March 20th
It was with some trepidation that Sarah entered the office, sat down at her desk and booted up the computer. She logged on and went to the Continuing Education website she'd selected from the board's list of acceptable choices. After much consideration, she'd decided on a course that discussed the latest findings on addictive behaviors for adolescents, adults and families; undoubtedly much of her practice would deal with addiction and resultant abusive behavior. It was a work-at-your-own-pace setup, with Skype classroom sessions every two weeks over three months, and accredited with several major universities and colleges. She just hoped her internet provider would keep transmission dropouts to a minimum; when stormy weather came in, they sometimes had trouble with service. She and Gene had discussed cable installation, but since that would mean they'd actually have to pay for the cable to be brought out to the house, it was an extravagance they couldn't really justify, not now anyway. Maybe when she got her practice up and running . . . they could always talk with Greg and Roz about a fifty-fifty split.
Sarah called her thoughts back to the task at hand. She was a bit surprised to find she was nervous. It had been a long time since she'd attended class; she wasn't quite sure what to expect from herself or the situation, but she'd do her best to adjust and adapt to the setup as best she could.
She'd just set up the webcam and the class was about to start when someone walked into the office—Greg. "What are you doing here? You're supposed to be at work," Sarah said, a bit surprised. Greg pulled the Eames chair from Gene's desk, set it next to hers, shrugged off his pea coat and sat down.
"Thought I'd sit in," he said cheerfully. He propped his feet on her blotter and dumped little chunks of half-melted dirty snow all over it. "Coffee and a couple of rolls would taste pretty good. It was a cold walk over here."
"If you want some, get 'em yourself. You know where the kitchen is." Sarah pushed his feet off her desk and wiped up the water with a tissue just as the link was activated and the instructor came on.
"Good morning," he said with a smile. "Let's do roll call."
"Let's not," Greg said loudly. Sarah gave a silent sigh.
"I'm sure you don't take this seriously, but I do," she said.
"Everything all right there, Doctor—" The instructor checked his notes. "Goldman?"
"Yes," Sarah said. "My apologies for disturbing the process, Doctor Kimura."
"Disturbances are okay," Kimura said with a smile. "I don't want this to be a typical classroom where I lecture and you take notes. As far as technology will allow, this is an interactive group. Discussion and debate is encouraged."
"Oh, he'll regret that," Greg said with barely repressed glee. Sarah reached out and gave his thigh a light pinch. "Ow! Hey!"
"Wimp," she said, and settled in with her notebook and syllabus print-out.
"Dinosaur," Greg said. "Pen and paper, so old school."
"And happy to be so. Now hush up."
Gradually she was drawn into the session. Kimura was a good lecturer; he didn't pontificate or blather as he laid out the course requirements and objectives. Sarah felt a familiar sense of interest push up beneath the anxiety. The course already offered some intriguing lines of research and thought. Her pen flew across the syllabus as she added notes for follow-up and study.
"Working with patients addicted to drugs, alcohol or behaviors can be difficult but ultimately rewarding, though you'll need time and patience. And don't get discouraged if you're unable to achieve breakthroughs on the first, fifth or even the tenth try," Doctor Kimura said. "As you're all CE students, many of you with practices of your own, you probably know this quite well. What I'll emphasize in this course is finding new ways to use whatever you have in your toolbox—talk therapy, pharmapsychology, the experiences of fellow psychologists, and so on—to give you more possibilities for your patients to find growth and healing." He nodded at the camera. "So let's talk about-"
"Question," Greg said before anyone else could speak. Kimura peered at the webcam.
"Isn't this Doctor Goldman's Skype? You're—"
"Just a resident. Let's say you have someone in moderate to severe chronic pain," Greg said. "The people around her are convinced she's an addict because her use of a narcotic drug is unregulated." He sat back. "What do you think?"
"Well, I was actually about to ask for questions concerning the course," Kimura said wryly, "but let's consider your query. I need more information to give you an informed answer, however. What's the nature of the injury? Physical, emotional?"
