I sign Shawn Trainer’s death certificate, dreading what comes next. A jogger found the twenty-four-year-old’s body along a trail in the suburban Pennsylvania county where I had been elected coroner the year before. Toxicological testing confirmed my suspicions. Now I have to tell his parents.
I call Shawn’s mother after five on a Friday afternoon. Giving bad news after business hours means our call is less likely to be interrupted. Shawn’s mother is the first of three families I will call this evening. Not for the first time, I wish I were a psychiatrist rather than an internist.
“Hello, Mila, this is the coroner’s office. Is this a good time to talk?”
A quick intake of breath, then the long exhale of defeat. “Yes, it’s fine.” It will never be fine.
“I’ve just completed Shawn’s death certificate, Mila.” I pause in case she wants to stop me. “I didn’t want to know,” someone once said after I blurted out the cause of death.
“I’m so sorry, but Shawn died of a fentanyl and heroin overdose.” Five seconds of silence.
“I’m not surprised,” Mila finally says, “but at least I know now, thank you.” Another pause, another sigh. I wait, silent, sensing she has more to say.
“Shawn was such a good kid. Then, about six years ago, he hurt his back at a summer construction job. The doctor put him on Oxycontin, and he got addicted to it. I don’t know when, but at some point, he began using heroin instead. He was in rehab last year, and I thought he was clean. He was a good kid. He was my son.” Her voice stumbles over the word “son.”
I’m glad Mila had not seen what I’d seen: Shawn lying alone on the cold ground. I’m glad she has a story with good memories and a clear bad guy—Shawn’s doctor. Whether that story is fiction or nonfiction doesn’t matter anymore.
My brother Dirk has been in and out of addiction for almost six decades, and so far, my story of his life has few good memories and no obvious scapegoat. Dirk is probably alive only because drugs like fentanyl weren’t around when he was younger. The second, third, and fourth chances he got are rare now.
A black and white Brownie snapshot taken in 1953 shows five-year-old me and two-year-old Dirk sitting on a stone wall behind a rambling Pennsylvania farmhouse. My curly black hair and olive complexion contrasts with Dirk’s blond locks and pale skin. I’m holding open a book and smiling at the camera. He’s staring at something, but it’s not the book or the camera. The photo must have been taken the year he stopped talking, his language development arrested when my parents left their family and the trauma of World War II to emigrate to the United States from the Netherlands.
The scene in the photo strikes me as false: my smile might have been a grimace, and Dirk rarely sat still for long. Maybe my mother staged the shot to nurse a family myth she could export to those she’d left behind: Look at Dirk and his doting big sister. Life in America is wonderful.
Except it wasn’t. Struggling financially and barely speaking English, our parents worked—one all day, one all night—to make ends meet. Sometimes preschool me was left in charge of toddler Dirk in the gap between their shifts. I remember trying to read to him—reading was my world—but that never held his attention long.
Hans Christian Andersen’s story “The Wild Swans” was a favorite of mine. In the fairy tale, Elisa and her brothers are outcasts with only each other left in the whole wide world. When an evil stepmother transforms her brothers into swans, Elisa must break the spell by staying silent and weaving them shirts from stinging nettles. She rescues all but her youngest brother, whose shirt lacks one sleeve, leaving him with a swan wing instead of an arm. The story seemed to have a happy ending, but what always stuck with me was that white wing, a reminder of Elisa’s failure as a sister.
Dirk morphed into a hyperkinetic whirlwind when he began first grade. Doctors and others were popping Ritalin as early as the 1960s, but ADHD wasn’t a formal diagnosis until the 1980s. Maybe Dirk wouldn’t have become what he did if he’d been born twenty years later.
By the time he graduated from high school (“Hallelujah!” yelled Dad), Dirk’s life revolved around parties and the drugs of the time—marijuana, LSD, various uppers and downers. Not alcohol, for some reason. Never alcohol.
I didn’t know any of this because I rarely came home after escaping to college and then medical school. I flew home for Dirk’s wedding, but six months later, crack cocaine and his first mental breakdown ended the marriage and his job. It was years before I learned of the breakdown or his year in prison for drugs and terrorism threats. A stroke left Dad unable to speak, and Mom, overwhelmed, continued to spin her own fairy tale. The truth—that her golden boy was a mentally ill drug addict—wasn’t part of the narrative.
