Book Reviews

A Piece of Cake

By Cupcake Brown

Cupcake Brown (that's her real name) was 11 in 1976 when her mother died. Custody of Brown and her brother was given to a stranger — their birth father — who only wanted their social security checks. He then left them with an abusive foster mother who encouraged her nephew to rape Brown repeatedly.

Brown got better and better at running away. A prostitute taught her to drink, smoke marijuana and charge for sex. Her next foster father traded her LSD and cocaine for oral sex. Eventually she went to live with a great-aunt in South Central L.A., where she joined a gang.

Almost 16, having barely survived a shooting, she decided to quit gangbanging. Drugs were her new best friends. A boyfriend taught her to freebase, but then there was crack, which was easier. Before long she was a "trash-can junkie," taking anything and everything.

It wasn't until she woke up behind a dumpster one morning, half-dressed and more than half-dead, that she admitted she needed help. Brown conveys this all in gritty detail, and her struggle to come clean and develop her potential — she's now an attorney with a leading California firm and a motivational speaker — ends her story on a high note.

Drinking: A Love Story

By Caroline Knapp

Freelance journalist Knapp began drinking in her early teens and continued unabatedly until she "hit bottom" in 1995 and checked herself into a rehab at the age of 36.

During that time she managed to graduate with honors from Brown and have a successful career as a journalist, and few people suspected she had a problem with the bottle.

Here she recounts the years of denial that helped her rationalize the blackouts, innumerable hangovers, broken relationships and family tensions characteristic of the alcoholic's story.

Knapp interweaves her personal history with factual information about alcohol abuse, including frequent references to the AA meetings she's attended. Here's a confession utterly devoid of self-pity, an extraordinarily lucid and very well-written personal account of a common addiction that is filled with insights as well as a comprehensive treatment of the subject.

The text reproduces a questionnaire for alcoholism made up by the National Council on Alcoholism and Drug Dependence.

Note: Carolyn Knapp died June 3, 2002, at the age of 43.

Nurses in recovery.

A new book on prescription drug abuse

From Unbecoming a Nurse to Overcoming Addiction

By Paula Davies Scimeca, RN, MS

Sea Meca, Inc. $19.95

“One day after having been up all night getting high,” a registered nurse writes in her testimony in Paula Scimeca’s book, From Unbecoming a Nurse to Overcoming Addiction, “I got ready for work in the wee hours of the morning. I took my shower, ironed my uniform and walked to work.

“Mid-morning that day, I was passing medications. I don’t know if I blacked out or fell asleep while standing up, but when I came to, I realized that the medication in the cup in front me was not the medication for the patient I was about to dispense it to.”

If you are a patient in a hospital reading this, you may be reaching for your street clothes and planning your escape. But hold on, the nurse in this case got it straightened out in time, checked herself into long term treatment and is today a nurse in drug treatment program helping others recover.

Still, there is much to be concerned about, says author Scimeca, an RN for 35 years and an adjunct professor of nursing at New York’s Wagner College who has had extensive experience working in drug treatment programs. She has been a vigorous campaigner against drug abuse in the nursing profession.

“Though statistics are hard to come by,” she said in a recent letter to One Day at a Time, “it is widely accepted that between ten and twenty percent of nurses develop a problem with alcohol or other drugs during their lifetime.

This means that given the nearly three million RNs and hundreds of thousands of LPNs currently licensed in the U.S., even the lowest estimate of ten percent equates to nearly five hundred thousand nurses encountering an issue at some point.”

Scimeca has had an interest in addressing addiction problems in the nursing profession for a long time, but what really got her dander up and resulted in her writing her first book was actress Edie Falco’s character, Jackie Peyton, in last year’s Nurse Jackie television series.

The show, promotional material says, “is about a drug-addicted nurse who struggles to find a balance between the demands of her frenetic job at a New York City hospital and an array of personal dramas.”

What galls Scimeca is “the powerful and wholly untrue perception the show gives that the behavior of the Nurse Jackie character portrays is benign.

“Nurses in real life who do step over the numerous lines Jackie crosses in a half hour segment,” Simeca says, “face devastating, exquisitely painful consequences. Many of the repercussions are irreversible and last a lifetime.

“The unvarnished truth is that thousands of nurses in this country surrender their license to practice nursing every year related to habitual use of substances, even those legitimately prescribed.  Many lose fine jobs as well as reputations and respect among their peers.

