The Pastoral Clinic: Addiction and Dispossession along the Rio Grande

John is the first patient at the heroin rehabilitation clinic that Garcia introduces to the reader. Garcia sits on the front porch of the clinic with John and two other patients. They eagerly await their next dose of medication, so Garcia suggests going for a stroll to keep their minds occupied. The others fall back, but Garcia walks with John to the Rio Grande where they find a heroin cooker and syringes. John declares that the river is dead. Later that day, he checks himself out of the clinic and is arrested the following morning.

John’s story is an important introduction to Garcia’s work. His declaration that the river is dead causes Garcia to wonder if his story may have changed if the river had been found vibrant and alive. John helps Garcia see the complexities of drug addiction and how it is tied to history and loss. John recalls the river of his youth—one teeming with animals and beautiful water. The dried-up river surrounded by debris is a reminder of what has been taken away, a visible marker like the descanos. Garcia proposes that this continued reminder of loss helps to underpin heroin addiction.

Patients and workers at Nuevo Día warn Garcia about a particularly difficult patient named Lucretia who is about to be admitted. When she arrives, Lucretia is covered in dirt and her own feces. While helping Lucretia take a bath, Garcia listens to her repeated cries that the treatment will not work. She has experienced detoxification multiple times, but her grief is too strong for her to maintain recovery. After one night, Lucretia checks herself out of the clinic. In a handwritten note, she cites the death of her daughter and begs to be left alone to die.

Garcia runs into Lucretia months later. She invites Garcia into her home and then gets high while she is interviewed. Lucretia lost her husband to an overdose. Although she tried to seek rehabilitation for herself, she was placed on a waiting list. Lucretia was found unresponsive in her hotel room while her daughter cried nearby. The loss of her daughter and husband intensifies Lucretia’s drug use. Garcia uses Lucretia’s story to contextualize how individual loss is combined with other types of mourning to create a framework for drug addiction. Her story also symbolizes the hope that can be found in reclaiming the past. Lucretia’s one moment of joy is looking at the mountains through the hotel window—the mountains of her childhood—underlining The Connection Between Land, Loss, and Experience.

Alma’s story is revisited multiple times throughout the work and exemplifies many of the themes of The Pastoral Clinic. After being brought to the hospital after an overdose, Alma is admitted to Nuevo Día for the second time. Alma’s recidivism helps Garcia to understand how framing addiction as a chronic illness contributes to a never-ending cycle of recovery and relapse. Alma also causes Garcia to consider how staying rooted in past grief and loss is perpetuated by institutionalized care and contributes to this pattern.

Alma shares with Garcia that after her sister died in a car accident, she felt guilty. Her sister was not a drug user, and Alma felt that she should have died instead. After her sister’s death, her heroin use increased. She implies that she used the drug, intending to die by suicide. For a while, Alma maintains sobriety with the help of an evangelical group that focuses on being born again and leaving the past behind. However, when she reunites with her estranged husband, she begins using heroin again. After Alma dies of an overdose, her husband shows Garcia Alma’s descanso, a small cross with syringes affixed to it, left on the site of her ancestral home.

In Chapter 3, Garcia introduces two mother-daughter pairs to explore both the relationship between kinship and drug use and the unique experiences of women with drug addiction. Eugenia and her daughter, Bernadette, lead Garcia to questions about how families provide both care and harm. Bernadette idealizes her relationship with her mother and avoids casting judgment about her drug use or choices. Garcia learns through multiple medical records and interviews that Eugenia began using heroin first when her daughter was 12, possibly after an experience with domestic violence. Watching her mother suffer from withdrawal symptoms, Bernadette soon helped support her mother’s habit by calling friends, asking for help, and selling furniture to buy drugs.

Bernadette tells Garcia that she began using heroin with her mother at age 16, but Garcia determines that their use together likely began when Bernadette was only 12. While Bernadette is under house arrest, her parole officer tells her to stay away from her mother. Bernadette is later put in prison, and Eugenia refuses to visit her. When Garcia visits the Española Valley years later, she runs into the mother-daughter pair and notes that they are using heroin again.

In Bernadette and Eugenia’s story, Garcia learns most of their history from the daughter. In the example of Lisa and Michelle, Garcia receives the history from the mother, Lisa. Garcia first meets Lisa at the clinic after Michelle died of a heroin overdose at age 25. Lisa feels she is judged by the other women in her recovery group. Garcia determines that their animosity toward Lisa is driven by their own loss of loved ones. Many of the women in the group are estranged from their children because of drug use and incarceration, while Lisa’s daughter's death is considered a more “legitimate” form of loss. Garcia is repeatedly frustrated with Lisa, who frequently lies and changes her story and continues to use heroin after her daughter’s overdose.

Lisa describes feeling relieved when she learned that Michelle had begun using heroin because she no longer felt she had to hide her drug use. She felt a sense of solidarity with her daughter in their shared addiction. When Michelle overdosed, she had handwritten the Lord’s Prayer and stuffed the piece of paper in her pocket. Lisa remains insistent that Michelle did not intend to die when she took heroin, cocaine, and prescription medications together. She wonders aloud what the note in her daughter’s pocket may have meant. Garcia asserts that Michelle’s return to the Española Valley right before her death was born out of a desire to be close to her mother, knowing that she intended to die by suicide.