Inflammagation
BY SUSANNAH B. MINTZ
- Guts
She tells me I might taste salt, and I taste salt, like a memory of losing my breath in the ocean, just at the back of my throat. She tells me it’ll feel like I’ve wet my pants, and I feel that too, a heat that surges between my legs and fades even as I’m forming the words to help me remember the sensation. She’s busy at the crook of my left arm, fingers fluttering and pressing like a winged thing wanting but unable to land, and I keep my eyes closed because I did not know I’d be getting intravenous contrast and needles that stick in and stay in ache so deep inside the vein that if I paid them any mind I’d rip them loose and flee in a whipsaw of blood. I’m clothed, shoed, but jeans are pulled down to mid-thigh; I’m under a sheet; it’s a clash of intimacies. Then I’m being slid, back and forth through a giant ring the technology of which I will try, and fail, to comprehend. To some expert gaze everything will illuminate, down to the diverticula, far down in my guts. To my own eye, later watching cat scan clips on YouTube, it’s meaningless kaleidoscope, undulating shapeshift in blue and gray that bears no relation that I can find to this body of mine, to its unrelenting months of pain.
*
I was fifty-nine, well into menopause, when ultrasound detected an eight-centimeter cyst on my left ovary. I went in for a routine annual after a week doubled over my knees with cramps, pressing my abdomen into the backs of chairs. This many years past menstruation—eight, since my very last period—such pain merits attention, though I’m not sure, thinking back, that I would’ve made a special trip. Hasn’t my hypochondria trained me to assume it actually is nothing? And aren’t I schooled, too, as a woman, to anticipate the bored expressions, the politely arranged features of a medical face not given to credit ambiguous complaints? It might’ve gone undetected till it burst.
But I had a practitioner of old-school, conscientious doctoring who took the pain seriously and ordered the scan, and when the scan revealed its night-vision-goggly interloper, she hurried me toward a surgical consult and put a gentle hand on my shoulder as I waited for bloodwork like a schoolgirl on a bench (medical space being inherently infantilizing, and large cysts in menopausal women being cause for concern, though neither my gynecologist nor the internet told me that). Surgery three weeks after that, a miraculously—or ominously—quick span of time during which I kept stupidly referring to my “lady bits” and stunning myself with panic about anesthesia and knives.
I’d never had surgery before, and even the minimally invasive laparoscopic procedure with its lovely opiate afterglow felt disturbing medieval, an untoward transgression of the border of flesh. I kept thinking about metallic instruments rooting about in the artificially inflated tent of my abdomen, distending and snipping their way through epithelial layers. Then post-op pain was a study in synonyms, as when I texted my brother-in-law, a surgeon himself, about the searing, burning, grinding, pulsing, crunching, ripping sensations that lit up my middle while livid bruises seeped ochre and purple across my skin. Three weeks later, when the surgeon showed me pictures of my own interior—the deflated cyst stretched through an incision, the uterus, the other ovary prior to removal, intestines slumped in the background—I could not make what I saw correspond to that drawing of the female reproductive system that anyone who’s waited in a gynecologist’s office has memorized in the insulting dullness of passing time.
It was an existentially loaded affair. These female parts of myself, ovaries and Fallopian tubes—responsible for the children I never had—I couldn’t quite fathom what it meant to me to lose them except to say I felt rearranged. The possibility of pregnancy was twenty years at least in the past and I’d long felt menaced by ovarian cancer, notoriously difficult to detect. I tried to balance a weird mourning for these grape-sized powerhouses against the relief of never again having to worry about them as the site of my dying. Exactly middle-aged loss, then, demarcating youth from all the time to come as a kind of dimensional excision, where inner became outer in a manifestation of all that we do not control of our bodily beings. My sister, twenty-one years younger than I, came to aid the recovery, kept the ice packs fresh, brought us meals in bed, fetched the dog from daycare; and when she threw a frisbee for Sophie so awkwardly it arced back over her own head, I screamed in the agony of laughing. I once held this woman as an infant to my own twenty-one-year-old chest; we hold the past as penumbra of our future. I could be a sister, still, if never a mother.
I was buoyed by loved ones in those weeks of spring, and especially women, from the surgeon who removed the offending but not malignant mass (never so glad to hear some part of myself described as bland and boring), to my other sisters keeping tabs from afar, to friends who shared their own stories or left goody bags at the door. I want to say there’s something uniquely meaningful about the corporeal events of illness and surgery for a single childless person, when the urgent needs of our embodiment force us to make requests of others we may be embarrassed to articulate—something I think this visiting sister of mine must also grasp as a woman who has organized around herself a found family of extraordinarily tight friends, though her worries might not yet carry the particular inflection of how it’s supposed to work, the nursing and dependencies, when one is very old. We wintered together in the Covid lockdown of 2020, and I was surprised then at how easy it was to reacclimate to moving around another body in the enclosed space of my house, when our only respite were walks in the snow and masked forays to Trader Joe’s. Now she’s seen me through six days of post-surgical prostration. It gave me comfort to imagine this recovery period as a precursor, a kind of rehearsal, for what might come when she is my age now and I am eighty. For this, too, is our fleshliness, our capacity to extend ourselves toward another being in the gentle companionship we cultivate in times of care.
