Death Diminishes
by Tom Crowley
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Table of Contents parts: 1, 2, 3 |
conclusion
It was August and, watching them leave, Everston thought again of wildflower meadows and of an August thirty years before, two months into marriage. The pack horse they had hoped to rent earned more in a day than Everston, then an intern, so they backpacked their aged heavy gear, slowly ascending through montane forests, the Indian paintbrush blooms gradually changing from scarlet to rosé as they climbed until, toward evening, they reached at timberline a high alpine meadow and pitched their lean-to tarp between a stream and a veritable continent of azure lupine.
The last steep pitch of Buckskin Pass rose above them, five hundred vertical feet of treeless alpine tundra, the trail in seven switchbacks. Pat started the fire to cook the noodles and the freeze-dried spaghetti sauce while Everston took their heaviest pack and slowly walked up those seven switchbacks to drop the pack behind a large rock.
He looked down then to see far below the setting sun’s yellow light making Pat’s blond hair gold, while long dark arms of shadow reached into the lupine, turning its azure to deepest indigo.
Relieved of the pack and now descending, he soon was back to Pat, who said, “We’re having tomato soup — really, boiled spaghetti sauce.”
Surprised, Everston asked, “What happened to noodles?”
Seeing — and visibly moved by — that last burnished gold now lighting only the pass’s top, Pat smiled and said, “They’re up there.” Later, exhausted, still hungry, they laughed themselves to sleep.
Now sad, Everston thought, My God, a love so strong, until we’d bled it with ten thousand cuts, small and large.
* * *
In mid-October occasional Indian blankets still bloomed, each outer yellow wheel recalling summer’s sun while purple-black centers predicted coming frigid nights. Probably on account of brevity and low doses, Andy’s relapse before meeting Everston had produced no withdrawal depression and required no detox. Andy’s lawyer had recommended the contract. With the NA meetings and counseling, it initiated an abstinence that had now lasted two months.
Everston had guessed correctly. Andy knew that his coke use could get him into trouble, but he had used hundreds of times without trouble. He could always tell himself, I’ll almost certainly get away with using this particular time, and that was true. Balancing the huge immediate reward of this one dose against the tiny risk of immediate trouble, reward of course won out; abstinence could come later.
But now, with a written contract, frequent and unpredictably-timed urine tests, and his signed license-forfeiting letter, one dose probably would terminate his medical license, income, self-esteem, and community standing. That motivated continuing abstinence.
Andy now had provisional practice privileges, but even ophthalmologists who regularly turned away referrals wouldn’t hire him. Everston, concerned by Andy’s unusual, fiscally-motivated suicide threat, intervened beyond his usual scope, visiting the ophthalmology department’s chairman.
Concealing name, age, and gender, Everston said he was treating a drug-involved ophthalmologist, now clean and provisionally licensed, who couldn’t find work. Could that doc start rebuilding an employment record as a Special Fellow in the department’s clinic?
But the jungle drums had beaten. The chairman said, “That has to be Karnik, that Dr. Feelgood who sells prescriptions to addicts, fouling ophthalmology’s name. I wouldn’t let that bastard near my department.”
Everston said that he couldn’t name the person, but would the chairman consider interviewing him or her? “Sure,” said the Chair, “but if you send Karnik, I’ll interview him for thirty seconds, then throw him out my eighth-story window.”
* * *
Rabbitbrush, everywhere and yellow in October, had faded to gray before November’s first snow. Andy’s abstinence continued. He was now in the Yellow Group — each morning call the clinic and have a twenty-five percent chance of being told to come in to pee, observed by staff. Seven-a.m. pee-watching is usually joyless, but the staff loved Andy’s dumb jokes: “The Yellow Group, headwaters of the Yellow River,” or “Urine love with me,” or “A day without pee is like a day without sunshine.”
When Everston asked what kept his spirits up, Andy said, “Things will work out, one way or another.”
Everston said, “How’s that?”
Andy answered, “Well, either I’m working soon, or I suicide in January, leaving Liz well off. Either way, I’m happy.”
Liz added, “I hope it never comes to that, but his plan is keeping him happy.”
Everston asked, “Liz, do you sometimes tell him that you want him alive?”
“Of course I want him alive, but I respect his judgment. If he thinks he’d be better off dead,” — now each word was a hammer blow — “then neither you nor I know better.”
“Andy, I need to ask you some questions about depression,” said Everston.
“Ask what you want.”
“First, do you feel sad, or depressed, or get teary at times?”
“I told you, I’m not depressed. I haven’t been teary since our dog died a couple of years ago.”
