The Pain Clinic

by Billy Dennis

Margie Gallagher pulled into the pain clinic and parked her 2006 Suburban under a haggard elm tree that stood near the back of the lot. She looked around and then opened her purse and plucked out an orange pill bottle, dumping out the last three pills of Oxycontin into her hand. After making sure her daughter was still sound asleep in the backseat, she crushed the pills between two spoons and then gently laid the powder under her tongue. Her face shrunk and contorted as she forced herself to not swallow the bitter powder until it had completely dissolved. When it had, she swirled her tongue around her mouth, took a long sip of a fast food Coke, and then shook her head violently. She pulled the rearview mirror down and to the side and checked her makeup. She reapplied her lipstick—a bright red number she picked up at Wal-Mart a few minutes earlier—pumped a few squirts of perfume onto her neck, and then woke Amber from her slumber.

Inside, Margie checked-in with reception and handed over the new patient paperwork she had printed and filled out the night before, and then she sat in a row of empty chairs along the back wall of the waiting room, reading a gossip magazine and half-listening to her daughter talk about what she did in school the day before.

She glanced around the room at the other patients, making note of anyone looking her way. Despite being in her mid-forties, Margie could still turn heads when she walked into a room, and she used that to her advantage. She wore a low-cut white shirt that allowed newly minted tans lines to peer out from beneath the near-see-through fabric and a pair of faded denim jeans that were ripped wide at both knees. She looked a little like Alicia Silverstone, if Alicia Silverstone had chain-smoked Marlboro Reds for twenty years, had a habit of snorting Oxy, and adored abusive men with gambling problems.

When Mitch Jennings sat down in the row adjacent to hers, she noticed the absence of a wedding ring on his finger and the Rolex on his left arm. He was handsome, nice eyes, and wore a tailored suit—Armani, Margie thought to herself—and he had the frame of a middle linebacker in the NFL and a smile that was just a little too white to be natural. He was on the phone with work, she guessed. She listened to him talk numbers with a woman named Lily, whom she took for his secretary. Margie kept her head down, pretending to read the gossip magazine but listening in on his conversation. She liked doing that, especially when men didn't know she was listening. She thought it the best way to get to know a man. They don't lie to you when they don't know you’re listening, she once told her daughter. When Mitch mentioned the pain drugs Norco and Dilaudid, Margie’s left foot began to bounce and she bit at her nails but quickly stopped once she realized what she was doing. When he ended the call, Margie got up and strolled back over to the magazine rack. She bent down and placed the magazine on the bottom shelf, lingered there for a moment, and then slowly walked back to her seat—scrolling through her phone—not looking at anything in particular. She sat back down and crossed her legs, the rips in her jeans widening as she did so.

“Pharmaceutical rep, huh?” she asked.

Mitch looked up from his phone and smiled. “That’s right,” he said.

“How long have you been doing that?” Margie asked. She tried to sound friendly and hide the rasp in her voice.

“Since grad school, about six years now. What about you,” he asked, “are you a patient of Dr. Sino’s?”

She made sure to keep eye contact to prevent him from looking down at his phone lighting up. “This is my first time here,” she said. “You had to go to grad school to be a pharma rep?”

Mitch laughed and slid his phone into his pocket. “No. I went to grad school to be a writer. I became a pharma rep so I could eat.”

“You’re a writer?”

“Well, I write, but I’m not sure that makes me a writer.”

“How do you mean?” she asked.

“I fixed the toilet the other day in my bathroom, but that doesn't make me a plumber, now, does it?”

“Ah,” she said, “I see. What do you write when you’re not being a writer?”

“Mostly short stories. But I’ve been tinkering with a novel since college. Going to finish it any decade now, just you wait.”

Margie laughed and then leaned forward to re-tie her shoes. “What’s your novel about?” she asked, still tying her left shoe.

“Mom!” her daughter shouted. Everyone in the waiting room looked up. Amber was across the room working a Where’s Waldo puzzle at a little table near the magazines. “How much longer are we going to be here?”

