Pubdate: Sun, 24 Jul 2016
Source: Washington Post (DC)
Copyright: 2016 The Washington Post Company
Author: Eli Saslow


A Story of Truth, Lies and an American Addiction

She had already made it through one last night alone under the 
freeway bridge, through the vomiting and shakes of withdrawal, 
through cravings so intense she'd scraped a bathroom floor searching 
for leftover traces of heroin. It had now been 12 days since the last 
time Amanda Wendler used a drug of any kind, her longest stretch in 
years. "Clear-eyed and sober," read a report from one drug counselor, 
and so Amanda, 31, had moved back in with her mother to begin the 
stage of recovery she feared most.

"Is this everything I have?" she asked, standing with her mother in 
the garage of their two-bedroom condominium, taking inventory of her 
things. There were a few garbage bags filled with clothes. There was 
a banged-up dresser she had put into storage before moving into her 
first abandoned house.

"Where's my good makeup?" Amanda asked.

"Maybe you pawned it with the jewelry," said her mother, Libby 
Alexander. "What about all of my shoes?" "Oh, God. Are you serious?" 
Libby said. "Do you even know how many pairs of shoes you've lost or sold?"

Amanda lit a cigarette and sat in a plastic chair wedged between the 
cat food and the recycling bins in the garage, the only place where 
she was allowed to smoke. This was the ninth time she had managed to 
go at least a week without using. She had spent a full decade trying 
and failing to get clean, and a therapist had asked her once to make 
a list of her triggers for relapse. "Boredom, loneliness, anxiety, 
regret, shame, seeing how I haven't gone up at all in my life when 
the drugs aren't there," she had written.

She had no job, no high school diploma, no car and no money beyond 
what her mother gave her for Mountain Dew and cigarettes. A few days 
earlier, a dentist had pulled all 28 of her teeth, which had decayed 
from years of neglect. It had been a week since she'd seen her 
9-year-old twin sons, who lived in a nearby suburb with their father, 
and lately the most frequent text messages coming into her phone were 
from a dealer hoping to lure her back with free samples: "Got 
testers," he had just written. "Get at me. They're going fast."

In the addicted America of 2016, there are so many ways to take 
measure of the pain, longing and despair that are said to be driving 
a historic opiate epidemic: Another 350 people starting on heroin 
every day, according to estimates from the Centers for Disease 
Control and Prevention; another 4,105 emergency-room visits; another 
79 people dead. Drug overdoses are now the leading cause of 
injury-related death in the United States -- worse than guns, car 
crashes or suicides. Heroin abuse has quadrupled in the past decade. 
Most addicts are introduced to heroin through prescription pain 
pills, and doctors now write more than 200 million opiate 
prescriptions each year.

But the fact that matters most for a chronic user is what it takes 
for just one addict to get clean. The relapse rate for heroin has 
been reported in various studies to be as high as 97 percent. The 
average active user dies of an overdose in about 10 years, and 
Amanda's opiate addiction was going on year 11.

She believed her only chance to stay sober was to take away the 
possibility of feeling high, so she had decided to pursue one of the 
newest treatments for heroin. It was a monthly shot of a drug called 
naltrexone, which blocks the effects of opiates on the brain and 
makes getting high impossible. But the shot came with dangerous side 
effects if she still had opiates in her system. Doctors had told her 
that first she needed to pass a drug test, which required staying 
clean for at least two weeks, which meant her appointment for the 
shot was still four days away.

"Soon you can breathe. You can start getting your life back," Libby 
said. "That's all just days away."

"Days are forever," Amanda said. "Do you even know how hard it is to 
go for one minute?"

