Carol was sitting in Buck Speer’s office, trying to control her emotions. This was her least favorite place. His office had once been a place of creativity and inspiration. Now it was a war zone. Spears had begun to look for any opportunity to discredit or embarrass her.
Today, she was accompanied by the entire addiction recovery staff. Carol had originally conducted these weekly manager’s meetings with Spears one on one. The purpose had been to resolve any problems and to keep Spears up to date on the department’s issues. Now, with Carol out of the manager’s seat, there had been no newly appointed honcho. Spears had decided that it was a good way for the center to save money, at least for a while.
So, here sat the entire department, moving through the process with the grace of congress. No one could agree on anything. Today’s topic: their means of assessment. Carol had devised the process and the forms they used to assess each patient upon admission. She had developed this based on her years of addiction experience and the guidelines used nationally by the American Society of Addiction Medicine. Known as “ASAM," the structure was becoming the most universal language for diagnosis and determined level of treatment within the addiction recovery community.
It was not a complicated process. There were always a multitude of options when it came to recommended treatment. If a patient presented with heavy substance use, suicidal thoughts, and their entire household revolved around drug use, the patient was in need of in-patient treatment. In English, John Doe needed to be hospitalized, watched carefully, and his return home reconsidered. If baby John Doe smoked marijuana, felt remorseful, and had Ozzie and Harriett for parents, he probably only needed some outpatient groups.
Carol’s assessment process had covered all the symptoms of addiction and all the criteria of ASAM. Spears had helped her develop it and had applauded the final package. But since her demotion, the group had been working on a shorter version of the process. Carol was all for simplicity, but she had found the new version to be so incomplete that she had to use the back of each page for the information the process failed to capture.
She had just voiced her concern about the new version and the room had become silent. Carol looked at the other members of the department. Most of the individuals had been completely clueless about assessment and diagnosis when they came to Newberg Mental health and Carol had personally trained each and every one of them. The fact that they had an equal voice in this process now was a joke as far she was concerned. But she understood the new hierarchy and “lowerarchy,” and had been willing to play by the new rules.
Finally Spears looked directly at Carol, and said, “So, why is it that everyone else seems to be able to use the new format and you seem to be the only one having difficulty with it?"
Carol was sick to death of the pissing contest Spears had come to enjoy. Her immediate thought was that the other staff’s version of “successful use” was questionable at best.
Instead, she squared off at Spears and said, “I guess I must have a learning disability."
She could hear gasps from the other staff members. No one ever spoke to Spears that way. Carol continued to stare at the Center Director, who now appeared to have smoke coming out of his ears.
“The meeting is over," Spears said finally. “Except for Carol. The rest of you can go."
Everyone quickly left the room. When the door had been closed behind the last person, Spears glared at Carol. She steadied her gaze on him, refusing to back down. “What the hell was that?" he said finally.
“That was a ridiculous response to a ridiculous statement. You know full well that the staff doesn’t know squat about assessment."
Spears did not respond.
“You also know,” Carol continued, “that I am the most experienced person in our department."
“You are the most careless person in that department," Spears retorted.
“Fine," Carol said, standing to leave. “I may be a lot of things, but my assessment skills are above reproach, and that is what the hell that was all about." Carol was about to walk through the door, when Spears stopped her.
“This is your final warning," he said.
She stopped and turned to look at him.
“What does that mean?"
“It means that your insubordination is going to be documented and placed into your file.”
“My insubordination was provoked by an attack," Carol said incredulously.
“Doesn’t matter," he retorted. “This is the third and final report. It’s all I need."
“All you need for what?"
“To avoid a fourth one," Spears said. “Now you may go."
Carol hesitated at the door and thought about continuing the argument but even an inkling of her current assessment of Spears would assuredly bring on the final reprimand. Instead, she glared at the Director and closed the door behind her.
Carol was so exhausted and achy her teeth hurt. She dragged herself back to her office and sat down heavily on the patient’s couch. She didn’t want to cry or seek justice. She wanted to lie down and sleep for a solid week. She sat back and rested her dizzy head on the back of the couch, trying to control the spinning.
The light knock on her door came a few minutes later. Carol lifted her head off the back of the couch and said, “Come in."
A tall thin woman peered around the door.
“Is it safe to come in?"
“Linda," Carol said. “Of course it’s safe."
“I am so sorry about what Spears said to you in that meeting," Linda said, soothingly.
“Thanks. This has become a regular game with him."
“We know," Linda responded.
Carol sat up and looked at the woman. She had hired Linda herself and had worked with her for only a short time, but knew she was a person of integrity. “Linda," she began. “Would you be willing to document your view of what took place in that meeting?"
