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  • Writer's pictureDr. Steven L Orebaugh

A Perfect Setting

Updated: Dec 29, 2022

I hope that my book, The Stairs On Billy Buck Hill, will serve as a cautionary tale, a lesson for anyone who reads it, on how opioids can destroy a career—and even a life. The story seemed to fit naturally in Pittsburgh, even though it is a fictional account. Oakland, the Southside, the Slopes, the Church Route—it all just fell into place as the perfect setting. I got a lot of enjoyment out of describing the topography of this city. I’ve lived in many places during my life, and I think the geography of Pittsburgh has been the most interesting. Pittsburgh is an unusual city, carved into a challenging landscape, much of it clinging to hills and bluffs that give it a vertical dimension, as well as a horizontal one. What other city can claim to inhabit three river valleys? The steep slopes have made building impractical in many places, providing great swaths of green during spring and summer, and astounding displays of color during the fall. While less welcome, the snowscapes are breathtaking as well during the cold months of winter. It was convenient—and perhaps appropriate—to utilize the hilly terrain of our area in a metaphorical way. For Kurt, the main character, the steep hills and valleys reminded him of the profession of anesthesiology itself—one moment, everything appeared to be level and smooth on a plane of physiologic stability, the next he could be careening down a steep descent as his patient’s vital signs rapidly deteriorated (a reaction to the surgery or some unexpected complication that demanded instant decision-making and action). His professional life paralleled the abrupt and acute changes in elevation that marked the terrain around him. The action in the story reflects these moments of terror that are interspersed with the often mundane, relatively stable life of an anesthesiologist. Not surprisingly, the steep descent of the hills also comes to represent the slippery slope that Kurt finds himself upon when he compromises his own principles and agrees to take an opioid tablet, a casual decision with tragic consequences. In the moment, it seems harmless enough, especially since he has no desire to take the pill, and simply relented under gentle pressure from his new lover. But all too quickly, he becomes fond of the feeling the drug provides, and begins to lose control of the entire situation—the drugs, his practice, his relationships. And, like a crumbling staircase tumbling down a precipitous grade, he finds himself cast uncontrollably downward in a free fall that he could not arrest, and only when he tumbles to the very bottom does he begin to sort out his life and make a bid to re-establish himself. Finally, the stairs also represent the threads that tie Pittsburgh together—ties to history, ties between communities. I had several uncles who worked in the steel industry, and I wanted Kurt to be conscious of how the men (and women) who worked in the mills trudged up and down those stairs every day for decades, descending into the hot, hellish factories for their modest pay, and ascending in exhaustion at the end of their day. Pittsburgh’s neighborhoods are literally held together by staircases, and the stairs of the Church Route on the Southside Slopes, near Kurt’s home, served to hold together the many different levels on which the diocese had established itself, helping to integrate the Church’s presence into the neighborhood, and even today to tie it to its religious past. It’s easy to view the slopes as a celestial, heavenly place to dwell, while the flats far below represent a more nefarious, forbidding level. All of this is fictitious, of course. In an effort to pull together Kurt’s careless decision, the tragic consequences, and the setting of the story, I emphasized aspects of the city and neighborhoods that are not rooted in fact, but in artful impressions. I hope that the synergy between the action and the surroundings is an enhancement, but it’s important for readers to remember that this is a novel, not a memoir.

If you'd like to read The Stairs On Billy Buck Hill, get your copy here.

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