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Now It's Inescapable

Now It's Inescapable

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Now It's Inescapable

330 pagine
5 ore
Jul 4, 2017


Superficially, Dr. Glen Coyle seems to have everything, a beautiful wife, a successful cosmetic surgery and financial security. But postoperative infections are ticking steadily upwards and Glen's patient/surgeon interaction leaves something to be desired. It doesn't take long for official organisations such as the DEA to become concerned and start investigations and those investigations rapidly hone in on a possible criminal offence. As a sideline, Dr. Coyle runs a pain clinic; but aren't those prescriptions abnormally high? If they are it is because Dr. Coyle is hiding a secret, he is addicted to opiates, an addiction that threatens not only his business, but also his marriage and everything he holds dear.
Drawing on his experience of years spent treating addicted physicians, Bill McCausland writes a taut novel about addiction and its consequences. Extra-marital indiscretion, the DEA, unhappy patients - the clock is clicking on Dr. Coyle - but who can he turn to for help?

Jul 4, 2017

Informazioni sull'autore

Bill McCausland has a doctorate in clinical psychology and is APA board certified in the treatment of alcohol and other psychoactive use disorders. He has treated addicted physicians for numerous years and has a wealth of experience. He also has a Master of Fine Arts in creative writing.

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Now It's Inescapable - Bill McCausland


Chapter One

Susan was screaming at me. She had to be a Valium addict—I knew all the signs—since she was an unhinged wreck today. She must have run out of her pills. I drew the receiver away from my ear, since she was shrieking so loudly.

You left me high and dry just like everybody else!

I checked my watch—already late for my next surgery. On the contrary, I shot back, feeling fairly wretched myself this morning. I did more follow-up with you than any other patient that week.

I was trying to remember her face. I could see her nose, the excellent job I did on it, and then remembered our interview in my office before her surgery, the way she inspected me with her narrowed eyes. I should have known she was paranoid.

You messed my nose up on purpose! I look ghastly!

I began to worry she was hinting at blackmail, suing me or reporting me to the Medical Board of California. Why would I want to make you look awful?

I don’t know! But I do! I can see it in the mirror!

I was used to soothing ruffled feathers. It was a big change, I know. But now your nose is in proportion to the rest of your face. And that bump is all gone—your profile is straight as an arrow now. The bulbous shape on the tip of your nose is now perfectly formed. Your nostrils were the size of dimes before I reconstructed them. It was close to an ideal rhinoplasty.

Yeah, and then I got an infection after the surgery and had to take those goddamn antibiotics you prescribed.

Paranoid, maybe schizo, but definitely a bizarre personality disorder, I was sure of it. We discussed you stopping smoking before the procedure because of the risk of infection and you said you’d stop, but didn’t.

Aaaahhhhhhgh! She screeched again into the phone. I really had to get down to the operating room. I cut her off—

Why don’t you speak with my receptionist and make an appointment so we can discuss this in person? I can show you the before pictures if you like.

I heard the line go dead. That was great. My day was looking up. I noticed my hand as I put back the receiver. I was shaking, that little unstoppable tremor that made me feel like I was aging prematurely. If my hands were to be steady in surgery, I needed some help before I entered the operating theater. I found my last bottle of oxycodone in the top desk drawer, and downed a couple.

I headed down the hallway, still preoccupied with thoughts about Susan. The last thing I needed was inspectors sniffing around the clinic. I had to get a hold of myself. I was a tough guy army doc once upon a time. I did war trauma surgery, seeing the most stomach-turning injuries of mangled young soldiers. Those days weren’t that long ago.

I walked into my office-based surgical suite where we do procedures. The thirty five-thousand dollar operating table occupied stage center. The sight of the pricey equipment rang bells in my head. What if Susan won a judgment against me? A jury wouldn’t know a nose job from a hole in the wall.

Get it together, I told myself. The surgical suite was my domain, where I ruled. Of course, it was also my prison, where all my well-guarded secrets were ripe for exposure. You think you know Dr. Glen Coyle, but if you sniff around…

That reminded me. I went to the reception area where the fax machine was located. I sent off the standard order form to our medication distributor.

My nurse anesthetist came up behind me. Jackie looked breathtaking, being thirtyish and svelte, a long-haired brunette with luminous expressive china blue eyes. She was also, oddly, a master of elocution. I had to have the best-spoken anesthetist in California. My patients all became more polite when she spoke to them. I never knew that perfect diction could have that effect on people.

Jackie said, Glen, let me order those medications for you. I’m well versed on what the needs of the office are… for the patients and et al. She had a pleasant, almost bland voice that hid the passions within. I’d sampled some of them myself.

