THE END OF MY ADDICTION (1. Moment of Truth)
I CAME TO MY SENSES and took stock of where I was: in a cab, with blood streaming down my face and spattering my trench coat. I looked out the window and in the glow of the streetlights saw the cab was on Lexington Avenue in Manhattan, waiting for the light to change at 76th Street. The church on the corner reminded me it was Sunday, and I looked at my watch. It was almost midnight. The few people on the street were buttoned up against the late winter chill, but it was warm in the cab.
My apartment was not too far away, on East 63rd Street between York and First Avenues, but I needed medical attention. I asked the driver to take me to the emergency room at New York Hospital, at 68th Street and York Avenue. He seemed oblivious to my condition, and I wondered what had happened. Had the cab braked suddenly so that I hit my head, or had I been injured in some other way before I hailed it? I knew I’d been drinking, but not where or how much.
As the cab pulled up in front of the hospital emergency room entrance, a memory of the evening began to come together. Around 8:30 p.m. I had visited my friend Jeff Steiner, the CEO of Fairchild Corporation, to ask his advice on running my cardiology practice, which I’d started two and a half years before. I’d been introduced to Jeff in the late 1980s by a mutual friend, another physician.
Although I’d intended not to drink that evening, I felt insulted when Jeff’s butler offered me a choice of teas. “Why doesn’t he offer me an alcoholic drink as well at this hour?” I thought. “Is this a judgmental message?”
I asked for and drank a glass of Scotch, then made a show of declining a refill. Much later I learned that Jeff was not aware that I had been drinking heavily. He’d known me only to have a few drinks at large parties, here and there, over the years. But my mounting concerns about my practice finances had changed that.
The standard expectation is that it will take a new medical practice two years to break even. Mine broke even in four months. And almost three years later, in March 1997, there it remained—hovering a little over the break-even point.
Staggering into the emergency room, I thought, “They will see I’m drunk. That’s not so good. But at least I know the place is well run and will fix me up right.” I had been associated with New York Hospital and its partner institution, Cornell University Medical College,* ever since I arrived from France in the fall of 1983 to do research and clinical fellowships in cardiology. Thirteen and a half years later, I was a clinical associate professor of medicine at Cornell and an associate attending physician at New York Hospital, in addition to running my private practice.
Inside the emergency room, I passed out again. When I came to, one of my ex-students, Matt, now a resident, was standing over me preparing to stitch the wound in my forehead. So as not to be left with a scar, I asked him to use Steri-Strips instead. He did and then left me to lie quietly for a few hours so I could sober up enough to walk home safely. He was plainly even more embarrassed to treat me in my drunken state than I was to need treatment. I cringed at the thought of my appearance in the ER being discussed around the hospital, then pushed the thought out of my mind. Matt was not the kind of person to talk about it; that was some comfort.
Lying there, I ran the video of the evening in my mind. “Run the video of what happens when you drink” was something I’d been hearing in Alcoholics Anonymous, where I was still very much a newcomer.
My conversation with Jeff Steiner had been frustrating for us both. Although he was eager to help, there was a mismatch between his expertise and my problems. What I really needed was a small business adviser, not a big corporate dealmaker.
As I left Jeff’s apartment, my mind whirled with conflicting thoughts. My cost-blind practice style might function better in France’s universal health care system than in the United States, I thought, and I wondered if I should relocate back to Paris, where I was from. But I loved my life in New York. In 1991 I had acquired U.S. citizenship, and it pleased me to be a citizen of a country with so many shared ideals with my country of origin. If not profitable, my practice was at least busy and my work enormously rewarding. My patient roster included wealthy and celebrated people along with Harlem church ladies on Medicare or Medicaid and the indigent, and I liked that mix. And my social life was wonderfully stimulating—more so than I could imagine having anywhere else. No, I wasn’t eager to leave.
But my practice could not continue indefinitely at this rate, and the constant anxiety created by financial worries was growing into a source of full-blown panic. I struggled with a deep sense of failure, and I lived in fear that the world would see that my accomplishments were nothing but a sham, a house of cards that could collapse at any second.
