Free Refills

PART ONE

Free Refills

It was a frigid winter day in February 2005, when two officers—one from the state police, one from the Drug Enforcement Agency—arrived at my office and sat waiting amid the spellbinding view of the neighboring arboretum and the friendly clutter of charts, papers, stethoscopes, medical books, discarded coffee cups, and pharmaceutical samples.

At the time, I was scurrying back from a noon lecture on cholesterol management, in order to resume office hours. My attention was focused on the first patients I was soon to examine, an elderly Jewish couple plagued with anxiety and hemorrhoids, when, stethoscope in pocket and monogrammed white coat fluttering, I stopped dead still in the center of my office. My momentum was arrested by the concentrated accusatory gaze of the law enforcement authorities.

Unlike the patients in the packed waiting room, these officers didn't have the uncomfortable and deferential "I'm waiting for my prostate exam" look. Rather, their demeanor more resembled that of famished carnivores.

Far from famished, Rufus, the police officer, was morbidly obese, pasty, and spoke with a thick Boston accent. Bruno, the DEA agent, was thin, sarcastic, and fake friendly. He seemed as if he wanted to put his feet on my desk. (Why certainly, your Federalness. Go right ahead.)

Reflexively, I started hedging, stalling for time, trying to create some understandable context for their presence in my office. "My wife, H., gave me your business card yesterday, and I've been meaning to call you. I'm really glad that you are here, and that—" Bruno waved his hands dismissively and interrupted me with, "Doc, cut the crap already. We know you've been writing bad scrips."

Bruno and Rufus weren't here to arrest me and drag me outside in front of my staff or, worse, my patients, bumping my head against the top of their cruiser as they stuffed me into the backseat. They didn't read me my Miranda rights or pull out guns. They didn't yell, "Freeze, and put your hands up!" They didn't handcuff me, shock me with Tasers, club me with riot sticks, or detonate any canisters of tear gas in my office. They didn't hunker down behind my desk and radio in for reinforcements, bawling into their handsets, "All units, we've got a doctor here who is taking drugs!"

Instead, seemingly with relish, they informed me that I was to be charged with three felony counts of fraudulently obtaining a controlled substance. They had evidence that I had written prescriptions for the powerful narcotic Vicodin in the name of a former nanny, who had long since returned home to New Zealand, and that I had been picking them up from the pharmacy for my own use. They were tipped off by an astute pharmacist at CVS.

They say the universe is still gradually expanding, but at that moment, my universe started collapsing, even imploding, like a balloon stuck with a pin. Just minutes earlier, I was blithely sipping on gourmet coffee and chomping down doughnuts that some drug rep had dropped off (trying to push, no doubt, a cholesterol-lowering drug) while daydreaming through some lunchtime lecture. I had the expectation of a moderately hectic but lucrative afternoon examining grateful patients, and then returning home to see my kids.

Suddenly I was facing serious legal and career uncertainty, and was feeling awash in guilt and confusion. I had dealt with handcuffs during the tumultuous years I worked for Greenpeace, and knew that they were child's play compared to what my wife, H., was going to do to me when she learned of these charges. I'd take a Taser any day. And what about my kids? Were they going to be allowed to visit me in the penitentiary, waving at me through dirty plastic and speaking to me through a buzzing telephone connection?

At that point, I decided that I had had enough drama for one day, so I tried to politely signal to Bruno and Rufus that office hours were over. Doctors are excellent at dismissing people. We stand up, indicate toward the door with body language, ruffle some papers, and say something pithy about how we hope their fungus, or whatever is ailing them, feels better soon.

Unfortunately, Bruno and Rufus were just warming up. They pressured me with not-so-veiled threats. "Doc, we're here just trying to get you the help you need. If you tell us what we need to know, we don't have to blab to the other docs here and to your patients." They were threatening to expose me if I didn't sing, and to leave no stone unturned.

"Who else has been writing scrips for you? What other docs? Give us names. How else do you get pills? Buy them on the streets? Do you shoot up? Snort? Sell pills on the side? What other drugs do you use? Weed? Coke? Heroin? Angel dust?"

Under duress, my mind started wandering. I couldn't help thinking, "Since when do doctors do angel dust? Get with the times."

