I was early for a change. It's not that I make appointments with Dr. Hsiao all that often, maybe once or twice a year, but when I'm late, the health clinic personnel become parental and dominant--all professional warmth dissipates, then turns icy and I'm forced to wait hours. Luckily, I remembered their primary regard for promptness and, like I said, arrived 10 minutes early.
The waiting room was big, airy with a flat screen television on which interviews with baseball personalities were being conducted while the network twiddled its thumbs waiting for a rain delay to cease in St. Louis. Dodgers vs Cardinals was the subtitle banner. I'm not someone who likes televisions in public places: Thai restaurants, supermarket check-out lines, produce departments of the grocery store, even little monitors on gasoline pumps blaring the evening news. Obviously, it's an infringement on my desire for quiet and serenity, but the core of my disdain is its mind-numbing homogeneity. Just once I'd like to see an announcer with a large facial scar and bad teeth loosen his badly-tied Windsor knot and stutter his way through the teleprompter's highlights. And instead of programming Titanic, or Harry Potter as the movie to watch while I gobble my Tom Kha Gai and Yellow Curry, perhaps someone at the television studio would broadcast Venus In Furs, or a filmed colposcopy. Anything but the dross we refer to as family entertainment.
I should mention I had booked the doctor's appointment for suicide. My own. No, I wasn't going to pull out a gun and blow my brains all over the pharmaceutical advertising and IKEA furniture. I merely wanted a prescription of sleeping pills to effect a nap into eternity.
While I waited, and leafed through a Newsweek, I tried to rehearse a convincing story to tell the doctor. Many years ago I was very good at such stories. With the aid of many a gullible, or greedy doctor I once kept my dosages of barbiturates in hefty supply. That was decades ago however, when my rainbow cache of downers might include: nembutals, seconals, amytals, tuinals, or luminals. Interesting that Pentobarbital, the pharmacological name for nembutals, has spun off to become the prime ingredient used for animal euthanasia, some of whose trade names include Euthasol, Euthatal, Euthanal, Euthanyl (in Canada), Beuthanasia-D, and Fatal Plus. Pretty cool huh? I don't suppose there could be any misrepresentation of my plans if I walked in and asked the doctor for a three month supply of Fatal Plus.
In movies, they always seem to glide over the actual procurement of sleeping pills. They're always just there in appropriate supply. Open a bathroom sink mirror and they appear next to Viagra, 0.5 ml syringes of Restylane and hormonal anti-wrinkle cremes. In reality, it takes a bit of dramatic enhancement to get sleeping pills from a doctor. A bit like getting absolution from a priest. They make you work for it.
I had taken a seat in a finger of the waiting room which blocked any view of the television. A mother and daughter were also tucked away there, whispering and playing on the girl's blackberry phone. They somehow seemed too happy; I imagined them sharing their last good afternoon together. In a few weeks tests would be interpreted to show an advanced stage of breast cancer in the mother. A pall would descend over their world never to be excised, never.
Although I knew it was merely my quixotic imagination at work, probably from stress at my approaching audition with Doctor Hsiao, it did seem true somehow. An old episode of Twilight Zone had opened here in the clinic, giving me the dubious power of temporal projection. I didn't want it to happen. Christ, who'd want cancer to be visited upon utter strangers, especially the happy duo I peered at over my copy of Newsweek? Fate wasn't in my hands, I was just able to look into the screenplay twenty pages ahead of the mother and daughter. Or as Rod Serling might intone: "There is a fifth dimension, beyond that which is known to man."
When my name was called from the rear door, a heavy set and rather attractive nurse waited for me to follow her. We stopped so that I could weigh myself on a white enamel scale. Then she led me into a generic examining room where she asked a few dull questions, took my blood pressure
and placed a thermometer under my tongue. It was quick and business-like, she could have been plucking feathers from a headless rooster. "The doctor will be with you shortly" she told me and exited the door, closing it behind her. I looked at some of the graphic aids on the counters and walls. Mostly weird medical artwork paid for by pharmaceutical companies with their logo emblazoned across the top. One shiny poster was for Atherosclerosis. It had 5 subsequent cross sections of the blood stream showing a progressive build-up of fatty tissue and cholesterol. It looked exactly like one I'd seen in an article on home plumbing, but instead of tree roots growing inside and blocking the clay pipes which lead to the street sewer, this artwork described heart attacks, brain hemorrhages, and paralytic strokes. Someone should curate an art exhibit of frightening posters in doctor's examination rooms with the faint voices of a choir barely audible from invisible speakers singing something funereal and appropriate. It had the effect of telling me the doctor was boss. He lived around this creepy stuff and called it healing.
