SOUTH CHARLESTON, W.Va. – The midmorning sun came in through the curtains, and Zaine Pulliam awoke to the debris of a weekend party. There were blankets strewn across the floor and half-finished plates of food on the couch. Zaine, 17, picked his way around a sleeping teenager and walked into the kitchen, where his grandmother was already drinking coffee. "Look at you," she said. "Long night?"
Madie Clark had allowed her three grandchildren to host a sleepover for friends the night before, and it had begun with pizza, Sunkist and board games. But eventually she had gone to bed, and now she could see a few beer cans and nicotine vaporizers scattered around the house. On the other side of the wall, in the bathroom, it sounded like a teenager was throwing up.
"You were being good last night, right?" she asked Zaine. "Nobody was driving? Nobody was acting stupid?"
"Of course not," he said. "We were fine. Everything was fine."
She looked at him and rolled her eyes. "Yeah, okay, Bubby," she said. "I trust you. But you're walking right up to that line."
Nearly everyone in Zaine's life had been anxiously monitoring that line for the past year and a half, ever since both of his parents died of heroin overdoses in April 2015. His parents had become two of the record 33,091 people to die of opioid overdoses that year in a national crisis that has been worst of all in rural West Virginia, where health officials estimate that overdose rates are now eight to 10 times higher than the national average.
Middle-aged white men in this part of the country have lost a full year of life expectancy during the past two decades. Middle-aged white women have lost more than two years. The opiate epidemic has essentially wiped out an entire generation of health advances, and now West Virginia has begun to focus more of its resources on prevention and preservation among the next generation entering into the void.
These children are sometimes referred to by health officials here as opiate orphans, and three of the most recent ones live in a small house in South Charleston: Zoie, 10, who believed that her parents had died in their sleep; Arianna, 13, who was just starting to wear her mother's old makeup; and Zaine, 17, who had been the one to discover his parents that morning on their bedroom floor, and whose grades had begun to drop ever since.
Now Zaine started to clean up the house, carrying plates from the living room into the kitchen. Every wall was decorated with pictures of his parents, Austin and Amanda. They had started dating during their freshman year of high school and stayed together for nearly 20 years, spending most of that time in this house. Their clothes were in the closet, and their old fish tank was still in the living room. Zaine dumped some fish food into the tank, and his grandmother tapped her hand against the glass to make sure a fish was alive. "Wake up, buddy," she said.
Madie, 53, had retired from her maintenance job at the public schools and moved into the house to help take care of the children after the overdoses. "Mah-maw," they called her, and she told salty jokes, cooked their breakfast and slept in Zoie's bedroom when the girl had nightmares.
But, on some nights, it was Madie who couldn't sleep, when neither her doctor-prescribed antidepressants nor her occasional swallows of Fireball whiskey could quiet her grief or her rising anxiety. She had once struggled with addiction herself before getting clean. She had raised a daughter who had become an addict. Now she was responsible for three more children in a place where that same disease had officially been classified as a "widespread, progressive and fatal epidemic."
"What's to keep these kids from getting over on me?" she sometimes wondered. "How do I know they won't go the wrong way?"
Now one of Zaine's friends was calling his phone. He answered and spoke in a whisper. He hugged Madie, told her he loved her and then said he needed to go.
"Go where?" she asked.
"I'll be back," he said. He started walking toward the door and grabbed her car keys.
"Don't you take my car," she said.
"Love you," he said, as he got into her car.
"When will you be back?"
"So many questions," he said, and then he smiled and waved to her as he drove away.
The most pressing question of all in the days after the overdoses was one that so many people here had begun to ask: What would happen to the kids? How could a generation of children in West Virginia overcome two decades of decay and despair?
The Kanawha Family Court, which lately had dealt with addiction and its impacts in about 80 percent of its cases, had begun considering some of the options available to the Pulliam children soon after the death of their parents. There was a great-aunt with whom the children had sometimes stayed during the summer, but she was already letting a few recovering addicts live in her basement. There was a grandfather in Georgia who thought he could help, so the court had sent the children to go for a trial visit, but they had gotten homesick and returned within the week.
