Page 14 of Puck My Pain Away

I take a pad from my drawer and I write him a heavier script. The same opioid, the next dose up, the strength that puts a real warm wall between a man and his life. I write it in my clean prescriber’s hand, I tear it off, and I don’t hand it to him. I cap the bottle of samples I keep for exactly this and set it on the desk in the no-man’s-land between us. I sit back, and I let him look at it.

“You said last week we’d hold the dose,” he says. His voice has gone careful. Some sober watchman in him, the same one I can always hear under the want, has sat up. “You said the goal was down. Off them, eventually.”

“The goal is your recovery.” I fold my hands. “Your pain’s escalating because your activity’s escalating, which means the joint’s working, which is what we want. We manage the pain so you can do the work. When the work’s done, we taper.” Every sentence true. Every sentence a door painted on a wall. I have spent my life learning to say the responsible thing in the responsible voice while I hand a man the next link in his chain, and the trick is that I’m not lying, not in any way he could prove, not in any way I could be made to answer for. The bottle on the desk is medically defensible. Everything I do is medically defensible. That’s not the cover for the crime. That is the crime.

He looks at the bottle. He looks at me. He knows, somewhere, the same as I knew somewhere, every time, all the way back. He reaches across the desk and takes it anyway, and his hand isn’t quite steady. I watch him close his fingers around it the same way he closed his fingers around my wrist three weeks ago, the same drowning grip. And I feel the old warm catch in my chest, the one that is the only thing I’ve ever found that fills the hole. I say nothing about the whiskey he’s going to take it with. That’s the part a good doctor would say. I leave it out. I leave it out of the chart, too.

“Thursday,” I tell him. “Ice tonight. Water, not whiskey, with these.” A small mercy, offered so he’ll remember I offered it, so that later, when it’s bad, the record and his memory will both show a careful man who cautioned him. “Go home, Roman.”

He goes. He takes the bottle, the bigger want, the unanswered thing between us, and he goes. I sit in the quiet after the door, and I do not feel like a monster. The sample bottle is gone from the desk. The chart on my screen shows a careful dose increase with a documented rationale, and nothing a review board could touch. I feel like a man who has been needed, which is the only feeling I have ever been able to keep down.

—

Blake Fox stops me in the hall the next morning.

She’s sharp, decent, and the only person in the building who looks at me a second too long. She’s got Roman’s med chart on her tablet and a careful set to her mouth, and she falls into step beside me where the corridor’s loud enough that no one will catch us.

“His scripts,” she says. “The dosing’s climbed twice in three weeks. That’s fast.”

“His activity’s climbed twice in three weeks.” I don’t slow down. “We’re loading the joint harder. Pain tracks the load. The plan is to taper once we’re past the strength phase.” Three sentences. Clean, true, complete. I have them ready before she finishes the question, because I’ve had a version of this conversation in a hallway before, with a different careful colleague, in a different building that I left in a box of personal effects.

“I’d taper sooner,” she says. “He’s got the profile. Family history, how he—” She stops herself, professional, but I heard the rest. How he is about them. How he reaches for the bottle before the pain’s even bad. She’s seen it. She’s good. “I’d just watch it.”

“I’m watching it closely.” I meet her eyes and hold them, open, untroubled, a senior clinician hearing a junior’s reasonable note. “Send me your taper proposal. I’ll fold it in.” I won’t. But the offer makes me a man who collaborates. I watch her weigh me against the thing her gut is telling her, and I watch the gut lose. Because I am the most trusted clinician in the organization and she is twenty-nine and new. The institution is built to make her doubt herself before it doubts me. She nods. She lets it go.

But I clock it on my way down the corridor, the small fact of her, and I file it with the rest. She’s right. That’s the trouble with Blake Fox. She’s not suspicious of me out of ambition or dislike, the two motives I know how to use; she’s suspicious because she’s good at the actual work and the actual work is telling her something’s off. Those are the dangerous ones. You can’t flatter a person out of their own competence. You can only get ahead of it, give them a paper trail that shows a careful man, fold their notes into your file so the record reads collaboration instead of cover, and make very sure that when the day comes and someone finally asks the question, the answer’s already been written in your favor, in your own clean hand, weeks before they thought to ask. I’ve done that before too. I have a whole drawer that proves how well I do it. She’ll write the proposal and I’ll thank her for it, and it will change nothing. And a small flag has gone up in the part of me that surveys, the part that already knows Blake Fox is the one I’ll have to manage.

