“Let's Try Again”

Early in my medical career I worked at a medical detox center, where people addicted to drugs and alcohol went to get clean. Most left before they were sober, but for those that stayed, we tried to get them on the road to recovery. The easy part was managing their withdrawal symptoms. Hangovers, tremors, nausea, sweating - “dopesick” in their lingo - are all reasonably treatable with anti-nauseants, anti-inflammatories, and mild sedatives. Within a few days they’d start to emerge from their stupor. However, that’s when the tricky part began. Without drugs and alcohol, all their mental health issues boiled to the surface. 

Nearly everyone who abuses substances has severe psychiatric issues. In fact, most use/drink just to feel normal, to escape the trauma they’ve suffered throughout their lives. They all struggle with anxiety and PTSD. Many are depressed, some are bipolar. We even see the occasional schizophrenic - as they sober up, they become more, not less, psychotic. Turns out crystal meth is a half-decent antipsychotic medication, keeping intrusive voices at bay. Sadly, my patients at the detox center don't have a chance at staying sober as long as their psychiatric issues remain uncontrolled. Living with severe anxiety, psychosis, guilt, and depression is simply not sustainable; self-medicating with drugs and alcohol is their survival mechanism. Unfortunately, most addicts don’t realize that their mental health troubles are often treatable, and they leave before experiencing any meaningful relief. 

Working there wasn't easy. It’s like the mental conditions I encountered were contagious - the heaviness my patients carried weighed on me too. How many evil spirits came into my clinic room, piggybacked by troubled souls? Most of the staff reported a “negative energy” that permeated the facility. It was easy to get discouraged with all the awful problems those folks have gone through. 

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Sandra was one of my longest running patients. Before I met her in detox, she was referred to me by a social worker who cared for victims of abuse and the sex trade. I cautiously agreed to see her if they could find me at the local medical clinic, and didn’t mind waiting with the other walk-in patients. Before long, Sandra was on my day sheet. As soon as I walked into the exam room, she blurted out that I was “such a hot doctor”. I instantly turned red but graciously accepted her compliment with a laugh and a joke. “Well thank you, darling. You caught me the day after my weekly bath.” We all laughed. And so began our friendship. 

Sandra’s psychiatric situation was a mess, more complex than any I’d seen. It took months to get her symptoms controlled on nearly a dozen medications. Slowly, her post-traumatic flashbacks, panic attacks, severe depression, and insomnia became more manageable. 

Her physical health was just as bad. She contracted hepatitis C from injecting drugs with dirty needles; consequently, her liver was full of scar tissue. One time she had to be admitted to hospital for a severe kidney infection - it took weeks for her to recover well enough to be discharged. Add diabetes and chronic pain to the mix and her health was a recipe for disaster. Just staying healthy was a fulltime job.    

One day she came to my clinic and noticed my new colorful sneakers. “Nice kicks, Dr Ryen!” I replied that I’d had to wipe blood off them from a C-section the day before. She laughed and said she’d had to wipe blood off her shoes too, but for other reasons. Violence is a way of life on the streets. Her ongoing legal issues, stints in jail, and probation kept her busy, and sometimes missing appointments. To say she could have an abrasive personality was an understatement. 

Sandra had the worst life ever. She was forced into the sex trade at age eleven. Her pimp injected her with drugs daily until he was murdered in front of her. During her gang involvement, she’d been beaten many times, and beaten others many times (thus the blood on her shoes). Not the sort of woman you’d want to meet in a dark alley. As one of eight kids, she was the only one left - all of her brothers and sisters died by murder, drug overdose, or suicide. She buried both of her parents before she turned 30. Sandra managed to stay sober for 17 months, but when her son was murdered, she relapsed hard. 

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Early on in my career, I got frustrated at the relapse rate of my patients. Some returned to detox remorseful and full of guilt, while others blamed the system and their life situation. All were in bad shape after using again, possessing minimal self-esteem, full of piss and vinegar, dripping with attitude, quite often brain-damaged, and lacking insight into the reasons for their condition. None deserved another chance. However, when it comes to sin, none of us are any better. 

