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An Interview with Sarah Smarsh, Author of ‘Heartland’

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Angela Chen | Longreads | September 2018 | 14 minutes (3,488 words)

“I was born a fifth-generation Kansas farmer,” writes Sarah Smarsh, “roots so deep in the country where I was raised that I rode tractors on the same land where my ancestors rode wagons.”

In her memoir Heartland, Smarsh tells the story of four generations of that Kansas family. The book reaches back to a great-grandmother working multiple jobs and beaten by her husband, but is addressed to a future generation that will never be: Smarsh’s unborn daughter August.

Smarsh, the daughter of a teenage mother who is the daughter of a teenage mother, “was on a mission toward a life unlike the one I was handed.” August is a theoretical child born during Smarsh’s teenage years, whose very existence would have continued the line of teenage motherhood and derailed Smarsh’s mission. August is at once a guiding principle (“what would I tell my daughter to do?”) and a symbol of the poverty Smarsh worked to escape.

Heartland is the story of a family and the story of a class in America, an explanation to August of all she would have inherited and lost. I spoke to Smarsh by phone between New York and Kansas, where she lives. We discussed the invisibility of class, how “the country” has become a clichéd set of imagery, and how politicians on the left can reach alienated voters. This interview has been edited for length and clarity. Read more…

Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth

Sarah Smarsh | Scribner | September 2018 | 11 minutes (3,022 words)

We’re delighted to bring you an excerpt from chapter two of Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth by Sarah Smarsh.

Body of a Poor Girl

Our bodies were born into hard labor. To people who Grandma Betty would say “never had to lift a finger,” that might sound like something to be pitied. But there was a beautiful efficiency to it — form in constant physical function with little energy left over. In some ways, I feel enriched rather than diminished for having lived it.

I know the strength of this body that helped hoist an air compressor into a truck, leveraged a sheet of drywall alone, carried buckets of feed against prairie wind. I know the quickness of my limbs that scaled a tall fence when a bull charged and that leapt when a ladder fell. But while I worked in those ways, like my mother and father I wrote poetry in my mind.

There’s an idea that laborers end up in their role because it’s all they’re suited for. What put us there, though, was birth, family history — not lack of talent for something else. “Blue-collar workers” have jobs requiring just as much brainpower as “white-collar professionals.” To run a family farm is to be a business owner in a complicated industry. But, unlike many jobs requiring smarts and creativity, working a farm summons the body’s intelligence, too.

To run a family farm is to be a business owner in a complicated industry. But, unlike many jobs requiring smarts and creativity, working a farm summons the body’s intelligence, too.

Sometimes it was miserable. Sometimes it was satisfying. The farmhouse living room where we spent evenings had a big woodstove in it, and no fire will ever feel more glorious than the ones we sat next to after working outside in January sleet that clung to the metal fences as a coat of ice. I’m a little sorry you never got to feel that. But I am not sorry that you never experienced the dangers of being devalued outside those farmhouse walls.

The person who drives a garbage truck may himself be viewed as trash. The worse danger is not the job itself but the devaluing of those who do it. A society that considers your body dispensable will inflict a violence upon you. Working in a field is one thing; being misled by a corporation about the safety of a carcinogenic pesticide is another. Hammering on a roof is one thing; not being able to afford a doctor when you fall off it is another. Waiting tables is one thing; working for an employer whose sexual harassment you can’t afford to fight and risk a night’s worth of tips is another.

For black and brown bodies, a particular danger exists regardless of how much money is in a bank account. We were white bodies in peril specifically because we were laborers.

The person who drives a garbage truck may himself be viewed as trash. The worse danger is not the job itself but the devaluing of those who do it.

For those of us who were female, the body was also defined by its role as a potential mother. That’s true in every class but becomes more problematic in the context of financial struggle. Poverty makes motherhood harder, and motherhood makes poverty harder. Single mothers and their children are, by far, the poorest type of family in the United States.

The frustration at the dangerous crossroads of gender and poverty was sharpened for my mom in a couple of ways, I think. She had a mind that wanted books, ideas, and sketch pads — things she sat with privately but didn’t get to share with the world. And, because people considered her beautiful, she got a constant stream of attention about her body, at work and elsewhere. Being physically objectified that many times over — as a labor machine, a producer of children, and a decorative object — all while being aware of your own unexpressed talent can make the body feel like a prison.

