by Lauren Brown
I knew I could use the extra money but I wondered what the consequences would be if I was caught. The more I debated with myself, the more I realized there wasn’t a way for me to really be found out unless I confessed. Who would a judge believe, a doctor or a patient? Pain patients had a stereotype about them. A large majority of patients had a talent for fabricating the truth in order to get more pain medication. I really did have the upper hand. I came to the conclusion that what Allyn was suggesting wasn’t all that terrible. I could choose to give them out or not. If it didn’t work or if I lost my nerve, I could flush the pills and act like it had never happened. I knew there was a slight chance of consequences, but if I was smart about it, who would ever know? I liked to believe I was smart enough.
When Allyn returned I asked him, “So, what’s in it for you?”
“I can sell you the container for a one-hundred-fifty dollars. I brought three of them today, and you know what? Since this is a special visit, being our first one and all, I’ll give that container to you for free.”
I hesitated for a moment.
“Look, I wouldn’t lie to you, John. My friend practicing in Oxford has been a much happier man, doctor, and husband since he began doing this.”
I took another sip of my coffee and furrowed my brow, really contemplating the idea. I was struggling financially. I had been confident I could repay my loans and start making good money soon after residency, but when Hope’s car threw a rod and we had to move, things got worse. I looked at Allyn who hadn’t taken his eyes off me. Next thing I knew, I was pulling out my checkbook from my briefcase.
“So, three hundred dollars?” My stomach clenched at the thought of writing a personal check for that much.
“Yes, sir.”
I signed my name and handed him the check in exchange for three large containers. I stacked them into my safe that housed the nine mm I kept out of Hope’s sight. She didn’t approve of guns.
“Great, Dr. Livingston. I’d say this was a successful day! Two bangs for one buck. Well, three hundred bucks to be exact. Regardless, it was great doing business with you.”
I was amazed at what I had just done.
“Have you been keeping up with the Cubs lately? I remember you saying you were a pretty big fan.” He folded the check and slid it into his wallet.
“Yeah.” I was finding it hard to think clearly. “I, uh, heard they lost last night.” He was way too nonchalant about our business deal.
“It was a real bummer.”
I didn’t go along any further with his conversation. The normality of it was too disturbing and made me uncomfortable.
“All right, well, I’ll be leaving around noon to go back to Oxford. Call me if you have any questions. And don’t worry too much about this, John, really. Everything in moderation is fine. That’s what I tell myself every time I reach for those powdered donuts.” His stomach bounced with his laughter.
“I suppose so. I’ll, uh, try to set up another time to meet in the next several months.”
“Wonderful, thanks again, John,” he said, all too comfortably, as he wiped his forehead, opened my door, and walked out.
“Oh, I almost forgot!” He chuckled as he stopped in the hallway and pulled out a handful of injections from his bag. “Here are some samples for you to try this week. If you and your patients like them then give me a call and I’ll give you a bulk supply for a discount.” He zipped his bag shut and then waved, “Thanks again, Dr. Livingston.”
I watched him disappear into the lobby. I returned to my chair, sinking deep into it. My head was spinning. I opened my mouth and strummed my cheeks. Allyn was right. His friend was a smart man. Why I hadn’t ever thought about writing a few extra prescriptions for some money shocked me. As I thought about this, several patients popped into my mind. One of them, Rick Wallace, was on the schedule for that day. I hesitated to begin selling the pills so soon, but I knew Rick would be the perfect person; a litmus test to see if this was doable. I knew he would agree because he had previously asked me if I did such a thing. It was shortly after I’d opened my clinic and, afraid of losing patients, I hadn’t reprimanded him for asking me. Instead, I shrugged it off and simply responded, “No, Rick. I cannot prescribe you any extra pain medication at the moment.” But on that day in January, my mind changed. I decided to give it a try with Rick that afternoon, and if it went terribly wrong, I would flush the pills and kick myself for spending three hundred dollars. Little did I know that making that first deal with Rick would change my life.
