“One pill makes you larger
And one pill makes you small.”
From Grace Slick’s song “White Rabbit”
He was new to the practice. Handsome; average build; a young man in his mid-twenties. He was brought in by his mother, who politely asked if she could stay to confirm his story.
“He’s staying with me now. I just want to make sure that he tells you everything.”
Not a common beginning for an interview with what seemed like a capable young man.
Talk to me.
Long and sad story. Pain since his teen years. No injury; no history of abuse; nothing to give me a clue as to why he hurt. Interesting: he was able to function, and get a job doing, of all things, manual labor. Of course he developed more pain. He left high school; got a good job; got involved with a young woman and her child. Still more pain.
He never did well in school. Special classes; assigned teachers. The typical history for a young man with ADHD. People would tell him that he was smart, but he just didn’t learn well.
The drinking began. The only way that he could cope with his discomfort. Incredibly large amounts of booze. And cigarettes to boot. Now he cannot make it through the day without being intoxicated.
I examine him. I think that I may have a clue as to why he hurts.
There may be genetic factors. You may have an immune disease. I think that I may be able to help.
I look in his eyes. There’s no sparkle; no life. It seems that he’s looking way past me.
I need some blood tests; some X rays. Again: I may be able to help. But you have to stop drinking. The medicine that I give you will not mix with alcohol. I see that your liver tests are abnormal. You’re harming yourself. You have to quit.
His mother interrupts.
“He’s in severe pain. He has to drink. Something needs to be done.”
I understand your concern. But he has to quit. I cannot treat him otherwise.
His eyes find the floor. He nods; I think that maybe he’s willing to try.
I explain about the tests; how he has to take the medicine. There will be monitoring labs; he will need to return to check on his liver studies. Alcohol would make his liver worse.
I get ready to stand up. He begins to talk.
“I can’t do it. The pain is too much. I can’t quit.” His eyes water.
At this stage it may well be the need for alcohol that makes you hurt. Your body just cannot live without it. Your brain will not function without its fix. There is help available, but you have to commit to quitting. I understand it will not be easy. Think about the Ray Charles movie: it shows very well how difficult withdrawal is. I can make a phone call.
He moves his head sideways. His mom seems upset that I’m asking her child to suffer. I cannot make them understand that as long as he takes extraneous chemicals he will not improve.
Three human beings in a closed room having a painful conversation. Each one thinks they’re doing as best they can to fix the situation; no one is happy. Life waits outside the door, ready to impose its harsh reality no matter what decisions are made. We only have a few minutes alone; seconds of peace before we have to face the music.
Let me see what the tests show. Let’s get more information. You go home and think about what we have discussed. Remember: there is hope. I need a commitment; you need courage to face the unknown without your chemical. You have many people who love you; you should do well. Believe.
He leaves; his mother follows; neither of them look up from the floor.
Pain. It takes over your life; it leaves room for nothing else. We cannot stand the loneliness and disability that pain creates. We medicate, either on our own by using legal and illegal drugs, or we rely on prescriptions which give us a few minutes of relief as they stick to our brains and leave us with an insatiable desire for more. It isn’t long before it becomes impossible to separate the original distress from the prison that drugs carefully build for our souls.
There will be small pills, and larger ones, and brews and concoctions that may or may not have a name. We don’t care any more: we seek relief; we want out of our self-inflicted jail.
But we can’t walk out without feeling more pain.
We need to be strong; to believe. We need to have the support of the people we care for. We need to make a habit of health. To live. To love.
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