“Are you happy to see I’ve failed?!” Dr. Berger growled as he entered my office

I was in the middle of eating my lunch when Dr. Berger, accompanied by his wife, showed up outside my door.

“Are you happy to see I’ve failed?!” Dr. Berger growled as he entered my office and slammed the door behind him, leaving his wife outside. “She can stay there! She’s already done enough damage!”

“She isn’t the one who brought a bottle of whiskey back into your house, Dr. Berger,” I said flatly.

“How’d you know I brought whiskey into the house?”

“Well, I assume you’re not here to find out where I picked up this pretty good spinach quiche,” I said, wiping my mouth. “Look, you and I both knew you wouldn’t last 30 days. Now are you ready to own up to it and call a spade a spade?”

“What? That my wife drives me crazy and makes me need a drink to calm down from time to time?  Sure, I’ll admit that.”

“Dr. Berger, no one makes anyone else need to drink.”

“You don’t know my wife and her nagging then,” he grumbled.

“Dr. Berger, no one makes anyone else need to drink,” I repeated. “Why are you dragging her into this? This isn’t about her, it’s not about me, it’s about you agreeing to go clean for 30 days. You said no drinking, no alcohol in the house, and then you were unable to make it, you drank after 13 days. It’s about how you’ve got a drinking problem.”

“Dr. Freedman, the whole situation with my wife is just, I mean, she makes me sooooo angry!”

“Because she’s worried about you?  Worried about your health?  Worried about you drinking and driving? Worried about you losing your medical license? You’d prefer she should let you throw everything away?”

Silence.

“Dr. Berger, no one can make anyone angry. We can be forced to deal with frustrating circumstances and challenging situations, but no one can force another into self-destructive behavior. The only person who can do that to me is myself.”

“Okay, so let’s say that’s true, for argument’s sake. So, I just need a little more willpower when the tension rises, and I’ll be okay.”

“Dr. Berger, I’d say it differently. When the tension rises, I’m out of control. The compulsion is too strong. It takes over. It has me in a chokehold. It makes me do things I really don’t want to do.”

Dr. Berger looked ashen.

“Yep,” he said in a monotone, nodding his head as it sunk into his hands, as he proceeded to rock back and forth. “Okay, Dr. Freedman. I hear. So what do you want from me?”

“What do I want from you? Nothing, Dr. Berger.”

At our first meeting, Dr. Berger had failed the primary screening quiz. While he didn’t have an eye-opener — a drink first thing in the morning — he was positive for all the other questions.  Dr. Berger certainly felt guilty about his substance use and was getting serious flak from the people who knew him best. On top of this, he’d now flunked the 30-day sobriety test. Sneaking a bottle of whiskey into the house was a low-percentage move for anyone who didn’t “need” to drink.

And here he was. Sitting in the very place that every physician dreads most: the doctor’s office. Being on the opposite side of the stethoscope and discussing, of all things, alcoholism.

It wasn’t just the embarrassment of “knowing better,” although this was certainly there. Every second-year medical student had learned about the leading cause of preventable cirrhosis, that horrible condition that comes from pickling one’s liver with years of heavy drinking. The complications of esophageal varices, alcohol-induced bone-marrow suppression and platelet dysfunction, and dilated cardiomyopathy are among the dozens of problems that the alcoholic patient can die from.

And every third-year med student had seen inebriated individuals come into the emergency room after drunk driving accidents and end up in the operating room needing orthopedic repairs and pints of blood. Anyone who’s rotated through a transplant service has seen patients who needed a new liver due to their drinking problem and tragically, it’s something that doesn’t always happen in time. These interns have surely seen patients in alcohol-withdrawal. Some of them need a few days of detoxification with benzodiazepines, and others need treatment in the ICU.

So when Dr. Berger rocked back and forth with his head in his hands and asked me again and again, “What do you want from me, Dr. Freedman?” the answer was pretty simple.

I wanted him to figure it out so he wouldn’t die and torch his life — and the lives of his loved ones — in the process.  But it wasn’t about me at all; this one was about him, and he needed to know it.

I told Dr. Berger about another physician patient I’d met around ten years ago while moonlighting at a detox facility to pay off my medical school debts.

Dr. Chung was a Korean-American cardiac surgery fellow who had been kicked out of his training program after they found him stealing vials of morphine from the operating room. He’d bounced around from rehab to rehab but couldn’t get sober. Things got worse, his insurance stopped paying for treatments — and then one day, Dr. Chung was found unconscious in a janitor’s closet at a local hospital in Boston. Apparently, he’d talked his way into the surgical floors with the story that he was a visiting professor. He’d found a syringe in the nurses’ station along with enough opiates to nearly end his life.

Like many Bostonian physicians at the time, I’d heard the story and was shocked. This wasn’t some guy on welfare hanging out on a street corner. How could a physician have fallen so low? That could have been any of us, and it was scary. But there I was, meeting the infamous Dr. Chung as a weekend rounder on the detox unit one Sunday morning. I’ll never forget our brief interaction: I checked his vital signs, adjusted the medications to treat his withdrawal symptoms, and asked him if there was anything I could do to be helpful.

“What do you want from me, Dr. Freedman?” he asked me.

And all I could tell him was, “I want you to live, Dr. Chung.”

We parted ways after he told me to “jump off a cliff” in a much less polite fashion, and a month later he was dead from an accidental overdose three days following his discharge from the detox.

Dr. Berger shook his head and asked me again, “So what do you want from me, Dr. Freedman? And please don’t say, ‘I want you to live.’ ”

“I don’t want anything from you, Dr. Berger. But I do want plenty of things for you: happiness, health, honesty, and other good things that come with sobriety and the process of getting there.”

“Tachlis, Dr. Freedman.” He was on the verge of tears. “What do I need to do?”

It was time to be direct. “You need a break,” I told him.

“Rehab? You gotta be kidding. With all those druggies and criminals? You’re telling me it can really help?”

“It can only help if you’re willing to put in the work.”

“Am I?”

That was a question I couldn’t answer.

To be continued…

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

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 875)