The waiting room

The Waiting Room With the barrel of a drug rep's pen, I crushed hard rocks of cocaine in a mini--ziplock. My next patient, a laser face- lift, sat in the waiting room. I was tired. I had already per- formed with no lunch break three tattoo removals, a scar revi- sion, and five laser hair removals. It was 5:00 pm, and I needed a lift. My assistant's Voice erupted from the phone intercom. "Your patient wants to know if she can drink tea while she waits." "Herbal, no caffeine. You give her an Ativan yet?" "Half-hour ago." ' I was envious. My next patient, Aimee, was entering lorazepan-induced bliss. 'From the mint-green wall cabinet I removed an amber plastic vial of Ativan. My assistant's name was on the pre- scription label, written that way so as to evade DEA scrutiny.' I placed the tiny white tablet under my tongue. The mere thought of its rapid sublingual action calmed me. I pushed aside the remaining unbroken rocks of coke in the bag with the flat end of a pair of steel forceps. In one motion, I stood up from the blue vinyl examination stool and lifted the forceps, piled high with white powder, to my nostril. I inhaled deeply while looking at my re- flection in the wall mirror, feeling sinful and yet justified. As a Catholic, it was a familiar sentiment. The odor of acetone filled my sinuses. A two-day old beard framed my face. Replacing the Ativan in the cabinet, I hid the bag of coke in the pocket of my teal scrub--top. The sting of the cocaine brought a tear to one eye. Instantly, I was energized. With my left hand, I pulled fresh examination paper from the supply roll onto the treatment table. With my right, I tapped the intercom. "Christine, I'll be ready in a few minutes. Can you give me a hand tonight with the smoke evacuator?" "Sure, but I can't stay past seven. I'm having dinner with my daughter." I admired Christine. She was smart, sexy, organized, and never let the chaos of the office get to her. When I ran late, as I often did, she tactfully rescheduled. Patients that I kept waiting, she entertained with banter in her cool French accent. And she maintained a personal life -- dating, working out, roller- blading in Central Park and lunching at the Boathouse Cafe. My life had no boundaries. Work, home and nightlife melded into one dysfunctional mess. I partied with patients, sleeping with models and actresses I thought successful. I had no code of ethics. My ego ran the show. I often left my office at 1:00 am, heading directly to a club after changing into a black Kenneth Cole shirt. Sometimes, I returned to work after a Broadway show and answered e-mails until 3:00 am, sustained by cocaine. At parties, I quoted treatment prices with a drink in one hand and with the other peeking under blouses and skirts to see undesired tattoos. I invested in lasers like models bought clothes, buying the latest, the hottest, the sexiest. Between patients, I visited Union Square for tanning, or a quick haircut. If I looked good, and my patients looked good, that was all I needed to prove my success. But the facade hid the pain. Behind the mask, I was just a kid looking for acceptance, for some sign of approval. Any- thing to counterbalance what I thought of myself: an amoral greedy bastard. Yet I was proud of the treatment center I owned in posh Gram- ercy Park. It was the culmination of my efforts to prove I was talented, adhering to the example taught to me by my father. He had built a one-secretary office in a run-down city into a pub- lic relations agency in a commercial hub. He too was in the business of improving images. In a modern co-op, my office offered a host of treatments, from laser hair removal to scar revision to Botox. In the center and on my own websites, I sold a line of skin-care products I had developed, choosing the ingredients, the packaging and the name: Skin Ovations. The line consisted of creams and lotions to erase wrinkles, lighten skin and clear up acne. I promised rejuvenation, youth and beauty. All with a money-back guarantee. As the business took off, I expanded to offer alternative therapies such as Reiki, acupuncture and shiatsu. In A-list magazines, sexy black and white ads trumpeted the center's treatments. My success was partly due to serendipitous timing. Advances in lasers along with society's renewed quest for fitness and youth, propelled me to succeed in the beauty industry. Laser resurfacing was non-invasive, offering fast recovery. New York's elite pre- ferred it over the cutting and stitching of plastic surgery. Luxurious health spas spurred New Yorkers to work out, tone, and tan. The fashion industry jumped aboard the trend with beefy male models displaying hairless chests. Marky Mark's pecs and washboard stomach towered over Times Square like Atlas. He stared at Kate Moss's long silky legs draped over Tower Records. Neither of them displayed a single body hair, or a wrinkle. As I opened the treatment room door, cool air