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Frank’s legs were carrying him out of the patient room and onto the main floor before he even consciously registered it.
It was simple.
A patient needed painkillers, and per the Physician Health Program, the scope of his practice no longer included controlled substances.
The nurse, Emma—sweet girl, decidedly still green—offered to go grab another resident. She didn’t do anything wrong; she was helpful, proactive, clearly absorbing all the lessons thrown her way. Generally speaking, Frank liked her, enjoyed working with her. Exactly the kind of nurse you want in an ED where time was the most precious commodity. But that growing bank of knowledge happened to include, Doctor Langdon isn’t allowed to dispense controlled substances, ingrained enough that she could immediately default to accommodating for it. And that was what set him off; not the offer, not the restriction itself, but that it had become common knowledge, automatic like grabbing gloves on the way into a room or shoving your palm under the sanitizer dispenser on the way out. And for Emma—one of the only blessed people in that ED he didn’t have to apologize to when he came back—that was the only version of Frank Langdon that she knew. Perhaps that was for the best.
He set the tablet down in one of the open docks, watched as Whitaker followed Emma into the room he’d just vacated. Something twisted deep beneath his ribs at the sight of it. He felt unusually out of place in the too-loud, too-fast ED, like he was just slightly out of tempo.
It wasn’t just that, of course. It was the call with his alcoholic patient’s next of kin, the lady’s son, who simply told him to stop calling. The number of times Robby found an excuse to leave the room as soon as Frank walked into it. The moment a group of his colleagues stopped talking when he walked up, even if he knew logically they probably weren’t talking about him, and he was being paranoid. The ED was suddenly too hot, too small. Kinetic energy pulsed through his legs like a coiled-up snake. Any thoughts in his head were now replaced with the simple urge to get out of there. The break room would have to suffice.
This wasn’t panic, though that was certainly an element. Perhaps if it was, the benzos could’ve been justified, could’ve come in an orange canister with a psychiatrist’s name on the label. But this was something both more vague and more specific, something that required months of dual-diagnosis PHP and off-label lamotrigine twice a day.
Frank’s eyes darted around the landscape of the ED as he navigated to the break room on unsteady legs. Doctors and patients milled about, dark scrubs and colorful clothes, beds and wheelchairs, the one light in the corner by the ambulance bay that flickered every few seconds. The din of overlapping conversations, the whoosh-click of a ventilator, the dysrhythmic beep of monitors, sneakers on sheet vinyl. It was all overwhelming, but good; it meant he could disappear. No eyes tracked him as he moved, no one followed after him. He made it through the door to the break room, pressed his back against it, worked his fingers through his hair.
Overwhelmed. That’s it. That’s what his therapist had taught him to call this feeling; a shorthand for too many feelings to list individually, emotional polymorbidity. He’d feel overwhelmed, because he was emotionally dysregulated, because some stupid little thing had set him off. It didn’t used to feel like this on the benzos; even towards the end when his tolerance had built up enough that he’d start to hit the wall of withdrawals and rebound symptoms by the midpoint of his shift, it was different. He’d get irritable then, snappy. It was embarrassing, especially when it left him screaming at first-year residents in the hopes of scaring them into backing off (and, yes, he absolutely owed Santos an apology more than anyone, more than Robby, but his sponsor recommended building his way up for Step 9, and he was pretty sure Santos was going to be his well-deserved Everest.) But there was something less humiliating about being prickly and raising his voice than this, hiding in the staff room, rummaging through the freezer for anything he could press to the inside of his wrists before he started hyperventilating.
It was a stupid thought to have; Frank knew, with his “logic mind”, that sitting with his emotions was better than letting them bubble over as anger. Recovery was full of stupid thoughts. He was supposed to integrate them, supposed to radically accept them. More often than not he found himself begging God—or however he understood Him—to make it stop.