“Is it going to come to that?" Linda asked in surprise.
“It could."
“Well, if it does, I guess you can count me in."
Linda Mestry was a nurse. She could pick and choose her places of employment and had always danced to the beat of a different drummer. Carol felt sure she could count on her if necessary. “You are a good friend," Carol said. “And I won’t forget this."
“No problem," Linda said. “You look fried. You should go home."
“Don’t have to twist my arm," Carol laughed, grabbing her head to convey the painful effort.
“As sick as you have been, I really don’t know why you put up with this."
“I have begun to seriously question it myself," Carol answered. She stood and put her arm around Linda. “Let’s both get out of here."
Carol walked Linda to her car, both of them laughing about the antics at Newberg Mental Health. Carol told her to go on. She had forgotten something inside. As she watched Linda drive away, Carol slowly turned on her heels, and went back to her office. The building was fairly empty now, except for an evening substance abuse group that was self-contained in the back of the building. Carol began to wander the dark hallway, thinking about everything that had led her to this point in her life.
She had always been driven to succeed. And despite her terminally rebellious attitude, she had some milestones to be proud of. Carol had assumed that the counseling field would be a caring and compassionate place to settle in. But it had not turned out that way. Just like any other place in the world, there were good people and bad. The only thing noteworthy about the mental health setting was that the bad ones were full blown lunatics.
It was time to re-evaluate her life. She knew that there was no perfect situation. No matter where you were, you always had to factor in the human equation. People were capable of such greatness and such destruction, depending on their demons. She just didn’t feel she had the life force to absorb anymore. Maybe it was the illness that had drained her, but she thought it was more.
She had remained so driven by the proverbial carrot in front of her nose that she had never stopped to think about the capture of the prize. What would she have, once the target that remained forever-just inches from her grasp was suddenly realized? The approval of one Mr. Buck Spears? Was that the final reward? No. It had to be more than that. Carol’s vision of true success was the intangible that could only be evidenced by the people around her. It would have been nice to feel accepted by her co-workers, even respected, but her greatest measure came from her patients.
Recovery within the addiction population is statistically one in ten. That is a generous prediction. Carol’s odds had never been in her favor. She knew that. So, what was the biggest issue here? Maybe it was that she couldn’t remember a time when she had not been all consumed by her job. There was no time that belonged to her. She had worked so hard for a system that seemed to absorb every waking moment of her time without showing the slightest acknowledgement of her presence.
The mental health system was a crowded entity, fighting to stay afloat among the needy, and justifying its presence by going through the motions of treatment. The hard copy evidence of treatment and “well thought-out” plans of action that were required by licensing entities received more time than the patients. It had to be this way, when annual audits by these bureaus demanded individual documentation for each person, notating their every move, as well as a step-by-step outline of the person’s goals. These beautifully executed treatment plans were about as applicable to reality as the grand idea of the unicorn. Realistically, a patient’s only goal was to begin putting one foot in front of the other without falling on their face. The stream of paper on each patient was a grand illusion that maintained a facility’s license, and most of a mental health worker’s time was required to maintain it.
In addition to all the paper, the system lacked the manpower and the talent of its workers to ever provide any real change. Its ineffectiveness not only failed its population, but also blocked them from hope through the tangled mess of their bureaucracy.
So, was the problem Newberg Mental Health, or was it something bigger? This job aside, all jobs had drained her. When engulfed in full-time employment, she eventually lost the ability to discern where the job left off, and she began. It was a never-ending cycle. She got up, went to work, crawled home at the end of the day, drifted off in front of the TV, and then went to bed. The following day, she would get up and do it all over again. The weekend would be a time to recover from the endless cycle of the previous week, catch up on all the responsibilities that had been neglected, and would end early Sunday night, because tomorrow was a workday. And the one question that continued to pop up in her mind was what did she have to show for it? An aging, lifeless face, and an empty heart. Was this due to some character defect in herself, or did everyone secretly feel this way?
Sedative withdrawal had stopped her dead in her tracks. It had captured her. The extent of its grip on her soul went beyond her current physical and mental disability. In her altered mental state, she felt as though it had wiped out her entire existence and her identity. She had experienced a complete loss of self. All the things that had made her who she was were gone. In psychology, this was called de-personalization. She now knew the true meaning of that term. Her sharp wit, her creative energy, even her compassion had been stripped from her. Through this void, she had been forced to search for a new identity. She was still going through the motions and relying on her memory of who Carol used to be, but she was now sure of one thing: this life made no sense. She only had a limited number of active years left and she was wasting them. What was the alternative? She didn’t know. She just knew that she didn’t want to fight for this anymore.
