by Lauren Brown
I grabbed my bags and walked to the front door. I didn’t look back as I left his house.
I hadn’t known that it would be the last time we would eat dinner together or the last time I would talk to him. He died from cirrhosis of the liver three months later.
I hadn’t even invited him to the wedding.
I returned to Johnson City, purchased a ring, and proposed to Hope the following week in my apartment. It hadn’t been the proposal I had originally planned, but she didn’t mind. She said yes before I could even finish the question.
We were engaged for almost a year and married in 1995 just before my graduation. She had been more than willing to stay in Johnson City when I accepted my residency position at the hospital. We purchased a small home on the outskirts of town, and, for the following six years, before I opened my own practice in 2002, we just lived as newlyweds and young residents do. We laughed and sang and made love. And on the early mornings when I would return home from the hospital sleep-deprived and irritable, she would always be waiting for me, fighting to stay awake so she could embrace me before I went to bed.
Beau had met and married a girl named Janie, a nurse who worked in the same practice as he did. They lived in the Mayflower Golf and Country Club neighborhood, about a twenty-minute drive from our house. We often had dinner with them, and Hope’s parents and Sarah would visit on occasion as well. We were comfortable and content. Sure, there were setbacks. Hope and I were tight on money, she wanted a baby and was having trouble getting pregnant, but in all of the setbacks, we were nonetheless happy.
Then I met Allyn Copperfield.
Chapter 5
January 6, 2003
It all began with a shiny, informative brochure a year after I opened my practice.
Normally, soliciting mailers were temporary clutter bound for my office trashcan, but that specific brochure caught my attention. It was from Payne Pharmaceuticals and it featured an elderly couple frolicking through a field of daisies, free of pain and full of love.
I read through the brochure and made the decision to finally call the drug representative listed on the back. My practice had been open one year and I had yet to schedule any drug rep luncheons. Seeing the brochure reminded me of the importance of these outings. I felt the need to establish a good repertoire with drug companies. I was more than excited to finally have my own clinic and contacting them, I believed, would help me exceed all expectations.
My original intention in calling the number on the back of the brochure was to broaden my horizons for chronic pain treatments, and in turn, make my office Johnson City’s top-rated pain management clinic. I knew more patients meant more money, but holding the brochure on that bitter cold January day, I had no idea that it would bring with it more than I wanted. It would bring irreversible pain.
His name was Allyn Copperfield, and he was the one who initially introduced me to the dark side of opiates. I had invited him for a meeting to learn more about the injection listed in the brochure. He was based at the company’s head quarters in Oxford, Mississippi, but traveled the southern states, particularly Johnson City, Tennessee, to lure physicians into choosing Payne’s brand over the others on the market. I knew about pain medicine, more so than the average doctor, but it wasn’t until I met Allyn that I realized I didn’t know it well enough.
In my final rotations of medical school, I had thought long and hard about whether or not I wanted to pursue oncology but just couldn’t bring myself to do it.
“I know it’s terrible to see someone die,” Beau had told me once through a mouthful of food while we discussed our futures, “but saving a life makes up for the loss.”
I wasn’t so sure I agreed with him. I had seen what cancer had done to my mother and, although I found the growing field of oncology and cancer research intriguing, I just couldn’t bear to see so many patients that would remind me of her death. Beau had then suggested that I apply to the internal medicine residency at the same hospital that he would be applying to for family medicine. The hospital was about thirty minutes from Ryans. The idea of being with Beau for another four years had been exciting at the time and I concluded that staying in Johnson City might be nice.
I was accepted into the hospital residency program with flying colors, I did well on my rotations and my final examinations, and, upon finishing, worked in the hospital for two years before deciding to open my own pain management clinic in 2002.
The one-level, brick building I made into my practice had been an old, vacant psychology office. It sat on the corner of Houston Street and Marigold Lane. And for my patients’ convenience, there was a physical therapy office adjacent to my building. White letters spelling LIVING WELL spanned the space above the front door. The name, the design, the décor, everything that made up my office had been Hope’s idea. She had also insisted I put white window boxes on the two front lobby windows. They were filled with yellow marigolds that she planted.
There was a small parking lot behind the building, and patients could enter through either a side door or a front door to the lobby. The lobby was filled with black chairs, an Oriental rug, a small fish tank, and a large painting of the human vertebrae that Hope had given me for Christmas. A receptionist desk separated the lobby from the clinic side. There were several small clinic rooms in the back of the building with a medium-size nurses’ station in the center and a large storage room for our patient charts. My office sat at the end of a long hallway at the very back of the building. There was another mirrored office on the other side of the clinic, which at the time belonged to my nonexistent office manager. It’s hard to believe it’s been a year since I’ve been there. I’m sure the marigolds are dead by now.
At any rate, my clinic was staffed with a nurse and a receptionist, Beth and Marty, whose roles were pretty much interchangeable. The clinic opened at nine in the morning and closed at four in the afternoon Monday through Thursday and was closed half a day early on Friday in that first year. I had planned to hire more nurses and ultimately another physician after a year, assuming everything was progressing accordingly.
