One Patient, One Doctor, One Year
By Michael Stein
275 pages. William Morrow. $25.99.
“Once my name was on her bottle, we were linked,” Dr. Michael Stein writes, delivering one of the stranger quasi-romantic pronouncements you may ever find on the printed page.
The woman in question is 29-year-old Lucy: fetching (“When she smiled, the corners of her eyes crinkled”), scared, defiant, vulnerable and uncontrollably addicted to Vicodin, America’s most widely prescribed painkiller. Dr. Stein, who has spun his intimacy with Lucy into “The Addict,” a protracted two-person drama set in a small, claustrophobic medical office, is prone to obsessive behavior of his own. When confronted with a visitor like Lucy, Dr. Stein cannot seem to resist playing power games with his patient while trying to cure her.
Combine those attitudes with the high-concept presentation of “The Addict” (“One Patient, One Doctor, One Year”) and you would seem to have the formula for a work of lurid exploitation. You would also seem to have yet another book-length trek down the well-worn path of the addiction story, and one more memoir in which the line between fact and fiction (Dr. Stein has written five novels) is dangerously blurred.
But “The Addict” winds up defying expectations and conquering its own worst impulses. If Dr. Stein has a tendency to dramatize Lucy’s plight, palpitate in her presence and even swoon a little (“Was meeting the eyes of a man in a small, closed room a form of surrender?”), he also has a different take on a familiar situation. He writes with genuine professionalism and compassion. And he makes this story idiosyncratic enough to keep it interesting. Lucy’s insistent love for old Burt Reynolds movies may be one unusual symptom of her problem.
“The Addict” unfolds chronologically, so it begins with the doctor’s first encounter with Lucy. (Names in this book are fictionalized. Dialogue comes not from audiotapes but from Dr. Stein’s memory, and he only occasionally took notes.) The doctor has no difficulty in explaining why this patient captures his attention. As an internist, he is as apt to be treating a 60-year-old man’s case of shingles as the drug problems of a nubile, attractive woman willing to put herself entirely under his control.
And he admits to a fascination with addiction that goes beyond the usual medical aspects of the condition. “I am interested in the opposite side of myself,” he writes. “I fear the appetite that would control me.”
Dr. Stein’s character is defined as much by his omissions as his descriptions. He finds a welcome escape in his involvement with patients. (Escape from what? He doesn’t say.) He is extremely methodical, and inquisitive almost to the point of voyeurism. He has known addicts well since his early training at Harlem Hospital, and he is drawn, in an almost Sherlock Holmesian way, toward trying to fathom and analyze their behavior. He’s a good judge of character, as he demonstrates quickly in an encounter with one of the half-dozen other patients who figure in this story.
An angry, impatient man named Dan prompts a good illustration of Dr. Stein in action. Dan comes in citing a car accident six months earlier and saying, “Doc, I really need something for this pain.” Dr. Stein prefers watching Dan move to asking detailed questions about what hurts. In general, he says, he learns more from what patients do than from what they tell him, and he seems in no hurry to make a diagnosis. He loves to listen and analyze. That’s what makes “The Addict” a gripping, illuminating book.
Then Dan tells the doctor exactly what drug he would like prescribed — and, Dr. Stein says, “the list of medical possibilities shrank to exactly one.” While the doctor is not punitive about such signs of addiction, he’s not a patsy, either. “I had all the power,” he tells the reader, when Dan tries threateningly to block the office door.
But Lucy, as this book’s main event, provides a much more complex medical conundrum. In 2005, when most of these events took place, Dr. Stein was one of relatively few doctors licensed to dispense a drug called buprenorphine, which blocks the effects of opiates on the brain. (If he is a paid consultant or researcher for the company that manufactures this drug, “The Addict” doesn’t say so.) Lucy knows that, and it’s one of the reasons she seeks him out.
When his first job, getting her off Vicodin and onto buprenorphine, requires Lucy to follow very strict orders or risk severe drug withdrawal symptoms, she doesn’t follow the orders. Dr. Stein is sorry about that, but not surprised. When it comes to addicts’ behavior, he seems to have seen it all before.
If Lucy’s case fascinates him more than most, her quick intelligence has something to do with it. But so does the element of seduction. “The Addict” risks becoming clammy with repressed passions as the doctor investigates Lucy’s dealings with men, from her drug-addicted boyfriend to her lascivious landlord. “I could imagine her landlord’s lusty, grinning eyes,” the doctor writes, upon hearing that Lucy is thinking of trading sex for rent money. He is horrified to hear that her main reason for not doing this is that she might use extra money to get back onto drugs.
Lucy has family problems too. Dr. Stein is convinced that she has a hidden, terrible secret from childhood, and eventually he digs one up. He shows interestingly scant interest in the nonerotic and nonpsychological details of her existence; he prefers the hot stuff, just as his readers will. “The Addict” thus wanes in interest as Lucy gets away from drugs and confronts the blahs that, Dr. Stein says, his newly drug-free patients often legitimately fear.
Lucy’s story alone would not be enough to make “The Addict” a compelling book. It’s the doctor’s story that leaps out, and his reluctance to reveal much about himself only serves to make him more intriguing. In addition to his novels, Dr. Stein has written one other nonfiction book, “The Lonely Patient,” in which his empathy for the terminally ill and description of what goes on inside his white coat came through. This time, even more hauntingly and successfully, he lets readers make a doctor’s experiences their own.