Carol walked into her office and composed a letter to the Center Director, giving him two weeks’ notice. After she had slipped it under his door, she walked back out of the building and got into her car. She didn’t put the key into the ignition. Instead, she stared at the building and felt one final emotion. She absorbed the realization of how hard it was to let go.
Sheila arrived at Hartsfield Airport in a thunderous downpour. When the plane finally touched the ground, the entire airplane population applauded the pilot. “Thank you for the vote of confidence," came the overhead announcement. “But our safe landing was always in the hands of a Higher Authority." The people cheered even louder and the pilot waited for them to finish their celebration. “Welcome to the sunny south," the pilot continued. “If your destination is Atlanta, I hope you brought an umbrella. For those of you continuing on to Dallas / Fort Worth, you have one hour to enjoy the weather. I have been informed that the current weather condition in Dallas is blue skies and the current temperature is seventy-two degrees." A few individuals clapped, while others groaned, collecting their belongings. Sheila was standing in the isle, ready to fly when they finally reached the terminal and opened the door.
Jerry saw her first and waved when she entered the baggage area.
“Thanks for picking me up," Sheila said, as she climbed into the passenger seat of Jerry’s Toyota pickup.
“No problem," he said, checking the side view mirror and pulling away from the curb. “Getting you back here in one piece was my personal goal."
Sheila knew that Jerry had been keeping close tabs on Dominex. They had not continued regular communication once they had established the company’s pattern and motive. They had just agreed to deal with it once Sheila returned home.
Now that she was here, she wasn’t sure if she was ready to hear all the messy details. The past month had been happy and peaceful. Sheila fiddled with the radio, while Jerry navigated out of the airport. The rain had turned an already busy Atlanta Friday rush hour into a disaster area. “If we ever get out of here," Sheila offered, “I will buy you dinner.”
“You’re on," Jerry said, zipping into the turning lane that would free them from the airport traffic.
Heading up I-85 towards the city, the traffic was much lighter. The two chatted about Dominex in Newark, the great staff, the sales contest, and Jerry’s recount of his parents’ trip to Florida. The topic of the study did not come up during the drive. There would be time for that later. When they hit Midtown, Sheila directed Jerry to the restaurant. “You’ll love this place," she assured him.
It was still fairly early in the evening, and Jerry pulled into a space close to the restaurant’s entrance. The rain was still steadily pouring down, but the two made it in without too much water damage.
“So how bad is it?" Sheila finally ventured, after the waiter had taken their orders.
Jerry’s face darkened as he looked down to study his beer. Sheila felt a tug at the pit of her stomach and took a swig of her wine.
“That bad?" she prompted, when Jerry did not volunteer any information.
“Well, I was hoping for a few more happy minutes," he said finally.
“Sorry," Sheila said, touching his hand. “We can do that."
Jerry had been carrying this burden around with him for a while without the benefit of being able to share it with another human being. He had had a lot of sleepless nights, pondering the magnitude of what Dominex was doing. The fact that he had not only done nothing to stop it, but that he had actually warned the company when the situation was at risk of going public, did not make him very pleased with himself. His reason had neutralized the immorality of his actions. At least that’s what he had told himself at the time. Now he had the opportunity to share the burden with someone else.
Jerry pulled a thick stack of papers out of his wet briefcase. The papers did not show the wear of the weather or their long travel of the past few months. Silently, he handed them to Sheila. While she studied the information, Jerry polished off his beer and ordered them both another round of drinks. By the time she had finished reading the last page, she was ready for the glass the waiter presented. They drank in silence.
Sheila was the first to break their quiet reverie. “I can’t believe how many people were rendered completely disabled by that shit." Jerry shrugged and nodded, helpless to find the words to convey his disgust. “What I don’t understand," she continued, “is how in the hell can they present this to the FDA? Slightly less than half of the entire study group became so violently sick, that they either dropped out of the study and sought medical attention, or dropped out of the picture all together.”
“I know," Jerry said, finally finding his voice. “And when they did see a doctor, they weren’t even provided with real treatment. Oh, and one more interesting little tidbit,” he added. “That Pharmlab address is an abandoned house.” Jerry reached into his bag and presented her with several photos.
“This is a fiasco," Sheila marveled, looking at each picture.
“So, what do we do now?"
Sheila didn’t respond. She merely gave him a look that said, “You don’t want to know,” slipping the pages and pictures into her bag.
“Sheila, I can’t let you deal with this alone," he said.