It wasn’t the work. It never had been; the job had always just been another direction to run in. The threat of death that seemed to permeate the ED like the blade of a guillotine in perpetual suspension didn’t quite bother him; he was at peace with the inevitability of death, and if you asked him, sometimes it was the real mercy. The bullshit attitude from patients rolled off of him, because he didn’t care what strangers thought about him. Maybe it was a little narcissistic, but those people meant nothing to him; their opinions meant nothing to him. Those were never the real stakes. But his colleagues, his wife, his kids. Robby. Those were the voices that mattered, the validation he needed, the approval that, once removed, felt like his ribs pried open and heart wrenched from the hollow of his chest.
That night in September, he stumbled through the front door intentionally after he knew Abby would’ve had the kids in bed, hands trembling. She asked what was wrong, and he told her, “Me. I’m what’s wrong.” Told her he fucked up, he was hooked on benzos, it had less to do with his back and everything to do with a different kind of pain altogether. She rubbed her palm up and down his sweaty back as he cried, and that was the first time the thought that would follow him all through rehab and therapy appeared: I don’t deserve this.
He’d told her that night that, for the first time, he really thought about his own death. Not about taking his own life, but just what it would feel like. What would happen. Who he’d hurt and who’d be better off. It felt like a reasonable place for his mind to go—he was pretty sure he’d just completely destroyed his entire life, and that was about as close as he could get to death with a beating heart—but the cold fear in his wife’s eyes told him he’d said something wrong. A day and a half later, he was clad in paper scrubs, shaking and sobbing and hyperventilating in the corner of the intake room, and those sad, scared eyes met his again one last time as the intake social worker walked her out of the room. He wasn’t sure if it was the withdrawals that felt like they were already tearing him apart on a cellular level, or the tangled ball of emotions he’d forgotten he’d been running from. Either way, it felt pathetic. That feeling never quite went away.
And now here he was, standing hunched over the counter of the break room, someone’s ice pack sandwiched between the insides of his wrists. In four, hold four, out four, hold four. Rinse and repeat. He bounced on the balls of his feet—attempt at the I in TIPP or just nervous energy, he wasn’t sure. There was a bottle of propranolol in his locker specifically for times like these—the hydroxyzine he used throughout rehab and outpatient was too sedating for work—but he was terrified of what any of his colleagues would think if they walked in and caught him with a pill in his hand. It was the same reason his Vyvanse never made it into his bag or past the front door of his house; his psychiatrist might trust him with a medication he wouldn’t be allowed to dispense, but he wasn’t interested in finding out if his colleagues agreed with that assessment. Besides, he was trying to move away from quick fixes. He’d learned that lesson quickly in rehab, and intimately in PHP.
He shifted the ice pack to sit nestled between his wrist and the center of his chest; it would leave a dark wet spot on his scrubs, but he couldn’t bring himself to care. With his other hand, he spun his wedding band around his finger. He still couldn’t believe sometimes that she hadn’t taken the kids and ran while she had the chance. Definitely couldn’t believe it back then, back when every conversation circled back to her reassuring him again and again that she loved him and wasn’t going to leave him, when his only thought every time was that same I don’t deserve this. When phone calls were brief and supervised and any other contact was non-existent. It was funny; he knew the implications of one-to-one, line of sight, Q15. He just never expected to be on the other end of it. It felt oddly, almost comfortingly like an extension of his real life—still a fish, just in a different tank. When he was finally somewhere Abby could visit him, after it’d been a few days since he’d thrown up on himself or panicked unconsolably for hours at a time or said anything to make someone inadvertently skeptical of his will to live, the first thing she’d commented on was the abject lack of privacy. That, he thought, he deserved. That was just something he was going to have to get used to, he’d told her; the Physician Health Program meant it was going to be a long time before he was out from under that microscope.
He wasn’t sure whether more prescription bottles or urine cups had passed through his hands in the last ten months (which was a funny enough thing in itself, for a diagnosis without a single pharmaceutical FDA-approved to treat it). It’s not necessarily that he didn’t mind, so much as he knew there was no one to blame but himself. Same for the awkward chatter when he walked past, or the triage purgatory, or the ten months of radio silence from everyone but Abby and the kids (and his union rep, though that was strictly business). He was getting sick of penance. Or maybe impatient with the tedium of it. If he could just prostrate himself in supplication, cleanse himself of all of it all at once. He’d take a worse torture over a slow one; Frank had never been one for waiting. If Robby told him, “I’ll forgive you right now if you go walk into oncoming traffic”, he’d be wheeled back in covered in road rash and ecstatic. But Robby telling him he needed more time made him wonder if he hid in the EVS closet for long enough if he could will his body to become a mop or a wet floor sign.