That’s all right. I know you can do it, but I’d prefer keeping tabs on the medication flow myself. Just in case anyone asks.

I make sure there’s always an abundant supply for all the office needs. Now she was speaking in code because the receptionist was overhearing our conversation.

She seemed reluctant to back down, and I wasn’t sure what was going on. She’d let a lot go under the radar so far. Is there some consideration that I don’t know about?

No. I’m just trying to be the helpful me. She practically made a curtsy and turned to walk out of the reception area.

I’d beaten off that attack. Another reason I had a private surgical suite was to escape the scrutiny that came with operating at the hospital, where I would have to submit myself to other physicians or nurses breathing down my neck, inspecting my every move. So, except for reconstructive surgery, I avoided the complicated cases that required the more intensive protocols of the hospital.

I returned to my office to check my schedule, and, like clockwork, Jackie stuck her head through the doorway. Glen, on the schedule for this morning is a combination mastopexy and breast augmentation." Jackie was the linchpin in my surgical team, making the cogs of the operation mesh exactly. She liked to take charge to make sure I didn’t mess up.

Jackie ran through the routine. She would start with Versed, and when the patient calmed down she would add intravenous fentanyl for the induction of anesthesia and Jackie would move to propofol for deep sedation. And then the standard antibiotics to help guard against postoperative infection. For the recovery Jackie would use bupivacaine for the long-acting local anesthesia and then Vicodin via IV.

Jackie languidly ran her hands through her hair, maybe to refocus my attention since I had glazed over listening to the conventional formula. I responded by caressing her cheek.

She answered back with a glowing smile.

No teasing before surgery. Jackie’s voice had an absent sound, flat and clinical. Right, I had to focus.

The scrub nurse, Lana, and circulating nurse came into my office. Okay Dr. Glen, we’re set to go. Colette Hardel is ready in the operating suite. She’s pretty antsy.

The comment about the unhappy patient set off a thrumming sensation, reminding me of the conversation with Susan. I hurriedly changed into scrubs and joined the surgical team in the suite. The room didn’t have much of a smell, except for the residual faint odors of disinfectant and cleaning solution, since the cubic feet per minute (CFM) filter setting swept and sanitized the air giving it a mostly neutral smell.

The surgical platform’s positioning functions were run by a handheld control device. The operating table had the capacity to handle up to a seven hundred-pound person. God save me if I ever had to operate and do liposuction on someone that heavy. The three pieces of wall art were dreamy, mystical looking landscapes, which set the stage for the patient to drift off into the ether. Overhead were two large disc-shaped adjustable operating lights.

Jackie checked the functions of the anesthesia machine and oversaw the vital signs monitor, each situated above and to the left of where the patient’s head would be. The scrub nurse placed the surgical instruments and drapes on a narrow stainless steel rolling table situated to be moved closer or out of the way depending on my surgical needs—to the left of the operating table. The stainless steel table held other surgical supplies, such as Betadine microbicide surgical scrub to topically de-germ the patient’s skin before surgery.

Blue drapes would cover the patient during surgery and generally expose only the operating surface. An endotracheal tube maintained intubation that secured the airway of the patient, and if needed a stream of nitrous oxide. The suite had oxygen, and IV fluids to hydrate the patient. The circulating nurse kept things clean and tidy. The four-person team made the day’s work sleekly process.

Colette was already dressed in a surgical gown. Her hair neatly enveloped in a clear head cover. I took her hand and said, Are you ready to become more beautiful? I couldn’t seem to get the hackneyed starch out of my voice. Sometimes I despised myself for being so rote and lacking the authenticity to be more genuine.

I’ve been up and down getting ready—anticipating this operation. My husband has big… expectations. She bit the corner of her lip. He’s looking forward to the new me. She was twisting her wedding band, and then clutched the fabric of her gown. He thinks I’ll look like I’ve stepped out of a magazine.

You must be a little apprehensive. My two comments so far sounded like I’d hit the replay button on a tape recorder. Jackie and Lana and Ann turned bland smiles.

Tense? Yeah. On edge, yeah, but I still want it. Colette looked off for a moment, like she was in another universe. Her face radiated a plea as if Colette desperately wanted me to understand, to take good care of her. It’s like I fear waking up in the middle of the operation and I won’t be able to talk. Or I won’t be able to wake up at all.

You know what that says?


You’re on target. Those are the usual fears that patients have before the procedure.

So, I’m normal?

Yes. We’d be concerned if you didn’t have some uneasiness.

