AMERICAN PAIN (7 page)

The guy yelled: Gimme some roxies, dude!

And roared away. Like Derik was a king, the guy who had everything, the guy making the decisions. Figuring out who got what.

Chris and Derik laughed about it the rest of the night.

Every so often, a patient went away unhappy.

One day, an out-of-state patient submitted a forged medical record, and Derik kicked the guy out. A few minutes later, Derik was catching a smoke in the parking lot, and several things happened, one right after another. A smacking sound on the asphalt of the parking lot a couple feet to Derik’s left, followed by a crack of gunfire from somewhere nearby. Without thinking, Derik was moving toward the building. Another bullet rapped the stucco wall behind him, shoulder height, way too close. Derik crouched behind the big plastic garbage can and saw a battered blue pickup swerve out of CC’s Fish Camp parking lot across the street. Derik realized the garbage can wasn’t going to protect him. He stood up and moved toward the door. The truck sped away—no more gunfire.

Derik went inside, jumpy with adrenaline, laughing his loud laugh. He told Chris and Dianna what had happened. After a while he went back outside. The slug had knocked a little stucco and paint off the wall, but the building wasn’t in great shape anyway, and the bullet hole was barely noticeable. A couple of patients were standing by their cars, and they gaped at Derik.

One asked: Was someone just
shooting
at you?

Derik just laughed it off and went back to work.

Derik and Chris tried to shield the doctors from incidents like that. And they never had a frank conversation with Gittens or Joseph about what was really happening at South Florida Pain, what the patients were doing with the pills. Why broach the subject? It might make the doctors feel uncomfortable or guilty, and that was the last thing they needed.

Derik couldn’t tell what the doctors thought about the clinic and its customers. Gittens and Joseph were fast, yet still more cautious than Overstreet, who would write for basically anybody over eighteen. The new doctors sometimes turned down patients who were incoherent or had obvious needle tracks from shooting up. But it was difficult to say no to a desperate addict who would beg or threaten. So they’d just leave the room and tell Derik, and he’d bounce the patient, no problem.

Dr. Gittens made a big deal of these ejections, pitching a little fit, as if she was shocked and disappointed that one of her patients was using the drugs for the wrong reasons. She told Chris that she believed that some of the patients were lying to her, and it troubled her that they all asked for oxycodone. Derik didn’t buy it. He believed her scenes served a psychological purpose: to justify her actions to herself, to prove she was still a good doctor, despite the fact that she was churning out oxycodone prescriptions all day long for $75 a patient.

Dr. Joseph was a little different, Derik believed. He rejected fewer patients than Gittens. And when a major problem did arise with a patient, Derik noticed that he didn’t make trouble. He would simply instruct Derik to refund the patient. He seemed to just want the problems to go away.

You’d have to be an idiot, Derik believed, to not figure out that virtually every patient was either using or selling the drugs, often both. Or else why would the majority of them drive across four states to get legal medications? Why were they so desperate? Why were so many of them nodding out in the waiting room?

Derik believed the doctors
had
to know the score.

Dr. Gittens told Chris the clinic needed to beef up its diagnostic procedures, or at least its paperwork. She wanted the clinic to require patients to bring in MRI reports, something South Florida Pain could put in its patient files. Something to show they weren’t just writing scrips based on the patients’ word that they were in pain.

Chris understood. It was asking for trouble to have no real diagnostic paperwork in the patient file. What if the Florida Department of Health showed up? Or, God forbid, the DEA?

But procedure and paperwork created a problem on the customer-relations side of things. The entire business philosophy of South Florida Pain, the thing that gave them an edge, was customer service, making it easy for patients to get what they wanted. Chris didn’t want to tell every patient, including walk-ins who had just driven fifteen hours across four states, that they had to go get an MRI before seeing the doctor. Dr. Over-street had referred some patients to an MRI service, but only every once in a while. That diagnostic company took three days to turn around the MRI reports, which wasn’t going to work for most of South Florida Pain’s out-of-state patients. So Chris and Derik would give the patients one free pass but told them they
had
to bring an MRI to their next visit, twenty-eight days later, which gave them time to get it done at home. Of course, being junkies, they usually didn’t do it. So they’d give the patients
another
month, but say that this was the last time, they absolutely had to bring an MRI report to their next appointment.

Derik discovered there was competition in the MRI world. Half a dozen MRI services were fighting for South Florida Pain business, representatives visiting the clinic, handing out leaflets. Certain companies were willing to kick back fees to Derik in exchange for referring patients to them. Before long, Derik was making a grand or two a week just from the MRI companies.