My mom was beloved among her friends as a kind, funny, wise, and generous person, I’d learn as an adult. But there was a deep pain in her that only those closest to her saw. I think sometimes that she didn’t really hate having children as a young woman; she hated her life, and the children who came into it would feel that.

My mom was beloved among her friends as a kind, funny, wise, and generous person, I’d learn as an adult. But there was a deep pain in her that only those closest to her saw.

There is a good chance you would have felt it, too. The anger she put on me, I would have put onto you. I can count on one hand the number of times someone has seen me in a moment of true rage; they would tell you my voice became quiet and my eyes stopped blinking. But I have felt the wild, ungrounded frustration of the women before me many more times than I have shown it. Not so much now. But very much when I was a teenager and into my twenties, during what would have been your most formative years. Back then it took every bit of strength in me to stop that energy running through my body like lightning, to refuse to be its conductor.

Anger was not Jeannie’s true self, I’d learn as she aged. But, as tends to happen with people who are beaten down by daily circumstances, my young mother’s core nature was glimpsed only in moments of life and death: the hospitalization of a loved one, her own water breaking. It was not a tender nature, but it wasn’t mean, either. It was a severe serenity, doing whatever a moment required without complaint.


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The day my brother arrived, she sat on the edge of my twin bed to wake me in the dark early-morning hours. She’d picked out my ruffled mauve bedding and kept it well laundered, but before that moment she had never sat on it, that I can recall. She had a habit of keeping her distance and flying off the handle at the smallest frustration. For this event that might actually warrant panic, though, she was calm as a priestess in the October moonlight.

“It’s time,” she said.

At the hospital more than thirty miles away in Wichita, Mom hemorrhaged during the labor. Her blood pressure dropped so low that the doctors said, “Stay with us.”

Once she had recovered, someone put me in a blue smock and took me to meet Matthew, who was blotchy and black haired. The visitors’ room had blue balloons and food on long tables; I’d never seen such a big spread of treats and drinks on a day that wasn’t Thanksgiving or Christmas. Dad gave me a cup of sparkling grape juice, which I knew was expensive since it was in a big glass bottle involving bubbles and foil.

Mom wore a pink-and-black-striped cotton gown. She had curled and teased her long brown hair and put makeup on her twenty-two-year-old face, but her eyes were tired. They would stay tired for a long time.

My parents couldn’t afford a babysitter and didn’t live in a proper neighborhood where there might have been fellow mothers to help a woman recovering from childbirth. Both my grandmothers, Betty and Teresa, had promised to come by when they could. Dad was determined to get back to work. The Family and Medical Leave Act that might have protected Mom’s job for a few weeks wouldn’t be passed for another eight years; toward the end of her pregnancy, she’d been forced to quit whatever low-paying gig she had at the time.

So Mom would be on her own with a child not yet in school, an infant, a checkbook for a bank account with thirty bucks in it, and long miles between us and any town, any store.

So Mom would be on her own with a child not yet in school, an infant, a checkbook for a bank account with thirty bucks in it, and long miles between us and any town, any store.

With Matt’s arrival just weeks before Ronald Reagan’s reelection, Mom would soon cast her second vote in a national election. This time, though, her politics were different. While her teenage instincts had gone with losing incumbent Carter the year I was born, by 1984 she had been won over by Reagan’s charm or at least by the national consensus that he was a good president. Many others in our community would vote for him, too — if they voted at all.

“They’re all crooks,” I often heard about politicians. Mom never said that. She was not given to apathy and did her best to stay on top of the news. Based on what she could glean, Reagan was a good man.

The Republican party would hurt women like my mother in direct and indirect ways that decade: removing the Equal Rights Amendment from the party’s platform, dismantling aid programs that helped poor women feed their children, eroding reproductive health rights. Unbeknownst to my mom, the Republican party was turning deeply socially conservative, different from the moderate, fiscally conservative party that people respected in my area. Mom didn’t think women on welfare were lazy or that feminists were militant monsters. She voted for Reagan because a cultural tide told her it was the right thing to do, and she had little time or resources to question the wave of sentiment the country was riding.

The country was swinging right, and working people were changing party allegiance. My mom was one of them, part of a national trend that I have found says more about clever political messaging than about what people truly know or think about the issues. Meanwhile, poor rural mothers like her were receding from view in both political parties, if they’d ever been in view at all.

