I’ve worked throughout California in over 15 different hospitals, and have seen people die from all kinds of drug abuse, from alcohol to methamphetamine, heroin, and even prescription drugs. But I’ve never seen so many people die of cocaine than at the hospital at which I work in Compton.
Working as a hospital doctor (hospitalist) in Compton since 2016, I’ve observed so many young people, some even in their 30s, either on dialysis from permanent kidney failure, or with congestive heart failure, where the heart pumps only a fraction of one’s normal flow—both diseases and damage from crack cocaine.
Even as an ER doctor, my awareness of cocaine and its consequences had fallen off my radar. It’s not the 80s anymore, with DARE and the drug war going on, or the memorable “This is your brain on drugs” commercial of the egg frying in a pan, or Chris Rock smoking crack in the 1991 film, New Jack City. It seems the conversation, both in popular media and within the world of medicine, has left this disease and these patients out.
Honestly, it can be flat out depressing working in this type of setting, where there is an almost revolving door so-to-speak of drug related illnesses. You treat one person, just to have the bed fill up with another. The never ending suffering from this drug makes me wonder, “Are we making a difference? Does my work here matter?”
My assumptions prior to working in this environment, I’m embarrassed to say, were that crack addicts are hopelessly strung out and just don’t give a shit. In a busy hospital setting, it’s often easier for us providers to move them through the system, rather than to sit down with them for a moment and talk about what’s really going on. So I decided to try this, and I discovered something almost equally as shocking:
Crack addicts want to live. All of them.
Yes, that’s right.
Here’s a conversation I’ve had countless times and how it usually goes:
Me: I’ll be your doctor today. I understand you had some chest pains, I’m wondering what that could be from.
Patient: Oh I don’t know. Maybe my blood pressure or stress.
Me: Anything else that could have caused that? Anything you’re taking or doing?
Sometimes I have to specifically ask them about cocaine, but most of the time these suggestive, guiding questions will get my patient to discover this for themselves. Most know it’s bad for them.
Patient: Could crack do that to me?
Me: I think you’re exactly right. Smoking crack did caused your chest pain, and I don’t know if they told you this yet, but you had a heart attack.
I allow silence, sometimes even up to a minute while the patient processes the reality of substance use threatening their life.
Patient: Well I’m done with crack. No more of that.
Me: I have a question for you. What are you living for? Kids? Anything you enjoy in this life? Anything you’re still meant to do?
Patient (in tears): Ya I got kids. I got things I like to do. I want to live.
Me: How long do you want to be around for them? Is smoking crack going to take years away or give you more years of your life?
I ask them this because I want that connection made between crack and what they value most. I want that connection made in their brain.
I was surprised to hear that my stereotypical crack addict — to be blunt, was a real person. With a family, kids, wants, and things they like to do. Some even have a mission. One guy wanted to run his own program to help people. Shocked me. Yes, they are real people. But after having the same conversation over and over again, I have realized this wasn’t just one patient.
Now let’s be real, I will admit my limitations, I cannot get through to everybody. I would say that most, maybe 90% of my patients, respond well to this intervention. They really appreciate the honest talk about their health and what matters to them. Almost all ask me to be their primary doctor. Taking a couple of genuine moments like this, I hope, might make a difference.
But there remain the 10% who truly are lost souls. They have a glazed look in their eyes, and I can’t help them. I feel it in the pit of my stomach as I type that. I won’t quit. But I’m no savior. Nor am I delusional that the Come to Jesus moment permanently changes lives. I know many, probably most, go back out and use. That the resources we have for drug rehab are almost nonexistent, and despite my patients being good people, they live in a bad environment with temptation to use on too many corners.
But still, for my crack addicted hospital patients, contrary to what I ever expected, they want to live. For their kids, for their lives, for themselves. No crack addict wants to die. Although a tiny drop in the ocean, that still gives me hope.