American Pain

by John Temple

  When Jeff and his friend arrived, Derik did his thing, punching the friend and then flipping him. The man landed on his head on the hard floor. He was knocked out for a moment, his body rigid as a plank. When he came to, his eyes were screwy. Jeff pulled out a gun and a pair of hand-cuffs—he was always coming up with random items like that. Their captive started going berserk, thrashing around, so Derik snapped the cuffs onto his wrists. Jeff yelled questions and waved the gun around. He fired the gun at point-blank range, the bullet creasing the cuffed man’s scalp and burying itself in the floor.

  Now their captive was terrified and brain-scrambled from hitting the floor with his skull. He didn’t seem to fully comprehend what they were saying, but he knew enough not to admit that he’d stolen the money. So it was a standoff.

  Derik and the George brothers huddled. Chris and Jeff wanted to let their friend go, to pay him to not tell police about what they’d done to him. Derik believed things had gone too far to just let the man walk out of the house. It wasn’t a situation that money could solve, something Chris and Jeff never seemed to understand. Derik lost the debate. They decided to let him go, although Jeff couldn’t find the handcuff key for a while.

  Later, Chris told Derik he’d given the man $10,000 and persuaded him to sign some sort of legal document, swearing that the incident had never happened. To Derik, it seemed like the dumbest thing he’d ever heard of. You couldn’t walk both sides of the line, couldn’t be a gangster and a straight citizen. You had to pick a side, and they’d already chosen theirs.

  On the other hand, the outlaw life was stressful, and Derik understood the need for a little normalcy. That’s why he’d begun seeing the pharmacy tech at South Florida Pain.

  Derik wasn’t as attracted to his new girlfriend as he had been to his Brazilian ex-girlfriend, but he liked her and he loved her young daughter. He rented an apartment in Tamarac for the three of them. The relationship wasn’t particularly physical, but he needed something normal to come home to after a day of running South Florida Pain. Without that, Derik knew every night would be as crazy as the days, just an endless cycle of blow and alcohol and hookers and women like the Brazilian addict. He also didn’t mind the veneer of respectability his new relationship gave him. Taking care of his girlfriend and her daughter made Derik feel like a good guy.

  The days were chaos. Always interesting, but always exhausting too. Patients going into withdrawal, their bodies turning on them, skin as gray and wet as an oyster. Every so often, a patient would just slide off a chair in the waiting room and fish out, flopping around on the floor like a hooked tarpon on a boat deck. The first time Derik saw a seizure, the patient fell and split his head wide open, blood everywhere, Derik and one of the doctors frantically trying to wake the guy up. As the patient numbers rose, the seizures grew more frequent. It became almost routine: Derik would yell for a doctor, run and dial 911. No one ever died right there in the office, but it was a concern, another reason to try to shield themselves legally. Derik knew junkies could die from too much dope—everyone knew that—but the idea of patients dying of overdose was abstract. He knew it could happen, but it was easy to not think about.

  Some of the junkie stunts amused Derik, and some pissed him off, like when patients tried to bring their kids into the waiting room with them. The clinic was no place for children. But he was always curious to see how far people would go to get their fix or how dumb the pills made them. One pet peeve: how some of the zombies could never get the hang of tightening the drug test cup lids. They’d fumble the handoff and drop the cups, which turned them into what Derik called “exploding urine bombs.” At least once a day, Derik would dodge one or get soaked, one of his least-favorite parts of the job.

  Most of the time, nobody watched the patients actually urinate into the cups. Derik knew patients were using other people’s urine. He knew this because the toilets where they did the drug tests were constantly clogged with containers and condoms that patients had used to smuggle in the substitute urine. Sometimes a pee-filled condom tucked into someone’s shirt would burst, soaking the patient. And at the end of the day, the parking lot outside often had broken condoms on it, ruptured and melting onto the hot asphalt.

