#the doc wouldn’t even see me just a nurse practitioner

[the-traveling-poet]

I love how doctors in my area literally don’t give a single shit abt their patients :)

Seriously I’m in a lot of pain I just wanted something for my sinus infection and bronchitis why is that so hard to get-

[parvulous-writings]

Medbay magic // Angela Ziegler (Mercy) x Reader

Request:    Ello, It's me,Ya bor. So I wanted to request a lil' something- Can we get a one shot where Angela (Mercy, for those of yall that don't know (: )nurses the reader back to health, but ends up falling for the reader with all the time they spend together? Then she's super confused about her feelings and doesn't know what to do about it, and she's too scared to tell the reader, but... turns out the reader has always kinda liked Angela too, and they confess to Angela-And they all live happily ever after- 😭🤌No but fr ily bor ❤

Requested by: @rey-is-not-a-skywalker​​

Summary: The reader and Doctor Ziegler develop feelings for each other :)

Warnings: N/A

Words: 1.3K

Notes: I would like to thank one of my old classmates for the word soup conversation :) My requests are currently open! My pinned post (found here) contains both a list of characters I write for, and a masterlist!

Not my gif

You had been in the medical bay for nearly a week now. It wasn’t so bad, you supposed, you were being looked after well enough. You were frequently seen by several different doctors, one whom you greatly preferred over the others. Your favourite doctor was none other than Angela Ziegler, the best medic on the force. This wasn’t just your opinion either, this was just a common fact that everyone accepted. Under her care you had been nursed back from near death to almost perfect health. You swore on your own life that she was magic, it was like nothing you had ever seen. That wasn’t the only magic she used though, you were sure of it. She had managed to work her way into your heart as well, and you held her higher than any other. 

During your time in the medbay, you had several deep conversations with Angela, when there wasn’t all that much for her to do, and she needed something to keep her mind busy. Most of the time they started as nonsense words that she would respond to fondly- word soup, she dubbed it. It was mostly obscure facts or some line of thought that didn’t make much sense.  Angela’s personal favourite conversation was one from when you were half sedated due to the pain of your wounds, and you started spouting drivel about Sciron- an old figure in Greek mythology, who would ask passers by to help him was his feet.  When they knelt before him, he would suddenly give them a kick over the cliff into the sea, where the victim's body was devoured by a huge monstrous sea turtle which used to swim under the rocks. How you remembered about such an obscure figure in common knowledge Ziegler didn’t know, but your words were even stranger.  “What if the turtle was Sciron’s brother?” You posed, staring up at the ceiling as Angela patted down your bed, making sure you were comfortable. She laughed quietly at the absurd idea and shook her head slowly.  “As interesting as the theory is, I do not think that that is what the Greeks were striving for when telling that tale...”  “But why else would he feed the turtle, well, people?”  “I do not know- but there are many instances of strange stories such as this, yes?”  “I s’pose so..” You mumbled, pursing your lips in thought. “But like it could be his half brother, right? Cause that would explain-”  “Quiet down now, you need rest, not stress over fiction turtles and the men who feed them.” 

Why was this Angela’s most fondly remembered conversation? Purely because of it’s ridiculousness. It wasn’t often that such strange topics popped up; no matter what Captain Amari would have had people believe.  Plus you didn’t remember it, and thus she could use it to entertain you in future.

Soon enough, Angela was conflicted as she walked to deliver you the news of your discharge from the medical bay. She was happy for you; she understood how frustrating it can be to be cooped up in one place for any prolonged amount of time. But she was almost... Melancholy, beneath that joy. With you leaving the medbay, she was unsure when she’d get to see you properly next. She didn’t get much free time when off the field or out of the medbay. Most of that free time was spent taking care of herself and her mental health, and was often only late at night. She wanted to spend more time with you so badly, that it made her heart practically ache from the thought of not seeing you for an extended amount of time. She had become enamoured with you, as unprofessional as that was.  As she approached your bed, clipboard in hand, she took a deep breath. She forced a wide smile onto her angelic features, and cleared her throat to capture your attention when she got close enough.  “Any news, Doc?” You ask with a small smile, to which she nods.  “Yes, actually. You’ve finally been deemed fit to leave the med bay.” At this information you looked rather happy, and Angela couldn’t fault you for such a feeling. 

As you started to sit up and swing your legs over the side of the bed, Ziegler also moved round to offer you some help should you require it. Your legs are a little weak after staying in bed for so long, so you are a little wobbly  when you first get to your feet, but you don’t fall over, which is a very good sign in Angela’s eyes. “Thank you, Angela...” You smile at her, referring to everything she had done for you during your time in the medical ward.  “Bitte.” She replied, quite curtly. “Before you go, actually, there’s a couple of things I’d like to talk to you about...” Your brows furrow as she keeps talking.  “Is... Is something wrong?”  “No, no, not at all.” Angela assured you, understanding why you may be anxious about her words- usually when doctors or medical practitioners say something like that it’s never really good. “Far from it, actually.” This put your mind partially at ease, but not by much. She tried to give you what was an encouraging smile, but all it really managed to do was set your heart a-fluttering. Angela cleared her throat quietly.  “So- it may seem a little bit out of the blue for me to say something like this, I am well aware.” She started, trying to keep herself calm as she started to open up a little bit. “During your time under my care, I have... Grown rather fond of you; attached even.” With every word that passed her lips, you found yourself more and more awestruck. You silence seemed to unnerve Ziegler, causing her nerves to skyrocket. She remained outwardly calm, though. She didn’t know what to add to what she had said to improve it or make it less awkward, so she just stood there, tapping her fingers anxiously against the others. 

“Really?” Is all you can think to ask, your voice laced with an incredulous wonder that sounded closely akin to adoration. You would have asked if she were joking, but you knew very well that Angela wouldn’t joke about something like this. “I...” You trailed off, trying to think of how to phrase your next sentence adequately. “I’m rather fond of you too.” You settled to using her own words to describe your feelings. The look on Angela’s face told you that she probably didn’t think she’d get this far. “Oh...” She seemed at loss for words. 

You both stood their for a moment, trying to think of what to say to each other in light of these revelations. After about a minute or so, you broke the silence. “So.. Would you want to get a coffee, or tea sometime?” Your words seemed to break Angela out of a daze, and she gave you a rather large smile.  “Ah, yes, that would be lovely... Tea, and maybe some chocolates? I can bring some Swiss chocolate... It’s the best.” She told you with a quiet chuckle, and you nodded eagerly.  “That sounds good to me... What about time- when are you free?”  Angela had to think for a moment, “I’m off shift next Thursday.. What about five o’clock?” She asks, and you nod happily. “Wonderful!” She chuckled. “I shall see you then... I think you should get going before Morrison starts complaining that I’m keeping you back unnecessarily... I do believe he wishes to see you.” She informed, the fondness starting to show through in her voice.  You nod in gratitude.  “Thanks, Angela... Could I call you Angie, now?” You asked, rather cheekily. Angela rolled her eyes a little bit at the question.  “We’ll see. Now get going.” She hit your shoulder playfully, before moving away to fill in the paperwork about you being discharged. She gave you a final wave, and blew you a kiss as you walked out. 

[the-hopeless-haze]

A Dwindling, Mercurial High

Pairing: Elliot Stabler/reader

A/N: Okay so I had a dream about Stabler the other night and he’s my original SVU crush (sorry Barba) and I had “Illicit Affairs” stuck in my head the whole day after so I had to write this. Thank you to @caked-crusader​ and @detective-giggles​ for encouraging my insanity lol!

Content Warning: NSFW due to sex. Brief mentions of cases that Elliot is working on. Infidelity.

The first time you met Elliot, it was because Dickie had a bad asthma attack and had to be hospitalized overnight. You were fresh out of nursing school, more anxious than confident, and it was a night from hell in that pediatric ward, maybe the worst you’d seen in the couple months since you’d started working. The charge nurse could only start one thing before she was asked to help with something else, two nurses called out and only one could cover, and everyone had at least a three-patient assignment. Suffice it to say tensions were high on that floor, and because Dickie wasn’t the sickest of your patients, you didn’t get to see him as often as you should have. Doing your best felt akin to doing nothing, and every time you came in the room, you apologized you hadn’t been able to come in fifteen minutes ago.

Elliot and Kathy told you it was okay and that they’d been through this before and knew what to expect. But it wasn’t really okay, you knew that. No one wanted to think that their nurse was too busy taking care of other sick children to pay attention to theirs.

Needless to say, you were far too busy that night to pay much attention to Elliot that night, but it wouldn’t be the last time you saw him, so maybe it didn’t matter. Still, sometimes you want to remember that glance that started everything because you have so little to hold onto.

You nearly have a heart attack the next week when your nurse manager says an NYPD detective needs to speak with you, and you nearly have another when you see Elliot’s face. You’ll remember the glance vividly this time; you look down at the linoleum hospital floor before finally sweeping your eyes across his face. He’s not mad; you can tell he’s the kind of man who’d let you know if he was angry, so you try to still your shaking hands.

“I just wanted to let you know Dickie’s doing a lot better,” he says, the hint of a smile on his lips. “Thank you.”

“Um, you’re welcome. I’m sorry I couldn’t have been more help—"

“Don’t beat yourself up, kid. It was a madhouse in here that night. Besides, I know it was you who got the doctor to switch his meds. They’re working a lot better now. He can actually sleep through the night.”

“Well, that’s great!” you say brightly, genuinely feeling a lot better about that night now. “Did you really come out all this way just to tell me?”

He chuckles, shakes his head. “No. I’m working. Victim’s getting a rape kit done here, so I thought I’d see if I could find you while I wait.”

“Oh,” you say, your eyes widening. “What unit do you work on?”

“Special Victims. I’d say I hope I see you around, but I really don’t want my work to bring me to this floor.”

“Me neither. I sincerely hope I never see you again,” you say, smiling, and he smiles back, claps you on the shoulder and thanks you again before leaving.

“He was hot,” Tammy, your best friend on the ward, says as she comes over. “And he came back to see you. Maybe you should ask him out?”

“Well, he’s married,” you laugh. “All the DILFs are. Wives don’t wanna let that go.”

And you really thought that was that. You did have your fair share of DILFs come through that floor, and on slower shifts you’d fantasize about what it would be like to be the other woman, especially when couples would argue to the point of tears. Sure, tensions were always high when children were ill, but those screaming matches were always the result of a more systemic issue within their relationship. Some marriages were destined to fall apart, and sometimes it was exhilarating to dream about being the catalyst, even if you’d never actually act on it. No harm done in imagining yourself with a man you’d only see once in your life.

But you’d see Elliot again in a few months when his job did in fact bring him to your floor. He’s accompanied by a brunette woman, who you later learn is his partner, Olivia. You have no idea how they do their jobs. Sick kids you could handle, but children that had been abused, that were put into that hospital bed, not by the hands of a virus or disease process but by the hands of an adult... it was enough to turn your stomach. But now, at least, you had a direct line to call whenever you thought something iffy was going on between a family, as Elliot gave you his card. He said he trusts your judgment. You tried to suppress your heart fluttering. You’re too young to be having palpitations, but you can’t help staring at him longingly the whole time he’s there talking to the doctor, and you hope neither he nor Olivia notices. He just cared so much, and there’s nothing that gets the ovaries into action like seeing a man that protective over children.