Hanging from the wall was a dispenser of conical black plastic funnels, the ones doctors place on the end of light-emitting tools they use for checking your ears. I stole one and put it in my pocket. A small victory for the patients against great and expensive odds.
Dr. Hsiao opened the door as if a cartoon caption said "Swoosh." Big smile, thick-rimmed glasses, bloodless white lab coat. We shook hands politely, but I thought it was more like pugilists touching boxing gloves to begin round one. He had my file opened and quickly got to the point. "The nurse said you're having trouble sleeping?" He began. "That's right doctor" I lied. "Don't get to sleep until after the birds start singing each morning." I was looking him in the eye and tried to look convincing. "I've been out of work for awhile and I stay up all night on the computer or reading, just can't sleep."
He looked at my file in his hands to refresh himself with my past. He obviously didn't remember a thing about the 7 years of doctor-patient relationship we'd enjoyed up until this time. I didn't blame him. It was a clinic after all. He was merely the first line of bureaucratic defense summoned by the insurance companies to keep costs and complaints at a minimum. For any serious problem or ailment he merely recommended a specialist who then sent the patient to a battery of technicians to run tests, and who then sought interpretation from additional specialists until you were in the hospital with a shaved chest and a male nurse joking that your quadruple bypass operation was nothing to worry over. The end result is often bankruptcy and death.
"Are you still taking the Depakote and Wellbutrin?" He asked matter-of-factly. " That's one of the things I wanted to tell you, Doctor." I said, acting more interested in this conversation than I really was. "I quit taking them a few months back. At first it was difficult, but now it seems fine. After 15 years of constant medication, I want to see what I feel like without using them." I could tell from his silence that he didn't agree. The issue wasn't terribly important to me one way or the other. In truth, I had quit taking the medication a few years ago and was selling the medication refills he prescribed to me and which were paid for by my union health plan. Between unemployment and a rank economy, every little piece of untaxable income was a bromide to mind and body. There was a woman I once worked with who had been prescribed the same concoction of pills to combat Bi-Polar Syndrome, however she had no health insurance. Instead, she paid me cash every three months when my supply arrived. I only asked about half the pharmacy price. Both of us considered the transaction fair.
"That's why you're not sleeping." The doctor pronounced with alacrity and certainty. "A symptom of Bi-Polar disease is sleep disorders and insomnia. If you begin your medication again, your sleep patterns will return to normal." I knew that the conversation was beginning to slip away from me. "There's a new generation of anti-psychotic medication I recommend that's probably more effective than the Depakote and Wellbutrin. You'll also sleep deeply." Jesus, I thought, now I'm psychotic. This doctor has no idea what I am. Even the Bi-Polar diagnosis was not his. He merely continued an on-going prescription once given me by a Psychiatrist in Ventura before the good doctor was incarcerated from a County Medical Malpractice sting. That had been many years ago and I'd never been to a shrink since. We had both liked each other, he wore funny clothes with horses embroidered on his sweaters and shirts and thought my stories amusing. I complimented him on the paintings which covered his office walls, mostly idyllic landscapes of childish accomplishment. Doctor Durning. It was reported that he bilked over a million dollars from a county program: mostly by creating fictitious patients in a walk-in clinic downtown. It was for the homeless. After an initial aversion, I grew to like him. He kept my disability benefits flowing for years before his unfortunate exposure to the criminal courts. It was his diagnosis that Dr. Hsiao was referring to when he mentioned the new pharmacological treatments which would improve my emotional health and my circadian sleep rhythms.
