“WHO’S THE DOCTOR???”

PART ONE

It’s not well written. Meant only to offer insight. Nothing more. I wrote this nearly two and half years ago and had barely researched the matter legally. This was what I ALREADY recognized at that time. I’d soon discover that my problem was much more involved. Here’s one of six completed parts. It’s obviously unedited. I send it the way I originally wrote it. Didn’t think too many people would ever see it regardless. Didn’t have a destination originally.
It’s in portions. Hopefully the first two get read though.

†********************************

It’s unlikely that anyone reading about this experience will be an attorney or even a concerned doctor. Methadone maintenance patients may not recognize how medically and legally it’s important to understand that everyone is afforded the right to acceptable care. Doctors are supposed to behave professionally. That includes the manner in which they treat you medically.
I’ll be as straightforward as I can be. Everyone should arm themselves with at least some of this information.

**”TREATMENT DOESN’T = CURE”

Not all occupations were created equal. Being a doctor is considered prestigious and society respects any person who has chosen to heal others for a living. What profession could possibly be more important than treating sick people? And when a doctor has successfully done her job, she’s even able to save lives. That’s why they earn our admiration as well as earn impressive amounts of money. 
However there’s a reason why they earn trust and respect. Not just anyone who feels like it can suddenly decide to be a doctor. For example, waitresses.
Naturally they don’t have the medical knowledge that doctors possess. While waitressing is not easy or particularly glamorous. Being a physician requires a person to pledge an oath that promises to DO NO HARM while practicing medicine. Obviously waitresses aren’t required to make that same promise. And truthfully when a waitress makes an error or a mistake it’s very unlikely that anyone will actually die from her oversights. Unless she’s poisoning the food.

There’s consequences for misbehaving. That’s true for anyone and doctors are no exception. There are legal sanctions, including fines and penalties. There are medical boards that can suspend or revoke a medical license altogether if a doctor neglects her duties. And most importantly, there are laws meant to protect the welfare of the public. When a doctor is found to be in violation of those laws she can even be found criminally responsible. She may be ordered to pay the “DAMAGES” if a court decides she has injured someone. Or an injunction can halt risky medical procedures or treatments until a judge can decide.
In other words, a judge can declare a doctor responsible or “LIABLE” which is a legal term basically meaning that when doctors and nurses fail to live up to their professional duties and patients are harmed. Patients can file a suit and may be awarded damages. Or monetary settlements can occur. Mediations can take place when both sides wish to avoid further action.

Most physicians to the best of my knowledge, perform their duties with integrity. Even doctors who assessments might not be embraced by their patients usually appear to behave professionally. At least  from what I’ve personally experienced. Thankfully.

Now “Malpractice” has a very specific criteria. Hopefully no one is likely to experience all four points. If so than that is legally defined as malpractice. Malpractice has ruined my life. If I had realized that physicians were obligated to not HARM me than perhaps I could have gone to court much sooner. By the time I recognized all the harms I had endured, all the damages it cost me. Basically statues of limitations had run out. But it was moot, or so I thought so. My life couldn’t ever be restored. I sacrificed my own well being and I’m still in distress, twenty years later. I also never realized to what extent the damages were until many years into my treatment. There’s nothing I’ve not lost to substandard care. Every single possession. All of my hopes and dreams. Even my future achievements. Gone now. I’d even argue that I also lost my soul. Maybe some one will read what I’m writing and then I can ask them honestly if they disagree.(?)
And cruelest of all were the innocent victims that didn’t get a choice in the matter. My beautiful babies. Nobody told me that by simply trusting the wrong healthcare provider,  my children would also be harmed too.  Surprisingly physical harm occured to them as well. I wish sincerely I had been the only one hurt.
If only someone had explained a few critical items to me. Maybe I could have made an informed choice instead of simply trusting that no possible harm could occur to me by following my doctor’s suggestions.

This is what I’ve learned on the fly. I’ll warn you, on FLY

MALPRACTICE
1. Misdiagnosis can be considered malpractice. Did they miss something even unintentionally? If so did, due to a lack of treatment did the condition worsen?
2. Negligence can occur with substandard care is the cause of injury. If a capable physician didn’t prevent an obvious blunder or condition than he’s neglectful.
3. As a result of treatment was HARM created?  Treatment doesn’t have to be raving success in terms of improvement. But it isn’t supposed to cause a more severe debilitating condition than the one you arrived with.
4. You were engaged in a Patient-Doctor relationship at the time.

I guess it might seem unnecessary to define what a horrible medical experience will look like. Especially since when you begin to suffer, trust me you won’t need a law book to confirm that treatment has damaged you. Still I pray no one’s ever going to hurt as long as I have already. 
 
Now if a waitress is performing your surgery, assuming she’s got your permission. You can’t reasonably expect her to not HARM. Just because she’s playing doctor doesn’t mean that you’re engaged in a “Doctor-patient” relationship. She can’t be held legally liable.  However a professional, like your doctor can be held liable. A doctor-patient relationship is established once a doctor has officially seen you or treated you.  The two of you have entered an unwritten contract. He cannot breach that contract. He’s responsible if you are injured simply by virtue of him being the ONLY one who can be responsible. He’s the one who attended medical school, not you. That’s why doctors are punished for overwriting prescriptions. It’s automatically his duty and his sanction and most importantly he should not write a prescription for anything other than what it’s intended for. NEVER forget that part. Even if he examines you inside a circus tent. He’s acting as your medical provider. And he’s obligated to live up to his professional duties. You might not realize it but included in your role as the patient. You have an obligation to speak up when treatment goes awry.

Doctors tend to underestimate the intelligence of their patients sometimes. If you feel like your doctor is not quite interested in hearing about your issues than start paying closer attention at that point. It’s a red flag. 

Last bit of knowledge that might arise. Ideological influences! It’s not really that complicated but it is used to manipulate patients occasionally and it’s a major influence even without realizing that it’s being used. Patients would be wise to remain on the lookout for ideology that doesn’t respect their needs and attempts to convey messages. It’s not always present but you should try to recognize it whenever it is used.

My least favorite part of being admitted into treatment is all the boring paperwork and pamphlets. I used to never read any of it. I’d sign documents regarding my healthcare after a mere glance. Trust me, I’ll NEVER let one signature of mine wind up on anything that I’ve not carefully read! For example, the word “Client” is sometimes used in instead of the word “Patient”. In my own case it’s meant to imply that I’m not exactly entitled to the same rights as a full blown legitimate PATIENT. It’s used to subtly remind me that I’m merely a consumer paying for treatment and medication. The term “Client” is sometimes used by prostitutes and by drug dealers during all kinds of exchanges where you are ONLY a paying customer. But here’s the catch legally speaking, medically speaking.  They are both exactly the same in terms of rights to adequate care. There’s no difference. It doesn’t matter what a provider chooses to refer to you as. You are entitled to proper care and he’s supposed to live up to his professional duties.  The “contract” is the same.  Remember either at an upscale practice or being examined inside a circus tent. You have entered into a PATIENT DOCTOR relationship/ contract the minute you’re treated by a physician and that relationship is sacred. Period.

Unfortunately, there are doctors, nurses, hospitals, facilities etc. that are widely accepted by the medical community even though they harm people when delivering sub-standard care. Recognizing when care is not just unsatisfactory but being able to identify potentially harmful care is how a person can take personal responsibility to make sure that treatment doesn’t rob a person’s health, life and their future. Most medical scenarios can include an advocate who’s job it is to explain the full consequences of your treatment. They ideally should not be paid by the same clinic or hospital where services are rendered. So how do you even know if you’re in need of further explaining at the Doctor’s office? I can’t provide a list of everything that I’m unaware I don’t need. Unless an advocate climbs out beneath the doctor’s desk and introduces herself. I’m completely oblivious. I’m also going to recommend that recovery coaches be the type of advocate who’s truly qualified to explain what in the hell methadone maintenance clinics are going to be like. Remember- treatment is not the same as a cure. They’re not interchangeable.

“PART-ONE”

“WHO’S THE DOCTOR??”

I had been in a horrific car accident my senior year of high school. I ended up breaking my jaw bone, crushing four of my fingers on my left hand as well as various other cuts and bruises. After being escorted to an Indianapolis community hospital I was told that I would need extensive work. Including having my jaws wired shut for about six weeks. The procedure was very painful. My jaw hurt so much I thought I’d probably loose my mind! To make matters worse I was nine weeks pregnant with my first child. Initially I didn’t even ask for painkillers since I was concerned about my baby’s development. But after an agonizing sleepless night. I called the emergency room sobbing and was told Vicodin would not hurt my unborn child. Thankfully they called me in a script of Vicodin and I immediately got relief. 
During those long six weeks my wired jaw needed maintenance and that meant tightening screws into the bones that were broken. Each visit I received another refill. Bear in mind that 25 years ago doctors wrote painkillers pretty liberally. Back then pill mills weren’t in the headlines and the DEA weren’t out to sanction doctors for over-prescribing narcotics. Of course that would quickly change. The Opioid epidemic caused many patients concern. Particularly chronic pain patients.* But there’s more than one group of patients that suffered reprecussions due to the nation’s opioid crisis.
Believe it or not certain substance use disorder patients also felt the reprecussions first hand!

I began to use my Vicodin to relax after work or for a headache. Largely it was simply an opportunity that allowed me to use the Vicodin I already had at my disposal. I just happened to have them on hand sometimes.
My teeth were in poor shape after those wires. I suffered tooth aches and Vicodin helped a lot.  As I look back and ask myself where did I go wrong?  What could I have done to avoid abusing them? When did it happen I wonder? I certainly never made a conscience choice to abuse hydrocodone. I never needed more than two or three pills which was within the prescription guidelines, that is until the day it wasn’t.

It didn’t take that long for me to go from relieving pain to feeling pretty warm and fuzzy all over. I started requesting Vicodin at almost every medical visit. For awhile, perhaps a year. It wasn’t difficult to be accommodated. That didn’t mean I always had Vicodin handy. But of course I was able to make them last back in those days.
Naturally it finally stopped being easy. I would be questioned suspiciously about my pain issues and the quantity was decreasing. I didn’t want to go without them more than a week or two at a time so that’s when I begin buying from friends and family. I began to supplement them. Sometimes I just callously raided my dear friends medicine cabinets. I would mainly rely on luck as far as supplies go. I was never was able to have them all of the time. I wouldn’t like it if I had none to take after work or for a headache. Waitressing is physically quite demanding.
However it certainly wasn’t overly difficult to obtain more. It was frustrating to go without them. It wasn’t physically painful though. I didn’t experience physical withdraw from not being able to find any. Only a desire to use more.

At one point I didn’t have luck locating any so I told myself that I’d make an appointment and attempt to reason with my doctor. Although it didn’t impose on me physically to wait a few a days or longer while I was looking for more. It was inconvenient at best. And truthfully I was a bit spoiled.
Surely I could just persuade him to assist..
To my great disappointment he flat out refused and then informed me he wouldn’t be writing them again. At one point he made a suggestion. He hands over a pamphlet and says I’m addicted to Vicodin. Dependant on opioids. He says if I need an opiate narcotic that this same community hospital also included a methadone outpatient clinic. He explained that every twenty four hours I’d have to drive into downtown Indianapolis in order to drink an opioid narcotic called methadone. It must be taken in full view of the nurse so no prescriptions available. He says that it can be addictive (cough, cough) but I’d never need Vicodin again and once I was stable.
I could simply ween myself off at any point in time. Whenever circumstances were right I could get off of the medicine.
Then adds that I’ll be required to pay for it every week. Payable only with a money order. The cost was fifty dollars back in 1999.
Over the years inflation etc meant the weekly fees grew more and more expensive. And virtually no insurance would provide coverage. Least of all Medicaid. That meant my coverage under the hospital’s managed health care program wouldn’t cover it either. It was called the Wishard Advantage plan, later renamed Eskenazi Advantage of course.
I was very trusting of my doctors back then. I can still hear myself thinking that a physician wouldn’t possibly hurt me or recommend I take medicine that’s too addictive or even difficult to ween off from.
But at the same time I was also apprehensive.
This entire process sounded like a huge commitment for a single mom working as a waitress. Plus I wasn’t collecting any child support. How was a doctor who was supposed to be helping me recommend that I pay for medicine I couldn’t afford? And honestly didn’t need? Then only to become hopelessly (and it was so very hopeless) addicted to it?

Behavioral mental health disorders should be evaluated from a socioeconomic perspective as well as from a clinical point of view.
Not just from one person’s subjective opinion. Addiction is a complicated disease and there’s many considerations, causes and treatment options available. Methadone maintenance isn’t always the most appropriate treatment for every type of Opioid addiction. It’s essential to closely monitor patients when they first arrive. Close supervision will reveal if that person is regularly exposed to opiates. Blood work is probably a critical determination. Not that I would ever get the chance to benefit.

 I was skeptical but thought I’d try it for a month. After all it was written there in black and white right in the pamphlet. I could always stop going if it became inconvenient. Or once I was stable(?? Mention problem with that later)*
After all it’s an evidence based form of treatment according to the handout I was reading.
Of course it didn’t say under what circu ofmstances it was an evidence based forms of treatment!  I didn’t know it back then but I was about to make my descent into Hell. Into madness.

*”Methadone is a powerful opiate based narcotic. After ONLY fourteen days, your brain begins to change and starts to become starved for it’s fix. The rewiring of your brain will alter it forever. Brain damage in two weeks.”

I didn’t know what the word opioid dependant meant. Didn’t know what OPIOID addiction was from a medical standpoint. I barely had a clue how addictions worked or realized that dependency on opioids is a physical response. Everyone gets dependant on it who takes it on a long enough time line. It behaves much like heroin. Oh well, ok ok not exactly like heroin. It is legal and methadone is four times the strength of street heroin.(Terrifying & completely true) Growing more and more opioid seeking receptors with time. Building a tolerance and your body will NEVER have enough. You’ll grow receptors for the entire time. You’ll eventually need the $50 weekly fix more than food or family. (How’s this is not a drug deal disguised as some type of medical treatment is beyond me). Unless a person IS ALREADY DEPENDANT or severely addicted methadone will only harm you.
Of course nobody told me that.

I wanted to question my doctor further but he seemed to have all the answers. I didn’t realize that since this little outpatient methadone clinic was part of the community hospital’s network, that meant the profits are all going straight back into the main hospital. I can’t believe I didn’t recognize what his incentive probably was by referring me over to the methadone clinic.
The community hospital’s outpatient clinic was sitting on a cash cow. In retrospect I was probably more recruited than I was referred. And of course avoiding possible sanctions for overwriting opioid prescriptions was probably a factor. I would give any amount of money to go back and beg him to tell me what methadone withdraw is like.  Or even deny me access to any narcotic medication altogether.

I had no idea what I was getting into. But without an advocate who’s job it is to see that I fully comprehend what I was signing, how in the hell would I know that my life was getting ready to seriously go down hill and I would pay $125,000 for almost twenty years? Monetary loss might appear to be a nightmare for some folks but I was only getting warmed up in the “loss” department. 

ASSESSMENT! ADMITTING DAY:

Generally most methadone clinics share the same criteria for admission. 

1. Must be dependant on an opiate. That means you’re incapable of going without it. No one who’s truly dependant will skip a day or neglect to feed those screaming receptors. Trust me.

2. EACH PROSPECTIVE “CLIENT” MUST PROVIDE A URINE SAMPLE ON ARRIVAL AND IT MUST BE POSITIVE FOR OPIOIDS. NOW PERSONALLY I DON’T GET HOW ONE URINE SAMPLE ON ONE PARTICULAR DAY is PROOF POSITIVE of ANYTHING OTHER THAN YOU WERE POSITIVE FOR OPIATES ON THAT ONE OCCASION.
But hey I didn’t go to MEDICAL school.

3. And a start up fee of about $150 in addition to a picture ID. (1999) That’s the remainder of the requirements. After a brief assessment you are welcome to begin serving your sentence! Or rather, you are now a client.

  What also adds to my frustration is that I’m trying to figure out how a qualified specialist is content with preforming an assessment as opposed to a thorough exam. A proper exam makes it far more likely to receive a diagnosis. And a proper diagnosis makes the likely hood of receiving effective treatment a reality. Not to mention makes it less likely a person will suffer.

Who wants to head into the operating room based on their own assessment as to what the problem is and what type of surgery your doctor should be performing? Well assuming that it’s not a fellow surgeon who fills out the assessment alright (?)! And would it be of any comfort to realize that it’s not just any surgeon who’s going to perform the operation. It will be a SPECIALIST! What does it matter if he’s not going to perform or treat you using his specialized skills in the operating room.? Does a hospital really need to pay an expert to treat patients based on what they themselves are telling him to go ahead and do? Like I mention constantly. Never went to medical school. Maybe I’m misunderstanding.

I was handed a question-answer based survey to complete asking me to rate or gauge my drug use and symptoms. A questioniarre. It’s probably not surprising to discover that a lot self described opioid addicts will on occasion “lie” in order to ingest a powerful opiate such as methadone.  I myself had been advised from friends and coworkers who recommended that I claim my body was dependant on some type of opiate each and every day if asked. And I guarantee you that I wasn’t alone. I didn’t want to leave empty handed. Plus I didn’t fully understand what opiate dependency was. I’d never heard the term opioid dependant before. Waitress, not med student**
I naively assumed that the clinic’s expert would examine me and let me know his professional opinion on what I needed. The only opiate I’d ever had was Vicodin. Vicodin Is a relatively weak narcotic when in comparison to others. And methadone makes Vicodin look like baby aspirin in comparison.

Methadone studies have reported that it’s in fact four times the strength of street heroin. That’s in terms of physical withdraw. And they aren’t wrong. To this very day I can’t feel Vicodin any longer. In fact I’ve not felt Hydrocodone in almost twenty five years.
See, you can’t go back once you cross a threshold. Once your brain and body develop a certain tolerance, you’ll require that exact same amount to even register you’ve taken it. And methadone is no different from any other opiate. Meaning you’ll continue to grow more and more opioid receptors whether it’s methadone, heroin or even Vicodin. You’re eventually going to have to take more. Subuxone is different but that’s another subject.

However at the time I wasn’t even able to obtain Vicodin daily. The night before being admitted I was frantically trying to locate any opiate in order to test positive the next day. I ended up buying half of one Vicodin and took it in the morning before I was admitted.

