Junky

New to my blogroll: Purrty Gud, written by a med student who will soon be matching in psychiatry. In his most recent post, Magnificent Bastard (Purrty Gud’s author) griped about a shooter with a Staph infection who kept injecting drugs into her PICC line. He jogged a memory — a gal I hadn’t thought about in many years.

Jump back to the late 1980s. I’m in my month #2 Internal Medicine clinical rotation, this time at the local county hospital, and the team consists of me, a severe ex-Marine PGY-2*, and an unlikely intern — more on him later.

On my first call night, we admitted a thirty-something gal with bacterial endocarditis. Fever, chills, joint aches, and a penetrating whine:

PLEASE GOD GIVE ME SOMETHING FOR THE PAIN, THE PAIN, I NEED MORPHINE, AND NONE OF THAT 4 MILLIGRAM SHIT . . .

She was blonde, cute, junky-thin. My PGY-2 radiated disgust the way a dog shakes off water. He told me and the intern, “Go for it, boys. She’s your private patient.”

I awoke from The Sickness at the age of forty-five, calm and sane, and in reasonably good health except for a weakened liver and the look of borrowed flesh common to all who survive The Sickness.

William S. Burroughs, Introduction to Naked Lunch

Let’s call her Liz. I can’t remember her real name. God help me, the only name I can remember from that group was my PGY-2, my least favorite of the bunch. My intern, we’ll call him Ed. Tall, gray, with a salt-and-pepper goatee, he was a psychologist who must have been dropped on his head as a baby because midway through a successful career he quit, applied to med school, decided he had to be a psychiatrist. Now 50 years old, he’s suffering through his year as a medical intern, re-realizing each and every call night, I’m too old for this. I love the poor tired bastard.

Back to Liz. She sort of adopts me. Now, she knows that as a med student I can’t write orders, so her friendliness must be genuine. Asshole PGY-2 sees it as manipulative behavior because that’s the only reason Those People are ever nice. She’s with us for the duration (if I remember correctly, six weeks of IV antibiotics to treat her rotten heart valve), so, very soon, she goes from being Ed & my patient to just my patient. Ed and I round on her by ourselves. PGY-2 votes with his feet.

Pre-rounding is what a med student does when he plays at being a doctor. I check her out every morning and report back to Ed. I guess I could breeze in and out in two minutes flat, but Liz is funny, and she’s full of stories. Good stories. She had been a mule in Southeast Asia and India, and later became a Hare Krishna to get connected. Her fortune rose and fell countless times on the money she’d earn as a mule. She’d buy a Porsche or a BMW, then lose it all on junk. At her high points, she would sell to the children of Hollywood’s finest — names you would recognize.

She wanted to kick it this time, kick it for good. It took a bad dose of bacterial endocarditis to make her see the light.

She’d kicked it before, of course.

I had 1/16-ounce of junk with me. I figured this was enough to taper off, and I had a reduction schedule carefully worked out. It was supposed to take twelve days. I had the junk in solution, and in another bottle distilled water. Every time I took a dropper of solution out to use it, I put the same amount of distilled water in the junk solution bottle. Eventually I would be shooting plain water. . . .

Four days later in Cincinnati, I was out of junk and immobilized. I have never known one of these self-administered reduction cures to work. You find reasons to make each shot an exception that calls for a little extra junk. Finally, the junk is all gone and you still have your habit.

William S. Burroughs, Junky

I’d like to think Liz succeeded, that she put it all behind her, turned herself around, walked away, all those physical things which symbolize a permanent change in behavior. Truth is, I have no idea what happened to her. I left the service after four weeks and Liz still had a couple of weeks left on her IV cure. We never crossed paths again.

She wasn’t like other junkies. She wasn’t like that gal on 5-West, a skin-popper covered with more boils than Job, who somehow managed to sell herself to buy her next fix. And she wasn’t like that gal I met when I was an intern, who in the middle of the night staggered away from her ward to have a smoke, tangled herself up in her IV tubing and yanked the catheter from her femoral vein . . . smoking her cigarette by the hall phone, blood soaking her gown, extending outward like an oil slick. You’ll bleed to death, I said. Come back.

Not until I finish my smoke.

Those two? I don’t care so much to know what happened to them. I don’t love all junkies. But Liz had stories in her. She could laugh at herself and wonder at her rollercoaster wreck of a life. Did she manipulate me? I gave her my time and attention, and she sang for her supper. I never felt manipulated.

Yeah, I’d like to know what happened to Liz, good or bad.

For certain others — way too many to count — I would prefer to be left with my pleasant fantasies.

Like the 32-year-old mother of three with breast cancer whom I first met on my General Surgery rotation, on the eve of her mastectomy. She asked me, Do you think I’m doing the right thing? At the time, I thought, You’re asking me? I’m a medical student! I didn’t realize then that she had to ask someone. She couldn’t ask her husband. She couldn’t ask her doctors; those guys recommended the operation in the first place. She had to ask the question, had to get it out of her head and into the hospital’s stale air.

Several months later, I met her again. Chemo and radiation hadn’t been so good to her. She was re-hospitalized for Stevens-Johnson syndrome, a nasty, life-threatening exfoliative condition which occasionally complicates chemotherapy. Oy, don’t ask. But here we were, back together again. We’d bonded once. Now I was a few months older and a tad less incompetent, and she was decades older, battlescarred, spent. We didn’t have much to say to one another.
I’d like to think her fight with Stevens-Johnson syndrome, which she won, concluded a long and grisly chapter in her life. I’d like to think she’s a grandma now, one of those gals who tattoos her mastectomy scar, writes books, takes up pottery, runs for public office, you name it.
I’d like to go on thinking that.

D.

*PGY-2: Post-graduate year 2, as in “second year out from med school.” A PGY-1 is an intern, a PGY-2 is a first-year resident or R1, and so on. Don’t they teach you these things on Grey’s Anatomy?