Doll

January 5

The patient’s name is Tina Karin Sachs. She is divorced, has a daughter aged five. She lives in the city and leads an active professional life, which is one of the reasons she was reluctant to seek assistance before now. She stated, however, that she had made a New Year’s resolution, and that she is determined to break the habit. She has been a narcotics user since the time she was seventeen, and is now addicted to heroin.

I explained to her that the methods of withdrawal which I had thus far found most satisfactory were those employing either morphine or methadone, both of which had proved to be adequate substitutes for whatever drugs or combinations of drugs my patients had previously been using. I told her, too, that I personally preferred the morphine method.

She asked if there would be much pain involved. Apparently she had once tried cold-turkey withdrawal and had found the attempt too painful to bear. I told her that she would experience withdrawal symptoms — nausea, vomiting, diarrhea, lacrimation, dilation of pupils, rhinorrhea, yawning, gooseflesh, sneezing, sweating — with either method. With morphine, the withdrawal would be more severe, but she could expect relative comfort after a week or so. With methadone, the withdrawal would be easier, but she might still feel somewhat tremulous for as long as a month afterward.

She said she wanted to think it over, and would call me when she had decided.

January 12

I had not expected to see or hear from Tinka Sachs again, but she arrived here today and asked my receptionist if I could spare ten minutes. I said I could, and she was shown into my private office, where we talked for more than forty-five minutes.

She said she had not yet decided what she should do. and wanted to discuss it further with me. She is, as she had previously explained, a fashion model. She receives top fees for her modeling and was now afraid that treatment might entail either pain or sickness which would cause her to lose employment, thereby endangering her career. I told her that her addiction to heroin had made her virtually careerless anyway, since she was spending much of her income on the purchase of drugs. She did not particularly enjoy this observation, and quickly rejoindered that she thoroughly relished all the fringe benefits of modeling — the fame, the recognition, and so on. I asked her if she really enjoyed anything but heroin, or really thought of anything but heroin, and she became greatly agitated and seemed about to leave the office.

Instead, she told me that I didn’t know what it was like, and she hoped I understood she had been using narcotics since she was seventeen, when she’d first tried marijuana at a beach party in Malibu. She had continued smoking marijuana for almost a year, never tempted to try any of ‘the real shit’ until a photographer offered her a sniff of heroin shortly after she’d begun modeling. He also tried to rape her afterwards, a side effect that nearly caused her to abandon her beginning career as a model. Her near-rape, however, did not dissuade her from using marijuana or from sniffing heroin every now and then, until someone warned her that inhaling the drug could damage her nose. Since her nose was part of her face, and her face was part of what she hoped would become her fortune, she promptly stopped the sniffing process.

The first time she tried injecting the drug was with a confirmed addict, male, in a North Hollywood apartment. Unfortunately, the police broke in on them, and they were both arrested. She was nineteen years old at the time, and was luckily released with a suspended sentence. She came to this city the following month, determined never to fool with drugs again, hoping to put three thousand miles between herself and her former acquaintances. But she discovered, almost immediately upon arrival, that the drug was as readily obtainable here as it was in Los Angeles. Moreover, she began her association with the Cutler Agency several weeks after she got here, and found herself in possession of more money than she would ever need to support both herself and a narcotics habit. She began injecting the drug under her skin, into the soft tissue of her body. Shortly afterwards, she abandoned the subcutaneous route and began shooting heroin directly into her veins. She has been using it intravenously ever since, has for all intents and purposes been hopelessly hooked since she first began skin-popping. How, then, could I expect to cure her? How could she wake up each morning without knowing that a supply of narcotics was available, in fact accessible? I explained that hers was the common fear of all addicts about to undergo treatment, a reassurance she accepted without noticeable enthusiasm.

I’ll think about it, she said again, and again left. I frankly do not believe she will ever return again.

January 20

Tinka Sachs began treatment today.

She has chosen the morphine method (even though she understands the symptoms will be more severe) because she does not want to endanger her career by a prolonged withdrawal, a curious concern for someone who has been endangering her career ever since it started. I had previously explained that I wanted to hospitalize her for several months, but she flatly refused hospitalization of any kind, and stated that the deal was off if that was part of the treatment. I told her that I could not guarantee lasting results unless she allowed me to hospitalize her, but she said we would have to hope for the best because she wasn’t going to admit herself to any damn hospital. I finally extracted from her an agreement to stay at home under a nurse’s care at least during the first several days of withdrawal, when the symptoms would be most severe. I warned her against making any illegal purchases and against associating with any known addicts or pushers. Our schedule is a rigid one. To start, she will receive ¼ grain of morphine four times daily — twenty minutes before each meal. The doses will be administered hypodermically, and the morphine will be dissolved in thiamine hydrocholoride.

