Timothy's Law

That opened a discussion of Timothy's Law, insurance parity legislation that has been consitently blocked in New York state by the Republican-controlled Senate leadership despite widespread support in the Democrat-controlled state Assembly. Timothy O'Clair was a 12-year-old boy suffering from mental illness whose parents were forced to place him into the state's foster care system because their insurance coverage was inadequate to pay for appropriate care for his Depression, Attention Deficit Hyperactivity Disorder, and Oppositional Defiance Disorder. He hung himself in his bedroom closet on a visit home a few weeks before his thirteenth birthday. Deirdre had recently testified on behalf of passage of the law in Albany.

We touched on how recovery, as with any disease, often takes repeated treatments. When Amber first went into rehab in the early Eighties, she said, no one knew how to address an addiction to "powdered drugs." She was loaded up with pills, booze and methadone.

"They had me so high because they didn't know. They gave me too much methadone, then they gave me valiums, they gave me something to sleep at night. So it doesn't go; you get addicted to something else. And when you're dually addicted, you may kick one thing and seem fine but a week later, goombatz okay, the pills or something kicks in and you're right back where you started from and you don't know why you used again."

She mentioned one drug rehab she was in where patients earned drinking privileges after a certain period of clean time "until they realized you might just as well smoke crack."

Anne and Amber started discussing the stigma that family members of alcoholics and addicts feel.

"This is the part that gets me mad," Amber said. "It has nothing to do with the person who is trying to get better. It has to do with the other people because they're embarrassed. They're embarrassed because someone may say, 'Well, you raised them.' It goes back genetically."

They agreed that a person didn't have to be a "falling-down drunk" to be an alcoholic, and that there's a widespread misperception that people who just drink beer aren't alcoholics.

"It's not what you drink, it's how you drink," Amber said. "There are weekend alcoholics who have two cans of beer but the guy will crush the can on his wife's head when he's done with it. Alcoholics are people who can't have a couple of drinks and put it down. When they drink, they drink to get blasted."

We discussed how difficult it was, sometimes, to stay away from having "just one" beer.

"[Amber] said when grandma, my mother, died, 'You think I didn't want to have a beer with the guys?' " Anne said. "And then when dad, Bob, died ..."

"You know, to get over the grief and this and that," Amber said. "Once you pick up, kiss it goodby because it's all over."

Amber stopped drinking in 1986, and doing drugs in 1988.

"I don't take an aspirin now. I get a headache, I lay on the couch with a rag over my face or, like the old Italians do, with a potato on my head. It has something to do with the postassium, or the folic acid."

Teo was ready to leave; they wanted to beat the holiday traffic back to Connecticut. I asked Amber if we could talk some more. Sure, she said, she came down every Saturday. As she walked to their car, Anne called out instructions to do this and that, and to rest, when she got home.

Decline

“She's got a lot of problems but I feel very confident that she will get on a list, and will have a successful operation," Anne told me after Amber left. "I hope to God. She's a good woman. A good young woman. A good woman. When Bob died she came down here and spent two and a half months with me. She is one of my ... she is my best friend. And I admire her attitude."

She described some of the complicating factors of her condition.

"I don't consider her living on borrowed time,” Ann said. “I am optimistic she will get a liver, she will survive the surgery and she will do well.” She punctuated this with a resolute declaration: “That's what I say,” and I was reminded of Rita, my next door neighbor, who felt a similar conviction that her husband John would recover from the cancer that had spread to his liver. She had recently told me that she believed that it was in remission, that John wanted to live, had put his life in the hands of the Lord, and would beat it. What could I do but agree, saying something about the awesome power of the will to live, which I believe to be true. But that will obviously only takes us so far.

It was a busy fall, and I had a hard time setting up a date to talk to Amber. Her mom said she was looking forward to telling her story, but she didn't come down a few Saturdays because she was feeling weak. Finally, we settled on talking during the Saturday of Thanksgiving weekend. Anne called me an hour before we were scheduled to get together and apologized. Amber was too tired, and was resting. She died two weeks later, on Dec. 13, before a liver became available.

It's Madness!

We were at a low point in our tempestuous relationship with Carrick. In November, she had run away from New Hope Manor, an affordable long-term rehab that we felt was her best shot at sobriety, and was back living with Pete on the Lower East Side. We knew he had been supplying her with drugs; we didn't know at the time that he was a small-time dealer supporting his habit by selling heroin.

