An excerpt from
Pain Management
by Andrew Vachss

For more information about Pain Management, click here.

The small house was modest, but in pristine condition, its fresh coat of blue paint with white trim set off against a masterful landscaping job that used boulders for sculpture. The 'Vette's big tires crunched on the pebbled driveway. In the carport, an ancient pink Firebird squatted next to an immaculate Harley hard-tail chopper, its gleaming chrome fighting iridescent green lacquer for attention.

The man who answered the door was big, powerfully built, with dark, intelligent eyes. He looked past Ann to me. "I told Dawn we were coming," Ann said.

He nodded, stepped aside.

The living room was dominated by a rose-colored futon couch. And the striking strawberry-blonde who sat on it. She was a pretty woman, but you could see she'd once been gorgeous. And way too young to have aged so much.

Ann went over to her. They exchanged a gentle hug and a kiss.

The man who'd opened the door took up a position behind the couch.

"Tell him, Dawn," Ann said.

The woman's gaze was clear and direct, azure eyes dancing with anger. But her voice was soft and calm, almost soothing.

"I've got MS," she said. "When I was first diagnosed, I set out to find out everything I could about it. Kind of 'know your enemy.' Back then, the medical establishment would go into this 'Pain is not usually a significant factor in MS' routine every time patients complained. Now, finally, it looks like they figured it out...."

"Or decided to finally give a fuck!" the man standing behind her said.

Dawn reached back with her right hand as he was reaching down with his.Their hands met as if connected by an invisible wire. "Yes," she said. "And now the Multiple Sclerosis Society is admitting that as many as seventy percent of folks with MS have what they call 'clinically significant pain' at some point, with around forty-eight percent of us suffering from it chronically."

"You couldn't get painkillers for MS?" I asked her, surprised despite everything I'd been hearing.

"Well, you could always get drugs," she sneered. "Even in the bad old days, neurologists liked handing them out—stuff like Xanax and Valium. Not because our muscle cramps and flexor spasms were 'real,' you understand. Since the pain was 'all in our heads,' they figured the tranqs would calm us down and make the problems in our brains and in our spines magically disappear. And since they did acknowledge that the deep fatigue was 'real,' you could always get stimulants."

"But aren't all those just as addictive as painkillers?" I asked her.

"Addictive?" She laughed. "Oh, hell yes. I had one neuro prescribing eighty to a hundred milligrams of Valium a day for me. She told me not to worry, there was no chance of becoming addicted. Needless to say, she was full of it. She just wanted her patients calm and placid, so they wouldn't complain or take up too much of her time. Medicaid wasn't paying her to give a damn, just to keep us quiet."

Her left arm twitched. Her mouth was calm, but I saw the stab in her eyes. She took a deep breath through her nose, pushed it into her stomach, then her chest, and finally into her throat. Let it out, slow. A yoga practitioner, then. People in pain try every path out of that jungle.

"Let me tell you," she went on, "detoxing from the Valium was a megaton worse than jonesing off cocaine. They used to say that was nonaddictive, too. But when I was young, I was into all kinds of street drugs, even freebasing. And I got off all of them myself. No programs, no nothing. But that Valium . . . damn!

"And all the stims they hand out for fatigue, they have pretty serious side effects . . . plus a potential for permanent damage I'm not willing to accept. The hell with the neuros. These days, I treat the fatigue with good strong coffee and naps."

"What about the pain?"

"All I get for that is the medical marijuana—it's the only 'illegal' drug I've used since I got pregnant, and Tam's eighteen now. And in college," she said, proudly. "But even that doesn't always work."

"And that slimy Supreme Court just struck down the law that allows medical marijuana," Ann said, fiercely. "They won't let people even—"

"Shhh, honey," Dawn said to her. "Look," she said earnestly, turning to me, leaning forward slightly, her man's big hand on her shoulder, "the thing about neurologically based chronic pain is, it doesn't work like 'normal' pain. Pot isn't enough. It relaxes the muscles just great, but does nothing at all for 'nerve burn.' It's like a really bad sunburn, only all over your whole body. I can even feel it inside—like if you could get a sunburn on your large intestine, or something.

"And the thing about that is, when it gets bad enough, it makes you . . . I don't know . . . something less than human. When you can't sleep, can't sit up, can't move, can't get any kind of relief, just lay there and cry, curled up in a ball. It got to the point where I was willing to do just about . . . anything to make it stop, even for a few minutes."

"The only people who really understand pain are the ones who have it," her man said, making it clear he was ready to help a few doctors learn. "When Dawn scratched her cornea, that lowlife punk in the white coat acted like she did it on purpose, just to score a few stinking Vicodins. You think I couldn't find better stuff in ten minutes? You think I don't know where the tweek labs are? If Dawn hadn't...."

He didn't finish. Didn't have to.

© 2001 Andrew Vachss. All rights reserved.

For more information about Pain Management, click here.