She had been trying to occupy herself with coloring books and 
cellphone games, anything to keep her hands busy. Now she picked up a 
hand-held mirror and began reapplying her makeup for the second time 
that morning, even though she hadn't left the house in a few days. 
She had worked as a model in high school, but now her gums were 
swollen and her arms were bruised with needle marks. She tugged down 
her sleeves and put away the mirror. Shame was a trigger. Regret was 
a trigger. She grabbed her phone and looked at the dealer's latest 
text message. She wondered if her mother was still locking her car 
keys in a safe. She wondered if she could find a ride into Southwest 
Detroit for one last $10 bag: the euphoria when the drug entered her 
bloodstream, the fullbody tingling that moved in from her hands to 
her chest, erasing pain, erasing fear, erasing sadness, erasing 
anxiety and feelings of failure until finally the tingling stopped 
and the only thing left to feel was blissful numbness, just hours of nothing.

One minute -- she could make it one minute. She watched a video on 
her cellphone. She sorted her nail polish and lit another cigarette. 
Libby came back into the garage, setting off the burglar alarm she 
had installed a few years earlier, after Amanda had helped a 
boyfriend steal $5,000 worth of guitars from Libby's husband.

"I hate that sound," Amanda said. "It brings everything back. It's a trigger."

"I'm sorry," Libby said. "It's our reality."

"Yeah, I know," Amanda said. "And reality's a trigger."

Their condo was tucked away in a small development surrounded by pine 
trees and occupied mostly by retirees: no loud noises, no solicitors, 
no unauthorized visitors allowed beyond the guard shack after 8 p.m. 
Libby was usually in the living room with the TV on mute. Amanda's 
stepfather was in the study, playing chess online. It was a place so 
quiet that Amanda could sit in the garage and literally hear the 
clock tick. Seventy-two hours left until the shot. Seventy-one. Seventy.

"No way I'm going to make it," she said. She was sweating and picking 
at her nail beds, and when she said that she might know of a few 
clinics where she could get the shot right away, Libby agreed to drive her.

They drove out of the exurbs, through the suburbs and into the city. 
Libby tucked her purse against the driver's side door, where Amanda 
wouldn't be able to reach it. She relocked the doors as she drove and 
cupped her hands over the car keys, remembering a time when Amanda 
had grabbed her keys and refused to give them back unless Libby paid 
her. For most of the last week, she had been requesting time off from 
her job as a beautician, afraid of what could happen if she left Amanda alone.

Amanda sat in the passenger seat and stared out the window as they 
came into Southwest Detroit, passing the overgrown lots and decaying 
houses where she had spent so much of her adult life. Her first 
opiates had been a prescription for 120 tablets of Vicodin, offered 
by a doctor to treat a minor snowmobiling injury in high school. The 
pills chased away that pain and also the anger left over from her 
parents' divorce, her depression, ADHD and self-doubt, and soon she 
was failing out of high school and becoming increasingly dependent on 
pills. Just one or two to make it through another shift at work, a 
pawnshop where she stood behind the counter and gave addicts their 
$25 loans. Just two more to pass the time spent alone watching TV 
while her husband, a truck driver, was traveling. Just three or four 
to get going with the twins in the morning, to feed them, to sing to 
them, to feed them again, to sit and play all day in a lonely trailer 
out in Macomb. Just five when it started to feel like she was 
suffocating, 24 years old, divorced and already so stuck. Just a dose 
every five or six hours throughout the day to quiet the noise in her 
head, so why wasn't she numb? Why was 15 pills each day still not 
enough? If only there was something cheaper, stronger, and so in 2012 
a boyfriend had introduced her to heroin, and she had been injecting 
it into a vein in her forearm twice a day ever since.

Now they drove past the boarded-up trap houses where she'd met 
dealers and learned how to buy a $10 bag, until her tolerance grew 
and she needed five or six bags each day. They continued past the 
corner where she'd panhandled; and the blocks of abandoned houses 
where she'd learned how to strip out copper wire and sell it for 
scrap; and the motel where she'd worked from 4 a.m. to 4 p.m., 
shooting up before and after each shift, the only housekeeper in a 
31-room motel where the rooms were rented in three-hour blocks and 
the best tips were drugs left behind by customers.

