|BOUNDARIES Home | Contents | Authors||Wordrunner eChapbooks | March 2017 | echapbook.com|
God only knows what drug she was on. Barbiturates most likely but it could have been heroin. Whatever Rene had taken, she couldn’t stand on her own. She came into the clinic, a guy on each side of her, their large hands locked under her arms. They were dragging her more than she was walking. Her eyes were barely open. She tried to talk but her tongue twisted around in her mouth. “I want my methadone” was garbled but I knew what she had said.
Rene was close to six feet tall, with skin as black as night, piercing eyes and long dark curly hair. When she was straight she would strut up to the window like a runway model. Not so today; today she was limp and pitiful.
The clinic was still full of clients and with her entrance the talk stopped and silence descended. When I see methadone clinics today I know they are very different from the clinics we ran in the early seventies. Methadone was new back then and our clinic, a part of a large community center, often looked more like a social gathering than a medical clinic. We did have a small, sectioned-off staff office and a dispensing window, but the rest of the place belonged more to the clients than it did to us.
That morning, similar to many mornings, clients who had already received their medication were lingering in the waiting area. We offered free coffee and lots of Salvation Army couches and they took advantage of both. Until Rene walked in they were paying more attention to each other than to the staff, each besting the person beside them in drug and street stories.
I knew I would refuse Rene her medicine as soon as I spotted her in the doorway, all slumped over and held up by those two guys. And I knew that, with all those clients sitting around, there would be an immediate reaction from the crowd in the room. And there was. Mike, a self-fashioned client advocate was off the couch and standing behind Rene as soon as I said, “I’m sorry. I can’t give you the medicine. You are too sedated.”
I had come to this south Texas town from the suburbs of New York City. I was white and solidly middle class. Only three years out of nursing school and already tired of working in hospitals, I had walked into work I knew nothing about. But I wasn’t alone; no one really knew much about methadone work back then. And Mike, who really had no official say in the matter, had not wanted me hired. “She is white and she’s a Yankee. She doesn’t come from here, what does she know about us?”
When I told Rene no medicine, she immediately tried to rally. She shook off the guys who were still holding her, but as soon as she did that, she began to slump and they had to grab at her to keep her from falling. They were tiring of it all, though, and when they got her steady, they walked her over to one of the couches, where the other clients made room for her. They lowered her gently but still she fell against the back of the couch at an odd angle. I watched her for a full minute, counting her breaths which were deep and regular. I knew if I went over and shook her, she would rouse. But if I did that, she would start asking me for her medicine, so I let her sleep.
“You can’t do that; you can’t refuse her the methadone unless you call someone,” Mike said to me as I watched Rene breathe. “You can’t deny her the medicine, she was on time. You have to call someone to get permission not to give it to her. If you won’t call the doctor, you should at least check with Margaret.”
I couldn’t call Margaret. She would think I couldn’t make decisions on my own. Margaret was the other nurse. She was raised in this town and, like Mike, she was black. And she had stood up for me when I was hired. “We don’t need all black staff,” she had said in a meeting Mike had insisted on having. “This is a methadone clinic not a black clinic,” she had told him.
Turning back to look at Mike, who now filled the dispensing window with his bulk, I was nervous. Not about my decision, I knew not giving her the methadone was the right thing to do. And I wasn’t worried that Mike would get out of control. My nervousness was about my feeling out of place here. It was about maybe Mike being right when he said I didn’t belong. His beefy arms were now resting on the sill of the window which was small enough that only his head and arms were visible in the space. I knew I could not back off.
“It isn’t safe,” I said to him, “She is too drugged. And I’m not going to call anyone.” He moved back a bit but he kept his eyes on me. “I told them not to hire you. This is not the end of this.” Then he walked away.
Over the next few days Mike stood outside the clinic talking to any methadone client who would listen. “Rene got to the clinic, she was on time, her fees were up to date and still she denied her the methadone. She should not be working here,” he told them. Some of our clients came and went quickly and others hung around for hours. I was reassured when I would see a client avoid Mike, move past him quickly, not wanting to be engaged. But others did listen, nodding their head. They all knew each other. Many of the black clients had grown up in the sprawling, low-rise housing projects that surrounded the community center. Most of the white clients grew up closer to the beach, but all of them had spent their drug days down here on the streets I drove each day to work.