You have to realize, though, that he was just being nice, and he just wanted another set of eyes out there to make sure no one got away with hurting children. You were all too happy to fill that role, anyway. It was a noble one. It had nothing to do with you specifically, and you had to be okay with that.

But fate is a funny thing, because even though you dated around throughout the next couple years, even though you had plenty of other things to occupy your time... Elliot always came back into your life somehow. Just when you thought you forgot about him, it seemed like he was waltzing onto your floor, or, god forbid, there was a child’s family you wanted him to speak to and make sure was alright.

Most times he came empty-handed and almost every time he came with Olivia, but on occasion, he’d show up by himself and with two coffees. And you grew up a little in those couple of years, even if you never grew past harboring your little crush on Elliot. You lost your anxiety that came with being a fledgling nurse and enrolled in a nurse practitioner program. You had your heart broken a few times and you broke a few hearts of your own. You moved out of your parent’s apartment and got your own place.

As for Elliot? Those years didn’t treat him as kindly. He wasn’t growing up as much as he was going down. Kathy wanted to leave him, he felt like he was losing touch with his kids, and his career path only fueled the anger that gnawed at him day after day and night after night. How the hell did his life get this fucked?

Of course, you weren’t privy to this information until he punched a hospital wall. It was a long night, and one of the children he rode on the ambulance with didn’t make it. You were upset, too, of course, even though he wasn’t your patient, and you couldn’t wait to get out of here and cry over a bottle of wine. But when Elliot’s fist connected with the wall, you knew your night was going to end much differently.

“(Y/n)! Are you busy? I need you to take your cop friend out of here. We don’t want the parents seeing that. Go! Clean up his hand and make sure he’s billed for that wall,” the doctor barks at you. “You gonna move?”

“Yeah, yeah, I’m on it, Doc,” you murmur, but you’re frozen in place at the nurse’s station. You can’t help staring at Elliot as he steps out of the room, with his chest heaving, his hand bloodied, his blue eyes ablaze. Eventually, your legs cooperate with you again, and you nod at him, motioning for him to follow you down the hallway. You grab some gauze and alcohol from the supply closet on the way and lead him into an empty room, taking his hand in yours. “Can you make a fist for me? I need to see if it’s broken.”

Elliot doesn’t say anything; he barely even looks at you, but he does as you ask.

“Okay. Good. You're just gonna be a little sore. You can relax it now. The alcohol is going to sting—“

“I know,” he says hollowly.

“I’m sorry. You’re the oldest patient I’ve had since I was in school,” you say, feeling your face flush as you grab the alcohol and wipe his knuckles. "This isn't the first time you've attacked a wall, then, hm?"

Elliot shoots you a withering look and you swallow thickly. Was he going to yell at you now? Thankfully, he sighs and the anger in his eyes fades. "Listen. I'm sorry you had to be here for that.”

"It's alright. I've seen worse. And I know it's tough, Elliot," you say. "Everyone handles grief differently."

"It ever get any easier for you?"

"No," you whisper, letting your hair fall in front of your eyes so he can't see them well up with tears as you lean over to bandage his hand. "Guess it never does. I don't get angry; I just get depressed. You don't want to get desensitized to it, though. I'd rather see people punch walls than not care."

Your breath catches in your throat as he pushes your hair back with his good hand, and he keeps it there on the side of your cheek. All this time, in the four years of knowing this man, and he'd never touched you like this. Come to think of it, you never exactly stood this close to him, either. Your relationship was always professional, despite all the times you wished it wasn't. Wasn't there a reason you two kept ending up in the same rooms? Wasn't there a reason you ended up in this one, alone? And you could get drunk off his scent, couldn’t you? The slight musk of sweat from his earlier exertion, the woodsy headiness of his cologne, the hint of spearmint on his breath from his mouthwash... it was all too much, and it’s all you have in you to not lean into his touch, to not lean over and press your mouth to his...

“Elliot—“

"Don't talk," he murmurs. "Unless you want to stop me. Do you?”

You wouldn’t dare.

When your lips finally do connect, it's electric, even though the only thing running through the back of your mind is how you'd probably be fired if anyone stepped into the room at this moment. You can't very well deny yourself what you've been wanting on and off for years, though, even if it’s wrong. His hands grab your waist and yours find purchase on his shoulders, feeling the muscles flex underneath you as he moves you to straddle his thigh. You have to try very hard not to search for that friction your whole body aches for, not yet, not when you don’t know how far he wants to take this and when you’re still on the clock.

“When do you get off?” he asks, and you both chuckle at the unintended double-entendre.

“At eleven.”

“Come have a drink with me.”

“I don’t want a drink. I want to continue this,” you purr, getting off his lap to fix the bandage and tape it down.

“You sure?”

“Elliot, I thought you’d never ask me. I would’ve been sure four years ago,” you say, feeling slightly guilty at that, but it was true. The more you saw of him without his wife and children the easier it was to forget that they were the reason you met him in the first place. And if at any time he kissed you like that? You know you’d be putty in his hands just like you were now. “You don’t need to go back to the precinct?” You don’t dare ask about home. Selfishly, you don’t want that to cross his mind.

“I’ll be back here by eleven.”

It’s another breathless kiss before you’re out the door, heading back to finish your shift.

“The hell are you all red for, (y/n)?” Tammy asks as you round the corner.

“Nothing,” you say. “Just ran up here. You need anything?”

“Ran up here? Weren’t you taking care of... oh. You’re playing with fire, girl,” she says, smirking.

“Shut up,” you say, but you can’t force your cheeks to cool down. “Nothing happened.”

“Mm. Be careful. He’s still married, isn’t he?”

You wouldn’t listen. You were only after chasing that high, even if it was only born to die in front of your eyes. —- You’re straining against your handcuffs, and you can’t see Elliot at all through the blindfold, but you can feel his hands and his mouth, hot and heavy, touching you everywhere. You have no clue where to focus, and you still can’t quite believe he’s here in your apartment. Part of you expected him to stand you up and realize that he should be going home instead of taking you to bed. But he either didn’t have that epiphany or he didn’t care - and you were desperate enough for him that you’d take either - and so began your first illicit meeting.

“I told you to stop pulling at those, baby,” Elliot says, his tone stern. “You’re going to make yourself bleed.”

“Maybe if you gave me what I wanted, I wouldn’t have to—“

He cuts you off with a firm kiss, and you can feel his cock hard against your thigh, and not being able to see only heightens the sensation. “You gonna give me attitude, baby? I don’t think so. Why don’t you relax? I’m gonna take care of you. Gonna take my time though. Been four years of seeing your ass in those tight scrubs and not being able to do fucking anything about it.”

“You noticed me…. Like that?”

“You think I’d be here if I didn’t? Don’t act innocent now. You know what you do to me.”

Of course, you had noticed him looking at you sometimes, but you never let yourself read into it, but now, everything was coming back to you and… oh, fuck, finally he slips two fingers into your entrance and you’re drawn out of your thoughts, arching your back as he drags his fingers across your walls, painstakingly slow.

“You’re fucking soaking, baby girl,” he grunts. “You think you can take three? Mm. Gonna stretch you out a little.”

His bandaged hand comes to still your hips and you can’t believe he’s fucking you this good with his non-dominant hand, his thumb flicking against your clit every so often, those little shocks of pleasure bringing you closer to the million little deaths you deserved. Sometimes you’d feel his mouth where you’d least expect it, too, his tongue licking a trail up your stomach to take your nipple in his mouth or his teeth and tongue working on leaving a mark on your collarbone.

“Please. So close, El,” you pant, rolling your hips in vain.

“That’s it, that’s it, that’s it, come on, let go, baby,” Elliot growls in your ear. “Just let go.”

And you do, falling apart with his name on your lips before he kisses you again, swallowing down all your moans and whimpers, his hands leaving your lower body to find purchase in your hair.

“You good?” he asks, barely pulling away from your mouth.

“So good,” you gasp, straining upward to press your lips to his again.

“Gonna fuck you now, baby, that okay?”

“More than okay.”

You’re so wet he doesn’t meet much resistance, but you’re still sensitive from your orgasm so soon before, and combined with the fact that you can’t see or touch him - it was almost too much at once.

“Oh fucking hell,” Elliot grunts. “You good?”

“Yes. Please start fucking moving,” you whine. “Fuck me hard.”

You can tell he needs that; he needs to let go of all his pent-up anger and frustration, and you didn’t really care if at the expense of that you couldn’t walk tomorrow. You’d do anything, anything for just the chance to occupy a sliver of his life.

And God, once given permission, he doesn’t hold back at all. He sets a brutal pace, the bed shaking and moving in tandem with the force of his thrusts. You can’t see him, obviously, but you can feel the weight on the bed shift and his angle change as he grips the headboard, driving into you so roughly you think you might black out. He starts grunting softly with every thrust, and then, oh - you feel him move back down, his lips catching yours and his hands cupping your breasts and it’s all you can do to fight with your body not to come yet; you want to come with him, experience this high together.

“Fuck, (y/n), so good,” he groans, his tongue running over the bruise he’d sucked onto your skin earlier, and you whimper in response. “So fucking good for me, taking my cock so good. Knew you’d be fucking amazing.”

If his dirty talk wasn’t enough to send you over the edge, well, he adjusts his angle with a particularly strong thrust of his hips and you’re pulling on the handcuffs again, the sting as they slice into your wrists a sharp contrast to the impending pleasure - if you could just hold on - and thankfully, Elliot’s panting brusquely in your ear that he’s close, that you should let go again. Coming together is a beautiful euphoria - one that was desperately needed after the night you had, after the four years of longing stares that neither of you, apparently, knew was reciprocated until now. But like the end of all highs, you have to come down at some point. Elliot lifts the blindfold and looking into his eyes for the first time since he stripped you naked, you can’t help but feel like a fucking mess. But you know you’d do it again, and again, and again...

“I told you not to pull at those,” he tsks, leaning over to unlock the handcuffs and free your wrists. “You’re bleeding, (y/n).”

And, like some bad deja vu, Elliot’s cleaning your wounds with alcohol like you did for him only hours prior.

And after, he stays and talks with you a little, mentions vaguely his marriage is going downhill, which you could have easily figured out yourself, and when you wake up in the morning, he’s gone without a trace. You had to expect that he couldn’t stay, and you wonder what lie he fed his wife. You wonder if she believed it. Was this just a one time thing? Maybe you just both needed to get this out of your system, as almost half a decade of sexual tension needed to be dealt with somehow.

But no. Like always, you see him again, and on most occasions, now, he ends up tangled in your bedsheets. It feels like you’re always competing with other women for Elliot’s attention, whether it be Kathy or Olivia. But you take solace in the fact that you’re the only one he’s going to fuck like this. Olivia’s his partner, and that relationship is already too close for comfort to bring sex into. And if he came home with handcuffs and a blindfold to his wife, she’d drag his ass to therapy. You’re the only woman in his life that he can use for this, and that thought alone could get you high, could get you off. And sometimes, that feels like all he’s using you for, a sense of release for the moments when he doesn’t want to be at home and he can’t be at work. But other times - he lets you in, tells you jokes, tells you stories - and in some ways you’ve never felt this close to another person. He played such a different role in all the other areas of his life - but with you - he didn't have to play one, and sometimes you caught a glimpse of the man he was before all his burdens were placed onto his shoulders. You know you’ll never have a relationship like this with anyone else.

And for that reason, you’ll always answer the phone when he calls, even if you ruin yourself every time. You would for him. You always would for him.

[gins-potter]

The Yaya and Torrey of it all...

