by Roman McClay
And she thought this the way that all confident and young people think things; without question, without doubt; without evidence. She was a young woman who had never worked a physically demanding job in her life; never had broken bones, never had disc or tendon compression, never worked like a man .
Anyway, there was a moral issue at stake, in addition to the epidemiological and pharmacological issues; I mean, she thought, the pain pills don’t even work after a while, these people just take them reflexively, and to slake their desire for the drug not quell the pain . The body would restore natural equilibrium on its own, with its endogenous pain suppressants, this was well known in the field , she thought and believed. All he needed was yoga and mindfulness and maybe an aspirin or two.
“Do you understand the effects of pain medication on the body?” she asked him with haughty contempt. Explaining etiology and sequela and drug interactions to these people was so tedious , she thought.
“Besides attenuating the pain?” he said with a wry smile. “You mean the deleterious effects, like respiratory failure, acute respiratory failure,” he said in terms that made her uncomfortable for its specificity.
“Yes, it slows breathing down,” she made it demotic, as if he needed it dumbed down from her high elevation of erudition. She was still behaving reflexively; not noticing the cues.
“Right, in the event of an overdose or in combination with barbiturates or alcohol, that is correct. See, I’ve been on these meds for a long time, over a decade, and I’ve never once OD’d; because I take the pills as prescribed by my physician,” he said with his own contempt now.
“Right, but accidents do happen,” she said as if that was applicable to such a man. As if this man was like other men; as if all men were the same. Statistics mattered to her, and they mattered right now.
“Right, to other people, they certainly do. But, since I’m the patient, we must look at my track record; and in 10 years, not one deviation from the course of treatment, not one. I am a model patient and that is because I am not a drug addict. I am in chronic pain from a C5/6 compression fracture which feels like, I don’t know if you know this,” he paused, “of course you know this, you are a physician, but just to tell you what you already know, it feels like there is a 10-pound weight on my head pressing down all the time on a detonator between my vertebrae; and that detonator is linked -neurologically- to a bomb in my soul. I feel squeezed.
“And that is in addition to the pain, the acute stabbing pain when I move, the chronic aching pain all the time, the waking up at 0300 in pain, the radiating pain down my back and the sequela of cramping and spasms and limited range of motion which cause me to move in awkward ways. And of course, the nerve damage, a burning sensation in the foot and hand now, and stingers that feel similar to being electrocuted, all verified by the EEG, which shows I have nerve propagation vitiation along the arm and leg and that I have nerve impingement from two starburst bone spurs in the neck that have grown sufficient in girth to touch the back of my trachea now.
“The X-Rays and MRI will show -most if not all of- this; if you look at them,” he added to allay her -he felt likely- provenance concerns; he had not yet figured out that she was not going to help him regardless of the evidence. He had foolishly believed her when her biography -on the pamphlet- said she practiced, evidence-based medicine . He was almost permanently naïve about the way the mind of man worked. He thought reason would overcome their prejudice. At times he forgot all he knew about human nature. At times he thought his words mattered .
“That won’t be necessary. Ok, so we don’t prescribe pain meds here, not for long term pain management, so I’ll refer you to a place in Pueblo,” she said curtly.
“I was trying to avoid driving, see, it’s 450 miles round trip to Denver from here, and that adds 1800 miles a year to my driving; I only drive 1,600 miles a year total now; so, it doubles my chances -by doubling my time on the road- doubles my chances of an automobile accident. Deaths on the roads are at 35,000 and injuries are twice or three times that. So, your bio says you’re evidence based, right? Well, that is some empirical data for you; driving is more dangerous than pain meds.”
“Well, actually 60,000 people died from opiates last year,” she said even though this was a lie.
“Right, 40,000 of that number are from illegal or counterfeit narcotics, like heroin or Fentanyl, not at all what I take, and another 11,000 are from people who drink alcohol with their meds. So, the real number is less than 9,000 deaths from legit pain meds and yet, still that 35,000 deaths -that number from driving- remains.
