by Amber Jensen
An entire wall of the doctor’s office might have been made up of windows – the lower panes frosted for privacy, upper panels clear, allowing light in – and yet the room seemed clouded. Maybe it was late enough in the day that the sun had passed to the other side of the VA, to shine beams into hospital rooms where patients lay. Maybe the day was overcast, maybe the room had fewer windows than I remember. Or maybe the clouds were imagined, because this feeling of not seeing, not knowing, was nothing new.
Blake had masked his back pain for years, symptoms evaporating like water droplets. Some signs were more visible – less golf and fewer innings of baseball – but it seemed natural for a young father, busy with work and kids. I did notice his slow rising in the morning, the dragging of his feet, but like a light fog, I moved beyond them without pause. Eventually these symptoms became denser, took physical form: mountains of prescriptions and empty ibuprophen bottles, an old man’s posture, not just in the morning but at family dinners and my cousin’s wedding, when people asked, “What happened to Blake?” Still, daily routines continued, undisturbed. Until the first clap of thunder: sleeping pills. I had assumed that Blake moved from our bed to the couch most nights because of the hot, constantly wiggling boddies of our kids, who ended up in our room almost every night. But his VA doctor prescribed a sleeping pill along with a higher dose of pain meds. “I really can’t sleep at night,” he said. “It’s that bad.” When did it get this bad? How had I missed it? Why didn’t he tell me? The stories that Blake didn’t tell, the questions that I didn’t ask had been clouding my vision for seven years.
So in the VA that day, as I sat in the corner on a curved plastic chair, the kind that cups your body, giving the illusion of comfort, it may have been guilt or regret that cast a shadow. But at least I was there. The fact that Blake had asked me to come with him was a sign of light coming in, even if, when we entered the exam room, Blake took the chair next to the doctor’s work station, rather than sliding up onto the examination table, relegating me to the corner. I peered across the room, watched Blake’s eyes graze over the floor.
“You can be honest,” I said, leaning toward him, hoping he would look up. “You have to be honest. Because you deserve to feel better.”
Blake acknowledged me with a glance, and then the PA entered. She took her place on a padded, swiveling stool, her back to me, quickly greeted Blake, and moved into the initial questions. I felt like I was eavesdropping. “Any feelings of depression?” Blake answered with a quick no. “Thoughts of hurting yourself?” Another negative. I found myself nodding in agreement. And then she asked, “How many alcoholic beverages do you consume in a week?” Blake probably answered honestly – sometimes one or two, sometimes four or five. I leaned to the side, hoping to meet Blake’s eyes. I remembered again our conversation about the sleeping pills, when I had almost cried at Blake’s strength, how he managed the pain and, instead of self-medicating, drinking more, I had actually noticed him drinking less than ever. But before I could connect, the PA was moving beyond required formalities. “So, how are you doing overall, Blake?” She sounded genuinely concerned.
Blake responded without hesitation. “Not that well, actually.” But then he paused. In that sliver of silence, I prepared to interject, explain that it wasn’t just golf or baseball, Blake couldn’t shovel snow. He couldn’t stand without swaying and pacing. He was losing flexibility, his feet heavy stumps. He couldn’t sleep. I leaned forward, preparing to move around the wall created by this woman’s body, but as I ran through the symptoms in my head—some I had only recently learned of myself—I realized that maybe Blake needed this wall between us, maybe he didn’t need to feel me examining his weakness. So I shrunk into my plastic chair and listened. When Blake spoke, he didn’t recite a list of symptoms. “We’ve tried all these treatments,” he said, “but it just keeps getting worse.” His voice was a forced whisper. “I really don’t know how long I can live like this.”
I closed my eyes to absorb words I hadn’t heard him speak before. A tone in his voice that was unfamiliar, quietly desperate.
The PA drew her shoulders back, put her glasses in place, and flipped through the pages of his file. “Let’s see where we’re at, here. We’ve tried physical therapy.” I imagined Blake’s eyes rolling back, his jaw clenching in frustration, at the reminder of years of physical therapy with no benefits. “We’ve done cortisone,” she added. I imagined Blake’s core tightening, his body shifting into stiff right angles at the memory of months between shots, the insistence that sometimes it takes a few tries before cortisone provides relief. Still flipping pages, the PA said, “I see here image guided cortisone, no success there. And the surgical consult?”
