“Sometimes You Have to Build a Wall Around Your Heart”

Stacy was sorry.

The 9 a.m. meeting on Tuesday had turned into a 10 a.m. meeting on Friday, which became a 9 a.m. meeting on Monday. Stacy answered the phone each time, and each time, she apologized. “Something came up,” she’d say. She had to walk her dogs. She slept too late. She forgot. “Heroin users aren’t the most punctual,” her daughter jokes.

Stacy Pettersen was receiving methadone treatment at a clinic a few miles from her government-subsidized apartment in Englewood. The dosing was still off, and she’d begun vomiting and feeling the intense agony of withdrawal. It had been more than a month since she last used heroin, the longest she’d gone without since she’d first tried the drug five years earlier. Despite pain so terrible she considered killing herself, she tried to remain hopeful. But it was difficult. Now she was entering the stage of recovery she worried she’d never be able to complete.

Experts who study drug abuse say there aren’t many old heroin users. Stacy is one of the exceptions. She is 62, divorced, and the mother of three adult children. I want to be a better person, she’d recently told her daughter, Colorado state Representative Brittany Pettersen. I want to make things right.

Now, Stacy says she wants to meet. She sets another time. She’ll be there. She promises.

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The metal gate to the Harm Reduction Action Center in downtown Denver swings open this past winter, and a dozen men and women empty onto the sidewalk, scattering in every direction along Colfax Avenue. Lisa Raville, HRAC’s 37-year-old director, stands in the doorway, waving to her clients.

“I’ll see you later,” she says.

“Be safe.”

“Take care.”

Raville is slim, with rectangular glasses and short, straight hair, and she looks more like a school librarian than the most important voice in Colorado’s battle against heroin. Since 1999, overdose deaths involving opioids and heroin have quadrupled nationally, part of a crisis that in 2015 claimed more Colorado lives than homicides. This past year, Denver’s Medical Examiner Office investigated an average of one heroin-related death per week. For every death, many more people overdose and nearly die. For each near-death, there are heroin drug users languishing on waiting lists for clinics, for methadone treatment, or for a shrinking number of beds at treatment facilities. And for every person waiting for help, there are even more who have yet to ask for it.

Those who know Raville well say she is relentless. In nearly eight years running HRAC, she has developed an unusual consortium of pushers, cops, drug users, and politicians who’ve joined her mission to redefine what we talk about when we talk about heroin in the state. Governor John Hickenlooper is an ally. So is a rural police chief who teamed up with her to convince Colorado police departments to carry a lifesaving anti-overdose drug called naloxone. When heroin users speak of her, it’s with reverence.

In the past five years, every major harm-reduction policy decision in Colorado has come from—or gone through—Raville. She was the primary influence behind a Good Samaritan law passed last year that grants limited immunity on simple drug-possession charges for people who call 911 to report overdoses. HRAC’s push for wider distribution of naloxone has saved 502 Colorado overdose victims since 2012, Raville says. She also convinced jails in Arapahoe, Boulder, Denver, Douglas, and Jefferson counties to give naloxone to heroin-injection drug users upon their releases. “I don’t want to imagine where we’d be without Lisa,” says Steve Koester, a University of Colorado Denver professor who has worked with heroin users for the past 27 years. Says state Attorney General Cynthia Coffman: “Lisa’s a force.”

After saying goodbye to her last clients of the day, Raville walks back inside the center, a smallish group of rooms in the shadow of the Capitol. About 150 people funnel through the office every morning—from homeless users to white-collar workers—which makes this place the largest harm-reduction center within a 500-mile radius. The center is one of nearly 200 nationally that subscribe to a wider harm-reduction philosophy that seeks to minimize damage associated with drug use and considers medical care and counseling more effective interventions than punishment. “If incarceration and shame worked,” she says, “we wouldn’t be in the situation we’re in now.” Raville’s center offers free sterile needles and needle-disposal bins and helps drug users find long-term treatment as well as short-term medical help.

A majority of those who visit the center are white and male, and some began abusing prescription pain medications before moving to cheap Mexican black tar heroin when their prescriptions dried up. They arrive seeking needles and small kits, which help users inject safely and include bottle-cap-size cookers, small water bottles, and pellet-size cotton wads to strain impurities out of heroin. Because of the work, needle sharing and needle reuse is down about 50 percent, according to a survey of HRAC clients last year, which significantly reduces the chances that users will become infected with diseases like hepatitis C and HIV.