“I have been dealing with this alone for a long time," she answered. “Don’t worry about me, really. I have been waiting for this moment, and now that it’s here, we need to celebrate."
“Then why doesn’t this feel like a celebration? I’m very confused."
Sheila studied Jerry’s face. He was a few years younger than her, but she felt that he was a kindred spirit. He was also a very handsome guy. She had been so pre-occupied that she hadn’t really noticed before.
Sheila took Jerry’s hand and said, “If you really want me to fill you in, I will."
He held her grasp, and said, “I do not want you have to deal with this alone."
Sheila wanted to leap over the table and hug him. She had had a taste of what it felt like to be close to other human beings and she was addicted. “Okay," she said, finally. “But you might need a six pack before I’m through.”
George Donovan hung up the phone and turned to his significant other, who was standing in the doorway. “Sally, we are having dinner with Jeff Edwards at six-thirty."
“What do they want now?" she grumbled.
“I don’t know, but I’m sure it has something to do with their public image." She closed the office door and sat in the chair facing his desk.
“This whole plan has been very reckless on their part," Sally remarked. “How far are you willing to go with this?"
“Let’s just see what they want first."
“You know," she continued, “we have done very well so far to avoid public scrutiny. I’m not willing to risk everything because Dominex needs to get their drug on the market."
Donovan began tapping his pen on his desk. They had been having this same discussion for weeks. He knew she was right, but he liked being connected with a big and powerful pharmaceutical company. He could see a brighter future, as long as he could stay in their pocket. They had already agreed to provide him with a lifetime supply of every drug they manufactured. He would fill prescriptions right there on the premises and then charge the patient for the medicine. His income would double over the course of the next few years.
“Sally," he said finally, “we have been all through this. We both know all about the risks involved in staying connected with them, but we also know about the potential money they represent.”
Sally just rolled her eyes at him.
“The money won’t mean squat in jail."
“You are being very dramatic. At this moment the only thing we are doing is offering these people vitamins or the option of going back on their meds.”
“Prior to this moment, they had us handing out sedatives and telling people they were vitamins. And let’s not forget the dead woman in exam room number two.” Sally’s voice began to rise in volume. “We’ve never had to call a medical examiner to come and pick up a dead patient before. Our patients do not go into withdrawal, much less die from it. Where is this going to end?”
“Sally, please calm down," Donovan said soothingly.
“No, wait," she continued. “If an employee at Dominex had not intercepted a phone call, we’d still be running that ridiculous scam. And don’t forget that the people they are continuing to send us are still at risk of the same outcome as that poor woman they hauled away in a body bag. Seizures are the number one and most likely result of abrupt termination of sedatives. How could they be so reckless?” She waited for Donovan to absorb her words. “Can you guarantee that what they ask us to do tonight won’t come back to bite us in the ass?"
Donovan knew she was upset and was smart enough not to disagree with her.
“Sally, let’s just find out what they want first, okay?"
Sally didn’t answer him. She just gave him a fiery glance.
“We have patients," she said, standing up to leave.
“Sally," Donovan whined, extending the first syllable to convey pleading.
“It’s fine George," she said to reassure him, although she did not sound reassuring at all. “We will wait and see. But this conversation is not over." And with that, she briskly walked out of the office.
Donovan watched her close the door and stared at the empty chair she had occupied. Things were different now. In their younger days, they were fearless. Every decision they had made had paid off. Now. there was an added issue. Sally was pregnant. They were both happy about the prospect of a baby, but they also knew that things were about to change. Sally wasn’t showing yet, and no one in the office knew anything, other than she had been taking more ‘”personal days,’” lately. Sally’s personal days were more like “camping out in the bathroom days.” When she was in the office, she was becoming a little more short-tempered and emotional. Donovan told the staff that it was stress.
In her present condition he would have preferred that she not be involved with Dominex at all. But she had been an integral part of his life and his practice. He couldn’t eliminate her from things now. Besides, she would never have allowed it. So, he would have to work through this new plan with Dominex very gracefully. She usually felt better by the evening. She would be more tired, but less queasy. He had suggested to Jeff that they go to her favorite restaurant. Maybe she would be in better spirits later. He hoped so, because he was determined to move forward.
Donovan opened the door for Sally as they entered the busy restaurant. An attractive woman bumped into Donovan, as she and her male friend were leaving through the same door. “Oh, excuse me,” Donovan said and tripped over his own feet to grab the door for the woman. Sally just shook her head. “Would you have done a triple summer salt to grab the door for an ugly woman?"
“Sally, there are no ugly women."
“Yeah, right," she retorted.
