Nothing to lose.

"The most dangerous creation in any society is the man who has nothing to lose." 

~ James Baldwin (1924 - 1987)

You were shivering and covered with goose flesh. A slick film of sweat enveloped your skin and stayed that way no matter how many times you tried to wipe it away. Food particles floated on top of the murky liquid in your emesis basin, sloshing back and forth on your lap with every tremble of your rebellious body. You looked up at me with eyelids at half mast; you tried to speak but could only moan. With your torso still quaking you finally got a few words out: "I-I-I-I fee-fee-feel like I'm gonna d-d-die." And the look on your face when you said it made me believe you.

Damn. This wasn't what was intended. You were supposed to make it over to your friend who said he had some money. Once you got the money, things would be fine. You'd get what you needed before feeling like this set in. But you stepped off of that bus and walked those four blocks just as you said you would. Problem is, when you knocked on that flimsy screen door, the person who came to greet you wasn't your friend.

"He ain't here," the other person said. You could feel the urgency welling up inside of you. Your head cocked sideways as you studied the person on the other side of that screen. He had you by at least fifty pounds but that didn't stop you from making a quick assessment about whether or not you could take him down.

"He supposed to have some money for me. Did he leave it?"

The other person just laughed out loud when you said that. Then, intuitively he stopped and said, "Don't even think about getting froggy and trying to leap on nobody neither 'cause it won't end pretty for you." That urgency turned to desperation when he slammed the wooden door shut in front of that screen. You started to knock, begging for something, anything he might have in there but the minute you heard that loud click you stepped away. Was it a deadbolt or a glock? You weren't sticking around to find out. 

Light became dusk. And dusk became dark. That urgency and desperation evolved into physical sickness. Innards threatening to hurl and bones feeling like each one was being broken from the inside out. And this? This wasn't what was intended.

Calmly, I took your medical history. I asked you about your story and listened as you told me what happened through your chattering teeth and glistening face. But honestly? The explosion of red confetti dots covering your left hand and forearm explained it all. Well, not all of it. But at least it explained your immediate clinical picture.

"How did this happen?" I asked.

Somehow you got what I meant by that question. You knew that I wanted to know how this happened. All of this. You spending your days roaming around and hoping to get what you need to not feel like you feel now. At what point you even stepped into the threshold of this shitty existence. And I am thinking of that adjective to describe it because this just could not have been what was intended for you life.

"I got in an accident. A bad one. They gave me some pain pills and they gave me a couple of refills. Next thing I knew, I was hooked."

"Dang." You offered me up this lopsided shrug when I said that and something about that gesture made me sad. I squinted my eyes as I tried to sift my brain to get the course of events. Then it clicked and I nodded slowly. "First the pills . . .then. . I guess you turned to heroin because it was easier to get?"

"That and way, way cheaper. It hits you harder, too." You winced between sentences and then went on. "Nobody get on this stuff like they did in the old days. Just about everybody I know that shoot up or snort heroin started off on pills. First they was prescribed by a doctor and then all hell broke loose. Like I don't know nobody that just chose heroin to get blowed right off the rip. No way. It's just the way to keep from getting sick."

I just stared at you when you told me that part. My body filled up with these complex emotions that were hard to get my mind around. Pissed that the medical profession was now a new part of an old problem. Intrigued by this suggestion that shooting up heroin just for the sake of getting high was as played out as Tab soda. Pills had become the Coke Zero, and for many it was on accident. In other words, it wasn't what was intended. By the patients or by their doctors when they acquiesced and gave "just a little" of "something strong."

"So you don't know folks who just decide to give it a shot? I mean, no pun intended."

"Naaah. Not really. Not no more. Maybe some really stupid rich kids. But most folks I know start with pills. For real. The needles don't come until they go broke from buying pills. Then, as for the other drugs, once you all caught up in the life, you just in it. So you'll try whatever, you know? Meth, heroin, speedballs, all that."

Again, I said nothing. I mean, what could I say? Instead I just sat there pondering this quote from James Baldwin because that's what that last sentence made me think about.


"The most dangerous creation of any society is the man who has nothing to lose."

~ James Baldwin

Let me tell you. Some of the deepest truths I've learned about addiction have come from simply listening to the voices of my patients. Patients who have lived it or who are living through it. People like my Uncle Woody or like my patient who explained to me the real truth about how a crack addiction develops. And every time it is nothing like what I'd seen on television or heard through urban lore; the common thread being that this--the wretched monkey now perched upon their backs--was never, ever what was intended.

No it was not.

The sad truth is that there was little we could do for you without resources. I couldn't carefully place you into the open arms of an inpatient rehab facility nor could I hospitalize you until I could. Instead, the ball was placed into your court forcing you in your broken state to dribble down a full court and shoot.

You left before I could wish you luck. That ball before you turned out to be an airball. Your sheets were empty before I could even get back down to you.

I guess in my Pollyanna-ness I imagined this brief encounter as something more pivotal than it was. I pictured us plotting your comeback and me running into you somewhere looking robust and strong someday. And I swear to you, I believed that this could be your story. I did.

But as of today? This wasn't what was intended. The magnetic pull of your own back alley hospitals was greater than me and my scattered words of encouragement. In your mind, you had nothing to lose at this point--and maybe you were right.

I guess I just wish I could have convinced you of all you had to gain.

***
Hump Day, it is.

And now I'm crying because writing this made me think of a Grady angel who left in August of 2009--and now is making me hope this one won't be joining her in August of 2014.

Addiction sucks, man.