“Plus, I will take the meds either way, either from you or from my doctor. That is constant. What is the variable is how far I drive to get them; which is why from a purely logical perspective it makes no sense to make me double my driving miles each year to get what I could get here,” he said with words she neither heard not understood.
“Well,” she was opening the door now to get him to leave.
“Second, nobody with a science background takes a look at data and extracts out one variable. One must do a multi-variant analysis and extract out how many of the patients who died from respiratory failure while on legally obtained pain meds had a suicidal ideation, or drank alcohol on a regular basis, or were new to the drug, on it less than one year -for example- and were unfamiliar with the effects. How many had IQs under 105, might be worth looking at. An IQ in that range might explain their inability to appreciate the regime itself or its consequences for failure to follow it.
“See, if you eliminate all that and look at patients with 115 or higher IQs, with over 13 months of consistent use of the meds, and no alcohol use or suicidal ideation or depression, the number drops to under 10%.
“That means 3,000 people who fit the profile that I present, high IQ -you can use my ASVAB scores, just request them from the VA or administer your own test for all I care- and no use of alcohol, no depression or other mental defects, and a long record of proper use of the meds, then you can make an evidence-based judgement call that I have a 10 times greater likelihood of death from driving to Denver every three months to get the meds, than I do from taking the meds themselves.
“And yet, in your mind, it’s dangerous to prescribe me the pain killers, but totally sane to send me out onto the highways of America despite the evidence.”
“Are you done?” she was not happy. Her adrenaline was spiking. Her skin was damp. Her mouth was dry.
“I’m never done,” he said with a grin that made her heart increase in rate by 22% .
“Well, I am then; the pain management people will call you. Have a good day,” she said as her head dropped to gaze at the floor and she pushed opened the door even wider while her frail female arm -insufficient in every way- was held out as some falsely polite gesture.
He was twice her size, and twice as right as her, and his cognitive capacity was one standard deviation higher than hers, and he had made five times the money in the last five years than she had; but none of this was acknowledged by her. She was like the goofy tourist at the zoo fucking with the tigers or the chimps with zero clue how superior those beasts were to their dumb ass , he thought. He rose from his seated position and walked toward the door.
“I see, I’m just unworthy of your beneficent treatment. Well, I may not understand the vagaries and the minutia of the medical fields’ new protocols and taboos, but I know when I am being treated like I’m sub-human, and ma’am , you have been hostile and indifferent to my maladies since before I even arrived, and my appearance no doubt confirmed your bias,” he said as he looked down at her over his hard visage. He was between her and the wall; in the doorway but lingering.
“That is unfair, I, we just don’t do pain meds here; it’s not what we do,” she could feel his malice and anger and her body was scared at the brain stem; at the subcortical zones. Her voice had changed from hard to soft, her ideas on medicine changed and went watery and she had no idea what she was about at all. She was almost nice now.
“I can still be your doctor, just not for that,” she said as if bargaining.
“Oh, I see, so,” he stopped before he let that thought escape.
“Look, I can write you one prescription to bridge you. When do you run out of your current,” she was willing to compromise this once as he interrupted her question.
“Next week,” he said curtly.
“Ok, I’ll be right back,” she said.
He thought of how undignified it all was, for a grown man, a man with documented spine and vertebrae injuries, and chronic pain, a man who had sacrificed his body against the wheel of this culture, done jobs and carried out missions that benefited all these bourgeois fucks and they didn’t care at all. He thought of how emotion, empathy, was verboten , inefficient, counter-indicated. He thought of how he felt, and how his feelings were not important at all to modernity and their efficiency and their fucking rules.
