the Hope Initiative was still months from opening its doors, Jamie reached out to Tess on “Call me if you need help. I might just know of something right up your alley, Girl. Much love.”
Tess called immediately. She wanted to hear how Jamie’s older son, whom Tess had once dated, had gotten sober. They made plans to meet the next day, but Tess canceled at the last minute.
By early June her son’s dad was out of jail. They squabbled, it turned violent, and Tess went deeper underground.
Patricia and Jamie worked their contacts to find her. Jamie’s son showed her where they’d once done drugs together while Patricia, worried that Tess was seriously hurt, filed a missing-persons report.
They distributed flyers across the region and on Facebook with a smiling picture of Tess and her description: “Last seen June 11, 2016. Brownish/red hair, green eyes, 5' 7", 130 lbs. Tree of Life tattoo on left shoulder blade.” Two days later, police received a report that Tess had stolen a car and a credit card—she’d been sent out for groceries by a woman she was staying with and never returned. Police found and arrested Tess later that day.
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