LOWHANGERZ

The one thing that was about to change drastically was that on July 1, 1986 I would be starting a career based on me helping people – people in need, sick people – people who trusted me and were looking to me for help, for life-saving help.  I know that it was an impossibility for me to put other’s needs before my own self-serving impulses.  The patient’s whose medical care was putinto my hands were definitely dealt a “bad card” in the game of life.  These patient’s needed Kings & Queens – they ended up getting a Joker. 

Bruce, now things will get real ugly real fast.  Remember those two waitresses’ from the Pontchartrain Hotel?  (The ones whose tables I sat at for dinner seven nights a week for five years while bribing them into giving me over $10,000 worth of food for a guaranteed $5 tip each time.)  Well Jenny ended up seducing me in the back seat - - - wait a minute – this is not the whole transcript of my letter to Cousin Brucie – that is for his eyes only, and for those who read the book.  These posts on the web site are to give you a glimpse into my life and what I went through growing up & living as a young adult.  While Jenny & Jacky are vital to the story, that is too involved for a brief internet chapter, so lets just get to May 1986, my graduation. 

It was supposed to be a happy time for me & my family.  I was not thinking about having survived Hepatitis B, an anal fissure, being left behind a year in med school, not having any real friends, and not being emotionally prepared for what would be required of me.  I was graduating and going off to become a surgeon and follow in the steps of my father.  I will have more to say about my dad.  My mother was real excited because now when the phone rang and someone asked for Dr. T, she could say “which one?”  My folks were real proud of me – my dad really enjoyed bumping into me at the hospital.  When I was on the surgical wards making rounds, all the nurses would giggle as they said “Aren’t you Dr. T’s son?”  The hours were long and being an intern, I was at the bottom of the pecking order.  I didn’t like being told what to do – especially by someone just a bit older than me and someone I thought was a real jerk.  It’s just amazing how as an intern I though I knew more than the senior residents and that I always had a better way of doing things.  I couldn’t see the big picture – that I was paying my dues for four years in order to learn my profession and have an unbelievable life for the next 35 years.  I was just a spoiled brat who didn’t want to be told what to do, didn’t want to work the long shifts, and still wanted to look good in the eyes of my superiors, and wanted to get high and cruise the streets of Manhattan for porno stores and street hustlers.

It was amazing that no matter where I was that I had the ability to sniff out those people in my life who could get me what I most wanted – drugs!  I befriended the super attendant of my building and lo and behold, he turned out to know a coke dealer.   The dealer, Angel, was married to one of the telephone operators  at the hospital.  I saw her daily and she had know idea of how many times I had been to her house and cooked up an 8-ball in her kitchen and smoked it in her living room with her husband why she worked the midnight shift.

During July, I managed to get to Manhattan once or twice a week. I hung out in the Village, Christopher Street, and the west side piers – seeking out the same type of guys that I had picked up for the last 5 years in New Orleans.  Being on the piers was a lot more dangerous than in the confines of a peep show – all types of guys mulled about and they were not interested in hustling sex for money – most of them were young guys strung out on crack looking to rip off anyone they could.  I had a few close encounters.  Remember, this was 1986 and the crack epidemic was just starting to become widespread, ushering in a new wave of society’s dregs.  I was one of them, but I wasn’t as bad as they were because I was a doctor… I was different.  It was this case of “terminal uniqueness” that has been (and continues to be) my Achilles heel.    Crack would end up being the one thing that changed my life forever.  I managed to cook up a batch of crack once in July.

In August, I did crack twice.  In September I was doing it every week, and by October I was doing it several times a week.  I developed my rituals – it was just as important to go through all the preparation and compulsive rituals as it was to smoke the shit.  The crack began to consume my existence.  I would be at the hospital for 5:30 am rounds, spend my days doing the general surgery internship grunt work, look to get out as early as possible, jog 4 miles, eat, and then sit down for a night of cooking up and smoking crack.  It was a very lonely, pathetic existence.  My apartment had a gas stove and I got to be an expert at mixing the coke & baking soda, cooking it & watching it bubble up, then heating the sides of the test tube & melting it down, and then adding just the right amount of water to cool it & make the opaque yellow blob solidify into a rock.  Then I would pour the rock onto the glass top coffee table and start to cut it up into perfect pieces.  The TV would be on and ignored, even when the channel went off the air and displayed the test pattern, that’s how it would remain until the station resumed programming at 5 am.  I would be consume with cutting up & smoking those crack rocks until 2 or 3 in the morning, knowing that I had to be at work at 5:30 am.  So I took valium at 1 am to make me “come down” so I would be able to sleep for an hour or two.  I had concerns about my heart – I knew that I had a bad aortic valve and I didn’t want my blood pressure or heart rate to get too high, so I also took Propanolol to block the cardiac effects of the crack.  I really had no idea what I was doing, but I kept doing it because there was not an approved protocol intended to allow crack smoking with minimal cardiac side effects.  There were plenty of nights that I didn’t sleep at all and just went right from an all night crack binge into the hospital.  I Love Lucy always came on at 5 am – if I was still up smoking crack and Lucy started, I knew it was going to be a long, miserable day ahead of me.   As I  mentioned, even though I did the grunt work, these tasks were vital for patient’s well being, and the tasks had to be competently performed.  My mental and physical states were definitely way impaired, but I was still out on the hospital floors to do my job.  This is where things get ugly & uglier.  There are a few incidents that stand out in my mind.

One afternoon I was told by a 2nd year resident to change a patient’s central line.  (A central line is a catheter that is inserted just below the clavicle into the subclavian vein and into the heart).  They have to be changed every week, and it was time for Mr. Davidson’s one-week old line to be changed.  Normally this is not a procedure for an intern, especially a crack-impaired intern, but I was told to change the line.  I was left in the room with a nurse – she told me that a guide wire must be placed in the old line, then the old line is pulled out leaving the guide wire in place, and finally a new line is placed in over the guide wire.  It seemed simple enough.  No one ever mentioned that the guide wire had a soft end (that was supposed to go in first, and just curl up inside the patient’s heart) and a stiff end which was to remain outside the body and be used as a guide for the new catheter to follow into the right position in the vein.  Well, you can guess what happened: I placed in the stiff end of the guide wire first and instead of just curling up in his heart, it pierced his ventricle.  The patient immediately went into cardiac tamponade (not a good thing) and turned blue and he was dead in 45 seconds.  A “code blue” was called and they tried to resuscitate Mr. Davidson, but he was gone.  What is real irony: he was recovering from a Whipple Procedure - that is one of the most complex, difficult abdominal surgeries known.  The survival rate is less than 30%, so here you have this 78 year old man who made it through a 14-hour operation, but he didn't even last 10-minutes with me.  The image of his face still haunts me in my dreams 23 years later.

There is more, a lot more, to come.  I need a break now to recollect my thoughts.  It only gets worse, a lot worse.