FROM THE INSIDE

★ ★ ★ ★

A SIMPLE TRANSACTION

By Ryan M. Moser

The police car sits idle on the shoulder of I-95 with its headlights beaming through the mist of an evanescent dusk, reflecting off the wet macadam as I explain my predicament. After a few minutes, the state trooper shows mercy and drives me to the Jacksonville Memorial Hospital so I don’t have to hitchhike with a “medical emergency,” and I grab my abdomen the entire 15-minute ride, faking my symptoms like a professional actor.

“Yeah, I’m vomiting. And my stomach hurts…like a burning, sharp pain,” I tell the intake nurse as she checks my vital signs. “No ma’am. I’ve never had stomach pains like this before.” I clutch my right side as if I’m holding my intestines in after a knife fight, not sure if my ruse is working. When she lightly touches my obliques with her finger, I decide to go for the Academy Award. “Ooww! That hurts really bad.”

“Oh dear, I apologize,” the woman says. “You sit right here, sugar, and I’m gonna get a doctor to have a look at you.”

I’m nauseous and sweating profusely, and the hot/cold chills are almost unbearable, but I don’t need a doctor to tell me what’s wrong—I haven’t had a Roxy or a Vicodin since yesterday morning. I know from experience that when I go eight hours without painkillers I get cranky and anxious. After 12 hours: flu-like symptoms. Twenty-four hours: desperation, restless leg syndrome, diarrhea, and shakes that consume my existence until (a) I score some pills or (b) five days pass to detoxify my system.

The emergency room smells like antiseptic and is full of activity. I spend 10 minutes in the bathroom with the runs and then sit on a padded hospital bed covered with tissue paper, awaiting some relief—a compassionate nurse who feeds me a codeine pill to ease my suffering; a stern doctor who warns me not to come back as he gives me a Lortab; an impatient and overworked resident who writes a small script for Percocet to get me out of his hair. I’ve played this game three times with the local hospitals and each time I’ve won, but as the attending physician walks into the room. I have a foreboding sense that he is all business.

“What concerns me is the location of the pain, Mr, Moser.” The doctor is a handsome, Middle-Eastern man with a hairy chest poking through the blue Oxford under his lab coat and chewing gum on his breath. “Severe abdominal distress of this nature is very serious, and I’m concerned that you could have an inflamed appendix. Typical symptoms are fever, vomiting, nausea…I’d like to do an ultrasound image and go from there.”

“Um…okay. Whatever you say, doctor.” I haven’t eaten or slept and I’m dehydrated; it takes all of my skills of manipulation to ask my next question sincerely, and not raise any suspicion. “Do you think I can have some water and something for the pain?”

The erudite healer looks up from my chart in an aloof manner and turns to leave. “Not until we know if you need surgery.”

My hopes drop. What can I do to exploit him? I’m not leaving without something…no goddamn way. I can’t go through another night of this agony. I don’t want to lie in a pool of sweat on a bare mattress, replaying my mistakes over and over in my mind like a highlight reel on ESPN. Failed relationships…lost jobs…unpaid bills…near arrests…bad parenting. I look around the emergency room and fantasize about the pharmaceutical treasure trove hidden behind a Plexiglas cage somewhere not far from me, sinking into despair at the thought of leaving empty-handed. I’m adrift in a sea of misery with no land in sight…and ready to drown.

A petite general surgeon stands next to the attending physician, examining my ultrasound film like a Monet painting; twisting and turning it; pointing at the suspect in question—my appendix (the only organ with no known function in humans). After a brief and methodical study of the Rorschach test that is my internal anatomy, the puzzle of my ailment is surprisingly solved.

“You have appendicitis,” the surgeon states frankly. She is an older woman with faded brown hair tucked into a bun and boring glasses. She clicks her pen and consults the ultrasound once more before showing me the evidence of my body’s supposed treachery. Bewildered, I stop writhing in dramatic fashion just long enough to ask her to repeat herself. “This darkened area here shows an inflammation of your appendix, and we need to perform an emergency appendectomy. The surgery itself is routine, but necessary. In your case, with the amount of pain you’re experiencing, I recommend we operate now, Mr. Moser. Recovery time is about three weeks, during which you will be properly medicated and receive some follow up treatment to remove the surgical staples.”

The attending physician holds a legal document in front of my face, clearly not happy about having an uninsured patient in his E.R. “We’re not legally allowed to turn away any emergency surgeries…this will absolve the hospital of neglect and a bill will be sent to you for the cost of operation.”

