Sheryl had called off work, recovering from bronchitis, but she wouldn't miss those moments with her family for anything.
For two years, Melissa had struggled with an addiction to painkillers. A year had gone by since her breakup with Justin Norris, a former boyfriend with the same addictive behaviors. She'd moved back in with her parents, was enrolled in a Cleveland Clinic program for rehabilitation and pain management, and regularly attended support group meetings at a recovery facility in Mentor. She hoped to someday become a facilitator for discussions there.
She was taking classes at Cleveland State University again and had several baby-sitting gigs to keep her busy. Melissa still had sudden mood swings and occasionally argued with her mother, but things were finally getting back to the way they used to be. Her boyfriend, an education major, was part of that.
Around 8 a.m., the men left the house. Melissa announced she was going back to bed, and Sheryl decided to do the same. She told her daughter that she loved her and promised to see her off to a therapist appointment before 10:30 a.m.
But Sheryl overslept. A phone call from her sister woke her at 11 a.m. As she carried on the conversation, she got out of bed and headed downstairs. She looked into her daughter's first-floor bedroom and froze.
The blinds were half-open, letting in a few shafts of light. The hamsa, the hand-shaped Jewish good luck amulet hanging on the wall, looked colorless.
Melissa sat below it on the bed, her feet dangling off the edge. Her purse was slung over her right arm as though she were about to leave. But she was slumped over, face down in a pool of vomit, unconscious and no longer breathing.
The paramedics arrived minutes later and found Sheryl straddling her daughter's body and frantically giving her chest compressions.
"I could hear her gurgling as I would press on her chest," Sheryl says. "It sounded like there was fluid in her lungs and her throat, but I wasn't getting any breath."
The paramedics forced her to step back as they took her daughter's vitals and gave her oxygen.
As the paramedics worked, Melissa's cellphone started ringing from inside her purse. Bewildered, Sheryl pulled it out. The phone showed the name of a young woman in Melissa's support group. But when Sheryl answered, she heard Justin on the other end of the line.
***
Melissa Koppel, wide-eyed and full of curiosity, was the kind of kid who went out of her way to make friends. She would ride her bike down the street and introduce herself to everyone she passed.
She grew up surrounded by a strong, progressive Jewish community, attending Agnon Jewish Day School from fifth to eighth grade. She proudly talked about wanting to become a rabbi. While a student at Brush High School in Lyndhurst, she studied Hebrew at the High School at Akiva every Tuesday and Thursday night.
In December of her senior year, during a student exchange trip, she prayed at Jerusalem's Western Wall on the Temple Mount, the holiest site in Judaism. Afterward, she was moved to tears.
"She was a deeply caring person," says Josh Davidson, a friend and travel companion from Melissa's synagogue. "She was never afraid of showing her emotions."
Melissa, like her mother and aunt, suffered from occasional migraines. She would rarely complain about the pain, but turned to Tylenol, Advil and Aleve when they struck. When she returned from Israel, however, her headaches became constant. She took over-the-counter medication up to three times a day.
"I would start getting the migraines three to four times a week, and that baseline headache would just be there 24/7, when I woke up and when I went to sleep," Melissa said during a recorded interview with a Cleveland Clinic neurologist in 2010, when she was 20. "I wake up and it takes me longer to get out of bed than it would a normal person, and if I ever do get out of bed, the only things I can do are usually my required activities."
In 2007, Melissa went to the Ohio State University to pursue a degree in physical therapy. She wanted to help others who suffered from pain. But by the end of her freshman year she was bedridden, often sitting in her dorm room in the dark holding ice packs to her head.
"I took her to every neurologist in the city," says Sheryl. "We took her to chiropractors, acupuncturists and allergists, and we never did find what the cause was or where [the migraines] were coming from."
Back in Cleveland that summer, Melissa worked an internship at University Hospitals Rainbow Babies & Children's Hospital, where she cared for conjoined twins learning to walk and befriended a 7-year-old boy who suffered from a flesh-eating condition.
"She never saw their disabilities. She just saw them as children that needed a little extra help," says Sheryl. "Children were her life. She came home so excited and told me that she was going to make a living by getting to play with kids all day."
Melissa transferred to Cleveland State University in fall 2008. As the migraines worsened, she sought medical attention from a specialist who prescribed her OxyContin. Over the next three years, while trying to live a normal life, she became dependent on the opiate.
"When you are in that kind of pain, you just want anything that will take it away," says Sheryl. "It doesn't matter if it makes it worse later."
***
Sheryl's husband, Denny, was white-knuckled, clutching the steering wheel of his Nissan Maxima as he drove through a terrible snowstorm in January of 2012, heading north from Cincinnati on Interstate 71 toward Cleveland. Melissa was thrashing uncontrollably in the backseat, throwing her body against his chair and screaming for him to pull over. Her skin was sallow, her tongue lolling out of the side of her mouth. She had been this way for nearly two hours.