Once this line of questioning dried up, they tried a different tactic. "Doc, if your wife is popping these pills, you will never get out of this." They had the pleasure of meeting her the day before. According to the police report,

Oh yeah. H. mentioned that the police came by. Really bizarre pillow talk. "Honey, the police stopped by today to ask about our former nanny." I should have made a run for it. Possibly, just possibly, I could have made it over the Canadian border and spared myself the misery of the next few years. Good-bye wife. Good-bye children. Good-bye career as a primary care doctor.

I answered that no, thanks for your concern, but unfortunately, my wife doesn't take prescription painkillers, and I was the one who had a problem.

Why would I admit that to them? What would I say next? I prided myself on being a cunning drugstore cowboy, but this situation was feeling increasingly out of control, like a bad episode of Law & Order. I started to grasp that Bruno and Rufus had a broader agenda than just "getting me the help I need." They wanted to nail me. They were somehow getting me to divulge things that should be kept private, to fill in the details for them, and to hoist myself on my own petard. The police report further reads,

At that point, I suggested that I get a lawyer. This was like pulling the final control rod out of the Fukushima nuclear reactor. Bruno and Rufus became bullying and hostile. "Doc, we could arrest you right now, cuff you, drag you out in front of your staff." I summoned my inner donkey, and the interview ended in a Mexican standoff. They instructed me to report to police headquarters at 8:00 a.m. the next morning to be booked and fingerprinted, and left in a huff. Have a nice day. Thanks for stopping by.

I was born at the Boston Lying-In Hospital, in the heart of Harvard Medical School, so that the pressure for me to become a doctor at Harvard could be inhaled with my first breath. My twin brother, Martin, born four minutes earlier, was allowed to go home several days before I did, because he hogged most of the food in utero and I was underweight coming out of the womb, weighing in at just over five pounds.

Being so scrawny, I was relegated to the preemie nursery for the better part of a week. Had we been able to speak, he would have said, "See you later, sucker. Now I get first pick of crib space and Binkies at home." I would have replied, "You shameless pig! Just wait until I can crawl. I'll make you pay!"

I've often wondered if they could have switched us in the hospital. Back then, in 1966, they weren't as uptight about identity bracelets on newborns. That would mean that I am him and he is me. Hey, Bruno, hey, Rufus. You incompetent bullies, you've arrested the wrong guy.

Assuming we weren't switched, why did I become an addict and he didn't? Were our lives really so different? Was it the trauma and influence of being stuck in the preemie nursery that set me on the wrong path from day one? Did I encounter some perinatal pre–gang members who corrupted me? Maybe someone said, "Gaa gaaa gooo goooo" ("Yo, homey, let's go smoke a spleef"). After all, the Boston Lying-In Hospital was in a bad part of town. It was located in Boston's notorious Mission Hill neighborhood.

Or maybe it was bad karma? Perhaps in a previous life I was a marauding Visigoth, chewing on human skulls, and he was a peaceable man of the cloth. Was it a random assortment of genes? Maybe I am just a victim of the law of averages.

Or did I lose some intrauterine game of rock, paper, scissors over who had to shoulder the family mantle of becoming a doctor, with the stress and sleeplessness of this calling. By becoming a doctor, you can improve the health of thousands, but it's not necessarily good for your own health.

To this day, Martin asserts that all of my problems result from the immaturity associated with my being four minutes younger than him.

On the wall of my childhood home is a picture of me when I was two years old. I am staring straight into the camera as if startled by it, with wide blue eyes and fluffy brown hair. My finger is stuck into a crack in the stone wall I'm standing next to. A minute later I'll start to cry, when I can't get my finger out of the wall without twisting it. Most telling of all is the Harvard Medical diaper I'm wearing.

As soon as the fuzz left my office, I told my staff that I had a migraine and had them cancel my patients for the rest of the day. This was the second sick time I'd ever taken. I must have looked convincingly ill, because I was drenched in sweat and I was shaking from head to toe. My medical assistant expressed sympathy, which I felt I didn't deserve.

I promptly swallowed the eight oxycodone I had hidden in my bag in a bottle labeled ALLERGY MEDICINE. In case of emergency, break glass and swallow pills. I was desperately hoping this oxycodone would cause what I warn patients about: sedation, amnesia, euphoria, and a false sense of well-being. I didn't think I could possibly get into more trouble, though, in retrospect, a DUI would have been the straw that broke the camel's back.