My stomach turns and I wipe sweat from my brow; I watch the doctors watch me, waiting for an answer. A simple transaction: one appendix for 100 Oxycontin. I feel like a slimy clam withering around inside its shell. All I want is to get rid of this unbearable monster devouring my soul, and at this very second, I will do almost anything to have the chills go away. I can no longer contain my retching and shaking from withdrawal. I’m in full crisis mode and need immediate help. Things are now officially out of control; I realize that if I choose to follow this trail of madness, this charade, that the humiliation will follow me forever. The gravity of such a mistake will weigh on my conscience every time I look down at the pale-pink scars, and I know I’m about to cross a line of degeneracy. But I don’t care. The only thing that matters is relief, so I text my mom a cryptic message about minor surgery and sign.

I can’t really formulate a rational sentence. I curl up in a ball on the bed as the E.R. nurses prepare a gurney to take me to the operating room. I’m rolled to a pre-op area on another floor, and ache with anticipation for the morphine that will soon be flowing into my vein from an intravenous line, trickling down a tube-like hypnotic nectar from the gods. I’m given a gown to change into, and some more paperwork to sign, and I write down a fake address while the surgeon tells me how lucky I am to catch this early.

“If the appendix wall ruptures, infection will spread to the abdominal cavity, causing peritonitis. Oftentimes this can be fatal, so this is an urgent procedure.” When she leaves to scrub in a new face joins my bedside, with a series of shots to my trembling forearm.

“You may feel a little groggy and confused when you wake up from the anesthesia, that’s typical. I’ll be monitoring your vitals and all that…you’ll be fine, dude.” The anesthesiologist is a hip Spanish guy in his forties wearing multicolored scrubs and a bandana, and he has an especially cavalier attitude for someone who could legally kill me. All I want at this moment is to be knocked out so it can start—the sooner I wake up, the sooner I can feel the comforting warmth and euphoria of a painkiller drip. I’m oddly at ease as the surgeon reappears wearing medical scrubs, a mask, and gloves; the last thing I remember before going under is the cold air conditioning on my stomach as a nurse opens up my gown and the bitter smell of iodine.

* * *

“Do you know what your name is?” I hear the faint sound of fingers snapping in the distance of my dream-state and slowly open my eyes. “What’s your name?”

“Huh…um…Ryyyan” I lick my dry lips. “It’s…I’m…Ryan.”

“Good. You’re in the hospital, mi amigo. How do you feel?” The anesthesiologist waves a pen flashlight in front of my eyes and pinches my thigh.

“Ouch. I’m uh…really good. I feel high,” I spurt out reflectively. My mind is clouded but I sense my dope sickness is over and I see the doctors and nurses around my bed are in urgent motion, tending to my abdomen and fixing the I.V. lines and sensors. Monitors beep incessantly around me. I’m relaxed but incoherent, and as I fade back into unconsciousness, I hear an official voice instructing the nurses to watch me closely because I’m an “at-risk patient.”

The emergency room doctor from my intake is checking my pulse unsympathetically as I suck water through a straw. I’ve only been awake for a minute, but I see bright sunlight peeking through the curtains and wonder how long I’ve been sedated. “What time is it?”

“Four o’clock. You’ve been asleep for some time. Dr. Walsh is the surgeon who operated on you, and she’ll do your follow ups. The surgery went well and you’ll recuperate fine. However, I’m very concerned about your personal welfare, young man.” He puts my chart away and stares at me intently. “Mr. Moser, did you know that hospitals share information about psychiatric patients on a state-wide database? In the last month alone, you’ve been involuntarily committed to a mental health clinic under the Baker Act two times, for suicidal tendencies. And upon further inquiry, it turns out that you’ve visited all the area hospital emergency rooms recently. Would you care to elucidate?”

The doctor’s question catches me off guard so thoroughly, and I’m so stoned, that I’m just outright honest. “I’m a pill head. And I started smoking crack this month – I just can’t stop.” I pause to drink more water and wipe a tear from my cheek. “My girlfriend left me and I lost my job. I don’t know what to do. I’m homeless and hooked on drugs.” I turn away from him and a shooting pain sears my abs, prompting the physician to look at my staples.

“That explains your high tolerance for morphine.” The doctor takes his glasses off and leans very close to my bedside, earnestly analyzing my facial clues for trustworthiness. “Did you admit yourself to my hospital under false pretenses to get prescription pain medication?”

I don’t answer him. 1 wonder if I’ll eventually die from this disease—my anathema. I lie in bed staring at the wall in embarrassment, afraid of the repercussions of my duplicity. I know that I can’t really get in any trouble for what 1 did, but understand that if I say the truth aloud it will make this a real and tangible horror story about my addiction, not a footnote. Admitting my fraudulence to this judgmental man will carve the problem in marble like a Rodin sculpture, on display for all eternity. I weep in silence as he shakes his head slowly, pinching the bridge of his aquiline nose while acknowledging a grim reality—his hospital made a critical mistake and performed unnecessary surgery on a pill-seeking junkie. An $18,000 mistake, considering I wasn’t going to pay the bill. After a tense moment, the contrite doctor stands to leave, wordlessly confirming our secret collusion. 1 guess he knows there’s nothing to be done now except focus on my recovery, and the truth will only cause more harm than good for all.

