San Francisco is not a city that feels it has to reach up towards the sky at every opportunity; it leaves such luxurious, tempting heights to New York. It is not like we cannot do a good ugly skyscraper here in San Francisco, after all we have the TransAmerica Pyramid, a horror of modern architecture that looms ominously over a particularly old and charming part of town. From Hotaling Place where the old shoreline is marked and memorialized, partly built on the bones of old ships, the Pyramid slams into the horizon, without any regard for propriety or fitting into the world around it. Salesforce Tower is somewhat less jarring. It sits in the City, dominating the skyline, its strange barrel like shape settling into the spread of the City around it. I do not hate it and I do not love tall buildings. I once went up the Space Needle in Seattle, and had a panic attack. It was too high, too fragile and tempted Fate too hard for me to feel anything other than absolute horror. It was Babel-like in its scope, reaching higher and higher, towering peering down to see if anyone had been turned into a pillar of salt yet. I went up. I looked. I felt sick. I descended.
The walk down to North Beach is mostly steeply downhill. I have to walk a block or so up and then turn towards the east side of the City and head towards the water. Everything in my head is fuzzy and exhausted from the moment I wake up. My heart pounds and my chest feels like it is on fire. My hands, feet and back are riddled with horrendous arthritis, the bone erosion on the xrays confirming the worst, and have left me stumbling and trying to stave off having to use a cane to go long distances. I hambled down the road towards China Town and its comforting red dot lanterns strung across its streets. I look longingly at healthier folk and try not to break down and cry again. I would love to just feel alive and not one foot in the grave. No painkillers at this point seems like cruel and unusual punishment. Outside the window as I write a man is fighting with a wall. A drill buzzes irritatingly in the distance, metal against metal, like a gigantic mosquito whose poisonous drone exists only to put the nerves on edge.
The Boy is with me, as we walk into the now old familiar streets of China Town; he leans over and points out the Chinese characters outside the Bank of America. “They mean ‘beautiful country’ Ma.” He has been learning to read Japanese, and as a result can make a decent stab at some Chinese hanzi. He pulled out his phone and nodded his head excitedly. “Yes…yes…the Chinese characters for America mean ‘beautiful country’, I mean, they are not wrong, are they!” It pleased him immensely. He explained that the old Japanese kanji for America meant ‘Rice Country’, but they were phonetic, ‘Ame’ being a reading for the ‘rice’ symbol. Down streets book stores and clothes shops, little food joints and places that do or sell heaven only knows what to my uncomprehending eyes, but picked clean of information by my intelligent son, jostle for position. China Town is not a tall district. It is old and shabby and quite beautiful. It has its unique identity and does not waver or gentrify. I love it there. I just miss being able to feel that old brightness in my mind and body. I have got quite unwell.
The doctor called yesterday. The upshot of it all is that at least the disease has not killed my kidneys, but my lungs look dodgy. I need a CT scan. I get a little shrill and panicked. The specialist will not answer any questions over the phone, I have to wait until next week to ask dire things like how long I have left, or if they think they can give me a reasonably normal life span. They will not answer much, except to tell me I am going to be put on some pretty horrendous treatment next week, and I am to go to the hospital if I start bleeding, fitting, fainting or collapsing in the meantime. I am then told to ‘try and relax and not get too stressed or do too much.’ I laugh darkly. Sure, Doc. I will sit here not knowing if I am about to kick the bucket and will be absolutely relaxed about it. Sure. I am not sure, however, I am going to be able to be a good patient. I know the doc has done decades of study, but hey, I read the SECOND page of google and asked A.I. about it and I am pretty sure she is wrong and I am absolutely going to be fine, I just need an aspirin and a RX for some heavy hitting painkillers to try and get me back up on my feet again and cut through the pain. That, my friends, will relax the daylights out of me.
My mind wanders as we drift in and out of shops. The boy buys some dried mushrooms. I, yet again, am left in wonder of the fact that the kid can read so many hanzi. I made a very clever young man. He has been broken up by my being so unwell. He babies me and makes me tea and insists I sit down. Finally we make it down to the TransAmerica Pyramid. I want to show him Hotaling Place, but my legs are gone and I am gasping for breath. I start to cry pathetically. I can’t find the street and am left to sit hopelessly in a café drinking sparkling mineral water and trying to get my legs to work again while the Boy tuts gently at me and asks if I need to go to the hospital. I tell him not to be ridiculous and drag him uphill again to the Beat Museum, which is closed. We then end up in City Lights, since the kiddo is too young to sit in Café Vesuvio with me.
