To Walk a Meth-Mile in Her Shoes

People who are labeled the “dregs of society” seldom fret about the dregs of society the way those, who aren’t dregs, do.” –Ralph Ebe

Stephanie and I had grown up together, our houses separated by an easily climbable chain link fence. We were both born at Boston Medical Center during the fashionable phase of care, before epidurals were invented, in which our mothers were given “twilight sleep” and then were delivered of their babies—that is, us—using forceps. Fernand Lamaze would turn over in his grave.

Nothing indicated we had been forceps babies. We both excelled at the same school with other children whose birth techniques remained a mystery. We were both breastfed for 16 months, but we couldn’t tell what kids hadn’t. We each had two parents, as well as uncles and aunts. We each had two siblings, a little brother and a littler sister who were about the same age. Ours was apparently a community of synced pheromones, waxing and waning according to some mysterious neighborhood algorithm involving radon, tidal gravity, or perhaps even sanctifying grace. (Stephanie and I were both Catholic, studied the same catechism, and had the same guilt infrastructure in place). We got the same grades, won the same extracurricular and academic awards, and were probably quantumly entangled.

Until high school, when we each went to a Catholic high school exclusive to my and her gender. Besides gender and, now, high school, the only difference between us was that I had always wanted to be a doctor, and she had always wanted to be a good Catholic.

We remained close during those years, dated, and even dipped into the bodily fleshpool a bit, but never went all the way. She was a good fire-and-brimstone prude and I was scared of venereal diseases and pregnancy; and of her father. After all, I had plans.

“You can’t get VD if I’m a virgin, too, stupid,” she said.

“I like the way you think,” I replied.

Homework together in her room or mine became a non-issue for both sets of parents, since we had done that since the fifth grade, but the grade levels weren’t the only things that had changed. Like the sure-thing tip on a hot horse, the surging hormones invited me, implicit with my self-appraised status of being sexually underserved. So, I fell victim to a mutual denials between my encouraging hormones and the diseases, pregnancies, and fathers that only happened to others.

“No, but I can get pregnant,” she added. “That’s when my father kills you. Better to get VD, because he’s a Teamster.”

“A Catholic Teamster,” I clarified.

“Teamster first,” she said. “I could never tell him I was pregnant, well, not until Sunday, when he’s a Catholic again. But, then I guess the priest would kill you.”

“I don’t think they’re allowed to do that.”

“They’re allowed to on Sundays. They’re Jesus on Sundays.”

“Today’s Saturday,” I pointed out. She laughed. “How come you’re not on the pill yet?” I pressed her.

“Are you kidding? Dad would kill me.”

“I guess if you get pregnant, we should just kill him, right?”

“Over my dead body,” she vowed.

“This is getting way too complicated. Can’t we just trust the crystal ball and, well…we had promised that when the time came, we would lose our virginity to each other. You remember that, right?”

“Yea, when the time came,” she said. “And it’s not tonight.”

“Prom?” I asked.

“Oh, that’s so spontaneous and romantic. You want an appointment? Should I pencil you in?”

There is a term in Catholicism called “the near occasion of sin.” The Church recognized that if you sin because you can’t help it, it probably isn’t a sin; but if you put yourself knowingly into a position where you will risk not helping it—then that’s the sin. That tenuous zone, open to interpretation, is the near occasion of sin.

“No appointment,” I said. “Let’s just put ourselves in the near occasion of sin and see what happens."

“For Prom,” she pointed out.

“Yea,” I said, “for Prom.”

“You haven’t asked me yet.”

“Of course! Will you, Stephanie, go to Prom with me?”

“Whose? Yours or mine?

“Both.”

“And which one is the one?”

“I was hoping maybe both.”

“Poor baby. You’re here all hot and bothered—the only one ready—and I’m the party pooper.”

I remained silent, seeing a glimmer of hope in her smiley eyes and hoping this thing could turn around yet. When it didn’t, I surrendered. We were nowhere near any occasion, of sin or otherwise.

“Look,” she offered, sex is too important. It’s not just putting Tab A into Slot B.”

“Again, I like the way you think.”

“It’s communion, the forging of a completely new, composite being, so it’s holy.” I put Tab A away dutifully.

Truth be told, we really had pledged to lose our virginity to each other. When the time came.

That time never came which, as a male, meant being cheated my opportunity for a free and easy sexual encounter—all the way, mind you—at a time when accomplishing this was neither free nor easy. I couldn’t understand this tragic miss, because I had already gotten through the hard part—her agreeing to sex with me; the timing, it seemed, should have just followed. It didn’t.

I’ve often wondered to whom she did lose her virginity. I’m not jealous, just resentful, because it should have been me—should’ve been mine. I owned it. It was my unopened package at the bottom of the Christmas tree. I could only hope that hers went as unpredictably and awkwardly as mine had gone. They’re all like that the very first time, aren’t they? The gift wrapping all ripped up and lying tattered on the floor, the toy that can't be fixed--forever broken.