It is my hope that withdrawal will be complete within two weeks.

January 21

I have prescribed Thorazine for Tinka’s nausea, and belladonna and pectin for her diarrhea. The symptoms are severe. She could not sleep at all last night. I have instructed the nurse staying at her apartment to administer three grains of Nembutal tonight before Tinka retires, with further instructions to repeat 1½ grains if she does not sleep through the night.

Tinka has taken excellent care of her body, a factor on our side. She is quite beautiful and I have no doubt she is a superior model, though I am at a loss to explain how photographers can have missed her obvious addiction. How did she keep from ‘nodding’ before the cameras? She has scrupulously avoided marking either her lower legs or her arms, but the insides of her thighs (she told me she does not model either lingerie or bathing suits) are covered with hit marks.

Morphine continues at ¼ grain four times daily.

January 22

I have reduced the morphine injections to ¼ grain twice daily, alternating with ⅛ grain twice daily. Symptoms are still severe. She has cancelled all of her sittings, telling the agency she is menstruating and suffering cramps, a complaint they have apparently heard from their models before. She shows no desire to eat. I have begun prescribing vitamins.

January 23

The symptoms are abating. We are now administering ⅛ grain four times daily.

January 24

Treatment continuing with ⅛ grain four times daily. The nurse will be discharged tomorrow, and Tinka will begin coming to my office for her injections, a procedure I am heartily against. But it is either that or losing her entirely, and I must go along.

January 25

Started one grain codeine twice daily, alternating with ⅛ grain morphine twice daily. Tinka came to my office at eight-thirty, before breakfast, for her first injection. She came again at twelve-thirty, and at six-thirty. I administered the last injection at her home at eleven-thirty. She seems exceptionally restless, and I have prescribed ½ grain of phenobarbital daily to combat this.

January 26

Tinka Sachs did not come to the office today. I called her apartment several times, but no one answered the telephone. I did not dare call the modeling agency lest they suspect she is undergoing treatment. At three o’clock, I spoke to her daughter’s governess. She had just picked the child up at the play-school she attends. She said she did not know where Mrs Sachs was, and suggested that I try the agency. I called again at midnight. Tinka was still not home. The governess said I had awakened her. Apparently, she saw nothing unusual about her employer’s absence. The working arrangement calls for her to meet the child after school and to spend as much time with her as is necessary. She said that Mrs Sachs is often gone the entire night, in which case she is supposed to take the child to school in the morning, and then call for her again at two-thirty. Mrs Sachs was once gone for three days, she said.

I am worried.

February 4

Tinka returned to the office again today, apologizing profusely, and explaining that she had been called out of town on an assignment; they were shooting some new tweed fashions and wanted a woodland background. I accused her of lying, and she finally admitted that she had not been out of town at all, but had instead spent the past week in the apartment of a friend from California. After further questioning, she conceded that her California friend is a drug addict, is in fact the man with whom she was arrested when she was nineteen years old. He arrived in the city last September, with very little money, and no place to live. She staked him for a while, and allowed him to live in her Mavis County house until she sold it in October. She then helped him to find an apartment on South Fourth, and she still sees him occasionally.

It was obvious that she had begun taking heroin again.

She expressed remorse, and said that she is more than ever determined to break the habit. When I asked if her friend expects to remain in the city, she said that he does, but that he has a companion with him, and no longer needs any old acquaintance to help him pursue his course of addiction.

I extracted a promise from Tinka that she would never see this man again, nor try to contact him.

We begin treatment again tomorrow morning. This time I insisted that a nurse remain with her for at least two weeks.

We will be starting from scratch.

February 9

We have made excellent progress in the past five days. The morphine injections have been reduced to ⅛ grain four times daily, and tomorrow we begin alternating with codeine.

Tinka talked about her relationship with her husband for the first time today, in connection with her resolve to break the habit. He is apparently an archaeologist working with an expedition somewhere in Arizona. She is in frequent touch with him, and in fact called him yesterday to say she had begun treatment and was hopeful of a cure. It is her desire, she said, to begin a new life with him once the withdrawal is complete. She knows he still loves her, knows that had it not been for her habit they would never have parted.

She said he did not learn of her addiction until almost a year after the child was born. This was all the more remarkable since the baby — fed during pregnancy by the bloodstream of her mother, metabolically dependent on heroin — was quite naturally an addict herself from the moment she was born. Dennis, and the family pediatrician as well, assumed she was a colicky baby, crying half the night through, vomiting, constantly fretting. Only Tinka knew that the infant was experiencing all the symptoms of cold-turkey withdrawal. She was tempted more than once to give the child a secret fix, but she refrained from doing so, and the baby survived the torment of force withdrawal only to face the subsequent storm of separation and divorce.