I saw patients all morning and couldn’t help but think about the pills I had tucked away in my black safe. I was giddy and distracted but, at the same time, extra keen to my patients. Scarily enough, I wasn’t all that worried. Maybe initially, but I mean, if Allyn’s friend could do it, then so could I. Selling pain medication in the back of my office was something I had never imagined myself doing, but, as Allyn had said, I was having to resort to my last option. Plus, I didn’t have to do it for long. I only had to do it until I sold all the pills in the containers.
After lunch, Beth informed me that Rick was ready. I jumped out of my chair. “Perfect!”
My reaction surprised her. “Lunch did you wonders today, Dr. Livingston.”
I made my way to the clinic room and read his chart, although I already knew what it would say. I had been treating Rick for pain since his diagnosis of carcinoma. He had been a regular of mine since I had opened in 2002. In addition to cancer, he was also a retired railroad worker with a herniated disc and a tendency to pick up a whiskey bottle at night. He came to me that afternoon for a refill on his oxycodone, a referral to a physical therapist, though I doubted he would go, and another discussion on why he should try spinal surgery for a second time. “I don’t have the money” would likely be his response. His visits were always repetitive and mundane.
I knocked on the door and walked in. He sat on the examination table with his legs crossed at the ankles, his hands in his lap. He was about six feet tall, had a thin, tanned figure, and a peppery scuff that grew around his wrinkles. He was wearing the same baseball cap, gold watch, and jeans he always wore. He smiled at my entrance, revealing the black space where his right canine should have been.
“Hey, Rick, how are you feeling today?”
“Eh, so so. Cancer’s a bitch.”
“Yeah. Yeah it is,” I said, taking a seat on the rolling stool in front of him. “I think I’ve told you this before, but my mother died from skin cancer. It’s sort of the reason I went into pain medicine.”
“Yes, you have. That’s real sad, Doc.”
“Anyway, tell me what’s been going on with you? Any update on the spinal surgery?” I was eager to get to my question, but cautious. I made sure to ease into it.
“I ain’t got no money. I told you that. My ex-girlfriend took it all.”
I would have protested this but decided to shift the conversation to medicine instead.
“Yes, you have. What about the pain? On a scale of one to ten, ten being burned alive, what would you rank it?”
“Fifty.” He leaned his weight back into his palms but only for a moment. The sanitary paper on the table crinkled.
“I see. Is it under control?”
“Well, Doc, the dose you gave me last time—it just ain’t strong enough. I can’t sleep at night the pain is so bad.” He sat straighter, shaking his head.
“Let’s see. You’ve had this cancer for a couple of months…” I scanned his chart, “…which is quite awhile. How’s the chemo going?”
“It’s about the worse thing I’ve ever done. Makes me so doggone sick.”
“Yeah, well drinking doesn’t help either. I’m having Marty fax the oncologist for a report. How’s your back?”
“I guess it’s fine. It’s not like it was back in the day, but I make do.”
I looked at the rough individual sitting in front of me and did feel some pity for him. I didn’t know his life story, but he had cancer and a h
erniated disc and I convinced myself this justified an increase in pain medication.
“Rick, I’ve got a serious question for you.” I rolled towards his knees briefly looking behind me to make sure the door was shut. My hands were clammy. He looked down at me then stiffened his neck, curiosity filling his eyes.
“Yes?”
I wasn’t quite sure how to start the conversation, so I started with, “You’ve been my patient since I opened my clinic and, with our history, I want to tell you first about something I’m going to start here in my practice.”
He raised an eyebrow. “Oh, yeah?”
“What I’m about to ask you can be life changing not just for you but for both of us. And not life changing in a good way, in a bad way. But only if we aren’t smart about it.”
“What is it?” he asked, sitting even straighter.
