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He sits across from me, crossing and uncrossing his legs.

When did you last smoke? I asked, casually.

Last night, he replied.

He did not meet my eyes, but I did not feel the usual shame when someone tells me of their drug use. The admissions couched in well, I have to tell you because you are my doctor and I don’t use every day, you know. Only sometimes. Only when the pain is bad.

No, he owned it.

Yes, I use. Yes, I was clean for a while, but then I broke my leg and it needed a rod and six screws and of course, I had to have pain medicine. I’ve been using since then. I crush the pills, smoke it in foil.

I used to get high and feel it. It felt so good. You know, like nothing else in the world mattered.

(I cannot help but wonder—what else is there in his story? What did he need to escape? What abuse or separation or pain? Did his mother die young? Did she overdose? Did his brother have cancer. did he grow up playing with matchbox cars and reading Highlights in hospital and clinic waiting rooms? Did his cousin pull him into a gang? How old was he when he heard his first gunshots?)

I don’t feel it anymore. I smoke so I don’t go into withdrawal. When the shakes come on, you know? I can’t sleep. I wake up soaked. I can’t eat. The anxiety is the worst.

I’ve seen people overdose. I watch to see if they are still breathing but I don’t really notice. None of us do. We are all too high.

Tell me the truth. That’s all I ask. I don’t tell him that I appreciate his honesty, though I do. He’s not telling me what I want to hear. He’s telling me what is.

Maybe that means, when he tells me later that he’s not quite ready for medication-assisted therapy to help him come off the oxy, but he’ll call me when he is, that one day, I’ll actually get a call.

I’m ready.

And he will be.