by Matt Samet
“Okay, Mr. Samet. Dr. Jabba is ready to see you,” she says.
I follow her to a windowless room, go inside, and sit down across from the doctor. He’s a fat, jowly, bearded troll with Dick Cheney lizard eyes and all the warmth of an Antarctic ice shelf. He does not extend his hand nor introduce himself.
“It says here, Mr. Samet,” he launches in, leafing through my file, “that you want help getting off Klonopin. Is that correct?”
“I—I—Yes! Yes, I do,” I say. “Please, please, Dr. Jabba. You’ve got to help. The anxiety is so bad … so, so bad. Oh God, oh please, I need your help.…” I’m openly sobbing before this man, a man I’ve never met in my life. It’s something I would never ordinarily do—in fact, before this period and especially after it, I’m often accused of being too reserved, too silent and emotionally standoffish around family and friends.
“And how long have you been on it?”
“Years. I—I was on Ativan for five or six years, then Klonopin for the last year or two.”
“And you want to stop?” His words are clipped, emotionless.
“Yes, please, please, please help me quit, Dr. Jabba. I—I—I—just want to get my life back. To be with my girlfriend and my dog.” I reach for some tissue, dab my eyes, blow my nose. “I … I’m a climber.”
“And you live here in Colorado?”
Something is wrong. Why is he asking questions he could have easily answered himself by reading my file?
“I do. Boulder. But I thought you—”
He cuts me off: “Look, Mr. Samet. You have chronic anxiety. Why would you want to stop your pills?”
My spirit sinks like the proverbial man who wakes up in a coffin, realizing that he’s been buried alive.
“Because I think the pills are making the anxiety worse, Dr. Jabba. Because I—I … This is what I came here to do. The woman out front, she said you guys could help me get off benzos. That’s the only reason I’m here.” I stutter and stammer as he stares at me with all the compassion a black widow might feel for a fly: “It’s … it’s what I came here to do. All the way back to Colorado … Didn’t you read my evaluation from Johns Hopkins? They said I needed to stop the Klonopin, too.”
“No.”
“No?!”
“No. I haven’t had time.”
What? It has been twenty-seven hours since my admission, three hours beyond the timeframe in which, legally, a doctor must evaluate his patient, and he hasn’t even cracked my fucking file? What kind of cunted-up three-ring shitshow is this place?
“But you need to read it to understand what—”
He cuts me off again: “Klonopin treats anxiety, Mr. Samet. And I see you sitting in front of me sobbing and clearly severely anxious and wanting to go off, but you need to be on it. The proof is your extreme anxiety. The proof is right here in front of me—you yourself are the proof. In fact, Mr. Samet, you need to be on Klonopin for the rest of your life. It is a safe, reliable anxiety treatment, and I can’t see why you would want to stop. I’d even suggest that we increase your dose tonight.”
How can this doctor, knowing me for all of two minutes, make the snap judgment that I need to be on benzos forever? This is “health care”? I’m waiting for Allen Funt to emerge from behind the door and say, “Hey, great one, Matt. Well-played, but you’re on Candid Camera!” What a fine joke that would be.
“But, Dr. Jabba, I’m not here because I want to keep taking Klonopin,” I protest. “In fact it’s the opposite. I keep trying to tell you that.”
He inhales deeply, rubbery man-teats rippling beneath his cardigan, drawing air down into his panniculus, this shabby, obese, dead-eyed motherfucker who could not even crawl up the cattle trail on mountains I’ve climbed by their toughest routes. This “doctor” pauses, scribbles a note in my file, and then sighs, loudly, theatrically, exhaling sour smoker’s air. This is who I’ve flown back to Colorado to see: Jabba the Fucking Psychiatrist Hutt.
“Fine, then,” he mutters. “We’ll switch you to Seroquel, see how that goes tonight.”
“But—but how long will I be here?” I ask.