But when, nine months after the double oophorectomy, cramps carried on unabated and in fact were migrating around my guts; when I’d lost ten percent of my body weight I was not trying to lose and maybe worse lost entirely a taste for chocolate, upon which I had for a long time subsisted without shame; when the surgeon wondered if the pain had never been about the cyst in the first place, when she mentioned a uterine fibroid she’d not told me about before and then pointed me toward the door and a gastroenterologist, then I moved into a new realm, a limbo space of solitariness marked by undefined etiology. For months I had ignored the roiling guts as normal sequelae, a word my mother uses, of the March procedure. Fallopian tubes and ovaries attach to the uterus by ligament, and I imagined those four sites of separation announcing the insult in a lexicon of throbbing, grinding pain. And what was it like for that lonely uterus, for those yards upon yards of intestines, to relax or expand or resettle around unfamiliar emptiness? New juxtapositions, unaccustomed densities. And dissolving stitches at the three sites through which camera, instruments, and air had been inserted, a few of which breached the surface like the spiny tips of a sea urchin—so many logical explanations. I began to think that surgery had flipped a switch in the complex interworkings of body and brain, such that pain carried on as a malfunction of a warning system and appetite, hunger for something, faded along with the slick darkness of younger parts of myself—I’m mourning them after all.
But by fall, anyway, none of this made sense as healing.
*
For a long time my sustained bodily problems have been concentrated along my spine—degenerative disk disease, compressed nerves and the like—and this new concentration of discomfort in my abdomen in my sixtieth year lends itself obviously to the symbolics of birth and death. Moments before I strip for my very first colonoscopy, I’m required to sign a pregnancy test waiver because, the nurse says, I still have a uterus and sixty is the cut-off and I am a week from that age. She’s just mentioned the double oophorectomy as part of my medical history and seems to grasp the perversity of drawing my attention to a pregnancy it is impossible the colonoscopy could damage. It surprises me in this moment of focus on the alimentary system to be reminded of a baby, as if we are children who still believe everything originates in the stomach, babies and bowels and what it means to be nurtured, to be a body that creates.
It was Freud who theorized (by now infamously) that the juxtaposition of anus and genitals practically guaranteed neurosis. Naomi Alderman calls it “a terrible joke played by human biology,” this proximity of sites of pleasure and disgust, desire and filth. Or, as in some of our practices, their coincidence. Maybe too we can’t understand how our bodies make waste of beauty and deliciousness (oh, I am thinking right now of the six-course Michelin-star tasting menu I had in Prague, just three weeks ago, a pre-birthday gift from my sister and one of the most visually and gustatorily marvelous meals I have ever consumed), how we mash and liquify and swallow it down—how we ruin it—and then produce at the other end something that bears it no relation, just monochromatic stink and slime. And we are not supposed to admit it feels good, that emptying; culturally speaking the enjoyment of shit is countered by embarrassment we discharge in graffiti and jokes.
Psychologist Nick Haslam lamented in 2012 that his field had not taken excretion at all seriously enough, writing that psychology averts its polite attention “just as people wish to conceal their bodily waste.” But the last decade has corrected that dearth with a great deal of literature on the profound intelligence of our guts. The “second brain” of the enteric nervous system refers to the hundreds of millions of neurons—more than in any part of the body aside from the actual brain—along the digestive tract, from esophagus all the way down, that regulates actions like swallowing and elimination and can process information and make decisions about the GI tract without relaying signals back to the brain. This sophisticated neural firepower works in concert with the teeming community of the gut biome. Here there are trillions of microorganisms: not just the “good” bacteria we’ve been taught to foster by ads for probiotics and yogurt but also viruses, parasites, and fungi. We all have one of these fantastically intricate ecosystems within—their makeup is unique in each of us—and we depend upon it for processes we’re not aware of until they malfunction: the breakdown of fibers, the absorption of vitamins, the metabolism of bile in aid of digestion of fats. A diverse array of gut microbes protects the immune system; eighty percent of our immune cells originate in the bowels. Certain moods may start there, too: some ninety-five percent of the body’s serotonin, one of the first neurotransmitters to be implicated in the regulation of depression, is synthesized by the intestines.
The gut-brain axis, from large intestine to medulla oblongata, from microbial action upon food to the state of our mental health, travels along the vagus nerve, the superhighway of mind-body connection, responsible for activating the body’s defenses against threat and in turn restoring homeostasis. It’s the vagal circuitry that initiates the tripartite response to danger of fight, flight, or freeze—whether that danger is external (home invasion, say) or internal (a memory, even a suspicion of an insult)—and we sometimes need it to reboot to subdue a sense of peril no longer commensurate with environmental risk. It’s not surprising that so-called low vagal tone is a feature of gut problems with a psychological component, like irritable bowel syndrome.
