Aches and Pains

You tell me about your bad knee, your achy back, your sore shoulder. I’ve heard your sob stories. I’ve listened to your complaints. I’ve been a doctor for 24 years and I’ve heard it all. You say you need something for your pain. I’ve had two vertebrae in my spine fused together and a metal socket implanted in my right hip. Both times, I went home with a month’s supply of Vicodin. I bet you did too. It’s why you’ve come to my clinic. You’ve run out and your doctor won’t prescribe any more. You come to me with the cash and I provide the scripts for whatever you need - Oxy, hydrocodone, morphine, tramadol. I even tell you which pharmacy to get them filled at. It’s the easiest money I’ve ever made.

My first patient this morning is Mike. He’d been the top running back at the junior college located a few exits north of my clinic off the interstate. When he plods into my exam room and takes a seat, I wonder if the plastic office chair will collapse beneath his hulking frame. Mike’s told me his dream of playing ball at the state university. I nod as I examine his left knee - the one that the opposing linebacker shattered last season. The telltale scar from ACL surgery runs in a jagged line from his lower quadricep over his kneecap to his upper tibia. 

“Still having pain there?” 

“Yes sir.”

“Experiencing limited range of motion?”

“Yes, sir.”

I’ve asked these cursory questions a million times and the answer is always the same. Yes, it hurts. Yes, I’m in pain. I know Mike’s lying. That scar is three months old. They gave him hydrocodone after his surgery. He only needed to take a few pills for 48 to 72 hours, but they sent him home with a full bottle. Two weeks later, the bottle was empty and Mike was writhing in his dorm room bed with stomach cramps and body chills. He called his coach, whose referred other injured players to me. The first few pills were “freebies,” but Mike quickly learned that nothing’s free. That’s why he’s now in my exam room, pulling fifty-dollar bills from the pocket of his gym shorts, as I write him a new prescription.

Do I feel bad for him? Yeah, a little. But then again, he’s going to college tuition-free because he can run an oval-shaped ball through a pile of hyped-up, helmeted teenage boys. I was never good at sports, so no one offered me a free ride to college. I took AP classes in high school that earned me a $250 scholarship from the Lions Club to apply to my entire college tuition bill. 

Rosie is my second patient of the day. She’s a single mom who worked for the postal service. For years, she carried bulky sacks of mail, delivering all of those bills, birthday cards, store fliers, magazines, and credit card offers to each house and apartment on her route. Then a dull ache in her right shoulder began to require a daily dose of Advil. As the pain worsened, radiating into her neck and down her right arm, she took more Advil. 

Denied repeated requests for medical leave, she tried to keep working until the pain became unbearable. I suspect she’s torn her rotator cuff. An orthopedist could remove those painful bone spurs and re-attach the damaged tendon, but she told me her health insurance wouldn’t cover the surgery. I used to hate health insurance companies when I worked at the hospital, but now I know which ones will always pay the claims I submit. They’re all wildly profitable.

  I don’t ask Rosie for an X-ray or an MRI to confirm my diagnosis. There’s no point. A co-worker at the post office referred her to me. She never said their name. Said she didn’t want to rat anyone out. Rosie retrieves a stained nylon wallet from her peeling faux leather handbag and hands me $300 in wrinkled twenties and tens. I stuff them inside the pocket of my white coat, wondering if she’d lifted them from her daughter’s Girl Scout cookie money or her teenage son’s restaurant tips. That’s what my mother did to my sister and me whenever she needed quick cash for a pack of cigarettes, a pair of new shoes, or a fistful of quaaludes. 

Speaking of my mother, that’s who my next patient Valerie reminds me of. She wears the same pained expression that Mom donned whenever she wanted something from Dad. And Valerie always wants something from me. She wants morphine for the pain that cancer inflicts on her. When I asked her what type of cancer she’s been diagnosed with, she says she can’t pronounce it because the name is so long and it is incredibly rare. Each time, she claims her “extremely rare cancer” has spread to a different part of her body and the pain is excruciating. 

