Placebo Junkies Read online

  Now: Purgatory. A place where the already dead wait for whatever comes next.

  Ain’t reality grand?

  Jameson walks up behind me and drops down to one knee, sneaky casual, acting like he’s just stopping to tie his shoe. I don’t turn around, not even when he does his little throat-clearing thing extra loud [Persistent Vocal Tic Disorder, diagnostic code 307.22]. “I’m sorry I freaked out on you, Audie. I think of you as a friend, and sometimes I forget that you’re …”

  I fill in some possible words for him. I hold up the heavy diagnostic manual I’ve been reading, show him that he’s not the only one who can swipe things from doctors’ offices.

  It’s actually sort of fun to flip through the pages and pick out labels for people. If you get to know someone well enough, I guarantee you can find a diagnosis or ten for them in here. Everyone’s got at least a little crazy going on just below the surface.

  “No.” He shakes his head. “I was just going to say that sometimes I forget how sick you are. I shouldn’t have brought you today. It was unprofessional.”

  He hangs his head, puts on his best shame-faced expression. He knows what it looked like over there, he says. But it’s really not that much different from what the doctors are doing here. “It’s just the way the sytem works.” He shrugs and makes his eyes go round and blameless.

  He doesn’t want to leave me with the wrong impression, he says. He has big plans. He’s going to open up his own CRO, do things the right way. “You don’t have to have a degree or anything. Only a doctor’s name somewhere on the letterhead, someone willing to act as a silent partner. It’s just a matter of running a good business,” he says. He’s going to run studies the right way, he says. Maybe I can work for him. (awkward pause, foot shuffle) When I get out.

  Now look who’s delusional [diagnostic code 297.1].

  As if this were only some sort of temporary psychosis [diagnostic code 298.8].

  What’s that old saying we were talking about earlier? Sometimes paranoia [former diagnostic code 295.30; current manual no longer distinguishes a paranoid subtype of schizophrenia] is just having all the facts.

  Funny thing, I tell him. There’s no diagnostic code for a compulsive liar. Why do you think that is, Jameson?

  He doesn’t answer. Shocker.

  “Maybe because you’d all have to diagnose each other. Every single person working here who’s making a living putting poison in my veins.”

  His skin flushes pink, and he stands up and stops pretending to tie his shoe. “You’ve gone off your meds again, Audie. Haven’t you?” He shakes his head, tries on a few different expressions, and settles on sad. “I hate that it has to be this way,” he says, and then turns and walks away.

  I start to laugh. “Oh, don’t be like that. I’m just messing with you, Jameson. Come back.”

  He doesn’t.

  Chapter 46

  The nurse brings a paper cup of pills to my room as I’m getting ready for bed. I thank her automatically, like she just delivered late-night pizza, double-pepperoni mushroom, instead of a cup full of poison.

  Because, what was Jameson really doing here?

  Lucky sweatshirt, my ass.

  I can’t take the chance that his off-schedule visit, his casual swing through the nurse’s station, was a coincidence. I can close my eyes and picture it: him floating past the nurses who ignore him anyway, leaning in to spike my nightly dose with something a little stronger. Something a little more deadly, perhaps.

  I’ve seen him with the books. I know about his special interest in certain controversial pharmaceuticals. I know about his secret stash.

  I know quite a few things about him, really. Things he probably wishes I didn’t know.

  I stare at the pills, poke through them with my index finger. How many should there be? In which sizes and colors? My memories aren’t clear enough to answer these questions.

  I have no way of knowing whether these pills are the cause or the cure.

  Taking them would be an act of faith.

  Not taking them would be a very different act of faith.

  Who to believe? Who to choose?

  The longer I stare at the pills, the more the lines between everything blur together. I’m afraid to blink, afraid everything around me will blend together into a gooey mess, the way my memories do. I swat away the buzzing sound in and around my thoughts to give myself a second to figure this one out. I’ve been down this road before; I’ve raced this same track a time or two. Surely I’ve learned from my mistakes.

  Through it all, the buzzing and the blurring, only one thing remains clear: how very, very alone I am in all of this. Without Dylan, without the people I thought of as my friends, my life is a permanent experiment on the long-term effects of total isolation. I might as well be still locked in the sensory deprivation tank.

  Or maybe I’m not quite as alone as I think, because when I close my eyes I can hear Charlotte’s voice singing. Oh, which came first, the crazy or the pill …

  I stand up. I’ve made a decision.

  I race out of my room. This is no time to be selfish. As I run, my progress down the long hallway is marked in units of Plexiglas-framed motivational posters bearing aggressively capitalized advice:

  commit to your chosen path

  every accomplishment starts with the decision to try

  be the best version of you that you can possibly be

  we do not remember days; we remember moments

  courage is a choice

  It’s a long fucking hallway. It’s a lot of fucking advice.

  Here’s my advice—capitalize it however you’d like: Don’t mistake consent for surrender.

  I burst through closed doors into other rooms at random, slapping pill cups out of hands, sticking my fingers in people’s mouths if I have to, ignoring their protests as I fish out the toxins. Because how would Jameson have known which medicine cup was mine?

