The End of My Addiction
named Jean Durup, and I became engaged intellectually in what I was doing. I saw aesthetic beauty in how chemical bonds formed and how different arrangements of atoms and molecules created different substances. My mother had pushed me into a field that I would soon come to love.
The following year my older brother, Jean-Claude, followed me into medical school. (Eva also studied medicine in due course. Jean-Claude became a distinguished immunologist and Eva a fine surgeon.) Thereafter Jean-Claude and I often prepared for our exams together and throughout medical school we had a great intellectual partnership, the closest and most stimulating that I have ever had with anyone. But this also meant that in my mind I carried the burden of Jean-Claude’s prospective progress, as well as my own. Having taken the exams before, I had to be sure that he knew what to expect. My anxiety left me unable to sleep, and I was soon exhausted from insomnia.
Desperate for more rest at night and less anxiety during the day, I went to our family doctor, Dr. Gilbert Meshaka. He listened to me carefully and prescribed a two-week supply of Tranxene, a tranquilizer that belongs to a family of drugs called benzodiazepines, or benzos, that includes Ativan, Valium, and Xanax. That helped me get through the ordeal of exams, and thereafter Dr. Meshaka prescribed Tranxene or another benzo intermittently when my anxiety became unmanageable.
In 1977 I completed my basic medical training. Having passed the medical internship test, I did internships in neurology, internal medicine, and cardiology. In French hospitals then there was usually wine on the table in la salle de garde , the room where interns and residents ate meals and took catnaps when they were on call. One day at lunch I decided to have a drink. It ruined the rest of the workday, and I concluded that alcohol did not agree with me.
After my internships, I did a residency in nephrology at Saint-Cloud Hospital in the western suburbs of Paris. Saint-Cloud had one of the best-known alcoholism treatment programs in France, and I sometimes admitted patients when they arrived to enter the program. They all had a similar look, pale and grim, that I later saw among my fellow patients in detox wards and rehab centers in the United States, not to mention when I looked in the mirror during binges, after I became an alcoholic.
What puzzled me as a young physician, however, was that the criterion for admission was a minimum period of abstinence from alcohol. It seemed there was only help for those not in the most immediate need of it. I wondered about those alcoholics who were in even worse shape. But I never stopped to question the requirement of abstinence before treatment and its implicit assumption that alcoholism was largely a question of willpower.
After much debate, I decided that cardiology was the medical specialty for me. France had a strong tradition of research and training in cardiology, and I did a cardiology residency in Paris. But I wondered how the field looked from an American perspective. Ever since I had seen the Statue of Liberty at the age of fifteen, I had harbored a dream of spending at least a year in America, and my heart was set on New York, the city of Woody Allen, Leonard Bernstein, and Carnegie Hall.
I arrived in October 1983, for a fellowship in the cardiology division of the department of medicine at New York Hospital–Cornell University Medical College, where I worked under and with Drs. John Laragh, Jeffrey Borer, and Paul Kligfield. Laragh was the head of the cardiology division and had recently been on the cover of Time magazine for working out some of the mechanisms of hypertension. This cover story popularized the concept of hypertension as “the silent killer.” Jeff Borer and Paul Kligfield were also enormously talented and productive people, and Jeff headed up the hospital’s division of cardiovascular pathophysiology.
The research project that Jeff Borer and Paul Kligfield were running, and which I joined, was an effort to refine the accuracy of the heart stress test. False normal results were common with the stress test, meaning that serious heart disease was routinely being missed. Over time we developed a new form of the test that took the individual’s heart rate into account, and we published a number of papers on the ST/HR (ST segment/heart rate) slope. This innovation enabled very precise differential diagnosis of mild, moderate, or
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