The Weight of Air

by David Poses

  Dr. Baudelaire enters the room. Andrea heaves a sigh when he says I have a complicated migraine. He asks if I have a history of migraines. I shake my head. Until now, I thought “migraine” was a word wimpy people used interchangeably with “headache.”

  “There are many types of migraines. They all present differently and have different causes, but it’s extremely uncommon to have so much pressure in your head that it damages your vertebrae.”

  Andrea clenches up.

  “The MRI also showed a cyst on your pineal gland,” Dr. Baudelaire says far too casually. “It’s benign. Low probability of becoming malignant, but we’ll keep an eye on it.”

  Andrea lies next to me, stroking my hand with her fingertips. “I asked Dr. Miller to recommend a therapist for you,” she says.

  “Why?”

  thirty-nine

  After two days in the hospital, Dr. Baudelaire clears me to go home. He writes a prescription for a drug to prevent migraines, another drug to fight them, and forty Percocet, 2.5 mg/325 mg acetaminophen—the lowest dose of the active ingredient, oxycodone.

  I tell myself it’s okay. The pain is legit, and Dr. Baudelaire is a doctor. Andrea isn’t concerned.

  At home, I take the prophylactic medicine as directed, have no need for the combatant, and I’m justifiably liberal with the Percs. When the bottle is almost empty, I call Dr. Baudelaire’s office and ask the receptionist for a refill, slipping, without thinking, into the voice I used in high school, when I called in pretending to be sick.

  “No problem,” the receptionist says.

  Andrea goes to our local pharmacy, the aptly named Drug World, to pick up the script: sixty pills, 10 mg/325 mg. In a few days, the pain is gone, but I keep taking the Percocet. When I’m down to the last three pills, I call Dr. Baudelaire for another refill.

  “No problem,” the receptionist says.

  I swallow the last Percs and go downstairs. From the bottom step, I see Andrea and Ruby at the dining room table, making another batch of “get well soon” cards.

  Andrea says I look much better. She holds up a drawing of a bull running through a green traffic light. “Unstop-a-bull. Get it?”

  Blinking back tears, I nod and turn away. Everywhere I see reminders of the life we’re building, the love we have. Ruby’s first painting on the dining room wall: pink and red blobs on a white canvas; the picture from Ida Applebroog; the collage I made for Andrea’s birthday; the drawing she made of a speaker powered by pedaling a bicycle—inspired by one of the books I’ve talked about writing. Out the window, I see the writing cabin. In the hall by the door, a pile of red low-top Chuck Taylors in three different sizes, our books mixed together on shelves. Nothing is singular. Each of us in everything. We are one.

  It’s unfathomable to think I could piss this away.

  It’s impossible to think of not picking up the prescription.

  “Ladies, I need to go to Drug World.”

  Ruby bolts out of her seat, asking to come with. “Bees, Dada.” She and I set out on foot. Andrea leaves for the gym.

  Coming down the hill behind the bank, I remember a dream I had when Ruby was a baby. She was floating in the ocean, in an inflatable yellow tube with a duck’s head. From the shore, I begged her to come back. She just waved and smiled and drifted farther away.

  We pick up the prescription and walk home, holding hands, my stomach in knots, pills in an opaque brown plastic bottle, shaking like a maraca. I carry Ruby upstairs and set her down in the bathroom. I take a long look at my daughter—this miraculous creature with short brown pigtails, happy and healthy.

  “Ruby, take a mental snapshot and remember this moment forever.”

  I pour the pills into the toilet and flush.

  Ruby runs out of the bathroom and yells at the top of the stairs.“Bees, Dada, bees!”

  She’s almost three years old, and her life’s ambition is to conquer our steep staircase solo. We strike a deal—she’ll hold the rail the whole time, and I’ll go down backward in front of her, one step lower, every step of the way.

  In the living room, I turn on the stereo and crank the volume on “Idioteque” by Radiohead. Ruby and I shake our cabooses without inhibition to the chirping, agitated beats.

  I should come clean and enlist Andrea’s help but I don’t. I can’t. I call the shrink her shrink recommended and take his first available appointment.