I don’t bother to ask for CT scans or any other diagnostic test that would reveal the type of cancer she claims to have. Instead I listen to her litany of symptoms - aching joints, sore muscles, nausea, insomnia. All the classic symptoms of withdrawal. Each time she visits my clinic, she slips me crisp hundred dollar bills enclosed in a white envelope. And each time, I prescribe her 30-milligram immediate release morphine tablets. 

All day long, patients cycle through my clinic. The housekeeper who’d been injured in a car accident. The roofer who’d fallen off a house. The combat veteran with bits of shrapnel lodged in his thigh and horrific memories seared into his brain.

Bradley, the pharmaceutical rep, will be pleased when he visits my office later this week. Last time, he said my patient numbers and prescription orders were “very robust.” Each time, he arrives with a larger order of medications from his brand-name pharmaceutical company. And I get a gift certificate to my favorite store, dinner at the swankiest restaurant in town, and an invitation to speak at the company’s medical conference. A course in “Negotiating with Pharmacy Reps” was never on the syllabus when I went to med school. I learned it on the job, and now I get so many gift certificates that I donate the ones I don’t use to the community center. It’s a nice tax write-off.

My last patient of the day is Matt, a house painter with chronic back pain. Nice guy. Always affable. A little goofy with his stupid jokes. “Why do ants never get sick, doc? Because they have antie bodies.” 

“Good one,” I reply absently as I reach for the prescription pad in my chest pocket.

He comes in every two weeks after work for Oxy and Vicodin. Always dressed in paint-spattered white pants, a brightly colored T-shirt, and work boots. Never tries to short me and always hands me the cash without complaining or whining. Thanks me today for squeezing him in at the end of the day.  

“Been a busy day, doc?”

“Yeah,” I reply as I write Matt’s order on the last sheet of the prescription pad. 

Matt reaches into his back pocket for his wallet. He’ll hand me a wad of fifties and twenties and then he’ll be on his way. But this time, Matt opens his wallet and holds up a gold DEA badge. “You’re under arrest, doc.”

Bile rises in the back of my throat. Sweat trickles down my back. I swallow hard, trying to maintain my composure. “Matt, this has gotta be a mistake.” 

He glares at me. “I’m Special Agent Thompson and you’re being charged with 32 counts of unlawful distribution of a controlled substance.” I’ve never seen him look so serious.

My hands tremble as he snaps the zip ties around my wrists. The exam room suddenly feels like a convection oven. When the door flies open, my heart leaps into my throat. Two uniformed police officers stand side-by-side in the hallway. The shorter one holds up a piece of paper. Without my glasses on, I can only read the first two lines typed in all caps across the top of the page: 

UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF FLORIDA

“We have a warrant to search your clinic,” the officer says. 

“And your person,” adds Matt/Agent Thompson, as he directs the other officer to pat me down. 

He finds the cash from my last patient in my coat pocket and deposits it in a clear plastic evidence bag. I coil my restrained hands into two fists, feeling my nails biting into my palms. I was gonna use that money to replace the water pump on my boat. 

“We’ve had your clinic under surveillance for the last two months,” Matt say as he guides me into the hallway. I can see the parking lot through the wide-open front door. Several police cruisers and a large black van are parked outside. 

“I’m a licensed doctor. These are my patients.” My mouth feels dry as I utter the words. 

Matt ignores me. He knows I’m lying. 

What will Bradley think when he shows up at my clinic on Thursday? He promised me tickets to the Dolphins game.

  When we step outside, I see Rosie standing by the van talking to a man wearing a black baseball cap and a windbreaker emblazoned with the letters DEA across the front. As Matt leads me toward the van, she pats her shoulder. “Should’ve ordered an X-ray, doc. Shoulder’s just fine.” I feel like my knees are going to buckle. Rosie’s not a postal worker. She’s an undercover agent and she ratted me out!

I’m feeling nauseous as Matt opens the back door of the van. I stare into the stark gray hull lined with two metal benches. 

“I can’t sit back there,” I protest. “I want a lawyer.”

Matt cocks an eyebrow. “What do you get if you put a hundred lawyers in your basement? A whine cellar.”

I really dislike Matt and his stupid jokes.