It’s something I regret every single day of my life. I had a clean system and I risked it all to try out a drug that’s simply not meant to be “sampled” unless you are in serious need. However looking back I can clearly identify myself as engaged in drug seeking behaviors. That’s part of having a substance use disorder. I wasn’t in control. But I wasn’t OPIOID dependant. Not yet anyway.

There are plenty of other ways to verify an addiction to opioids. Check a person’s criminal background, ask them to show you their injection scars. Ask them to sit in a waiting room as the feeling of complete dread and panic begins to slowly creep in. They are very unlikely to be able to continue sitting or standing too long. Plus a runny nose filled with a very thick mucus that never quits. I always run a fever and my blood pressure goes way up. None of these indicators would have been found in my case. 
And whose more qualified to determine if I was in physical withdraw than a man who is an Addictionologist? I assume it’s part of his training to determine my level of care using his skills. Not basing it on my recommendations.! I’m not even sure if it’s possible to lie to a doctor in the first place. After all what if a patient honestly believes they know what is plaguing them but they are mistaken? Waitress not med student* remember (?)
I can’t walk into a doctor’s office and announce that I’ve got lung cancer and insist he administer chemotherapy right away! Besides my number of correct/incorrect assumptions ratio isn’t exactly impressive these days.

Only at a methadone clinic can a patient offer up a treatment plan!

I waited patiently for the doctor to examine me in his office. Meanwhile I got so bored I began actually reading the new pamphlet. And here’s exactly what methadone maintenance was supposed to achieve.

Lessening criminal justice system, cases

Less chance of a family court case

Increased Job stability, financial stability.

Improvement of social skills and bonding, strengthening family ties

Less chance of transmitting an infectious disease from dirty needles

I was puzzled wondering why I’d ever have to be worried about those problems any way. I’d never seen or used illicit narcotics before except for weed occasionally. (For the record had I just stuck with weed rather than a fondness for opiates, I’d have a brand new life right about now)!

The doctor entered the room and performed a very brief physical exam. He took my blood pressure, listened to my heart, listened to my lungs and five minutes later he left. I briefly considered attending medical school myself since it looked pretty easy. Huh

Within thirty minutes I was handed my very first dose of methadone.  I do recall the doctor asking me if 30 milligrams sounded like enough to me (??)
I had nodded my head up and down in agreement I but didn’t have the slightest clue. I’d never taken anything close to methadone before. I’d never seen heroin. I’d never injected or snorted opiates. The absolute strongest opioid medication I’d ever been prescribed was Vicodin. The low end ones at that.
And I didn’t even have any ongoing scripts of those at that time. Which was probably the motivation for me to consider methadone in the first place. Times were tough…
Forty five minutes afterward I’d be puking my guts up and barely able to stand. I was so lethargic I couldn’t open my eyes all the way and my speech was badly slurred. It was nothing short of a miracle that I managed to drive the twelve miles back to my apartment. I quite literally crawled into my living room where I vomited right on the carpet.
I would eventually get to my phone and call the clinic asking what in the hell was wrong with me. The twenty year old gal answering phones listened to my concerns and then assured me I was still in withdraw without my Vicodin.(??? Ahhhhh ok sure if you say so)*
She then filled out what’s called a “Dose Increase” form that my doctor would sign off on the next day. The next morning I was given a ten milligram dose increase. This routine continued for about a week. Possibly two weeks. It’s been a minute.. so I can’t accurately describe the rate of my increases from twenty years ago. I do remember each additional morning my dose was increased by ten milligrams. I was told to wait it out. I was told my symptoms were fairly normal and would subside once I was stabilized on the correct dose. (?? Or maybe once the clinic managed to  overdose and kill me? Maybe that’s the stability stage(?) Death. In reality if I had died as a result of being seriously overmedicated my odds of getting an attorney to represent me in a malpractice suit would be far better! Sad but definitely true) Unfortunately I lived to tell the tale. Death would have been an easier injury to endure than what ends up happening to me.

I finally was dosing at one hundred milligrams in under two weeks time. For the record people have overdosed and died on as little as thirty milligrams. I was a very small person. I still cannot believe that this didn’t kill me back then. Honestly I really wish that it had. And unfortunately I’m completely serious about that part.

I would come inside to be dosed.  Once dosed, I’d then jump into my car as soon as I could in order to race back home within forty five minutes time!! Forty-five minutes was the absolutely maximum amount of time I had before the lethargy set in. (Trial and error I’m afraid)!
If I didn’t drive fast enough then I’d simply fall asleep while still on the road. Thankfully I would typically doze off at a red light or a stop sign-usually. Not always though.
God forbid that traffic prevent me from arriving back home before my allotted forty five minutes was up!
A fellow motorist once found me asleep at the wheel on a set of train tracks. He was extremely concerned but too kind hearted to summon the police. Obviously he didn’t realize that regardless of what my condition was or whatever the consequences might have been for me.  It wasn’t safe to not summon police or paramedics!  I’d have been much better off if a train had arrived before that good Samaritan. Saving me years worth of tragedies and misery. Not to mention thousands of dollars.
Sad but true.

I wasn’t being UNDER medicated. I was quite clearly being OVER medicated. Although since I would not have another meeting with my doctor for nearly a year. It began literally sucking all the life out of me. I was incapable of staying awake. I even began to fall asleep at my waitress job. Customers would be ordering dinner and I’d fall asleep standing up while taking their orders down!
I weighed 89lbs when I first started methadone.  Truthfully I had no business taking it and I was being poisoned. Of course without diagnostic tests or even under the  supervision of the clinic’s specialist. There was no one to prevent it from happening. Hoping for the best, I trusted my circumstances would soon be improving. I was wrong, AGAIN.

About two months went by with no significant changes. I finally got fed up and decided to leave. When I informed them of my decision they didn’t appear overly surprised
In retrospect it felt like they expected me to leave. No one seemed interested in finding out what my symptoms meant medically.
Instead they told me I would have to slowly decrease the dose until it was very low and then I would have few if any withdraw symptoms (cough..cough). 

Stupid ass me is still under the misconception that I was basically receiving sound medical advice. After all they were the experts. Since everyone knows that regardless of what treatment might not accomplish physically, medically. It can’t actually hurt you more.

“AND THE TRAP IS SET”

What everyone discovers is that gradually decreasing after you’re on a decent amount is painfully slow. Usually one milligram a day. And often it’s recommended to decrease the one milligram every other day. At least until you know how it’s going to affect you.
In theory- if eighty milligrams is far too much. Than decreasing by one at a time means only seventy nine more to go. Assuming you decrease that dose all the way down to one. That’s eighty milligrams in 160 days.  Somewhere in the neighborhood of three months, probably longer. Let’s just hope that  person doesn’t need to make a speedy exit at that point! Medical experts will usually remind folks that decreasing too fast will cause “uncomfortable” (cough..cough) withdraw symptoms. Best to take the slow and gradual approach here. And for those of us patients who can add under pressure, those eighty days will of course double your detox. Eighty turns into one hundred and sixty days. Bear in mind that the average “higher” end doses are one hundred and twenty days. Especially over time your starting dose won’t medically fill the newborn opioid receptors that continually grow.
All the while your brain’s chemistry has been changing and adapting. With new receptors popping up, you’re going to start to feel a strong need to fill them.

One ungodly early morning while I was standing outside freezing.  Waiting in line on the outside of the building in order to get in a line on the inside of the building. I noticed something. I began to realize that as the seasons changed, the years passed, jobs are lost, etc.
The same faces were always there. As unobservant as this may sound. I guess I’d never really acknowledged it before. Nobody leaves a methadone clinic. Usually anyone who does manage to make an exit isn’t doing so voluntarily. The doctors moved on. The nurses were rotated out. Even the clinicians would never stay too long. It’s kind of  like serving time in prison. Everyone else makes some type of significant life progress. Everyone that is with the exception of the paying consumers. The majority of patients had been “consuming” for years. However I began to wonder how much life progress any of us were truly making. I pushed the thought out of my mind that recalled without evolution, all life would be extinct! Change.  If only I had listened to my intuition all the years ago. I’m still haunted by thoughts of what my life might have been without the role of methadone in it.

“IT’S A MATTER OF WILL POWER! MIND OVER MATTER!’

Now the next ignorant son of bitch who informs me that getting off of methadone after ten, fifteen or twenty plus years is largely a matter of will power, may be swallowing some of their own teeth!! I can’t even begin to explain how this simply isn’t the case where methadone is concerned. And God knows that I’ve tried! Over the years I was desperate to depart. Occasionally someone in the methadone line would announce that they were in the process of tapering off and were going to leave the clinic for good! Of course all the veterans knew better since time and time again we had also made this VERY same announcement. Not that we wanted anyone else to fail. On the contrary, we’d wish them luck and we knew better than to mention how terribly difficult it would be. And as the weeks passed we’d watch them decreasing their dose and eventually attempt to leave. On average it took about five to 12 days  before their return. They always looked awful. But no one dared critized their honest efforts. We knew all too well that methadone maintenance was more or less a life sentence.
And whenever a family member would let me know that if I had really wanted to get off the methadone, anybody could. It was simply mind over matter!
And in nearly twenty years of being a methadone maintenance patient I am unable to provide even one name belonging to someone who successfully managed to get off methadone using nothing more than their mind and their fierce will!
Not even one.
I suppose that’s because everyone I’ve known was just weak, right? Maybe everyone I knew personally just screwed up the recipe where methadone withdraw was concerned?

Who continues paying outrageous fees and driving miles out of their way every twenty four hours? Seven days a week? Even Christmas day unless they knew that they were going to suffer immensely if not? Does that sound like the ability to choose even  exists?
No one’s involved just for kicks. No one that I know asks to suffer. 

It’s worth mentioning that I didn’t know a single person who’s employment wasn’t adversely affected by the constant inconvenience of the clinic. And what made matters worse, (besides poverty, evictions, loss of employment and broken down automobiles) was the cardinal rule that every methadone “client” knows by heart.
NEVER ever tell ANYONE that you’re a methadone patient. Never. Not under any circumstances will it not be risky business!
The consequences of being honest are most certainly too devastating to bear. Unfortunately I was going to get my first of many lessons. And what follows next is almost too hard to write about. Turns out that an invisible entity better known as STIGMA is the methadone “client’s” worse enemy. And nobody cares.
**********************************
That’s the first-I
02-2019
 
 

“IS THERE A DOCTOR IN THE HOUSE?”

PART VI -2 On the day I moved back home with my parents it finally seemed possible that one day soon I’d be free from methadone altogether! Not only did I have the full support of my immediate family but I also still didn’t have a car. This meant I wouldn’t be able to go […]

“IS THERE A DOCTOR IN THE HOUSE?”

“IS THERE A DOCTOR IN THE HOUSE?”

PART VI -2

On the day I moved back home with my parents it finally seemed possible that one day soon I’d be free from methadone altogether! Not only did I have the full support of my immediate family but I also still didn’t have a car. This meant I wouldn’t be able to go running back to the clinic in a moment of weakness. In the past I had done that, rush on back when withdrawal became too difficult to endure. I’d make the request to restart or be readmitted to the methadone clinic. And I knew that no one at home would be willing to drive me back there again either. The nearest city bus stop was more than two miles away at that point.
It was a GET OFF METHADONE OR BUST scenerio!
My twin sister’s battle with breast cancer lasted several years and at one point she also moved back into our parents home so our mother could help take care of her during such a difficult time. My mother had decided to take a leave of absence from her job in order to help both her daughters out with their respective health conditions. She was glad to do that for her babies. I look back now and I realize how much hope and how much determination I had for the future. It took a lot courage to walk away from everything and tackle my problems head on. It was also the very last time our family would ever stand united together and support one another. Those were some good days back when I was still considered a valuable member of the team. My team family.
Within just a few years my mom would be dead and I’d be injecting heroin and completely alone living on the streets.

No more team family. No more anything any longer.

Even my father managed to contribute to the cause and nuture his addicted daughter. There were plenty of times during the first two weeks of withdrawal that he’d find me hysterical waundering around the house sobbing before work in the mornings. He would always show compassion and attempt to raise my spirits by reminding me loudly that I could succeed. My father had been a drill sergeant for many years before he started his own carpentery business. Although my Dad has always been very slim in build. His voice is practically legendary when he’s barking out orders. I’m sure dead people can hear him when he raises it. I knew he was trying to keep me motivated. I did appreciate that effort.
After work he’d immediately take out the phone book and begin calling around to hospitals and rehabs in search of anything that might allievate the symptoms. He’d lock himself back in his home office and speak with addiction counselors for hours at a stretch. His main priority was to confirm that what I was going through was normal and that it wasn’t dangerous to simply allow my body to experience it without a doctor’s care. I knew he would take one look at me and become very frighened. I felt awful about letting him see me in that condition but I couldn’t respond to anyone else’s feelings anymore. I was too busy trying to manage the suffering to do anything about it. And everyone who was forced to witness my suffering would have exactly the same terrified look on their faces. I started to seriously regret being around others. I wondered if perhaps we had made the wrong decision in regards to moving me back home during that time. Made me feel selfish and inconsiderate allowing them to see what was happening with me. It’s also very humbling to let others know just how bad your opiate addiction truly is.

My mother was beside herself with worry.  She became my only connection to the outside world during that time. Since I wasn’t able to focus or respond to much in my environment, including my body. She’d stand guard. Sometimes literally all night long. My mother was the person who escorted me to the restroom to pee, undressed and bathed me. She would attempt to fed me and keep fluids in me. Most significantly though she tried to comfort me. My mother, my nurse. She might not have understood exactly what I was going through personally but she could see that something very scary was happening.
That’s probably the worst part of withdrawing from methadone. The sense of intense isolation that accompanies it. All kinds of opioid withdraw will create a sense of isolation. However methadone withdraw in particular causes isolation like none of the other opiates can possibly match. It’s as if there’s some type of force field surrounding your entire body. You’re on the outside dying to get back on the inside with the people that you love. But you can’t join them anymore. You’re too busy suffering to engage. I’d sometimes watch in tears as everyone except me sat down together at the dinner table and long to join them. But I couldn’t. I was obviously too busy doing something else. When symptoms were at their peak during the night while everyone else was peacefully sleeping my mom would crawl right up beside me and hold me in her arms. That’s the thing about methadone withdraw. Someone can be sitting right next to you, even cradling you in their arms. But it still feels like they’re a million miles away. How was I ever going to get back to them again? I was incredibly lonely and I missed being a part of every day life. One morning after I had sat up all night long counting to myself,”1 2 3 4 5 6 7 8 9 10.” Once I reached ten I’d then repeat the process. “1 2 3 4 5 6 7 8 9 10” I’d reassure myself I was that much closer to finally being finished with withdraw. Besides Nobody sleeps while they’re in methadone withdraw. Nobody.
My father was frantically searching the whole house for the car keys he misplaced right before work. I remember watching him search. He looked under paperwork and on top of the fridge. I was almost envious that he was able to focus on whatever he wanted to. I also wanted to be able to get engrossed in something again. Anything else other than withdraw. It had been twelve whole days since my last dose of methadone by then. Like a boxer constantly moving, I was exhausted. Not just physically either. My mind and my spirit were thoroughly spent. I didn’t have much more to give to withdraw. I desperately needed someone to ring the bell. Without realizing it I began to count to ten again out loud in front of my Dad. For some reason he got quite angry with me about this. I suppose seeing your child suffer is not an easy thing to accept. No matter how old they are. He started yelling in typical drill sergeant fashion. My mother immediately appeared. “Calm down Michael! She’s trying ALRIGHT!”
Then he slammed his fist down on the kitchen table and asked her-
“I thought she tapered down Paula (?) Is this what we paid for? Is this okay with you?”
My mother didn’t dignify this with a response. Instead her maternal instincts kicked into high gear and she helped stand me up to escort me to the bathroom. Moments later we heard the front door slam as he left for work. Car keys in hand. Once again I was putting my family through total hell over a methadone problem.

“FOUR DAYS LATER…. HOMOPHATHIC REMEDIES”

My parents always considered dinner time to be the family’s quality bonding time together. It was one of the only times during the day when we would get to enjoy spending time together and relax. We were usually finished with homework and chores. My Dad was finally home from work by then. Which meant we could enjoy listening to each other. We could learn about each other. We were also welcomed to mention any personal problems we were struggling with at that time. Honestly that’s how I got to learn the most about my father, during supper. We would continue on with this ritual until my mother passed.

Four days after I’d seen my father’s first slam into the kitchen table. My father and I sat across from each other enjoying dinner together as a family once again. As if I’d never been so sick. Like someone waved a magic wand and the spell was finally broken.

“Majority you seem like you’ve really turned a corner here. I know it wasn’t easy but the work paid off. I’m glad it’s over with.”

My mother nodded her head the whole time in agreement with him. When she was finished chewing she added-
“I really think the worse of this is past us now. We’re both very proud of you.”

I felt my stomach beginning to turn. I didn’t know what I was supposed to tell them. They looked so pleased and so calm. They assumed that sixteen days in and the problem of methadone addiction was gone from our lives. In fact the last time I attempted to eat dinner at the table with my family I hadn’t hardly swallowed when the food came right back up! I vomited while still sitting in my chair. That had been almost two weeks earlier. But to see me back that first evening. I was the very picture of health.

The last sixteen days had been a nightmare for the entire family. My mother was due back at work soon and she was completely exhausted. She’d been on call managing methadone withdraw twenty-four hours a day for almost two straight weeks. Same as myself. My father’s stress level was obviously high. Both my parents appeared to have aged ten years in the span of only sixteen days. Finally I couldn’t take it anymore. Not just my own suffering, which was maddening for sure. But knowing my family was suffering right along with me. They had tirelessly devoted themselves to my problem. They were truly exhausted and reaching the end of their ropes. They had put their entire lives on hold to deal with my methadone withdrawal. In addition to their selfless acts they also had another daughter and she was fighting breast cancer. She required trips back and forth to the hospital and various medical procedures. Treatments that often left her lifeless and feeling sick. Plus she had been responsible for trying to locate a local charity to help pay for hair wigs and prosthetic bras. More appointments for all of us. Not that any of us minded.  I couldn’t bear knowing that I wasn’t helping matters any. It felt as if I was imposing on all of them. I truly loved each of them and I didn’t want to subject anyone to more suffering than what was absolutely necessary. And truthfully I was lonely. I missed being with them in our normal lives.

