Hooked

by Jaime Maddox

  Jess began to sweat and fought the urge to bite a nail or chew her lip. This is impossible, she thought. Who could do this, she wondered. Then, as Dr. Ball listened to her chest, she tried the strategy she’d learned in the past weeks. Accept it. Deal with it. It’s only for a few months, she thought, still wondering how she’d fit all these trips to Wilkes-Barre in around her busy ER schedule. Well, she supposed that was one of the perks of being the department director. The schedule was hers to manipulate.

  Dr. Ball hardly noticed her silence as he continued. “I see you’re taking twelve milligrams of buprenorphine and three milligrams of naloxone combined.”

  Looking up, he waited for her response. “Yes.”

  “And how long have you been taking that dose? Three months?”

  Jess nodded. Two. Close enough.

  “Well, that dose is too low. All of these so-called specialists try to stabilize you with a low dose, and really, what sense does that make? An addict’s brain is all about getting more, trying to satisfy that addiction. Open receptors in your brain cause you anxiety and cause you to misstep and fall off the path of recovery. You need to be taking twenty-four migs.”

  Jess was shocked. Dr. Gompers was happy with her dose. Everything she’d read had indicated she should take the lowest possible dose of medication to stabilize her addiction. She’d titrated the dose at Hartley, and she felt good on twelve. On eight, she’d still been shaky, but twelve was a good dose for her. Why take more? Sure, she had empty opioid receptors in her brain, but they weren’t annoying her. Her occasional stress did cause her tremendous anxiety, but so far, she’d been able to deal with it.

  She supposed so far was the key observation. What would happen when she fell apart, when she wasn’t able to cope? Would she start abusing again?

  As before, the doctor didn’t seem to notice her hesitation as he rambled on. “There’s a meeting in two hours. I’d like you to attend. In the meantime, you can get your prescription filled and come back. We’ll give you your medication here, make sure you’re taking it right, and then I’ll see you tomorrow.”

  Handing her a script, he smiled. “You’re going to do great here, Jessica.”

  Jess forced a smile in return as she accepted the prescription. It was for just three strips of bup. Truthfully, she didn’t need to get the prescription filled. The bottle from Dr. Gompers was in her medicine cabinet at home, and she’d already taken her dose for the day. Her twelve-milligram dose. Should she take another twelve, as the doctor suggested?

  “Just go right over to the pharmacy,” the clerk instructed her. “And when you come back, you can go straight back to your room.”

  Jess walked slowly toward the pharmacy, wondering what to do. Would Dr. Gompers be available to discuss this? Probably not. Sure, she’d return Jess’s call, but it would be too late by then. She’d been hesitant to bother Ward lately, but she always seemed happy when Jess called.

  It was interesting, really, to talk to Ward and see how she was growing as a person. She’d been weak in her relationship with Jess, but with Abby, she seemed to find a true equal. The balance of power was more neutral, and Ward seemed more confident, even in her dealings with Jess. After handing the prescription to the pharmacist, Jess went outside and dialed the number for the ER in Philly.

  “How’d you know I was working?” Ward asked after Jess greeted her.

  “I took a chance. How’s it going?” Jess asked. “Packing up?”

  “I hate it. But it fills my time when I’m not working, and every time I go to Abby’s, I take some stuff with me.”

  “She doesn’t mind your taking over her house?”

  Ward laughed. “She’s trying really hard. We bought some new furniture and a painting. Trying to make it ours instead of hers, you know? It’s so perfect, though, that I really don’t want to change anything.”

  “Do you have your own room to escape to?”

  Jess heard Ward take a deep breath. “Jess, it’s so fucking small we trip on each other. I don’t know what we’re going to do about that.”

  “How about an addition? Remember we talked about putting on a sunroom? If you hire the right architect, they’ll design something that blends right in with the existing structure.”

  “You think so?”

  “I do. Those guys can do wonders.”

  “That’s good news. Because I really want this to work out.”

  “I hope it does, Ward. You deserve someone who appreciates you. I’m sorry I wasn’t her, but I’d feel redeemed if this pans out with Abby.”