from the hall- way chilled the dots of perspiration on my forehead. My pre-surgery jitters had begun. Like an actor ready to take the stage, I was scared yet exhilarated. Christine, her straight blonde hair cascading over her petite shoulders, sat at her desk chatting in French with Aimee. They were both from Quebec. Aimee looked up and smiled as I walked into the room. I made a mental note of the wrinkles around her green eyes. I was pretty sure I could get of the lines completely. Light-skinned, with high cheekbones, she would get good results from the erbium laser, my newest toy. But even though I had performing laser treatments for years, I was nervous. I wasn't a doctor. I was a fraud. In the back of my mind always lurked the fear of discovery. An engineering school drop-out, I had finagled my way through A a number of professions -- civil engineer, electrologist, and dermatologist. Fascinated with math and sciences, I was drawn to the technology in each of those fields. An over-achiever, I mastered most anything I put my mind to. But I wasn't licensed, or even well-qualified, for any of the fields I chose. Impatient by nature, I had a problem following through on things, like degrees and licenses. I was usually too busy getting high. But my determination to excel often compensated for my failures. I was intent on proving to my hyper-critical father that I was a success, and his equal. I had attended a good engineering college -- Rensselaer, popularly known as RPI. My good grades (high school salutatorian) got me in. But emotionally, I wasn't ready for independence, especially at a hard-partying fraternity college. My junior year, I was put on academic probation. My low self-esteem, along with my father's negativity, convinced me I wouldn't graduate. So I left. However, I quickly found employment as a project manager for a real-estate developer. Reinforced-concrete high-rises became my specialty. They satisfied my inner-child curiosity. My earliest recollection is building skyscrapers with wooden blocks on my mother's kitchen floor. At four years of age, I topped them with broken pediments. I did well in construction. Personable and motivated, my smile opened doors. But my popularity led me to the New York city nightlife. At packed clubs I partied till the morning hours, a denizen of the bathroom drug clique. As my addiction spiraled out of control, I missed days at work. Eventually, my employer tired of my excuses and fired me for absenteeism. I started my own construction company, doing small renovations. The flexible hours gave me more time to party. While renovating a medical office in Soho, I developed a friendship with the owner, a dermatologist. She was expanding her practice to offer laser treatments -- an emerging medical field at the time. I was fascinated with laser physics. Focused coherent light had the power to explode tattoos, cut through skin, and cure diseases like rosacea, port wine stains and acne scarring. Dr. Paris, seeing my drive and my potential offered to take me to a medical laser conference at a teaching hospital to see for my- self the amazing technology. Surrounded by plastic surgeons and dermatologists, I took on their personas, like Woody Allen's Selig. In crowded treatment demonstration rooms I talked their lingo. "Excellent results. Rapid recovery, too. Yes, I'm here with Dr. Paris... that's right. Derm,.Soho." Before the renovation of the laser center was even complete, I started working with Dr. Paris to develop her business. Talking with magazine reps, who I found to be as pushy as used car sales- men, I researched ad rates. I chose magazines popular with ar- tists, musicians and actors, and created a chic advertising cam- paign with black and white photos of sexy nude models. As the phones began to ring incessantly I set up a hi-tech phone system to handle the calls: 1-800-DR-LASER. On our first laser treatment day, Dr. Paris trendy waiting room held black leather sofas packed with patients, some sitting five hours, flipping Vanity Fair pages, chattering on cells. Madonna waited on Spring Street in her limo for a laser consultation. The business took off. Every 'laser day' was booked solid. The receptionist reported patients offering a thousand dollars for one hour of laser hair removal -- enough time to do only one leg. Laser face-lifts commanded five-thousand. At first, I only performed treatments when Dr. Paris was in the room. But as the demand, and the income, increased we used separate treatment rooms. In return for a commission, I worked twelve-hour days. She occasionally checked in on me to give the impression of all treatments being done under her supervision, as required by FDA guidelines, and the law. The laser, a prescriptive device, could only be administered under the 'supervision' of a doctor. To Dr. Paris, that meant being somewhere in the building. To make the treatments more comfortable, she taught me to inject