Twelve Patients: Life and Death at Bellevue Hospital (18 page)

Arnie’s description brought the memory of a young radiologist to mind. He was a new attending, smart and capable, with a lovely wife and two adorable children. He came to see me after an emergency room visit for the abdominal pain of recurrent pancreatitis where he had received intramuscular narcotics and a prescription. The problem with the entire story was that the pancreatic enzyme amylase level in his blood never was elevated, although the amylase was high in his urine. One night after a couple dozen visits to the emergency room and similar follow-ups with different doctors, I realized what was happening. The next time he came in, we ordered a urine culture along with a urine amylase enzyme. The amylase was elevated in the urine, and the culture of his urine grew out bacteria that colonize the mouth. Our salivary glands also make the digestive enzyme amylase, and he had been spitting in his urine to raise the amylase level, giving a falsely positive test. When I confronted him with these findings and his obvious drug addiction, he was remorseful and talked about an old injury and inadvertent narcotic addiction. He looked sadly pathetic. There was no answer to my phone calls the next day. Overnight he had packed his house and left town with his wife and children, never to be seen or heard from again. Addictions ruled his universe. Drug-seeking behavior no matter the cost.

I started lying to my wife, who found stashes of medication. My medical problems became more elaborate, and the specialists I went to and the treatments multiplied. Each one was plausible by itself, but together they made no sense. There was no one pulling them together except myself—I was the impresario of my illness or addiction. I would tell my ex-wife medical stories my friends and colleagues told me. I collected them and hoarded them as my own. But it was really my mood swings that affected her the most. She couldn’t put them together with the alcohol and drugs. I forgot huge amounts of time. I had nightmares from Klonopin for almost a year. Nightly horrors dredged up from my childhood that were played out in Technicolor as I kicked my way through the blankets and avoided death by gang and Mafia members out for my blood. By this time our marriage was a mess; she was living in another bedroom and moved a lot of her belongings to another apartment we owned in Tribeca. My libido had shriveled up along with the rest of me. I blamed her immaturity, her super-ficiality, her criticisms, her lack of criticisms. I blamed her being there and her not being there. I worked at undermining her self-esteem with a watchmaker’s precision. I knew exactly what I was doing and could not control it or did not want to control it. We had a more formal relationship that got colder over time. Have you heard of zero degrees Kelvin? It is the coldest temperature there is. It is the temperature of interplanetary space. It was the temperature of my relationships. Zero degrees. I didn’t notice and I didn’t care. Little did I know.

My work became a substitute for my family and friends, and everyone understood or seemed to make excuses that supported the high-flying lifestyle of an arbitrageur, deal maker extraordinaire, at the top of his game and packing in a couple of lives where there was only room for one. I wasn’t aware of it at the time but I recruited people to aid in my personal deceptions. Dropping a few comments here, an indiscretion there. A few too many drinks, trips, meetings, late nights, pressure from deadlines, financial reports, mergers and acquisitions. I was so successful by day—how could that not be the real me, the real deal? The issues had to lie elsewhere. Perhaps not enough home support, lack of understanding, caring, selfishness, and superficiality. Not mine but my wife, my family, everyone else. And the money. It stunned people into a complicit silence. Lifetime security for family and friends alike. Silence was purchasable from everyone around me. I looked down on all of them as sycophants for hire. Just tell me the price, sir.

Arnie, back in the Bellevue ER, was too physically labile to go to the cath lab even though he was heavily sedated. There was something strange about the hallucinations. We got the alcohol level test back; it was moderately elevated, but this was too early for withdrawal and the DTs or delirium tremens, probably the most lethal withdrawal syndrome from alcohol. There were times we had to give hundreds of milligrams of Valium intravenously to patients who were seeing bugs crawling over themselves and the walls. Their hearts racing, blood pressures sky-high, and adrenaline levels off the chart. It took a lot to break through the entire body’s hyper-alert nervous system as alcohol leached out of the system.

