When I first met Amanda at a needle exchange program in Fresno late last year, she agreed to let me document her life. She had three kids, and she was homeless. But she didn't want people to know her last name because she's a sex worker, and she's addicted to methamphetamine and heroin. Below is an account of the nine months I spent with her.
"I felt really, really good," she said. "I felt really relaxed. Calm. Everything was just not a worry in the world."
Amanda has been anxious and depressed for much of her life. Not only did she experience the trauma of her boyfriend's death, but she was also sexually abused as a child. Amanda has been using methamphetamine since she was 14.
“It’s really hard for people to understand why people who are addicted to drugs can’t stop,” I tell her. Then I ask if she can help people understand what it’s like.
“It controls you,” she says.
“The drug controls you. ... I’m not really good at answering that question 'cause I ask myself that. 'Why couldn’t I just stop?' ”
I ask Amanda to describe herself. She says, “I’m 5’4” 131 pounds, bluish-gray eyes, curly hair, I’m chubby. I have freckles.”
Amanda has the names of her three children tattooed on her ankle. She usually wears glittery eye shadow and keeps her nails painted.
A couple of weeks after I meet Amanda, she brings me to the motel where she’s staying. It’s a few miles from downtown Fresno, on a street filled with other motels.
Amanda is sitting on her bed, showing me photos on her cracked smartphone. There are a few burn holes in the blanket. And on the side table there’s a plastic cup with cigarette butts floating in brown water. She shows me pictures of her three kids.
When she shows me one of her son, she says, “He looks just like me. It blows me away.” We laugh at the app she’s using to add funny animations to their faces.
“Is your mom excited to be a grandma again?” I ask.
“Yeah, she is but she isn’t," Amanda says. "At first she was, you know, pissed off. She’s still a little bit pissed off.” Amanda’s mother is upset because Amanda is pregnant again.
Amanda’s children live with their fathers. She still has legal custody of them, but she doesn’t feel like she can take care of them now. While she was visiting her kids one day, Amanda says her 4-year-old daughter rifled through her makeup bag, where Amanda had stashed two dirty "rigs," or syringes.
Her daughter had pulled them out of the bag and Amanda warned her that they were really sharp. Three days later Amanda got an angry phone call from her daughter’s father. His mother was watching the girl, and she had a rig in her makeup bag.
“Her little makeup bag I gave her because she wanted to be like her mommy,” Amanda says, crying. “ 'Cause I had one in mine, she wanted one in hers.”
With this pregnancy, Amanda didn’t find out until she was 19 weeks along, during an unrelated doctor’s visit. When she went to see an OB/GYN afterward, the doctor was upset with her because she was so far along in the pregnancy. Amanda could already feel the baby moving in her stomach.
The doctor referred Amanda to a methadone clinic so that she could stop using heroin. Methadone is a synthetic opioid considered safer than street opiates. It has fewer ups and downs. The doctor told her if she didn’t stop using before the baby was born, Child Protective Services (CPS) could open up a case and place the baby with a foster family, something Amanda adamantly doesn’t want. So, her plan is to get on methadone and get off drugs before her baby is born.
Amanda’s mother recently confronted her about her ability to take care of a newborn.
Her mother said, “You can’t take care of this baby. If you don’t pay rent tomorrow, you’re on the street. You can’t be on the street with the baby.”
Amanda agrees that all of that is true.
“I don’t know what to even do with the baby anymore,” she says. “I really, really, don’t want to lose this baby.” She cries.
When Amanda is seven months pregnant, she starts dosing on methadone. At the clinic, they give her a cherry-flavored liquid that she must drink in front of them. She’ll have to go to the clinic every day to dose.
A month later, Amanda is still dosing on methadone but continuing to use heroin. And she’s still making money through sex work.
She’s in bed in her motel room because she’s had high blood pressure and she’s been bleeding.
“There could be something horribly wrong with my baby right now,” she says. She tells me she’s terrified to go to the hospital, though, because she doesn’t want them to induce labor. She knows the baby, a girl, would test positive for drugs and CPS would get involved.
“I don’t want them to take her because of that, but I don’t want her to die or something,” she says. “I shouldn’t be bleeding right now at all.”
Finally, I convince Amanda to go to the doctor. She says the bleeding is likely the placenta separating from the uterus. That could be because of her heroin use. Amanda will need to come in twice a week for fetal monitoring.
A couple of weeks later, Amanda has lost some weight. She’s continuing to use heroin.
Amanda calls it “black,” short for black tar heroin. She tells me how the baby reacts to the drugs. “If I do dose [on methadone] or if I do a shot of black, she's like, ‘Woo,’ like crazy with me,” she says. “It's sad but it's true. She has to have it. You can tell it makes her feel better.”
Throughout the pregnancy, Amanda talks about the baby “needing” heroin. And in a way, it’s true. At this point, the biggest risk to the fetus is not heroin itself, but heroin withdrawal. The baby could be born premature or even die.
When Amanda is 8½ months pregnant, she starts having contractions and goes to the hospital with her boyfriend, Twin. She’s in the high-risk wing of the pregnancy ward. Twin feeds her ice chips and her labor progresses normally. The labor lasts several hours.
Amanda’s baby girl is born. Amanda names her Maci. Immediately, the nurses put the baby on a scale. She’s 5 pounds, 8 ounces. They ink her feet with black and stamp them on the birth certificate.
The doctor tells Amanda the baby was born healthy.
“Her lungs are OK,” Amanda says, “hearts OK, belly’s soft. I wonder what that means. That’s what the doctor said.”
Maci is staying in the hospital’s NICU, neonatal intensive care unit, for a few days. She’s being watched carefully for signs of withdrawal, which can be yawning, shaking, persistent sucking, or spitting up. Amanda can hold her and care for her in the NICU. She can also get permission to take the baby to her room to care for her there as well.
When Maci is 3 days old, she starts having symptoms of withdrawal from heroin -- spitting up and shaking. The doctors start Maci on methadone treatment, which is normal for babies born dependent on opiates.
Because Amanda admitted to using drugs in the hospital, CPS opens up a case and Amanda has to go to family court. There the judge orders Maci to stay with a foster family until Amanda can prove that she’s ready to be a stable parent. In the meantime, she’ll have drug testing and supervised visits with Maci.
Maci is 2½ weeks old, and is living with her foster family.
I meet Amanda at her motel room. Right away, she goes into the bathroom and starts preparing a shot of heroin. I’m nervous watching Amanda shoot up. I’ve been carrying naloxone -- a treatment for opiate overdose -- since I met her, just in case.
After Amanda shoots up, we sit by the windows of her room, which look out onto the back parking lot.
She tells me last week she was sleeping in her car, and that she was still bleeding from the birth. She also says her milk came in.
“Yeah, it was like pouring,” she says. “It was just sad. That’s just something I dealt with being a mother. I miss her so much.”
Amanda and her boyfriend, Twin, are allowed to visit Maci twice a week for one hour. The visits are in a living-room-style space at a CPS office. A social worker supervises. I ask Amanda what she did with Maci.
“Held her,” she says. “And fed her. And changed her poopy diaper. She pooped.”
“And what was that like?” I ask.
“It was OK,” she says. “I don’t know how to explain it. I don’t know. It was awesome. But it went by really fast.”
Maci is still taking methadone, but being weaned off slowly. Amanda is waiting for her next court date, where the judge will order her to go into rehab.
When that happens, CPS will cover the costs. Amanda has until August to start making major changes in her life, or else Maci’s foster family can adopt her.