“Some forfeit child custody rights, while some face criminal prosecution in addition to professional discipline charges.  As this article is being printed, several nurses await sentencing for up to twenty-five years in prison.  Hundreds have already relinquished their lives due to prescription addiction and other substance use.”

In Scimeca’s first book, Unbecoming a Nurse she emphasizes that the seriousness of drug addiction in nurses cannot be overestimated and that even the most conscientious nurses can succumb to the pressures—and temptations — of “a demanding and exciting profession.”

Scimeca’s latest book, “From Unbecoming a Nurse to Overcoming Addiction” consists of 29 testimonials from nurses now in recovery. These stories remind us of the astonishing degradation associated with drug addiction, and the “Aha!” moments of self discovery and redemption make for great reading.

Still, while applauding the achievements of these nurses in overcoming their addictions (at least for today), some readers may also find revelations of professional wrongdoing alarming. For instance:

“During nursing school,” says one young nurse in recovery, “I was working in a head shop, which is a place that sells drug-related paraphernalia. So I was doing clinical during the day, and in the afternoon I was working in the head shop. By this time I was a daily pot smoker and was drinking alcohol pretty heavily.

“Then I started working in a pharmacy which was where I began diverting medication. I did a lot of experimenting and tried everything even anti-depressants, because I wanted something to make me feel better. This went on for quite some time. I just fell in love with opiates, which became my drug of choice.

“I would read the package inserts and think, “People like me are going to abuse this stuff. And I did.”

The testimonials also remind readers that the power of addiction is frequently underestimated. To wit:

“I thought I knew what addiction was at the time. I relied on what my drug handbook said about an addict being someone who became physically dependent on the substance. I felt if that was what it took for me to get through life. I would be OK.

“The drug handbook left out the part that I would build up a tolerance to the substance I used and that I would require larger amounts, not just to feel high, but to just feel normal. The handbook omitted that when the pills and alcohol were taken away from me that I would lie, steal, cheat and do just about anything to get what I thought I needed.”

And then there are the happy endings:

“My life has actually been enriched by my relapse. To this very day, I do not take for granted that I am sober. I do not take for granted that I am still married to the love of my life, despite all that I put him through. I do not take for granted that I have a good relationship with my son who turned out to be kind and loving despite what I put him through. And I do not take for granted that I am allowed to practice as a Registered Nurse in my state without restriction on my license.”

While the stories of recovery are enormously gratifying and inspiring to those in need of recovery, Scimeca says, there is much more to be done.

National and local nursing associations and nursing schools, she says, must become more affective in addressing the exposure nurses encounter in the workplace so that nurses with addictive disorders can be identified earlier. It will save their lives and careers and safeguard the public.

One of Scimeca’s major complaints has to do with the decades old professional terminology which refers to unused partial and full doses of medication as “waste medication.”

It promotes a mind-set in some nurse vulnerable to addiction, Scimeca says. that these “waste” doses are up for grabs and can be salvaged by nurses for their own use rather than disposing of them properly.

Editor’s note: For those who want to check on a nurses record, there is a web site called “NURSYS” that could be helpful.

By Mary Karr

Harper Collins

“Age seventeen, stringy-haired and halter-topped, weighing in the high double digits and unhindered by a high school diploma, I showed up at the Pacific ocean, ready to seek my fortune with a truck full of extremely stoned surfers.”

With this opening paragraph in Lit, her third memoir, Mary Karr, author of Liar’s Club and Cherry; a Guggenheim Fellow in poetry; and a Peck professor of literature at Syracuse University, takes us on a wild, insightful and often hilarious ride through her addictions and ultimate redemption.

She, herself, is surprised by the happy ending.

“If you’d told me even a year before I start taking my son to church regular that I’d wind up whispering my sins in the confessional or on my knees saying the rosary,” she says, “I would have laughed myself cockeyed.”

A more likely pastime, she suggests, would have been “Pole dancer. International spy. Drug mule. Assassin.” And she might have added “alcoholic,” which actually happened.

Karr, who writes with insight and humor about her addiction for the first half of the book, turns to her recovery in the second, which begins inauspiciously, albeit hilariously, at her first 12-Step meeting. More about that shortly.

Life with the surfers, which opens the book, quickly turns south, and she impulsively accepts a ride from a clearly unhinged young man in a broken down Volkswagen who suddenly turns monster.

