by Jaime Maddox
“Jess, you could run into someone you know in there.”
“I’ll cross that bridge later.”
“What about the hospital? Won’t they want some sort of progress report before they allow you to return to work?”
“The hospital doesn’t know I’m here. I told them I’m going away to relax and recover. I didn’t tell them I’m being admitted.”
“Okay, fine. What about your insurance? Someone from HR could get a call to verify your coverage, and then they’ll know. What then?”
“I’m not using my insurance.”
“What?”
“You heard me.”
“No, I couldn’t have, because I thought you said you’re not using your insurance. Which would mean you’re paying cash. Thirty thousand dollars in cash.”
“It’s a check, actually, and it’s thirty-one. What’s the big fucking deal? I have the money. Why can’t you understand the implications here, Ward? If the state finds out what I’ve done, I’m screwed. My only chance to get my life back is to do it this way. Why can’t you support me for once instead of having to be a fucking Girl Scout, doing everything by the book?”
Ward was silent for a moment before speaking. “It’s your license, Jess. What would you like to eat?”
Chapter Five
The First Step
“Wow,” Ward said two hours later as they rounded a bend in the tree-lined road and caught their first glimpse of the clinic. It was a massive structure of stone, with towering chimneys protruding from gabled sections of roof, reminiscent of colonial mansions Jess had seen throughout the Delaware Valley. She knew this one was modern; it was built twenty years earlier, not as a residence for wealthy colonists but solely as a rehab hospital. The exterior was much the same as the old psych hospital where she’d rotated during her medical school days, but she knew from her Internet search that the similarities ended there. Inside, she wouldn’t find any drab white walls and gray tiled floors. The Hartley Clinic was colorful and cheerful, a bright place where the space made people feel good, or at least could help them to.
Signs directed them to a large lot, and after Ward found a spot and parked, they walked toward the portico and the hospital’s entrance. Jess pulled her largest suitcase behind her, happy to be moving, grateful for the weight that caused her to breathe a little harder than normal. The effort felt good, and she felt good, so she suddenly questioned her decision to come to this place.
Couldn’t she and Ward just keep driving, down to Delaware? They’d rent a beach house for the month—hell, with thirty grand they could get beachfront in Rehoboth. They’d ride their bikes and read on the beach, make love in the afternoons, and then watch sunsets over the bay.
Her legs stopped moving, and ahead of her Ward glanced back. Good, sweet Ward was reading her mind, Jess knew when the lopsided smile appeared on her face and she reached for Jess’s hand. “It’s going to be okay.”
“I’ve fucked up my life so badly,” she cried into Ward’s shoulder.
“Badly, yes. But not sooo badly. Not beyond repair. You just need a little help. I know you think you’re smarter than these people, and that you can figure out this disease on your own, but the statistics suggest otherwise.”
“I’m not a statistic. Statistics are for normal people, and I’m not normal.”
Ward laughed. “No, you’re not.”
Jess laughed, too, and lightly punched Ward’s shoulder. “You know what I mean.”
“Didn’t you already try to wean yourself?”
Jess nodded, and her vision of Ward blurred from the tears that flooded her eyes. She had tried. And tried. And tried. She could tolerate the sweating, and the muscle pain, even the diarrhea. But the anxiety made her crazy, and in the last moments of the most recent effort she’d made at weaning herself, she truly understood why people killed themselves, because if she had no fix for that feeling, if she couldn’t just pop a few oxycodone tablets in her mouth and make it all better, she would have chosen to end her own life then and there.
“I couldn’t do it.”
“And you don’t have to, Jess. You just need treatment. That’s what this is. Medical treatment, for a medical condition. It’s no different than what you do every day. If one of your patients had an infection, you’d tell them to take their antibiotic. If they were diabetic, you’d tell them to take their insulin. This is no different. You have a disease, and you need to take medication to treat it.”
“Is that really what you think? You don’t think I’m a junkie?”