In her office, Raville has banned words like “dirty,” “clean,” and “addict” to describe drug users’ struggles with sobriety. She doesn’t talk about recovery or her center as a means to an end. It’s more like a bridge to the next stop. “I want to keep them alive one more day so they can decide what to do with the next day,” Raville says. In 2016, she hired a heroin user to lead training sessions for naloxone. The man—who has personally saved 90 people from overdose-related death—trained Hickenlooper. A photo of the governor intensely watching the training was posted on the center’s Instagram page with a caption that read, in part, “Governor Hickenlooper is now equipped to save a life in our community” and included the hashtag #everybodysdoingit. In the spring of 2016, Raville coordinated a slew of drug users’ mothers who spoke at a public hearing for the Good Samaritan legislation. Seven months ago, fewer than 10 police departments in Colorado carried naloxone. Today, it’s nearly 130.

Still, the center can’t save everyone. In 2011, a mother gave Raville a framed photograph of her son, who’d recently overdosed and died. Raville hung it on a wall inside the center’s main room. It became a touchstone for her staff, a place for the man’s friends to mourn. For Raville, it was a daily reminder of what was at stake. Over time, more families and friends brought photos of their recently dead. Two became 10. Ten became 40. Raville stares at the photographs, which now number 103. “In this job,” she says, “sometimes you have to build a wall around your heart.”

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On the afternoon of May 20, 2015, Colorado’s attorney general entered a conference room in Denver, stepped up to a podium, and announced the largest and most complex heroin bust in the history of the Rocky Mountain West. For people in the anti-drug industry, it was a rare moment of joy, a good day for the good guys.

Roughly two years earlier, Coffman said, agents started following leads on a money-laundering operation. Those agents eventually made a major discovery: hundreds of thousands of dollars in cash, all of it linked to a cartel shipping heroin, cocaine, and methamphetamine from Mexico. Traffickers pushed their product across the U.S. border and then along country roads, highways, and interstates—through Pueblo and Colorado Springs to Denver—to be distributed in the city and throughout the metro region, in parks and on street corners, to be used by everyone from homeless men to suburban soccer moms.

Drug agents and local law enforcement picked off suspects one by one: on I-70 near Evergreen. In a garage in Aurora. In an apartment bathroom in Thornton. In one year, authorities arrested 34 people and seized 273 pounds of brown heroin with a street value of $40 million.

U.S. Attorney John Walsh called the case—including the arrests of ringleaders Yael Osuna Navarro and Marcos Lopez Garcia—“the gold standard for federal-state law enforcement cooperation to attack and dismantle a dangerous international narco-trafficking organization.” The announcement had the typical visuals of a made-for-television drug bust. There were tough-talking cops and photos of drug bundles and stacked cash. The initiative even had a catchy name: Operation Chump Change. Coffman said in a release: “This bust deals a knockout punch to a highly organized and invasive bunch of traffickers.”

Except, of course, it didn’t. The work that resulted in dozens of state and federal indictments barely registered among the drug community. “Literally, within a day, the organization was ordering another 10 or 20 pounds to replace the lost loads,” one DEA official admitted at the time. “It didn’t seem to faze [the cartel] that much.”

Even the bust’s Chump Change moniker was a not-so-subtle nod to the futility of fighting the traffickers. Despite seizing tens of millions of dollars in heroin, the DEA’s effort amounted to little more than a temporary inconvenience for the organizations that supplied the drugs.

“It’s frustrating,” Coffman said early this year, recalling the Chump Change busts. “Every time we take down an operation, we see availability decrease, but someone eventually steps in.” She frames the problem in practical terms: Her job includes rooting out heroin sources, understanding addiction as a disease, and helping users get treatment while also being realistic enough to know the drug isn’t going away. “Did the war on drugs work?” Coffman asks. “We all have our opinions. But do we stop the battle? I don’t think we can.”

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Stacy walks the three blocks from her apartment to the coffeeshop where her daughter is waiting. They hug hello in the doorway. While Brittany goes off to buy her mother a latte, Stacy moves slowly across the room and lowers herself into a seat next to a window. She gives a tight, pained smile.

Her eyes are watery and squinty. Her face is drawn. She’s a tiny woman, her short-sleeved shirt exposing a pair of thin, wrinkled arms. Her body rests uneasily in the chair. She looks exhausted, as if she might crumble.