Everston asked, “Is your weight going up or down?”
“I told you I’d lost about fifteen pounds doing coke, but since stopping I’ve gained back nearly half of it.”
Everston said, “What are you doing for fun?”
Andy answered, “Well, we play tennis at our club three days a week.” He smiled; “Liz played for her high school and college, so I have fun when she lets me win.”
Liz interjected, “He’s a damn good player, and we both love it.”
“Any other fun activities?”
Andy said, “At least once a week we’re at a movie, a play, or a great restaurant — and yes, I really enjoy them.”
“How are you sleeping?”
Andy answered, “For maybe two weeks after quitting coke, I slept half of every day, but that’s gone now. I wake up a lot at night, and St. Anne’s said that might continue for months without Ambien.”
Turning, Everston asked Liz, “Would you say that Andy’s activities or thinking are either slowed down or speeded up?”
“He’s great now. On coke he was really speedy when high, or drowsy when he didn’t take it. Now, without coke and those office stresses, he’s more relaxed and attentive, definitely neither slow nor speedy.”
“So you’re not seeing fatigue or loss of energy now?” Everston asked.
“Absolutely not,” Liz replied.
Turning again to Andy, Everston asked, “Do you sometimes feel guilty or worthless?”
In that firm, directing voice used with naughty children, Andy answered, “Look! Doing coke was really dumb — bad for my body, bad for my mind. But I probably cared for three hundred patients during that time. I helped them all and didn’t hurt one. You think I should feel guilty? I’m proud of what I did then. Especially the CFS patients — no one else would give them the medicine that keeps them going. I definitely don’t feel guilty or worthless.”
How are those patients doing now, without you? Everston thought. Instead, in his most conciliatory voice, he said, “OK, Andy. Now just a couple more questions. Do either of you feel that Andy’s having trouble thinking, concentrating, or making decisions?”
Liz laughed. “God, I wish he was! He wants to make every decision, and when he’s decided something, a bulldozer can’t move him.”
“Yeah, and to save money I’m doing my own income taxes this year,” said Andy. “A zillion forms and quarterly reports — those big-government IRS guys can’t think simple, but I get through their forms.”
“OK, here’s my last question,” said Everston. “You’re thinking of suicide. When did those ideas start?”
Finally, Andy looked serious. “Thirty years ago, in college. I still lived with my parents, and I’d be in my room trying to study. Dad would get home about seven, pour his third whiskey since leaving the office, turn on a sports station loud enough to wake the dead, growl something at Mom, and fry himself an egg and onion sandwich. After two or three more shots, he’d fall asleep in his big chair in the living room, radio still blaring, an untouched cigarette burning down to a cylinder of ash in its ashtray, stinking up the room. Anyone would think of suicide there.”
“Did you plan how to do it or make any attempts?” Everston asked.
“I planned how to get out of there. One summer, I mowed ditches for the county highway department and made enough to rent an apartment. I decided then and there always to have enough money to live well, and I do.”
Everston asked, “Any other periods with suicidal thoughts?”
“None, until my income ended. I’ll do whatever it takes for Liz to stay in our home. I bought that insurance right after the DEA first inspected my records, and it cost an arm and a leg. But if it keeps Liz in the house, it’ll be a great investment.”
“Why is the house so important?” Everston asked.
“I was two years ahead of Liz in high school. She wouldn’t date me then; she was a tennis star, while kids said I’d been to prison for that BMW. Same thing when we went to university. But when I got into med school, I guess I looked OK, and she invited me on a coffee date. Her family was pretty poor, and a prospective doc who’d get a big income and community respect — she still loves that. I want her comfortably happy.”
Everston asked Liz for her thoughts. Irritated again, she said, “I’ve told you! I’ll be devastated if he dies, but we always support each other’s choices.”
Everston thought, Stay on message; come back to this later. He asked Andy, “Do you have a plan for how to commit suicide?”
“Probably with a gun. And — I know you’ll ask — I don’t own one or have one in the house.”
Everston said, “Well, those answers don’t add up to what psychiatrists call ‘major depression,’ so your suicide thoughts aren’t due to that. Heavy drug involvement sometimes leads to suicide, but you’ve been clean now for months. And you obviously aren’t psychotic — that’s another antecedent. So, I’d like you to consult with Dr. Brent Abrams, a psychiatrist specializing in suicide prevention.”
Shaking his head, Andy said, “No way. Your call-and-pee program got me clean, and ‘you done good’ there. I want you for that program, because if some work comes along, the urine record will help a lot. But where my wife lives is between her and me. For me, suicide is a life choice, not a mental illness. No psychiatrist’s gonna push his choice on me.”