Blake exhaled. “It was a joke. Lasted 5 minutes.” His voice was tight and sharp, pinching back the same anger I’d heard in July when, after seven years of trusting his VA doctors, believing that the next treatment would alleviate his pain, we drove to Omaha, NE, to meet with a neurological surgeon. While Blake went in to the appointment, I waited in the car with our kids. Before I had even unpacked peanut butter and jelly sandwiches or poked straws into juice boxes, Blake returned. “He said I’m too young for surgery.” The words had affected Blake like a sudden temperature drop, so that a storm was finally inevitable. His voice rumbled. “I can’t even stand up to brush my teeth in the morning, I have to sit on the toilet to brush my teeth, and I’m too young for surgery. I’m in pain constantly, and I feel like I could just snap. But I’m too young for surgery.” We had parked in the shade of a line of trees in the lower parking lot to avoid the July sun, but it felt like our car was shrouded in ominous clouds.
In the exam room, I sensed the volatility of that storm.
The PA returned to Blake’s file, saying, “Let’s see what we can do to manage that pain.” She thumbed back and forth. “Well, we can’t go any higher on Hydrocodone, so it looks like the next step would be morphine.”
Her tone was steady, the word morphine uttered as easily as Tylenol, linking seamlessly to what seemed a memorized explanation of schedule I drugs and possession of controlled substances. I felt the word on my skin. Morphine. Hairs on my arms raised. My skin crawled like it had when I was 13, morphine dripping into my veins after surgery, when I thought snakes slithered around me in my bed and up my arms, when I imagined men on stilts teetering in the corner of my hospital room. Too young for surgery. “Don’t know how long I can live.” Morphine. The words rolled and rumbled like fast motion images of storm clouds gathering.
I didn’t know at the time that the hydrocodone Blake had been taking for years was just as bad as morphine, that it, too, bound itself to opiate receptors, essentially tricking the brain into feeling intense pleasure, but then losing effect, leading to increased tolerance, decreased effectiveness. I didn’t know, then, that the VA’s opiate prescriptions were rising drastically faster than their number of patients, that their fatal overdose rate was almost twice as high as the national average (Glants). But I did know that stories of homeless, alcoholic, drug-addicted veterans were suddenly more immediate, more real to me. Just hearing the word morphine had given me a terrifying understanding of how easily that could become our story. I wanted to claw my way past the PA, clench Blake’s shoulders, and look into his eyes, search for signs of life, signs that he wasn’t disappearing into this possibility.
At the sound of one word – morphine – I realized that Blake was bound by a VA medical system that was failing him, tricking him, numbing him into believing that all he needed was pain management. A higher dosage. Another drug. I felt disoriented, as I had standing at the top of Costa Rica’s Arenal volcano, where I was swallowed in thick fog. Like driving in a complete whiteout blizzard, it was dizzying. Even though I had climbed the mountain myself and knew that somewhere was a wooden walkway with chipped green paint, one I’d just walked over to reach this platform, even though I knew there was a railing nearby, that I could feel for and eventually find with the hand that seemed not to exist when I extended it in front of me, I also knew that beyond the railing was the crater of a volcano. I knew there was a safe way out of that fog, that if I needed to I could drop to my knees and crawl over splintered wood until I found smooth pavement. But I also sensed that deep cavity in the mountain below, the danger of that possibility. In the exam room of the VA hospital, I closed my eyes to the disorienting scene and began to feel for something that might steady me. I clenched the metal frame of my plastic chair. Remembering my research into treatments for degenerative disk disease – inversion tables, implants, surgeries – I said, “There has to be something else that you can do.”
