The Death of an Addict

June 17, 2015

As clinicians, we can only imagine what happens when patients terminate treatment. Thoughts from an addiction psychiatry fellow.

[[{"type":"media","view_mode":"media_crop","fid":"24455","attributes":{"alt":"opioid use disorder","class":"media-image media-image-right","id":"media_crop_2514394936226","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2114","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Claudia P. Rodriguez, MD","typeof":"foaf:Image"}}]]Introductory statement

Opioid use disorder has many faces. The face of the active user, who appears high and sedated, lost in a state of intoxication. There is the face of desperate withdrawal, recognized as individuals seeking immediate relief of symptoms. We see the face of recovery, that which is proud, yet careful. Finally, there is a face we aim to avoid, and fear most, that of overdose and death.

We can only imagine what happens when our patients terminate treatment. Many of us assume that relapse occurs and hope that someday the patient will return with greater readiness and motivation towards recovery. Unfortunately, many patients do not return. Some may die of an overdose.

In the consult/liaison setting, we may see the face of an overdose in an unstable patient, where family serves as a primary source of information. It is in talking with the family that one recognizes addiction as an illness that extends far beyond the individual. Parents and siblings live with the pain and suffering of their loved one. Feelings of guilt, shame, and fear reside in them as well.

When loss occurs, there is not a sigh of relief, but rather a sense of helplessness, sadness, and multiple “what ifs.” As clinicians, we too, process these thoughts and emotions. Importantly, we must appreciate the individual, rather than focus on the addiction itself. Every person struggling with addiction has a valuable story.  

As an addiction psychiatry fellow, I shared my silent doubts with the patient’s mother and cousins, and thereafter, wrote this in his memory.

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The Death of an Addict

I met him–
Intubated, sedated, motionless, and swollen.
His eyes shut and he, surrendered,
Embodied in defeat of an addiction that now lay still–
Attached to life like a puppet,
Through lines and tubes that carried fluids through his veins
And oxygen through his lungs and his body.

I knew him–
Not now, not as my patient, but as echoes of stories in my past.
I recognized the story of a person living a broken life,
Hanging on by lines that carried heroin through his veins,
Allowing for an absent existence of
Scheming, feening, using, [barely] breathing.

And then I saw him–
His life, his struggles, his anger, and his hurt
Through the eyes of his mother.
She could not accept this awful disaster.
She sat across from me, tearing,
Looking to me for answers.
She asked for hope and strength.
She wanted forgiveness and relief, but more than anything,
She wanted her addict.

That’s when I noticed me.
I could not offer any of it.
It was a disaster.
The fear was palpable,
And his death, came thereafter.

I knew she’d suffered through years of distress, angst, and fear,
Of the very situation that brought her, today, here.
I felt relief, for her, for a moment,
Though quickly realized how worthy, to her,
Was the life of this addict–

And as soon as he took his last breath,
A hole was left in the middle of her chest.
For despite the pain, the tears, and the struggles,
In moments of health, he was close to his mother–
And the hope of recovery far surpassed the pain,
So that living with his addiction,
was much easier than surviving with his death.

Disclosures:

Dr Rodriquez is a Fellow in Addiction Psychiatry at Boston University Medical Center.