(Note: sections of the essay discuss suicidal ideation.)
I was arguing with myself about whether or not I liked the schmaltzy romantic undertone in one of the variations of Rachmaninoff’s Rhapsody on a Theme of Paganini. Arguing with myself because I prefer my Rachmaninoff severe and melancholy, but I do think that he is a composer of underrated warmth and vitality. I have a hard time making up my mind about what I want from Rachmaninoff, and I was listening to Daniil Trifonov’s recording with the Philadelphia Orchestra, led by Yannick Nézet-Séguin. The argument I was having with myself was whether or not the sentimentality I detected in the recording had to do with Rachmaninoff’s view of Paganini or if it was leaking into the music from Trifonov and the orchestra. I don’t know how to describe it except to say that it felt sticky somehow. Anyway, I was going back and forth about this when I heard the sirens.
The firetruck came up East Washington and parked near the bank. I was in the pedmall, which is a large open courtyard surrounded by shops and bars in downtown Iowa City. I was there because it was the first cool, sunny afternoon in quite a while. We had been getting a lot of rain or otherwise, the temperatures were too high to be outside. I was shocked but not really shocked to see how many people were walking around and eating lunch in outdoor patios. I picked a place in the pedmall where there was shade and where I wouldn’t be near anyone. I texted a friend that there were a lot of people outside and didn’t they know that there was a pandemic happening? It had been that way for much of June and the back half of May, people resuming the regular course of in-restaurant dining and grouping together at bars. Or shopping without masks. Once, a cashier had reached for my debit card without wearing gloves, and I’d recoiled in shock at her bare human hand. She seemed to notice and laughed and said, It’s alright. And I thought, But it’s not.
Sometimes, I feel angry about it. Don’t they know they’re putting everyone at risk? Don’t they know we’re all going to suffer if we don’t knuckle down? But then I remember that most people aren’t thinking like that. They aren’t thinking they’re doing anything to hurt anyone. They figure that if they make choices for themselves, other people will be responsible. What they don’t imagine is that we are all irresponsible. We are all going around all of the time thinking that someone else will make the reasonable choice and just this little bit of selfishness is okay.
Our societal problems in some way arise from the accumulation of small and large acts of selfishness, little bits of civic inattentiveness. Or, worse, it flares into a kind of hostile attitude of entitlement. Don’t tell me what to do, is what a friend says when I ask what the people who come to his casino say. They don’t want to masks, he says. They don’t want to have their temperature taken. They just want to do whatever they want. They think I’m healthy. But they don’t think, my friends, of all the other people who think that too, and then all it takes is one person to say It’s not that bad, I’m fine before everyone has it.
But there I was in the pedmall when the fire truck came, and I knew that something was happening to someone. People stopped and watched as three firemen in their navy blue pants and tight shirts exited the truck and put on masks. They wedged their thick palms into thin nitrile gloves and walked with a kind of casual saunter across the street. They were coming in my direction, and I paused the music to watch them, like being able to hear them would make my vision sharper, clearer. Like I’d be able to pick subtleties that might reveal something to me about their goal.
An ambulance came a few minutes later. Maybe not even that much. But the firemen had already gone into the building by then. Some EMTs got out of the ambulance and brought out a gurney. It was in a sitting, upright position, and it was easy to imagine a person there sitting upon it like a litter. Bright yellow railing, black straps. The wheels struck the gap in the pavement and it jerked as they pulled it over the pedmall. The whole thing rattled pitifully. We all watched it. I say we even though I was by myself because the pedmall was full of other people, and though we did know each other and were not there as a group or a party or anything like that, we had been joined by the sirens. We had become a collective, and our watching felt like a group activity. Like we were all together in our looking. Our watching.
I felt that I could understand their thoughts, too. There was a lot of whispering, yes, and no one was saying out loud what I was sure we all were thinking. Covid-19, corona, governor, lockdown, quarantine, social distance, cough, wet, dry, pneumonia, oxygen, pulse, blood clots, mask. It felt very much that we were joined in our looking and in the idiom that had formed over the last few months from news and broadcasts and press conferences and Twitter and Instagram and messages and emails and texts. A means of communicating had taken hold, and it really did feel, for a moment, like I understood them without them saying anything. That what they expected to happen was what I expected to happen. And we all were sitting there, together, watching the EMTs wait at the propped open door the way one watches a magician as they pull something mysterious and colorful from their hat or their sleeve.A siren splits the ordinary into the before and everything else. It carries us, effortlessly, from one phase of being into another.