With extra care, I creeped my car out of the parking lot and, granny-like, navigated the brief drive back to my home. I remember a vivid escape fantasy where I just kept driving and left all of this behind me. With my credit cards, how far could I get before anyone noticed I was missing? Would these criminal charges stop me at the border?

During this drive, I was having trouble piecing together how I ended up with two agents tracking snow, and criminal charges, into my office. How did I descend into the cunning mind frame of a common criminal? Last time I checked, I was a successful and empathic doctor. At the same time, a small part of me was feeling a Raskolnikov-like sense of relief, thinking, "Thank God this is going to end."

Parking the car with care, I glanced briefly at the closely set, shabby, but well-tended houses of our lower-middle-class blue-collar neighborhood, steeled myself, said a quiet good-bye to the life I knew, a life built on lies, said some sort of good-bye to myself, and walked into the vestibule of our comfortably furnished Victorian home.

Our house still smelled faintly like reefer from a private smoking session H. and I had had a few nights before. H. has red hair, a trim figure, and clear blue eyes. She is quick to smile but quicker to anger. On the occasional times we smoked together, H. became amorous, demanded chocolate, demanded sex, and then fell into a deep sleep. What more could a guy ask for? Legalize it!

At all other times, I was lonely, and I clutched at any crumb of tenderness she would toss my way. I was desperate for these rare bonding moments, because I was increasingly alienated from my marriage. The night after our wedding, H. started talking in her sleep, vitriolic speeches criticizing me, as if we were in Salem's Lot and she were possessed by the undead. It gave me goosebumps and insomnia. Daytime wasn't much better.

In the living room, I was met by friendly commotion and bustle. "Daddy's home!" Anne, who was five years old and who has penetrating blue eyes, and Milo, who was four, with dirty-blond hair, boisterous and fun-loving, raced each other to get to me first and hug my legs, elbowing each other out of the way. They are almost "Irish twins," a mere fourteen months apart in age.

H. greeted me as if nothing were amiss, though I could tell she was suspicious that I was home early. That wasn't my role. I was supposed to be earning.

I switched into robot mode and completed what was required of me for the rest of the day. Something about this unconditional love from my kids made me feel like an imposter, and I had a dark premonition that I was going to be seeing less of them.

Later, when the children were asleep, and H. and I retired to our cozy double bed, I wasn't sure how to broach the day's events. "Hi, honey, the police were in my office today and I've ruined our life." No, that didn't sound right. "Hi, honey, you look beautiful and, by the way, I might be going to prison and you might have to work full time." No better.

H. can become furious about a dish being left in the sink, or an unmade bed. So, naturally, I was not enthusiastic about mentioning the fact that criminal charges were impending and that it wouldn't be clear for quite a while whether my medical license would be returned to me during this lifetime. I dove in and gave an honest and thorough description of what had transpired.

This conversation didn't go well.

"You fucking asshole. You asshole. I've been telling you, you're a drug addict, and now you have ruined our lives."

"Look, H., I'm really sick and I need help. I feel really bad about this."

What else could I say? Technically, I was guilty as charged, though I was hoping for some warmth and compassion, and I felt hurt and betrayed by her reaction.

Granted, H. had suffered the fallout of my steady descent into uncontrolled pill-popping over the last six years. When I told her this news, I wasn't expecting praise or congratulations. I wasn't expecting her to stand up and applaud, or to offer sexual favors, or to nominate me for husband of the year. But after seven years of marriage, I did hope for at least some sympathy and nurturing. Some sense of "I'm here for you; we'll get through this together." Or at least an acknowledgment of how sick and miserable I was and how painful my current circumstances were. No dice.

Later, burrowed into my new habitat, the downstairs sofa, whose pillows didn't quite connect together in a way that permitted sleep without back pain, and whose dusty covers triggered my allergies, I started formulating some questions to myself. How exactly did I get caught? I had committed hundreds of illegal acts over the last few years; it wasn't clear to me which ones had led to the criminal charges. Am I really caught, or can I talk my way out of this? Am I possibly going to jail? Is this going to be on the front page of the Boston Globe? Will I ever practice medicine again? What is wrong with me anyway? All in all, it was a long night on the sofa.

