Living and Dying in Brick City (21 page)

But the following week, Tony was back at Beth. It was impossible not to notice him as he wandered around outside the hospital.
He saw me speaking to a co-worker in the hall of the emergency department and knocked on the ambulance bay entry door. My spirits dropped at his once-again scruffy appearance, but he wore a giant smile. When I opened the door, I saw that he was holding two enormous chocolate bars in his left hand. He extended the other hand and thanked me for all that I had done. Then he immediately began explaining. He’d been admitted to the hospital the night I wrote the order, he said, but he was discharged the next day because he didn’t have his Social Security card. Puzzled, I looked at him as if to say,
C’mon, dude, stop lying!

He swore it was the truth. One thing I’ve learned about drug addicts is that a lie can fly out of their mouths with such ease that it sometimes feels like the truth to them.

“I swear to you, Marshall, they said it was impossible to bill me for my stay if they didn’t have my information,” Tony said, obviously having noticed the disappointment on my face. “They told me to come back to New Jersey and secure the proper paperwork and then they could help me.” He paused. “Well, regardless, I have been clean for one week.”

“Where are you staying now?” I asked.

Tony hesitated again. “I’m in a shelter in downtown Newark. It’s cool. I have to be out by nine and back in by six.”

Tony lifted his hand with the candy bars. “Say, why don’t you take this candy off me for three dollars. Man, I’m hungry and could use the money to get something to eat.”

I smiled in disbelief. I’d been a target the instant Tony saw me through the glass doors. He was hustling me, most likely to get high. Drug addicts are the best salesmen in the world. They can sell hot water on a summer day. I fumbled around in my pocket and came up with two dollars.

“Here, go get something to eat,” I said, handing him the cash.

He pushed the chocolate bars my way. “Here you go.”

“Naw, man, I’m all right,” I said. “I can’t eat that stuff. It tears my stomach up. Why don’t you eat them? You said you were hungry.”

He nodded. I felt like the basketball player who hustles to the sidelines in the last minutes of a close game, pulls back a stray ball headed out of bounds, gets it into the hands of the star player under the net, only to watch him stand there, refusing to go for the layup. A mix of anger, sadness, and disappointment rose inside me. I wanted to yell at Tony, make him see that the ball was in his hands, that he was just one leap from victory.

“Tony, you have got to get your life together,” I said, exasperated. “You have a family, especially your children at home.”

“I know, man. You’re right. You’ll see. I’m gonna straighten up. I’m done with getting high.”

I couldn’t say another word. My spirit was crushed—and maybe a bit of my ego, too. I’d wanted Tony to win this time, and I’d wanted to be the game changer. But to make a difference here, I’d need to put in a lot more effort, I realized, and I’d need a lot more patience. Anywhere from half to 90 percent of people with an addictive disease experience a relapse, statistics show. For alcohol and drug addiction, relapse often is chronic, especially with men, who are less inclined to participate in group counseling and therapy.

“Well, thanks again, man,” Tony said, scurrying away. “I have to run, got to hustle up another dollar to get something to eat.”

And with that, my old friend disappeared around the corner.

Trying to locate appropriate treatment for a loved one, especially a program tailored to an individual’s particular needs, can be a difficult process. However, there are some resources currently available to help with this process, including:

M
y old friend Tony’s eyes provided the first clue that he was depressed. They looked empty, and everything about him that day at the hospital said that he had lost hope. I suspect that when he first began feeling that way, he turned to alcohol and drugs to dull the pain, instead of seeking help for depression. Practically every day I see signs of untreated depression in the faces and behaviors of men and women I encounter on the street and in the emergency department. The hollow eyes are a familiar telltale sign. It’s as if you can see through them into empty souls. Many of those who suffer, especially in minority communities, don’t see depression as a medical condition that is as treatable as high blood pressure. More times than not, they refuse to seek help because they fear being labeled “crazy.” If they are religious, they sometimes see their persistent depression as an indication of poor faith, which only deepens their despair.

According to a major 2007 psychiatric study financed by the National Institute of Mental Health, black Americans, including those of Caribbean descent, are less likely than white Americans to suffer from major depressive disorders, but the struggles of black Americans with depression tend to be more chronic and more severe. The National Survey of American Life included one
of the largest populations of black participants for a study of its type—3,570 African Americans, 1,621 blacks of Caribbean descent who immigrated to the United States or were born there, and 891 non-Hispanic whites ages eighteen and older. It showed that fewer than half of African Americans and just one-quarter of black Caribbeans with major depression undergo treatment. Untreated depression is the leading cause of suicide. Various studies have shown that African Americans and Latinos are the least likely of all racial groups to commit suicide. But sometimes they remain locked in their private hell—until their sadness turns to desperation.

Throughout my residency, I treated many patients who wound up in the emergency department after swallowing too many pills on purpose. Once, I even pronounced a newly divorced man in his sixties dead: He had draped an American flag across his body, plunged a butcher knife through his chest, and bled to death before he made it to the emergency room. But nothing prepared me for Juan, a twenty-four-year-old from Puerto Rico who landed in the emergency department during one of my shifts about a year after shooting himself in the head.