“How are you, Mom?” Brittany asks when she returns with the latte.

“OK, I guess,” Stacy says.

Her doctors are still tweaking her methadone dosing, she tells her 35-year-old daughter. They’re trying to find the right amount that will curb her withdrawal symptoms and keep her heroin cravings in check. To get the methadone, she has to attend mandatory counseling sessions, which are covered by Health First Colorado, the state’s Medicaid program. She’s been to several clinics and counselors over the years, but she says this one seems different.

“For the first time, I really want the help,” Stacy tells her daughter. “I’m getting some hope in my life, like maybe I can beat this.”

The hourlong talks are deep and painful, though, and she has left in tears on more than one occasion. Pain is her trigger. Stacy had been abused emotionally, physically, and sexually for much of her life, and now she was reliving it. She experimented with LSD as a teenager and dropped out of high school, then got married. As she moved into parenthood with an alcoholic husband, she drank too much herself and abused pills.

Stacy was never sober enough to attend her kids’ school functions. She’d pass out on the couch. When she was awake, she’d sometimes walk out the door and disappear for weeks. She didn’t remember birthdays. When her son Justin died by suicide in 2008, she didn’t attend the funeral. “I’ve been a terrible mother,” she says. Brittany doesn’t say a word.

When she turned 18, Brittany left her home in Littleton for Colorado State University; she was forced to drop out when she couldn’t get financial aid because her parents hadn’t paid taxes in years. Brittany transferred to Metropolitan State University of Denver and waited tables as she pursued a political science degree. She worked at a nonprofit and for political campaigns before deciding to run for office. Maybe I can help someone like me, she thought.

By then, her mother had moved to prescription painkillers. Stacy’s doctor cut her off a few years ago, so she started buying pills from a dealer. When that became too expensive, she says, “heroin became my last resort.”

If she goes even a few hours without the drug, the withdrawal symptoms take over. Withdrawal scares her more than death. Her body burns. Her muscles ache. She vomits nonstop. She shakes. Every month for the past year, she says she’s considered killing herself. She’ll buy heroin and other drugs from her dealer and take them all at once. Just before Thanksgiving, she decided it was time. She looked in her wallet. She didn’t have any cash.

Brittany hears her mother’s words and winces.

The relationship Brittany has with substance abuse—and now with heroin—has put her closer to the issue than she ever wanted to be. She’s sponsored a bill creating more access to clean needles, and she supported the Good Samaritan law and the expansion of naloxone access in the state. She doesn’t invoke her mother’s name when doing it; instead, she describes once being a “high-risk youth” in a family with a history of substance abuse. Brittany’s been elected three times to represent her state House district, which encompasses part of Jefferson County, but not all of her political colleagues know her past. None have met her mother. If they did, Brittany’s not sure how she would explain the situation. She has trouble explaining it to herself.

During a legislative hearing about a year ago, Brittany got a text from one of her brothers. She needed to get to Lutheran Medical Center. Fast. Their mother had overdosed and was unconscious.

“Mom, why were you in the hospital?” Brittany asks at the coffeeshop.

“I had pneumonia,” Stacy says.

“No, that was not pneumonia.”

“Yes, it was,” Stacy says. “I was sick.”

“Mom, you got pneumonia because you passed out and inhaled your vomit.”

“Well, I don’t remember that,” Stacy shoots back.

“Of course you don’t, Mom, because you’re the one who was unconscious.”

Stacy closes her eyes.

Days later, Brittany’s still thinking about the conversation. “I don’t know if she’s purposefully lying or if she’s making up her own reality, or if that’s really how she’s remembering things,” she says. “I’m so sick of getting dragged into this. But she’s my mom. How can I give up on her?”

As her mother’s grown older, Brittany’s mind has begun drifting to dark places. She lives in fear of the next text, the next phone call, but there’s an even bigger worry. She wants her mother to get better, but what if it really happens? “I would almost rather have her like this forever than get her sober for a year and see the person I’ve been missing all this time,” Brittany says. “What happens if I see my real mom, and then I lose her?”