I couldn't exactly tell him that he was merely following the lead of a psychiatrist with a pony fixation who's medical license was revoked and who had served 2 years in Tehachapi State Prison for getting rich on the backs of homeless street people. It would complicate matters. I also couldn't tell him that my circadian sleep rhythms were actually maintaining a stable schedule, all things considered. And where he gathered that I was in need of new anti-psychotic
chemicals instead of simple sleeping pills--well, I was flummoxed. This was going to be more difficult than I had supposed. I wish I'd worked harder on a good story.
"Couldn't I just get some sleeping pills? Use them to get myself back into a normal rhythm?" I inquired, sounding a tad more like an imbecile than I usually took credit for. "Sleeping pills aren't the answer." He countered. "You have to use them every night and pretty soon you become addicted. It's very difficult to stop once addicted. If I give you Ambien, you'll feel groggy every morning and might even begin walking in your sleep. People find themselves sleeping on the front lawn without any recollection of how or when they moved from their bed." I could tell that Doctor Hsiao had never taken a sleeping pill in his life. Nor had he taken a prescription for Bi-Polar Disorder or psychosis. He also had no idea that my file was filled with incorrect information in the main. Oh I was borderline crackers alright, but not along the lines he believed to be curative.
"I don't really want to go back on psych meds doctor. It took me too long to finally stop them. Why not prescribe some sleeping pills--any ones you feel comfortable offering me. I'll take them for a month or so and when I return for a follow-up visit, we can decide to change the plan or continue?" I don't get more rational than that. It was a good mixture of adult confidence in my own decisions and respect for the doctor's esteemed wealth of knowledge. If the police ask questions after my death, he can with good conscience offer the valiant rebuttals he tried to convince me to accept. He'd sleep well. I'd sleep longer.
"No Mr. Kelly." He continued. "I don't think you understand how easily you can become addicted to sleeping pills, and how difficult it is to quit them. Soon you'll rely on them every day. Sleepwalking at night, groggy at work, irritable." Christ, I thought. People give sleeping pills to their fucking Pomeranian dogs and this professional pill-pusher won't even give me a month's script? Does something I embody scream drug-addict? Do I have some tell-tale signs of suicidal depression written across my forehead in a secret language unknown to me?
"I'll go write this prescription for Risperidone and be right back Mr. Kelly." In a flash he was gone. What had happened? I was a grown man with a sincere request concerning a drug to help my short term health. Over 42 million sleeping pill prescriptions were sold last year. Ambien and Lunesta accounted for $3 Billion dollars worth. And here I am being refused by a doctor of higher moral caliber than his entire AMA brotherhood? I smell a stoolie. God, is this your doing? Are you telling me I just haven't earned it yet, as if suicide were some great reward unavailable to the unworthy?
I had walked in the doors feeling suicidally depressed, then followed a continual progression of wellness care until I arrived at a further moment which retained not only the exact same ennui, but had added a new desperation and a fresh sting from the swollen slap of refusal. Killing oneself shouldn't be quite this difficult, I mused. Merely stock-piling the necessary aids to eternal rest was becoming hard to arrange. Does this mean it has to be one of the less agreeable methods I'd hoped to avoid: the bullet, the bridge, the high-balling Amtrak locomotive? Don't you hate being treated like a kid? If I were a politician or a monsignor I'm convinced I'd be leaving with pocketfuls of deathly digestibles.
The good doctor returned through the door and handed me a typed and signed prescription for something I didn't want. Does it occur to these professionals just why people with low self-esteem like myself would want to end their life? We're tired of being treated like entities less important than a middle-class poodle. If you can sell 42 million scripts a year, why don't I rank in equal measure? Fuck, I'll even pay cash. How can I hold my head up at a Narcotics Anonymous meeting? It's all so seedy and humiliating, this living.
Instead of filling the script, I tossed it in the back seat and drove to a temple in Hollywood. There I attended a 6:00 meditation service hoping to calm myself and rethink the firm desire for an overdose. It would have to wait, at least a few days. While listening to the car radio I'd discovered the surf was pushing 15 feet and a rare B-movie noir, The Burglar, was playing at the Bing Theater. I suppose death must take it's place in line like everything else, at least until the right moment comes along in its own sweet, bedraggled way.
(Painting at top: "Sleep" by Gustave Courbet)
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