Dirk and Mom came to my house for Christmas one year. I was married and had an eight-year-old daughter by then. Dirk left unexpectedly early Christmas morning. Three weeks later, I got a credit card bill for over two thousand dollars’ worth of stuff he’d bought with the stolen card. My husband forbade him from ever coming to our house again.
“I’ll pay you back, Chris,” Dirk reassured me when I confronted him. I’m sure he believed it every time he said it over the years to come.
At the scene, a police officer signs me in, then points me to a path that slopes down into the woods. I push tall weeds aside, trying to avoid slipping on the rain-damp dirt and follow a faint trail to a two-person tent in a small clearing next to a rushing river. The flap is zipped shut and I can’t see inside, but the flies buzzing around tell me I’m at the right place.
“Hi, Doc, thanks for coming out. The girlfriend called 911 when she couldn’t wake him up this morning,” says the officer, gesturing at the tent. “They were camping out here after they got evicted because of drugs. Looks like an overdose.”
I put on gloves and unzip the tent flap. A fully dressed man lies on his back on a rumpled sleeping bag. Jack, as I’ll call him, has been dead for hours, maybe even overnight, judging by the purge fluid on his beard and shirt and the degree of rigor mortis that’s set in.
When we roll him over, I find a syringe. The wallet in his jacket pocket gives me a name and a former address. According to his driver’s license, Jack turned thirty-two not long ago.
As we carry the body to the coroner’s van, I see a young woman on her knees, sobbing her heart out. This has to be Jack’s girlfriend.
“Hello, I’m Dr. VandePol, the coroner,” I say, kneeling down beside her. “I’m so sorry about Jack. Can you tell me what happened?” But Yvonne isn’t in the mood for an interview.
“Where are you taking him?” she screams. “Did somebody kill him? I saw blood on his face, and he had bruises.”
“Yvonne, I think it may have been a drug overdose,” I say. “That isn’t blood, but something that happens after someone dies. Same with the bruises. Can you tell me what kind of drugs Jack might have taken?”
“What are you talking about? I love him,” Yvonne screams, immersed in her grief and ignoring my questions. “What are you doing with him?” When I try to speak to her about seeking help for her own addiction the next day, she hangs up on me.
“I’m not surprised he’s dead,” Jack’s father says in a flat voice. He, too, has a story, though he leaves much unsaid. “You’ll find it was drugs, I’m sure. I tried, but there was nothing I could do.”
After Dad died from another stroke, Dirk continued to live with Mom in her isolated country cottage. One day I went to visit my now eighty-four-year-old mother, relieved to find Dirk nowhere in sight when I arrived. Hunter, Mom’s larger-than-life golden retriever, bounded up to greet me while her adopted feral cat ran off into the woods. Mom, still in a frayed nightgown that needed laundering, sat trembling on the edge of her bed.
“I’m scared of him,” she whispered, a tear drifting down one gaunt cheek. I’d never seen her cry. Fear shot through me. I looked out the window. How long did I have until he’d be back?
“Did he hurt you?”
“He yells at me, and yesterday he shook me,” she said, still whispering, eyes downcast.
“Mom, how about coming to stay with me for a few days?” No way is she coming back here as long as he’s around.
A quick look around the house told me Dirk was dangerous. He had punched holes in drywall, pulled electrical wires out of walls, and moved the refrigerator into the living room. I raced around, getting Mom, the dog, and a suitcase into my car. Gravel flew as I peeled out of the long driveway as fast as possible.
Mom’s Lewy body dementia got worse in the assisted living facility, where she sometimes hallucinated about her dead husband and missing son. Three years later, she lay dying in a locked dementia unit, safe from Dirk’s predation but not the ravages of old age and disease. I hadn’t seen or heard of Dirk since the day we raced out that driveway, but I knew what I had to do.
“Dirk loves you, Mom. I promise to take care of him,” I whispered in her ear.
I tried to keep my deathbed promise to Mom, but there was only so much Dirk would let me do once I located him. Fiercely independent despite all his physical and mental problems, still convinced fame and fortune were around the corner—he nominated himself for the Nobel Peace Prize—Dirk only got in touch with me when he ran out of options.
One night he called with a story about a bad landlord and not wanting to go to a homeless shelter. Could I help him out with a deposit for another place? The next day I drove across the Delaware River into South Jersey for what seemed like the millionth time in my life. I parked in a run-down neighborhood, wondering if I had scribbled down the right address.