Margie tried to smile, but it looked much more like a frown. “I don't know, sweetie. Not long. Finish your puzzle.”

Amber went back to her puzzle and Margie went back to Mitch. “I’m sorry,” she said, shaking her head—smiling.

Mitch flashed a quick smile but pulled his phone back out of his pocket and started texting.

Margie spoke up. “What, um—what’s your novel about?”

Mitch looked up briefly, acknowledged the question, and then went back to texting. He was still clicking away and looking down when he said, “Pain. Loss. Love. All the good stuff. What it’s like to go through life not realizing your true worth until it’s too late. Living a life beholden to someone else’s dreams or expectations of you.” Again, Mitch looked up for a moment and made eye contact. “It’s going be a best-seller, I’m telling you.”

“Sounds like a real hoot,” she said. Sounds like my life, she thought.

The door opened to the waiting room and Dr. Sino stood there looking disheveled and tired at eleven in the morning, his lab coat unbuttoned, his khakis stained from his morning cup of Joe. “Mitch, you want to come on back and talk for a second?”

Mitch stood up, slung his satchel over the shoulder, and told Margie good luck and to have a nice day, and then he disappeared behind the door with the doctor.

Margie dug though her purse to see if perhaps she had overlooked a stray Oxy. When she couldn't find any, her foot and knee started to bob up and down again. She looked at her phone, made a few half-hearted attempts to talk to her daughter, and bit at her nails until they’d been chewed down to the flesh.

“You keep biting your hand like that you’re going to ruin your lunch.”

Margie looked up and tried to locate the voice.

“Haven’t seen you here before,” a man said. “This your first time?”

Margie tracked the voice to a young man—not a day over twenty-four—sitting on the other side of the waiting room. He was smiling at her and talking away like they were the only two in the room. He wore a pair of camouflage cargo shorts, a faded Grateful Dead T-shirt, and a baseball cap with the sides of the bill folded sharply over.

“Must be,” he continued. “They always schedule everyone on the same day every month. Would’ve remembered you.”

“What? You talking to me?” Margie asked.

“You talkin’ to me?” He moved his head side to side and turned his mouth downward. “You talkin’ to me?” he said again in his best Robert De Niro voice and then laughed at himself. “I see these cats,” he said, pointing around at the other patients, “every month. Can’t get refills on controlled pain meds. Gotta come back each month to pick up your script. You end up seeing the same people every month.” A few patients nodded their heads; a couple of them said yep in agreement.

Margie wasn’t following what he was saying and said, “Yeah, I guess. This is my first time here.”

The man got up, walked over, and sat down beside Margie. He stuck out his hand. “Greg Stockton.”

Margie hesitated for a moment and then shook his hand. “I’m Margie.” She nodded her head toward her daughter, who had managed to finish the puzzle but still couldn’t find Waldo. “That’s my daughter Amber.”

Amber walked over and laid her head in Margie’s lap and said, “Can we go now—please?”

“Hi, Amber. I’m Greg. How old are you, eighteen?” he asked.

Amber laughed out loud. “No,” she said, drawing out the word. “I’m six.”

“What, six? Holy moly! You sure could’ve fooled me,” Greg said. “Hey, I bet you like magic, don’t you?” Amber nodded her head in a grand up and down fashion. Greg pulled out two red foam balls from his pocket and showed them to Amber. “These are magical balls, the only two in the whole world.” He handed one ball to Margie and said, “Hold this.” He asked Amber to hold out her hand and then placed the other red ball on her palm. “Okay,” he said, “close your hand around the ball. Don’t let anything in or out, okay?” Amber said okay and closed her hand tightly around the ball. “Okay, Mom, now hand me the other ball. Amber, whatever you do, keep that ball in your hand. Keep your fist good and closed. Don’t let anything in or out.” He took the other ball from Margie, placed it on his left palm, and closed his hand. “Hey, you don’t know any magical words, do you, Amber?”