I’m sure the PA turned toward me, offered a glance of recognition, or a comment: “I can understand your concern.” But she turned to Blake and explained, “There’s really nothing else we can do for you here, though you may find help with an orthopedic surgeon.” But there was a catch. “Unfortunately, I can’t make the referral,” she said. “We have an orthopedic surgeon on staff, so I can’t refer you to an outside provider, even though our surgeon doesn’t deal with spinal injury. It’s policy. We can’t refer out for services we offer internally.” Maybe she turned to Blake thinking that only he – the veteran, the insider – would understand the complexity. But I had read Catch-22. I understood absolute simplicity: the VA didn’t offer the services Blake needed, yet by name, they offered orthopedic services. Blake was trapped by policy, by absolute simplicity. What I didn’t understand was why this treatment had never been mentioned before, or why a system paying a veteran for his disability would want to prolong that disability rather than eliminate it. I moved to the edge of my chair. “But you’re saying there is possible treatment outside the VA?”
The PA still answered to Blake, her body a perfectly square and unmoving wall between us. “If I were you, yes, I would see what else is available. It does appear to be an orthopedic problem.” Could she have known that Blake could receive the treatment he needed at a hospital less than three miles away? That within two weeks Blake could walk out of that hospital without pain shooting down his leg? That even in recovery from surgery his hydrocodone prescription could be cut in half? Or was she only certain of her next statement: “You would, of course, be on your own financially.”
When I heard Blake’s voice, I expected an objection. Instead, he said, “I guess I have to thank you, really. I just wish someone had told me five years ago.”
The PA spun toward her computer, fingers skipping over keys as she summarized the visit. She spun back. “So, Blake, I’m going to go ahead and send these prescriptions.” She maintained an even tone, professional detachment maybe, as she recapped. “When you get downstairs, you’ll need to sign some paperwork since this new prescription is a controlled substance, but the pharmacist will explain it all again.” Did she feel satisfied? I wondered. Relieved at the possibility that Blake might finally receive the care he needed? Or maybe she felt a tinge of regret, knowing that he should have received that care years ago, or guilt, knowing that we would end up paying for the treatment of this service-related disability. Or maybe she worried about what might happen to a young father and husband, about what might happen to his family, if he became dependent on the morphine she prescribed.
I was already searching for a number on my phone. In the waiting room, I called the Orthopedic Institute; they offered an appointment later in the week. I tugged at Blake’s forearm, pulling him toward me, begging. “Don’t fill the prescription, please. It’s only a few days.” I slipped my hand down his arm, laced my fingers with his. “You can last a few days, right?”
Blake squeezed my hand. A low laugh escaping as he said, “Yeah, morphine is like the last hope for a dying man.” His fingers fell from mine, and he turned away as he said, “Anyway, I have to fill the other prescriptions, so I’ll meet you at home.”
Less than two weeks later, I walked into the surgical recovery room to find Blake smiling. “I suppose it’s not really possible,” he said. “It’s probably the drugs talking, but I swear I feel better.” In spite of the blue-print smock, the IV taped to his arm, the white sheet tucked around his lower body—the usual signs of sickness and fragility—he beamed. “I don’t think there’s pain in my leg, and my back hurts, but it’s different, like no more pressure, like it’s a good pain.” The relief was visible. I marveled at the way his smile reached his eyes. How had I not noticed the absence of this smile?
At home, Blake moved slowly, walking only blocks, at first but within days he had picked up the pace and was walking miles, sleeping soundly, and laughing easily. He was returning to life. Until one afternoon, about a month after surgery, when I noticed him pacing the living room. He fidgeted on the couch, his face red, neck sweating. He spoke in spasms. “I feel awful. You know, I thought it was great. I thought the surgery worked. And now I feel terrible.”
“Maybe you need to take a walk.” Blake had recently returned to work, just a few hours a day. “Maybe it’s all the sitting at work. A walk will help.” But Blake didn’t eat supper, and he went to bed early. When I came to bed later, he moved to the couch. I heard the snap of a blanket, the shuffling of pillows, then silence. I held my breath. Then more shuffling, the squeal of skin against leather. I went to check on him.
“What’s wrong, Blake? What do you need?”
He still spoke in tight, choked phrases. “I don’t know. I can’t sleep. I don’t think it worked. The surgery. I think it’s worse than before.”
