“Fine, what do you want me to say? Yes, it was me. I took them.” She sighed, her eyes glittering with tears. She dabbed at them with a tissue. “But I’m not a junkie, I swear. I just take what I need to manage my condition.”

“What condition?” I couldn’t remember Julia being sick once in the time I’d known her.

“I have lupus.”

I was stunned. Like other autoimmune diseases, lupus caused the body’s immune system to attack its own tissue and organs. It caused excruciating joint pain, stiffness, and swelling. Julia was energetic, bubbly. I’d never have guessed at her pain. Maybe doctors thought we knew what people were going through, that we could read the signs and symptoms, but maybe in the end we were just guessing.

“Your wrist.” My eyes flew to Julia’s bandaged wrist, remembering how she’d blamed the pain and stiffness on carpal tunnel syndrome.

“Yes. It’s advanced to lupus arthritis.” She smiled sluggishly. “Here, let’s sit.”

Julia walked unsteadily toward the living room, tipping abruptly to the right and almost falling. The immediate high evident in her speech and movement came from crushing and snorting the pills instead of swallowing them. It rendered the extended-release mechanism obsolete.

“Come on.” I curled my hand around her elbow and helped her to the living room. We sat on an overstuffed couch offset by blue-and-white-striped cushions. The living room was a small but neat space with rich wood panels, antique furnishings, oatmeal-colored area rugs, and a box-beam ceiling. The tiled fireplace opposite was covered in candles of every size and shape.

Julia leaned her head back and closed her eyes. She sighed as the drug wound through her system, her whole body limp as an old washcloth. When she spoke, her voice was soft and dreamy.

“I was diagnosed with lupus when I was sixteen. My older sister had it too. We both lived with chronic pain our whole lives. Stephanie, my sister, she lost her hair, her body broke out in rashes. The pain was constant. She killed herself two years ago. She couldn’t cope anymore.”

“I’m so sorry,” I murmured. “Is that why you moved here?”

I’d only lived in Skamania for a year when Julia arrived; being the new person in a small town was one of the things that had bonded us.

She nodded. “Yes. I wanted to start over. And I was doing really well. I’d been put on a low dose of OxyContin to help the pain, and it made my life manageable. Under normal circumstances I couldn’t work at the clinic, I couldn’t see patients or go grocery shopping, or even get out of bed some days. I wouldn’t be able to work. I would lose my home. But the oxy allowed me to reclaim my life.”