The clinic was above a feed store in a town called Hollow Creek, which was not on most maps and was on fewer people's minds. Dr. Will Harris had been here two years, which was the longest any doctor had stayed in Hollow Creek since the clinic was built in 1987, which was the longest anyone had stayed in Hollow Creek since the coal company left in 1983, which was the longest anything had stayed in Hollow Creek since the mountain started wearing down.

Will was thirty-eight and looked fifty. Not because of the work, though the work was heavy. He had worked in emergency rooms in Pittsburgh and Lexington and somewhere in between, and he had learned to separate the heavy from the unbearable. The heavy was patients who needed pills they could not afford. The unbearable was patients who needed pills and could not stop taking them.

Martha Cole ran the community center down the road from the clinic. She was fifty, with hands like shovels and a voice that could be gentle when she wanted it to be and sharp when she did not. She came into the clinic on a Thursday morning with a man she called her cousin, though Will knew from the records that they were not related by blood.

"This is Bobby," Martha said. "He has been coughing. And he is shaking."

Bobby was sixty, with a face that had been shaped by hard things and was now shaped by harder ones. His hands shook with a rhythm that Will recognized: withdrawal, or approaching withdrawal, or both. The cough was the other thing, the one that everyone in this part of the state had, the one that the doctors in Pittsburgh called pneumoconiosis and the people here called mountain lung, the disease you got from breathing rock dust for thirty years and then breathing heroin smoke for five.

"Let me listen to your chest, Bobby," Will said.

Bobby sat on the examination table and lifted his shirt, and Will put his stethoscope on the man's back and listened to lungs that sounded like gravel in a mixer. This was not going to be fixable. Will knew that. He knew it the way he knew that Bobby would be back in three days asking for something to stop the shaking, and he knew that he would give it to him, because that was what doctors did, and he was a doctor, even here, even in a town that the maps had forgotten.

"Your lungs are bad, Bobby," he said, after listening for two minutes. "Not fixable bad. But manageable bad, if you stop smoking and stop breathing dust and stop shooting up. And I know that is a lot of ifs."

Bobby looked at the floor. "I know, Doc. I know."

Martha stood by the door with her arms crossed, watching. She had been watching Will for two years, the way a farmer watches weather, trying to figure out if it is going to rain or if it is going to drought, if it is going to last or if it is going to blow over. Hollow Creek had had four doctors in ten years. Will was the fifth. She was keeping score.

After Bobby left, dragging his legs with the weight of a man who was already halfway to the next dose, Martha stayed behind.

"I need to talk to you," she said.

"About Bobby?"

"About everything." She sat in one of the two chairs that visitors could sit in, the other one being the stool Will sat on, and they were both uncomfortable by design, because comfortable chairs made people stay too long and in this line of work, nobody could afford for anybody to stay too long. "You have been here two years. That is longer than anyone else. Why?"

Will was filling out Bobby's prescription, a routine thing, morphine for the pain and something for the cough and something for the shaking that would not really stop the shaking but would make it quieter, and he did not look up when he answered.

"I live here."

"That is not an answer."

He finished writing and tore the paper from the pad and handed it to her. "That is the only one I have."

Martha took it and did not hand it back. "There is a woman down on Route 9, named Diane. She has been using for twelve years. Her kids are with her sister in Charleston. She comes to the clinic every week, and you give her prescriptions, and she leaves, and then she is using again, and then she comes back. And I watch this happen every week, and I watch it with the other people, and I am starting to think that what you are doing is not helping."

Will looked at her. For the first time in two years, someone had said it out loud. The people in the community center talked about it in private, in hushed voices, in the way people talked about things they were not supposed to talk about. The doctor was enabling them. The doctor was feeding the addiction. The doctor was part of the problem.

"I am a doctor," he said.

"I know what you are. I am asking what you do."

He thought about the answer he wanted to give, which was something about harm reduction and the disease model of addiction and the ethical obligation of physicians to treat patients regardless of the circumstances, and he thought about the answer that would actually help Martha, which was: I do not know. I do not know if it helps. I do not know if it does not help. I know that when they are in pain, I give them medicine. I know that when they are sick, I treat the sickness. I know that when they come back next week, I will see them again. And I know that is not enough, and I know that it is all I have.

"I treat them," he said finally. "That is what I do. I treat them when they are sick, and I treat them when they are using, and I treat them when they are dying. I do not decide which kind of sick they are. I treat all of them."

