“A River in Egypt” by Dr. Les Cohen

So I made a mistake, one stupid mistake, and now I’m payin’ for it. There must be some way out of this mess. Better just concentrate on driving, following directions. Gave myself plenty of time in case I got lost.

Over-caffeinated as it is, I’m too jumpy. Got to calm down. Compose myself. Think it through again.

No, I’m sure … definitely no. I’d never known a medical colleague who was a drunk or junkie. Maybe I’d always had my eyes closed, thought the best of people. Sure, we had access to samples, could write prescriptions, self-medicate … but never outside of an occasional sleeping pill or tranquilizer, getting tipsy at a college party or wedding reception, or a shot or two of whiskey just to take the edge off after a hard day.

No, definitely not. We were cautious, conservative people—too intelligent, rational, self-disciplined. I knew that our profession was not immune to life’s temptations, that some had character flaws. I’d read newspaper stories of greed, insurance fraud, sexual abuse of patients. They were rare. But … never alcohol or drug abuse.

So I thought, until I became a newly christened alcoholic.

It’s her fault, dammit. She’ll come to her senses ‘n come back, I’m sure. Give her time then everything’ll be fine again, like it’d been for twenty years. My life’s been a nightmare since she abruptly walked out. It’s been a month since she abandoned me and the kids. I’ve been a mess; frequent crying spells, up every night worrying about the kids, unable to concentrate in clinic or the hospital. I can’t go on like this. Maybe I’ve taken a pill or drink at night to get to sleep. Some nights a bit more, I think. Yeah, a bit more. Then that afternoon
when Mankin, her lawyer called. I shouldn’t have picked up the phone. Legal terms I  couldn’t understand.

Veiled threats that I was going to lose everything! The kids, the house, my savings. I had to get a lawyer to protect me.

I was crazy with fear and downed a big glass of sherry to calm my nerves before the night’s clinic session. Just sherry, that’s all. Not the hard stuff. Within an hour my sodden emotional collapse at work did me in. Somebody must’ve had it in for me and called the chairman. I didn’t even make any medical mistakes that hurt my patients. That’s all there was to it. Nothing more.

The next morning Dr. Finch, my department chairman, a dour man I’d known for years, with the hospital’s counsel seated alongside, allowed me just five minutes. He didn’t ask for any explanations or details. No compassion or forgiveness was shown. How could he do this to me? After all my accomplishments, what I’ve done for the department? Probationary medical leave, termination of admitting privileges, a report to the Board of Registration in Medicine. Late that night a medical colleague urged me to promptly sign an impaired physician contract with the Physicians Health Service, a branch of the state medical society, to protect my license. I was scared and called them next morning, and signed up. Though I’m not one of those Bowery bums or smack-addled criminals, I knew was in trouble, big trouble.

It was a three-year contract: random urine tests for drugs and alcohol twice a week for ninety days, then weekly thereafter; two 12-step meetings a week; a breathalyzer test before each clinic session; regular visits with an AA sponsor and psychiatrist, and monthly reports to the medical society that were forwarded to the Board. That’s all. Three goddamn years. I needed  a lot of help, legal help, but not this.


It had been a long, confusing ride – over an hour of wrong turns, almost giving up and turning back several times – to find the Medical Society building. Though I had made notes of the directions–my handwriting seemed as jumbled as my mind – it was difficult following the secretary’s instructions.

“His name is Charlie,” she said, “He’ll meet you in the lobby. Be there by seven twenty-five. The meeting starts at 7:30 sharp.”

“Hello doctor, I’m Charlie,” he said, offering his hand. A gray-haired man in his 60s, with a soft voice and sad, knowing eyes. I tried to appear cool, as if attending a department meeting. “I’m glad you made it. Your first meeting can be a tough one. You’ll soon get to know everyone.” He handed me a card with phone numbers on the front, and a Serenity Prayer on the back.

“It doesn’t matter if you’re religious or not, or into praying. You can never tell when it may help you through a rough time. We can talk about it later, but, if you wish, I can be your sponsor, son.”