But then, humming beneath that common language, was something more furious in me. We did not know what was wrong with the person. It might have been anything. A heart attack. Asthma. Dizziness. A cut hand. A broken leg. We didn’t know. And yet, because of the moment in which find ourselves, it felt like we did know. We were intruding upon the private circumstances of someone else’s life like we knew them. And no one seemed ashamed or aware that they were staring. No one seemed unnerved by it. They seemed to be saying with their posture and the open staring that they had a right to see. They had a right to information. In the same way that people always seem to feel when it comes to someone else’s life, like they personally are owed answers for things. I felt implicated by sitting there. Even if I didn’t look or tried to look away, by virtue of sitting there, I was taking part in the spectating.
I was a part of it.
In March, I was in a similar position.
I had just come home from what would be the last book event I did for my debut novel. I had come from Madison, Wisconsin, where much of the book is set, and I had seen friends of mine. I had been to restaurants and on planes and in stores. I had washed my hands and wiped down menus. But as I watched the news as the pandemic spread and deepened into our communities, I thought of those crowded, packed restaurants with new fear and anxiety. I also developed a cold. Or something like a cold. I was sniffy and had something that I wouldn’t call a cough exactly, but perhaps it was. I spent a lot of time looking up videos about coughs, wet and dry. I spent all of my time reading wiki articles about what a cough was or wasn’t. And how to tell. I checked my pulse. I checked my oxygen levels. I felt dizzy. Or did I not?
Then, one evening, as I was making dinner, I felt my breathing hitch a little. Just a little bit. And I thought, is this shortness of breath? I thought, what was that? And then I couldn’t breathe at all. I couldn’t get any air in. My heart was going fast, and my vision blurred, and I didn’t know what to do. I spun around. Felt my knees go jelly. I thought, I have to call someone. Before I pass out. I have to call someone.
I called 911.
The technician asked what was wrong with me. And I said that I was having shortness of breath. And that I felt dizzy. And she asked me if my hands tingled, and I said, yes, yes. And she asked me the questions they ask you when you have maybe been exposed, if I was worried about having been exposed. Recent travel, recent contact with people with known positive cases, did I work in medicine, did I not? Then she said she was sending someone to get me.
I remembered in that moment, that very moment, that in Joan Didion’s The Year of Magical Thinking, she took things with her to the hospital when she went with husband. I found my insurance card. I found my insurance forms to make sure that I could use my insurance card. I collected my medicine. I collected my phone charger. I put these things in my backpack and waited on the porch. I would be ready. I waited. I thought again of The Year of Magical Thinking. That joke I sometimes make online, when something hilarious and ironic befalls someone. Life changes in the instant. The ordinary instant. I regretted making that joke.
The ordinary instant.
There was snow coming down. It was mid-March. I was maybe seven days post-travel. It was one of those beautiful days that other people don’t find very beautiful. What I mean is that the sky was utterly opaque, a kind of milky marble gray. There was a dim cast to the light, and everything was saturated. The snow was flakey and thick, and it descended so slowly that it felt possible to count all of the pieces of it if you moved your eyes swiftly enough. The roads were slippery and grainy with melting snow. It clung to the brown branches of the shrubs and the trees. The air was cold and clear, and I tried to breathe deeply, but I couldn’t get the air in. I thought, I will die. I will die.
So much of that premonition had to do with the news I was reading. The statistics. I felt that I was in the middle of some kind of deadly Venn diagram. Pre-existing conditions. Black. Overweight. It felt possible that I would die. It seemed to make sense. In that moment on the porch as in so many other moments of my life, it felt that my death was the most logical outcome. The solution to the ridiculous equation of my life. I thought, this is it. This is how I die. This it. Someone had to die. And why not me. Dying was the most ordinary thing in the world.
