The Pastoral Clinic: Addiction and Dispossession along the Rio Grande

Nuevo Día is a heroin addiction clinic in the Española Valley surrounded by neglect and abandoned homes. Garcia emphasizes the importance of history, sharing that the clinic was formerly a state-run residence called Juniper Hills. Like Nuevo Día, Juniper Hills was underfunded and understaffed. One of the patients at Juniper Hills set the building on fire, forcing the clinic to close. Locals used the abandoned building to use heroin, taking advantage of the empty beds and deserted medical supplies.

Nuevo Día opened as a detox facility for individuals with heroin addiction and is unique in the region for its focus on mental health. Garcia works there from six in the evening to seven in the morning. During her first shift, Garcia notes in the daily log that every bed is occupied and that she is the only worker on the premises. For three hours, she deflects patients’ cries for medicine and anything else that might ease their suffering. When it is finally time for medication, Garcia administers the doses, and the patients go back to their beds. One patient named Peter does not seem relieved after receiving his medication.

As Garcia helps Peter take a bath with Epsom salts, the electricity in the clinic goes out. Then, she and Peter sit outside, huddled under a blanket together, talking until the dosing hour at two o’clock. The blackout thrusts Garcia into a new understanding of this world: “The blackout had a dramaturgical effect, amplifying the precariousness of the life of the addict, the vulnerability of institutional life, and the instabilities and anxieties of subjects caught within” (48). Her experiences with Peter make her feel uncertain about how close she should become to patients and about the blurry lines and subjectivity of responsive care. She realizes that it is impossible to render human experience into something entirely clinical.

Peter tells Garcia that he has gone to prison twice and drug rehab three times. His father died six months ago and was the person who first introduced Peter to heroin. Peter was determined never to try the drug, but the first time he met his father as an adult, his father offered him marijuana. When Peter told his father it tasted funny, his father told him it was laced with heroin. Peter shares with Garcia that he will finish his 30-day rehabilitation, but he knows he will continue using heroin once he is out. He explains that clinics like Nuevo Día do not consider how being surrounded by other drug users who are experiencing withdrawal impacts patients, nor do they consider what will happen to patients once they are released.

For patients, the clinic is purgatory, a space between the complications of their previous lives and the problems they will face in the future. When they leave, many patients will return to their old lives or face prison sentences. Although they are patients receiving treatment, their lives are highly monitored, and they recognize that they are a part of one institutional step in a long narrative of governmental control. One patient named Marcos shares with Garcia that after experiencing sexual abuse as a child, he got a tattoo of Jesus on his back to deter sexual assault in prison. At night, he sleeps in a closet out of fear.

Lucretia is a former patient at Nuevo Día who returns while Garcia works there. She is known for being a difficult patient; she is brought to the clinic by a law enforcement officer. As Garcia helps her remove her soiled clothes and puts her in the bath, Lucretia cries that the treatment will not work. The next morning, Lucretia is gone, leaving behind a shaky note explaining that the loss of her daughter is too great for her to overcome: “[L]ife is hell just let me go” (54).

Garcia runs into Lucretia months later and visits her at her home. Lucretia gets high while Garcia is there and tells her about the death of her husband due to a heroin overdose. At the time, Lucretia had nowhere to go; she wanted to get help for her addiction but could not afford the $50 self-admittance fee. Police officers found her in a hotel room, passed out from heroin use, while her daughter cried nearby. After so many failures and roadblocks, Lucretia felt that her life was over, and there was no reason to recover.

Lucretia’s loss of family and Peter’s introduction to heroin by his father reveal the importance of kinship within the region’s Latinx culture. Garcia argues that institutionalized care fails to incorporate kindship into treatment in a productive way, further alienating patients from their culture and potential for recovery. However, outside of the institution, family members are on the frontline, bearing the effects of loved ones’ heroin use. Free monthly trainings on administering naloxone to prevent overdoses are highly attended. However, just like the institutions that boast an antidote while providing unstable care, family life is inconsistent and unpredictable.