When we met you, we didn’t believe your pain. We didn’t believe you when you told us your pain was nine out of ten, because wouldn’t you be screaming if it were? Because you sometimes slept. Because you were addicted.
At home, you treated your pain with heroin, so I carefully gave you opiates, limiting the amount and the frequency. You came for an infection and you brought your pain—you brought it everywhere you went.
We didn’t believe your pain even when we saw the images of your spine, distorted from years of degenerative disease, the cord strangled and the nerves compressed, the damage too old and too complete for surgical intervention. You’d tried the injections and they hadn’t worked.
I’d known you for a few days when the fires started. As old forests burned, the fog filtered the smoke through an orange sky and the sun was just the outline of a circle. Then the smoke swirled down to us, to our hospital, to your hospital bed. I could smell it when I saw you in the mornings, when you asked me about your next pills. You watched the clock; we all watched the skies. On the news, aerial images showed the smoke stretching its fingers for hundreds of miles.
Your infection cleared but your pain stayed. For weeks, the smoke lingered. We titrated your pain medications and spaced them apart as we prepared to discharge you. We couldn’t send you with them. We’d tried suboxone, but it failed you. I threw ice, heat, and lidocaine at your pain.
I’d known you for a while when you grabbed my hand and put it against your cheek and said, “If you could feel this . . .” You said you would start using heroin again at home, because the pain was too big. I asked you not to. I brought you chocolate pudding and told myself that I was helping.
We walked through the thick-aired hallways, past your room. They told us the air was bad, the worst in the world, but wouldn’t we be coughing if it were? We could still breathe. We kept walking, and we told ourselves that you can get used to anything.
Months later, an email told me that you had died of an accidental overdose. When I opened the message, I squinted against the sun; the skies were blue now, but you probably never noticed.
San Francisco, California