Once we finished eating dinner I ran off to my bedroom to hide and sob. How could I possibly let my father praise my abilities? How could I lead him to believe that we fixed this problem with only bare determination? What kind of a person sits there and takes full credit when knowing deep down inside they had cheated? I should have told my Dad the truth at that time. I should have confessed that I had started using heroin to combat the symptoms of methadone withdraw. But I was too scared he’d stop loving me. I foolishly believed I had everything under control.






“ADDICTS HAVE RIGHTS TOO!””

*I had originally hoped to get my hands on a copy of the original consumer protection complaint (complaint #1) that I filed from the year 2017. However I discovered that no one is permitted to request a copy of filed complaints. Not even the complaints they themselves have already filed. Since I was living outside in a tent immediately following the original complaint I made,  I couldn’t reasonably make a copy of complaint #1 that year.
However I learned my lesson and copied the next complaint I filed with the Indiana Attorney General’s Office #2 almost word for word. It’s not ALWAYS necessary for a medical review panel to investigate a malpractice complaint. It depends on which state the complaintant happens to reside in. There’s both advantages and disadvantages to this  administrative requirement. I thought possibly since the Indiana Attorney General’s Office- consumer protection agency, professional licensing division (still unclear exactly what to call or refer(?)  to whichever department had agreed to investigate the original one)! That by successfully reopening complaint #1 (only after I officially filed yet another complaint#2 with exactly the same agency) That it would finally be easily resolved. Which now I am beginning to realize was very naive of me.
In the event anyone else would like to see an example of what an official consumer protection agency complaint actually looks like. Feast your eyes on mine!! Plus I wanted to document everything that’s occuring for posterity’s sake…
PS —
I’ll happily send a money order to anyone that can clarify what I’ve managed to legally accomplish and might know a more articulate way to explain my progress!!

DECEMBER 2021********

I’d like to request a reopening and a complete investigation of my original 2017  consumer protection complaint concerning the harm I suffered as a result of substandard care. Due to a miscommunication regarding how my complaint would be handled by the agency I wasn’t able to read, review or even sign documents required for an investigation. Once my doctor received his copy of the complaint he denied me further care to a community outpatient clinic where I had been a patient for seventeen years. This was the only outpatient methadone maintenance clinic in Marion county Indiana. This meant as a Retaliation for filing a legitimate complaint, I suffered a debilitating condition. One that included complications. Addiction, self medicating, homelessness, loss of employment and family support. Without medical care or even electricity.  I couldn’t get better any sooner than I did. I’d like a medical review panel to investigate the substandard care as well as my doctor’s breach OF duty. My original complaint is meritorious. My condition was worsened after being admitted without a thorough medical exam or a diagnosis. Basing treatment on the answers I once provided on a brief behavioral mental health assessment- I wasn’t opioid dependant like guidelines require. Without diagnostic tests or the physician’s supervision, I was severely over medicated for a number of years. Dosing virtually every single day for almost seventeen years. Therefore worsening my opiate addiction. I couldn’t leave the powerful opiate narcotic. I was harmed by treatment that didn’t properly explain the risks to me-explicitly! And in terms that I could easily understand.
Harmed again by filing a complaint and left without adequate medical care or even referrals from the Attorney General’s Office.  I was forced to manage my symptoms completely alone. This means the damages are considerable.  And violating my right to petition and causing interference with an ongoing investigation was my doctor’s intention. Please don’t let him succeed in violating my due process rights. I’d like to be refunded for all of the treatment that has injured me. As well as adversely affected my children. Approximately $125,000.
Most of all I’d like the SAME RIGHTS afforded to everyone else in the Constitution. I filed the original complaint well within the statue of limitations period. It’s seems to be a risk to the public. I developed Hepatitis C as well as suffered severe emotional trauma. I’m lucky that his refusal to medicate me didn’t end up killing me. I’ve included more details on a separate page. Thank you
 

PART II “SUFFER IN SILENCE PLEASE!”

“THE RIGHT TO PETITION”(??)

The one thing a methadone maintenance patient in my situation should never ever do is make the mistake of complaining.

Periodically, over the years. The awful realization that I was more or less chained to the methadone clinic would cause me to suffer a brief meltdown. Constantly being forced to address the reprecussions that were associated with Midtown and knowing that I was miserable at the same time. Most distressing. On these occasions I’d often unburden myself to anyone in close proximity. 
And although I usually felt a great sense of relief from being able to express my anguish out loud. I’d always later regret unburdening myself. My lapse in judgement. Always. And here’s why.

Regardless of how much I resented what was happening. I couldn’t actually leave the clinic no matter how strong my desire was. No matter how much damage it was causing. No matter how much heartache I endured. Honestly I wasn’t bitching specifically about the methadone addiction in itself. Although it certainly wasn’t making me feel any better-prospect wise.
  What was upsetting me the most was knowing that I no longer had power. No matter how much I knew I didn’t want to continue with treatment. From my perspective it was almost arbitrary whether or not I continued dosing.  If I didn’t show up, I’d suffer. And even when I did show up- I’d still inevitably suffer.

The reality was that as long as I continued to make the methadone clinic a priority I wasn’t being a good parent to my son. How could I possibly offer my son anything other than poverty and despair? During the year that me and my son lived at the homeless shelter, I still hadn’t come to terms with the fact that I was forcing my son to choose Midtown as well. Truthfully I couldn’t properly parent him while over medicated for years at a stretch. Even later when I was physically managing my symptoms somewhat better I choose to knowingly deny my son clothes, toys, food and even the fenced in back yard he’d always dreamt of playing in. For the record our apartment downtown didn’t even include a patio to enjoy. It was just one of the sacrifices I automatically made on his behalf, without any consideration for what was best for him. And I did that for the clinic’s sake. And for my own sake. From the age of five on up he would accompany me to the clinic before school started in the mornings. He would resent having to wake up and travel by car or the city buses at 5:30 am. And if he wasn’t able to get enough sleep the night before, he couldn’t sleep in like most children. (Another blind sacrifice)
It’s one of the things I’ve had to admit that I was wrong about as a mother. I expected my son to also work around the clinic. Parents aren’t supposed to sacrifice years of their children’s lives standing outside in line, etc in order to ensure that their own “needs” continued to be met. That was my responsibility, no one else’s. If this treatment had been legitimately prescribed and wasn’t constantly hurting us than it would have been productive for us as a family. Unfortunately it wasn’t. It was just TIME spent and sacrifices made. I suppose the argument could be made that I was the single mother who choose to raise a child by herself. I took that responsibility on voluntarily and alone. I’d have to agree on that one. Here’s my argument:
Before prescribing methadone maintenance one of the factors to consider should be a person’s social economic situation. After all addiction is a behavioral mental health disorder and there’s likely evidence of the problem in all areas of a person’s life. Financially my addiction hadn’t yet reached the stage that it was detrimental to our livelihoods. However once admitted to the clinic I felt the impact-hard. And ironically for the first time ever. It’s another harm generated when methadone isn’t properly prescribed. And I wish like hell the doctor had given this aspect some thought before shuffling me on over to the Midtown methadone clinic where’d I remain stuck running in place for the next seventeen years. Unfortunately once admitted the damage was done. Since I certainly wasn’t spending as much money on pills as I’d have to later spend on the price of methadone. That’s part of the overall totality of everything that the clinic should have recognized might become harmful. And it did hurt us. It hurt us both for years. Honestly it still hurts us even to this very day, financially. It was one of those so-called adverse consequences that developed from my addiction to methadone. Yet, I still continued to show up. Despite the negatives.
   They’d have my full cooperation. And it was my willingness to surrender that made me so angry with myself. Clearly I was suffering. There was not a single advantage by  remaining in treatment. The only benefit was that I didn’t have to tackle the devasting withdraw symptoms. (Another “positive” checkmark where Midtown was considered ✔️)
Yet I remained loyal as ever. Midtown’s agenda ultimately meant more than my own. And even today I have trouble convincing myself, psychologically,  that they didn’t use the implied threat of not being able to dose as a means of control. In my mind I was powerless to do anything about it. Especially later on once the Shelter Plus program compounded matters further.  But even before then Midtown’s overall approach concerning some of the issues I occasionally had the courage to mention was basically -damage control. They provided suggestions that would support methadone maintenance. They we’re all too willing to let loved ones know that it was a legitimate based form of treatment! They couldn’t see the bigger picture. They were focused on making treatment happen. They had tunnel vision where methadone was concerned.
Now I don’t honestly believe that this was intentional. I think most clinicians meant well. They just didn’t understand that treatment wasn’t ALWAYS good for all of the ones who had been admitted. Guidelines clearly state that anyone being admitted must be opioid dependant for at least one year. And how would the clinic verify that medical fact for a certainty?? Obviously they’d ask you on the admitting assessment to tell them how long you’ve been addicted to opiates! (Gosh problem solved…. NOT.)  That’s not exactly a scientific or reliable source. I know me personally, very well. I’m not always reliable and I’m never scientific. Otherwise I’d probably have no need for medical professionals whatsoever.

Occasionally after a meltdown a good Samaritan would step in on my behalf. Usually it was a  member of my family. Not always.
In actuality it made things much harder when someone else tried to manage it. It also confirmed my worse suspicion. That there was nothing that could be done to help me. If I truly wanted to exit I’d have to suffer without medicine. I felt as if I had two choices in front of me. 1) continue to manage the suffering you’re familiar with(evictions, poverty, discrimination, depression loss of self respect etc.) The usual. Or I could face another daunting prospect. 2) Attempt to experience suffering on an unknown level(methadone withdraw) Deal for the very first time with opioid withdraw. Do it without medication or much community support. And risk hurting your son even more.)
Who would consider my options vast at that point(??) Or reasonable? Bottom line was I wasn’t getting out of this situation unscathed.
Least I was surviving the way it stood. I wasn’t in physical distress for the time being.
  I understand why people assumed they were helping me as opposed to interfering. But truthfully they weren’t. They didn’t comprehend I was hysterical about the fact I couldn’t do anything. I was upset because I realized I had been harmed. Who was going to help me get back on my feet while in withdraw?  Noticable lack of “Good Samaritans”  where that area was concerned. Approximately eight years into my treatment (or  2,920 doses) despite all the negative consequences. I was still a “client” at Midtown. From all outward appearances I didn’t seem to care or acknowledge how much I was getting hurt by my addiction to methadone.  Most people assumed that I was enrolled in a legitimate treatment program by choice.  A medically necessary treatment. It appeared to be voluntarily. No one put a gun to my head! They didn’t understand that in my mind, that’s exactly what was occuring to me each day. Didn’t matter if the gun was loaded or not. I didn’t check for bullets.  Of course anyone who knew and remembered me back from before the days of methadone maintenance realized just how far I’d fallen in those eight years. It didn’t make any sense to them. Why on God’s green earth was I  still on methadone? The pressure to get off methadone was enormous. Especially from my own family. My father in particular couldn’t understand how addicted I had become. He just couldn’t imagine the problems at that point.  I lost track of how many different times I’d flat out lie to my parents about tapering off my dose. I had simply caved under all that constant pressure. It was much easier to tell them whatever they wanted to hear. Particularly on Sunday evenings.  If I seriously expected anyone to hand out cash for my weekly fees then I had to tell them what they wanted to hear. I had to make them believe that there was an end in sight. I had to give them false hope.  Definitely couldn’t afford to make them angry with me as I begged them once again for their help paying my fees. I needed them to believe that it wasn’t a life sentence so I’d tell them anything they were hoping to hear. And reassure them that I was working on a plan. Anything but the truth- That in six days time, almost down to the exact minute. I would appear before them again making the same exact plea as the week before.

In fairness they (family) assumed that the pamphlet from orientation day was medically accurate.
“Anyone can ween off methadone..” (paraphrase)
I wanted to know on which planet that was a reality?) Perhaps there was room on board the space craft for me as well?
  No one understood. That’s why I’d breakdown to begin with. Time and time again I’d become overwhelmed with shame and helplessness.  The Desperation, stealing and lying constantly to the people I loved most in the world.  It wore me down. It went against my nature.
On one occasion a social worker from the homeless shelter had been the concerned “bystander” during yet another breakdown. Happened to be in the path of the tornado, so to speak.
After crying in her office for nearly an hour and revealing how bleak my future now was. (typical Sunday nervous breakdown, still hate Mondays for this reason). She wanted to help me! (I do still appreciate her compassion) She immediately picked up the phone and dialed Midtown’s number. Then I realized suddenly that Midtown was only TOO willing to cut me loose before I had a chance to remedy the problems that methadone had already caused me.  I couldn’t risk having my dose rapidly decreased against my will while simultaneously trying to rebuild my life. I didn’t know if I’d be physically better off either.  She left a voicemail but I never returned to follow up. As a general procedure matter, patient consent would prevent anyone from Midtown communicating with a social worker. Just as long as I didn’t sign off the release of information. And of course I wouldn’t.  I had a reprieve for my lapse in judgement. Which meant Midtown wouldn’t have to find out what I had done. I knew Midtown wouldn’t be overly concerned about the withdraw from methadone. I knew I’d be obliged right away. Remember it was my first experience with opioid withdraw on this level.
That was the scariest part.
In fact according to the clinic’s brochure. I could make an exit anytime I was stabilized and READY to do so. I’m still not sure what kind of person suddenly wakes up after being stabilized and decides that they’re ready to endure methadone withdraw(?) But I didn’t attend medical school.

Besides not dosing wasn’t going to magically fix all of the problems generated by my addiction.  Making a request to exit would complicate things further. It Felt reasonable to slap on a band aid every morning until I could figure out any course of action.  Or until I died from natural causes. I’d resort to dosing out of necessity. Only one thing I was sure of. I wasn’t better off in withdraw.
I was still living in a homeless shelter back then. Certainly didn’t wanna experience methadone withdraw(opioid withdraw, first time) while living among strangers and raising a child. Plus there was always the possibly of failure where detoxing was concerned. How could I know if I’d be able to do it? I wasn’t opioid dependant on arrival. I didn’t know what to expect from methadone withdraw. I couldn’t be absolutely certain that my very survival as well as my child’s, wouldn’t one day depend on obtaining methadone through the Midtown narcotics treatment program. Midtown NTP was the ONLY methadone maintenance outpatient clinic in Marion county Indiana. As long as I had a son to care for I couldn’t risk closing that door forever.  It was hopeless. Hadn’t the social worker yet heard???
YOU NEVER BITE THE HAND THAT’S BEEN FEEDING YOUR ADDICTION! (Junkie 101)*

It was back then while living at the shelter I was finally pushed to the breaking point. I don’t think anyone else could experience guilt on the level that I did. The main reason I felt guilty was knowing I was to blame for everything that had happened to my young children due to being a patient at Midtown. The heartbreaking adoption of my baby girl then the devastation caused by discrimination. It had been excruciating.
  Added to the load was knowing that everyone who did agree to support me (weekly fees, transportation, housing) was subjected to some form of manipulation.  No one helped me voluntarily. No one who truly cared about my well being wanted me to stay at the methadone clinic. I had to make them believe that they wanted to. I had to lie. Not just once or twice but literally hundreds of different times. I could never just ask someone for money based on the fact it was important to me.
On one occasion I ingested a handful of pills, benzos, opiates along with a methadone take-home bottle. It was unusual that I even had take-home medication bottles since inevitably at some point something would prevent most patients from being eligible for the privilege of take home bottles.
Once I actually had mine confiscated due to what’s known as a diluted urine screen. I had no idea why the urine screen came back as officially “dilute”! But it wasn’t intentional on my part. I was informed that there’s plausible explanations. Merely drinking too much water could cause this reaction. But It didn’t matter to Midtown’s staff what the reason was. Better safe than sorry. My bottles were immediately revoked without notice. I had rightfully earned my take homes at that time. I was clean and attended all the required groups. Probably unecassary to mention I had virtually perfect attendance as well. It was painful explaining to my family that once again, Midtown called dibs.
And this meant that once again I was forced to return to begging anyone who was willing to bring me back and forth every single day of the week.  Just as I had been getting used to the idea of only having to beg five out of seven days. Nope. Nothing I could do about it. Especially complain. My son was away from the shelter visiting his grandparents and I swallowed as many pills as I could easily fit into my mouth in addition to drinking a methadone take-home bottle. I collapsed right outside of my room in the shelter’s hallway where I was discovered by another resident covered in my own vomit.  I was taken to a hospital. It might have been Eskenazi hospital or formally known as Wishard. I don’t remember where I wound up that day. (For record I think it was my pancreatitis that probably saved my life. Throwing up was something I was constantly doing. (Check ✔️ Midtown).
Truthfully I can’t even remember what year that happened since most of those years weren’t distinguishable from one another.
My mother had received a call while she was at work and dropped everything to drive into the heart of downtown and be by my side. When I finally did regain consciousness, the first thing I became aware of was the sound of my mother sobbing quietly near by.

“Majority tell me you didn’t do this to yourself on purpose did you? I love you and I need you here with me. You didn’t did you? The doctors are asking questions.”

The only time I recall speaking with a physician during my “foggy” period had been during some kind of memory exercise. The doctor read off my medical history or facts as they were presented on a print out with my mother sitting in the room. The doctor would confirm my answers by looking over at my mom who would nod her head to say, yes that was true. At one point as she inquired about various medical procedures that I’d had over the years including the details related to childbirth. She had asked me to confirm that I had two children. She hadn’t asked me if I had given birth two different times. She asked specifically if I had two children.
She’d probably assumed that two live births meant I had both my babies at that time. And instead of answering her I felt my face crinkling up as I stuttered trying to explain to her that I couldn’t be with my daughter. The words got stuck in my throat and I became visibly upset trying to sit up. My mother then jumped to her feet and held onto my hand. She took over from there as I passed back out. My mother. My co-pilot. My dear, dear friend.