Realizing that we were only enabling Carrick by giving her access to a bed, warm shower, full fridge and money or possessions she could hock, we had barred her from our house. My last conversation with her was taut with fear and rage. She was in a car with a fellow named Chris, with whom she had run way from a detox that New Hope that sent her to. As Chris' car idled at the end of our block, I ran outside to make one last plea.

Carrick rolled down the window. I started to address Chris. Carrick said: “I'm going to die, yeah, yeah, yeah.”

“I just want you to know what you're getting into," I said to Chris. "She's going to wind up in jail, dead or in a rehab. I want it to be a rehab.”

“Great vote of confidence,” Carrick said, as the car pulled away.

I tried not to let those words — mine and hers — haunt me, but they were in the back of my head for months. I never knew when a call was going to come from some stranger to tell me that Carrick had been arrested, or injured, or found dead.

One morning in early December, the phone rang.

"Is this Mr. Forbes?" the voice said.

I didn't recognize it, and I was filled with trepidation. It must be like what the parents of soldiers in Iraq feel. This time it was a solicitor for the American Heart Association.

A day before I got word of Amber's death, I finished Alice McDermott's Charming Billy, a novel about an alcoholic who, despite the best efforts of his family and his own attempts to quit drinking over the years, dies. One phrase, in particular, rang out as pathetically true.

"Billy succumbed to an illness we couldn't cure in time. It wasn't a failure of our affections," the parish monsignor tells the family. "It was a triumph of the disease."

An hour after I got word of Amber's death, a friend emailed to ask if I'd be interested in playing racquetball, one of the activities that was keeping me sane. "Sure," I replied. "I'm kind of bummed out this morning and could use a few games. First, Deirdre left a cancelled check on my chair. Carrick had forged one of her checks for $30 just before we took her up to rehab the last time. Four others are missing."

Then I told him about Amber.

"Ann must be devastated," I wrote. "I only met her a couple of times, and I know I am," I concluded.

"Did I mention that on Friday I got a bill for $1,600 from the ER of a hospital in Port Jervis that decided that it could not treat Carrick? No details except that it had billed my insurance and this is what I owed. I can't imagine what the bill would have been if they did treat her. And because of the patients rights bill, I'll bet you that I can't get any information about what they did (i.e., what they are billing me for).

"It's madness, I'm telling you, madness!!!!"

The Funeral

Annemarie's coffin was rolled down the center aisle of St. Matthew's. Teo held Anne's left elbow; her daughter-in-law, Jean, Bob Jr.s wife, was on the right. Deirdre and I were seated in a row near the back of the church. I heard her sniffling. As the priests took the altar, she asked me if I had a tissue. I did not. She dabbed at her nose with her suede gloves. I thought she had a runny nose.

The Mass was concelebrated. The pastor of the parish, a man who speaks with a brogue, was in a minor role. I assumed that the priest who officiated had known Annemarie, and had been invited to say the Mass. His sermon was, for the most part, a generic reflection on us all being reminded of our own mortality, but he did sprinkle in references to Annemarie's work with the Red Cross. He also made an allusion to our having seen the backside of the tapestry that was Annemarie's life - loose threads and “patchwork quilts” - that on the other side formed a beautiful picture. I thought this probably resonated as true with the people who knew Amber well. But wouldn't it resonate for any one of us? Perhaps that's the point.

Then there were more prayers. Deirdre leaned over and asked me when communion was going to be.

“No one needs to see me like this,” she said, her voice cracking. “I think I'll slip away when everyone gets on the line.”

She had pulled her hat low on her forehead. I tilted my head and looked up and could see that tears were streaming down her face. She swiped her face with her gloves again. I gave her the keys to the house. (We never used to lock the door, but we started to after Carrick skipped out of her last rehab. We were her easiest mark.) Deirdre did leave during communion. She said later that the funeral was like a kick in the gut; she felt like she was glimpsing the future.

After the service, Bob, Jr., delivered a very moving elegy in the form of a “Dear Amber” letter. It was about a typical, loving American family coming of age in the Fifties and Sixties. He spoke of Amber being the first girl in the family after three boys, and how she really didn't have to walk around with a six-shooter and call herself “Walter” to fit in with her siblings.

He remembered the time she cut off a chunk of her flowing red hair, making a joke about he wished he had it for his own balding pate. No one laughed though; levity could not penetrate the thick somberness we all felt.

He talked about how much the family had hoped for a medical breakthrough, “or a miracle,” during those last five days in the hospital.

I was reminded once again how hard we keep hoping against hope with Carrick, who we had learned had contracted Hepatitis C.

