by J. R. Helton
I was starting to get worried again about my supply, as it was also getting expensive to order my online meds. I was paying a couple hundred bucks for what was normally a ten dollar co-pay at my pharmacy. I was also starting to realize that Dr. Kungwale was on his way out as a drug source as he had become strict and questioning in giving me my scripts. He told me in an offhand manner on my very last visit to him that he was being investigated for some of his patients falsifying their prescriptions, copying them or altering them. He made sure not to insult me or even vaguely insinuate that I would do such a thing, which was correct; such tricks were for desperate, strung-out idiots who wanted to end up in jail.
What so many chronic illicit drug users fail to realize is that the whole drug system in America is set up to make you fail the urine test. A gigantic business on one side pushes the legal and illegal drugs, and a multi-billion dollar DEA and prison for profit industry on the other keeps any unlucky bastard who gets caught up in it entangled in an equally for profit legal system that would never let him go. I didn’t fit the drug addict loser profile, and Dr. Kungwale knew it. He truly wanted to keep me as a client, but just one look at the other three, poor, lower working-class, sniffling and fidgeting patients in his waiting room told me that I wanted nothing to do with this guy who’d always given me a bad vibe anyway. It was time to cut him loose.
To make up for this supply loss, I was forced to ask Dr. Garza for more pills than the two a day he’d been giving me for a few years now. He reluctantly bumped me up to three a day but he was much less friendly than he’d been in the past. He grew adamant when I asked if I could just come in every three months instead of two and get more than one refill and he said no way. He also gave me blood tests for anemia and even bent me over a table and shoved his finger roughly up my ass one day for a surprise physical and prostate exam. His manner was growing more gruff and disdainful every time I saw him. Our one-on-one visits finally disappeared altogether. I rarely even saw the man as he pawned me off on his new physician’s assistant or PA, Carol Palmieri, and told me to meet her in two months’ time at his new office.
It was obvious what was happening when I reached Dr. Garza’s new office two months later in a newly constructed strip mall on the edge of the suburbs. It was no longer Dr. Garza’s Family Clinic, its waiting room filled with poor people, but instead a corporate business clinic chain called Healthmed. He’d found a new way to make more money, a lot more money by the looks of it, by becoming some sort of phony cosmetic beauty clinic doctor. When you walked through his front door now, you were greeted by a life-size cutout cardboard figure of some beauty pageant winner, Miss Brownsville or something, a heavily made up woman who looked like a transvestite wearing a tiara and body sash and dressing gown over her giant fake silicon breasts. The office was nicer, filled with more “nurses” or “medical assistants” whatever they were. The heavyset friendly old Hispanic woman who had been at his front desk for so long had been replaced by two attractive young white girls with blond dye jobs who wore skintight shirts covered with sequins that spelled out Healthmed over their own globular fake breasts.
While waiting to see PA Carol Palmieri, who wore a white coat and dressed like a doctor, you could peruse Garza’s many health and beauty magazines in the lobby, or his new brochures that offered Botox injections, electrolysis and unwanted hair removal, and a number of other shady sounding, vaguely medical “treatments” to supposedly enhance your beauty. Older, formerly attractive women and a few, uncomfortable, badly toupee-ed men, mostly filled the lobby now. I only saw one of his former patients from the old office, an overweight old man who looked very sick. Soon, it felt like it was just me, the last of Dr. Garza’s old patients.
The first time I saw the physician’s assistant, she gave me some attitude I didn’t like, making me sign over again the old form about drug tests and not going to another doctor, etc. Sensing I might have trouble with her, I had brought my MRI to show her. She took it out of the room but left the door open, and in the hallway I could see Dr. Garza looking at it up in the light with her. He gave it back and our eyes met. I smiled and waved but he gave me a definite go-to-hell look and said nothing. It was time to leave this asshole. He always kept me waiting forever, and this coming in every two months thing was a bullshit money con. Now, I had to get attitude from him and his PA just to get enough of this drug that I needed not only to kill my back pain, but just to feel normal. The high was almost completely gone, even when mixed with alcohol. PA Palmieri came back into the room with a smile on her face, relieved like Kungwale had been a few years before.