Her then-boyfriend, Justin Norris, sat beside her without saying a word. Catatonic, he stared out the window at the sheet of white snow closing in around them. Denny didn't want Justin anywhere near his daughter, let alone in the car with them. But Justin's parents couldn't pick him up, and Melissa had refused to get in the car without him, afraid that he would kill himself in her absence.
Melissa was going through withdrawal. To handle the shock and sickness that came with the sudden absence of pain medication in her system, she had taken too much antinausea medication. Now she had an allergic reaction and was losing control of the muscles in her limbs. Denny was driving as fast as he could to get her home, then into a detox program.
Justin and Melissa's story seemed archetypal at first: the good girl with high ambitions attracted to a renegade in desperate need of salvation.
They met in 10th-grade study hall and hung out in skate parks and watched movies on the weekends. But while Melissa had grown stronger in her faith and built relationships with friends in the Jewish community during high school, Justin had begun a slow descent into darkness. He had lost all ambition and barely finished his senior year. He'd turned to alcohol and marijuana to cope with problems at home.
By the time Melissa returned from Ohio State, Justin's parents were often kicking him out of their house. But instead of turning him away, she was drawn to him, becoming his girlfriend and trying to help him change.
"My husband wasn't too happy about it, and we fought tooth and nail," says Sheryl. "But if they were dating, I wanted to at least try to make him a decent human being. I took him under my wing and started talking to him like a mother would. I bought him clothes. I constantly fed him. He almost lived at my house." He became a familiar face at Hirsh family gatherings, celebrating Jewish holidays alongside Melissa.
This show of familial love inspired Justin to repair his relationship with his own parents. When Melissa transferred to the University of Cincinnati in fall 2010, Justin's parents even cosigned a loan so that he could join her the following year.
The young couple were already united in their experience with physical pain. Some nerves in Justin's back had been severed in a car accident, when a friend drove into a parked van at 55 mph. His pain was severe, sometimes crippling. Though he'd exhibited addictive behavior at a young age, after failed attempts at physical therapy, he was prescribed Percocet, Valium and MS Contin. By the time Justin and Melissa moved into an apartment in Cincinnati in fall 2011, he had developed an addiction. It coincided with Melissa's own dependency.
In their first five months together at the University of Cincinnati, the two shared each other's medications and ran out of them weeks early.
"To go to class or in order to go to the store, we'd have to do something," says Justin. "We were in a lot of pain, so it was OK to do them - that was our excuse.
"It would let her get through the day and be able to do things she had to do, like go to school or shower or get out of bed and go to the bathroom. With me, it was a little different. It helped, but I just really liked to get high."
After Melissa's father brought them back to Cleveland, the two enrolled in separate detox programs: Justin in a 10-day outpatient service at the Windsor Laurelwood Center for Behavioral Medicine, Melissa at the Cleveland Clinic's Chronic Pain Rehabilitation Program. In the eight-week Clinic program, patients who suffer from both long-term chronic pain and an opiate addiction are weaned off the drug and learn to manage their pain. They undergo urinalysis and take part in a support group.
Melissa joined the Self Management Recovery Training program in Mentor. More determined than ever to get a degree, she insisted to her parents that she needed to return to Cincinnati with Justin to finish out their school year.
But when they returned to their apartment, they found an unfilled prescription and filled it. They immediately returned to their former habits, doubling up on prescriptions by seeking out physicians in both Ohio and Kentucky. The amount of pills increased and their prescriptions ran out faster. Back in Cleveland to visit family and attend support group meetings, they bought pills for cheap on the city streets. Running out of money, they ended up stranded in Cincinnati with no desire to attend class, no way home and no way to feed their pill addictions.
Justin, hoping to avoid further withdrawal and sate their addictions, bought heroin from a drug dealer at a local gas station.
"Nothing really mattered anymore," says Justin. "I just didn't want to be sick. I wanted to get something for Melissa so she could feel better. There was no thought into what could happen."
***
At the end of spring 2012, Melissa failed out of all her classes. She left Justin and returned to her parents' house in Lyndhurst.
By the end of the summer, she found a new, healthy relationship with a Jewish secondary education major. She resumed school at Cleveland State University, now intending to become a child life specialist. She worked three part-time jobs, as a library assistant alongside her mother at the Aaron Garber Library in Beachwood and as a nanny for two families. She took care of children ages 3 to 9, often picking them up from school, helping them with homework and making dinner.
"She was so happy," says Sheryl. "Her life at that point was so good. Everything just seemed to be coming together."
Childhood friends noted her optimism.
"She would talk about boys and how she wanted to go to grad school in Israel," says Alyson Letsky, who had known Melissa since first grade. "She wanted so badly to get married, and she would read bridal magazines and look online at things like that."
Her addiction seemed like it had happened in another life entirely. Melissa passed monthly urinalysis tests, saw a therapist and attended group meetings where she shared her success story of overcoming her addiction to pain medicines. For her pain, she was now taking Suboxone, a drug prescribed by a Clinic physician. It stopped cravings and helped her get through the day.
