Connie Curry remembers her phone ringing, and the caller ID saying it was St. Luke's University Hospital.
She remembers how she and her husband didn't answer the first time. She remembers it ringing again, and him picking up, then handing the receiver to her.
"I'm doctor so-and-so," a voice on the other line told Curry. "Your daughter Sarah is here. She died from an overdose."
"I just refused to believe it," the 58-year-old South Whitehall Township woman recalled a year later. "I screamed and cried on the phone. I dropped the phone."
With a heroin epidemic that keeps getting worse, and not better, an ever-growing number of families are receiving such calls. In 2016, heroin took a life nearly every other day in the Lehigh Valley, including that of Curry's daughter — 28-year-old Sarah A. Shankweiler, whose death after surviving previous overdoses shows the difficulties in efforts to stem the crisis.
Last year 58 people in Northampton County died after accidentally overdosing on heroin or other opiates, a review of coroner records by The Morning Call showed. That represented more than one death each week in the county, and fell just one death short of the total in 2014 and 2015 combined.
In Lehigh County, 38 accidental overdoses involving opiates were reported, as well as 73 deaths tied to multiple drugs. County Coroner Scott Grim would not provide details of the substances involved.
Taken together, Lehigh County's toll of 111 marked more than two deaths a week. In the two previous years combined, 116 people died.
That the problem is only growing comes despite a full-court press by state policymakers, who have made stanching Pennsylvania's heroin crisis a priority. It speaks to how multi-layered the public health issue is, and to how even the state's best efforts prove ineffective.
Shankweiler's death is an example of those challenges. Twice before she overdosed and was saved by authorities equipped with naloxone, an opiate antidote that Gov. Tom Wolf has made more readily available to first responders and the public — a key part of his administration's efforts to get a handle on the epidemic.
Shankweiler was first saved in July 2014, when someone found her collapsed in the bathroom of a McDonald's in Bethlehem, bleeding from a fresh puncture wound in her arm, a syringe and other paraphernalia nearby, according to court records.
About six months later, Shankweiler was revived again, after overdosing while staying with a friend at a week-by-week rental in Allentown, her mother said. But despite the scares, stints in jail and in rehab and the lost custody of her three children, Shankweiler was unable to overcome her addiction, Curry said.
When Shankweiler's body was found Feb. 14, 2016, in her boyfriend's apartment on West Goepp Street in Bethlehem, police said she was cold to the touch and her lips were blue. It was too late for her to be saved a third time.
"As a parent, you feel like a failure, that you did something wrong," Curry told The Morning Call during an interview at her ranch home a mile from Trexler Memorial Park. "As a parent, you'd like to help your child. Do something to make it better. Fix it."
It's not just parents who are struggling to come up with answers. So are public health professionals, who predict a long road ahead in the battle against heroin.
"This is a problem that's developed for more than 20 years and there's no quick fix or easy solution," Pennsylvania Physician General Rachel Levine said in a recent interview. "It's going to take an all-hands-on-deck approach between agencies to solve this."
The average age of those who fatally overdosed last year in the Lehigh Valley was 38. The youngest were 20, and the oldest was 70. Many attended or graduated from college, and some had advanced degrees, according to their obituaries. They were former social workers, construction workers, cosmetologists and mechanics. They loved to cook, , to hunt and fish, and to collect everything from Indian relics to World War II memorabilia.
Their deaths are just one piece — albeit the most devastating — of the epidemic's impact locally. For every death, there are still more overdoses that addicts survive, emergencies that still tax first responders and the medical system.
"Our last one we just had, talking to the girlfriend, it's the fourth time he OD'd," said David Mettin, chief of Slate Belt Regional police. "Which is just a shame."
"You got to take the need away and I don't know how you do that," Mettin said.
Surveyed by The Morning Call, 16 Lehigh Valley police departments reported responding to 466 overdose calls last year, and to using naloxone on 218 occasions. The number of calls represented a tip-of-the-iceberg figure, since many departments do not generally track when they respond to overdoses, which often are first reported merely as medical emergencies.
