Pour Pause Pay Attention: The Third Pressing

Cyndi finally makes the call. And what happens in Dr. Reyes's office on that Friday afternoon is something neither she nor Christopher was fully prepared for — but both of them, somewhere deep down, already knew was coming. In Episode 3 of Pour. Pause. Pay Attention., we pull back the curtain on the Sackler family and Purdue Pharma — the architects of an opioid crisis that did not begin in the streets but in a boardroom — and we trace the invisible line between their decisions and the pill organizer sitting on Cyndi's kitchen counter. Meanwhile, the Grenache called November finally clears. And the Cabernet Franc — the batch that has been waiting — gets the only name that makes sense. Honest.

Transcript

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Welcome back to Take Care of Time, the Tells and the Exhales of Caregivers. I'm your host, Beverly Nance, and I wanna start today a little differently. I wanna start with a question. Have you ever been so focused on keeping someone alive, keeping them stable, keeping them on schedule, keeping them running, keeping everything running? That you didn't notice what was happening to you, not to them, to you. I think about that a lot because caregiving, it does something to you that nobody really warns you about. It reshapes you quietly without asking permission, and sometimes the thing that keeps you going, the thing you reach for when the day gets too heavy. Starts to become its own kind of story. That is what today is about. Two stories running parallel, and the more you look at them, the more you realize. They were never really separate. Last time we were together, we left Cindy standing in her garage. It was after 11 at night. The house was quiet. Christopher had gone to bed early. Another one of those evenings, she had started calling Good without Really Meaning it. She had just named a batch of wine. She called it Pay Attention, and she had almost almost reached for her phone to call Dr. Reyes. Almost today we find out what happens when almost is no longer enough, but before we get back to Napa. Before we get back to Cindy and Christopher and the kitchen counter and the pill organizer, that never lies. I need to tell you something. I need to tell you about a family. A family that had every advantage, every resource, every reason in the world to do the right thing and chose not to because what happened to Christopher and what is happening in living rooms and bedrooms across. This country did not happen by accident. It was engineered. The name Sackler used to be synonymous with generosity. If you walk through certain museums, the Louvre, the Gutenheim, the Smithsonian, the Metropolitan Museum of Art in New York, you'll find their name on wings and galleries and exhibit halls. The Sackler Gallery, the Sackler Center, the Sackler name was carved in stone, literally in institutions that house some of the most celebrated art and culture in the world. Philanthropy, on a grand scale, the kind that makes the news, the kind that gets you invited to galas and honorary degrees and profiles and magazines and here's the thing. For a long time it worked. The reputation held the name gleaned. What most people did not know, what many still do not fully understand is what was funding all of that generosity. The Sackler family owned Purdue Pharma and Purdue Pharma made Oxycontin. Now, I know some of you have heard this story before. Maybe in pieces, maybe from a documentary or a news article, a conversation around the kitchen table, about someone you loved. But I want to tell you today in a specific way, not just as history, not just as a scandal, but as a backdrop, the invisible infrastructure behind what Cindy is living through in that house in Napa, because it matters. It deeply matters. Author Sackler was the patriarch, a psychiatrist, advertising genius, who died in 1987 before Oxycontin ever existed but the foundation, he built the understanding that pharmaceuticals could be marketed directly to physicians The way consumer products are marketed to the public was his own legacy. His brothers, Raymond and Mortimer carried it forward, and their children and grandchildren inherited both the wealth and the business. In 1996, Purdue Farmer produced Oxycontin to the American market. The drug itself, oxycodone in an extended release formula was not new. Opioids have been used in medicine for decades, primarily for cancer patients and end of life care. The medical consensus at the time was that opioids carried significant addiction risks and should be used carefully and sparingly. Purdue Pharma,. Well, they had a different idea. What they did and what has since been documented in thousands of pages of legal filings, internal memos, and court testimony was launch one of the most aggressive and deliberately misleading pharmaceutical marketing campaigns in American history. Sales representatives were deployed across the country. They visited doctor's offices, they bought gifts, they bought data, they bought a message. That was crafted with extraordinary care. The message was this, Oxycontin was different. Oxycontin's extended release formula means the drug is released slowly, which means the highs are lower, and the risk of addiction is minimal. Less than 1%, maybe even less than that. It was not true. Internal documents later revealed that Purdue Pharma knew. Knew that Oxycontin was being crushed and snorted for faster absorption, that the addiction rate were not what they claimed that the extended release formula when tampered with delivered an opioid punch comparable to heroin, they knew and they kept selling. They trained their sales force to downplay addiction concerns. They used a term internally, you may have heard of it. They called it the pseudo addiction problem. The idea was that if a patient seemed that be displaying addictive behavior around their medication, it was not addiction. It was undertreated pain. The answer was not less medication. It was more, more. Think about that for a moment. Think about a doctor sitting across from a patient,, a patient who is showing signs of dependency, who is asking for refills earlier than scheduled, who