  Derik played dumb with the patients, like he couldn’t see the bulges in their jacket pockets when he took them to the bathroom for the urine test. But he couldn’t afford to be too accommodating with them. He could never be sure whether someone was working with the police, hoping Derik would screw up and say something incriminating. So if a patient was too dumb to figure out how to cheat the test or stupid enough to get caught with a container of urine, Derik would kick that patient out. A couple of times, patients were caught using a Whizzinator, basically a fake penis attached to a plastic bladder of synthetic urine that was belted to the patient’s hips.

  A few times a day, each doctor called Derik back to discharge a patient. Most often it was for track marks, which he’d become good at identifying. The patients always had an excuse. The marks, they said, were from a recent hospital IV. Or from cutting briar bushes. Or the cat had scratched them.

  Many patients didn’t realize how easy it was to get a prescription, so they overdid the fakery, coming in wearing a neck brace or even a cast. Sometimes the staff would find crutches discarded in the waiting room by a patient who had received medication. One day, Derik told a patient in a wheelchair that he was being kicked out for going to another pain clinic. The guy just popped out of the wheelchair and came after Derik.

  What some patients never grasped was that the staff at South Florida Pain was on their side, that Derik and Chris wanted them to get their drugs. All the patients had to do was follow the official rules. Don’t doctor shop. Don’t sell pills in the parking lot. Don’t let track marks fester. Don’t come in high. Don’t be too obvious about smuggling in urine, and make sure it’s not suspiciously clean or suspiciously dirty. And don’t behave like a drug addict—acting desperate or begging to have your dosages “upped”—because that might make the doctors feel like drug dealers.

  These rules protected everybody, and if the patients followed them, they’d get their meds. At first, Derik had believed that the patients would do anything to preserve their access to their pills, so of course they would follow his rules. Over time, he found that the junkies’ desire for drugs was constantly at odds with their tendency to screw up.

  So the parking lot at the new location remained a constant headache, a lawless zone where some patients felt like it was OK to bang a pill into their arm in full view of everybody. Despite all the amenities Derik provided in the waiting room, nothing seemed to keep the patients from loitering outside. The problem was the wait. It was always too long, and patients needed to grab a smoke or crush a pill before they got too sick. There were fights out there, including one where a guy had a canine tooth knocked out by a blow from a can of Mountain Dew. And always people pissing in the hedges, which was understandable if you were at a concert or something, but you couldn’t just whip out your dick in an office park on a major thoroughfare.

  Derik tried to be a good communicator. Several times a day, he would stand in the waiting room and address everybody in his raspy, New York shout: OK, everybody, if you want to see the doctor today, here are the rules. You come here, I need you to stay inside. No hanging out in the parking lot, no shooting up outside. And then when you’re done, you take off.

  Early one morning before the clinic opened, Derik was catching a smoke on the north side of the building, which faced Cypress Creek Road. A big RV passed on the other side of the boulevard, coming from the direction of I-95, then swung in a big U-turn and turned into the office parking lot. Derik had a feeling they were clinic patients. Sure enough, the big camper came to a halt, parking sideways across several spots. The door on the side of the RV popped open, and a large family came streaming out, what looked like three generations, young and old. The family proceeded to settle in for a long day, propping up a canopy on the side of the RV
, unrolling an outdoor carpet on the asphalt, setting up a grill and some chairs.

  Derik thought: You gotta be shitting me.

  He gaped at the scene for a while, then finally walked over.

  Derik said: Hey, does this look like a Miami Dolphins game?

  The people didn’t seem to understand. Derik explained that they were drawing attention to the clinic, making the operation look unprofessional.

  Derik said: This isn’t a concert or a game. This is a trip to the doctor’s office. It’s not supposed to be a fun family outing.

  A big woman who seemed to be the head of the family just scowled. Derik made them pack up the vehicle. Then he put them at the front of the line for the doctor, got them out of there as soon as possible.

  Everyone, always, had a scam. The patients would try to “tip” the doctors, hoping they’d be given extra drugs. Or they’d cause a problem outside just so the staff would have to call Derik out, and they’d have a chance to talk to him alone. The conversation was always the same. The patient would call him by his first name, like they were pals.