Martha was quiet for a long time. The feed store below them was open, and they could hear the sound of the radio playing country music, the kind of music that talked about trucks and dogs and mothers and beer and things that were real in a way that this town could no longer afford.

"I am not asking you to stop," she said. "I am asking you to think about what you are actually doing. Because I watch these people every day. I see them when they are at their worst. And I need to know if you see them too, or if you just see symptoms."

After Martha left, Will sat in his chair for a while, listening to the radio through the floor. He had medical school printed in his head, the ethical codes and the oath and the long list of things doctors were supposed to believe about their role in the world. He believed most of them. He believed them the way a drowning person believes in buoyancy, not because it is real but because it is the only thing left to believe in.

Sheriff Bob Gray came in that afternoon. Bob was sixty, with a face that had been sheriff for thirty-five years and had not changed much in that time. He was a good man in a bad place, which was the worst kind of man in the worst kind of place, because good men in bad places had expectations, and expectations were heavy.

"Will," Bob said, sitting in the visitor chair without asking. "There was a girl found in an abandoned trailer off Route 11. Twenty-two years old. Overdose. She had two kids."

Will felt something move in his chest, a small tight thing that he had learned to recognize. It was not grief, exactly. Grief was too big a word for what he felt. It was smaller than grief. It was the weight of a specific number: two kids.

"What is the girl's name?" he asked.

"Lindsey Cole. Martha's niece."

Will nodded. He had seen Lindsey once, in the clinic, when she had come in with a cut on her hand that she said she had gotten from a bar tab. Will had cleaned it and stitched it and asked her nothing, because he had learned not to ask, because questions in a place like Hollow Creek were a form of violence.

"Did she have a family?" he asked.

"Two kids. Martha is taking them. They are six and eight. Martha is--" Bob stopped, the way people stopped when they were looking for a word that did not exist. "Martha is doing what she has always done. Carrying things that are not hers."

Will stood up and walked to the window. Outside, the mountain was wearing down, slowly, invisibly, the way mountains do when they are older than the people who live under them. He thought about Lindsey, twenty-two, dead in a trailer, with two kids and a cut on her hand that she had gotten from something that was not a bar tab. He thought about Bobby, with his lungs full of rock dust and his hands full of shaking. He thought about Martha, carrying things that were not hers, the way good people carried heavy things in places where heavy was the only thing that existed.

"I am going to the trailer," he said.

"Will, there is nothing--"

"I know there is nothing. I am going anyway."

He drove to the trailer on Route 11, the kind of drive that took twenty minutes and felt like twenty years, past abandoned houses and closed businesses and churches with no congregation and stores that sold only liquor and bait and nothing that sustained life except in the most immediate sense. The trailer was in a clearing, surrounded by trees that had stopped growing ten years ago and were now just standing there, waiting for something to happen.

He went inside. The room was small, with a single bed and a kitchenette and a bathroom that was visible from the door. On the bed, a body that had been twenty-two and was now just a body, the way all bodies were in the end. He did not touch it. He did not need to. He had seen enough bodies to recognize what they were telling him, which was: this happened, and it will happen again, and nothing will change.

He stood in the kitchenette and looked at the counter, at the things that a twenty-two-year-old kept on her counter when she was trying to live and trying to die at the same time. Pills. A spoon. A lighter. A photograph of two children, a boy and a girl, smiling in front of a Christmas tree that was probably fake and probably from a thrift store and probably the best Christmas they had ever had.

He picked up the photograph. The boy had his eyes. The girl had Lindsey's mouth. He put the photograph in his pocket and walked back to his truck and drove home and sat in his kitchen and held the photograph of children who would grow up in a house that was not theirs and with a woman who was not their mother but was the only thing they had left.

The next morning, he opened the clinic at seven and saw three patients before nine. All of them were using. All of them were sick. All of them were human. He treated them the way he treated all of them, with the same hands and the same attention and the same quiet certainty that treating was the same thing as caring, even if caring did not change anything.

Martha came in at ten, with the photograph still in his pocket. She looked at him and saw something in his face that she had not seen before. Not grief. Not anger. Something that was not named yet, in any language, because it was too specific to be named. It was the feeling of a doctor in a town that the maps had forgotten, treating patients who were dying from things that could have been prevented, knowing that nothing would change, and treating them anyway.

"I brought the kids," she said.

He looked at her. "The kids?"

"I want them to see you. I want them to know what a doctor looks like, when the doctor is the kind of person who sees them too."

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