It must have been beautiful once, this Victorian mansion surrounded by weeds. Now its peeling paint, rotting eaves and broken windows screamed neglect and abandonment.
This looked like the kind of place Dirk might end up. But I saw no signs of life, no curtains, no curious faces in the windows of the decrepit structure. As I got out of my car, I looked all around, wondering if this was a good idea. You promised.
“Chris, come up. Second floor,” Dirk yelled from an upstairs window. “I’m here alone.” Yeah, either that or a drug dealer is holding a gun to his head.
The temperature inside was the same as outside, about forty-five degrees. It was eerily quiet and dark because the power had been cut off.
Dirk sat on his cot smoking a cigarette, his face sunken and unshaven. Bushy gray eyebrows hung over intense brown eyes, and his stringy white hair was stained nicotine yellow.
“Chris, thanks for coming. I’m freezing, those bums left and didn’t pay the electric bill. I only had enough charge left on my phone to call you. Hey, the Prevent Homeless office, they found me a place, but I need a deposit, and I don’t get my check until next week, so. . . .”
Dirk stopped, gasping for air, and pulled out his inhaler. His oldest addiction—nicotine—was catching up with him, his chronic obstructive lung disease now diagnosed as severe. At sixty-seven, he looked like he needed a nursing home, not an apartment.
By some miracle, Dirk scored Section 8 senior housing. I paid the deposit, and he moved into a studio apartment not far from where he’d once terrorized his mother.
Wanda had a lot in common with Dirk. Except for one thing. She was dead. Seventy years old and with COPD from a long-time smoking habit, she lived alone in a senior housing complex not unlike Dirk’s new place. After a neighbor called for a well-being check, police found her deceased on her couch, an oxygen tank still running.
A routine natural death, I thought, nodding in recognition as Wanda’s doctor confirmed the usual chronic illnesses: hypertension, COPD, diabetes.
Then he said, “And she also had a history of heroin abuse.”
“But she’s been clean recently,” he added quickly. Another lesson I learned as coroner? Patients don’t tell their doctors the truth when it comes to drugs and alcohol. Hardly ever.
The drug paraphernalia in Wanda’s apartment—a rolled-up dollar bill, a razor, empty wax packets stamped by illicit drug dealers—validated my skepticism. The fentanyl, methadone, and heroin in her blood clinched drug intoxication as the cause of death.
Wanda’s age and sex made her an outlier among those dying of a drug overdose in my county. Most of the dead were twenty-five to forty-four-year-old men. I would have to call a son instead of a parent this time. But Larry wasn’t any more surprised than Mila Trainer or Jack’s father.
“She’s been in and out of rehab for years,” he said. “Heroin was what she used.”
I wondered what Larry’s life had been like. Had he, like me, been the only one left, doing the best he could, showing up for emergencies? Had he, like Jack’s father, tried but finally given up until there was nothing left to do but make prearrangements with a local funeral home?
Maybe settling into stable housing did the trick. Maybe it was a condition of his lease. I had no idea how it happened, but someone or something convinced Dirk to go to a pain clinic. A doctor there added Ritalin and Suboxone to Dirk’s extensive list of prescribed medications. I knew about medication-assisted treatment for what was now called opioid use disorder—I’d even given a talk on it to the parole officers in my county.
Unlike Wanda, Dirk had been given yet another chance. He was now on a safe and legal drug that staved off the withdrawal he feared more than anything. Suboxone and his apartment gave Dirk a stable, safe lifestyle for the first time in decades. He began calling me every few weeks just to talk, even reaching out to recognize my birthday. The decades of drugs had taken their toll, though; I mostly listened, but I could not make much sense of what he said.
Dirk didn’t have a car anymore, so travel to and from the mandatory pain clinic appointments could take all day. He’d come home exhausted and need days to recover.
By now, I was sending him gifts for birthdays and Christmas and making sure he had coverage to pay for his medical care. But it wasn’t the same as showing up in person. Dirk was too frail to scare me anymore, so instead of waiting for another call for help, I punched in his number one evening.
“Hey, Dirk, when’s your next appointment with the pain clinic? How about if I come there and drive you, then we could have lunch afterwards?”