"It is crazy," Palmer Township police Chief Larry Palmer said of heroin's reach. "It is unlike anything we've ever seen before."
The Morning Call assembled the data on fatal and nonfatal overdoses through annual coroner reports, and requests for information — sometimes successful, sometimes not — from police departments, hospitals, and emergency management agencies.
A similar database for all of Pennsylvania's 67 counties is being compiled by the state to determine the scope of the epidemic and where officials need to focus their efforts, Levine said.
Levine called naloxone a critical first step in reducing heroin deaths. But the state has begun focusing on what happens after an overdose victim is saved — a "warm handoff" approach under which the emergency room visit is paired with efforts to get the addict into treatment.
A protocol on how to counsel overdose survivors and encourage them to seek rehabilitation has been developed by the Pennsylvania College of Emergency Physicians. It will be distributed across the state to ER physicians and medical staff, Levine said.
"We need to do a better job in making that connection with those suffering from addiction," Levine said. "We don't want them getting medical treatment for an overdose and just walking out and lacking an intervention."
Sometimes the tug of addiction is too great even for those who do get plugged into treatment and the social safety net.
The death of Philip M. Ditalia demonstrates that.
A 29-year-old man from Lehigh Township, Ditalia was accepted in November 2015 into Northampton County's drug court, an innovative criminal justice program that emphasizes help over incarceration.
Ditalia, who had a series of criminal convictions stemming from his substance abuse, got into rehab and regular appointments with a treatment team hoping to keep him clean.
But in August, Ditalia disappeared, with a warrant issued for his arrest after he was kicked out of Victory House, which serves the homeless in Bethlehem. His probation officer wrote that Ditalia had overdosed on heroin at the facility, and was saved by police with naloxone.
It was too late when authorities finally caught up again with Ditalia. He died in an alley on Aug. 15 — six days after the warrant was issued — after overdosing on fentanyl, morphine and alcohol, according to coroner records.
Northampton County Judge Craig Dally, who administers drug court, fought tears recently as he described what happened to Ditalia.
"His father came to every court session we had, even when [Ditalia] was in rehab and we talked to him on the phone," Dally recalled in an interview. "So it was just heartbreaking for him to meet that demise."
Ditalia had a job, was able to live independently and seemed to be doing well, Dally said.
"It was emotional for all of us," Dally said. "He was smart enough and he was invested. It's just the pull of the drug. I can't really explain it."
Dally added: "What would we do differently? You can't predict."
Can treatment catch up?
Treating the problem won't be easy because of how quickly the opioid epidemic has overwhelmed communities, said David A. Patterson Silver Wolf, an expert in drug addiction who teaches at Washington University in St. Louis.
Until substance abuse is considered a chronic illness, the problem will continue to grow, Patterson Silver Wolf said.
"If cancer patients were treated like opioid patients, communities would be outraged," he said. "I'm unfortunately pessimistic about the outlook on this epidemic."
Patterson Silver Wolf called the treatment industry "underfunded and overwhelmed." He also chided doctors for over-prescribing highly addictive painkillers, saying the crisis will continue until that practice is curbed.
The Drug Enforcement Administration has arrested dozens of doctors nationwide, many for over-prescribing narcotics. And last year, the DEA announced plans to reduce the amount of nearly every opioid pain medication made in the U.S. by 25 percent or more.
"Once individuals are prescribed opioids, they either have to continue getting prescribed or switch to other street drugs like heroin," he said.
That was echoed by Summer McGee, a public health authority at the University of New Haven in Connecticut.
The key is preventing the "easy and inappropriate" access to opioids, she said.
Better education for doctors on how to safely prescribe opiates "is desperately needed," McGee said.
In July, Pennsylvania's boards of medicine, pharmacy and dentistry adopted new guidelines on the safe use of opiates to treat pain, with an eye to reducing their overreliance.
Also last year, a prescription drug monitoring database began in the state that aims to prevent "doctor shopping," in which addicts visit multiple doctors to secure prescriptions for painkillers they don't medically need.