“Sponsor? What’s that?”

“It’s our term for a mentor, a guide, a helper in emergencies. Something like that. Instead of picking up a drink or a pill, pick up the phone and call me. Come on in, it’s getting late.”

We walked briskly through the lobby into a large boardroom. He showed me to an empty seat at a polished oak table, and softly patted me on the shoulder.

“If you’re hungry you might want a snack.” I shook my head. My appetite had vanished weeks ago. There was a coffee urn, platters of sandwiches and cookies, stacked Styrofoam cups, plates and napkins neatly arranged on a side table. I warily looked around. Who are these people? Nobody I knew, thank goodness. There were about fifteen or so standing around talking: mostly men, a few women, looking my age. Two were quite young. Medical students? house staff? A grizzled few looked much older. Several wore sports coats and ties like me.

On the walls were long rows of formal photographs of Society presidents: serious faces of exemplars of probity and rectitude. Sitting low in my chair, looking down at the table, I felt them staring down at me in judgment.

I heard Charlie’s voice, “OK, let’s begin,” and looked up. All took their seats.

“As you know our tradition is to maintain total anonymity, and what you see here, what you hear here, stays here. We are here to share our experience, strength and hope.” He scanned the room. “Anybody counting days?”

A somber, young man in a black Led Zeppelin T-shirt raised his hand. “Yeah, I’m Mark. I’ve been offa crack for three months now, that’s about ninety days … no it’s  more if you count rehab it’s five months. A hundred and fifty days. The halfway house sucks but I get time to study, and I’m hoping to get back in school next fall. Fingers crossed.”

“Anybody counting anniversaries?”

One old-timer nodded. “I’m Greg ‘n it’ll be fourteen years of recovery next Wednesday, but who’s counting? A crooked smile. “I didn’t even toast the Sox win in the World Series with my old drinkin’ buddies. How’s that?” Everybody chuckled.

Charlie was looking at me.

“Since we always have new members introduce themselves first, if you feel up to it, briefly tell us why you’re here.”

I hadn’t counted on this. Mouth dry, palms sweaty, voice quavering, I began.

“Hi, I’m Les, and … I … really don’t know if I belong here. I don’t think I’m an alcoholic. I . . . ”

No one stirred. All were looking at me.

I couldn’t say it. I wasn’t one of them.

“Hi, Les,” the group cheerfully responded.

Hesitating at first, I spoke slowly, carefully measuring out words, then sped up.

There was much to say; many details that I needed to get right to show them what I’d been through. I had to make clear that it wasn’t my fault. I was crying, rambling, not making much sense. After a few minutes, Charlie gently interrupted.

“Thanks for sharing, Les. You’re in the right place. We hope to see you regularly from now on. Let’s go ‘round the table, then, as planned, we’ll do Step Four.”

Embarrassed crying my guts out in front of strangers, I quickly dried my eyes on my coat sleeve. I had just begun. Over the past several weeks I probably had worn the patience of close friends and colleagues telling and retelling my story. Now I had to try to pull myself together, calm down and listen.

Charlie nodded to a prim, red-haired woman seated beside him.

“Hi, I’m Beth, and I’m an alcoholic and drug addict,” she said matter of factly.

“Hi, Beth,” the group answered.

”It has been one tough week. First the group medical director called me on the carpet. My productivity numbers weren’t as high as he wished, then my daughter’s teacher called, and it really shook me up. My kid hasn’t been doing too well at school, and my son’s been hanging out with a bad crowd. I’m worried. I had to go to a meeting that night to get centered. I felt lonely and very shaky. You all know what I mean. And … well, it helped, as usual. Still clean and sober, thank you.” A forced smile.

Nobody was looking at me. I tried to appear as if I were paying attention. My mind was elsewhere. Time passed … I’m not sure how long.

Suddenly a stentorian voice snapped me out of my fog.

“Hi, I’m John, just a garden-variety drunk.” A thin, balding, bespectacled man in customary physician garb–-blue blazer with gold buttons, starched white shirt, and crimson silk bowtie.

