Patricia texted Jamie the news: For the first time in months, she told her, she could go to sleep knowing that, at least for that night, her daughter would not die.
*
The baby was a toddler now, and Tess hadn’t witnessed a single one of his steps. He was living with his other grandmother in North Carolina, and Patricia made the twelve-hour round-trip trek to see him monthly, texting me pictures of their visits: her grandson playing on the beach, wearing a silly sock monkey hat.
Summer turned into fall as Tess bounced between the streets, jail, the battered women’s shelter, and the psychiatric wards of two local hospitals, the last of which she knew were prevented by federal law from turning suicidal patients away regardless of insurance status or ability to pay. “It’s so costly and ineffective,” said psychologist Cheri Hartman, another Hope volunteer. “If only [politicians] understood that getting access to Medicaid would actually save money and lives!”
Tess wanted Jamie to find a long-term rehab program for her. “But we all know once her withdrawal gets bad enough she will want to be released and get her fix,” Jamie said in July. “Pray that this time we can get her somewhere before that happens.”
The moment an addict is willing to leave for treatment is as critical as it is fleeting, Jamie said; she called it the liminal phase. “You only have a very small amount of time; you have to strike while the iron’s hot.”
But Tess disappeared, again, before they could meet.
The next time Patricia saw her daughter, she was nearly naked, posing for an ad on a prostitution website under the headline sweet sultry sexy 26. The baby’s father had discovered the ad through Tess’s cellphone number and told his mother, who alerted Patricia to it.
A half hour for sixty bucks. There were pictures of Tess, crudely posed with her face cropped out, and a cellphone contact. “I looked at it as a way to contact her and let her know I still love her and support her. There’s nothing more I can do for her” until she’s ready to accept help, Patricia said.
She was covertly tracking Tess via instant messenger now, a holdover from months earlier, when Tess signed onto Facebook using Patricia’s phone but forgot to sign out. She’d read heartbreaking exchanges between Tess, her drug dealers, and her friends, including another young woman from Hidden Valley, Jordan “Joey” Gilbert. Tess and Joey compared notes about dopesickness and black-market Subs (Suboxone or Subutex). They’d arranged to meet once to trade Xanax for crystal meth.
Joey had had earlier success with the monthly naltrexone shot, Vivitrol, which is expensive but also impossible to abuse or to divert. Among the thirty-one states that had then expanded Medicaid under Obamacare, some improved access to naltrexone, even giving Vivitrol shots to people before they left prisons and jails, since they understood that addicted users were most vulnerable to overdose death just following a period of nonuse, when tolerance is low. But Joey lost access to the shot when she turned twenty-six and was no longer on her father’s insurance. “Without insurance, it would have cost us fifteen hundred dollars a month,” her father, Danny Gilbert, said.
Joey eventually transitioned to buprenorphine, prescribed by Dr. David Hartman, the same Roanoke psychiatrist with the mile-long federally mandated waiting list that had stymied Tess. “Dr. Hartman would not write the prescription unless she passed her weekly drug test,” Danny Gilbert said. “And I held all her medication and gave it to her daily so there was control over it,” at an average price of around $700 a month.
But there were still so many hurdles Joey faced in her quest for treatment, from the waiting lists that kept her from starting rehab to the byzantine rule that she had to be drug-free upon entry, not to mention her continued drug usage with people like Tess—all of which put her perilously close to relapse and death.
*
In late October 2016, Jamie Waldrop and I visited Tess in the psych ward of a local hospital; she’d checked herself in, complaining of anxiety and suicidal thoughts. There was an outstanding arrest warrant out for her from a fraudulent seventy-eight-dollar credit-card charge earlier in the year. Her son was now fourteen months old, and Tess hadn’t seen him in eight months.
She’d asked me to bring her a copy of my latest book, Truevine, which she’d read about in a People magazine at the psych ward. She thanked me for it and said it was OK when I asked to take notes. Her writer hero, David Sedaris, was about to publish a new book, and I promised to try to get her an autographed copy when it came out.
Tess told us she was no longer using heroin, that she now favored crack cocaine. “I thought the cocaine would help me get off heroin,” she told us. “And it did, actually…but it’s very mentally addictive.”
Asked if it was a relief to be off the streets, Tess nodded. “When it starts getting cold out, I’m ready to come in for help.” She’d been beaten by a drug dealer, she said, but didn’t want to go into details. Jamie recommended an Asheville rehab that she had sent other people to, with good results, she said, but it would not accept patients on MAT or the antidepressant Cymbalta, which is sometimes not recommended for people with substance abuse disorder.
“That’s the one I’m on,” Tess said. But Jamie remained relentlessly upbeat throughout our visit and promised to double-check on the Cymbalta, and Tess seemed brighter and more hopeful than she had in months. The Asheville rehab featured a regimen of horticultural work during the day and intensive group therapy at night.
“It’s kinda hippie-ish,” Jamie said, knowing that would appeal to Tess.
“Like Warren Wilson?” Tess said, hopefully, referring to the liberal-arts college nearby.
She would not be allowed to talk to anyone back home for six months. It would drive her crazy not to see her son or hear about him, she said, “but my goal is, I want to get him back.”
*
But the liminal window passed, as it usually did, when Tess checked herself out of the hospital before the Asheville rehab bed, or any others, could be secured. “She’s back out again,” her mother said. “All it takes is one contact, one blinging on the cellphone, and there they go, spiraling again.”
The flood of street fentanyl had not slowed. From September to November 2016, Roanoke claimed the highest number of emergency-room overdose visits in the state, most fentanyl-driven. EMS workers reported having to give people as many as five doses of the anti-overdose drug, naloxone, to reverse its effects. One such call ended with a young mother dead in her bedroom, her baby beside her in the bed, cooing.
*
A week before Christmas, Patricia showed me a card she was mailing to Tess, with pictures of her son tucked inside. She’d found what she believed to be her current address from a series of Facebook exchanges between Tess and her drug dealers, some angry (“Damn man. You stole shit from me”) and some matter-of-fact. She was staying in another apartment in southeast Roanoke, catty-cornered from the church where I’d first taken her to NA.
Patricia wanted to tell her about a new Beck song that began:
I met you at JC Penney
I think your nametag said “Jenny”
It was their favorite department store, the place where she bought Tess a new wardrobe every time she left a hospital or rehab stint—only to return home, months later, with just the clothes on her back.