When she got home from the hospital, to our new house in the country, Mom was still bleeding through the stitches between her legs. She was exhausted in a way she’d never been and scared to have a four-year-old and a newborn under her care. Dad had to go back to work.

“Please don’t go,” Mom said to him. She was generally too proud to ask anyone for anything, including her own husband for support. But she pleaded. “I can’t do this alone.”

There were houses to build, though. My uncle was outside honking the horn, and Dad left — believing, to some extent, that it was his job to provide and her job to take care of the kids. There was no paid leave for him either in such a moment.

Once Dad was gone, Mom lay in their bed trying to sleep through her pain as Matt cried from his crib. I crawled up a chest of drawers in her bedroom and tipped it over. The dresser crushed me against the carpet.

Mom ran from her bed and somehow lifted the chest off me, straining so hard she tore her stitches. Blood ran down her thighs.

I don’t think we went back to the hospital. When she told me the story, it was about a day she barely survived because of my dad’s absence. I see it now as a day she barely survived because society valued productivity and autonomy more than it valued women and children. Pregnancy slows you down, so pregnant women lost their jobs; mothers were alone in their nuclear households while fathers worked extra hours to make up the difference. For the poor and rural among them, the situation was keenly dangerous.

When Dad came home that night, Mom was quiet. She stayed quiet for weeks, until Dad made another announcement. He would be leaving for a construction job a long drive east of us. That meant weeks away from home. Mom thought he was finding excuses to be away from us.

I see it now as a day she barely survived because society valued productivity and autonomy more than it valued women and children.

“Please don’t go, please don’t go,” she said, screaming and crying. She often screamed but almost never cried. It was like something had broken in her when the stitches between her legs tore.

But Dad packed up his tools and left again.

He was concerned about providing for his family, he told me when I was grown, sitting next to him in his work truck and telling him how Mom remembered that day.

“I couldn’t have turned down good money, even if I had to be gone for a long time,” he said. His eyes filled with tears. “Look, maybe I was wrong.”

* * *

How to handle the stress of it all when you don’t even know that your life is stressful? Women saying “my nerves are shot” was the closest anyone came to examining the situation. What they didn’t discuss, though, they felt. That’s what substances were for.

Every adult I knew was addicted to something — mostly cigarettes or booze. Also pills, both prescribed and gotten by other means. The women of my mom’s family, who had grown up in Wichita with doctors nearby during decades when health care was cheaper, were sold on the idea of prescriptions for symptoms rooted in psychological strife. Most of them were on “thyroid medicine” for exhaustion, “nerve pills” for anxiety.

Dad, however, didn’t take even the most benign aspirin — not thinking it harmful or ineffective but suspecting it amounted to money spent on something your body and mind could do on their own, for free and without side effects. Dad had a quiet inner life as a self-healer. Once in a while he shared it with me, and in that way he was the most maternal force in my life.

Dad had a quiet inner life as a self-healer. Once in a while he shared it with me, and in that way he was the most maternal force in my life.

He tucked me in most nights and helped me say my Catholic prayers to the Father, the Son, the Holy Ghost, Mary, and the guardian angels of me and all my family. This helped me relax at bedtime, but I had a horrible time falling asleep. I’d lie in my bed thinking through every problem and staring at my closed closet while my muscles were frozen in fear. One night I finally told Dad that I couldn’t fall asleep for the longest time, even after the prayers. He listened. Then he put his hands around my toes through the comforter.

“Relax your feet,” he said in a soft voice, and I did.

He said to relax my legs. I was amazed to find that I could and did.

“Now relax your tummy,” he said. I did, knots and tension disappearing as though Dad had helped me wave them away. I felt like a warm blanket was being drawn over me, but on the inside.

“Now relax your arms and your fingers,” he said. “Now your shoulders.”

By the time the magic had reached my head, my eyebrows relaxed, and I fell asleep.

Dad knew how to help me quiet my mind because he had taught himself to quiet his own. No matter how hard a day was, he almost always treated me with respect, if only by keeping his distance when his own emotions were raging.

And he really listened to me. Even though Mom was the reader and writer of the two, Dad liked to claim I grew up to be good with words because he talked to me like a grown-up rather than in baby gibberish when I was an infant.