  “We were good for a while, Jess.”

  “Yes, we were. Now enough of this mushy stuff. I need some medical advice. Don’t think like you’re treating me. Think like you’re treating a patient.” Jess went on to explain Dr. Ball’s plan to double her medication dose.

  “Wow, Jess, that seems really stupid. Everything I’ve read about this says it’s just as addictive as heroin, so it will be very difficult to wean. If your goal is to get off this stuff eventually, why give yourself a bigger hurdle to jump? And why take a higher dose than you need? It doesn’t make sense to me. Unless you feel shaky or something.”

  “I actually feel better than I’ve felt in years. I don’t really think I need more, but he’s sort of pushing it on me. He says the people he treats are very successful and don’t relapse.”

  “Jess, I don’t know what to say. Do you feel like you’re in danger of relapsing? Do you have a plan if you do get to that point?”

  Jess had shared her adventures in rehab with Ward on the ride home from Hartley. Ward wasn’t surprised that Dr. Gompers had figured it all out. “Dr. Gompers gave me her cell. I can call her if I’m in crisis. She’s going to turn me in if I screw up, so I’m very motivated to stay on the straight-and-narrow path.”

  “So don’t take the extra medication. I mean, take the prescription, but don’t use it. And then if you need it, it’s there. But it doesn’t sound like you need it. Wait. You won’t abuse it, will you?”

  “I don’t think so. I think I’m good.”

  “How about if I keep it for you? Just give you a few days’ worth at a time.”

  “What’s your plan? UPS?”

  Ward chuckled. “You know I’ll be in the mountains, so…I can meet you.”

  “What about Abby?”

  “Abby would like to have you over for dinner. Meet you properly and all. She’d understand. What do you think?”

  “About you being my keeper, or having dinner with my replacement?”

  Ward must have sensed Jess was teasing, because she answered with a rejoinder. “Both.”

  Jess went right back at her, and for a moment, she thought of the good times with Ward—only for a moment, though, before she thought of Mac. “Maybe. Can I bring a date?”

  “Sure! Do you have a date?”

  “I’m working on it.”

  “Really?”

  Jess smiled at the image of Mac that lingered. It was a ridiculous thought, she and Mac, but a pleasant one. She was fodder for fantasy, and while Jess hadn’t actually thought about sex in a long time, maybe she was on her way back. Not that she’d share that with her ex, though. “I’ll talk to you soon, Doc. Thanks for the free advice.”

  Jess collected her prescription and headed back to Dr. Ball’s office for further instructions. This time she had no wait. She was taken back to the same room, and immediately after Jess closed the door, the nurse opened it. “I know you’ve done this before, but I want to be sure you’re doing it right.”

  Jess debated arguing with her about the dose, but she didn’t want to rock the boat. She peeled back the foil packet and removed the strip.

  “Okay, one more,” she said.

  Jess had to speak up. “I already took twelve this morning. I need only half of that one.”

  The nurse nodded and watched as Jess placed half a strip under her tongue.

  “Perfect! Now don’t swallow, and don’t drink anything. I’ll be back to
check on you in a few minutes.”

  As soon as she left, Jess pulled the melting strips from under her tongue and flushed her mouth with water. She was sure some had absorbed, but hopefully not enough to impair her on the drive home. She felt fine to function on the twelve-milligram dose, but how would she feel with double that?

  A few minutes later the nurse found Jess engrossed in a novel. It took her just about a minute to go through the COWS score, which was zero, as it had been for the past two months. When they finished, the nurse offered Jess a remote. “The chair reclines, and you’ll find blankets in the armoire,” she said.

  After she took her leave, Jess opened the doors to the cabinet. For a medical office, it had few of the expected supplies. One shelf held cotton balls and swabs, while the others were stacked with pillows, blankets, reading material, and CDs. A small CD player was tucked into a corner, and a college-dorm-size refrigerator sat on the bottom shelf, next to a basket of snacks. Jess opened the fridge, pulled out a Snapple, then grabbed a pack of Oreos before reclining on the chair.

