By day, she's a tough-minded prosecutor in Raythune County, West Virginia, a region scarred by poverty and prescription drug abuse. By night, Bell Elkins takes on a softer role. She volunteers at an auxiliary intensive care unit where nurses deal with the youngest and most vulnerable victims of drug abuse: the children born to mothers addicted to painkillers.
The place is known as Evening Street, and it is here Bell comes whenever she can spare the time. She rocks ailing infants to sleep, and she provides what medical science-for all of its marvels-cannot: A simple human touch.
One terrifying night, the distraught father of an Evening Street baby breaks into the facility. Gun in hand, he holds the staff hostage and demands a reckoning for a family grudge--with helpless infants only inches away.
And so begins a standoff at Evening Street. Bell Elkins is swept up into the crisis, as the drama escalates toward a lethal flashpoint. At the center of it all is a baby, only hours old, but already ancient in his knowledge of pain.
About the Author
Julia Keller, winner of the Pulitzer Prize and former cultural critic at the Chicago Tribune, is the author of many books for adults and young readers, including A Killing in the Hills, the first book in the Bell Elkins series and winner of the Barry Award for Best First Novel (2013); Back Home; and The Dark Intercept. Keller has a Ph.D. in English literature from Ohio State and was awarded Harvard University’s Nieman Fellowship. She was born in West Virginia and lives in Ohio.
Read an Excerpt
A Bell Elkins Novella
By Julia Keller
St. Martin's PressCopyright © 2015 Julia Keller
All rights reserved.
I am moved by fancies that are curled
Around these images, and cling:
The notion of some infinitely gentle
Infinitely suffering thing.
— T.S. Eliot
It was a good place to go at the end of a long and complicated workday. Not because it was a happy place — God knows it could never be that — but because it instantly sucked all the self-pity out of you, and the petty complaints and minor frustrations, too.
Step through the door and they disappeared. Just like that.
This place was — this place had to be — about other people. It forcibly eliminated the self-indulgence of introspection. And for Belfa Elkins, who looked too long and too often into her own soul, yet had always felt unable to stop, this place was a bracing tonic and a stern corrective. She would never have described it that way out loud, but that was what it was. It provided a rugged sort of solace, and it restored perspective. It cleaned the slate. It cleared her head.
It was called Evening Street.
This was the place where they treated the babies who were born addicted to narcotics. Their mothers were addicts, and a nasty little corollary to addiction was that when you had a baby growing inside you, the baby came along for the ride. The baby had no choice. She was addicted, too. Before that new human being had even crossed the threshold of her mother's body and emerged into the world, she was saddled with a grievous burden.
The year before, the Raythune County Medical Center had run out of space in the neonatal intensive care unit because of all the babies born addicted to opioid painkillers. More and more and more. Each year, the number rose. Addicts' babies were crowding out the babies born with other needs, other maladies.
The solution had come from Henry Smathers, a retired tobacco broker who'd made his fortune from another kind of addiction. Compared to pain pills, cigarettes seemed courtly, benign. They were hardly benign. But they did their damage stealthily, over the long haul. It was easy to ignore it. For a while.
Smathers donated a yellow-brick warehouse that his company no longer used. The warehouse was located at the far end of one of the scruffy side streets of Acker's Gap, West Virginia, a long stretch of empty storefronts and heaved-up sidewalks and burnt-out streetlights known as Evening Street. Smathers also paid to have it remodeled into a specialized medical facility, a clinic that would treat the newborn babies who suffered from the effects of their mothers' addiction. This is where Bell went at the end of her workday, whenever she could.
"Hey, there," said Lily Cupp. She said it softly. She was the head nurse here, and in her arms she was holding an impossibly tiny infant swaddled in a light yellow blanket. The baby's eyes were closed. He opened his mouth over and over again, like a frantic goldfish missing the water, but he wasn't crying.
"Hey," Bell replied.
It was 7:20 P.M. Bell had just arrived in the large square room dotted with basinets. Each small bed was connected to stacked rows of talkative monitors and serious-looking equipment. The overhead lights in the drop ceiling were dim, so that the infants wouldn't have to squint up into the harsh glare, but the space was still well illuminated by the lights on the machines.
Bell had walked over here from the Raythune County Courthouse. At the checkpoint just inside the front door, the guard, a burly man named Delbert Ryerson, had given Bell the once-over, paying particular — and particularly disgusting — attention to her breasts, and then waved her on through. He'd pushed a button under the desk to release the lock. Ryerson's head was as thick and fibrous-looking as a root vegetable, and his tiny gold spectacles were almost lost amid the folds and pinched-fat creases of his face. He was, Bell recalled, related to somebody. Somebody with influence. That's how he'd gotten this job. Such was the usual hiring routine in these parts, she knew; the very few new jobs that ever popped up were almost always spoken for, earmarked for somebody's brother-in-law. She even called it that: the Brother-in-Law Factor. Ryerson might have been qualified for security work, but if he was, you could chalk that up to sheer coincidence. The Brother-in-Law Factor was the salient reality that had netted him this job. Not competence.
