We titrated medications to help him weather his withdrawal, and soon he

could sit upright in bed. He sipped tea from a plastic cup, and talked about
his disdain for life on the streets.

“I know I can’t keep living like this,” he would say.

Yet he only spoke in euphemisms. A restlessness possessed him. He never

reclined into his pillow, but rather propped himself on his elbows, as if even
the sheets at his back disquieted him. Naïve and insecure, I kept our
conversations shallow.

“Since 1999, the number of deaths from opioids in

the United States has quadrupled.”
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When he accepted the social worker’s offer to review addiction centers, hope
leapt within me. Together, we pored over lists of treatment programs. We
talked about methadone regimens and counseling strategies. The morning
of transfer, we found him fully clothed, waiting for us. In my ignorance, I
beamed at him.

“I need to leave,” he said flatly. “How do I sign out?”

He resisted our urgings to stay. We had offered medications and counseling

centers, but missed something crucial, something that mattered more than
air. We ignored the pain that lurked within him — hidden, coursing to his
bones.