When you need help, really need help, you’ll take it wherever you can get it.
It had been almost two months since our initial visit with the transplant team, when they’d unexpectedly advised us that a liver transplant was not just the next step, but the only remaining step available. John had subsequently, spectacularly, failed tox screens for both alcohol and pot. And instead of being fast-tracked for the transplant list, so I could be reviewed for donation, the team told us they wouldn’t do anything until he was seeing a substance abuse counselor. Steps vital to survival were suddenly, maddeningly, on hold.
He didn’t want to do it, to go to a counselor. He told me, standing there in our kitchen, that it would be easier to just let him die. He’d prefer it.
It was his first explicitly suicidal expression.
I’ve never been punched in the gut, but I suspect this duplicated the sensation nicely. I bent double and slid down to the floor, because standing was incompatible with the kind of crying I was doing, the kind that comes from your stomach and feels more like shedding your last meal through your eyes, rather than mere tears.
I think that kind of crying frightened him, and he told me he didn’t mean it, that he’d go to counselling if I could find someone.
So, once I was able to resume an upright position, my mission was clear.
I got several referrals from a friend, and when this particular substance abuse counselor finally called me back (calls to two others remaining unanswered), I fully engaged the grappling hooks. How soon can you see us? It was soon enough for me to see a brief light at the end of the tunnel, and I was too desperate and grateful to recognize any manner of oncoming train.
Since then, though, a thought has occurred to me. Some people are not good at their jobs. That’s a fact of life. With some jobs, if someone’s bad at them, it’s an inconvenience. Your eggs and bread get bagged at the bottom under the gallon of milk. But some jobs sit at the gateway between life and death. If someone is bad at these jobs, you’re going to end up with way worse than a mangled loaf of bread or broken eggs.
Perhaps it’s an uncharitable thought.
In that first phone call, I’d explained John’s particular circumstances to her. We could see her soon, which meant we could resume the basic tasks required for not letting John die, and I was welcome to come for the first appointment. Things were looking up all around.
We arrived at her office in an ugly area of town, and struggled to find parking. We waited at her office door, down on the street, having gotten her text that she was running a bit late and having trouble finding a parking spot herself.
She finally met us at the door: beautiful, energetic, enthusiastic, and casual, with tattoos running up her arms, ink the same color as her long, dark hair. I liked her immediately. Gratefully and desperately.
We settled into her office, with its strange smell, whiteboard and markers, wildly mismatched furniture and slightly lumpy seat cushions. She maintained her energetic, enthusiastic and casual demeanor, but warning bells started to go off. There were three in a row in just that first hour.
#1: “You can’t trust western medicine.”
That first “yikes” was a big one.
She said this, within the first ten minutes of our session, without a whiff of hesitation, to a man who was going to die without a liver transplant. I don’t refer to western medicine as the “medical-industrial complex” because I love it, or because I think it’s doing a particularly wonderful job at many crucial things, but by this point I’d spent enough time taking care of this desperately ill man not to think that we just needed some macrobiotics and acupuncture. Considering the fact that I’d been struggling to get him to take the basic meds he needed to keep from getting irreversible brain damage from the hepatic encephalopathy and going into a coma, this seemed like a uniquely unfortunate thing to say, until she followed it up with:
#2: “You should try medical marijuana for your anxiety.”
Oh, my god, what? We’re literally here because he can’t stop failing tox screens!
I wasn’t as well-versed in effective recovery methods as I am now, but the “least-harm” notion of replacing one addiction with another was definitely not going to work in this situation. I was stunned at the suggestion.
(Fortunately, the local medical marijuana industry had a better grasp of the ins and outs of treating transplant patients. John, unsurprisingly, insisted on pursuing this avenue, and a trip to the nearest dispensary ended in us getting summarily and almost embarrassingly kicked out, with vexed comments and insinuations that they would certainly NOT approve him for marijuana use without the explicit approval of his transplant team because it would surely keep him from getting listed, didn’t we know that, what the hell was wrong with us, could we please stop wasting their time like drug-addled punk-ass thugs?
Of course, I was the one who’d mentioned, or let slip about, the transplant in the first place. John was quietly furious with me. He was just following his substance abuse counselor’s advice…)
Back at this first session, John had finally rejoined us after a panic attack so severe he’d had to excuse himself for many long minutes to vomit. Keeping to her energetic, enthusiastic, seemingly increasingly oblivious form, she exclaimed, a propos of literally nothing:
#3: “What you guys need is date night!”
By this point, all I could think is, damn, girl, you’ve really gotta read the room. My husband is roughly the color and shape of Homer Simpson from liver failure, and has just finished puking his guts up in your bathroom from unchecked anxiety. I’m not sure dinner and a movie is the next logical step. It felt like being homeless, and having a clean, well-fed person with a Gucci bag walk up to you and blurt brightly into your filthy, tired, hungry face, “What you need is a house!”
