My Brother’s Ghost

I don’t like to talk about my brother’s death, mostly because it’s painful, but also it makes for an uncomfortable conversation, especially if I’m honest about the circumstances. There is a stigma associated with addiction and drug overdoses.  More often than not, if someone asks me how he died, I will just say it was an accident to avoid having that conversation. But a few months ago I was forced to attend several opioid addiction events with a visiting Humphrey Fellow at work. It was at the end of March, right after the 18th anniversary of my brother’s death and his birthday. It was basically three weeks of Hell and constant reminders of Todd’s death and the terrible disease of addiction that nearly destroyed our whole family. Every day now it’s in the news. It’s an epidemic and we don’t want to talk about, because it makes us feel uncomfortable. Because we’re taught that addiction is something that we should be able to control–that it is a personal failing, addicts are criminals, they are not good people, it’s something to be ashamed of, something to hide. Only poor, uneducated people are addicts. The truth is, if more people talked about it, we could see how pervasive it is. Addiction isn’t discriminatory. So now I feel that it is time to talk about what happened to Todd.

Todd was smart, athletic, handsome, charming, creative, and full of potential. He was the guy that would sit at the kitchen table and talk to your friend’s mom when you weren’t ready. He could, and would, talk to anyone. He liked people. He liked kids. He was great and patient with our elderly and ornery relatives. He was charismatic and fun, played guitar, and was never shy to perform in front of a crowd. Unfortunately, he inherited the addictive gene that cursed both sides of our family and he developed a degenerative disc problem, which also seems to run in the family. At an early age those two things collided and at some point, he lost control of them.

Todd, me, and Matthew

My father has degenerative disc disease and had a herniated disc when I was a kid. I can remember him crawling out to the deck because he couldn’t walk, but he just had to lie on a chase lounge and give me instructions on where to plant the various vegetables in his garden. He had surgery soon after that to remove the broken piece of disc that was pressing against the nerve. Fortunately that’s the only time he has needed surgery on his back, but he has had many occasions when his back has “gone out” on him.

I can’t remember when Todd started having back problems, but it was sometime in his late teens. He had his first surgery when he was 19 or 20, I think. In total he had four or five surgeries. At times it seemed that Todd had a pharmacy in his room, he had so many prescription bottles–there were muscle relaxers; narcotic pain killers like Percocet and Vicodin; anti-epileptic drugs used for pain like Neurontin; and anti-depressants. It seemed that the doctors didn’t know what to give him, so they gave him anything and everything.

Although we thought Todd abused the pain killers by doubling up on them, it took several years before we were aware of the extent of the problem. Initially we thought he would just run out of them sooner and then just have to go without.

The first time Todd overdosed was on a combination of methadone and Percocet. His girlfriend at the time called the ambulance because she couldn’t wake him up. The paramedics found the prescription bottles and thought he had taken over 50 tablets of methadone, because the prescription had been written for 150, but they had not seen the notation that the patient was owed an additional 50 tablets. This led to a lot of confusion. Apparently the doctor Todd had seen prescribed him 150 tablets of methadone and when Todd took it to the pharmacy, the pharmacist thought it was a forged prescription and called the doctor to verify it. It was such an unusual amount of methadone that the pharmacy did not have that quantity on hand and could only give him 100 tablets. Todd also said, and this may or may not be accurate, that the doctor told him that it would take 24 hours or so for the methadone to kick in, so he could continue to take the Percocet, which he did. Judging by the number of methadone pills missing, he still took more than he was supposed to and he probably mixed them with alcohol. My parents spoke to the doctor who had prescribed the methadone and he told them that Todd was an addict. Of course he was right, but at the time it seemed that he was just trying to cover his ass for irresponsibly prescribing a shitload of a highly controlled substance.

I don’t know exactly at what point Todd turned to heroin. The trouble with dealing with addicts is that you can’t believe everything that they tell you. He said that the first time he used heroin was a Thanksgiving weekend when his back pain was bad and he couldn’t get a prescription for anything and decided he would self-medicate. Things started spiraling out of control for him in his early thirties. It was hard to watch and be around him while this was happening. When we realized the extent of his problems it was shocking and crushing. I never in my wildest imagination would have thought he would shoot up with heroin. I could imagine all sorts of other things, but not heroin.