“Why didn’t you tell us you had broken your back?” she asked me.
I stared at her in disbelief. In every visit I had made to Dr. Garza, I had been telling him that I had not only broken my back but some ribs and my sternum as well in the accident. These people obviously didn’t have a clue or had simply assumed I’d been lying for years. She started to write me out a four hydrocodone a day script with one refill. I asked her to bump it up to maybe five.
She finished writing the existing prescription and said, “Look, this is not a pain management clinic, okay?”
“What kind of clinic is it?” I asked her. “Are y’all even general practice doctors anymore?”
She shrugged vaguely and said, “We still have a few of Dr. Garza’s old patients but we are primarily a wellness and beauty clinic now.” She was still holding the script in her hand. In the old days, Garza just gave them to me, I went to his secretary, she photocopied them, and I left. Now, at Healthmed, they sent them up front to be copied and the large-breasted receptionist gave them to you after she collected your co-pay. Carol saw me looking at the script. “Oh, by the way,” she said. “Before we can give you your prescriptions today, Dr. Garza said you’ll have to take your random drug test. Jose will bring in a cup for you and the bathroom’s right there.”
I was caught completely off guard by this. And I was pissed. “You want me to urinate in a cup?”
“Yes, it’s part of the agreement you signed and you haven’t been given one in three years or . . .”—she looked at my chart—“or . . . ever, actually.”
I hesitated, finding this to be a huge invasion of my privacy. In addition, I had smoked a little pot the night before and knew for sure it would show up on the panel.
As if reading my mind, Carol added, seeing my hesitation, “We do the standard panel run on illicit drugs like cocaine primarily but the main reason we have to do this is to make sure you even have the hydrocodone in your system. We’re not saying you’d do this, but some people come in here and get a large amount of pills like this and go out and sell them on the street for quite a profit.”
This was the final insult and I let her know it. “Look, I need to take every last one of these pills and I am even asking you for one more a month, so I find that ludicrous that I would sell them. I don’t appreciate you insinuating it either.”
She feigned apology but I could see a hardness set around her mouth. “No, no, no, of course not. We simply have to do this as part of our policy. Or . . .”
Piss in the cup or no pills.
“You know, I just urinated before I came here,” I said. This was true, plus, the hydrocodone jacked with my prostate whenever I took more than six, making it difficult to urinate at midday or in the evening at times.
“We can wait,” she said. “I’ll get Jose to get you a bottle of water or two when he comes in. And uh, I’ll have them copy your script and you can get it up front. We’ll see you in two months and talk about the tox screen. Also, I need another blood test from you today to check on your anemia again. Have you been taking your iron?”
When I’d told Dr. Garza about the blood, he’d prescribed, besides the colonoscopy, some iron pills for me, but they were so strong they made me nauseous and constipated, defeating the whole purpose. “Yeah, sometimes,” I said and she was gone.
Jose came in with a bottle of water and the cup and I drained it down, trying to get the urge to piss while he stood there waiting for me. I was so rattled that I asked him if they tested for pot.
He looked pretty square and was surprised at the question. “Oh, umm . . . yeah, I’m sure they do.”
“You don’t know how long it stays in your system on these piss tests do you?”
He shook his head, confused, a rare question for him. “No, I uh, I really don’t.”