This was not a new feeling to me. Throughout my life I had been plagued by anxious feelings of inadequacy, of being an impostor on the brink of being unmasked. I had been seeing therapists for a long time before I started drinking. To be honest, they never were much help with my anxiety. Nor was the Xanax they prescribed me.
The one Scotch at Jeff’s made me aware of how thirsty I was. I went to a Chinese restaurant, intending to have a meal as well, but wound up eating nothing and drinking one double vodka after another. And then…I found myself bleeding in the taxicab.
It wasn’t my first blackout drinking. But the blackouts were getting more common, whole stretches of evenings expunged from my memory. And this was the first time I’d come out of a blackout with a physical injury. Until then blackouts had only been sources of intense mortification as I wondered what embarrassing things I might have said or done.
The next morning I thought briefly about amusing tales I could concoct to explain the bandages on my forehead. Deciding that I was too hungover to go to work, I had my office assistant reschedule the day’s patients. As my drinking had increased, I had scrupulously honored my first duty as a doctor—to do no harm. I stopped driving. And I never set foot in my office or the hospital when I was not completely sober.
Still, I resisted seeing myself as a problem drinker. All I really needed, I thought, was to learn to drink better. This delusion was encouraged by a well-meaning friend and an equally well-meaning but I think even more misguided therapist, both of whom undertook to show me how to be a moderate wine drinker rather than a binger on Scotch or vodka. I even began AA with the thought that it might give me tips on managing my drinking better rather than stopping completely.
Not everyone thought I was a candidate for moderation. The two friends who escorted me to my first meeting didn’t think so. One was a longtime AA member, a poet and a writer and a very beautiful woman who looked a bit like Katharine Hepburn. She used to say, “I want you to see me before I lose my looks.” She still has those looks today. When we met, she had been sober for many years, yet she told me, “I am an alcoholic.” That struck me as very strange, and I was embarrassed to hear her say it. People with diabetes or hypertension didn’t identify themselves by their illnesses. Why should people with alcoholism?
Of course, I thought that because I did not want to admit—to myself or anyone else—that I might be alcohol-dependent. And so I was terrified to go to a meeting. But my friends each took me by an arm, and escorted me from my apartment on East 63rd Street to the major AA meeting place in the neighborhood—the 79th Street Workshop, in the basement of St. Monica’s Catholic Church, on 79th Street between York and First Avenues. It was my first step, taken reluctantly, toward facing my illness. But it was a vital one.
It is hard for everyone who attends AA to get past the potential embarrassment of being seen as an alcoholic. Shortly before I went to AA for the first time, my shrink began encouraging me to go. I said, “What about anonymity? My office and my apartment are right in the same neighborhood. What if a patient or somebody else I know sees me?”
He said, “Don’t worry. Anyone inside will be an alcoholic and won’t say anything.”
“But what if a colleague sees me entering or leaving the place?”
“It won’t happen.”
It did happen. But after I started going to AA, I told him, “AA is a great place. Have you been to a meeting?”
“You refer people. Maybe you should know what it’s like. Will you come with me to an open meeting?”
“Because somebody might see me.”
There is a moral stigma to addiction, and it is prospective shame that drives people to resist admitting they have a problem. It leads physicians to miss or delay a diagnosis of addiction, too. Only a couple of months earlier, I had brought up AA in a session with my shrink. “Oh, you’re not an alcoholic,” he said dismissively, “but you could become one.” Then he changed the subject away from alcohol and drinking.
Later on in my alcoholism, when I knew more about the course of the illness, I wondered how he could have missed the signs of its onset in me, and could even have turned a deaf ear to my first outright call for help. The responses of my physician colleagues at New York Hospital–Cornell puzzled me, too. When I would discreetly ask around about how to help “someone” with a drinking problem, they’d ask, “Is the person close to you?”
If I said no, they’d say, “You don’t want to get involved. It’s a minefield.”