“He smiled,” Karr writes, “showing the pointy incisors of a gerbil … I could see how wildly high he was. I must have had heat stroke to miss it. His eyes were tar pits, his body slick with sweat. This wasn’t a cannabis saliva high, nor heroin nod-off high nor John Lennon’s imagine-all-the-people-living-in-one-world high. This was eye-ball-boiling grind-your-teeth-to-bloody-stubs high. In short crystal meth high.”

Karr forthwith makes a successful run for it.

Karr grew up in a tough Texas town with a neglectful even homicidal alcoholic mother (who finds 20 years of sobriety in her later years and reconciliation with her daughter) and a hardworking but disengaged father about whom she writes “Daddy floated through the house with an increasingly vacant stare, leaving a wake of Camel smoke.”

Despite the handicaps of her rough childhood, she manages to get an education, support herself and develop her love of poetry. She also develops that nasty drinking problem that accelerates when she marries Warren Whitbread, a 6’5” Ivy League, handsome hunk, from a prominent Dallas family who shares her love for poetry. Together they have a son, Dev, Warren is everything she is not — solid, steadfast, careful with a buck and on the boring side. And she loves him.

Mary, for her part, is irresistible because of her spunk, wit, good looks and self-awareness, but there is also the pain of her depression, which she treats with alcohol and visits to mental hospitals.

Eventually Mary finds herself in that first 12-Step meeting in Cambridge. Here is part of her account.

After contemplating the overall tacky appearance of the room and its “cornball slogans,” Mary reports, she tries to pretend she is there by accident.

“I warp my mouth into a stiff rictus and begin trying to impersonate a good and sober person who’s only wandered in through curiosity and happenstance.”

Later, while the meeting is in progress, she slips out for a cigarette and meets a young man who asks her, referring to the point of the meeting, if she “gets it.” She replies, “I wouldn’t be out here smoking if I got it.

“Same here, says the young man, adding that while he drank a lot he mostly did marijuana which can’t be so bad because it’s natural.

“I say — cleverly I think —strychnine’s natural.

“He concedes that’s true but also points out how, since the average pot smoker doesn’t tend to steal your TV, people don’t frown on it like they do, say, smoking crack, then plowing over the crossing guard.”

But as time passes, the meetings begin to work, and to provide further verification, Karr, still new to the program runs into Tom, a legendary drunk from her past life who sobered up the 12-Step way and became a model family man.

“That morning after my weepy crash,” Karr writes, “I stand snot-nosed before Tom and his wife in their breakfast nook, waiting for both of them to deliver some healing whap to my head.

“Great, Tom says instead. You’ll get sober and your poems will get better and your kid will grow up with a happy mother.”

Karr chooses a priest for her fifth step, basically a verbal acknowledgement of past sins, and when it’s over he tells her to drop all the baggage.

“Brother Francis blinks behind his smeary horn-rims, saying, ‘Leave all that stuff here with me. God wants you to put this stuff down now. Go wear the world like a loose garment. And be of good cheer. If you let God in he’ll take this shame from you.”

Later, when she has doubts about her Christian faith and wonders whether it is all a big scam, another mentor sets her straight.

“Toby tells me how being a Christian during the Roman occupation was (as scams go) not so lucrative. The followers weren’t rich guys but riff raff—tax collectors and whores.

“So let’s say Jesus was sincere. Maybe it’s the Church. Maybe Paul’s the big fakir.

“You think Paul’s conversion made him some rich cult leader? That’s a laugh. He essentially resigned a CPA job to ride with the Hell’s Angels.

“Early Christians, he tells me, partly won converts by going to death singing. I mean, a lion is eating your face, and you’re singing.”

Then there is her weakness for men, which she discusses with sister Margaret with the following result:

“Let’s eat a cookie and pray for each other’s disordered attachments, she (Sister Margaret) says. Mine involve pride and cookies.

“Mine, I say, involves pride and good-looking men.

“Together we bow our heads.”

In the end, Mary has become a woman of faith, but she is not without her doubts, which she discusses with Father Kane, a retired priest.

“I sit weeping across from him, fully aware of the ingratitude I’ve occasionally nurtured and fertilized like a garden of black vines. Which posture rankles him. ‘Oh, get up, Mary,’ he says. ‘You know damn well God loves you.’

“And I do. I (mostly) always do.

“I’d like to say I never waver from that place, but on a crowded subway I still pine for a firearm some days.”