On her way in, Bell turned her cell to vibrate. Lily strictly enforced that rule. The infants needed calm and quiet. They also needed — more than medicine, perhaps, more than machines — skin-to-skin contact.
"This is Abraham," Lily said, holding up the tiny bundle. "Two days old. Abe, say hi to Belfa Elkins. She's our prosecuting attorney. Don't get into any mischief if she's around — that's my advice, mister."
Bell leaned in to look. The infant resembled a famished old man. His wrinkled skin was an odd gray color. It was the shade of a newspaper left out in a rainstorm.
Abraham began to shake violently. At first, Lily tried to hold him steady, but it wasn't working; the child's shaking intensified. And then, even more suddenly, the shaking stopped. His tiny head reared backwards, and his limbs froze in place.
"Can I do something?" Bell said.
Lily ignored her. She walked quickly across the floor and settled Abraham in his basinet. She prepared an IV.
Someone else spoke. "He's having a seizure."
Bell turned. She hadn't seen the second nurse approaching, and the sentence took her by surprise.
"It's pretty common," the nurse added. "With these babies, it happens all the time."
Bell nodded. "I know. Unfortunately, I've seen it before. I come by as often as I can." She put out a hand. "You're new. I don't think we've met. I'm Bell Elkins."
"Oh, right. Lily told me about you. The prosecutor, right? I'm Angie Clark."
"How long have you worked here?"
The woman looked down at her wristwatch. "About four and a half hours."
"Wow — you really are new."
"Yeah, first day on the job. There's a lot of turnover. Some people just can't take it — watching newborns suffer like this, from all the drugs they've been exposed to in the womb. You feel so helpless. So useless. But I guess you know that. You've seen it yourself, visiting regular like you do."
The nurse was about thirty, Bell guessed. She had sallow skin, short straight dark hair, red glasses, and a solid, thick-thighed physique. Her blue scrubs were about one size too small for her.
"I have," Bell said.
"Want to sit?" Angie gestured toward the row of black folding chairs along one wall of the large room. "Lily might be a while. Abe's got serious problems. Diarrhea. Irritability. Dehydration. He can't sleep, either. I know it's a terrible thing to say, but sometimes I think he'd be better off if —" She bunched up her mouth into a tidy frown, letting silence finish the thought for her. Then she sighed a grave and heavy sigh. All of it struck Bell as theatrical. There was something about this new nurse that she didn't much like.
Bell walked over and sat down in one of the chairs. Angie went with her. There were several rocking chairs on the opposite side of the room, and that was where Bell usually spent her time when she was here; Lily would pick out an infant and bring her or him over, settling the child in Bell's arms. Bell would rock back and forth, humming, talking softly to the wizened lozenge of flesh, flesh that might be black or white or brown. Mostly she murmured vague words of encouragement such as "There's a good girl" or "You're going to grow up to be big and strong and smart, aren't you," but sometimes Bell ran out of words. If the day had been long and demanding, if she'd had to spend a lot of it talking, she couldn't find any more words. She felt as if she'd used them all up. She needed to say something, though, because it was important for the babies to hear loving human voices, and so Bell would revert to sentences she knew as well as she knew her own name, adding softeners at the end of a curt phrase: "You have the right to remain silent, you precious thing, you. If you give up that right, anything you say can and will be used against you, punkin. In a court of law, sweetie."
At the moment, though, Lily was too busy with Abraham to set her up in a rocking chair with another infant. Bell would have to wait.
"Hope I'm not keeping you from your work," Bell said to the new nurse. Because I'd rather you just went away, she added to herself, wishing she had the guts — and the bad manners — to say it out loud.
"Oh, no problem. I'm on a break," Angie replied breezily. She thumped down in the adjacent seat. "And I needed it, you know what I mean? We've been swamped today. We got two more this morning. A little girl named Marie Christine and a boy named Tyler. Funny — these mothers always have the names all picked out. They practically inhale those drugs and they guzzle alcohol all through their pregnancies, and it's pretty obvious they don't give a shit about anything but the next party — but by golly, they know what they're going to name that baby, don't they? First and middle." She could speak freely because none of the mothers was present now.
When an expectant mother going into labor admitted her drug dependency, the paramedics automatically brought her to Evening Street for the birth, so that treatment for the addicted newborn could begin right away. Not every mother acknowledged her problem up front; sometimes the baby's addiction was discovered only after the birth. Even then, some mothers still denied that they'd ever used drugs. They would feign shock and astonishment at the news that their child exhibited symptoms of drug addiction. Even with evidence so brutal and absolute, right there before them — a sick, trembling, vomiting, severely underweight newborn with mottled skin and with a preloaded sadness embedded in the eyes — some mothers would still rant and scream and claim they were clean. It was the doctor who'd hurt the baby, they'd insist. Had to be. It was the doctor, dammit. And that witch of a nurse. I'm going to sue. I'm going to own this fucking place and all of you fucking fuckers. You watch me.
But when the mother's addiction was known in advance, she was brought to Evening Street. There were two rooms in the back of the facility that served as mini-ERs, where the on-call obstetrician would do her work. Afterwards, the mothers were ferried back to the main hospital. They could visit their children in a day or so, once the immediate medical crisis was over.
