Me, My Father, and Our Pills

This is Better Living Through Chemistry, a column by Ariana Remmel on how atoms and molecules can help us explore our lives.

Both of my parents are psychiatrists, which means I grew up surrounded by pills. In preschool, I was the only kid in my class who could swallow a baby aspirin (with or without water), and I could measure out my own dose of orange-flavored kiddie ibuprofen in both teaspoons and tablespoons by the time I was five. I remember marveling at the stockroom closet in my parents’ office, with its floor-to-ceiling shelves of colorful bottles, filled to the brim with pastel tablets. There were pills to help you sleep, pills to wake you up. Pills to make you happy, and others to make sure you weren’t too happy.

“Better living through chemistry,” my father would say.

Dad used to fascinate me with stories about the most recent developments in treatments for psychosis and how pharmaceutical companies kept coming out with new and better ways to shift the flow of neurotransmitters in the brain. He taught me to love the natural world too. Dad and I spent hours in the garage one cold winter, building a telescope to look at Betelgeuse, our favorite star. When I turned sixteen, he signed me up for scuba lessons so we could spend our family vacations exploring the ocean. He was the first person to teach me what it feels like to be weightless and unburdened—fully supported by the dissolved salt of seawater—and I knew I was safe with him by my side.

I cherish these happy memories of being my father’s child, because most of what I remember about being young was feeling miserable. Maybe it was partly due to being a genderqueer kid without the language to express their dysphoria. Maybe it was the isolation of loving science in a community that called secular thinking the work of the devil. Perhaps it was both of those things, or neither of them. But at eleven years old, I sat in front of Dad’s gun safe contemplating the most likely combination to open the lock. I cried in the darkness of our little attic, wondering if killing myself would make too big a mess.

After a time, I got up, wiped away my tears, and washed my face with cold water to soothe my puffy cheeks and erase the evidence of my sobbing. I walked down the stairs to my parents’ bedroom, where they lay reading in bed. I made my voice even and unaffected.

“I think I would like to take some medicines to make me feel better,” I told my parents.

I don’t remember what they said, but I do remember us walking to the kitchen cabinet, where Mama pulled out a drug rep’s sample pack of Lexapro.

I took that little white pill every day for years afterward. I was a little less miserable, if not happy, and grateful for the chemicals that kept me alive.

*

This faith in the miracle of modern medicine meant that I wanted to become a physician, a psychiatrist, up until the moment I discovered organic synthesis in college. I fell in love with building carbon-based molecules. I was especially fascinated by natural products, the fiendishly complicated compounds made by living organisms.

I studied what my professors called “heroic total syntheses,” the grand strategies to build these complex molecules from scratch. The first synthesis of brevetoxin—produced by microscopic marine organisms and responsible for fish die-offs in the seasonal red tides of the Gulf coast—took more than 120 steps to execute in the lab. I also learned about medicines like paclitaxel, a cancer drug commonly known by the brand name Taxol. Paclitaxel was originally isolated from a plant called the Pacific yew. But an extract of the yew contains only a small amount of this natural medicine, mixed in with all the other biochemical juices that sustain the plant; it would take a whole forest of Pacific yew trees to produce enough paclitaxel to cure even one person’s illness. Thanks to organic chemists, paclitaxel is now made in the lab rather than begotten in the flesh of trees, and it is widely used to treat cancer even today.

I was sure that chemistry would lead me to make newer and better drugs to treat every illness under the sun.

It was a wonder to me that any chemical reactions happened at all, much less the kind that gives my body form. Even a tiny vial could contain a whole universe teeming with molecules rotating and vibrating and zipping through solution, only to collide with one another at just the right angle with just the right amount of energy to make something new and potent. And to think that I could guide these invisible substances to create one product over another and lead them through iterative steps to, maybe, build something so grand as a cure for cancer? I held on to a silent hope that the secret to mending the chemical imbalance in my own body, the one that manifested in unrelenting depression, was within my grasp. I was sure that chemistry would lead me to make newer and better drugs to treat every illness under the sun.