They continued past a decaying apartment tower and then a small 
Victorian with busted windows. It reminded Amanda of a vacant house 
where she'd squatted for a while with a dozen other users, a 
rat-infested place without heat or electricity. She'd tried to make 
it feel like home, scrubbing the floors with Pine-Sol and hanging a 
poinsettia wreath on the boarded-up bedroom door. She'd met a girl 
there who had become like a little sister - a young runaway from 
Tennessee who was always using too much at once and risking an overdose.

"I want to go find Sammy," Amanda said now, turning to her mother.

"What? Who's that?" Libby said. "What about finding a clinic?"

"This is more important," Amanda said, and so she began to explain 
how Sammy reminded her of herself, and how they had looked out for 
each other in the abandoned house. "If she sees I'm doing good, maybe 
I can convince her to go into rehab."

"This better not be some kind of scheme," Libby said, but she also 
remembered this side of her daughter from before the addiction - 
selfless, determined, enterprising, sometimes sneaking extra cash 
into the loans she handed out to desperate customers at the pawnshop. 
Maybe helping someone would boost her self-esteem.

"Okay," Libby said. "Tell me where to go."

"Up there," Amanda said, pointing to a two-story building with no 
windows, no door and trash spilling out from the entryway. Libby 
pulled over and Amanda jumped out. "How long?" Libby said. "Not 
long," Amanda told her and then disappeared into the building. Libby 
tapped her hand against the steering wheel and stared out the window. 
She could see a sleeping bag and a needle near the building's 
entrance. She saw something moving on the second floor. "Come on, 
come on," she said, until a minute or so later Amanda stepped out.

"She's not in there," Amanda said. "Try that next one," and so Libby 
pulled up to another decrepit house, where a few people were sitting 
on the porch and others were pacing outside. One of the men waved to 
Amanda. "Be back in a minute," she told Libby, and then she hurried 
out of the car.

Libby checked the clock on her dashboard and thought about all of the 
other times she had watched Amanda disappear. Once she had stolen 
Libby's car and run off for a week; another time she had gone out to 
buy a Mountain Dew and then called a few days later from Florida. 
"Let Go and Let God," was the advice some other mothers had repeated 
in Nar-Anon group meetings, but instead Libby had gained weight from 
stress, developed insomnia and started losing her hair. How many 
times had she filed a missing persons request? How often had she 
called the police station, and then the hospitals, and then the 
morgue to ask again for Jane Doe and to describe Amanda's birthmarks 
and her "Wild At Heart" tattoo?

"This was so stupid. This was a mistake," she said now, banging her 
fist against the steering wheel. She checked for her keys. She felt 
for her wallet. It was all there, but Amanda had been gone for seven 
minutes. Libby sent her a text message.

"This doesn't look good at all," she wrote.

"I'm about to walk back," Amanda responded.

Libby drove around the block and pulled closer to the house. She saw 
a man digging into his pockets. She saw other people walking up to 
that man carrying cash. Twelve minutes Amanda had been gone now. 
Libby drove around the block again, drumming her hands against the 
steering wheel, possibilities racing through her head. Was Amanda 
using? Where had she gotten the money? What had she done to get it?

She felt again for her wallet. She checked again for her keys.

"This is bullshit," she texted to Amanda, but there was no response.

"Come on," she wrote, and still nothing. "So over this." "Come on 
right now." She started to circle the block for a third time, and 
then suddenly there was Amanda, walking down the sidewalk and opening 
the passenger door.

"What the hell was that?" Libby said. "What do you mean?" "Where the 
hell were you? Where's Sammy?"

"I found her, and we called her parents, but she decided she didn't 
want help," Amanda said, and to prove it she handed Libby her phone 
and showed her a seven-minute call made to a number in Tennessee.

"So that was it?" Libby said, staring at her daughter. Her eyes were 
clear. Her hands were steady. She looked the same as she had when 
she'd left the car. Another 79 opiate addicts dying every day, but 
today her daughter wouldn't be one. A 97 percent chance to relapse, 
but at the moment Amanda looked clean.

"Okay," Libby said. "Let's get the hell out of here."