More stupid thoughts. His arm was cold-numb where it made contact with the ice pack. The burn was muted but pleasant. His breathing had started to return to something resembling a healthy respiratory rate. The queasiness remained deep in his gut, but retreated just enough for him to no longer gauge whether he ought to puke on the sink, the trash can, or try to make a run for the bathroom. His legs still bounced uselessly beneath him. He told his therapist once during one of his one-on-one pull-outs that the “flight” part of his adrenaline response had always felt overwhelmingly literal. Calves tensed, weight balanced on the forefoot, toes curled.
That had never felt more true than the moment Robby appeared in the window, the door swung open, and everything abruptly sharpened. When bolting wasn’t an option, “freeze” usually won, and his breath caught in his throat. Maybe if he stood completely still Robby wouldn’t see him, as if he were a T. rex from Jurassic Park.
“Langdon?” was the first word out of his mouth, still standing in the doorway with the door propped open by the shoulder. No such luck on the T. rex idea. “We’re swamped out—” Frank could see the second Robby spotted the ice pack, watched his eyes trail him up and down. “When did you hurt yourself?” Frank took a tiny step back, back brushing against the counter behind him. “You seen one of the nurses about it? Need someone to take a look?” The whiplash of it jarred him—the accusation of carelessness in “hurt yourself” to the almost gentle offer of help. It was perhaps the kindest thing Robby had said to him since he’d come back. That same thought as always made itself at home again.
An uncomfortable, probably gratuitous length of silence stretched between them. Frank wasn’t sure if he was breathing too fast or not at all.
“I—I’m not,” he eventually, finally replied, testing his voice. It was thin, reedy, embarrassing. He cleared his throat, tried again. “Not hurt.” He traced Robby’s unreadable gaze down to the ice pack against his wrist and the wet spot on his chest, back up to almost-but-not-quite eye contact. “Uh, TIPP. Temperature. It’s a skill I learned, in...” He let himself trail off; they all knew the rest of that sentence. It was the same story every time.
Robby stood and stared some more, expression carefully flattened. Frank wondered which step this was supposed to be covered in, or at least what circle of hell he was trapped in.
“Right. Good.” The neutrality was somehow worse than the overt friction. “You need anything?”
“No.” It came too quick, too eager. The therapist he now saw every Wednesday morning had recently introduced to him the concept of a fourth adrenaline response: “fawn”. He wasn’t sure yet how something so compulsive could make him so disgusted by himself. “I’ll be good,” he corrected, finally setting the ice pack down on the counter. It had gone warm anyway, slick with the sweat of thawing.
Robby simply nodded and left, and Frank could do little more than stand there with his mouth half-open like an idiot and stare at the space he’d just occupied. He missed when Robby used to care about him—it was, he imagined, the emotional equivalent of a phantom limb. He tried not to think about it, busied himself with returning the ice pack to its home in the freezer. When he spiraled, this was often where it started: wanting something. Like wanting Robby to walk back in and tell him he forgave him and pat him on the shoulder. This was a feeling he was no longer entitled to, something he’d lost the privilege of wanting. Then he’d feel ashamed, even if it was a thoughtcrime. But that meant he was wallowing, which was also something he’d forfeited his right to. Round and round until he’d run out of emotions he felt like he was allowed to feel. The line between self-awareness and self-pity was a tightrope, and Frank was equal parts unsure how to walk it and terrified of stumbling onto the wrong side. Recovery wasn’t a lecture course he could get a good grade in, even if he didn’t quite know how to turn that pull off. It also wasn’t a moral venture, but he was having a harder time accepting that one.