All the while, I fought back the whispers in my mind that told me the world would be better off if I jumped off the Ross Island Bridge or walked into moving traffic. Much to my chagrin, well-meaning friends would occasionally suggest “natural” or “chemical-free” alternatives to my prescriptions—it would be a shame if I became dependent on pills, they said, as if my inability to cure my mental illness were somehow a moral failing. Particularly irksome was this insistence that the atoms in my pills were inferior to those crafted by garden herbs like Saint-John’s-wort, a dubious treatment that comes with its own host of possibly devastating side effects. Though I do not know if my antidepressants were originally inspired by a plant’s biochemistry, it does not bother me that my medicines are made with heat and vacuum in a flask. Would you tell a cancer patient to take a tincture of Pacific yew when a Taxol prescription contains the same medicine in a purer form? The nature of my pills did not concern me nearly as much as the reasons I needed to take them.

It is not natural to want to die, I thought. It is not natural to want to cease the beating of your own heart. So why not use nature itself—the miracles of chemistry—to fix myself? And if I could not be fixed, then at least I’d have a life jacket to keep me from drowning in sadness.

The days when the tears fell in heaving sobs that could not be stopped by chemical intervention alone were the days I called my dad. “What cures all wounds?” Dad would ask, his voice always warm and soothing.

“Saltwater,” I would answer, still crying.

“That’s right, honey. Saltwater—sweat, tears, and the sea,” Dad reminded me, reciting his favorite quote from Isak Dinesen.

Thousands of miles away, Dad would stay with me on the phone until my tears subsided. Then we’d make a plan for me to do some kind of exercise, maybe drink a glass of water. “Have you been taking your meds?” he would always ask. And I would assure him that I had been. My trust in medication was resolute; between my meds and my dad, I believed I was safe.

*

After graduating college, I got a job in a natural-products lab looking for the ocean’s undiscovered medicines in the fibrous, brown-green mats of ancient organisms called cyanobacteria. By all accounts, I was following my dreams. Yet my mental health was worse than ever. Between a devastating breakup, the death of a mentor, and moving to a new city where I barely knew anyone, I was experiencing near-daily panic attacks—some so severe that not even a sedative could calm me. I needed my dad more than ever.

But Dad’s behavior was now erratic. Quick to anger, the gentle man who once soothed my panic had turned into a snarling, mean-spirited stranger who spewed curse words at the slightest provocation. When I tried to share my pain, he spoke back at me like a patient instead of his child: “Have you been taking your meds?” His voice was cold.

Eventually, I stopped calling. He had become too toxic, I tried to explain over the phone, keeping my voice even and unaffected. Whatever he was going through, I was no longer strong enough to support him, and he was too far gone to support me. The respite was short.

A few months later, my mother called in the middle of my workday. She was driving Dad to a rehab facility, she said, sounding angry and exhausted. He would be treated for the opioid addiction he had been struggling with, unknown to us, for well over a year.

Suddenly, everything made so much more sense—and also made no sense at all. Pills had only ever helped me. The opioid crisis had been an abstract concept that I heard about on the radio while I worked at my bench. It seemed unfathomable that a prescription could have stolen my father from me. I felt betrayed.

For the next year and a half, my father and I faced our illnesses separately. He completed his term at rehab, then moved into sober living and began outpatient therapy for his addiction. I started graduate school. Wanting desperately to take comfort in my beloved world of atoms, I spent countless hours wishing away my sadness in lab. I imagined I was pursuing some kind of heroic total synthesis, that this was the path to becoming the hero of my own story. Instead, I was surrounded by the broken fragments of my life.

Pills had only ever helped me. It seemed unfathomable that a prescription could have stolen my father from me. 

Searching for relief from my burdens, I took weekend trips to go scuba diving along the canyons of the Pacific coast. Yet even buoyed by the caress of marine saltwater, I imagined myself sinking down to the inky darkness of the deep sea. I worried that my dependence on medications to keep me from doing the unthinkable meant that perhaps my life was not worth living after all.

