Placebo Junkies (21 page)

Well, hello there, faithful readers.

Or shall I address you simply as the voices in my head?

No, no, you're right. Let's not drop the charade just yet. It's a productive conversation, in any event, regardless of how you classify our relationship here.

If a blogger shits on the Web and nobody clicks on it…?

Anyway. For today's topic, let's move outside ourselves for a moment. It's so easy to get focused on our own bottom line, on the
me, me, me
of it all, that sometimes we forget to examine the motives of people around us. People whose behavior and decisions may be controlling
our
behavior and decisions.

People who hold invisible keys.

When you don't even know you're locked in a cage, you don't realize how limited your options are. And then you just end up chasing your own tail.

Ha ha—see what I did there? Oh, sorry. Inside joke. I'll explain some other time.

Moving on.

Up until now we've been focused on the microeconomics of the testing world.
Who
will pay
how much
for
which
study. Oh, and how much each of those pills or procedures is going to hurt, of course. We've been distracted by all the talk about
this
scalpel, and
that
side effect. How am I going to feel
today
? Will I still have that rash
tomorrow
?
Which
of my friends will end up in a morgue, and
which
one will stick a knife in my back?

The shitty nitty-gritty.

Because that's all you can see when you're locked in a cage.

But when you get out of that cage, escape even for a moment, all of a sudden you see the big picture. The macroeconomics, you could say.

Do you remember anything from your econ class? If you even made it that far in school, obviously. Does GDP ring a bell? Gross domestic product? It's the total value of all the crap a country produces in a year.

Yeah, snoozefest, I know. But let's talk about the guinea pig version, which I think is a little more interesting:

Gross Domestic Pain (GDP):
The total value of all the things you've ever taken. Pills and kicks and slaps. Insults you've sucked up, bullshit you've tolerated. Electrodes on your skull, a stranger's hands on you, in you, holding you down, holding you back. An experimental cough syrup. A prison sentence. A needle in your spine. The endless grief of everyday life.

Because, really, isn't it all the same?

Gross Domestic Pain: the value of everything you've ever absorbed.

So what?

What's the fucking point?

To be honest, chickadee(s), I'm not really sure. But I guess if I've learned anything, anything at all from this lab-rat life, it's the importance of control. The importance of taking all the crap life has thrown at you all these years, and turning it back on the crap flingers.

So use your GDP, my silent, invisible friends. Add up all the pain you've accrued over the course of your lifetime. And once you're sure there's enough—that is, once you're certain you've had enough—then cash out and spend it wisely.

And never look back.

Once our stack of flyers is exhausted, we drive in Jameson's shitty, dented car to a shitty, dented strip mall in a shitty, dented part of town, where a testing center sits between two vacant storefronts.
CLINIC
says the sign masking-taped to the door.

This is not a place for healing, says everything in sight.

Jameson tucks his shirt into his pants before we walk in. Smooths his hair. Stands a little taller.

We go inside and he cuts through the crowded waiting room to an office door in the back. He knocks once, then opens the door without waiting for an answer.

I know without being told that I'm to wait out here, so I sit down in an empty chair in the back of the room. I can still hear him from here. He's talking in a different voice than he uses with me, a little deeper and maybe a little louder, and he's using words like
clinical assessment
and
population
and
inclusion criteria.
He doesn't do his throat-clearing thing, not even once, and he doesn't sound like an orderly anymore.

Here, he sounds like a guy with a well-tucked-in shirt who's read lots of medical journals. Here, he looks like a man who's in control of his life.

Naughty little schemer.

I can't see the person he's speaking to inside the office, but I can hear a woman's voice murmuring sounds of agreement and appreciation. It makes me feel better to know I'm not the only one who's been tricked into believing in a fictional version of Jameson.

He looks over his shoulder, then closes the door so I can't hear what's being said anymore. Denied, I focus instead on the people sitting around me in various states of quiet agitation. It's depressing as hell, the view from here, and I wish I had waited in the car.

This is not a smartphone-checking kind of crowd.

This is not a magazines-and-bottled-water type of waiting room.

These are not sick people in search of a cure.

All around me, I see my future. It's like a Benetton ad turned inside out in here—a grayscale cross-section of the indigent and the addicted. Labor-dirtied men whose spring-loaded postures and darting eyes telegraph their questionable immigration status sit next to pierced and green-haired teenagers carrying their world's worth of possessions in backpacks covered in Sharpie-drawn anarchy symbols. A woman with trembling hands sits next to a man with a trembling jaw.

The destitute. The down-and-out. This is a no-other-options kind of crowd—each and every one of us.

Because, let's be honest. I'm one of them, aren't I?

Like its occupants, the room itself is filthy, the patchy carpet tarred over with a decade's worth of grime, the walls covered with scuffs and smears and graffiti. An overflowing trash can sits on its side in the corner.