If yes, “Well, I really don’t know what to say. It’s very complex…”
Recent studies have shown that, at least among physicians who are not specialists in the field, a missed or delayed diagnosis is the rule, rather than the exception, in cases of addiction. One study videotaped doctors and patients and found that when patients mention addiction issues, doctors tend to change the subject as quickly as possible.1
I didn’t know what to make of this phenomenon when I first encountered it. But it has dawned on me that doctors are uncomfortable with the subject because they don’t have a reliable treatment to deliver or recommend.
The lack of reliable treatment also explains the moral assumptions attached to addiction. Whenever medicine has lacked a means to cure an illness, it has blamed the patient’s lack of moral virtue, positive thinking, and willpower. In the nineteenth century, tuberculosis was associated in novels and operas with characters of dubious morality or sanity, at least insofar as the establishment was concerned. Think of Fantine, the unwed mother turned prostitute in Victor Hugo’s Les Misérables; the deranged revolutionary Kirillov in Dostoevsky’s The Possessed; or the courtesan Violetta in Verdi’s La Traviata. Susan Sontag memorably exposed a similar dynamic at work in relation to cancer and AIDS, respectively, in Illness as Metaphor and AIDS and Its Metaphors.
I very much feared moral judgments about my drinking, and no one was judging me more harshly than me. “I am supposed to be an intelligent person with willpower. I should be able to control my urge to drink. When people find out about my drinking, they will finally see what a fake I am,” I told myself.
What further complicates the picture is the fact that some people are able to halt their compulsive behavior with the help of twelve-step programs like AA and commonly prescribed medications like Revia, Campral, and Antabuse. But for the vast majority of people with addiction, these are not enough. They weren’t for me. Which is not to say that AA didn’t help me. It did. It was a critical resource without which I might not have survived until I found an effective medication in baclofen. It taught me a great deal about accepting my illness and about my fellow sufferers and myself, but it couldn’t stop my cravings or the uncontrollable anxiety that led me to drink.
I was terrified of living without alcohol. Without it, I would be an anxious wreck. Admitting my problem drinking to most of my friends and my colleagues terrified me, too. I feared being ostracized, and since I felt that drinking should be under my control I felt ostracism would be justified. (Naively, I assumed that very few physicians had a drinking problem. I didn’t yet know that about 10 percent of physicians, like roughly 10 percent of the general population, will become dependent on alcohol at some point in their lives, that many more in each group are problem drinkers, and that according to the British Medical Association, physicians are three times more likely than the general population to have liver cirrhosis from alcohol abuse.)2
Through the next two months after my appearance in the ER, I clung to abstinence. I called my new AA sponsor regularly, and worked overtime in my practice so that I had no free time for drinking. And in June, I went off to the Swiss Alps, which, since my childhood, had been a magical place for me. But hiking in the mountains and quiet evenings after a good dinner failed to restore my spirits as usual. I had been sober for sixty-three days, but there was no peace in me. My drinking had threatened my career, even my life. I needed to talk to someone about it.
I decided to call André Gadaud, whom I’d met in 1984 when he became France’s consul general in New York. After other high-level diplomatic postings, André had become the French ambassador to Switzerland. He was also what they call in AA a “civilian,” that is, a non–problem drinker. We’d always had a great rapport, and I thought sharing my secret with him might help me.
André generously offered to drive from the French embassy in Bern and meet me for lunch at the Hotel Quellenhof in Bad Ragaz, a luxurious thermal resort town. As we sat down to lunch, André said, “Let’s order champagne and have a toast, since we haven’t seen each other in several years.”
“I’d rather not have champagne,” I said.
“Why not? It’s been so long!”
I did not know how to say no, so I gave in. It felt impossible to refuse champagne when it was proposed by a French ambassador, and then it felt equally impossible to reveal that my drinking had become a serious issue. I worried that André would assume I was not exercising enough willpower and lose respect for me. It seemed better to keep quiet and not risk ruining our visit or possibly even our friendship.
After lunch, during which I restricted myself to only one glass of champagne, André and I walked for hours in the mountains, talking about everything except my problem, before he had to drive back to Bern. That evening, I went to a pizzeria for dinner. When the waiter asked if I wanted a drink, I immediately started craving alcohol. The glass of champagne at lunch had reactivated the whole cycle, which I knew would be hard to fight.
