It’s the annual Fiction Issue with the theme of “American Jobs,” and there are two short stories that I liked very much. I’m a big fan of Sherman Alexie, and “Clean, Cleaner, Cleanest” doesn’t disappoint. (In an online-only feature, Alexie talks about how he knows about a motel maid’s experience partly because his sister had that job but also from his own observation: “I have spent hundreds of nights in motels and hotels of widely varying quality, and I pay attention to the lives of people around me, especially the folks who are working in service. I am the guy who will clean and organize his room—towels piled in the tub, garbage in the bins, stray hairs gathered—before checking out so that the maid has it a bit easier. She will spend less time in my room, so she’ll have more time for the messes left behind by the inconsiderate guests. I also tip ten bucks for each night I have been in the room.”)
I started out annoyed with Curtis Sittenfeld’s “Show Don’t Tell” because it seemed to be another insufferably insular tale about writers, set in what I’m guessing is a thinly disguised version of the Iowa Writers Workshop (correct me if I’m wrong), but the author (a woman named Curtis!) takes it in some surprising directions and won me over.
The centerpiece of the issue, though, is one of those classic New Yorker pieces that every caring person should read: Margaret Talbot’s “The Addicts Next Door.” It’s long and deeply depressing article about the opioid epidemic playing itself out in West Virginia. Here are just a few passages reflecting the gravity and hopelessness of the situation.
Talbot spent a lot of time in Berkeley County, WV, following around emergency paramedics Michael Barrett and Jenna Mulligan. “Barrett sometimes had to return several times in one day to the same house—once, a father, a mother, and a teen-age daughter overdosed on heroin in succession. Such stories seemed like twisted variations on the small-town generational solidarity he admired; as Barrett put it, even if one family member wanted to get clean, it would be next to impossible unless the others did, too. He was used to O.D. calls by now, except for the ones in which kids were around. He once arrived at a home to find a seven-year-old and a five-year-old following the instructions of a 911 operator and performing C.P.R. on their parents. (They survived.)”
At another house, the paramedic rescued a man who’d overdosed by treating him with Narcan. “The next week, Barrett’s crew was called back to the same house repeatedly. The man overdosed three times; his girlfriend, once.”
“According to the Charleston Gazette-Mail, between 2007 and 2012 drug wholesalers shipped to West Virginia seven hundred and eighty million pills of hydrocodone (the generic name for Vicodin) and oxycodone (the generic name for OxyContin). That was enough to give each resident four hundred and thirty-three pills. The state has a disproportionate number of people who have jobs that cause physical pain, such as coal mining. It also has high levels of poverty and joblessness, which cause psychic pain. Mental-health services, meanwhile, are scant. Chess Yellott, a retired family practitioner in Martinsburg, told me that many West Virginians self-medicate to mute depression, anxiety, and post-traumatic stress from sexual assault or childhood abuse. ”
“‘The Changing Face of Heroin Use in the United States,’ a 2014 study led by Theodore Cicero, of Washington University in St. Louis, looked at some three thousand heroin addicts in substance-abuse programs. Half of those who began using heroin before 1980 were white; nearly ninety per cent of those who began using in the past decade were white. This demographic shift may be connected to prescribing patterns. A 2012 study by a University of Pennsylvania researcher found that black patients were thirty-four per cent less likely than white patients to be prescribed opioids for such chronic conditions as back pain and migraines, and fourteen per cent less likely to receive such prescriptions after surgery or traumatic injury.
“But a larger factor, it seems, was the despair of white people in struggling small towns. Judith Feinberg, a professor at West Virginia University who studies drug addiction, described opioids as ‘the ultimate escape drugs.’ She told me, “Boredom and a sense of uselessness and inadequacy—these are human failings that lead you to just want to withdraw. On heroin, you curl up in a corner and blank out the world. It’s an extremely seductive drug for dead-end towns, because it makes the world’s problems go away. Much more so than coke or meth, where you want to run around and do things—you get aggressive, razzed and jazzed.’”
” In 2012, Macy’s opened a distribution center in the Martinsburg area, but, Knowles said, the company has found it difficult to hire longtime residents, because so many fail the required drug test.”
It’s not all gloom and doom. Talbot also meets three women who started the Hope Dealer Project, their volunteer effort to drive people to detox facilities all over the state, and a doctor who gives free public classes to anybody who wants to learn how to reverse overdoses with Narcan. Selfless service, so strong and honorable and moving.
Does it go without saying that, like every other county in West Virginia, Berkeley County voted for Donald Trump?
another eye opens 
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