“I don’t know,” he says. “We’ll just have to see. I’ll call it in to the med station.” And with that the psychiatrist waves one flabby paw and dismisses me. I shamble out of the room, too dazed even to be anxious anymore. I forgot to ask how Seroquel works, but it hardly seems to matter. I know that it’s an antipsychotic. Still stunned, I head for the med station and queue up next to a small, grandmotherly woman who asks my name. I tell her it’s Matt, and her eyes light up. She says that Jesus had asked a “Matt” to relay a message to her. Thinking of no better option, I hug her and tell her that everything will be okay. The woman looks into my eyes, mumbles something, and takes my hand to thank me, saying God bless you God bless you God bless you God bless you. She swallows her pills and wanders off. I take the meds they proffer in a tiny Dixie cup, like the sample cups at an ice-cream shop: Trileptal and a dose of Seroquel. I swallow them and return to the dinner table. There someone tells me that the grandmotherly woman’s son died and that she has not been the same since, that she is lost in a way no one can fix. I try to eat but within ten minutes can barely move, as if my entire body has been shot full of Novocain. When I stand the room yaws like the deck of an Alaskan trawler, so I shuffle unsteadily to a couch and plop down poleaxed, gripping the armrest and staring at patterns in the linoleum floor. I space out on scuffs and scratches and puke-colored flecks. My thoughts are like blood clots: lodged in there somewhere but dark and obscure, obstructing the proper flow of information.
I couldn’t tell you how long I’m on the couch. Minutes? An hour? Days? I feel an arm around me and it’s my father. I turn to the other side: Kasey.
“Dash, yoov harsh tor gar meen aortarrr har,” I say. “Kasey, theev garve me a barn pile and eesh … marfing me snicter.”
“What, Matthew? What?” my dad is asking. “Are you okay? Did you see the doctor?”
“Arsh dard I dinnint tell nawr.”
“He didn’t see you until now? What—What did they give you?”
“Zhairerquill.” My eyes are glassy, fixed.
“Oh, nuggins,” Kasey says. “What have they done to you? What did they give you? You’re not yourself.”
“Auntie shycaustic.”
“Antipsychotic?” my dad asks. “But why?”
“Strawp klonnerpenn … preesh, I wanter go harm.”
“I think maybe you should go home,” my dad says. “Did the doctor even read your file from Hopkins?”
“No.”
A flicker of anger crosses his eyes; this is a man who’s accustomed, in the medical milieu, to seeing things done immediately upon his request.
“They can’t do that,” he says. “They have to see you in twenty-four hours, and we paid a lot of money for that evaluation. I can’t believe this.”
Kasey takes my hand and holds it, kneading it in her lap. My mitts are smoother than they’ve been in decades—office-worker hands, not those of a climber. I’m crying again, but silently, tears gliding over my cheeks, the face muscles frozen. I just want to go home and finish this taper on my own. My dad stands up and says he’s going to find the hospital administrator. When he returns with the man—to his credit, profusely apologetic—they agree to release me, and my father pushes the point that in addition to a full refund the facility note that I did not leave “against medical advice,” as it might prejudice future practitioners against me. The administrator agrees to everything and has me sign discharge papers. I trail my hand across the page, willing my fingers to close around the pen. We collect my clothes, my new boxer shorts, my new razor, Smeech the frog, a self-help paperback on chronic hyperventilation that I’ve been reading. I’m starting to unfreeze simply by moving around while my father steadies me. I look back into the room a final time as we go and my roommate’s still lying there, looking into the night and awaiting a liver that might never come.
One half milligram a
day, Klonopin, Boulder, Colorado, late September/early October 2005:
Autumn—not “fall,” which is a dirty word to climbers—is a sacred time for Colorado rock jocks. We call September “Sendtember” for its cool, dry conditions, and October can be even better. The cliffs, etched against azure skies, ripen to their full beauty, dark smudges of stone emerging from red, sienna, and golden stands; underfoot ferns turn yellow then dry, flaky brown, and even noxious plants like poison ivy glow vibrant crimson. Unlike late spring, with the whole climbing season before you, in autumn you feel the clock ticking—it’s time to finish up any outstanding projects before the snow starts to fly.
Too bad I have to sit this one out. Tragic, really—it would tear at any climber’s heart. You get only so many autumns in a lifetime.