He managed to function well enough to keep working for several years, but eventually it took over and he lost his job and then he got kicked out of where he was living. We were told that we had to practice “tough love” and not to give in if he asked for money or a place to stay, otherwise we were just enabling him. They told us that he had to hit rock bottom before he would help himself. The hardest thing I ever had to do was turn him away on a cold night when he came to my house looking for a place to stay. I gave him an old sleeping bag. He said he had a friend he was going to try to meet up with. I know he was disappointed, but he didn’t get mad. I barely slept that night and when I woke up before dawn I knew he was outside my house. I looked out the window and there was his car parked in front of the house. I went outside. It was freezing. He was asleep in the backseat, wrapped in the sleeping bag. I brought him inside and cooked him breakfast. I remember that I had an open package of bacon and it looked old and I thought it maybe had turned and he said it was okay, I should cook it anyway. He was starving. He didn’t care if it was bad. To this day, I cannot cook bacon without thinking of him and that day.

Shortly after that Todd checked himself into detox and they kept him there for a week or ten days, I can’t remember exactly. I just remember that it was longer than usual. He wanted to go into the county’s long-term residential treatment program called Crossroads, but there was a waiting list. The social worker assigned to his case and my parents decided the safest place for Todd to be while he waited to get into Crossroads would be at my parents’ house, so he moved in there at the end of January. While he was on the waiting list, he was required to go for weekly drug tests and attend AA and NA meetings, which he did for six weeks. For six weeks he was clean and the old Todd was back, but then one night something happened that made him give in and use one more time. My father found him in the basement early on a Saturday morning. He had been dead for several hours by then. When my parents talked to the social worker on the phone she said, “If it’s any consolation, he passed all of his drug tests and he was the next one of the list to get a bed.” I guess some people just don’t know what to say under those circumstances, but trust me, that is not it.

What we didn’t know early on was that Todd had tried to kick the heroin on his own before. He had been fighting it and losing the battle for a few years. He had checked himself into detox and gotten clean for a short period, only to end up using again. He told me once that he didn’t use anymore to get high, he just used to not feel sick. I remember once he said, “I wasn’t raised to be like this.” I think it really upset him knowing how much it hurt the family. At the end he was just ready to get on with his life and he had decided that he was going to take whatever came first–a job offer or a bed in the rehab place. We’ll never know what triggered him to shoot up that last night, but I can say there is no consolation in knowing that he had passed all the drug tests up to that point and that he was next on the list to get a bed. It’s heartbreaking to know that he came so close and we did everything that we were told that we should do and we still couldn’t save him.

Todd died on March 13, 1999, one week before his 35th birthday. Fast forward eighteen years and we are full on into an opioid epidemic. I was listening to the latest Lovett or Leave It podcast episode and something the guest, Travon Free said, astounded me and I thought it couldn’t be accurate. He said that 91 people die every day in the U.S. from an opioid overdose. Of course I had to google it and sure enough, he was right. According to the CDC, “Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses. 91 Americans die every day from an opioid overdose.”

And in the midst of this crisis, our Congress is trying to push through legislation that will take away money from the Medicaid and opioid treatments. Furthermore, there are proposed cuts to NIH that will impact substance abuse treatment. We, as a society, do not know how to talk about or treat chronic pain and addiction. I know it would be dishonest to blame all of Todd’s problems on his back pain and the doctors who over-prescribed him narcotics. Todd, like many of his peers in the 70s and 80s experimented with recreational drugs and alcohol. He liked to party and have fun. But most of his friends are still alive and leading productive lives. What made the difference? Was it genetics or lifestyle choices?

 

As with any other chronic disease like diabetes, heart disease, depression, or celiac disease, an addict has to make lifestyle choices and know their limitations, but they also need access to treatment and long term healthcare and they need to not be afraid or embarrassed to seek it. That’s what we need to learn from people like Huyen Pham, the Humphrey Fellow from Vietnam who is a senior researcher for drug policy related studies with the Center for Research and Training on HIV/AIDS at the Hanoi Medical University. We have to stop stigmatizing addiction. People need to be able to talk about it openly in order to be treated with dignity and respect and to be treated as patients not criminals. Families need support and shouldn’t be embarrassed to ask for help for their loved ones who suffer from addiction.

I have degenerative discs also and I don’t always make the best lifestyle choices. I abuse my body playing soccer and do stupid things like move furniture by myself, but until recently I’ve only had short term issues with my back. However, this past year I’ve had more, recurring pain and in February my doctor recommended that I get a epidural cortisone injection. Something went wrong with the procedure and a few hours later the pain in my back and the sciatic nerve was so bad that I couldn’t walk. I was home alone, crawling on the floor, trying to make it to my bed. I had never been in so much pain, aside from childbirth, and there was no relief. None of the pain medication I had helped at all. I kept thinking of my dad and Todd. And I thought the “pusher man comes with a silken glove.” If he had been there to offer, I just might have accepted.

Todd with my son, 1992