So I must wonder, do I have a functional gastrointestinal disorder? Meaning: chronic symptoms with a strongly emotional aspect and no discernible damage of tissue or structure (I’ve seen the photos of my colonoscopy: it is indeed pristine). And could vagal breathing, which I know how to do as a feature of meditative calming, cure months of pain that so far the medical scans are not diagnosing?
Or, less cheerfully, have I gotten somehow dumber in the guts, as I feel so sure I have in the brain? An older friend commiserates with me on the failure of our “component parts.” Is this what happens as we age, that we lose intelligence from head to … to rectum? The word vagus derives from the Latin for “wandering,” the nerve so-designated because its branches are distributed broadly throughout the neck and torso. As a student of Paradise Lost, I’m taught to think of wandering in the best sense, as the natural process of getting where we need to be. (The very rivers of Paradise “wander” in Milton’s epic, untainted by sin; Earth itself, newly formed and likened to Heaven, seems “a seat where Gods might dwell, / Or wander with delight”). But vagus is also “vague.”
Linguistically speaking, the wandering nerve is a capricious one—materializing within us as vagrancy and vagabond, vacancy and vacillation; as rootlessness and inexplicable change; through Old High German as staggering, tottering, wavering; as the peculiarity and eccentricity associated with the elderly. All this makes an apt kind of sense, etymology doing more than etiology to capture what it feels like in the aging body of a literature prof, the link between my unruly guts and my indistinct head a matter of skewed imprecision and my symptoms not matching any identifiable cause. I want to trust all this vagary in Milton’s sense, assured that my body knows the truth of itself, whether as diagnosis or not, and that the state I’ve been in for nearly a year now doesn’t augur systemic collapse but is instead a language I have yet to learn the grammar of. Digestion is such a ready metaphor for thought process, for emotional continence, for the maturation of psyche as we learn to integrate ourselves with the world beyond our edges.
But the vagus nerve makes this connection between stomach and temperament literal (as it was in Milton’s day, though with different corporeal agents), bound in a reinforcing kinship. Maybe this requires that I withstand the need to know what is wrong. Maybe I quit the medical testing and resist a hard threshold between health and unwellness, or age and youth. Maybe, like Milton’s Eve, that literary protagonist I’ve long mapped my sense of a best self onto, I just wander forward into the world all before me, even if in my current version of her choices I wouldn’t be tempted, not even in the fullness of noon, to eat.
Another friend suggests that maybe it’s all “just stress,” an otherwise dismissive catch-all explanation that the vagus nerve makes not unreasonable. I sit here in—as—medical mystery, embodying the limits of what is understood of our systems, especially pain. (Some call it “prognosis time,” defined by the interminable waiting we do, especially as we age, for the next scan or test.) But experiential knowledge means that I do know what it is like to be my body; five decades have accustomed me to its rhythms of anxiety, sorrow, fear, arousal, remorse. The only emotion that’s ever killed my appetite is grief, and for all that the last years have volleyed a series of blows, some personal, many communal, I’m not in mourning. And I have never, never in all these years, foregone chocolate. I need someone to grasp how bizarre this is.
The endoscopy is scheduled for two weeks from now. I’ll have turned sixty by then; I won’t have to sign the pregnancy waiver. This means that in the very moment of descent into my stomach to figure what in all get-out is going on in there, my womb—I think this is mordantly funny—will be officially perceived as barren.
Mordant means bite, with its roots in the darkness of shadows.
*
There’s a word for the rumbling noises of our digestive process: borborygmi. A short piece published in Psychotherapy and Psychosomatics in 1984 (it shows up on JSTOR; you can read it for yourself), written by Swiss psychiatrist Christian Müller, declares body organ language “phonologically and heminomatically” interpretable (125)—and decodes one patient’s borborygmi, printed “‘Aw … l el … le … vo …,’” as “‘Awful, help, help, less vodka.’” “If our findings are confirmed,” declares the author at the end of the article, “then we can say, together with Freud … ‘Where gibberish reigned, let there be speech’” (126). From what I can discover, the author of this charming send-up of professional smugness was a very real professor and director of a psychiatric clinic in Lausanne admired for his deeply humane treatment of patients with schizophrenia and one of the first European psychiatric researchers to take an interest in old age. Who’s who doesn’t really matter. Whoever this Müller was (along with the writer of the essay that calls him to my attention), their important idea is that our bodies have something to tell us—if we can obtain the right equipment with which to decipher the message.
