feel better, you know. I do know I can get better.”
I leaned forward.
“That’s why these drugs are so dangerous. The stakes are getting higher. Pretty soon your body’s going to have to take some desperate measures if you don’t get a strong enough support network around you. You’ve got to let a few people take care of you. You’ve got to let me take care of you. You’ve got to let your parents take care of you. You’re not strong enough to take care of yourself yet. The part of you that wants to live has got to give in to us and let us sit with you, not leave you alone, let you know that we’ll do what we can as long as we can.”
He looks up at me.
“I . . . I just don’t want them to worry about me, my parents. I . . .” He fell silent.
OK, time for the big guns.
“Look: I’m a father. I can tell you this without a doubt. Your parents know when you’re suffering. It ain’t a secret. And nothing–nothing–is harder for a parent than seeing a child suffer and not even be able to try to comfort him, sit with him. Nothing. You’re not making your parents’ lives any easier by not talking with them about your pain.
“One of the best acts your Mom or Dad could do for you is simply sit with you when you’re hurting, scared, ready to run out and use. Even if you guys just watch some stupid TV show, even if you just sit on a couch and say nothing, you won’t be alone. You need to let them–let me–comfort you so that one day, finally, again, you will be able to comfort yourself as well as any of us humans can.”
For a good thirty seconds or so, we sat in silence, his head down, my body now back upright in my chair. Slowly he looked up at me.
“Will you talk with my parents if I bring them here?” he whispered.
“Of course,” I whispered back. “Of course.”
I finish writing these words much later in the day, as I fly out of Logan, heading back to Indianapolis, the Boston skyline ablaze before me for the few seconds before the airplane wing covers it, hurries it to short-term memory, its ultimate recollective fate unknown. When I was much younger, I almost ached as I would fly away from Boston. My life had changed there in so many ways.
Yet now I am no longer young. I have created a life a good two hours away by direct flight, two days away by car. It is a good life. My youth may not be renewable, but my own hope, my own passion is. It will return as I go home to my family this evening. It will return as I go back to the hospital on Monday.
My patient is slowly starting not only to believe, but to feel in his gut that his youth, though partially diverted into several years of horror and pain, can still be renewed, renewed in his own hope, in his own passion. Forces deep within him, gut urges will keep trying to draw him back into a part of his psyche that had barely been holding on with life supports. He will have to take the risks of depending on us. He will have to take the risks that, just as with his buddies, something could happen to us. He’s going to have to learn to soothe himself again. He’s going to have to trust that we’ll do our best to help him do that–and that we’ll do our best to remain available for that very task.
Life would have been so different had my wife and I stayed in Boston. For one thing–I’d have never met this man. True, I’d have met many others, sat with many others. But not him.
I am glad to be flying home, as a husband, as a father, as a psychiatrist given the opportunity to work with a very renewable, very aching, very hopeful-to-be-hopeful young man.
Life can be hard. Life can be good.