Guilty Pleasures

During the summer I like to catch up on books. So far this summer I’ve read “The Film Club” by David Gilmor and “The Survivors Club” by Ben Sherwood. My guilty pleasure this summer was reading “Here’s the Story,” an autobiography of Maureen McCormick, Marcia Brady from the Brady Bunch TV series ($4.99 in the discount bin at Borders). 

The book is filled with lurid stories of sex and drug use with more than a sprinkling of mental illness (the author’s mother had congenital syphilis and living with that stigma in small town Iowa in the 40s severely damaged almost all her relationships, particularly that with her daughter). Mrs. McCormick doesn’t sugarcoat anything.

It’s a pretty typical tell-all book and it’s a fun read and it reminded me why I hate taking care of drug addicts so much.

Maureen McCormick is typical of most drug addicts that I’ve known. She incessantly thinks and philosophizes about herself, yet has remarkably little insight into her own behavior. (She has the unfortunate luck to be an actress and so also deals with the genetic solipsism that is required for that job). She searches desperately for an explanation for her self-destructive behavior and blames everyone around her while destroying the trust and respect that people mistakenly place in her. She finally manages to overcome her addiction to cocaine, replacing it with a series of other, less destructive addictions to religion and finally to her family. It’s funny how drug addiction and alcoholism are the only two diseases that can be cured through will power. Try that with cancer or diabetes.

I’m so tired of the destroyed lives and the lies and the disappointment that I see in the eyes of wives and parents and children. The sounds of self-recrimination and tears and pleadings for “just one more chance” have become nauseating to me. Drug addicts and alcoholics are selfish. Even in recovery they are selfish. (“How do you expect me to go through rehab and work at the same time?”)

The prerequisite honesty necessary for rehab becomes a lie when it’s your 103rd time through the program, as was the case with one of my first patients in Brooklyn back in the summer of 1988. How many more times has that guy been through rehab in the subsequent 22 years?

In the world of academic medicine it’s incredibly un-PC to express impatience or annoyance with alcoholics or drug addicts, but I’ve had it. I’m tired of their narcissism and their expectation that they deserve another chance with my trust. I’m sick of the self-absorbed pondering and navel-gazing that they do when confronted with their weaknesses and yet another relapse. I’m fed up with having to divert my attention from patient’s with actual diseases to care for their self-induced complications of intravenous drug use and alcohol consumption.

It drives me nuts to have a patient with an incurable disease process like cancer or chronic kidney disease lying on the stretcher next to an overdose patient. I want to grab the drug addict by the neck and scream at them and say, “Open your eyes! The person in that bed over there would give everything they had - their house, their money, and everything else - just to have what you have: your health. And you are throwing it all away!”

Of course not all drug addicts and alcoholics are humanity’s hopeless detritus. An emergency medicine study earlier this year found that for the first time, overdose of prescription drugs, like Percocet and Vicodin, has become more of a problem than “traditional” drugs of abuse like heroin and coke. I guess a lot of people have their own guilty pleasures.