A couple of months ago, I got a call from a long-time patient, a man in his late 30s with an autistic five-year-old daughter.
"My wife died last week."
Obviously this was a shock; to us as well as to him. What happened?
"I have no idea. She got up out of bed, fell on the floor, and started seizing. By the time I called 911 and started CPR, I could tell she was gone. It was awful."
"Do they know why she died?" I asked.
"No," he answered. "They have no idea. They did an autopsy, but they said it could take up to twelve weeks to get all the toxicology reports back. They also said the only way I could get the results was through you. Will you please let me know as soon as you hear anything? This not knowing is terrible!"
I saw him a few times over the next few weeks. He was coping as well as could be expected. I tried to help as best I could.
Finally I got the results in the mail. I tore open the envelope and began reading. I sighed deeply when I saw the cause of death. Then I asked my staff to call the husband and invite him to come in to go over it in person.
I escorted him into an exam room and we sat down together.
"I didn't want to do this over the phone, because I wasn't sure what your reaction was going to be," I began.
"Was it an overdose?" he asked.
"Yes," I said. "Cocaine."
I watched him carefully.
"Are you surprised?" I asked.
"No," he answered. "I knew it."
He sighed, and the words began flowing like a torrent.
"We did it together. It was our thing; alone together in our room. Always after our daughter was safely asleep; our door was always closed. We did it once or twice a month. You always asked me and I always lied about it. We never shot up, or smoked crack; we were afraid of smoking crack. We only snorted it, so we thought it was safe. We were doing it together. She had just snorted a line, and she started gasping, like she couldn't breathe. But she'd done that before. Then she just fell off the bed and began seizing. And I knew."
He sighed another deep, shuddering sigh, and I passed him a tissue for the tears that had begun flowing.
"Why her? Why not me? I did twice as much of it as her. That's why she was doing that line so fast; I was getting greedy, and she wanted some."
"So what do I tell people?" he asked. "Help me. Make up a word."
"Why can't you tell them the truth?" I asked as gently as I could.
He looked horrified.
"I can't do that!"
"I wouldn't want people to judge her. Even though she's gone." He teared up again.
I considered my next words carefully.
"You know, maybe among your friends there's another couple, just like you, who's doing this too. You never told anyone, so maybe they aren't either. And maybe they feel safe, like you did, because they're 'just' snorting it, not shooting it up or smoking crack. And maybe if you came right out and told people what happened, they might think twice about doing it again. And maybe if you didn't, if you lied, or said it was 'indeterminate', maybe this might happen to one of them too."
He sighed again as he dabbed at his eyes.
"You know, you're right. Besides, if I start lying, I have to remember who I've told what. It's harder to keep them all straight, isn't it."
He straightened up.
"You're right. Fuck it. I'm just going to tell them. It sucks, but...what the hell. Yeah. I'll just tell the truth."
"Do you feel better?" I asked.
"Yeah," he said. "Yes, I do. Like a weight's been lifted."
He turned to me and shook my hand.
"You're welcome," was all I could say as I watched him go.