I drained the last of the bottle and said, “Okay, let’s give it a shot” and Jose followed me almost into the restroom with Carol Palmieri now standing there behind him, my two suspicious guards. This further pissed me off that they thought I was going to try to pull a switch with the urine. Unfortunately, I was also one of those men who never liked to urinate in front of others. For some reason, it bothered me, and even though I might really have to go at, say, a baseball game between innings, waiting in line with fifty other men before the urinals, by the time I got to my turn, something—my bladder or prostate or whatever it was—would clam up, and I couldn’t go with the pressure of others waiting for me. Now, I had Jose and Palmieri standing outside of the partially open bathroom door tapping their feet. After several minutes of standing, I gave up, pulled my pants down and went ahead and took a shit as it was the quickest and only way to get them a sample. I gave the warm, yellow urine to Jose who sealed the cup, went up front to get my scripts and never went into Healthmed again.
-15-
I didn’t appreciate being treated like a criminal and met with suspicion just for trying to get a painkiller. Though I’d made some dumb decisions on the amounts and intake of certain drugs, I was an older professional user now at forty-five years of age. I wasn’t completely convinced I would need hydrocodone for the rest of my life. It was still my decision. On the other hand, I absolutely had to take the drug Prilosec every morning for the rest of my life. Prilosec was a wonder drug also known as omeprazole which was sold over the counter now. The greedy fucks who made it still charged an arm and a leg when it went over the counter, but it had been even worse in the ’90s at two or three bucks a pill by prescription with no insurance—pure extortion. It was still cheaper to get it from my gastro guy by script.
It bothered me to have to take Prilosec forever, simply because I never wanted to be at any drug supplier’s mercy, especially a corporate connection. But omeprazole changed my life. Within days of first taking it, my once chronic gastritis was gone almost forever, as long as I took my 20 mg every morning. I had had an ulcerous stomach since I was seventeen and heartburn that woke me in the night many a time with tears in my eyes from the excruciating pain in my esophagus and gut. There was nothing I could eat, no matter how bland or spicy that didn’t give me too much stomach churning acid. My excellent gastroenterologist preformed an endoscopy on me in the mid ’90s after I told him I’d taken Tagamet and Zantac for years, and that I also ate a pack of Rolaids a day. When I came to after the procedure, he said my throat and stomach were red, raw, and ulcerous from the chronic overproduction of acid, but that I should try this new pill omeprazole and it should work. And it did, letting me eat or drink most anything like other normal people again.
Now, in addition to Prilosec, I was also dependent on these pain pills just to be able go to work or mow the lawn. I had never heard of a pain management clinic like the one PA Carol Palmieri had mentioned. I called her and Garza one last time for the results of my drug tests. Even though I had paid for the test on the spot, over a hundred bucks out of pocket, she told me I couldn’t have the results unless I came back in at my regular two month visit and then “we’ll have a little talk about it,” she said, a bit coy. There was no way I was going to sit there and let this ignoramus give me a lecture on pot, so I told her to just keep it and I’d find a new doctor. She said nothing of course, as that had been her plan all along, unless I suddenly decided I needed hair plugs or some wonder wrinkle cream.
My backup supply was dwindling and I was starting to get sick again, so I went through the phone book looking for pain management clinics and had a few down to visit. I passed near an upscale downtown neighborhood one day and just happened to notice a brand new three-story professional building with the words “pain management” on its sign. I stomped on the brakes and went inside without an appointment. It turned out to be a very professional clinic that had some of the best doctors and surgeons in the city. People with severe back pain were only a small part of their clientele. The majority were terminal cancer patients, men and women like my old office mate Bill Johnson who had severe, life-altering illnesses and pain. I lined up an appointment with a Dr. Jacobs there for the next day.