To distract myself from the fact that Chicago Med likely won’t be uploaded for hours yet, and also because I’ve been kind of slack about posting about One Chicago lately, I thought I’d write down some thoughts I’ve been having about Yaya and Torrey leaving.

At first I was stunned, like I did not see that coming at all.  Tbh I’d forgotten completely that with this being the sixth season most of the main casts contracts would be up.  Fire owns my heart so I’ve mostly been following news about Jesse and Taylor’s contracts, while keeping half an eye on news about PD contracts - Med was so not on my radar.  But once I think about it, Torrey and Yaya leaving kind of makes sense.... emphasis on kinda.

(it got kinda long so full thoughts under the cut)

April Sexton - Nurse Practitioner

I think everyone agrees that this is the departure that makes the most sense of the two.  I think I remember being a little worried when this storyline started that this was a way of writing April out but I guess I just settled into the assumption that she would study off-screen and maintain a work/study balance ala Penelope from ODAAT (if you’ve never seen that show the main character Penelope works as a nurse while studying to be a NP at the same time and both are shown on screen).  Presumably now April will just be written out completely to go study.  

I’ve seen some theories floating around that she’ll move out of state to be with Noah (where did he move to? Atlanta?) and I think that could really work.  I do wonder how this might be tied in with Archer’s offer to get her into that school she wanted.  I cold see April going back and forth for a few episodes deciding if she wants to take him up on his offer or not, so I’ll be interested to see how that develops.

I’ll definitely miss April, she was never my favourite character, but I think season 6 was really good for her and seeing her work in two different areas she was clearly passionate about was nice to see.  And as far as storylines go, writing her out so she can advance her career is a good way to do it, it’s hard to be too sad about her leaving when you’re happy for her as a character.  I am a little bummed in terms of the Chexton of it all just because I did ship them for a little while, and I did kinda see them getting back together eventually, but I guess that won’t be happening now.  I’m not too heartbroken about it but I did think they had moments where they were good together.  I think one of the biggest downsides to writing April out is that it means we’ve completely lost another sibling duo in the One Chicago universe (and if I’m counting right that leaves only the Halstead bros standing?)(editing to clarify I mean siblings who are main characters/regulars on the shows not characters who have siblings in general).  But it sounds like Yaya already has a new show lined up in which she’s the lead (correct me if I’m wrong about that part) and I think this NP storyline really serves for a good exit for April and Yaya both.

Natalie Manning - Where the hell does she go from here?

The one that makes less sense to me has to be Nat’s exit.  And I say that in the context of the entire show, her current storyline trajectory makes a lot of sense actually.  Obviously we don’t know for sure what’s going to happen but there’s a lot of theories going around that make a lot of sense.  Where we’re at as of writing this post (I haven’t seen 6x14 yet) Nat’s taken the pills, Will’s in trouble for it, and she knows he’s in trouble for it.  It seems plausible to me that from here we get a couple episode of Nat fucking around trying to come up with a way to get Will out of trouble, before ultimately coming clean to save his ass, the repercussions of this being that she has to leave the hospital.  I have two problems with this.

The first, where the hell does this leave Natalie?  Because at this point we’re contending with two different entities, the drug company who was in charge of the trial (spacing on the name) and Chicago Med as a hospital.  Will’s in trouble with the former so to save him that’s who Nat’s primarily gonna have to come clean to, and I’m having a hard time seeing how realistically they wouldn’t want to charge her with the theft.  But where would that leave Nat besides probably in jail and Owen on his own with a sick grandma?  It’s kind of a shit ending for Torrey’s character, and I just can’t see the Med writers going that route.  So I guess my theory is that Sharon steps in and brokers some kind of deal with the drug company where she convinces them not to press charges but to show that Nat is facing consequences she’s fired.  Then she either stays in the city with Owen and just (presumably) finds a new job, or I can even see her also moving out of state as I think her parents live in Seattle?

My other problem is that this kind of doesn’t make sense in the broader context of the show.  The Chicago Med docs are always up to shady shit, Will and Nat most especially, why is now suddenly the time they face consequences for their actions (besides the fact that Torrey is leaving of course).  It just seems mighty convenient to me, and that’s not something I particularly like about character exits like this.

In terms of Nat’s character in general leaving, my feelings are pretty similar to April’s exit.  While I think the exit itself hasn’t been set up great (I much prefer how they’ve set up April’s) I am vaguely sad about Torrey/Nat leaving.  Much like April, Nat was never my favourite character, in fact I swung wildly between eh she’s alright and oh my god I hate this chick for a while there.  But again, like April, season 6 was good for her, and I even got on board with Mancel (rip that relationship) and it’s sad to see her go just when I was starting to like her again after really really not liking the way Manstead ended.  Speaking of, I think even more so than Chexton I fully expected Manstead to get back together by the end of the show, and I even thought they were setting that up by giving them storylines together in the back half of this season (now I just wonder if they wanted to give fans a chance to see them interact again before Torrey left).  So it feels very weird to me that we won’t see them again now after spending seasons thinking of them as an endgame ship.  I can see there being some kind of final romantic moment between them, especially if Nat’s written to move out of state but idk if I would want that or if it would just be rubbing salt in an open would.  That all being said I wish Torrey all the best, I read that she already has a movie gig lined up so that’s awesome for her.

Final Thoughts

Look, the writing on Med has always struck me as kind of repetitive if not weak in general so I can’t really blame either Yaya or Torrey for wanting to move on to new things.  Even if it was the best writing in the world, playing the same character for 6 years is a long time and while there are plenty of actors who like a steady gig there are also plenty more who like the challenge of new characters/stories/sets etc.  And like I said above, they already have new gigs lined up so this is clearly something they both want so I’m at least glad that that allowed the writers to set up somewhat believable exits for them both.  I don’t know if I would say I hope they come back someday, but it seems like they’re certainly going to leave it open for that.  Unless they pull an Ava Bekker-esque last minute death, it seems like they’re both going to leave the show alive and somewhat happy so there’s always a chance they bring them back one day (this feels more likely for April/Yaya then Nat/Torrey but you never know).  All in all definitely not the worst character exits I’ve seen in this franchise, or even this show, yeah I’m looking at you Ava Bekker.

[goat-yells-at-everything]

Another story time! (This one good!)

So had an appointment with the nurse practitioner at my docs office this morning. Made it last week when they fucked all my shit up cuse I wanted them to tell me to my face Rosie wasn't a service dog.

I was 100% right about the policy being for ESAs. She wasn't totally sure off the top of her head about service dogs but she said that it didn't make sense that they wouldn't sign off on service dogs. She said she'd double check to be sure but she's pretty sure that nurse just didn't want to take the time to learn about Rosie.

So she had me explain everything from getting her to figuring out her 6th sense to how ive trained her both to be in public and how ive reinforced her natural instinct to alert. She said it is now 100% documented and after spending time with Rosie and me (and seeing her in action when she alerted to my anxiety rising) she absolutely backs me up that Rosie is a service dog.

She told me, no matter what the policy says, if i need something for work again that i should just ask for her and she'll noodle something out for me.

I could make a stink about how the actual doctor and his nurse treated us but, at this point, I'm just too tired. It was, technically, a misunderstanding (even though if they'd just TALKED to me about it we coulda cleared it up) so I'm just going to drop it for the time being. Next time I see the actual doctor may end up being a passive aggressive bitch fest but, y'know, he deserves it. Xp

[kelleyish]

Happy Wednesday Tumblr. Let’s do some bullets today

Yesterday was Super Tuesday for the primaries, in which Texas participates. I voted early last week. I didn’t really have strong feelings about any particular person, as I plan to vote for whoever gets the nomination for Democrat candidate in November. I ended up going with Warren, and she didn’t do well at all, something like 1% of the vote. I voted for Sanders in the primary four years ago, and then of course voted for Hillary that November. This time I just wasn’t super hype about Sanders for whatever reason, so I decided to vote with my vagina.

(Not literally, that’d be pretty unsanitary) 

I tend to do that in general, and vote for women wherever possible in the local elections. 

Today it looks like Biden just squeaked out the win here in Texas. I’m not super thrilled with Biden either, and he’s got some problematic shit in his record, but you best believe if he gets the nom I’ll be voting for him over the pussygrabbing cheeto.

Yesterday I had my first official “physical” from a general practitioner, mainly so I could get him to refill my heartburn medication so I can get it for free with my insurance instead of having to pay money for the over the counter version. 

I used to have yearly exams my gyno of course, although now that I’m not being held hostage needing birth control refills I haven’t been to see her in three or four years. I know I should, but it’s not like I’m in any danger of STDs at the moment and I’ve never tested positive for HPV, so I’ve just been letting it slide. 

Anyway, there wasn’t a whole lot to the physical. He listed to my heart and arteries in my neck, which in retrospect did not necessitate me taking off my bra. I had a paper gown deal but it’s not like he gave me a breast exam so I’m not sure why that was necessary.

So the nurse said undress from the waist up, and then she made a comment about putting my shoes under the chair, I guess so the doc wouldn’t trip on them when he came in?

She left the room and I was like, if I have to undress from the waist up, why do I have to take off my shoes? So I opened the door again and asked her just that, and she was like I think he wants to look at the bottom of your feet?

He did not look at my feet

He also looked in my ears, felt my neck a bunch, and went over my blood test results. Those were pretty good for my age and signifiant oveweightness. My blood sugar was perfect at 84, so I’m still avoiding diabetes for now, yay! My cholesterol was 208, which is just over the recommended level of 200. The good and bad ratios could use a little work, but my triglycerides were fantastic, which is apparently a side effect of low carb eating.

He didn’t mention my blood pressure reading, but I have noticed a general trend that I’m usually in the 140s over upper 80s these days. I used to have excellent blood pressure but I guess weight and age must be starting to catch up. I’m hoping I can get that down lower with more weight loss, especially now that I may have blood vessel weakness in my DNA.

So I told myself I was going to jump back into super healthy living but I didn’t go to the gym like I’d planned and I just ate a Starbucks chocolate croissant. I don’t know what it’s going to take to jumpstart my motivation again. 

Maybe I need to ask out another dude who is inappropriately too hot and young for me, spend a week working out like crazy, and then when he doesn’t call I’ll just go ahead and feel occasional stabs of embarrassment every few days for the rest of my goddamn life.

Here’s a picture of me from last night. The light was kind of interesting outside, and I’d put on a little makeup that day, so it was prime selfie time, apparently. 

I’m wearing an apron because I was getting ready to make dinner. 

This is outside the front door of my parents house. Inside the house on the wall behind me you can see the remnants of some of our old photography business. We had a huge wall covered with large framed bridal and engagement portraits and pictures form weddings. 

A couple years ago I started helping my dad rearrange the wall. We took down a lot of the bridals but left up a few that we liked the most. Yeah, they’re pictures of virtual strangers but it’s also our art, too. 

It also features a picture of me and Chip from our wedding, and the bridals we did for my little sister. This is about half the wall, and the rest is blank because we never got around to filling up the other half. It’s on the todo list.

We had a client once come in for photography services, and made a comment about how many daughters my dad must have. Even though he was there to procure photography services from us, he somehow thought all the pictures on the wall of brides must be family, otherwise why would they be on the wall of our house?

That shirt is my current favorite shirt. It’s green and the pattern on it is very slimming. At least i think it is.