He had survived the suicide attempt, but the gunshot had left him blind and disfigured. His eyes had been removed during emergency surgery after the shooting, and he had not yet healed enough for prosthetics. The sockets were infected and leaking pus, which is why his parents had brought him to the hospital that day. Juan was a big guy, about six feet tall, 230 pounds, with short black hair. A scar on both sides of his face, just underneath his temples, indicated the path of the bullet. He towered over both of his parents, a plainly dressed couple in their late forties or early fifties. They seemed distraught and weary as I motioned for them to step into the hallway with me to talk. A translator provided by the hospital followed them out of the room. The father, a medium-built
man with black hair and graying temples, stood off to the side, stoic and silent. The mother’s salt-and-pepper hair hung straight, just past her shoulders, with the sides tucked behind her ears. She wore no makeup, and her face bore the permanent etchings of worry. The weight of her guilt was palpable. She turned to the translator and spoke in rapid-fire Spanish. She wanted her son checked for depression. She clearly blamed herself and was taking no chances that Juan might hurt himself again. I looked down at his chart, which noted that he’d been seen a few times in the psychiatric unit of the emergency department in the months since the shooting. I assured Mrs. Ortiz that I would make sure Juan saw the psychiatrist when I was done.

I had already begun to piece together the story from the medical records and the scars on Juan’s face, but I wanted to know more. “What happened?” I asked as sensitively as I could.

She covered her face with her hands, shaking her head as though she still could not believe it. And all of her pain came flowing out.

He had been a beautiful, happy boy, she said. They had come to America when he was just a baby, to give him a better life. They’d settled in Perth Amboy, New Jersey, between Newark and New Brunswick, and worked long and hard to provide for him. But something went wrong in his teen years. He shut them out, started staying out late, and sometimes locked himself in his bedroom for hours. His temper was explosive; a simple request for him to take out the trash or clean his room would send him into a rage. Other times, he was sullen and sad. Maybe it was just some weird teenage phase, the parents thought. Maybe he’d grow out of it soon, and they’d get their happy, energetic boy back.

But time didn’t improve Juan’s condition. He dropped out of high school, couldn’t keep a steady job, and could never earn enough from odd jobs to leave his parents’ house. He never brought his friends over. Then one evening, when his mother made it home
from work, the house seemed quieter than usual. There was no loud rap music coming from Juan’s room—in fact, she didn’t hear him stirring at all. After a while, she took the chance of making him angry and knocked on his door. When he didn’t answer, she pushed it open slightly, peeked inside, and there he was, sprawled in the middle of the floor in a pool of his own blood. A gun lay next to his hand. She screamed and dropped to her knees, begging and praying. She crawled to the nightstand, yanked down the telephone, and punched in 911. She screamed to the dispatcher in her broken English: “Help! My son been shot!”

My heart ached for this family. As the mother stood there, trembling, weeping, recalling that awful night, her husband eased to her side and slipped his arm around her waist.

“It’s not your fault, Mrs. Ortiz,” I said, trying to reassure her. “You did the best you could for him. And you did the right thing to bring him to the hospital today.”

I explained that Juan had developed an eye socket infection, and I described how to administer the antibiotic ointment that I was prescribing. I also prescribed antibiotic pills and wished them well. But I will never forget the disturbing image of Juan, a once strong young man, now blind and disfigured by his own hand. According to the National Institute of Mental Health, there are eleven suicide attempts for every death. Juan probably had no idea that there was a healthy way out of the darkness that had driven him to such desperation. And even though his parents saw him changing, they knew nothing about depression and where it could lead. Neither did I, the last time I saw my childhood friend Lil’ Moe.

He was my basketball buddy. As kids, the two of us shot hoops together under the blazing sun almost every day. I was in awe of his crossover dribble and pull-up jump shot—
swoosh
, it was all net. His nickname at first was Showtime because he was so entertaining to watch. He was the tallest kid in the second grade, but
the rest of us quickly caught up, and by the time we reached sixth grade, he was the shortest. His interests switched to boxing, and his older brother, who was known around the neighborhood as Big Moe, became his trainer. When it seemed my friend would become his big brother’s protégé, everybody began calling the little brother Lil’ Moe. I went with him to the gym a few times, and once or twice even sparred with him, but it didn’t take me long to figure out that boxing just wasn’t for me. It didn’t make much sense to me to allow someone to beat me upside my head and body. But Lil’ Moe excelled and quickly gained respect for his fast hands and knockout power. He had extreme talent and ambition and a burning desire to master everything that was presented to him as a challenge. He was also a fun-loving, down-to-earth guy whom everyone loved. He soon became the local junior glove champion. Word quickly spread on the street not to go up against Lil’ Moe, and his street credentials grew exponentially after an encounter at the neighborhood skating rink one night with a much-feared neighborhood bully named Rock.

Rock was from the Dayton Street projects, and he’d roam the neighborhood, pick a target, and demand everything from money to clothes and jewelry. Everybody was scared of Rock. I remember looking out my bedroom window once and seeing him handle another guy on the street. They were fighting, and Rock had pulled his own shirt off. Rock’s opponent was six, maybe eight inches taller, but true to form, Rock connected on several punches and kicks, knocking the guy out right there on the street, for all to see. Rock trained in boxing as well as martial arts, but to reinforce his domination, he also carried a gun. He’d occasionally pull it out during a confrontation to make sure everybody knew the deal. Some guys even paid him for protection.