The Waiting Room

Daniel Pustay is a fourth year medical student at the Lewis Katz School of Medicine (photo by Michael Vitez).

By Daniel Pustay

At 19 years old, he was a skateboarder. He didn’t just skateboard for fun, he obsessed over his board, he practiced past when most would think it was fun and he competed on his own dime. He drove four hours to enter competitions in New Jersey, he used any extra money he could find to buy new wheels, he practiced his footwork in the house, and perfected tricks on his street until it was dark and he couldn’t see his board under his feet. His dream was to go pro, and he was getting close. He started winning more and more, even talking to local skate shops about sponsorships. Then he missed on a landing and broke his arm, broke it bad. After a few surgeries, he was left with a plate and 9 screws, and he couldn’t skateboard for a month. But worst of all, he had pain.

His doctors gave him Percocet, which helped a lot. After the prescription ran out, he got another from his primary doctor. When that one ran out, he went back for more. He couldn’t stop himself, he didn’t want the pills but he just couldn’t bear the pain without them.

His doctor refused. So he went to a friend of a friend. He bought a few Percocets, but they were pricey. So the “friend” sold him Oxy instead, and that satisfied for a while. But then he needed more, and the Oxy cost too much, so he tried heroin. He hated needles, so he snorted it instead.

His cravings grew stronger. One year after surgery, he was snorting 8 bags of heroin a day — until police caught him in a sting.

After a few months in jail he was placed in a methadone maintenance program. They started at a high dose, making sure he had enough to stop withdrawal symptoms, and hopefully to stop the cravings. The hope was that he had enough independence to develop new habits, find a new environment with new friends and change his life around. Then he could wean down until the withdrawal wouldn’t be intolerable.

Arranging his whole schedule around making it to the clinic every day was a hassle, but he found a way. He made it every day, without fail, for ten years. In the meantime, he moved. He ran with a new crowd and met a new girlfriend. They got married, they had one daughter and then another. He worked for a construction company, roofing. He got an apartment/home for his family, was on top of the bills and still made it to the clinic every morning. He started to wean, from 100 mg all the way down to 6 mg. He was getting close, ready to take the leap off the end of methadone, away from the addiction that occupied his last 11 years.

Then his grandfather died, and he tracked down his old dealer two days later.

It’s hard to explain why, beyond the unexpected, the pain and loss he couldn’t resolve. At first he only needed a couple bags, but he stopped going to methadone. For the first time he was injecting, and his use was growing faster than before. He still made it to work for a few months, but all the money was going towards heroin. His wife started fighting with him, angry and betrayed. He never used at home, but the embarrassment and guilt he felt when he got home just made him want to use more. He didn’t know why he was using so much. He never worried about overdosing, but he knew he was being reckless. Then his wife took the kids. He had never spent a day without them.

The next day he went to the Crisis Response Center, asking for detox. He was excited to get clean again, looking forward to calling his wife, asking for forgiveness, showing he was making a change, pleading that he could get back on track.

“There aren’t going to be any beds opening up today,” the nurse told him. “You can wait in the chairs till tomorrow when we call again, or go home and come back.” Hope vanished and so did he. He walked straight to find a bag and get rid of the sweating, anxiety, shakes and pain he had endured all morning in the hopes of placement.

He had insurance coverage in a detox, but there were simply no beds available. The doctors at the crisis center told him he could call the rehab himself to find a bed, the approval was good for a while. He called and he called, hundreds of times. He was on the phone trying to find a bed every day for three weeks, injecting with heroin between calls. He was losing hope, and pictured losing his family every day that went by. Every pang for more heroin was a reminder of his dependence, of his family drifting away.

After three weeks of trying, he went back to the hospital. The insurance approved his methadone program again, just had to wait for a bed. Another day gone, still no beds available. He went home again and returned to the hospital the next morning. Still no beds. Back home only to return the next morning

According to the Mayor’s Opioid Task Force, there is estimated to be 70,000 heroin users in Philadelphia. The governor has declared a state of emergency. There are only 2 centers in Philadelphia that provide inpatient rehab with methadone maintenance, with 38 beds total. An estimated 15 people per day seek out an open bed at one of these 2 facilities.

After 24 days, the attending physician called and the insurer promised to make a special arrangement. The doctor knew a few programs that would hold a spot for him, or make a new bed if he needed.

A nurse passed out the brown bag lunch, a turkey sandwich on white bread. He sat back down in his cracked pleather chair in the crowded crisis center waiting room, waiting for his bed and his chance to get his life back.


Daniel Pustay is a fourth year medical student pursuing a residency in Psychiatry.


Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University. Michael.vitez@temple.edu