“I think you’re an addict. And addiction is a disease. And you have PTSD, which is another disease. And if we stay out here any longer, you’re going to have hyperthermia.”
Jess looked into the bright, cloudless sky. “I wonder when I’ll see daylight again.”
Ward grabbed the handle of her bag and they began walking again. “Probably at your evening Stroll with the Staff.”
“How about that?” Jess smiled. Every evening, regardless of weather, patients were encouraged to hike the ample grounds. Counselors and physicians led the group treks, and they all talked about a variety of topics as they took in some fresh air and Vitamin D.
“This weighs a ton. What the hell did you pack?”
The bag was stuffed with casual and exercise clothes, slippers and loafers and sneakers, toiletries, and her own bedding. “It’s probably the twin comforter. I don’t think it fully dried before I packed it.”
Ward turned to eye Jess and her jaw dropped.
“What? You can’t expect me to sleep on their blankets! Who knows who used them last? Besides, you know how sensitive my skin is.”
“Jess, you are—”
Jess held up her hand. “I know, you have no words.”
“Special. I was going to say special.”
Jess stopped. They’d reached the portico, and just a few yards separated them from the grand front door and the unknown world of integrated care. “I want you to know that I’m not giving up on us. I know you think you’re in love with Abby, but how could you be? You’ve known her for two weeks. I’m going to give you a little space—like a hundred and twenty miles. And a little time—like twenty-eight days.”
Ward’s eyes clouded and Jess saw the hesitation there. She worked quickly to remove it. “Or longer, Ward. I don’t care. What’s the hurry? I just want you to know I’m dedicated to getting better. My addiction drove you away, not my heart. Not my real heart.”
Jess wasn’t sad for the tears in Ward’s eyes. She knew they meant Ward cared. Ward still loved her. There was hope.
“I want you to leave now,” Jess said as Ward wiped her eyes.
“Why?”
“What’s the point? I can take it from here. I’ll call you when I can, and I’m counting on you for a ride home, right?”
Ward looked confused and Jess stepped closer, hugged her. “I’m good, Ward. Really.” She stepped back and saw the doubt on Ward’s face. “I promise I won’t run away.”
They both laughed, and the sound buoyed Jess. “I’ll call you,” she said, and before Ward could reply, a door opened and a middle-aged woman in a lime-colored pantsuit stepped through.
“Welcome,” she said. “Are you checking in?”
Jess nodded. “My friend is a little nervous about leaving me, but I’ve assured her I’ll be fine. She has a long drive ahead of her, and I’d feel better if she gets started.”
The woman nodded. “Of course, that’s fine. If you’re okay, she can certainly be on her way.”
“I guess this is it, then.” Ward opened her arms, and Jess stepped into them again. Jess tried not to think about how good it felt to be there.
“I love you,” Jess said, and Ward murmured the words back to her. Then Jess took the handle of her suitcase and turned, following the lime-swathed woman through the doors and into her new life.
“I’m Annette,” the woman said. “I’ll get you signed in, if you’ll just follow me to my office.”
“Jessica Benson.”
“I’m an admissions counselor. That’s my job title. My background is in counseling, but I do many things here. I speak to people on the phone, to make sure our services are appropriate for them. You talked to my colleague, so I’m guessing you’re familiar with that process. Now that you’re here, I’ll ask you more detailed questions, to help determine the plan of care we need to follow with you. I’ll make some recommendations to the psychiatrists—both the PTSD psychiatrist and the addiction specialist.”
Jess interrupted her. “You have a psychiatrist who specializes in PTSD?”
“Let me clarify,” Annette said, and she didn’t seem at all condescending. She sat back in a cozy leather chair, one of four in the conversational grouping in her large office. “PTSD is not a specialty in itself. The doctor isn’t board-certified in that field. But we see so many patients with PTSD that we have one doctor who treats only them, so, as you can imagine, she’s gotten quite experienced at it.”
“It’s a woman?” Jess asked, feeling better already.
