It was not until her third month of feeling unwell, in the fall of 2016, that Alicia thought to take an at-home pregnancy test. Until then, she assumed her fatigue and nausea were withdrawal symptoms from the Percocets she’d been dependent upon since the year before. “When some days you don’t get enough, you could definitely throw up or wake up feeling sick,” she told me. “It was easily confused with morning sickness.”
Alicia, who asked that I use her nickname to protect her privacy, was 26 at the time, living with her boyfriend in a tiny apartment just outside Providence, R.I. From the start of their relationship, she had been inspired by his seriousness; he had a job in I.T. that paid $20 an hour. Unlike some of her previous boyfriends, this one wore collared shirts to work and did not use drugs. He had a gangly earnestness that was endearing. “He grew up as a good boy,” Alicia told me. “He did what was right, and he was smart. I wish I could have been like that.”
She had struggled with drugs and alcohol since age 15. Family life was often painful; her father, a mechanic, was an alcoholic (he quit drinking years ago); she has a mentally ill sibling; and her mother, a secretary who later went back to school and became a corporate manager, held the family together in a suburb outside Providence. As a teenager, Alicia was shy and often depressed — afraid of saying the wrong thing and looking foolish. “All of this paranoia and social anxiety, it made me very worked up,” she told me last May. “I could never look normal in a social setting.” At 15, she discovered that being high made her loose and funny. “I had my first drink, I tried weed, I had my first cigarette,” she told me. “I was able to go out and hang out with people. I wasn’t isolating myself and staying home. I created a whole new personality of me.” As an older teenager, she began taking the bus into Providence and hanging out with a crowd of drug-using adults, many of whom were homeless. “After 18, 19, I felt like, Whoa, I don’t even know who I am without using stuff.”
Around that time, she got what she called a “dream job” at a Macy’s Clinique counter, but she was fired for chronic lateness. She had fallen into abusing synthetic marijuana (plant particles sprayed with chemicals), known in Providence as “monkey.” At her parents’ insistence, she underwent a seven-day inpatient rehab; later, when she was 22, they sent her for a second, longer rehab for excessive drinking. Toward the end of the 18-month period of sobriety that followed, she met her boyfriend and moved with him into his parents’ house. She was 24; he was 28. He encouraged her to apply to cosmetology school, and she arranged for student loans and enrolled in a two-year program. She saw a psychiatrist and was prescribed medication for her depression and anxiety, as well as for obsessive-compulsive disorder.
But other struggles persisted. She had a habit of picking at small lesions on her skin, which, early in her new relationship, worsened a staph infection she acquired from sharing makeup. Alicia went to the emergency room twice, but even as she wept from the pain, “in the back of my head I remember thinking, I wonder what they’ll give me?” She left the hospital each time with a prescription for five-milligram Percocets: oxycodone mixed with acetaminophen.