"Physical, duh," Greg said with some scorn.
"No 'duh' about it," Kimura said. He smiled, but his expression was serious. "Pain is pain, whatever the origin." He paused. "Has this woman spoken with anyone about pain management, preferably as an adjunct to ongoing physical and talk therapy?"
"PM after the initial injury was unsuccessful. According to the specialist, the patient wasn't serious about getting better." There was a subtle bitterness in Greg's voice Sarah hadn't heard in quite a while. Her heart ached for him, for this old wound that hadn't healed yet. She wasn't sure it ever would, not completely.
"It sounds to me," Kimura said slowly, "as if lack of success lay with more with the specialist and not the patient. It often takes several tries to find the right person or team to administer healing, especially if the pain is chronic. That's not uncommon for pain sufferers." He looked concerned. "Has the patient since received successful treatment?"
"Not applicable," Greg said. "Totally hypothetical situation."
"I see. Excellent question, ah—resident." One corner of Kimura's mouth twitched upward. "Now, anyone else?"
Ten minutes later the class ended. "Except for you, Doctor Goldman," Kimura said. "If you'd stay online, please? I'd like to talk to you." Greg gave an evil little chuckle. Sarah rolled her eyes and kept the Skype link open.
"About that question," Kimura said after a few moments. "It didn't sound so hypothetical to me, Doctor House."
Greg turned his head to glare at Sarah, his amusement evaporated. Sarah shook her head. "I didn't say anything," she said. "You know I wouldn't do that." Sarah saw Greg relax a little, and some of the wrath left his gaze.
"Doctor Goldman said nothing. I recognized you from a conference we both attended some years ago. You made a . . . shall we say, memorable impression on some of the attendees, myself included." Kimura smiled, but there was an edge of compassion in it. "It was before your disability. Your question today wasn't exactly hypothetical, I take it." There was no pity or even sympathy in his statement, just a quiet understanding.
"Well, aren't you just the smartest little Asian," Greg said softly. "That conference . . . you were the keynote speaker. 'New Perspectives on Pharmapsychology'."
"Not one of my better efforts," Kimura said wryly. "I was wrote everything down on a cocktail napkin in the airport bar on the way to Boston, and then left the napkin behind. I ended up giving the speech the next day, hung over. I've seen the vid. It was pretty bad." He chuckled.
"Don't feel too bad," Greg said. He sounded amused again. "You had a quite a few people wincing in sympathy."
"But not you, as I recall," Kimura said, and his smile widened. "You gave me a very hard time. It was a welcome distraction, actually."
"Glad to be of service." Greg tilted his head a bit. "You've cut back considerably on your work load."
"I've found what makes me happy," Kimura said simply. "I hope you've done the same." He hesitated. "You look—better. I take it you found help."
Greg said nothing, just glanced at Sarah. She offered him a slight smile and he nodded. "He has," she said, and left it at that. Greg said nothing, but she felt him relax a little more, as her discretion plainly eased his underlying anxiety.
"Glad to hear it," Kimura said. "If you plan to audit the class with Doctor Goldman you'll definitely liven things up, of that I have no doubt." He nodded. "See you in two weeks. If you have any questions please contact me any time."
"Don't hold your breath," Greg said, and reached out to end the session. Sarah smacked his hand away.
"My class, I make the decisions," she said, and turned back to the screen. "I'll be in touch, Doctor Kimura, thank you." Once the webcam was off she turned to face Greg. "So, are you plannin' to make this a regular occurrence?"
"You don't sound too enthusiastic." Greg watched her, his gaze bright.
"If you're worried I'm gonna talk about you or break doctor-patient confidentiality—" She stopped as comprehension dawned. He hadn't come here to harass her, he wanted to make sure she was all right; the harassment was the price for his concern, but it was a small one by his standards. On impulse she put her hand on his arm, touched and warmed by his unspoken affection. They stayed that way for a few moments, the room quiet.
"Perfect opportunity to get out of work," he said at last. Sarah laughed.
"Thanks." She gave him a little squeeze and let go.