I think this was the point that I realized she had a rap, a patter, a list of points and suggestions that she considered uniformly appropriate for all situations. In fairness, we have all observed the similarities, the patterns, the templates, in substance abuse. Given that, it’s really easy to lose sight of the individual, and their separate circumstances. Alcoholics don’t all fall out of the same cookie cutter, and they aren’t all at the same point in their addictions.
Some are literally dying, and soon.
After that first session, I called her and asked her straight up if, after meeting us, she was sure she was qualified to help John. Her answer came in pretty hot: she assured me she was a professional, and that if she had any doubt on that matter, she’d be the first to say so, and to suggest someone else.
A surprise for many who think they know me: I don’t really care for challenging authority figures. And much to my chagrin, I seem to assign authority easily. So I took her at her word, despite my disquiet, and sent her information about hepatic encephalopathy, which she’d never heard of.
Most subsequent sessions were just she and John, and he seemed to thrive in his first-ever counseling experience. There were a couple that I went to, for various reasons, and there were a couple of things that came up, that didn’t properly haunt me until much, much later.
#4: “So often the real problem is the wife.”
I remember her saying this with great conviction. If only the men coming to her for help were in better home situations, they’d be able to kick this thing.
At first I passed the spouse test with flying colors. I wasn’t just okay with him quitting drinking; I’d quit myself. I wasn’t just supportive of him getting help; I made it happen.
But things change, as they are wont to do.
(I remember the first time John told me that it was my fault that he was an alcoholic. I’d come far enough to know that it wasn’t true, but fuck me if I didn’t spend the rest of that night googling “is my husband’s alcoholism my fault?” (I note for the record that all I had to type were the first four words. Google helpfully auto-filled “my fault” as the first option, a testament to the search habits of wives of alcoholics, and to the things they are being told in their most vulnerable states.) I didn’t even do it because I thought it was my fault, but because merely knowing it wasn’t enough. I had to see it in (someone else’s) writing.)
Interestingly, John had been seeing his substance abuse counselor for about six months when she made an amazing declaration.
#5: “You’re not really an alcoholic.”
At the time, this was a huge relief to hear from a professional, despite all evidence to the contrary. Yes, John had cirrhosis and was going to die without a liver transplant. But he didn’t exhibit any of the classic obsessive behaviors of an alcoholic, he didn’t talk like an alcoholic, he didn’t act like an alcoholic, he was different: ergo, in her professional opinion, not an alcoholic. Perhaps he had some unfortunate hereditary tendency to liver disease?
John certainly took this to heart.
However, she did eventually recant this assessment.
Whatever the status of his other addictions is or isn’t, I watch as he becomes addicted to his substance abuse counselor.
We’re struggling to keep intimacy alive, and he tells me, “You should get more tattoos. That would be so sexy.” I think of her, with ink the color of her long, dark hair running up and down her arms. I don’t say anything. And I come dangerously close to doing it.
I’m trying to communicate with him, and he tells me, “I can’t talk to you. I need to talk to her. She’s the only one who understands me.” He goes on to add that she says I’m not capable of getting the help for myself that I need, that I’m not willing to open myself up to it, and that there’s no love in our house. I don’t know if it’s true that she’s said these things. He’s what you’d call an unreliable narrator at the best of times.
When I finally find him passed out with beer, the first time it happens after the surgery, she’s the first person I contact. I text her pictures of everything I find: full bottles, empty cans, receipts from the bar, including one from a day that he’d cancelled an appointment with her because he’d been “tired.”
I call her and she talks to me from the road, on her way home to see her sick father, her kids in the car with her. We make an appointment for the three of us to meet when she returns, and she tells me, “Take care of you.”
When we finally meet, she tells us that she’s told her husband, who’s also a counselor, that her liver transplant patient relapsed. She tells us that he chided her for being surprised. It didn’t surprise him at all. When I talk about what I found in the house, I mention a flask in John’s underwear drawer that was half-full of whiskey, that I dumped out. He seems so surprised, and protests that he didn’t even know about that. I tell him that I believe him, because I do. She looks at me, and says,
“You can’t trust him.”
She was telling me something big and true, that I struggled to get my head around at the time. But she was telling me something personal, too.
I’m not saying that, after everything that happened, I never considered tossing a Molotov cocktail through her living room window, or at least contacting some credentialing agencies in my less felonious moods.
It occurs to me, though, that this is a thankless job, and a heartbreaking one. One that is probably very hard to feel like you’re any good at at all, as handfuls of your clients slide slowly off your calendar, out of your sphere of influence, some to jail, some to the endless haze of addiction, some to unnaturally early final rests. Some you’ll never even know what becomes of them. And some you’ll be certain.
She thought she’d gotten through to him. And he fooled her.
He broke her heart.
That makes us kin, right? She’s someone I share that blistering sense of shock and despair with. A load borne across many shoulders can’t help but become lighter.
I felt a terrible empathy for her in that moment she told me I couldn’t trust him. “Why do you do this?” I asked, meaning the counseling.
“I might get through to one person. If that’s all, it’s worth it.”
She is right about that. I wish her luck.
If you love or loved an alcoholic, we hope you’ll find some of the healing you deserve in our Echoes of Recovery program.