by Tom Crowley
Table of Contents|
parts: 1, 2, 3
Two days later, Andy’s wife, Liz Freeman, joined them. Spouses may facilitate or sabotage abstinence and, either way, couple’s therapy seemed wise to Everston. Vigorous but rigid in posture and gait, this forty-nine year-old CPA in an expensive business suit reminded Everston of a slide rule — long, lean, and logarithmic.
Despite the empty place beside Andy on the sofa, she took a chair across the room. After asking how to address her, Everston said, “Liz, tell me about Andy’s cocaine use.”
She answered, “We never believed that marijuana was addictive, and we’d smoked it together since our first date. A couple of years ago, Andy said that coke improved marijuana’s high, so with the kids at college, I snorted with him. I loved the feeling, and our sex went over the top. But it was too good and kinda scared me. It kept me awake nights, and I’d be dog-tired at work, where I need to be a crackerjack.
“When Andy started injecting and wanting me doing that, I drew the line. To me, ‘injector’ equals ‘addict,’ and I’d have none of it. I quit coke altogether. It’s just too damned attractive, and I watched it pull Andy further and further down that road — you know, irritable and talking fast after doses, never having time to see a movie or go out to dinner or even have sex, staying up till all hours, falling asleep during breakfast. Injecting, he was terrible.
“Then, one day at six a.m., I answered this loud knock on the door, and a half-dozen DEA thugs pushed past me with a search warrant. They took both of our computers and checked every drawer, leaving everything out, including my vibrator so each pervert could examine it. Maybe they were after Dexedrine; in emergencies some fatigue patients call at night and Andy writes prescriptions for them. They pick those up at our house, but he never dispenses medicine there. The agents stayed till nine, so every neighbor saw that big yellow ‘DEA’ on their jackets. Thank God, they didn’t find his damn coke.”
Liz’s account mostly corroborated Andy’s, so Everston brought up goals. He looked at each and said, “If we work together, and if the treatment accomplishes what you want, what would be different a year from now?”
Andy began. “In a year I’ll be back in my office full time with a full patient load, again making 450k a year. Coke — only weekends, and only snorted.”
Everston smiled. “Let’s take ’em one at a time. Will you really need 450k?”
Andy answered, “We have two kids in college and high monthly mortgage payments on both a big house and a condo in Vail. If I don’t make close to 450, it’s all gone.”
“How about now, with your practice shut down?” asked Everston.
“Years ago, I bought very generous disability insurance, and my illness, ‘cocaine dependence,’ is covered for six more months. Those payments, plus some savings draw-downs, just cover expenses. But, after six months, we’re in deep trouble if I’m not practicing.”
“Could you downsize, live on less?” asked Everston.
Andy, now angry, said, “With our architect Liz designed and outfitted a house that got into Great American Homes. I’d die rather than drag her into some 1950’s Rambler with an ugly screened breezeway.”
“If you died, you’d have no income. Could she wind up there anyway?”
Andy just laughed. “No way. I bought lots of life insurance about two and a half years ago. If I die, Liz gets three million bucks. Right now, it won’t pay if I suicide, but that limit ends three years after purchase, so... next January tenth I can suicide, Liz gets three mill, and she stays in the house.”
Suicide talk didn’t change Liz’s posture or expression. Everston asked, “Liz, did you know of that plan?”
Tipping her chin up, she said, “We have no secrets.”
Everston, sounding puzzled, asked, “What do you think of the plan?”
“We’ve been together twenty-four years, and we love each other. He’s also really stubborn and, if he makes a plan, he carries it out. I always support his decisions. If Andy decides that suicide is best, I’d be devastated, but I’ll support his decision.”
Everston thought, Devastated? You’d have three mill and no more coke or DEA hassles, but he said, “Let’s talk about those other goals, ‘back in my office’ and ‘full patient load’. That’s really between BOME and you, but I’ve seen them operate. They seldom grant unlimited privileges at first, and they generally require that another doc monitor the practice and report to them. I’m also guessing that they’ll restrict your practice to ophthalmology, eliminating those stimulant patients.”
Andy, now red, leaned forward and exploded, “Goddammit, they’re half of my patients but two-thirds of my income! And if I don’t treat them, who will? Sure as hell, those lazy BOME bastards won’t.”
With a calm face and calm voice, Everston said, “So we need clear goals. Maybe your lawyer can talk BOME into some other disposition, but” — now he leaned forward — “it’ll be bad if you expect an outcome that’s just not possible.”
Sitting back again, Everston said, “And look: although this adds more pressure, we also need to discuss your cocaine goal. At our first meeting you said” — Everston looked at a note — “ ‘that first injection... unbelievable, sent me over the moon.’
“Andy, IV coke reminds me of Adam and Eve in the Garden. Eat that apple and life changes permanently. Coke is so attractive that, if you snort, I’m sure you’ll soon be injecting again. Remember those yellow sticky-notes? They proved that you can’t control your coke use, and you’ll either abstain or be destroyed.”
Liz sat silent, immobile. Andy slouched, looked to the floor, and said quietly, “You sure gut-punch a guy. My practice gets cut way back, my income nose-dives, I’ll be paying a damned monitor, and I can’t use the energizer I need.”
Be encouraging, Everston thought. “Yeah, it’s tough to talk about goals. I absolutely believe what I said about coke, but maybe your lawyer can move BOME in some different directions. Now I think we should break. At our next meeting we should try to agree on goals and how to achieve them. If we can’t agree, that’ll be our last meeting.”
