Ketamine Dreams

Content Warning: This story contains sensitive content about mental health and substance abuse.

Elijah opted for the Champagne Lanson over the the cheaper Saldo Chenin Blanc he normally gets with his steak frites at The Golden Bull. After all, he just got promoted to Head of Sales at GoodMood, a startup that specializes in at-home ketamine therapy. Elijah and his co-workers, barely squeezed into the 50's style maroon booth, toasted to his future.

“Elijah, how does it feel to be Head of Sales?” Tara, Head of Software Development asked.

“It feels damn good,” he responded. “That’s for sure. Sales should come naturally to me since we have such a good product. We’re really changing the world with our company, and we can sell ketamine to millions more.”

“Well, ketamine isn’t for everyone or every situation,” Ramon, the Chief Medical Officer, said.

“I know you’re the psychiatric expert for the company, but there’s no need to bring the mood down. Everything is looking up – not just for me but for the whole company, too. I’ll make sure of it.”

“I’m sorry I brought it up,” Ramon said.

Ramon shut his eyes and rubbed his forehead. This wasn’t the first time his warnings were dismissed, and it wouldn’t be the last. He finished his salmon to avoid saying anything to upset Elijah. It was his night after all.

“GoodMood needs to tackle a world where mental illness is on the increase. Ketamine doesn’t help with just depression. It treats anxiety, PTSD, eating disorders, OCD, bipolar disorder, chronic pain, insomnia, and more.” That was the intro for Elijah's sales presentation. Within the next week, Elijah sent out an Outlook invite regarding sweeping changes to sales strategy. He then practiced his PowerPoint presentation in the main conference room. Elijah rehearsed the delivery of that slide alone twelve times. Despite wanting to get every detail of his presentation just right, he was confident in the narrative he was selling – that ketamine was a wonder drug, and tons of people needed this miracle. No one doubted Elijah’s work ethic. The main conference room, which was centrally located at the office, was encased in glass and lit harshly with blue-white LED bulbs. GoodMood employees saw for themselves how hard Elijah worked on this project; moreover, it was widely known that Elijah was a client himself. His testimony was even featured on the website. He was not just Head of Sales, he was an evangelist. 

“Given ketamine’s effect on the brain’s neuroplasticity, we should be promoting this drug for psychiatric conditions beyond depression. Furthermore, we should push more for more frequent maintenance treatments given that more than two-thirds of our users report a return of symptoms after the original series of treatments. With this new sales strategy, we can further disrupt the mental health care industry, making ketamine more available than ever before. By expanding the conditions we treat and offering more frequent booster treatments, GoodMood has the potential to be a disruptor in the mental health industry.” Elijah explained, flashing a wide smile. “Are there any questions?”

Tara just kept clacking at the laptop, her eyes glued to the screen; however, Ramon lifted his gaze from his hastily scribbled notes and raised his hand. “What measures do you have in place to prevent clients from abusing this drug, given your new sales strategy? I think we need some guardrails in place.”

“We aren’t going to give people unlimited ketamine, of course. We’ll do some additional research to establish when clients become at risk for addiction,” Elijah replied. “It’s no big deal.”

“And what about the effects of ketamine on the bladder? What measures are going to be taken to prevent that if we’re going to promote more frequent boosters?” Ramon asked.

“We’ve never had our clients complain about that according to our current data.”

“They may have never complained directly to GoodMood about that, but clients may have sought treatment for this kind of issue without informing us. Besides, we never pushed the drug like this before. We have an ethical responsibility. We can’t put people at risk, and we certainly can’t paint a picture that ketamine cures everything. Don’t forget that this is still a potentially dangerous substance if misused.”

Elijah scowled. “This is why I am in sales, and —”

“And I’m the Chief Medical Officer. Why even have me here if we’re going to throw science out the window and turn ketamine into snake oil. We want to treat people who actually need this drug.”

Owen, Head of User Experience, said, “Let’s keep our heads cool here. I know there are recent promising studies with regard to ketamine and anxiety that we shouldn’t ignore. But I’m not so sure about touting it as a treatment for some of the conditions you listed, Elijah.”

“Well, I think you’re underselling it. It can do what traditional psychotropic drugs often can’t. A lot of people deal with treatment-resistant conditions. I know that from personal experience.”

Tara, still staring at her laptop screen and typing, said, “If we go with this new sales strategy, how will the roadmap for our software devs be affected? They’re already slightly behind on current deliverables.”

“It shouldn’t affect the roadmap too much. We’ll be adding a list of the new conditions we treat and a description of the new booster process to the UI on the website and the mobile app. That’s all. Should be a quick fix,” Elijah replied.

“If deliverables aren’t impacted, then I’m good,” Tara replied.

