On weekends, I tend to take a break from health policy to focus on personal writing here on The Frontier Psychiatrists. This one is unfortunate, and it is a fair warning to readers who are in no mood for something like that.

My older sister,  Alison, was troubled.   She was also very gifted.   She was trained as the chef at LaVernne, which was a very serious place to do your training as a chef. Parisian chef school doesn't f- around, and she was a gifted teacher of her craft.   She landed a job that she thought would be great. Less work than teaching at a busy New York teaching school for chefs, the Culinary Institute of America. Something Downtempo.

The Wexlers are incredibly wealthy people. She was a personal chef for Les Wexner. It was not an easy job. She is a personal chef for a fabulously wealthy person who is now notoriously on the list of individuals who are routine customers of Jeffrey Epstein. She wasn't just cooking for one person’s family. She was cooking for their hundreds of guests. She was one person. Her body couldn't take it. She had degenerative disc disease, and doing a job where she had to stand, endlessly, to cook hundreds of meals for hundreds of guests, as if one person could do all that by themselves, destroyed her body—destroyed her back. She ended up needing surgery. The surgery did not relieve her pain.

After that back surgery, she was introduced to opiate pain medication. She has been prescribed a lot of opiate pain medication. And she took that opiate pain medication for years.   She became addicted. She couldn't stop. The help wasn't there for the pain, and the fire she sent to her apartment that left her foot singed made the pain worse.

Now she had chronic neuropathic pain from a fire that she sat in her apartment --the investigators told us that she had left a shoe on the stovetop. She was not well.

She eventually reconnected with a friend, he became a boyfriend, he became a husband.

For a while, he took good care of her. He had a problem also. In his case, it was with drinking. Her health was not excellent. This is often the case with burn victims. It's often the case with trauma victims. It's often the case with people addicted. It was the case with my sister.   She was admitted to the intensive care unit, unbeknownst to me, three weeks after my father died of bladder cancer. She returned home. The next moment, as related to me, was probably after her last. She had survived a few suicide attempts already. There are only so many lives each of us has to spare.

A phone call was placed to my mother by my sister's husband, letting her know that he found Alison in the bathroom, on the floor, not breathing. It was a fair question as to why the phone call was to his wife's mother and not to 911, given the not breathing... a subsequent call was placed to 911, and about an hour and a half of CPR took place, and like most CPR, the person did not come back to life. My sister was dead.

The burial of my father and the burial of my sister were, unexpectedly, on the same day, in the same hole in the ground. I had lunch with my mother, my sister's husband, and others. We spoke well of her. We were sad. We all went about our days that followed.

In her blood at the time of her death were the following compounds: olanzapine, Oxazepam, temazepam--both benzodiazepines--and heroin.

She was also adopted. Her biological mother gave her away for adoption at age 14. She just didn't want her daughter anymore. If I had to guess the root of her pain? The event, the lesion, was this moment. Growing up, it didn't register how messed up this was. My mother adopted her. Her father was her father the whole time, but who switches moms? My sister, that is who.

She posted this photograph of her and her mother on her Facebook, commenting that it was the last time she saw her mother, “20 years ago, and she was in a blonde phase.”

It's not normal for your daughter to be given up for adoption. I have another older half-sister. That one? She wasn't given up for adoption. Just Alison. Not her older sister. This woman—whose name I don’t even know— gave away one child, not the other. It never mattered how much my mom loved her—my mother, who was her mother, which was a lot, frankly. How could you trust anyone wasn't going to leave you if your biological mother just dropped you from her life? It's hard for any child to understand the problem is factually with the parent. Healthy people don't do that. They are not so disconnected from their children that they pick and choose between them. That's not normal. That's not healthy. This is the kind of human Alison had as a biological mother. Our love for her? Perhaps it would never have been enough. The only thing that could fill that gaping hole was morphine, more morphine, heroin, oxycodone, Vicodin, more heroin, more Vicodin, endlessly until the end.

I remember the last time we spoke—she apologized for being a bad sister. I reminded her that infinite forgiveness is what we are owed as family members, so she didn't use up anything. It was good to see her, and she was forgiven, and I loved her. This was at the funeral of my father. Three weeks later, she was dead. A few days later, both of them were buried in the same hole next to each other, in tiny boxes that held their ashes.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe