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Photo by Mats Silvan/Getty Images. Edit by Cheri Lucas Rowlands.

Miranda Ward | Adrift | Weidenfeld & Nicolson | January 2021 | 15 minutes (4,339 words)

The bald conclusiveness of a positive pregnancy test draws a clear line between yes/no, this/that, knowing/not-­knowing. For a moment at least it clarifies everything, or distils it, into a single and irrefutable piece of knowledge. This certainty, when it comes to the body, is rare (later a doctor will tell me: if everything in medicine were as reliable as a pregnancy test, my job would be a lot easier), so I hold on to that piece of knowledge, which is proof of my own productivity, for as long as I can.

But doubt, worry, have a way of threading their way through even the solidest conviction. Threat is everywhere: a light fever, an undercooked egg. Indeed the more I read the more I realise how fragile a pregnancy is, how it isn’t as simple as a positive test and a baby nine months later, which is something I suppose I always knew in the abstract but never had any real frame of reference for before. I was aware that some of my friends and acquaintances, for example, had had miscarriages, but I had not until now really understood what it meant, in both practical and emotional terms, to have to hold an awareness of this terrible possibility always alongside a hope, a longing, for it not to happen to you. Most of what I know about pregnancy, in fact, comes from fiction, from books, films, TV: the way certain signifiers – wooziness, weakness, nausea – are used to suggest a pregnancy before it is confirmed; the way, once it is confirmed, a woman must somehow both alter her behaviour drastically and hardly at all, vomiting copiously into a bin at work seconds before giving a presentation just as if nothing is amiss, but studiously avoiding, suddenly, a whole litany of food and drink; most of all the way a baby is almost always the inevitable result of a pregnancy. The plain fact of it – that at least one in four pregnancies end in miscarriage, perhaps more, since sometimes a woman might miscarry before she even knows she’s pregnant – had somehow eluded me, or else I had somehow failed to think of it in tangible terms.

What does that statistic actually mean, practically speaking? It means that nothing is a given. It means that there are people – a lot of people – for whom the result of a pregnancy is not a baby. It means that even the purest elation is often shaded, especially in the early weeks, when miscarriage is most likely, with fear.

I develop a set of superstitions for protection; certain shirts for luck, certain routes home from the library or the grocery store, certain songs skipped or repeated. An aping at control. And for a while everything is normal, in the sense that nothing is normal, in the sense that I feel slightly ill, weary, a little as if I am not myself. My overriding emotion is happiness, but there is also a part of me that feels as if I have become separated somehow from my body, as if it is acting of its own accord, and the thinking part of me is just along for the ride. There are psychological adjustments to make – I have to play the phrase I’m pregnant over and over to myself to believe it; I have to think about what is good for me not in terms of my body only, but also in terms of the invisible body-­to­-be inside me. There are physical symptoms, too, though they are mild (another thing I didn’t realise: that while some pregnant women are indeed debilitated by illness or weariness, not everyone is). I am never actually sick, though I am dogged by a whisper of nausea that asserts itself at odd times and leads me to keep a pack of digest­ives on my bedside table. I can feel a largeness, a tenderness, to my breasts, and although I know it’s far too early for the pregnancy itself to show I feel fuller somehow, heavier than I was before I knew, as if the knowledge itself has some weight or substance to it.

This is not an unpleasant feeling – because it is a novelty, and because the pregnancy is so unequivocally desired – but it is hard to escape a sense of uneasiness, too. I find myself tracing familiar routes around Oxford, where I’ve lived for years, ever since I moved to the UK after university; I know the roads well, and yet I feel every encounter between feet and pavement to be different now, because I am differently bodied. What I have is a sense, visceral and unignor­able, that my body no longer belongs wholly to me – and in a way it doesn’t. As I walk I feel not exactly a ‘we’, but a blooming plurality, an ‘I and…’, perhaps, the assertion of a possibility taking physical form. Where once I occupied my mind during walks with long, elaborate daydreams, there now seems to be no room for anything other than the immediacy of experience and the planning and execution of the tasks of my own daily life. I take to listening to radio shows and podcasts, tuning out my external surroundings and internal circumstances, focusing on the minute details of, say, a true crime story, losing myself in the voice of the presenter.

* * *

Geographers write about the inseparability of the body from our experience of place: we sense places, are bodily present in them, see them, hear them, smell them, move within them. How else do we know a favourite room or city or mountain trail? The body, as Tim Edensor writes, is the means through which we experience and feel the world.

To which he adds: bodies are not only written upon but also write their own feelings upon a space in a process of continual remaking.

What I am struck by in the delicate earliest weeks of pregnancy is that I am being both made and unmade; rewritten. The pregnancy is largely unspoken of: we have told our doctor, and our parents, which perhaps lends it a weight in the world that it wouldn’t yet have had we not told anyone, but day to day I move through the hours without anyone but us knowing, because the pregnancy is still invisible. When I stand in front of the mirror I see nothing different, but nothing the same, either. When I go to the swimming pool, as I do most mornings, an almost religious habit, the place of it has shifted, though the change is microscopic, under the surface. On a quiet morning I watch the play of sunlight on the bottom of the pool and I am in a foreign country. In the changing room, pulling off my wet suit after a shower, I am self­-conscious for the first time – can they tell? But I want them to tell, even though there’s no way they possibly could, even though when I think of it I have the sense not so much of the world tilting on its axis but of the axis itself having drifted elsewhere. I smile knowingly at a visibly pregnant woman undressing and she looks away, uncomprehending or embarrassed or both. I am the foreign country, or else I have lost the map of this place. Walking home, along the same roads I have always taken, the green of the trees fading into yellow, I feel somehow both lonely and plural.

* * *

And then.

