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VIP Treatment

Jacob L. Freedman MD

Four nos is most certainly a grievous admission

Wednesday, April 10, 2019

"T

he truth is, Dr. Freedman, I really don’t even know why I’m here,” he let me know for the third time since he’d walked in less than ten minutes before.

Professor Shochet was a well-known epidemiologist and public heath advocate in the field of substance abuse. He was a dedicated husband, father, and grandfather. Another fun fact about him was that Professor Shochet was a semi-professional tennis player in the 60-and-over age group where he regularly won tournaments in Herzliya and around central Israel.

And Professor Shochet was also an alcoholic.

“Well, it’s really not that bad, Dr. Freedman,” he minimized.

I sat quietly and waited for the punch line.

While he took a few moments, he eventually said it a fourth time: “The truth is, I don’t even know why I’m here.”

An age-old rule in therapy is that “no” once is negation, and “no” twice is affirmation. With this in mind, four times is most certainly a grievous admission.

So while Professor Shochet might have been a well-known epidemiologist and public heath advocate in the field of substance abuse, he was also an alcoholic. While he might have been a dedicated husband, father, and grandfather, his relapse into drinking was starting to scare his family. And while he might have even been a semi-professional tennis player, he hadn’t been able to play in weeks because he’d been too hungover to wake up for his 5:45 a.m. chavrusa on the court.

It wasn’t my job to force anyone into treatment, but the professor seemed to be stuck in that place between denial and admission, unable to make the unequivocal leap to the other side, to the side of surrender and coming clean, even though intellectually he knew exactly how the game worked.

Okay, so I have a little problem,” he began to open up. “But I know what I have to do. Remember, I’ve been researching alcoholism since before you went to medical school. I need to get back into Alcoholics Anonymous meetings, get back on the program, the whole nine yards. That’s what I need to do.”

Actually, he’d been researching alcoholism since I was in high school, but why pick a meaningless fight? See, this is the thing with addiction: You know everything, but it still has you in a chokehold. Because before you can recover, you have to admit that you are powerless over your addiction, that you can’t muscle your way through it no matter how much willpower you think you can muster. This admission of powerlessness is the crucial first step.

“Professor will you call me tomorrow to let me know that you made it to your first meeting?”

“You’ve got it, Dr. Freedman.”

But after a few weeks without a phone call from Professor Shochet I wasn’t surprised to hear from his wife that things hadn’t gotten any better.

“I can’t go to those meetings, Dr. Freedman,” he rationalized the next time we met. “I know everyone there and it would just be ridiculous. You have to remember that I’ve built substance abuse research programs all across the country.”

I sat silently and waited for him to make the next move.

He began to get frustrated and then said, “So you really think I need to go to AA meetings?”

“You know the research better than I do, Professor.”

“Fine,” he grumbled. “I’ll swallow my pride.”

But he didn’t — and had the same excuse two weeks later. “It’s just a waste of time. I already know all of the Twelve Steps.”

Sure, he knew the Steps cold. But as with any addiction, and especially with alcoholism, there’s a wide chasm between knowledge and surrender.

“Professor, are you going to be able to make it happen, or do you need a detox?” I asked as I reviewed his medical chart and noted a number of laboratory tests suggesting he’d been doing a number on his system, especially his liver.

“Dr. Freedman, I appreciate your concern, but I know a little bit about alcoholism.”

I handed him the printout of his lab work. I had circled about nine different things with a red pen.

“Now you think you’re pretty smart, Dr. Freedman?”

“Professor, if I were smart I probably would have sent you to a rehabilitation program a month ago,” I said honestly.

“Yes, yes, yes. You want to send me to Beit Shemesh where I used to be the head psychologist? To Rishon LeZion where my former student is the director? Or to Eilat where I’m the featured speaker at their major fundraiser this summer?”

“I don’t want anything beyond you getting good care as a regular patient. Don’t you know that VIPs always get the worst care?”

And it was true. Whether it’s doctor-turned-patients who demand a dozen treatment-delaying tests and consultations that delay life-saving procedures, or the Saudi Prince who was allowed to smoke hookah in his private floor on the cardiac transplant unit, VIPs never get the right treatment.

“What do you mean?” Professor Shochet asked.

“I mean that you’re too smart for your own good. If you were sitting in my chair instead of the other way around, you’d say that anyone who has liver tests as wacky as this printout suggests is in need of a detox. And you’d send the patient straight to a program before he pickled his organs with another bottle of Manischewitz.”

“Well, I’ll admit, it’s hard because I’m used to sitting in your chair,” he confessed.

“And while you’ve helped so many people to escape the shackles of addiction, the Talmud clearly teaches—”

“… that a prisoner cannot free himself.”

And seizing on the moment, I picked up my phone and began to dial my colleague Rabbi Zvi Gluck to get the process started.

“What are you doing, Dr. Freedman?”

“I’m calling Amudim to arrange for a detox program that isn’t in Beit Shemesh, Rishon LeZion , or Eilat.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Originally featured in Mishpacha, Issue 756. Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in The Old City or hiking the hills outside of Jerusalem.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

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