Amber giggled and said, “Aba-ca-daba.”

“That’ll do it all right,” Greg said. He opened his hand to show the ball he had had disappeared. “Holy—where did it go? Amber, check to see if you still have your ball.” Amber opened her hand and screamed with glee. “I have two!” she said.

Margie smiled at Greg and laughed with her daughter.

“You can have those, Amber,” Greg said. “Just be careful that they don’t fall into the wrong hands. They’re magic, so you have to take good care them.”

“What do you say?” Margie said.

“Thank you,” Amber said, and she walked back to the table with the puzzle.

Greg gave Margie a nudge with his elbow and then leaned back into the chair. “You’re wasting your time with Mitch,” he said.

Margie was suddenly caught off guard. “What?” She said it like she wasn’t sure she heard him correctly.

“Man, those pharma reps that deal with pain meds are watched like a hawk. Every sample has to be accounted for. Most even have to take a poly a few times a year.”

“A poly?”

“Lie detector test. Make sure they’re not abusing their samples,” he said, then paused a moment. “Pretty sure he’s married, too.”

Margie tried to sound indifferent. “Oh, I’m not—”

“This your first time, you’re gonna need an x-ray or an MRI—medical records detailing your pain. You got any of that?”

“No, not with me. But I heard Dr. Sino was—you know—pretty liberal with his prescription pad. Didn’t ask too many questions.”

Greg leaned a little closer to Margie and lowered his voice. “Okay, look. Yes, this is a pill mill. Most of these people are not in pain, at least not anymore.” Greg pointed to a man sitting near the door; he was slouched in his chair—his Texas Ranger cap pulled down over his eyes—sound asleep and snoring softly. “I saw that guy last month playing catch with his son before they opened. He was running up and down in the parking lot like he was trying out for the Dallas Cowboys. Comes in here and can barely walk. Doc knows but he doesn’t care, because he can prove that he might be in pain.”

Margie stared at the man for a few seconds. Then she shook her head and looked over at Amber who was now trying desperately to repeat the magic trick. “I’m not sure I follow,” she said, still watching her daughter. She turned back to Greg. “What does any that have to do with me?”

“Ah hell, I’ve been doing this for years. I can spot a seeker from a mile away. If I were you, I’d open my phone and turn the screen to the brightest setting and stare at it until he calls you back.”

There was an audible guff from Margie. “What the hell for?” she asked. She was starting to get annoyed, which caused her to again bite at her nails and bob her leg.

“Sweetheart. Your pupils are the size of dinner plates. The bright screen will help reduce the dilation.”

Margie didn’t appreciate being called out, labeled a seeker, but she was grateful he had been so nice to Amber. She loved seeing the way her face lit up when she opened her hand to discover two red balls where there had been just one. She thought about the last few men she had dated—the way they avoided being around Amber—only coming by after she had gone to bed or on the weekends when she was with her father. She sat silent for a few moments, trying to decide how best to respond. Part of her wanted to tell him to fuck off—to go back to his seat and leave her alone—but, instead, she opened her phone and did as he suggested.

Greg continued the interrogation. “Where’s your pain? What meds are you on? What pharmacy do you use? What relieves your pain? Do you use illegal drugs?”

The last thing Margie was in the mood for was twenty questions. She just stared at him with an intent, exacerbated look that said—Who the fuck are you to ask me that? She shook her head slowly, squinting her eyes as the morning sun came through the window and landed on her face. “Yeah . . .” Her voice trailed off and she glanced back over to Amber and watched as she attempted to perform the magic trick for a blue haired lady on the other side of the room. Margie snapped out of her daydream and looked back at Greg. “What?” She said the word with all the strained, indignant emphasis she could muster.

“He’s gonna ask, might as well be prepared,” Greg said. “What are you using, by the way?” Margie hesitated to answer and wondered if she should be offended or concerned that this guy, who had only been talking with her for a few minutes, could so easily see that she was on something. “Hey, it’s cool,” Greg said, putting his hands up. “You don’t have to answer.”