I was on my knees beside the couch, my hand on his shoulder. “I can sleep on the couch if you can’t get comfortable. The bed is probably better for your back.” I ran my hand over the flannel blanket that he had pulled up over his head. I could only make out the no in his answer. I gave up and returned to bed, but I couldn’t sleep. I lay still, staring at the textured ceiling, making out shapes in the dark—the plant hook left from the previous owner, the light fixture we’d always planned to replace with a ceiling fan—and identifying sounds—the moan of the couch as Blake shifted his weight, guttural frustration muffled by pillows, then silence for a while. When I closed my eyes, I remembered Blake’s pacing, fidgeting. It had been a month since the surgery, and he had felt so good. How could things go so suddenly wrong? He seemed so nervous, agitated. Before I could open my eyes, my fingers fumbled for my iPhone. Angling the blinding screen away from my eyes, I opened the browser and typed: hydrocodone symptoms of addiction withdrawal.
Sweating. Nausea. Phantom pain.
I tiptoed to the end of the hallway. As my eyes adjusted to the street light filtering through gauzy curtains, I watched the couch for the slightest movement. I wanted Blake to be awake, wanted to reassure him, it’s not the surgery, your back is fine, you’re just addicted to drugs. He would appreciate the dark humor. But I remembered his red face, his clammy skin, his pacing. Even before I recognized them as withdrawal symptoms, they had bothered me. I’d kept the kids outside and downstairs until bedtime. Since Blake appeared to be sleeping, now, I felt for the chair rail I had nailed it into place when we moved in. I knew it was there, and I knew that my fingers could slide along the curve of the molding, follow it down the hallway to our bedroom, even though I couldn’t see.
I lay in bed, counting minutes, watching the clock, until our daughter finally woke in the morning, until I finally had an excuse to go back out to the living room. I touched Blake’s shoulder, telling him Addie was awake, maybe he should lay in our bed. When he stood and sluggishly shuffled toward the hall, I stopped him, my hands on his chest, and said, “I don’t think it’s the surgery. I don’t think that’s what’s bothering you. I think you’re addicted to pain medicine.”
He stood for a moment, looking past me, but lifting his chin as if listening.
“I just realized it last night. I looked it up.” I handed him my phone.
He glanced through the list of symptoms. With an incredulous laugh, he said, “I guess it’s kind of a relief.” We both laughed. But he was still agitated and sweating, and by the time he called the VA later in the morning, he was dry heaving, too. “They’ve had me on this medicine for years, never mentioned addiction. And now I call them for help, because I want to get off it, and now they treat me like an addict.” He yanked his shoelaces into a tight knot. “They won’t do anything until Monday. I have to come in for an emergency appointment.” He stood, head jerking side to side, hands on hips. “So, I guess I’m going for a walk.”
“Ok. But you’re coming home, right? You’re not gonna go live under a bridge or anything?” It wasn’t funny, but we both laughed – my laugh was a question that moved through my body like a shiver, Blake’s a loud rumble trapped in his clenched jaws.
“I’ll be home,” Blake said. “But if not, at least you know where to start looking.”
As he walked out the door, I smiled with relief. Even though the reality was an addiction to pain killers, I trusted that he would overcome the addiction. Still, tears collected as I realized that even now, even seven years after Blake’s safe return from war, I still felt on the verge of losing him to that war.
I would feel the same way a year later as we prepared to move, as I stood in the bathroom, throwing out expired children’s medicine and empty tubes of lotion and toothpaste, packing useful toiletries between towels and rolls of toilet paper. The garbage can was already overflowing when I moved up to the second shelf, where I found at least a dozen orange prescription bottles, all labeled “Jensen, Blake.” Most were empty except for the chalky dust of the pills that had once rattled in them, others still clamoring with pink or white capsules. Each white-labeled bottle that I flipped into the trash was a reminder of the fact that he no longer dreaded getting out of bed, the way he laughed so much easier now. But then another bottle rattled. Unfamiliar blue pills. I read the label: morphine.