Arnie’s liver enzymes were elevated, there was a mild anemia—and otherwise nothing was remarkable except for a cardiac enzyme bump indicating early injury to the heart muscle. The toxicology urine screen would be back shortly. Plan B was to bring him to the coronary care unit with one-on-one nursing and keep a close eye as his condition evolved. By then his wife had arrived. A stunning blonde half his age was waiting in the family room with two adult children from earlier marriages. They were all about the same age. I entered with some trepidation. There were deep histories hidden in plain sight, and we as physicians not infrequently became the receptacles for the rage and anguish that hadn’t been touched. The wife was clearly in charge and was going to direct traffic. Facts, names, phone numbers, prognoses, percentages, options… She let the children have their say respectfully, but treated them as emotionally unstable and incompetent to handle the real issues.

My addiction to everything I got my hands on was my problem and had become my family’s problem. But I didn’t realize that until later. I rationalized and denied everything as work and stress and lack of understanding of the key people in my life. All of the doctors I saw except one just kept ordering more tests. They played me and I played them for prescriptions so the game would keep going round and round. It was legal and I didn’t have to steal anything or do anything that wasn’t prescribed by New York’s elite medical professionals. There was one psychiatrist I had been referred to for possible depression from chronic pain who listened to my pressured speech and hyped-up diagnosis and treatments who said to me one day, “You are an addict.” I never saw him again and went about my business. There was no system. There is no system. No one connected the dots. The privacy laws gave the doctors plausible deniability to not talk to one another or my family so the game could go on. It was an inconvenient diagnosis and I could pick and chose at will by this time any other diagnosis I wanted. I channeled migraines, slipped disks, kidney stones, recurrent abdominal pain, spinal stenosis, sciatica, and neuralgias I couldn’t pronounce. And others I read about, heard about, dreamed up, and then acted out. The world started to come apart a bit when something happened in my family. It was the first time something got through the heavily fortified tissue of fabrications and falsifications I had built around me. But only briefly.

He took a pause and took a long drink from a plastic bottle of designer water. People were quiet in the room. Many had been there before, and many had done a lot of things that would never be revealed in a qualification, or with their sponsor. Nothing was off-limits. He slipped off his jacket and slung it over an empty chair. Beads of sweat glistened on his forehead. His shirt was blotched with irregular dark spots and stuck to his chest. He wiped his neck with some paper towels a willowy twenty-plus-year-old female member handed to him. Step
13? Where you fuck the new and emotionally vulnerable AA members. I couldn’t help but wonder. The New Balance sneakers squeaked on the freshly waxed wooden floor as Arnie moved around the lectern.

My eldest son tried to kill himself. An overdose. The entire family including my ex-wives rallied around him. He was found by his law school roommate, barely arousable, with a bottle of pills and a note to his family. Prior to his suicide attempt, he had become more reclusive. He had stopped attending his classes. From being a top student the first year, Martin had gradually slipped off the grid by the middle of his second year. He was hospitalized at the best institutions and received top care by the best doctors and psychiatrists, social workers and psychologists money could buy, literally. But the point of the story is not just my son’s near-death experience and depression. The emergency room overnight doctor showed me the pills he had taken. They were in a ziplock plastic bag. I took them out. Every single one of the orange bottles with white screw tops had my name on it. Every single one was from a different physician, nurse practitioner, or physician assistant. They had all been my prescriptions, filled in my name, that I had squirreled away in some dark corner I hadn’t even remembered. My son had discovered my stash sometime earlier and made them his own. My addiction had become his addiction. His addiction had led to his inability to function. He slipped where he never had before and the sheer absurdity of it, the panic of it had left him needing more medication to control the anxiety and the despair—and ultimately to the feeling that there were no solutions. Every road was a dead end was how he put it. The entire episode was covered up without asking anyone to cover it up. He was weak and had a problem. Me. The stress of growing up with too much of everything and an overpowering father. Overachieving father and a son who couldn’t cope. The only thing missing was an absent mother to make it complete. I didn’t lift a finger then to change that story. It would have been too much to ask of myself. A bit of honesty was in a very short supply. I just accelerated my own pill taking and alcohol consumption. It smoothed things out. The sharp edges were smoothed over as I chewed some bitter white tablets and washed them down with GlenWhatever, golden liquid in finely cut glass. I glowed and life went on. A mere speed bump. I wouldn’t be derailed yet.