lidocaine, a chemical cousin of novocaine, under the skin. Lidocaine was a prescription drug. It was illegal for me to provide it to pa- tients. But the intoxicating atmosphere of Soho, along with my ego, convinced me it was OK. It was the 90's era of greed in New York, and I dived in with relish. Like a gourmand at a ban- quet, I needed little coaxing. Dr. Paris and I got along well. At the end of a long day, we often dined next door at Penang, a Malaysian restaurant with a waterfall, banana trees and spicy ginger prawns. We were both driven by avarice. According to Dr. Paris' staff, she was also corrupt, submitting fictitious bills to patients' health insurance companies to collect fees. Her greed repulsed me, but I saw her as a doppelganger, and sadly, a mentor. Like a sponge, I soaked up everything she taught me about removing moles, freckles, birthmarks and tattoos. Under her tutelage, I developed my own laser hair removal method using a proprietary lotion. And I created a laser facial based on her laser resurfacing techniques. As the media touted the new technology, resurfacing began to re- place cut and stitch face-lifts. The strength of the health and beauty craze was fueled by this state-of-the-art technology. The momentum swept me along, into my own office after being with Dr. Paris for two years. Initially, I opened an office in Chelsea. Flushed with success, I moved to the Upper Eastside, where I met Christine. She had worked for a Park Avenue plastic surgeon, Dr. Keenan. She ran his office, managed his daily schedule, and assisted him in the operating room. Manhattan socialites checked into his clinic and left a few days later, their fat obliterated by liposuction, their wrinkles vaporized by laser. I was awed by the scope of the business and the magnitude of Dr. Keenan's talent. I invited him to a business meeting dinner at Le Cirque where we talked about the future of cosmetic laser treatments. By the time our Grand Marnier souffles arrived, he had invited me to join his staff. After only a year working for Dr. Keenan, heading up his laser clinic, he fell ill with stage IV myeloma -- bone marrow cancer. He flew to M.D. Anderson in Texas for experimental treatments. But within three months, he had passed away. Like many highly successful doctors, his personal life was a mess. He died with no will, no thought of his mortality. With his estate in limbo, the haughty co-op board that collected the rent for his clinic tossed his employees into the street. Christine and I stood in front of Dr. Keenan's office as my equipment was being loaded into a truck by laser technicians. Red and yellow tulips bloomed in profusion on the lush median that runs the length of Park Avenue. Like two kids being tossed from their home, I asked Christine to leave town with me. I had no idea where we would go, but lashing our dingies together, we started paddling. Our boat landed in Gramercy Park. I walked into the waiting room in the Gramercy Park office. Aimee sat in a mauve leather club chair. "Bon soir, Aimee. Com- ment allez--Vous?" I smiled, hiding the anxiety that always in- habited my head. "Bien." Aimee flashed perfect teeth and glossed carmine lips. "You can come on in. I'm ready to get started." From the mint--green wall cabinet in the treatment room, I removed a unit of Stadol. It had Aimee's name on the prescription label. I had taken the liberty of having it filled for her. It was a trick Dr. Paris had taught me to get prescription medica- tions to keep on hand. I had the scrip delivered to the office in the patient's name. Pharmacies had no problem with that. The FDA only required that the patient consume the drug. A powerful rapid-onset pain reliever, Stadol was usually prescribed for women in labor. It was synthetic morphine. My medical director, a psychopharmacologist, had recommended Stadol for laser resurfacing procedures. He had also turned me on to it at a drug-fueled sex party in his penthouse overlooking Central Park. He had a thing for models, too. He decorated his place with them, strewing them over Bauhaus sofas like throw pillows. I glanced at my watch and noted the time. "Aimee, this is a nasal spray. It'll make the procedure more comfortable. when I tell you, I want you to inhale deeply." I inserted the spray pump unit into her nostril. "OK, inhale." I squeezed the trig- ger. "Good, OK, now the other side." "It has a funny taste." She wrinkled her aquiline nose. "Christine, could you get Aimee some water? Aimee, the Stadol is going to make you groggy. If you want to sleep, that's fine." I hoped she would. It would make my job easier. "I'm a little nervous. Is this gonna hurt?" She looked to me for comfort, her green eyes imploring my trust. "You'll experience some discomfort. I'll try to make it tolerable. If you need me to stop, just raise your left hand." Aimee looked over at Christine, who put a hand on her shoulder and gave her a paper cone of spring water. "Don't