is having difficult mornings and settled evenings. And being told that the answer was not to pull back. The answer was to prescribe more. And here's the thing that stayed with me when I learned this. Those doctors were not villains. Many of them were doing exactly what they had been trained to do. They were treating pain, they were following guidance from what appeared to be authoritative medical resources sources that had been, in many cases, quietly funded. By the very company selling the drug, the system was poisoned at the source By 2001, Oxycontin was generating over $1 billion a year for Purdue Pharma by 2010, over 3 billion. The Sackler family members who sat on the board. Were not passive investors. Documents and testimony reveal they were actively involved in sales strategy. They received detailed reports on prescription numbers. They pushed for higher doses to be marketed more aggressively. They track the data the way any business owner tracks revenue because to them this was what it was. Revenue. Meanwhile, in communities across the United States, rural communities. Suburban communities. Communities that had nothing in common except that a doctor had handed someone a prescription. People were dying. And maybe you have felt that too. Maybe someone in your family was part of that story. Maybe you are caring for someone right now whose dependency tracks back in some way to the pipeline because the opioid epidemic did not start in the streets. It started in a boardroom with a family that knew In 2007, Purdue Pharma pleaded guilty to federal charges of Misbranding Oxycontin. They paid $600 million in fines. No Sackler family member went to prison. In 2019, Purdue Pharma filed for bankruptcy. Amid thousands of lawsuits, states, cities, counties, and individuals had all come for them. The Sackler family had. In the years preceding the bankruptcy withdrawn an estimated 10 to $11 billion from the company. 10 to $11 billion moved out protected while the lawsuits gathered. In 2023, the Supreme Court of the United States considered settlement that would have shielded the Sackler family from further civil liability in exchange for a payment of roughly $6 billion. The court ultimately rejected that arrangement. The legal battles continue. Museums began removing the Sackler name from their walls, one by one, quietly at verse, then loudly. The stone that had been carved with their name has been chipped away. But the damage, the damage that was done to hundreds of thousands of families in communities, to the bodies and the brains of people who trusted their doctors and trusted the system, that can be chipped away. It lives in the people who are still here. It lives in the people who are caring for them. I wanna come back to Cindy now because I have been thinking about her all week. Not just as a character in a story, but as a person who represents something real. She did not know about the Sacklers. She did not know about the internal memos or sales training manuals, or the word pseudo addiction. She was not thinking about boardrooms or billion dollar settlements. She was thinking about Christopher. She was thinking about whether he had taken his morning medication, whether the physical therapy appointment had gone okay. Whether the tension in his jaw at breakfast meant the pain was worse, or whether it meant something she was not ready to name and in the evening she was thinking about wine. I wanna talk about the wine for a minute because I think it is important, and I think maybe you have your own version of it. Maybe it's not wine, maybe it's the garden. Maybe it's a book, a run in the early morning before the house wakes up a show you watch with the sound low after everyone is asleep, something that is yours, something that no one needs, anything from. Cindy had the garage, and here is the thing about the relationship with wine making that I keep coming back to. It was not escapism in the way we usually mean that word. She was not running away from her life. She was not pretending things were fine. She was doing something harder. She was staying present while also staying sane. She was finding a way to be two things at once. Fully in her caregiving life and also for one or two hours a night fully in something that was hers. There is a difference between escaping and restoring, and I think caregivers sometimes feel guilty about the things that restore them, like, they do not deserve to feel good when someone they love is struggling. Like joy is a betrayal. It is not. It is survival. But here is what I want to say gently because I think Cindy will want me to say it. The garage was also the place where she was not watching, not because she was negligent, not because she did not love Christopher, but because the garage was the place she had given herself permission to stop watching. And that permission, that necessary human, completely understandable permission meant that certain things were happening in the house that she was not seeing. And maybe you have felt that too. Maybe you have a place like that, a place where you finally exhale and maybe if you are honest, you sometimes wonder what you might've missed while you were exhaling. I am not here to make you feel guilty about it. I'm here to sit with that truth alongside you because I have a place. Also, cindy called Dr. Reyes on a Wednesday morning, not the morning. She had planned to call three days after that morning, three days, three more days of watching and noting and opening her log and reading those seven entries again. It took her three days to talk herself into making the call. She already knew she needed to make. That is normal, by the way. That delay, that is not weakness. This is the particular terror of being the person who holds all the information and has to decide what to do with it because. Once you say it out loud, things change. And caregivers, people who already had so many things change on them, sometimes need a little extra time before they can invite another change in. She called from the parking lot of the physical therapy building while Christopher was inside. She did not go inside with him that day. She told herself it was because he was making