Exchange

© Katy Harrison 2023

[Click here for a Gloves Off on this piece from Chuck Palahniuk]

The needle punctures the orange peel and there’s a wet hiss. Juice splashes his hand and he says, ‘Pay attention.’ 

Presses his thumb and the plunger sinks down to the first black line. He pulls out the needle, leaving behind a dainty hole in the flesh. Placing the syringe in the box, he says, ‘Just the first 0.4mls. Then wait two minutes.’ 

The needle is strong enough to go through jeans or sweatpants. Don’t boot the whole dose at once. You can bring someone back from the grave that fast, they’ll punch you in the dick and ask for their money back. 

He tells us naloxone has more than a ninety-nine percent success rate. That’s better than your favourite brand of condoms. Naloxone only reverses opiates. Morphine. Heroin. Codeine. Fentanyl. You can hook someone up to the National Grid, but without naloxone you’re no better than a fried orange. 

He says, ‘Everyone grab an orange and a kit. Stab like someone’s life depends on it.’

Our trainer is an expert. Not ex-junkie, but has lived experience. Instead of needles, it’s pins. Spoons are pans. Syringes are barrels. Injecting is digging and a script is methadone. He wears prison cobweb tattoos on his elbows and a clean wedding band.

Sharp citrus in the air and it smells like Christmas. Mama mixed dry peel with cinnamon.

No one does this because they like it. Not like they used to like it. 

And stop. 

We don’t say that. 

We don’t say don’t do drugs. We don’t say you’re making a mistake. We say don’t share. We say use each needle once even if it’s on yourself. We say bring your used kit back to the Exchange. We say carry your naloxone. 

After stewed coffee, he tells us about central nervous system depression, how heroin slows your heart rate, your breathing. How sometimes botulism gets into the chain and suddenly we have clients with their arms being cut off. Or leg ulcers being treated for the whole time it took me to finish college. Blood borne viruses, unplanned pregnancies. Endocarditis, when an infection blows your heart valves apart.  

Before we receive our Certificates of Attendance, he tells us the signs of an overdose. Tiny pupils. Slow breathing. Blue lips. Breathing they call the death rattle. Dial the nines and three clicks opens a naloxone kit.  

We never beg or plead. Please, please, please stop. It’s killing you. Please don’t do this. Please. 

Using heroin and crack cocaine together is called speedballing. Crack is sold in stones or rocks. Heroin in bags. Crack is white, base. Heroin is brown, gear, smack. The shadows in padded jackets and hoodies inside the bus station lean out when I walk to work, muttering, ‘White or brown?’ They fall into step with me, tugging my sleeve. ‘You need tabs, bro? Xanax, DF118s, moggies, jellies?’  

It can take three years to qualify as a nurse. Five for a doctor. I can learn to dispense needles and reverse an overdose in the time it takes to watch Trainspotting. 

No one has names in the Exchange. Initials only. We play make believe that it’s confidential and no one will know. Just a sharp secret just between us. Next door is a chicken shop with a two star hygiene rating. A late night chemist. A pub with planks across the windows and chicken wire over the letterbox. No one should want to be on the road, but it’s always busy. 

Yellow tubs piled high marked SHARPS BINS. Copies of The Safer Injecting Handbook. Medical grade foil to smoke off. A dusty spider plant that no one waters. Condoms available in extra safe and flavoured. An intercom bleats when someone presses the buzzer on the street. 

FT usually comes in at the start of the week. She’s sweating, shivery and tells me she thinks she’s got the flu. Her elbow crooks are perforated, lacy like a doily. A fat gold cross nestles in the fist-deep hollows of her collarbones.

Not withdrawing, but rattling.  

She asks for blue and pink NeverShare needles. Ten for him and ten for her boyfriend.  

Ten little fingers and ten little toes. 

I unlock the cupboard and count out the 2ml needles, the plastic wrapped metal spoons, the cigarette filters. My hand hovers over the packets of powdered citric acid and vitamin c. I look back at her. 

‘Citric, not vit c', she says. ‘Vit C burns me.’ 

We say smoke, don’t inject. And if you do inject, do it safely. Think of your body as a blast zone. The more you stick to the edges, the safer you’ll be. Hands, arms, ankles. If you’re going in the neck or the groin, you’re getting too old for heroin. Dig an artery instead of a vein, and you’ll bleed out in the time it takes for you to sing Happy Birthday.  

FT has a fat bruise on her neck. Tells me it’s a love bite. She weighs as much as a wet cat and smells like a dead one, but sure, it’s a love bite. Once the veins collapse you have two options. Switch to smoking or it’s UYB. Up Your Bum. Load a syringe, take off the needle, cram it in your rectum and hit the plunger. 

The forms ask me to ask the same questions for each person. 

What are you using? 

Have you been tested for hepatitis and HIV? 

Are you street homeless? 

Are you sex working? 

Injecting or smoking? 

Using alone? 

Do you carry Naloxone?  