Here’s what I made for dinner last night. https://recipechampions.com/recipe/keto-bacon-cheeseburger-burrito/ 

It was pretty good, but my goodness was it fatty and high calorie. It kept me full the rest of the night, I will say that. You have to work fast with the cheese tortilla, it gets hard really quick and makes it hard to fold the burrito.

The underwire came poking out the end of one of the channels in my bra. It took me several weeks to get around to fixing it. I sewed it up finally a couple days ago, and today it is poking through again.

I’ve done a couple transcription jobs for cooking competition shows lately. Specifically it’s these talking head interviews that they later splice bits into the footage of them actually doing the cooking and whatnot. I’m not sure why they are bothering to do a transcript of raw footage like this, when only a fraction of it will make it into the final cut of the program. It seems like it would be more cost effective to wait until the episode is finished and then have a caption person do the whole thing. Who knows, maybe that’s not even the purpose of these. I’ll take their money either way, I guess.

Because of the way they splice the footage in they want the talking heads to be present tense, and people have a really hard time with this sometimes. This is taking place after the competition is over, so they’re saying things like “I went over and grabbed the flour and started making my crepe batter,” and so the director has to keep stopping them and making them say, “I walk over and get the flour and start making my batter.”

The end. Time to leave Starbucks now.

[nancygduarteus]

The Penance of Doc O

Well past seven one evening in 1988, after the nurses and the office manager had gone home, as he prepared to see the last of his patients and return some phone calls, Dr. Lou Ortenzio stopped by the cupboard where the drug samples were kept.

Ortenzio, a 35-year-old family practitioner in Clarksburg, West Virginia, reached for a box of extra-strength Vicodin. The box contained 20 pills, wrapped in foil. Each pill combined 750 milligrams of acetaminophen, the active ingredient in Tylenol, with 7.5 milligrams of hydrocodone, an opioid painkiller.

Ortenzio routinely saw patients long after normal office hours ended. Attempting to keep up with the workload on this day, he had grown weary and was suffering from a tension headache; he needed something to keep him going. He unwrapped a pill, a sample left by a drug-company sales rep, certain that no one would ever know he’d taken it. Ortenzio popped the pill in his mouth.

“It was a feeling like I’d never felt before,” he told me recently. “I’m tense and nervous, and that anxiety is crippling.” The pill took the anxiety away. The sense of well-being lasted for four hours, carrying him through the rest of the night’s work.

Back then, Ortenzio was one of Clarksburg’s most beloved physicians, the kind of doctor other doctors sent their own families to see. His patients called him “Doc O.” He made time to listen to them as they poured out the details of their lives. “To me, he wasn’t like a doctor; he was more like a big brother, somebody I could talk to when I couldn’t talk to anybody else,” says Phyllis Mills, whose family was among Ortenzio’s first patients. When Mills’s son was born with a viral brain infection and transferred to a hospital in Morgantown, 40 miles away, Ortenzio called often to check on the infant. Mills never forgot that.

As a physician in a small community with limited resources, Ortenzio did a bit of everything: He made rounds in a hospital intensive-care unit and made house calls; he provided obstetric and hospice care. Ortenzio loved his work. But it never seemed to end. He started missing dinners with his wife and children. The long hours and high stress taxed his own health. He had trouble sleeping, and gained weight. It took many years, but what began with that one Vicodin eventually grew into a crippling addiction that cost Ortenzio everything he held dear: his family, his practice, his reputation.

The United States is in the midst of the deadliest, most widespread drug epidemic in its history. Unlike epidemics of the past, this one did not start with mafias or street dealers. Some people have blamed quack doctors—profiteers running pill mills—but rogue physicians wrote no more than a fraction of the opioid prescriptions in America over the past two decades. In fact, the epidemic began because hundreds of thousands of well-meaning doctors overprescribed narcotic painkillers, thinking they were doing the right thing for suffering patients. They had been influenced by pain specialists who said it was the humane thing to do, encouraged by insurance companies that said it was the most cost-effective thing to do, and cajoled by drug companies that said it was a safe thing to do.

Opioid painkillers were promoted as a boon for doctors, a quick fix for a complicated problem. By the end of the 1990s, Ortenzio was one of his region’s leading prescribers of pain pills. It was a sign of the times that he didn’t think there was anything wrong with that.

Clarksburg sits atop rolling hills in northern West Virginia, halfway between Pittsburgh and Charleston. Lou Ortenzio came here in 1978, a recently married young resident out of the University of Maryland School of Medicine. “Small-town living seemed so much better than suburban life,” he told me as we drove around town one afternoon. “In Clarksburg, every block had something going. We had mom-and-pop grocery stores in every neighborhood. All these houses were occupied by teachers, downtown business owners, and people who worked in glass factories.”

Coal mining was the state’s dominant industry, but in Clarksburg, the glass business boomed. Glass manufacturing had arrived at the turn of the 20th century, drawn by the state’s high-quality river sand and rich fields of natural gas. Pittsburgh Plate Glass opened a factory in Clarksburg in 1915 and for years was one of the world’s leading plate-glass producers. Anchor Hocking employed 800 people making tumblers, bottles, fruit bowls. The city had family-owned factories too: Rolland Glass, Harvey Glass, and others.

Unlike simple resource extraction, glassmaking required sustained technological investment to meet new demands from the marketplace. The mass production of plate glass made skyscrapers possible. Picture windows and sliding-glass doors made small homes look bigger and more luxurious. The industry forged a middle class in Clarksburg and even gave the city a cosmopolitan air. The glass factories attracted artisans from France and Belgium; French was commonly heard on the streets for years.

Glass manufacturing helped forge a middle class in Clarksburg, but by the mid-1980s the industry, and the city, was in decline. Clockwise from top left: Lou Ortenzio; the abandoned Anchor Hocking glass factory; glass collected from the city’s streets; downtown Clarksburg. (Jason Fulford)

Each neighborhood was a self-contained world, with its own churches, grocery stores, and school; many had a swimming pool. High-school sports rivalries were fierce, and football games drew large crowds. When Victory played Roosevelt-Wilson, or Washington Irving went up against Notre Dame, people knew to arrive early to find a seat.

By the late 1970s, Clarksburg’s older physicians were retiring. Like many small towns at the time, it had trouble attracting young professionals. Ortenzio was among the few physicians who moved there to fill the void. He and two other young doctors opened a practice in 1982. Almost immediately, Ortenzio was seeing 40 to 50 patients a day.

The people who came to see him were mostly older; many had served in World War II. They had the aches and pains to show for a lifetime of hard work in the glass factories or at the gas company, but they had retired with something approaching financial security. They owned homes and cars, had pensions and good health insurance.

Ortenzio’s patients suffered from the ailments of the old—arthritis, diabetes, hypertension—and most of them did so stoically. This was partly generational and partly an Appalachian inheritance. One man, Ortenzio remembered, came to him thin and wasted away from cancer. “The disease was advanced, but he put up with it. I said, ‘Why didn’t you come in earlier?’ He said, ‘Well, I wouldn’t want you to think I was complainy.’ That was the Appalachian line—‘I wouldn’t want you to think I was complainy.’ ”

Ortenzio grew into his adopted city. In 1992, he established a free clinic where Clarksburg’s uninsured could get medical care. The county chamber of commerce named him Citizen of the Year for that. He had been trained to treat patients holistically. Most of what a doctor needs to know to make a diagnosis, his professors had taught him, could be learned from taking time to listen to the patient. X-rays and lab tests were mostly to confirm what you gleaned from asking questions and paying attention to the answers. He’d also been trained to help his patients help themselves. Part of his job was to teach them how to take care of their bodies. Pills were a last resort. This careful approach endeared him to his patients, but it lengthened his day. “He would have office hours until 11:30 at night,” says Jim Harris, a friend and the director of the free clinic. “People waited until then because he was worth the wait.”

Drug salesmen visited him weekly. It was a stodgy profession back then. Ortenzio remembers the reps as older men who had grown up and lived locally and who cultivated long-term relationships with doctors. One of the reps for Eli Lilly was a deacon in a local Catholic church. Once a week, he would visit Ortenzio’s office in a business suit, with information about the drugs Lilly produced. Like many in his profession in those years, he avoided hard-sell tactics. Ortenzio grew to rely on the salesman’s counsel when it came to pharmaceuticals. Once, when the Food and Drug Administration removed a Lilly drug from the market, the rep dropped by Ortenzio’s office, embarrassed and apologetic.

Before long, Ortenzio and his wife saw Clarksburg as home. They found a two-story, three-bedroom house in the Stealey neighborhood, southwest of downtown and at the foot of a hill. They set off to the bank for a 30-year loan. To their surprise, they were denied. “The house won’t keep its value that long,” the banker told them. “The best we can give you is a 15-year loan.”

The banker was right. It wasn’t yet clear, amid the bustle of Main Street and Friday-night football, but the city’s prospects were fading. Newer glass technologies required large factories, which meant stretches of flat land rare in West Virginia. Mexico and Japan emerged as competition in glass manufacturing, and plastic and aluminum emerged as alternatives to glass. Pittsburgh Plate Glass had closed in 1974. Anchor Hocking left in 1987. Its hulking concrete plant is slated for demolition, but for now it remains, just off Highway 50.

By the mid-1980s, the city was in decline. Glasswork was replaced by telemarketing. Downtown, locally owned stores began to disappear. Homeowners yielded to renters, many relying on Section 8 assistance from the government. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. The swimming pools, too, slowly closed; resident associations lacked the money to maintain them.

Ortenzio drove me by the massive Robert C. Byrd High School, home of the Eagles. It was built in 1995 to consolidate two smaller high schools in Clarksburg, whose population had receded. Replacing neighborhood schools with one centralized school allowed for better course offerings. But Byrd is far from any student’s home. School consolidation extinguished the sports rivalries that had brought people together each week. Without local schools, neighborhoods lost their social centers.

When glassmaking departed Clarksburg, locally owned stores began to disappear as well. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. (Jason Fulford)

Lou Ortenzio began to see people in economic as well as physical pain. Many were depressed, worn out by work or the fruitless search for it. Obesity became a more common problem. Some patients began to ask whether he could get them on workers’ compensation or disability. Others left to seek job opportunities in New York, North Carolina, Florida. “I was always calling people out of state telling them how sick their parents or grandparents were,” he said.

When Ortenzio had opened his practice, he’d tended to see young people only for pregnancies or the occasional broken leg. By the mid-1980s, younger people were showing up in larger numbers. They were coming in with ailments that their parents and grandparents had borne in silence—headaches, backaches, the common cold. “The new generation that came in the 1980s, those kids began to have the expectation that life should be pain-free,” Ortenzio said. “If you went to your physician and you didn’t come away with a prescription, you did not have a successful visit.”

The shift was not peculiar to Clarksburg. Americans young and old were becoming accustomed to medical miracles that allowed them to avoid the consequences of unhealthy behavior—statins for high cholesterol, beta-blockers and ACE inhibitors for hypertension and heart failure, a variety of new treatments for diabetes. Fewer patients showed up for annual physicals or wanted to hear what they could do to improve their wellness. They wanted to be cured of whatever was ailing them and sent on their way. Usually that involved pills.

The medical establishment, to a large degree, abetted this shift. In the 1980s, a new cadre of pain specialists began to argue that narcotic pain pills, derived from the opium poppy, ought to be used more aggressively. Many had watched terminal cancer patients die in agony because doctors feared giving them regular doses of addictive narcotics. To them, it was inhumane not to use opioid painkillers.