Mike had grown up close by and had been on the streets since he was a teen. Addicted to heroin early, he was dealing drugs and running women by his twenties. Everyone knew him. He had served on the client committee as the clinic was being planned and was one of the first people to apply when we opened the doors. He was close to thirty by then and maybe he was not yet ready to give up drugs, but he was ready to slow down. He kept his urine screens clean enough not to get discharged and made excuses when they came back dirty. He was almost gifted at getting by with submitting urine that wasn’t his, even with one of the counselors standing by him as he peed.
Determined to have his say about me, he talked the medical director into a meeting. He only managed to get two clients to come with him, so almost everyone in the room was staff. “She never offered to let her come back later, she never called anyone else to check,” he said, looking not at me, but at the doctor.
Dr. Morgan never looked the part of a methadone medical director. While the staff often wore blue jeans and even shorts in the heat of the summer, he was always in a suit and tie. Sometimes seeming distant, always reserved, he still had an uncanny ability to cut through useless talk even as he made people feel that their issues were worthy of his time. He ignored any craziness in the client stories, opting for direct alternatives to each problem presented to him. He told clients that getting off drugs was hard work. He told them we would help the best that we could, but that it was their choice to make.
All the staff knew what he would say in response. He only agreed to the meeting to emphasize that the nurses were hired to make these kinds of decisions. “If you look like you are actively using drugs, if you are sedated in any way, I expect them to refuse to give you the medicine.”
When the room finally emptied I cornered the doctor. “I hate this,” I said to him. “They are mean and they are personal in their attacks. And those counselors, they push for more authority, even the authority to give out the medicine. But when I said no to Rene, neither one of them said a work to support me, not even after Mike walked away.” He listened to every word, maintaining eye contact and nodding his head. Then, his eyes never leaving mine, he said, “Eileen, this is not an easy place to work. Not everyone can do it.” The words were blunt, but his tone was caring. For one second I felt like I was his daughter more than his employee.
I came in the next day expecting more trouble from Mike but when he came up to the window his “good morning” was neutral, even friendly. He thanked me after I handed him his medication, then he turned and joined a group in the waiting room. In retrospect I feel like everything changed after that meeting, but in reality the change came slowly as one day slipped into another. At some point I noticed that Mike had stopped arguing with me and started using persuasion. “It is what they are used to, Eileen, drugs are a game to them, and getting methadone from you is a game as well.”
He was helpful in ways that a textbook could never be. One day he pulled me aside and told me, “Don’t tell these guys that methadone is long acting and if they miss a day the withdrawal will be very mild. They will just think you don’t understand.” But he didn’t stop acting like a drug addict. Confronted with his own positive lab slip, he talked about lab errors or the staff mixing up the specimens. He would plead his case for delaying his fee with stories of money stolen from him or needing just one more week to pay his overdue balance. Overtime he pushed his dose higher than any client, always saying that with just a bit more methadone, he could clean up.
It took me awhile to figure out that trusting or not trusting the clients to tell us the truth was a concept that had little bearing on our work. In reality, they were trying the best they could to get from us what they felt they needed. Telling us rambling stories filled with mixed truths and outrageous falsehoods was simply part of their strategy to get their methadone. To counter that and to give us space in which to work, we created an alternative structure. We built a world made from rules. And every time we learned something new, something that was getting by us, we made a new rule.
We made so many and then adjusted them so quickly that we had to keep a book. We had rules about continued drug use, about supplying urine samples to be tested, about paying fees, about dosing hours and about no yelling, and no threats. And rules that you had to be sober and alert to get your methadone every day and rules about take-home supplies, how to earn them, how to keep them, and how, once they were in your hand, they would not be replaced for any reason. And when we discovered “methadone spit” being sold right outside our doors, we made a rule that you had to talk to the nurse after you drank the liquid medicine.