  Dr. Aftergood appears to be in his fifties and has kind eyes behind roundish wiry glasses. His small square office is on the ground floor of a residential building in White Plains—a desk in the corner, two leather Eames chairs facing each other and an ottoman in the middle, a low leather sofa under a wide window framed by tall bookshelves. On the wall behind me hangs a print of the Buddha and the seven chakras in colored circles, each explained in small text.

  I offer the most honest version of my life that I can muster, feeling self-conscious but removed—like I’m auditioning for the role of myself in a play. I talk about my parents and Daniel, Jane, Andrea, and Ruby. I tell him about heroin and the history of addiction on both sides of the family. I describe my fears and insecurities, and I name every therapist I’ve ever seen and every antidepressant I’ve been prescribed. Dr. Aftergood takes copious notes. When I finish, he lays his pad and pencil on the edge of his desk.

  “Did any of the medication give you any relief?”

  “No, but heroin did.”

  “Well, heroin is more of a blunt instrument than an antidepressant, no?”

  “When you want to destroy something, a blunt instrument does the trick.”

  “Ah. And what are you trying to destroy?”

  “My depression.”

  “Try looking at it differently. Our work is about building, not about destroying.”

  I feel like I’m lying on an operating room table, watching a surgeon prepare to dig into my soul with a rusty scalpel. Too early to know if the surgery will be a success, but I know it’s going to hurt like hell and the healing process will be lengthy.

  Dr. Aftergood asks what I want to accomplish from our time together.

  It takes a minute for me to think of an answer. “I want to be content.”

  “What does contentment mean to you?”

  Silence swallows me whole—I don’t know how to respond.

  “Have you ever experienced contentment?”

  “The beginning of my relationship with Andrea. Ruby’s birth. I’ve had other moments before and since—hours, or maybe a day or two, but other than that, I’ve been miserable for as long as I can remember. Unless I’ve been on dope. And even then . . .”

  “Even then?”

  “I’d see somebody worse off or read an article in the New York Times Neediest Cases series—kids without enough to eat, parents taking turns going hungry every other night. I know how good I have it, how lucky I am. I’d think, What right do I have to be so miserable? I couldn’t stand that a speck of powder could make my brain work in ways I couldn’t on my own. I must not deserve to feel this way.”

  “You’re kind of glossing over it. By telling yourself that you don’t have the right to be an addict, you’re giving yourself an excuse not to deal with it.”

  A month after the complicated migraine, I haven’t had another, but I’m averaging at least two standard migraines a week. The pain concentrates behind my eyes and I have to lie down in a dark, quiet room. Sometimes when I feel one coming on, I take Zomig, the combatant Dr. Baudelaire prescribed, but then I feel defeated. That’s why I haven’t been taking the prophylactic medicine. My “faulty logic,” as Dr. Aftergood calls it, comes up a lot.

  “If I can’t vanquish a problem without a foreign substance, it means I’m weak. If I need a foreign substance, it might as well be heroin.”

  “You realize there’s a difference between heroin and legally prescribed non-narcotic medication, right?”

  “Obviously.”

  “And you know migraine is a medical condition, and so is depression and anxi
ety.”

  “Okay . . .”

  “I can’t see properly without glasses, so I wear them. Does that make me weak?”

  “No.”

  “Taking medication is no different. It doesn’t make you weak.”

  “Maybe it doesn’t make you weak. But you’re not me.”

  With Dr. Aftergood’s help, patterns become clear in every aspect of my life: impossibly high, self-imposed expectations and unrelenting, unforgiving punishment. I keep raising the bar, setting myself up for failure.

  “How are you feeling right now?”

  “Like a failure.”

  “Because you’re not living up to your own—”

  “Because I know it’s fucking insane and I can’t stop it.”

  I reach for a box of tissues on the bookshelf. Dr. Aftergood says to breathe. He says, “You have to forgive yourself.” At the end of the session, he writes a prescription for the antidepressant Wellbutrin. I fill it.