Margie told Amber to leave the lady alone and then pulled her dirty blonde hair back in a ponytail—tying it off with a hair band—and said, “I had a prescription of Oxycontin but it’s run out. I just need a refill.”

“You had a prescription—from another doctor? He’s gonna wanna know how come you don’t go back to that doctor for your refill.” Greg paused like he was thinking through an important chess move, and it occurred to Margie that he seemed sincere. “Where’s your pain, exactly?” He nodded his head, like he was giving her permission to tell him.

“I was in a car wreck. I have a bulged disk in my back,” she said.

“Okay. Okay,” Greg said. He tapped his right index finger against his temple a few times and then pointed it at Margie. “When—when was the wreck?”

“A couple of years ago,” Margie said and then added, “But I am still in pain. I even had to quit my job.”

Greg put his hand on Margie left shoulder and lowered his gaze. “Do not tell him that shit,” he said. “You can’t tell him you quit your job. It doesn't look good. Say you can’t do your job unless you have pains meds to get you through the day. Tell him you sit all day and it kills your back.”

Margie said, “I don’t want to lie to him.”

“Oh, please. Don't want to lie to him. Sweetie, he doesn't give a fuck. He knows the score. He knows damn good and well what he is. But you gotta meet him halfway. They’ve cracked down on docs like him in the last few years. He’s gotta cover his own ass. And you—you have to learn how the game is played. You understand what I’m saying?”

“Uh, not really. I don't know why he can’t write me a prescription. I had a car wreck and I have—”

“Yeah, car wreck, bulged disk, yada yada yada. I got it.” Margie feared she was about to cry. “Don’t get offended, now. I’m just trying to help,” he said. “Been where you are.” Greg looked Margie up and down, noting what she had on—the way she was dressed. He made a series of clicking noises with his tongue. “That’s not gonna help you with Sino.”

“What’s not?” she asked. She was growing impatient with this man-child taking to her like she was kid—like she needed help crossing the street. “What’s not going help me with him?”

“You lookin’ all hot and shit. That won’t help you with Dr. Sino. Mitch might spin you a yarn for a chance to stare at your—” He paused and smiled. “Your body. But he’s nothing but a douche-y toothless tiger. Sportin’ that fake Rolex and knockoff suit like he’s the man. If he’s workin’ this doctor, he ain’t shit. Know what I mean?”

“Are you always this direct with people?” she asked. “Some might find it off-putting, you know.”

“Would you rather I beat around the bush a little, never get to it?”

Margie suppressed a laugh. She didn't really like the fact that this—this kid, as she would refer to him later—was talking down to her—but she had to admit that he had a certain juvenile charm about him and she liked the way he looked her in the eyes when he spoke. He also seemed to know what he was talking about. “You think his watch is fake?”

“Oh, hell yeah.”

“How do you know that?”

“Um, because he’s wearing it, and because no one drives a Honda Accord and wears a twenty-thousand-dollar watch.”

They both laughed, and then Margie said, “You don’t think he’ll fill my prescription?”

“Sino?” Greg shook his head. “When’s the last time you got it filled by a doctor?”

“Maybe year ago. I moved and it was too far to go back and forth to see him.”

“How you been getting Oxy then?”

“My mom had hip replacement surgery last year. They wrote her several prescriptions for it. She can’t stand the way it makes her feel, so she was giving them to me to get me by. But she’s not able to get them anymore.”

Greg looked at Margie and slapped his right hand against his head. “Jesus Christ, you can’t tell him that either. That’s technically a crime, using someone else’s controlled meds.” He paused for moment and then put his hand on her knee where bare skin peaked out beneath the rips. “No, he probably won’t write you anything today.”

Margie thought about removing his hand but decided against it. “Really? Are you serious? You don’t think he’ll write me anything?”