The craving became stronger, growing in my chest, in my throat. Some cravings are more violent than others. Although cravings have an emotional component, the physical part was the hardest to bear for me. An AA acronym, HALT, sums up the states—Hungry, Angry, Lonely, Tired—in which cravings strengthen. I was experiencing all four. I was jet-lagged, lonely and angry because my friend had left without my being able to mention why I had called, and hungry because my food was very slow to arrive.
Just to take the edge off, I ordered a double vodka tonic, assuring myself that a single drink would forestall a major binge. It almost worked. After dinner, I felt somewhat soothed. But as I walked back to the hotel, I passed a bar and the craving struck again with irresistible force.
I entered the bar and ordered a double vodka tonic. Another customer came over. “I heard you play the piano here last summer,” he said. “You were terrific. Would you please play again?”
As I sat down at the piano, a wave of anxiety swept over me. What if I didn’t play well? Another vodka tonic materialized, offered, I was told, by the customer who’d asked me to play. After gulping it down, I felt great—relaxed, personable, happy. I played with confidence; people danced and applauded. After two more vodka tonics, I returned to my hotel and fell into a peaceful, refreshing sleep.
I awoke feeling good, but in the late afternoon I went out and bought a bottle of vodka. And I drank it, launching myself on a binge.
With great effort, I ended the binge and managed to dry out in time for my flight home to New York.
My failure to stay sober on vacation frightened me. I called my office assistant, Erdie, and told her to cancel all appointments.
“For how long?” Erdie asked.
“Until the end of the summer,” I said.
“But why, Doctor Ameisen?”
I hesitated a moment, and then said, “Because I’m an alcoholic, Erdie.”
She laughed and said, “But seriously, Doc, why?”
“I am serious, Erdie.”
Over the next several weeks, I decided, I would either manage to arrest my downward slide or ease myself out of my practice until I regained control.
Almost immediately, I began drinking heavily every evening. Finally, I managed to wrench myself out of the abyss and stop. I grew ill, vomiting and aching all over, but as usual staved off acute withdrawal with B vitamins, gallons of fluids for hydration, and Valium. I was usually well supplied with Valium, which my physician prescribed for my anxiety, and since I had started bingeing, I had always made sure to have some on hand so that I could detox myself.
Detoxing from alcohol takes around five days. A day into this regimen, I called my girlfriend, Joan, who proved immensely empathetic and encouraging, even though we were having a rocky time over my inability to make a long-term commitment.
The next morning, August 19, 1997, I realized I had run out of Valium and could not remember when I had taken the last pill. With Joan’s help, I searched the apartment repeatedly, desperate to find at least a couple of pills, but there were none in the bathroom medicine cabinet, on the nightstand by my bed, in the kitchen drawer, or anywhere else. The doctors I knew and trusted were away, and I could not imagine explaining to another doctor why I needed a prescription on an emergency basis.
Joan did not understand my concern. “Why do you need Valium so badly?” she asked.
I explained that withdrawal from alcohol can easily become a medical emergency with delirium tremens (the DTs), seizures, loss of consciousness, hallucinations, major spikes in blood pressure, and even death. The risk of serious, and potentially lethal, medical consequences is much higher in acute withdrawal from alcohol than in withdrawal from any other drug of abuse.
I also explained that in the days before Valium and similar drugs existed, people were detoxed using diminishing doses of alcohol. If I could get out to a liquor store, I could halt the progression of my symptoms. But my arms and legs felt like they were made of rubber; I was so exhausted that I could not even stand. Terrified of what might happen, I begged Joan, “Please, buy a bottle of vodka and bring it to me.”
She refused. Looking back, I suppose I could have written Joan a prescription for Valium that she could then give to me. But I was horrified by the thought of doing something that would compromise my ethics.
I said, “I’m having a medical crisis. Either I drink or risk a negative neurological event, like a seizure.”