So eventually it was decided that the best place for the Pulliams was where they had always been: in West Virginia, where overdoses were continuing to rise; and in Kanawha County, which had more overdoses than anywhere else in the state; and in a three-bedroom house where two of those overdoses had happened in the back room. Madie had moved into her daughter's old bed. The Pulliam children's other grandmother had become their legal guardian, paying their bills and inviting Zaine to live with her during the school week.
Theirs was a big, loyal family that had persevered for five generations in West Virginia. Seemingly every relative wanted to help, and each had a different idea of what the children might need. Maybe more toys and video games to provide distraction. Maybe occasional drug tests for Zaine to make sure he stayed clean. Maybe a strict 11 p.m. curfew. Maybe therapy and counseling. Maybe more hugs and constant affection. Maybe weekend hunting trips. Maybe a military-style boarding academy across the state. Maybe helping to spread information about the danger of addiction, and so now one of Zaine's relatives was pulling up to the house and telling him to get dressed.
"I want you to see the place that saved my life," said Scott Hudson. He was taking Zaine to a weekly meeting of about 100 addicts at a rehab facility in Huntington, an hour down the highway. "These guys have stories you should hear, and they should hear from you, too," Scott said.
"That's good if somehow I can help them, but it's not like I need to be scared straight," Zaine said. "I've already seen what happens. I would never put a needle in my arm."
"I know, buddy," Scott said. "That's exactly what I said. That's what everyone says."
They drove to Huntington down a winding road known to some locals as the heroin highway, passing chemical plants and coal towns where opioid pain pills had first become popular as a salve for workers enduring long days in the mines. But, during the past decade alone, 65,000 of those mining jobs had disappeared from the West Virginia economy, and now there was so much more poverty, pain and hopelessness to chase away. Drug companies had bombarded West Virginia's rural towns with record numbers of narcotics, according to court records: 300,000 tablets of hydrocodone to the mom-and-pop pharmacy in the town of War, population 808; half a million oxycodone pills to Kermit, population 400. During a five-year period ending in 2013, a single drug company had shipped more than 60 million doses of hydrocodone into a state with fewer than 1 million working-age adults.
Though hydrocodone was essentially the same drug as heroin, heroin was stronger and also cheaper to buy on the street. Now the heroin highway had billboards advertising rehab programs, suicide hotlines, clean needle exchanges and budget funeral homes.
"It's the West Virginia disease," Scott said as he drove. "You don't even know you've started and you're already spiraling down."
Scott often talked about his own spiral, which had continued for much of his adult life, from meth to pills to heroin. Only after his 34th arrest had he finally ended up at Recovery Point, a rehab facility run by former addicts in a converted elementary school. He had stayed for a year and remained clean for more than four years since.
Now he led Zaine into the meeting a few minutes late. The room was packed, so they grabbed extra chairs and squeezed in near the back. A recovering addict was telling a story about begging for money in his coal miner clothing. "I promised myself I wouldn't ever use a needle," he said. He finished his speech, and then Scott walked to the front of the room. Everyone already knew who he was. After he had gotten clean, he had walked around South Charleston in a shirt that read "Neighborhood Hope Dealer" and persuaded dozens of addicts to enter treatment. He had spoken at these meetings several times. "I lit myself on fire twice while I was high and kept using," he said. "I lost my kid. I got high around her. I thought she'd be better off without me. How many people have lost their kids to this?"
About half of the people in the room raised their hands.
"Come on. Don't lie to yourselves," Scott said, and another 20 hands lifted into the air.
"There's someone here who can tell you about what that does to a kid," Scott said, and then he pointed to Zaine. "Come on up here, Bud," Scott said, but Zaine shook his head. "Come on," Scott said again, but instead Zaine stood and walked out into the hallway to go to the bathroom. He could hear Scott stalling at the front of the room, telling the group about Zaine's parents and how they had been "high-functioning addicts." Austin had run the kitchen at a restaurant; Amanda had sometimes worked as a nurse aide and taught her daughters to play volleyball. They had been trying to get clean – always trying to get clean – and they had both gone away to detox early that April with plans to quit for good. But they couldn't afford to miss very many days of work, and they couldn't stand being apart from the kids, so they had come home early and then overdosed a few days later.