progress and needed independence. But really, and she knew this, even as she thought it, she needed 45 minutes alone in the car to make a phone call, she had been avoiding the nurse who answered, put her on hold for three minutes. Those three minutes she told herself later felt longer than the entire month of December. When Dr. Reyes came on the line, his voice was exactly what she needed it to be quiet, unhurried like he had all the time in the world. Even though she knew he did not. Mrs. Marlowe, he said, what's on your mind? And something about that question, the simplicity of it. The openness of it cracked something loose in her chest. She told him everything. The seven entries, the Wednesday compartment, the earlier doses, the way Christopher settled in the evenings in a way that no longer felt like rest. The refill that came seven days early, the word earlier spoken so casually over coffee. She read from her log, she read every entry. Every date, every two word note she had made to herself. In the middle of an ordinary morning, Dr. Reyes listened without interrupting. When she finished, there was a pause, not a long pause, but long enough for her to wonder if she had said too much long enough for her to feel briefly, like maybe she was overreacting. You did the right thing in calling me. He said, this is important information. Four words, important information, not you are overreacting, not he's just in pain. Give him more time. Not This is a side effect of TBI recovery. It will pass important information. I remember thinking when I first heard Cindy, describe the moment. How much those two words must have meant because caregivers spend so much time, second guessing their own observations, wondering if they are seeing things clearly or through the distorted lens of exhaustion, wondering if their concern is love Or anxiety or both to be told that what you ever observed was important, that your log mattered, that your two word notes in the middle of the ordinary morning had just changed the course of what happened next. This is something Dr. Res asked her to bring Christopher in at the end of the week. He wanted to do a full medication review. He used careful language. He talked about reassessing the pain management protocol about the intersection of TBI recovery and opioid sensitivity about some newer approaches he wanted to discuss with both of them. He did not use the word addiction on the first call, but Cindy heard it anyway in the careful spaces between his words. In the way he said both of them, meaning he wanted Christopher in the room, but he also wanted Cindy in the room together. She sat in the parking lot for a long time after she hung up. The physical therapy building was quiet. A few cars, a pigeon on the curb, an ordinary world. Going about his business and Cindy sitting in the car felt simultaneously like she had just done the bravest thing she had ever done and the most terrifying because now it was real and real is always hotter than suspected. The appointment was on a Friday afternoon. Christopher did not ask why they were both going. Cindy had told him gently without accusation that Dr. Reyes going to check in with both of them. That it was a routine reassessment, and Christopher, to his credit, had nodded. He did not push back. I think about that a lot because. Some part of Christopher, the part that had been a precise, careful man who color coded his project timelines and double checked his scaffolding specs. Some part of him already knew he had been living inside this thing. He knew what those evenings felt like. He knew the difference between pain relief and the thing that came after pain relief, he knew that the clock in his head had started counting down to the next dose in a way that had nothing to do with pain. He had just not said it out loud either. They sat in Dr. Reyes's office, not the waiting room, the actual office with the desk and the diplomas on the wall and the window that looked out onto the parking lot, that looked like every parking lot. Dr. Reyes was direct, not unkind, but direct. He explained what Cindy had shared with him. He explained it to Christopher without framing it as betrayal. He said, and this is important He said that what Cindy had noted was consistent with something that he had seen before in patients recovering from traumatic brain injury who were on opioid based pain management. He said that the frontal lobe injury had almost certainly changed the way Christopher's brain was processing the medication, that the reward response was heightened, that the cravings were not a character flaw. It was neurology. Christopher sat very still through this. Then he said something that Cindy told me she would never forget. I thought I was just managing the pain. He said, I thought that was all it was. Dr. Reyes said for a while, maybe it was what stayed with me. When I heard that was the honesty of it. The absence of shame in the room, not because shame was not present somewhere underneath it almost certainly was, but because Dr. Reyes had created a space where the facts could be named, where the situation could be described without a verdict, that is rare and it matters enormously because caregivers and their loved ones often cannot have conversation. They need to have, because the conversation feels like an accusation, like a trial, and nobody wants to be tried by the person who loves them. What Dr. Reyes gave them that Friday afternoon was a room where no one was on trial. Just people with a problem and a plan. That night, Cindy went to the garage. She bought two glasses. She poured wine from the batch that she called November, the one that had taken so long to clarify the one that had been through the second pressing and came out the other side. She poured two glasses and she stood in the garage for a long moment. Then she carried one glass into the living room and set it on the table beside Christopher. He looked at it, then he looked at her from November. She said he picked it up, held it in a way she had taught him to hold it slightly, tilt it to the light so you could see the color at the edge. It cleared, he said. It took a while. She said they sat together not talking about