worry. I've had it done. It feels like a bad sunburn. Tomorrow, though, you're gonna look like hell. Don't leave your apartment for a few days. Order chinese. I Christine looked at me and smiled. I had done her resurfacing two years earlier and her skin still looked great. I justified flaunting the law because my treatments brought happiness to the recipients, and to Myself. I used the treatments like a drug. All laser procedures involve some degree of discomfort. Hair removal and laser facials were tolerable for most people. -But resurfacing and tattoo removal were very painful- most could not handle those procedures without some type of medication. I tried to make the treatments as comfortable as possible. Laser resurfacing was a bloodless procedure, but at times, depending on the patient's sensitivity, I needed to inject lidocaine locally. Sometimes it was necessary around the eyes where I needed to go deep with the laser in order to remove rhytids, or crow's feet. If the treatments were intolerable, the success of the laser clinic would be threatened. I employed doctors as consultants to provide prescriptions for the drugs, all perfectly legal. But the availability of those drugs in the office became a problem for me. I was always looking for a glimpse of serenity. Morbidly curious, I had to try every- thing. I had rarely experienced any type of contentment, much less happiness, even as a child. I recall always being afraid, uncomfortable. But afraid of what, I didn't know. The beginning of any high -- alcohol, coke, marijuana -- was the most exciting part, the nauseating descent from the top of the roller coaster, the fear of death. Once the ride levelled out, I got bored. I wanted to try everything. I became addicted to most anything -- Stadol, benzodiazepams, codeine, any thing that altered my state of mind. I wanted to be lifted from the depression that surrounded me like a steamy sauna, weighing me down, making me lethargic. I treated the drugs as a business expense. I felt I needed them to be productive, to ensure the success of the treatment center. And I did anything, legally or illegally, to supply my needs. I wanted to stop using, but feared the loss of my constant companion, my evil confrere. Christine gave Aimee a green scrub top with 'Lenox Hill Hosp' stamped on the pocket. "Put this on over your blouse. I'm going to put a hairnet over your head." As Christine helped Aimee, I began to get impatient. I had a lot of work ahead, and my high was wearing off. "Christine, could you bring in the evacuator?" The device captured ablated tissue, the layers of skin removed by the laser. Its name, 'smoke evacuator,' was a misnomer. It didn't evacuate smoke. It trapped the patient's vaporized skin in a charcoal filter, after I had removed the skin with the laser beam. The under lying skin was healthier, younger and generally free of wrinkles. With the laser in hand, I had the ability to transform, to rejuvenate. I was powerful, and successful. Turning a thick chrome key, I powered up the erbium laser. The control panel came alive, displaying rows of bright red digits. 'The warm-up timer started counting down. At zero, the flashlamp began firing ten times per second and the strong cool- ing fans whirred. As their speed increased, so did my adrena- line. The heat from the laser, the drugs and the anticipation of the procedure made the room smaller. I lowered the air--conditioning thermostat, preferring the room cold during face-lifts. I didn't like the patients to see me sweat. I checked my watch again. Fifteen minutes had elapsed since administering the Stadol. Aimee would begin to feel its effects' in about five minutes. with my back to Aimee and Christine, I slipped the bottle of Stadol into my front pants pocket. In most patients, the drug produced drowsiness. But in me, it produced euphoria. Because it was an agonist/antagonist, it produced different results according to a person's chemical make-up. It 'gave me energy, a sense of joie-de--vivre. I could work for hours, bantering with patients, never tiring. -Until the drug wore off. "Christine, I have to use the rest room, be right back." I wanted my energy level to match that of the photons bouncing between highly--polished mirrors in the laser cavity. I walked to the waiting room that I had designed. It was empty. The staff had left hours ago. Black leather club chairs encircled a green glass coffee table littered with recent issues of Vanity Fair and Elle. An 'Enya' album clicked into place on the CD Carousel. The Orinoco flow of Gaellic lyrics emanated from Bose speakers. Above a leather and chrome Breuer chair hung a black and white photo of Jerry Hall, nude, reclining on a white sand beach. Richard Avedon's signature was scrawled in black magic marker across her naval. Grains of sand encircled one erect nipple. I shut the bathroom door and removed the Stadol from my pocket. Inserting the spray tip into a nostril, I