Zaine tried to slip back into the room. Scott noticed and pointed at him again. "Let's hear it for Zaine," he said, and when everyone started to applaud, Zaine walked to the front.
"It's a pretty normal story around here," he said, and then he started to tell them about Easter morning in 2015. It had been so quiet in his parents' room that morning, even though his father always snored. He had knocked on the door and gotten no answer. He had sent his sisters to wait in the car and then walked around the back of the house to look through a window into his parents' room. They were both lying on the floor. He thought they were passed out. He opened the window and leaned into the room to push over a fan, but his parents still didn't startle. He ran back into the house, called 911 and slammed into the locked door. He knew CPR. Maybe he could save them. He busted through the lock and fell into the room, landing on his father, whose body felt cold.
"It was a shock, but then again I always knew what they'd been doing, so it kind of wasn't," he said.
"If you don't think your kids know what's going on, they're smarter than you think," he said. "We might not be able to put words to it, but we feel it."
"It sucks. I know I'm trying to be positive, but I'm just telling you the truth. It's kind of hard to explain," he said.
There was one place where he did feel understood, so one Saturday night he rode out of town and up into the hills alongside the Big Coal River. He crossed an unsigned railroad track and turned down a dirt road that led to a small house guarded by a Rottweiler. His uncle, Zach, was standing outside near an aluminum garage, holding a saw in one hand and a nicotine vaporizer in the other.
"Hand me my drill, will ya?" he said, when Zaine got out of the car.
"Where is it?" Zaine said, kicking through a pile of tools on the garage floor.
He found the drill and then sat in a plastic chair to watch his uncle work. The garage was cold and dark except for the sparks flying off the drill. There was poor cellphone service, nothing to eat other than a few hot dogs and nothing to do except help his uncle repair old cars. But Zaine had been coming here almost every weekend since his parents' deaths. Out here nobody was asking him to spread hope or pass drug tests or be responsible for his sisters. There weren't so many questions, and he could sit with another relative who seemed as grief-stricken and uncertain as he sometimes was.
Zach had been two years sober and earning a good salary as a highly regarded mechanic until his only brother, Austin, died of an overdose. Now he said he was up and down, surviving on odd jobs and managing his way through addiction with a doctor-prescribed opioid called Suboxone. It dulled the cravings but didn't do much for the anger or the guilt. How many times had he gotten high with Austin and Amanda in that same bedroom? He had saved his brother in that room once after another overdose, giving him CPR until the paramedics came to revive him with an opiate antidote called Narcan. Now he wondered: Why couldn't he have been there to help again?
Zach set down the drill and lit a fire for warmth. The garage filled with smoke, but they stayed there anyway.
"I've been thinking about my worst memories with all of this," Zach said. "A lot involve you."
"Like what?" Zaine said.
"Mostly all those times you'd be sitting outside their bedroom and the door would be locked. We could hear you out there making noise."
"I was listening to make sure everybody was breathing," Zaine said.
"I hate myself for that," Zach said. "How early did you figure out what was going on?
"Probably when I was 10. Maybe 11," Zaine said.
"What kind of childhood is that?"
"It was mostly okay," Zaine said, because he had lots of good memories, too. His mother had made it to almost every school event, taken the children shopping for nice clothes and planned their annual summer vacation to the beach. His father had taught him jokes, introduced him to music, hired him at the restaurant and showed him how to cook. But, by the time Zaine was 12, he was also beginning to notice how his parents would sometimes nod off at the dinner table, and how his father's hands were bruising around the veins. Sometimes, when the refrigerator started to get empty, Zaine would ask neighbors for eggs, cook breakfast for his sisters and then walk them to the school bus so that they didn't suspect anything was wrong.