For the most part, doctors are nothing but glorified mechanics with maybe a little more at stake in an operation than a transmission job. I’d been a pre-med student in the early ’80s and had watched and even assisted one of my uncles, a wealthy, well-respected doctor in Austin who had encouraged me to go into medicine. After just a few days of watching vaginal and abdominal hysterectomies and some other surgeries, I lost interest in the profession. Many doctors were no smarter than the next guy but, like lawyers, they peopled every other dramatized film or TV show. As the main characters of our make-believe television society, they’d been raised to an artificial, exalted status. Many of these MDs like Kungwale and Garza were in the end simply pushers working for the drug companies, screwing the cute drug reps that came into their offices regularly to push this drug or that. Many doctors handed out these new, barely regulated med samples by the handful which explained the drawer full of potentially deadly Vioxx and Celebrex Patricia and I had at home. Two doctors who were friends of mine had even given up their once successful practices almost completely to work directly for the drug companies themselves doing trials and tests for them. Dr. Jacobs at the pain management clinic seemed different though, more honest, straightforward, and accomplished as an orthopedic surgeon, miles above these other MDs I’d been seeing.
He immediately asked for my MRI when we met, explained my compression fractures and said, “Ya know, it ain’t that bad, not the worst I’ve seen. It’s the fact that they healed back off center that’s doing it.”
He put me in a gown and gave me a complete physical, drew my blood. He had me lay down on my stomach and started poking and prodding my spine. When he hit the two vertebrae and pressed down I almost jumped off the table.
“Okay,” he said, and sat down next to me on the examination table. “What we can do is keep you on the hydrocodone but I’d like to start injections, regular injections, near your spine—” I couldn’t hear what he said next as my skin had grown cold and I began to sweat. I held up my hand and stopped him.
“No injections,” I said. “Look. I’m only in my mid-forties and I don’t wanna go down that road yet. Injections are my last resort. I will try anything before that.”
He said sure, that was fine, but I should know it was an option, maybe even a probability in the future. “How much hydrocodone are you taking?”
I mumbled out that it was three or four a day and produced the last pill bottle that PA Palmieri had given me from Healthmed, which read four a day at 10/500. He held the bottle and looked at me again, over his glasses, a serious, don’t give me any bullshit look, one that I preferred to Garza’s suspicion. “You really only taking three or four a day?”
I came somewhat clean and told him no, that four didn’t really cut it anymore. Without hesitation, a busy man, he told me he was putting me on six 10/500s a day with three 10 mg pills of Flexeril to take along with it. I went on at length about what a joke the Healthmed clinic had become and how often I had to go in and he waved me off. “You just need to come in every six-months for a checkup and we’ll give you six month scripts otherwise, or three months and then just call our refill line.”
I asked him about taking six a day, the acetaminophe
n, wasn’t that too much?
“Nah, you can take 4000 mg a day of that stuff before it hits your liver. Don’t drink too much and you’ll be good.”
“And what about the 60 mg of hydrocodone?”
“It is a narcotic, if that’s what you mean. But hell, I have people in here taking five times, ten times your dose, people with narcotic pumps installed in their bodies, so—” He hesitated. “Tell me, what happens when you stop taking it? Any vomiting or . . . ?”
“No, I’ve cut down to two a day a few times now and I just feel extremely lethargic. I can’t sleep, feel sore all over and I get diarrhea.”
“I bet that helps with the constipation, huh?” he said and smiled. He slapped me lightly on the knee and said, “Hey Professor, don’t worry. I’ll see you in six months.” And he was gone.
I liked this guy. His office and staff were nice. He treated me with respect and was taking me seriously, my injury as well as my dependency on the opiate itself by giving me plenty from one source which was as it should have been all along.
Now that I had enough legit HC from one source, I gave up all internet and strip mall doctors and decided not to go any further down the road of opiate addiction. I fluctuate between my legally prescribed four to six a day, which gives me no high whatsoever. I would need something stronger, Oxycontin or heroin or morphine, to get those heavy, floating highs ever again. The amount I take is roughly equivalent to half a grain of morphine, that is, not much. I tell myself that much like Prilosec, I may have to take this drug hydrocodone on a limited dosage for the rest of my life. If so, by the end of my days, as an old dying man, I may indeed switch to Demerol or morphine if possible to once again feel such a euphoric high as well as alleviate the physical suffering that usually accompanies our deaths. Otherwise, I’ll go all the way with nothing.