The specialists began to push the idea that the pills were nonaddictive when used to treat pain. Opioids, they said, could be prescribed in large quantities for long periods—not just to terminal patients, but to almost anyone in pain. This idea had no scientific support. One author of an influential paper later acknowledged that the literature pain advocates relied on to make their case lacked real evidence. “Because the primary goal was to destigmatize, we often left evidence behind,” he said.

Nevertheless, an alliance of specialists who saw their medical mission as eradicating pain was soon joined by the pharmaceutical companies that manufactured opioids. Medical institutions—the Department of Veterans Affairs, the Joint Commission on Accreditation of Healthcare Organizations, hospitals and medical schools across the country—bought into this approach as well.

By the late 1990s, medical schools, when they taught pain management at all, focused on narcotics. By the early 2000s, doctors were being urged to prescribe the drugs after almost any routine surgery: appendectomy, ACL repair, wisdom-tooth extraction. They also prescribed them for chronic conditions such as arthritis and back pain. Chronic pain had once been treated with a combination of strategies that only sometimes involved narcotics; now it was treated using opioids almost exclusively, as insurance companies cut back on reimbursing patients for long-term pain therapies that did not call on the drugs.

The U.S. drug industry, meanwhile, was investing heavily in marketing, hiring legions of young salespeople to convince doctors of their drugs’ various miracles. Nationwide, the number of pharmaceutical sales reps ballooned from 38,000 in 1995 to 100,000 a decade later. The old style of drug rep, grounded in medicine or pharmacy, largely passed from the scene.

“It went from a dozen [salesmen] a week to a dozen a day,” Ortenzio remembered. “If you wrote a lot of scrips, you were high on their call list. You would be marketed to several times a day by the same company with different reps.”

Most drug companies in America adopted the new sales approach. Among them was Purdue Pharma, which came out with a timed-release opioid painkiller, OxyContin, in 1996. Purdue paid legendary bonuses—up to $100,000 a quarter, eight times what other companies were paying. To improve their sales numbers, drug reps offered doctors mugs, fishing hats, luggage tags, all-expenses-paid junkets at desirable resorts. They brought lunch for doctors’ staff, knowing that with the staff on their side, the doctors were easier to influence. Once they had the doctor’s ear, reps relied on specious and misinterpreted data to sell their product. Purdue salespeople promoted the claim that their pill was effectively nonaddictive because it gradually released an opioid, oxycodone, into the body and thus did not create the extreme highs and lows that led to addiction.

[From April 2006: The drug pushers]

The reps were selling more than pills. They were selling time-saving solutions for harried doctors who had been told that an epidemic of pain was afoot but who had little time, or training, to address it. For a while, Ortenzio still suggested exercise, a balanced diet, and quitting smoking, all of which can alleviate chronic pain. But his patients, by and large, didn’t want to hear any of this, and he was busy. So he, too, gradually embraced pain pills. Nothing ended an appointment quicker than pulling out a prescription pad.

The number of people on pain pills grew from a tiny fraction of Ortenzio’s practice to well over half of his patients by the end of the 1990s. The shift was gradual enough at first that he didn’t recognize what was happening. Patients with medical problems unrelated to pain migrated to other doctors. Still, Ortenzio was working 16-hour days, seeing patients who had been scheduled for the afternoon at 9 p.m.

The more drugs Ortenzio prescribed, the more he was sought out by patients. Many would use up a month’s supply before the month was out; in need of more pills, they were insistent, wheedling, aggressive. Many lied. Some would curse and scream when Ortenzio told them that he couldn’t write them a new prescription yet, or that he wanted to lower their dosage.

The pills were soon on the streets of Clarksburg as well. They replaced beer and pot at many high-school parties. Phyllis Mills, Ortenzio’s longtime patient, had two daughters who abused the pills. Theirs did not come from Ortenzio, at least not directly, but the supply of pills was exploding, due in large part to doctors like him who were overprescribing them.

Ortenzio should have noticed what the pills were doing, to his patients and his community, but he was less and less himself. After his late-night encounter with Vicodin in 1988, he had begun his own slide into addiction. By the late 1990s, he was using 20 to 30 pills a day, depleting even the plentiful supply of free samples from the ubiquitous sales reps.

Desperate to get his hands on more pills, he found a friend he could trust, a middle-aged accountant and a patient of his. “I’m in some trouble,” Ortenzio told him. “If I write you this prescription, can I ask you to fill it and bring it back to me?”

“Sure thing,” the man said, without asking for an explanation. “If you gotta have it, you gotta have it. You’re the doc.”

Soon a dozen or so trusted patients were helping Ortenzio. He knew he was out of control and needed help—even the amount of acetaminophen he was consuming was toxic—but he feared that seeking treatment for his addiction might cost him his medical license. Around 1999, he found a new way to get his fix. He began writing prescriptions in his children’s names.

Ortenzio could plainly see that the claim that these pills were nonaddictive was untrue. He would try to quit and feel the symptoms of withdrawal. “I couldn’t be away from my supply,” he said. His patients, too, were terrified of going without. One, a nurse at a local hospital suffering from chronic pain as well as depression and anxiety, would approach him in his office parking lot, often bearing gifts of quilts or canned goods, insisting that she needed her pills that morning, that she couldn’t wait for her monthly appointment.

Ortenzio saw no way to break the cycle the pills had created for the people in his care. He never found a way to get his patients down to lower doses of narcotics. They rebelled when he suggested tapering; just cutting people off made them sick. The area didn’t have enough pain clinics or addiction specialists to refer them to, and insurance companies wouldn’t reimburse for many pain treatments that did not involve pills. Without good alternatives for his patients, he kept on writing prescriptions.

Top: A resident of the Mission, a shelter that opened in 1969 with a few beds, for alcoholics and homeless veterans. Today, many of its 120 beds are occupied by opiate addicts. Bottom: A set of house rules. (Jason Fulford)

Addiction and overwork had estranged Ortenzio from his wife and children. As Clarksburg declined, his wife moved the kids to Pittsburgh to find better schools. In 2004, after more than a decade of living in different cities, they divorced. Raised Catholic but without much feeling for the Church, Ortenzio joined a Protestant congregation. Ultimately, he found Jesus in his exam room. During an appointment one day, he and a patient, a Baptist, talked of his search for redemption. The patient knelt with Ortenzio on the linoleum floor and prayed for the doctor. Ortenzio marks that moment as his new beginning. He had advantages many addicts don’t have: a home and a car, financial resources, generous friends and colleagues, and, later, the support of a second wife. He managed to taper off the drugs. A couple of months later, he was baptized in a deep section of Elk Creek, where baptisms have taken place since the early 1800s.

Not long after that, federal agents raided his office. They interrogated his staff and confiscated hundreds of patient records. The investigation dragged on for nearly two years. His children had to testify before a grand jury that they knew nothing about the prescriptions their father had written in their names.

In October 2005, prosecutors charged Ortenzio with health-care fraud and fraudulent prescribing. That year, 314 West Virginians died from opioid overdoses, more than double the number of people five years earlier. By 2006, according to the Centers for Disease Control and Prevention, physicians were writing 130 opioid prescriptions for every 100 West Virginians.

In March 2006, Ortenzio pleaded guilty. His sentencing occurred shortly after a 2005 Supreme Court decision made federal sentencing guidelines nonmandatory and individual sentences up to judges’ discretion. Despite what he’d done, Ortenzio was still beloved in Clarksburg. More than 100 people wrote to the judge on his behalf. He received five years of supervised release plus 1,000 hours of community service, and was ordered to pay $200,000 in restitution. He would serve no prison time, but he did lose his medical license.

At 53, Ortenzio was unemployed. A temp agency offered him a landscaping job at the Stonewall Resort, where, as a doctor, he had taken his family for Sunday brunch. He’d never worked outdoors in his life, but he took the job. It paid $6.50 an hour.

He worked at the resort for a couple of months, then as the janitor at a local community center before returning to Stonewall as a full-time groundskeeper. He also found a night job.

Tom Dyer is one of northern West Virginia’s leading defense attorneys; Ortenzio had been his client. One night in 2006, Dyer ordered a pizza from Fox’s Pizza Den in Bridgeport, a town near Clarksburg. When the doorbell rang, he opened the door and there stood Lou Ortenzio, holding a pie. It took a minute before Dyer realized: Doc O was now a pizza-delivery guy. “I was just speechless,” Dyer told me.

“I made pizza deliveries where I used to make house calls,” Ortenzio said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.”

Ortenzio eventually left pizza delivery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addiction. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.”

Today, Ortenzio spends his days trying to atone. He does this through constant work. There are places in and around Clarksburg where addicts can get help, and Ortenzio can be found at most of them.

The Mission opened in 1969, in Clarksburg’s Glen Elk neighborhood, at the time a small red-light district with bars and backroom gambling. The shelter started with a few beds, intended for alcoholics and homeless veterans. A neon-blue jesus saves sign outside has remained illuminated for all the years since, as the shelter has expanded. Today, many of its 120 beds are occupied by opioid addicts.

One afternoon, I met Ortenzio in a small, windowless office at the Mission. Now 66, he is thin, gray-haired, and bespectacled; he dresses in a hoodie, blue jeans, and sneakers. He does a bit of everything at the Mission, from helping the addicted find treatment to helping them find a coat, or shoes for their children, or a ride to the probation department. He is a volunteer adviser there, too, and at the county’s drug court, where he guides addicts through the criminal-justice system.

Ortenzio is also involved with two newer initiatives, which suggest the challenges of repairing the damage done by opioids. A wood-beamed downtown church is home to Celebrate Recovery, a Christian ministry founded in Orange County, California. Celebrate Recovery has grown nationwide due in large part to the opioid epidemic. On the cold Tuesday night I visited, the service featured an electric band singing the kind of fervid new gospel music that is common to nondenominational Christianity: “You are perfect in all of your ways …”

Ortenzio is Celebrate Recovery’s lay pastor in Clarksburg, running its weekly services. The flock is about 100 or so strong. One evening, a young mother named Sarah stood before the congregation to give her testimony. Sarah’s story started with parents who married too young and divorced before she was 3. It featured father figures who were coal miners and truck drivers and a stepfather who molested her repeatedly, beginning when she was 8. Then a life of illicit drugs, marriage, divorce, and addiction to prescription pain pills.

Clarksburg’s traditional congregations have dwindled along with the city’s population; many rely on support from former residents who commute in from elsewhere on Sundays. The place these churches once held in this community has been taken by new churches proclaiming a gospel of prosperity, insisting that God wants us all to be rich. And by ministries such as Celebrate Recovery.

A regular devotional service held in the Mission’s cafeteria (Jason Fulford)

Ortenzio coordinates the training of recovery coaches at the church, people who can help addicts as they try to wean themselves from narcotics. Addiction, however, seems as present as ever in Clarksburg. At the Mission one day, I met a group of recovering young drug users. Several of them had started out on heroin but then turned to meth. In Clarksburg and many other parts of the country, meth is coming on strong, poised to be the fourth stage in an epidemic that began with prescribed pills, then moved to heroin, and then to fentanyl. Meth seems to reduce the symptoms of withdrawal from opioids, or maybe it’s just a way to get high when anything will do. Whatever the case, like the various forms of opioids before it, meth is now in plentiful supply in Clarksburg.

