The Only Life I Could Save

by Katherine Ketcham

  Pat was riding his bicycle on the way from home to his office. He must have come home for lunch. I stopped the car.

  “The doctor thinks something is wrong with Ben,” I said, my voice choked with tears. “He said, ‘I can’t tell you not to be worried.’ I don’t know what that means. Do you? Does he think Ben is brain damaged? He did these tests, reflexes . . .”

  Pat leaned his bike against the car and kissed me. His eyes softened as he looked in the back seat where Ben, his face flushed with fever, was asleep in his car seat.

  “He’s still our boy,” he said softly. “He’ll always be our boy.”

  That night at the dinner table, Pat, Ben, and I talk about the pipe incident. Ben is contrite.

  “I meant what I said,” he tells us. He is folding and unfolding his hands and keeps his eyes focused on the table. “I promise, I’m done. I’m sick of drugs.”

  “Mom said she found the pipe and film canister rolled up in your gym clothes,” Pat says. “So you’ve been taking the drugs to school? Smoking before school? After school?”

  “I told you, I’m done with them. Can’t we just forget about drugs for a while?”

  “No,” Pat says firmly. “We can’t forget about drugs.”

  “Your brain is still developing, Ben,” I say, automatically reverting to my default position, the know-it-all expert. “And drugs interfere with normal brain functioning. Marijuana is not a safe or harmless drug for adolescents.”

  I want to read him these paragraphs from Teens Under the Influence, the book I’ve been working on with Dr. Nicholas Pace:

  The short-term effects associated with regularly smoking marijuana can have devastating consequences. Anxiety and panic attacks, depression, and suicidal thoughts can disturb social relationships and personal growth. School performance and grades often drop due to the effects of marijuana on memory, concentration, and the ability to solve problems.

  Chronic marijuana use leads to decreased activity in the temporal lobes, which are involved with memory, understanding language, facial recognition, and temper control. Problems in this area can lead to temper tantrums, rapid mood shifts, memory and learning problems, and a sense of being out of balance, out of control, and generally confused.

  The look on Ben’s face stops me. “Do you think I haven’t heard this before?” he says, practically spitting the words at me.

  I don’t want to get in another fight, so I don’t respond. Pat is silent, too.

  “Okay, yeah. You’re right,” Ben blurts out. The tendons in his neck are strung tight. “I’m using. Every day, sometimes multiple times a day, sometimes before school, always after school.”

  We just stare at him. We had no idea.

  “Weed makes me forget about shit.” His tone is belligerent, challenging. “It makes me feel good. I can control it.”

  Pat takes a deep breath, gathering his thoughts. “Mom and I made an appointment with your doctor. We’re concerned about your health, and we want you to talk to the doctor about your drug use.”

  Ben is trapped. He fell down a dead-end rabbit hole, and now we’re shining a blinding spotlight on him.

  He rolls his eyes and sighs heavily. “Whatever,” he mumbles.

  A week later, Ben and I are in the doctor’s office. Ben says he’s okay with me being in the room with him. “You’re the one with the concerns,” he shrugs. I wonder what he is hiding, what emotions—anxiety, fear, panic—he is covering up. He looks calm, almost bored.

  I’ve been looking forward to this appointment, seeing it as our chance to have an expert, a respected physician Ben has been seeing for a few years, give him the hard facts about teenage drug use. He’s heard enough details and statistics from his mother. Pat has also often shared with our children his reasons for quitting drinking in his early thirties, including his genetic history, his high tolerance, and the fact that he liked to drink often and much. It’s time, perhaps even past time, to get a medical professional involved.

  The doctor walks in, shakes Ben’s hand, and smiles and nods at me.

  “How can I help?” she asks.

  I had practiced what I wanted to say, repeating the words over and over again so I had them carefully ordered in my mind. I wish Pat were with me, but he has a geology lab and faculty meeting this afternoon.