One guy said he could match the prices of the company the clinic was currently using, but he would turn around the reports in twenty-four hours, which would make things much more convenient for South Florida Pain’s out-of-state patients. The interesting thing about this company was that its MRI machine was located inside an eighteen-wheeler trailer, and the unmarked trailer was parked behind a strip club called Goldfinger Gentlemen’s Club, a place up in Lake Park that Derik had never patronized. A line of people stood and sat in the strip club parking lot all day and night, holding red medical folders, waiting their turn to pay two or three hundred bucks to climb up into the trailer and onto the MRI machine inside.

Most of the reports noted some slight abnormality or other finding, and Derik noticed something funny. Say a patient had complained of neck problems early on, but then the MRI of the neck region showed nothing out of the ordinary. The patient would just get a couple more body regions scanned until some protrusion or compression or extrusion was discovered, maybe in the lower spine this time. Then the patient would return to South Florida Pain,
now
complaining of lower back pain. Derik never saw the doctors make an issue of this shifting pain, as long as the paperwork was in order.

Every once in a while, though, they’d see something they couldn’t ignore. One day, a guy came in, maybe thirty years old: dreadlocks, sagging black shorts, and a wife-beater. Derik took his $200 and made a copy of his MRI report, sent the guy back to Dr. Joseph.

A little while later, Dr. Joseph called Derik to the examination room, pointed to the MRI report. He looked upset.

Dr. Joseph said: Please read the conclusions, Derik.

Derik read the report aloud, all the way to the part where it noted a tear in the uterine wall. Dr. Joseph pointed at the patient.

Dr. Joseph: Does he
look
like he has a uterus?

Derik looked closer at the report and could tell the patient had duplicated his name over whoever’s report it actually was. The birth date on the report didn’t match the guy’s ID. Worse, on the gender line the guy had just left the “F.”

Derik apologized to Dr. Joseph and kicked the patient out. The guy had the nerve to argue with him over his $200 fee, which Derik refused to give back, on principle. He didn’t want word getting out that if you got ejected from South Florida Pain they’d just give your money back. Derik threatened to call the cops, have the guy arrested for prescription fraud. The guy left, then came back later with some friends. Dr. Joseph heard the commotion, came out and told Derik to give the guy his $200 back. So Derik did, and that was that.

Hey, Derik thought,
I’m
not the one who went to medical school. I’m learning as I go here.

And it was hard work. At any moment in a typical day, a million things were happening. Patients waiting in a long line out the door. Multiple phone lines ringing. A toilet overflowing because a patient had tried to flush a bottle of Mountain Dew. The patients were desperate and strung out, eagerly peppering Derik with flecks of spit when they finally reached the customer window. Or just standing there in a stupid opiate haze, drawling in that distinctive guttural oxycodone register, as if the drug had dulled their voice boxes along with everything else.

Derik called them zombies. Dumb and slow, but you had to watch your back around them. If one crushed a pill and nodded off, another would try to steal his meds. Or they’d start making side deals with each other and a fight would break out. They would lie to each other or rip each other off, if they thought they could get more pills. Or a guy would see someone he knew from back home in Kentucky and flare up over some old beef. One day, Derik saw two guys staring each other down and intervened: turned out, both were carrying guns.

And the parking lot! Everything you could imagine took place in that little lot, steps away from the cars on Oakland Park Boulevard. Pill-sick patients sweating, trembling, vomiting, peeing on the palm tree, trading pills for cash. A couple months in, Derik caught a guy shooting up around the side of the bungalow. The guy ran off, dropping an insulin needle. After that, patients shooting up became a regular occurrence. Chris bought a vending machine and a forty-two-inch flat-screen TV for the waiting room, trying to keep the patients from going outside and causing havoc, but it didn’t really work.

Derik also began paying a homeless guy who hung around the clinic, to keep an eye on the parking lot, and to call him when necessary. Everyone on Oakland Park Boulevard knew the vagrant, who slept at a nearby coin laundry, a gaunt and sickly-looking guy who was also funny and game in his cowboy hat and boots. One of those people whose age you couldn’t tell—could have been thirty, could have been fifty. Derik and Chris liked their new parking-lot sentry, kept him around like a stray dog, feeding him and paying him to run errands. The homeless man wasn’t really able to handle parking-lot problems himself, because no one took him seriously, but he could at least report them to Derik.