A couple of years ago, Ortenzio decided to open a sober-living house downtown, where recovering addicts could spend six months or more stabilizing their lives. He said God had instructed him to undertake the project, and had told him, in fact, where to do it—in a house right around the corner from the duplex where Clarksburg’s first resident overdosed on fentanyl. In 2017, more than two West Virginians a day were being claimed by opioids. Recovering addicts needed places where they could maintain sobriety. “We thought, This is going to be great. They’ll throw a parade for us,” says Ben Randolph, a businessman whom Ortenzio helped recover from pill addiction.

Instead, the idea of a sober-living house outraged many in town. The principals of two local schools were concerned that the house was too close to their campuses. Owners of local businesses worried that the house might further tarnish the city’s image. “The property value of the homes around it are going to plummet. You’re going to have both drug dealers and recovering addicts in one area, so they’ll have a captive market,” one resident told The Exponent Telegram.

But Ortenzio persisted, and a bank eventually granted him a mortgage. Since July 2017, he has run a six-bed home for men, with daily supervision and no problems—no spike in crime nearby, no complaints of loitering—reported so far. A similar home for women opened last May. Nevertheless, the episode showed where the city, perhaps even the country, was when it came to addiction: afflicted mightily and wanting it to go away, but not knowing how to make that happen.

Lou Ortenzio was the first Clarksburg doctor prosecuted for improperly prescribing pain pills. He was the first person most residents I talked with recall as putting a different face on addiction. He was the first to show that this was a new kind of drug plague, and the first to puncture the idea that the supply came from street dealers. He was also the first to publicly work at his own recovery without shame.

He was not, however, alone. In 2005, another local doctor, Brad Hall, gathered with members of the West Virginia State Medical Association concerned about addiction among physicians in a state that cannot afford to lose them. They started the Physician Health Program, which has helped some 230 West Virginia doctors with substance-abuse problems get confidential treatment and retain their license to practice. Many are overworked, as Ortenzio had been. Some were self-treating emotional and physical problems. About a quarter abused opioids.

Left: Lou Ortenzio beside one of Clarksburg’s abandoned neighborhood pools. Ortenzio managed to overcome his own addiction to narcotic painkillers and today spends his time helping other addicts recover, at the Mission (right) and elsewhere. (Jason Fulford)

Ortenzio managed to escape drugs, but he’s still living with the effects of his addiction. He is working to repair his relationship with his youngest son; Ortenzio didn’t attend his wedding and has yet to meet a young grandson. He leans on his faith to keep him going. Many of his encounters with addicts prompt sudden, public prayers, Ortenzio bowing his head as he clasps the person’s shoulder. His faith has humbled him, relieving him of a sense of hubris that got him into trouble as a doctor: the idea that he could heal an entire community, if he just kept the office open a few hours longer.

Doc O will never practice medicine again. Yet his work at the Mission doesn’t seem so different from his routine as a family physician, tending to the needs of one person after another. One morning, he took a resident to a clinic, then talked on the phone with an addicted doctor living in a halfway house. A pastor from the coalfields of southern West Virginia called to ask how to set up a Celebrate Recovery ministry in his large but dying church. A 24-year-old mother of four from a West Virginia mountain town was looking for $225 to pay the utilities for an apartment she was trying to rent. Ortenzio promised to reach out to the Mission’s supporters for a donation.

As the morning wore on, a gaunt 26-year-old man from North Carolina, a construction worker addicted to heroin and meth, showed up to report that he’d had five of his teeth pulled. The dentist had prescribed a dozen hydrocodone pills. The construction worker couldn’t fill the scrip without proper ID, which he didn’t possess. Ortenzio sat and listened as the young man, slumped beneath a baseball cap, stared at the floor and insisted on his need for the painkiller.

The dentist had probably figured that the fellow had lost a lot of teeth, that a dozen pills weren’t many. If that were the case, it would mark a change. Not that long ago, the dentist might have prescribed 20 to 40 pills.

Ortenzio offered the construction worker a prayer. The man clearly still wanted the drugs. Ortenzio, who as a doctor had prescribed pills by the hundreds each day, could only give him packets of ibuprofen.

“You want to stay away from hydrocodone,” he said.

This article appears in the May 2019 print edition with the headline “The Penance of Doc O.”

from Health News And Updates https://www.theatlantic.com/magazine/archive/2019/05/opioid-epidemic-west-virginia-doctor/586036/?utm_source=feed

[ionecoffman]

The Penance of Doc O

Well past seven one evening in 1988, after the nurses and the office manager had gone home, as he prepared to see the last of his patients and return some phone calls, Dr. Lou Ortenzio stopped by the cupboard where the drug samples were kept.

Ortenzio, a 35-year-old family practitioner in Clarksburg, West Virginia, reached for a box of extra-strength Vicodin. The box contained 20 pills, wrapped in foil. Each pill combined 750 milligrams of acetaminophen, the active ingredient in Tylenol, with 7.5 milligrams of hydrocodone, an opioid painkiller.

Ortenzio routinely saw patients long after normal office hours ended. Attempting to keep up with the workload on this day, he had grown weary and was suffering from a tension headache; he needed something to keep him going. He unwrapped a pill, a sample left by a drug-company sales rep, certain that no one would ever know he’d taken it. Ortenzio popped the pill in his mouth.

“It was a feeling like I’d never felt before,” he told me recently. “I’m tense and nervous, and that anxiety is crippling.” The pill took the anxiety away. The sense of well-being lasted for four hours, carrying him through the rest of the night’s work.

Back then, Ortenzio was one of Clarksburg’s most beloved physicians, the kind of doctor other doctors sent their own families to see. His patients called him “Doc O.” He made time to listen to them as they poured out the details of their lives. “To me, he wasn’t like a doctor; he was more like a big brother, somebody I could talk to when I couldn’t talk to anybody else,” says Phyllis Mills, whose family was among Ortenzio’s first patients. When Mills’s son was born with a viral brain infection and transferred to a hospital in Morgantown, 40 miles away, Ortenzio called often to check on the infant. Mills never forgot that.

As a physician in a small community with limited resources, Ortenzio did a bit of everything: He made rounds in a hospital intensive-care unit and made house calls; he provided obstetric and hospice care. Ortenzio loved his work. But it never seemed to end. He started missing dinners with his wife and children. The long hours and high stress taxed his own health. He had trouble sleeping, and gained weight. It took many years, but what began with that one Vicodin eventually grew into a crippling addiction that cost Ortenzio everything he held dear: his family, his practice, his reputation.

The United States is in the midst of the deadliest, most widespread drug epidemic in its history. Unlike epidemics of the past, this one did not start with mafias or street dealers. Some people have blamed quack doctors—profiteers running pill mills—but rogue physicians wrote no more than a fraction of the opioid prescriptions in America over the past two decades. In fact, the epidemic began because hundreds of thousands of well-meaning doctors overprescribed narcotic painkillers, thinking they were doing the right thing for suffering patients. They had been influenced by pain specialists who said it was the humane thing to do, encouraged by insurance companies that said it was the most cost-effective thing to do, and cajoled by drug companies that said it was a safe thing to do.

Opioid painkillers were promoted as a boon for doctors, a quick fix for a complicated problem. By the end of the 1990s, Ortenzio was one of his region’s leading prescribers of pain pills. It was a sign of the times that he didn’t think there was anything wrong with that.

Clarksburg sits atop rolling hills in northern West Virginia, halfway between Pittsburgh and Charleston. Lou Ortenzio came here in 1978, a recently married young resident out of the University of Maryland School of Medicine. “Small-town living seemed so much better than suburban life,” he told me as we drove around town one afternoon. “In Clarksburg, every block had something going. We had mom-and-pop grocery stores in every neighborhood. All these houses were occupied by teachers, downtown business owners, and people who worked in glass factories.”

Coal mining was the state’s dominant industry, but in Clarksburg, the glass business boomed. Glass manufacturing had arrived at the turn of the 20th century, drawn by the state’s high-quality river sand and rich fields of natural gas. Pittsburgh Plate Glass opened a factory in Clarksburg in 1915 and for years was one of the world’s leading plate-glass producers. Anchor Hocking employed 800 people making tumblers, bottles, fruit bowls. The city had family-owned factories too: Rolland Glass, Harvey Glass, and others.

Unlike simple resource extraction, glassmaking required sustained technological investment to meet new demands from the marketplace. The mass production of plate glass made skyscrapers possible. Picture windows and sliding-glass doors made small homes look bigger and more luxurious. The industry forged a middle class in Clarksburg and even gave the city a cosmopolitan air. The glass factories attracted artisans from France and Belgium; French was commonly heard on the streets for years.

Glass manufacturing helped forge a middle class in Clarksburg, but by the mid-1980s the industry, and the city, was in decline. Clockwise from top left: Lou Ortenzio; the abandoned Anchor Hocking glass factory; glass collected from the city’s streets; downtown Clarksburg. (Jason Fulford)

Each neighborhood was a self-contained world, with its own churches, grocery stores, and school; many had a swimming pool. High-school sports rivalries were fierce, and football games drew large crowds. When Victory played Roosevelt-Wilson, or Washington Irving went up against Notre Dame, people knew to arrive early to find a seat.

By the late 1970s, Clarksburg’s older physicians were retiring. Like many small towns at the time, it had trouble attracting young professionals. Ortenzio was among the few physicians who moved there to fill the void. He and two other young doctors opened a practice in 1982. Almost immediately, Ortenzio was seeing 40 to 50 patients a day.

The people who came to see him were mostly older; many had served in World War II. They had the aches and pains to show for a lifetime of hard work in the glass factories or at the gas company, but they had retired with something approaching financial security. They owned homes and cars, had pensions and good health insurance.

Ortenzio’s patients suffered from the ailments of the old—arthritis, diabetes, hypertension—and most of them did so stoically. This was partly generational and partly an Appalachian inheritance. One man, Ortenzio remembered, came to him thin and wasted away from cancer. “The disease was advanced, but he put up with it. I said, ‘Why didn’t you come in earlier?’ He said, ‘Well, I wouldn’t want you to think I was complainy.’ That was the Appalachian line—‘I wouldn’t want you to think I was complainy.’ ”

Ortenzio grew into his adopted city. In 1992, he established a free clinic where Clarksburg’s uninsured could get medical care. The county chamber of commerce named him Citizen of the Year for that. He had been trained to treat patients holistically. Most of what a doctor needs to know to make a diagnosis, his professors had taught him, could be learned from taking time to listen to the patient. X-rays and lab tests were mostly to confirm what you gleaned from asking questions and paying attention to the answers. He’d also been trained to help his patients help themselves. Part of his job was to teach them how to take care of their bodies. Pills were a last resort. This careful approach endeared him to his patients, but it lengthened his day. “He would have office hours until 11:30 at night,” says Jim Harris, a friend and the director of the free clinic. “People waited until then because he was worth the wait.”

Drug salesmen visited him weekly. It was a stodgy profession back then. Ortenzio remembers the reps as older men who had grown up and lived locally and who cultivated long-term relationships with doctors. One of the reps for Eli Lilly was a deacon in a local Catholic church. Once a week, he would visit Ortenzio’s office in a business suit, with information about the drugs Lilly produced. Like many in his profession in those years, he avoided hard-sell tactics. Ortenzio grew to rely on the salesman’s counsel when it came to pharmaceuticals. Once, when the Food and Drug Administration removed a Lilly drug from the market, the rep dropped by Ortenzio’s office, embarrassed and apologetic.