I was no longer faking a good bedside manner. I increased compassion and rapport with the patient. I told Colette we’d first administer a sedative which was short-acting and high potency. It was amnestic, meaning she wouldn’t remember much after taking it, and then when she was calm we would start the anesthesia. I told her each step of the procedure and in my head I was saying blah, blah, blah, as my lips mechanically made the right cooing sounds.

The nurses feigned thoughtful expressions helping to hide how phony I sounded. Jackie will send you home with instructions, so you don’t need to remember what we just went over.

Colette shifted on the surgical table, looking like she couldn’t get comfortable. What else?

I turned on some soft music—a Mozart violin concerto, and then went to a cabinet and pulled out several magazines. Let’s look at some possibilities. The surgical lift will restore your breasts after the wear and tear of having two kids. But don’t you want to make your breasts more of a work of beauty? I thumbed through a Playboy magazine to demonstrate some luscious examples of well-shaped breasts.

Colette let out a little yelp. I can’t believe you’re doing this. She fanned herself. But I have to admit those uptight medical before and after photos you also showed me at our initial consultation were boring. You know, the somber straight-faced women with the big boobs and with their backs up against what looked like a baby blue curtain.

Ann was hiding her repugnance because of the magazine, but Lana said, He’s not fooling around showing you the sexy chicks. Dr. Coyle will create a new you.

Ann blurted out, Yeah, be ready for a hot rack! We all looked at her, and Ann rolled her eyes. Still, the quips eased Colette’s pre-surgical anxiety.

She scrutinized the magazine pictures and then her eyes widened. She pointed, Just like that. I won’t be able to get my husband off me. Now, that’s what he would call walking right out of a magazine.

It was time to turn back on the serious-doctor act. Colette, let’s double-check your medical status that we initially talked about.

We went over bits and pieces about her history and their possible effects on the procedure. The hum of the suction device and the anesthesia machine started up. The monitor displayed the patient’s vital signs. Lana stood by the surgical instruments, ready to assist me. Jackie began the sedation, followed by the fentanyl for anesthesia. We inserted the breathing tube for tracheal intubation, followed by the propofol for deep anesthesia, and a small dose of antibiotics for infection prophylaxis. Colette drifted to a faraway place.

I said, Ann, enough of the spa experience. Turn off that goddamn Mozart and put on Green Day.

I marked up Colette’s chest where I’d make the incisions. Lana was right on the beat. Here’s your instrument, Dr. C.

Ann adjusted the sound on the music system. So, Dr. Glen we’ve all taken some time off. When is your turn?

I was already getting hammered by my wife on the subject. Now the surgery staff was getting on my case. Have you been conspiring with Julie?


This morning Julie asked me the same thing.

Jackie said, Well, it’s been a while since you’ve taken time off.

The truth was I didn’t want to be disconnected from my supply. I’ve got this and that to consider before taking time away from the office.

Keeping a poker face I tried to refocus on the mastopexy. Yet my agitation was revealed when I fumbled, dropping the scalpel. It danced off the hard linoleum floor and made a clanging sound as it ricocheted off the stainless steel leg of the instrument table.

Jackie and Lana and Ann went abruptly silent sensing something was wrong. Lana stoically handed me another scalpel, while Ann picked up the blood-tinged stainless steel instrument from the floor. She carefully wiped the blood specks off the operating deck. All the machines droned in my ears.

Jackie said, I’m glad didn’t spear yourself in the foot, Glen. You would not uphold your surgical standards hopping around the surgical suite on one foot. Lana and Ann managed to manufacture some laughter.

My cell phone rang. Annoyed by yet another interruption, I ordered, Ann, will you get that?

She picked up the telephone and read the screen. It’s Julie. She tapped the speak button. Hi, Julie. Glen is in the middle of a procedure. She listened for a couple of seconds. Glen, she is nailing down plans to go to Colorado and wants to know the dates you can go.

Tell her I’ll check. But really I wanted to put her off. Going to Colorado meant playing out another scene in the unending saga of Julie and her parents. Distressed, I realized the pressure I was putting on the scalpel and eased up. After the harangue that Susan put me through I didn’t want to mess up the operation on Colette.

Did you hear that? No? Glen said he’d check. Ann took note. Okay, goodbye. She set the phone aside. Julie has been checking flights out of San Francisco and wants to hook up with her triathlon friend to work out with in Colorado and to see her parents.

We hadn’t seen her parents for ages, and for good reason. She must have amnesia if she was thinking of stepping into that horror show. She hated them more than I did. Still, I knew the obligatory visit to Colorado was inescapable.

I robotically worked through the routine breast lift and augmentation procedures. The surgical team ran as a tight multi-operational unit despite all my preoccupations—amazing how well we got the job done, given they had a maniac as the head of their crew.