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Josh Blum was in his residency at the University of Colorado Denver in 1996 when Purdue Pharma released OxyContin. To Blum and thousands of doctors like him, the prescription painkiller was an “incremental game-changer” that served as an important tool in the way doctors handled their patients’ pain. Purdue’s marketing campaign included claims that the drug “simplifies and improves patients’ lives” by ensuring “smooth and sustained pain control all day.” It was safe and reliable, Purdue said. Just two doses would eliminate pain for 24 hours—about twice as long as generic medications.

OxyContin was especially intriguing to Blum, a Southern California native drawn to the intricacies and possibilities of pharmacology. Dosing could be fine-tuned; opioids could be combined and prescriptions rotated to new drugs for maximum pain relief. “When opioids became acceptable to prescribe for pain, we all felt really empowered,” says Blum, now a primary care doctor at Denver Health Medical Center. Just a few years after Oxy’s release, pain relievers began flooding the market. And then people started dying.

One of Blum’s longtime patients, who was in her early 40s, overdosed and died at an airport about 15 years ago. Physicians lose patients; it’s part of the job. But this one felt different to Blum. He had a nagging feeling about the woman’s demise, about the opioid Blum had prescribed to her over years of visits to treat chronic muscle pain. When he learned of the patient’s death—which today he describes as profoundly haunting—Blum at first didn’t understand the far-reaching implications it would have on his career or what the overprescription of opioids, like OxyContin, would do to communities across the country.

A few years later, Blum began reading stories of other opioid overdoses—people like his patient who were dealing with chronic pain. Unlike the crack epidemic of the 1980s, this wasn’t confined to America’s inner cities. From California to Vermont, well-meaning men and women were getting hooked on opioids. These were moms who’d gotten prescriptions for back pain, dads who had arthritis in their knees. For Blum, who’d become such a believer in these drugs that he was training other physicians in prescription pain management, the realization was overwhelming. In invisible, insidious ways, the prescription drugs reconstruct neural pathways, warping boundaries between actual pain relief and full-blown addiction. In some cases, the brain begins to crave the drugs. “I was personally responsible for giving people lifelong addictions,” Blum says. “I got into this profession to help others, but I was contributing to the problem.”

Withdrawal feels like a backache, like a badly strained muscle. As patients complained more about those pains, doctors wrote more prescriptions. Robert Valuck, a professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, remembers seeing the first wave of opioid drug users and the doctor-shopping, theft, and desperation for drug treatment that followed. “There’s no quick fix when your brain gets damaged this way,” says Valuck, who’s also the director of the Colorado Consortium for Prescription Drug Abuse Prevention. “We used to have physician after physician writing prescriptions because they thought it was their job to do away with pain entirely. They’d prescribe 30 pills when the patient needed three.” Doctors were essentially creating drug users out of their offices.

Health-care providers wrote 259 million prescriptions for painkillers in 2012, meaning every American adult could, in theory, have a bottle of pills. Almost overnight, millions of pills that had made their ways into medicine cabinets filtered onto the black market as more people got hooked. In Colorado, heroin treatment admissions have risen 244 percent between 2008 and 2015, and the drug overdose rate jumped nearly 68 percent between 2002 to 2014, putting the state above the national rate for overdose deaths.

Private insurers began to crack down on prescriptions over the past decade as federal and state governments started discussing overprescription and overdoses. In a simple supply-and-demand reaction, painkillers became more expensive on the black market. With reduced access to prescriptions, Valuck says, “we potentially had thousands of people across Colorado ripe for heroin addiction.”

With heroin, the most basic economic principles quickly came into play. Seeing future customers getting priced out of the pill market in the West, cartels in Mexico ramped up production of black tar heroin, then shipped it in bulk to their contacts in the United States. Across Colorado, opioid users suddenly had wide access to an affordable drug. The results have been catastrophic: Between 2010 and 2015, the state’s age-adjusted heroin overdose death rate for all Coloradans increased by 222 percent.

Blum became more cautious in prescribing opioids after seeing the impact of addiction. “It’s not worth the damage,” he says. These days, he’s supported public policy on naloxone and is the program manager and medical adviser at Denver Health’s HIV Primary Care Clinic. The blood-borne disease naturally intersects with heroin culture, where needle-sharing is still common. Blum’s job at the clinic has brought him face to face with the consequences of physicians’ early opioid advocacy.

