Gabor Maté - In the Realm of Hungry Ghosts - Close Encounters with Addiction

In his present drug-free state and benign mood Ralph puts up no argument. “I understand what you say and I agree one hundred per cent. I’ve approached things in an obtuse manner…”

“I wouldn’t even call it obtuse,” I reply. “I think you’ve approached things the way you’ve learned. My guess is that from a very early age, the world hasn’t treated you very well. What happened to you? What made you so defensive?”

“I don’t know…My father. My father is a mean, ugly person, and I hate his guts.” Ralph spits out the words. Under the sheet his legs tremble violently. “If there is one man in this world I loathe, it’s that man who had to be… mein Vater. Ah, it doesn’t matter. He’s an old man now and he can’t pay for his crimes any more than he already has. He’s paid for them a thousand times over.”

“I think everybody does.”

“I know that,” Ralph growls. “I’ve paid for my crimes. Look at me. I can’t even walk without this stupid stick. I want to fly and I’m stuck on the ground because…I’ll tell you sometime…”

Another conversation then starts up between us. Ralph articulates a clever, intuitive and astute critique of workaday human existence and of our society’s obsession with goals, the essence of which, he feels, varies little from his own pursuit of drugs. I see an uncomfortable truth in his analysis, no matter how incomplete a truth it is.

We part on good terms. “I’d love it if Daniel came back,” Ralph tells me, “and I hope he brings a video recorder. Daniel could do an intro for a couple of songs and accompany me—I’m the better singer, you know. We could do more Dylan or ‘Homeward Bound’ by Simon and Garfunkel. They’re all Jewish people. That’s where my anti-Semitism disappeared into nothingness, because many of the greatest poetical minds were Jewish: Bob Dylan, Paul Simon, John Lennon—if it wasn’t for these people, the world would be a far worse place.”

I reluctantly inform him that John Lennon wasn’t Jewish.

The plans for a new domicile didn’t materialize. Shortly after our civilized Vancouver Hospital exchange, Ralph resumed his life in the Downtown Eastside. With the drugs back in his system, he has reverted to the volatile, embittered persona from which he emerges only fitfully. He visited my office not long ago to recite more poetry.

“Here’s one you’ll like,” he says and starts in on his quick, mechanical drone.

I find myself loving the sordid honesty of Ralph’s verses. The internal rhymes he takes care to include in every couplet reinforce the airtight and suffocating logic of the speaker’s world: everything fits together: the futile search for companionship, sexual frustration, alienation, escape into drugs, grief, bathos, cynicism.

“Do you still write?” I ask.

“No.” He waves a resigned hand across his face. “I haven’t done it for a long time. Years, years. I’ve written everything I wanted to write. Every thought, every emotion I had, I wrote in poetry.”

I glance at my watch, aware of the crowd of patients outside my office. “Wait,” Ralph says quickly, “I have one more poem for you. It’s called…” He searches his mind for the title, scratching his newly bald crown. His fingernails are lacquered with dark, purplish blue nail polish. Below the hem of his soiled T-shirt his forearm muscles are doing an agitated, serpentine dance.

“Oh, yes, it’s called ‘Winter Solstice.’” Again, Ralph recites in his inimitable, fast-drawl croak. He fixes his gaze directly at me, as if insisting on being heard. The poem ends with an eagle falling out of the sky, dead in mid-flight. I recall what Ralph said in hospital:

“I want to fly and I’m stuck on the ground.”

Two days later he returns, with unrealistic demands for medications and for assistance with food and housing I am in no position to provide. Out pours the rage, expressed with Ralph’s uncensored Teutonic venom. “And there’ll be some art for you later,” he yells, stomping furiously out of the office into the waiting area, where his fellow addicts shake their heads in puzzlement and disapproval. “Can’t be easy for you sometimes, working here,” says my next patient, already walking in the door.

As I leave that afternoon, one of the Portland housekeeping staff, equipped with a bucket of soapy hot water and a scrub sponge, is washing a large, crudely drawn black swastika off the wall just beside the first-floor exit.

CHAPTER 8

There’s Got to Be Some Light

In writing about a drug ghetto in a desolate corner of the realm of hungry ghosts, it’s difficult to convey the grace that we witness—we who have the privilege of working down here: the courage, the human connection, the tenacious struggle for existence and even for dignity. The misery is extraordinary in the drug gulag, but so is the humanity.

Primo Levi, the insightful and infinitely compassionate chronicler of Auschwitz, called moments of reprieve those unexpected times when a person’s “compressed identity” emerges and asserts its uniqueness even amid the torments of a man-made inferno. In the Downtown Eastside there are many moments of reprieve, moments when the truth of a person arises and insists on being recognized despite the sordid past or grim present.

Josh has been living at the Portland Hotel for about two years. He’s a powerfully built young man with straight bearing, blue eyes, regular features, a blond beard and long hair to match. Because of his mental instability and drug use, his innate charm and sweetness are often lost on others. His intuition locks onto people’s vulnerabilities with radar precision; his intelligence gives his language a knife edge that cuts deep. On a Friday morning, as I was preparing to incise and drain a large abscess on his leg, Josh spoke one disparaging word too many. It was not a good day—I was irritable and fatigued. My reaction was unrestrained and aggressive—to say that I lost it would be understatement.

That afternoon, ashamed, I trudged upstairs to Josh’s room to make amends. As he listened to my apology, he looked at me in his customary intent and unblinking way, but with kindness in his eyes. Then, this man whose hostility causes others to cower in his presence and whose rampant, drug-fuelled paranoia can see ill will everywhere, said, “Thank you, but I meant to apologize to you. I see what it’s like for you. You visited me in hospital last week and you were calm and attentive, an image of the good doctor. It must be hard for you in this place, all the negative energy down here and some of it comes from me—I see you absorb it, and I wonder how you hold it and still do your job. You’re human, and something has to give sometime.”

“People down here show a lot of insight,” says Kim Markel, the vivacious, spike-haired Portland nurse, “but I still find it surprising when they express care about us. You think they’re too into their head trips and drug trips and diseases to notice anything. Like, when I was having a couple of bad months in my personal life, I remember Larry coming up, and he’s like ‘Something’s wrong with you. I can tell.’ [Larry, a narcotic and cocaine addict, has lymphoma that could have been eradicated if his drug use hadn’t sabotaged treatment. Now he’s beyond cure.] ‘You know what, Larry?’ I said. “You’re right. Something is wrong with me, and I’m working on that.’ And he’s like ‘Okay…do you want to go out for a beer?’ I said no, but I was touched. Despite their troubles, they pay enough attention that they actually know when we’re having a hard time of it.”