“Obviously, I’m going to write you a prescription for some oxycodone today, and at our previous visits, we had discussed weaning you down. Your family physician had recommended this. He was afraid—”
“Afraid I was gettin’ hooked on ‘em, I know,” he interrupted.
“But, after some thought, I’ve decided not to wean the dose at the moment. And I think you…” I swallowed the lump in my throat, “…you could benefit from some refills too.”
I watched him relax a fraction.
“Huh?” he asked, confused. He had been expecting me to lower his dose each visit. We had a serious conversation at his visit one month prior that had ended in him storming out of my office.
“Now, the clinic doesn’t know I’m doing this. I guess you could say I’m just ‘testing the waters.’ This offer is for certain patients only, patients I can trust. What do you think about this?”
He smiled in a way I had never seen him smile before, as if I had just removed a mask and the true Rick could now come out.
“Dr. Livingston, I think you’re a really smart man. You asked the perfect person. You can trust me. This cancer, it’s gotten so bad, anything extra will help. And the disc. And my ex-girlfriend took everything from me.” He looked into my eyes. “I won’t tell nobody.” He stuck out his hand to shake mine.
Surprised at how easy it had been, I smiled and shook his hand in return. “All right, well, very good then. But, I do have to charge you. Since this goes against the original contract we signed.” I pulled out my prescription pad. My heartbeat had slowed since the beginning of our visit.
“How much?” he asked, craning his neck to see what I was writing.
“One hundred twenty-five dollars a script and you’ll have to pay that amount to me personally in this room each visit. And you’ll still have to pay your normal fifty-dollar visit fee up front.”
“That’s a lot, Doc.” He started to shake his head in opposition.
“Well it’s one hundred twenty-five bucks or nothing.” I intended to come across stern but could hear a slight shake in my voice.
He thought about this for a moment before shrugging in passive agreement.
“I’ve also got these.” I reached into my coat pocket and pulled out three white pills I had taken from the container. “This is oxycodone. I can sell them to you for ten dollars a piece.”
He swallowed and leaned in to see the pills in my hand. He looked like a wild animal, hungry and desperate.
“Oh, Doc. This is, this is—I mean you’re willing to sell these to me?” Suddenly he backed away from my hand and shot me a suspicious look. “Is this some sort of trick? You settin’ me up?” His eyes darted to all corners of the room, searching for hidden cameras.
“No, no, Rick.” I stood from the stool and checked the door again. Lowering my voice I explained, “Rick. Look. You can trust me. I’m a pain specialist for a reason. I can do this. It’s not a set-up, I can assure you. We both benefit from this.”
He eyed me coldly before relaxing.
“Remember, you can’t tell anyone. Not even the nurses or receptionists up front.”
“I don’t have that much on me right now. But I do have a twenty. Can I reschedule up front to come back tomorrow and—”
I cut him off, “Just come back today. I’ll tell the nurses you had an emergency and to fit you in around three thirty.”
“Okay, that’s good. Real good, Doc.” I watched him reach into his pocket and pull out a wrinkled up twenty-dollar bill.
I placed the white pills into his outstretched hand.
“Two should cover the couple of days after your script runs out. Those plus the prescription should be plenty. With time, I can give you more. But let’s start with this for now. How much alcohol are you drinking?”
“Same as always. A whiskey a night.”
“Well, don’t drink and take these at the same time, for obvious reasons. Take them at night when your pain is the worst, and don’t drive or operate machinery. You know all this.”
His head moved up and down.
“Oh, and you know the drill. You’ll have a urine drug screen when you come in, and we’ll be checking for the presence of oxycodone. If I see any other drugs in your system, you know we’ll have to release you from our care, though how much oxycodone is irrelevant, as long as there is some oxycodone.”
He looked at me, confused.
“Look, Rick, if we want to do this right—I help you and you help me—then you’ll take only these. Take them as needed, but don’t feel like you have to use them all. Hang on to them, toss them, whatever, but at least you will have them if you need them. I don’t send your oncologist or family doctor chart notes unless they request them, they’ll never know if you’re on pain medication unless you tell them. Let’s keep this between us, okay?”