One morning, a few weeks after that first definitive, positive test, I wake up and feel my old self again – that is to say, not ill, not weary, not plural or novel – and that evening I experience some mild pain, a quick gush of blood which soon slows to an ambiguous but ominous trickle, and a sense of doom. I am not sure what the appropriate reaction is: denial? Despair? I cannot summon the energy to cook or even to eat dinner; although it is still early I retire to bed, lying on top of the duvet, curled into a question mark. Alexander lies down next to me, his body settling around mine. He tells me the things I both want and don’t want to hear: that it’s OK, that we don’t know for sure that anything’s wrong yet, that he loves me. He’s meant to be playing football in twenty minutes. Do you want me to stay? he says. I’ll stay with you. No, I say vehemently, as if this is in fact an uncharitable suggestion, you should go, you should play, what can you do at this point, what can I do? Nothing. Even after he’s pulled his socks over his shinpads, laced up his boots, he hesitates at the door: are you sure you don’t want me to stay? I don’t want you to stay, I say emphatically. If I were being honest – with him, with myself – I’d say exactly the opposite: stay, please. Instead I lie back and stare at the wall for an hour until he gets home and we go to sleep.

The next morning I call my GP, who arranges an emergency scan for me at the hospital. The soonest the scan can be done is in two days, so in the interim period I carry on as usual: I go to meetings, answer emails, run errands. It’s not as hard to do this as I would have imagined it would be, and after all, what choice do I have? But it’s also indicative of the ongoingness that will characterise much of the next two months.

I cannot summon the energy to cook or even to eat dinner; although it is still early I retire to bed, lying on top of the duvet, curled into a question mark.

I would have imagined, too, that a miscarriage was a definite thing – yes/no, this/that, knowing/not­-knowing – a neatly shaped happening with a beginning, a middle, a definitive end, each closely following the other. Women say, ‘I had a miscar­riage’, and until now I have always heard their experience as being something contained, even while brutally uncontrollable: all those stories of blood-­drenched bathroom floors, of unimag­inable agony, of horror and shock, of sadness and then resolution (often in the form of a baby arriving a year or two on, as if some consolation must always be offered): what I understand now, of course, is that these stories are told retrospectively, packaged in the way that all stories, to some extent, must be. But when I phone the doctor I’m unsure, grammatically speaking, how to phrase my concern: do I say to him that I have had a miscarriage, that I’m having one, that I’m worried I might have one in the future? The idea of the miscarriage in progress perplexes the part of me that imagined that this is a thing that can only happen privately, violently, suddenly, because it is a thing that is happening without much noise at all, and meanwhile here I am transcribing an interview, here I am meeting with a freelance client, wearing a new skirt I bought yesterday from the charity shop, here I am buying groceries and planning dinner, with nothing but a question mark inside me.

Alexander and I take a taxi to the hospital for the scan; it’s early morning and the driver is playing loud Pakistani pop, which is somehow soothing, and drowns out my own thoughts. In the waiting room Alexander scrolls restlessly through his phone. A little plastic radio on a cabinet in the corner of the room is pumping out cheerful tunes punctuated by cheerful radio host banter. I take my book from my handbag and lay it on my knees, open at my marked place. Knausgaard, A Death in the Family. In his younger-­self narrative, the author’s father has just died, while in his current­-self narrative, his partner is heavily pregnant, lumbering around, practically bursting with new life. But I cannot read on. I become fixated on a single paragraph, a description of a piece of artwork, which strikes me as incomprehensible. I read it over and over again until my name is called.

The scan reveals an embryo with no heartbeat. I lie on the bed, naked from the waist down, a blue plastic sheet draped over my legs. Alexander holds my hand while the ultrasound technician swirls a wand around inside me, talking us through the image of my uterus on the screen. It is illegible to me – darkness, light, hazy shapes – but to her the meaning is crystal clear. I’m so sorry it’s not the news you were hoping for, she says. She gives me a wad of tissue to wipe myself with before leaving the room to let me get dressed. She leads us back to the waiting room, which is fuller now, no one making eye contact, the radio still humming; a doctor will see you soon, she says, to talk to you about what happens next. ‘Soon’ is an ambiguous word, and time becomes difficult to perceive; we are there for what feels like both an eternity and an instant. I take my book out again, stare again at that same page; Alexander unlocks his phone, moves his finger across the screen in a kind of robotic motion.

What I am struck by in the delicate earliest weeks of pregnancy is that I am being both made and unmade; rewritten.

Sometimes these things resolve naturally, the doctor says when we are finally called in to see her; sometimes intervention becomes necessary, or desirable. She schedules me for another scan the following week, so we can monitor whether there’s been any change: in other words, whether the products of conception, as the embryo is now known, have been partially or even wholly expelled. After the scan, she says, we can decide how to proceed; you don’t need to make any decisions now. Good, I think, though I’m a little hazy on exactly what kind of decision I might be called upon to make; she has described the various forms of intervention but I can’t quite situate them in relation to my own body, my own products of conception.

She is very young, the doctor, soft-­spoken, apologetic. She says to call if anything changes before my next appointment, if I have any concerns. She gives me a business card, circles a phone number that’s operational 24/7. To minimise the risk of infection, she adds, seemingly as an afterthought, you shouldn’t take baths or swim.

No swimming. Of course. But I am thrown by the thought of this: the removal of the most obvious physical coping mechanism I have for dealing with what is essentially an entirely uncontrollable physical situation. I realise I’ve said this out loud without really meaning to. A silence falls, either respectful or uncomfortable.

I’m a swimmer too, the doctor says suddenly, as I’m standing to leave, abandoning, briefly, her professional distance. I’d hate not to be able to do it.

After the appointment we walk to a Starbucks near the hospital. It’s dark and anonymous inside, and smells of sweet pastries and wee. I order a latte, two shots, why not, and we sit at a counter at the window, watching buses trundle by. It’s mid­-morning and the place is full of new mothers and their prams, though occasionally someone in scrubs or a suit hurries in and then out again. Alexander texts his boss to say he won’t be coming in to work today. Not just the day but the month, the year, stretches out before us, suddenly open. What will we do with it? What can we do? The coffee is too hot, tasteless, the milk burned, but I suck it down in a rush, turning the inside of my mouth furry. Before all this, the test, the pregnancy, the ungrowing embryo, we were planning a wedding; we had set the date, hired a venue, made arrangements with the registrar. We should have cancelled everything – my due date was too close to the wedding date – but we never did; too superstitious, or preoccupied, or both. Now, of course, I say, devastated, amused, we won’t need to change the date. We can simply pick up where we left off. I feel myself begin to rewrite the map again, to slip in and out of familiarity with myself and my surroundings. There’s a simplicity to it all, underneath the ambiguity, the anguish, that makes me almost giddy: for what is this but a reversion to my natural state, a return to old routines?

A thought – terrible, comforting – hits me square in the face then, that there’s relief to be felt. The awful thing, the dreaded thing, has happened, and I need no longer fear it. I hate myself for feeling this but can’t let go of it, either, because I think it’s a way forward, a way out, a small tremble of light.

* * *

The second scan is no more or less enlightening than the first: there is still an embryo, there is still no heartbeat. No change, in other words: an unwanted stillness.

The doctor gives me a leaflet, which outlines in clinical language the three ways of managing a miscarriage when preg­nancy tissue remains in the womb: expectant, medical, surgical. The first is the wait-­and-­see approach, taken on the assumption that the tissue will pass naturally out of the womb with time. The second involves taking a course of medication to stimulate the passing of the tissue out of the womb: a potentially painful, lengthy, and often messy process, not always entirely effective, sometimes necessitating the third approach anyhow, which involves surgical removal of the tissue.

I still don’t know how to decide what to do, so I put it off: if nothing’s happened in a few weeks I’ll opt for some kind of intervention. I want above all to trust my body to do whatever needs doing, but already it’s betrayed me once, so what do I know?

Still no swimming, obviously, the doctor says sadly. Other­wise, proceed as normal.

As normal. Nothing is normal, I start to think – but then again, in a kind of terrible way, everything is normal again, isn’t it?

* * *

The present­-tenseness of the event, the miscarriage, which is not so much an event as a continual unfolding of uncharted territory, a vast grey area, makes it virtually impossible to talk about in any way that makes sense of what is actually happening. I don’t know what to tell people because the language I have is not elastic enough to encompass something which is past, present and future all at once. So I do what the doctor suggests: I proceed more or less as normal, going to meetings, going to the supermarket, scrolling mindlessly through Twitter, doing the laundry, eating, sleeping, working. I let myself lose track of time. At one point, in a notebook, next to a to-­do list, I write: The calendar is a kind of enemy, reminding me of the facts of things, the time it is actively taking to go through this process of miscarriage. I take to walking – long, slow strolls at the very edge of dusk, through parks and quiet suburban neighbourhoods that smell of woodsmoke and exhaust fumes. I feel my muscles going slack, and an irrational fear grows daily: what will my body become while I can’t swim?

My fear is really a form of vanity. I know that with each day or week that passes without a swim my body will start to look subtly different. I’ll lose, am losing, the public indicators of my fitness – the muscle, the shape of my arms and legs, the things that say to other people that I’m disciplined, that my body is under control. And I don’t want them to see what I know: that nothing is under control, that this body is not working properly, that athletically, reproductively, it is not doing at all what it’s supposed to do.

Mostly, though, if we’re honest, it’s the changes in our bodies that are in control of us, not the other way round.

Words come to me on my walks, as they used to on my swims. Some of them are obvious. Why is this happening to me? I think selfishly, inevitably, as I climb the hill to the park on a soft bed of wet leaves, fresh-­fallen after a night of howling wind. But other things, too, drifting like the smoke and the fumes. Disobedience. Betrayal. Softening, slackening, slowing. Undisciplined. Back at home, in my notebook, I write: I guess I feel disconnected from a part of myself. Not that I’m not still the same person or can’t be again, but that for a while I and some other part of me are not quite coinciding. I’m talking about the swimming, not the miscarriage, or at least ostensibly I am. I have a deep sense of geographical dissonance, like a dream of a familiar place in which the location of everything is slightly wrong, so that you round the corner and suddenly come upon a street that should be miles away, or discover that all along there has been an extra room in your house.

One Sunday afternoon, sitting in a booth at my local pub, I see a woman I used to see most weekday mornings at the pool; she always wore a bright pink cap, a navy swimsuit. She’s about my age, sitting with a friend, eating lunch. Perhaps it’s her local too, I think, for the first time realising, stupid as it sounds, that these people I’ve been brushing up against at the pool are people with lives outside that context, just like me.

Occasionally I log on to Facebook and check the page for the triathlon club I belong to. I look through the list of times from a recent 400-­metre time trial, spotting familiar names, noting the improvements, and wonder how much I, too, could have improved by now. For a moment I’m gripped by something which feels a little like jealousy but isn’t quite – desire, perhaps, something almost carnal. But then the desire, or whatever it is, fades: I’m here now, and maybe, if I can admit it to myself, I’m actually a little relieved that I’m not sweating away in a pool, that I don’t have to worry about how fast or smoothly I can cut through the water, how hungry I’ll be later, how tired.

* * *

The poles of the earth have wandered, the journalist John McPhee once wrote: even that which seems most permanent and solid is, in its own way, shifting. It’s true literally – think for example of the tectonic plates, the movement of the continents, which still, on average, drift a few centimetres a year apart, about the rate at which our fingernails grow, as the geographer Doreen Massey frames it, a reminder that the body is never in stasis either. In other words the whole world is a continual work in progress; the present is not some kind of achieved terminus, Massey writes. To underline this idea, she describes the slow movement of what she calls the ‘migrant rocks’ that came, over the course of millions of years, to form Skiddaw in the Lake District. Solid and eternal as it seems, she says, the mountain is not timeless. Like she and her sister, staying in a hotel in Keswick, it’s just passing through. It was once elsewhere. It will be elsewhere again someday.

It’s easy to lose your footing here, to feel that nothing is solid, but I’ve always found something comforting about this idea that place is essentially unfixed. The rigidity of permanence would be too much to bear, surely: who wants to be stuck in the same place forever? Who can know and love anywhere and not see that a point on a map is one thing, a living, breathing place quite another?

It’s a concept that scales well – if the world is a work in progress, then so too is a city or a street or a swimming pool. So too is the body, which is, after all, as the poet Adrienne Rich puts it, the geography closest in; it’s the first place, the place we must make peace with – subject, like all places, to the pressures of time, of external rhythms and events, changing from moment to moment, year to year, getting older, bigger, smaller, more or less capable of performing certain tasks, more or less like it was at the beginning.

There’s a simplicity to it all, underneath the ambiguity, the anguish, that makes me almost giddy: for what is this but a reversion to my natural state, a return to old routines?

Sometimes we’re in control of that change, or we think we are. Exercise in particular gives us the illusion of power over our own physical futures. Take your recommended thirty minutes of activity a day and stave off all kinds of bodily evil. Lose a bit of weight, add a bit of muscle, establish a routine, live forever, or longer, anyway. The geographer John Bale wrote of exercise as a literal form of recreation: through time, repeated action, the body is re-­created so that it works better. It incorporates knowledge, becomes stronger, fitter. Progress. Maybe next week, or the week after, I’ll be faster than I was last week. All it takes is discipline, resolve, another few thousand metres racked up. Most of all denial: of the body that wants, of the possibility of vulnerability or limitation. A few years ago, I remember, I became obsessed with watching Olympic swimming races; I trawled YouTube, read interviews with the athletes, fascinated by all their talk of sacrifice and discipline. And isn’t this why I watched in the first place? To see what happens when we write certain kinds of want out of our body, and one singular, possessive, demanding want into it: to be the best, the fastest, the one standing on the highest platform of the podium?

Mostly, though, if we’re honest, it’s the changes in our bodies that are in control of us, not the other way round. The fact of the matter is that not that long ago, my body was capable of run­ning 13.1 miles, of swimming 3,000 metres without complaint; not that long ago, my body was actually hosting another body, or the beginnings of one.

And now everything is different, and everything will be different again someday, and different again, and different again.

This excerpt has been lightly adapted for publication on Longreads.

* * *

Miranda Ward is a freelance writer, editor, and lecturer. Her memoir Adrift: Fieldnotes from Almost-Motherhood is published by Weidenfeld & Nicolson in the UK. She grew up on a cattle ranch in California and now lives in Oxford.

Editor: Cheri Lucas Rowlands

2020: One Year, Lifetime Consequences

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As a partner at True Ventures, a Silicon Valley venture capital group, Om Malik is easily able to work from home during the pandemic — a privilege he does not take lightly. In his ebook, The Longest Year, he reflects from his unique perspective on both the benefits technology has brought us, and the disparity it has created.

How often have you seen images of kids sitting in the parking lots of fast-food restaurants to access WiFi and attend their classes over Zoom? The Federal Communications Commission says that over 21 million people in the U.S. lack high-speed connectivity, though it should not be surprising that this is most likely a significant undercount.

Even from his more privileged position, Malik finds isolation hard, as he lives through not only the pandemic but the devastating wildfires that hit California, turning his home of San Francisco into a world where the “colors that one normally associates with movies such as Apocalypse Now, Blade Runner, Mad Max, and Dune are all around us …” In this ebook, Malik journals his thoughts throughout the year that was 2020, allowing us to see, and learn from, his personal struggles over hundreds of days of self-isolation. 

I recently found myself on a beach off the California hamlet of Bolinas in the middle of a seasonal transition. For a couple of hours, I watched multiple whales frolicking in the waters as they dove for food. I am not enough of a nature expert to say for certain if these were the blue whales that have been making appearances in Northern California. I could see these with my naked eye. It was easy to find them, as well, because the ocean was relatively calm. A gigantic, ever-changing swarm of sea birds was also taking part in this alfresco dining.

The sight in front of me was a reminder of the gentle rotation of the planet, which will keep going long after I am gone. Similarly, these whales will migrate elsewhere. 

Locked in my cave, as I have been for the last many months, I feel the passage of time. I don’t mean that in a rigid, mathematical sense. I feel its ebbs and flows. Time has fluidity and adaptability. It is fungible, only represented in the rhythms of the world around us. As I grow older, I realize that impermanence and time are part of the same journey. The biggest lesson of standing in place — especially during this pandemic — is the importance of listening to the heart’s rhythm and letting that define what time and life are.

Malik also thinks beyond his personal experience — considering the human psyche that quickly moved from selflessness at the start of the pandemic, to our social media “post-algorithmic reality,” where it is every man for himself. Malik goes on to share interesting reflections on the huge shift to humankind that the pandemic has fast-forwarded, and how “we are in a period of extreme, rapid change that will redefine how we interact with the world around us.”

Now as we prepare to welcome 2021, we are changed in many ways. Perhaps most significantly, the distinctions between our physical and digital worlds have largely disintegrated. We now work and we live online just as much, if not more, than we do offline. We may have always been heading this way, but this year significantly — and irreversibly — accelerated our pace. Transitioning to this new normal comes with tremendous opportunity, but we must remain aware that some will require assistance to make the adjustment.

