I write vignettes of my experiences as a practicing physician at Rikers Island Correctional Facility in NYC here. This is the latest.
He tells me that he want to come off Suboxone, the drug that is being used to treat his craving for narcotics. He tells me that he hasn’t taken it for two days and he feels fine. It’s is an odd story. I am incredulous. His history is complicated, but it seems he got put on methadone upon arrest when his urine came up positive for opiates on a drug test. In jail, this just happens de facto. Very few people refuse. Even if they don’t actually need it, methadone numbs the pain. He tells me he has never actually used heroin. He was only taking pain pills for a gunshot wound incurred the month before. I tell him we don’t know why some people get hooked on narcotics and some walk away. I can walk away, he promises. Again, I try to suppress my disbelief. The story is not impossible, but it is far more likely that there is a motive of secondary gain. Housing? A program? He doesn’t want to be moved from this jail–that is clear, but, what he really wants, it seems, is just to be off the drugs. How his treatment was changed from methadone to Suboxone, is buried in the chart. “I quit methadone– 110mg– cold turkey,” he declares, with pride. Then, he tells me his story. But, it is not at all the story I expect. I stop poking at my computer as he tells it because, suddenly, an almost mythological image arises in my mind of a little boy squatting in the shadow of a massive chemical processing plant somewhere in rural Illinois. “I was out fishing with my father, we used to fish all the time. It was hot, so he told me to go back to the car and get some water. But, it was so far, so I went to the chemical plant and there was a basin by the side of the building and it looked like it was filled with water. Crystal clear water, so I scooped some up with my hands and I drank it, and I think it was water. But, ever since, I never get sick. ” We are both dancing around what he is saying. It’s the Spiderman story. He has given himself a superpower. “Mind over matter,” he says by way of explanation. He has the will so he will do it. I look into his light green eyes, his hair, graying, in long dreads, and I can picture him as a little boy. I imagine all children believe they are magical at some point in their lives. It is a response to the powerlessness of childhood. And, I do not find it surprising that a man in jail would return to that story and remember what that was like when life was new and grass green and sky blue and all the possibilities present on a Saturday afternoon, fishing with your dad. But, now, he is in jail. The story takes him back, and I see him as he was, and I do not take away that hope. I do not disabuse him of this wisp of a belief, that he does have a superpower, that he has been blessed or chosen, that his fate is not just this. I, too, want to believe it. I tell him I do believe there are people who can do superhuman things. “It is like Star Wars,” I say, “the Jedi mindset. If you practice it, you can do it.” He nods in agreement, “if you think you can, you can”. “Yes”, I say. I take his vital signs, and though it is not a miracle, his are normal. There are no signs of withdrawal. So, I take him off the pill