Oh, they pretended to care, they pretended they didn’t want him to OD, but it was worse than that, he thought. See, the NSAIDs -the non-narcotic part of the drugs, what the opiate part is annealed with in order to help as a potentiator to the opiate part of the drug- is as -if not more- dangerous as the opiate part . Yeah, he scoffed to himself, what nobody says or admits to, but what the data show is that Ibuprofen leads to acute and chronic liver failure, cardiac arrest and heart disease at way higher the rates than the opiates prescribed .
Ibuprofen kills at least 20,000 people a year, and when he had asked for a higher dose of opiates -15mg- unalloyed with NSAIDs he had been turned down, even though the NSADIS are demonstrably more dangerous because of the heavy metabolic churning they put on the liver and heart. These NSAID drugs also thin the blood and since he lived at 9,000 feet, and was alone 99% of the time, and susceptible to bleeding out, the opiates were the least dangerous thing in real life. The NSAID were statistically and logically more dangerous. But try telling a doctor that. Try showing them the evidence, he thought as he waited for her to return.
The Johns Hopkins’ studies or the massive meta data studies done by Columbia University that show how dangerous non-narcotic analgesics actually are, was known by him, but no doctor would care to even listen. He was scum. He was a working-class man in massive pain, a worker in a world that used up and threw away such beasts as disposable, deplorable, the dregs of the earth. Their pain -the working man’s pain- was as relevant as the rat in the cage, the bacteria in the dish, the idea, the avatar that these professionals -these college grads- killed in reverie or throw-away lines.
Evidence based, my ass, he thought, they are just responding to political and media pressure, they are covering their asses . They didn’t give one fuck about him or anyone else.
Plus, he thought, even the people who die from heroin on counterfeit pills laced with Fentanyl, are only victims, only dead, because they are the refugees from doctors who cut off their pain meds. Yeah, he thought, the doctors get them hooked, prescribe them once or twice and then cut them off, without any compunction. And then the guy who is in pain, both from addiction and the underlying cause, is then forced to score smack on the street or counterfeit pills from some junkie dealer, and then -only then- do they overdose .
If the doctor had kept them on the pills, under supervision, under control, maybe they never would have resorted to heroin at all for christsake . But, again, he thought, try any of this flawless logic out on a doctor, a middle brow with a mere 130 IQ, or even worse, a politician with a 110 IQ at best.
Hostility wasn’t a symptom of drug addiction, he thought briefly, it was a symptom of being treated like shit by people who think they are better than you. She returned as he finished that thought in his head; he refused to even look back at her now.
“Here,” she said as she arrived back in the room with the prescription paper, but he looked only at it -not at her- and only with malice; and then said he couldn’t take it. She held it in her hand like a shield.
“No, I can’t take that, I have an agreement with my doctor not to access these medications anywhere else. It’s illicit for me to even take that.”
“It’s not illegal, you just have an agreement, you signed a contract, that is not the same as illegal,” she said as if she knew something he did not. Her language was so haughty and fatuous that he no longer could stand to hear her speak at all; his eyes rebelled against her visage, and now his ears were too in revolt. If she merely said her name or the day of the week now he felt he might snap a connecting rod.
“Doctor shopping is illegal, and I have a feeling that this is a trap set by you, my guess is your next call would be to the DEA. So, I respectfully,” he said without any respect, “decline.”
He walked out as she stood there with mouth slightly agape and her hand on her phone.
He walked to the front desk and breathed out through his nose like a bull and paid the $158.00 bill in cash. They made mention of insurance plans for the indigent . He laughed with a contempt that he was surprised he had left in reserve -maybe it was an endless supply, he mused- and said sternly to the receptionist that he was not broke. He was self-pay because he didn’t want some insurance company controlling his health care decisions, he said. He paid in cash for the autonomy it conferred, he added, not out of the inability to pay for insurance.