Then I heard the sirens. It’s a funny thing. I live at the corner of Iowa Ave and Gilbert. The police station is literally across the street from my house, and on the other side of the police station is the fire department. It takes less than two minutes to drive from the fire station to my house. It’s literally a right turn the minute they leave the station. There is a hospital visible from my porch. The name of that hospital is Mercy. A funny bit of lore is that Denis Johnson was inspired by the glowing Emergency sign outside of the Mercy ER. It’s Iowa City. Writers haunt every bit of this place. The sirens came, and the fire truck went screaming down Iowa Ave, past my house. Then the ambulance came and parked out near my lawn.
I watched through my porch door as the EMTs climbed down onto the snowy street. Put on their booties. And their gloves. And their masks. A woman, and a man. They came, slowly. Climbing the steps. They paused at the edge of the porch.
They asked me if I was the one who needed assistance. They were, I think, a little surprised to see me standing. I said that I was. That I wasn’t feeling well. That I found it hard to breathe. They said to stop talking. I don’t mean it that rudely. It’s hard to communicate what it was like on the porch. It was snowy, and cold. And I felt my fingers go numb. They were scared. I could hear it in their voices. I could hear their fear. Their human selves. I was afraid too. Of myself. And also of getting someone else sick. We did not know if I had been exposed. We existed in a state of unknowing. Of fear. Of doubt. It is space that is familiar to any who believe. I thought, in that moment, of theology. That it was a moment that could be understood through theology because what was theology if not the interpretation of such moments. When people encounter one another across a divide of unknowing and fear. I felt, in their presence with the porch door between us, their hands clasped over their stomachs and faces cast down, the way I sometimes felt when I was with my pastors in Sunday school. The moment passed. They had told me to stop talking because they did not want to be exposed if I had something. They were still learning the protocol. Asking me questions before handing me a mask was doing it out of order.
They slid a mask through the door and told me to put it on. I took the mask, and she almost jumped back from me. She was afraid I would touch her. The man was further back.
I heard them talk it over. Decide who would be the one who handled me. And who would stay clean so they could interact with the nurses at the hospital. I put on the mask. And then they asked me more questions. We talked about how I felt. They told me I could come out then. They took my pulse. My heart rate was in the 130s. They asked me if my body tingled. If I felt numbness. I said I did. They took my blood pressure. It was high. Dangerously so. They told me I should be checked. They asked if I wanted to ride with them. Or if I could get a ride from someone else. I said that I would walk. And they looked at each other and said, No. You won’t be doing that.
In the back of the ambulance, I thought about dying. I thought about the stories I had read. The people who go in and don’t come out. The people who get intubated. The people whose oxygen levels never go up. I thought about the time in the ER just a few months before, when I had a bad round of tachycardia, and I listened to some nurses talk about how an old man was septic and how his oxygen was too low and he probably had pneumonia. And I thought, oh, at least that wasn’t me. But here I was. In the back of the ambulance, being taken up my street. I could see the familiar places, my usual route when I went out walking. I could see my friends’ houses. And I thought I would never see them again. I would never see any of them again. And how sad that was. They rechecked my BP and my pulse, and all remained high, too high. I couldn’t calm down. I couldn’t be easy. I couldn’t relax.
I had entered that place inside of terror when everything goes quiet and still, and you think you’re calm, but really, your body is on fire and you just have ceased to be able to register it.
I was taken out of the ambulance. Dropped down on my feet onto the sidewalk. And they walked me into a white tented area just off the main entrance. It was basically the carport of the ER, but it had been sealed with white tarp. It reminded me of the place where you bought your tickets at the Alabama fair, under a big white tent, those cheap tables and rickety fold-out chairs that seem to bend under your weight. The wind was making the tent billow outward. It bulked up and then slimmed down. I sat on a chair and watched through the clear plastic squares that I guess were meant to be like windows. The sidewalk was slick, wet. I had forgotten to put on socks, and my ankles were cold.
The intake nurse was nice, but also afraid. One of them was sent out to check my ID. And to get my temp and info. They took my temperature in Celsius, and I did the conversion in my head, and felt horrified because it said I had a slight fever. And I thought about all of those cases I had read about. When someone had a mild fever and a little cough and two days later, they were dead. Healthy people. Perfectly healthy people dead. That’s what the news kept saying. That perfectly healthy marathon runners were rendered helpless and weak. And I thought, I don’t run marathons, what hope do I have. I am not a lucky person. I thought, oh, oh, oh no. Every vital they checked seemed to portend some dark future. Some bad outcome.