“You don’t have any medical records; you don’t have an x-ray or MRI; your wreck was two years ago.” He raised his hands, palms up, like he was a preacher about to perform a blessing of some kind.

“Then I’m royally fucked, because if I don’t—”

“Wait for me when you’re done. I’m gonna fill my script at the Kroger across the street. I’ll see what I can do—hook you up—give you a few to get by.”

“Seriously? That’d be great! Thank you,” she said. There was a long pause as Margie began to think her way through a new set of options. She watched her daughter play and laugh and wondered how she would take care of her if she were going through withdraws and not able to get out of bed. She turned back to Greg and said, “Still hope he writes me something today.”

“He won’t. Can’t,” Greg said flatly.

The door opened and Dr. Sino and Mitch came out laughing like they were college buddies who had just thrown back a few at the game. Mitch winked at Margie as he walked out of the office, and she suddenly realized what Greg was talking about: Mitch was an optical illusion just like the magic trick—pretty amazing so long as you didn’t look too closely.

“Maggie,” Dr. Sino said, reading off the clipboard in his hand. “Maggie Gallagher.”

“It’s Margie,” she corrected him.

“It’s your call,” he said, “but I like Maggie better.” Then he started singing off key: “Wake up, Maggie, I think I got something to say to you.” Dr. Sino laughed, pleased with his attempt at humor, and looked around the waiting room. The other patients gave an obligatory chuckle or thumbs up. “If you’re ready, come on back.” Dr. Sino held the door open for her.

Margie stood, took Amber by the hand, and then turned and whispered to Greg, “He can call me whatever the fuck he wants as long as I get my prescription.”

“Oh, Maggie,” Greg said.

Margie stormed out of the pain clinic, dragging her daughter in tow, and cursing under her breath the whole way. She opened the back door to the Suburban and buckled Amber in the child’s seat, threw her purse in the passenger’s side floorboard, and then got in and started the engine. She slammed the steering wheel with both hands, laid her head on the column, and began to cry. Between the sobs and muttered curse words, she heard a tapping at her window and looked up to see Greg standing there. She quickly wiped her eyes and then rolled down the window.

“I’m all done,” he said. “You wanna follow me? Going to drop the script off. I’ll buy you a cup of coffee while we wait.”

“You’re already done?” she asked, shaking her head in disbelief. “You weren’t in there five minutes.”

“Yep-yep. He had it all filled out and ready,” he said, doing a little jig beside her window. “Not my first rodeo, babydoll.”

They sat in a coffee shop in the same strip mall as Kroger—Amber coloring and working a maze on a placemat the barista had given her—Margie trying to rebound from the scene in the parking lot, and Greg, smiling away and doctoring his coffee.

He reached out and grabbed Margie’s hand like a grief counselor. “Take it things didn't go too well with Sino,” he said.

Margie scoffed. “That's an understatement. He wouldn't write me crap besides Tylenol three. Kept telling me I need to have an x-ray or a MRI. I don't have the money for that.”

“I’m sorry,” he said. “That’s rough. But that’s why I came out so fast. We usually shoot the . . .” Greg glanced over at Amber. “ . . . the bull for a few minutes and I stroke his ego. It’s a whole song and dance. But I figured he didn’t write you anything and I was afraid you’d leave before I got out.”

“All I’m asking for are a few pills. It's not like I’m asking him for morphine or something. Screw him, treating me like I’m some addict. Raghead.”

“Raghead? You think he’s Arab?” Greg asked, sipping his coffee with one hand and helping Amber color with the other.

“I don’t know,” she said, her voice cracking.

“I think he’s Spanish. Seville or something like that.”

“I think he’s an asshole. Making me feel like a criminal. He can go to hell.”

Greg gave a polite, albeit uneasy chuckle, and shook his head. “You’re not gonna find a doctor at one of these pain clinics to write you a script for opioids based on a hard luck story alone. Like I said, the feds have really cracked down on pain doctors. They have to justify every script they write for anything stronger than Advil or Tylenol these days. They’re audited every month.”