But as 2012 came to an end, Melissa started showing signs of change. One night, she and Alyson joined some friends for drinks. "She just became so secluded and completely silent," Alyson recalls. "You could tell she was a bit more miserable and her coloring was a little off, but I just thought her headaches were bothering her."
Sheryl questioned Melissa. She asked if she was using drugs again, but Melissa denied it.
"I could tell in my heart and soul something was wrong," Sheryl says. "She just kept saying to me, •I'm working with the therapist and I'm almost strong enough to tell you what's the matter.' "
Thinking that her daughter might still be struggling with an addiction to opiates, Sheryl waited for the day Melissa would open up.
The truth was that Melissa had never stopped seeing Justin, and they had continued to use heroin. Justin says they snorted it at first, until Melissa started injecting it with other friends.
In June 2012, just after she returned from Cincinnati, Melissa overdosed in her home while her parents were gone and without Justin around. A friend who had gotten the heroin and shared it with her called 911. Melissa hid the overdose from her parents.
Justin says he started injecting heroin with Melissa in a desperate attempt to keep her close. "I didn't want her to be with the people she was hanging out with," he says. "A way to take her away from those people was to do the same thing she was doing, so she wouldn't have to go to them."
By injecting heroin, Melissa and Justin got high instantaneously, but the effects wore off faster than when they'd snorted it.
"It's not a drug that has any quality control associated with it," says Cuyahoga County medical examiner Thomas Gilson. "Of the two [methods of use], injecting heroin [has] the highest risk of mortality. When we looked at the number of people who died of heroin overdose, at least half of them had a history of intravenous use."
Worried that Melissa would overdose again, Justin started injecting her with the drug, limiting the amount she took.
"In my head, I was keeping her safe by doing it for her," recalls Justin, who says he is now 16-months sober, working his first full-time job in more than six years and facilitating discussions at weekly support group meetings. "I guess in a way it would bring us closer. She became dependent on me."
They used heroin daily, in public restrooms between Melissa's jobs. They wore long-sleeved shirts to cover up the bruises from injection.
By the end of 2012, Melissa and Justin were using about a gram of heroin a day. They'd stop a week in advance of Melissa's urinalysis tests. By spring, they resorted to selling Melissa's Suboxone to afford heroin.
Justin became lethargic and began arguing with his parents about avoiding responsibility. On May 1, 2013, they kicked him out of the house again, and he moved into the Lutheran Metropolitan Ministry's men's homeless shelter at 2100 Lakeside Ave.
A week later, Melissa picked Justin up from the homeless shelter and took him to North Point Transitional Housing on Superior Avenue. The next day, May 9, he spoke to her on the phone around 8 a.m., just after her dad and boyfriend left. She told him that she was going to take a nap and that she would pick him up around 11. When she didn't arrive, Justin grew worried, called her cellphone and found Sheryl on the other end of the line.
***
Sheryl was in the waiting room at Hillcrest Hospital, sitting next to her husband and shaking from exhaustion and anger. As she was clutching Melissa's phone, it started ringing again.
She had hung up on Justin the first time, caught up in the chaos of the medics trying to save Melissa. Now he was calling again.
"Tell me what's going on," he said.
"No," Sheryl said, her voice swift and direct. "You have to tell me what she took."
Justin and Melissa had planned on getting high that day. (However, he says he doesn't know where Melissa got the heroin she used that morning.)
Wanting to help Melissa, he confessed to Sheryl that she had been taking heroin.
Before Denny could reach out for her, she headed straight for the nurse's desk.
"You have to tell them," she told the nurse. "You have to tell the doctors working on my daughter that she took heroin!"
The doctors already knew. They gave Melissa Naloxone, a new drug designed to reverse the effects of heroin after it has been absorbed by the body. But it was too late. Melissa died at 11:56 a.m. as the doctors worked furiously around her.
***
"All of us have different problems and issues that we deal with on a day-to-day basis, and we all try to keep hope," said Melissa three years earlier, looking wide-eyed into the camera during her recorded interview with the Clinic.
"My mom is one of the strongest people that I know, and she forces me to keep hope and tells me that I'll be able to do whatever I want as long as I continue to work hard and don't give up on myself.
"She won't give up on me if I don't give up, so that's what I continue to do."
The doctors let Sheryl into the room to see Melissa one last time. Her daughter's body lay uncovered on the hospital bed, her hair still damp from the nurses cleaning her up. Sheryl asked for the bars on the bed to be lowered, and for warm blankets to wrap her daughter, in the way she would tuck her into bed every night while she was alive.
Sheryl then climbed into bed with Melissa and lay next to her body for three hours, watching her skin color change, as family members arrived to pay their respects.
"She was very much my best friend, and she very much considered me her closest friend," says Sheryl.
"I went through everything with her, and I tried not to leave her side when she wanted me. And yet, I tried to set her free when she needed to be."
The day Melissa left for college, "I cried a little, like most parents do, because I was becoming an empty nester," says Sheryl, "but I didn't cry from the point of missing her. They were happy tears that she was moving on with her life, and she was going to become this wonderful person and grow into this wonderful woman. She was my baby."
