Since the start of the opioid crisis in the early 1990s, cities like Pittsburgh have been working hard to address the epidemic and warn people of the dangers of addiction.
While some medical professionals are conducting research and interventions, Dr. Steven L. Orebaugh, an anesthesiologist at UPMC, is spreading awareness to a wider audience through his second novel, “The Stairs on Billy Buck Hill.”
The book focuses on opioid addiction spreading through Pittsburgh’s South Side, centered on the East Carson Street party crowd. It tells the story of Dr. Kurt McCain, an anesthesiologist with a coveted academic position whose opioid addiction costs his profession and his relationships.
While “The Stairs on Billy Buck Hill” is fiction, Orebaugh says he drew from his years of experience working at the former UPMC hospital in the South Side.
“I worked at the South Side Hospital for 22 years, before it was closed, and got to know the neighborhood pretty well. It’s a gritty, hard-working, edgy sort of neighborhood,” says Orebaugh. “I was well aware that there was a series of rundown, ill-maintained staircases that lead up the slopes from the lower neighborhood, and knew a bit about their historical importance.”
Orebaugh, who is also a professor and contributor to many scholarly publications, says the idea for his new book is rooted in a real-life incident 10 years ago when he discovered one of his colleagues was removed from the workplace for diverting fentanyl from patients for his own use.
“This was incomprehensible to me — these actions were completely misaligned with the personality of the person that I knew. I had also witnessed similar situations with several of our trainees, and one of my mentors from my own training program,” he says.
“All of us in acute care understand that there is real risk inherent in our daily exposure to opioids. Despite this, opioid addiction continues to occur. I wanted to write a story that could focus attention on this vulnerability for those in the healthcare field.”
The biggest challenge for the author was addressing the central question of why and how a well-informed physician with a great deal to lose could become trapped by the powers of opioids.
“It seems contradictory that someone with a thorough understanding of the addictive potential of these medications, and their pharmacology, would cross the line and begin to use them,” says Orebaugh. “I struggled to make the situation in which the antagonist began to take oxycodone pills realistic and believable. This is the essential inflection point in the book, from which all the rest of the story follows. I hope that I succeeded.”
Although the opioid crisis goes back decades, the epidemic accelerated during the Covid pandemic because a loss of income, isolation and family issues can compound any addiction. Still, Orebaugh believes Pittsburgh is making progress in the battle.
“The Stairs on Billy Buck Hill” is Orebaugh’s second novel, following 2015’s “A Night In the Life,” chronicling a disenchanted emergency room physician’s evening in the hospital.
He wants his new novel to serve as a cautionary tale for those in healthcare fields.
“Twenty years ago, it was hard to imagine that we could arrive at this point, with 100,000 overdose deaths per year,” says Orebaugh. “Every effort to improve education, provide cautionary tales and open doors for recovery is necessary.
“I’m grateful to have been able to publish this book and add my own voice to the efforts to suppress this epidemic.”
Read an excerpt from “The Stairs on Billy Buck Hill.”