It began with a broken ankle.


He should have used a stepladder to reach whatever it was he was reaching for, and he knew that, but the nearby stool offered a quicker solution.


The fall wasn’t steep, not nearly his height. Had he been able to turn in mid-air, maybe even a half-inch, or taken the tumble on his arm or shoulder, or his bottom; or had the top kitchen shelf been but inches nearer, perhaps there would have been no damage. After all, he was young — in his thirties — and healthy, his build appropriate to his age. But the ankle has little muscle and no fat to buffer it. A measure of its vulnerability is the tape shielding the cluster of malleoli and related bones of athletes in a dozen sports.


The pain was immediate and intense, the emergency room doctor’s first priority. The needle brought quick relief, resolving a temporary issue but creating a nightmare that persists to this day.


The severity of the fracture dictated surgery rather than simply a cast. Before an orthopedic specialist could schedule the procedure, however, there was the continuing pain to manage, but that was manageable. Take one capsule every four hours, or “as needed.”


As far as the man’s family and friends know he had never “needed,” never ventured beyond some occasional undergraduate marijuana, and a fraternity beer bust or three. He was a social drinker: a couple of brews at a ball game, sometimes wine at dinner, every so often a cocktail after work with associates, and never a problem. He was a valued employee in a responsible position, performing important non-clinical tasks in a major Arkansas hospital, an environment not hospitable to impaired staff. Before and after the ankle operation he continued to work, arranging his duties to accommodate his handicap, which everyone assumed was temporary.


The longer, larger, life-threatening handicap slowly, steadily began to reveal itself. It was not mere discomfort but real pain, he told his doctor. The physician sympathized, initially, but soon grew concerned, then suspicious. X-rays confirmed the ankle was mending nicely, on schedule; at that stage others of identical injury with post-operative aches responded nicely to aspirin or ibuprofen.


Did he think he had a problem? the patient was asked. The patient replied, of course not. Then promptly found another doctor. And then another, and another, and another. If successive practitioners did not, could not, recognize the change in his personality, his demeanor, it was obvious to those closest to him. When they began asking questions he shut them out, sealed them off. When his supervisors discreetly inquired of his well-being, when they mentioned that the hospital offered an employee assistance program, he politely rebuffed them — until his job performance, his physical condition, his deportment, his grooming compelled them to order he take a drug test. He resigned rather than comply.


The doctors were catching on, began turning him away. Not that he was now uninsured, not just that; he had acquired the near-cadaverous countenance of the profoundly addicted. That which reputable physicians and pharmacies no longer would authorize or dispense, he discovered, was readily available from the disreputable among them. And from some other new acquaintances — shadowy men and women, some of them schooled in the unsavory science of “street script,” others with the product at the ready. In dark alleys connecting forbidding streets the man found the solution to his craving, though the solace demanded what small sums he earned from odd jobs; already it had consumed his typically insubstantial, thirty-something savings.


When his condominium was repossessed, his siblings — harried and exhausted from the burden their brother had become — allowed him residence in the home that had been their father’s, vacant since the latter’s move to a nursing facility. Scarce days later the fine old house was anything but vacant: neighbors complained to the man’s family, and to law enforcement agencies, of “undesirables” coming and going at all, but usually overnight, hours. Within weeks the structure was a shambles. Eviction was considered, guardianship contemplated.


The police arrived ahead of the lawyers. Next, what cops call jail-bail-fail: arrest and incarceration, then bonded release, then failure to appear in court. A sequence not infrequently repeated. And another: vows to obtain treatment, loans extended, promises abandoned, heartbreak anew.


In 2013, the latest year for which official statistics are available, more than 100 Arkansans died of opioid abuse. In the previous year, the state Health Department reports, Arkansas ranked 8th in the nation for opioid prescriptions.


The man stares back forlornly from the sheriff’s website, the saga of his chemical descent written in his face for anyone with Internet access to read. His kin comfort themselves: “At least he’s alive.” But only that, and only for now.