In Spite of Negative Consequences

By Nina Gaby

potato chips on a yellow backgroundOne coworker twirls a carrot in her Tupperware tub of hummus and mutters “A fucking plague,” while another grabs his cigarettes to go out behind the dumpster for a quiet smoke before the afternoon treatment groups begin. I’m jealous, I tell the rest of the team as they finish their lunch. I can’t wait; in two years I’ll be seventy and it won’t matter anymore. Lung cancer grows slow, and after age seventy-seven they don’t even treat it. I can start smoking again, and at least have the dumpster to look forward to.

No one laughs. It’s a Monday and there have been more opioid overdoses from the weekend, and we are having a collective moment of grief before we go back out there. “There” being the Hieronymus Bosch-like central area of the rural Northeast drug and alcohol treatment facility where we work. There, where we will be swarmed by patients wondering about family visits, while we may already know that there will be no visits if Child Protective Services comes in today to terminate parental rights, and that there will be a howling heard even as we clinicians are safely tucked away in our offices.

My first order of business for the afternoon is to meet with a heavily tattooed young man, swastikas everywhere, and I doubt that the antidepressant I’m about to prescribe for him will change anything about that. I suspend reaction; it’s easier the older I get and the further I head into these decades I’ve worked in the field of psychiatry and addiction. Later in his stay, I will ask him if he knows what the swastikas stand for—he doesn’t, just that his uncle who died from a hunting rifle to the head had those things all over, and he really loved his uncle. I will think about an aunt who suicided when I was eight. The kid with the tattoos will hug me hard as he leaves, tough kid crying. Me too.

The afternoon sun in my office slants light on a man shivering from withdrawal. His deep lines and scars remind me of Dorothea Lange’s photographs from the Dust Bowl days, and how the silt of this new tragedy piles up on our windowsills and threatens to overtake. I want to photograph him in stark relief, a living document of our moment. He tells me I do good in this world, even when I don’t give him the drug he wants. Later I take down a photograph of past patients, there were seven or eight of them, who started hiking together in recovery. The one who died this weekend was afraid of heights, so the others hoisted him up the mountain. He was a sweet man. He died anyway. The guy who tells me I do good asks if we can finish up the evaluation so he doesn’t miss his cigarette break. I get it. I already know I’ll stop by the 24-hour Swipe ‘n Save on my way home for a bag of Utz Dark Russet potato chips, appreciating exactly what the salt and trans fat will do to my next lipid profile. Somehow I’ve given up alcohol and nicotine for forty years, but potato chips?

I fill out the temporary disability paperwork for two other patients before I go down the hall, towards the drumming. Our cafeteria has been taken over by Ivy League college students and their professor—a dancer in wildly patterned silk—and both women’s treatment units. The women are practicing for the performance of a storytelling extravaganza that no one else will see because of confidentiality and HIPPA. The students, part of a course in women’s studies, enter the building feeling awkward in their privilege, but soon relax into a choreography of compassion in word, sound, hand and body. I watch the women, some who have lost their children to the state or lost their partners to overdose or jail, and observe the faces of the staff who listen to these stories all day, all night, listening to them anew as the pounding of the drums and the lift of voices – the theater of it – electrifies the otherwise dead air.

It’s dark, I have a long drive. I breathe in hope, and let it shape me for a moment and then leave for the Swipe ‘n Save where I gaze longingly at the Marlboros but settle for the Utz, righting wrongs one chip at a time until the bag is empty and I am sated.

Nina Gaby is a writer, visual artist, and advanced practice nurse who specializes in addiction and psychiatry. Her work has appeared in Psychiatric Times, The Intima, The Rumpus, McSweeney’s, and the Brevity Blog; and her artwork is held in collections at the Smithsonian, Arizona State University, and the Rochester Institute of Technology. Her anthology, Dumped: Stories of Women Unfriending Women, was published in 2015. She holds a Master’s degree in Psych-Mental Health nursing and a degree in Fine Arts. She offers trainings and workshops, and has taught at several universities. Find out more at

Photo by GR Stocks