  “We’re here because my husband and I are concerned about our son’s drug use,” I say. “We’ve discussed our concerns with Ben, and he agreed to talk to you.”

  She points to a plastic chair in the corner of the room, indicating that I should sit down. Her voice is very soft as she talks to Ben, who is sitting on the examining table. Her back is to me, blocking him from my view. I fight the urge to move my chair but remind myself that this is his appointment and his doctor. I’m just an observer.

  She listens to his heart and his lungs, takes his blood pressure, tests his reflexes, looks in his ears, eyes, nose, throat. As she examines him, she asks how he is doing, does he have any concerns to discuss, is the school year going well, does he enjoy his classes, is he happy with his grades? Good, no, good, yes, yes. She asks if he has any health concerns—fatigue, chronic cough, anxiety, depression. He shakes his head no to each question.

  She consults his chart. “You’re seventeen, just a few months shy of eighteen? Are you thinking about college yet?”

  “Yeah, but I’m only a junior, so I still have lots of time to think about college. My parents kept me back a year before starting kindergarten,” he says, in part as explanation and in part, it seems to me, as accusation. Ben has told me more than once that he wishes he had started school with his preschool friends. We held him back because his teacher thought it was a good idea. We thought we were doing the right thing.

  Ben and the doctor chat for another five minutes, and I’m feeling pretty good about this meeting. She’s taking her time, gaining his trust.

  “So, we’re here today because your parents are concerned about your drug use. Is that right?”

  “Yeah.”

  She asks if he uses drugs. Yes, he says. How often? Marijuana once or twice a week; alcohol on the weekends, but not every weekend; and cigarettes once in a while.

  Liar, I think, shifting in the chair. Should I tell her the truth, which he just confessed to us, that he uses marijuana every day, often before school, always after school?

  “Well,” she says, still with her back to me. “Physically, everything looks just fine. As for the drugs, I’m not concerned with occasional marijuana use. Alcohol and nicotine concern me a bit more.”

  He repeats that he only drinks and smokes cigarettes once in a while, mostly just on weekends, but I’m not really listening. I’m stuck on that part about not being concerned with occasional marijuana use. I can’t believe she just said that. Does she have any idea that she has just given him permission—a doctor’s permission—to use marijuana “occasionally”? I feel the heat rising inside me and wonder if I’m having a hot flash. I take off my scarf.

  I don’t know what to do. He’s giving her half the story, not even half the story, minimizing his drug use as people with drug problems often do. Surely she can see through him. I want to stand up, walk over to Ben, and say in as calm a voice as I can manage, “Why don’t you tell the doctor what you told us about smoking every day, sometimes multiple times a day, sometimes before school?”

  But I don’t, because I can’t get my thoughts under control. My heart is beating way too fast, and my throat feels like it’s being squeezed from the inside out. Ben is not telling the truth, and she seems to be accepting his version of reality. But still, even if he were being honest, the fact remains that he admitted to using three different drugs every week, sometimes multiple times a week. That’s not healthy, that’s not unconcerning. She should be talking to him about the risks, the fact that adolescents who use drugs before age fifteen are five times more likely to become addicted, that one in six teenagers who use marijuana become physically addicted to it, that the risk of schizophreni
a and other psychotic illnesses is six times higher in marijuana users. I wonder if she knows about all those research studies or the ones showing that regular marijuana smokers often suffer withdrawal symptoms, including cravings, sleep difficulties, mood swings, and significant increases in aggression, anger, anxiety, and irritability.

  I’m not making up these statistics; they’re spread all over the scientific literature. The teen brain is vulnerable—it’s still developing, and it doesn’t stop maturing until the mid-twenties. Throw drugs into a developing brain—even “just” marijuana once or twice a week and “occasional” alcohol and nicotine use—and you’ve got an explosive chemical experiment on your hands. And then there’s the genetics piece—people with a family history of alcoholism or drug addiction are four times more likely to develop the disease. Ben’s father, grandfather, and great-grandparents all struggled with addiction. Why doesn’t she ask about his family history? Doctors do that with all other diseases and disorders; it’s one of the first questions they ask. Why the hell doesn’t she ask if he has relatives who have this disease of addiction?