The roster of famed sufferers who spent lifetimes trying to translate their flatulence, abdominal cramps, and excretory habits includes Charles Darwin, Sigmund Freud, James Boswell, Samuel Coleridge, and Molière. That these are all men only means that women are not supposed to speak of their gas or their diarrhea, let alone associate these bodily indignities with intellectual prowess. I have read of one Marquise de Dampierre, known as the first clinically documented case, in 1825, of what would come to be named Tourette syndrome. Madame D., as she was called in the literature—the Countess Picot de Dampierre, born Érnestine Prondre de Guermantes in 1800—exhibited the classic tics identified by Gilles de la Tourette, crying out “shit and fucking pig” (merde et putain de porc?) at inconvenient moments.
Coprolalic language, I suppose—or just a lazy potty mouth, as I’ve sometimes accused myself of having, though I respect the obvious differences—is one way a woman might breach decorum in the exultation of forbidden words that match her mood. (Olivia Coleman and Jessie Buckley swearing their hearts out for 100 minutes in Wicked Little Letters is rollicking fun and a sly comment on the space women have to be playful, enraged, and grotesque inside of patriarchal respectability.) Voicing the state of my viscera, as I’ve been doing for months now, usually at someone’s dinner table, is me feeling my way through bafflement, trying to shape some causality around a body whose twinging and gurgling make no sense and whose contours I no longer recognize: hips jutting like the hocks of my terrier dog, substructure emerging like a rock garden from snowmelt.
Panic, just at bay, every time I get on the scale. This is not normal, I think. How low can this go? I’m the heroine of a Stephen King novel: I am shrinking, and I am hexed. Changes in gut microbia can intensify the sense of satiety; maybe I’m overrun with the bad kind—but surely it would’ve leveled back up by now: dieting is a struggle precisely because the body is so skilled at adjusting itself to maintain a constant weight. Maybe it’s poor sleep. Maybe it’s age. Where is my hedonic hunger? For nearly a year I have not indulged my secret pleasures, the foods I like to eat, a lot of, alone. Switch-flipped. Maybe a prolonged stress response to the operation set something in motion—nausea, disinterest—or maybe surgery altered bowel motility. (Is it odd that “surgery” looks so much like “sugar”?) Loss of appetite is a common-enough occurrence after gastrointestinal procedures, and though no one’s told me so, I wonder if even laparoscopic removal of defunct ovaries was enough to whack the microbiome out of balance.
There’s a science to hunger, too. The hormone ghrelin alerts the hypothalamus to stimulate appetite, and satiety hormones do the opposite. It’s possible that surgery disrupts this gut-brain relay as the body directs its energies toward healing, restricting ghrelin or exaggerating leptin. How to treat post-surgical appetite loss is hampered to an extent by the fact that appetite assessment, like that of pain, is highly subjective. While action of the guts can be quantified, experience of it can only be measured in words, and hunger scales rely on the same kind of meaningless fractions and semiotics that abstracts pain by number and states of suffering declared in squiggly lines. Is the person who “feels full after eating half a meal” an undernourished disordered eater, restricting herself unhealthily? Is she ill? How big is the “meal” one might feel stuffed on only part of?
I ate half an avocado toast in Prague that was the size of a Philly hoagie, sprinkled with pomegranate seeds and drizzled in honey. Other days on that trip I grazed my way through street food—veggie dumplings and latkes and spinach garlic pasta. Since that was “more than three meals” in a day, was I then a glutton, though I could finish only mouthfuls, and threw a scandalous amount away? And what if my mood while I’m contentedly munching on almonds and seed crackers is not exactly “very happy” or “neither happy nor sad,” and what if food, though not tasting “better” or “worse” than when I was “younger,” also isn’t stimulating the gusto, the fixation, I’ve known for years? Do these indeterminate vectors of body and emotion place me in a category that makes any diagnostic sense?
Nine hormones are involved in regulating hunger. An ennead of inspiration, enteric Muses, goddesses of guts. The actual Muses, daughters of Zeus and Mnemosyne (she the goddess of memory), put us in mind—from the root *men, to put or have in mind—making creativity an act of bringing out of us what we already know; and by some traditions, they allow forgetfulness of pain, too, making space for imagination. But there is also knowledge in pain—what we know because of what hurts, not in spite of it; what we create through pain. Thus I call to them: estrogen and cortisol, cholecystokinin and the peptides (and that one that’s like a peptide). Insulin and ghrelin. Leptin. Sustain me, visceral muses. Let me, grant me. O! Feed me. Help me be hungry again.
- Fugue state
The summer I got COVID, I threw the footrest of an Adirondack chair into the euonymus patch, and when that didn’t land with enough of a satisfying crash, I kicked an empty Chinese planter from the porch to the front walk where it shattered into pieces. Then I stumbled into the garage and sobbed and panted while my ex-husband held me and tried to tease me about the clogs I was wearing. I couldn’t tell if he realized that this outburst wasn’t caused by heat or the frustration of having stumbled on rocks while trying to hand him a hose to test the new gutter system he was installing. I’d been ill for seven weeks, but long-COVID is not officially diagnosed until you’ve had symptoms for three months (and then only as an “exclusionary diagnosis,” everything else being ruled out), at which point you’re eligible for protection under the ADA. My online news feeds were rife that week with reports of studies on long-COVID, having to do with people who got sick in the very first wave of the virus. Now the omicron variants were following their own idiosyncratic path, and it was too soon to know what their long-term effects would be.