Before long, Ortenzio and his wife saw Clarksburg as home. They found a two-story, three-bedroom house in the Stealey neighborhood, southwest of downtown and at the foot of a hill. They set off to the bank for a 30-year loan. To their surprise, they were denied. “The house won’t keep its value that long,” the banker told them. “The best we can give you is a 15-year loan.”

The banker was right. It wasn’t yet clear, amid the bustle of Main Street and Friday-night football, but the city’s prospects were fading. Newer glass technologies required large factories, which meant stretches of flat land rare in West Virginia. Mexico and Japan emerged as competition in glass manufacturing, and plastic and aluminum emerged as alternatives to glass. Pittsburgh Plate Glass had closed in 1974. Anchor Hocking left in 1987. Its hulking concrete plant is slated for demolition, but for now it remains, just off Highway 50.

By the mid-1980s, the city was in decline. Glasswork was replaced by telemarketing. Downtown, locally owned stores began to disappear. Homeowners yielded to renters, many relying on Section 8 assistance from the government. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. The swimming pools, too, slowly closed; resident associations lacked the money to maintain them.

Ortenzio drove me by the massive Robert C. Byrd High School, home of the Eagles. It was built in 1995 to consolidate two smaller high schools in Clarksburg, whose population had receded. Replacing neighborhood schools with one centralized school allowed for better course offerings. But Byrd is far from any student’s home. School consolidation extinguished the sports rivalries that had brought people together each week. Without local schools, neighborhoods lost their social centers.

When glassmaking departed Clarksburg, locally owned stores began to disappear as well. The city eventually had to destroy dozens of abandoned homes, leaving streets with toothless gaps. (Jason Fulford)

Lou Ortenzio began to see people in economic as well as physical pain. Many were depressed, worn out by work or the fruitless search for it. Obesity became a more common problem. Some patients began to ask whether he could get them on workers’ compensation or disability. Others left to seek job opportunities in New York, North Carolina, Florida. “I was always calling people out of state telling them how sick their parents or grandparents were,” he said.

When Ortenzio had opened his practice, he’d tended to see young people only for pregnancies or the occasional broken leg. By the mid-1980s, younger people were showing up in larger numbers. They were coming in with ailments that their parents and grandparents had borne in silence—headaches, backaches, the common cold. “The new generation that came in the 1980s, those kids began to have the expectation that life should be pain-free,” Ortenzio said. “If you went to your physician and you didn’t come away with a prescription, you did not have a successful visit.”

The shift was not peculiar to Clarksburg. Americans young and old were becoming accustomed to medical miracles that allowed them to avoid the consequences of unhealthy behavior—statins for high cholesterol, beta-blockers and ACE inhibitors for hypertension and heart failure, a variety of new treatments for diabetes. Fewer patients showed up for annual physicals or wanted to hear what they could do to improve their wellness. They wanted to be cured of whatever was ailing them and sent on their way. Usually that involved pills.

The medical establishment, to a large degree, abetted this shift. In the 1980s, a new cadre of pain specialists began to argue that narcotic pain pills, derived from the opium poppy, ought to be used more aggressively. Many had watched terminal cancer patients die in agony because doctors feared giving them regular doses of addictive narcotics. To them, it was inhumane not to use opioid painkillers.

The specialists began to push the idea that the pills were nonaddictive when used to treat pain. Opioids, they said, could be prescribed in large quantities for long periods—not just to terminal patients, but to almost anyone in pain. This idea had no scientific support. One author of an influential paper later acknowledged that the literature pain advocates relied on to make their case lacked real evidence. “Because the primary goal was to destigmatize, we often left evidence behind,” he said.

Nevertheless, an alliance of specialists who saw their medical mission as eradicating pain was soon joined by the pharmaceutical companies that manufactured opioids. Medical institutions—the Department of Veterans Affairs, the Joint Commission on Accreditation of Healthcare Organizations, hospitals and medical schools across the country—bought into this approach as well.

By the late 1990s, medical schools, when they taught pain management at all, focused on narcotics. By the early 2000s, doctors were being urged to prescribe the drugs after almost any routine surgery: appendectomy, ACL repair, wisdom-tooth extraction. They also prescribed them for chronic conditions such as arthritis and back pain. Chronic pain had once been treated with a combination of strategies that only sometimes involved narcotics; now it was treated using opioids almost exclusively, as insurance companies cut back on reimbursing patients for long-term pain therapies that did not call on the drugs.

The U.S. drug industry, meanwhile, was investing heavily in marketing, hiring legions of young salespeople to convince doctors of their drugs’ various miracles. Nationwide, the number of pharmaceutical sales reps ballooned from 38,000 in 1995 to 100,000 a decade later. The old style of drug rep, grounded in medicine or pharmacy, largely passed from the scene.

“It went from a dozen [salesmen] a week to a dozen a day,” Ortenzio remembered. “If you wrote a lot of scrips, you were high on their call list. You would be marketed to several times a day by the same company with different reps.”

Most drug companies in America adopted the new sales approach. Among them was Purdue Pharma, which came out with a timed-release opioid painkiller, OxyContin, in 1996. Purdue paid legendary bonuses—up to $100,000 a quarter, eight times what other companies were paying. To improve their sales numbers, drug reps offered doctors mugs, fishing hats, luggage tags, all-expenses-paid junkets at desirable resorts. They brought lunch for doctors’ staff, knowing that with the staff on their side, the doctors were easier to influence. Once they had the doctor’s ear, reps relied on specious and misinterpreted data to sell their product. Purdue salespeople promoted the claim that their pill was effectively nonaddictive because it gradually released an opioid, oxycodone, into the body and thus did not create the extreme highs and lows that led to addiction.

[From April 2006: The drug pushers]

The reps were selling more than pills. They were selling time-saving solutions for harried doctors who had been told that an epidemic of pain was afoot but who had little time, or training, to address it. For a while, Ortenzio still suggested exercise, a balanced diet, and quitting smoking, all of which can alleviate chronic pain. But his patients, by and large, didn’t want to hear any of this, and he was busy. So he, too, gradually embraced pain pills. Nothing ended an appointment quicker than pulling out a prescription pad.

The number of people on pain pills grew from a tiny fraction of Ortenzio’s practice to well over half of his patients by the end of the 1990s. The shift was gradual enough at first that he didn’t recognize what was happening. Patients with medical problems unrelated to pain migrated to other doctors. Still, Ortenzio was working 16-hour days, seeing patients who had been scheduled for the afternoon at 9 p.m.

The more drugs Ortenzio prescribed, the more he was sought out by patients. Many would use up a month’s supply before the month was out; in need of more pills, they were insistent, wheedling, aggressive. Many lied. Some would curse and scream when Ortenzio told them that he couldn’t write them a new prescription yet, or that he wanted to lower their dosage.

The pills were soon on the streets of Clarksburg as well. They replaced beer and pot at many high-school parties. Phyllis Mills, Ortenzio’s longtime patient, had two daughters who abused the pills. Theirs did not come from Ortenzio, at least not directly, but the supply of pills was exploding, due in large part to doctors like him who were overprescribing them.

Ortenzio should have noticed what the pills were doing, to his patients and his community, but he was less and less himself. After his late-night encounter with Vicodin in 1988, he had begun his own slide into addiction. By the late 1990s, he was using 20 to 30 pills a day, depleting even the plentiful supply of free samples from the ubiquitous sales reps.

Desperate to get his hands on more pills, he found a friend he could trust, a middle-aged accountant and a patient of his. “I’m in some trouble,” Ortenzio told him. “If I write you this prescription, can I ask you to fill it and bring it back to me?”

“Sure thing,” the man said, without asking for an explanation. “If you gotta have it, you gotta have it. You’re the doc.”

Soon a dozen or so trusted patients were helping Ortenzio. He knew he was out of control and needed help—even the amount of acetaminophen he was consuming was toxic—but he feared that seeking treatment for his addiction might cost him his medical license. Around 1999, he found a new way to get his fix. He began writing prescriptions in his children’s names.

Ortenzio could plainly see that the claim that these pills were nonaddictive was untrue. He would try to quit and feel the symptoms of withdrawal. “I couldn’t be away from my supply,” he said. His patients, too, were terrified of going without. One, a nurse at a local hospital suffering from chronic pain as well as depression and anxiety, would approach him in his office parking lot, often bearing gifts of quilts or canned goods, insisting that she needed her pills that morning, that she couldn’t wait for her monthly appointment.

Ortenzio saw no way to break the cycle the pills had created for the people in his care. He never found a way to get his patients down to lower doses of narcotics. They rebelled when he suggested tapering; just cutting people off made them sick. The area didn’t have enough pain clinics or addiction specialists to refer them to, and insurance companies wouldn’t reimburse for many pain treatments that did not involve pills. Without good alternatives for his patients, he kept on writing prescriptions.

Top: A resident of the Mission, a shelter that opened in 1969 with a few beds, for alcoholics and homeless veterans. Today, many of its 120 beds are occupied by opiate addicts. Bottom: A set of house rules. (Jason Fulford)

Addiction and overwork had estranged Ortenzio from his wife and children. As Clarksburg declined, his wife moved the kids to Pittsburgh to find better schools. In 2004, after more than a decade of living in different cities, they divorced. Raised Catholic but without much feeling for the Church, Ortenzio joined a Protestant congregation. Ultimately, he found Jesus in his exam room. During an appointment one day, he and a patient, a Baptist, talked of his search for redemption. The patient knelt with Ortenzio on the linoleum floor and prayed for the doctor. Ortenzio marks that moment as his new beginning. He had advantages many addicts don’t have: a home and a car, financial resources, generous friends and colleagues, and, later, the support of a second wife. He managed to taper off the drugs. A couple of months later, he was baptized in a deep section of Elk Creek, where baptisms have taken place since the early 1800s.

Not long after that, federal agents raided his office. They interrogated his staff and confiscated hundreds of patient records. The investigation dragged on for nearly two years. His children had to testify before a grand jury that they knew nothing about the prescriptions their father had written in their names.

In October 2005, prosecutors charged Ortenzio with health-care fraud and fraudulent prescribing. That year, 314 West Virginians died from opioid overdoses, more than double the number of people five years earlier. By 2006, according to the Centers for Disease Control and Prevention, physicians were writing 130 opioid prescriptions for every 100 West Virginians.

In March 2006, Ortenzio pleaded guilty. His sentencing occurred shortly after a 2005 Supreme Court decision made federal sentencing guidelines nonmandatory and individual sentences up to judges’ discretion. Despite what he’d done, Ortenzio was still beloved in Clarksburg. More than 100 people wrote to the judge on his behalf. He received five years of supervised release plus 1,000 hours of community service, and was ordered to pay $200,000 in restitution. He would serve no prison time, but he did lose his medical license.

At 53, Ortenzio was unemployed. A temp agency offered him a landscaping job at the Stonewall Resort, where, as a doctor, he had taken his family for Sunday brunch. He’d never worked outdoors in his life, but he took the job. It paid $6.50 an hour.

He worked at the resort for a couple of months, then as the janitor at a local community center before returning to Stonewall as a full-time groundskeeper. He also found a night job.

Tom Dyer is one of northern West Virginia’s leading defense attorneys; Ortenzio had been his client. One night in 2006, Dyer ordered a pizza from Fox’s Pizza Den in Bridgeport, a town near Clarksburg. When the doorbell rang, he opened the door and there stood Lou Ortenzio, holding a pie. It took a minute before Dyer realized: Doc O was now a pizza-delivery guy. “I was just speechless,” Dyer told me.