Conversations were different with the rest of my family. They often fell into trancelike repetition of nonsense once a kid had worn them out: “He needs a good pop upside the head,” they’d say. Or “He’s lazy,” or “She don’t mind when she’s told.” Even warm, loving Betty would brag about how she’d been beaten as a kid and it did her good. “She’s up to something,” grown adults would say about little kids — words of warning like an old fairy tale from a European forest, where a poor child was a burden unless she contributed to the household and obeyed the rules.

Dad never said things like that. He would have troubles with drinking and gambling over the years, but he carried an aura of peace even when our lives were chaotic. He brushed my knotted hair before the sun came up, before he went to work and I went to school. He jotted poetic little notes of wisdom on scraps of paper and put them in my bedroom. When I was older I realized how remarkable all that was in our culture where manliness had a specific definition.

“Writing poems and brushing your daughter’s hair before school isn’t something men brag about, where we’re from,” I told him, reflecting on how nurturing he was by nature.

“It ought to be,” he said.

He was so good with little kids over the years that, even though he never said he wanted me to have my own, I sometimes felt simultaneously relieved I wasn’t a mother and sad that he wasn’t a grandpa to you.

Driving his truck, he would hang his left arm out an open window and let the smell of his wheat fields fill the cab. He barely pushed the gas pedal. The truck seemed to stand still, but through the large, flapping gash in the floorboard under my dangling feet I could see the dirt road moving past. Dad was quiet. The radio was off or tuned to AM. The fields were dirt or green sprouts or blond waves or tall stubble like Dad’s beard. I’d crank my window down and do like Dad.

The place we lived was full of sharp objects, poisons, and frustrations, but there were moments — maybe most moments, on the whole — like in Dad’s truck with the windows down, when the west wind that reached us all the way from the Rockies cleared the air, and I felt more free than I’ve felt in cleaner, safer places.

To find that feeling by myself, I developed a trick I called “doing the reflection.” I’d crawl onto the bathroom countertop and press my face close to the mirror, my breath creating two little circles of fog that disappeared when I inhaled. I would stare into my own eyes. It was important not to blink, for some reason. Then I’d feel a shift inside my head, hear a little “swoosh” like the ocean inside a shell.

My face would suddenly look a little different, my vision was a fraction of a millimeter outside my own eyes. Then I felt calm, unlike the upset child I saw in the mirror.

The poverties that threatened my safety forced me to find that safest place. Eventually I would think of that realm as where we come from, and where we return when we die. That’s where I heard you. That’s the calm center where I received my most important assignment, as the body of a poor girl bound for a different life: to make sure you were never born.

* * *

From Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth by Sarah Smarsh. Copyright © 2018 by Sarah Smarsh. Reprinted by permission of Scribner, an Imprint of Simon & Schuster, Inc.

* * *

Journalist Sarah Smarsh has covered socioeconomic class, politics and public policy for The Guardian, The New York Times, The Texas Observer and many other publications. A frequent commentator on class issues in the U.S., she recently was a fellow at the Harvard Kennedy School of Government. Smarsh’s first book, Heartland, was long-listed for the National Book Award in nonfiction. She lives in Kansas.

People Sorting: An Interview With ‘Personality Brokers’ Author Merve Emre

Jessica Gross | Longreads | September 2018 | 23 minutes (5,900 words)

If you haven’t yet read Merve Emre’s writing on the history of the Myers-Briggs Type Indicator, you might assume that Myers and Briggs were men. In fact, as Emre documented first in a 2015 piece for Digg and with great depth in her new book The Personality Brokers: The Strange History of Myers-Briggs and the Birth of Personality Testing, the indicator was the brainchild of Katharine Cook Briggs and her daughter, Isabel Briggs Myers. Over the course of decades starting in the early twentieth century, and shaped by their interests in childrearing and the theories of Carl Jung—if not formal training in psychology—Katharine and Isabel created what has become one of our preeminent means of categorizing, and thus conceiving, people.

Though her writing ultimately accrues into a critique of the MBTI along several dimensions, including the way it upholds extant social, racial, and class inequalities and its perpetuation of insidious capitalistic values, Emre excavates the history of the indicator from its inception through its modern expression with tremendous rigor, nuance and, ultimately, empathy. It seems as important to her to honor these two women’s work as both inventors and mothers—as well as the profound meaning the MBTI can hold for people—as it is to examine the intent and effects of their creation. Writing in the New York Times Book Review, Jennifer Szalai described the book as “history that reads like biography that reads like a novel — a fluid narrative that defies expectations and plays against type.”