My favorite route to Dirk’s apartment takes me through a wetlands area, a marsh known for the eagles, herons, mute swans, ducks, and other species that flock there. The swans are the main attraction. As always, I stop for a moment to watch the graceful birds swimming, nesting, and diving for food.
The NJ Division of Fish and Wildlife slaughtered at least fifty-five of the stately swans fourteen years earlier, claiming they were non-native and might have avian flu, posing a risk to humans. Conservationists and bird lovers contended the swans were sacrificed to make room for more game birds for hunters.
I pull away from the marsh and call Dirk to make sure he’s awake. His sleep habits are as unpredictable as ever. I park on a pot-holed, dead-end street in front of Dirk’s first-floor studio apartment. The orange marigolds he’d grown from seed last summer now lie bent and brown along the steps up to his door.
As I knock and push the door open, I brace myself, hoping the Suboxone and Ritalin have evened out Dirk’s erratic behavior. I can keep it together for a couple of hours if I just agree with whatever he says and don’t get too close.
“Hey, Chris, you’re early. Thanks for coming,” says Dirk. He’s sitting in a swivel chair beside the cigarette-rolling equipment on his antique roll-top desk. He can’t afford to buy packaged cigarettes anymore, but he hasn’t been able to quit either. Not even after he was put on home oxygen. He looks about the same as when he moved here over a year ago, except now his white hair falls below his ears. Maybe I can take him for a haircut.
“We better get going,” I say, looking at my phone. “Looks like it’s about half an hour to the clinic.”
Dirk takes a last long drag on a cigarette before getting into my little sedan. As always, a nonstop flow of words comes out of his mouth: complaints about the bus, the neighbors, the heat in the apartment. And effusive praise for the TV show The Wire, which feels more like his life than anything else he watches.
Dirk insists he knows a back road to the clinic, but thirty minutes later, we are nowhere near our destination. I pull over to get GPS directions on my phone, cursing myself for listening to someone who hasn’t driven in years.
Dirk continues to run on, nervously rambling about being late, a doctor who “messed him up,” inconvenient pharmacy hours, how he can’t figure out email, and his invention for preventing school bus accidents.
“Shut up!” I finally scream at the top of my lungs. “Is it even possible for you to be quiet for one minute?”
Stunned, Dirk does shut up. I grip the steering wheel, afraid of what he might do next. Maybe we’ll both die in a fiery crash on this rural road. I steal a sideways look at him. He’s staring at me as if seeing me for the first time. As if I’d snapped him out of a hypnotic trance. His silence is louder than his voice.
Suddenly, I’m horrified that I, a doctor, have lost my temper with a sick person. I’m ashamed, but Dirk seems almost relieved at piercing my armor. His big sister isn’t perfect after all.
When we finally get to the clinic, a nondescript single-story stucco building on a backstreet, about fifteen people are waiting at the entrance. They’re a grim lot, hunched against the cold, shuffling around to keep warm, all eyes fixed on the locked door.
“Let’s stay in the car until they open the clinic,” I say to Dirk, not wanting him to stand out in the cold. Like Wanda, he’s an outlier here because of his age. I had planned to go in and see what the clinic was like, but now I know what’s inside: another chance of staying alive.
After the doctor’s appointment, we have that lunch at Burger King—Dirk’s choice—then stop at his favorite thrift store for four-dollar pants. He babbles away again on the way back, but the sound isn’t as exasperating anymore.
We make it back to his apartment with no further outbursts on my part and frequent thanks on his. As I drive away, Dirk stands on his front porch, leaning on his cane with one arm, waving goodbye to me with the other.
***
Rumpus original art by Liam Golden
Voices on Addiction is a column devoted to true personal narratives of addiction, curated by Kelly Thompson, and authored by the spectrum of individuals affected by this illness. Through these essays, interviews, and book reviews we hope—in the words of Rebecca Solnit—to break the story by breaking the status quo of addiction: the shame, stigma, and hopelessness, and the lies and myths that surround it. Sisters, brothers, mothers, fathers, adult children, extended family members, spouses, friends, employers or employees, boyfriends, girlfriends, neighbors, victims of crimes, and those who’ve committed crimes as addicts, and the personnel who often serve them, nurses, doctors, social workers, therapists, prison guards, police officers, policy makers and, of course, addicts themselves: Voices on Addiction will feature your stories. Because the story of addiction impacts us all. It’s time we break it. Submit here.
