Before I Let You Go(18)
“Sure,” he says warily.
“Can you get Eliza?” she asks. Her voice is small, and as soon as he leaves the room, I prompt her, “Are you in pain?” She’s scratching herself again, and her eyes move quickly around the room, like she’s scanning for an escape route. I frown and approach the bed. “What is it, Annie?”
“Eighteen hours,” she mutters.
“What’s eighteen hours?”
“Since I scored, Lexie. Eighteen hours since I scored. Maybe they can give me a little morphine. That’s safe in pregnancy, isn’t it? Just a little, I won’t need much—just to take the edge off.”
“You’ve already had the methadone,” I murmur, and Annie scowls at me.
“Fuck methadone. Did you see the dosage he ordered me? Twenty milligrams. You think that’s going to keep me out of withdrawal? I need something more.”
The door opens, and Sam and Eliza interrupt what was probably about to become an ugly sparring match.
“Let’s chat,” Eliza says, and she helps herself to a seat at the edge of Annie’s bed. “Feeling okay?”
“No,” Annie says abruptly, but then she sighs. “What’s the plan?”
The overall picture Eliza presents to us is murky. Annie and the baby are stable for now, but if there’s any change at all in their condition, Eliza will deliver immediately. In preparation for this, she’s giving Annie a series of steroid shots to mature the baby’s lungs, because there’s also no telling how it’s going to cope with delivery. It’s surely going to be tiny—with an estimated size of only a few pounds.
“The baby is suffering from what we call intrauterine growth restriction,” Eliza tells Annie carefully. She then goes to great pains to point out to Annie that this might just be related to the high blood pressure, and perhaps it would have happened anyway, even if narcotics weren’t a factor. I know that it isn’t as simple as that—perhaps Annie’s high blood pressure is just genetic, and the baby’s reduced size just bad luck. But heroin abuse in pregnancy tends to restrict the growth of the baby—and then there’s Annie’s poor lifestyle. And in any case, if Annie had been under proper medical care, she’d likely have been on bed rest and medication to manage all of this before it impacted the baby’s development.
“So if things remain stable,” I ask Eliza, “when will you deliver?”
“Ideally, we’ll keep the baby in utero for another four weeks . . .” Eliza murmurs, but I can tell from her careful tone that she’s not optimistic about this time frame.
“And how are you planning on managing Annie’s withdrawal symptoms?” Sam asks quietly.
“I consulted with an addiction specialist this morning, and he agrees that methadone is the best option for you, Annie.” My sister gives a frustrated groan, but Eliza’s gaze doesn’t waver. She presses on patiently. “There are alternatives we might have considered if your condition wasn’t so complex—but given that there are a lot of moving parts here, we want you to stick with the methadone. We know it’s completely safe.”
“It just doesn’t work. Not for me. Look at me now, for God’s sake.”
“Ron ordered you a very low dose last night,” Eliza explains. “He thought it best to treat you conservatively given how unstable things were—but seeing how quickly you’re experiencing withdrawal symptoms, I’m suggesting a much higher dose.”
“It won’t work anyway. Methadone has never stopped me from using.”
“Okay, tell me about that. Why doesn’t it work, Annie?” Eliza asks gently.
“It just doesn’t,” Annie snaps at the doctor. The frustration and impatience in her tone seems inappropriate somehow, perhaps because of how carefully Eliza has prompted the question. But Annie is coming apart before our eyes and all I can think is . . . thank goodness we didn’t tell her about the social worker. I’m not sure Annie would be up to dealing with that news just yet—and she’s clearly not kidding about the withdrawal symptoms. She’s trembling, and the hands that have been resting on her belly press her hair back from her face behind her ears, then again when the hair falls forward immediately, and she groans in frustration and clenches her hands into fists. “You know it doesn’t work for me, Lexie. I was on methadone when I was at your place last time, and that was a disaster.”
“Annie,” I say softly, “this time just has to be different. You don’t have a choice this time—you can’t just go cold turkey, and don’t you think it’s going to look better for the judge tomorrow if you start some treatment before the hearing?”
I don’t tell her about Mary’s comments about judges “not liking” maintenance programs, and if I’m honest with myself, I’m not sure I understand it. How could judges not like one of the only evidenced-based treatments we have to offer people suffering addictions? I make a mental note to clarify this with the attorney.
“Well, I only came here in the first place because you said you wouldn’t let them charge me,” Annie snaps. I open my mouth to respond, but Sam interrupts flatly,
“And if Lexie hadn’t convinced you to come here, your baby might not have made it even this far.” I shake my head at Sam furiously, but he persists, and I groan in frustration as he pulls all of the coldness right out of his tone as he adds quite calmly, “Lexie can’t fix this for you, Annie.” Annie is staring at him through narrowed eyes, but he shrugs, unaffected by her anger. “This is your mess, and there’s no easy way to fix it—no easy path out of trouble this time. There’s simply no painless solution for Lexie to find.”