“Yeah. I got it.”
“And no other drugs,” I repeated with raised eyebrows.
“Yeah, yeah. I got it. Thanks, Doc. I’ll only use what I need and the others”—he smiled at the pills in his hand—“I’ll dispose of.” He slipped the pills into his jacket pocket.
“Well, I’ll get that oncology report, and if I see anything we need to further discuss, then we can do so at three thirty. I’ll see you then, Rick.”
I stood and opened the door. He began walking to the checkout desk. He passed Beth who was putting another patient into a room.
“Oh and Rick! It’s just fifty dollars for today’s visit. You can pay that at three thirty.”
He nodded as if to say I understand.
“Beth, can you make sure Rick gets another appointment this afternoon, around three thirty. He has to leave for a family emergency.”
“I thought you had a conference call at three thirty.”
I had forgotten about this call. I shook my head. “No, it’s canceled. Seeing my patient is more important.” Rick smiled one final time as Beth opened the door to the lobby for him.
I put my hands in my coat pocket, pulled in a deep breath and pushed it out. A small smile formed in the corner of my mouth as I returned to my office. Now, I understood why Allyn had been so comfortable. As crazy as it sounds, dealing drugs wasn’t as hard as you might expect. Just like that, I was $165 richer…for a time.
It wouldn’t be long before my wallet was rich and my heart was poor. The dollar sign would chip away at the fine line between life and death and, just like that, rob me of everything.
Chapter 6
April 6, 2003
Looking back on it, there was a lot that played into my decision to begin selling pain meds. Every moment in my life’s past played a part in that situation. I was a young doctor, fresh out of residency, who wanted nothing more than to be debt-free. I was desperate to live the high life that being a physician promised. I wanted to make amends for my father’s weak hold on money. I wanted to be in control of my future. I believed I wasn’t a drug dealer in the sense you might be thinking. In my mind, at the time, I was simply doing what doctors did, diagnosing patients and writing prescriptions. Sure, I battled my days of worry, but once the money started flowing in, and I realized how easy it was,
those worries got pushed aside.
Before I knew it, four months had passed since my first meeting with Allyn. He had said that my name would spread like wildfire, and it did. It didn’t happen overnight, but it happened fast; so fast that before I knew it I had it down to a science.
If a patient pulled out $125 cash at the conclusion of the visit, I would check their work and social history on their chart to be assured they didn’t work in a profession that would be a threat to mine, like a government position. If they didn’t, I would simply say, “So you’ve heard,” and pull out my prescription pad and pills that I carried in my coat pocket. If their chart didn’t pass the test, I would say, “I’m not sure what you’re talking about. I think you’ve mistaken me for another doctor,” which made the patient hurriedly put away their money and never ask again.
With this method, I had found about fifty patients whom I could trust in those beginning months and, before I knew it, I was moving so fast that I didn’t have time to see the repercussions. I think I was blinded by the glory of it all too, the new control, the new influx of money, the way the patients looked at me. I felt… important.
The rapid growth in technology and switch from paper to computer charts was continuously making it more challenging for physicians nationwide. But Johnson City hadn’t quite caught up to other parts of the country. So much focus had been on heroin, cocaine, and methamphetamine, that narcotics were often overlooked. Once opiate addiction exploded, the consequences came to the surface, which in in a few years time made obtaining scripts more challenging. But in the 1990’s and early 2000’s it was still growing, and doctors found themselves in difficult situations. If a patient comes in complaining of withdrawal symptoms, what’s the physician to do? What if the patient is pregnant? Do you want a pregnant woman in withdrawal? The answer is a resounding no. The physician keeps prescribing, eventually weaning the patient to a dose he or she can manage, but that process can take weeks, months, even years. And that’s where my practice came into play.