Tinka was able to explain the hypodermic needle Dennis found a month later by saying she was allergic to certain dyes in the nylon dresses she was modeling and that her doctor had prescribed an antihistamine in an attempt to reduce the allergic reaction. But she could not explain the large sums of money that seemed to be vanishing from their joint bank account, nor could she explain his ultimate discovery of three glassine bags of a white powder secreted at the back of her dresser drawer. She finally confessed that she was a drug addict, that she had been a drug addict for close to seven years and saw nothing wrong with it so long as she was capable of supporting the habit. He goddamn well knew she was earning most of the money in this household, anyway, so what the fuck did he want from her?

He cracked her across the face and told her they would go to see a doctor in the morning.

In the morning, Tinka was gone.

She did not return to the apartment until three weeks later, disheveled and bedraggled, at which time she told Dennis she had been on a party with three coloured musicians from a club downtown, all of them addicts. She could not remember what they had done together. Dennis had meanwhile consulted a doctor, and he told Tinka that drug addiction was by no means incurable, that there were ways of treating it, that success was almost certain if the patient — Don’t make me laugh, Tinka said. I’m hooked through the bag and back, and what’s more I like it, now what the hell do you think about that? Get off my back, you’re worse than the monkey!

He asked for the divorce six months later.

During that time, he tried desperately to reach this person he had taken for a wife, this stranger, who was nonetheless the mother of his child, this driven animal whose entire life seemed bounded by the need for heroin. Their expenses were overwhelming. She could not let her career vanish because without her career she could hardly afford the enormous amounts of heroin she required. So she dressed the part of the famous model, and lived in a lavishly appointed apartment, and rode around town in hired limousines, and ate at the best restaurants, and was seen at all the important functions — while within her the clamour for heroin raged unabated. She worked slavishly, part of her income going toward maintaining the legend that was a necessary adjunct of her profession, the remainder going toward the purchase of drugs for herself and her friends.

There were always friends.

She would vanish for weeks at a time, lured by a keening song she alone heard, compelled to seek other addicts, craving the approval of people like herself, the comradeship of the dream society, the anonymity of the shooting gallery where scars were not stigmata and addiction was not a curse.

He would have left her sooner but the child presented a serious problem. He knew he could not trust Anna alone with her mother, but how could he take her with him on archaeological expeditions around the world? He realized that if Tinka’s addiction were allowed to enter the divorce proceedings, he would be granted immediate custody of the child. But Tinka’s career would automatically be ruined, and who knew what later untold hurt the attendant publicity could bring to Anna? He promised Tinka that he would not introduce the matter of her addiction if she would allow him to hire a responsible governess for the child. Tinka readily agreed. Except for her occasional binges, she considered herself to be a devoted and exemplary mother. If a governess would make Dennis happy and keep this sordid matter of addiction out of the proceedings, she was more than willing to go along with the idea. The arrangements were made.

Dennis, presumably in love with his wife, presumably concerned about his daughter’s welfare, was nonetheless content to abandon one to eternal drug addiction, and the other to the vagaries and unpredictabilities of living with a confirmed junkie. Tinka, for her part, was glad to see him leave. He had become a puritanical goad, and she wondered why she’d ever married him in the first place. She supposed it had had something to do with the romantic notion of one day kicking the habit and starting a new life.

Which is what you’re doing now, I told her.

Yes, she said, and her eyes were shining.

February 12

Tinka is no longer dependent on morphine, and we have reduced the codeine intake to one grain twice daily, alternating with ½ grain twice daily.

February 13

I received a long-distance call from Dennis Sachs today. He simply wanted to know how his wife was coming along and said that if I didn’t mind he would call once a week — it would have to be either Friday or Saturday since he’d be in the desert the rest of the time — to check on her progress. I told him the prognosis was excellent, and I expressed the hope that withdrawal would be complete by the twentieth of the month.

February 14

Have reduced the codeine to ½ grain twice daily, and have introduced thiamine twice daily.

February 15

Last night, Tinka slipped out of the apartment while her nurse was dozing. She has not returned, and I do not know where she is.

February 20

Have been unable to locate Tinka.

March 1

Have called the apartment repeatedly. The governess continues to care for Anna — but there has been no word from Tinka.

March 8

In desperation, I called the Cutler Agency today to ask if they have any knowledge of Tinka’s whereabouts. They asked me to identify myself, and I said I was a doctor treating her for a skin allergy (Tinka’s own lie!). They said she had gone to the Virgin Islands on a modeling assignment and would not be back until the twentieth of March. I thanked them and hung up.

March 22

Tinka came back to my office today.

The assignment had come up suddenly, she said, and she had taken it, forgetting to tell me about it.

I told her I thought she was lying.

AH right, she said. She had seized upon the opportunity as a way to get away from me and the treatment. She did not know why, but she had suddenly been filled with panic. She knew that in several days, a week at most, she would be off even the thiamine — and then what would there be? How could she possibly get through a day without a shot of something?

