First Person: Withdrawal
by David Kranes
No pain can be too much of a good thing. The danger of “staying ahead of the pain” with Lortab, the “good heroin.”
My wife, Carol, amuses herself sometimes by calling me a “druggie.” She’s noticed that on my rare headache days, I’ll take four or five aspirin. If I’m on antibiotics, I’ll take more than the suggested dosage and at shorter intervals. My father was a doctor. I want to get to the other side of disease as fast as possible. Disease sucks. Carol doesn’t take anything—even when she needs it. She languishes. Moans a little bit. Suffers. She’s a Spartan in real life, so a little bit of suffering, in its own way, is possibly fun for her. The point: We medicate differently. My wife, Carol, amuses herself sometimes by calling me a “druggie.” She’s noticed that on my rare headache days, I’ll take four or five aspirin. If I’m on antibiotics, I’ll take more than the suggested dosage and at shorter intervals. My father was a doctor. I want to get to the other side of disease as fast as possible. Disease sucks.
Carol doesn’t take anything—even when she needs it. She languishes. Moans a little bit. Suffers. She’s a Spartan in real life, so a little bit of suffering, in its own way, is possibly fun for her. The point: We medicate differently.
It’s been said that I seem a very restrained person. Actually I have two speeds, restraint and none-at-all. Restraint is me perhaps 85% of the time, and it’s been partnered, over my years, with a certain melancholy and loneliness. None-at-all takes up about 10% of my behavior. My speed is none-at-all when I’m writing, but sometimes I make the turn from the unimproved road of writing onto the highway of life and forget to shift, which means that, at times, the occasional heedlessness of none-at-all gets partnered with deep regret. I realize I’ve left out 5%, but there’s always that gray area.
There’s no question that I’m obsessive. Anything I unequivocally say yes to, I’m obsessive about. I’ve been obsessive about teaching. I’ve been obsessive about writing. For 15 years I was obsessive about the stock market. I’ve been obsessive about gambling.
Last December I had a hip replacement. I’d been in undeniable bone-on-nerve-on-bone pain for three years, but had taken a “live with it” approach. As long as you can live with it, people advise you, postpone any sort of surgery.
The operation was a success. I join the I-should-have-had-it-sooner chorus of many hip-replacement patients. I woke up and the pain was gone—and my right foot now faced forward, rather than being splayed to the side. Even on crutches, I walked without a limp. It was a kind of miracle. Did I mention I was put on Lortab? “As much as you can—stay ahead of the pain,” I was advised.
“As much as you can” is a dangerous thing to say to an obsessively restrained person. I’m a Yogi who can do more than the average bear, and if the object is to stay ahead of the pain, I’m going to try to be four or five lengths ahead at the wire.
The dosage instructions on my prescription read “Up to 2 capsules every four hours.” That’s clear: Stay ahead of the pain—which I hadn’t yet felt but was certain must be there. Twelve Lortab a day. I like to sleep—which I understood meant that I’d be missing two of the two-Lortab intervals. So, again—doing the math—that meant that instead of two Lortab every four hours times six, I should take three Lortab every four hours times four.
I don’t mean to brag here, but—I have to tell you—I stayed ahead of the pain.
I’ve always had the gift of ferocious concentration, the ability to enter an imagined world and stay there without a break for four or five hours. But for three years before the surgery the pain had, increasingly, been bumping me out. Now, however—and what else could I attribute it to but Lortab?—now I was able to write without deflection. No pain, all gain. The ability to return to the kind of immersion in work which I loved was an aphrodisiac.
In the second month after the surgery, I cut the 12-a-day habit in half, and then, again, to a third in the third month. Though any refill I sought required the physician’s okay, all requests got accommodated; I brought the empty pill-vial in to my pharmacy, then returned for pick-up the next day, and there they were again! My little friends in the bottle!
About four months after I began the Lortab, Carol suggested that it might be wise to cut back further. I told her, “Hey—I’m staying ahead of the pain.” But there was something in the mixed plaintiveness and sternness of her tone. We’d been having long conversations and visits with a close friend in the throes of trying to set his future course with a severely alcoholic wife—lots of talk about addiction and treatment and co-dependency. It had snaked itself into my brain and coiled there; I was ready to consider the possibility that too much of a good thing might be, in fact, too much of a good thing, and that reasons sometimes devolve into excuses.
So I decided to wean myself. I went from two Lortab a day to a single cap every second or third day. Anything that felt like slack, I filled in with Aleve. And, for good measure, I trimmed the edges with ibuprofen.
It seemed manageable—sort of. But at about the same time I started the weaning, I caught the flu. My usual energy sloughed away. My focus diffused. I had trouble sleeping and, when I finally fell asleep, I’d wake up with cramps and the sense that I was about to get a headache.