Hours later in typical Majority fashion I told her it was a stupid accident and then apologized to her for causing so much trouble. I assured her that I was fine. After all the good Lord knew I had plenty of practice telling her and everyone else- exactly what they wanted to hear.  She seemed to accept me at my word. I’m sure mother’s intuition told her I wasn’t being honest. And just like all the lies I told each week in order to pay for methadone.  She was courteous and willing to believe what I needed her to believe. Face value. (Thanks mom)*

It was awful knowing by the time of my discharge I still hadn’t found a way out of the methadone situation. It was as if nothing in the universe could prevent me from showing up on Monday mornings, money order in hand. Not my own free will, not a cocktail of prescriptions. Not even the hospital treating me. I’d be released back to the hell I had been burning in a short while later. Fortunately I had no idea that eight years in treatment was only about the half way point. Just a tad over EIGHT MORE years to go. Thank God my crystal ball was in the shop when discharged. Only 2,920 doses more to go. Thankfully I didn’t realize that part back then. Not too long afterwards our names came up on the list for the Shelter Plus program. I decided that finally there might be some hope for a meaningful future. That was just the type of opportunity that had brought me to the homeless shelter to begin with. (Remember it wouldn’t have mattered where I was. I ALWAYS had the same problem) I convinced myself that maybe now I could make something work out for the best? I put one foot in front the other and kept going.
In other words I told myself, “Shut up and dose. You’ll figure something out”







CONSUMING TO LIVE… LIVING TO CONSUME. 👍 It’s almost time to battle

-Preparing to get off methadone was a major undertaking. Based on my prior experiences I already understood that once the methadone left my body completely. I wasn’t going to be able to focus on anything else other than the physical withdraw. That included maintaining the methadone halfway house/apartment that had served more as a prison than it ever did a place to live and prosper. Leaving the apartment was almost as liberating as leaving the methadone clinic itself. Without being allowed to flourish personally, socially and especially economically due to the stipulations imposed by both Midtown as well as the Shelter Plus program. The only function my apartment had served was as a place to hangout and not suffer in opioid withdraw. Had I decided at any point in time to move out on my own without the grant money to pay my rent and utilities, I’d be too sick too accomplish anything regardless. At least for a period of weeks and likely months. It was if I had to constantly choose between withdraws or self fulfillment. Plus the fact I had been raising a child always came into play as well. There would have been no one to help me if I was recovering from methadone withdraw as a single mother. Moving back home with my parents would allow me the opportunity to place all my efforts into healing. I assumed once the very worse of the methadone withdraw had passed I could then get on with my life. I wanted so badly to have the same opportunities that I’d had prior to becoming addicted to methadone. I wanted to earn a living, pay my own bills and purchase a vehicle. I even wanted to finish getting my degree. These were all the things that I had achieved on my own nearly twenty years earlier prior to unknowingly selling my soul to the Midtown’s narcotic treatment program. One way I coped with being trapped inside of my apartment and having absolutely nothing to do or to look forward to any longer was by forcing myself to take daily walks. Weather permitting of course. Most days this was my biggest accomplishment. I had started to feel inconsequential as a member of society. In fact I had started to wonder if I was slowly disappearing altogether! I used to dream about walking around places totally invisible to other people! Sometimes I’d even dream I was riding a bicycle around the block and that still no one could see me. Another recurring dream I had was about being late and missing the scheduled dosing times over at the clinic. Probably because I had made extraordinary efforts to make sure I was able to pay and dose over the years. Midtown’s weekly fees weren’t the only problem I had. Even when I did somehow manage to cough up enough money to pay them I still had to figure out how to pay for enough gas to drive there and back. Occasionally I was only able to afford to drive to the clinic but not back home. (Which sadly I still considered to be a partial victory)! I’d beg fellow patients outside in the parking lot to assist me with gas money. Only so I could rush back home to sleep. Consuming too live. And living to consume. And later as time marched onward and I wasn’t able to afford car repairs and no longer had my own transportation to rely on. I was forced to beg anyone with a vehicle to please take me there and back each day. Every twenty four hours, seven days a week. Everything I did or (didn’t get to do) was centered around getting to the clinic on time and receiving my dose. It’s not as if I could ever stop the cycle of madness either! Even after I did manage to pull out a “Hat Trick” each morning and physically show up, MONEY ORDER in hand!(((For anyone who’s interested, I’ll be providing a sorta foot note or supplement regarding all the many things that can and DO go wrong while attempting to purchase a money order around five or six o’clock in the morning (That’s the weekdays of course! Not weekends, Eastern/Central standard Indiana Twilight* time Zone!! Naturally..👍). I had at best-just a few hours worth of a relaxing before I would need to start planning how to somehow do it all over AGAIN!! Like a record skipping that gets caught repeating over and over and over again in the same exact spot. I’d sometimes dream that I was racing up the sidewalk on Meridian Street downtown. I’d finally reach the clinic doors and suddenly realize, to my horror!! That it was too late!! I’d frantically beat on the glass with my fists begging and pleading with someone inside to please just let me dose! This technically meant even when I was asleep I was still consumed with Midtown! I’ll add that this treatment obviously did not improve my condition or enhance the quality of my life!! Not to mention my sleep.I had packed up what few possessions had meant anything to me personally and then called my mother to come pick me up from my apartment and take me away from all the gloom and despair. I left quite a bit there actually. All of the second hand furniture, all of the pots and pans. Even the few decorations I had. Nope. Wasn’t going to be needing them. Driving out of downtown we went right past the clinic only blocks away from my apartment.(Rink Savvoy)* In fact I had asked my mom to pull the car over across the street from the clinic parking lot. I got out of the car and I snapped a quick photo with my phone. I’m not even sure why I took the picture. Maybe a bit nostalgic about saying goodbye to something that had been a huge part of my life for so many years. After all familiarity breeds fondness! So I’ve heard… In that moment despite being terrified about all the many things my future might hold for me. I was still hopeful that finally whatever was destined to occur-the one thing I knew wasn’t going to be included was the Midtown narcotics treatment program. Even to this very day I know that I’m never as scared of the “unknown” as what’s “known”. There’s promise in each unknown day just waiting for all of us to get off our ass’s and discover it!! That’s a lesson I learned the hard way!Moving back home with your parents at age forty isn’t likely going to be easy on anyone! Regardless of how close our family network had once been! My father was the biggest proponent of me NOT living there. But as usual my mother, MY public defender, Pleaded my case and made it happen. She understood that the only way I could move on with the REST of whatever was left of my life was by getting off the methadone. Honestly I’m sure there was another equally compelling reason to move me back home. Shortly before my exit from the clinic my identical twin sister had been diagnosed with stage three breast cancer. It was devastating for the whole family but especially my mother. Evidently after testing her DNA, a cancer causing gene was likely to be the culprit. She had been thirty-eight years old and was forced to complete rounds of chemotherapy, radiation and a double mastectomy in order to stay alive. Which she did bravely and with very little complaining! On the day my sister was in surgery I had gone to stay with my mother as she nervously waited. At one point she had started sobbing with her face buried in her hands. “They’re Carving Up My Baby!” She yelled out angrily. I knew what she had meant by that statement. That was the only time I ever saw her completely breakdown. I’m sure that almost losing my twin sister was a major factor in the decision to keep me in close proximity to her. No one said what we we all thinking back then but I knew my parents were wondering when it would be my turn at bat.Little did we know that barely two years later we’d loose mom to pancreatic cancer within a matter of weeks of being diagnosed.In hindsight I feel fortunate to have been living back at home when she finally passed on and left me forever. I’m truly grateful for that much. Just maybe God did grant the tiniest of favors. Maybe…

The year I made my exit

NEEDLE IN HAYSTACK

NEEDLE IN HAYSTACK

—–supplement

Shortly before the birth of my third child, Adelaide. I got sick with the flu. At that point in time my distrust of doctors and general lack of faith in the healthcare system usually prevented me from receiving regular check-ups. However on this occasion I didn’t have a choice but to see a doctor about my symptoms.
Being crankier than usual I had thrown a tantrum when the baby’s father set up the appointment and even drove me to the clinic. I’m sure it was the constant whining that motivated him to set it up on my behalf. All the way over I complained out loud about the shitty care I’d undoubtedly expected to receive that morning. I even complained out loud to my sleeping newborn that I’d be in safer hands with the local witch doctor versus a person who attended medical school and pledged a professional oath! Strapped in her car seat and totally passed out she didn’t even bat her baby blues at me. 
I finally arrived to the appointment on time. And completely against my will.

Coughing and sneezing during the COVID-19 outbreak is never well received. Especially while inside an outpatient waiting room. A woman sitting nearby actually moved to the far corner of the waiting room. Which for some strange reason I took offense to. After all I hadn’t refused to mingle with her unknown germs! Huh 😣
I briefly considered hiding out in the facility’s bathroom for awhile and then pretending I’d actually been examined. Before I had a chance to retreat I heard the receptionist call out my name.
She directed me to an exam room and I sat miserable with congestion waiting on my twelve year old doctor to arrive. That’s when my phone rang. It was the baby’s father. He had wanted to remind me about the needle that had gotten lodged in my arm a year and half earlier. I was living outside at the time and I was unable to get it out on my own. Without much concern for my own well being, I let it remain there all this time. Even during my pregnancy it was there. I decided to avoid a possible CPS run in and didn’t mention it to my OBGYN while pregnant.

Now before assuming that I did nothing about the impending medical complication stuck in my arm, that’s not the case!!!
When I had returned back to the campsite where my tent was located. I had summoned the help of the camp’s number one know-it-all. He was definitely the most qualified person available for these situations. His father had been a surgeon. He was constantly boosting that he was slightly more intelligent and more observant than ordinary folks were.
And like the others who resided near my dilapidated tent. I too had heard how he himself could have followed in his father’s footsteps. Except for the heroin issues, lengthy criminal arrest history and of course the prescription fraud charges.
Since he was no longer welcomed back inside his father’s home he’d resorted to keeping himself well and living outside like most of us regular folks.
Although he was a bit too proud for my taste personally. He’d read right out loud from medical journals online and attempt to quiz the clan. Nobody was interested. I’d pretend that I was asleep to avoid telling him I couldn’t care less to his face. He may have had a first name but the only thing I’d ever heard him called before was “Youngster”.

I had explained to him that while kneeling behind a dumpster downtown around noon, I’d attempted to quickly shoot myself up. And instead of succeeding I had broken the needle completely off. And it remained in my arm. I added that it hurt, alot.
For the next two hours several valiant efforts were made to remove the needle. At one point I clearly remember looking up as a pair of shaky, dirty hands tried using a pocket knife to dig it out. But the effort had to be abandoned completely when a Marion county cop car decided to investigate the commotion.
Needless to say. It didn’t work out.

Besides after about ten days the initial pain and swelling subsided and I forgot about it. Although for those first ten days the pain was considerable.That’s probably why today I consider it practically a crime to not sell clean needles to those who desperately need one.
Well that and the fact I contracted Hepititis C. Seems like good enough reasons to have access to new syringes for me personally.

The baby’s father had always wanted me to address it medically. I probably should have kept this bit of information to myself when we first met.
I understood why he’d be concerned about it though. He has never experienced anything like that in his well balanced life.  Always stable, secure and obviously drug free. Totally opposite of the person I had become. He was a responsible member of any given society. An all around decent man. The notion that a person would even inject themselves, let alone mess it up so terribly must have sent shivers up his healthy spine. And knowing that I had simply ignored it seemed to irritate him endlessly. But that’s because he’s never had to loose his humanity before. He couldn’t fathom going to the places I had. He didn’t comprehend that I was merely a walking opioid receptor when we first met. Nothing else had mattered. Until the day I had discovered we were pregnant.
Thankfully I already had access to treatment even before I realized that I was pregnant. But it was a close call. Two weeks after I had been admitted into Medicated assisted treatment I found out about the pregnancy.

I’m an atheist. I don’t have to apologize about it because I know it’s not going to impact others one way or another. However if there had been a God who possibly wasn’t willing to let me die while homeless. It was the perfect remedy to get me to care again. Likely the only remedy.
She was my miracle. She doesn’t know that even before she took her first breath, she managed to save a human life. My life. She’s my hero!
She’s the reason I lived long enough to tell others about what happened to me. That probably doesn’t seem likely. But it’s very true. And I hate the fact that the infinite claw of Midtown NTP was able to seek out her too. Mothers who don’t manage to protect their own babies hate themselves for their ineptness.

The doctor finally came in and I began describing my symptoms to him. Including the exact color of my phelm and the fact I no longer had even one nostril left for blowing out of. He didn’t even make eye contact with me as he scribbled notes on his clipboard. Right at the conclusion I decided to go ahead and mention that I had a metal syringe tip lodged inside of my arm for approximately a year and a half. Then explained it happened while living outside last winter in a tent and using heroin to treat opioid dependency. I even added that if he could just manage proper lightening, I might still see it tucked underneath a layer of scar tissue. And if he was interested in getting it out, I was agreeable to whatever means were medically necessary.

This is one time in my life when I probably should have provided a healthcare provider with a disclaimer of my own. Seemed genuinely surprised by my omission.

His jaw was hanging open and he looked almost ghost-like. Being the meek polite woman I’ve always been, I immediately apologized. I’m not sure why though. I suppose I felt bad for imposing on the young man. I highly doubt he was expecting me to tell him that. But naturally it’s recommended by everyone that honesty is the best policy! Especially where your health is concerned.

He managed to close his mouth and pull himself together. Then sat down on a stool right in front of my arm. After turning on the overhead light and adjusting it. He peered down at the location where I had indicted it had once been.
“AHA!”
He found it. Then he said that it looked relatively easy to get out. It had moved up to the outside layer of my skin by that point. He muttered to himself that he could probably do some digging and it would pop out. Since the needle had been heated up by my cigarette lighter many times prior to using it on that fateful day. It had fragmented. I told him to go on ahead and give a try. Reminding him that I was immune to the pain of sharp utensils. Still, I turned my head and didn’t watch as he dug it out with something. A few minutes later, it came out. In three pieces. I watched each piece fall to the floor.

How could I ever have been so incredibly stupid? Or more appropriately,.
Was I really that sick and desperate??
And of course the answer is yes. Sadly, Yes, yes, yes.
And if someone else thinks they could have done any better than me. Go ahead and show me how it’s done!!

That’s the thing, it’s never really over for me. My very first semester of community college I had been a psychology major originally before discovering philosophy.
I thought perhaps that everything I’d ever need to understand about the human condition could be found somewhere in the psychology textbooks. Before I became too doped up to attend classes after being admitted to Midtown. I assumed that quite naturally I’d be a natural since I considered myself to be a compassionate person who was capable of emphasizing with some of God’s most pitiful creatures.

I distinctly remember reading about mental trauma and the concept of emotional distress. And as unsavory as it might be I wasn’t honestly convinced that people who had been to hell and managed to crawl their way back to society could actually suffer to the degree that the book had described. Sure, it would stand to reason that they would be depressed. They’d likely suffer a phase of time that included a few nightmares, decreased appetite and a lack of personal hygiene.
However I had always heard that the human spirit was resilient and they’d eventually get to a place where it didn’t bother them as much. A place they’d eventually recover from the suffering. And then they’d rejoice when they finally were back to their former selves again. They would live to fight another day!

Naive, young and unaware that one day I’d be struggling to manage the facade of normality. That’s because I might look like any other human being on the outside. But on the inside I’m nothing like most of the people I have the privilege to interact with. Inside I’m still bleeding. And I’ll always bear the scars. I’ll never get to a point in my life when I can brag that I single handedly defeated opioid dependency, Midtown’s NTP methadone maintenance and all the horrible things that came along with it. That’s because I’ll never be the person I was before. Never again. She died. I’m all that’s left. I’m not tougher or better than before. I’m just someone else. I can’t unload my problems in therapy or any place else. In that regard, it is finished. Now I’ll consider it a good day just to be around. I’m truly grateful of course for the opportunity to be here. I don’t regret surviving all the things I’ve managed to survive. But I’m not going to be able to rescue my old self. I understand that much now. It’s taken me some time but I’ve learned to accept her departure.
I still dream about her from time to time. It’s wonderful to visit. But when I wake up in the morning and see a reflection of myself, sometimes I really don’t know who is staring back at me.
That’s emotional distress in it’s truest form. And it might seem unlikely that it can be the result of substandard care. Trust me, it’s not as unlikely as you might presume.
I’ll go ahead and do my part to see that someone new Never has to know.

The baby’s father pulled up front and I hopped in the backseat next to my sleeping beauty. I kissed her as gently as I could on the forehead.
“I’m back baby, we’re going to be alright now.”

These are the FIRST infections I ever developed. (All apologizes)

This unfortunately is just another consequence of becoming dependent on opioids and injecting myself in order to stop withdraw symptoms. Too embarrassed to seek medical attention, I used hydrogen peroxide and Neosporin. Sadly, this is very very common. Clean needles would have prevented this from occuring. 😎

“LIFE, LIBERTY AND THE PURSUIT OF METHADONE “

My first order of business was to show the hospital why their programs involving mental health patients worked out in theory but not in the real world! I sent an apology to the administration because this section in particular was long. I knew most folks didn’t wanna bother reading anything let alone my personal struggles! Probably would have done better had I included illustrations. I’m sure they fell asleep at some point. Here’s exactly word for word what I sent them.

PART V

PART FIVE I

“LIFE, LIBERTY AND THE PURSUIT OF METHADONE..”

If I had to describe what life was like during the last ten years or so of my treatment at Midtown’s NTP clinic I’d have to use the word- STAGNANT. That’s because in respect to making any meaningful progress-there wasn’t any. Actually I don’t think the word “life” is an appropriate term. Existence serves my purposes.

After the case with child protective services was finally over my father preferred that I leave his home. I understood why though. He no longer wanted to support me while I was still at the methadone clinic. It was a terrible choice between not suffering and my father’s home. In the end I decided that heading to a local shelter was my best bet. It might be able to connect me with resources that would improve my circumstances. Of course I still didn’t comprehend that my location wasn’t the problem.

Upon first arriving to the shelter me and Daniel didn’t have much in terms of material possessions or money. Which of course was a problem. I decided to request a treatment team meeting concerning the situation.
Obviously Midtown would realize that I had invested a great deal of my time and money. They would have to show consideration or have pity. At a minimum I suppose I thought I could cash in my “methadone miles”. Besides they were beginning to accumulate.

I was stunned when they informed me that no one can get dosed until they had a money order for the full amount. Not even under my conditions was the clinic allowed to make exceptions. I was speechless.
My hardships were not relavant.
(???) Huh)?