*

Still a first-year graduate student, I sat in a packed lecture hall for Natural Products Chemistry. The professor walked us through the biological tricks that life uses to make complex organics. We explored the enzymes that construct antibiotics like penicillin and signaling molecules like estrogen. We learned about the catalytic triad of amino acids that make so many of these reactions possible inside cells. It all felt very academic, until we came to the biosynthesis of morphine.

Morphine is a natural product produced by the opium poppy. The professor used chalk illustrations to show how morphine and related opiates activate the same receptors in our brains as their synthetic analogues, including opioids. I sketched each step that the poppy uses to build morphine from its humble starting materials: how it formed and closed each ring, how it oriented a functional group here so that it bound perfectly with a receptor in our brains to soothe pain or induce euphoria. I was in awe of the elegance of the synthesis, how the plant’s biochemistry so effectively constructed such a beautiful poison.

Looking at the structure of morphine and all the other opioids drawn out in my notebook, I imagined how thrilling it must have been to discover the first synthesis of these molecules. Freed from the confines of the poppy’s tender flesh, opioids could be tinkered with, redesigned to become even more potent. Chemists could optimize their properties to squelch the signals for chronic pain without accidentally shutting down a patient’s ability to walk or the beating of their heart—a miracle treatment for those who find no other relief for their suffering. I imagined the exhilaration of holding even a milligram of a fine crystalline powder, the culmination of years of work, of countless failed experiments. How must it have felt to create a fragment of the natural world with your own hands?

Over weeks of memorizing this synthesis alongside the others I needed for the final exam, I ruminated on the power of these molecules and the people who make them. It gnawed at me. I wondered if the chemists who dedicated their lives to the craft of drug design knew that their chemical creations held the capacity to save me from my own worst intentions in one pill yet overwhelm me with the throes of a disease caused by another. I wondered if they felt at all responsible for the elegant destruction that comes from chemical dependency, or for the countless times a small yellow pill no bigger than a ladybug has helped me live to see another day.

But that wasn’t quite right, was it? The yellow pill might have stopped the panic, but it did not give me the will to live. And Dad’s opioids—a riff on nature’s own creation—had done their job to treat his pain before his disease took root. Those pills had not stolen my father from me, as I’d once feared; though battered and bruised, my dad had survived his addiction, when many are not so fortunate. And after all that, he still wanted to be my dad.

The molecules have no say in any of this. They continue their flow through the cosmos, agnostic to their own participation in our living chemistry. Someday, perhaps, those same atoms will find themselves embedded in the molecular machinery of another being’s neurons. Perhaps they have seen all of this before.

*

Whether your drugs come from a plant or a bottle does not matter nearly as much as choosing to take them or not—and why. Although we had both come so close to losing ourselves—and losing each other—over the course of our illnesses, my father and I decided that we wanted to live, and wanted our lives to include each other. Dad stopped taking his pills, and I continued taking mine.

The molecules continue their flow through the cosmos, agnostic to their own participation in our living chemistry.

But I had spent too long believing that my medicines were all I had to save me, that my pills were the only things holding me back from the abyss. Suddenly, it no longer seemed nearly as important to control the sequence of steps inside a round-bottomed flask as it was to look at my life and build a future worth living in—a future where a beautiful life grows out of the organic chaos that comes from choosing to love someone despite their flaws, myself included. Pondering the biosynthesis of morphine helped me understand that while my medicines help me manage my illness, I have always been the hero of my own story, the person most responsible for my own fate.

I took all the fervor I once channeled into making molecules and directed it toward rebuilding my relationships with my father and with myself. The conversations were awkward at first. Dad and I did not always meet with the same energy. We sometimes talked past each other. There were countless chats about groceries and the weather before it felt safe to talk about our hopes and regrets. But I already knew that it might take different strategies and approaches to rebuild something as beautiful and complex as the love between parent and child. After many failed attempts, there came small successes that grew with each interaction, each visit home.

One day, Dad and I sat by the shore and looked out at the vast expanse of the Pacific Ocean. “Look at all that saltwater,” I said to him. We wondered together at the lives of creatures who make their homes at sea. It had taken us both a lot of work, a lot of sweat and tears, to get here. When I looked at my dad then, in the glowing light of the setting sun, I felt buoyant.

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