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Is the Cure for Cancer Locked in Shrunken Heads from the Amazon?

Simon Prades

There’s a photo from the 1960s, of a young boy in California holding two shrunken human heads. The boy is the stepfather of writer Steven Lance, and the heads came from a family friend named Wilburn Ferguson. He had gotten them from an Amazonian tribe called the Shuar, who shriveled the heads of their enemies using a fluid derived from jungle plants. Ferguson, a nurse, former religious missionary, and lifelong dreamer who had moved his family to South American in the 1930s to pursue medical research in the Amazon, believed that the fluid could do something else—something life-giving. In his Atavist Magazine* feature “The Secret Formula,” Lance explains the root of Ferguson’s theory, which was shared by his devoted wife, Ruth:

Soldiers who fought the Shuar, according to stories Ferguson heard, might wake up one morning to find a stack of [heads] in their camp, shriveled but still recognizable as those of fallen comrades. It was powerful propaganda, a warning to steer clear. Head shrinking was “the most effective national defense ever devised,” Ferguson wrote.

He suspected that it might be much more than that…. “The thought occurred to me,” Ferguson recalled, “that perhaps the active ingredients of this process could be in some way adapted to shrink, or at least check, the wild growth of cancer cells.”

By that time, as Siddhartha Mukherjee explains in his 2010 book The Emperor of All Maladies: A Biography of Cancer, scourges like smallpox and tuberculosis were yielding to medical advances. “But of all diseases,” Mukherjee writes, “cancer had refused to fall into step in this march of progress.” Cancer is out-of-control division and growth of abnormal cells that can destroy healthy tissue and spread through the body. As Americans escaped other ailments and lived longer, more of them developed the disease. By 1926, it had become the nation’s second leading cause of death.

Long stigmatized and little understood, cancer now drew widespread attention. One senator proposed a $5 million reward for “information leading to the arrest of human cancer.” Americans dreamed of finding what Fortune called a “new principle of treatment.” The Fergusons were caught up in the zeitgeist. The thought inspired by the shriveled head was simple enough: If cancer killed by growing, shrinking was a way to fight it. For the Fergusons to test their theory, they needed access to whatever the Shuar were using on their enemies’ heads.

What followed was a saga spanning several decades and countries, and more disappointments than successes. Ferguson tried to prove his hypothesis, mustering evidence from lab experiments and patients (some consenting, others not). The scientific establishment rejected him. Yet today, more than 20 years after his death, he still has acolytes—people who told Lance that they believe Ferguson discovered something world-changing:

Ferguson wasn’t a snake-oil salesman or a con artist. Outlandish though some of his stories still seem, the details contained within them were consistent. The people I spoke to who knew Ferguson were struck by his sincerity. He could be stubborn and impractical, but as my stepdad recalled, Ferguson was always careful to point out that he hadn’t discovered a silver bullet, merely a promising treatment that needed more study. What he wanted most of all was a real scientific shot.

Ferguson was an outsider his whole life. Like a modern-day Don Quixote, he chased an impossible dream based more on faith than evidence. He wandered the wilderness seeking a miracle. The doctors and scientists who doubted him had every reason to. But what if they missed a bark or root of medical importance? What if Ferguson saw something they couldn’t? What if he was right?

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*The author of this post is the editor in chief of The Atavist, which is Longreads’ sister publication.

‘No Single Machine Should Be Able to Control So Many People’

Photo illustration by Jakub Porzycki/NurPhoto via Getty Images

Adrienne LaFrance has come to realize that Facebook is not a media company — it’s a doomsday machine, one operating above ground, in plain sight, just east of Highway 101 in Menlo Park, California. At the Atlantic, LaFrance traces the history and growth of the web giant, whose early mission was focused on making the world more open and connected. In its quest, it built “community” at an unprecedented global scale, but along the way stripped away all the good. As we’ve seen, Facebook is a government propaganda machine; a place for hate and terrorist groups to organize; a space for harassment, manipulation, and social experiments; and so much more. Today, its highly personalized, algorithmically powered informational environment is increasingly challenging to moderate — thus incredibly dangerous — and “no one, not even Mark Zuckerberg, can control the product he made,” La France writes.

I recalled Clinton’s warning a few weeks ago, when Zuckerberg defended the decision not to suspend Steve Bannon from Facebook after he argued, in essence, for the beheading of two senior U.S. officials, the infectious-disease doctor Anthony Fauci and FBI Director Christopher Wray. The episode got me thinking about a question that’s unanswerable but that I keep asking people anyway: How much real-world violence would never have happened if Facebook didn’t exist? One of the people I’ve asked is Joshua Geltzer, a former White House counterterrorism official who is now teaching at Georgetown Law. In counterterrorism circles, he told me, people are fond of pointing out how good the United States has been at keeping terrorists out since 9/11. That’s wrong, he said. In fact, “terrorists are entering every single day, every single hour, every single minute” through Facebook.

In previous eras, U.S. officials could at least study, say, Nazi propaganda during World War II, and fully grasp what the Nazis wanted people to believe. Today, “it’s not a filter bubble; it’s a filter shroud,” Geltzer said. “I don’t even know what others with personalized experiences are seeing.” Another expert in this realm, Mary McCord, the legal director at the Institute for Constitutional Advocacy and Protection at Georgetown Law, told me that she thinks 8kun may be more blatant in terms of promoting violence but that Facebook is “in some ways way worse” because of its reach. “There’s no barrier to entry with Facebook,” she said. “In every situation of extremist violence we’ve looked into, we’ve found Facebook postings. And that reaches tons of people. The broad reach is what brings people into the fold and normalizes extremism and makes it mainstream.” In other words, it’s the megascale that makes Facebook so dangerous.

In the days after the 2020 presidential election, Zuckerberg authorized a tweak to the Facebook algorithm so that high-accuracy news sources such as NPR would receive preferential visibility in people’s feeds, and hyper-partisan pages such as Breitbart News’s and Occupy Democrats’ would be buried, according to The New York Times, offering proof that Facebook could, if it wanted to, turn a dial to reduce disinformation—and offering a reminder that Facebook has the power to flip a switch and change what billions of people see online.

The decision to touch the dial was highly unusual for Facebook. Think about it this way: The Doomsday Machine’s sensors detected something harmful in the environment and chose not to let its algorithms automatically blow it up across the web as usual. This time a human intervened to mitigate harm. The only problem is that reducing the prevalence of content that Facebook calls “bad for the world” also reduces people’s engagement with the site. In its experiments with human intervention, the Times reported, Facebook calibrated the dial so that just enough harmful content stayed in users’ news feeds to keep them coming back for more.

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How Does the Story End?

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At Harper’s Magazine, author Ann Patchett relates working with Tom Hanks, through which she meets and befriends his assistant, Sooki. After a series of emails, Sooki comes to live with Ann and her husband Karl in the early stages of the pandemic while receiving treatment for pancreatic cancer in Nashville, Tennessee. This is a beautiful essay, about the different shapes that friendship can take, and the limitations of truly knowing another human being, despite our best intentions.

When I’m putting together a novel, I leave all the doors and windows open so the characters can come in and just as easily leave. I don’t take notes. Once I start writing things down, I feel like I’m nailing the story in place. When I rely on my faulty memory, the pieces are free to move. The main character I was certain of starts to drift, and someone I’d barely noticed moves in to fill the space. The road forks and forks again. It becomes a path into the woods. It becomes the woods. I find a stream and follow it, the stream dries up, and I’m left to look for moss on the sides of trees.

Putting together a novel is essentially putting together the lives of strangers I’m coming to know. In some ways it’s not unlike putting together my own life. I think I know what I’m doing when in truth I have no idea. I just keep moving forward. By the time the book is written, there is little evidence of the initial spark or a long-ago conversation in California Pizza Kitchen.

This story—which begins and begins—starts again here. Of course we would exercise together; it was good for both of us. Kundalini is nothing if not an exercise in breath, and as it turned out, breath was what Sooki was craving. More breath. Almost from the moment we finished that first practice, she identified it as part of her recovery, the thing she needed to stay alive.

I had never found a way of asking what having cancer had been like for her, or what it meant to so vigorously refuse the hand you were dealt. With every passing day I seemed less able to say, Do you want to talk about this? Am I the person you’re talking to, or are you talking to someone else downstairs late at night? I was starting to understand that what she needed might have been color rather than conversation, breath rather than words.

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The Racist Healthcare System that Failed JaMarcus Crews

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JaMarcus Crews’ mom was diagnosed with Type 2 diabetes while she was pregnant with him, making him more likely to develop the condition himself. As Lizzie Presser reports at ProPublica, he worked hard to manage his health after being diagnosed as a teen. He did everything right, everything they told him to do. He watched what he ate. He exercised. He lost weight. He drove hours and hours, sometimes having to borrow gas money to attend life-saving dialysis after the disease progressed. His only mistake? Putting his trust in a system that was set up to fail him as a Black man with Type 2 diabetes.

A race-adjusted equation was also at play in JaMarcus’ case. The formula calculates kidney function by looking at what’s called “estimated glomerular filtration rate,” or eGFR. Creatinine is plugged into the formula along with age, sex and race. Doctors must note whether their patient is “Black” or not. By design, the equation assigns healthier scores to those who are listed as Black, because at a population level, a few studies found that this was more precise. With little investigation into why this might be the case, it was just accepted. That inflated score can mean a longer wait for a kidney because eGFR must drop to a certain level before you can start accumulating time on the transplant waitlist. The best-case scenario is to get a new kidney before needing dialysis, to avoid weathering the side effects of the machines. But those transplants are given on a first-come, first-served basis, and Black patients are less likely to get one.

The researchers and physicians behind the original formula, developed in 1999, wrote that Black patients had higher creatinine levels because “on average, black persons have higher muscle mass than white persons.” The assertion that Black bodies are different from all other bodies keeps company with generations of racist ideas that have infiltrated medicine, some of which were used to rationalize slavery. Researchers who developed the equation acknowledge that race is an imperfect variable, but even though they have updated the formula, they continue to adjust for race. The vast majority of clinical laboratories in the United States use such formulas today.

Dialysis is corporate healthcare on steroids: For-profit companies dominate the market, reap their revenues from Medicare and lobby hard against government reform. DaVita and Fresenius recently spent over $100 million to fight a ballot initiative in California that would have capped their profits, much of which are derived from taxpayer dollars, arguing that the initiative would lead to a shortage of doctors. They have lower staffing ratios and higher death rates than nonprofit facilities. And studies have found that patients at for-profit clinics are less likely to reach the transplant waiting list; they are 17% less likely to get a kidney from a deceased donor. Purnell, the Johns Hopkins epidemiologist, said the whole system is broken as long as corporate dialysis, which is financially incentivized to keep patients, is in charge of steering them to the better treatment of transplant: “Why would I walk into a Nissan dealership to tell me about a BMW?”

Dialysis facilities are responsible for transplant referrals, according to federal regulations, and JaMarcus’ DaVita social worker was assigned to educate and support him. When he was first assessed, a couple of weeks after he began, she wrote that he was suitable for referral and she would get him one when he got insurance. JaMarcus qualified for Medicare within three months. But more than a year later, he still hadn’t been referred.