Sometimes, Bell knew, the mothers didn't show up back here at all. Ever. It wasn't that they didn't love their babies. She'd never believe that. They didn't come, because they were ashamed of what they'd done. Ashamed to touch their babies. They were deeply regretful about the suffering they had inflicted upon a guileless child, and the permanent deficits with which that child would now have to reckon. Often, the mothers didn't know how to handle the intense, overwhelming emotion — the gut-punch of self-loathing — that joined with the usual hormonal surge following childbirth. They couldn't look at the living results of their selfishness.
So they did what they'd always done: They panicked. They did whatever they could do to hide from those feelings. And they ran.
"What's the deal with Abraham?" Bell asked.
Angie shook her head. "Poor kid. Lily says he's one of the worst cases she's seen in a long while. The father's a worthless scumbag. The mother's a wreck — she bounced back and forth between OxyContin and black tar heroin during most of her pregnancy. Future's pretty bleak for that kid. Sometimes you wonder if he might be better off if he didn't —" Angie shuddered. "If we could just get these women to listen."
Bell nodded. She'd had the same desire. Sometimes you wanted to shake the addicted mothers, to get in their faces and scream and threaten. You've got a child to care for. A human being that you created. You've got to take some responsibility.
But that never worked. If she got to know Angie Clark better, she'd explain it to her: No amount of shaming did the trick. Leave the intervention to the experts — the doctors and the social workers. The focus at Evening Street had to be on the infant.
There were times when the county was forced to file suit to have a child removed from the mother's custodial care. Child Protective Services would present the evidence, and Bell signed off on the order. Some mothers acquiesced without a fight; others grew combative. On certain days, Delbert Ryerson had his hands full out in the lobby, trying to keep an angry, guilt-gripped mother away from the very sick child she'd just given birth to, while the court completed its investigation. Fathers, too, had been known to show up here, fists held high, fire in their eyes, demanding that the Evening Street nurses hand over their kids.
But that's not why Bell came by here as often as she did. She didn't come as a prosecutor. She came to hold the infants for an hour or two, and to move gently back and forth in a rocking chair while she held them. She came to offer them, inside the circle of her arms, for as long as she could, a safe place.
"So how will you do it?" Bell said. "Deal with everything you'll be seeing here, I mean."
Angie shrugged. "I worked in oncology before this. At a hospital over in Charleston. I got used to lost causes, you know?" She thought about her answer, and amended it. "But this is different. Grant you that. I mean, cancer comes, and it's sad. You can't do much about it. Not with kids. It's not like adults who get lung cancer because they've smoked four hard packs of Marlboros every day since 1979. Or pancreatic cancer from drinking a six-pack every night. No, with cancer, the kids are the innocent victims of fate." She stirred in her seat, rearranging herself. "With this — with these kids born addicted to drugs — fate's in the clear. It's the mothers who are to blame. And the fathers, too. Let's not forget the fathers. I mean, a lot of these guys, they know what the woman's doing. They see her using, all during her pregnancy. And they don't do a damned thing to stop her, even when she's pregnant. Because they don't want to lose their drug buddy, you know? Then the kid's born — and all the sudden, Daddy's mad as hell at the mother. Because of what she's done to his child. I've seen some fathers cuss out their women, just rip 'em a new one, right in the middle of the maternity ward, for all the world to hear. Calling them every bad name in the book. It's scary as hell, all that out-of-control ranting and raving and threatening. Can't imagine the emotional impact that has on a child. You know what? Some of these folks don't deserve to be parents."
Angie stood up. Bell had been listening so intently, and thinking so deeply about the words she was hearing, that the sudden motion startled her.
"Back to work," Angie said. "I don't like to sit around, but Lily insists on break time. She says we have to get away for a few minutes every couple of hours. To keep us going."
No one could endure the steady diet of sadness that was endemic to the work here at Evening Street, Bell knew. She'd discussed it with Lily. Breaks were not just a good idea; they were as essential as oxygen. And because Bell had been coming so long, she knew what lay upon this night's horizon: Abraham would receive a dose of methadone. The drug was necessary to lessen his withdrawal symptoms. Abe was paying the price for the drug dependency his mother had given him, just as surely as she'd given him her blue eyes and her snub nose.
Bell remembered the first time she'd seen Lily administer methadone. It seemed, on the face of it, unimaginably cruel and counterintuitive: to put into the body the kind of substance that had done the damage in the first place. But it was the only option. Without the drug, the child would be going cold turkey, in effect, and the shock to the system could be lethal.
The procedure had often struck Bell as a bleak metaphor for the prosecutor's role in a place like Acker's Gap: Sometimes you had to do harsh things in order to achieve desirable ends. Ugliness and beauty shared the same road around here. Anguish and joy traveled side by side, and sometimes, in the dark places that lived between the mountains, it was hard to tell them apart.
Excerpted from Evening Street by Julia Keller. Copyright © 2015 Julia Keller. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Teaser from Sorrow Road,
About the Author,
Also by Julia Keller,