Ruth Madievsky’s All-Night Pharmacy

An unnamed woman repeatedly puts her foot over the shower drain for fear of what might crawl out: her addiction, her traumas, but mostly, her sister. She hasn’t seen her in weeks, not since the incident, catalyzed by months of narcotic cocktails at a Los Angeles bar called Salvation and years, a childhood, of enraptured entanglement to an older sister whose charm hinged on her chaos. All-Night Pharmacy is so visceral and exacting in its prose that I often found myself wanting to put a foot over its drain to avoid further confrontation of a story that felt so true it was painful to be a part of. But the narrator is too sharp and sentimental to leave clogged for too long. Ruth Madievsky’s debut offers one of the more nuanced explorations of not wanting to deal, and the angels and demons that serve as our distractors.

At the root of the narrator’s story is what family owes to one another, or perhaps how family haunts one another. When her sister Debbie goes missing, the narrator is forced to confront the ways in which her sense of self has long been tied to Debbie’s will. Their relationship is coldly co-dependent and fierce and fraught, which the narrator largely attributes to Debbie’s personality, as if it was another unconsented circumstance she was born into. “You could fall asleep spooning her and wake up with a screwdriver pressed to your throat. She was so alive it was scary.” Debbie peer pressures the narrator into drugs, sexual trysts, blackout debauchery (although the narrator doth protest not-that-much), and then judges whether she is authentic enough, cumming enough, living enough: “If you’re not asking yourself, Am I about to ruin my life?, at least once a day, you’re not living a life at all.”

But this is more than just an exploration of coexistence with a wild child. This is about Blood and Water. At the precipice between adolescence and adulthood, the narrator must begin to untangle the familial allegiances we are bound to when her sister goes missing. Must she search for the woman who has for so long felt like a destructive force? Or can she pour herself into a life extricated from her missing sister, her mentally ill mother, her Russian-immigrant grandmother? There is a reason blood so often wins out over water. Blood is…blood. It surges through us, tickles our skin, envelops our brain. Madievsky makes this clear in All-Night Pharmacy as the narrator must confront the generational traumas that simmer within.

While she tries to push aside the toxicity of her relationship with Debbie, the universe reminds her there are larger histories to contend with. In her job as an emergency room secretary, a recurring patient presses her on Shoah grief: “She explained how the trauma of the Holocaust had been transmitted from her parents, how it lived in the spaces between her ribs and her untattooed arm and the part of her brain that should be making serotonin.” The notion of generational trauma has been grappled with in labs, and is now rightfully finding its place in literature. In a recent conversation at The Center for Fiction between Ann Leary and Maud Newton about the themes of intergenerational trauma in their works, Newton pointed to studies in mice and worms that seem to support the phenomenon’s existence: “It's a hotly disputed area in the sciences. But, I think a lot of us just really know that it happens. And there is a lot of science showing with other creatures that it's possible. And I think because of human exceptionalism, we have this notion that…” “That it doesn't apply to us?” Leary suggested.

Madievsky allows her narrator to grapple with this new psychological frontier as so many of us are: with cautious curiosity, unsure of its implications, afraid to unpack how to extricate from traumatic legacies. It is all too much. The narrator falls deeper into her growing addiction, starting a side hustle between the hospital pharmacist and her old Salvation haunt, and working through the opiates Debbie left behind.

As the title might suggest, substances serve as both recreation and balm in All-Night Pharmacy. Madiesvsky’s background as a clinical pharmacist brings an almost educational element to the narrative. For the pharmaceutical novice, the sensations, side effects and pathways into and out of dependency can often seem vague, but in All-Night Pharmacy, an expert hand reveals how easily one can go from their high school graduation to opiate dependency within a year, how tempting, maybe even manageable, the highs seem, how deceptively destructive they are, and how the escape is often more dependent on navigating the health care system and substitutive pharmaceuticals, rather than an emotional intervention in a living room and a fabled rehab stint. There are so many logistics involved in pulling ourselves out of our pits, and highlighting these hurdles is one of Madievsky’s great human observations. College registration portals and health insurance and private investigators, not to mention their financial tolls; existence comes with a lot of red tape. The narrator aptly gets at this inner turmoil: “It—the feeling—was like eating chicken and realizing halfway through it was raw. I felt that way all the time.” Madievsky is certainly not the first author to explore how illicit pharmaceuticals serve as a numbing agent for modern life, but there is something refreshingly non-blasé about her approach. The narrator has not submitted to her addiction as if it were a casual experiment: she is constantly pushing up against it, and against herself, questioning if she has the strength and know-how to confront it all.

In a book that can often feel quite heavy, Madievsky offers us a portion of levity of the psychic variety. Sasha introduces herself at the narrator’s ER desk with a confident “There you are,” and proceeds to identify herself as her spiritual amulet. The narrator is pulled into Sasha’s orbit and down paths of sobriety, sexual awakenings, ancestral discoveries. Madievsky’s Sasha feels like an embodiment of what psychics, real or fraudulent, can be for their subjects: a suggestion of our own desires. Sasha also provides a distraction from the narrator’s familial turmoils and un-reckoned-with traumas, allowing for what feels like unconditional friendship and love. But even this is an unsettling prospect. “No one had warned me how terrifying it was to get what you want,” the narrator reflects at the height of bliss. Inevitably, both Sasha and the narrator must confront their generational traumas head-on, with Debbie’s erraticism and disappearance reflected-on under a new lens: “Debbie walking the balcony railing was chaotic, memorable, deadly. It was sex and narcissism and pain and rage. The men who watched her saw a parlor trick. The women knew better; they saw a bleeding ulcer.”

Where All-Night Pharmacy truly succeeds is in its avoidance of lofty dreams or tidy conclusions. This is not a story of a woman desperate for success, fame, and the plot is not here to deliver these destinies to her. This is a story of a woman longing for a bearable existence. The narrator wants to go to community college, maybe, she wants a relationship, maybe: grasps at the paths our society advertises as stability. But there are many ways to achieve this: a manageable relationship to substances, a roof over our heads, a friend to watch Russian TV with, pet-sitting an iguana named Apples. There is satisfaction to All-Night Pharmacy, a sort of slowing of a swinging pendulum: there is relief when it comes to a halt, and the lingering satisfaction we got from watching the violent swings.