  If my brain were a football field, each end zone represents the two states of being I’ve known throughout my life. One end is even, achievable almost exclusively with heroin. The other is my default setting: not even. Going from one end to the other is a catapult, not a pendulum. I’ve seen the enormous space in the middle only when flying past. Wellbutrin acts as a gate, keeping me from the most extreme reaches of my natural state. It’s an improvement, but not much. To stick with the football analogy, the gate is under the goal post, a few inches from the out-of-bounds line.

  I worry about the future. I want to believe I could resist if dope finds me again, but depression is excruciating. At some point, my threshold will reach its limit. Pain can’t be willed away.

  Wisps of steam rise from a mug of chamomile tea centered on the table between Rob and me.

  “Buprenorphine,” he says, no judgment in his voice, only compassion as he urges me to find a licensed doctor.

  “I already kicked. There’s no dope in my system.”

  Rob takes a long sip and waves his index finger—no. “It’s not just for kicking,” he says. “I told you. When you decided to kick at your mom’s and made me leave you there with no money and no car.”

  I go home and google “buprenorphine.” The first article says induction occurs when an addict is in the acute stages of withdrawal, and buprenorphine can be discontinued after five to seven days or used for prolonged periods for maintenance. The author describes it as a “highly effective, anti-craving medication, a godsend for addicts who are worried about relapse.”

  Unlike methadone, a full opioid agonist that can be dispensed only at clinics, prescriptions for buprenorphine, a partial agonist, can be filled at pharmacies. But the Drug Treatment Act of 2000 mandated a special X waiver that physicians must obtain to prescribe all substances containing buprenorphine and limited the number of patients to a hundred each.

  Six licensed doctors are within two hundred miles of my house. One after another, they say I need to be in withdrawal to be induced. When I explain the obvious conflict, they refuse to bend the rules. I beg Dr. Wallace, the last name on the list, and he agrees to see me. He has an opening in an hour. I can make it.

  Dodging crater-sized potholes, I pull into a spot in the parking lot across from a row of identical brick buildings. Some are connected via steel-enclosed second-story breezeways. The doors have no numbers or signs of any kind.

  Through trial and error, I find the right building. An old, dusty smell hits me when I walk through the door. It must have been an elegant place at one time, but now threadbare carpet covers the floor and stairs, and thick coats of paint on the bannister obscure most of the intricate carvings. At the top of the stairs on the second floor, I follow a maze until I see a door with a paper sign taped to it. “Dr. Wallace.”

  The waiting area is tiny, the ceiling low and slanted. I sit on the edge of the stained brown couch and start thumbing through the old magazines scattered on the Formica coffee table. Time. People. Psychology Today. Harvard Business Review. The bottom right corner is torn off the cover of every issue.

  Dr. Wallace opens the inner door. Short, middle-aged, in a crisp white short-sleeved dress shirt and a pastel-striped tie. He waves me into his office, a slightly larger version of the waiting area, with a less pronounced slope in the ceiling.

  Before any discussion of buprenorphine takes place, he explains his fee structure: $500 for this session, $200 for each monthly session. He doesn’t accept insurance or Medicare or Medicaid. He cautions me that most insurance companies don’t cover the cost of the $400 monthly prescription.

  I give a painfully honest, exhaustive account of my history with opioids. Dr. Wallace doesn’t ask questions or take notes. When he swivels his chair toward a filing cabinet, I notice an orange sticker on the back of the seat: “PAID” in big block letters.

  “Normally, you’d be in peak withdrawal and we’d start with one pill.” He opens a drawer and takes out a white plastic bottle. The label reads, “Suboxone, 2 mg.” He shakes two small orange hexagonal pills onto a blotter calendar and uses white plastic tweezers to ferry them to my hand.

  Under my tongue, the pills taste like artificial orange flavoring and something I can’t quite identify. They dissolve quickly into a chunky powder, which disintegrates.

  Dr. Wallace says the active ingredient won’t work if I chew or swallow the pills, and I’ll immediately go into the most agonizing withdrawal of my life if I crush them up and snort them or inject them or combine them with any opioid. And buprenorphine has a seven-day half-life, he says.

  For a moment, I worry about a situation where opioids might be necessary. Surgery. A car accident. What if I’m unconscious when the paramedics show up and hit me with a shot of morphine? I don’t voice these concerns. I don’t want to risk making him suspicious that I’m already planning to relapse.