I make a note to be warmer to her. Warmth disarms. I learned that one early too.

—

That night, Tom from imaging asks me to dinner with a few of them, and I say I’ve got paperwork.

I don’t have paperwork. I have an empty office, a clean desk, a phone I keep glancing at, because Roman texts most nights now, somewhere between eleven and one, when the whiskey and the bigger dose have softened him enough to reach. And I have started to arrange my evenings around the window when he might. I tell myself I stay to be available, a responsible clinician managing a high-risk patient’s psychological state. The truth is simpler and worse. I stay because the text is the best part of my day, the small lit screen with his need on it, you up. The feeling I get when it comes is the feeling I have chased through three cities, one sealed file, a whole life built in society’s one unwatched blind spot.

I sit in the dark office past midnight. The phone stays dark. Tonight he doesn’t text, and I find that I mind, that the not-minding I’ve performed my whole life has a crack in it shaped exactly like a hockey player. I sit with that longer than I should before I make myself turn the phone face down and go home to the apartment where nothing has ever lived hard enough to disturb anything.

I have done this before, of course. That’s the part that should stop me and never does. I have sat in a dark office in another city waiting for another screen to light, and I know the whole arc of it from the inside, the slow climb of the dose, the slow narrowing of the man until there’s nothing in his life but the pain, the relief, the person who controls the gap between them, which is me, only ever me. I know what’s at the bottom of the arc, too. I read the bottom of it once a week with the file open on my desk. And the knowledge changes nothing, because the knowledge was never the thing in charge. What’s in charge is the pull in my chest when the screen lights, the one feeling I’ve found in forty years that doesn’t curdle the moment I have it, and a man will walk straight back into the worst thing he’s ever done for the only feeling that’s ever held. I’m no different from Roman that way. He reaches for the bottle. I reach for the reaching. We’re both going back to the thing that’s killing us because we’d rather die than face what we are without it, and the single difference between us, the only one, is that his hand shakes when he reaches and mine never does.

I check the phone one more time at the door. Nothing. I leave it dark and I go.

He’ll text tomorrow. The dose I wrote him guarantees it. I built the need with my own steady hands, and the worst thing I know about myself, sitting in the dark waiting for a screen to light, is that I built it as much for me as for him.

9

ROMAN

Theo calls for the third time this week, and I sit on the couch and watch the phone buzz itself in a circle on the cushion. I don’t pick up. The TV’s been muted for two days, some highlight package looping teams I used to play, and I haven’t had the will to find the remote.

I can’t. That’s the truth I dress up as I’m busy and I’ll call him back. I can’t pick up because Theo’s voice does a thing to me now, the warm worried rumble of it, hey man, just checking in, the kids miss their Uncle Roman. Every word of it is a hand reaching down to where I am, and I can’t let it touch me, because if it touches me, I’ll feel how far down I’ve gone and I’d rather not know the number. So I let it ring out. The screen goes to the photo of us, Theo and me and the cup, three summers ago, both of us sunburned, stupid, whole. Then it goes dark, and the little red one sits on the voicemail icon like a wound I’ll deal with later.

It’s eleven in the morning. I pour the first one at eleven-fifteen.

I’ve stopped pretending there’s a clock for it. The clock was the last fence, and I took it down sometime last week without ceremony. Now the whiskey just goes in whenever the day gets too loud—and the day is always too loud. The bottle’s down past the label, a case that came free turning out to be the most expensive thing anyone ever gave me. I drink it standing at the window of the glass box, looking down at a city that’s gotten up and gone to work without me. The knee throbs its dull background throb. And somewhere under the throb is the thing that’s actually wrong, the thing the pills and the whiskey only move one room over, and I cannot sit in this apartment one more hour with it.

My thumb’s already moving before the rest of me votes on it. I text him.

knee’s bad today