Too doped up to work for years at a stretch. And now completely flat broke after paying for their treatment and becoming opioid dependant as a result of their methadone.
I couldn’t receive one emergency pass?  Not even while living in a shelter for domestic violence?

This baffled me and still does to this very day. How could I function without methadone? They themselves were constantly asserting that methadone maintenance was considered a legitimate evidence based form of treatment! Supposedly the treatment was just as necassary as any other treatment was. Wasn’t it the DSMV-5 which stated substance use disorder SUD* including opioid dependancy is considered a disease? The bible of psychiatric conditions?

What about all the things I had already sacrificed just to come up with my clinic fees? I don’t like to admit it but the constant pressure to come up with my methadone money compelled me to behave in ways that I’d normally never dream of doing.

Once I even used the cash sent to my son inside his birthday card! His grandmother had wanted my son to have that money and I had no options left so I reasoned that had it been a utility bill, something that would affect his stability. I’d be justified in using it. I rationalized that I couldn’t properly parent him if I was sick from methadone withdraw. Yes, He was better off if I took it.(???)

Like I said earlier my free will was Missing In Action.
Instead the methadone was now in the driver’s seat. I could feel myself beginning to disappear. I was willing to compromise my own principles. Nothing was off limits if methadone required it. Methadone was my body’s priority now. It was a clear matter of survival. How could I exist to do anything at all if not for the methadone?

I wanted to believe it wasn’t hurting me. Wanted to believe that it was helping improve my condition. If someone did question whether they truly needed medicated assisted treatment. The clinic’s answer to the voice of opposition was to remind clients right back that treatment was for our own good. That treatment couldn’t possibly ever hinder a person.Why would we be better off alone? Since without the crutch of methadone we’d surely be in far worse condition.(?)
Evidently so**

I allowed myself to believe that without methadone maintenance I didn’t have anything else to look forward to. Without methadone-Laura Ruhl would cease to even exist.

And even while my life was continually plagued by misfortune and tragedies one right after the next. I still didn’t want to believe that my suffering was related to the methadone clinic. I could not face the consequences on my own. I wasn’t ready to confront the truth. Not just yet.

I happily floated down the river of denial. At least for the time being.
I couldn’t face reality yet. I forced myself to believe that it had served some kind of medical purpose where I was concerned. My body, my mind and my soul were effectively enslaved.

I tried to stay focused on the positives while living among the other shelter residents.

My son and I had been able to receive trauma therapy with a child therapist while living in the shelter for over a year. It’s difficult to explain the assault that continued on our minds after that CPS investigation. Each day we lived moment to moment. Most family’s are not constantly living under the threat of a CPS invasion. We would remind each other that no matter who tore us apart, when Daniel turned eighteen. Nobody could tell us we couldn’t be together!!
Does that sound like something most mother’s have to remind their children before they tuck them in at night? The damage was evident. I spent the remainder of my son’s childhood trying to reverse the damage that was caused by discrimination. CPS had become the boogy man. Great way to protect children. Way to go CPS! ******😳For the record my son would have rather watched as our home burn down to the ground completely rather than dial 911 ever again. And I would have been inclined to agree with him on that one. In fact I probably would have set up folding chairs and pop some popcorn. Hell with community support. We could always get another home.

We also had been fortunate enough to secure housing through a program for homeless people who were also enrolled in mental health treatment.
That included Midtown’s NTP clinic.

That’s possibly the only positive outcome of becoming addicted at the clinic. We were allowed to rent any residence in Marion county Indiana due to the fact we were living in a homeless shelter. That’s if you’d consider loosing your place to live to be a “positive”.

I could have chosen a nice cozy house to rent or even an apartment far away from the city.
In the end I had decided to move into an apartment building just nine blocks away from our homeless shelter. An apartment that was conveniently located within four blocks of the methadone clinic.
  Eliminating the need to own a vehicle. Transportation was a constant struggle. Lucky yet again!
Of course that’s only if you’re going to have to resort to leaving on foot each day around five in the morning and walk through the heart of downtown Indianapolis by yourself in order to dose at the methadone clinic. Lucky me!
I bet everyone I knew was green with envy. (No, no actually not)

Like I said and it’s the truth. Methadone clients will climb a mountain for their methadone. Too bad they loose the motivation to do much else.

I would never have to risk not dosing again. It was reassuring to know that by positioning myself within blocks of Midtown I had one less complication that might arise to interfere with treatment.
I wasn’t basing my choice of residency on the quality of my son’s school district or the luxury of a fenced in backyard-  as the former Laura would have done. Instead I  remained loyal to the clinic. Besides what else more could I want out of life?
Without Methadone maintenance* every thing else would fail to exist. I would fail to exist.
It stood to reason that I’d make dosing a priority.

I couldn’t even select a place to live without taking into account the role that Midtown NTP would play.

It wasn’t my life anymore. Whoever I used to be was irrelevant. Spiritually I was at a standstill. Midtown’s front doors was where my horizons ended.

Logically the reason my circumstances were declining was because I had developed the profile of an addict. The clinic wasn’t treating an addiction to opioids that I possessed. They were creating it.
I didn’t qualify under the admitting federal guidelines for treatment. I didn’t require daily trips to the clinic for the purposes of preventing withdraw.
And without a diagnosis or thorough exam, people can be harmed when prescribing a powerful narcotic without a  legitimate need. I’m not sure what compelled legislatures to accept an assessment rather than a medical exam. But clearly they defeated their own purpose by doing so. Didn’t they realize that it’s the duty of the professional to determine my level of care?

Settling for an assessment when you go to the eye doctor might be acceptable. But methadone is a schedule class two narcotic. That’s not something a person should be able to access for years at a stretch based on their own assessment.

Like I’ve said before.
I didn’t attend medical school so I suppose as usual my opinion will not be embraced by the medical community.
If I’m incorrect than how was it that I became far worse off after being admitted?

It was nearly a full year before we were eligible for the grant that was formerly known as the “Shelter Plus Grant”. At last we were able to leave the shelter. The grant itself was a miracle for a loser like myself. A methadone client. Life at the shelter was difficult. Obeying the rules and curfews day in and day out. Made me sentimental for my privacy. I also missed my personal liberties. The little things most people take for granted.
For example I have an odd and rather disgusting aversion to the sound a flushing toilet makes. This fact alone doesn’t make me the ideal candidate for public living. And for the record it’s not EVERY flush I avoid. So technically it’s just moderately disgusting..😁
Living under constant intrusion of not just the other residents but also the shelter’s staff members was beginning to take it’s toll on me personally. 

Please note that approximately seven or eight years after treatment first began- I could basically stay awake about sixty percent of any given time. Although still lethargic I was managing the symptoms of being overmedicated somewhat better. Methadone maintenance diminished my capacity to accomplish anything that requires a person to stay awake and alert for more than a couple of hours at a time. It’s the ideal way to subdue a person. 

Obviously my tolerance for opioids was increasing. Only took eight YEARS to remain conscious a large part of the day! Quite an accomplishment indeed (not).

It’s not as if I was actually missing out on anything special though while sleeping away the majority of my day. 

Methadone patients will feel energized once their morning dose hits their brains. But it’s a brief surge. Compare it to slamming down an energy shot. They’re physiologically dependant and once that dose begins to wane down the opioid receptors won’t be recharged until you fill them the following morning. Provided you can afford to pay your weekly fee of course.*

 Typically it’s about forty minutes before the “glow” takes effect. It lasts about two to three hours. And It was the only time I would describe myself as slightly motivated. I’d cook my son breakfast and tidy up the apartment. I’d even make plans for later on in the day. 
But by noon I was ready to retire to the living room couch. I suppose it was the making of breakfast that was responsible for my fatigue..? How can I not equate the lack of energy to the daily dose of a powerful opiate narcotic?

It was a similar story for most of the methadone clients there. A morning rush of dopamine determined my activities each day. When I make the statement that life revolved around methadone I’m not exaggerating. 

It honestly begins to feel as if you are the parasite and methadone maintenance is the host. And why wouldn’t it feel like your existence was dependant on methadone? I wasn’t in charge of my body any longer. Methadone was the dictator. Methadone told me when it was time to sleep. Methadone told me when it was time to wake up each morning. Methadone told me when it was time to eat. Methadone refused to be ignored. I was just reacting to whatever it insisted I do. I was only able to follow orders.

How likely is it that most of society would be able to accommodate or remain in treatment and still be productive? I wonder how many others could manage considering the constraints imposed by the methadone clinic? I’m not aware of any professional overachievers who attend methadone maintenance clinic. Doesn’t mean they don’t exist though. I once saw a nurses aide in line while waiting. She was employed and that’s an overachiever in my book.

 Here’s a test!!

Take out a daily planner and reserve every morning for the next ten years or so to the pursuit of methadone maintenance.
 Realize nothing else can interfere or take priority. Not your job or your hobbies, nothing.
 How certain are you about vehicle repairs, construction work or car accidents are concerned? On one occasion soon after being admitted I was stuck downtown practically within walking distance of the clinic. A road block had prevented me from making my way there. Stuck behind a long row of cars as parade was marching up the street. Another time I had forgotten about some type of charity marathon and once again I sat waiting as about a million people slowly jogged through the main artery of downtown Indianapolis, Meridian Street. Don’t forget to ask about city endorsed activities because your schedule now depends on them.
 So I Hope your crystal ball isn’t in the shop because you’re going to need one. Does that sound reasonable to you? And no there’s no sick days allowed. 
How free are you to pursue your life when you’re never allowed to sleep past ten am? Never again. In the last ten years or so did you ever have an occasion to sleep in? Better set an alarm or two. You wouldn’t want to loose money since you’ve paid ahead. Not to mention succumb to the horror of opioid withdrawal. 

How about a vacation? Go ahead and plan one but wherever you decide to go-can’t be away longer than twenty-four hours. What about an illness? Or attending the funeral or wedding of a loved one? They’ll understand your absence right? Best if you ignore the RSVP deal.

The level of commitment to the clinic is all consuming. And it’s absurd. I’ve personally got a problem with any facility or agency that expects very young adults to understand it will require years of their lives.
For the record my occasional abuse of Vicodin never prevented me from attending any family functions. That’s because back then I didn’t have to sacrifice one for the other. Hmmm.

Ironically there are people that would consider this kind of lifestyle to be an improvement. People who are deeply afflicted by opioid addiction are dysfunctional. The constant demand brought on by physical dependency doesn’t allow them to do anything else except pursue narcotics. Unfortunately/fortunately- I was not one of those people way back in 1999.
They are the ones who benefit from treatment. Patients I described are relieved to know that all they have to do in order to prevent withdraw symptoms is waiting for them at a single location. Then they’re free to go twenty four full hours without becoming sick. 
It’s not a sacrifice. They usually don’t have anything left to sacrifice by the time they’re in need of methadone maintenance. This is another red flag. It would have been a step up for me if I had ALREADY been homeless when admitted. The methadone clinic is successful due to the fact that the addict being maintained has been unable to stop using opiates due to withdraw. It was intended to serve those poor souls whose bodies can’t be ignored. Not offered to people with substance use as characterized by the desire to pursue more and more opiates. There’s one distinction between substance using/abusing and dependency that marks the beginning of opioid dependency. When it happened it didn’t occur to me that I was officially dependant on opioids until many years later. Once upon a time I was especially careful while driving working etc when using Vicodin. A little voice inside me would nudge me,
“You know Laura you shouldn’t take two Vicodin right before you have to drive to work. Wouldn’t want to become impaired and accidentally hurt someone on the road!”
But that’s back when I had a choice. Back before methadone maintenance started making all my choices for me. Once I realized the level of difficulty required to detox off such a strong opioid and felt my body’s reaction when I didn’t get it. Then everything changed. That same scenario from before had been altered.
“I can’t possibly go to work without my methadone today.”
“I can’t drive an hour straight without my dose today”
“I’ll never make it through Christmas dinner at grandma’s without my methadone”

 Heroin addicts are not usually recreationally using. If they are then methadone will exasperate the problem. They were not be able to function without a powerful opiate. Did it really make a difference if I developed an opioid dependency while on a licit or illicit drug?

One stipulation for receiving the Shelter Plus grant was that I must be enrolled in mental health services. As long as I was a client at the methadone clinic I would continue to be awarded the grant, which made living in the apartment possible. However I had to be unemployed to receive enough grant money each month to pay my rent and utilities. The fact I was enrolled in the community outpatient clinic where I was responsible for the out of pocket fees made this problematic. I’m assuming that the majority of grant recipients received their mental health treatment without paying for it because Medicaid or Eskenazi Advantage covered it. But not the Midtown narcotics treatment program. Medicaid reimbursement for medicated assisted treatment in Indiana didn’t happen until sometime after 2018-2020.
If I decided not to participate (lol) in methadone maintenance any longer, then I wouldn’t qualify for the Shelter Plus. I’d have no where to raise my child. And if I were to get a part job at a fast food restaurant in order to pay for the out of pocket expenses for mental health treatment,  I’d no longer be eligible for the full amount of Shelter Plus monies.
See the problem guys?(& Gals) I had thought that with this funding I would be able to get my life in order. Possibly begin to set goals for myself.  In actuality the only purpose Shelter Plus served was to ensure I could continue meeting my financial obligation to the methadone clinic. As long as I was a Midtown NTP client I had a home for my child. And of course as long as I found a way to keep paying, I’d not suffer. This wouldn’t meet my definition of adequate health care but I guess I’m stupid. I was constantly chasing my own tail.

This was defeating the purpose of relocating from the shelter. My location was not the problem. As usual methadone was running interference. Of course I wasn’t going to turn down the opportunity to move out of a homeless shelter and into an apartment. So I accepted the terms and relocated. Besides I was chained to the outpatient clinic regardless. Even without funding. At least this way I could have a home and not be sick from Methadone withdrawal. Since avoiding the withdrawal was the agenda. Forevermore.
Anything else I just happened to accomplish was gravy.

Over a period of time I started to become seriously depressed. A lack of ambition combined with feelings of worthlessness was eating away at me. With no prospects and no hope for a meaningful future there was nothing to look forward to. Each day was a rerun from the day before. Over and over and over again.

Each day I’d wake up around five in the morning. I live in Indiana so that means I’d have to bundle up in three layers of clothing. Then I began the walk from my apartment to the clinic. After medicating I’d return straight home to see my son off to school. After he boarded the school bus I’d find myself completely alone and without anything to do. I was resigned to sleep away the lonely hours until my only companion returned home from school. I couldn’t afford to buy a vehicle. And since I couldn’t work that meant I didn’t really need to worry about getting one. Besides the methadone clinic didn’t require me to have one any more. I couldn’t even afford the price of cable television. (Practically a necessity for anyone who plans to do nothing twenty two hours a day)**

In fact I was so destitute that even my son’s school supplies were too expensive. Every dime I had was invested into the clinic. I remember sobbing hysterically as I begged my Dad to please help me buy my son a belt! Part of his school uniform requirement. But I was always able to secure enough money for my clinic fees. Even if it meant I had to steal lie and cheat. Week after endless week.

One of the ways I paid my clinic fees was by using my Taniff money. I hadn’t been receiving my court ordered child support payments for years. Since I was unemployed indefinitely- or so it would appear,
 I was eligible for TANIFF. 

Now despite the fictional myth concerning a welfare mom who has baby after baby in order to precure a lucrative check and live happily off the government. It doesn’t exactly work out that way.

For a brief time period my son and I both received Taniff. If I’m not mistaken it was $70 a piece. That’s $140 I would have to verify that figure for anyone who requires proof but I am sure that’s in the ballpark. I didn’t receive it very long.

Then after a year my benefits decreased. I was no longer able to collect Taniff money for myself. That meant it was technically only my son who was the recipient of Taniff. This also meant my son’s income was now helping to support the clinic. Methadone took everything and everyone in its path hostage. It had no boundaries.

I spent my son’s Taniff benefits on my addiction to methadone. I doubt that’s what it meant in the literature when it talks about achieving financial stability as a result of methadone maintenance. Unless Midtown wanted federal and state funding to be the true breadwinners. If so then yes. I was financially not going anywhere as long as I was participating in the Midtown methadone clinic! 👏 Stability yet at last(??).

 Let’s remember, 
I HAD TOO. And besides it’s a treatment that was helping me. (??) I’d tell myself that I didn’t want to live in a shelter again. And I knew it wouldn’t matter where I lived once methadone withdrawal set in. You can suffer anywhere on the planet. That’s all I’d be doing anyway.

Another shining example of hard earned tax money well spent. Linked to Midtown’s methadone clinic. Ironically I was officially the one enrolled in a mental health facility.

Even using all the Taniff money was not enough since from time to time I was forced into other financial commitments that had nothing to do with the clinic. Plus over the passing of years the cost of those weekly fees gradually increased. I had only one other resource. My food stamps. They too were used to support the clinic. I sold as many as I could afford to sell without starving to death. Especially if I couldn’t figure out how to urge family and friends into making a contribution. Every Sunday evening I would dial up a loved one’s phone number and somehow manage to persuade them to donate any amount to the cause. Midtown would have appreciated that effort. Even if I was lucky enough to raise half it still couldn’t possibly cover it.

Another sign of stability(??) No, I don’t think so. Logically we couldn’t even enjoy food if we were homeless and had no place to store it. Besides you can’t eat while in methadone withdrawal anyways. Food will be the very least of your worries.

 The clinic was of course aware of my government benefits. They also understood the grant stipulations. I’m not sure how in the hell they thought I was able to pay my fee each Monday morning (?) Must have been one of those hear no evil, see no evil scenerios (??)

Of course my 60 year old mother was not able to refuse me help for the methadone clinic fees. Knowing she was employed full time as a customer service representative earning minimum wage didn’t stop me from pleading with her on Sunday nights. What mother wants her child to suffer?
 When I say that I have absolutely no shame. It’s the God honest truth. Methadone got that too. 

I was like a hamster running continuously on her wheel. I wasn’t going anywhere. Admittedly I was surviving in the sense I wasn’t dead yet. Although I’m not sure why I wanted to survive any longer. I was just treading water. Imagine what life’s is like when measured in twenty-four hour incriments? And repeatedly begging every six days? Now try it for nearly seventeen years in a row.

No one can tread this long without getting tired. Not even a methadone client. And I was getting tired.

“WHAT DO YOU WANT ME TO DO ABOUT IT?”