  “We’ll start with four milligrams a day and ramp up to eight over a week. You can go as high as twenty-four milligrams a day if the cravings don’t go away.”

  I happily write a check for $500, Dr. Wallace writes the prescription, and we schedule my next appointment. Then I make a harried exit and have to backtrack twice before I finally hear the stairs creaking rhythmically with my thumping footfalls. Once I reach the exit and push through the heavy door, I see my behavior for what it is: a force of habit. You don’t stand around after a drug deal. You get the fuck out of there.

  Outside, the tension melts away, and a familiar feeling takes hold—almost like a speck of heroin when I’m on the verge of withdrawal. My brain stops thrashing. I check for the prescription in my shirt pocket as tears roll down my cheeks. Brushing them away, I get in the car and twist the key in the ignition.

  John Frusciante’s “The Past Recedes” plays on the stereo. A simple three-chord progression on an acoustic guitar—an inverted funnel, narrow and focused. A deep blue sky goes on forever without a cloud. I pull out of the parking lot and coast down the hill, a straight road that leads everywhere.

  epilogue

  It would be a gross understatement to say buprenorphine saved my life. Buprenorphine gave me my life. For the first time, my focus shifted from surviving to healing. My emotional pain threshold was now above basement level, and I no longer had the constant distraction of trying to find and hide heroin or avoid thinking about it.

  In weekly sessions with Dr. Aftergood, a lifetime of behavioral and relationship patterns crystallized once I began to see depression as a distorted filter of negative self-bias. Under a fresh lens, I understood that family and friends really did love me—but I knew I’d never feel worthy as long as I continued to deceive them.

  Three months after my first appointment with Dr. Wallace, at a drug store minutes from his office, a pharmacist refused to fill my prescription on a Friday night at six o’clock.

  “Controlled substances are thirty days,” she said, her unblinking gaze on me. “I can fill it tomorrow.”

  “I can’t come back tomorrow.”

  “Sorry.” She
waved the next customer forward.

  An older man approached the register, and I stepped to the right and pretended to be interested in the brightly colored hand-shaped back scratchers while staring at my reflection in a fish-eye security mirror. Suit and tie. Short, neat hair. Clean-shaven. Not a junkie.

  When the older man paid and shuffled off, I slid back into position.

  “I can’t come back on a weekend. My wife doesn’t know about the buprenorphine, and even if she did, I don’t get to see my daughter much on weekdays.”

  “Then maybe you ought to stop doing drugs around her.”

  “I take buprenorphine so I won’t use drugs. It shouldn’t be a controlled substance.”

  “And yet . . .”

  I left without the prescription but with confirmation of every shitty feeling I’d had about myself. Choking back tears, I practiced spilling my guts to Andrea in rush-hour traffic. It felt like an unforgivable betrayal—like I’d cheated on the only girl I never cheated on. When I got home, I grabbed last month’s prescription bottle, dumped an orange, hexagonal tablet in my hand, and proceeded to tell Andrea about buprenorphine—except I said it was a new medication for migraines.

  Overwhelmed with guilt and shame and in a world of hurt from my self-inflicted wounds, I understood buprenorphine’s limitations for relieving pain—physical and emotional. Opiate receptors regulate pain and emotional well-being. Opioids kill pain by saturating your receptors. Heroin is to Vicodin is to buprenorphine as vodka is to beer is to the hard seltzer you might give curious toddlers when they won’t leave you alone about taking a sip.

  By 2018, after many gut-spilling practices and chickening outs, I’d been on buprenorphine for a decade without a single slip, and only three people knew: Dr. Aftergood, Rob, and Dr. Wallace. Everyone else believed I had been sober for twenty-three years.

  Opioid addiction had become a national health emergency, and our response was driven by stereotypes, misinformation, and a pervasive disregard of science and evidence—in policy, treatment, and prevention. I was profoundly aware of the ways my silence was working against my relationships and every change I wanted to see in the world. How could I expect anyone else to talk about their struggles with depression or addiction if I denied the existence of mine?