* * *
On Tuesday the couple wore sun hats, shorts, and hiking boots. “We’re going from here to Vail,” said Liz. Everston knew they’d see vast meadows of wildflowers, columbine and Indian paintbrush, fireweed; reds, yellows, blues, all sunning, waving, greeting.
“Sounds fun,” he said. All took their former seats. “I know that last discussion was difficult. What thoughts have you had about it?”
Andy answered, “I’m a fine surgeon. I’ve saved the sight of hundreds. I’ve also made life worthwhile for other hundreds with CFS. Now, you and your BOME pals want to box me in so I can’t help people, and I don’t like it one bit.”
Liz added, “You just have no idea how much Andy cares for patients. He often stayed up till two or three a.m., planning next-day surgeries.”
“I admit,” said Andy, “I was using too much coke. It was bad for me but never for my patients. BOME had no patient complaints, so they had no business suspending my license.”
Everston said, “Well, I won’t argue with you. BOME wants to box you in. They protect patients, and when coke’s causing insomnia, weight loss, and seizures, it also impairs judgment, cognition, and motor skills.”
Jerking her head toward Andy, asking more than asserting, Liz interjected, “You never had seizures!”
More restrained now, Andy answered, “Well, just twice, and only under lots of work pressure.”
Teeth clenched, furious, Liz said, “That’s disgusting!”
Everston continued, “So BOME won’t let coke-using docs practice. But it’s so expensive to train physicians that they do support rehab for drug-addicted docs. I can help there three ways.
“First, I can help you prove to BOME that you’re drug-free. Second, physicians swim in a sea of drugs, and I can help strengthen your motivation not to drink sea-water. Third, I can offer counseling to help you identify tempting situations and either avoid or deal with them. I won’t box you in, but I can give you tools to build your own box to separate yourself from coke. And if you don’t want me doing those things, you’ll go with my blessing.
“Also, regarding my BOME ‘pals,’ I really don’t know any BOME members, but they like my work, and they refer drug-involved docs to me. Some worked with me, some went elsewhere, but each one had to do something.”
Andy paused, put his hands on his head, looked to the ceiling, and said, “Sorry I got so mad. What would we actually do?”
Everston answered, “Well, consider this therapeutic quandary: suppose a physician I’m treating relapses. I know he’s endangering patients, but I’m bound by confidentiality not to report him.
“Here’s my solution. You’d deposit with me a letter to BOME. It would basically say, ‘Dear BOME, you suspended my medical license. Dr. Charles Everston has collected frequent urine samples from me since then. I deposited this letter with him and, in a legal contract, I directed him to send it to you if I don’t produce a required sample or if any sample contains drugs. At least one of those has now happened, so please terminate my medical license’.”
Shocked, Andy pulled his head back, saying, “You’re joking!”
Liz, again furious, asked, “One slip ends his career?”
“Coke intensely motivates coke use,” Everston answered. “These contracts intensely motivate abstinence. If you avoid coke, your patients get a good, drug-free doc. If you use, the contract protects them — and you — from tragedy. Also, it protects BOME; if you’re drug-free, they can safely let you practice.”
“No one ever claimed I hurt a patient,” said Andy. “That’s not even an issue.”
To reduce the next blow, Everston’s words softened and slowed. “Andy, you’ve been kidding yourself. You operated on patients’ eyes a few hours after a cocaine seizure. You were post-ictal, sleep-deprived, and still had coke on board. Each impairs function; you had all three. You’ve been in denial: patient safety is an issue here.”
As Andy’s head dropped, Liz pressed. “Andy, don’t do that contract! One minute of bad judgment and it’s all over. A good therapist certainly could find out why you use coke without putting a gun to your head.”
Everston smiled, nodded slowly, and said, “Look, Liz, I said I could help in three ways. The contract does the first two; proving to BOME that Andy’s drug-free and motivating abstinence. Third, Andy could use that abstinence time for practicing life changes to stay drug-free. That means therapy with me, support from you, and ninety NA — Narcotics Anonymous — meetings in ninety days.
“Liz, remember Andy’s words. While early traumas and current stresses are important and need examination, he used at first because he felt fabulous on coke. Later, he got depressed if he didn’t use, and coke relieved that, so he kept using.” Then, emphasizing each word, he added, “These contracts strongly motivate breaking that cycle.”
Turning, Everston said, “Andy, you’ll need to organize a drug-free life and, if you decide on treatment here, we three would meet together to do that.”
Returning to Liz, he added, “You worried about one slip ending it. Well, I could have said the end is the fifth, or fiftieth, positive urine, but at some point the next use must terminate the license, and any number over one means an intoxicated doc is treating patients. BOME needs proof of Andy’s abstinence, so ‘one time and out’ should help your lawyer argue for provisional privileges.”
Everston rose to give Andy some papers. “Our time’s about up, so here’s a sample letter and contract. They specify how testing is done, how often, and safeguards against test errors. I’d look for the whole range of abusable drugs: stimulants, opiates, alcohol, hallucinogens, marijuana, sedatives, all of them, including Ambien. If you need one for medical purposes, you’d give me a copy of your doctor’s prescription, with permission to call that doc.
“Please discuss it with your lawyer. If he advises against the plan, cancel our appointment, and I’ll suggest some other places for treatment. Or bring your lawyer to our next session to customize a plan for you. Everything’s negotiable, except one time and out.”
* * *
Copyright © 2018 by Tom Crowley