  If he wanted to be sure, he would have spiked them all with his poison.

  That’s what I would’ve done.

  I’m on a roll. I run down the hall, screaming my warnings. I feel powerful and unafraid, because now I finally understand: I am the hero of this story. I can save us all—myself and all these other poor, gullible bastards locked in here with invisible keys. I smash and I grab at anything dangerous. Even if Jameson didn’t do anything to our medicine, the pills are killing us just the same, with their broken promises and profit margins and bogus hopes. They’re false idols in capsule form; they’re sugar mixed with cyanide. They’ve turned us all into addicts and zombies—we’re broken-down junkies, drooling and shuffling our way through the years waiting for something outside of us to change what’s wrong inside.

  But not anymore.

  I am finally in control.

  I ignore the footsteps and shouts behind me; I ignore everything until I hear the sound of Dr. O’Brien barking out commands, and then I know it’s too late to save myself, so I go even further. I will be the hero of this story, even if it kills me. I shove the pills I’ve collected into my mouth and swallow until I choke. My pills, everyone else’s pills, the nurses’ pills, tucked discretely away into purses and taken when no one is looking. The pills under my bed, the pills in Jameson’s secret stockpile in the back of the supply closet. I swallow them all, and by the time anyone catches up to me, before they can restrain me, hook me up to their machines, plunge their needles into my veins, it’s too late for them to change what I’ve done.

  I am the Ouroboros, choosing my own fate. This may look like an act of self-destruction, but it’s not. It’s an act of salvation. Of self-preservation. No one else will ever nourish themselves from my body again.

  I stop as the blur of white coats descends—a feathered flock closing rank, wings flapping around me until I am overcome. I feel a prick, and then the sting of snake oil
coursing through my veins, and the words of one last motivational poster start to dance and blur overhead: it is never too late to be what you might have been.

  I am the warning label. I am the list of side effects. I am the guinea pig; I am the safety net.

  I am the probable outcome. I am the cure.

  I am in control.

  I close my eyes against the bright lights and the faces, and soon enough the hissing of the snake becomes the gentle shush of icy ocean waves as I drift off to sleep dreaming about a castle at the end of the world.

  Chapter 47

  “Really? Audie, are you serious? Are you completely serious?”

  The look on Dylan’s face is priceless—this is all turning out even better than I’d imagined.

  He’s so handsome, but the last few weeks have been hard on him. Really hard. You almost wouldn’t recognize him, the way his cheekbones stand out now and the way his eyes almost look like they’ve changed color. They’re darker now, a stormy shade that’s hard to pin down. It’s because of the pain, I think. It can change a person, it really can.

  Trust me, I’d know.

  It makes me so happy to do this for him, after all he’s been through. After all he’s done for me.

  I tell him all about the trip. “I’m taking care of every detail,” I say. “No luxury spared.” I tell him all about Castillo Finisterre, since his memory isn’t what it used to be and he doesn’t quite remember seeing it that night on TV—the spa, the guided kayak tours through meandering glaciers, the unbelievable views. “I mean, it’s the end of the freaking world. How amazing is that?”

  Nothing compares to the look on his face. They way he’s looking at me right now, almost overwhelmed with happiness and surprise. Nothing beats feeling loved like this. Good and fully and finally fucking loved.

  I wouldn’t trade it for anything.

  Moments like this make me feel sorry for those poor fools who get so caught up in the day-to-day bullshit that they never take the time to unplug and just escape now and then.

  The sad thing is, most people don’t know how. They don’t realize that the paralysis they feel is in their minds.

  And so is the cure.

  All our lives we’re told what to do, what to strive for. Two plus two equals four, they tell us. If you can just get to four, then you’ll be complete/correct/balanced/approved. Aim for four, then pat yourself on the back for a job well done once you get there.

  Fuck that. I want more. I reject the restraints and the crutches. I reject anything that numbs or sedates or embalms.

  I choose five. I choose the castle at the end of the world.

  Have I shown you the pictures?

  It’s kind of hard to see it, the way it’s carved into the cliffs the way it is. But take another look. Give yourself a minute to get into the right frame of mind. Now look again, there, between the ice floes.

  No?

  The thing is, you have to make a choice. You can look at the picture and choose to see icebergs crashing, melting, and careening into cruel, dark waves below. The only thing you’ll see, then, is the end. Or you can look again, and this time you can choose to see the castle carved into the ice, so high and precarious it almost seems like it’s floating. So pure and dreamlike you could almost mistake it for a cloud.

  Choose to look at it like this, and instead of the end of the world, you’ll see the ultimate what next.

  Sometimes you have to retrain your brain to see what’s possible instead of what’s obvious.

  The trip isn’t completely finalized, not quite yet. But do you see the way Dylan has his arms around me? Do you see the way he kisses me? The way his lips dance over every inch of my flesh, the way they know me in the best possible way? Watch how he’s careful of the tender spots along my spine, the old ones and the new; see how his fingertips draw gentle little circles, tracing the lines of the tattoos hidden beneath my clothes.

  It’s hard to break away from something as perfect as this, sometimes.

  One last procedure, and I’ll finally have enough to pay for the whole trip. It’s a bad one, but that’s okay. Because this is a love story.

