THE ADDICT: One Patient, One Doctor, One Year. By Michael Stein. William Morrow. March, 2009. 275 pages. $25.99.
A medical license is a license to ask questions. Ordinary conversation disappears quickly in my office. Business has to be taken care of.”
In The Addict, Dr. Michael Stein immediately gets down to important business with Lucy Fields, a 29-year-old opiate addict, who has taken Vicodin (and other drugs) daily for 10 years and steps into his office to seek treatment in his buprenorphine program. Dr. Stein follows Lucy closely for a year.
Dr. Stein is a university-affiliated internist who treats adults with a variety of medical problems. In his buprenorphine program, a daily sublingual dose of the drug blocks the opiate receptors in the brain and allows patients to begin to reassemble their lives free of deleterious opiate effects. Dr. Stein’s poignant account of the year in Lucy’s life reveals pathetic and redeeming details about her life as an addict and about his own frustrations and rewards in treating her.
An acclaimed novelist and a professor in medicine and community health at Brown University, Dr. Stein comments with great humility and authority about the suffering of addicted patients and about his own passionate concerns toward efforts of rehabilitation in society.
The year spent treating and analyzing Lucy — glimpses of her “user” boyfriend and her caring but clueless upper-middle class parents, her judgmental sister, her jealous employer at the pet store, her lecherous landlord, her deeply repressed secrets — flows swiftly and turbulently, propelled by Dr. Stein’s crisp, to-the-point style: “Losing her Vicodin seemed like an amputation, a disfigurement. Even though I was giving a new drug to replace the old one, it wouldn’t be the same.”
Most of the year’s date-specific encounters occur within the confines of the rather sterile office/examining room, which he describe thus: “What is visible in my room is intended to make as little statement as possible.” He describes each delicate gesture of the physical exam and the sacred ritual of his hand touching the patient’s body. He scrutinizes the physical language of each of his patients, their reluctance or willingness to make eye contact, their posture on the examining table, how their arms hang or are wedged under their legs — all with a detective’s attention to detail and often with Dr. Stein’s own visceral responses.
Dr. Stein richly punctuates episodes in the addict’s life with visions of his own past or feelings he has about his deceased parents or his growing children. His own running interior monologue is informative and full of delightful and vivid insights. He first became interested in addicted patients in medical school when he was at Harlem Hospital (“A medical student’s challenge is to be helpful while feeling helpless.”) These formative experiences in his training translated into an abiding interest and an arduous and fulfilling career in caring for drug-dependent patients. “If we are romantic, we believe the addict is after transcendence. If we are realists, we believe they are simply escaping,” he writes.
Along with Lucy Fields, he introduces us to a half dozen other addictive types who populate doctors’ offices, often in search of opiates. The narrative is delivered by a seasoned veteran of those sessions with patients/con artists who stretch the capacity of the most earnest physician to be compassionate. His coping skills are exemplary.
Yet Dr. Stein is nothing if not caring. His precise description of his patients and their needs grips the reader from beginning to end. With a novelist’s sense of plot, he absorbs the reader in the drama of a woman fighting for her life. He also speaks of his own needs, in parallel, as a practitioner and as a human.
Though Dr. Stein declares that he has altered the identities of various patients to protect their privacy, the reader is certain that these individuals are not fictional creations but rather real, flesh-bearing, spirit-owning people. He puts it this way: “To work with addicts is to enter the profession of possibility.”
By the end of a year with Dr. Stein in his office, the reader has become deeply involved in the lives this remarkable physician touches. He is not fancy or charismatic, but his methods seem to work, and his commitment must inspire those involved in any way with the healing professions.
The Addict testifies compellingly that the human heart can be extended to those who need help. Dr. Stein admits to being an addict himself to this principle, and in his medical practice and writing, the dignity of the healing act – for all its difficulties and frustrations — is honored and triumphantly verified.
Gerry Yukevich practices medicine in Vineyard Haven.