He didn’t want his recovery to be selfish, but he wasn’t sure he understood yet how to remove himself from something so inherently tied to him. Maybe the desire for a clean, exemplary paragon of recovery was, in itself, selfish. Did he want to be good for the sake of goodness, or because being a model addict would make him more tolerable and his sins more forgivable? His therapist told him that these questions were unanswerable, that his recovery was supposed to be about him, that the only thing he needed to validate his recovery was his sobriety. He just wished the “fake it ‘til you make it” approach had worked, had made his apathy as real as he presented it.
He should get back to work. The ice pack was returned to the clutter of the freezer. His breathing was manageable, his hands could administer medication or stitch a wound without threatening to shake. The break room smelt like an awful medley of Sani-Cloth and tuna fish. He finger-combed his hair back, wiped his palm over the wet spot on his scrubs, and shook out his limbs in the hopes of looking less like he’d disappeared into the break room to stave off some sort of breakdown. He couldn’t fathom having some boneheaded senior resident throw it back in his face in the aftermath of abject tragedy. He liked to think he could forgive, if he understood the crisis it was born from, but he couldn’t be sure. Empathy was a learned reflex, and the muscles still felt stiff and clumsy every time he exercised it. The worst day of his life was one he shared with hundreds of PittFest attendees. At least he went home that night with his body unscathed, heart still beating, and family still intact; that wasn’t a perspective he’d had at the time, but he had it now. The world’s strangest survivor’s guilt.
Stepping back into the ED felt like taking the TV off mute. He used to love this, the noise, the excitement. He still did, he supposed, but it was harder to enjoy something once you understood it. He tried to keep his posture loose and steps light as he made his way to the hub, his eyes scanning. Santos was huddled in front of one of the desktops, hunched over the SpeechMike she clutched in both hands. McKay and Javadi were walking and talking, occasionally glancing back down to the tablet in Javadi’s hands. Perlah was just stepping out of North 4. On the other side of the double doors, Robby was leaning on Dana’s desk. For a moment, Frank was certain they glanced in his direction, and dread washed over him before he remembered he didn’t have something to hide anymore. He fought the urge to turn heel and disappear the other way, like that was where he’d been headed all along. His stride hitched briefly but continued. Robby clapped the desk with his palms before turning and walking off, mercifully in the opposite direction. But Dana was already out of her chair, stepping around the desk, watching in his direction.
His heart hiccuped, a cold sweat erupting at the nape of his neck. He was going to be sent away again, banished, thrown out the back door with his loose belongings clutched against his chest. And this time Robby wasn’t even going to give him the time of day to do it himself; or maybe Robby thought he was too damn fragile to take it from him. Stupid thoughts—she smiled gently as she approached him.
“Hey.” Her tone was light. His shoulders relaxed. “How you doing, kid?”
“I’m okay,” he said, and he could mean it this time, because he was talking to Dana, not Robby. “Just needed a few to cool down.”
“It happens. We all need a break sometimes.” Her hand landed on his upper back, steering him. He let her guide him; he’d learned how to surrender control six steps ago. “You need anything?”
He opened his mouth, closed it, forced himself to actually think about it this time. “No, I’m good now. Did the ice pack thing.”
She smiled, stopped him in front of one of the chairs behind the desk, gestured for him to sit. “That’s good, you’re taking care of yourself.” She stepped to the side for a moment, reappeared with a juice box and held it out to him.
“Yeah.” He tore open the plastic with his teeth and stabbed the straw through the little foil circle on the top. “Not like I have much choice anymore.”
“I’ll be right back. Sit tight.” She squeezed his shoulder again before walking off. He let himself almost meet her gaze this time, before she was swallowed up by the endless motion of the ED and he lost track of her.
He leaned back in the chair, craned his neck to look up at the tracking board. If anyone asked, he’d say he missed lunch, his blood sugar was low. Not that he expected anyone would; no one showed much interest for ten months, after all. He tried not to feel hurt by it; it was his fault, after all. His therapist usually said both things could be true. He didn’t know what was true half the time these days. It felt like he’d gone through most of his life on fast forward and only recently found the play button. Abby always did comment on how she couldn’t comprehend how he could understand his podcasts on 2x.