He was used to assuming responsibility for his sisters, so that Easter morning he had tried to take control, too. He had made sure his sisters stayed in the car. He had sat with his parents for six minutes while he waited for the paramedics to come, counting out his breaths and telling himself not to cry. He already knew they were dead, and he already knew what some people in South Charleston would say. Just addicts. Just a couple more overdoses. Nobody's fault but their own. So, while he waited for the medics, he had cleaned the drug residue off the bedroom counter and hid his parents' used needles in his shoe, hoping the police might mistake it for carbon-monoxide poisoning.
Soon after Zach learned of his brother's death, he had gone out to buy a pistol. He wanted revenge, but first he had to figure out whom to blame. Was it the dealers who were bringing heroin and pain pills to South Charleston? Or the rural doctors who had first prescribed those pain pills at record rates? Or the small-town pharmacies that had profited off extra-strength oxycodone and fentanyl lollipops? Or the drug companies that had increased sales of their opioids by marketing pain as the "fifth vital sign"? Or the politicians who had been slow to recognize a crisis and slower still to allocate adequate funding for treatment?
Eventually Zach had become so frightened by his own rage that he had given the gun to his mother. He had two daughters of his own, and he didn't want to spend his life in prison.
"As far as most people are concerned, drugs are just killing off the lower class," he said now. "Who's going to fix that? What do they care?"
"As soon as you're on drugs, it's like everything is your fault," Zaine said. "People think you're trash."
"You're a damn druggie. You're nothing."
Zaine wanted to be a welder. He was tall, muscular and congenial like his father, and he had always liked hard work. He had done some basic welding in high school and found that he was good at it. He wanted a union job that paid $20 an hour so he could buy his own house nearby. Maybe his sisters could come live with him. Maybe he could help take care of them as they finished high school. He was already beginning to worry that Arianna was withdrawing little by little to spend more time with her friends.
"It's on me to make sure nothing goes bad for them," he said.
"They'll be okay," Zach said. The garage was almost entirely filled with smoke now. He stood up to douse the fire. "They're smart and tough."
"They're Pulliams," Zaine said.
Maybe the only way for a generation of children to recover from a drug epidemic was gradually, by making one good decision at a time: a Saturday night. Another party at a friend's house. The parents were out of town and somebody had already gotten the beer. Zaine's girlfriend was on her way there, and she wanted him to meet her.
"You're going to be safe and smart tonight, right?" Madie asked him.
"Yes. Of course. You don't even need to ask that," Zaine said.
"You're a good kid, so make good decisions," Madie said, as she watched him grab his vaporizer.
"You're a good kid," she said again, as he stuffed a blanket into his backpack in case he decided to spend the night.
He hugged her goodbye and went out the door, and then the house was quiet. Arianna, the 13-year-old, was away at a sleepover of her own. Zoie, the 10-year-old, was finishing a board game. Madie walked into her bedroom, where sometimes she still thought she could see the imprint of her daughter and her son-in-law on the floor. She had moved the bed and switched around some of the furniture to make the room feel different. She never locked the door and always left it open.
Zoie came in and tugged at her leg. "Let's watch a movie," she said, and Madie sat down next to her on the couch. She pulled a blanket over her legs. She thought about Zaine at his house party and what it was like to be on the verge of adulthood at 17. She thought about everything that adulthood had come to mean in rural West Virginia.
They started a movie and watched it for a few minutes, until she saw headlights pulling into the driveway. Zaine got out of a car and came back into the house with his backpack. He had only been gone for half an hour. "What are you doing back here so quick?" Madie asked, and so he told her about the party. Too many people had come. A few of his friends had gotten into a fight. It had felt out of control and like a bad place to be.
"I'd rather just hang out here and watch TV," Zaine said, squeezing in next to them on the couch.
He reached for the remote and grabbed some of his sister's candy. He noticed that Madie was still staring at him. "What?" he said.
"Nothing. Just glad you're doing good," she said.
"I'm fine," he said. "What were you worried about?"