By senior year, attrition wrecked our broken plans originally woven out of gossamer, and we drifted apart according to fair-weather lures of newfound social circles. I had heard she went to her prom with the singer of the very band who had performed for it, so she danced alone. I wondered if she lost it at her prom.

I missed my own prom because of strep throat. Streptococcus made the sour grapes of my missed rite of passage taste a little less bitter in my mouth.

We both had impressive grades in high school, and we were both accepted into universities, 1500 miles and two whole time zones apart. We wrote letters until email made such thing passé. After that, our communications suffered from the dreaded “poverty of speech” that barely held together truncated relationships which dangled by just a verb or an abbreviation. Our communication line finally snapped.

Was I over her? She was a beauty, but so is anyone who is 18-years-old, until they’re ravaged by age, obesity, the slings and arrows of outrageous fortune, or just the consequences of bad choices. In my indelibly inked mind’s eye, she was still angelically faced, muscularly sinewy and lean, twinkly and smiley-eyed, and just pouring out with excited enthusiasm for every micromoment of her day. But, yes, I believe I was over her.

Still, I wonder what would have happened had we not gone in two different compass directions for our educations. The fantasies, the plans, the expectations of our young, open, and pioneering minds—would they have been realized? Maybe. Perhaps a few of them?

In college I was pre-med, as were 60% of my entering freshman college class. By senior year, only 4% of our class were still pre-med. By the next year, only 1% of us were actually in medical school. I went as an out-of-state student to LSU School of Medicine in Shreveport, Louisiana, which is really in Texas, for all practical purposes. After my second year, I was granted the opportunity to switch to the LSU in New Orleans which, for all practical purposes, isn’t really in the South.

I remember a particular lecture from a visiting professor of Emergency Medicine. He explained that you can always predict what the next drug-fueled societal calamity would be in the United States by looking at what was happening in Japan in the present. I was curious.

“What is the drug problem in Japan right now, sir?” I asked.

It was rude, because I had interrupted him; but he was gracious and answered. He didn’t say, exactly, “crack,” but it was whatever crack was back then. By the time I applied to residency programs, crack was all over New Orleans, consumed by those who not only didn’t care whether you died when they mugged you, but didn’t even care if they died. The guns didn’t help, certainly. By senior year, both crack cocaine and I prepared to seek our destinies.

I had decided I wanted to be an Emergency Medicine doctor. I was accepted by Boston Medical Center’s Department of Emergency Medicine. I remember well my personal statement I had sent to them when I had applied:

For me, the Emergency Room is a special place, because it is the final resting place of consequences. Not only the accidents that come from being in the wrong place at the wrong time, but the bad diet and sedentary lifestyles that doom the physiology, foolish stunts and senseless risks that imperil the body’s integrity and structure, and poor life choices—their victims all ending up needing help for problems bigger than them. And this is probably why such things get to that point—the lure toward such maleficence was too powerful to resist. In any event, they’re at a point where they need help beyond that of which they are capable. As an Emergency Department physician, I become their steward, to mend them, perhaps fix the problems that got them there, and hopefully educate them so that I never see them again. This is not their gift to me; this is their gift to me—an honor entrusted to the very few. Although a real doctor learns to accept that he or she cannot fix everyone, were it another’s responsibility, the outcome may have been worse: at the end of each endless day, when I tally what I had done, the fact that it was my responsibility that oversaw such people to the best of my abilities is a feeling like no other. It's not hubris; it’s love, and without it no real doctor has any business practicing medicine. This is the passion I want to bring to my rotation and to the specialty into which I venture.

Whoever sat in judgment of such Admission Committee fodder loved it. A quick weekend trip was enough to establish a place to live, within walking distance to the hospital, and I was all set to report to my first rotation in the Emergency Room on July 1, the most dangerous day of the entire year in medicine—when shiny, new MDs with no unsupervised experience were thrown, unsupervised, at those who would have fared better on June 30, the safest day of the entire year in medicine. I defiantly said Bring it on! This is me. A real doctor. My call, my vocation, my destiny. I was ready, grandiose, and pompous.

Rotations of 12-hour shifts began on the 7s, so by 6:00 AM I was walking along Massachusetts Avenue toward the medical center. It was only a ten-minute walk, but I wanted to get there with enough time to have a cup of coffee and perhaps meet some of my equally inexperienced doctors, ready to assume stewardship of those for whom July 1 seemed no different from any other day in the calendar.