Emre, an associate professor of English at Oxford University, has written prolifically for both academic and popular literary outlets. (Her first book, Paraliterary: The Making of Bad Readers in Postwar America, came out last year.) She is, in my estimation, one of the sharpest critics working today. But we first met long before she published her first piece—in fifth grade.

This past June, when I visited Emre in New Haven, where she was staying with her family before moving to the U.K., we spoke not only about the MBTI but also about our own history. Though we were friendly and moved in similar circles during our childhoods, we didn’t become close until our early twenties, by which point both of us had changed enough that we were able to become real friends. If the MBTI is predicated on the understanding that a person’s personality type never changes, how does one account for personal evolution?

* * *

Even though parts of your Digg piece are incorporated into this book, there’s a great tonal difference overall. The Digg piece is acerbic in a way that was kind of fun, so I assumed the book was going to be more of an outright critique. But it’s much more biographical than critical, and tonally much more subdued. Can you talk about that choice?

The Digg piece was sharper and a little bit snarkier, you’re right. Part of what that was registering was my frustration that I had gone to these great lengths to follow the directions of CAPT [the Center for Applications of Psychological Type, which holds the personal papers of founder Isabel Briggs Myers] in order to get access to their archives, and then they denied me access for no discernible reason or purpose. Or rather, the purpose was discernible, and it was that they wanted to protect this person’s image and they didn’t want anybody to write anything that might be even a little bit critical.

So the Digg piece was in some ways excavating those frustrations. But when you sit with any subject for long enough, certain nodes of sympathy begin to open up that you might not have anticipated.

Once I got access to Katharine’s papers, I saw that there was that there was a real struggle for her and for her daughter to figure out how to take what at times seemed to them like the banal and unpromising labor of motherhood and domestic care and transform that into something that they felt was self-actualizing, and self-actualizing in a very professional way. It’s hard for me not to feel sympathy for that. The more I sat with their materials, with their letters—the more I learned about their lives from primary sources—the less I wanted to write a straightforward critique. Or, I felt that I had written a straightforward critique for Digg, and that it had served its purpose.

For the book, I wanted something that would make a little bit more sense of why we continue to be drawn to an instrument like the MBTI even when I think many of us know that it’s not valid or reliable, that it’s a flat and unspecific understanding of human personality. It seemed to me that I couldn’t answer that question with critique alone—or that critique alone would only answer half of that question and leave the other half, which was about the human desire to know ourselves and to know our intimates, unanswered. Read more…

On Being an Ill Woman: A Reading List of Doctors’ Dismissal and Disbelief

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Just months after I turned 18, I sat on the white crinkly paper of a patient bed, waiting for my first neurology appointment. I repeated, I am a Division I athlete, as if reminding myself of my athleticism would somehow erase the strange symptoms of fainting, blurred vision, and dizziness that had plagued me for the previous few weeks. The illness, like a flower from concrete, seemed inconceivable. I had been healthy my whole life.

The doctor rapped on the door, entered, and shook my hand before taking a seat. “The doc at your school called. Thinks you had a bad reaction to medication,” he said, referencing antibiotics I’d been prescribed for bronchitis. “He says you’ve had blurry vision, vertigo, two episodes of syncope.”

“Is syncope fainting?” I asked, feeling as though the language of my body had been translated into something incomprehensible. I wanted to snatch it back.

“Yeah, yeah,” he crooned. “You been running?”

“I’ve been trying,” I told him. Each attempt ended in a swell of vertigo and subsequent collapse. The assistant coach carried me to my trainer, who took my blood pressure and pulse, always murmuring, “you’re fine.” The athletic doctor assigned to our team, after performing several tests, had told me that I presented no abnormalities; he encouraged me to run.

The neurologist pulled out a mallet and tapped my knee. My lower leg reacted as it should, swinging forward like a pendulum. He told me to walk, and watched as I made my way from the bed to the door, and back again. “It’s fine for you to run,” he said, scribbling down notes. “I don’t see what’s holding you back.”

I left the appointment with a sense of unease. If the athletic doctor, a trainer, and a neurologist had seen me and told me I was fine, then was I really sick? At the time, I didn’t know how to advocate for myself while in the position of patient. I felt alone with my illness, scared of my own body.

