Breaking point, p.1
Breaking Point, page 1
Breaking Point
M. D. Thomas
Copyright © 2020 by Matthew D. Thomas
All rights reserved.
No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the author, except for the use of brief quotations in a book review.
This is a work of fiction in its entirety. All names, settings, incidents, and dialogue have been invented, and when real places, products, and public figures are mentioned in the story, they are used fictionally and without any claim of endorsement or affiliation. Any resemblance between the characters in the novel and real people is strictly a coincidence.
Breaking Point
The patient doesn’t look like a drug addict. She isn’t rock-star skinny, with blown veins and bloodshot eyes. Her blond hair isn’t lanky or dirty. She isn’t dressed in worn clothes because she spent all of her money getting skin-pops on a street corner. No, what she looks like, with her stylish, fitted black pants-suit and her trendy, short haircut, is an upper middle-class housewife.
“Ma’am, I’ve been looking at your prescription history and I’m a bit concerned.”
Her eyes narrow as I speak. “Why?”
“Well, in the past month you’ve received a prescription for thirty percocet, another for sixty vicodin, and another for sixty oxycontin.”
“They’re all prescriptions for my migraines.”
I want to sigh, but I don’t. I went through four years of residency and I’ve been an emergency room attending physician for a year, and I still don’t see how these people can fail to face the truth about themselves.
“It isn’t just the prescriptions, Ma’am.”
“Well, then what is it?” she asks, and as she reclines in the gurney before me I see the demon come to life in her eyes.
“You were seen here in the ER on three different occasions in the past month – ”
“My migraines – ”
“Yes, Ma’am.” It’s best to be deferential and polite. “On all of those occasions you received an intravenous dose of medication – ”
“Yes, what was it called? Daulin? Dauvin? Dau something. It seemed to work okay.”
“Dilaudid, Ma’am?” I say. I play the game even though I detest myself for it.
“Dilaudid! Yes, that was it!”
Her eyes blaze with excitement. She thinks she’s about to score. Dilaudid is the brand name, the pretty name, the I’m not a junky name, for a powerful narcotic derived from morphine.
“Yes. Dilaudid. Well, anyway, because of the number of prescriptions you’ve had and because of your frequent visits to the ER for a rather serious medication I’m a bit concerned.”
The excitement leaves her face. I see it drain out of her like the water from a ten gallon bucket that suddenly has a basketball-sized hole punched through it’s side – all at once, in a rush, and the demon returns. It senses the enemy. The obstacle between it and it’s fix.
She leans forward on the gurney. “Are you calling me an addict?”
“I’m not calling you anything, Ma’am.”
“Because I am not an addict. You don’t understand what it’s like to live with this pain. I get migraines almost every day and they’re so bad that I can’t do anything. They incapacitate me. I can’t drive. I can’t work. I can’t even get out of bed! Do you know what it’s like to feel that kind of pain?”
Toward the end her eyes plead. Another tact. She’s trying her best, putting on her grandest show.
When I finished residency I was convinced that I would finally get to live the life I wanted, after four years of working seventy-two hours in six days and nights and getting a miserly two days off before doing it all over again, weeks at a time. Not that the attending docs at the program didn’t warn me. They told me it only got harder, even though you don’t work as many hours. I didn’t believe them. One of my favorites, a guy named Jonathan who was full of interesting, twisted platitudes, told me that an ER residency was like a pie eating contest, except that when you win, all you get is more pie.
Of course I didn’t believe him.
“I understand, Ma’am, but these are all very powerful narcotics. I’m just concerned there might be a problem.”
“There’s no problem. Except that I’m in excruciating pain and you won’t help me.”
I want to scream at her.