Back at the hospital, there is at least the comfort of procedure and the pretense of a cure. There is protocol. Basic sanitation, at a minimum. Even when they're torturing you—tearing your flesh, or scrambling your brain—at least they practice good hygiene while they do it. They steal your thoughts in sterile conditions. They document your screams in triplicate.

Not here. This is a place where hopes curdle and options wither. This is the clinic at the end of the world.

Have I been here before?

I double over, head on my knees, trying to stop the panic that's fluttering and expanding inside my chest like a trap-frenzied bird. I try to slow my breathing, but I can hear the animal sounds of my panting and I know I'm already too far gone.

Have I been here before?

“Jameson!” His name tears out of my throat in a shrieky roar. Downturned faces swivel up in concern, and even in my panic it's not lost on me that
I
am the spectacle in this roomful of castoffs.
I
am the down-est and the out-est.

I am the crazy one.

Jameson comes running and now he's an orderly again, whisking me up and out by my arm, gripping hard enough that I know it's going to leave a bruise. By the apologies he offers over his shoulder as he steers me through the door, it's clear he's more embarrassed than concerned.

“Audie, what the fuck?” he asks once we're back in his car. “I was in the middle of a business conversation in there.” His voice is whiny, like a child who wants what he can't have.

“What the hell is that place?”

He sighs. “It's called a CRO. A contract research organization.”

He tries to stop there, as if that answered anything at all, but he sees me glaring at him and heaves another big sigh, like I'm torturing the answer out of him.

“It's capitalism. That's what it is.” He puts a hand up in the air. “I know, I know—don't look at me like that. It's fucking disgusting in there. They run clinical trials for whoever's willing to pay for it. Some of the big pharmaceutical and biotech companies like to outsource the grunt work, so they pay places like this to do it for them.”

“They do medical research in that dump? I felt like I was about to audition for a goddamn snuff film in there. Incidentally, can we get out of here? This place gives me the creeps.”

Jameson tells me I'm being melodramatic, then puts the car in reverse. Halfway out of the parking space, he slams on the brakes. “Damn it!” he swears, and jumps out of the car. “I didn't hit you, did I?” I hear him asking the person standing behind his car.

I climb out, too, just in time to see the look of unhappy recognition flit across Jameson's face. The dark-haired young man staring at the bumper that's stopped a centimeter from his kneecaps, on the other hand, shows no sign that he's even registered our presence. “Oh, hello there,” Jameson says. “Uh, how are things going? Well, I hope? I thought you were long gone by now.” He's trying to use the formal, tucked-in-shirt voice he'd been using inside, but I can hear his nervous stammer jitterbugging underneath his words.

The man hitches one bony shoulder up in response, a vague semblance of a shrug, but keeps his eyes on the car's bumper. I have to fight the urge not to reach out and rip off the grimy hospital bracelet I see looped around his wrist; it looks like it's been there a very long time.

Jameson lets out a phony laugh sound and gestures over to the guy, who shows no signs of moving. “This is the hardest-working guy I've ever met,” he says to me in a loud voice. He turns back to the man with an overbright smile. “You're saving up for your wedding or something back home, isn't that right? Or was it law school? I remember it was something important.”

The young man turns his glassy, unfocused eyes to Jameson, but still doesn't answer.

Heh heh.
Jameson's nervous throat-clearing habit comes back before he can fill the awkward silence. “See, I told you this was a good gig,” he says to me. “Guys like this come over here for a month or two and make ten times what they can in a year back home. Free medical care, too. Right?” he prompts the man, who does not look like he's been on the receiving end of anything remotely resembling proper medical care.

Finally, the guy seems to hear what Jameson's saying, and a huge grin splits his face. “Ka-ching,” I think he says, though his accent makes it hard to be sure. “I got one. A side effect—one of the big, good-bad ones. I just gotta check for my check, see if it's here yet, then I'll go home.” This seems to amuse him, and the smile across his face goes even bigger. “Check for my check for my check,” he says, then giggles in a high-pitched voice.

“Ka-ching,” he sings out one more time, and then turns around to resume his shuffling, crooked path across the parking lot toward the clinic.

“Holy fuck, Jameson” is all I can think to say as we slide back into his car.

He shakes his head to stop me from saying anything else. “They're not all like that. That guy…this study is…” He sounds rattled. “This study is more concerned with maximizing profit than most of the others I've worked with. The lower the overhead costs, the more money they get to keep at the end of the trial period, so some places cut corners anywhere they can. The testing you've been doing has all been at a university hospital. It's just a totally different business model.”