  The patient would say: Look, Derik, I’ve been coming here for five months now. I bring three people with me every time. I drive twenty hours one way. I follow all your rules. I don’t go to any other doctors.

  Then the patient would bring up whatever deal he was trying to cut. Could Derik give his girlfriend a break, let her see the doctor even though she had oozing track marks? Could Derik cut the red tape, let him skip the doctor visit and just sell him, say, a couple thousand pills, straight out of the pharmacy?

  They could never see the big picture, that Derik wasn’t going to risk a million-dollar-a-month enterprise by doing a straight-up drug deal with someone he barely knew. The red tape, the bureaucracy, the rules and regulations protected everyone. He and Chris had learned this the hard way when they’d been chased off from Oakland Park Boulevard. It was a new era at the South Florida Pain Clinic, and Derik was getting used to telling people no. It went against his friendly nature and his outlaw instincts, but Derik was learning that the best way to deal drugs was to keep it impersonal and keep it legal.

  One October morning, Derik and Chris stood underneath the covered walkway outside the clinic door, the early-morning sun casting palm-tree shadows against the concrete walls. From a distance, if you didn’t count Derik’s half-grown-out Mohawk, the friends looked like mirror images—two six-footers wearing designer jeans and black T-shirts, hair clippered short and tapered.

  Derik was heading to the airport, where he and Jeff were going to catch a plane to Los Angeles for a party at the Playboy Mansion. Derik and Jeff hadn’t been speaking to each other much, aside from the incident, two weeks earlier, when they’d grabbed Jeff’s friend after Chris’s money went missing. The dispute between the George twins over South Florida Pain had spilled over into Derik’s relationship with Jeff. But Jeff was trying to make things right with Derik, and he’d offered to take Derik to a party at the Mansion on October 17. Jeff knew a girl who’d been a Playboy bunny. It was an early Halloween party, and they were going to dress like gangsters.

  Derik’s driver’s license was still suspended, so he relied on others to drive him around, though sometimes he didn’t bother and just drove himself anyway. Chris was going to give Derik a ride. On the way to the car, Derik and Chris had stopped to talk for a moment.

  And that’s when Derik saw his friend’s eyes widen just a little, and they both turned to look at a middle-aged woman with short-cropped red hair and a black suit approaching them. Holding a microphone. Followed by a cameraman.

  “Morning,” she said. “Mr. George?”

  Chris didn’t panic. He turned slowly and sidled toward the clinic door, trying to look casual. Derik followed. The woman followed Chris, speaking to his broad back. Her voice was authoritative, sharp.

  “We have pictures of people snorting, shooting up in this parking lot after coming out of your clinic,” she said. “I mean, what do you have to say about what’s going on here?”

  Chris opened the clinic door, and the woman stuck the microphone inside. It had a 7 News logo on it. Chris spoke over his shoulder.

  “I . . . I don’t believe you’re right,” he said.

  The glass door’s pneumatic closer was easing it shut too slowly, so Chris reached back to yank it closed.

  “That’s all you have to say?” the woman said.

  Derik had made it inside too, and he and Chris started chuckling, slightly in shock. Then they realized that Dr. Joseph had not arrived yet. They peered outside and saw the little Haitian physician pulling into the lot.

  Chris told Derik to get him. Block him from the camera.

  Derik went back out, but the cameraman beat him to the doctor’s car. Dr. Joseph got out, staring warily as the redheaded woman approached. He actually looked very doctor-like, a stethoscope around his neck and a manila file full of papers under his arm.

  “Are you certified in pain management?” the reporter asked Dr. Joseph.

  Derik swept in, wrapping his arm around the diminutive doctor and guiding him toward the clinic door. The reporter jogged ahead, asking more questions. “Why do you think so many people are coming from out of state to see you here?”

  Chris had answered the reporter’s previous question, so Derik figured it couldn’t hurt if he said something too.

  “’Cause they’re from the Bible Belt states, and they can’t get pain medications,” Derik said, and hustled the doctor inside.