After I had finished up and the patient was wheeled away, I said, Jackie, while you work with Colette in recovery, I’ll take care of wasting the unspent drugs.

My voice wasn’t overly dismissive, since she was supposed to watch me waste the drugs. She knew what I was up to, though. I took the remaining drugs to my office. I promptly deposited them in my cache to protect the supply.

I still had my hand in my desk drawer when I felt a new presence. I glanced up at the receptionist who had materialized in front of my desk. Tara Swan called… She has a postoperative infection.

At that moment Jackie appeared as well. My hands remained stiffly inside the drawer, not wanting to draw attention. Call her back and tell her to have her primary care physician take care of it.

She already contacted her PCP. He told her to call you since you are the treating physician who is responsible for the surgery.

Her primary care physician was an uptight asshole. I managed to slide the drawer closed as though everything was routine. Okay, I’ll take care of it.

Jackie was a nurse practitioner and licensed to recommend medications under a physician’s supervision. She said, Glen, do you want me to call Tara and determine the symptoms? I should be able to prescribe some antibiotics.

Sure. Thanks. You know the drill.

Jackie didn’t go, however, but instead approached me. She murmured, I have to say something that can’t wait.

The apprehensive look on Jackie’s face unnerved me. So, what’s the problem?

The practice has experienced more and more outcome problems lately. I mean, she added, as if apologizing, the procedures are great, but the rate of infection is above the norm.

You think there’s erosion in my skills? I felt the creases form in my forehead, thinking Jackie was going to turn on me.

I think you’d better watch it.

I wasn’t bowing that low. And if—

I don’t think Lana or Ann is a whistleblower, but if more patient complaints are generated there could be a report to the Medical Board of California or an inquiry by the Physician Well Being Committee at the hospital.

I felt heat in my cheeks. Those goddamn women are not following the postoperative instructions.

She laid a light hand on my arm. Look, I’m your friend.

I laughed. I’d like to think it’s a tad more than that.

Come on, Glen, not right now, she said pulling away. I’ll speak plainly. You don’t look right in the morning until the medication safe is opened up.

I can handle it. It’s not like I’m spiraling in some dark vortex that’s sucking me down to hell. I was protesting too vigorously. She, of all people, knew how much medication was disappearing inside my desk.

Glen, I care for you, but I hate…

My fists got tighter, thinking she was about to throw me off a cliff. Finish your sentence.

Jackie was not going to be intimidated. There’s so much at stake, and these days I don’t know what’s going to happen next. I mean goddamn it, Glen, you scare me. You have to stop.

Like that was going to happen. A tightness developed in my throat. I wasn’t putting up with any more of this bullshit. I paid everyone’s salaries, every second Friday. Is that it?

Jackie stormed out, in a huff.

I could feel my skin tingling weirdly, like yellow jackets were buzzing all over me. I could feel a strangled pulsing in my blood, a gushing through my veins that made my wrists ache. Jackie, my accomplice through so much, had just defied me.

The practice I had built was tottering, shifting on the pills I ingested by the truckload. She was right, I had to stop. And I would when I wanted to. Right now, though, I was hoping she’d leave the office so I could reach my hand inside my desk drawer.

Chapter Two

The overhead announcements said what flights were boarding. Julie was wearing Lycra athletic pants, running shoes and a hooded navy blue sweatshirt that had the Boston Marathon lettered on it in white. Her hair was pulled back in a swishing ponytail. We passed through security at the San Francisco airport to board our two and a half hour flight to Denver. I could feel my nerves jumping when I put my carryon bag on the conveyer belt to be scanned.

I didn’t pack the medication in case the airline lost our bags. I took only the standard maximum daily dose of the opiate, Vicodin—eight tablets per day for seven days and an extra day in case there was some a flight delay. Sixty-four of the hydrocodone and acetaminophen tabs to get me through the week. Really not optimal for me, but it would have to do. I couldn’t get caught by some idiot TSA officer. I had the medication in a container with Julie’s name on it and the prescription signature for dosage. She wouldn’t like it, but she would cover for me.

I was on edge all the way through the gauntlet. I’m tattered, anticipating the TSA security people were going to hassle me about the drugs I was carrying. I felt skinless; my hyper-vigilant gaze darted from place to place while going through security. I had strange sensations, being hyped on opiates, mixed with adrenaline. But the place was packed and we slid through.

My eye was twitching rapidly, and I had to calm myself down. I didn’t want to call any attention at all to my frayed nerves, but I said to Julie, I’m so relieved they didn’t harass us. They always make me feel like a drug dealer.