* * *

When I wake back up, it’s nighttime and there’s a blonde nurse hovering around my bed, checking on me like a concerned aunt. I’m aware of her movements, but I’m in a drug-induced haze, and all I can manage is a slight smile while I ask about food. After neglecting basic needs like sleep, food, and water for days, my body is screaming to catch back up.

“Sure thing. How ‘bout some meatloaf and taters? Do you like Sprite?” She tucks the blanket under my cold feet and pats my leg.

“Yes, ma’am.”

She huffs jokingly. “Do not call me ma’am … you can call me Stacy, darlin’.”

I turn on the television and put the remote on the tray table. “Okay, I’m Ryan.  Where are my clothes? I need my cell and smokes.

The nurse grabs my pants from a closet and pulls out my phone, “There’s a charger plugged in next to your bed. Sorry… no smoking for you until you can walk outdoors. I’ll be back soon with some grub, so you just relax.”

“Thanks, Stacy. You know, you’re very pretty,” I add, trying to be charming.

“Well, thanks. Oh … your phone’s been ringin’ a lot, you should check your messages.”

When she leaves I look at my cell and see that I have over thirty texts and missed calls…most from my dealers or ex-girlfriends, and several from my mother. I remember the message I sent to her before surgery and cringe—she must be more worried than usual, if that’s possible. My family has been on the roller coaster ride of my addictions for years, and they already know I’ve lost everything over the past few months of debauchery. I’m ashamed. Now that the withdrawals are gone and I’m lucid, I second guess my decision—the abnormal subterfuge that fed my demon, I don’t want to talk to her, but I know that I have to.

The phone call is excruciating. Hearing my concerned mother fret over a self-inflicted injury brings me to a new low; maybe this is the rock bottom everyone talks about. I’m so feeble-minded, allowing a tiny pill to lead me into situations of such vulnerability. I’ve compromised my integrity, family, self-respect, to get what I crave. I’ve sold everything I own of value. I cover my head with the sheets and search my foggy mind for an explanation of this insanity. In the last few months, I’ve tried committing myself to a mental health clinic, paid for a weekend treatment center, begged my ex for help, and told my family about my problem, but nothing has worked.

When I was eight and innocent and unbound by the troubles of adulthood, I never saw my future self as a hostage to an enemy like this, losing in battle against a temporary high. I wanted to be a fighter pilot or an author or a prince—not a destitute drug addict doing anything to come up. How the fuck did my life come to this at thirty-four? I used to have a beautiful wife and a new sports car and an important job, but if those things really matter in life, why wasn’t I happy when I had them? Why use drugs? What caused me to start spiraling down the rabbit hole and give up everything I’d worked for? What is it about my personality that clings to drugs like an octopus wrapping its tentacles around a hapless clownfish?

When the morphine drip is suspended, I’m given Percocet orally that I “cheek” and save for later because I need a higher dosage than the hospital will give me; I store the 10 milligram pills up to take them all at once. In order to combat the physical pain without any Percs in my system, I beg for morphine until a doctor comes to see me. When she wavers, I threaten to check myself out of the hospital against orders and the physician concedes to my childish tantrum, feeding me a steady I.V. of dope once again. The nurses, doctors, and employees all know I’m an addict, and acquiesce to my demands of extra food and pain medication, albeit with pity bordering on repugnance. They ignore the infraction when I smoke a cigarette in the bathroom and take me in a wheelchair down to a patio to appease my nic fits. Nurse Stacy treats me with compassion and laughs cheerily when I repeatedly ask her out, but is blunt about my prospects; I fear that she has seen many people in my position and has me pegged. When I walk out of the hospital I will have an enormous amount of pain pills at my disposal—enabling a few weeks of abuse—but when I run out I’ll be right back where I started…desperate, alone, and in withdrawal. I know that I’m only one bad decision away from going to jail and it scares me.

* * *

Two days is a very long time to lie in bed buzzed on morphine, ruminating over your existence. I’m finally able to walk to the bathroom unassisted and take a hot shower—‘maybe the best shower of my whole life—and I’m nourished, rested, and clean. I have enough opiates in my veins to knock down a horse, but even after the extreme and pathetic lengths I went to in arriving at this moment, I’m already thinking about partying when I leave. This idea fills me with disgust. As I shave and look into my glassy blue eyes in the mirror, I can’t help but feel empty inside. Why can’t I just shake this monkey off my back long enough to heal? My chi is no longer my own; it’s been high-jacked by the ebb and flow of addiction—my current raison d’être. And now it’s near checkout time at the Pharma Hotel, and I’m still off the tracks.

