An excerpt from Are You the F**king Doctor?: Tales from the bleeding edge of medicine.

The vein stands up proudly. It’s good to look at; it’s inviting. The tourniquet is satisfyingly tight, the syringe waits like a shark on the bedside table, the new orange needle catches a glint of light, a silver gleam of expectancy, hungry for the vein; one of the small benefits of being a doctor and an addict is that new and clean needles are easily available, and the risk of AIDS and hepatitis B or C and other infections is accordingly low. New needles also won’t have been blunted by repeated use. I had used a bigger green needle to draw up the drug, a needle that can reach right to the bottom of the ampoule, so that not one drop will be missed. I use an orange needle for the actual injection because it is of smaller bore and will penetrate the skin much more easily, with less trauma, and will leave less visible evidence.

Beside the syringe lies the pack of Cyclimorph, a combination of morphine and cyclizine, empty now, and ominous, a small harbinger of doom. The particular color of the red and blue packaging is like a beacon to me; when I see those colors alarm bells go off in my head, if a pack was lying by the side of the road a mile away I would spot it immediately. At this moment I don’t care that it’s my last dose; the future, and the price I am going to have to inevitably pay, is irrelevant. I’m living in the now, isn’t that the secret of happiness, and everything is focused on my preparations.

The discarded packaging of the needles, ampoules, and syringe lie in a tidy little pile. I put the guard back on the green needle and set it beside the empty ampoule; these need more careful attention, as discarded needles can turn up anywhere and ampoules can shatter easily and leave small but sharp shards of glass. The detritus has to be kept together, so that it can be secretly disposed of; secrecy is paramount, nobody can know, nobody can suspect. If I wait till after I’ve used, I may forget, or become too casual, and leave some evidence behind. I don’t want questions I don’t want challenges, I don’t want tough love, I don’t want people who care about me, I want the drug.

Everything is quiet, the doors are closed, the curtains pulled, all is dark except for the bedside lamp, just bright enough to see what I’m doing, a small island of light in this world I have created for myself, a world of shadows and self-destruction. I am alone in the house, just the way I have planned it; there is no glamour here, no drama, no heroin chic, no grande passion, no tortured artistic sensibility, it’s just a selfish, venal, deceitful, squalid, solitary vice.

I roll the vein lightly with my forefinger, testing the bounce, no, much more than that, not just testing it, enjoying the bounce; the vein you can feel is more reliable than the vein you can see. The vein is sweetly engorged, sensual, and will be easy to access, little chance of missing the vein and the drug leaking into the subcutaneous tissues, which would leave a painful and visible bruise and, even worse, would mean losing some of the drug. The vein I have selected is on my right forearm, on the inner surface. As I am right-handed, my left arm is a better choice, but after months of injecting, the larger veins there have collapsed, and the only veins that remain visible are thin and thready and would be unreliable. I still have some attractively superficial veins on the back of my left hand which would be easy to access, but the marks there will be too easy to see. The hand veins can wait for the time when I become more desperate; their day of service will come, and come soon.

My right forearm is doubly awkward, as not only will I have to use my clumsier left hand to access the vein, but also the skin on the inner surface of the arm is paler and will show up marks much more vividly, especially if something goes wrong and I bruise excessively. I am pale-skinned at the best of times, and months of regular using has turned me wraith-like; I’ve seen recent photos, I look detached, like a ghost.

But this vein looks good, not only is it visible and easily palpable, but it is also near a junction, which usually means that it is tethered down by subcutaneous tissues, and shouldn’t move around too much; veins can be capricious, as if they have a mind of their own and sometimes seem to deliberately wriggle away from the needle. I have also become more skilled even with my left hand, so it shouldn’t be hard to hit; I am confident.

Of course, even if I do bruise, I can always wear long sleeves; why should anyone be suspicious enough to want to inspect my arms? It isn’t any of their business, it’s my problem, I’ll handle it myself. Who do they think they are, interfering, are they perfect? Nobody asked them.

I lift the syringe, holding it up to the light, admiring the liquid clarity of the drug. I flicking the syringe to get rid of any air-bubbles; this is just another small piece of the ritual, small air-bubbles aren’t dangerous. I check the needle; it is beveled, and I want the bevel on the down-side of the needle, so it will be less likely to pass through the vein and out the other side. I line up the needle along the length of the vein and push it in. The needle penetrates the skin easily and painlessly; like a kiss, just a moment’s resistance in the subcutaneous tissues till I feel it push through the wall of the vein. Yes, that’s it, perfect; I draw back on the syringe to confirm I am in the vein. The dark blood froths satisfyingly back into the syringe, a plume of red billowing into the clear liquid of the drug, intoxicating to look at, an unforgettable image, I have hit the motherlode, a red flag signaling go; is it joy I feel, or is it more like relief? Joy is too decent an emotion for something like this.

Liam Farrell is a family physician and the author of Are You the F**king Doctor?: Tales from the bleeding edge of medicine.

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