Nevada

Nevada is presented as a distant destination to which Tess Henry and the people trying to help her repeatedly turned when treatment in Virginia seemed out of reach. It offered the possibility of another residential-care attempt, but distance could not remove the financial, medical, and logistical barriers surrounding that attempt; Las Vegas ultimately became the setting of Tess’s death.

A destination for treatment

By early 2017, Tess was back in a local hospital’s psychiatric ward. Hope Initiative volunteers Jamie Waldrop and Terrence Engles were trying to arrange admission to a long-term rehabilitation center in Nevada, but the plan depended on a bed being available as soon as Tess left the hospital and on finding $12,000 beyond the remaining money in her college fund. Her mother, Patricia Mehrmann, considered asking Tess’s eighty-five-year-old grandfather to release part of her inheritance early, reasoning that the money could not help Tess if she died.

The transfer required practical steps as well as funding. Tess had lost her identification, so Patricia persuaded a hospital employee who was also a notary to make a temporary replacement. On February 26, 2017, Engles coordinated the handoff from the hospital to a cab bound for the airport. The Nevada center did not accept patients receiving medication-assisted treatment. Tess had stopped taking Suboxone months earlier, after losing Medicaid coverage when her son was removed from her care, and was mostly using crack and heroin.

Treatment and the limits of access

Nevada was not a first, guaranteed solution but another turn in a long sequence of treatment attempts. The book contrasts Tess’s planned transfer with the care she had received during pregnancy at the Life Center of Galax, one of the few Virginia facilities that accepted patients on medication-assisted treatment. There, she had taken Subutex. By the time the Nevada transfer was arranged, however, she was no longer taking Suboxone, and the destination’s exclusion of patients on medication-assisted treatment narrowed the available options further.

The barriers were not simply a matter of willingness to enter treatment. Tess’s earlier care had involved substantial costs, while access to medication-assisted treatment could require expensive cash-only appointments and long waits. After losing her coverage in Virginia, she later applied for Medicaid in Nevada, a state that had expanded Medicaid eligibility in 2014 under the Affordable Care Act. The account does not establish what coverage she ultimately received; it places the application within her continuing search for treatment and support across state lines.

A second Nevada plan

The first Nevada attempt did not end Tess’s search. In the fall of 2017, after learning that local medication-assisted treatment remained difficult to access, Patricia contacted the Roanoke Community Services Board and was told that its limited expansion was then accepting only pregnant women. Soon afterward, Tess messaged the reporter from another person’s phone at four in the morning. She said she planned to enter another Nevada rehabilitation program and asked for books to read there.

Tess had no address at which to receive them and promised to provide one after checking into rehab. Her grandfather agreed to fund another treatment attempt, though he had recently wired her $500 after she said it would pay a friend to drive her back to Roanoke. Patricia believed Tess’s explanation was probably a pretext to obtain money for drugs, but she was also encouraged that Tess had reached out to family and the reporter and had updated her Facebook page with pictures of her son. At that point, the family did not know that Tess had applied for Nevada Medicaid. The second proposed admission remained a hope, not a confirmed arrival.

Las Vegas and the ending

By the time Warren Bickel learned that Tess was still in Las Vegas, she was homeless and relying on sex work to obtain money for illicit drugs. His concern arose in a discussion of treatment: he described evidence that buprenorphine could protect people from overdose and called attention to how little that evidence had changed practice. Nevada, in this part of the narrative, is no longer only a destination for rehabilitation; it is also where the consequences of interrupted treatment and unstable access had become visible.

On Christmas Eve, a homeless man looking for cans found Tess in a dumpster at an apartment complex in central Las Vegas. The morning after Christmas, police traced her identity through her fingerprints and tattoos, and Patricia received the call. The book reports that Tess had been murdered and that the cause of death was blunt head trauma. Her death brought the Nevada thread to a close without resolving the uncertainty that had attended each treatment plan: whether another bed, another transfer, or another attempt could have changed the outcome.