I want to yell, “You’re not in pain! You’re an addict! You came to the ER with a real migraine once and some shit of a doctor screwed up and gave you Dilaudid and when you felt it blow through your veins you loved it! It made you feel great! So you tried to get more of it but all you could score at first was some percocet or some vicodin, and that wasn’t bad, but it wasn’t the same as the Dilaudid, now was it? And then you got lucky, or you learned how to game the system, and you got Dilaudid a few more times and now you’re hooked on all of it and you’re an addict but you’ve convinced yourself you’re not. You think you’re too good to be an addict. That because you drive a Beemer there’s no way you’re a junky. Well you’re wrong!”
But I say nothing. I’m a professional and my career depends on my behavior toward people like her. I may not like it, I may not like her, I may despise her, but these people dictate my life.
She dictates my life.
So I stare at her as my possible futures spin out before me, as I contemplate what my options are and what my morals are and what I should do versus what I want to do.
Before I can settle on anything she speaks.
“I want another doctor.” She leans back once more and crosses her arms, that cliché of defensiveness, as she looks away from me toward the sterile white wall of exam room number four. “You aren’t taking care of me and I want another doctor. Someone who will actually listen to me and help me with my pain.”
These are my options, my possible immediate futures: I can give her what she wants. I can go to the computer down the hall and pull up her chart and put in the orders for the nurse to push two milligrams of IV Dilaudid because the patient has extreme pain due to a migraine headache. She has a chronic pain history and other physicians have given her Dilaudid in the past, so my orders won’t seem abnormal. I can ride the wave of the lazy, conflict-avoiding docs who just want to move the patient, who just want to clear out the ER waiting room and who don’t give a shit if they’re aiding an addict because it won’t hurt them and they don’t care and they just want to go home on time and see their wife or their kids or their dog or their favorite television show. Or, I can tell her that she’s messed up, that she needs to get therapy, because even if she might get migraines and might have needed strong medication to cope with the pain once it’s gotten out of control and now she’s a pill-popping, Dilaudid-loving, drug-seeking, out-of-control housewife from the suburbs who, if she doesn’t get some help, and doesn’t get her act together, will be on a street corner pretty soon trying to score some heroin from some scum-of-the-earth drug dealer, and when she berates me because she can’t bear to hear the truth I can kick her out of my ER.
I look away from her expensive clothes, from her fancy Dooney & Burke handbag on the table beside the bed, it’s bright pink sheen and lettered DB’s screaming I’m expensive! – hell, her husband might even be a doc – and I look at the clock on the wall.
Seven forty-nine. In the morning.
I’ve been at this for more than twelve hours and I’m tired. I’m exhausted. I haven’t eaten anything more substantial than a Snickers in fourteen hours. I haven’t peed in eight hours. I’m mentally and physically drained from running my ass off all night trying and failing to keep the waiting room clear, from spending half my time on patients that are actually sick and the other half on patients that shouldn’t be in the ER at night on a Tuesday but should instead be seeing their primary health care providers during the light of day on Wednesday, except that they’re idiots or they can’t afford insurance and know that in the ER they won’t have to pay their bill, or even if they have insurance they still come to the ER first because people just don’t think anymore.
The shift is supposed to end at seven, but it never does.
And now I have to decide what to do with this lady.
With this addict.
The clock entrances me, as the second hand continues on it’s never-ending journey, and I feel my full bladder and my empty stomach and my tired mind and I no longer care and I throw aside my morals, my professional ethics, my desire to do the right thing, and I give in.
“I’m sorry, Ma’am,” I say, as I sell out.
I just want to go home.
I just want to sleep.
“I’ll do my best to help you. I’ll have the nurse down here as soon as possible to get you some relief.”
She smiles.
THE END
About the Author
M. D. Thomas grew up in the middle of nowhere Louisiana, a locale that let him spend most of his free time reading. When that got old he left, eventually earning a Ph.D. in Microbiology at the University of Virginia. He ditched a career in science a few years later, became a stay-at-home dad, and settled in Tidewater Virginia, where he’s been writing ever since. His works have won writers conference awards and were selected for the Pitch Wars mentoring program in both 2017 and 2018.
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M.D. Thomas, Breaking Point
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