“As the only medical professional at this meeting, I can’t approve of this. We need to act with integrity and think of our clients’ interests. Don’t forget that there are people that abuse ketamine. We absolutely need to be judicious. Let me remind you that the FDA hasn’t approved ketamine for the treatment of any disorder. They approved Spravato, but that’s a ketamine-derived drug used in a certified clinical setting, not a mail-order situation like what we’re doing,” Ramon asserted. “Why even have a Chief Medical Officer if you don’t actually care my input?”

“There’s no need to fearmonger. We are a business, Ramon. Of course, we need to make more money. We’re so close to being ready for the Series C funding stage. We all will be rich if things play out the way I plan them. We just need to push ketamine more.”

“Is that what you truly want? Be careful what you wish for.” Ramon jolted up and left the conference room, carrying his laptop and fat stack of files with him.

“So is everyone else on board?” Elijah asked, smiling sheepishly this time.

“Why don’t we circle back and have another discussion after emotions settle?” Owen asked.

Being in different specialties, Elijah and Ramon always butted heads. While Ramon always felt secure in his medical knowledge, Elijah felt like he had more to prove. When he started at GoodMood as a software engineer for the company’s mobile app, he felt the need to prove that his boot camp education could hold up to his teammates’ computer science and computer engineering degrees. He was consistently the first to arrive in the office and the last to leave, learning his app’s software architecture, databases, and backend services in that extra time. Despite his hard work, he often became depressed and relied on GoodMood’s star product to reset his brain and make him functional again. Ramon’s objections to his sales plan reverberated in his head, and he needed another boost. Again. Doubts were creeping in that he wasn’t good enough or knew what he was doing. He took the next day off.

“My intention is to understand what I need to do to excel at work and get approval for my sales strategy,” Elijah whispered to himself. He had meditated as soon as he woke up and then spent half an hour journaling to compose this intention for his treatment. He then fasted until he took his ketamine pill in the afternoon.

Elijah lied on his bed, on top of his navy blue duvet. He then placed a ketamine tablet under his tongue and then put on an sleep mask and headphones. He began listening to Johns Hopkins Psychedelic Playlist on Spotify. Within ten minutes, he began to feel formless and weightless. Suspended in the warm darkness, he luxuriated in a euphoria born of dissociation. He felt that he was everywhere at once in this mystical reverie. For the next hour, Elijah felt like he had the power of the universe at his fingertips — the frustration from Ramon’s negativity was nowhere to be found. When it was all over, Elijah took off his headphones and mask and drank some water. That single pill was dehydrating. Next, he took his own blood pressure. 150/90. Too high. He stayed in bed and waited 20 minutes. 120/50. Much better. 

The next day, Elijah strutted back into the office with his confidence restored. Not even Ramon could take the smile off his face. He went back to work on his sales strategy. He rejected all of his meeting invites for the day and just focused on salvaging his plan. How much could salvage while getting Owen and Ramon’s approval? Ketamine works. There was no doubt about that in Elijah’s mind. He’s experienced it so many times. Ketamine was there for him like a good friend every time he has sunk into depression or started to seriously doubt his worth as an employee, as a person. He just wanted to share his success story with all of the people out there struggling. Concentrating on work was difficult because he kept needing to go to the restroom. He started feeling a lot of pressure in his bladder despite the frequent bathroom visits.

“Hey, Elijah, did you take another one of our ketamine kits yesterday?” asked Rachel, a nurse practitioner with the company.

“Yeah, I did. Don’t worry I’ll pay for it by the end of the day,” Elijah reassured her.

“It’s not just that. First of all, you’ve been doing this a lot lately. Haven’t you been taking ketamine weekly for the past several months? I’m worried you’re becoming dependent. You shouldn’t need this many boosters in close succession.”

“I’m fine, Rachel. In fact, I feel great.”

“You’re also supposed to meet with one of our therapists for the integration process. You’ve been bypassing that entirely. That’s an important part of the treatments. We’re supposed to do integration work to help increase the neuroplasticity in your brain long term. Tripping out is not the entirety of the treatment.”

“Okay, okay, I’ll go see one of the therapists. It’s not that big a deal.”

“But it is a big deal. You’re bypassing the company’s protocol. We wouldn’t let our clients just take all they want and then not offer integration therapy. That's how you process the insights from the ketamine. It's why we call it integration.”

“Just don’t tell Ramon. Whatever you do, don’t tell Ramon.”

“Fine. I won’t tell Ramon, but you need to stop abusing the system. Taking this much ketamine is not without consequences. I’m worried about you. I’m coming from a place of concern. That’s why I haven’t reported you to anyone.”

“Thanks, Rachel, but I’ve got it under control. I promise.”

“I hope so,” Rachel muttered under her breath as she walked away.