They took me to their Covid-19 unit. And I lay back in the bed. They took X-rays. They took an EKG. They took blood. They ran tests. They swabbed so deep in my head I could taste the fibers for days. But they ultimately decided that I had had a panic attack. And that I had post-nasal drip and needed some allergy medicine and to clean my room because it might have collected dust during my travel. A diagnosis at once so vague and so mundane that it felt to me that they were just trying to get rid of me because if I did have Covid-19, which they did not really test me for because I didn’t meet the criteria, they wanted to preserve their resources for worse cases.
It all felt like a scam.
But I went home. And then a week later, I was back in the ER for another panic attack. And then four days after that, back again for another. Each time, it felt that my life was ending. Each time, I felt that I couldn’t breathe. In between my ER visits, I had telemedicine conferences. I tried to see a doctor at QuickCare. I had recently changed my healthcare provider and didn’t have a relationship with my GP. I felt that I had been deserted because I couldn’t see a doctor. No one could make me feel better. I stayed up all night reading articles. Watching videos. Trying to diagnose myself. I read the stories about people who had tried to get help and who had been sent home and who had died. I read about people’s anxiety on social media. I watched the videos of young healthy people who were now skeletal and unwell. I watched the videos of people inserting tubes down patients’ throats. I read research papers on inflammation and the signaling pathways involved. I had learned in graduate school the language that cells use to communicate to each other. I understood disease as a kind of miscommunication within tissues. This knowledge only served to increase the ways I could be afraid.
I was totally undone.
My life took on a grayish cast. I had a hard time breathing. My heart rate was routinely north of 100 but south of 130. I became an expert in reading my body’s many numbers. Fluent in temperature and oxygen and pulse and BP and glucose. I pricked and bled and sampled and fed my biological self into all the little devices I had accrued. And I measured them against each other. I stayed in bed for about two months. I sobbed on the phone with my friend routinely. I said that I knew I was okay. I knew I was alright. I didn’t have a reason to be afraid, but why was I so scared? I could tell that I was scaring him. I could tell that I was making him nervous about my state of being. But I couldn’t change it. I knew with my human mind that I was okay. But I also felt, could I trust the machines? What if something was missed? What if something that seemed small became important? What if there was an important clue?
On each of my ER visits, the doctor would ask how I felt, and I would spend ten minutes reciting all of my data. The nurses marveled at the specificity and detail of my reports. At my understanding of pathways and processes. And when I concluded, they would say, Yeah, you’re right. You’re fine. And I’d say, I don’t feel fine.
My last ER visit came many weeks after the one before it. I had been feeling okay. I had been feeling just fine. But a new wave of research had gone public, implying that the heart could be damaged by Covid-19. That it seemed to be affecting blood vessels and the vascular system. And, as if someone had pressed a button, I felt a wild little flutter in my chest, and then a burning sensation. I thought, oh this is it, this, this explains everything. The pulse, the slight elevation in temperature. This explains it. And I went to the ER. I walked myself there, my heart thundering. I was taken in. My BP was through the roof. My pulse was 125.
But the doctor said that I was having another panic attack. And that they would give me something but we needed to really work on this because I was making myself ill with fear. As they went out to talk among themselves, I lay in the bed. There was a cross above the sliding door. I remembered that the hospital was called Mercy. The hospital was probably very Catholic. And I don’t know why, but I began to cry when I thought about that. And I thought, Why can’t I just be okay? Why can’t I just control myself? Why can’t I just be fine? It wasn’t loud or sobbing. Just a hot line of wet coming out of my eyes and down my face and into the crease of my neck. I repeated to myself I’m fine. I’m fine. I am alive. I am fine.
The crying, I know, was because I was furious at myself. Because I had almost gotten better, but at the slightest prompting from a bit of information, I had flared brilliantly, brightly back into terror. The doctor gave me a valium, and sent me home, and I slept for a day and a half almost. And for days after, I felt sluggish. Heavy. Slow. My mind wouldn’t make thoughts. Nothing was clear.