It was a muggy afternoon in 2022, and smashing a porcelain pot was not cathartic. I heard my ex cry, “Don’t do that!” after I threw the footrest and before I kicked the planter. I took that to mean not don’t damage the furnishings but don’t be so hard on yourself. Ribbing me about wearing clogs in the yard was his way of pulling us both back to a status quo he’s comfortable in, and reluctantly I did start to laugh (it’s hard not to if someone keeps saying clogs). I had to remind myself that people experience COVID in wildly divergent ways, and that it’s not a moral failing if it hangs on and on. Naturalist Bathsheba Demuth wrote in The Atlantic in 2020 that, after three months of “persistent” COVID, maybe “weaker, wan, soggy-brained” is “just what [she is] now.” “It is tedious to tell people I am still sick,” she wrote—a sentiment I grasped completely. I worried every day in those miasmic weeks about being disbelieved. A crushing fatigue can only be reported, after all, never proven, as if COVID had left behind traces that only I, its diligent tracker, could discover, clever pawprints vanishing into the underbrush.
In this way the COVID summer overlaid my hypochondriacal childhood upon the nineteenth-century doppelganger occupying my mind who suffers neurasthenia, a now-obsolete nervous disorder whose primary symptoms were bodymind fatigue and anxiety about cognitive failure—or as one expert mildly describes it, concerns about not doing well intellectually.
I am a woman out of time.
“You’re middle-aged with new symptoms after your COVID infection,” I read one evening, “—fatigue, brain fog, joint pain. Is it long-COVID? Or are you just getting older?”
Like many a Victorian, I think I’d happily take to my bed to rest and write books, routing my days around my body’s weather, to take the liberty of adding myself to Demuth’s metaphor.
*
In Gabriel Garcia Marquez’s 1988 novel Love in the Time of Cholera, which I reread the first COVID summer after thirty years, the widow Fermina Daza, reunited with the object of her girlhood infatuation after a fifty-year marriage to someone else, thinks to herself that “It is incredible how one can be happy for so many years in the midst of so many squabbles, so many problems, damn it, and not really know if it was love or not.” She had a long marriage to Juvenal Urbino, ultimately a good marriage, but also not quite the passionate marriage her youthful correspondence with Florentino Ariza might have led anyone to expect for her.
At the end of the book, Fermina and Florentino embark on a steamboat cruise up the Magdalena River, making love for the very first time, and settle into a comfortable septuagenarian friendship. When they hold hands, they feel the uncanny contours of bones, the slide of skin over bones that are no longer twenty years old. When they kiss, they can smell each other’s age.
The morning of their return to port in their Colombian city, Fermina Daza wakes with a headache. “‘It is going to be like dying,’” she says of the “horror of real life.” They want to endure in their riverboat connection. Florentino Ariza, head of the company whose ship they’re on, tells the captain to hoist the yellow cholera flag, so they can stay on the water and no one will approach them. “‘Let us keep going, going, going,’” he says. “‘Forever.’”
I read of people who were sheltered-in-place with lovers they’d only just met, exes who bunkered together for the sake of their kids, and friends who quaranteamed in pods. And also families further rent as they were forced into close quarters for unaccustomed and insalubrious stretches of time.
The “time” of Marquez’s novel is both el cholera and la cholera, sickness and anger; the backdrop of love is the violence of illness and war. Marquez understood love to be a form of violence, a kind of delirium. He wrote of love that perseveres in a time of terrible loss, and of cholera as a kind of escape, an act of defiance, an expression of truth. Is that the worst sort of delusional co-optation, making metaphor of trauma? Or just a promise to keep up the journey, inexorable and no less real, even if that means perpetual motion on a river that never ends?
*
I got COVID in Umbria. Blooming jasmine, wild rose, and a type of flying insect with broad horizontal orange bands on its black body and wings polka-dotted in white. They seem to have trouble getting themselves off the ground, despite the elegant colorings, and one morning after yoga a group of us stood with our heads bent toward the terracotta floor where one such bug was moving its wings in a way that looked like panting. Like hands opening and closing in supplication to the universe. Maybe they don’t live that long, someone said. Maybe it’s come to ground and is waiting to die. Is this sad? We come to our endings, anyway.