“Here are your prescriptions and discharge papers, Mr. Moser. Just sign here,” the young duty nurse informs me. He’s a new face and seems likeable. “You have an appointment scheduled in two weeks to have the staples removed. Good luck and take care of yourself.”

I unplug my cell from the charger, hesitant to leave the comfort and security of my nice accommodations. Over the last three nights, I haven’t had to hustle for a motel room, go hungry, or worry about my next score; my guard was down and I was relaxed. Now, my anxiety about running the streets returns to my psyche like an ex-stalker. I may be holding two bottles filled with Oxycontin and Dilaudid, but they can’t erase the problems I’ve created for myself outside these walls. The stocky nurse stands in front of me, waiting patiently as I accept the reality of leaving.

“Thanks, man.” I muster weakly.

“Jake. You’re welcome.” I introduce myself and we shake hands. “Can I make a suggestion to you?”

“Sure.”

“Get some help…you don’t want to live like this. You seem like you have so much potential and it’s a shame to see it wasted.” He hands me a folder with some paperwork. “Here’s a list of treatment centers and meeting places and times for Narcotics Anonymous. I know it’s not really my business, but I want to help.”

Since the moment I walked through the hospital doors, every interaction I’ve had has been filled with an underlying embarrassment about my weakness; my insecurities have been on overdrive and only masked by a constant stream of heavy narcotics to numb my pain. But standing here in front of this caring, kindhearted nurse, I feel a glimmer of hope. I’m moved that a stranger sees past my transgressions and wants to help me climb out of the insidious abyss. Jake’s affability reminds me of normal life; being around sober people who work and have barbeques and take kids to soccer practice and make plans about the future. Of the everyday commoners who share love and good times with someone special. Ordinary people who’ve overcome ordinary unhappiness without drugs or alcohol; who strive for something real and true in life with purpose and determination; who have a circle of friends, family, and co-workers to lean into on this planet of uncertainty and occasional loss. Jake’s empathy inspires me to do something better. I’m mentally revitalized and want to try anything different. I want to stop the cycle of damage and destruction that I always leave in my wake, and try to get back to the way things used to be. I sincerely want to change, but just I don’t know how. It’s like I fell off a cliff and the rope to save me is just beyond my grasp the whole way down.

I look at Jake with a renewed sense of optimism, and ask him if he’ll walk with me downstairs. We talk like old friends, and it feels so good to have a normal conversation. Both of us have sons the same age, and we share stories about their adventures and sports. When we step out of the elevator, I slow my pace and lower my voice.

“Look, Jake, I’m messed up right now, but I’m not a bad guy. I promise. If we met under different circumstances…”

“We’d coach little league together?” he says.

My heart softens at the image of seeing my boy play ball again, and 1 choke up. “Yeah…yeah…so you understand.”

The lobby is cavernous and echoing with footsteps as I steer towards the front doors with trepidation. I’m scared to leave, to head back into the crazy world of tricks and manipulations, violence and new regrets. Jake sees the fear in my eyes and grabs my cell out of my hand.

“This is my number, bro. Go to a meeting, get clean, and call me up sometime soon. I need a third baseman for our softball team, and you look like a power hitter,” he says with a smile.

We shake hands goodbye and I step through the door, blinded by the splintering sunlight and hoping for a new beginning. And while I know that it may just out of reach, I’m willing to try.

Ryan M. Moser is a recovering addict serving a ten-year sentence in the Florida Department of Corrections for a nonviolent property crime. Previous publications include Evening Street Press, Storyteller, Santa Fe Literary Review, The Progressive, themarshallproject.org, medium.com, thewildword.com, thestartup.com, and more. In 2020, his essay “Injuries Incompatible with Life” received an Honorable Mention award from PEN America, including publication on pen.org. Ryan is a Philadelphia native who enjoys yoga, playing chess, and performing live music. He is a proud father of two beautiful sons.

This column was made possible with the help of Exchange for Change, a non-profit based in Florida that teaches writing in prisons and runs letter exchanges between incarcerated students and writers studying on the outside.

Exchange for Change believes in the value of every voice, and gives their students an opportunity to express themselves without the fear of being stigmatized. Their work is based on the belief that when everyone has the ability to listen and be heard, strong and safe communities are formed, and that with a pen and paper, students can become agents of change across different communities in ways they may otherwise have never encountered.

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