caught a glimpse of myself in the wall mirror. Puffy, sleep-deprived eyes stared back. My forehead glistened with an unctuous coat of perspiration. As the bitter taste of the Stadol hit the back of my throat, I felt guilt, then relief. The tension in my shoulders eased. My adrenaline surged as warm sensations of euphoria spread through my body. Returning to the treatment room, I left the door ajar to let the warm air escape. Christine looked at me; she knew. I felt sheepish as I smiled at Aimee like a charlatan. "You ready to get started?" I knew I was. My neurons were firing. I had the pre-show jitters, the anticipation and the excitement of a stage performance. I was crucial to the show. It was the only way I could justify my morally bankrupt behavior. The patients needed me. My sins were absolved as long as the patients left happy. Engaging Aimee in conversation to help her relax, and take the focus off me, I asked, "How do you feel?" "Kind of groggy. Am I going to go to sleep?" "You'll be aware of what we're doing. You'll be able to hear us and talk to us. If you need me to stop, raise your left hand, OK?" She nodded. "Christine, would you turn on the evacuator?" I avoided using the word 'smoke' in front of patients. I donned latex examination gloves, non-powdered. I detested the kind with white powder that would mar my black Armani slacks. With squares of gauze soaked in rubbing alcohol, I daubed Aimee's forehead and cheeks. "Aimee, close your eyes for me, please." I swabbed, then blotted with dry gauze so as not to irritate her eyes. "OK, folks, laser protection on." Christine put on her white framed laser goggles. We both tied our surgery masks. I put on my favorite pair of goggles: blue tint with black frames. I imagined myself as Bono as I tightened the strap behind my head to hold the goggles tightly. Reflected laser light could cause per- manent damage to the eyes -- a direct hit: blindness. I already had several small black specks in my vision from accidently look- ing at the laser beam while tuning it. As I fumbled with my strap, hindered-by the latex gloves, Christine came to my aid. Standing close behind me, she whispered into my ear. "You OK?" "Yeah, fine." "Be careful, her father's an attorney." A blast of heat radiated from my face. Nausea tightened my stomach. I was unlicensed, uninsured, heavily in debt for half a million in lasers, and a fake. A lawsuit would be catastrophic. "Christine, turn the evacuator up to full power. I'm going to start with the forehead." She adjusted her goggles and placed the suction wand near Aimee's temple, the pleated hose draped across Christine's arm. I moved the laser-activation pedal into position near my right foot, then put the laser into firing mode. "Laser on." Raising the power to 20 milliwatts, I brought the steel arti- culated arm and focusing handpiece into position above Aimee's forehead. A red aiming beam illuminated the contact area, a 5 millimeter circle. The practice, preparation and drugs converged. Steadying my arm by cupping my elbow, I stepped on the acti- vation pedal. The laser began firing ten times per second. Each shot produced a loud pop as it vaporized the skin. I traced her brow wrinkles. The lines disappeared instantly, leaving behind ashen circles of ablated tissue. Christine followed my movements with the evacuation wand. A plume of vaporized skin entered the pleated hose, drawn into the machine's charcoal filter. I wondered how long it would be before I would have to replace the filter, shipping the used one to a bio-hazard disposal. I still owed them money for the last filter. "Aimee, you OK?" She managed a weak, "I'm fine," The reality of the procedure, the noise of the equipment, and two masked faces peering intently made her nervous. ' I made a series of overlapping passes, completing the fore- head. Pausing to check the skin color of the treated area, I could see a reddish pink --- a sign that the laser power was at the right level. I felt more confident. The Stadol energized me; the power of the laser exhilarated me. I still had to conquer the suborbital area. Working around the eyes was delicate work, the area sensitive. Aimee raised her petite hand. "It's hot. It feels like it's Burning." "Christine, could you hand me some gauze. Soak it with saline." I considered giving Aimee more Stadol. But she weighed no more than 110 pounds. Too much Stadol might induce vomiting. I put the laser on standby. "Christine, could you give Aimee another Ativan, half a tablet?" She gave me a sideways glance. Christine often had to deal with patients I had overdrugged -- helping them walk, put- ting them into cabs, calling to make sure they got home alright. Always looking out for me, she was the one who really ran the office. I was more worried about getting good results, pushing patients to the limits of pain tolerance. Ideally, the patients should have been completely anesthetized. But that would have