Eight years have passed since then and, in my own continuing journey toward a diagnosis, I have felt a strange mix of emotions when reading narratives of other women being discredited by medical professionals. I feel outraged when I read about their attempts to voice symptoms, only to be silenced. Guilt — and a desire to work toward reforming our current medical system — washes over me when I am reminded of the extent of my own privilege.

The essays below are both a salve to the years of dismissal from doctors and a call to action. I’m inspired by other women’s efforts to advocate for themselves, practice radical empathy, change policy, and create resources so that other patients don’t endure the same harrowing experiences. When I hear my voice in chorus alongside them, I feel as though I’m somehow part of a community, or at least not alone anymore.

1. “PCOS. POC. Poetry. & Pilates” (Tiana Clark, Lenny Letter, April 13, 2018)

Tiana Clark tries to ignore symptoms of panic attacks, hair loss, brain fog, and more, until her ovary throbs with an excruciating pain that forces her to the walk-in clinic. There, a doctor waves Clark’s symptoms away with painkillers and, at an appointment with a white female gynecologist soon after, Clark’s self-diagnosis of polycystic ovarian syndrome (PCOS) is initially belittled.

Her casual dismissal of my problem reminded me of what I’d so often seen living as a black woman in America: an erasure of my distress.

In this incisive, empowering essay, Clark highlights researched material about black women’s health care in the U.S., relays her own harrowing experiences with medical professionals, and emphasizes the importance of learning to advocate for herself.

2. “Memoirs of Disease and Disbelief” (Lidija Haas, The New Yorker, June 4 & 11, 2018)

By examining female narratives of illness ranging from Virginia Woolf’s essay On Being Ill, Jennifer Brea’s documentary film Unrest, Susan Sontag’s canonical Illness as Metaphor, and Christina Crosby’s book A Body, Undone: Living On After Great Pain, among others, Lidija Haas reviews Porochista Khakpour’s Sick with an eye toward how storytelling can affect treatment, act as a form of escape, and undermine dangerous expectations of what a patient should be.

(Related: read an excerpt of Porochista Khakpour’s Sick here at Longreads.)

3. “Doctors Told Her She Was Just Fat. She Actually Had Cancer” (Maya Dusenbery, Cosmopolitan, April 17, 2018)

After experiencing coughing fits for three years, Rebecca Hiles visits the doctor, only to be told her condition is “weight-related.” Hiles is not the only one to be dismissed in this way; in this insightful and eye-opening essay, Dusenbery collects stories of women who have been fat-shamed by doctors rather than being treated with care, resulting too often in dangerous downward spirals in illness.

4. “The Reality of Women’s Pain” (Rachel Vorona Cote, The New Republic, March 7, 2018)

Rachel Vorona Cote situates Abby Norman’s Ask Me About My Uterus: A Quest to Make Doctors Believe in Women’s Pain, a book about Norman’s arduous experiences receiving treatment for endometriosis within a long history of “wild theories about female anatomy” such as the “wandering womb” theory of Ancient Greece, Freud’s dismissal of patients as hysterical, and others.

As Norman communicates so powerfully, a woman’s relationship to her pain is a snarled coil of memory and socialization.

(Related: read Abby Norman’s Women’s Troubles, from Harper’s.)

5. “On Telling Ugly Stories: Writing with a Chronic Illness” (Nafissa Thompson-Spires, The Paris Review April 9, 2018)

Nafissa Thompson-Spires not only chronicles the emergency room visit and appointments that led to her initial diagnosis of endometriosis, but also writes about what it means to be a woman with an invisible chronic illness, and her identity as a black woman within the realm of the medical world.

In Ain’t I a Woman: Black Women and Feminism and Talking Back: Thinking Feminist, Thinking Black, bell hooks problematizes the persistent myth of the strong black woman. This myth contributes to real-life consequences in medicine and elsewhere.

6. “Checkbox Colonization: The Erasure of Indigenous People in Chronic Illness” (Jen Deerinwater, Bitch Magazine, June 8, 2018)

When Jen Deerinwater visits the doctor, her identity as “a citizen of the Cherokee Nation of Oklahoma” is erased by problematic intake forms that only include the options of “American Indian” or “Native American,” and she is often asked “degrading and humiliating questions” by medical professionals. Deerinwater lists a litany of ways in which Native people are ignored and mistreated by the healthcare system, resulting in lack of access to resources and treatments, shortened lifespans, and a host of other harms.