Sally had nothing to worry about. She was a Lauren Bacall look-alike. Her curly, naturally blond hair was cut to shoulder length. Prior to her pregnancy, Sally could have been an underwear model. Recently, Donovan had picked on her mercilessly when she emerged from the bathroom, and he noticed a small belly forming. “I guess you’ll have to give your two week notice to Victoria’s Secret," he told her. Sally had just smiled and put her hands on the tiny protrusion.
“Yes, but I’ll be back," she announced.
Jeff Edwards was nowhere in sight, so the two decided to have a seat at the bar and wait for him. Donovan ordered a martini. Sally settled for a carbonated water. They were in deep discussion about a June wedding, when Donovan felt a tap on his shoulder.
“Sorry I’m late," Jeff explained. “The traffic…"
No one who lived in Atlanta ever had to finish a sentence that started with the word “traffic.”
“No problem," Donovan said. They stood from their seats at the bar as another couple swooped down to claim them.
“Hey, Sally," Jeff greeted. “How are you?"
“Hungry," she answered.
A waiter showed them to their table after a heated few moments about the smoking section. Donovan had little patience for incompetence. He had made the reservation himself and had specifically mentioned the smoking issue. They were both reformed smokers, which had hurled them into the “anti-smoking Nazi club.” In addition to their policy about second-hand smoke, the smell of it had become one of Sally’s biggest triggers for nausea.
“I can’t believe they allow that barbaric behavior in public places," Sally began, once they were seated. “It’s one thing if people choose to suck that poison into their lungs. It’s another when they have the right to make that choice for others. If heroin users walked around shooting up strangers, I bet people would have something to say about it."
Donovan let her ramble until she was finished. Of the two, she had become the worst anti-smoking Nazi. He was used to the speech. He heard it every time they went to a restaurant. Jeff looked at Sally in bewilderment. Donovan gestured to him to just let her vent.
“She’ll be okay in minute," he assured.
The waiter appeared for their drink orders, and Jeff suggested a bottle of wine for the table.
Sally and Donovan exchanged glances. “Uh, better make that two glasses of wine, and one caffeine-free coke.”
Jeff looked at Sally with one eyebrow extended upward.
“Busted," she said to Donovan.
The doctor filled Jeff in on Sally’s condition, and their wedding plans. When he had finished, the drinks arrived.
Jeff held up his glass. “To both of you. Congratulations."
“Thanks," Sally said. “Believe it or not, you’re the first one we have told."
“Wow, I’m honored," Jeff retorted.
“It was inevitable," Donovan added. “She won’t be able to avoid maternity clothes much longer.”
Sally gave Donovan a light punch on the arm.
“At least I won’t have to wear a maternity wedding dress," she laughed. “God, don’t you think that is the tackiest thing? Like she didn’t know she was pregnant until she lost sight of her feet."
“Yeah," Donovan added. “And it’s always a white dress. Give me a break.” Everyone at the table was still laughing when the waiter returned for their orders.
“Looks like you might need another minute," the waiter said when he looked down and saw that no one had even opened a menu.
“Well, I know what I want," Sally said.
“She always gets the same thing," Donovan explained to Jeff.
“Why tamper with perfection?"
“You are right about that," Donovan said, putting his arm around her.
“Can this dinner get any cuter, I ask you?" Sally said, enjoying the attention. Jeff motioned for the waiter to return. He was anxious to get down to the real purpose of their meeting.
After they had placed their orders, Donovan said, “Okay, Jeff. If Dominex is picking up the tab, they must want something."
“Very astute," Jeff responded. “I won’t keep you in suspense. We just need a place for our remaining volunteers to check in. And to be honest, there aren’t a whole lot of them left. Most of them have technically finished their six weeks of abstinence."
“Technically?" Sally repeated.
“Well, half of them never made it to the end of the study,” Jeff explained. “The rest completed the cycle with us.”
“Doesn’t sound that complicated," Donovan interjected hopefully.
“It’s not. We will need blood pressures and drug screens. You can bag up the urine samples and we’ll continue to have a courier come by every two days.”
“I hate to question a perfect plan," Sally interjected, “but why make the change now, so close to the completion of the study?"
“Ah, that’s the million dollar question. We have some very interested employees who, shall I say, are not interested in letting well enough alone."
Both Sally and Donovan nodded their understanding.
“We have just under six weeks left," Jeff concluded. “We’re almost home and we don’t want any last minute complications.”
“Well, I’m okay with it," Donovan said, looking at Sally for any objections.
“I don’t see a problem with it," Sally conceded.
“Great," Jeff said. “I love it when a plan comes together."
A few minutes later, the food arr