Finally, Bob concluded by relating how he'd dug up a line on the Internet that had haunted him since he first heard it, in that same church, several years before. It was from a Viewpoint column that John Cardinal O'Connor had written from the hospital, where he was undergoing tests, for Catholic New York. Before he got to the line he'd looked up, however, Bob read liberally from the piece.

“One reflects on one's failures, one's imperfections, one's hope of what one might have done and perhaps failed to do or should not have done and perhaps did,” was one line that caught my attention. Then the Cardinal quickly reflected on evil, goodness, life, death and faith in a way that only a fervent believer, with a massive body of doctine to bolster him, can pull off. Then came the line that had stuck in Bob's head:

“But God writes straight with crooked lines and only he knows what the next moment will bring.”

I wasn't sure what to make of the first half of the sentence, although I got the general drift. When I got home and Googled “God writes straight with crooked lines,” the first hit was for a hand-cast bronze plaque inscribed with the phrase. It cost $239. Text accompanying a picture said that the phrase is “a paradoxical Portuguese proverb, first attributed to a Sixteenth Century Portuguese bishop, that has appeared over the centuries in the writings of many spiritual thinkers and writers. It serves as a reminder of the role of faith in our lives. Out of evil, good can come... “

The phrase was also the title of a sermon by a Methodist minister, Dr. Michael B. Brown, about the New Testament Book of Philippians, which he called “St. Paul's Love Letter.” Brown interpreted the line thusly: “God has an amazing capacity for taking bad circumstances and creating blessings - or for taking imperfect people and creating ministry.”

I don't know how religious Annemarie was, but she immediately struck me as having the divine fire of a zealot who had been stuck from her horse by a lightening bolt. It will always be one of the regrets of my life that I didn't get to talk to her for many more hours.

If you knew Amber, I'd love to hear from you. Let me know how she touched your life.

The Impact of Addiction

Even when she was not with us in our home, Carrick's demands on our psyche dominated our lives. Multiply our experience by the anguish caused by the one in ten Americans who are dependant on or abuse alcohol, illicit drugs, and/or prescription drugs and it's clear that the emotional impact of addiction on our society is enormous.

The economic cost of substance abuse in 1995 — ten years ago — were pegged at $414 billion by the Schneider Institute for Health Policy, Brandeis University in its Substance Abuse: The Nation's Number One Health Problem report.

Well over half of Americans - sixty-three percent - say that addiction has had an impact on their lives, according to a survey conducted in April 2004 by Hart Research and Coldwater Corp., either because they are addicts themselves or a friend or family member is.

According to the government's most recent National Survey on Drug Use, more than twenty-two million people (9.3 percent of the total population) needed treatment for an alcohol or illicit drug problem in 2003, although only 1.2 million actually received it. There are no accurate estimates of the number of people in recovery, whether through formal treatment regimens, twelve-step programs, or on their own, but they logically number in the many millions.

Teen drug use is epidemic. More than one-fifth of eighth grade students report that they use alcohol, according to National Institute on Drug Abuse's Monitoring the Future survey. The figure rises steadily through high school to nearly fifty percent of twelve graders. Fifty-four percent of students have tried an illicit substance by the time they finish high school; twenty-nine percent of twelve graders have tried an illegal drug other than marijuana. The number of adolescents from twelve to seventeen admitted to substance-abuse treatment programs increased sixty-five percent between 1992 and 2002, according to the Substance Abuse and Mental Health Services Administration.

Substance abuse among adolescents is particularly insidious.

"More than ninety percent of adults with current substance use disorders started using before age eighteen; half of those began before age fifteen,” according to a position paper issued by Physician Leadership on National Drug Policy.

According to National Academy of Science figures quoted by the New York Times, thirty-two percent of people who try tobacco become dependent, as do twenty-three percent of those who try heroin, seventeen percent who try cocaine, fifteen percent who try alcohol and nine percent who try marijuana. Other ramifications of substance use - from fights to vandalism to rape to automobile accidents - are well known.

Still, some parents remain remarkably ambivalent about their children's drug and alcohol use, and this dichotomy has become front-page news. A Wall Street Journal feature proclaimed: “Uneasy Compromise: To Keep Teens Safe, Some Parents Allow Drinking at Home” (9/14/04, $$$).

We all know kids will be kids. The question is whether parents will be parents. I think that parents who condone, facilitate, encourage, or turn a blind eye toward underage drinking and drug use are putting their kids, and ours, in harm's way. They certainly are perpetuating a myth — drinking and drugging are requisite part of “growing up" — that unfortunately has become a social norm.