As part of his work today, he’s trying to understand what makes a heroin user—and how to prevent new ones. Childhood trauma, especially physical or emotional abuse, seems to play a large part. In other ways, though, it’s a crapshoot. “Some people’s brains are simply wired to be more susceptible to addiction,” he says. “Heroin is killing them, both physically and mentally. They feel isolated. They know they’re wrecking trust and destroying their families, but they can’t stop. Heroin turns even the best person into a thief and a liar. They’re at the mercy of their drug use.”

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Jesse stands outside a convenience store across from the Wellington E. Webb Municipal Office Building in downtown Denver, blowing the chill out of his fingertips. The 28-year-old is wearing a black hoodie, loose jeans, and a flat-billed hat pulled low over his forehead. He’s selling methamphetamine from a small, clear baggie he’s hidden inside the crotch of his pants. His buyer, a man in his early 40s, already has some heroin and wants to mix it with meth—a combination known as a “goofball.” Jesse stands shoulder to shoulder with the buyer, takes $10, and shakes a small crystal mound into the man’s open hand. Jesse then rolls up the baggie, zips his pants, and wishes the man good luck.

Jesse gets his black tar from a Mexican middleman. To buy his heroin, you first need to call one of his five cell phones; Jesse will then appoint a time and a place to meet. His heroin is “the best in the city,” he brags. “My shit will kill you.” A vast majority of the heroin in Denver is black tar and comes primarily from the Sinaloa Cartel in Mexico. Jesse knows enough about the group to understand he wants no part of their world. He never sells directly for them. It’s one thing to mess up your own deal, he says; it’s a whole other thing to screw up and have a drug network on your ass.

Among his clients, he says, are lawyers and teachers. He claims he’s sold to a television journalist. Before he meets a buyer, he places a small, marble-size clump of heroin into a balloon, ties a knot at the end, and puts it in his mouth. If police catch him on the street, he quickly swallows the balloon. He’s done it five times. As we talk early this year, Jesse grabs my coat, pulls me close to him, and puts his forearm on my throat. This, he says, is the first thing police do when they think you’re carrying heroin in your mouth.

Of the users and dealers I met while reporting this story, Jesse is the most self-aware. He understands what his drugs are doing to his community, to his buyers, and to himself. “Heroin has ruined everything that was good in my life,” he says. He grew up near Boulder, where he had “two loving, hippie parents” and was a shortstop on a school baseball team. He began using heroin about a decade ago and started dealing shortly afterward. “I moved to Denver to become a full-time drug dealer,” he says. “Business was booming.” Since then, though, his own addiction has made it impossible to stay ahead financially. He’s been arrested for dealing, he says, but never for heroin. A friend was just put away. He shares an apartment with two other people. Several of his teeth are rotting. On this afternoon, he has a black eye.

The city is in a heroin crisis, Jesse says. The number of buyers has increased in the past year, which has made it difficult for him to walk away from the business—if only so he can still afford his own habit. Getting high is now a near impossibility for him; these days, he simply doesn’t want to suffer through withdrawal. “This is the worst thing in the world,” he says, “to know you’re hurting your life and the people who love you and not being able to stop.”

As Jesse’s talking, one of his friends stands nearby. The man is short—maybe five-foot-seven—and a little bit pudgy but has a vaguely handsome, angular face, broad shoulders, and the perpetually forward posture of someone who was once an athlete.

“I got him hooked,” Jesse says, motioning toward his friend. “He was my neighbor. He was a boxer at one time, a really good one, and I gave him free heroin because I thought he was a nice guy. We were friends, and I ruined him.”

The man hears Jesse and walks over. “No way,” he says. “That’s not true, man.” He pulls up the sleeves of his red fitted sweater. “It was a girl who got me into this. You know that, man. This isn’t on you. Don’t blame yourself for me.”

Jesse looks down toward the sidewalk and slowly shakes his head. “I did this to him,” he whispers.

“No, man. It was a girl.”

“I’m sorry,” Jesse says. “I’m so sorry.”

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Raville turns the lights off inside the HRAC, locks the front door and the metal gate, and walks past the Capitol to a restaurant a few blocks from her office. She finds a seat at the bar and orders a cup of mint tea, then pulls a blue binder from her bag on the floor. The binder has a rectangular sticker on it that reads “Don’t Be A Jerk.” She leafs through the pages until she finds what she’s looking for: the list of heroin-overdose deaths in Denver from the past 10 months.