  “Oh, no!” the nurse said when she came back in. “You’re not supposed to eat or drink anything for twenty minutes.” She looked at her watch. “It’s only been fifteen.”

  “I think I’ll be okay,” Jess said. “My COWS score is still zero.”

  The nurse went off to find the doctor, and Jess picked up the remote to channel surf while she waited. It took him nearly half an hour to respond to the crisis.

  “How do you feel?”

  “Perfect.”

  “Aha! I knew twenty-four milligrams was the right dose for you. Now if you’ll gather your things, you can meet some of my other patients in the therapy room.”

  Jess collected her food and her purse and followed him down a hallway and through another door. A dozen men and women stood talking. Around them, three rows of cushioned stadium seats formed a semicircle.

  At his entrance, eyes turned to the clock and then back to Dr. Ball. “I don’t mean to interrupt your meeting, but I want to introduce your newest member. Jessica, this is our Narcotics Anonymous group. Listen to these people. They have a lot to share and can really help someone just starting out. Now I’ll leave you in very capable hands. I’ll see you tomorrow morning at nine.”

  He must only know one script, Jess thought, the one for new bup patients. She was well on her way, and judging by the cost of this experience, both in time and money, she planned to sober up quickly and get off the bup. Should she explain it all to them, or just go with Dr. Ball’s version? No, she told herself. No more lies.

  They had coffee, of course, but instead of a burnt pot and paper cups, it was served in tasteful floral mugs and brewed in a Keurig. A plate of pastries sat close by as well. I’ll get fat if I spend too much time here, she thought. Another reason to get totally clean.

  Jess sat next to a woman her age and introduced herself. “Kayla,” the woman said. “I’ll teach you all the ropes.”

  “Really?”

  “Oh, yeah.”

  “How long have you been doing this?”

  “With Dr. Ball? Two years. Before that, another two years.”

  “Would you mind if I ask your dose?”

  Kayla laughed and suddenly looked younger. Her brown hair, cut short, fell in sassy waves that danced with the movement of her shoulders. Matching eyes seemed to smile on their own when she looked at Jess.

  “He wants you on twenty-four, right?”

  “Yes! I’ve been stable on twelve for a few months, but he insisted I’d feel better on twenty-four.”

  “He does that with everyone. I was on sixteen when I started here, and he tried to bump me up, but I wouldn’t take it.”

  “What did you do?”

  “Well, I just saved the extras, you know? Then, after a few months, I had like a hundred extras, so I sold them.”

  Jess couldn’t believe a woman she’d known for only thirty seconds was confessing to a felony, but then again, she should have known better than to be surprised by anything that was said during an NA meeting. It was all anonymous, and participants were encouraged to be honest.

  “Yeah, there’s a guy out front you can sell them to. The ambulance driver.”

  Jess didn’t want to hear anymore. “I’ll keep that in mind.”

  “Only don’t sell this month’s dose. They do random drug screens and med counts, and they’ll check the serial numbers on the package to make sure they’re yours.”

  Jess’s jaw dropped. She couldn’t believe a doctor that seemed to push these meds then worried about his patients selling them.

  Kayla must have read her mind. “The DEA requires random counts. Drug screens, too.”

  “I see. But why push the twenty-four-milligram dose?”

  “I think he owns the pharmacy. He can’t have more than a hundred patients, so he can’t sell more by getting more patients. He can only push more on us.”

  Jess felt more and more confused. Why do all this—the beautiful office, the CDs and blankets in the exam room, the cookies and Keurig, the NA meetings and private counseling sessions—if he didn’t really care about his patients’ recovery?

  Were bup doctors graded the way surgeons were, by the number of post-op complications? Did bup doctors get red marks against their names if their patients relapsed? If Jess did the math, Dr. Ball’s hundred patients were bringing in fifty thousand dollars monthly to his practice. That was a lot to lose. Perhaps if they were overmedicated and less likely to fail, he looked better in the eyes of the DEA and wouldn’t be shut down for his patients’ failures.

  “What kind of markup do you think pharmacies make?” Jess asked. “Twenty-five percent? At two bucks apiece, that extra strip is making him two hundred dollars a day.”