The room was completely quiet. You couldn’t hear anyone breathe. A father had just sacrificed his son.
Oh, God said to Abraham, “Kill me a son.”
Everyone in this room knew that the deepest and darkest secrets were never shared. You go public with what is pretty safe and sanitized. In a case like Arnie’s, there were always more skeletons dumped into killing fields. This family was a breeder reactor for psychic injury and pain. It would demand more human sacrifice. More lambs to the slaughter. Who would be next? Would it be by drugs, alcohol, cutting, food, emotional distancing, promiscuity, or the intergalactic emptiness that lives at the bottom of lovelessness?

I remember how complicated that family meeting proved.
Were we, the physician team at a public hospital, competent enough to care for a leader of the free world?
A reasonable question from the blond young wife. This was clarified when wife number four made some calls on her cell phone outside the room. She asked me to talk to Arnie’s international TV celebrity cardiologist at a prestigious medical center several miles to the north of Bellevue. The professor was down-to-earth and apologetic. I believe he knew implicitly this had nothing to do with heart valves, clogged vessels, or pacemaker malfunction. “Is there anything I can do?” I summarized the case and asked him to fax me Arnie’s records. He didn’t have much to add except the pain syndromes, the normal stress tests, some specialty referrals, and to keep him posted please; he gave me his cell phone number. We stressed the unknown nature of what we were dealing with since a myocardial infarction was one thing… but a myocardial infarct complicated with drug withdrawal and a mystery syndrome causing hallucinations and aggressive behavior requiring chemical and physical restraints was another.

I remember my nursing colleagues from the former St. Vincent’s hospital telling me about the alcohol prescribed to the hospitalized priests and nuns to prevent their withdrawal symptoms. Perhaps we were seeing a pure and simple withdrawal from a pharmacopoeia of possibilities all interacting to make his brain’s hippocampal neuronal synapses fire wildly or not at all. I called my colleagues at the poison center that was staffed in a city laboratory building across First Avenue from Bellevue. “Man, sounds like PCP to me,” said my colleague on the phone, matter-of-factly. “Forget the free-world-leader stuff. You soak some PCP in marijuana and he may not come down for a few weeks.” A few hours later, the tox screen came back positive for alcohol, benzos, OxyContin, marijuana—and PCP. This was the sort of OD we normally see rolling in from the ghetto or with pimply teenagers from New Jersey suburbs in their parents’ black Benz SUV. Not from a guy who owned a floor in the Dakota. We had a dual diagnosis (“double trouble”) ward, 20 East, full of patients hearing voices, seeing things that weren’t there, and at the same time detoxing from heroin, cocaine, alcohol, benzos, methadone, and everything else you could grind, liquefy, inject, snort, pop, inhale. Most didn’t have a chauffeur, air-conditioned wine cellars, or tricked-out personal 747s with truffles and gold foil grated on your mac-and-cheese. The symptoms were identical, and treatment and recovery were going to be complex no matter how much money you had in your personal piggy bank.

I had entered a bizarre world that I wasn’t even aware of at the time. Despite the fact that I was acting bizarrely and had memory outages like New York City blackouts in the 1970s, the company was making big money and my immediate colleagues covered for me without missing a beat. I caught a few comments like “Take some time off, long weekends,” but nothing more substantial. My family world had contracted. By intimidation and a bullying style, I managed to keep everyone in line. Huge doses of buying stuff for everyone seemed to keep people happy and allowed me to dose my guilt with something besides pills and alcohol. In a funny way I considered myself a pusher or dealer, controlling my family and colleagues with money, apartments, trips, jewelry, cars, and special favors called in regularly for mediocre performance, indifferent effort. Pusher father, a husband creating a smokescreen that hid the real problem as I was driving off a cliff with black smoke coming out of the exhaust pipe.

The beginning of my turning point happened during my hospitalization. I don’t remember anything of the first few weeks. I came to the hospital with a heart attack. The doctors told me they brought me to the intensive care unit and sedated me and were unable to treat me more aggressively with balloons, stents, or surgery because I was in an agitated state. They told me I was psychotic. I have no memory of this at all. They evidently sedated me and then had to restrain me. In fact my heart disease, or the heart attack, went from a small one to a medium-size one because of all of the stress I put on my system from the drugs I had taken. This part was all information that my doctors, the whole team of them, told me weeks after I was admitted.