Just like a drug addict that comes crawling back to the detox center, believers regularly come crawling back to Jesus after slipping back into sin. We’re all similarly hurting, ashamed, and powerless to help ourselves. We’re hungover and withdrawing from selfishness, often lacking insight into how we got so bad. We mess up again and again, screwing up lives and relationships. We get second chances, third chances, twentieth chances, and still Jesus welcomes us back. “Hi there, good to see you again! Let’s try again.” The past is wiped clean. Every time, no matter what. 

Consequently, when I look at my struggling patients from the doctor-side of the desk, I see shades of myself. If I was born into their situation, that could have very well been me sitting in the other chair. After relapses in sin, God treats me with limitless mercy and grace, so I try to treat my detox patients the same way. “Hi there, glad to have you back. I think you’re gonna do great this time!” Spiritual battles wage unseen above our heads as I explain how we’re going to try to get them on their feet again, starting with getting through Day 1 day as painlessly as possible. And, for a split second, the kingdom of God comes to that little clinic room. 

*     *     *

Sandra was a regular in detox. She showed up a couple times per year, pale and sweaty, withdrawing like crazy. After a week or two, we’d clean her up, get her stable on medications again, and she’d turn back into her regular self. Always laughing, but, below the surface, always suffering. No matter how many times she came back, we wiped the slate clean and did whatever we could to get her back on track. Sometimes that meant going the extra mile. 

After sobering up for the third time that year, Sandra showed me her ear. “I got in a fight, and this chick ripped out my earring. Do you think you could fix it?” Without adequate staff, resources, or time, we didn’t normally do any procedures in the detox facility. But this was Sandra. “We can try,” I said. The next day, I borrowed some supplies from the hospital. After numbing her ear, I cut away the skin that had healed abnormally and carefully sutured the edges together. As I worked, Sandra said, “Dr Russell, you know, you’re the only doctor I’ve met that has ever cared about me.” I believed it. Her demographic tends to get treated poorly. They rarely get the care they need, perhaps because their needs are so great. Personality disorders, anxiety, mistrust of authority, and frequent intoxication don’t help matters. “Sandra,” I replied, “I don’t know why, but you have a special place in our hearts. We can’t fix all your problems, but we’ll do our best with what we can. There, all done. You’ll have a scar, but it should heal nicely. With any luck, you should be able to pierce your ear again in 6-12 months.” I wrote her discharge prescriptions and she left the next day.

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Christ does so much for us. The least we can do is pay it forward to others in need, which is exactly what he wants us to do.

I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me… Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me. (Mt 25:35-40)

Most of the time, this is a thankless job. But once in a while, the light of Christ is shining through us. One day I came to work and found a letter waiting for me:

Dear Dr Ryen,

Thank you for your compassion and your support and understanding. We have been through alot together. You worked with me through the early stages of my recovery almost 4 yrs ago, you followed me through some good times and some very difficult times. You always have been patient and honest with me. We shared some good laughs and I will always remember you as an outstanding doctor and genuine man. I saw god in your eyes. I don’t know if your a christian, I heard you were? You helped me when noone else could. I pray blessings on your new journey and please get new kicks!! 

Love alwayz your crazy patient and lifelong friend,

Sandra

Soon afterward Sandra moved away to attend a rehab program closer to her extended family, that is, what was left of it. 

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We all have opportunities to love those who are unlovable. They might be drug addicts, estranged family members, grumpy customers, ex-partners, or the mentally ill. It’s not easy. But a little kindness (and a healthy dose of tough love) goes a long way to bringing the kingdom of God into a suffering world. 

God has a heart for the broken, the hurting, and the destitute. He cares for us, even when we’re at our worst and deserve it the least. We have a duty to do the same to others, knowing that showing kindness to the unlovables of this world is a faint shadow of the kindness Jesus shows us every day. Recovery is possible, from substance abuse and from sin, but it takes a lot of grace and a lot of attempts. Nobody is above falling into addiction or old habits, and yet nobody is so lost that Christ can’t save them. 

He’s always up for trying again, and so should we.

© D. B. Ryen Incorporated, December 2024.

A version of this article is scheduled appear in Premier Christianity (online), 2024. 

All Scripture quotations are from The English Standard Bible (ESV). Crossway, 2001.