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Boxed Warning : This type of warning is also commonly referred to as a “black box warning.” It appears on a prescription drug’s label and is designed to call attention to serious or life-threatening risks.
Adverse Drug Reaction: An adverse drug reaction, also called a side effect, is any undesirable experience associated with the use of a medicine in a patient. Adverse events can range from mild to severe. Serious adverse events are those that can cause disability, are life-threatening, result in hospitalization or death, or are birth defects.
—FDA Consumer Health Information/ US Food and Drug Administration, November 2012
Most common adverse reactions (incidence ≥ 5% and at least twice the rate of placebo) were (6.1):
• Schizophrenia: extrapyramidal symptoms and akathisia
• Bipolar mania: extrapyramidal symptoms, akathisia, dyspepsia, vomiting, somnolence, and restlessness
—VRAYLAR (cariprazine) Capsules, Reference ID: 3821760
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James doesn’t remember the pinch or the burn the first time. Just the shadows of his captors and the fog of the drug he’s been given. They’re saying something to him, but he can’t understand it. It isn’t English, and it doesn’t sound like Pashto. James cycles through the bits and pieces of French and Spanish cached in the recesses of his brain, then stops when he gets to Yiddish. It’s been greater than a decade since he’s heard any of that, though somewhere in the haze he’s eight years old again and in trouble.
There’s a sound like the cocking of a gun, and he realizes he’s just scared. Then there’s a needle in his arm again, and he’s asleep.
***
James opens his eyes when the water hits his face. It’s just water, no cloth, but it still makes his eyes burn. Or perhaps it’s the chink of neon sunlight filtering through a crack in the boarded-up window. He struggles to recall whether it was light outside last time. He thinks not, but he can’t be sure.
Liquid hits his skin again, dripping down James’s cheeks and into his mouth. It smells like dirt and animal shit, the sort of water that pools and festers at the bottoms of ditches. It might mean he’s somewhere without modern plumbing. Or it could just mean the captors don’t want to give any of the clean stuff to him.
There’s a blank in the conversation going over James’s head. An upward note. A question.
“Barnes,” he croaks in response. “Sergeant.” He starts on the serial number, but salt and bile explode up from the back of his throat. He leans forward involuntarily, pulling at the ropes he hadn’t realized were fastened around his chest.
One of the captors catches him with a backhanded blow to the cheek. His ring splits the corner of James’s lip, and blood joins the sludge and sick collecting in the thick stubble around his jaw. The other captor mutters something and spits. James doesn’t have to know the language to understand. He’s disgusting. But then he gets another pinch to the arm, and he’s asleep.
***
The first thing James is aware of is the speech. It’s familiar and unfamiliar at the same time. Unfamiliar because he doesn’t recognize the language, but familiar because he’s heard it before. Yesterday? He can’t be sure.
He’s aware of the taste next, metallic and bitter. James coughs and gets hit for it. Again? He doesn’t remember, though it must be. He feels the scab crack at the corner of his mouth when the man’s big ring catches him there again. James has but a moment to consider it before his neck snaps back and stars burst into his vision. The captor laughs and grabs a handful of James’s hair.
James blinks, the brightness from the window searing his eyes. It hurts. But then again, everything hurts.
The second captor grips below James’s chin and holds it there, perfectly poised so he can’t swallow. He can barely breathe. Something’s wrong with his muscles; two sets of hands on him shouldn’t be able to incapacitate him this badly.
But it isn’t just hands. There are ropes, too. James hasn’t moved since the last time he was conscious. It shouldn’t surprise him, and in a way, deep down, it doesn’t. It’s as if he already knows where he’s restrained, where the captors are standing, where the sun hangs outside the window. It’s as if time is passing without actually passing at all.
James inhales raggedly and narrows his eyes. This time he sees the glint of the syringe before the needle buries in his arm and he slips away again.
***
This time he vomits before he opens his eyes, before he can control the air coming in and out of his chest. Flecks of acid bounce into James’s lungs in a burning mist. He can barely hear anything over the ringing in his ears, but there’s something. A sound of distaste that transcends the barriers of language. James supposes it’s good, for the sake of communication. He’s no good at languages, practically useless at telling French from Pashto from Yiddish. Not that he’s heard Yiddish in years.
The captor makes the sound again, then hits him again. It must be again, because otherwise it wouldn’t hurt so much. This time it’s with the butt of a rifle, though. Not a hand. The hand is fumbling with a vial, then squeezing the inside of his elbow, then James knows no more.
***
It’s dark, which is different. Then James realizes he’s looking at the backs of his eyelids. Opening them makes no difference, for the line of sunlight is gone. There’s no moonlight to take its place, so only the shadows of furniture give any depth to the room. A blockish thing sits beside him, an overturned crate used as a table or chair or a place to put one’s feet. James tries moving his feet, but chains bite his ankles and pins and needles break out beneath the scrapes. He hisses in pain, bubbles of thick saliva pressing between his dry lips, then looks around wildly in the dark.
There’s no one. Nothing. The room is as good as abandoned. Were it not for the chafe of the ropes and chains, the rancid stench of blood and vomit, the haze of drugs still mapping the neurons from James’s brain down his spine, he’d think it was a dream. Maybe an exercise. But the guys play-acting back at the stateside base tend to get gun shy once somebody gets sick or starts sobbing.
James isn’t sobbing, though. He blinks hard, and his eyes don’t so much as water. It is the desert, after all. His head throbs, and so do the track marks trailing in the crook of his arm. His sleeve is gone on that side, making him lopsided and cold.
James looks to the window again. Wind whistles, and the quality of the not-light changes slightly. It swells and retracts, swishing against the window from the outside. Not dark. A tarp. So it’s not night after all. They’re just fucking with him.
Anger seethes through James’s veins, but he just sighs. Who knows who’s watching him. Next time someone appears in the room with him, he’ll consider fighting. Maybe throwing insults along with his name, rank, and serial number. But for now, he’s tired. There’s nothing to do but play along. So James shuts his eyes and lets himself drift back to sleep.