Annette smiled. “As a matter of fact, both your psychiatrists will be women. Do you feel more comfortable with women?”
“I’m a lesbian. I feel much more comfortable with women.”
“Ha! You’re in good hands, then. And I guess I can skip the lecture about fraternizing with the male patients.”
“No worries there.”
“No fraternizing with the women, either.”
Jess met her eye. “You’re just going to have to trust me, I guess.”
Annette looked at her sideways. “Until you give me a reason not to.”
Jess nodded at the not-too-subtle warning.
“Let me tell you about your day. I’m going to ask you a few questions about your history. Then I’ll walk you to the detox area, where the PA will examine you and make sure you’re in good health. While you’re with him, your bags will be searched for contraband. Whatever is deemed inappropriate—reading material, drugs, phones—will be removed and put into a locker for you to pick up at the time of your discharge. If you’re hungry, you can get something to eat then, and afterward you’ll meet with the addiction specialist so you can begin treatment. In your case, since you’re beginning buprenorphine, the process will be relatively benign. Most people feel normal on bup.”
“I’ve read good things about it,” Jess said. Even though she was a doctor, she knew very little about addiction and its treatment. During the past days, that had changed as she scoured the Internet for information and formulated her own treatment plan. She was here for bup, and she was sure it would help her. It had to. If she didn’t stabilize her addiction, she was in real trouble.
Jess tuned back into Annette, who’d continued her speech as Jess sat daydreaming. “During the induction phase—until your dose of medication is stabilized—you won’t be doing much. It’s hard to predict how you’ll feel, so we don’t schedule anything. If you feel well, we would encourage you to begin attending some of the meetings that occur just about every hour. After your addiction is controlled, you’ll begin meeting with the psychiatrist to determine your treatment plan for the PTSD. Unless the addiction specialist thinks you need to be seen sooner, of course. We try for a nice combination of structure and flexibility here, so everyone can get what they, as individuals, need to recover.”
Although she was anxious, a wave of optimism came over Jess, and she felt something she hadn’t felt in a long time. Hope. She was hopeful about getting her addiction under control. She wanted her life back. “It sounds like a great place.”
“We have an excellent record, Jessica. People who are motivated to recover can, and we’re proof of that fact.”
“I’m motivated.” Annette had used the word “normal” when she discussed the therapy. Jess wondered if she’d ever been normal, even when she wasn’t taking drugs. She’d felt okay, maybe a little out of place at times, but she’d found a good fit in medicine. The medical field included a plethora of geeks and nerds, and she was just another one, overly smart and a little socially challenged. Without her career, she didn’t know what she’d do. It was her ground, and she needed to get over this addiction, because if anyone ever found out her truth, her career could be over.
It wasn’t just her career, though. If she ever wanted to win back Ward’s heart, she’d have to be clean to do it. Ward would never accept her this way, and that was a big motivating factor.
“First things first. You’re here for treatment for opioid addiction. Are you currently experiencing withdrawal symptoms?”
Jess shook her head. “No.”
“Very well. I have a paper for you to complete, a brief medical history. Once you meet your psychiatrists—probably tomorrow, since it’s so late in the day—you’ll have an extensive psychiatric exam. But this will get us started. I find it helpful if I ask the questions rather than having you complete the paper yourself. Would that be okay?”
“Sure.”
“And would it be okay if I type the answers into my computer as we go along?”
Jess wanted to tell her she understood the woes of electronic medical records, but she kept quiet and merely nodded.
“Do you take any medications?” she asked, and looked up, meeting Jess’s eyes.
“Oxycodone. Ten migs.” She nearly said “Q4,” medical lingo for every four hours, but she caught herself. If she wasn’t going to tell the staff at the hospital she was a doctor, she had to try hard to not act or sound like one. The task would require patience, an attribute she admittedly lacked. Allowing someone else to spend an hour extracting a history she could have accurately provided in minutes was the first test of her hospital stay. How many more awaited her?