She had been an admitted opiate addict for 11 years, five months and 
14 days, and on almost every one of those days she had promised to 
quit. She had tried therapy and group counseling, inpatient and 
outpatient. She'd run up thousands of dollars in credit-card debt to 
pay for a wellness retreat in the woods, and she'd slept on a cot in 
the hallway of a Medicaid addiction center. She had tried flushing 
away her supply; and erasing every number in her phone so she 
couldn't contact dealers; and waiting again on the long list to get 
into the city's free medical detox; and showing up at the hospital 
psych ward to say that she was suicidal. She'd searched for God at 
12-step meetings and instead found new dealers. She'd tried methadone 
and Suboxone, two synthetic opiates used to treat heroin addiction, 
but instead wound up abusing those synthetics to get high.

She had even tried an earlier version of the naltrexone shot a few 
years back, and it had helped her stay clean for five months until 
she relapsed. Maybe this time it would last. Nineteen hours now until 
her appointment. She lit a cigarette and sat down in the garage. The 
air was still and the neighborhood was quiet. A group of retired 
women walked by in visors and spandex, making their usual morning loop.

She had been warned by a doctor that it was normal in the first year 
of sobriety to feel "bored, flat, depressed, blah, tired, anxious" - 
a change in brain chemistry that exacerbated so many of the longings 
that made heroin appealing in the first place. "I'm not seeing what's 
so great about being clean," Amanda already had told her mother once, 
and in an effort to feel better she had started thinking back to a 
time when she was 19, hopeful and sober.

For most of that year she had traveled with her husband as he drove 
long-haul loads. They had made it to 48 states without ever planning 
beyond the next week. Maybe they would stay for a while in Texas. 
Maybe they would move up to the Rocky Mountains in Colorado. All that 
sky. So many possibilities. And then eventually the job had gone away 
and the road had led them back to Michigan -- to the trailer, to the 
pawnshop, to the pills, to the twins, to a dissolving marriage and a 
courtroom dispute for custody, and it felt to Amanda like she'd been 
fighting to hang on ever since.

The walkers circled past the garage on another loop. Amanda stomped 
out her cigarette and headed inside.

"Seventeen hours," her mother said, greeting her.

Amanda sat down next to Libby on the couch, where Libby was watching 
daytime TV and scrolling through Facebook on her phone. Lately, Libby 
had been spending a few hours each day in a conversation group for 
addicts' mothers. It had more than 20,000 members, and Libby came to 
them for support, advice and most of all for a reminder that the 
addiction overtaking her house was also ongoing for 1.6 million other 
chronic heroin users and 8 million abusers of prescription drugs.

"I just got the call," read the first post of the day. "My son was 
alone in his hotel room. I can't breathe."

"OD #6 but he's alive," wrote another mother. "Hospital kept him a 
couple hours and put him back on the street barefoot in scrubs with a map."

Libby set down her phone. She looked up at the clock. Still almost 17 
hours to go. "These days are like dog years," she said. She leaned 
her head against Amanda's shoulder and kept scrolling through her phone.

"My addict son and his girlfriend were just found passed out at home 
with their baby crying. When does this nightmare end?"

"Dead in a walmart parking lot . . ."

"On our way to view her remains . . ."

"My daughter was last seen around midnight . . ."

Libby stood up and walked into the kitchen. How many times had she 
reworked Amanda's obituary in her head: a sarcastic sense of humor, a 
sharp wit, a patient mother of young twins, a woman so disarming that 
once, when agents from the Drug Enforcement Administration came to 
confiscate her prescription pills, she wound up dating one of the agents.

"Do you want a Mountain Dew?" Libby called out to Amanda, but when 
Libby looked into the living room, Amanda was pacing and talking on her phone.

"What do you mean there's a problem with my appointment?" Amanda was 
saying now, and Libby started cursing under her breath.

"I really need this to happen tomorrow," Amanda was saying, and Libby 
balled her fists and knocked them against the kitchen counter.