Upon awakening, I Googled the address of the police station I had to report to. Canceling work in order to avoid being arrested at my office was as good an excuse as any, so I left a message on my secretary's voice mail, claiming ill health and letting her know that I wouldn't be coming in to work that day. (Or ever again?) I felt bad about this because, short of being hospitalized once for viral meningitis, I hadn't missed a day on the job, stoically working despite colds, stomach flus, and headaches. Doctors are mostly expected to continue working no matter how they are feeling, which is part of the problem.

At five in the morning, hopelessly awake and eager to avoid another interaction with H., I skulked into the bedroom to get my clothes for the day and, unable to face Annie or Milo either, I left the house, bought acidic, burnt coffee at 7-Eleven, mooned around for a while, and then, at daybreak, started driving toward the police station on South Boston's waterfront.

On the way, I passed the clinic in "Southie" where I trained as a medical student. It was where I had my first, fumbling experiences interviewing patients and listening to their insides. Passing that health center reminded me of this earlier phase of my life, when I was an eager, enthusiastic medical student with a universe of opportunity in front of me, chomping at the bit to learn as much as possible and to start trying to heal people.

The police station was dingy, dilapidated, and sparsely populated. It was just waking up for the day, and I was its first client. It was all so drab, I felt as if I were in a black-and-white film.

Rufus was waiting for me when I arrived and, for all his look of studied nonchalance, booking a doctor was clearly out of the ordinary for him, a highlight in a career that I imagined was otherwise spent dealing with low-level thugs and traffic violations. Businesslike, condescending, and without the warmth or feigned concern he showed the day before, he guided me into the special area, behind the large front counter, where a computerized fingerprinting apparatus was set up. "Sit down and stick your hands out." (I guess that's better than "Bend over.")

I hadn't anticipated that this process would be computerized, which meant that my fingerprints would never be lost and that I would be tagged for life. I wondered if my twin brother had the same fingerprints. With every molecule of his three-hundred-plus-pound bulk, Rufus squashed the fingers of my right hand onto the glass screen, attempting to push my hand through the table. As my fingers started burning, I began to grasp more fully the seriousness of my predicament.

Rufus then told me about the three charges being filed against me, identical to one another, all felonies, which read as follows:

I was told to report to the West Roxbury courthouse on a date to be provided, not more than ten days hence.

Rufus watched me like a hawk as I drove away. Perhaps he fantasized that I'd commit a moving violation and that he could then take some more fingerprints, on my left hand, which still had intact nerves and blood vessels. Carefully dodging the wired and aggressive Boston drivers, I drove home slowly in order to have some time to internalize what had just happened. With no audience to impress, I started shaking like a leaf.

That night, when the kids were in bed, I wanted to give H. a sanitized version of the day's events, but things were so bad, and I was so worn down, I had no choice but to be open and honest. In an icy, detached voice, H. said, "If you can't work as a doctor, you are going to work at Home Depot. If you are in legal trouble, your parents better pay our legal fees." Then she rolled over, with her back to me, and fell asleep. I trudged downstairs to the sofa.

Martin and I are now five, and we are following our older brothers, Danny, at age thirteen, and David, age eleven, on one of our earliest acts of familial ecoterrorism. This was a full seventeen years before I started working for Greenpeace.

Behind our childhood home is a seemingly endless expanse of woods, which Babson College, an up-and-coming business school, is trying to clear-cut so that they can demonstrate to their students how to turn a profit by destroying the environment. To us, this is clearly wrong, and we are intent on stopping it.

Our parents are not particularly intent on preventing us from stopping Babson, so they explain to us that there is a drainage system slowly siphoning the entire woods in preparation for clear-cutting and paving. All we have to do is dam up the shallow creek that runs behind our house, cause a flood, and delay the project, hopefully for years. This becomes our mission in life. We spend every free moment cementing stones with mud and sticks into increasingly elaborate dams, which were designed by Danny.

As afternoons floated by blissfully, working together on our dam in the sun and the mud and the gently trickling creek, I was unaware that Babson would succeed in paving much of this forest, and that my brother Danny was slowly dying. It was only much later that I understood about the wigs, the nausea, the mood changes in the other family members, and the sweet-smelling smoke.