  The scalpel cutting my flesh is the Cupid’s arrow.

  The hum and the beep of the life support are the priest reciting the vows.

  Watch how my heartbeat responds when you give it a little poke: I do. I do. I do.

  It doesn’t matter that I’m alone. I’m doing this for him, so he is in the room with me, even if he’s not.

  I choose five. I choose the castle at the end of the world. I choose love. I’ve found what I was looking for, and I’ve written my own perfect, happy ending.

  Because this is a love story. If you can’t see that, maybe you’re just not trying hard enough.

  Author’s Note

  In late June of 2013, I crawled out of bed at 3:30 a.m. and wrote what is now the prologue and first chapter of Placebo Junkies. This fact is remarkable for several reasons. First, because I was traveling with an infant at the time and was so jet-lagged and sleep-deprived that it’s amazing that anything could compel me to get up at such an early hour. And second, because never before in my writing career have words come so fast and furious—as if several entire chapters had been gifted to me by some character in a dream I could no longer remember.

  It may have felt like it at 3:30 in the morning, but the concept definitely did not materialize out of thin air. Instead, it was inspired by two very brief and totally unrelated experiences from the day before; it just took a short night’s restless sleep for the ideas to loop and coil and, ultimately, converge in my travel-fatigued mind.

  1.

  I spent the day before my 3:30 a.m. writing session in a section of Seattle with a large homeless-youth population. I’d spent several summers working in this neighborhood back when I was in college, and at first glance, not much seemed to have changed over the years. But unlike when I was nineteen and passing through the occasional cluster of homeless teens as I made my way home on public transportation, this time I reacted as an adult and as a mother. These were kids, I now saw. That day, with my own children in tow, the thought of the circumstances that must have led to these young people living on the streets struck me as particularly heartbreaking.

  2.

  A few hours later, I woke up from the nap I was taking in the car en route to my in-laws’ house, where we were staying. I opened my eyes as we pulled up to a red light and stared groggily at a small, hand-written sign staked into the ground. “I made hundreds of dollars losing weight and so can you!” the sloppy writing said. “Get paid to try an amazing new weight-loss drug.” Two digits of the phone number provided had been scribbled out and corrected with a different-colored marker.

  Does anyone, ever, actually believe signs like that are legit? Who would be crazy enough to swallow pills provided by a random stranger who stuck a sloppy sign in an intersection? I wondered about the sign until our light turned green and then promptly forgot all about it.

  That night, the two elements came together while I slept: the characters, as viewed on the streets of Seattle; and the premise, inspired by a dubious claim on a roadside sign.

  When I sent the initial chapters to my literary agent, semi-apologetically since they were “kind of crazy,” I thought that the concept was perhaps a little too outlandish. I mean, come on—people actually trying to make a living by participating in paid drug studies? No way.

  But once I started to research, I was amazed to learn that my concept wasn’t outlandish at all, and that the practice of making a living via paid medical trials has a long and well-documented history.

  In the course of conducting research for this book, I spoke to numerous people on each side of the testing equation. I even interviewed several people who had personal experience as both a subject and as a researcher. One, a physician who now runs clinical trials, regularly “
volunteered” for drug studies while he was in medical school in order to earn extra money. Another source, who is employed by a contract research organization (CRO), had enrolled in a clinical trial of birth control pills along with several other coworkers, because, hey—free birth control!

  The people I spoke to had wildly varying experiences. One source on the research side told me horror stories of some of the studies she had facilitated; she had personally witnessed the recruitment of obviously mentally ill “volunteers” from a New Orleans bus station. Another source employed by a research organization in Mexico, on the other hand, described scrupulously designed and controlled studies with both ethics and safety considerations paramount.

  Many of the paid test subjects thought it was a great way to earn easy money. Others swore they’d never make that same mistake again.

  My book is not intended to undermine clinical trials. Personally, I like having the latest and greatest medicine available when I’m sick, and human subject testing is a critical part of getting drugs onto pharmacy shelves. Furthermore, the overwhelming majority of the men and women who are a part of the discovery process are dedicated to ethical and safe practices. There are, of course, exceptions—on both sides. But in this book, I specifically wanted to avoid the traditional medical-thriller pattern of having “Big Bad Pharma” at the root of the evil. Instead, I wanted to turn things upside down a little. I wanted to create a spin on a medical thriller in which Big Pharma did not play the typical villain’s role. This gave me a joyride of an opportunity to explore a number of themes that I find fascinating: control, ideological versus physical threats, perspective, causation, and intent.

  One of the biggest challenges I faced while writing Placebo Junkies was achieving the right balance between certain scenes that are (I hope) quite funny and certain topics that are not at all funny. I have a sense of humor that veers sharply toward dark and a solid appreciation for the poetically grotesque, but I absolutely did not want to make light of any of the very serious subjects touched upon in the book: mental illness, drug addiction, medical ethics, or human subject testing, among others. My goal, then, was to craft a story that simultaneously thrills and challenges readers. Placebo Junkies is intended to spin assumptions and prompt questions and discussions, and it is my sincere hope that it does.