After months of unmoored disquiet, I wanted Italy to reset my psyche, to rejuvenate at a writing retreat directed by friends that in previous years had been a revelation in shucking the oppressions of selfhood. I debarked the bus from the airport in Rome in a Let’s get the band back together! kind of mood, but the energy was off. It’d been three years, and I felt quickly that too much had intervened, that we weren’t moving around each other with the right kind of unselfconscious ease that this location, with its atmosphere of curiosity and creative freedom, had worked in past summers to invite. I sensed a bone-deep inhibition, not just the kind of shyness with strangers that gradually wears off but a deeper weariness, a wariness, that emerged in coded remarks across tables and downcast eyes at readings and a forced quality to the gregariousness and cheer, as if we were performing an exuberance that had worn a little thin after so much constriction around threat and loss. But maybe I was projecting, unable to shuck the grief, boredom, and rage at the gates, though it seemed to me truer than ever that we carry our travails with us, tucked in invisible backpacks that crowded our feet as we sat to a meal and distorted the choreography as we jostled for space in museums and cocktail hours. Impatience, especially, was so close to the surface.
And then we all got sick.
There was something choleric about it, no doubt, the way COVID held us to each other in the floating murky way of fever, in a blink yet impossibly slow, and disappeared, at least temporarily, the sting of schism, “the horror of real life,” as we WhatsApp’ed each other through the hours about our progress and our needs, shredding red and pink hearts into our messages. It was no metaphor, of course, the gritty eyes and body aches, coughing up things unpleasantly reminiscent of offal and slugs. But one afternoon I opened the door of my flat to find a small plate of Italian cookies and a packet of extra-strength Tylenol, left by someone who’d anticipated what might ease my suffering, both the loneliness and the pain. I thought of Fermina and Florentino, ancient and ill, discovering the pleasures of each other’s bodies for the very first time on their barge of death, and I no longer felt that COVID—or I—would take my life.
*
For the first ten days after I got home from Italy, the dog slept under the bed in the guest room, which at first I thought was due to heat but then I determined that he smelled illness on me, wafting out of me, and it unnerved him, so he hid.
“More and more,” wrote David Rees in The New York Times magazine one Sunday in one of the COVID Junes, “I feel as if my leverage on the world is slipping, that any talents I enjoy are inferior to the darkness of the moment.” I think that was 2021, but it could’ve been yesterday for all that I recognize his experience of futility.
There was good reason, given politics, climate, a wily virus, and the myriad details of private distress, not to feel especially celebratory on the Fourth of July that year. But I was reminded, reading Thich Nhat Hanh, the celebrated Vietnamese Buddhist master who died that January at 95, that the true miracle of life is walking on neither water nor air but on the ground, in all its prosaic lowliness. This is why the Buddha is so often figured with one hand reaching down, touching dirt—because it was the earth and not heavenly beings that bore witness to his enlightenment. Some would say this particular mudra (bhumisparsha, earth-witness) encapsulates embodied cognition, as the physical gesture honors a connectedness that is at once material and spiritual. We know through our bodies as well as our minds, and even when we’re tired beyond a breaking point of the meannesses we exact on each other, our aliveness on this planet deserves respect. There is always something to honor, if not to feel that joyous about.
So I went to sit outside, to feel the air and the world alive around me. My stomach was doing unnatural things, but the air felt good on my skin. Moths were flitting about in the sunlight and little Jack was tethered on the lawn, lying beneath a cherry tree, gazing at me with his round black eyes from a patchwork of shade. We were waiting for the ex to arrive, because people don’t set off backyard fireworks in his neighborhood and the dog reacts wildly to that noise, ThunderShirt™ notwithstanding, and neither of us needed that stress.
I closed my eyes into the late-day sun and awaited the moment I could crawl back under the covers and contemplate the notion of independence, between my Filipino neighbors lighting firecrackers behind their house for an hour and the house down the street with the “Trump is my Jesus” flag flying at full mast. It’s all miracle, said Thich Nhat Hanh. Even the sickness, the ugliness, the wound.
*
The word “inflammaging” was coined in 2000 by Claudio Franceschi, a former University of Bologna immunologist, to designate the causal effects of chronic age-related inflammation on illness. The role of inflammation in COVID’s more pernicious consequences, including its tendency to resurge long after a test has declared a body clear of virus, is well documented, and our pandemic-sensitized, age-defying imaginations have now caught hold of inflammation as the cause of everything that ails us, from bad skin to colitis to “post-exertional malaise.” (Is it meaningless that after a day of writing, I wake up feeling drugged?)
The first I heard of cytokines was my stepdad ascribing a generalized feeling of malaise to the release of these immune system proteins. Later I learned that immune response begins with inflammation to surround toxins or start the process of healing tissue, and that when the system misfires—when it’s triggered and can’t shut down—a cytokine storm can cause the kind of unspecific complaints (fatigue, diffuse aching, even emotional distress) that might impel a hypochondriac to the doctor’s office or make it feel like a virus carries on unabated even when tests are no longer positive. Now I understand inflammation generally as I do anxiety and pain, as part of elaborate processes that warn and protect but instigate problems of their own when the off-switch malfunctions. Acute inflammation is obvious: pain, heat and fever, swelling and redness. Chronic inflammation, though, implicated in many and varied conditions, has notoriously ambiguous symptoms: weariness, weight loss, belly pain, depression, brain fog—a list I’ve cherry-picked because I have them all. Today I read that inflammatory diseases “account for more than half of all deaths” around the world.