The clients had their rules too: if you substitute another’s urine make sure it is from a client on the program (they check for methadone, you know), never admit you have some money in your pocket when trying to get your fee deferred, in fact admit nothing, not drug use, or that you lost your job or you were not in the emergency room when you were late, but home asleep in bed. When they tell you your urine is dirty, tell them about lab errors or staff mislabeling of bottles and when they ask you for money, tell them you had to give your mother money for food. If none of it works get dramatic, don’t yell, but don’t be afraid to tell them, “Y’all are forcing me to go out and steal to pay these fees.”
“You have to pay today, you owe two weeks.”
“Ah come on, y’all said tomorrow, and I’m trying to get to work and I can’t work without my medicine.”
“No, it is today; you agreed to pay today.”
“Alright, just give me my methadone and I will come back after work and pay.”
“You know it doesn’t work that way. You have to pay before I can give you the medicine.”
The clients thought we had all the power and, in reality we did; but we thought they were masters of getting the best of us, and they were. What they most wanted from us was the drug. And their biggest worry was that on any given day, we might say no.
They came in to the clinic friendly and casual or at other times haughty or arrogant, but they always felt vulnerable. For a long time I was oblivious to what they were thinking as they walked up to the window. I thought the rules were straightforward and if you followed them, the medicine could be had. But to the clients this was never true.
“What do you mean I have to give urine today? I just peed Monday.”
“Urine screens are random, random means anytime we ask for one. You know that, we’ve had this discussion before.”
“Man, this is unfair, Roger tells me he hasn’t given urine in a week, what about him, does he have to pee today?”
“You have to give a specimen today, do you want to try now or do you want to drink some water and try in a few minutes?”
“Shit, this is worse than being on the streets. I’d be better off just scoring some dope.”
Still, months after my complaining to the doctor, I realized that I was beginning to like these people. So much so that sometimes I just wanted to forget the urine screen or the few dollars they owed us and give them the medicine. These people lived a life at war with a drug. Everything, their ability to work, take care of a family, even simply get through the day depended on them getting a drug. We hadn’t caused their problems, but we claimed that we were there to help them. Now I was saying no just because they couldn’t pee on demand or owed us five dollars.
That was one reason I loved to see Walter come in. He was a white guy in his forties, who drove a big truck down to the valley and brought back produce to sell to the local markets. He dressed in black slacks and thin short sleeve shirts and he was always pleasant with us. He never argued about money or urine collections, his drug screens were always clean and he rarely hung out in the clinic. He came in, drank his methadone and left.
He had been with us over a year, when his urine came back positive for opiates. I looked at that slip and my first thought was, this has to be an error. But Walter didn’t claim it was an error. Instead he said, “I was down in the valley that week, I was in a club, and at the time I thought someone had put something in my drink.” And I believed him. At our next staff meeting, I advocated that we not remove his take-home supplies, the usual action in these circumstances. And we did just that, continued him on these privileges.
A few weeks later he was busted. It was an unusually large bust for that city, serious enough to make the papers in a distant city. He was driving his truck into our parking lot and underneath all those fruits and vegetables was lots of heroin. I never saw Walter after the bust; his charges were sufficient to keep him in the county jail until he made a deal and was sentenced. Different from Mike, Walter looked like me. He was courteous like me and he worked. He didn’t sit around the clinic all day and he did not tell endless drug stories. He did what we asked and he was never refused his methadone.
Bernice, Gloria and Joyce looked nothing like me. They were three black women in their twenties who had drugged and tricked since their teens. Each of them had lied to me about fees, urine screens and drug use. Each of them had been angry with me at times, and made hostile or insulting comments when I asked them for money or told them they had to pee to get their dose. And each of them had, at some point, been humbled by life and by drugs and had pleaded with us for help.
Late one afternoon I looked up to see the three of them coming through the door. The sun was bright and warm and they came in search of free coffee and the coolness of air conditioning. They were loud, that day, laughing and stumbling on their high heel sandals. When Bernice saw me, she pulled me to the window. She pointed to a small boy outside, “He asked me if I tricked,” she told me. The boy looked twelve but I hoped he was older. She pulled a folded twenty from her pocket and said, “I told him sure, I trick.” She would deny it later, say it was a joke, “I was just trying to get Eileen to blush,” she would tell her counselor, “I don’t trick anymore.”