By 2015, JaMarcus had a new DaVita social worker, Robbin Oswalt, who attributed the delay to a different prerequisite: “He is interested in getting a transplant referral if the Dr. approves after his wgt loss.” JaMarcus had lost 108 pounds since he started dialysis, and his body mass index had been hovering around the University of Alabama’s limit for months. At the time, he didn’t know that his height had been mistakenly entered into his DaVita records as 5-foot-11 — an inch and a half short of his actual height. Their incorrect number was then used to calculate his BMI, which made it look to his doctor that his weight was disqualifying, when it wasn’t.

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Longreads Best of 2020: Investigative Reporting

All Best of Longreads illustrations by Kjell Reigstad.

All through December, we’re featuring Longreads’ Best of 2020. This year, our team picked and featured hundreds of in-depth investigations published across the web. Here are our top picks.

If you like these, you can sign up to receive our weekly email every Friday.

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The Last Patrol (Nathaniel Penn, The California Sunday Magazine)

In July 2012, U.S. Army First Lieutenant Clint Lorance gave an order that killed two Afghan civilians on a motorcycle near an operating base outside of Kandahar, in a volatile region in Afghanistan. Lorance was convicted of murder. The narrative weaved by Sean Hannity and others at Fox News framed Lorance as a war hero; he was pardoned by Donald Trump in November 2019 and served six years of a 20-year sentence. The former Army officer, who had been advised to take interviews only from conservative media outlets, agreed to talk with Nathaniel Penn, and the result is an incredibly riveting and comprehensive piece on his case.

Arriving on the dirt road that led into the village, the patrol discovered two of the three Afghan men lying beside a ditch. They were dead. Their companion had run away. Near them, the motorcycle leaned on its kickstand.

It wasn’t at all the scene Lorance had imagined. “If I would have been up there,” he told me, “and would have known that they were stopped and off their motorcycle, I would never in a million years have said, ‘Fire at them.’ I would want to go talk to them and get intel out of them. I’d be like, ‘Who are you? Where are you from?’ I would want to know everything about them.”

A woman and two children stood near the bodies, weeping.

Holy shit, Lorance thought. Did we just kill good people?

The way to find out was to do a Battle Damage Assessment. Skelton was the intelligence specialist who carried the SEEK. But Lorance wanted Skelton to follow him into the village to carry out the mission and get the biometric enrollments. The engagement with the motorcycle had been necessary and unfortunate, but it wasn’t important. He ordered two of his men to conduct the Battle Damage Assessment while he proceeded into the village. They had the necessary training, even if they didn’t have the SEEK. They knelt by the bodies.

Captain Swanson, who had been alerted to the situation, was radioing Lorance from headquarters. What was happening? he asked. Were the dead men combatants or civilians? Had Lorance done the Battle Damage Assessment?

No, Lieutenant Lorance replied, they hadn’t been able to do the Battle Damage Assessment. The villagers had taken away the bodies.

As he spoke, he knew he had just made a critical mistake. He should have said that his men would get to the Battle Damage Assessment eventually, that they didn’t have time to do that shit right now. Because when you speak over the radio, “you might as well be putting your hand on the Bible,” as one member of the platoon told me.

In the years to come, Lorance’s decision not to use the SEEK device for the Battle Damage Assessment would prove to be crucial and polarizing. It would contribute both to his imprisonment and his pardon.

The weeping woman was screaming now. Lorance told himself that her tears didn’t necessarily mean he’d done anything wrong. The men whose bodies she was crying over could be insurgents. That shocked him — the idea that the Taliban had families, too. It had never occurred to him before.

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Longreads Best of 2020: Essays

All Best of Longreads illustrations by Kjell Reigstad.

All through December, we’re featuring Longreads’ Best of 2020. This year, our editors picked and featured hundreds of beautifully written and poignant essays published on the web. Because of the wide range of writing across many topics and themes, it was a challenge to sift through them all over the past several weeks to compile a definitive Best of Essays list. As I shortlisted stories, I realized there could be many different versions of this list, but, in the end, these eight reads really spoke to me.

If you like these, you can sign up to receive our weekly email every Friday.

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Mississippi: A Poem, in Days (Kiese Makeba Laymon, Vanity Fair)

Kiese Makeba Laymon was on a book tour when the pandemic hit in the U.S. In this stunner of a piece that unfolds over 14 days, the author writes on fear, racism, death, and home amid a moment of awakening. We follow along on the journey, from event to event in Ohio and West Virginia, with Laymon’s observations and thoughts interspersed with daily COVID-19 death counts and the latest words or orders from Donald Trump and Mississippi Governor Tate Reeves. It’s a powerful meditation, one that will stop you in your tracks.

We are awakened, I want to believe.

75 miles from the armed confederate statue in Oxford, Emmett Till’s childish body was destroyed. 70 miles from that armed confederate statue, Fannie Lou Hamer was nearly beaten to death. 160 miles from that armed confederate statue, Medgar Evers was murdered as he enters his home. 80 miles from that armed confederate statue, Martin Luther King was murdered in Memphis.

It took way too much Black death to get here.

I am wandering around the spiritual consequences of materially progressing at the expense of Black death. I want to be courageous. I wonder, though, when courage becomes contagious—when courage is credentialized, subsidized, and incentivized—if it is still courage at all.

Today, as I prepare to push send, and I lather my hands in sanitizer, it feels a bit too much like cowardice.

Maybe I’ll wait to send tomorrow. Maybe I won’t send at all.

The Lafayette County Board of Supervisors, a group of white men, unanimously vote to keep the armed confederate monument in the middle of Oxford, the town where I live, teach, and write.

Humiliation, agony, and death, are what I feel.

It could all be so much worse, is what the worst of white folks want us to recite.

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Longreads Best of 2020: Science and Nature

All Best of Longreads illustrations by Kjell Reigstad.

