My first substance abuse patient

Published Monday, November 3, 2025

---

In her womb, the treatment plan was:
           Let your heartbeat show you’re not absorbing vodka/barbiturates.

When two, the treatment plan was:
           Words are not for talking about it.

When four, the treatment plan was:
           Don’t see her fall down the stairs toward you.
           Play outside the house for as long as you can.

When six, the treatment plan was:
           Don’t smell it on her breath.
           Cradle your baby sister.

When eight, the treatment plan was:
           Don’t see the ambulance in the driveway.
           Help her back to bed when she wanders weeping into your room.

When ten, the treatment plan was:
           Knock on the door of your father’s study only if necessary.
           Don’t talk to him about it afterwards because there wasn’t a before.

When twelve, the treatment plan was:
           Go away to boarding school.
           Think of her digging her grave.
           Think of your little sister at home without you.

When fourteen, the treatment plan as:
           Study the drawings of her dead brother for whom you are named.
           Get perfect grades.
           Be glad your sister’s at boarding school although she’s only eight.

When sixteen, the treatment plan was:
           Master disdain.
           Let your beauty be triumphal.
           Lose the capacity to smell alcohol on anyone.

When eighteen:
           Publish poems that make her proud, envious, and sad.
           Look forward to dancing on her grave.
           Don’t think about your little sister.

When twenty:
           Get married to someone who doesn’t know how to play charades.
           Cut your body so that invisible ink becomes visible writing.
           Tell the therapist you have no reason to be sad.

Twenty-five:
           Hold the baby you longed for, planned for, blue-eyed and joyful.
           Know he needs you more than she does.
           Notice how many women writers drink and kill themselves.

Thirty:
           Three babies make a circus and she can sit in the bleachers and drink.
           Confront your father about the fake diagnosis for her liver disease.
           Pretend you understand free love.
           Stop smiling so much.

Forties:
           Work and get you’re doctorate at the same time.
           Admit you’re still scared of her.
           Pretend you’re too tired and busy to think of her.
           In the stillness of the night, ache with love for her.

Fifties:
           Hold her hand and listen to her flooded heart.
           Inhale her unfathomable losses.
           Tell her that you, too, find life crazy hard.
           Regain the ability to smell alcohol — on a patient’s breath.
           Write a novel before the sun rises, before commuting to work.

Sixties:
           Fall in love with her again.
           Her lovely laugh.
           Her love of dogs.
           Her spoonbread.
           Her intermittent sobriety.
           Her pride in teaching incarcerated men to read.
           Her heart’s search for a brother’s unmarked grave in Spain.
           Her rage.
           How she forgave her own mother.

Forever and ever afterwards and as often as you can:
           Dig up her body and cradle it in your arms.
           Gaze into eyes once the same gold-brown as yours.
           Tell her you understand the invisibility of shame.
           Thank her for your sister.
           Forgive your father for being an incarcerated man.
           Tell her you’re learning to read.
           Tell her that, finally, you understand the plan.

---

The Perch, a journal of Yale University and Wesleyan University,
Vol. 7, Spring 2024.