Before my father left, we devised a plan to see me through my taper. He wanted me to return to Hopkins, but I just couldn’t. I agreed to start seeing a therapist in addition to working with Dr. Porridge. This therapist came highly recommended, an anxiety expert who’d mentored the woman I used to see back in Glenwood Springs. I approach it all with fresh optimism, at least for the first week or two, happy for my nominal freedom. The therapist isn’t cheap—she works from her stately Victorian home—but my father is paying and seems fine with doing so. I feel guilty, a broke and uninsured thirtysomething leech, until he tells me he just wants me to get better.
This therapist: It’s complicated. She is a well-meaning woman who did come to care for me, who once came and plucked me from my house when I’d stopped answering phone calls and become semisuicidal. She helped me to leash-train Clyde by showing me how to use a Gentle Leader and how to bribe him with bits of frozen hot dog. She visited at Mapleton when I ended up back there as an inpatient. And she would have me come over for an oatmeal-and-blueberries breakfast, and then take me walking around the Pearl Street Mall, downtown’s pedestrian area, to show me how to be out in the world again. But she is also distinctly overbearing and takes a narrow “tough-love” cognitive-behavioral approach, which means she operates only within certain paradigms. She really does not know the first thing about supporting benzo withdrawal, a fact borne out by her confession to me, after I returned from Hopkins, that not one of her patients had ever successfully tapered without hospitalization. Things could have been framed so much better, so much differently.
Early on, this therapist gives me solid tools: a bag of birdseed in a pillowcase that I heat in the microwave and then place on my belly for breathing exercises. The heat, weight, and pressure are reassuring, and it’s nice to have something I can reach for other than pills at sundown. And she refers me to a healer and yoga teacher, Steven, who leads therapeutic-yoga classes in Boulder and does private sessions at home. With Steven, I work on chi breathing exercises, stretches, and “bottle work”—using the neck of a plastic bottle to massage my belly as I visualize breathing through it, drawing the air down deep using the diaphragm instead of taking nervous upper-chest breaths. Steven has a theory that by using the bottle until your guts soften and burble, you’re stimulating the enteric nervous system to promote calm. I begin carrying a Perrier or Vitamin Water bottle with me—it will become a talisman, my only solace on nights of unending agony.
I also start visiting a massage therapist, a beauty with a South American accent and miracle hands. I have a secret crush on her, so it’s no problem battling my way across town for an appointment, and I always leave feeling better … at least for a half hour. Between the psychiatrist, the therapist, Steven, and the massages, I have at least one appointment every day: all the king’s men, trying to piece Humpty Dumpty back together again. These visits provide the only structure to my days—a raison d’etre when the ones that matter most, climbing and work, have been stripped away. I’ve taken to lifting weights at home, using chi exercises between sets to temper my breathing. I will keep to the weights religiously for the next two years because it’s often the only exercise I can do.
The therapist promises that if I can “withstand some strong sensations” she will get me off benzos. I’m encouraged. We start with a benzo-tapering workbook. It’s written by two psychiatrists who, given their breezy, clinical tone, have clearly never undergone withdrawal. It’s on loan to me, the pages coming loose from the binding, the glue old and cracked. I take the book home, start reading, dutifully tracing the withdrawal timetables onto paper of my own so I can track my progress. According to these experts, I should be done in four to six weeks—not so long at all. I can’t wait! I have it in my head that once I’m off, the anxiety will, lacking fuel, smolder and die out. I just need to be shut off this last half milligram. Then I see it: an equivalency table. It reveals that my “tiny” dose of four milligrams of Klonopin a day actually translated to eighty milligrams of Valium, as much as I was abusing in 1996. Right now, at a half-milligram of Klonopin a day, I’m still on essentially ten milligrams of Valium: an entire Roche Blue Note. I flip the page, landing on a random paragraph: “There is some evidence that the higher the dose and the longer the duration of use, the more symptomatic will be the withdrawal process, though the patient should not let this fear impede his or her progress off the drug.”