An older gentleman is standing by the stairs booming into his cell phone.
“Yes, I am aware that it was a 90 day prescription, but I have used them up in 35 days and I need some more!” I smile. Poor bastard. There is no way if he blew through 90 days of opiates in 35 days, that the doc is going to let his self indulgent ass have any more! They will close the shop, decide he is having too much fun and relief and force him to take gabapentin. He keeps on barking down the line in the manner of a man who is not used to being told ‘no’ to anything, ever. I take a better look at him. Early 70s, stoutly built, looks as if he used to work in business or banking. He is wearing a nice leisure suit, with an expensive looking tie, and neatly shined shoes. In short, an upstanding citizen. Still, even upstanding citizens are sometimes wooed by the charms of not being in bone shattering, exhausting pain all the fucking time, and even them might do a little oxy and go ‘wooooo baby, that feels good!’ and perhaps do twenty five milligrams instead of the five they were prescribed. He carried on.
“No, no no…the 10’s are smaller than the 5’s! Is there anything bigger? I heard there are 30s?”
He honestly believes that the only reason the doc is not croaking up the goods is because they simply do not understand that he wants more of them. He is even lying to himself. I see a flash forward in my mind’s eye. The doctor refuses to give this man the legal and safe pain relief he needs and desires, so the man is forced to the street. He has money, he worked hard his whole life. He buys street ‘oxy’ which in his innocence, he does not realize is actually just fentanyl and possibly a little devastating desomorphine. It would hurt no one, including the man, to be given enough safe and legal painkillers to deal with his needs. Even if his needs are to get some mental relief, it would hurt no one to give him more of the safe oxy, but the doctor is bound by the rules of the failed war against drugs, and is in a punishment mindset. Pain is now a moral issue and doctors will leave you screaming before they will cough up the safe stuff – the dilaudid, the hillbilly heroin, the morphine and the norco, and worse than that, if they do accept they need to have a little mercy, the mercy they give is very little indeed. It won’t keep anyone well, let alone comfortable. They need to up the dose continually, which has no effect on the patient except to keep them well. Opiates are no trouble as long as the user has enough of them not to ‘get sick’. Back to the Nice Suit. He now has a dangerous edge to his voice and I see his future clear as day. He starts to use street drugs, and then he loses his house, his family disown the man who has been a good father and granddad to his children and grandchildren, they show him some ‘tough love’ and throw him out of their good graces. He starts to drink and sleep rough. A cardboard box on the sidewalk outside City Lights in Kerouac Alley. There he dies in increments until the cold or an overdose gets him. If the doc had just coughed up those 30s, he would be in his house, dandling a grandchild on a knee and boring everyone over Sunday lunch about how the Yankees are gonna win it all this year. All for the sake of the pill.
The answer is not to stop giving pain patients relief, but to give them enough safe legal painkillers that they are not forced to the streets. But now I am eyeing my own future up from the near distance, and to be frank, I am afraid. I am afraid of the pain. I do not want to die. I can be kept alive even in the worse case scenario for a while, and I can be kept very comfortable in the meantime, so I can write and go out and do things. Except….. there is no way any doctor will ever give me painkillers that work, or enough of them. My future looks bleak.
The Boy wants a book of Japanese poetry, but it is $16, and just not possible. He reads some of it standing on the top floor of City Lights. “They are so stuck up in here, Ma! I bet they would throw Neal Cassidy out on the street if he stepped through the doors today!” I nod in agreement. I much prefer the Beat Museum book store with its dusty shelves and agreeable management. They have more real than City Lights can ever regain, I suspect.
I look at the hills. They rise up in front of me. I did not bring a stick with me. It is ugly and medical and makes me feel hopeless. I am not going to make it up the damn hill. I have stranded myself in North Beach. I take the mask off my face, as I am now gasping for breath and command my legs to move. It is about six blocks and up to the eight dollar street car that does the worst of the hills. I have a card for one of us, but have to pay for the kid. We hop on and start to climb past hotels and fancy apartments, cathedrals and park spaces. We have to stand. I won’t ask for a seat and wouldn’t get one if I did. I start to wish I had the fucking stick.
California Street stretches out before me in the early evening spring light. Pot shops and grocery stores and all the people, ugly and pretty, and all the suffering and the cardboard coffins and the street nodders and the crack dealers and the sun, the sun, the sun as it starts to drift Californian down down down. We need potatoes and I buy a bag of apples and forget entirely the fact that I need apples of the earth not apples of the sky. This morning I cannot get out of bed.