required an oxymeter and heart monitor -- expensive equipment. It would also require the services of an anesthesiologist who made a minimum of a thousand dollars per patient, putting the cost of my treatments out of reach for many. The advent of laser treatment, its ease of use, and its tolerability, was supposed to eliminate the need for putting patients to sleep. Fewer patients would have imperiled the business. I was strug- gling with monthly payments for five lasers, in addition to the astronomical office rent in New York. A ground floor entrance in Gramercy commanded ten thousand a month. Laser treatment was a hot field, but New York was very competitive. My office was only steps from Park Avenue, which was lined with the polished brass plaques of MD's announcing plush waiting rooms, and real doctors. I was envious of them and determined to prove I was their equal. I socialized with a coterie of those in the medical field -- plastic surgeons, internists, psychiatrists, anesthesiologists. I got advice from them: tips on new treatments, new medications. I practiced their swagger, adopted their vernacular. I had convinced myself I was one of them. While I waited for Aimee's Ativan to take effect, I made a bathroom run for a hit of coke to last me the next phase of the treatment -- the cheeks and around the eyes. Stripping off my latex gloves with a snap, I tossed them into the trash. As I walked down the corridor to the bathroom, I felt shame. I couldn't get through a single day of work without medicating myself --- Ativan to deal with the stress, cocaine for energy, and Stadol for long hours spent hunched over patients, laser in hand, sweating, tense. I wanted to be magically free of the drama that had become my life -- buying drugs, using them, and dealing with the consequences. But each of my attempts to get clean -- rehabs, AA meetings, group therapy, cognitive therapy -- had ended in failure. I would put together some clean time: thirty days, six months, a few times I made it to a year of sobriety. But I always returned to using. Ugly events -- deaths, break-ups, disappointments -- could set me off. But so could the good times -- birthdays, holidays, successes. I had a drama addiction, wanting every experience to be powerful and intense. I often found myself thinking, "This is good,' but it would be better with a little coke." After a few hits, I hurried back to finish the procedure. My anxiety was starting to climb. I thought maybe I did too much. I could feel my heart pounding. Aimee's eyes were closed when I entered the room. She looked so peaceful; the Ativan had taken effect. Christine had her back to me and was straightening the mess I had left on the counter. The laser, in standby mode, purred softly like a resting cat. . Christine turned to me and spoke quietly. "Listen, my daughter's in town with her fiance. I promised to take them to dinner. I gotta go." "How long since you've seen her?" "Three years. We're so alike that we can't tolerate each other for very long." ' "I hope you two work things out. My father and I haven't spo- ken in years. We're both stubborn. Don't let it get to that. Where you going tonight?" "Cafe Boulud." "Ah, le degustacion, tres bien. See you tomorrow." She smiled, but there was a sadness behind it. If Christine had had a magic wand, she would have relieved me of my misery. But she knew my case was hopeless. We had had a fling together in the Cayman Islands, scuba diving, when she first starting working for me. But once she realized the depth of my insanity, my debauchery, the relationship fizzled. We remained close though, enjoying each other's company, commiserating about our unfulfilled lives. She held the office together, faithfully, despite my efforts to raze it. ' As Christine left the room, I felt a stab of panic. I had the responsibility of a drugged patient, a face--lift to finish, and I was alone. The room was hot, I was sweating, and the laser was ticking impatiently. But I was high. I had to concentrate and not let the drug-induced euphoria affect my judgment. I decided to tackle the eyes -- tricky work. A slip could cause scarring or blindness. I cut the laser power to compensate for the delicate skin, and turned up the smoke evacuator. Stepping on the pedal, I made my first pass across Aimee's lower Lid, stopping at her ear. She opened her eyes and grimaced. "That burns." "I could turn down the power a bit more, but your results won't be as good." "No, no. Leave it where it is. I'll be OK." She was torn between looking younger and suffering, or comfort. "Try to relax. It goes quickly." I started another pass, but Aimee raised her hand. "Oh, my god, that's so painful." Frustrated, I placed the laser on stand- by, and exhaled. The coke was making me impatient. "I could do a nerve block around the eyes, inject lidocaine to numb the area. Are you allergic to novocaine? Have you had novocaine at the dentist?" "I don't like