Pain Management

in MS’ routine every time patients complained. Now, finally, it looks like they figured it out. . . .”

“Or decided to finally give a fuck!” the man standing behind her said.

Dawn reached back with her right hand as he was reaching down with his. Their hands met as if connected by an invisible wire. “Yes,” she said. “And now the Multiple Sclerosis Society is admitting that as many as seventy percent of folks with MS have what they call ‘clinically significant pain’ at some point, with around forty-eight percent of us suffering from it chronically.”

“You couldn’t get painkillers for MS?” I asked her, surprised despite everything I’d been hearing.

“Well, you could always get drugs,” she sneered. “Even in the bad old days, neurologists liked handing them out—stuff like Xanax and Valium. Not because our muscle cramps and flexor spasms were ‘real,’ you understand. Since the pain was ‘all in our heads,’ they figured the tranqs would calm us down and make the problems in our brains and in our spines magically disappear. And since they did acknowledge that the deep fatigue was ‘real,’ you could always get stimulants.”

“But aren’t all those just as addictive as painkillers?” I asked her.

“Addictive?” She laughed. “Oh, hell yes. I had one neuro prescribing eighty to a hundred milligrams of Valium a day for me. She told me not to worry, there was no chance of becoming addicted. Needless to say, she was full of it. She just wanted her patients calm and placid, so they wouldn’t complain or take up too much of her time. Medicaid wasn’t paying her to give a damn, just to keep us quiet.”

Her left arm twitched. Her mouth was calm, but I saw the stab in her eyes. She took a deep breath through her nose, pushed it into her stomach, then her chest, and finally into her throat. Let it out, slow. A yoga practitioner, then. People in pain try every path out of that jungle.

“Let me tell you,” she went on, “detoxing from the Valium was a megaton worse than jonesing off cocaine. They used to say that was nonaddictive, too. But when I was young, I was into all kinds of street drugs, even freebasing. And I got off all of them myself. No programs, no nothing. But that Valium . . . damn!

“And all the stims they hand out for fatigue, they have pretty serious side effects . . . plus a potential for permanent damage I’m not willing to accept. The hell with the neuros. These days, I treat the fatigue with good strong coffee and naps.”

“What about the pain?”

“All I get for that is the medical marijuana—it’s the only ‘illegal’ drug I’ve used since I got pregnant, and Tam’s eighteen now. And in college,” she said, proudly. “But even that doesn’t always work.”

“And that slimy Supreme Court just struck down the law that allows medical marijuana,” Ann said, fiercely. “They won’t let people even—”

“Shhh, honey,” Dawn said to her. “Look,” she said earnestly, turning to me, leaning forward slightly, her man’s big hand on her shoulder, “the thing about neurologically based chronic pain is, it doesn’t work like ‘normal’ pain. Pot isn’t enough. It relaxes the muscles just great, but does nothing at all for ‘nerve burn.’ It’s like a really bad sunburn, only all over your whole body. I can even feel it inside—like if you could get a sunburn on your large intestine, or something.

“And the thing about that is, when it gets bad enough, it makes you . . . I don’t know . . . something less than human. When you can’t sleep, can’t sit up, can’t move, can’t get any kind of relief, just lay there and cry, curled up in a ball. It got to the point where I was willing to do just about . . . anything to make it stop, even for a few minutes.”

“The only people who really understand pain are the ones who have it,” her man said, making it clear he was ready to help a few doctors learn. “When Dawn scratched her cornea, that lowlife punk in the white coat acted like she did it on purpose, just to score a few stinking Vicodins. You think I couldn’t find better stuff in ten minutes? You think I don’t know where the tweek labs are? If Dawn hadn’t . . .”

He didn’t finish. Didn’t have to.

“What’s with the Grand Tour?” I asked Ann on the drive back toward Portland.

“I’m not sure what you mean.”

“All these people, the ones you’re making sure I meet. They’re all in on whatever scheme you’ve got going. What do I need to see them for?”

“I thought, maybe if you knew that it wasn’t just about cancer . . . if you knew the . . . caliber of the people we’ve got involved, and why they’re doing it, you’d—”

“What? Enlist in the cause? This was supposed to be a trade, remember?”

“I told you, I’m ready to take you back to Kruger any—”

“And I told you, I don’t think it’s over. And if I want to get anything out of him, I need to make sure it is.”

“That’s the real reason you’ve been with me every second, then. Not because you really wanted to meet the others.”

“You like saying things like ‘real reason,’ don’t you? Like you’re just pure virgin goodness and, me, I’m a man for hire. You’re right about the last part, anyway. Only thing is, I’m not a stupid man for hire. Reason you brought me around to all those people is so they’d get a good long look at me, right? Just in case something goes wrong . . .”

“What could go—?”

“I think you’ve got a lot of information, and maybe even some halfass plan, but you’re not sure yet. Besides, I think maybe you’ve got desire confused with skill.”

“What are you talking about?”

“I knew a girl once. Janelle. She was loyal to the core. The kind of girl who’d never drop a dime. But she was so dumb, she might let one slip, you understand?”

“Yes,” she said, keeping her anger at bay because she wanted something. Or maybe she was smart enough to realize I wasn’t talking about her.

“We’ve been doing this running around for almost a week,” I told her. “I met a lot of people. More than one who could do anything I could do. Dawn’s man, he’s a good example. So here’s what I think, lady. I think I’m the perfect man for your job. Because the people you’ve got, they’re all good people. In your mind, anyway. You don’t mind them doing some stealing, maybe. But violence, that’s not their thing, as far as you’re concerned. And that’s all that counts, what you think. No plan is perfect. If things go wrong, if somebody has to be hurt—”

“Like that . . . man with the white knife.”

“Yeah. Like him. I’m perfect for it, the way you got it scoped. If I have to take a fall, well, I’ve been down before. And you know I wouldn’t take anybody else with me.”

“You think I set up the whole—?”

“Yeah. Yeah, I do. I mean, sure, it’s true: there was a freak doing shakedown. And Kruger was burned about it. And maybe there even are a couple of men looking for Rosebud, too. But I think this was all about me proving in. Again.”

“What are you talking about?”

“A test. Another test.”

“That’s not true! I need your help, I told you that. And I wanted to show you that we could . . . I mean, SueEllen alone, she’s good for the money I promised you. But I never thought it would come to—”

“I see how careful you are about risking your own people. You had it your way, none of them would be in on it.”

“They’re not criminals. All they want is to—”

“Sure. I’ve heard it. Heard a lot of it, these past few days. So it’s just you and me, right, bitch? Joan of Arc and the expendable fucking ex-con.”

She did a lousy job of trying to slap me as we were rounding a long curve, but a pretty good job of almost running us off the road. I kept my right hand and forearm in a blocking position in case she wanted to take another shot, but she seemed done.