Everston turned to Liz. “So, he can be stubborn, but this is heavy stuff. A clear statement from you might keep Andy alive. What do you think?”
Frowning, still irritated, Liz answered, “Andy’s a grownup. Don’t pressure me to get him to do what you want.”
Andy said to Everston, “Anyway, maybe you can relax. Remember, my other option is finding work, and Friday morning I’m seeing a young ophthalmologist who’s opening a second office. He wants an associate three days a week. If you’ll give me a letter confirming all those negative urine tests, the chances sound pretty good.
“Absolutely,” said Everston. “You’ll get it tomorrow. And we’re meeting Friday afternoon, so we can discuss it then.”
* * *
Andy and Liz arrived for their Friday session ten minutes late, unusual for them. Andy began a breezy account of an early-season ski run through Vail’s fresh powder snow with his son, home from college.
In a quiet voice Everston asked, “Andy do you really want to pay me to listen to ski stories?”
Silent for a moment, Andy then said, “That ophthalmologist called Thursday afternoon, saying he’s decided against hiring now, so we didn’t meet. He probably talked to some damned eye guy or a BOME bastard who claimed I sold scripts to addicts.”
Everston worked to maintain his calm, only raising his eyebrows and saying, “Um-m. So where do you stand now?”
Andy answered, “Exactly where I was months ago. If work appears, I’ll work. If I can’t, Liz will be OK.”
Everston said, “Suicide happens when hope ends. But if you haven’t checked all options, there’s still hope. I really want you to see Dr. Abrams.”
Liz, volume up, interjected, “Please — knock off that crap! I promise, Andy has twice the smarts that Abrams has. He’s told you clearly enough for any ten-year old — he doesn’t want your consultant. You’ve helped stop Andy’s drug use, but he decides live or die.”
Actually, Everston himself had consulted Abrams three weeks earlier. Everston told the story, all the while carefully concealing Karnik’s identity. Abrams agreed that the contract did seem to be working, though neither thought that Liz was a partner in keeping Andy alive.
Everston and Abrams considered whether Everston should initiate a “Hold and Treat” court order, hospitalizing Andy for a 72-hour involuntary evaluation by a new team. If he was found to be “a danger to himself or others,” the hospital could treat him for up to three months.
Of course, Andy could demand a court hearing on that hold, but most judges would agree that his suicide plan warranted involuntary treatment. Everston and Abrams knew that Hold and Treat orders prevent suicides among depressed patients. Feeling too hopeless even to take meds, those patients respond to a caring hospital environment and antidepressants, and most soon return to outpatient treatment.
But Andy lacked symptoms of depression or cognitive impairment. He appeared fully rational and was sufficiently manipulative to claim that his suicidal thoughts had ended. A hospital would not hold him, and he probably would be too angry to return to Everston and renew the contract that had stopped his drug use and improved his survival chances.
Abrams advised continuing without hospitalization, maintaining the contract, and helping Andy and Liz identify simple things — aside from wealth — that made them love living together. Everston agreed but worried, seeing so a fragile a frame bearing so heavy a weight.
Driving home, Everston thought that Pat seemed happier, sometimes laughing a little at dinner. Without hard proof, he knew that he’d confront, she’d deny, and their distance apart would only grow. But he also thought, What if she wants confrontation, wants proof that she matters to me? Confrontation might drive her away or keep her.
Everston never confronted Pat.
* * *
In late January nothing bloomed. Only dried dead seed-pods still stood above the snow. Mornings, gray, damp, bleak, and cold, chilled Everston — and Mankind.
Liz had called with details, but Everston wouldn’t attend the funeral. Sad, he still smiled a little. What if he attended and made a Freudian slip, saying to Liz not, “I’m sorry for your loss” but, instead, “for your gain”?
Everston recalled his group’s Mission Statement, posted in the hallway: “To reduce death and suffering from substance abuse through treatment, education, and research.” He glanced at his poster, “No finish line.” He recalled his father, clubbed down; his mother, dying alone in her fog; Donne’s sickbed bells; and his own question, “Why do we continue?”
From Everston’s card Donne — across the centuries — answered: “Any man’s death diminishes me, because I am involved in Mankind. And therefore, never send to know for whom the bell tolls. It tolls for thee.”
Continue, Everston thought, putting away the card. He opened the door, walked a few steps to the man sitting in the hall, and said, “Good morning. I’m Dr. Everston. Please come in.”
Copyright © 2018 by Tom Crowley