They didn’t understand 40% of the words he used, but somehow they still got the point as they marked his 100 bills with counterfeit-detection pens and the bill turned the appropriate brown. He left an air of malice in his wake, the atmosphere was heavier than before he came, the jagged words in their heads felt unable to move to their mouths. This effluvium of body -of mode- is what communicated, not the words. And they all thought it was because he was the problem, not them; it was not their lack of empathy, or erudition, or soul. It was he that was the problem. Always. It had always been this way with the world versus the man of intelligence and pride and no bend to his knee.
“There’s no water in the lake. Thus, the superior man stakes his life on following his will. Because his words have no effect,” his right hemisphere read to itself now -his ears almost heard it too- from the I-Ching as it lay closed up at home on the shelf; home at elevation, as the pages grew hot between boards.
It, he thought of the world, had always been this way with the man far ahead -or the beast far behind- of the goddamn herd.
29. Are You Playing this Game with Me
History knows no scruples and no hesitation. Inert and unerring, she flows toward her goal. At every bend in her course she leaves the mud which she carries and the corpses of the drowned. History knows her way. She makes no mistakes.
Darkness at Noon [Koestler, Arthur]
Men may seem detestable as joint-stock companies and nations, fool, knaves and murderers there may be; men may have mean and meager faces, but in the ideal man is so noble and sparkling, such a grand a glowing creature that over every ignominious blemish in him all his fellow should rush to throw their costliest robes
The Whale [The Author]
I’m no one to be trifled with; that is all you ever need know
The Princess Bride [Goldman, William]
I. 2008 e.v.
“Crank,” he said.
The process of disillusionment seems like no process at all when one is merely angry -at everything and nothing at all- before that, when one is young and all the world seems a crater of love filled to the lip so one may simply come ashore and never touch whatever bottom only the water itself knows, one cannot be disillusioned.
For one cannot -yet- conceptualize that one lives in an illusion of any kind. One still thinks it is all just fine and the way things both ought and are to be.
He was born angry. This is no bragging hagiography. Every photo from an age of 6 months to double digits had a baby face with a proto-scowl working on
the fissures he had now at age 34. This face was built, like a grand prix roadway -perfect grade and banks and winding lanes- built for the speed and Tartarean power of angry torque in the rage-machine. It also, with black road to hide the blacker mars of abrading tires and the shavings of metal hulls that spark then fall like atomic dust upon the treadle of the loom, had both fresh and tired scars from where the rubber met the road.
“Crank,” he barked again -louder- and held the throttle wide open. The solenoid, then crankshaft, the pistons and rockers all turned; valves next and the distributer whirred and a spark was sent from axon to dendrite sparkplug cables like heat across the vacuum of space; the infinite of man's mind. A small but perfect explosion entered the #6 cylinder as the piston compressed what had been a chimera of fuel and air like the mist of Angel Falls from the jets of the carburetor -more vapor than fluid- atomized from that great height .
The non-sequential firing took over like an instinct now; cylinder #1, then #4, then #3 then #8, all compressed the fuel-fog and held the spark and then exploded in a singularity of Detroit Iron Doom.
He released the throttle body and let the spring pull back the arm. A flame belched up through the carb and popped; he didn't move a muscle; leaning in the engine bay looking for vacuum leaks between the intake and the engine; then clockwise he checked each hose.
“3,000 rpm, steady,” he ordered to his mechanic behind the controls. The car began to howl as the man with his hands on the wheel depressed the accelerator bringing the engine idle to 3,000 rpms and held it there.
A delayed concussive shudder rumbled through him from his right hand as it cupped the paddle on top of the carb's secondaries; that aftershock ran through the sinew of the arm then buried itself in the blood as it shocked the rest of his large corpus. Only a slight grimace and twitch of the head on his imperfect neck gave any hint that that promethean flame -that had escaped the gods’ belly of the combustion chamber- had unnerved him. The spinal cord still -and always- transferred fear faster and without permission of the conscious, inured, cortex that no longer feared the internal combustion engine and its violence. The spine and dorsal horn still felt ancient fear no matter how modern the rest of him got.