A couple of hours later, Owen stopped by Elijah’s office to check on the revisions with the sales plan.

“I know how important getting your sales strategy approved is, and I didn’t necessarily agree with everything you said, but I’m really on your side. I do want to see you succeed, “ Owen said.

“It’s not you I’m worried about,” Elijah said. “It’s Ramon. It’s always Ramon. He’s always out for me.”

“I wouldn’t say that’s true,” Owen explained. “He’s our medical guy, and he really knows his stuff. He doesn’t want our company to get in trouble with issues that aren’t medically ethical. That’s why we pay him. We don’t want to be like those other mindless cash grab startups, do we?”

“This shouldn’t be a cash grab, sure, but we should have achieved a greater market share by now,” Elijah replied. "I see the potential."

Elijah doubles over in pain.

“What’s wrong? You’re not looking good,” Owen said.

“It’s nothing.”

“Are you sure?”

“Yeah, I’m fine. Can we talk later? I just have to go to the restroom.”

Elijah was able to hide his condition for only two more days. His attention was almost always on his bladder, not his work. More of his colleagues began to notice that Elijah was struggling with something. Ramon marched directly to Elijah’s office after lunch.

“Elijah, it may not be obvious to others what is going on with you, but I have some idea of what this could be,” Ramon said. “I’m guessing you could possibly have developed ketamine bladder syndrome, or ketamine-induced cystitis. You need to see a specialist and get a proper diagnosis, so that you can get this treated properly.”

“Did Rachel rat me out?” Elijah asked.

“Rachel didn’t tell me anything, but the frequency of your bathroom trips and your inability to concentrate on work tipped me off. I just made an educated guess.”

“Did you come here to gloat?”

“Is that what you think? I’m a doctor. I came here to help. I know we’re not the best of friends, but I don’t revel in your suffering.”

“You were right, okay? You were right. I thought I was invincible, relying on ketamine. I even started taking it without any authorization or integration therapy. I thought it was helping me in any case.”

“It was helping you until you consumed so much that it damaged your bladder. How often have you been taking it?”

“I’ve been taking it weekly for the past year.”

“That’s too much! You should have said something. There are other ways to help your depression.”

“But it worked so well. I felt like I could conquer the world.”

“It worked well until it didn’t. We have to get you some help. I can refer you to an excellent urologist. And if you can’t quit ketamine on your own, we’ll find a rehab program for you.”

“How can you say this so calmly? I can’t even process all of this right now. I thought I had everything — the promotion, the new direction for the company, the money, the status — I had it all, and now I’m losing it.”

“You’re seriously ill. You need to focus on yourself right now. Never mind those other things. You’re a smart guy — you’ll get your career back on track. But only if you take care of yourself first. I’ll help you, Owen will help you, Rachel will you, and if Tara can be taken away from her laptop, she’ll help you, too.”

“Why are you doing this?”

“You might not realize this, but I do care about your well being. And not just as a medical professional. As a person. I was never your enemy. We just had differing opinions. There’s a huge difference.”

“I wish I realized that earlier.”

“It’s not too late.”

A year later, Elijah was back at the Golden Bull with Ramon, Tara, Owen, and Rachel in the same booth where he celebrated his promotion to Head of Sales. This time, though, he was no longer working for GoodMood. Those days were over. After he was terminated from GoodMood and sought treatment, he landed a product management job at HarmonyPlate, a vegan meal-kit startup. 

“I’m a new man. No more ketamine for me — not professionally, not personally. Some days, I still can’t believe I lost everything I had at GoodMood, but I’m actually glad things unfolded the way they did,” Elijah explained.

“You’re the comeback kid, Elijah,” Rachel said.

“I knew you had it in you,” Ramon added. “You’re too driven to stay down.”

“That’s right. Here’s to Elijah,” Tara said, raising her glass of Emmolo Merlot. Everyone clinked their glasses. For the remainder of dinner, Elijah did not say much. He picked at his Ribeye while everyone else chatted about the latest goings-on at GoodMood: the expansion of their services to five more states, the hiring of more medical personnel, and the expanded integration therapy program. The company managed to grow without Elijah’s sales strategy. It was humbling to hear. After dinner, he caught up with Ramon in front of the restaurant. 

“Look, man. I was such an asshole to you when we worked together,” Elijah said. “I didn’t give you the respect you deserve.”

“Where is this coming from?” Ramon asked.

“I thought about this a lot this past year. I thought I knew everything, but I should’ve listened to your expertise. I wouldn’t have gotten into so much trouble if I had. I was consumed with becoming successful and feeling good. I didn’t have any sense of perspective. I was in it deep, Ramon.”

“It looks like you’ve really grown since you left. I’m proud of you,” Ramon said.

“You know, I’m proud of myself, too.”

“Now there’s the Elijah I know.”