My walk on Mass Avenue, toward the corner of Melnea Cass Boulevard, was stymied by persons with substance abuse issues whose dispositions were not keen on yielding politely. “Mass and Cass” represented a zone of homeless, addicted, underserved, and abused individuals foretold by the same scourge in Japan years earlier. They endured, between their visits to methadone clinics, homeless shelters, and drug treatment centers, in their ramshackle tents.

My walk was like entering an enchanted forest; true, there may be an augmented degree of adventure the deeper I journey, but it can also rain upon you a progressive accruing of menace and danger, from those who didn’t care whether they died, and also didn’t even care if they died. The farther I went, navigating my zigzags through this human heap of desperation, the more frightened I became. I witnessed active drug deals involving cash for pills, patches, vials, and needles.

I wasn’t really looking at anyone as I walked; I had my tunnel vision on, avoiding eye contact, my destination the horizon, as my only vantage reference point, like an actor performing to the “fourth wall,” far in the distance. Some eyes, it seems, can hook you.

A woman, easily 20-30 years older than me, flashed smiley eyes reminiscent of my childhood Stephanie. They were the only things on her that rang that particular bell, because she was so different otherwise—pale, emaciated, slightly stumbling in her gait. Obviously ravaged by age and the traditional nemeses of any 18-year-old: the slings and arrows and consequences of bad choices. All of this poor woman’s micromoments, originally slated for celebration, had blurred into the last throes of survival. I watched her stagger toward me but, to my relief, she was aiming past me, not at me.

We crossed paths and that was that. A closer examination as she passed revealed a haggard woman, impossible to age and life-exhausted. She had cutoff shorts that were too tight, but which revealed that the track marks were not exclusive to her arms. Yet her eyes twinkled, but not as much as I remembered Stephanie’s because of the dilated pupils and jerky movements of them. Japan’s troubles of yesterday were alive and well in this woman’s eyes.

It was emotionally exhausting. Although I hadn’t been to Mass in years, I found myself offering Catholic prayers as I passed, because I had nothing else to give them. Hail Mary’s, Our Fathers, and Glory Bes. Hell, if I were able, I would have hauled novenas at them. Self-reflecting on my faith, I realized I was not qualified to pray for anyone.

I would take a taxi next time, if they’d be willing to go this way.

My first official duty was to attend a briefing—how to be a real doctor—a 10-minute primer:

Use this suture for lacerations; use that antibiotic for punctures or dog bites. Give anyone with hypoglycemia dextrose IV until the Internal Medicine resident came. Put restraints on anyone combative until the Psych resident came. Use these settings on the defibrillator until the ECG gets read. Epinephrine sub-Q for anyone wheezing. Put a tube in every orifice before consulting the Surgery resident; no narcotics for anyone.

We all scribbled furiously, although it was mostly common sense.

“Go report to the ER and ask the Chief Resident to assign you a patient,” the elderly doctor briefing us said. Then, with his back to us as he left, added, “When in doubt, ask. You’ll be a real doctor when you don’t have to ask questions.” He yelled back to us more loudly the farther down the hall he went, “And if you don’t feel you need to ask any questions right now, here on July 1, please tell us, because we’ll make sure you won’t ever be a real doctor.”

I managed a question for every patient I saw, even if I knew the answer. “Treat ’em and street ’em” was the protocol. For the others, the consulted residents would take them away to their respective services. In the meantime, there was my stewardship, in full glory.

It was a revolving door, and I was lucky enough that my passengers went smoothly with its torque. At one point, my collection of patients had reached zero, and I decided I should try to hide if I wanted to get anything to eat. I salivated over my brown bag lunch, sitting in a cubby hole, hopefully not stolen. Like a heat-seeking missile, I made a beeline for it, but my run for the gold was thwarted.

“Room 8,” the resident said. “Meth Mile patient in bad shape. Really yellow. Watch out, she’s a spitter.”

I masked, goggled, and gloved myself. I opened the door a crack and peaked in. No spitting. At least not yet. I stepped all the way in and I saw that same woman I had passed on Meth Mile. Indeed, she was much yellower than I had realized. No smiles in these eyes, only a buttery hue to the whites of them. Still pinpoint, they looked right at me.

“You my doctor, now?” she asked. Her voice was raspy from 40 pack-years of smoking crammed into only a decade.

“Right now, yes,” I answered.

“Good,” she said. “You’re just my type.” This threw me off a bit.

“How’s that?” I asked.

“You just know it, don’tcha?”

“Well, there are things I need to know about you—besides that.”

“Sure.”

I looked through my notes for her demographic intake sheet and looked back up to ask her a question, but she was asleep. Her sickly eyes were closed, closing her windows to the world, and with that, her brow unfurrowed, her face unfolded from the anticipation, apprehension, or bitterness; her jaw unclenched. I was able to see the child in her, even though she semmed middle aged. Her disastrous life was swaddled in respite, visiting another place, hopefully dodging the very things that landed her here in Room 8.

