by Jacob Louis Freedman, SOM ’09
I sit down on the radiator next to his bed so that he knows I mean to hear the full answer when I ask him Why do you use drugs Mr. Reyes? It’s the question that I’ve been waiting to ask him since he was admitted to our service nine days ago with a bad case of Staph Endocarditis.
“When I was a boy in Puerto Rico I lived in a very tiny house with all of my brothers and sisters and my parents and my grandpa. We only had electricity in two rooms. I remember that my father was always at work. He worked as a janitor and worked so hard like every night until almost dark. When he would come home I was always trying to get him to play baseball with me and my brothers but he was too tired. He used to tell me that I should get a job where I wouldn’t have to work so hard; where I wouldn’t have to lift heavy things and clean toilets to pay my bills. That I should get a job that paid a lot of money so I could have a real house for my kids. I wasn’t any good in school but I was good at being on the street, so I said to my neighbor Ricky that we should go into business together.
Ricky and I started out real small, just moving nickels and dimes. I was still a boy like fifteen at the time and I never touched it more than once or twice because it got me real scared and stuff. So that was pretty much it. Selling nicks to make some money to buy a new stereo. Then I met my wife. She wasn’t my wife then, but I knew her at school. Like two years later she was already pregnant with our first daughter. She wasn’t my wife at the time and we were both still living with our parents, but after she had our first daughter I started to move on to bigger things like selling coke because there was bigger money and by now I had more connections across the Island. So me and Ricky were selling coke and we started making big money that we could move out from our parents’ house and get an apartment. That was good because my wife she could live with me, she was my wife now, we got married after our baby Gabriella. And so we were married and living in an apartment with Ricky and his girlfriend and making more money like every day. It was good and my wife got pregnant again and I had like everything to support her. We were moving kilos and making lots of money too so I got an apartment for just her and me when I was eighteen and Miguel was born. Miguel was my son and I loved him so much. Now he lives in Florida and I don’t see him too much but he was my only son and man I would do anything for him. He plays baseball you know and he’s real good. So me and my wife and our babies had our own place and Ricky had his own place nearby with his girlfriend and we used to still run together making money. My wife had our next girl that she was pregnant with when I was nineteen and she was beautiful my little baby girl Nina. Nina was so beautiful and I remember that with the money I was making that I could buy her just about anything so I got her a beautiful new pink dress when she was still like just born.”
“I remember that I used to not really ever think that anything bad could happen but I had enough money that people get jealous and they want the things that you have. You know I had this red sports car that my friends suped up with rims and everything man and it could go so fast but mostly I just rode around in it. I tell you that I remember one time I was coming home from picking up our kilos and I saw a lot of cars around my house and I said damn man, this is it. And I wasn’t so surprised that it would happen because people are jealous you know but it surprised me that Ricky was there with them. It was June 22nd 1995 at 1:31pm and I remember that as my wife ran out the door holding Nina that I started to hear shots coming from lots of different places. I knew that I was hit but I didn’t care because all I could see was Nina bleeding from her head. I ran to pick her up but it was too late. My wife was also hit a lot of times. I didn’t even have time to look for my other kids. I thought they were dead but thank God I know that they were visiting their Grandparents that day and that was what saved them. Nina was dead and we left her because I had to get my wife to the hospital. It was 1:48pm when I got her to the hospital and the doctors started to operate on her immediately. I was only hit in the leg so they didn’t care then. I got x-rays and other tests first before they operated on me but all I could think about was my kids and my wife.”
“My wife was in a coma for like almost a year and I remember that the day she came out of it I was eating breakfast with my parents when they called. The hospital said that she’s moving around and that she’s talking and it was a miracle. I went to go see her and it was May 6th 1996 at 10:22am when she looked up at me and smiled. She was still not strong enough to hug me but I didn’t care. I thought it was going to be very quick with her getting better but instead May 9th 1996 the doctor said that she was very sick because of bleeding and then she died like right after we talked. I still don’t understand what happened. I remember that I went right home that day and cried so hard that I couldn’t even see my kids. I cried and I wanted to die because I didn’t know why I should live anymore.”
