The worst kind of betrayal

My therapist, Suzy, and I were discussing alternative treatments to deal with depression besides medication. Specifically, we were discussing the possibility of me trying a treatment called transcranial magnetic stimulation (TMS),

The way my therapist described it to me was like when you go to the dentist and they have to, periodically, take x-rays of your teeth. They put some contraption close to your face, position your head just right, and then they step into another room and zap you.

My medical nurse practitioner, Mike, was the first to suggest TMS (I don't know how many times I had to edit this article because I kept wanting to type TMZ instead of TMS). This is why Suzy and I were having this discussion. I told her it sounded like electroshock treatment to me and I didn’t want to do it. 

She assured me it was nothing like that. TMS uses electromagnetic pulses which are positioned to specific areas of the skull to stimulate certain parts of the brain which affect depression. I told her I still hear the word “electro” in there, so that still concerns me.

She said TMS is non-invasive and then she said the line that is pertinent to this article, “It is not like getting ketamine treatments in which they inject you with drugs.” This was the first time I had heard the word “ketamine” and I had pretty much forgotten the word by the time I got to my car to drive home.

What was that word she used again? Camamine? Calamine? It didn’t matter.

Oh, but it did matter and little did I know I would hear the word again less than twenty-four hours later in a shocking piece of news. The following morning after my visit with Suzy, I woke up to the news that five people had been arrested in connection with the death of actor Matthew Perry. 

What? In connection with his death? Are authorities saying he was murdered?

Perry was found dead in his hot tub on October 28, 2023. I was so affected by his death that I wrote an article about it. Perry had battled addictions for most of his life, but it looked like he had turned his life around. He wrote his autobiography, Friends, Lovers, and the Big Terrible Thing and released it in November, 2022. In the book, he chronicled his battles with alcohol and drugs during his time on the iconic TV sitcom, Friends.

At the time, he said he had been to rehab 15 times. He claimed to have gone through detox 65 times. He had once been in a coma and given a two-percent chance to live. Here are the eerily foreshadowing opening lines of his book:

Hi, my name is Matthew, although you may know me by another name. My friends call me Matty. And I should be dead. If you like, you can consider what you're about to read to be a message from the beyond, my beyond.

Wow! Goose bumps.

He had been to thousands of AA meetings in his life. He had been in therapy for thirty years. There is no doubt he met hundreds of medical professionals. You would like to think those professionals all tried their best to help him. That is what they are supposed to do, right? 

Doctors are supposed to take something called the Hippocratic oath. Even I knew this from a young age. To me, it meant that doctors were always on duty and were obligated to help someone in need. If a doctor was having dinner with his family at a restaurant and another patron, suddenly, began choking on a chicken bone, that doctor was obligated to help the person. He couldn't just look over and say, "Oh, well. I am in the middle of my chicken marsala dinner. He'll be fine."

It doesn’t matter if the patient was someone who went against everything the doctor believed in, he was obligated, under the Hippocratic oath, to treat them. If Charles Manson were stabbed in jail and he was rushed to the emergency room at the local hospital, doctors had to treat him.

There is a famous story about Ronald Reagan after his assassination attempt in 1981. Reagan, a Republican, had only been president for a little over two months. I have always considered myself a Democrat, but even as a child, I admired Reagan for his quick wit and his comedic chops. The guy was suave and cool under pressure.

As he lay in the operating room on that fateful day, waiting for the anesthesia (maybe ketamine?) to knock him out, the story goes that Reagan looked up at the surgeons and said, “I hope you are all Republicans.”

It was classic Reagan. It was a joke, but Reagan need not have worried. Despite whatever political differences any of the surgeons may have had with Reagan, they were obligated to do their best to save the president’s life.

It wasn’t only because Reagan was president. Doctors and surgeons and any medical professional are obligated to do their best to help their patients. You and I are afforded the same privileges of the president of the United States.

The website, Brittanica, describes the hippocratic oath in this way:

In the oath, the physician pledges to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life.