I wasn’t staying ahead of the pain anymore, but it didn’t seem to be getting ahead of me. I articulated a distinction: I didn’t have discomfort any more in my life; it was more distraction. I tried to work, but the work was fuzzy. A lot of the time, I felt like I’d been beaten up. I called my internist who—when she called back and after she’d heard my short-list of symptoms—told me there was a lot of gastroenteritis going around, and that might be what was slowing me down. She suggested I give the symptoms a week and, if there was no subsiding, call her back.
The symptoms grew more aggravated. When I took my Lortab prescription in for yet another refill, I discovered the number of tablets had been reduced by half, plus there was a two-day delay.
Perhaps my orthopedist was sending me a message. It was time to check in about my progress anyway.
Everything couldn’t be better. “You’re a poster child!” my surgeon said. He seemed in a good mood, so I sheepishly brought up the Lortab. “You’re still taking that?” he said. “Well, sort of,” I said. “I’m cutting back, but—” He explained that Lortab was opium. “Good opium. Still—if you can stop taking it…. I would.” I agreed to.
The next day, I saw my internist to check out the gastroenteritis. As I listed my symptoms, her two penciled brows moved toward one another and a slightly quizzical look shaped itself on her face. She said my symptoms were not exactly a gastro profile. Certain symptoms didn’t line up; perhaps I should have an ultrasound and some blood tests. Just before I was about to head off for the tests, an impulse struck. “Oh—one other thing,” I said. “I’ve been taking Lortab for four months and, a couple of weeks ago, started to cut back.”
“For four months?” My internist drew a breath. “Cut back from what? From what to what?” she asked. I told her , and she began to nod. “I think we can reasonably dispose of the tests,” she said. “You’ve been having withdrawal—and you need to stop taking the Lortab altogether.” I told her I’d reached the same decision the day before.
“You’re going to have a rough month,” she said. “Or maybe even five weeks. It won’t be fun.”
And it wasn’t. I said things like, “I’d rather drink lye,” or “I think I’d rather put an ice-pick through my head.” I had experienced mindless beatings by bullies in my life, but now the knocking down was much more merciless and random.
There were the cramps; there was the sense of being without purpose or direction. My words “restraint or none at all” came back to haunt me. As a person of appetite, I lost all of mine. I wanted only to sleep but sleep wasn’t available. There were crying jags. There was the loss of light, the dark, the internal black-on-blackness such as I’d not felt for years. And The Assassin returned.
In my late teens, 20s and 30s, I’d had bouts of depression, replete with all the stock pathology. But what wasn’t stock was The Assassin. He came right out of Pinter—very film noir. Cleverly mixing dream and reality, he would enter whatever bedroom I was sleeping in, through the door precisely where the door was placed. He would hover over me in the dark and announce that he had come to eliminate me, worthless piece of dross that I was. When I woke, usually screaming, his phantom image would linger in the bedroom’s dark for 10 or 15 seconds—he was that real.
He came unannounced and dug me into very dangerous and very black pits. I went into therapy, where I tried to understand all I could about my Assassin. The therapy helped; he came with less frequency. I got more therapy. And then, one night when he arrived to do his assassin’s work, I somehow managed to scream at him: “Get out! Get out of here! Go away! The last thing I need to do is send an Assassin to myself in my dreams! Fuck off!”
I remember his face collapsing, crumbling like the face of a child who’s been scolded. For an instant, I thought he would cry. And then he simply shrugged, turned and disappeared. It was amazing! It seemed he was gone. And, for the most part, he was. For the last 15 years, he’s only made guest appearances—cameos, sort of. He’s still scared me. I’ve still screamed.
But during my withdrawal, my Assassin sensed a rare moment of opportunity. He has to be old now; certainly I am—but he came back with youth and vigor. While he’d drawn blood a couple of times in my 20s and 30s, clearly he was back to finish the job, pull the black over my head with such dedication that no morning light would find me.
Now the worst is over. Most days are fully productive and unjarred. I wonder what precisely in me needed to stretch the intake of “good opium” to its prescription limit. I wonder why my orthopedist never added to his stay-ahead-of-the-pain advice the word “But—!” As the son of a doctor, I should know that pharmacology is never the answer.
Writing now from withdrawal’s far side (most days), I would say that my Assassin is my absence of appetite in the world. He is neither restraint nor is he none-at-all. He is the absence of hunger, of desire, of the passion to mentor, of the need to be productive and to create.
“It’s only when your writing gets dangerous that it’s possibly good,” I hear myself advising. “Drive a little faster. Drive closer to the median strip, to the edge of the road.” For writers, the advice is sound—though the state of mind it encourages may not be. And that is, possibly, the point—and the price. Restraint or none-at-all. Stay ahead of the pain or court it?
The next question is: Do you choose your pain or does your pain choose you? With The Assassin, after nearly a half-century still looking over my shoulder, I feel a bit more hunted than hunter. We do what we think we need to survive and to feel productive. I’ve withdrawn. I don’t want to withdraw again. I’ve lost time. The dark’s too close. Give me a pen….and a gun….but don’t give this son-of-a-doctor another prescription. Please.
David Kranes is a novelist, playwright and ameritus professor of English at the University of Utah.