Hiding in Plain Sight

The determination to detoxify herself was a red flag.

Posted Oct 08, 2020

Source: Pixabay/prettysleepy1

I was heading to the library on a Friday afternoon when I heard Sara call my name. We had once worked together, but she had left town to join a pharmaceutical company. With her charismatic personality and attention to detail, she had been quickly promoted to vice president.

“Would you sit here with me for a moment?” Sara said, pointing to the top of a low brick wall. “I have something important to tell you.”

Her news came as a complete surprise. “I’ve found out that I’m an alcoholic,” she said quietly. “My father was one, too, and it’s the last thing I ever expected to happen to me.

“My husband and I read your book, Dying for a Drink. I saw myself on so many pages, and on Monday, I’m starting treatment."

Sara’s honesty was deeply moving, and I was relieved to hear that she had chosen a top treatment program. We both knew that the recovery rate for medical professionals was extremely high, and we were optimistic about her chances of getting sober.

The only red flag was her determination to detoxify herself. Despite a prolonged appeal, I could not convince her to get medical help for what was likely to be a bumpy ride. “I am dying for a drink,” she joked. “But I’ll be okay, and it feels good to have everything out in the open.”

Sadly, everything was not in the open. For whatever reason, Sara did not tell me that she was suffering from alcoholism and severe mental illness. With an obsessive-compulsive disorder seriously damaging her family relationships, she had fallen into a deep clinical depression.

Without understanding Sara’s peril, I wished her well and went on my way. That Sunday night, after returning from a weekend away, I found a message on my answering machine from Sara, asking me to call.

Her husband answered the phone. “I’ll have to call you right back,” he said. “Sara’s gone missing, and the police are at the door.”

The police had come to inform him that Sara’s body had been found in her car. Later I learned the disturbing details. After our conversation in the courtyard, Sara had told a mental health professional that she was thinking of killing herself. She was immediately hospitalized, put on a suicide watch, and given medications to stabilize her mood. Then, for reasons that I never understood, she was released to the care of her husband. After spending an agitated evening at home, she went for a drive, pulled over in a park, and took a lethal dose of pain medication.

Sara’s death left us all—her family, friends, and colleagues—feeling bereft and in shock. Our “whys and what ifs” would never be answered, and our lives were much the poorer for her death. We knew that, in her right mind, she would never have chosen to take her own life. She had truly intended to get help, and it was just hours away. But something in the interplay among her uncontrollable craving for alcohol, her depression, and her obsessive-compulsive disorder had made living through another day seem impossible.

I wish that I could say that Sara’s death had happened long ago, in the early days of my medical practice, before doctors used the phrase “dual diagnosis” and understood the role that mental illness can play in addiction, both as a cause and a consequence. But Sara died just a few short years ago. Her death remains a tragic reminder of how much work we have left to do to find effective ways to support the tens of millions of people who suffer from both addiction and mental illness.