What’s killing to our fabulous performing artists?

Elvis Presley, Michael Jackson, and most recently, Whitney Houston:  all died prematurely with toxic substances in their system.  Did they ever hear of Marilyn Monroe, home, alone with a bottle of barbiturates on a Saturday night?  The death of each of these gifted people and many more creative artists from alcohol and drugs are a loss of unique talents which extend the bounds of human nature.  Their extraordinary gift brought them fame and wealth. Why did they have to succumb to substance abuse?  What goes wrong? What were their doctors doing?     

I have not been privileged to treat the Whitney Houston’s of the world in my career.  But I have cared for many individuals who dealt with inordinate professional and personal stress in their lives and continued their high octane performance without needing drugs to cope.  These are men and women from all strata of our society and include clergy, senators, judges, deans, chair persons, scientists, professors, teachers and master physicians. I saw the difference between these admired and accomplished people and others who were addicted to drugs.  

I had plenty of experience with drug abusing patients. I am the product of inner city hospitals:  Newark’s Martland Hospital, the Jersey City Medical Center and the East Orange Veteran Administration Medical Center of the riotous 1960 era when I was a medical student.  I further trained at Kings County Hospital Center in Brooklyn and the Bronx Municipal Hospital Center.  The Battle of the Bronx was so intense and demanding in the early 1970’s that the Albert Einstein Medical School, which oversaw my education, was able to defer my 1A draft classification to work in the Bronx rather than in Viet Nam.  I cared for patients with the complications of alcohol and cigarette addiction, the acute flooding of blood in the lungs caused by heroin overdose and the deep coma of patients with barbiturate overdoses or suicide attempts.  I cared for many patients with the complication of intravenous drug abuse which results in hepatitis, heart valve infections, AIDS and other esoteric infections.

I am indebted to these patients who helped me develop my skills as a physician. How do they differ from my well adjusted patients?   I often observed the absence of enriching interpersonal relationships in these patients who needed love more than others. Their childhoods were predictably chaotic as their parents were usually unstable.  Chiefly the patient had an inability to suppress the hedonistic or pleasure seeking impulses of the brain. Together these brought the patient poverty in circumstance, body and mind.  

I recall a patient who required heart surgery to replace his infected aortic heart valve, caused by his habit of giving himself intravenous narcotic injections. These patients routinely reuse and share their needles which cause them to contaminate themselves.    After a successful operation, he returned to the hospital several months later, again with an infected aortic valve. He had resumed injecting crack, a combination of heroin and cocaine.   I asked him:  “Why?  Wasn’t one near death experience with your first infected heart valve, enough of a warning that this might kill you.” “Doctor, you have no idea of the stress I experience.”   I had to treat him again to clear the infection and convince a heart surgeon to insert another aortic valve.  I turned to the resident physician in training who was caring for the patient with me.   I said: “You are working over 80 hours a week. You work with 20 patients a day.   You have to make 100 right decisions a day to care for them. Why are you not taking drugs to cope?”    He was then 27 years old and has gone on to have an exceptional career as a physician’s physician in Princeton, NJ.  He said:   “I have been prepared to handle stress.”

That preparation began in childhood.  His parents taught him that he was special but that he was still govern by the rules of healthy living.  He had to keep his body strong and fit to deal with the challenges of his education, his relationships and ultimately his work.  He can not disappoint the family who gave him their values with love and support and will be there to help him.  He did not need drugs to suppress the stress of dealing with new situations or to give him moments of pleasure.   As he overcame his educational hurtles, he grew in confidence and self esteem and he became capable of dealing with increasing responsibilities until he was independently in charge of his patients.  He kept sight of the big picture:  staying healthy and maintaining his interpersonal support.  Why put his mental acuity or body at risk with mind boggling drugs though these are more readily available to him in purer forms than to the patient on the street?  There is nothing free of consequences.    

If a resident physician in training realizes all this and knows why he is succeeding, it is puzzling why the doctors who provide drugs to our fabulous entertaining artists have not counsel their patients to preclude their killing themselves with substance abuse.  These artists are special people too but they are human and the rules of healthy living apply to them like the rest of us. Their families, friends cannot stand by and let them ignore these rules and trust doctors who treat with unlimited access to potentially harmful drugs.

We do not know the details of Whitney Houston’s problems but she appeared at times to be anorexic.  Drugs are generally poorly effective for weight problems. She might have benefited from behavioral counseling done very frequently in which the therapist worked on her insight and motivation and simply tried to develop in her an aversion to self destructive hedonistic impulses, like taking cocaine. In the last moments of her life, Ms. Houston craved a “high” from that agent but instead the drug constricted her coronary arteries which it often does. Her heart became weak and she collapsed into a full bathtub and drowned.  Ironically she was in one of the most beautiful neighborhoods in the world on a Saturday afternoon.  Instead of taking alcohol and cocaine into the bathroom, she might have learned through counseling to avoid risk. She could have said to one of her companions.   “Let’s become inconspicuous and let’s take a walk down Beverly Boulevard where there are some of the most beautiful houses in Beverly Hills. Let’s go to the park down the street and watch the kids play in the sand and the old men play bocce.  I might want to talk to a few fans.”  Can you image the mutual thrills and adulation she would receive in that little park?  That would be a high greater than any provided by cocaine.  If she took that walk in the sun that afternoon with her friends, we might still be enjoying the sound of her genius.