Amanda hung up and told Libby there had been a miscommunication 
between her Medicaid insurance and the doctor's office. She said 
Medicaid needed more time to approve coverage of the shot, and 
without coverage it would cost more than $1,000. Instead of getting 
the shot in 16 hours, she would have to wait five more days.

"That's not possible. Call back," Libby said, because she wasn't sure 
if Amanda was telling the truth or inventing a reason to put it off. 
Amanda dialed again. Libby stood close so she could listen.

"I'm seriously worried I'm going to relapse," she heard Amanda say.

"Please, I'm trying to do good here," she said. "There's really 
nothing you can do?"

"Fine. See you next Tuesday," she said, and then she hung up.

Amanda walked out to the garage to light a cigarette and Libby 
followed. "If this is all a big lie, just tell me now," Libby said.

"Jesus. Can't you ever trust me?" Amanda said. "I want this shot way 
more than you."

"How are you going to make it five days?" Libby said, her tone 
softening. "You need a plan."

"You're the one freaking out," Amanda said. "What about you?"

Four days left to go, three days, two, and as the hours crawled by 
until the appointment Libby decided she needed to leave the house. 
She asked her husband to keep an eye on Amanda and went to have 
dinner with two of the women she'd met in the Facebook group for 
addicts' mothers.

For nearly a decade, Libby had avoided talking to anyone about her 
daughter's addiction, mostly because Amanda didn't want people to 
know. "How's Amanda doing?" friends and relatives would ask, at every 
graduation, wedding and baby shower, and what was Libby supposed to 
tell them? That while everyone else's life was marching along in neat 
succession, her daughter was still sleeping late in the basement? 
That she was giving Amanda an allowance for cigarettes and cleaning 
up her moldy cereal bowls? "She's just fine," was what Libby had 
always said, until eventually people stopped asking, which felt even 
worse. So Libby had started spending more time at home, and then more 
time on Facebook, where she had connected with a group of local 
addicts' mothers who had become her closest friends.

"How's Amanda?" asked one of them, Mary Carr, as they sat down at a 
restaurant and ordered drinks.

"Who knows?" Libby said. "Clean? Using? You'd think by now I could 
figure it out, but I honestly have no idea."

"They're masters of manipulation," said another mother, Dana.

"My rule at this point is don't believe anything," Mary said. 
"Otherwise you end up feeling naive. I'm done with that."

Mary said that she had bumped into her son a few nights earlier in 
their neighborhood. He was 27, and he had been homeless for parts of 
the last 12 years, but lately he had been living with a girlfriend. 
He looked good and it was nice to see him, Mary said, but later that 
night he had called her a dozen times, harassing her and begging for money.

"Do you know how many times he's done that?" Mary said. "So I'm 
finished. For the first time ever, I actually blocked him on my phone."

"See, that's the part I'm no good at," Libby said. "I can't let go. I 
always think I can save her."

Libby had been a mother for only three months the first time Amanda 
got sick. Doctors had told her it was just a stubborn cold, until one 
night Libby went to check on her infant daughter and found her 
wheezing in the crib. The baby was turning blue. She couldn't 
breathe. Libby picked her up, blew air into her mouth and rushed her 
to the emergency room. They stayed in the neonatal unit for the next 
two months as doctors ran tests to see what was wrong. Finally Amanda 
had been diagnosed with a severe kind of asthma, treated and sent 
home, and for the next year Libby had stood over her crib for a 
little while each night watching her breathe.

Now she had spent 11 more years trapped in that cycle -- expecting 
her daughter to die, sacrificing her sanity to save her, and doing 
most of it alone. She rarely talked to her ex-husband about Amanda's 
addiction; her current husband was patient and supportive, but 
sometimes, as Amanda's mother, Libby felt that the responsibility was 
mostly hers. So Libby had gone by herself to heroin awareness rallies 
at the state capitol. She had forced Amanda to take monthly drug 
tests and locked her out of the house. She had gone through the 
medical records Amanda left lying around and cursed out the doctors, 
pill mills and pharmacists who continued filling her prescriptions. 
She had tried, most of all, to be loving and patient with her 
daughter and to remember what so many experts had told her, that 
addiction was not a choice but a disease, even as Amanda stole her 
checks and then her credit cards, running up more than $50,000 of debt.