“Well I guess I’m screwed then, because I don't have insurance and I don't have the money to pay out of pocket for a goddamn MRI.”

“Even if you did, there’s no guarantee it would prove you need Oxy or methadone. It’s not always so easy to see a person’s pain on a scan or x-ray. Not unless something is really out of whack can they tell. I had a good friend who went through the same thing. She was in pain, even had an MRI, but it didn’t show anything was wrong. Couldn’t get a sugar pill. Lucky for her I was able to give her enough methadone to keep the pain at bay and keep her from going through withdrawals until I found her an x-ray that she could use to get it from a doctor.”

Margie leaned forward in her seat, her elbows on the table, hands folded in front of her. “You mentioned that before. Don't think I’ve ever heard of methadone. Is that a pain drug?”

“It has many purposes. Mostly known for being used in rehab clinics to wean addicts off heroin. But it’s also used for pain. It’s pretty much the same thing as Oxy, a synthetic opioid. Works off the same receptors. Some call it the poor man’s Oxy because it’s so cheap.”

“It’s cheap, and you can get it?” she asked, her voice ticking up a couple of octaves.

“It’s cheap—if you have a prescription for it. About twenty-five bucks for ninety ten-milligram pills at any pharmacy in the country. If you don’t have a prescription, it’s about ten dollars a pill, if you can even find it,” he said and then added, “I usually can.”

“You can find it, for ten dollars a pill? Is that how you’re going to help me—letting me pay you three hundred bucks for thirty pills that won’t last me a week? I don’t know what you were thinking, but I can’t pay that. Not even close.” She thought for a second and said, “That's almost a thousand percent markup.”

Greg sipped the last of his coffee and laughed. “Yeah, almost. But that’s not the only thing I meant when I said I could help. What if I told you I can get you an x-ray showing that you have a severe back problem that’s causing you a lot of pain? Get that, get your own pills.”

“Where do you get something like that?” she asked.

“I have a friend who’s a radiologist at Parkland. That’s where I got the one for my friend.”

Margie leaned back in her chair and pulled down on the bottom of her shirt until she was satisfied she had revealed enough to render his answer honest. “How much is the x-ray?”

Greg grimaced a little. “A thousand.”

Fuck that, she thought. Who does this guy—this kid—think he is? A thousand dollars. Might as well be a million. “A thousand dollars!” she said. “Are you insane? I don't have that kind of money.”

“I know it’s a lot, but—” Greg reached out and grabbed Margie’s hand again and pulled it toward him, a little farther and firmer this time. “Maybe we can work something else out.”

“What does that mean—‘work something else out?”’

Greg shrugged his shoulders. “I guess it means your plan kinda worked out.”

Margie cocked her head. “My plan?”

Greg gave her a look that suddenly made him seem much older. Margie liked the gentle frankness in the way he spoke to her. “You know,” he said, waving his finger up and down Margie in a Z-like motion. He raised an eyebrow. “What do you think?”

Margie looked over at her daughter and watched her for a few moments color neat blue and red circles on the placemat—no closer to solving the maze than she was to finding Waldo—and an almost undetectable smile glinted across her face and then quickly disappeared. She looked back at Greg and blushed and then looked down at the red lipstick on the lid to her coffee.

“It’s called a win-win,” Greg said. “You win, I win.”

“A win-win, huh?” she said, looking up at him.

“Only in America.” Greg got up from his chair. “So,” he said, “you live far from here?”

“No, not really—ten minutes,” she said.

Greg put his hand on the back of Amber’s chair and leaned down. “What do you say, Amber, do you want to see another magic trick?”

Amber looked up from her placemat with a big smile, her eyes wide and dancing. “Yes, please, Mom. Can he? Can he?”

Margie glanced at Greg and pursed her lips. She then looked at Amber, her little hands balled her at her sides, and with a long exhale Margie said, “Go get your prescription and you can follow me.”