As I watched some news reports about the arrests in the Matthew Perry case, I learned that Perry was receiving ketamine treatments at the end of his life. There was that word Suzy had mentioned. Holy shit! That was the thing that she compared to TMS by saying, “at least it is nothing like ketamine injections.”

I don't think I'll ever forget that word, anymore.

Ketamine treatment can be used to treat depression, just like my therapist mentioned. It is supposed to be done, however, under the guise of a medical professional at a facility in a controlled environment. Ketamine is oftentimes used as an anesthetic for putting people to sleep during surgeries so it is important to be precise with the dosage.

Ketamine has also been used, improperly, as a party drug due to its potential for causing hallucinations and general euphoria. It also causes one to feel detached from their bodies. 

Perry was suffering from depression. He had been to hell and back numerous times. His acting career appeared over. He had lost his youthful good looks. His addictions had drained him of his charisma and humor. He had put on weight.

For an addict like Perry, any drug was dangerous. If it helped, he would want more. Then he would want more. 

He liked the effects of Ketamine, but he wasn’t satisfied with taking it only at scheduled times and under supervision of a doctor. He wanted to experience that feeling whenever he wanted – and by “whenever,” he meant always.

He wanted to be able to experience ketamine’s hallucinogenic and detachment effects at home – possibly, even while relaxing alone in his hot tub by himself. He had said in several interviews that the most dangerous thing for him was being alone.

In an interview with Dianne Sawyer for ABC News, Sawyer said that she was getting ready to wrap up the interview when Perry made an unusual request. He told Sawyer that he had heard her, in another interview, ask a recovering addict a question which he found "interesting" and he wanted her to ask it of him.

So Sawyer asked him, "How will we know when you are in trouble, when you are not okay?"

Perry paused for a long time and then said, "If I say I am just going to chill alone at home tonight. And, part two, the other thing is... if I ever say I am cured."

But how could Perry get more ketamine? How could Perry get his hands on 55 Vicodin per day like he claims he was taking at one point in his life? How does any addict get more opioids?

Where there is a will, there is a way. When you a celebrity with vast resources like Matthew Perry, there are easier ways.

Perry said, in that Dianne Sawyer interview, he would wake up every morning with the first thought in his mind being how he was going to be able to score that many pills.

Perry was a celebrity with money. He managed to find a physician who ignored his Hippocratic oath.  Perry managed to find a physician with no ethics. Perry managed to find a physician who valued the almighty dollar over the well-being of his patients. That physician's name is Salvador Plascenscia.

That physician would find a like-minded physician. That physician's name is Mark Chavez.

U.S. Attorney Martin Estrada said, in announcing the charges against the five people that were arrested:

These defendants took advantage of Mr. Perry’s addiction issues to enrich themselves. They knew what they were doing was wrong. They knew what they were doing was risking great danger to Mr. Perry, but they did it anyways. In the end, these defendants were more interested in profiting off Mr. Perry than caring for his well being.

Plascenscia helped Perry procure more ketamine. When Plascenscia needed more ketamine, he went to Chavez. Plascenscia wasn't sure how much he should charge Perry and when he discussed it with his Chavez, he texted him, “I wonder how much this moron will pay." He then texted, "Let's find out."

Moron? He, actually, called his patient a moron. Oh my God. When I heard that, it sent me through the roof. That one quote is what got me thinking about writing this article.

Here you have a doctor whose job – whose responsibility – is to look out for his patients. Not only was the doctor not doing that, he was trying to profit off of it. Even worse, he was belittling his patient. 

Moron? 

I don’t think I could feel more sorry for an individual than I do for Perry. Perry needed help. He was vulnerable. He was dying a slow death. This physician sped the process to a far sooner death. This doctor had no regard for life. That feels so absurd to write. A doctor having no regard for life. That is the scariest of all statements to roll around in your head.

I can think of fewer professions, or people, that you would trust to look out for your best interests. Doctors would be near, or at, the top of the list. 