She was dressed like the others in shorts that fit tight across her belly and barely covered the swells of her buttocks. Joyce started making fresh coffee, prancing more than walking around. Her knit top was stretched across her breasts leaving her midriff bare. Gloria and Joyce knew to keep their street-walking stories in the past tense, telling them as if they happened years ago when it might have been the night before. But Bernice was incorrigible. She knew the rules, once on methadone, prostitution was supposed to stop. She also knew that if she kept her urines clean and paid her fees it was unlikely we would discharge her.
Filling her cup halfway with creamer before she added coffee, Gloria told Bernice, “Sometimes those young kids go limp before they even start.” As soon as she said it my mind fashioned a picture of the kid, his penis hard, then going flaccid. And the picture in my mind made me blush. Gloria sat down and pulled in hard on her cigarette and crossed her legs which her shorts and heels made even longer. But nothing left on her was pretty. Her hair was dull, any shine long gone and her once gorgeous legs were marred by reddened bumps and old abrasions.
Soon the room was filled with story after story of “Johns” and sex in sweaty rooms and alleys. Finally Joyce slapped her thigh and cried, “Look how red she is.” She had barely got it out before her laughter caused her to choke on her coffee. As she raised her hand to cover her mouth I could see the scars that lined the inside of her arms.
They were embarrassing me and they were doing it on purpose. But I didn’t leave; because as I sat there, I was getting lost in those women. I was looking at Joyce and remembering her telling me how she practically raised herself; her mother disappeared into alcohol and drugs. And Gloria telling me how her baby had been taken from her, “Snatched by social services,” she said. “They told me in the hospital, they knew I used drugs. You have to come in every week to see us, and bring the baby. I couldn’t get to the hospital every week. I didn’t have any car or taxi money. Did they want me to trick to get the money? And damn it; I was staying clean after that baby. And they took her anyway.” And I thought about another client, a woman who had been working hard to change her life, got herself into GED classes, but then gave up before the test. She quit coming to the clinic after that. I would see her sometimes on the streets around us, stumbling along, her eyes haunted.
I was the same age as most of the women on the program. Looking at Gloria, Bernice and Joyce, I knew that while I was in high school, they were getting started on the streets. While I was pushing my way through nursing school, paid for by my parents, and thinking that my life was hard; they were tricking to buy the heroin that dulled the future they saw in front of them.
Would I ever do it, I asked myself. Could my life ever change in ways that I would prostitute myself? What if my rent was three months late and there was no one to help me? Joyce’s voice broke through my thoughts, “I like the old guys best, they are just grateful they are still doing it,” she said as she wiggled her ass. She was funny sitting there mimicking the movements of sex.
We were cut off when one of the late clients walked in and I got up to get their medicine. The ladies left when he left, all of them still playing and laughing at jokes that no longer poked fun at me. When the door closed, it was again still and I walked to the window and gazed out to the project site. The basketball court was momentarily empty and, for the first time, I saw the extensive cracks in the concrete. In this poor community center the cracks on that court would never be repaired. They would just get worse. I stood looking at the lines snaking across the courtyard, until a new bunch of kids came along, picked up one of the balls and once again, shouting and the noise of shuffling feet filled the clinic.
Mike never again tried to get rid of me. Eventually he stopped saying that I would never understand. Sometimes he even talked to me about his own life and what he wanted. It was probably only six months past that last meeting when he and I sat alone one afternoon on the same couch where the ladies had caused me to wonder if I could ever have sex for money. “I am tired of lying,” he said. “I am tired of stealing, I am hurting my family, I want more than this.”
I listened to him that day. I was empathetic but I had little faith that he could ever make it out of the drug world. But I would be proven wrong. In the years to come, he would stop his spotty heroin use. After more time had passed, he would start a slow, but steady decrease off Methadone. He would get a job, get up every day and do work that he felt was useful. I watched him do some of these things. I even helped him manage that detox. After I left, I heard from others how well he was doing. Still later, I left the city and lost track of him.
But on that day we sat on two Salvation Army couches next to the big coffee urn amidst the noise of the busy project site. I was satisfied. We were not great friends, but we were no longer adversaries. He did most of the talking. Then I noticed that the long afternoon was near its end and the sun was beginning its gradual descent into evening.
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