The lingering effects of COVID, exactly mimicking the very symptoms of age-related decline to which I was already so alert, was likely related to inflammation; I imagined my sinuses puffed out and gloopy and pressing into an already clouded brain. For most of that summer, I did not get out of bed. Or I went from bed to couch and back again. I walked the dog no farther than once around my block, ambling along in the manner of Austen heroines; I stared at various screens and thought about doing things that I did not do: write, call a friend, fiddle with watercolor or pastels. My ears ached and rang, sometimes my teeth hurt. I was clammy, short of breath, and wanted only to close my eyes. My head felt stuffed with cotton and at the same time activated, a buzzy sensation from sinuses to eardrums (“brain on fire” captures this effect). I tried to read, but couldn’t take anything in. I felt overwhelmed by tasks, a sense of working too hard to think.
Immanuel Kant wrote in 1798 that “paying attention to certain local impressions makes us feel them more strongly or persistently.” I knew that zeroing in on symptoms likely amplified their resonance, my mind exerting its vibration on my body in a mutually reinforcing frequency, but the fact that we think what we feel, feel what we think, doesn’t mean something isn’t happening. When I complained to my doctor that I couldn’t shake the weariness, the congestion, I caught a tone in her voice—hard to discern these things over the phone—of skepticism and impatience. I was frustrating the forward motion that physicians are trained to expect, and she was mad at me, I think, because I embodied the limitations of her knowledge, the edges of her knowable universe. You might say she was not so much doubting my story as confronting the failure of her own domain, and with each new suggested treatment I had the sense that we were engaged in an elaborate game of Hangman where neither of us knew the word.
In fact I was losing words, saying words in the wrong order, or exactly wrong—reality when I meant fantasy—and mixing up names, like Cambridge for Oxford or Jacinda Ardern for Sanna Marin. The kind of small slip that aggregated as evidence, that followed me into the school year by way of missing handouts, losing my place in my own syllabi (“Professor, that poem is next week”), the mind-swiping heat of panic on a Sunday while prepping or, more often, right in the middle of class, when I couldn’t tell whether the sensation of something not right in there, in my head, was explained by the operations of a virus, or looming senility, or the anxiety stoked by both of those possibilities at once.
The sense I had in my COVID present that I was living an elderly future—as if illness had triggered some time-warping acceleration of my own old age—tinged those months with a lurching, anticipatory disorientation informed by bigger social attitudes toward what it means to leave youth and health behind. The one thing I managed consistently to do that summer, even when I couldn’t concentrate long enough to read, was write: sentence after sentence unfurling out of me, onto the page. “I can’t go on,” says the narrator of Beckett’s novel The Unnameable. “I’ll go on.”
One night while sick I propped myself up in bed and drew a self-portrait in pastels from the two-inch image of myself on my phone’s camera. Taking stock of this moment: me in COVID. Only later did I realize that the face now regarding me from across the room, done without regard to realistic color, deep lines parenthesizing its mouth, eyes wide in a kind of surprised admonishment, is exactly that of my mother.
- Guts, redux
I dreamt an earthquake was shaking the foundations, and when I opened my eyes realized it wasn’t an earthquake but the gurney I was on, being wheeled to recovery after the endoscopy, bumping indecorously along the floor. Los Angeles, where my mother and older sister live, had been on fire that week, and so I layered my fear of LA’s natural disasters, for my family, the loss of neighborhoods where I once lived and which I had both hated and loved, atop this moment of coming back into consciousness of my body’s mysterious vulnerability. I had been shaking before the procedure, too, made to wait too long under meager blankets in a thin hospital gown, cool saline dripping through the IV to keep my vein prepared for the anesthesia to come. The longer I lay there, the more uncontrollably my body shivered and jerked, the more my mind worked itself into not-quite-irrational anticipatory fear. Something is wrong.
I’d had endoscopies before, more than once; just two weeks earlier I’d had the colonoscopy—this was supposed to be easy. But it was all taking too long, a drawn-out process in which the sound of nurses trying to figure out the role of glucose in seizure and someone on the other side of a curtain describing his son’s hair was not ordinary and comforting but instead terrifying, the dim light a movie-set tactic to signal impending doom. My body did its clenching and I tried to still my breath. When at last I was steered into the procedure room, even after oxygen in my nose and monitoring pads stuck to my chest and three women moving around me with experienced casualness; even after the anesthetist told me she was starting the drip and assured me the metallic taste would go swiftly away, I had time to register the impressive array of equipment and drawers and cabinets and the conviction that I was going to die; had time to think about how I was still awake and that I needed to keep my eyelids open as long as possible so they’d know I was awake and wouldn’t shove a camera down my throat.