Methadone lines are the worst in terms of roughness. Most of us are not at our personal best at five thirty in morning. Especially if under pressure to medicate and get to our jobs on time. It created a rather hostile environment. Trust me when I tell you, I’ve seen it ALL! And over sixteen years I’m sure I’ve seen it all,

twice**

The next time you’re held up in a grocery store line. Or when you’re frustrated by a long line at the ATM. Please do me a personal favor and be grateful for your own sake that you’re not waiting in line to be dosed with an opioid narcotic four times as strong as heroin at a methadone clinic. Ok?

I think it was on day two after being admitted that while waiting outside in line at the clinic I saw the Midtown security guard breaking up a fight. It wasn’t really a fight because after a man attempted to cut in front of an elderly woman in line she began hitting him over the head with her wooden cane! Repeatedly. Ouch.
Truth be known she definitely showed him who was boss.

Another incident involving two Midtown clients who were witnessed during some type of “exchange”. A weapon was branished after the program director asked them to step aside. You could’ve cut the tension with a..
..
well a gun.
This was all before sunrise.

Needless to say you didn’t want to be caught in the cross fire during a methadone clinic dispute. This meant that it was essential you remain on your toes. It was best to be on alert for the possibility of a confrontation that might wind up causing collateral damage.

Occasionally clients themselves would have to intervene when the tension got too thick. Especially if not under the watchful eye of the security guard or clinic staff. That’s when someone would yell out-

“Hey what do you want me to do about it?”

Then we’d all chuckle and things would usually simmer down.

Everyone knew immediately what the line was referencing. The clinic’s doctor, a specialist. A psychiatrist who also treated patients for addiction was famous for saying this.

If a client had occasion to see the clinic’s doctor for their annual checkup or some other concern. Odds were fairly good that after they had detailed their problems to him he’d respond by asking the client what it was they wanted him to do about it. Not the typical response from a physician. But hey it was the methadone clinic.

He’d said this line to many of the clients over the years. Naturally clients talk to each other about their experiences and I too had been asked by the doctor what it was that I expected him to do about my health issue during one of my appointments.

I wish I had a time machine. I wish I could transport back to the exact moment in time when the clinic’s doctor asked me what I wanted him to do about my health concerns. If I did here’s exactly what I’d say,

“Well for starters Doctor, I’d like you to do your job. I’d like you to treat me based on what you learned in medical school. I don’t give a damn about guidelines or admittance criteria when it comes to my individual needs. I don’t want you basing my health care on a value based system or fee for service. I’m not a stepping stool. I’m not a statistic either. 
 I’d like you to consider all possible outcomes when prescribing treatment for me as a patient. In my own case as a person- the single mother of a beautiful son. As a waitress who enjoys serving the public. As a daughter and an identical twin sister. Even as the aspiring moral philosopher enrolled in community college. I don’t want to sacrifice my livilhood just to try your treatment.
I want my health issues properly addressed.
Please don’t hurt me. If hurting me is unavoidable then please God don’t harm my children too.”

I can’t go back though. Maybe someone else will say it for me and move forward. I hope they will say this on admittance day. Maybe they won’t become opioid dependant afterwards.

To be frank I was shocked when I realized the man was on a psychiatry board. It simply did not compute. That would have been my very last guess. I suppose I’m referring to bedside manner. His was not so inviting. And this was the medical expert who specializes in opioid addiction or SUD. You’d think that he would have an active interest in the clients and their lives. It didn’t appear that way from our perspective. 

Some patients interpreted his aloofness to his dedication to the profession. Although mostly he was perceived as rather snobbish. Either way I tried not to be overly critical. After all he was accustomed to relying on question answer based assessments submitted by the patients to determine treatment. Perhaps he was still in the mindset of admitting day(?) Eskenazi is considered to be a teaching hospital. He might have been fulfilling a requirement for credentials or other programs he needed. I don’t expect doctors to always be enthusiastic about showing up.

The fact that the clinic’s doctor was seemingly uninterested and clueless wasn’t lost on Midtown’s NTP clients. One morning as I sat in a chair waiting for a scheduled appointment with my clinician,
I overheard a conversation between two clients. They were waiting for a what is referred to as a “Treatment team meeting”. 

I didn’t catch the whole story or any specific information but evidently they were not able to dose. In theory there’s plausible reasons why a client wouldn’t be able to medicate other than lack of money to pay the weekly fees. 
Realistically though I think I can only recall a handful of people who had not been in compliance due to their substance use. The clinic was not very strict when it came to the repeat offenders. In the clinic’s defense I’ll admit during my last remaining years while in treatment they had made an effort to enforce the rules and banish(if necassary) anyone who continued to flunk the drug tests. 
But denying services was always a last resort in those cases. They’d enforce a split dosing before they’d sincerely kick a person out. Treatment team meetings involved a gathering with the patient and the entire staff. Like a public humiliation deal. So if you didn’t necessarily want the entire staff knowing you had been using drugs, too bad. They got front row seats.
However the primary reason a person wasn’t allowed to be medicated was due to not paying the clinic fees. 

Obviously whatever the reason they were attending a treatment team meeting with the entire Midtown staff it meant they were not being medicated until it could be discussed by the “Team”.

Both clients were unhappy about the current situation. They talked at length about the agony of methadone withdrawal. They also commented on how they regret the day they first came to treatment for methadone.

I had heard this same regret expressed by other clients over time. Clients who had been merely engaged in substance use would remark how terribly wrong it was of the clinic to allow them to began treatment with methadone. Knowing that once a person has started taking it, they’re unlikely to ever leave. And even under the best of conditions anyone who did manage to exit would suffer. Imagine trying to get through ten or eleven days before another doctor transfer you to Suboxone? Personally I’d rather have my toes broken with a sledgehammer than ever experience methadone withdrawal again. And if a methadone client was fortunate enough to be independently wealthy and locate a Suboxone doctor who wasn’t full already. That meant they still had to endure a living hell if they wanted off methadone. And it’s not as if you’re home free even on Suboxone. You’re still dependant on an opioid that is stronger than most pain killers. How can someone who wasn’t physically dependant prior to being admitted consider this a victory? You might be able to take the methadone out of your body but you’re not able to outrun the opioid dependency it created quite as easily.

One of the clients said he would like to take the staff and doctor out to the forest and tie them to a tree and continuously dose them with methadone for sixty days straight. Then simply cut them off after those sixty days. That way the clinic would be able to understand what it felt like when you’re suffering from methadone withdrawal. Their health books description of opioid withdrawal includes , “flu like symptoms”

Pardon me.???

It’s unlike any flu I’ve ever had!! Is this just the interpretation written by someone whose has never experienced methadone withdrawal, personally? Maybe they weren’t referring specifically to methadone withdrawal? Or maybe they meant if you’re withdrawing off methadone after a month on a very low dose?
A low dose might be seemingly less hellish. Even heroin is easier. Whatever the reason- The flu-
it is not! If methadone withdrawal resembled the flu then why would someone continue dosing for years and years? Who drives(or walks) into the heart of downtown Indianapolis and waits in line while it’s snowing or raining for hours. Just to medicate and leave? Then return twenty four hours later? Only to do it again and again and again? Lather rinse repeat! Lather rinse repeat! In order to avoid “flu-like ” symptoms?

Wouldn’t it be an extreme way of coping with something that’s as manageable as dealing with the flu? Who would continue to live this way for years at a stretch if they didn’t have to??

Well besides myself that is.
I didn’t know it yet but there was finally about to be a change in my situation. No longer content to just get by. The winds of change were getting ready to finally head straight in my direction. 

Looking back at my years in treatment I can’t believe that I actually was content to submit to the conditions that being a methadone client demanded of me. 

I probably wouldn’t understand this same scenario had another person shared it with me. I’d likely assume that there must have been a solution to the methadone maintenance problem. Even though I’d like to imagine myself as being compassionate and understanding regarding such a sensitive matter. I don’t want to be judgmental about experiences I’ve not endured personally.
 But I can’t be positive I’d be convinced that people can become addicted to that extreme. How could a person who wasn’t opioid dependant to begin with- continue to dose with methadone until they’re practically non existent?
For almost twenty years without finding a solution? 

I made my son a promise that I’d do everything in my power to prevent this same treatment from harming another person’s child. If no one’s going to take the initiative than that obligation will remain mine alone. I promised him that I’d fix it. And if times do become drastic I’ll have to apply the appropriate measures.

What’s terrifying is that it can and it does happen. In fact every Wednesday is the clinic’s intake day. Or it used to be anyway. That means even as I type these words someone new is at the beginning of their sentence over at the Midtown NTP clinic.

In my own case it was the urging or refferal made by the primary physician who was treating me over at that hospital. But there’s an equal amount of referrals made via outside agencies and the crisis unit. Truth be known all a person is required to do is call the clinic up and schedule an appointment. The rest is history! (Quite literally).

For longest while I wanted to believe that my primary Doctor from the hospital didn’t fully realize that methadone maintenance is more or less a life sentence. However later on I wasn’t so sure. I do remember that before sending me to the methadone clinic my doctor told me he was going to taper me off Vicodin for about three days.

Now this is something that I also cannot believe was offered as a remedy for patients who are actively engaged in drug seeking behaviors. From a medical standpoint it might appear to be a genuine course of care for opioid abuse or possibly a mild dependency. My doctor seemed motivated to try this out. In retrospect I can see what the problem was. 

If a patient’s doctor has just refused to provide Vicodin upon request for a person who’s activity engaged in a substance use disorder- then why would they agree to provide Vicodin for a three day period?? And which reasonable person wouldn’t accept the offer knowing that it might be the only prescription they’re going to receive?
 Would it make a difference to them how it’s prescribed? All they hear is that A doctor’s agreed to provide an opioid narcotic for any purpose. They’ll agree to the taper and pick up their first  prescription and leave. Once they’re at home they’ll take however much they like. A taper requires patients to take their narcotic medication as prescribed.  Then they’ll return to the pharmacy in order to receive more pills that they’ll go home and take their pills how they please. That’s one of the symptoms of the behavioral mental health disorder they have. They’re not using self control. That’s sorta the fundamental problem.

I don’t know any one who’s successfully managed by a three day taper. And now knowing the difference between abusing opioids and dependency first hand. I can tell you that three days is absurd. If Besides had I actually been dependant back then there’s no way a three day taper could help me. 

Midtown also began dealing with substance abuse in the same manner. By offering the very patients who were exhibiting drug seeking behavior,,,,
more drugs(?)

The only substance I had ever tested positive for was valium. Periodically I’d been able to locate a pill or two. By this point in my treatment my entire world had collapsed. I had lost virtually everything I ever owned. I had devasted my family’s lives by agreeing to this treatment. Including my young son. We were both thoroughly traumatized. And my life was completely void of any meaning.
 Truthfully I probably did have a need to use Valium occasionally. When confronted I was offered yet another taper(??) And I accepted. Of course I wasn’t hooked on those either but at that point it didn’t really matter to me. As long as it wasn’t an opiate based narcotic that would cause me crippling withdrawals. I knew I could manage. And after a few days it was finished.
 I wondered why they’d even offer(?) Bear in mind that when first admitted into the clinic that benzodiazopins weren’t known to be as dangerous as they are today. Using them in combination with methadone can and does kill people. Even a small dose might affect a person’s body differently from time to time. It’s unpredictable and it’s not safe.

Although I personally don’t think that benzodiazopins can provide long term relief from anxiety and depression. Just like anything else, you’ll build a tolerance to the same amount of medicine prescribed. Although I could see me agreeing with a doctor who uses it occasionally and for short periods of time. That would make sense.

Of course you’ll not suffer in agony without it like you do without methadone. Although there’s definitely withdrawal from them. It requires medical care to detox off them. But it doesn’t hurt like methadone. 

Nothing else in the universe hurts like methadone withdrawal can. Nothing. If the general practitioner from the hospital didn’t recognize the risks involved with methadone maintenance surely the outpatient specialist knew. 

You’d like to think my doctor had my best interests at heart. But honestly I can’t be sure of that fact.

One morning as I began to make my usual four block walk over to the clinic I began to reflect back on everything I had lost over the years. By this point I had been a “client” at Midtown community narcotics treatment program for nearly seventeen years. I had stood in their long lines, had attended hours of mandatory groups. Most significantly, I had managed to scrap up a little over in $125000 in cash to pay them. cash that was now gone right along with the time I could never get back.

Seventeen years is a long time to be doing anything. Especially when you’re talking about paying for a narcotic that’s four times the strength of heroin. I imagine that it was my son’s enlistment into the army and finally leaving home that forced me to do something I had never been brave enough to do before. I wanted to confront my problems. No matter how difficult it was. The time had come to stand up for myself. Since no matter what the consequences might be it couldn’t hurt my children anymore. The only person left to harm was me. And what did that mean any how? Harming me? 
I barely existed as it was. I was already suffering so much that it felt like I couldn’t possibly suffer any more. Besides what would happen if I refused to dose with methadone again? Could it take my home away from me? Could it degrade me publicly?  Could it cost me my college education? Could it damage my health? Would it force me and my child to live in poverty? Would it take my child (ren) right out of my arms? 
I realized that it had already done so much damage. I no longer cared. I almost double-dog dared methadone to take it’s best shot.

Before my son left our home to begin his basic training he had given my life purpose. When he became an adolescent he began to pull away from me. Most teenagers do. However it had been emotionally very difficult to accept. He was my best friend. He was my whole world. I didn’t know how to breathe without him. And it was time for him to finally leave. Truthfully I wanted him to get away from the life I had been willing to accept. I never wanted him to settle the way I had. He was important. But at the same time I was selfish.  I didn’t want to keep on battling alone. I thought it would make things easier if I had someone with me. I was wrong about that. 

I know that life’s not fair. It’s not as if I can’t accept the hardships that every human being will have to deal with sooner or later. It’s knowing I had been loyal to a fault to Midtown’s methadone clinic and they never once could return the favor suddenly made me so angry. If not for being dependant on methadone I know my life might not have been any better but at least it would have been mine.
And for every decision I didn’t get to make entirely on my own suddenly hurt like never before. The realization that I didn’t get my shot at the last twenty years. Free will is a beautiful thing. And mine finally got loose.
Methadone had forever altered the trajectory I had once been on.

When I opened the clinic door I could see that very few people were there that morning. I hadn’t arrived at my usual time that day. It was around seven in the morning and as luck would have it the place looked virtually empty. 
I approached the front desk and was given the clearance to dose. I didn’t have any appointments or other business to complete. I got in a line behind only two other people. And as I waited for my turn up at the dosing window I heard the nurse say that I would have to provide a urine screen that day before I could dose. It was one of those randomized tests we were all accustomed to. 
Except this time the voice screaming inside of my head said
“Fuck you”

I went to the back of the building where a counselor was waiting to dose clients who had a random. I took my tiny cup and shut the bathroom door behind me. Then the voice inside my head told me if I wasn’t forced to leave this hell hole, I’d never be able to walk away on my own.
I couldn’t take it anymore. All the years and the pain. All the sacrifices and the fear. All the emptiness.

No way. No more.
If I couldn’t voluntarily leave than I have to get myself kicked out.

That’s why when I sat down to pee I scooped up the toilet water instead.

Midtown narcotics treatment program wasn’t going to get one more damn thing out of me. Never again. Not even my piss.
I handed my cup over to the waiting counselor and I signed my name and client number for the very last time.
Laura Ruhl #600

Methadone had even invaded my name. To this day I sometimes accidentally include the number 600.

But that’s just how determined I was to escape. What type of legitimate treatment forces someone to get themselves kicked out because the overpowering addiction wouldn’t otherwise allow it? I never had that experience while abusing Vicodin (??)

Does that resemble what the pamphlet said from admitting day when it suggested anyone could ween off this substance, gradually with very little symptoms? So many, many years earlier?
Truthfully the pamphlet provided to clients on their very first day at Midtown might as well say welcome to the Hotel California. You can check out anytime you like…but you can never leave.

**********”******************

Being well familiar with the clinic’s procedures and protocols. I predicted that it would take approximately three to four business days before the proverbially “shit” would hit the fan. And I’d be correct in that assumption. I knew that the clinic wouldn’t get the labs back until after the weekend was over. And I also knew that my clinician was definitely an overachiever. She’d not be likely to waste too much time before putting a hold on my dose. I still hasn’t decided what I was going to tell her. I thought about making a request for the infamous fourteen day medically supervised detox or MSD.  After all I had read every patient was entitled to one of those. Whether the exit was voluntary or involuntary. Which I’ll add isn’t true. It might be an official patient right but it certainly wouldn’t be accessible to me.
And of course I had to wonder how my counselor was going to address the fact my specimen was in fact- toilet water instead of urine. I wasn’t sure what that conversation was going to look like.
And the nice part about it was knowing that I didn’t really care anymore. I had stopped caring about  appearances in general while begging people for money in order to keep paying for methadone. I didn’t realize how well that skill would serve me later on as I panhandled for cash to treat myself. I suppose it’s another check in the “positive” Midtown NTP box.
I had always been considered a compliant client. Sure, I had my problems now and then. My financial struggles were usually to blame. I had taken some benzodiazopins while heartbroken. But other than those issues I was basically a model prisoner. Certainly never went out of my way to be a problem. I wasn’t a behavior problem. I usually never am one. I was desperate to depart and I had no other way.

I guess it boosted my confidence knowing that for once I had the control. There was something satisfying about knowing that as long as I didn’t rely on the medication I could get away.
I was empowered by my refusal to medicate. I hadn’t ever felt that way before when it came to the methadone. I had only known desperation.
In the past the fact I was paying someone to continually hurt me caused me to fall into denial. Denial about the fact that I wasn’t treated properly. I didn’t feel worthy enough on my own to receive medicine without money. Realizing that my body’s need to medicate wasn’t nearly a good enough reason for the clinic not to hurt me. But now at least I was the one with the power to hurt myself.
Midtown NTP could no longer hurt me.
Realistically what I couldn’t yet understand is that I had already been hurt by the methadone clinic, physiologically speaking. That reality would soon begin to dawn.

