The physician, a slim, young man with a shaved head and intense, dark eyes, reaches out to shake hands. I fumble to extend one hand while the other clutches a questionnaire that I haven't finished filling out.
"That's okay," Dr. Gordon says. "You can finish later."
He can tell that I'm nervous, but seems to understand. He knows that I've had to sign in at a window surrounded by other patients, many younger than my own children. Some of them look dazed; others have dozed off. Still others, alert, look as if they'd just come from their job at the bank.
Me? I walk with a cane. My clothes have been carefully chosen to look presentable. I've come through a door labeled "Chemical Dependency Clinic" in small, discreet letters. If you hadn't been looking for the sign, you'd have missed it. The building has no street-level windows and is in a neighborhood that could kindly be called "transitional," rundown at its core but reluctantly yielding to gentrification.
I am seventy-five years old, and I have come to Dr. Gordon because I've become addicted to drugs.
While he scrolls through my lengthy records on the computer, I flip through the questionnaire. Do I drink alcohol? (Barely.) Am I depressed? (Often.) Do I ever feel suicidal? (Well, I guess not--but maybe. Don't we all sometimes?)
Dr. Gordon brings out a breathalyzer to measure my alcohol level. "Sorry, it's a requirement," he says.
I tell him my story.
Five months ago,I fractured my pelvis in two places, the result of a fall suffered when the theater "popcorn guy" showed me to my seat after the movie had started--and there was no seat there.
"From that moment on, I felt pain as I'd never known it," I say. "After x-rays at the hospital, I was transferred to a nursing home and was immediately put on pain medication."
"What kind?" asks Dr. Gordon.
"A fentanyl patch," I say. "I was complaining about extreme pain." The patch was started at 50 micrograms, I recall, but was increased over time until, by the time I left, I'd "graduated" to 125. "They sent me home with a prescription for Percocet and those patches."
"When did you notice a problem?" Dr. Gordon asks.
"When I got home. The pelvic fractures were healing, so I wanted to feel like myself again and not depend on drugs. Despite my daughter's warnings--she's a nurse--I started to downgrade the dose of the patch, figuring it would make my recovery go faster." What no one had explained to me is that fentanyl, an opiate, is 50 to 100 times more potent than morphine and can be addictive.
I found out just how addictive the hard way. Not having been told how to lower the dose, I went at it too quickly and ended up in an emergency room with withdrawal symptoms.
"I sat for three hours waiting to be seen," I say. "I couldn't stay still. I kept putting my head in my daughter's lap. It was how I imagine the worst flu to be. Finally they gave me morphine and sent me home."
Dr. Gordon glances at the record and says, "You were prescribed Percocet to withdraw from the fentanyl." Percocet--oxycodone--is another opiate.
"I'm here," I say, "because now I'm addicted to Percocet."
I tell him about bothering my physician for more frequent prescriptions and about waiting anxiously, like a wino craving a drink, for my son to return from the pharmacy with my next supply of pills.
"I'm trying to withdraw on my own, but my nights are, well, nightmares. I shake, my legs flail all over the bed, I can't sleep," I say. My primary care physician told me to "bite the bullet," that I will get better. A psychiatrist sent me to group therapy for addicts and gave me various tranquilizers, including Ativan, Risperdol and Seroquel. But the misery lingers.
With a feeble attempt at humor, I say, "If I'm going to be a drug addict, at least I should enjoy it."
I tell Dr. Gordon that I'm reminded of that nursery rhyme about the old lady who swallowed a fly, then a spider to catch the fly. ("Perhaps she'll die.")
Dr. Gordon seems both sympathetic and worried. "Addiction isn't only a problem for young people," he says. "It's growing among seniors."
There's sort of a war going on in the field of pain management, he continues. One camp worries about opiate addiction; the other is more concerned about the effects of long-term pain. It seems that, given my pain's severity, my doctors opted for opiates.
Dr. Gordon then hands me a day-by-day timetable of gradual Percocet withdrawal and clonidine tablets to counteract the withdrawal symptoms, assuring me that clonidine is not addictive. The last thing I want, I tell him, is to get addicted to yet another drug. ("There was an old lady who swallowed a bird....")
Eventually, my pelvis heals, although even now my gait sometimes resembles that of a very old Frankenstein.
And I finally kick the Percocet habit.
In some ways, though, I will never be the same. I'm more wary, less resilient. Even though I've always considered myself independent, I know now that the slightest waver in the orbit of my life can send it off course.
I still ask myself: Why wasn't I strong enough to handle the pain? Handle the drugs? Did I do something wrong? Did I not bite the bullet hard enough?
Most of all, I regret having missed the chance to avoid all of this. What should I have asked the doctors at the nursing home? What should they have told me about the heavy-duty drugs I was taking?
And what about the doctor-patient communications that never happened, but that might have made things turn out differently? The doctor prescribes. The patient follows instructions. It's a neat paper transaction. No questions asked on either side.
Finally, there's something else that bothers me.
One substance-abuse expert has called addiction among elders "the silent epidemic." How long, I wonder, before that waiting room at the Chemical Dependency Clinic is filled with people like me?
About the author:
Arlene Silverman, a San Francisco-based writer, started contributing to local publications when her children were small. Since then, her articles have appeared in the San Francisco Chronicle, Christian Science Monitor, Saturday Evening Post, Newsweek ("My Turn") and other publications. In the past, she has worked as a teacher, parent-involvement coordinator and grant writer. At present, she is very happy while in the company of her four grandchildren.