“Cheyenne? Cheyenne Skye,” I asked. She started, then reposed when she saw me again. “What brings you here?”

It was a rhetorical question. Her intravenous drug abuse had brought her here; her hepatitis, her HIV+ status, her malnutrition, and her addictions had all brought her here.

“I need a bump,” she answered.

“Excuse me?”

“A bump. A dose, a hit, a fix, ’cause I’m going down…” she began in singsong, “down to the pits that I left uptown…I need a fix ’cause I’m going dow-dow-down.”

She smiled, but it was a smile of self-irony—of resignation. It was the smile given when there’s nothing else left to give. And it was a plea as well.

“First, Ms. Skye—”

“Cheyenne,” she mumbled, but not to me—for me to catch.

“First, Cheyenne,” I continued, I’m going to have to draw some blood, I’m afraid.”

“Go ’head,” she agreed. “Not afraid of needles,” she laughed, whether this was funny or not.

“Good. Let me wrap this around your upper arm and lay it down here.” I applied the rubber hose tourniquet and looked her arm over. “Should I even try here?” I asked, looking at the gridiron crease in her mid-arm.

“Those ships have sailed, Doc,” she said. “Here, I’m gonna show you Ol’ Faithful, but you gotta promise you won’t tell anyone else.”

“Top secret,” I said.

She slapped the inside of her lower arm and there appeared a sinuous tract, complete with knobby valves. I ran my finger along it upwards, and it collapsed, indicating patency; I released my pinch on it below my little test and it refilled.

“Looks good, Cheyenne,” I said.

“Something on me that looks good,” she huffed sarcastically. I had no answer because she made a good point. “Cheyenne’s my stripper name.”

“Oh. What’s your real name, then?”

“Stephanie,” she answered.

Couldn't be was the fastened door whose locks and tumblers started fumbling loudly. I studied her carefully. Could it? Malnutrition, drug abuse, disease, emotional collapse, and a failing liver meant she could be anybody.

I swabbed the area with alcohol and it glistened, beckoningly. “Yea,” she said, “I should do that with the alcohol, too, I guess.”

I uncapped the needle and connected a vacuum tube to the syringe’s end, but not enough for the needle to penetrate it and establish a suction yet. For that I needed penetration into her vein. She crooked her neck up to watch as I placed the needle right over her skin for the thrust, and I saw a different type of look come over her face—not wan, forlorn, no longer desperate—a lover’s look, but twisted by passion. “Doc,” she said seductively.”

“Yes?”

“Make it feel like a good…like a good fuck.”

It wasn’t romantic, but it must have worked for her, for now her face showed absolute pleasure. “That was so…good. You’re the best. See? I told you.”

“Told me what?”

“You’re my type,” she answered. “We just had to put ourselves in the near occasion of sin, that’s all. After that, it ain’t a sin, right? That’s how I always go about it. Helps with all that guilt. I thank the guy who told me that all the time.”

“No, don’t,” I cautioned. “It’s bad advice.”

“What about for me? Not for me.” She sat up halfway in a pose, allowing the wardrobe malfunction hospital gowns were prone to suffer. I reached over and pulled one side of it toward the other, reducing her exposure and spurning her invitation.

“Sorry,” I said. “That time won’t come. I’m going to send in another doctor, now. Someone not your type. But know this, Cheyenne, sex isn’t just penetration. It’s not just putting Tab A into Slot B. It’s communion, the forging of a composite being, so it’s holy.”

“It’s Stephanie, Doc, not Cheyenne” she said sternly. As I turned to leave the room she spat at me, and I felt her spittle strike my white coat from behind.

We each had had our masks, preventing recognition—mine an N95, and hers, malnutrition, drug abuse, disease, emotional collapse, a failing liver, and the pock marks on her soul from the slings and arrows of outrageous fortune. Her mask had fallen, but mine kept me safely anonymous.

I was decimated with a type of pain I had never felt before. Empathy is one thing, but when it’s to the point of sharing a person’s total surrender, there is no rip in the world more treacherous—a one-way trip into the black hole. Some problems are bigger than you, once you’re past the event horizon. Hers was bigger than me. Here in Room 8 was a final resting place of consequences and poor life choices.

I had failed: I was a bad steward, unable to mend her, fix her problems, or educate her. This honor of stewardship—the doctor’s calling—was no gift but a trap from which there was no return. I would either escape it or die in it.

To this day I wonder how the outcome might have been different for her, had the responsibility of her stewardship been assigned to someone else. That night, at the end of my first day as an Emergency Room doctor, when I tallied what I had done, I had a feeling that blindsided me. It was antithesis to the passion I so eloquently had offered in my application personal statement.

Newly etched in my lifestone were two things I knew for certain:

I wasn’t over her; and—

I would never be a real doctor until I was.