needles." "You won't feel the needle. I freeze the skin first, with ethyl chloride. You might have some bruising from the injections. But it'll be a lot more comfortable." She hesitated as she weighed whether she trusted me. "OK, that's fine. But I don't want to see the needle." I didn't like injecting lidocaine because it produced swelling. The resulting tautness made it difficult to see the wrinkles: my laser target. But in order to get good results, I needed the patient to be still. Involuntary movements could be disastrous. Returning to the wall cabinet, I removed a glass vial of lidocaine, a box of needles, and a syringe. With fresh gloves to guard against contamination, I filled the syringe with a solution of lidocaine and epinephrine. The lidocaine caused numbness. The epinephrine, or epi as it was usually called, was a vasoconstric- tor. It caused blood vessels to constrict, keeping the lidocaine at the injection site, and making the numbness last much longer. I placed the syringe on the back of the treatment table, out of Aimee's view. With a bottle of ethyl chloride in my hand, I braced my fingers against Aimee's cheek. My hands trembled slightly as I directed a fine stream onto her temple. A coating of frost formed immediately. I injected the lidocaine, forming a bubble under her skin, just as Dr. Paris had taught me. Continuing, I encircled her eye with the injections. As Aimee realized that there was no pain involved with the needle, she relaxed her grip on the table. "Aimee, turn toward me, please." I repeated the procedure on her right temple. With squares of cotton gauze, I blotted dots of blood that leaked from the in- jection sites. Lightly stepping on the pedal of the bio-hazard waste can, I disposed of the gauze and tossed my gloves. The tension of the injections tired me. My back hurt. It was time for one more hit before the final stretch. I rational- ized that I needed a few minutes for the lidocaine to fully take effect. It was a convenient excuse I often used to assuage my guilt. I took foolish risks not because I didn't care about the patient, but because I was drawn to the danger -- like a skydiver poised at a plane's open door, or a lone kayaker negotiating frothy white water. The fear, the adrenaline made me feel alive. It was crazy, sick behavior. But I didn't have the moral strength to say no. "Aimee, I'm going to give that a few minutes to spread out. "I'll be right back." She simply looked at me, giving tacit per- mission. As I walked the corridor to the bathroom, the office was eerily quiet. The music had stopped and there was no sound from the street. The broad windows of the waiting room were black. Despite being alone, shame made me close the door to the bathroom. Without looking in the mirror, I took a hit of coke followed by two hits of Stadol: the professional's speedball. I needed something that would last me all the way through the lasering. Leaving the bathroom, I took a furtive look in the beveled wall mirror. I was still wearing my laser protection goggles. I Had no idea they were on my face. Hurrying back to the treatment room, I passed Jerry Hall's breasts without my normal glance. Aimee turned toward me as I entered the room. Heavy-lidded and lethargic, she managed a weak smile. Her forehead was a raw pink. Specks of dried blood dotted her pale cheeks. The laser, on standby, ticked loudly, impatiently. I left the door partly open to let heat escape. I felt confident and ready to finish the procedure. Aimee and I were both well anesthetized. My synapses were filled with serotonin waiting for reuptake. I bumped up the power on the laser. With Aimee numbed, I could push the limits of her tolerance, improv- ing her results. I wanted her to see a dramatic change in her skin. Turning Aimee's head toward me, I pulled taut the skin of her lower lid. Smoothly and deliberately I passed the laser beam across her lower lid and cheek, stopping again at the ear. I no- ticed a few hairs on her ear lobe. I made a mental note to remove those on-her next visit. "Aimee, you OK?" She didn't answer. The medications were working. I made another pass, slightly overlapping the first. The pinkness of the treated areas indicated my laser settings were perfect. I started to work on the maxilofacial lines, those sep- arating the cheek from the mouth: the smile lines. I noticed at the corner of Aimee's mouth several small bub- bles had formed. I stopped. A white crystalline foam filled the interior of her open mouth. Larger bubbles slipped noiselessly from behind her front teeth. Panic seized me like a bear's claw. "Aimee, Aimee!" ' She was unresponsive, her eyelids closed. Quickly I put the laser handpiece into its holder and shut off the machine. The drone of the smoke evacuator filled the room. I stared for a moment at Aimee's open mouth, stunned. Fear welled up. Grasping Aimee's chin, I turned her head. With my thumb, I raised an upper lid. Her