“I made pizza deliveries where I used to make house calls,” Ortenzio said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.”

Ortenzio eventually left pizza delivery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addiction. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.”

Today, Ortenzio spends his days trying to atone. He does this through constant work. There are places in and around Clarksburg where addicts can get help, and Ortenzio can be found at most of them.

The Mission opened in 1969, in Clarksburg’s Glen Elk neighborhood, at the time a small red-light district with bars and backroom gambling. The shelter started with a few beds, intended for alcoholics and homeless veterans. A neon-blue jesus saves sign outside has remained illuminated for all the years since, as the shelter has expanded. Today, many of its 120 beds are occupied by opioid addicts.

One afternoon, I met Ortenzio in a small, windowless office at the Mission. Now 66, he is thin, gray-haired, and bespectacled; he dresses in a hoodie, blue jeans, and sneakers. He does a bit of everything at the Mission, from helping the addicted find treatment to helping them find a coat, or shoes for their children, or a ride to the probation department. He is a volunteer adviser there, too, and at the county’s drug court, where he guides addicts through the criminal-justice system.

Ortenzio is also involved with two newer initiatives, which suggest the challenges of repairing the damage done by opioids. A wood-beamed downtown church is home to Celebrate Recovery, a Christian ministry founded in Orange County, California. Celebrate Recovery has grown nationwide due in large part to the opioid epidemic. On the cold Tuesday night I visited, the service featured an electric band singing the kind of fervid new gospel music that is common to nondenominational Christianity: “You are perfect in all of your ways …”

Ortenzio is Celebrate Recovery’s lay pastor in Clarksburg, running its weekly services. The flock is about 100 or so strong. One evening, a young mother named Sarah stood before the congregation to give her testimony. Sarah’s story started with parents who married too young and divorced before she was 3. It featured father figures who were coal miners and truck drivers and a stepfather who molested her repeatedly, beginning when she was 8. Then a life of illicit drugs, marriage, divorce, and addiction to prescription pain pills.

Clarksburg’s traditional congregations have dwindled along with the city’s population; many rely on support from former residents who commute in from elsewhere on Sundays. The place these churches once held in this community has been taken by new churches proclaiming a gospel of prosperity, insisting that God wants us all to be rich. And by ministries such as Celebrate Recovery.

A regular devotional service held in the Mission’s cafeteria (Jason Fulford)

Ortenzio coordinates the training of recovery coaches at the church, people who can help addicts as they try to wean themselves from narcotics. Addiction, however, seems as present as ever in Clarksburg. At the Mission one day, I met a group of recovering young drug users. Several of them had started out on heroin but then turned to meth. In Clarksburg and many other parts of the country, meth is coming on strong, poised to be the fourth stage in an epidemic that began with prescribed pills, then moved to heroin, and then to fentanyl. Meth seems to reduce the symptoms of withdrawal from opioids, or maybe it’s just a way to get high when anything will do. Whatever the case, like the various forms of opioids before it, meth is now in plentiful supply in Clarksburg.

A couple of years ago, Ortenzio decided to open a sober-living house downtown, where recovering addicts could spend six months or more stabilizing their lives. He said God had instructed him to undertake the project, and had told him, in fact, where to do it—in a house right around the corner from the duplex where Clarksburg’s first resident overdosed on fentanyl. In 2017, more than two West Virginians a day were being claimed by opioids. Recovering addicts needed places where they could maintain sobriety. “We thought, This is going to be great. They’ll throw a parade for us,” says Ben Randolph, a businessman whom Ortenzio helped recover from pill addiction.

Instead, the idea of a sober-living house outraged many in town. The principals of two local schools were concerned that the house was too close to their campuses. Owners of local businesses worried that the house might further tarnish the city’s image. “The property value of the homes around it are going to plummet. You’re going to have both drug dealers and recovering addicts in one area, so they’ll have a captive market,” one resident told The Exponent Telegram.

But Ortenzio persisted, and a bank eventually granted him a mortgage. Since July 2017, he has run a six-bed home for men, with daily supervision and no problems—no spike in crime nearby, no complaints of loitering—reported so far. A similar home for women opened last May. Nevertheless, the episode showed where the city, perhaps even the country, was when it came to addiction: afflicted mightily and wanting it to go away, but not knowing how to make that happen.

Lou Ortenzio was the first Clarksburg doctor prosecuted for improperly prescribing pain pills. He was the first person most residents I talked with recall as putting a different face on addiction. He was the first to show that this was a new kind of drug plague, and the first to puncture the idea that the supply came from street dealers. He was also the first to publicly work at his own recovery without shame.

He was not, however, alone. In 2005, another local doctor, Brad Hall, gathered with members of the West Virginia State Medical Association concerned about addiction among physicians in a state that cannot afford to lose them. They started the Physician Health Program, which has helped some 230 West Virginia doctors with substance-abuse problems get confidential treatment and retain their license to practice. Many are overworked, as Ortenzio had been. Some were self-treating emotional and physical problems. About a quarter abused opioids.

Left: Lou Ortenzio beside one of Clarksburg’s abandoned neighborhood pools. Ortenzio managed to overcome his own addiction to narcotic painkillers and today spends his time helping other addicts recover, at the Mission (right) and elsewhere. (Jason Fulford)

Ortenzio managed to escape drugs, but he’s still living with the effects of his addiction. He is working to repair his relationship with his youngest son; Ortenzio didn’t attend his wedding and has yet to meet a young grandson. He leans on his faith to keep him going. Many of his encounters with addicts prompt sudden, public prayers, Ortenzio bowing his head as he clasps the person’s shoulder. His faith has humbled him, relieving him of a sense of hubris that got him into trouble as a doctor: the idea that he could heal an entire community, if he just kept the office open a few hours longer.

Doc O will never practice medicine again. Yet his work at the Mission doesn’t seem so different from his routine as a family physician, tending to the needs of one person after another. One morning, he took a resident to a clinic, then talked on the phone with an addicted doctor living in a halfway house. A pastor from the coalfields of southern West Virginia called to ask how to set up a Celebrate Recovery ministry in his large but dying church. A 24-year-old mother of four from a West Virginia mountain town was looking for $225 to pay the utilities for an apartment she was trying to rent. Ortenzio promised to reach out to the Mission’s supporters for a donation.

As the morning wore on, a gaunt 26-year-old man from North Carolina, a construction worker addicted to heroin and meth, showed up to report that he’d had five of his teeth pulled. The dentist had prescribed a dozen hydrocodone pills. The construction worker couldn’t fill the scrip without proper ID, which he didn’t possess. Ortenzio sat and listened as the young man, slumped beneath a baseball cap, stared at the floor and insisted on his need for the painkiller.

The dentist had probably figured that the fellow had lost a lot of teeth, that a dozen pills weren’t many. If that were the case, it would mark a change. Not that long ago, the dentist might have prescribed 20 to 40 pills.

Ortenzio offered the construction worker a prayer. The man clearly still wanted the drugs. Ortenzio, who as a doctor had prescribed pills by the hundreds each day, could only give him packets of ibuprofen.

“You want to stay away from hydrocodone,” he said.

This article appears in the May 2019 print edition with the headline “The Penance of Doc O.”

Article source here:The Atlantic

[thoughtsfromparis]

As It Turns Out I Have No STDs • Surgery Part 2

I could work here!

In order to get my hernia fixed, I first needed to get cleared for surgery.

If you missed part one where I wrote about the discovery of a disgusting belly button hernia, click here to familiarize yourself.

The surgeon who was to perform the hernia operation told me I must first see another doctor who could run the appropriate clearance tests. I guess once you become a surgeon you don’t have to do the low-level stuff. Like how the guy who drives the garbage truck doesn’t leave the driver’s seat. He’s got a guy riding on the back who deals with the actual garbage.

I protested that I didn’t need any tests and he could take my word that I was healthy enough to handle a small incision. My case was admittedly unconvincing as I didn’t have a fancy medical degree and my knowledge of gastroenterology was limited to knowing that word means “gut stuff.” I further weakened my position by acknowledging that I hadn’t read the medical questionnaire I was handed at the beginning of my appointment. He frowned when I told him this. But, c’mon, does anyone actually pour through those questions with precision? I simply checked “no” to every disorder, disease, or preexisting condition. If this was a more serious medical issue, like a triple heart bypass, I’d take the “Have you ever bled from the eyeballs?” question more seriously.

But even if I had completed the medical questionnaire correctly he would have made me get cleared for surgery anyway. It’s a malpractice thing. Lawyers ruin everything, right? I mean, until you need a lawyer to sue someone because they said you have a tiny wiener on Snapchat and though the message self-destructed a few people saw it and your reputation had been damaged enough to sue for restitution. I wouldn’t know because I don’t have a tiny wiener. Seriously. Let’s clear that shit up right quick.

Upon arrival at the medical testing facility I met the general practitioner who would perform the necessary exams. And while I feel that salespeople in general are annoying, I had to hand it to this guy. He was the best up-seller (note – not a word) I’ve ever seen. Halfway through the blood work he asks, “Hey, when’s the last time you had a physical?” It had been over a year and he said, “Should we tack it on?” I was already in my underwear so I said, “Sure.”

After the physical I was upsold again. “Hey, you’re dating, right?” I nodded. “You probably want to check for STDs, then. Should I perform the HIV test?” I told the doctor he did not need to sell me on an HIV test. In fact, I told him that for the rest of our relationship as a doctor-patient, he never again needed to ask me for permission to perform this test. He should just do the test. I don’t care if it’s free or costs $300. HIV is an important piece of information and I told him I would never say, “No thanks. I’m good.”

When he came back with the HIV-negative results a few minutes later, he pushed on. “You know, since we’re doing all this other stuff do you want us to test for every STD?” I said, “Once again, you never need to ask me that.” This doctor was now batting 1.000.. As he’s pricking my finger for herpes or whatever I asked, “Wait – does anyone actually turn down the STD test?” He said that many people do. Which made me feel superior to those people. Which felt good.

After all the tests were completed, he announced me I was in excellent shape for surgery, I added, “..also, in excellent shape to hit the disco tonight for some action, right Doc?” Not my best joke. “Actually,” he said, “We won’t know about the full STD results for three days. We’ll call you when they come in.”

I asked that they not call me unless it was bad news. I’d rather not be bothered. However, if they find out that I’m ridden with chlamydia, please go ahead and send word. He said that it was protocol to call with the results, positive or negative. I waived him off and said, “Seriously, just call if there’s bad news.”

A nurse called a few days later and told me the lab results came in and that I was negative on all STDs. I thought of making a joke telling her I went to an EDM concert over the weekend and that all hell broke loose and I’d need to get rescanned, but thought better of it.

I once dated a girl whose favorite genre was EDM. Every time I walked into her townhome that awful music was playing. And I’d have to take deep breaths until the feeling of wanting to smash the stereo over her head would leave me. It’s too stressful to date a chick with bad taste in music.

Now I knew I was healthy enough to get my hernia fixed, and healthy enough to start dating. The girl I was seeing at the time ended the relationship around right after this exam. Smart on her end because she was going to have to drive me to the hospital and sit there during the procedure. Like any good boy I called my mother and she was happy to fill the role.

In the next installment I’ll talk about how the procedure went (spoiler – I now have two belly buttons), and how after I went to a first date with a girdle.

Looks better on me.

photo credit: Tom Simpson Figure Slimmer, 1955 via photopin (license)

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