Ruth Madievsky’s pill-popping debut diversifies the male-dominated genre of addiction narratives by introducing a queer, female voice, whose colorful lifestyle is perhaps more galvanizing than that of her male forebears. Despite the sedating effects of the opioids the narrator consumes, Madievsky’s prose is clear and insightful, rivaling William S. Burroughs’s dizzying classic, Naked Lunch (1959), in which the kaleidoscopic writing reflects the muddled state of its author. Unlike Burroughs’s male-driven fiction, Madievsky’s debut provides insight into the making of a female addict. In All-Night Pharmacy, the narrator struggles to reprocess her traumas into a coherent identity. Her fragmented self illuminates issues of mental health stigma and intergenerational and sexual trauma. With intuitive prose, Madievsky transforms the narrator’s struggle into a narrative strength.
Madievsky’s novel follows an unnamed female narrator who struggles with her identity. She atones for a lack of self by participating in chaos, hoping to fill the void within her. The narrator also looks for an identity by fusing to dangerous people. She is a virtual cipher who mirrors the destructive behaviors of her older sister, Debbie, a stripper and opioid addict. Debbie’s boyfriend, Dominic, is also a heroin addict. Although the narrator recognizes the dysfunction that impairs Debbie and Dominic, she feels that “being Debbie’s sister was . . . the closest thing to knowing who I was.” However, despite the narrator’s negative attachment to Debbie, she recognizes that her older sister perpetuates dysfunction. But without a stable family, Debbie is the only source of consistency in the narrator’s life. The narrator’s accurate perceptions of Debbie play out most vividly in her subconscious. Through metaphor, she perceives Debbie’s laughter as a warning, “a manhole cover scraping across asphalt.”
The novel opens with the narrator and Debbie breaking away from their mentally ill mother, who is misunderstood by psychiatrists and stigmatized by those who care for her. Debbie and the narrator are headed to the club Salvation, previously a Christian bookstore. It mock-honors its origins by stamping its attendees with an inked cross upon entry. Debbie and the narrator use Salvation as an escape from their mentally ill mother who claimed, one night at the bowling alley, that bowling balls were absorbing her family’s DNA. Madievsky insightfully highlights one of psychiatry’s flaws. She writes that the narrator’s mother was given conflicting diagnoses (among them, borderline personality disorder and schizoaffective disorder), which speak to how psychiatric labels are problematic. The psychiatrists who determine them have their own erroneous thought patterns, as psychiatrists are, in fact, human. Madievsky also emphasizes an underlying callousness toward disability and mental illness. The narrator perceptively notices that “it was bleak to see Janice [her mother’s aide] accept my mother as she was, because she was being paid to.” The narrator’s observation reflects a tendency to see mental illness sufferers as subhuman; in this context, only a monetary incentive encourages others to behave cordially toward someone with acute mental illness. While paying an aide seems like an easy option to the narrator, Janice’s artificial fondness for the narrator’s mother facilitates deceit. In misleading a pathologically suspicious woman, Janice will worsen the paranoia that she was paid to help control.
Janice isn’t the only one who deceives the narrator’s mother. Debbie and the narrator affirm their mother’s psychiatric delusions because it is easier than challenging what the mother believes to be true. However, deception extends beyond these interactions. The narrator even goes so far as to commit to an inconceivable lie. After Debbie vanishes, the narrator tells her mother that the self-absorbed, merciless Debbie has joined the Peace Corps. While her mother refutes the lie, the family’s foundation is so steeped in falsehood that the narrator believes that her outlandish lie is plausible. Meanwhile, at Salvation, the narrator tricks herself into thinking her addiction to Oxycodone and Ativan is purely recreational. As dishonesty is central to the function of addiction, Madievsky infuses her novel with layers of multi-circumstantial distortion so that the reader, along with the characters, bears witness to the depth of deceptive dysfunction that imbues the lives of people with substance abuse disorders.
Enter Ronnie, the narrator’s first (and older) boyfriend. Although the narrator admits to readers that sex with Ronnie is “fine” at best, she stays with him. Ronnie claims he understands the narrator, and she latches onto him, as if fusing with him will give her an identity. Even though Ronnie compares sex with the narrator to “fucking a corpse,” she claims to want to morph into Ronnie: “I thought I could learn to be like him through osmosis.” She would rather be Ronnie than herself, who, she believes, is a void encased in human skin. Her identity issues and worsening addiction inhibit her from making basic life decisions; she gets in her own way by refusing to sign up for classes. Somehow she lands a job at the college library, which depresses her further. She harbors bitter resentment toward the focused students at their carrels, shooting them angry side-eye while they sweat over Shakespeare. It is safer for her to live on the periphery of the literary world that she secretly desires to join because there is no chance of failure. Ronnie is an easy distraction. By living with him, she avoids her mother (her previous roommate), who encouraged the narrator to attend college. Ronnie, assumed to be a high school graduate, mistakes the narrator’s apprehension about higher education as a healthy preference for the workforce. His perspective permits the narrator to underperform.
There’s a reason behind the narrator’s struggles, and it doesn’t have to do with dusty bookshelves or Ronnie’s lack of skill in the bedroom. When she was nine years old, the family’s hired handyman molested her. Debbie struggled with a similar situation. At sixteen, she had sex with her slimy pediatrician, whom she ran into at a nightclub. She became pregnant and then had an abortion. At the time of the handyman’s abuse, the narrator deluded herself into thinking that the handyman had violated her because she was “special.” However, Debbie, years later, continues to deceive herself by asserting she had held the power in her situation—at any moment, she could have had the pediatrician’s license revoked. The two sisters had been neglected by their parents, and the men choosing them made them feel unique. Despite her strong attraction to women, the narrator seeks out subpar men at Salvation, subconsciously hoping to replicate the misplaced feeling of being “special” that resulted from abuse.