Joan knew that I was a good doctor, but she also knew the depth of my dependence on alcohol. A tall business executive, Joan looked me in the eye and said, “I’m sorry, Olivier, but I can’t bring you liquor.”
I gave up the fight. “Something is going to happen to me,” I said. “When it does, you must call EMS and have them take me to New York Hospital. I don’t like going to my own hospital in this condition, but they will take good care of me there.”
“Isn’t there anything else we can do?”
“You can bring me liquor, or we can wait for the bad things to happen.”
Half an hour later, I felt a strange sense of agitation mixed with relief. I wondered if this was the “aura” that precedes a seizure. And then I lost consciousness except for a vague impression of medical personnel milling in the lobby of my building or on the street, and a bit later someone pulling a privacy curtain around me in the hospital and whispering, “He’s an attending,” shorthand for attending physician. Then I lost consciousness again.
When I awoke, I was attached to several IV tubes and a urinary catheter. A young medical student, a bit pompous but sweet, appeared and questioned me about my “malady.” I liked his choice of words so much that instead of asking for an experienced nurse or an intern, I let him draw arterial blood gases. This was a long, very painful process, because I was his first live patient.
My next visitor was Professor John Schaefer, an outstanding neurologist originally from Australia, whom I knew very well and greatly admired. With matter-of-fact kindness and no hint of moral judgment, he explained that I had suffered multiple seizures, which had been controlled with intravenous Valium. I had been kept heavily sedated for two days and I was continuing to receive Valium intravenously to treat acute withdrawal.
The seizures were so violent that they produced rhabdomyolysis, a breakdown in muscle tissue that is toxic to the kidneys and is measured by the level of CPKs—creatine phosphokinase isoenzymes—in the blood. The same thing can happen to people who suffer what is known as crush syndrome, from traumatic injuries in a car accident or being trapped in the rubble of an earthquake. Only recently, a colleague told me that on seeing my chart in the intensive care unit, he assumed I must have been in a massive car crash, because my CPKs were extraordinarily high. Rhabdomyolysis explained the urinary catheter and another of the IVs; they were to make sure I was getting enough fresh fluids to prevent renal failure.
“You almost lost your kidneys, my boy,” John said. His characteristic jovial “my boy” cheered me up and made me feel I could talk to him about the real problem, that I had subjected my body to this trauma by excessive drinking. (Perhaps fortunately for my state of mind at the time, he only told me much later that I was admitted to the hospital in “status epilepticus,” an ongoing seizure state that put me “near death.”)
“You are going to have to report me—” I began.
“On the contrary,” John said. “I’d like to commend you. I know you haven’t seen patients all summer. Too many doctors continue to practice for years when they are—and know they are—alcohol-dependent.”
“I am going to resign as associate professor and associate attending physician here.”
John shook his head. “Are you crazy? You don’t resign because you have an illness.”
“I know alcoholism is a disease. But in my case, that’s not what it is. I know I should be able to control my drinking, but I have not succeeded so far. I guess it’s a weakness on my part. Do you understand?”
“No,” John said. “It is an illness. One you will have to recover from and then you will come back and work normally. To help that along, you should begin seeing an expert in these matters. With your permission I would like to call in a friend of mine, Professor Elizabeth Khuri, as a consultant. She is right next door to the hospital at Rockefeller University and also has an office here. Would that be okay with you?”
“Can I tell her…?”
“You can tell her anything and it will not filter to anyone here at the hospital, including me.”
“Okay, then, I will be glad to see her. Thank you. Thank you for everything.”
“Glad to be of service, my boy. I will check in on you in the morning. For now, just get some rest.”
“John, given the risk of infection, don’t you think this urinary catheter could be removed now?”
John laughed. “You must be feeling better if you’ve got the energy to resent that imposition, and you are right about the infection risk,” he said. “I’ll tell the head nurse about the catheter. Now get some rest, and you’ll be back to normal in no time.”
I wondered if things would ever be normal again for me. One fact was clear and could no longer be denied: I had become an alcoholic.
THE END OF MY ADDICTION Copyright © 2009 by Olivier Ameisen