the appointment, not talking about the plan or the adjusted medication, or the therapist referral. Dr. Reyes had mentioned just sitting with the wine that had finally become what it was always trying to be. And I think about that image a lot, a caregiver and her person sitting with something that had been threw pressure and uncertainty and time, something that had drifted and had been corrected and was still becoming, this is not a metaphor for closure. This is a happy ending wrapped in a bow that is just two people still in it, still together, still choosing to sit in the same room and sometimes I really believe this. Sometimes that is enough. For one night before she went to bed that night, Cindy went back to the garage. She stood in front of the Cabernet, fron, the batch that had been waiting, the batch that was ready had been ready for weeks, but had no name. She opened her notebook. She picked up her pen and she wrote one word. She called it honest. Because that is what the week had been. Not easy, not resolved, but honest and in Cindy's world, in the world of wine and caregiving and long, quiet nights in the garage in Napa, honest, was the most valuable thing a batch could be. I wanna sit with you for a moment before we close. I have been carrying two stories in this episode. The story of the Sackler family and the story of Cindy and Christopher, and I wanna be honest with you about why. Because I think sometimes when you are deep in caregiving, when you are exhausted and managing and just trying to keep everything from falling apart, we forget that our situation exists in a larger world. That the thing we are dealing with in our home did not just arrive. That it has a history that it has architects. The Sackler family did not create pain. Pain existed, long before they did, but they absolutely did create a system that turned pain management into a profit machine and dependency in a revenue stream. And families like Cindy's are still living in the wreckage of the choices that family made in boardrooms decades ago. That context does not fix anything. It does not give Cindy her easy mornings back. It does not undo the weeks of watching and filing, and not yet naming. It does not make the appointment with Dr. Reyes less hard. But it does mean something. It means that it is not your fault. It means if you are caring for someone who has struggled with opioid dependency, whether it started after an injury, after a surgery, after a prescription that seemed completely reasonable, you are not dealing with a moral failure. You are dealing with a public health catastrophe that was deliberately created and profit ablely maintained, and you are doing the hardest thing. You are staying, you are keeping the log, you are making the call. You're carrying the glasses to the living room and sitting in the same room, even when it is complicated and scary and unresolved. That is caregiving in all its ordinary, extraordinary, exhausting, loving reality. And here's the thing I want you to hear right now. Whoever you are, you deserve to exhale. You deserve your garage, your garden, your book, your hours that belong only to you, not because you have earned it through suffering, but because you are a person, not just a caregiver, a person, and people need space to breathe. I wanna tell you something I created specifically for this. The Take Care Time and Respite Box. It is a bi-monthly themed. Subscription box curated specifically for caregivers, not for the person you are caring for, for you, for the person doing the work. And I have to tell you about our May, June box because. I am so excited about it. The May and June box has a wine theme. I know, I know. Given everything we just talked about, Cindy, in her garage and the wine she called November and the cabaret Franc, she called honest. I hope that lands the way it's meant to. This box is not about wine as an escape. It's about wine as celebration, a sensory experience, and as a particular pleasure of something that has been made with care and patience and attention, this box was curated for the caregiver who deserves to pour something beautiful into a beautiful glass and sit with it. Who deserves a moment of sensory joy that ask absolutely nothing of them. Every item in the box was chosen with intention with you in mind, with the understanding that rest is not a reward, it's a requirement. You can view the May June wine theme respite box at takecaretime.com. That's takecaretime.com. Go. Look, you deserve it. Before I go and I mean this sincerely, I want to hear from you. Has any part of this story felt familiar to you? Have you cared for someone whose recovery was complicated by medication dependency? Have you been Cindy standing in the parking lot working up the courage to make a call you already knew you needed to make, have you named something, a batch, a moment, a season, and felt the strange relief of finally having the right word for it? Or maybe you have a story that has nothing to do with opioids. Maybe your caregiving story is different. And it is still heavy. Still real, still worth telling. I want to hear it. You can reach me at podcast@takecaretime.com. That is podcast@takecaretime.com. With permission, your story may become part of this show. Because caregivers listening, the ones driving to appointments and filling pill organizers and making phone calls that they have been putting off for days. They need to hear that they are not alone and you are the proof of that. Next time on poor pause, pay attention. Christopher begins a new chapter in recovery, one that will require something from both of them that neither of them was quite prepared for. And Cindy starts a new batch. She does not have a name for it yet, but she has a feeling and in her world, that is always where the best batches begin. Please note that this episode features reenactments and dramatized details. While in most cases the exact verbatim dialogue may not be known. All dramatizations are grounded. In thorough research and crafted to honor the stories shared to respect the privacy and confidentiality of the individuals involved names, and some identifying details have been changed. Until next week, take care.