All through December, we’re featuring Longreads’ Best of 2020. We’ve searched through our archives to find the science and nature stories that take you into ancient forests, through dark swamps, to the bottom of the sea, and right up into the stars. 

If you like these, you can sign up to receive our weekly Top 5 email every Friday.

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The Social Life of Forests (Ferris Jabr, The New York Times Magazine)

Old-growth forests in North America are like something out of a fairytale — huge trees, luminescent with moss, with boughs arching above your head, and “gnarled roots” beneath your feet, “dicing in and out of the soil like sea serpents.” And, as Ferris Jabr discovers in this story, the magic of these trees goes beyond what we see — with intricate fungal networks weaving them together into an inclusive community that links “nearly every tree in a forest — even trees of different species.” This is a fascinating piece that shows you these giant sentinels are more than you expect — more than just individuals. 

Jabr goes into the forest with Suzanne Simard, a professor of forest ecology at the University of British Columbia who has studied these systems and proved “a dynamic exchange of resources through mycorrhizal networks” between the two species of paper birch and Douglas fir. Her work has provoked a certain amount of controversy: “Since Darwin, biologists have emphasized the perspective of the individual … the single-minded ambitions of selfish genes.” Simard is proving this is not what is happening in old-growth forests; they are “neither an assemblage of stoic organisms tolerating one another’s presence nor a merciless battle royale: It’s a vast, ancient and intricate society.” And trees are not just interacting with each other, “trees sense nearby plants and animals and alter their behavior accordingly: The gnashing mandibles of an insect might prompt the production of chemical defenses … Some studies have even suggested that plant roots grow toward the sound of running water.” 

A forest operating as a complicated, sharing society is a powerful notion. Not only does it garner more respect for this ecosystem, but it could prove that cooperation is as central to evolution as competition: “Wherever living things emerge, they find one another, mingle and meld.”  Read more…

Longreads Best of 2020: Writing on COVID-19

All Best of Longreads illustrations by Kjell Reigstad.

All through December, we’re featuring Longreads’ Best of 2020. This year, our editors featured many COVID-19 stories from across the web, and below, we’ve narrowed down 11 picks that really resonated with us. This roundup is focused on reported features; we initially included a few pandemic essays in this category, but those will instead appear in the upcoming Best of Essays list. 

If you like these, you can sign up to receive our weekly email every Friday.

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How the Pandemic Defeated America (Ed Yong, The Atlantic)

The Atlantic‘s coverage of COVID-19 was exceptional this year, and Yong’s deep, thoughtful September feature lays it all out. How did the U.S. get here? Everything that went wrong was predictable and preventable, and despite all of its resources and scientific expertise, America’s leaders failed monumentally to control the virus at every turn.

The coronavirus found, exploited, and widened every inequity that the U.S. had to offer. Elderly people, already pushed to the fringes of society, were treated as acceptable losses. Women were more likely to lose jobs than men, and also shouldered extra burdens of child care and domestic work, while facing rising rates of domestic violence. In half of the states, people with dementia and intellectual disabilities faced policies that threatened to deny them access to lifesaving ventilators. Thousands of people endured months of COVID‑19 symptoms that resembled those of chronic postviral illnesses, only to be told that their devastating symptoms were in their head. Latinos were three times as likely to be infected as white people. Asian Americans faced racist abuse. Far from being a “great equalizer,” the pandemic fell unevenly upon the U.S., taking advantage of injustices that had been brewing throughout the nation’s history.

Inside the Nightmare Voyage of the Diamond Princess (Doug Bock Clark, GQ)

Another devastating read, “The Pariah Ship” by Michael Smith, Drake Bennett, and K. Oanh Haat, recounts the nightmare journey of Holland America’s MS Zaandam.

The pandemic has exposed the flaws of tourism, and cruise ships are a symbol of the disastrous effects that COVID-19 has had on the travel industry as a whole. Princess Cruises’ Diamond Princess, which departed on January 20 this year from Japan’s Port of Yokohama, was the first ship to suffer a major outbreak. Clark’s account of the voyage and subsequent quarantine of the ship’s 3,711 passengers and crew is riveting yet terrifying. He weaves stories of numerous people on board, from the more-privileged (a pair of traveling couples called the “Four Amigos”) to the overworked and underprotected (like security crewmember Sonali Thakkar). His reporting of the U.S. government’s response is superb, especially from the perspective of Dr. James Lawler, the infectious-disease expert called in to lead the evacuation of American passengers back to the U.S. We also get a glimpse of what the experience is like for the ship’s captain, Gennaro Arma, who was eventually the last person to disembark.

The Amigos, reduced now to three, along with the 325 other American evacuees, were still waiting on the buses. They had spent three hours idling on the pier and then, once they drove to the airport, sat on the tarmac for two more hours. Now, as the delay extended into a sixth hour, the passengers were nearing revolt. They were exhausted. And more problematically for the largely elderly passengers: The buses had no bathrooms.

Meanwhile, in Washington, D.C., where it was still Sunday afternoon, the fate of the waylaid evacuees was being decided. Around the time the passengers were exiting the Diamond Princess, Japanese officials had blindsided their American counterparts with the news that some of the passengers boarding the buses had actually tested positive several days before. Soon many of the highest-level members of the Trump administration’s coronavirus response team, including Dr. Anthony Fauci, were arguing about what to do. Representatives from the CDC continued to fear spreading the virus. William Walters, the deputy chief medical officer for the State Department, wanted to bring everyone home anyway. Those urging the evacuation noted that the planes had been prepared with isolation units to contain the sick.

As the debate raged, the evacuees were demanding to be let off the buses, quarantine be damned, to find a bathroom. Carl was breathing so hard his masked breath fogged his glasses as he strained to control his bladder. Some seniors were crying. Finally, a few were allowed to relieve themselves in bottles beside the bus or were brought to a nearby terminal.

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