Starting Living Well was exciting, but tiring. The certifications and financial requirements of beginning my own practice were overwhelming, and to be quite honest, I wasn’t sure if my plans would succeed. Opening Living Well had been a challenge, a gamble, considering Hope and I were already thousands of dollars in debt. Taking out a loan to begin my practice, purchasing a home and a medical building, not to mention paying back school loans had all set me back financially. But Hope overlooked the money, she always did. She pushed me to fight for a place that had the potential to help those in need. That’s just who she was. Life wasn’t perfect in that first year, but it was steady.
That is, until I called Allyn.
Pain medications don’t change frequently, so when I saw his brochure claiming that Payne Pharmaceuticals, the mass distributor of oxycodone and hydrocodone, had a new steroid injection approved that could be better for patients in the long term, I was eager to know more. I figured having the newest and most efficient drugs could only help my practice.
But meeting him would turn out to be a massive mistake. It was that day that marked the beginning of something new, and the cascade of events to follow would mark the end of everything.
“Dr. Livingston, Allyn is here to see you.”
I looked up from the journal I was reading.
“Great. See if he’d like any coffee and then send him in.”
I closed the medical journal, took a sip of coffee, straightened my tie, and waited for Allyn to walk in. A few moments later, a short, plump, baldheaded man wearing a navy suit pushed open my door.
“Hello, Dr. Livingston! I’m so glad you called! I kept telling Jerry those mailers were a waste of trees and money, but I guess I was wrong.” He tucked his handkerchief into his pant pocket and reached out his pudgy, clammy hand. He was sweaty despite the plummeting temperature outside.
“Hey, Allyn, come on in.” I
motioned for him to sit.
He plopped into a leather chair across from me and retrieved his handkerchief again, wiping his forehead.
“Funny to be sweating in January, I know. It’s a problem. You should see me in the summer in Oxford. Yikes.” There was an awkward pause between us. “But your office is nice. I like the name by the way.” He looked around my office, briefly fixating on the plant I kept forgetting to water before turning his attention back to me.
“Thanks, my wife’s idea.”
“Clever wife.”
I watched as he began pulling out a pamphlet from his bag.
“So, I’m here obviously to talk pain medication with you,” he stated. “Are you currently happy with the pain medications you’re using?”
“I suppose. I just thought I should look into some updated drugs and start an annual routine of meeting with drug reps. You know, to stay on top of side effects, new discoveries. I’m curious about the new injection that was in the brochure.” I pointed to it on my desk.
“Well, you’re a smart businessman to call because that injection is the latest, best selling drug of its kind on the market at the moment,” Allyn honeyed. “As you know, drugs are changing all the time, and Payne is staying on top of, well, pain.” He laughed boisterously at his play on words. He must have used the pun a hundred times.
He continued, “It’s a good thing that you’re willing to stay on top of the drugs. As you know, oxycodone has been around a long time and it has some addictive properties. I’m sure they taught you all that in medical school. Payne has been consistently working on improving it, not to mention fighting with insurance companies. Always a battle, it seems. But this injection, see, it’s not addictive. It’s merely intramuscular, doesn’t cross the blood brain barrier, blah blah blah. You get the picture.”
I had first learned of oxycodone in my pharmaceuticals class in medical school. The drug was first created in the early 1900’s in Germany. It wasn’t until the early 1990s that Payne Pharmaceuticals began manufacturing it and, by the early 2000s, it had become America’s leading painkiller.
Not long after its invention, people began realizing the problems the pill brought with it. It masked pain but, in turn, it created a “high,” this sort of void from reality.
We had learned in medical school of its addictive properties, but in the 90s we still didn’t realize the cumulative effects, in other words, the effect it would have on communities, even the economy. I had been taught that, if kept under control and within moderation, oxycodone wasn’t all that harmful. The catch was being able to trust your patients.
He pulled out a syringe from his bag and placed it on my desk. He then went on to explain how the drug worked, where to inject it, occasionally opening his brochure and pointing out diagrams and statistics. He was a forward and talkative man, one you wouldn’t want to get caught up with inside the grocery store. He even injected himself right then and there, standing from his chair and lowering his waistband.
“And you put it in just like this.” He winced from the pain.
“Um, okay,” I started to rise from my chair to help him but he waved for me to stay seated.
“Don’t worry, Dr. Livingston, do this all the time. I actually have a bad hip and meeting with you physicians is like”—he pulled the syringe out and tossed it into his bag open needle and all—“a free way for me to numb the pain. Only hurts going in, I swear.”
“Huh, well that’s simple enough. Any side effects?” I asked after he had finished pulling up his waistband and wiping his face.
“Yes, occasional swelling, possible allergic reactions, same risks as any other steroid shot.”
Allyn continued discussing the medication, and I wasn’t really paying attention until he suddenly lowered his sotto voice and said my name.
“Dr. Livingston?”