I mean, you would hope you could trust your parents. But how many times have we heard of parents abandoning their children? This is a bad example, but I remember my father leaving me alone, at the age of 17, to interview five potential tenants for our second floor apartment. When I saw him leaving that morning, I asked, "Where are you going? You know we have five appointments for interviews for the apartment this afternoon."

"Some friends came in from out of town, unexpectedly, and they are over your uncle's. I have to go entertain them and show them around. What am I suppose to do? Ignore them?"

Uh, yeah.

If you are religious, you would put your pastor or priest up near the top of your list of most trusted people. We all know how that trust was obliterated with recent revelations – and not the kind of Revelations you read about in Bible verses.

You would like to think your therapist is trustworthy. You tell them all your darkest secrets. In my case, that trust was betrayed when I saw one of my therapists released his notes – discussing what we talked about on every single one of my visits – verbatim to the Social Security Administrative Law Judge reviewing my case.

And, yes, we expect our doctors to do right by us. 

My father’s doctor, in particular, was the first medical professional that made me question doctor’s motives. My father only speaks Portuguese and we live in a heavily-Portuguese neighborhood. My entire life there have only been one or two Portuguese-speaking doctors, locally, that seemed to service the entire local Portuguese community. If you were a Portuguese speaking doctor within twenty miles of our neighborhood, you pretty much had a monopoly on being their doctor.

Growing up it had been Dr. Nunes. He was the only doctor I knew for my first 20-25 years. I remember my brother never liked him and referred to him as a “horse doctor,” discrediting his medical knowledge. My brother wasn’t the only one I heard refer to Dr. Nunes with that moniker. 

When I was in high school, I almost died because of this doctor's incompetence. My mother had taken me two or three times over the span of a couple of weeks to see him because I was feverish, lethargic, dehydrated, wheezing, and having difficulty breathing.

He took out his stethoscope and listened to my lungs and heart.

It is just a common chest cold. It will clear up in a couple of days. It will pass on its own. Just take a couple of Tylenol every couple of hours for the fever.

When my fever reached 103 degrees a couple of weeks later, my mother took me to the hospital where I was diagnosed with severe pneumonia. I was in the hospital for over a week. My parents said I almost died, but I don’t remember it being that extreme. The point is – my “horse doctor” misdiagnosed me and his delay in treating me almost killed me.

After Dr. Nunes, there was a Dr. Maia, who operated out of a home a couple of blocks away from me. For about five or ten years, it seemed like he was the go-to doctor for the local Portuguese community. 

Dr. Maia sticks out in my memory for bitching at me for wearing a baseball cap to one of my visits. I was there because I had a fever and I was having cold sweats. As hard as it may be for my bald self to now believe, at the time I had a mop of hair which was drenched with sweat. It had taken all of my effort to get out of bed to get to this appointment, so I had a baseball cap on to try and cover up my sweaty head.

The first thing the doctor said to me when he entered the examination room was, in a pissed off voice, “Take off your hat when you are inside someone else’s home. That is so disrespectful. This generation.”

Sorry, if I was sick as a dog and looked like shit. I am pretty sure I got diagnosed with another pneumonia. It was a chronic thing with me when I was younger.

Now, for the last twenty or so years, it has been a Dr. Yamada who has, seemingly, had a monopoly on the local Portuguese community. Yamada is a Chinese doctor who speaks Portuguese, which I found odd. It shouldn't have come as a surprise as Portugal has had a colony in China for centuries. Portugal only recently, in 1999, handed that colony territory, Macau, back over to China.

I still found it weird to hear Portuguese words coming from a Chinese person. Anyways, it is not uncommon to wait over an hour in this Dr. Yamada's waiting room.

You want to complain? What other doctor, locally, are you going to find who speaks Portuguese?

A couple of times I went with my father or mother to go see him. Thankfully, he wasn’t my doctor. But during my extended stays in his waiting room, I would watch as a parade of pharmaceutical salespeople would be ushered back into his office. It was one after another.