In the ER, the doctor had asked me if I wanted a prescription of valium. I gave it some thought. I really thought about it. But then I thought about my parents, both prodigious alcoholics. I thought about all the adults I knew growing up, and how all of them had been addicts. I don’t drink. I don’t smoke. I abstain. I don’t have moral objections to substance use. I think people should do whatever they want. I think that criminalizing substances disproportionately affects marginalized communities. But I also know that addiction is difficult, brutal. I know that addiction has a strong genetic and environmental component. I know my reward pathways are too easily, too readily coopted. I told the doctor that I did not think it was wise that I should take a habit-forming medication. Especially since I hadn’t established care with a GP. Especially not when my anxiety was sending me to the ER every week.
Instead, I doubled the dose of my anxiety medication. It’s not habit-forming. Or it’s not supposed to be. I doubled the dose to get through the day. I drifted through the rest of March, all of April, and most of May in a fugue. I had lost my ability to be in the world without wanting to crawl out of it by any means necessary.
I spent a significant amount of time researching ways to voluntarily check myself into psychiatric care. I spent a lot of time trying to figure out how I could go away. None of my doctors asked me if I felt unsafe. I would have said yes. Yes. Yes. I feel unsafe. I do not feel that I can be in charge of myself. I do not feel that I can protect myself. I do not feel safe. I am a danger to myself. I think about harming myself. I would have told them that had they asked. But they did not ask. Instead, they told me about breathing exercises. And suggested valium. But I think what I wanted was to go away. I couldn’t find any peace, and I wanted it desperately.
This was not the first time in my life I have been suicidal. But it was the first time in a long time that the suicidal ideation was not passive. Typically, my ideation comes as if from below, like clouds reflected in the surface of a river. But during those first months of quarantine, I was unable to escape the desire to kill myself. It seemed increasingly like the only viable way to get any quiet at all. I was tired of feeling. I was tired of hurting. I was tired of having to steward myself through the world. I wanted it all to stop.
I think in part, what made it all feel particularly unbearable was that I had just gotten over a period of intense anxiety. From November to January, I went to the ER at least five times for similar symptoms. Pounding heart. Dizziness. Difficulty swallowing or breathing. Blurry vision. An inability to think clearly. I had just gotten over that. And here I found myself again. It felt like I’d spend the rest of my life that way. Wrung out and laid up for weeks and months unable to do anything.
Back in December and January, I couldn’t read or write. I could barely stand listening to music or to podcasts. The only thing I could do was lie in bed and watch shows about white people in small towns. I consumed The Gilmore Girls and Virgin River and The Good Witch. I re-watched the first few seasons of Grey’s Anatomy. I tried to get better, and then I simply had to get better. Because I had a book to promote. So I did get better.
Then came March, and the world stopped, and I descended back into that pit of despair.
Yet, I still had to read and edit stories for the magazine I work for. I had to answer emails. People were asking me to do readings over video. Journalists wanted to know what it was like to have my book tour ended, what it was like to be a debut author in a time of global calamity. Would you like to comment? Would you like to get a word in? I’m on a tight deadline? Would you please say something to the state of your condition?In the back of the ambulance, I thought about dying. I thought about the stories I had read. The people who go in and don’t come out. The people who get intubated.
Suddenly, people had so many ideas about how I should promote myself during the end of the world. My inbox was full. Every day, new emails. New offers.
Meanwhile, I didn’t even know if I would survive the week, the day, the hour, the minute.
I told everyone no. Or I did not respond. I would not promote my book. I would not do their events. I would not sign on to anything. I went quiet the very moment everyone else seemed to get louder. The world was going on in new ways and new modes, building new ethics and operations. They built up new grammars.
I went on crying to my friend because I thought I was dying.
And then, bit by bit, day by day, I got a little better. I could sit up for longer. I could breathe. If my heart pounded, I waited for it stop. I built up my tolerance for reading again. I built up my tolerance for screens again. I made dinners and watched Grey’s Anatomy. I watched Brothers and Sisters. I watched Big Little Lies. I watched Billions. I read Joan Didion. I read Alice Munro. I watched chefs make things on YouTube. I imagined what it would be like to see my friends again. In New York and Portland and Wisconsin. I imagined what it would be like to go back to Alabama. I imagined who would meet me at the airport. I imagined smelling the summer air there again. The winterlight, so blue and clear. It snowed and I watched it through my window. I sat on my porch and learned to type again. One letter, one line, one paragraph, one story.