I went under in that state of panic and I came to in a quake.
*
Of course, nothing was wrong. I woke up, the doctor arrived, and I associated my twilit earthquake to my family, threatened by fire. I don’t know why I needed to tell him, in that moment, that my niece had lost her house, when he had his own meaningful news, except that everything in my awareness felt precarious and important to name. Turns out I’ve got various gastrointestinal itis-es, announced by suffix as conditions of being inflamed.
- Carapace
Ladybugs occupy my house every fall, retreating indoors for warmth. Tiny russet smudges at the edge of my vision that occasionally disengage from the background and flitter to some other spot on the wall or floor. The French—who call them coccinelles—believe the touch of a ladybug will cure your ills and that killing them dooms you to a lifetime of grief. I read of an infestation in a Vermont farmhouse so thick that ladybugs rained down from the ceiling upon the heads of the owners in their beds.
Take “lady” out of these sentences and the image is even more disturbing.
*
A friend wrote two years ago on the occasion of my fifty-eighth that she imagined I was “deepening” in some way, but I didn’t recognize myself in her image of a woman “undaunted” by aging who is actively cultivating some sort of reflective poise. It was the heart of winter, sunless and raw, and after my younger sister’s birthday visit, I sank quickly, feeling at once out of control and inert. It’s illnesses that deepen. Twilight deepens, thickening around the ankles. Deepening is the fathomless cold of space, the cold of the woods where I walk with the dog, wherein lies a buried stillness. Calm in my experience of it has a hard time penetrating beneath the surface.
Deep sleep, deep freeze. Deeper is where you go in hypnosis, as my father and I used to do, a weird party trick, a game we played. Deepening is a process we cannot know the end of. Once, in meditation, I went so deep I terrified myself. Grip is an easy thing to lose, if you think about it.
*
My dog is rolling in something in the grass and I say to him, like I do every time, “Knock yourself out, dude; someone’s getting a bath,” because it comforts me to remember there’s an antidote to this penchant he has for dead things and scat. Then he pants at me because he hates to be idle when we’re technically on a walk and I stare at the little crusty bits on the end of his nose that the veterinarian assured me is benign age-related hyperkeratosis.
This phenomenon of hardening. The lesion behind my right shoulder is pronounced a neoplasm of uncertain origin and removed for biopsy; as the wound heals, it whitens grossly inside a red circle so it looks like a coral atoll or a ring nebula embedded in my flesh. I’ve been rereading Franz Kafka’s “The Metamorphosis,” in which Gregor Samsa, become a bug, suffers an apple lodged in his back (hurled at him by his father); the apple decays, inflames the chitin, and gets “entirely covered in white dust.” Kafka was himself a notorious hypochondriac, but not just in the straightforward sense of fearing disease. He often felt dissociated from his physical being, and the scrutiny, the nervous assessment of sensations, became a process of guaranteeing his realness, that he was there.
Some say that worrying about dying is paradoxically a way to stay in control.
The lesion is a seborrheic keratosis, noncancerous, utterly benign, common in “older adults.” Keratosis is defined as a “horny overgrowth.” I imagine waking up to an exoskeleton like Gregor Samsa. Gregor’s grotesque transformation is read, variously, as the alienation of modern life, the inhumanity of work, the absurdity of bourgeois domestic ritual. It’s also a tale about how the intense anxiety of hypochondria, fearing the worst of what if, objectifies and dissociates us: when we don’t know what’s wrong, we become unrecognizable to ourselves, body parts behaving in unfamiliar ways, as if with tiny minds of their own. And even so, Gregor-as-bug communicates with his family, eats and sleeps, enjoys a few delighted moments of newfound capabilities (he can walk on the ceiling!). It’s not hopeful, exactly, but it’s more than a devastating tale about the repugnance of humanity.
I’ve spent so many years trying to take up less space, to make my body slimmer or shapelier or less unruly, I like thinking of it deliberately overgrowing itself like a horny toad, or a unicorn. Or I’m becoming my own dog, with his still-occasionally age-related hyperkeratosis-encrusted nose.
*
In Ovid’s Metamorphoses, all of human history, from the creation of the world, is narrated by way of transformation, beginning with the resolution of primordial Chaos into order. Gods become human, humans turn into animals, water gods are shape-shifters, the dead are reborn as plants. Even language enacts flux, as Ovid had a particular fondness for tracing place names toward memory and thus emotion, so that where we are is always how we once were, back in the thickets of psychic origin. The words we use to manifest reality are never the thing-itself, of course, but only point to it, evoking and symbolizing; and how many times does searching for the exact word we want end up ferrying us elsewhere, toward an unexpected thought, unearthing emotion? Thus we transmute ourselves, even as we say who we are.