"You chose a full course. Could have done a one-day workshop or a seminar."
"Yeah, I could have. But it's been a while since I sat in a classroom and did some real learning. It's a little daunting." She sat up, clicked on the 'all programs' icon and went to her music files. "I could use a laugh."
Her choice was Cookie Monster singing 'Share It Maybe', complete with video. "Me look at you and me tell/you may have snickerdoo-del," she said, and giggled. Greg groaned.
"Oh my god. Three year old," he said, his tone accusatory. "Speaking of cookies . . ."
"I baked some last night," she said, and waved her hand in the direction of the kitchen. "There's coffee too."
He returned a few minutes later, with a large plate piled with cookies and two steaming mugs. Sarah cleared a spot and took the mug with the teabag string. "Thanks," she said, and switched the video playlist to early Marvin Gaye. They listened to 'Stubborn Kind of Fellow' while they munched brown sugar cookies.
"So . . . was it addiction or dependence?" Greg said. Sarah glanced at him. He looked out the window as he spoke, but she saw the tension in his body, the way he gripped the mug in his hand. This was old territory for them; she understood he needed reassurance on this point though, so she accepted his need to talk about it.
"There's a fine line between the two," she said. He snorted. "No, I'm not hedging my answer. It's not that cut and dried, not with you." She smiled a little. "Never with you."
"Explain." He slurped his coffee and took another cookie.
"Well . . . in my judgment, and Gene concurs by the way, any addictive tendencies on your part came about mainly because you weren't able to obtain reliable coverage. Anxiety and resulting behaviors are understandable, given that circumstance. Now you did have some opportunities to dial things down, I'm not sayin' you're completely clear on this—"
"Gabapentin didn't even touch the pain!" Greg snapped. "Nothing in the GABA family did!"
"You had a chance to use fentanyl," Sarah said quietly.
"And how's that any better than Vicodin?"
"With the right dosage you had a chance to bring your levels down without facing wholesale destruction of your stomach, intestines and liver, as you well know."
Greg glared at her. "It's a C-2 narcotic. I'd have been stuck seeing some incompetent PM guy every month for a paper prescription and then put up with the morons in the pharmacy refusing to fill it because the scrip would likely have been written for a higher dose than the manufacturer recommends."
Sarah bit into a cookie. "Point taken," she said through a mouthful of crumbs. "Still, you'd have managed. But I think you felt like the Vicodin was your best, maybe your only real lifeline in that situation. Yes?"
Greg looked out the window again. "Maybe," he said after a long silence, his voice so soft Sarah could barely hear him.
"I'm not blaming you," she said. "Mostly you did what you thought was best for yourself while facing a daily level of pain most people would find horrifying. And that's what makes your diagnosis a slippery one. You had a legitimate claim to powerful meds, but your needs weren't recognized. That created a climate for addictive behavior. And yet when you started using the TENS unit and Gene prescribed other meds for you, you gave up the Vicodin and you haven't gone back to it. To me, that indicates dependence was the stronger force."
He munched a cookie and said nothing in reply. Sarah put a gentle hand on his shoulder and rubbed in a slow circle. Gradually he settled under her touch.
"So, you're gonna show up for all my Skype sessions?" she asked eventually.
"I'll keep you guessing." Greg turned his face to hers. "Can't get all predictable on you at this late stage." He got to his feet, snagged another cookie and stuffed it in. "Lunchtime," he announced. "Got anything for sandwiches?"
"Hell's bells, you're worse than Jason," Sarah said in affectionate exasperation. She stood too and picked up the empty plate. "Come on, let's go see what's in the fridge."
"Sarah." The use of her first name made her pause. "You'll do fine," Greg said. In his gaze was everything he would never say aloud. Then he went to the door and slipped out of the room. Sarah watched him go, conscious of a bittersweet sense of peace deep inside. Finally she followed him to the kitchen, glad of the comfortable old house around her.
'Stubborn Kind of Fellow,' Marvin Gaye
'Share It Maybe,' Sesame Street