gaze, unfocused, pointed over my shoulder. "Aimee, can you hear me?" Bubbles of saliva continued to emerge from her mouth, bursting as they slipped across her lower lip. My arms felt incredibly heavy. Trying to quickly lower the back of the inclined treatment table, I jammed the mechanism; After freeing it, I lowered the back slowly. I was strangely afraid of slamming Aimee's head down. I pinched her nostrils and braced the heel of my hand against her forehead. She felt cold. I cupped the nape of her neck. With my palm against her chin, I placed my lips against Aimee's, breathing into her mouth. Barely any air left my lungs. I tried again with more effort. My breath passed more easily into her lungs, but her chest remained still. The smoke evacuator continued its monotonous whirr, sucking air into its filter. I placed my hands in an 'X' over Aimee's sternum, locked my elbows, and pushed against her frail chest. I had no idea how many compressions I managed before I returned to giving breaths. As I inhaled, I realized I was crying. My chest shook, emptying my lungs of air; tears clouded my Vision. I shoved the laser away from the table, banging it into the wall. Grasping Aimee's wrist to check her pulse, I felt nothing. I waited. Still nothing. I returned to giving breaths, pushing harder. At the end of each exhalation sobs and tremors shook my torso. My day of reckoning had arrived.. I recalled visits when Aimee came to my office, so happy with her laser treatments. Years of frustration with ingrown hairs had darkened her thighs and groin. She had tried a lightening cream, but it burned her skin, leaving dark scarring. She was too shy, too embarrassed to even show me the damage. But working patiently with her to gain her confidence, the laser treatments returned her skin color to normal. I remembered her joy as she told me about her results, beaming. I paused in giving breaths. I saw helpless, frightening moments in my life: attacked by a German shepherd, being beaten senseless by my father, witnessing my mother's death from cancer. I saw that my life was yielding to a destiny. I was just an observer. Shaking, I made another effort at giving breaths. But I knew she was gone; I became resigned to my fate. I wondered if Aimee knew what was taking place. I would not hear her voice again. I thought of the time she had come to my office on a Saturday. I had been up all night, partying. I arrived late, frantic, sweating. I told her I had gotten stuck in traffic. She was so sweet about it. We sat in the waiting room while I calmed down. She told me about her childhood in French Polynesia, moving to Quebec with her par- dents, and learning English. She taught me a little French which I still used when she came to the office. "Tu parles tres bien" I reached over and shut off the whirring smoke evacuator. As I stared at Aimee, the room became loudly quiet. I struggled to think. But my mind was sluggish, heavy. Reasoning was beyond me. My body operated with no thought. Panic rose like bile and dictated my movements, making me only a witness. I found myself outside the treatment room, standing in the corridor. I suddenly thought of Christine at Cafe Boulud. She had a shocked expression on her face, mouth agape, her fork in mid-air. I walked to the waiting room and stood, arms akimbo, hands tightly gripping my hip bones. I was so terrified, like a kid who had just smashed his mother's favorite vase, frantic to hide, to avoid discovery, to just save his own ass. Outside the office windows, Gramercy Park was still -- no taxis, no pedestrians, no sound except the roar of silence. Atop the beaux arts Con Edison building, an alabaster statue of Ares, floodlit in red, stared down at me. The murderous cursed warrior and coward held a sword at his side. A bronze helmet shadowed his brow as he glared at me. I caught a glimmer of my soul, and it was horrifying. I felt an overwhelming urge to flee, to get out of that office and into my car. The thought of being cocooned by leather and steel comforted me, drew me. I just wanted to believe every- thing would be fine, to pretend I was someone else, someone with pride, with feelings, with morals. My gutless, selfish behavior had resulted in the ultimate sin. I had let Aimee die. Returning to the treatment room, I stopped at the storage closet in the corridor and opened the door. My clothes were suspended neatly from thick chrome hangers. On the floor sat my luggage, abandoned after a trip to Costa Rica. My eyes fell upon the wheeled check--thru I had used to carry my scuba gear. I reached for the handle. In the treatment room, I wrapped my arms around Aimee's small waist and pulled her off the table. Cradling her back and legs with my arms, I carried her into the corridor. She was lighter than I expected. Gently, I placed her, positioned like a baby in the womb, into the travel bag. And then as I watched, disembodied, I heard the whirr of the zipper. -September, 2011