It came as no surprise that when I sat in as he examined my father or mother, that he would give out various “samples” of drugs to them. It was the first time I began to not only question the competency of these “horse doctors,” but also their allegiances and ethics.

My dad must be on, at least, ten different medications. It amazes me to look at his pill boxes. He has no clue what they are all for. When I go to see a specialist for him, the doctors always question why he is on so much medication. They say he takes several pills for the same ailments.

My mother, God rest her soul, was a picture of good health until her retirement at 72 years old.  Up to that point, I am pretty sure she never took any prescriptions. One of Yamada’s nurse practitioners then prescribed something for my mother’s anxiety – which she always had, but was never so extreme that it should have been an issue. She just worried a lot.

Three years later, without my knowledge, come to find out my mother was taking five or six prescriptions for depression, anxiety, sleeping issues and whatever other side effects may have been cropping up from her earliest medications. It was around this time that I began seeing signs of her mental deterioration.

Now, she is no longer with me. Do I blame her doctors? I have a big blame pie in my mind and, yes, the doctors own a slice of it.

So hearing these newest developments in Matthew Perry’s story has had an impact on me. My initial reaction of feeling bad for Perry – for his treating physician calling him a “moron” and exploiting him for money – has evolved into rage.

In the last month of his life, Perry paid his doctor $55,000 for 20 vials of Ketamine. An ex-girlfriend of his was quoted in an article, “They said he was paying $5,000 for a $12 vial of ketamine.”

An LA Times article says that Perry was paying $2,000 for a vial of ketamine that cost Chavez $12. Whether it was $5,000 or $2,000, it was an absurd amount to charge an unknowing – and, increasingly, vulnerable and desperate – Matthew Perry.

Here was a hurting individual, who was undisciplined enough to help himself, seeking a helping hand from a professional who had taken an oath to do what is best for his patients. Perry needed someone to say “no” to him. His personal assistant didn’t. His physician didn’t.

The last thing Perry said to his assistant before entering his hot tub – which would prove to be the place he would breathe his last breath – was, “Shoot me up with a big one.” His assistant had been taught by that same evil doctor who sold Perry the drugs how to properly inject ketamine into Perry’s arm.

Perry’s assistant was no doctor. Even more so, Perry’s assistant, Kenneth Iwamasa, was a poor excuse for a human being.

Iwamasa didn’t inject Perry just that one time on Perry’s final day on this earth. He didn’t inject him just twice. No, he injected him three times – all before most normal people were finished having their lunches. The final dagger was Iwamasa thinking it would be a good idea to go run some errands while Perry sat in a hot tub after being injected with a drug which he must have known is used to knock people out for surgeries – especially knowing he just abided by Perry’s request to give him a “big one.”

The LA Times reported that the levels of ketamine found in Perry’s blood “was about the same as would used during general anesthesia.”

There is nothing I hate more than deaths which didn’t have to happen. People go through a lifetime of going to school, working long hours at jobs, getting married, having kids only to have everything snuffed out in a split second because of the actions of one deranged individual who hates their life.

I just finished watching the newest Netflix documentary on the Laci Peterson murder (why is it I only found out now by hearing the 911 call from her father that she was Portuguese?). I still don’t understand what Scott Peterson’s motive was. Was it because Laci was eight months pregnant and he didn’t want to be a father? Was it because he wanted to be with his mistress, Amber Frey? Just get a divorce then, and move on. Why did he have to kill a beautiful soul like Laci?

It is this same reason I hate hearing about murder-suicides or mass shootings. If you want to kill yourself, I am sorry for you, but just kill yourself. What gratification do you get from killing other people who want to live? Not only do you end the lives of the people you killed, but you ruin the lives of countless other family members and loved ones of the deceased. And for why?

Which is all to say that I feel disheartened. I want to believe that human nature is good. I want to believe that people want to help each other. I want to believe that everyone, not only doctors, don't have to hear of the Hippocratic Oath or The Golden Rule and view them as novel concepts. I would hope that people don't feel the need to say an oath to these kinds of things, but that goodness and selflessness are ingrained in us already.