  It seemed like peanuts compared to the money he made on office visits, but a pharmacy that prescribed three hundred bup strips a day was certainly profitable.

  Jess shook her head. “Can’t you go to another pharmacy?”

  “They frown on it. Dr. Ball says he knows this pharmacy is a good one, and they’ll always have a supply on hand.”

  “Three hundred a day,” Jess observed.

  “He’s making a fortune.”

  Jess couldn’t argue.

  The meeting was called to order and everyone recited the pledge, which Jess had committed to memory, and she was invited to speak, since she was the newcomer. She gave the story she’d been telling since Hartley about being attacked and having PTSD, then turning to drugs to cope. Everyone sympathized, congratulated her on her decision to get sober, and welcomed her to Dr. Ball’s program. No matter what her feelings about Dr. Ball, this meeting was the best one she’d ever been to. The people were bright and articulate, no one used foul language, and they all shared insightful opinions when appropriate. I guess that’s what I should expect from people who pay a small fortune for their therapy, she thought.

  “The next meeting here is tonight at seven. And of course, there’ll be a seven a.m. meeting tomorrow, and a noon meeting as well.”

  The group stood and gravitated toward the coffee, but Jess opted for a water to replace the tea she’d finished. Every member of the group approached her, introduced themselves, congratulated her, and offered phone numbers if she wanted to reach out after hours.

  “I think I’ll come tomorrow morning,” Jess said. The meeting and socializing would lead right into her doctor’s visit, and it might be quicker that way. She hadn’t planned to attend another meeting—only one a week was required—but she’d enjoyed it. Maybe Dr. Ball was right. These people could help her.

  With a bounce in her step, and with an older man named Barry beside her, Jess made her way out of the office, through a door hidden in plain view at the front of the building. As she talked with Barry about his recipe for pumpkin bisque, she smiled at the handsome ambulance driver who met her gaze from behind a wheelchair.

  Chapter Seventeen

  Blown Cover

  Derek watched the front d
oor of Dr. Ball’s office, just as he had a million times before. This time, though, he was dressed in jeans and sneakers, and sitting in his Mercedes. He wasn’t buying or selling today, just watching.

  When the woman with the flaming ponytail had appeared at the doctor’s office on two consecutive days, Derek knew why she was there. Yet another addict looking for the cure. Something bothered him about her, though, and that’s why he’d called in sick on this bright fall day. He planned to follow her and learn her secrets. Maybe it would pay off, and maybe not, but his instincts told him something was going on with her, and he always trusted them.

  Her Jeep was already parked in the lot when he’d arrived at eight, and he realized she’d come for the early NA meeting. He began watching both doors, then, but she wasn’t in the small group that exited the building a few minutes after his arrival. It was after ten when he finally saw her, looking energetic and happy. He must have her on some good drugs, Derek thought.

  Waiting until a few cars separated them, Derek pulled the Mercedes into traffic behind her and followed her through a few lights until her destination was obvious. He fell back as she entered the on-ramp for Interstate 81 and followed from a distance. The white Jeep was easy to keep in sight, and he stayed behind her along the route as she merged onto Interstate 380 near Scranton, then Interstate 84 heading into the Poconos and New England. When she turned off at the Garden Exit, it hit him.

  The ER doctor from Garden had been kidnapped by the psychopathic doctor. She’d been on the news, and he couldn’t help noticing how attractive she was. Holy shit! he thought. What was her name? He drove past the exit, no longer needing to follow her. He had the information he needed, but how would he use it? The doctor was an addict. Was this because of what happened? He doubted it. That wasn’t enough time to get hooked and then clean. Maybe the kidnapping had pushed her over the edge, though, and she’d had a major crisis and ended up in rehab. Now she needed outpatient treatment, and like so many others who could afford it, she’d gone to Dr. Ball.

  Lucy had told him about the doctor’s fees for treating drug addicts. His patients had to have money. Tons of it. Or was he treating the redhead for free, a professional courtesy extended to his colleague? Knowing what he did about Dr. Ball, he doubted it. Dr. Ball was interested in making money, not giving it away.