And then, finally, nine years into her daughter's addiction, Libby 
had come up with a plan to be done with all of it. She had put on a 
bathing suit beneath her beautician uniform one morning and driven 
out of the city toward Kensington Lake. She had been a competitive 
swimmer as a teenager, but now she was out of shape. If she could 
swim out for a mile or so, she would be too exhausted to make it 
back. Nobody would see her. Nobody would hear her. She sat at a 
picnic table and stared out at the water. She watched a family shove 
their canoe into the lake. She watched two kids throwing rocks. She 
sat for hours until the sun descended over the water and then she got 
back in her car and drove home, resolved to seek help. She met with a 
therapist, confided in her husband, consulted with a bankruptcy 
lawyer and started talking regularly with the mothers she'd met online.

"If I cut the cord with Amanda, would she recover faster?" Libby 
asked them now. "Would it be easier on both of us?"

"There's no one right way," Mary said.

"I worry about enabling," Libby said. "But what if I kick her out and 
she dies in some abandoned house? How do I live with myself ?"

Nobody answered. They sat in silence for a moment and Mary reached 
for Libby's hand. "You're doing everything you can," she said.

"I don't know where to draw the line," Libby said.

"Ineed your pee," Amanda was saying to her mother now, on the last 
day, just hours before her appointment for the shot. She had come 
upstairs with darkened eyes, a runny nose and a confession.

"Excuse me? You need what?" Libby said.

"I need your pee. For the drug test. Otherwise I'm not going to pass 
and I can't get the shot."

"What are you even saying?" Libby said, and so Amanda began unwinding 
the lies she had been telling her mother for the past week. That day 
she jumped out of the car in Southwest Detroit and then disappeared 
for 12 minutes? She had been trying to find Sammy, but she had also 
been trying to buy heroin, and she hadn't been able to find any. The 
appointment five days earlier that had been postponed at the last 
minute because of insurance? She had actually canceled it and then 
made a series of fake phone calls to confuse her mother. That night 
earlier in the week when she said she was going to sleep over with 
her twins? She had stayed with them for a while, played with them and 
taken them to a movie, but then she had found a babysitter and gone 
to a motel with a friend, where she had gotten high on $50 worth of 
methadone, a long-acting opiate that was still running through her body now.

It would be at least two weeks before the methadone was out of her 
system and she could pass a drug test. In two weeks, Amanda said, 
"I'll probably be using and back out on the street."

Libby started to shake her head and bite her nails, cursing under her 
breath. "It's always the same with you, isn't it?" she said.

"I need the shot now or I'll never do it," Amanda said. "I can deal 
with the sudden withdrawal."

"I can't believe you're even asking me to do this," Libby said, but 
she had already decided that she would help Amanda, even if it 
required going to extremes. Withdrawal might send Amanda to the 
emergency room, but it was still safer than going back on heroin.

Libby went into the bathroom and came out carrying a small bottle, 
and they drove together to a clinic wedged between a liquor store and 
a pharmacy near the Detroit River. Amanda checked in at the main desk 
and then waited outside the front door, smoking a cigarette until a 
nurse came out to get her. "There are a few things we need to go over 
first," the nurse said, leading her back to a small exam room.

She explained that the shot was an opiate antagonist. She explained 
that if Amanda still had drugs in her body the shot would cause an 
immediate and severe reaction: muscle spasms, cold sweats, abdominal 
cramps, vomiting, diarrhea, fever, impaired breathing.

"When did you last have opiates in your system?" the nurse asked.

"I'm not really sure," Amanda said, looking down, picking at her nail 
beds. "Has it been over 14 days?" "I think so." "No heroin? No 
Suboxone or methadone?"