“I had to leave Puerto Rico because I was too stressed out. I went to stay in Florida with my cousin Carlos. My cousin Carlos said that I should go to smoke with him to chill out for a bit the night that I came to stay with him. I calmed down. Then when he started to use needles I thought maybe it would help me too. Then after that I used needles every day. I had a doctor that said to me once I should see a psychiatrist and when I did he told me that I had depression and anxiety and bipolar and a drug problem. I don’t know too much but I know that I was always sad about my wife and my kids and I couldn’t trust nobody because of what my best friend had done to me. I always use clean needles but then I got hepatitis and my heart surgery that you said you knew about. I used to go between Florida to Worcester and to Puerto Rico to find work but it was too hard. Sometimes I get arrested. Sometimes I go to jail and sometimes I go to rehab. Now my chest hurt again this time and so came here and now I talk to you because you asked me.”
I struggle to connect my thoughts to my lips. I tell him I am sorry to hear about your wife and your daughter.
“Its OK man. You know I’m going to be a grandpa soon. In four months. June 2nd is when the doctor said my Gabriella is going to be a mommy. You know sometimes I used to not care if I died but I know that my Gabriella needs me to be her dad. She needs me to be a grandpa to her baby. My son needs me too also you know.”
I am unable to control what I say to him next because it is reflexive. You know Mr. Reyes you have so much to live for. You have a son who needs you to watch his baseball games and a daughter who needs you to be a grandfather to her baby. But you are killing yourself with drugs. Many people who come in with your illness don’t ever leave the hospital. They die here. And even though you are going to be able to walk out of the hospital this time, next time you might not be so lucky. Next time you might not even make it to the hospital because the streets are too hard. And if you keep on using drugs then you can trust me when I tell you that there will come a time soon when using drugs will kill you. I had a patient last week that used drugs his whole life and then he died. And he had nothing to live for, no family, no nothing. But I’ll tell you again Mr. Reyes, you have so much to live for. And the drugs are already out of your system. All you have to do is make a decision not to use again.
“You’re right man. I know you’re right. And I want to stop using. That’s what I’m telling you is that I don’t want to do drugs no more so that I can be a grandpa.”
He stands and opens his arms to give me a hug. I meet him and I feel his tears on my shoulder just as sure as he must feel mine.
“I been to like a thousand places man and you’re the first person I ever know that hugged me back. I want to live, I tell you that I want to live and that I don’t want to use drugs any more.”
I can’t stop smiling as I walk out the door; all I can think about is how good it feels to connect with my patients. My resident sees my happy face and says, “I see you already heard the good news. We’re discharging this prick today. But don’t be too excited, he’ll bounce back in a week with some other complication from his IV drug use.”
I swim outside of my body attempting to consider the whole encounter as objectively as I can. I think about everything I’ve know about the personalities of chronic drug users and how deceptive and manipulating they are. I think about how many times Mr. Reyes must have told his doctors I want to live. I think about how many fake hugs he must have given to his social workers over the years and I hate him. I think about how he’ll be back on the streets searching for his fix and then back in with another endocarditis, pneumonia, or osteomyelitis within a month to drain the free care pool and completely screw the health care system. And then I think about his son Miguel the baseball player and about his daughter Gabriella about to be a parent herself. I think about his baby Nina in her pink dress and his wife whose name I don’t even know. I think about how he wanted to be there for his family and to give them a better life than the one he grew up with. I think about what happened on June 22nd 1995 at 1:31pm in front of some apartment in Puerto Rico in one horrifying minute that I’ll never understand. I look at my resident and all I can think to say is I hope not, I hope he won’t be back. “Hell yeah I hope he doesn’t come back, I hate the guy. Now let’s grab a cup of coffee quick before radiology rounds.”