My first reaction was panic. Flush it. Get it out of my house. A quick Google search reassured me that I could flush the pills. Once they were gone, I could breathe. I sat on the bathroom counter thinking about the questions I didn’t ask, the stories Blake hadn’t told. I didn’t think he had filled the prescription. Or at least, I didn’t want to think he had filled it. I probably should have known. Blake’s way of disagreeing had always been to pretend that he might agree. Why hadn’t I asked him about it again? He wouldn’t have lied to me. But he wouldn’t have let me change his mind, either, if he had decided to take the morphine. Maybe that’s why I allowed myself to believe what I wanted to believe.
Throughout the day, the discovery hummed in me, hovered over me. It hung in the air as I packed, trembled in my stomach at supper time. I watched Blake, suspiciously. I studied his laughter, the movements of his hands. When the kids were finally in bed, Blake and I sat in the living room, dimly lit by images on TV, its walls bare, boxes stacked against them. I slid forward on the couch, inching closer to Blake who sat on the loveseat, facing the TV. “I sorted through all your old prescriptions today, found the morphine.” He nodded. “I didn’t think you filled the prescription.”
“Oh yeah, I filled it,” he said. He sounded surprised I didn’t know.
“Did you take it?”
“Up until the surgery.” He looked me in the eye, a near laugh interrupting the memory. “It didn’t help at all. I even took it with the other pain meds. That didn’t do anything, either.”
I sat for a moment in the fog of this truth: Blake had abused prescription pain medicine. Fumbling for something to hold on to, I blamed the VA. I blamed Blake for not being honest with me. And I blamed myself for not pushing harder, not asking questions, not demanding better treatment or seeking a second opinion.
The surface tension of my anger and blame collected questions and implied possibilities. What might have happened if I hadn’t been at the VA hospital that day? Would Blake have accepted the prescription as his fate and moved on? Would I have discovered his addiction and stepped in, like the family of Tim Fazio, who had to threaten to sue the VA for medical malpractice before they would stop prescribing him opiate pain medication (VA Pushing Pills and Getting Vets Hooked on Opiates)? Or would the VA have eventually discovered his addiction and demand that he seek treatment, as they did Jeffery Waggoner? Waggoner was released from a VA in-patient rehab program with more than enough opiates and muscle relaxers to overdose, and he did overdose, in a hotel a few miles away (Glants). Or would Blake have begun to supplement his ineffective pain medications with alcohol or other drugs? Would we be divorced? Would he be dead? With each possibility, the air in our living room grew more dense. I felt, suddenly, as I had while Blake was in Iraq, as if any moment I could lose my husband to war. I was squinting to make out Blake’s profile just a few feet away from me.
As I felt myself swallowed, again, by fog, sensing, again, the possibility of a dangerous plummet, as I searched for someone to blame, I was overwhelmed again by guilt. I was convinced that the VA system was flawed, policy preventing optimal care, but I also knew that each individual I had encountered within the system wanted the best for veterans like my husband. No one wanted to watch him lose his quality of life to chronic pain, or lose his life to addiction. And yet we had. I was guilty, and Blake was, too. Because we had all stood by and watched as his quality of life had diminished, as he hovered at the mouth of the abyss of addiction. We had walked through light fog, felt our way forward as it thickened. We had stood in the shadow of clouds as they gathered. Feeling small and helpless in the darkness they cast, we took cover, hoped to weather the storm, prayed the storm would pass.
Glants, Aaron. “sfgate.com.” 2 December 2013. Report: VA Prescribes Opiates to Patients Not Seen. 10 Feb 2014. .
National Institute on Drug Abuse. Prescription Drugs: Abuse and Addiction. October 2011. http://www.drugabuse.gov. 9 March 2014. .
“VA Pushing Pills and Getting Vets Hooked on Opiates.” 13 September 2013. The Hero Project. The Daily Beast. 8 February 2014. .
Amber Jensen’s husband Blake was a member of the South Dakota Army National Guard for ten years, and she has written several essays about our family’s experience during and after his deployment to Iraq in 2005. Her writing has appeared in North Dakota Quarterly, online at The Fertile Source, terrain.org, Gently Read Literature, and Assisi, and was included in the anthology Red, White, and True, edited by Tracy Crow.