Amanda looked across the room at Libby, who stared back at her and 
nodded. Amanda sat for a minute and thought about telling the truth. 
Her appointment would be rescheduled. No shot. No muscle spasms or 
impaired breathing. She would be outside in a few minutes smoking a 
cigarette, and she could catch a ride to Southwest Detroit and be 
high within an hour.

"Yes. I'm clean," Amanda said finally. "It's probably been, like, 20 days."

"We'll need to do a drug test," the nurse said, handing her a small 
cup for a urine sample. She said the test was mostly for record keeping.

"Right now?" Amanda said. "I don't really have to go."

"That's fine. You can do it after the shot," the nurse said.

The nurse left and returned with a long needle. "I'm not ready. I'm 
not ready," Amanda said, and then she said to just do it and closed 
her eyes. The shot was over in 10 seconds. She thanked the nurse, 
went into the bathroom to leave Libby's urine sample and then hurried 
outside. She lit a cigarette. She took a deep breath and wiggled her 
toes and squeezed her arms and rolled her neck and decided she felt . 
. . fine. "I think I'm actually okay," she told Libby.

"You're great. You're clean," Libby said. She looked at Amanda with 
relief and then reached over to squeeze her shoulders. "Twenty-eight 
days without having to worry about this nightmare."

"I can't believe I actually did it," Amanda said.

"Pretty damn brave," Libby said, but now as she looked at her 
daughter she saw that her face was turning pale and there was sweat 
on her forehead. Amanda's right leg began to tremble. Her left leg 
jolted forward and she almost fell to the curb. She dropped her 
cigarette and crawled into the back seat of the car. "Take me to the 
emergency room," she said, and Libby started driving.

By the time they arrived at the hospital 10 minutes later, Amanda was 
in full withdrawal because of the methadone that had still been in 
her system. She couldn't stand, so Libby got her into a wheelchair. 
She couldn't steady her hand to fill out the intake forms, so Libby 
helped do them for her.

"Heroin?" the receptionist asked, because the hospital had already 
seen 11 of those cases in the last 24 hours.

"Yes," Libby said, and then added: "Recovering."

"Okay. Have a seat and wait to be called," the receptionist said. 
They sat in the waiting room for five minutes, then 10, then 30. "I 
need medicine," Amanda began to moan. "Put me to sleep. Give me 
something." She started to tremble and then convulse. Her arms swung 
wildly and collided hard against her legs. Her muscles cramped, and 
she slumped in the wheelchair and slid toward the floor. "Can I get 
some help over here?" Libby asked, but nobody answered. Amanda threw 
up in the bucket, in a trash can, and then all over the bathroom floor.

"How much longer until we get seen?" Libby asked, and finally after 
about half an hour a nurse came out to check on them.

"Sorry, ma'am," she said. "We'll get to you soon."

"But there's no one else here," Libby said, gesturing around the 
empty waiting room.

"We have to go by priority," the nurse said. "People who are having 
chest pain come before other things."

"And this isn't a priority?" Libby said, pointing to Amanda, who now 
was crying and saying that she needed a sedative, that she wanted to 
be knocked out. She had vomit caked in her hair and welts rising on 
her legs in the places where she'd been hitting herself.

"She'll make it," the nurse said, looking down at Amanda. "We see a 
lot of addicts in withdrawal."

"She needs help," Libby said, her voice rising. "It's too much. Can't 
you see that?"

The nurse walked away and then a few minutes later a doctor came out 
into the waiting room. He grabbed Amanda's wheelchair and started 
rolling her back into triage. He told Amanda the hospital would take 
good care of her. He said she would be out of withdrawal and feeling 
better within three or four days. "Congratulations on Day One," he 
said, but Amanda didn't seem to hear him. Every nerve in her body was 
on fire. She was sick. She was clean. She was scared. She was feeling 
all of it now, so many sensations rushing in at once. "Please," she 
said, reaching up for the doctor's arm, tugging at it. "Make me feel nothing."

About this series: Since the turn of this century, death rates have 
risen for whites in midlife, particularly women. In this series, The 
Washington Post is exploring this trend and the forces driving it.
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MAP posted-by: Jay Bergstrom