“Hi, John.” The chorus of greeting.

“You know, I’ve never been the religious sort, but there must be a higher power for me to thank. When my chairman asked me to present Medical Grand Rounds I felt nervous, very nervous. Sure, in my day I’d given plenty of them, but none since my fall from grace seven years ago. He had stuck by me—a true friend. No, I didn’t have my usual pre-lecture double shot of Jim Beam this time, or my post-lecture one either, or my celebratory couple when I got home. They all said it went well, very well, I’m happy to say.”

The chubby, curly-haired man sitting next to John flashed a wide grin.

“Hi, I’m Bob. I’ve been a drug addict for over twenty years. That’s almost half my life.” Laughing softly, he shook his head, as if in amazement.

“Hi, Bob,” all chimed in.

“There are times when I feel I could have been a professional actor instead of a sawbones. I could play any role, con any ER doc, put on the face of a migraneur, the limp of a sciatic. When I’d choose to  roll around with renal colic I’d have to prick my finger in the men’s room. Five to ten drops of blood into the urine cup usually was enough to fool them. Fake almost anything to get what I needed. Percocet was my drug of choice, but I’d settle for Vicodin. Sometimes I’d drive as far as fifty miles to get to an ER. Of course I’d rotate them, carefully choosing their busiest hours, use a whole stable of names, pay cash. Pretty foolproof, eh? I’d even keep computer records, so I’d not repeat myself. You know the drill. Somebody must’ve tipped them off. Then the DEA dropped into my office almost eight years ago, took my computer and handcuffed me. That was it, the end of my acting career. Let me tell you, the jail and rehab stint were a bitch, and it took forever to get the license back. But, now I’m doing pretty well. Glad to be here.”

On Charlie’s other side was the last speaker, a fashionably dressed, graying woman. I hoped I could get out of here soon.

“Hi, I’m Jan, an alcoholic, drug addict, bi-polar and workaholic. How’s that for a mouthful?” A matronly lady with a soft voice, an ingratiating smile.

“Hi, Jan.”

“It’s been a good month. I’ve just come back from a vacation, my first in 12 years. It was difficult getting away, but I did it and I’m very proud of myself. A Caribbean cruise with a friend – also in recovery. I feel so relaxed now. I used to work 18 hours a day, and sleep in my office. Anything to keep from going home. That was after I lost my husband and children. Now’s not the time to go into the whole story. Charlie, maybe I should lead a meeting, it’s been a while. Anyhow, a long time ago I was caught stealing Demerol from one of my patients and washing it down with Scotch. That was my bottom. It’s all been going well since. I’m glad to be back and see all of you.”

I sat stunned by what I’d heard; the starkness of their revelations, the unimaginable sadness they experienced.

Charlie passed around several copies of a well-worn book. “Let’s turn to Step Four.”

Each of us read a paragraph, just like a Passover Seder, then passed the book along until the Step was completed. Then there was 15 minutes of discussion. The Step had something to do with a “searching and fearless inventory of ourselves.” I felt I’d already done that on my own. I had nothing to say.

“OK, next week Step Five, and Jan, you can take the lead.”

Everybody then stood, heads bowed, holding hands and recited the Lord’s Prayer. I’d forgotten everything except “Our Father who … “

I walked out of the boardroom alongside a tall, thin young man. Maybe he had spoken … I wasn’t sure. I noticed his striking gold and orange T-shirt—a large decal of the pyramids and sphinx.

“Did you get that in Egypt?” I asked, “I’ve read it’s an interesting place.”

“Nope, picked it up off a the Internet. I can tell you the website.”

On closer look I noticed the large print running across his shirt:


I shook my head, puzzled what it meant.



Dr. Les Cohen has taught and practiced Internal Medicine in Boston for many years. His short stories have been published in the Annals of Internal Medicine, Archives of Internal Medicine, Journal of the American Medical Association, Cleveland Clinic Journal of Medicine, Hospital Drive, and in 2000, 2001 and 2005 he won the Journal of General Internal Medicine’s Creative Award for Prose.

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