I don’t like this book so much anymore. I also don’t like a couple things the therapist lets drop, careless tidbits discouraging in timbre, things not to say to someone as fragile as I’ve become: Namely, that she can’t be certain that Vicodin abuse hasn’t left me permanently panicky, like a musician client of hers she mentions who fried his circuits with cocaine, and that I have the absolute worst anxiety of anyone she’s seen. When you’ve lost all sense of yourself in a crisis and your brain has been chemically rendered so malleable, ideas like these congeal like footprints in wet cement. They’re dangerous. They extinguish hope. As she tells a roomful of fellow panic sufferers one night during weekly group therapy, “This is Matt, who’s joining us for the first time. And can you believe that his anxiety was so bad that his doctor had to put him on four milligrams of Klonopin a day?”—the implication of course being that the problem is intrinsic to me and not entangled with these addictive pills.
Bullshit—I’m a climber. I deal with more fear in a year than most people will in their lifetimes, wasting away before the idiot box second by brain-dead second.
Remember, we go to health-care practitioners for, if not perfect wisdom, at the minimum an infusion of hope to empower us to keep fighting. Primum non nocere—“First, do no harm”—is the guiding principle of modern health care. This should also extend to the way one’s condition is verbally framed by a caregiver, especially if the patient is psychically vulnerable.
Housebound and hopeless, I’ve lost all sense of myself, all discernment when making decisions, especially when it comes to my health. I’m able to work a little, on freelance transcription and copyediting projects for a local publishing house, but besides my various appointments this work is my only contact with the outside world. I dwell in a thickening twilight, a fear-fog teeming with winged bugaboos, howling banshees, and fanged demons. There are no longer any boundaries between the anxiety and me: I’ve become anxiety, though a better word really is terror. It is existential terror—not a fear of any particular thing, but a bottomless horror at simply existing so lancing it precludes rational thought. As my father would later put it, “You certainly didn’t have control over your thinking.” My brain is like a sponge, but not in the good way, like a toddler soaking up language. It’s more like a cinder-block wall on which any gangbanger can spray-paint his tag because the ego boundaries that make me me, my assembled years of opinions, emotions, thoughts, and experiences, have been obliterated by benzodiazepine withdrawal.
Little wonder then that I continue to drink the Kool-Aid when Dr. Porridge reiterates that this taper must be approached from a “place of strength” and that “not having other meds on board could be very dangerous.” I still trust and believe him that there mustn’t be any “gaps in treatment.” I am the empty, shocky vessel into which
he can pour his steaming elixirs, a walking, talking human-test-tube experiment. I find myself at his office on a dim late-autumn afternoon, the sky snot hued and gauzy out the window, telling him how much trouble I’ve been having sleeping and focusing. I ask the doctor what he thinks about taking another month to get off Klonopin, and he says that I could easily cut a quarter milligram every three days, which would mean I’d be done in, well, a week.
Only a week?
“And you’ve seen other patients do this, Dr. Porridge?” I ask.
“Yes, certainly.”
“Tapering this quickly, without any problems?”
“No. No problems—they were completely fine, with no spike in anxiety after a week or two. You might feel some flu-like symptoms for a few days, a headache, fever, and chills, but that’s about it.”
“And I’m done.”
“Yes, you’d be done.”
“Just like that?”
“Just like that.”
Dr. Porridge writes a prescription for a few sleeping pills, Ambien, which he assures me won’t interfere with my taper. What I don’t know and what the doctor doesn’t bother to relate is that Ambien, like Lunesta and Sonata, is one of the “Z drugs”—for their generic names zalpelon, zolpidem, zoplicone, and eszoplicone—which despite being labeled “nonbenzos” because of structural differences have a nearly identical chemical action. The drugs bind selectively at BZD receptor sites and can cause similar problems to benzos, among them rebound insomnia when you quit taking them. I shouldn’t be on Ambien, especially not now. But he doesn’t tell me that. He also gives me samples of Risperdal, an antipsychotic.
I have just one more question:
“Dr. Porridge, what do you think about doubling my dose of Paxil, like the doctor at Hopkins suggested?”