Nonsense, Glen. I mean anyone who knows you knows you’re a drug taker.

Julie and I tapped on the door of her parents’ French provincial house. The landscaping was potentially beautiful, but an overgrown mess, mirroring the state of mind of the occupants within. I saw a conflicting look of horror and hope on Julie’s face, a crease across her forehead and uplifted cheeks from her smile. Well, hello. It’s so good to see you. We walked into the home where she spent her childhood. The antique furniture looked like it had not been polished in ages, and a finger’s experiment revealed a layer of dust on the sideboard. The terrible two—Tess and Thad—hugged and pulled us into the house. The gush of his acetaldehyde breath was a left over from yesterday’s drinking.

The expectancy of cloyingly sweet honey was sickening. As always, I wanted to defend Julie against what’s coming next. Thad rubbed his hands together. His eyes brightened, I just made a pitcher of vodka martinis. Let me pour you one.

Tess jerked her head up and down in eager agreement. Her bubbly grin puffed up her spider-veined cheeks.

They always offered us drinks the split second after we walked through the door. They were so pushy; it agitated the hell out of me. We’ve been here thirty seconds and you want to get us juiced, I remarked wryly.

As much as I loved bright-minded and beautiful Julie, I had to deal with the sloppy mess of having Thad and Tess for in-laws. They couldn’t wait to shit on their daughter, despite being through it a million times, she came back for more.

Hey Glen, good to see ya, son. Thad leaned his head back and chortled, adding the unattractive bit of putting his hands on his liquor-bloated paunch. Beyond his head I noticed a couple of paintings on the wall that were crooked. The impact of two people staggering around a house could make things out of whack, I supposed.

I saw the change on Julie’s face. Now she realized she was back in the morass of her toxic childhood. Hello, Dad. She patted him on his shoulder to get his attention.

Thad perked up and gave her a bear hug. He looked as if he was about to crush her ribs. Okay, darling. He pulled back. His beaming smile showed two rows of straight teeth. They must have been veneers—too perfect and overly white, almost looking iridescent. Let me get you a drink.

No thanks. I’m in training for the Ironman in Hawaii this October. Liz and I are doing a hundred-miler road bike training ride tomorrow. Julie was remaining upbeat, avoiding any comment on cocktails at noon. Drinking is out and nutrition is in.

Tess furrowed her brow. When’d you get so pure on us?

Julie always wanted her folks to simply say she’s okay, and they’re so preoccupied with themselves, they never acknowledged her accomplishments. I saw this every time we came to visit them—she’d emotionally get down on her knees and beg like she a five-year-old waif.

I decided to fill in the slack. You’ve got an accomplished daughter, you know. Her prowess as a long-distance runner is nothing short of remarkable. And then I shrank inside myself, not wanting to be sucked into their cesspool.

Tess shrugged it off. Well, honey, don’t you think all that running for someone your age is a waste of time? I mean to say, we provided you with a wonderful education at Scripps College and the only good that came from it was meeting Glen. She produced a half smile that didn’t cancel out her bloodshot eyes.

I thought about the amazing good fortune of going to Pomona, practically right next door to Julie. But Tess wasn’t interested in what a gifted daughter she had.

Julie was determined to stay upbeat. It’s what I want to do, she said simply.

Thad muscled in, not wanting to miss out on the blood sport. You really like all that running around, treading water and pushing pedals? His voice boomed. An educated girl like you.

I couldn’t help myself. Yeah, Thad, the body and the mind work together, you know. I believe they were teaching that even back in your day.

Faced with my unmistakable hostility, Thad flipped the conversation. He slapped me on the back. Say, son, I’m glad you’re in one piece. Did you almost get your ass shot off over there in Iraq?

I felt a burning anger toward Thad who never served in combat. I wanted to return the favor by slapping Thad so hard on his back that he’d fall face first onto the hardwood floor. However, I merely replied, Yep, I almost got my ass shot off.

Terrible images always hovered just beyond my consciousness, flooding in at the last reminders. Soldiers with their feet blown off. Whole faces penetrated by debris from IEDs. The ass being shot off comment insulted all of the poor souls I stitched back together in the OR. The country they fought for included alcoholic blowhards like Thad.

Tess looked at Thad. Let’s have that drink now.

I was still reeling from my surge of anger. I had to calm down for Julie’s sake. I said, I need to use the bathroom.

Tess gulped down a third of her martini. Use the bathroom in the master bedroom. The plunger in the guest bathroom is broken. Why was I surprised?

As I walked out of the room, Julie followed right on my tail. When we got to the bedroom with the unmade bed—with clothes on the floor—she reached for me. I held her tight, imagining how she was

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