She runs an index finger down the column that indicates where the overdoses happened, where bodies were found. An apartment. A 7-Eleven restroom. A bus stop. A sidewalk. A stairwell. A park. A creek. A car. She reads off a couple dozen deaths before turning the page. “This is totally unacceptable,” she says. “People are dying, and we can do better.”

Raville took the job in Denver in 2009, when the HRAC’s main office in Salt Lake City had dissolved and the Denver facility was in a small red house on Lipan Street that served as a day shelter for those experiencing homelessness. People stopped by to eat, shower, or wash their clothes. During her work, she often came across heroin users. Needle exchanges didn’t yet exist in the state; instead, Raville administered a program called Break the Cycle that focused on intravenous drug education and how to prevent initiation into IV drug use. “I was hearing about the need for sterile syringes, but we couldn’t do it,” she says. “I was hearing about the need for access to naloxone. And I was the fucking jerk who couldn’t help.”

When needle-exchange legislation went into effect in 2012 across the state, the center’s former office became a magnet for policymakers. The room was often packed with heroin users whenever they came by. “I wanted these people to bump into my clients and see how crowded it was,” Raville says now. “I wanted them to look my people in the eye and see someone who could be in their family. I wanted them to see that these are good people who needed help.” Today, when the Legislature is in session, Raville often arrives at the Colfax center around 7:30 a.m., works through the morning, then heads across the street to lobby for her latest initiative. “We needed someone with her mindset here, who isn’t going to stop simply because things are hard,” says Koester, the CU Denver professor. “Lisa doesn’t back down.”

Which brings her to the blue binder and all those overdose deaths. This year, Raville plans to pursue her most ambitious project yet: a supervised heroin-injection facility, where users would be able to legally and safely take narcotics. The facility would be modeled after 102 similar international programs, including one in Vancouver that has been operating for nearly 14 years and has never had an overdose fatality. Just like those centers, the Denver facility would have medical personnel, who could administer naloxone or call 911 in case of an overdose, monitoring clients. Users also would have access to sterile equipment. Seattle this year became the first American city to approve safe-injection sites, and Baltimore, New York City, San Francisco, and Portland, Oregon, are all looking into similar government-approved safe sites for heroin users. Raville says her proposal would be similar to the ones green-lighted in Seattle, with a safe-injection area adjacent to another office where users who want to quit can get counseling and treatment referrals.

She expects pushback on the proposal, but she’s ready for the challenge. Raville closes the binder and sips her tea. “We’ll get it done,” she says. “I like when people underestimate me.”

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They line up outside the HRAC, men and women dressed in heavy coats on a cold January morning. Some have thick scarves wrapped around their necks. Raville is standing on the sidewalk, welcoming each of them inside. A city bus rumbles by.

Nearby, on the third floor of the Capitol, Brittany sets a plate of breakfast burritos next to a bowl of kiwi, grapes, cantaloupe, and blueberries. It’s her first official morning of work since her re-election in November, and she’s hosting a breakfast for supporters. Other representatives and staff flit about the small room outside her new office, which has a view of Civic Center Park. A dozen roses are in a vase atop her desk, where her fiancé, once the chief of staff to the former Speaker of the House, is tapping away on his laptop. Across from her gathering is another small office with a Dr. Seuss quote framed and hanging on the wall: “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”

Brittany has hardly ever mentioned her accomplishments as a legislator to her mother. For two months, she’d been looking forward to the opening of the new House session on January 11; it’s always a special day, an occasion usually marked with friends and family celebrations and lots of photos. Brittany didn’t bother telling her mom. “She wouldn’t come, anyway,” she says. “I just don’t want to be disappointed anymore.”

At 10 a.m., she excuses herself and moves to the House floor, where she takes a seat at her desk in the back. She likes her spot. As the new Democratic whip, her chair allows her to see who’s leaving early. Her fiancé sits next to her and takes pictures when Brittany stands and smiles and raises her right hand to take her oath. Afterward, he leaves to go back to work. Brittany sits alone for a while, then pulls out her phone and takes a photo of the embossed certificate given to each member of the 71st Colorado General Assembly. She thinks about her wedding this coming summer and who she wants to keep track of her mother—if Stacy shows up at all.

Shortly after noon, Brittany makes her way out a side door and walks to the parking lot. She has lunch scheduled, then she’ll be in Lakewood to meet with constituents. She’ll call her mom later. She won’t mention her day.

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“Mom, did you do heroin?” Brittany asks as she stands next to a hospital bed, brushing her mother’s long, graying hair.