Under it, doctors must run a patient's name through the database each time they prescribe an opioid. Pharmacists are required to enter prescriptions into the database within a day of dispensing them.
Levine, the physician general, said health care providers need to be "a lot more judicious" about painkillers. She said society also needs to learn to look past the shame that drug abuse carries.
"Addiction is a potentially chronic medical condition, not a moral failing," she said. "And yet, that stigma continues despite our efforts."
This month in Easton, officials celebrated the opening of Change on Third Street, a drop-in center a little more than a block from Centre Square for people in recovery. Funded by Northampton County, the center has computers, books and board games, hosts 12-step meetings and gives those struggling to stay sober a place to be with others who share their experiences.
"You might have a challenging day," said director Phillip Chaney, who has been clean for more than 16 years. "You might need somebody to talk to about what is going on."
At the event, Timothy Munsch, the executive director of the Lehigh Valley Drug and Alcohol Intake Unit, said it is important to avoid feeling defeated by the epidemic. As someone long involved in the treatment field, Munsch said he used to attend funerals, but had to stop because of the pall they cast upon him.
Remember, he said, there are many success stories about those who turn their lives around and manage to defeat their addictions.
"There is a solution," Munsch said. "You can get sober and there is hope out there. ... There are many people in recovery and the Valley is full of them."
Six good months clean
Curry remembered Shankweiler — the second of her four daughters — as outgoing, compassionate, always fun and always good for a laugh.
A hard worker, Shankweiler never lacked a job in the restaurant business and dreamed of owning her own food truck, Curry said.
"Her personality was the one that could brighten up my day every day," Curry said.
Shankweiler experimented with drugs and alcohol as a young adult and was later introduced to heroin by a former boyfriend, Curry said.
For a couple of years, Curry said, she and Shankweiler had fallen out of touch. Then one day in 2014, legal paperwork of her daughter's was sent to Curry's address, and she learned Shankweiler was in Northampton County Prison.
Curry said she reached out to Shankweiler, saying she knew her daughter had a problem, knew it was a disease and wanted to help.
The road was pockmarked. Shankweiler had her second overdose. She went to rehab for 28 days. She wound up getting arrested again for stealing, her mother said.
"Changing your people, places and things, Sarah had no way to do that," Curry said. "Old friends contact you. You run into them."
For nearly the last seven months of her life, Shankweiler lived at her mother and stepfather's home. She seemed to be doing "exceptionally well," and appeared "about the happiest she had ever been," Curry said.
"I really think she felt good here. She felt comfortable, safe," Curry said. "It was good halfway house. Mom doesn't play the game."
Looking back, Curry thinks of that time as a gift, a chance for her and her daughter to have a healthy relationship, and for Shankweiler to reconnect with her other sisters.
"It was as if God knew what was going to happen, but we did not," Curry said. "It was all good, all good."
A couple of weeks before she overdosed, Shankweiler moved in with her boyfriend. Curry said she had encouraged Shankweiler to do so, believing she was ready to be independent again.
The death rocked the family, Curry said. That day, Shankweiler's boyfriend had left to visit his mother, and she told him that she was planning to take a nap. When he returned, he found her body, Curry said.
Curry recalled her daughter's belongings fit into a single garbage bag. That bag, she said, was a stark and unhappy marker of 28 years of life.
In a notebook she found with Shankweiler's things, Curry discovered a handwritten letter she cherishes. It was the last entry in the journal, and was written Sept. 5, 2015, Curry believes.
Never sent, it was addressed to Curry and her husband. In it, Shankweiler marked six months clean, saying how grateful she was and thanking them for their support.
Shankweiler said she had grown as a person and was happy to be writing them "in sober mind." But read in retrospect, Shankweiler also presaged her own relapse, warning that she had a "long road ahead of her" and "there will be bumps."
Curry said she believes it was fated that she would see the note only after her daughter's death five months later.
"I will treasure that letter forever," Curry said.
"Thank you for being here," Shankweiler concluded as she reached the end of the page. "Thank you for putting up with me. I love and appreciate you all the way up to the sky and back again."