Art Cutler had called and proposed the St Thomas assignment, and the idea of sun and sand had appealed to her immensely. By coincidence, her friend from California called that same night, and when she told him where she was going he said that he’d pack a bag and meet her down there.

I asked her exactly what her connection is with this ‘friend from California,’ who now seems responsible for two lapses in her treatment. What lapse? she asked, and then swore she had not touched anything while she was away. This friend was simply that, a good friend.

But you told me he is an addict, I said.

Yes, he’s an addict, she answered. But he didn’t even suggest drugs while we were away. As a matter of fact, I think I’ve kicked it completely. That’s really the only reason I came here, to tell you that it’s not necessary to continue treatment any longer. I haven’t had anything, heroin or morphine or anything, all the while I was away. I’m cured.

You’re lying, I said.

All right, she said. If I wanted the truth, it was her California friend who’d kept her out of prison those many years ago. He had told the arresting officers that he was a pusher, a noble and dangerous admission to make, and that he had forced a shot on Tinka. She had got off with the suspended sentence while he’d gone to prison; so naturally she was indebted to him. Besides, she saw no reason why she shouldn’t spend some time with him on a modeling assignment, instead of running around with a lot of faggot designers and photographers, not to mention the Lesbian editor of the magazine. Who the hell did I think I was, her keeper?

I asked if this ‘friend from California’ had suddenly struck it rich.

What do you mean? she said.

Well, isn’t it true that he was in need of money and a place to stay when he first came to the city?

Yes, that’s true.

Then how can he afford to support a drug habit and also manage to take a vacation in the Virgin Islands? I asked.

She admitted that she paid for the trip. If the man had saved her from a prison sentence, what was so wrong about paying his fare and his hotel bill?

I would not let it go.

Finally, she told me the complete story. She had been sending him money over the years, not because he asked her for it, but simply because she felt she owed something to him. His lie had enabled her to come here and start a new life. The least she could do was send him a little money every now and then. Yes, she had been supporting him ever since he arrived here. Yes, yes, it was she who’d invited him along on the trip; there had been no coincidental phone call from him that night. Moreover, she had not only paid for his plane fare and hotel bill, but also for that of his companion, whom she described as ‘an extremely lovely young woman’.

And no heroin all that while, right?

Tears, anger, defense.

Yes, there had been heroin! There had been enough heroin to sink the island, and she had paid for every drop of it. There had been heroin morning, noon, and night. It was amazing that she had been able to face the cameras at all, she had blamed her drowsiness on the sun. That needle had been stuck in her thigh constantly, like a glittering glass cock! Yes, there had been heroin, and she had loved every minute of it! What the hell did I want from her?

I want to cure you, I said.

March 23

She accused me today of trying to kill her. She said that I had been trying to kill her since the first day we met, that I know she is not strong enough to withstand the pains of withdrawal, and that the treatment will eventually result in her death.

Her lawyer has been preparing a will, she said, and she would sign it tomorrow. She would begin treatment after that, but she knew it would lead to her ultimate death.

I told her she was talking nonsense.

March 24

Tinka signed her will today.

She brought me a fragment of a poem she wrote last night:

I asked her why she hadn’t finished the poem. She said she couldn’t finish it until she knew the outcome herself. What outcome do you want? I asked her.

I want to be cured, she said.

You will be cured, I told her.

March 25

We began treatment once more.

March 27

Dennis Sachs called from Arizona again to inquire about his wife. I told him she had suffered a relapse but that she had begun treatment anew, and that we were hoping for complete withdrawal by April 15th at the very latest. He asked if there was anything he could do for Tinka. I told him that the only person who could do anything for Tinka was Tinka.

March 28

Treatment continues.

¼ grain morphine twice daily.

⅛ grain morphine twice daily.

March 30

⅛ grain morphine four times daily.

Prognosis good.

March 31

⅛ grain morphine twice daily.

One grain codeine twice daily.

April 1

Tinka confessed today that she had begun buying heroin on the sly, smuggling it in, and has been taking it whenever the nurse isn’t watching. I flew into a rage. She shouted ‘April Fool!’ and began laughing.

I think there is a chance this time.

April 2

One grain codeine four times daily.

April 3

One grain codeine twice daily.

½ grain codeine twice daily.

April 4

½ grain codeine four times daily.

April 5

½ grain codeine twice daily, thiamine twice daily.

April 6

Thiamine four times daily. Nurse was discharged today.

April 7

Thiamine three times daily.

We are going to make it!

April 8

Thiamine twice daily.

April 9

She told me today that she is certain the habit is almost kicked. This is my feeling as well. The weaning from hypodermics is virtually complete. There is only the promise of a new and rewarding life ahead.