 It's
not one of my Portland days, but the work won't leave
me alone. Susan, our health coordinator, rings me on
my cell, sounding exasperated: "Mr Grant is back here
at the hotel. What should we do?" I stifle a profanity.
I have no patience for treating addiction today; I'm
supposed to be at home, writing a book about it.
"Mr Grant" is Gary, a barrel-bellied,
grey-bearded bear of a man, with HIV and diabetes —
both risk factors for infection. Neither condition deters
him from injecting any accessible vein in his foot with
cocaine. His upper-arm vessels are too scarred and corroded
by chemicals to serve. A large ulcer is eroding his
right big toe, its black base oozing with the breakdown
products of dead flesh. For two weeks we'd been urging
Gary to accept hospitalization, since it was still possible
that intravenous antibiotics could save his toe. "Yes,
tomorrow," he'd say. But tomorrow never came.
Four days ago, late on Friday evening,
I sought him out in his eighth-floor room. The homecare
nurses treating the wound had called in desperation:
"Would you commit him on mental health grounds?" Loath
to use that ultimate weapon on someone in no way psychotic
— just addicted — I promised to see what I
could do. I was prepared to pull out the pink slip of
involuntary committal, but only as a final resort.
Gary had just come in from scoring
a deal. Like many in the Downtown Eastside, he supports
his habit with what his long-time friend Stevie once
mockingly called "a self-initiated, self-organized marketing
endeavour." He makes just enough to keep himself in
his substances of choice. Only two weeks before, Stevie
had died of liver cancer. Gary had been very close to
her — "a fellowship of free trade advocates" in
Stevie's words. Intensely distressed by Stevie's demise,
Gary had been on an extended cocaine binge since her
death.
"Everybody's worried about you,
Gary," I said. "That's why I'm here."
"Well, I'm worried about me, too."
Just then Kenyon appeared in the doorway, leaning on
his cane. "Got any crystal, Gary?" he asked in his keening
voice, slurring his words and seemingly oblivious of
my presence. "Fuck off, you idiot. Can't you see the
doctor's here?" "Okay," Kenyon replied, soothingly,
as if humouring an obstreperous little child. "I'll
be back." He hobbled off, the tap-tap of his wooden
cane on cement echoing away down the hall.
"You could lose your foot," I resumed.
"The gangrene is spreading." "I can see that. If you
tell me I have to go to hospital, I will." "I appreciate
your confidence in my opinion. I only wish I could be
equally confident in your capacity to fulfill your intentions,
honourable as they are." The bite in my tone is deliberate.
"You promised the same last week, and since then the
ulcer has doubled in size. Will you go tonight?" "Ah,
not on a Friday night. I'll be in Emerg until the morning.
Tomorrow." "Gary, I hate to even say this, but if by
tomorrow at eleven a.m. you haven't left for the ER,
I'm going to declare you mentally incompetent and commit
you on the grounds that you're endangering your own
health. You want the truth of it? I don't think for
a minute you're crazy, but you're acting crazy. So I'll
do it."
It's the same line I'd used on
Devon a few months back when he'd refused treatment
for a spinal abscess that could have left him quadriplegic.
I rarely resort to such threats, as I find them ethically
unjustifiable and, for the most part, valueless in practice.
I did hospitalize Devon under duress, however, and he's
thanked me for that since, many times over.
Next morning Gary did get himself
to hospital, only to be discharged with an ineffective
antibiotic. The hotel staff had not called me in time,
and I'd had no opportunity to communicate with the ER
physician. Arranging Gary's admission and linking him
up with the appropriate specialists had been Sunday's
work. And now, on Tuesday, he'd absconded from the HIV
ward and fled back to the Portland. He'd passed the
point of antibiotic salvage. Toe amputation was scheduled
for Wednesday.
Although it's my mid-week writing
morning, Susan believes Gary's situation is too delicate
for the doctor who's filling in for me. I agree to drop
in and, if compelled, to play the pink-slip card. I
hear Susan's voice soften in relief. Heading downtown,
I'm thrown a curveball by the addicted voice in my own
head."Sikora's? Just for a minute?" No, I tell myself,
tempted as I am,that would be impossible to justify.
I arrive at the Portland to find that Gary, mercifully,
has returned to hospital in the nick of time, just before
he would have lost his bed. Good, I think to myself.
I'm tired of having to drag people to healing by the
scruff of their neck. With that, I drive away from the
Downtown Eastside, that woeful planet of drug users
and dealers who hustle, grind, cheat and manipulate
24/7 to feed their habits.
I'm on my way to St Paul's Hospital,
where, in addition to my Portland work, I provide medical
care to psychiatric inpatients. I take my usual route:
exit the Portland parking garage, left out of the alley
onto Abbott, right onto Pender. Two blocks past Abbott,
my pulse quickens as I approach Sikora's — without
doubt one of the world's great classical music stores.
Agitating my mind and body are
thoughts of a CD of operatic favourites by the tenor
Rolando Villazón. I listened to selections yesterday
when I went to the store to pay off my latest debt,
but resisted the urge to purchase. Today it's clamouring
for me to return and pick it up. I must have it and
I must have it now. The desire first arises as a thought
and rapidly transforms itself into a concrete object
in my mind, with a weight and a pull. It generates an
irresistible gravitational field. The tension is relieved
only when I succumb. An hour later, I leave Sikora's
with the Villazón disc and several others. Hello,
my name is Gabor, and I am a compulsive classical music
shopper.
A word before I continue: I do
not equate my music obsession with the life-threatening
habits of my Portland patients. Far from it. My addiction,
though I call it that, wears dainty white gloves compared
to theirs. I've also had far more opportunity to make
free choices in my life, and I still do. But if the
differences between my behaviours and the self-annihilating
life patterns of my clients are obvious, the similarities
are illuminating — and humbling. I have come to
see addiction not as a discrete, solid entity —
a case of "Either you got it or you don't got it" —
but as a subtle and extensive continuum. Its central,
defining qualities are active in all addicts, from the
honoured workaholic at the apex of society to the impoverished
and criminalized crack fiend who haunts Skid Row. Somewhere
along that continuum I locate myself.
I've been to Sikora's several times
a week in the past two months—not to mention brief
forays to the Magic Flute on 4th Avenue and lightning
visits to Sam the Record Man and HMV in Toronto during
a recent speaking tour, to say nothing of the closingout
sale at Tower Records in New York. As of now, mid-February,
I've blown two thousand dollars on classical CDs since
the New Year. I've broken my word to stop bingeing,
pledged with maximal contrition to my wife, Rae, after
my thousand-dollar pre-Christmas and Boxing Day splurge.
Day in, day out I've obsessed about what music to get
and spent countless hours poring over write-ups on classical
music websites — time that could have been devoted
to family or to writing this book with its rapidly approaching
deadline. But as soon as the reviewer says something
like "no self-respecting lover of symphonic/choral/piano
music should be without this set," I'm done for.
Excerpted from In the Realm
of Hungry Ghosts: Close Encounters with Addiction
by Gabor Mat�. Copyright ® 2008 Gabor Mat�. Published
by Knopf Canada. Reproduced by arrangement with the
Publisher. All rights reserved.
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