RIPPLE EFFECT | Naazia Azhar
Tim, as a boy, would carry around a duffel bag filled with toys. When he and his siblings were taken to their grandmother’s house, they were each supposed to pack their own clothes and underwear. His oldest sister, Hannah, would instruct and guide the packing. Tim is the middle child of five. The two that came before him were his older sisters, the makeshift moms. The two that came after him were the babies. A younger sister, and then finally, take a deep breath, his younger brother Matthew. The five kids were shipped away sometimes every few weeks and sometimes not for a year or two. Tim did not know the reason. He did not know that their mom would sometimes drink too much or run out of money or get an eviction notice or whatever it was. He just knew that his grandmother would come to get them, and oldest-sister-Hannah would rush him along with his packing. After the first few moves, he got wiser and started packing his toys first.
“We were like a blanket for one another,” he reflects, so many years later. Their lives did not seem so chaotic because wherever they went, the five of them were together.
Tim is now twenty-eight. He likes to skateboard, hike and play video games. He works with a friend installing floors. He lives in a small town outside of a mid-sized midwestern city. Three months ago, his baby brother Matthew died of a fentanyl overdose.
Tim shakes his head like it still doesn’t make sense. Matthew was supposed to have been clean for a week, headed to their mom’s house that day, but he got sidetracked. Mom, the imperfect one from their childhood, is still around and doing well now. She works with the local school district as a secretary and has been there for over ten years. The three sisters live locally. They were all supposed to be meeting up at mom’s house, with a glimmer of hope that Matthew was sober and coming home. Mom baked chicken. Tim shakes his head like it’s not fair.
These five siblings kept each other safe throughout their childhoods. When the baby brother overdosed and died, their worlds collapsed. The ripple effect. The ripple effect is defined as what happens after an initial disturbance in a place or system spreads to further disruption in a larger system. I don’t know why, but I ask him, who do you think is taking it the worst. Tim answers, sadly. Probably my mom.
I am meeting Tim in an inpatient psychiatric ward. He is using meth more often that he can admit. His sisters and mom wrote to the police in desperation to get him admitted to the hospital. I read the affidavits. The testimonies describe how he keeps shouting and threatening everyone. He talks about how he wants to be where Matthew is. Is he going to commit suicide? They don’t know. He gets angry at everyone and then takes off on his bike for days. They don’t know where he goes or what he does. This family cannot lose another son.
How can I say to this stranger, Tim, that there is something profoundly likable about him? Beyond his disheveled face and pissed off attitude. I know that when he cleans up nice, he looks handsome as hell. I know that he love-love-loves his sisters. I know that he sees his mom’s pain. And even though his meth use and his explosive behavior is making everything worse right now, it also feels entirely reasonable. He is hurting and everyone is hurting and it just hurts.
This rugged and jittery man sitting across from me in the interview room —I want for him success. We just met, but I feel it deeply. Could the methamphetamine turn into an old memory? I wish for him a safe place to land when he leaves it behind, perhaps a person or a place. I wish that he pursues his interests in a way that shakes the world around him. I wonder if his love of hiking could take him away from this small, flat town to discover the Painted Desert. I wonder if he’d consider a career as a National Park ranger. I imagine he’d come back to Missouri for Thanksgiving or Christmas, buying his nieces and nephews lots of obnoxiously funny gifts. The toys he brings them reminiscent of the toys he used to pack into his duffel bag when he was a kid.
I think about opioid overdoses frequently and spend much of my time working in a methadone clinic. I mourn when a patient dies from a drug overdose. I write their first names with marker on large pebbles and keep them in a ceramic bowl. I wear a silver ribbon on Overdose Awareness Day. I prescribe naloxone, the antidote for an overdose, to everyone I encounter. When I meet Tim inside the drab walls of the psych ward, I realize that he is not just a ripple effect. Tim’s hospitalization is not just a subtle unintended consequence of his brother Matthew’s overdose.
A ripple implies a gentle stir in an otherwise calm place. But when a large heavy stone falls flat into a lake, it is followed by a drought or a sea monster or something much less peaceful than a ripple.
Naazia Azhar, MD, MBA, grew up in New York City and attended Union College and Albany Medical College in Albany, NY. She completed her training in Adult Psychiatry at Washington University in St Louis. Azhar, who specializes in addiction and works as an outpatient and inpatient psychiatrist, believes in the healing power of writing the words down and challenges herself to do this often.