Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, March 24, 2010

The Truth

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!"

"Of course!"

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."

I waited.

"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!"

"Why not?"

"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.

"Thanks, doc."

"You're welcome," was all I could say as I watched him go.


At Wed Mar 24, 09:38:00 AM, Blogger rlbates said...

Terribly sad.

At Wed Mar 24, 11:01:00 AM, Blogger Bookhorde said...

That is so sad.
I hope he does talk about it to his friends.

Stupid way to die. They sound so young.

At Wed Mar 24, 12:06:00 PM, Anonymous ndenunz said...

How do you get through that one? So senseless. Yet you had to break the news.

At Wed Mar 24, 02:33:00 PM, Anonymous birdie23 said...

all I can say is wow, so sorry for his family. No drugs are safe for recreational use.

At Wed Mar 24, 03:42:00 PM, Blogger Unknown said...

Great post, Dino.
Reminds me of the phrase "if you kept this from happening to one other person, it was worth it" phrase.
Your advice was definitely "worth it."

At Wed Mar 24, 03:53:00 PM, Blogger RoseHelene said...

Thank you for sharing this. It sounds like this conversation was hard on both of you.

As a pre-med with thoughts of becoming a family doctor, it helps to hear what I might be getting into.

I teared up. Thank you.

At Wed Mar 24, 05:09:00 PM, Anonymous Anonymous said...

Very sad indeed. Not to be insensitive, but I wonder if he (or you) have seen the study:

Davis et al., Autism and developmental abnormalities in children with perinatal cocaine exposure, J Natl Med Assoc. 84, pp. 315-9 (1992)

The last line of the abstract says: The high rate of autistic disorders not known to occur in children exposed to alcohol or opiates alone suggests specific cocaine effects.

Makes you wonder if this tragic death isn't the only harm done since I doubt he started snorting after the child was born.

At Wed Mar 24, 11:08:00 PM, Blogger Luvei Viti (Children of Fiji) said...

Awesome sharing. It should be a wake up call!! 'Truth' matters.

At Thu Mar 25, 07:54:00 AM, Blogger StorytellERdoc said...

Great post, Dr. D. This is heartbreaking--did you have your suspicions? I was referred over to your blog for this post and it didn't disappoint. I also wrote about a mother of three using cocaine, with a little better outcome.

Sad, but well done post.

At Thu Mar 25, 08:33:00 AM, Anonymous Anonymous said...

Great post. This is very similar to a issue in our city. Last week a healthy man in his early forties died suddenly of necrotizing fasciitis. Many members of the public are worried about the apparently random nature of this horrible disease. Yet what has not been told is that he was a percocet addict. Without being judgmental about his drug usage, and knowing it seldom affects anybody without some underlying condition, I wonder how this information would alter the perceived risk of suddenly contracting it.

At Thu Mar 25, 09:37:00 AM, Anonymous Outrider said...

The younger sister of one of my high school classmates died similarly. She was only 20 years old.

At Thu Mar 25, 02:39:00 PM, Anonymous Anonymous said...

I was just told of the premature death long ago of the wife of a man now old alcoholic and dying of cancer. "It was awful she died so young, leaving her poor daughters to his shoddy care. She died of choking to death at night." I gently prodded the relative who was deifying her- "Was that really it? I mean, that's how ELVIS died."

"Well," it comes out, "She was off with her new boyfriend and they had been drinking...." Old Dad is a sinner but he was never married to a saint!

I also meet or hear of so many people- mostly patients- who had a stroke in their 30s or 40s. Is Alabama cerebral artery malfunction central, or are these poor pitiful folks just the small fraction who paid a price for their cocaine use? Well, my 30 year old MN cousin had one from a VSD- maybe these folks just don't get a full medical work up or tell me the whole story (no, they tell me an MD the whole medical story they aren't embarrassed about!).

At Fri Mar 26, 02:20:00 PM, Blogger Pies said...

While there is no consensus as to how much cocaine causes an overdose when taken trough the tissues in the nose, I think it's safe to say more than 1.5g.

A line made from 0.25g would be considered very long. Either he's lying, or you are.

At Fri Mar 26, 05:51:00 PM, Blogger Unknown said...

I'm going to have to call bullshit on this one.

I don't buy it.

At Fri Mar 26, 06:40:00 PM, Blogger #1 Dinosaur said...

The conversation is nearly verbatim. Multiple other identifying details have been changed/added/made up in the interest of confidentiality.

At Thu Apr 01, 10:03:00 AM, Blogger The Happy Hospitalist said...

I think he just lied to you.

At Tue Apr 13, 03:16:00 AM, Blogger Dr. Emer said...

Heart-rending and beautifully told.

Won't he be persecuted by the law if he tells the truth? If so, the outcome must be worse for their kid. She might be taken away by social services.


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