Later on my life would gradually begin to improve. Certainly the impact of Midtown’s treatment devasted my past and my poor body. There’s no question about that much.
In the short period of time since  managing to escape the clinic, my life improved. That’s very interesting how my life managed to evolve once again after I was no longer a client. Even when taking into account all the horrible things I had to endure after leaving. Overall I could see that Midtown did not deliver what they had promised. I wanted to ask someone what it was I gained from this treatment,  Besides the dependency of a powerful opioid narcotic?  I Q Surprisingly $125,000 would have been the very last item.
It would have seemed next to impossible for Midtown to continue hurting me even more than it had already by that point. As was usually the case where Midtown was concerned the pain and suffering still hadn’t finished with me.
I didn’t know that very soon I’d be marching onto the battlefield for one last personal standoff. Like battling Satan for a of your soul back. That’s a far more accurate portrait of what methadone withdraw is going to look like than what Midtown prints up.

Before my impending meeting with the Midtown clinician I had to begin taking a personal inventory in regards to what was left of my life to salvage. Of course exiting out would mean I was no longer eligible for the Shelter Plus grant money that was paying for my apartment. I did have the option of transferring to another mental health outpatient clinic in the area. But after nearly twenty years of being tied down to Midtown’s regimented schedule and demands I simply couldn’t entertain the whole client/clinic  scenerio. I felt like I needed, like I deserved a long vacation from that set-up for awhile. Definitely overdue. It didn’t really matter. I wasn’t going to need to worry about anything much longer though.
How was I supposed to know that regardless of my plans, aspirations or hopes for the near future, all I would soon be capable of was suffering? Surprisingly I was correct about the assumption that it simply wouldn’t matter where I was living when it was withdraw time. Only one item on the agenda.

Suffering

On the following Tuesday morning I knew that when I arrived at the methadone clinic I’d be on “Hold” for sure.

Tuesday meant that the labs had been processed and the results were already sent to the clinicians. I knew she’d be forced to speak directly to me concerning the toliet water I knowingly sent to the Midtown lab. In the past when I had occasion to be on hold and was forced into a confrontation about it I was very nervous. I’d usually try to formulate a logical reason ahead of time for why I wasn’t in compliance. Since benzodiazopins were usually the culprit in those cases I’d try reasoning with Midtown. I’d make an effort to explain what my life was like at that time. And then I’d try to make someone understand how awful my situation truly was. For the record even if you took into account every benzo I ingested from start to finish from my entire time at Midtown NTP, I probably didn’t have twenty pills. However they have the unfortunate side effect of taking up to thirty days to clear out of a person’s body. Not all benzodiazopins take thirty*
So, once I decided to take one I was likely to be discovered at some point. Midtown didn’t care about why a person took a medication. Compared to administrative requirements my problems were irrelevant. Odd because my problems sure didn’t feel all that irrelevant to me. But I was a junkie. And junkies are all lying about the reasons they might possibly need to take a medication. Any medicine.

Also my overall lack of confidence didn’t serve me well when confronted about anything I might be doing wrong. There was a period of time while at Midtown that my anxiety issues had become debilitating. Even the routine matter of standing in a line. The problem with my anxiety was probably tied to the fact I rarely left my apartment. Naturally the primary reason I ever did leave was associated with the clinic. I had become reclusive. The more people that were around the more it began taking a toll on me mentally and even physically.
At that time simply standing in line to be dosed had become physically unbearable. Very stressful.
After getting in the regular morning line to be dosed I found myself unable to stop shaking. I’ve heard about this very problem before where anxiety disorders are concerned. Usually I’d remind myself that other people couldn’t possibly see me trembling and that it’s purely happening only in my mind’s eye. However the problem was quite pronounced and I’d often overhear remarks made by other clients that confirmed things had gotten bad for me.

“Look how bad she’s shaking!”
“She’s sick. She’s in withdraw.”

In fact if I didn’t make an effort to firmly grab my dosing cup with both my hands I’d almost risk spilling it out onto the counter.  Obviously something was physiologically amiss.
*If only I’d had access to a psychiatrist who was present while I was dosing every day then perhaps I could have been helped. Unfortunately I never was dosed directly in the presence of Midtown’s specialist. Unless he happened to be hiding somewhere behind the nurse’s station that I couldn’t see. Incredibly no sooner than my feet hit the pavement outside, it completely stopped being a problem.
And by this time I understood all too well that involving Midtown in my problems was only going to serve as one more hold up as opposed to genuine help. I certainly didn’t want to spend more time in the clinic’s waiting room instead of being able to return straight home right after dosing. Plus the bottom line was that- I couldn’t think of anything that might honestly help me. Nothing Midtown could medically, legally allow anyways.

Another factor influencing my odd behavior was knowing that in the past I had actually seen clients who, were obviously under the influence and who were subsequently pulled right out of line by a staff member. When that happened the entire line would fall silent and watch as the accused was escorted to the back.

Despite doing nothing wrong it didn’t matter. I’d begin to tremble just thinking about that possibility. And even more terrifying was when I actually had done something to violate a rule. If I had taken a Valium a week or so earlier, I was scared that it might somehow be discovered on that very morning. Right at that anxiety filled moment. Even weeks later.

Not that I ever ingested enough of any substance on a regular basis that would warrant this measure of attention to begin with. But my mind and I suppose my conscience- would not allow me to escape punishment. And I’d begin to pray to God that the line would move as quickly as possible. Or sometimes pray for a diversion of some type. Divine intervention, anything that might deflect the attention I felt was surely headed in my own direction.(?)

However that particular Tuesday for the first time in years I entered Midtown and approached the front desk with ease. I already realized that I was going to be on hold for dosing and that what I had done would certainly warrant a  discussion between me and my clinician. I literally had nothing left to loose and more importantly nothing left to fear.
I simply didn’t care.
So what if things went seriously downhill at Midtown NTP clinic? It was no longer the center of my lonesome world. In fact it wasn’t even a bleep on the radar.

Another consequence of low self esteem was that I rarely lifted my head up to soak up the world that was alive and thriving all around me.
That day it felt alright to look. I didn’t attempt to dodge anything.
After all I knew positively I was guilty of something this time!

Just wasn’t exactly sure what it was though.🤔

Finally I heard the clinician call my name and I followed her back to her office.  She immediately closed the door behind us. Which was never a good sign.
I sat down in the chair across from her desk as she began to read the scientific evidence reported by my specimen. Which of course concluded that the sample was actually water.
“Majority, did you have anything you’d like to tell me? You didn’t provide toliet water on your last drop did you?”
Not having another answer readily available. I told her no.
She lowered her head and asked me if I was absolutely sure I hadn’t?

Now personally I hate it when folks give me the opportunity to lie under pressure. This allows me to entertain the notion that perhaps there’s another plausible excuse they’ll accept as opposed to the truth.
And I especially don’t appreciate being asked if I’m absolutely sure about the bullshit I just tried peddling.

I flashed back to my childhood when I was seven years old and my father asked me who broke my brand new pair of glasses that he had just paid for? Was it me or my twin sister? Was I sure it wasn’t me..??

Would it be believable if suddenly I remembered exactly opposite of whatever answer I had just provided?

“Majority your sister says that you are the one who actually took your glasses off your face and sat on them, intentionally? Is that true? Answer me right now majority!”

“No way Dad!”
“Are you sure about that?”
“No wasn’t me,
..
“Well, now wait a minute Dad- ok ok yes, I remember now. It was me. It wasn’t actually someone else. I just realized I’ve accused a perfectly innocent person for no good reason. I also denied breaking those glasses by myself.
My bad.
I forgot about that part. Just remembered though.””(??)

At that point I’ve lied twice and it wasn’t even a viable option to begin with.
Either accept my lie at face value or call my bluff. I’m a grown up.

Besides I didn’t really want to discuss the whole situation with anyone from Midtown NTP yet. For almost twenty years by then my entire life had been under Midtown’s microscope. Then usually criticized by a staff member. This time I felt that setting boundaries regarding something so highly personal was important to do! I wasn’t surrendering anything anymore.
With my mind still reeling, I heard myself say that,
I didn’t have any idea what she was talking about.

This excuse obviously wasn’t going to surfice. And actually, as far as these things go, I liked my latest clinician. She’d been assigned to me years earlier. I had never had any other counselor at Midtown for this length of time. And she was smart too.

She didn’t miss a beat. She then proceeds to explain that clearly something was medically wrong with my body if my urine didn’t have it’s proper chemical makeup. Then she said that I couldn’t be dosed again until I had a complete physical over at the hospital. The clinic obviously didn’t want to be held responsible in the event they gave me methadone when I had been suffering from some unknown condition.(obviously..?)

As she continued to imply threats concerning my defiance- my mind’s voice started screaming again. I couldn’t find the strength to not be candid. She may have still been talking when I suddenly blurted out loud,
“I WANT OUT.”

She paused only momentarily and then began talking again. Like she hadn’t really heard a word I just said.
Letting me know that what I was doing was not the answer. Midtown would probably be willing to work with me on whatever the drug issues were. Addressing this specifically in a “Treatment Team” meeting.
She assumed I had been trying to avoid detection concerning a “dirty drop”. Which almost made me laugh right out loud. That’s how little I cared.
Once again I cut her off and announced
“I WANT OUT.”

This time she must have absorbed my statement because she took a deep breath. Then she began telling me about the consequences of my decision.
I found this to be rather patronizing. As if I needed anyone from the Midtown narcotics treatment program to inform me that methadone withdraw was going to be difficult. I spent every Sunday night for the past seventeen years on the phone, motivated by fear knowing how much suffering would follow if I couldn’t find a way to pay for my medicine. I already understood all too well what the lack of methadone meant. I also decided that surely something else had to be equally as important in  life as methadone maintenance. My free will.
And how in the hell would any person there know? How dare anyone else lecture me about the possibility I’d require a damn miracle just to get by now?
Especially given that there was no concern when I first started. Nobody cared about my welfare twenty years earlier. At least not enough to mention that if I wasn’t dependant I’d become so once I was admitted. No patient advocate, no warnings. I felt like I had walked into a trap instead of agreeing to treatment.

I already thoroughly understood the gravity of my situation. I didn’t need to be advised.

I decided not to mention that over seventeen years I had tried many times to decrease my dose and leave that place for good. I failed. Each time I’d come crawling back and raise a white flag along with increasing my dose. Or readmitted.

As I’ve mentioned I did like my clinician. Besides she was probably twelve years old back in 1999 when I was admitted. Instead I nodded my head to show her I understood.
Then asked her what the protocol was when a client decided they wanted to stop for good.
She explained that it was plausible to exit out in fourteen days after “gradually”decreasing the dose down.
That meant since I was dosing at 120 milligrams, if I actually did take advantage of the fourteen days.
Most likely about 40-30 when it was time to depart.
The reality was I didn’t get down past seventy, maybe sixty. Not that it technically matters. Whether at 400 milligrams or thirty milligrams–after almost seventeen years suffering is imminent.

Still it would give me the opportunity to make arrangements.
I decided to do whatever it takes. And I filled out my very last Midtown request for the detox out.

Walking home I wondered about the fact I had just paid Midtown’s Monday fees. Would that matter in the event I did require additional time to decrease before leaving? Technically all patients were afforded a medically supervised detox or MSD for fourteen days. At no expense whether voluntarily or involuntarily. When did mine start? I didn’t want to waste the rest of the week not decreasing. Still, fourteen days without paying was not exactly thoughtful considering all the cash I had already paid Midtown. Wouldn’t it be foolish to not take advantage of this time period? Financially?

For the record I’ve got a serious problem with the philosophy that Midtown embraced.

I’m not exactly sure how the official medically supervised detox is  different from any other day dosing at Midtown NTP. Since the only person who had ever been present while I was dosing was the dosing nurse.
I suppose that it’s referred to differently when a client is all out of money to pay for anymore. And because the medically supervised detox required any person who changed their minds and abandon the request to pay off the fourteen days before they would be permitted to restart. Only clients who were truly interested in leaving opted for a MSD.
This was obviously intended to not allow anyone take advantage of the two weeks when dues were not owed. That’s not a morally decent thing to do when people find themselves in tough predictiments(shelters, impending family court cases etc) and are desperate. But that’s just my humble opinion.
It meant on top of whatever problems a person faced they couldn’t get out of paying Midtown NTP. The message was clear, go rob a bank, sell your food stamps even prostitute yourself if you must. Do whatever it takes to pay if you don’t want to hurt.
I remembered a young couple with three children who actually sold their car in order to pay off Midtown NTP. In fact I still know where they are today. And it didn’t have a happy ending.

Clients were supposed to believe that this legitimate,  evidence based form of treatment provided by caring medical professionals? However upon examination of how the clinic regarded the lack of ability to pay it appeared they shared the same philosophy as any other drug dealer. I hate to use that comparison but when you’re forced to compromise your morals, steal from your own family, sell your possessions off and tell outrageous lies all for the shake of staying current on your clinic fees. All to avoid excruciating opioid withdrawal. Then in spite of the fact that it’s a prescription provided by a doctor. It’s a drug deal disguised as legitimate treatment. Which is a damn shame. Because it was never intended to be one. Using methadone itself as a weapon doesn’t align with the professional oath that instructs you to do no harm.
I doubt a diabetic had to beg an outpatient clinic to allow her the medicine her body clearly needs. I bet if it was a chemotherapy based outpatient clinic and the community realized that without enough cash they’d be denied medical care. Every advocate in this city would have showed up to pound on the front doors.
Unfortunately, it was just a methadone clinic. Besides, everybody already knows. Opioid withdrawal won’t kill you. But you can bet your life that you hope it will.

Since my exit from the methadone clinic I’ve done a lot of research. In fact, I’ve done more voluntary research in my lifetime that I ever thought possible. And I’ve also corresponded with doctors, nurses and mental health counselors.
All of them have a tendency to sympathize with the patients who were in my position but they chalk it up to a matter of legislation. In fact none of those people seem to feel guilty about the role they played when they knowingly allowed substandard treatment to harm innocent people.
Poor people.
Sick people.
Personally, I’d have to feel guilty for being employed anywhere that Medicaid didn’t provide coverage for sick addicts unless they had the cash.
I always appreciate the sentiment when someone says that they feel bad about what I went through but honestly I still don’t understand why they were willing to make a living, profiting off the despair of addicts. I don’t think I could even face myself in the mirror knowing that my quarterly bonus was funded by a low income family’s desperation, their vehicle, for example.
Sold just to keep the suffering at bay. And today, I continue asking others one question.

“WHAT ARE YOU GOING TO DO ABOUT IT?”

I’m referring to all the lives that were adversely affected before Medicaid reimbursement in the state of Indiana. Innocent children who were dragged along for the ride. They certainly didn’t agree to start medicated assisted treatment. However assuming the cycle of poverty and drug addiction was kept alive and well, they are now likely to one day truly qualify under those admitting guidelines.

And especially if a person turned a blind eye or fingered poor legislation while cashing a paycheck. Think about that.
Hasn’t anyone else heard yet? Sometimes you don’t even need a reason. You can just do right by others. Or in this case. Live up to the professional oath you pledged.
And I discovered that there are times in your life when every person shouldn’t accept something that other people are willing to accept.
For the time being I’d have to put the rest of humanity on hold though. Since the only suffering I needed to address was my own.

As soon as I walked inside my apartment I immediately left a message for my son. To be perfectly honest I didn’t know exactly where he was at that time. He had told me of course that he would be going to a place called Kosovo. And then he told me not to worry too much.
Little did he know that when he said Kosovo, I had raced into his old bedroom and immediately started searching for it on his  globe. The globe had been a Christmas gift from my mother years earlier. Truth be known I’d probably gotten more use out of it then my son ever did.
I’d never even heard of Kosovo so I promised him I’d not worry myself needlessly over his location. But only because I had no earthly idea what kind of place it was. I couldn’t worry about the conditions under which he might have to endure. Impossible, I didn’t even know how to spell it.
At the time of our conversation he’d ask me if I knew exactly where it was.(??)
Naturally I assured him that of course I knew! What grown woman wouldn’t already know this? 😳 Ignorance is bliss.

Despite the fact my son was a million miles away, or might have been a million miles away(?) I wanted to update the one person who would completely realize what my decision to leave Midtown would mean. And not just in terms of tangible resources either.
Wherever he might be.
When I finally did receive a call back from him it was two days later. I told him that I had decided not to be a client any longer. After a minute or so he asked me, “Yeah but mom didn’t you decide that a very long time ago?”

smart kid*

*******************”**

REALITY CHECK ..

DISCLAIMER

It may appear that life became far worse at this point. But remember, do not presume anything. Probably shouldn’t presume anything in this lifetime! Grab Kleenex..

PART IV

“Reality Check ✔️”

“Fast forward Leap Year-2020. Twenty years down the road”

It took approximately three days to give birth to my daughter- Adelaide (Addie). The baby’s father is a stable, caring hands on kind of Daddy. At the age of fifty one, Adelaide is his first and only child!! He spent nearly every day in the hospital room hoping for any sign that he would soon meet his baby girl. He was the most anxious father to be I’ve ever encountered. Of course that’s probably because I’ve never seen a father right before I give birth to their baby.
One even joined the United States Army and left the country. As is always the case where I am concerned. Seems like it’s best for people to just leave. For some strange reason he didn’t leave me.
We both were shocked when at forty-three I discovered I was pregnant. I had been malnorurished for quite some time prior to becoming pregnant. I didn’t even realize I was healthy enough to have any more children. Apparently it’s a miracle! The Lord works in mysterious ways.

On the second day a nurse entered my room and announced that my father was there to see me. 

I can’t tell you how unlikely it was at that point to receive any visitors. Especially a member of my family. And even more especially my father.
After all I hadn’t laid eyes on him for over a year. I hadn’t seen anyone who used to claim to love me in a year. Every effort I made to contact them always ended up causing me an intense amount of pain. Clearly I was not welcomed or missed. I finally stopped trying when I found out I was pregnant with my daughter.
  My mother had died suddenly approximately a year and a half before I would give birth to my third child. Her death had one of the most difficult things I’ve ever had to manage. My mother was not just my mother, she was without a doubt my best friend. Even when I moved away from home I’d phone her religiously. Sometimes three or four times every day. She was an extremely intelligent person. Her recorded IQ was around 140. This wasn’t something she’d mention in day to day conversations. In fact I only became aware of how exceptionally bright my mother was- officially- after I graduated from high school and I overheard a conversation about her high IQ. In spite of never enrolling in a university after her graduation from highschool she was an expert on virtually any subject (that didn’t involve algebra,, 🙏) I’ve always been humbled by her intelligence. It made me feel lacking since school academics were never something I excelled in.
She seemed to have a never ending well of knowledge on reserve. It’s due to the fact that my mother read continuously throughout her lifetime. I can’t remember a time or place my mother didn’t bring reading material along no matter what the occasion.
She didn’t enjoy television and made it a point to include me and my identical twin sister by reading out loud to us. In the summertime before school resumed she’d read out loud to us from one her preselected books. Always careful to pick one that dealt with some kind of personal struggle. She would light a small candle on the front porch and sit in her patio chair with us two girls nestled at her feet. I loved those days. The sound of her voice resonated through a night time sky full of stars.
Some of the books she read out loud during my childhood-when I was as young as nine or ten. I’d later discover were on the required list of reads for some of my college classes.