  I want to ask the doctor straight out if she understands the word disease in the context of alcohol and other drug use. Addiction isn’t a choice; it’s not a moral failure, a maladaptive lifestyle habit, or a developmental learning disorder. It’s a brain disease that is both chronic and progressive, beginning in an early stage that looks nothing at all like a life-threatening illness, proceeding into a middle stage where mental and emotional problems begin to appear and intensify (and that, I think, is where Ben sits). If the drug use continues, it steadily marches on into later stages when physical and psychological problems become apparent and undeniable.

  But all this knowledge and all these statistics do me no good, because here sits Ben, a big healthy boy whose heart, liver, lungs, and other vital organs are working as they should and who exhibits no outward signs of mental or emotional problems. So, the doctor has apparently concluded—they’re chatting about sports now—that Ben is just experimenting with drugs, like so many other adolescents. As time goes by, he’ll grow out of this phase, go to college, establish his independence, and discover who he is and what he wants most in life.

  Maybe. Maybe. I hope so. Hope—that word sounds so positive and upbeat. But it doesn’t seem real to me; it feels ephemeral and nebulous. Hope isn’t going to help Ben. I imagine comforting myself with thoughts of what his future might hold—college graduation, a good career, marriage, children, good health, a happy and fulfilled life—and I want to kick myself in the shins and yell, “Wake up!” I don’t know what the future holds, but I’m fully aware of what’s happening to Ben right now, right here, and something is really, really wrong.

  I want to kick the doctor in the shins, too. She should know better. If parents are concerned about a child’s drug use—concerned to the point that they make an appointment to discuss it—wouldn’t it be a good idea to include them in the conversation? Or has she written me off as an overprotective, overwrought mother? I don’t know, maybe I am, but that doesn’t mean I don’t have valid concerns.

  My mind suddenly switches gears. Give her a break, I think to myself. Maybe she’s being sensitive and respectful to Ben by talking to him directly, counseling her patient, treating him as an individual and not a young child who needs his mother’s involvement to manage his care. Maybe I am a panic-stricken, hovering-helicopter mother who needs to back off and let her child—almost an adult—live his own life, make his own decisions.

  I’m suddenly flooded with self-doubt. I had set my expectations for this appointment too high, hoping she would see Ben through my eyes, understand that he is in harm’s way, and join with me in my efforts to help him. But her perspective is clinical, detached—she sees a healthy, respectful teenager who (he says) is moderate in his drug use, maintains his good grades, and plans on going to college. Her job is not to comfort me, see my pain, or presume my needs—Ben is her patient, not me.

  Back and forth I go, thoughts and emotions careening off the insides of my bony skull like pinballs ricocheting around in an absurdly complicated machine. I’m angry. I’m frustrated. I’m close to tears but hold the emotions in, trying hard to appear calm and collected when what I want to do is shout at her, He’s in trouble. Why would we be here if there weren’t a problem? She doesn’t see me shaking inside, the trembling of my muscles, the fibrillations of my heart, the tension in my gut. She doesn’t know what led up to this meeting. She hasn’t seen the holes in the walls. She hasn’t heard the swearing and shouting. She can’t understand the depth of my fear and desperation. She wasn’t there to see my hands shaking as I dialed the clinic’s number to make the appointment. She has no idea how much value I put on this meeting, seeing it as an opportunity to get through to Ben by enlisting the help of someone he respects, if only because of the MD after her name—someone with knowledge and insight, perhaps even with wisdom.

  She shakes his hand as we leave the office, thanks him for coming in, and tells him to call if he ever has any concerns he’d like to discuss with her. Ben and I don’t say a word to each other the whole way home. His legs are jumpy, and his fingers tap tap tap his jeans. I imagine what he’s thinking: Wow, glad that’s over! Time to get high.