“Yes?”
“When we were on the phone last week, you mentioned being on a tight budget and that remaining up-to-date on your medications could help you increase your patient count and possibly help your financial situation. Do you still feel that way?”
“Yes,” I said with curiosity. Allyn had, just as he was doing in my office, talked a lot on the phone. He had told me small details about his life like how he wasn’t married, he was a New York Yankees fan, he had graduated from Ole Miss several years before Beau but, no, he didn’t know Beau personally. There wasn’t much important information exchanged when we talked, so I couldn’t help but wonder why he was bringing up this brief conversation we once had.
I saw him glance at the door, wipe his forehead, then lean in close to my desk, lowering his voice to just above a whisper.
“I’ve got something that can help you. And I mean, really help you, John. How old are you? If you don’t mind me asking.”
I found this odd but answered, “Thirty-five. Why do you ask?”
He ignored my question. “Wow. Only thirty-five. So young.” He put his forearm on the edge of my desk to brace his upper half. “You just seem like a doctor who has fallen into the trap of medical school debt and, for all the time and money you spent to get here, why is it that you have to suffer? It’ll be another ten years before you can pay off your loans. Am I right or am I right?” He raised his eyebrows.
“I’m confused as to where this is going.”
He didn’t answer but pulled out a large container of pills from his black rolling bag and slid it towards me on the table with a grin. He leaned back in his chair and interlaced his fingers behind his head.
“I can make you an offer, a personal offer, of selling you this here container of oxycodone.”
“How many pills is this?!”
“About three hundred.”
“I write prescriptions, Allyn,” I objected shaking my head. “I don’t give out this kind of pain medication in the clinic directly.” I was struck by his gesture. He was insane to be carrying such a thing around with him.
He continued, excited, breathless, “John, I know that. Don’t you see? There are lots of other doctors in your same position. They’re drowning in debt, but the difference between them and you is that you’re willing to go the extra step. And, you carry two very important letters after your name. ‘M’ and ‘D.’ Those two letters automatically give you the upper hand. I can tell you’re an over achiever. Most physicians are. But they’re also worriers.” He paused to catch his breath before continuing, “Your office is nice, but how long will it hold up? I know you, like any other small business owner, worry about the stability of a practice like this in the heart of Johnson City, and when doctors worry they, by human nature, have to resort to doing what others might consider to be… extreme.”
I gave him a perplexed look.
“Let me explain it a little better. I have a doctor friend who is in a similar situation in Oxford. He sells these to patients that he really trusts in his clinic to make some extra money on the side. He even goes so far as to write extra refills on prescriptions for extra money, you know, cash in the back. He also prescribes to people who really don’t need the medicine, patients with questionable diagnoses like fibromyalgia or unexplained ‘chronic pain.’ You don’t have to do that if you don’t want to.” He glanced up at the sound of Beth outside my door and softened his voice. “It’s nothing too much or too risky, but it’s just enough to pocket a little extra each week. It’s actually quite brilliant, if you ask me.”
“Allyn, look. You’re a nice guy and all, but this isn’t really my thing. I mean, if I got audited or someone reported us we would not only lose our jobs, but I would lose my license and my life. I may be in some debt, but I didn’t spend all that money to then lose my license.”
“I understand. It’s the same thing my friend in Oxford first told me. But let me reassure you that he’s been doing this for over a year and hasn’t had one problem. Not one. I can give you his number if you like?” He started to reach for his cell phone.
“No.” I waved my hand. “That’s all right.�
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He shrugged then continued, “I’m not pressuring you. I just want you to know what half the other doctors in your position are doing. I hate to see someone like yourself fall behind.”
I pondered this idea. In all honesty, he was right. It was quite brilliant, and I wasn’t sure why that type of business hadn’t occurred to me before.
After a moment of silence, I questioned him, “And how much money are we talking?”
“Well, if I’m not mistaken he charges a hundred and twenty-five dollars cash to write prescriptions. For example, if a patient signed an original contract with you to only receive two months of pain medication before trying other alternatives, then you, assuming you trust the patient, tell them you’ll give them two or three extra months of medicine for cash. In addition, he sells the pills from this container for ten bucks a piece. He’s not a millionaire, but in a year, he’s at least making enough to buy a boat, a golf club membership, whatever it is you doctors buy for pleasure.”
I was curious as to how exactly he obtained the pills but decided it was best not to know. I assumed they were dated pills from the factory or something. It didn’t really matter how he acquired them, the fact of the matter was, he had them.
“And how does he know he can ‘trust’ a certain patient?”
“I’d say he has it down to a science. Once you agree to doing something like this, those ‘perfect patients’ just sort of come to you. Trust me, once word gets out that you’re willing to help people in this way, your name will spread like wildfire and you’ll have patients flocking to you left and right. Going to medical school will finally pay off and you’ll officially have the upper hand in just about everything.”
I eyed the plastic jar of pills.
“I’ll let you think about it while I finish my coffee and take a phone call,” he said. He stood and left my office.