  Derik stayed inside—worrying he was going to miss his flight—until he thought the reporter had left. He walked out and lit a cigarette, and then she popped up again, from behind one of the columns, scaring the shit out of him.

  She asked what his name was. He didn’t tell her. She asked if he was one of the clinic owners. Derik, wanting to keep her guessing, said he might be. He told her that she was on private property, that they’d leased the parking area and she needed to get her camera off it. But she was tough and seemed to know what she was talking about when she called his bluff, saying he didn’t lease the whole area and couldn’t tell her to leave a public access area. She wouldn’t back down. She chased him back inside. Derik finally sneaked out of the office and barely made his flight to Los Angeles.

  A week after Derik got back from LA, the story about South Florida Pain Clinic aired on WSVN-TV. Chris and Derik didn’t get Channel 7 at their homes up in Palm Beach County, which is why they hadn’t recognized the redheaded woman, Carmel Cafiero, who was some kind of investigative reporter. But Derik found out about the South Florida Pain story as soon as it aired, when basically everyone he knew in Broward and Miami-Dade, including his grandma in Deerfield Beach, started calling him, saying he was on TV and what kind of trouble was he getting himself into now?

  Chris and Derik watched the video on the Internet. Cafiero’s story pretty much laid the whole operation wide open. It showed the Oakland Park Boulevard location with its big South Florida Pain Clinic sign. It showed Kentucky, Ohio, and West Virginia license plates on cars in the clinic lot, the numbers blurred out. Grainy, headless shots of patients leaving clinics, zooming in on the plastic bags in their hands. Patients arguing in parking lots. And the money shot: a close-up, through a car window, of a man in his car, crushing and dissolving a pill, then slow-motion footage of him pulling out a hypodermic needle.

  Cafiero’s report said that Broward County was the nation’s number-one dispensing site for oxycodone, that doctors in the county had dispensed more than 3.3 million pills in the first six months of 2008. A Broward County Sheriff’s Office spokeswoman said: “The appearance is that they are pill mills, simply handing drugs out, hand over fist. We’re talking hundreds of thousands of individuals trafficking into the state of Florida specifically to obtain pharmaceutical drugs.” The report showed photos of a white body bag on a grassy strip next to a highway, and Cafiero said in her voiceover: “And when they leave the clinics high, police say some of them die in accidents or ove
rdose on the side of the road.”

  The last third of the report was devoted to Cafiero’s ambush of South Florida Pain. Chris was named in the story, but he was only on-screen for a few seconds, as Cafiero chased him inside. Derik wasn’t named but was the star of the piece. Looking thuggish in a black skull-and-crossbones T-shirt, they slo-mo’d a grainy shot of him staring intently at the ground and exhaling a lungful of cigarette smoke. Later, he “rescued” Dr. Joseph and ushered him inside, wrapping a tribal-tattooed arm around the little doctor’s shoulder. The incongruity between the compact physician and the mysterious hulking guy with the wraparound shades propped on his forehead was striking.

  Still, one line in Cafiero’s voiceover made everyone feel better.

  “But the problem for law enforcement is that what these clinics are doing is perfectly legal,” she said.

  There you go, the guys said. Perfectly legal.

  After the kidnapping incident, Chris and Jeff went back to not speaking to each other, and the lawsuits between the brothers proceeded. Jeff finally had opened his own clinic in West Palm Beach, calling it East Coast Pain and modeling it after South Florida Pain. But he was juggling South Beach Rejuvenation and other enterprises, including trying to start a strip club and running a timeshare resale business. So Jeff hadn’t focused on building East Coast Pain, and his doctors saw only a fraction of the patients South Florida Pain was handling.

  As he and Jeff had originally planned, Chris wanted a string of clinics in multiple locations. He wanted a presence in West Palm Beach to compete with Jeff’s clinic. He also wanted to get Dianna out of South Florida Pain and into her own place. As they’d hired more staff, Dianna sat around and did nothing, mostly. She had been bored for months. She didn’t like all the girls around the office, especially the former bikini model who liked to sit on Chris’s lap in his office.