I learned to be in the world again.
In the pedmall, I tried to read. I decided that I would abate my queasy feeling of complicity by walking to the very end of the courtyard and sitting away from the crowds. I decided that I wouldn’t participate in the gawking. That if a person was brought out, they wouldn’t have me sitting there, looking at them. And so I read and listened to the other variations. I took pictures of the small sparrows that landed nearby and sent the pictures to my friend who lives in Upstate New York. He works for a rich woman and takes care of her upstate house. He has three or so chickens, and we talk about them quite seriously. I ask him How are the ladies? And he gives me updates about them. One of the little chickens, Cordey, is sick. She’s laying soft eggs, and he’s worried about her. After I had taken pictures of the sparrows—I only knew they were sparrows because he said so—I looked back toward the bank.
The firemen had gone, but the ambulance was still there. I didn’t see any sign of the gurney. They might have taken it up or back to the truck. People were still standing around staring into the open door. More people had come to a stop. It was like we were all at the same outdoor concert. My neck felt hot. I felt uneasy about it. I wanted to not be there anymore, so I stood up and walked home.
I walked around the people, who glanced at me. They smiled. That same expression you make when everyone is in on a particular joke. I wanted to say that it wasn’t funny. I wanted to say, You’re not even wearing a mask. It seemed to me the height of American foolishness that a group of strangers would stand so close together to peep and peer at someone who very might well have one of the most contagious diseases on the planet in the middle of a pandemic without wearing a mask simply because they wanted to see. But I was not different from them. I was not better than them. I had the same thing in me. That reflexive turn of the head. The desire to stare at what was there. Because that’s what sirens did. That’s what their function was. To draw your attention and prompt you to move aside. To make way. To prepare yourself for what was coming.
A siren splits the ordinary into the before and everything else. It carries us, effortlessly, from one phase of being into another. It removes you so easily from the context of whatever you were thinking or feeling or doing, and you are transformed into a voyeur. Sirens scream through this city every day. I hear them. Like a pod of whales searching for each other.
Sometimes, when I am taking my walk by the river, I hear the sirens or the beat of helicopter blades. I say a little prayer for the person being taken. I learned to pray at an age so young that even though I no longer believe, I don’t know what else to call the act. This reflexive appeal to the wider, boiling cosmos. I do not know what else to call this intercession except prayer. If I had learned to pray later, it might not have grafted so deeply, and I might have another language for it. Some toothless, liberal ideology—thinking of you, or sending good vibes, or light to you. The things people say online when you Tweet vaguely about your feelings or your financial status. But to me, it is prayer. Even divorced from belief, it is prayer. And so I pray for them. In whatever small, derelict way I have left to pray, knowing that I am powerless, but just the same, hoping to steer whatever stray goodness in the universe remains to be steered toward that person and their family and all who love and know and cherish and need them.
On my way home, after leaving the pedmall, I decided that I did not like the romantic undertones in the variation I had heard. That just because people didn’t know how warm Rachmaninoff could be did not mean that I needed to pretend to like romanticism when I didn’t. And I decided, too, that the fault lay with Trifonov’s performance and not with Rachmaninoff’s interpretation of Paganini, because after all, it wasn’t present in the other performances of the piece I had heard. And I decided that I didn’t much care for what contemporary pianists did with Rachmaninoff, that they were either too cold or too hot, that they interpreted the more reserved passages of his work as being passionless and in doing so overcompensated with all their heaving emotion. The great sin of contemporary music, I thought, was that people thought feeling was a kind of virtue. That the chief recommendation one could make was It made me sob. People go around performing their feelings, their tears. All that private self made public for the benefit of public consumption. And why not. We are all making meals of each other’s misfortune. We are all feasting on the public spectacle in which we find ourselves. Feeding and gnawing on the personal.
As I was walking, I heard the sirens again.