“How often do you take the oxycodone?”
Jess swallowed her prompt reply and instead pretended to ponder the answer. “I’m supposed to take six a day. Sometimes I take four, and sometimes I take eight.”
Annette nodded, and Jess expected a follow-up question regarding the source of the pills, but none came. “Anything else?” she asked instead.
For a moment Jess contemplated telling the truth about her Xanax. It could cause a fatal overdose when used with bup. She knew that wouldn’t happen to her, though. She didn’t take extras. If she admitting using Xanax, the doctor might not give her the bup. There was no way she could come clean about it. Her dilemma was the inevitable urine drug screen she expected within the next few hours. A small lie seemed like the best course. “I take Xanax once in a while. When I can get them.”
Annette’s head popped up from the computer screen, and she eyed Jess with concern. “How often do you take the Xanax?”
“Oh, once a week, maybe.”
“When was the last time you took one?”
“Last night, to help me sleep.” Jess smiled, what she hoped was a sad smile. “I was really nervous about today.”
Annette’s expression softened. “I understand. But we won’t be giving you any Xanax here. It doesn’t mix well with buprenorphine.”
Jess tried to sound surprised. “Oh, okay. Well, I don’t need it, so whatever you have to do.”
“Okay. Did you bring your medication with you?”
Jess had both the oxycodone and Xanax hidden in a secret compartment in her suitcase, in case of emergencies. She wasn’t about to share that information with Annette, though. “No! I didn’t know I was supposed to.”
Annette smiled again. “No, you don’t need them. You’re not allowed to take anything, even ibuprofen, unless a nurse gives it to you. Does that make sense? We want to control medication use. It might not be convenient to walk to the nursing desk for a Tums, but this practice helps curb addictive tendencies, like popping a pill.”
Jess had a whole pharmacy in her suitcase. She never left home without a supply of antibiotics and other essentials. “I do take ibuprofen, for headaches. Is that okay? Can I get that from the nurse? I forgot to bring it.”
“Of course. You can request
anything you need, and within reason, they’ll give it to you. Now, back to your history.”
Annette went on to ask questions about Jess’s allergies, surgeries, and family history. Unlike those of a typical family history, her questions focused on mental illness. “Any relatives ever commit suicide? Die suddenly with no explanation? Leave home and lose contact?”
How boring for Annette that Jess was an only child, that her parents had no skeletons hanging from their family trees. She shook her head. “My mom died last year from ovarian cancer. My dad is healthy.”
“Oh, how awful. I’m sorry for your loss. You know ovarian cancer can run in families, right? Have you been checked?”
Of course she’d been checked. She’d had all the studies available, not just for ovarian cancer but every other disease that had shown genetic affiliation. She was a doctor, after all. “I don’t really have a doctor, but I’ll look into that.”
“Let’s talk about your social history. Do you smoke?”
Jess shook her head.
“How much alcohol do you drink each day?”
“I don’t really drink much alcohol. Maybe a couple of glasses of wine a week.” Jess had grown bored with the interview and studied the diplomas on the wall. Annette had her master’s in counseling from Villanova. Impressive.
“What drugs do you use beside the oxycodone?”
“None. That’s it.”
“No heroin, cocaine, amphetamines?”
Jess met her eyes and shook her head again. “Nothing else. Just pills.”
“Are you married?”
“No.”
“Oh, that’s right. Do you have a partner?”
Of all the questions she’d ask, why did this one cause her to flinch? Jess had managed to separate herself from the process, become analytical for the purpose of providing medical data. This was just a formality, the history-taking. Annette would gather this information, and a doctor or two would review it and probably discuss some of it with her. They’d sign off on the chart Annette created and then begin the real business of treating her.
Jess knew this and was playing along, but the question about a partner stung. Why hadn’t she opened up to Ward sooner? Why had she driven her away? Now she was alone, and scared, and the one person who could help her now had found another woman.