In light of everything the narrator has experienced and continues to experience, she is unable to let her guard down. She even takes to carrying a knife for protection, though in arming herself, she struggles between the polarity of “knife or knifeblock,” victim or aggressor. She is knifed, or wounded, by the handyman, Debbie, and her parents. She counteracts her knifeblock status by purchasing a dagger. It is as if only an instrument of violence can avenge her damaged core. Following the handyman’s abuse, Debbie punched and threatened the handyman’s other victim, as if doing so would also repel the handyman. But when the narrator has a miscarriage in the present, Debbie betrays her by leaving the E.R. in search of drugs. In both an act of revenge and an attempt to untether herself from Debbie, the narrator stabs Debbie close to the armpit. She then carries around the blood-encrusted knife, as if it verifies that she is a whole person. Subsequently, the narrator is plagued by images of her knife rocketing down household drains and through the pipes “to stab a Holocaust survivor or my mother.” This series of dreams demonstrate guilt, not over stabbing Debbie, but over disassociating from her family history, which, had she investigated and respected it, would have provided the narrator with a stable foundation to ground her identity.
Debbie vanishes after the superficial stabbing. Almost simultaneously, Moldovan refugee and self-proclaimed psychic Sasha appears, as if by magic, at the E.R. check-in desk where the narrator now works. Magic is not too far from how Sasha describes her sudden appearance. “I’m your amulet,” she gushes. “We were destined to meet each other.” Sasha comes with a curmudgeonly iguana named Apples, who eats Lexapro-soaked bread for his reptilian anxiety disorder. (The narrator also goes on Lexapro to taper off opioids in an attempt to get clean.) The narrator’s integrating herself with Sasha—despite Sasha’s sudden, comical appearance and frankly sketchy presentation—speaks to the extent of her need to merge with others to feel some semblance of completeness. The narrator soon realizes that glorifying Sasha is like glorifying Debbie. She celebrates someone else to atone for not having a self. During one conversation between the narrator and Sasha, where the narrator is worrying about whether Debbie is dead or alive, someone outside their house yells, “I’m a person! Fuck!” Moments later in this scene, Sasha reaffirms this statement by telling the narrator, “You’re your own person now.” The layered symbolism of personhood emphasizes the narrator’s pull to become part of Debbie, even when Debbie is not physically there; Debbie has become a presence in the narrator’s mind. When Sasha later confronts the narrator about her hitchhiking habit, and the two women have sex for the first time, Sasha encourages the narrator to take on her identity. Sasha seems to view hitchhiking as a misguided act toward independence that wants correction through the narrator’s imitation of her. “Pretend you’re me,” Sasha says, providing her with art supplies. Recalling the narrator’s relationship with Ronnie, Sasha and the narrator’s first sexual experience together signifies the narrator’s desire to become Sasha. However, this is the first time we see the narrator vocalizing her desire to be a full person. “I don’t want to be a parasite,” she says.
As an artist, Sasha uses her creativity to help the narrator develop more insight about her troubled family history. On a vacation to Sasha’s native Moldova, Sasha’s honoring of her grandmother’s grave inspires the narrator to question whether her trauma is intergenerational and can be traced back to one horrific act of violence: Nazis shot and killed her Jewish great-grandfather. In this light, the narrator’s mother’s paranoia is an act of survival. She absorbs the fear of persecution from her mother, and wears her best jewelry, day and night, in case, at any moment, she will have to escape the country. During one of the narrator’s shifts at the E.R., a woman comes in with the sole complaint of Shoah grief. She explains that her ancestors were killed by the Nazis, and she is tormented by the residual suffering. The narrator responds by popping Oxycodone and Ativan once the woman is out of sight. Clinicians cite first-hand trauma as one of the causes of borderline personality disorder (which involves unstable relationships, substance use, and a shaky identity). These symptoms are exemplified by the narrator. Her sexual abuse paired with her inherited intergenerational trauma multiplies her difficulties with relationships, drugs, and identity, which explain her level of dysfunctionality.
An anarchic cast of characters and scenes continue to mangle the narrator’s mentality as she searches for Debbie in the final pages. Between blurred memories, panicked thoughts, and coffee with the “forgettable” private investigator Mark, the narrator traces her face in the mirror with Debbie’s eyeliner. “I’ve been looking for you,” she tells her, or perhaps Debbie’s, image. Debbie is conjured by the narrator’s act, but does the tracing of her image belong to the narrator? Wasn’t art something she adopted from Sasha? At the novel’s end, the narrator questions whether anyone is ever truly their own person. Madievsky seems to believe that we cannot escape our origins. She suggests that human identities are byproducts of various traumas and abuses, mental illness, and the relationships we have with our family. The narrator’s search for an identity serves as a battleground for Madievsky to explore the myriad of above-mentioned issues, problems that are recycled down the family line and that affect the narrator’s (and Debbie’s) functioning. Despite our characters’ seemingly ill-fated futures, Madievsky advocates for the human capacity for salvation, whether it be found in a place of worship or in the remains of a dingy club with “Used Bibles” signs hanging by the bar.
Liv Albright is an intern at The Millions and an MFA student at Goucher College. Her work has been published in or is forthcoming from Chicago Review of Books, Full Stop, The Millions, and Ligeia. You can find her gazing at or snuggling with her cats, eating cheesy cauliflower, and reading a good book.
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