I try to ask him in the nicest possible way how a loony-bin orderly got so involved with whatever it is he's talking about, but it doesn't come out as tactfully as I hoped, and Jameson clamps his mouth shut and sulks in silence for almost the entire car ride back home.

Back to the hospital, I mean.

To the Cedar Fucking Hill Center for the Reality-Challenged.

A few blocks out, though, he finally answers. “I help out with the recruiting. They need bodies through the door, as many as they can get. They have a tight deadline, and they get a bonus if they meet it. It's big money, Audie. For them, for me, and for
you
if you'll help me.” He gives me a pointed look. “And for the volunteers, too. Most of whom, I should add, wouldn't be getting any medical treatment at all if it weren't for this study. So it's not as bad as it looks, I swear.” He sounds like he's trying to convince himself.

Dirty rotten liar.

“I can't get caught recruiting anyone from Cedar Hill. I told you, O'Brien's been breathing down my neck. But
you
can talk to people there. Spread the word. I'll even go up to a sixty-forty split for anyone you recruit.”

“What are they testing?” I don't look at him when I ask. I don't want him to know what I'm thinking. Which dots I'm connecting.

He perks up a little. “Long-acting antipsychotics. It's pretty cool, actually. You take a bunch of people like the ones we saw today, it's obvious they're never going to comply with regular treatment, which basically consists of shoving jarfuls of pills with unpleasant side effects down their throats. We send people like that out in the world with a handful of prescriptions they're never going to fill, and then we wonder why so many mentally ill people are homeless or in prison.”

He's animated now, the sulking already forgotten. It actually makes him happy, talking about this stuff. I think about all the times I've seen him playing armchair doctor, reading medical journals he probably swiped out of the offices of the real doctors. This is who Jameson wants to be—a scientist, or a businessman, or some twisted hybrid of the two, instead of a lowly peon in a nuthouse, a half step up in rank from janitor.

We all have our fantasy lives, don't we? There's a fine line between delusional and ambitious, it occurs to me. We're all just hoping for a better reality.

He's still going on about the trials. “If this stuff works, it could really make a difference. Get this—instead of pills, it's an injectable, which gets rid of the whole compliance problem. It goes right in the spine, and lasts for months. They already know the stuff works; now they're just focusing on administration issues, trying to figure out if placement or frequency changes the outcome.”

I go cold when he says this. “Spinal injections, hmm? Let me guess: they make a little tattoo at the injection site?”

Jameson nods, too busy accelerating through a yellow light to notice my reaction. “Yeah, they rotate the injection location, so the tats are to make sure they don't accidentally repeat the same location.”

I picture Charlotte's back.

I picture Mary's back.

My lips feel numb and my spine tingles in the most literal way—like someone is brushing against it with the tip of a needle. It's funny how sometimes your body remembers things your mind doesn't.

Or perhaps I just have an overactive imagination.

I know without him saying so that some sick bastard in that fly-by-night craphole of a clinic likes to get creative with their markings. Why ink up your nut-job test subjects with a boring old X-marks-the-spot when you could have fun? With little snakes eating their own tails, perhaps?

“Jameson, did you send Charlotte there? Is that what happened—you sold her out, and something went wrong?”

His hands go tight on the steering wheel, and he doesn't  answer.

But his silence
is
an answer. “Is that why she had all that cash? Was that some kind of giant payday for both of you?”

He pulls into the hospital parking lot too fast, car tires squealing, and then brakes hard enough that I slam forward against my seat belt. It locks into place and restrains me, just as it's supposed to do. Just as he's supposed to do.

It's for my own good.

“ ‘She's in a better place.' Isn't that what you said? And where exactly is that better place, Jameson? Did you fucking kill Charlotte?” I'm getting louder with every word. Shriller. Angrier. “Or did you just turn her into a vegetable with your little not-such-a-fucking-miracle cure?” I need to be calmer than this; I need to be more lucid than this when I ask him these questions. This is too important for crazy, I know it is, but I can't seem to control what's coming out anymore.

“How much did they pay you for her? How much was Charlotte worth?” I scream. “A new pair of shoes, maybe? A set of tires for this shitty car? I hope they're really great fucking tires, Jameson!”

He reaches over me and flings open my door. His mouth is clamped shut—he's done talking.

He looks around. To make sure no one else heard me? Or maybe for help.

My head is buzzing again, and I know that I've just spoiled everything. My anger sounds like a hive of bees inside my skull.

Orderly-quick, Jameson hops out and comes around to my side, scoops me out, and hustles me away from his car before I even realize what he's doing. “This was a mistake,” he says. “You're still fucking crazy. Go check yourself back in. Do it now, and I won't report this to O'Brien.”

He gets in his car, watches me with his doors locked and windows up.

We stay like this, staring at each other, for another minute, then he roars out of the lot, his tires nearly rolling over my foot.