Addiction’s Toll Hits Close to Home


We introduced the “high-five, handshake, or hug” exit process at some point, so that when I left every day, the kids had to choose one. They liked it, and they’d often mix it up. It was up to them. I’d be ready to leave, and the little guy would beam up at me, usually opting for a high-five.

As the kids got older, they wanted to play on the local youth football teams. It was decided that they could participate, but if they joined the team they would have to sign contracts agreeing to do specific tasks around the house—tasks that they, like most kids their age, were not anxious to perform.

So I typed out 3 contracts, each spelling out the obligations that playing football would mandate. I met with each kid individually, and I got to the little guy last. The older boys were glad to sign the contracts, and when I made sure that they clearly understood what they were agreeing to, they had no problem. But the little guy was more hesitant. As we went over it, discussing each item, he started to look a little worried. “You mean if I sign this and play football, I have to help put laundry away every single day?” he asked.

“That’s right,” I replied. “You don’t have to sign this, but if you want to play football, this will be necessary.” He paused and looked down at the piece of paper. Then he smiled and said, “Okay, Jim!” and signed the contract, leaping up from the table to run back out to the yard to play.

The contracts were all kept in a little black binder, and when the kids would balk when they had to help with the chores, I’d have them sit down with me at the table and I would pull out the contracts. “As you see here, you made an agreement to do this” I’d say sternly, and the little guy would grimace, shake his head and exclaim, “Man!” But he’d get up and get to the chores.

I work in addiction medicine in a methadone clinic, with people who are addicted to heroin. Most of stop or reduce their heroin use and become more functional. But the saddest cases are those who are not able to get better. Some of them die, and it’s hard to deal with that.

But it’s nothing like dealing with the death of my 24-year-old friend. Nobody is born with addiction, and it’s so hard to think of him as a sparkling, vibrant, happy little dude who taught me how to put him in the crib. I think the same thing sometimes about my patients. I try to imagine them as little children, and I wonder how they ended up sitting in front of me in a methadone clinic.

But I didn’t know them as children, so there is more distance than I have with the little guy, who I still see laughing or crying so quickly, who I see running through the park, who I see riding his bike for the first time with a look of determination and glee, who I see ice skating like a champ the first time he put on skates, and who I see coming up to me as an adult, enthusiastically saying “Hey Jim!” with the deepest voice you can imagine, looming over me with his notable height, and with his arms extended wide for his mandatory hug.  

And now he’s gone from a drug overdose, and it’s just hard to accept. So I pledge to keep him in my mind every day, and to dedicate my work with others who suffer from the same disease to him, the coolest little guy I ever knew.

See ya in heaven, Lu, and when I do, it’s your choice—high-five, handshake, or hug.

Jim Anderson, MPAS, PA-C, DFAAPA, is a physician assistant in Seattle.

This article originally appeared on Clinical Advisor