she assumed. “It’s like there’s a demon inside her,” Patricia said. “I do get mad at her, and there are times I want to say, ‘I quit.’ But the truth is, and I want her to know this, I’ll never give up on her.”
Tess had made her way home briefly at Thanksgiving and insisted on cooking for the entire family, never mind the bandage on her arm, an abscess from a dirty needle that required emergency-room care. But in spite of her efforts, Tess felt her contributions to the meal went unrecognized by her siblings, and she got high the following day on pills and alcohol Patricia had hidden in her shed.
That weekend Patricia bought matching bracelets for the two of them with the inscription “Your heart is my heart.” The saying was inspired by an e. e. cummings poem Tess admired and adopted as a kind of mantra about her feelings for her son. Tess had won a national high school poetry competition in 2001; Patricia still kept her winning poem displayed in her kitchen. Over the next several months, whenever she texted me with updates, she referred to Tess as “our poet.”
They made an appointment to get Tess’s hair highlighted. They were supposed to pick her little boy up from his other grandmother’s North Carolina house. It would be his second Christmas, and Tess was eager to see her son. They’d already bought his Christmas presents along with clothes for his Santa picture, complete with a matching sweater and pop-a-collar shirt set, bought used from Once Upon a Child.
“We had all these plans, and then suddenly the switch just goes,” Patricia said.
On her way out, the week after Thanksgiving, Tess left a note on her mom’s kitchen counter:
Gone to Carilion [psychiatric ward]. Mental Breakdown. I LOVE you so much Mom. You are my everything. I want to get better & I won’t stop trying.
Portrait of Bobby Baylis, held by his mother, Janine Underwood, Roanoke, Virginia
Chapter Eleven
Hope on a Spreadsheet
Tess’s best chance for recovery, everyone thought, came down to a five-page spreadsheet. The volunteers at Roanoke’s new Hope Initiative had spent months crafting it—a list of thirty-six rehab and aftercare providers in the southeastern United States they could contact to arrange treatment, depending on the patient’s finances and the centers’ availability of beds. A few volunteers also helped arrange outpatient MAT, but the angels were divided on its effectiveness, many believing it was wrong to treat drug addiction with another drug, despite scientific evidence to the contrary. Users could drop in at the Bradley Free Clinic on the second Monday of every month and, if police officers found no outstanding warrants against them, pair them with trained volunteers who would troubleshoot their care. Social service workers would be on hand to help those who qualified apply for Medicaid.
It was now early 2017, and fentanyl-overdose calls were coming in at a rate double that of the same period the previous year. In a region of three hundred thousand people, emergency-room doctors were now seeing drug overdoses daily—sometimes as many as three opioid-involved “gold alerts,” or severe trauma cases, at a time. In a single hour that April, three such patients would turn up in the ER of Roanoke Memorial Hospital, including a taxi driver found unconscious along the side of the road and a tree trimmer who’d been dropped off by a friend after injecting himself with two fentanyl-laced shots of heroin; he’d taken a second dose because he didn’t think the first one had worked. Emergency-room physician Karen Kuehl begged him not to leave the hospital after he was resuscitated: “I don’t want you climbing trees today.”
Once revived, the man got up, politely thanked her, and left, saying, “I’ve got to go to work.” An older woman was expecting him to trim her trees that morning, he said, and she’d be disappointed if he didn’t show.
In one weekend the following month, a local seventh-grader died of a probable overdose, the region’s youngest victim so far. The wife of Janine Underwood’s building manager at the clinic was getting her hair done only to be interrupted by the sound of a spectacular crash in the parking lot outside—a middle-aged professional man had passed out while driving, a heroin needle stuck in his arm, and crashed into her car.
Kuehl was studying opioid-related hospital protocols in Ontario, where overdose patients are automatically referred from emergency rooms to outpatient medication-assisted treatment and counseling. “We need to do a smooth handoff here,” she said. She