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Published On July 23, 2013

CLINICAL CARE

Point of Departure

In an excerpt from physician Danielle Ofri's latest book, a heroin addict makes a group of medical residents rethink their assumptions.

Indifference—or worse, contempt—are emotions that physicians often reserve for addicts, among the most difficult types of hospital patients, with their frequent readmissions and seeming unwillingness to change their plight. So notes Danielle Ofri, a clinician at New York City’s Bellevue Hospital in her new book What Doctors Feel: How Emotions Affect the Practice of MedicineOne morning as she leads medical students and interns through rounds, she visits a man on his fifty-seventh admission to Bellevue for heroin and oxycodone abuse—and she asks him an unusual question.

Mr. Carello, a 49-year-old white man, appeared exactly as billed—disheveled, unshaven, glassy-eyed.

The interview did not start out promisingly. Most of my questions were met with one-word answers or grunts. Mr. Carello (not his real name) could cite the standard data—stints at rehab, assorted methadone regimens, prison terms—but the facts blended into a bleak, familiar tableau. Though I kept my gaze directed at Mr. Carello, I could sense a restlessness as my team began to lose focus. I was neither connecting with the patient nor educating my trainees. It was just the morass of addiction—never-ending for the patient, never-ending for the medical team. Then a question came to me, one I’d never thought of before. “Mr. Carello,” I said, “I know you have been using drugs for many years. But might you be able to tell us the precise moment when you knew that you were addicted?”

Mr. Carello hoisted himself up onto his elbows and looked at me as though he’d only now noticed someone at his bedside. He squinted, extending the shadow of his brow farther down along his ashy cheeks. From his perch he cast a sweeping glance at the semicircle of white-coated doctors around his bed. The shuffling halted.

“When I got addicted?” he asked, focusing again on me, his jaw starting to move left and right like he was weighing the question.

He hitched himself up a few degrees more, clamped his lips, then released them. His jaw was less fidgety once he started to speak. “Oh yes,” he said, “there was an exact moment.” His voice narrowed, gaining more focus as he spoke. “It was early April—I know because those trees that are everywhere in the city had their white blossoms. Looks like snow on the trees for about two weeks, until all the leaves come out and then they’re just ordinary trees.

“Anyway, it was early April, and I was driving north on the Henry Hudson Parkway in this old Nissan I’d bought from a construction buddy. I was driving up toward Yonkers, to a barbecue my brother was hosting for his kid’s birthday. The trees were full of snow on both sides of the parkway. Like the Christmas display at Macy’s.” He paused for a second, perhaps savoring the recollection, perhaps straightening out his chronology.

“Then all of a sudden, I needed a hit. It came on a like a tidal wave, but I needed it and I needed it now. But more importantly, I wanted it. I wanted it more than anything. I wanted it more than seeing my brother, more than seeing my little nephew. At that moment, it was the only thing in the world for me.” Mr. Carello paused, and his jaw resumed its jerky, side-to-side swing.

“I remember turning that Nissan around,” he continued, “looping around on West 158th Street. As soon as I had that car heading southbound, I knew I was addicted. It was like some magnet pulling me back to that shithole downtown where my dealer was. But I had to get there. And that’s how I knew. Simple as that.”

He stilled his restless jaw with effort. “It was like God reached a hand down and flicked a finger at my car, at my life—flicked me in the other direction, and then there was no going back. The Big Guy just spun me downtown, and I’ve been heading that way ever since.”

The room was pin-drop silent after that. For the first time, we had some insight—even if slight—into what Mr. Carello’s life was like. This nascent empathy surely wouldn’t eradicate the years of addiction overnight, but it’s hard to imagine that his illness would have a chance of remitting without it.

Copyright 2013. Excerpted with permission of Beacon Press.

 

VICTORIA RICH FOR PROTO