  I’m flushed with anger and not a little shame. I didn’t speak up. I didn’t force myself into the conversation and rationally discuss my legitimate concerns. I was intimidated by her. I was hoping, right up to the moment when she shook Ben’s hand and told him to call if he ever needed to talk, that she would offer a warning of some kind, just a few words of caution about the dangers of using drugs when you’re young and your brain is still changing and maturing.

  She doesn’t know that if she had only said, “So, Ben, using these drugs regularly can harm your developing brain and make you more vulnerable to mental health problems, anxiety, depression, and suicidal thoughts,” she might have gotten through to him. Or she could have kept it simple and said, “If you’re using marijuana twice a week and alcohol and cigarettes once a week, that’s definitely not good for your health.” I don’t know what words she should have said, but holy shit, she should have said something.

  I needed an ally who would be willing to look at the situation from both the parents’ and the son’s perspective and realize that the truth, if there is in fact a truth to be found, is not black and white but multiple shades of gray.

  But I didn’t do my part. Once again, I failed him.

  Over the next few weeks, I think a lot about the “what if’s.” What if Ben had something visible like a tumor or a blood sugar anomaly or an abnormal thyroid test or a seizure? Would the doctors take an in-depth history, do some tests, write referrals to specialists, perhaps listen to the parents’ perspective? Certainly they would be concerned. But here’s the problem: The early stages of drug addiction don’t reveal themselves with surefire “objective” evidence of disease—all organ systems and blood work tend to be normal, and signs such as dilated pupils, shakiness, and lack of energy can be overlooked or attributed to other causes. The “subjective” symptoms are easy for family members and close friends to recognize but, again, are often attributed to other problems and are easily hidden from outsiders.

  What are the early signs and symptoms of adolescent drug problems? (I might as well use the word problems so nobody thinks I’m exaggerating or overreacting.) I’ll tell you what they are: Relationships going sour. The F-bomb flying. Anger. Anxiety. Depression. Irritability. Behavior changes. Denial. Rationalizations. Resentments. Blame. Shame.

  And that’s only the early stage. That’s only the beginning.

  I am filled with what seems like useless knowledge. I know how to talk and listen to other people’s children, and when I talk, they listen to me. But I don’t know how to listen or talk to my own child. I read the books I have written over the years, and my words sound preachy, pumped up, pathetically full of themselves.

  The only book that makes sense to me is The
Spirituality of Imperfection. After writing maybe fifteen drafts of that book with Ernie and reading and rereading it dozens of times, I still find passages that take my breath away. I pick up the book and open to a random page.

  To deny imperfection is to disown oneself, for to be human is to be imperfect. Spirituality, which is rooted in and revealed by uncertainties, inadequacies, helplessness, the lack and the failure of control, supplies a context and suggests a way of living in which our imperfections can be endured. Spiritual sensibilities begin to flower when the soil is fertilized with the understanding that “something is awry.” There is, after all, something “wrong” with us.

  I open to another random page.

  Saying “I’m sorry” and having the apology immediately accepted; listening to another speak of pain and seeing your own pain for the first time; hearing the words “I love you,” when you have just done something unforgiveable—these are universal experiences. As so often in the realm of spirituality and its antithesis, addiction, “alcoholic” means simply human being writ large.

  I email Ernie to apologize for being out of touch. I feel guilty because I haven’t been much help with the book on shame, which we’ve been struggling to get into shape over the past few years. Guilt and shame seem to permeate my life, but I just cannot put pen to paper or fingers to keyboard in a detached way.

  “I really do not know what is going on with me,” I write in the email. “Poor Pat. I keep picking on him, wanting him to be positive all the time, laughing and uncritical. I love him just as he is, but I seem to need him to be something else right now. It is difficult. Our Ben is using marijuana and being defiant, and that spins us against each other and slightly (completely?) out of control.”