After becoming a mother myself I developed a healthy respect for the woman described as merely just a “housewife”. My mother decided to give her children the gift of perspective. She was naturally intuitive and very compassionate. Every person who has ever met her felt she was speaking directly to them alone. It wasn’t artificial or annoying. She just knew by reading them what it was they were capable of understanding. If the situation called for it she could serious- or not. If she had to be witty or critical it just didn’t matter. She knew instinctively how to respond to individual needs. Her emotional IQ is what I’d love to have measured. I hope she never felt disappointed by my own abilities. Paled in comparison to hers.
Her death fractured our close net family and without my mother to help me navigate through life or even mediate between me and Dad I was lost. She was my whole world. And then she gone in a blink of an eye.

Two or three months after her death my father decided that he simply couldn’t live with the “Majority opioid crisis” any longer. Ever since the year 1999, the year I had been admitted into Midtown NTP. I had been involved in opioid addiction. And ever since my exit I had been battling it’s repercussions. Little did I know but making an exit was only half of the battle. My departure from the methadone clinic had included a parting gift of sorts. Since I had no prior experience with opioid dependancy I wasn’t equipped to manage it on my own. I foolishly thought will power alone would be enough. It’s not unfortunately.

It wasn’t as if I resorted to self medicating immediately after I was barred from the outpatient clinic due to my complaint. I honestly didn’t want to use any drugs. Actually I had made a concerted effort to not use anything. It isn’t something I would expect a person who’s body is normal to understand. Opioid dependancy is a physical response that everyone on the planet will experience if regularly taking opiates on a long enough time line.  Can anyone imagine what’s it’s like to only be able to eat or sleep with enough of an opiate coursing through their veins? You can’t shower or think or do anything that your former body used to do without an opiate. The opioid dependant person is constantly living with a timer above their head’s. I remember thinking
“Four hours, three hours two hours before it’s going to come again” A person can only take so much before they break. Surprisely it didn’t take nearly as long as I thought before I waved my white flag. And for those who believe that they’re far more resilient than most. Well, I double dog dare you. (Disclaimer: Rhetorical)

My father requested a home visit with some kind of Eskenazi Health substance use counselor. Her role was to determine the level of care I required and make the appropriate suggestions. I knew even before she arrived exactly what level of care I required and I also knew prescisely what  my options were. I didn’t want to appear argumentive so I said nothing.

She took one look at me slouched over in a chair and asked me how long had it been since I last had any opioids. She broke the news to my father that I required medicated assisted treatment after seventeen years on methadone. Then she explained to him that the only community outpatient clinic in Marion county Indiana was Midtown. She told him point blank I was unlikely to succeed without using medicine. That was the proverbially straw. He finally got fed up. I’m not sure what he expected the healthcare worker to tell him on that day. Apparently it wasn’t the news he hoped to hear.

My father had refused to have anything else to do with the whole mess from that point on. I might as well have died in his eyes. It wasn’t too long afterward I’d find myself completely alone with no place to live. Even as I begged him to communicate with me from the streets I lived on. He wanted nothing more to do with me. He refused to acknowledge that there had ever been a “Majority Ruhl”. I had become estranged from my entire family. They hated me. My room had been completely cleaned out and nearly everything I owned was thrown away. Even my photos. I didn’t exist. My son was in the army overseas and I didn’t want him to worry so I said nothing. Without a home a car or a job. I was living outside twenty four hours a day and I was trying to stay well.
Prior to being homeless I thought I knew what being cold was. But I was wrong. I didn’t have a clue. I was getting ready to find out though.

No one pays a person like me a visit for any reason.

“Excuse me? A visitor?”

I lifted my head up and looked to where the baby’s father was standing. I assumed the nurse was referring to his own father instead of mine since obviously my Dad was never going to visit me again. He shook his head in confusion. I asked the nurse to explain who was on the other side of my door and she reiterated that he was my Dad, His name was Michael Ruhl.

 It was like so many dreams I had while sleeping outside all alone. I would dream of touching the people who used to love me. I wanted hugged in the worse way. Waking up and then just for a moment remembering how it felt to be with them again. It always made me wish I was already dead so I’d never have to hurt like that again. Why couldn’t it be the other way around? Why couldn’t the old Majority dream she was a junkie sleeping behind a dumpster? It’s funny that once your reality becomes the stuff of nightmares, you cease having “bad” dreams.
Dreaming that I was some other place, regardless of what terrible scene my subconscious had conjured up for the evening. It was still a visit with the people I loved dearly. The same people who once even loved me. Even if it wasn’t real. And that in itself qualified it as a good experience.
At least I could be with them again. For a short while.

People absolutely hate it when I pull the car over and I give the pan handler cash but it would be wrong of me to deny desperation right in front of my own eyes. For the record, no I don’t give a God damn if a person is using it for heroin or alcohol. I just can’t stand to knowingly allow someone who is begging to suffer. I’ll never be critical again. NEVER. By the time a person has to resort to begging total strangers for cash they’ve gotten to the bottom of their abyss. And I would know more about that than most people do.

It wasn’t until about the time I was beat up by a drug dealer and his gun toting galfriend that I finally decided it was the right time to die. The two degenerates had been furious when I caught them stealing from me. In a heated outburst I had foolishly threatened them with the cops! Bad, bad bad idea(bad idea #5478). I saw the posture of the man stiffening and my instincts informed me that this was one of those fight or flight scenarios. Weighing about eighty four pounds, I opted for latter flight option.

I made a desperate effort to reach the gate of the fenced in backyard. I almost had the latch up when I felt my hair being jerked back. Immediately I began begging for them not to hurt me. But my pleas only attracted the local neighbors, who decided not to intervene since they were also not inclined to piss off a gun toting drug dealer (wise decision). Instead an audience watched as I was repeatedly hit, punched and slapped until I fell down. Then I was kicked by a pair of men’s black boots so many times that I could hear the sound of my ribs starting to crack. I tried rolling away but became stuck right up against that metal fence. Like a sitting duck.
This seemed to further excite them both. I glimpsed a bloody hand snatching my cellphone away. It was terrifying to know that the blood was coming from me
I had never been seriously assaulted before. Not only was I a pacifist and a total wimp who didn’t stand a chance in a fight.
I didn’t have a mean bone in my tiny body. I never have. From start to finish of the beating I never raised my hand to hit back.
When they finally stopped they were worried that some person might have phoned the cops. I was ordered to stand up and start walking towards the road.

Only problem was that I couldn’t stand. I had defecated on myself and was in terrible, terrible pain. Yet again I felt my hair being yanked as I was lifted up and thrown onto the sidewalk. No one helped me. Instead they went back inside their cozy homes and resumed the day. It took me over two hours to crawl to a deserted house that homeless junkies like me would often frequent when necessary. It was the most disgusting dwelling I had ever spent time in. But it was the ONLY place I had left to go. They wisely took my cellphone and pack with them. I could only make calls on a WiFi signal but even those two assholes knew that without my phone, I couldn’t call for assistance. And at that point in time I had an open warrant. My first arrest ever while in my forties for the act of trespassing. I couldn’t even make the court date while it was so terribly cold outside. Even without a warrant I was resigned to dying. Too bad they didn’t know just how much. They could have saved themselves the trouble. I couldn’t have called out for help. By this time there was not one name in my list of contacts left to communicate with. Not a single person I could call for help.
Later I learned that the two of them watched me crawl through muddy back yards in order to get to the abandoned house. They had to verify that I wasn’t going to call for help. They didn’t want anything bad to happen to them.

It took about two days before anyone else came inside. Without being able to even to get my own water meant I’d have to make my usual half mile walk over to McDonald’s. I could barely move. I sobbed for twenty-four straight hours begging God for just one last thing. I needed my mom. Even a temporary repieve. There are times in every person’s life when the only other human being that you require is your mother! Even in my forties, I still cried out for my mom. But by the time the sunlight vanished from outside the windows, she hadn’t come. I don’t think I ever hated God more than I did that day. I effectively went from agnostic to atheist. I can’t believe it took me as long as it did to renounce the God of my preference. The situation had been grim for quite awhile.

If someone hadn’t come along I wonder how long I would have survived. Maybe a week or less from all those survival accounts I’ve read. Of course most of those people were praying they’d make it until tomorrow.
Naturally the run down home didn’t have electricity or running water. I collapsed on top of a pile of full garbage bags. I hadn’t moved from that spot in two days.

Thankfully the person who stumbled across me didn’t want to hurt me and he sorted through the bags of trash piled up inside and found Saran wrap. He was one of the local homeless men from that neighborhood. On the few occasions I had to interact with him he was always polite and warm. He didn’t steal anything from me and he didn’t proposition me for sex. That alone made him memorable. I felt humiliated and embarrassed. He didn’t seem to care about it. He immediately started to clean me up using dirty rags he found on the floors.  He then stood me up and wrapped my broken side tightly together. It actually helped me move around better! He had been in school to become a nurse decades earlier of course. That was before he became a junkie like I was. I was very dope sick by then but had no possible way of securing my daily medicine. He knew that. He left for three hours and returned with half a rig full of heroin for me. 

He’s dead now. I was researching my cohorts from the methadone clinic who were also left to self medicate and live outdoors then. Of course the clinic’s doctor didn’t deny any of them treatment for writing a complaint.
We all lived inside a tent behind a Kroger’s grocery store. We all ran in the same circles, Addiction.
I moved in or “out” during the very end of October.

I was stunned when I read on a Facebook post that he had died. What(???) Didn’t God understand I was willing to go instead???
Evidently not.

He died about six months ago from an overdose. I feel so awful and if I could only explain to God how he had been kind to me then maybe it would make some kind of difference for his afterlife. 
But I got the feeling that it’s moot.

In fact six of my former associates are now dead. Less than two years later. Not surprisingly five were the result of overdosing. One died of hyperthermia. Besides overdoses, hyperthermia was my major concern. I was a very small woman and I was alone most of the time. I didn’t have anyone to help keep me warm and that’s not a good thing. After being thrown off the land behind the grocery store. I no longer had the luxury of a tent which didn’t even zip for protection. A trespassing sign now hung over the exact spot I used to sleep that winter.
I’d manage by myself by not stopping. I would spend the entire winter nights walking around the same size blocks just to keep moving and survive. As I passed by I’d see the soft glow of television sets and smell the aroma from their dinners. No one seemed to even notice me. Walking all night until dawn. I didn’t deserve to live inside regardless.

The life I was living was made from the stuff nightmares would consider to awful to include. My former life was merely a distant memory that I no longer even needed for reference to that hell. I couldn’t image belonging to a family again. Probably a good thing my mother had already passed so she didn’t have to witness what I had become. I’ll have to recheck the list of people who are disappointed in me later though. It’s long. Not that I care. (No shame)!

When I saw my Dad walk
into my hospital room I immediately burst into tears. He even smelled just like I remembered as I cried into his shirt.  I couldn’t believe I was touching him again. I wanted him to know everything that had happened since the day I had been outcast. But I couldn’t talk. An outpouring of grief wouldn’t allow it.
I think he stayed about ten minutes. I know it’s terrible of me to feel angry with him for abandoning me, but I can’t help it. I’m a human being at least I think I still am.
I introduced to him my new friend, the baby’s father. We decided to raise our baby together despite not being romantically involved. He looked reluctant to shake my father’s hand. He paused briefly before accepting it. He couldn’t comprehend how a parent could knowingly allow his child to suffer.

Of course he’s jaded. I deserved it. Truly I did.

Who in their rights minds wants to be involved with the problems that I have had due to the methadone clinic? Due to becoming opioid dependant? Nobody. Well no one I knew anyway.

She was born twenty four hours later and the moment I touched her hand, I was forever transformed!!
I knew I’d be having bad dreams again soon enough.What a relief. 

We both crossed our fingers that her Hepititis C test would come back negative when she was born. Even at this most precious private moment, opioid dependency found a way to interfere. It continues to invade my most sacred places even to this day.  Dependency, it’s Midtown’s lasting legacy.
You can take the methadone out of the addict but you can’t take away the dependency.

Before I ended up a homeless junkie living outside a grocery store in a tent. And before I gave birth at age forty-three (although still gorgeous..)
One particular day stands out.
Very soon after I was denied further treatment to the only outpatient clinic in my county. I picked up a newspaper.

The announcement that Medicaid was now going to reimburse providers for medicated assisted treatment in Indiana. Finally.
That included Midtown narcotics treatment program NTP. 2019
The one I had sacrificed and struggled to continue loyally paying. One in the damn same.

I felt like someone punched me in the gut.

I actually had to sit down.
That meant it was all for nothing.

I ended up homeless and strung out. I couldn’t afford a vehicle or a even food. Knowing why I couldn’t afford a lawyer when I was discriminated by CPS. Midtown was unrelenting in their insistence I pay them during the time I was sleeping in my car and defending my honor over their clinic. I had asked about possibly letting me slide a week or two.
No, not possible.

I had to steal cheat and lie to produce those Midtown out of pocket fees each week. The realization that my son never opened hundreds of Christmas gifts from his mom. Or birthday surprises. Or anything else that I should have been able to provide. Things a mother should get to do for a son as perfect as mine. Midtown’s fees always came first-

Just so I could continue to pay and loose jobs, homes and my divine right to parent in the process. I paid and trusted the professionals who had ruined my health.
It meant nothing. In vain.

What was I supposed to do now?

Write an apology for being so incredibly stupid? Or should I say, overmedicated? Write an apology to my own daughter, the newborn I couldn’t take care of? And she’s going to be alright knowing her first weeks alive she was battling methadone withdrawal, right out of the gate? Would you take comfort in knowing that life’s first few weeks included being given away and suffering? So now I’m supposed to let her know that if she’d been born when Medicaid reimbursement started, she’d have grown up with a mother who would have sold her own soul to protect her baby girl? Anything other than stop taking methadone?

I’m sure she’ll understand.
And when she does become a mother herself one day. Will she question her value as a human being? Will the fact I have never even heard the sound of my own baby’s crying been worth all this damage? What was the positive side of adoption?
PppShe wasn’t further injured by my stupidity or by the demand of paying Midtown. At least not after her battle with withdrawal was finally over.

Sure my father won’t be upset that I literally owed him thousands of dollars for the cost of food and shelter alone. Let’s not mention the out of pocket fees he’s paid as well over the years.
All so I could pay my captors? I even compromised my principles just to keep paying them. I wrote bad checks and cashed them. I told outrageous lies to for the purpose of gathering more money. I couldn’t hardly face my own reflection in a damn mirror.
I paid far more than Midtown and Eskenazi could ever know. I paid and I paid and I paid and I paid. Seventeen years worth. Never allowed to slide even occasionally just so I might have the opportunity to provide my child something extra? Hell with the “extras”. I couldn’t provide him anything that the welfare program didn’t award it’s participants.

The truth is that it’s too late. I can’t turn back the clock and make a different choice in terms of treatment.
I can’t undo what a specialist allowed to occur. I’ll never atone. I won’t grow to accept my fate. It’s over and at the same time-it isn’t over. It’s never over. It’ll never stop. Even after I finally did get away.

Around that same time  that Medicaid reimbursement began and I was left to self medicate.
I had received a letter from the Indiana department of health. I suppose in hindsight I shouldn’t have been surprised. But I was.

I had contracted Hepititis C.
(Didn’t the clinic say that methadone would reduce those kinds of ugly risks)??

Of course they didn’t understand I couldn’t possibly use methadone maintenance to avoid an infectious disease because I wasn’t allowed to be seen there ever again. As long as a client doesn’t file a complaint with the Indiana attorney general’s office, they can receive treatment for as long as they require it. But God help the next person who doesn’t realize that it’s the doctor’s authority that can deny you access to adequate care. Honestly it ended up denying me access to any kind of care at all.

And without any one left to assist me from the attorney general’s office, no referrals, no suggestions no rehabbing or any type of support and communication. My life became an unmanageable hell.

Even worse than the one I mentioned in my complaint. Even worse than the condition they caused. I have to wonder what the odds were Laura Ruhl would have injected herself prior to being abandoned by the community that also caused her to suffer? Would I have ever done something so damaging to myself if it had not been for the introduction of methadone?
I’ll concede it’s possible on my own I might have eventually self medicated and become severely dependant on opioids. It’s possible. Anything is possible.
I’ll reiterate.
Anything really is a possibility.

But the point is that I’ll never know. I didn’t get to make that choice. Midtown made my choice for me. If it was the use of my own free will that resulted in all the misfortunes than I’d have to find a way to accept that.

And the fact remains that it wasn’t entirely my own will.

I wish like hell I’d never filed the damn thing. I begged the doctor to help me. I pleaded with him over the phone. I apologized for the complaint. It was humiliating and it must have last five straight minutes. When I finally stopped between sobs to catch my breath I heard his reply.

NO

I also heard the slightest hint of apprehension in his answer. For some strange reason his hesitation never left my mind. I wanted to believe so very much that he felt some twing of responsibility or consideration for my predictiment. However he wasn’t torn between helping me after treatment had gone so wrong or concerned about how I’d surely suffer.
It was only a year later as I was freezing inside a dilapidated tent researching my predictiment that I realized he must have been contemplating the liability aspect of denying me care. That’s all he was considering as he condemned me to a life of hell, himself.
And if I had not been without electricity I might have charged up my cell phone long enough to file a meaningful suit as opposed to complaint after complaint.

I bet he never considered the possibility that he had harmed the wrong patient, the wrong person! And definitely the wrong junkie.