Do you have contact with any under-18s? 

Do you have any children? 

Did you have a child? A boy? Looked a bit like me if I grew out my hair and wore a Spiderman t-shirt and just a nappy even though I was old enough for school? 

I ask, ‘Do you know someone called Jenny? Black hair, blue eyes, tattoo on her hip?’ 

FT shrugs and says, ‘That sounds like a lot of girls.’ 

Instead of smackhead we say opiate crack user. Never a headcase, but a complex needs client.  

I say, ‘The tattoo says Mikey and there’s a heart over the i.’ 

FT bites at the skin around her thumbnail and says, ‘Can I get those pins now?’ 

I say, ‘She’s my mother. Do you know her?’ 

Not overdosing, but going over. 

FT slides a hand over her crotch, ‘You want your mama? Honey, I can be your mother if you want. Price of a bag and I’ll be anything you want.’ 

Not a junkie whore, but working girl. 

I bag up her kit and push the black plastic bag across the table. I lower my head and the door shuts behind her before I finish signing the form. 

The buzzer goes. 

LD limps in on crutches, one trainer empty due to having half a foot. Just the top half. He had necrosis start in his toes from sleeping in a wet tent under the bridge. Flies found him and by the time I met him in the Exchange, a trail of maggots dripped from each mushy footstep. Those maggots ate through the dying flesh and that’s why he has nearly two feet instead of one leg. Some people get lucky now and then. 

Today LD asks for foil. Tells me he knows a Jenny. Thinks he might have scored with her once or maybe lived with her. It’s all a bit hazy, he mumbles. He can ask around if I’m good for it? 

I hand him a foil strip of diazepam, blue 10mgs, and tell him I’m good. 

The buzzer goes. 

BR pulls down her sweatpants and beside her mound of stubble is a groaning abscess. Fat and eggplant purple. Fingertip sized bruises trickle down her thighs. 

She asks, 'Do I have a cream I could use?’ 

Green bubbles on the surface and an arm’s length away I feel the heat. In another few days she’ll have sepsis or an ulcer. If you want to know what an ulcer smells like, switch off your fridge. Leave the food in there and go away for the summer. When you come home, turn on the heating and open the fridge. Like an animal rotting in a collapsed drain, that’s necrosis. She needs to be in hospital yesterday. She nods and asks for another five needles. And strawberry flavour condoms if I have them. 

And the smell is bad enough I don’t ask anything.

The buzzer goes. 

RP has fleas. She’s breached an exclusion zone order to collect today. She flicks the black grains that crawl up her ankles. Smells like carbolic soap and cigarettes. Says she doesn’t need anything today, but heard I did. She holds out her hand.

Not a benefit scrounge, but economically inactive on health grounds. 

Fistfuls of Valium, Xanax, Percocet. Candy-coloured pills. A bowl of yellow stars, pink hearts. Blue moons and purple horseshoes. Scooby Doo on the television and mama needs her rest. 

We don’t say rape, poverty, neglect. We say Adverse Childhood Experiences. We don’t say shitty parenting. We say high support needs. 

When the box of cereal is empty mama is still sleeping. The room is cold and mama’s friends have gone home. When I’ve eaten from both cat bowls there’s buzzing at the door.   

I open the door and put a finger to my lips.  

Not dying but, she’s sleeping. 

And a dad-shaped man in green shoves past me, knocks me against the TV screen and Scooby Doo cracks. Runs to the sofa and stabs her in the leg.  

A whoop of air and mama gurgles. Static and footsteps and the squeak of wheels. A croak from the sofa. A shadow across my face and I shut my eyes. Hands grab me under the arms. Carried high above, I see mama lifted high also, to a bed on wheels, as the hands take me into the light. I sneeze in the sunshine and the hands curse. Wet runs through the nappy over the hands, the arms.  

Mama croaks, ‘You should have left us.’ 

Mama disappears into twenty-eight day programmes. Women’s refuges, jail. My address, my school changes faster than my underwear until it’s too late to know who either of us are. 

The buzzer goes. 

JR wanders in slow motion to the NEX. Pupils the size of pins. She mumbles out an order of ten one mil completes, slumps into the chair. Pale as a boiled egg. Her arms unfold and dangle off the chair. A hollow knock of knuckles on plastic. 

Three clicks.

And JR, her faded blue eyes slip back inside her head. Her chin drops to her chest and there’s a thick snoring. She tilts, starts to fall softly. I catch her and she’s heavy as sand. I pull her down to the floor. Into my lap. Cross my arms over her chest. Pants ride down and I see a black heart the size of a pip.  

The buzzer goes again. 

Press my nose into her hair that smells like wet cereal and oranges. Christmas and non-school days and mama. She gurgles. Blueing lips match the colour of her hidden eyes. I pat her hand, the scabbed pocks between the fingers.  

A knock at the door. Another that turns to drumming. I run fingers through her dried up hair.

Thunk of a shoulder on plywood.

I close my hands over her ears. I let her rest.