Excerpt from On the Ravine

hen opened his eyes into a taut, buzzing awareness. It was early, still dark out. Below his window, the barrel-roll rumble of the King Street streetcar. More distant but howling, the air brakes of a large truck, then the engine noise climbing an octave as it geared down into the left-hand overpass where the expressway turned north. Away from the lake and up through the city.

There was a particular aloneness that came to him from being awake while others slept. Chen knew the differential diagnosis of early-morning waking — depression, hyperthyroidism, anxiety. His overall picture did not fit any of these conditions. The doctor would have asked his patient, Is something bothering you? He sat up in bed, took his phone, squinted against the bright icons, and opened a folder of photos, swiped methodically through a few faces.

Junior's baby-face scowl for the camera, teardrop tattoo beneath the left eye, shaved head razor-nicked. He had promised to pull himself together when his mother made his bail. The last time I'm paying, she had told him. Almost off the meth juice, Junior pouted whenever he saw Chen and insisted, against Chen's advice, on dropping the dose again. Coming down fast, doc, see? I can tough it out.

One morning, Junior's mother called the clinic saying he had locked his bedroom door and was ignoring her. How important was it to get him to the pharmacy for his methadone? Would it be alright if he missed a day — maybe he needed the sleep? What should I do, doctor, if he's not answering? Haven't heard a sound since yesterday. Later, she wept in Chen's office. I didn't mean it…about the last time. Who had been the Senior to Junior? Chen now wondered.

Siobhan, whose mascara was smudged in her photo, as it often was in the mornings after work. The smeared halos made her eyes appear brighter, but oddly sunken, and her face more sad when she sat alone in the waiting room, until Dr. Chen called her and then, reflexively, she propped up her usual smile.

One of the early in-and-out crowd, Siobhan shrugged off the results of her urine tests while locking eyes with Chen, a teasing, inside-joke grin, Let me guess doc, Everything-cocktail? Molecule-mud-pie? Got my script? Then to the pharmacy, because her dose helped her sleep. Until she missed a week, then two.

It wasn't the first time she'd partied with those guys, so when I warned her she was like — Whatever, her friend Nan told Chen. Can you tell the cops she was with them? She saw something she shouldn't have. But you know Siobhan, thought I was being dramatic. Oh no, doc, I can't say what she saw. I'd be next. Just tell the pigs who she was with. 

Chen swiped the screen, found Ahmed, hard-faced. No one would guess he knew how to knit, or how much his appearance could soften with concentration, counting the stitches. In his file photo, a yellow-and-purple cap pulled to the eyebrows — an uneven, lumpy thing.

Got the yarn from the women's drop-in. And look here, doc…The little flap within for his stash. Who's gonna look in there? My grandma once made me one like it — told me that's where you hide a coin. For emergencies.

The cap was what Chen recognized, one afternoon when he was riding through a park and passed the pile where city workers heaped snow scraped from the ice rink. Shaded by spruce trees, late to melt, a yellow-and-purple diagonal stripe protruding.

Had Ahmed missed the shelter bed cut-off, and dug himself into the snow pile? The way kids made forts? Did he get beat up? Or had he just fallen down and been covered? 

Faces he would never again see in person looked out to Chen from the screen. Photos taken for the clinic record now lived in his pocket, on his desk, on his bedside table. A banner popped up  — in his news feed — Surging Deaths in Shelters: Coroner's Report. Over the previous week the words "Fentanyl Crisis" had appeared on his phone's home screen again and again.

Upcoming investigative reporting on the "Toxic Drug Supply" was promised on the six o'clock national news. Chen had started in this area of medicine when the call to do something, fix this problem, was fresh. However, for a few years now, rather than suggesting to him that urgency would soon lead to solutions, Chen had come to understand upticks in media coverage as signs of slow news cycles, lulls in other rhythms of public outrage, or a transient absence of political scandal.

When massive wildfires were doused to coals, when protesters were on intermission, when deadly epidemics retreated, and following the climax of sports playoffs, journalists could turn reliably to the opioid overdose statistics in order to summon shock, pity, unspoken disdain, and clicks. A Record-Setting Number of Deaths.

Chen's phone still glowed, the faces of the what-ifs.