Danny had always been an involved and affectionate older brother who wrestled with us and invented games for us to play. Maybe on some level he sensed he didn't have much time with us. He talked my parents into letting us paint the walls and ceiling of the closet in his room with black-light paints, so that we had a private room that glowed eerily under the black light we bought. This room was a private, magical space where, as kids, we were able to create our own world. (Or, as teenagers, get high.) We worshipped Danny like a Roman emperor.

We weren't old enough to notice that Danny was losing weight, or that he had lost his hair. I didn't even know that he wore a wig. Nor did we notice that, at times, he didn't quite seem his usual playful self.

With criminal charges filed, it was only a matter of time until the medical board yanked my license to practice.

Immediately upon leaving the police station, my first phone call was to set up an emergency meeting with Society to Help Physicians (SHP), an affiliate of the Medical Society of Massachusetts that helps physicians with depression, grief, drugs, alcohol, personality disorders, and disruptive behaviors. A hidden truth is that doctors crack under pressure like anyone else, and might even be more susceptible to depression and addiction. I was hoping SHP could provide cover. I felt I needed to keep working, because I had several thousand patients who were counting on me. I could even get sued for "abandonment" if I stopped treating my patients.

SHP provided a list of lawyers with specialty in the area of docs on drugs. Like the police, SHP told me that I didn't have a choice but to report to them at 8:00 a.m. the next day. This eight-in-the-morning thing was getting repetitive.

I had already made initial contact with SHP a couple of months earlier. I had been seeing an addiction counselor in response to an ugly threat by my regular psychiatrist to report me to the medical board as an "impaired physician." I was seeing this psychiatrist in order to treat depression and insomnia, which had plagued me since my teenage years.

My addiction counselor was named Ben. Ben tried to maintain a sense of personal gravitas despite wearing leather and biker boots, chain-smoking cigarettes, having long hair, and sporting a goatee. He could seem needy and insecure, and I felt like we spent most of our sessions focusing on his breakup instead of my problems. He had a reputation for being warm and fuzzy.

During our first meeting, Ben also threatened to report me to the medical board as an impaired physician unless I set up an appointment to meet with Dr. Stern at SHP within two weeks. So far, Ben seemed about as warm and fuzzy as a crocodile.

Dr. Stern's office was in a sterile, corporate office building, otherwise occupied by medically related Internet companies. It is contiguous with Fenway Park, which is a nightmarish place to drive to and park, especially if one doesn't share a special reverence for the Red Sox.

After I got past security and endured a short but nerve-racking wait, Dr. Stern lumbered in and brought me back to his office, which was the unapologetic den of an absentminded professor. It was cluttered with books, journals, articles, even some stale candy, which I was offered but was afraid to touch. The candy bowl itself was covered with dust and had a few imprinted marks where clients more desperate than I had succumbed to this invitation. Newly sober alcoholics tend to crave sugar.

Dr. Stern was a frumpy, lean, preachy, and seemingly sluggish man, with pasty skin and thinning blond hair. He was obviously very pious, which, right off the bat, allowed my atheistic eyes to invalidate him and the message he was trying to convey.

One of the central intellectual principles that had been ingrained in me since childhood was that religion, as Karl Marx said, is "the opiate of the people." In Dr. Stern's office, I silently and condescendingly marveled at this irony: This man was supposed to help me get off drugs, not substitute one for another. When he explained that, in his younger days, he had lost his medical license to drugs and had spent time behind bars, he started to rise in my estimation.

My goal was to appear cooperative but to reveal as little as possible. Dr. Stern and Ben knew each other from both being members of the small Boston addiction treatment community. Dr. Stern had been tipped off by Ben that I was a bullshit artist. As they say, "You can't bullshit a bullshitter." He didn't fall for my evasions.

I was hoping to come across as an exemplar of abstemious rectitude, so as to stop this evaluation dead in its tracks. My addiction was fighting for its life. I took a deep breath and dove in. "I don't know why I'm here. Sometimes I smoke pot. So do lots of other people. Ideally, I shouldn't touch pills, but I get migraines. My doctor prescribes them. I also have insomnia, so my shrink gives me Klonapin. It's all legitimate, except for the pot, which is harmless and should be legal. What else would you like to know?"

Dr. Stern looked as if he had stepped on something unpleasant. "By using these pills, you have changed your brain chemistry forever. You are unable to control this." I retorted, "That's crap; you don't know anything about me. I can totally control this. Things are going great at work. This is much ado about nothing."