Chapter Four
The visit to the doctor had not gone how Tommy had hoped. He had to use the chair again, the walk too much for him. Paige pushed the chair. The nurse, a young guy named Derek, introduced himself as Tommy’s evening nurse. He walked beside the chair as they headed to the doctor’s office, laying out the basics of Tommy’s schedule.
“You’ll have a rotation of four nurses, a little overlap between shifts for each of us.” His smile was warm. “You’ll get to know all of us pretty well. Feel free to ask for anything you need. Tomorrow will be a busy day. First official days usually are. Tests, meetings, plans, goal setting.”
It sounded exhausting.
“Days are normally filled with activities,” Derek continued. “At first, you will probably do only a handful per day. We focus on the basics. Get you eating regularly, small amounts of exercise, and therapy. But as you progress, you’ll attend more. The idea is that as you get better and have more energy, you can do more, so you’ll heal faster. It’s cyclical.”
Tommy said nothing as they guided him into the doctor’s office. It was big but bland. A large window behind the desk that looked out at trees. Degrees on the walls, books on the shelf looking to be a mix of medical and psychological guides. Nothing personal, but there were some artistic prints on the walls of watercolors that didn’t look generic as they were a bit haphazard.
“Did you want both of your guests to stay for the meeting?” Derek asked. “Or I can show them to the waiting room and bring them back when you’re done?”
Tommy looked up at his mom and then at Paige. He didn’t really know Paige, but she had not once looked at him in judgment. Her presence, so far, had been an anchor in helping pull him out of despair. As fancy as this place was, it was not home, nor was he even close enough to be dreaming about going home. He needed all the help he could get. “If they want to stay, they can.”
His mom took the seat beside the desk. Derek moved the other chair over and Paige parked Tommy’s wheelchair in the center before taking the moved chair. She patted him on the arm and gave him a firm smile, seeming unworried. His mother, however, looked concerned enough for the both of them.
When the doctor arrived, she was younger than Tommy had expected. She wore the white coat, and had a name tag that said she was a DO. Her smile was warm, and she offered her hand to Tommy first.
“I’m Dr. Brigham, nice to meet you, Tommy.”
He briefly shook her hand, then she greeted his mom, and Paige before sitting down. Derek shut the door behind them, leaving them to the meeting. Dr. Brigham took a seat behind the desk. “I specialize in overall wellness, Mr. Foster. Mental and physical. Holistic and traditional medicine. This facility tries to bridge the gap in-between. Treating mind and body with more than chemicals.”
“Okay,” Tommy had no idea what that meant.
“I’ve reviewed your files, and you and I will get to know each other over the next few weeks, but I want to start us off with a basic plan. A goal, if you will. A broad idea of what will happen while you’re here.”
“You’re not going to tell me what’s wrong with me?” Tommy wondered.
“You know what’s wrong with you, Mr. Foster.”
He flinched. “I’m an addict.”
“Yes,” she agreed, not seeming to throw the word at him like an insult. “It’s an illness. Lifelong, unfortunately, but that doesn’t mean you can’t have a good life.”
Tears stung his vision again. “But I feel like there is something physical too. And my brain is dark. I don’t know how to explain. It’s not only the cravings.” Though that was still a big part of things. He would wake up from the rare sleep he found, craving a drink, or something to take the edge off.
“Let’s talk about the function of the things you took for a moment,” she offered.
He frowned. “Okay?”
“Alcohol often releases inhibitions, why do you think that is?”
“I don’t know.”
“It down regulates the brain. Turning off small bits of reaction. The ‘lizard brain’ part of our function that is ingrained in us for safety. The stuff that says ‘danger’ when we step into traffic, or get that tingling unease when we are walking down a dark road at night. But the brain is ever trying to heal itself, turning things back on as those reactions are there to keep you moving, feeling, living, and safe. Benzos like Ativan do the same. Down regulate. Turn off functions. Benzos are often used to put someone under for surgery. Using them long-term is never a good idea. We are seeing more and more research that long-term benzo use, even as prescribed, does similar damage as alcohol abuse. And you have both. Add in drugs like cocaine, which tries to up-regulate what has already been hyper suppressed and you have a bit of…”
“Brain damage?” Tommy wondered.
“In a sense, yes? But, no.” She put her elbows on the desk and leaned forward. “As I said, the brain is always healing, trying to fix itself. We can look at long-term damage from an actual physical injury to the brain and see how it begins to rewire itself around the damaged area. Healing from this is similar. Rewiring is necessary. And the process is not fast or perfect. Sometimes long-term abuse means the brain has already rewired parts of itself in ways that aren’t particularly helpful.”
“Is that why I feel this dark hole?” Tommy put his hand over his right eye. “Right here? All my joy and happiness seem to vanish into it. Or like nothing can reach it?”
She let out a long breath. “That is depression. A very physical form of it. Your brain not processing serotonin and dopamine as it should be. It’s also why you’re not sleeping well. They are all tied.”
“But there’s medication for that,” his mother said. “Drugs,” she stuttered over the word “that can make those things work again?”
Dr. Brigham nodded. “Yes, but again no. In Tommy’s case, this clinical depression is brought on by the damage of alcohol and benzo abuse. The down regulation of his brain, if you will. Many think of it as long-term withdrawal symptoms, however, it’s actually part of the healing process. Which doesn’t make it any more comfortable. And in cases in which alcohol and/or benzos are involved, often we find anti-depressants do not help. The startup side effects and little long-term payout, aren’t often enough to outweigh any minor benefits they may provide. There is some evidence of an older medication that can help with sleep, but we’d like to try other methods to help with sleep before resorting to medication.”