It’s about five weeks later, mid-February, and Brittany’s at Swedish Medical Center. She came from a town hall meeting to see her mother. She needs an answer. Stacy’s been in the hospital for a few days since she collapsed and lost consciousness in her apartment. Stacy had thrown up and aspirated again. It’s her second day out of the intensive care unit, and her doctor has just cut off the anti-anxiety medicine Ativan and the anti-seizure medication that had kept Stacy’s withdrawal symptoms at bay. Now, the pain’s returning. Stacy’s nurses suspect she overdosed on heroin, though Stacy hasn’t admitted it.

“Mom?” Brittany says.

“What? No. What do you mean?” Stacy says, pulling the bed covers off her feet and exposing a pair of oversize yellow socks. “It’s so hot in here. Do they have the temperature up?”

Stacy’s hospital gown fits like a tent over her body, sagging off her left shoulder and exposing a tangle of white wires taped above her right breast. Her room on the 10th floor is still. The television is off. The dry-erase board in front of her bed has the names of doctors and nurses and Brittany’s phone number on it. Stacy’s weight, 117.1 pounds, is written just above her name. She’s gained 4.5 pounds. Afternoon light filters through a single window. Brittany’s eyes are fixed on her mother.

“Mom,” she says again, this time more firmly. “Did you do heroin?”

Stacy looks at the “FALL RISK” bracelet on her right wrist. She slowly raises her left hand, two fingers in the air. “Twice,” she admits.

“OK,” Brittany says. She resumes brushing her mother’s hair.

“I—I don’t know what happened,” Stacy says. “I cut myself off, and….”

“What’s been going on?” Brittany asks. Stacy exhales deeply and then finally begins to unpack the past two months. The methadone treatments she’d been getting? She stopped going. The counseling sessions that once encouraged her had turned into psychological torture. “I’m counseled out,” she says. She didn’t shower for weeks. At one point, she left her apartment and bought $25 worth of black tar heroin. She closed her door and didn’t leave. Because Stacy’s afraid of putting a needle into her vein, she takes her drugs subcutaneously. She has an abscess on the back of her left bicep, where she’d cut open her skin and inserted the drug into her muscle. Stacy touches her arm.

“Mom, don’t pick at it,” Brittany says.

“I tried to stop taking methadone about two weeks ago,” Stacy says. The chills came, then the uncontrollable shaking, then the vomiting. She had a pint of vodka in the apartment. Her ex and her sister were there. “I went for broke,” she tells her daughter. “I started hallucinating. I don’t know what happened. I went to the bathroom, and….” The ambulance showed up shortly after.

Stacy puts both hands over her face. A nurse walks into the room.

“Your heart monitor is acting a little strange,” the nurse says as she fumbles with the monitor in Stacy’s gown pocket. “Are you feeling OK? Is there anything I can get you?”

“A cigarette,” Stacy croaks.

“I can get a nicotine patch. Let me ask the doctor first.”

Stacy turns to Brittany after the nurse leaves. “I hate my doctor,” she says, still upset about having her medication stopped. “Why do people keep cutting me off?” Stacy pulls the rest of the blanket off her legs and hikes her gown above her knees. She says her body feels like it’s on fire. She squirms in bed. Her jumbled thoughts pour out.

“I’d like to enjoy just one season again,” she says. “Do you know how long it’s been since I enjoyed a summer?”

Then: “I’m so ashamed. Maybe if I get better, I can get everyone’s trust back. But it seems impossible. How long is this going to take?”

Stacy knows this won’t be her last trip to the hospital. At some point, everything will go dark again, and she’ll be taken to another strange room with doctors and nurses and dry-erase boards and heart monitors. Maybe it’ll be an overdose; maybe it’ll be withdrawal. Maybe she’ll die. Maybe she won’t.

“There’s a heroin dealer in the neighborhood,” she tells her daughter. “I’m scared to get out of here.”

Brittany stops brushing. She reaches for her mother’s hand.

“I think I maybe have two years left,” Stacy says.

Brittany inhales sharply.

“I’m sorry, Britt,” Stacy says, immediately realizing what she’s done. She studies Brittany’s face, sees the tears in the young woman’s eyes. Stacy smiles weakly and squeezes her daughter’s hand.

“I’m kidding,” she says. “You know I’m going to get better.”