When Dana returned, her arm was outstretched. He took the item offered to him before really processing what it was: a round, orange little tablet in a paper pill cup, stamped with a 10. He eyed it warily, as if it was going to sprout teeth and bite. Then he traced his gaze back up to Dana, the unspoken question written across his knitted brow.
“It’s propranolol. Ten migs, right?”
He stared up at her for a little too long, mouth slightly open. How did she know? Who did she get it from? Why would she do something like that for someone like him?
“I can’t. Everything has to be over the table, the Physician—”
“Hey, it’s okay. Robby documented it. All above-board, promise,” she reassured him, sitting down on one of the chairs and rolling it so she sat across from him. Robby ordered it for him. Charted it like he was a patient for him, because every last little pill had to be on paper. Robby. His mind caught on it like a stuck cog. He glanced back up at her again, like waiting for permission. Approval, always back to approval. She gave him a small nod, and he pinched the pill between his pointer and thumb, dropped it into his mouth, and swallowed it with a quick sip of the apple juice before he could think better of it.
“Did... Did Robby tell you to check on me?” His voice was quiet, tentative. The question felt like equal parts confession and transgression. Dana laughed in response, a window-breaker to the tension.
She didn’t answer, not directly; she didn’t have to. “You know he still cares about you, kid. Even if it’s complicated.” Her eyes flicked across the ED to Robby, looking at a chart over Whitaker’s shoulder. Frank bristled.
“Doesn’t feel like it,” he mumbled, staring down at his hands as he fidgeted with the empty paper cup. He couldn’t remember the last time Robby had smiled at him, or laughed at one of his jokes, or even so much as intentionally initiated an interaction with him. The ED had felt like a haunted house since he came back—or maybe a haunted cemetery.
“I know.” It was kind, he thought, and utterly undeserved, her attempts at reassurance. He’d been relieved she was one of the ones who didn’t treat him with kid gloves now, but god forbid that be enough for him. “He’ll come around. Just give it time.”
Time. He was so sick of time, of waiting, of climbing up the same hill day in and day out and getting nowhere. If Sisyphus was happy, Frank was certain he had to be delusional. Or maybe patience was just a virtue Frank would never possess.
“I wouldn’t blame him if he never did,” he said quietly, pulling up at the ridge of the paper cup to flatten it. That was the quiet part that he didn’t usually speak outside the lavender-gray walls of his therapist’s office. Everyone knew he was an addict, most had at least heard rumors that he was a thief. No one knew how he felt about it. And therein was the confession: not that these were things that he had done, but that he was ashamed.
Across from him, Dana reached out, cupped a hand on his jaw just long enough to force his gaze up. “You’re doing the right thing, you know. He sees that.”
He nodded slightly. “I know.”
He knew the first part. He was sober, willing and skillful, working the steps. The latter was harder to believe, not when the ice melted so glacially he couldn’t see it. But if Dana could, maybe it was true. Maybe it would all make sense one day, when the ice was gone with nothing but a puddle in its wake.
She patted him on the shoulder before standing up. “Then keep your chin up, kid.” She reached over, plucked one of the tablets from its charging dock and passed it to Frank. “Feeling up to getting back in the saddle? I’ve got a forearm lac in 17 calling your name.”
“Yeah.” He pushed up from the chair, glanced around the ED, reorienting himself. The constant thrum around them had never quite stopped; it always reminded him about that one line from The Great Gatsby about how big parties are more intimate. “And, thank you. For all that.”
“Don’t mention it.” She waved him off as if that hadn’t been one of the greatest acts of kindness anyone had shown him in months, already rolling her chair back to its usual spot in front of the computer. He took a few steps before something compelled him to stop. Before he could stop himself, he added,
“And give Robby my thanks.”
“Will do.” Dana was smiling when she glanced back up again. “It’ll be okay, kid.”
He nodded once before starting towards 17, glancing over the chart as he walked. Maybe it was the propranolol working, but something seemed to loosen in his chest.