(Related: read other essays from the 15-part “In Sickness” series from Bitch Magazine.)

7. “Health Care System Fails Many Transgender Americans” (Neda Ulaby, NPR, November 21, 2017)

As of November 2017, 31 percent of transgender Americans lacked regular access to healthcare, due in part to how difficult it is for transgender people to find jobs. Neda Ulaby notes that “insurance companies and many medical professionals still treat them as though their bodies don’t make any sense,” which causes anxiety for trans people when visiting physicians, something Planned Parenthood is trying to ameliorate through staff training.

(Related: read Making Primary Care Trans-Friendly by Keren Landman, from The Atlantic.)

8. “A Matter of Life & Death: Why Are Black Women in the U.S. More Likely to Die During or After Childbirth?” (Meaghan Winter, Essence, September 26, 2017)

When Fathiyyah “Tia” Doster was pregnant, she began to feel bloated late one night. Luckily, she visited the hospital, where she safely delivered her baby. A diagnosis of hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome left her hospitalized for more than three months, but alive. Other pregnant women are not so lucky. Meaghan Winter explores the historic backdrop of healthcare for black women, the current political climate which is threatening women’s access to insurance and clinics, and bias within hospitals, all of which have contributed to rising rates of maternal mortality.

The complex web of causes — which includes genetic predispositions, chronic stress, racial bias and structural barriers to health care — contributes to the racial disparity in maternal health.

In the end, Winter offers strategies for health providers, reformers, and patients and their families to implement necessary change.

Jacqueline Alnes is working on a memoir of running and illness.

A Song for the River

VWPics via AP Images

Philip ConnorsA Song for the River | Cinco Puntos Press | September 2018 | 28 minutes (5,578 words)

By sheer dumb luck I happened to be facing the lightning when it struck: a livid filament that reappeared on my eyelids when I blinked. A blue puff of smoke bloomed skyward from the top of the ridge, superheated sap boiled to vapor in an instant. It dispersed on the breeze so quickly I wondered whether I had imagined it — whether, having become at last clinically pyromaniacal, I had willed the tree to catch fire and conjured the evidence to prove it.

I reached for the field glasses where they hung from a hook in the ceiling of the tower, an instinctual move made without looking away from the spot of the strike. I lifted the binoculars to my eyes, focused on the ridgeline. Waited. Remembered to breathe. Waited some more. Nothing amiss. Nothing new or different along the contour of the hill. Read more…

Ten Translations of Care

Illustration by Wenting Li

Mary Wang | Longreads | September 2018 | 23 minutes (5,814 words)

 

1. Care /ker/ [verb], 保护o hù, the process of protecting someone or something.

In January 2018, Guo Zhen, my grandmother, was diagnosed with late-stage lung cancer. A month later, I arrived home for the first Chinese New Year that I’d spend in China since I had moved away 20 years earlier. I came home with my armor ready — my suitcase was packed with a library including Emperor of All Maladies, Siddhartha Mukherjee’s canonical book on the illness; Susan Sontag’s Illness and Its Metaphors, so that my analytical mind could help carry the weight of my emotional one; and Joan Didion’s The Year of Magical Thinking, a manual for grief in the event of the worst-case scenario. I had rehearsed the serene facial expression I’d use when I’d see Guo Zhen in her hospital bed for the first time, and I had conscientiously visualized every IV drip and beeping machine to blunt any potential shock. Yet what I found in our family home was the rehearsal of a familiar routine: Her son, my uncle Fu Yuan, was still battling with his son to choose his homework over his iPad; Guo Zhen still sat on her children’s stool in the morning, washing clothes in a bucket of cold water, and grandfather, Pu Cheng, still bugged her to play their daily chess game, holding up a paper board fortified so many times over that the plastic tape covering it was far thicker than the board itself.

Guo Zhen didn’t know she had cancer, and my family had carefully devised a strategy to keep it that way. Doctors and nurses in the hospital had been instructed to never speak of her illness in her presence, and visitors to our home signed an invisible contract before entering, agreeing to act as if her recent hospitalization was due to a case of pneumonia. I never asked her to sit down when she’d get up after every few bites during lunch or dinner to restock the table with congee, buns, or pickles — I knew she did this out of habit rather than necessity. Fu Yuan and his wife never fought to take over her housework, though we worried about the strain of repetitive hunching on her weakening body. Any deviation from routine risked puncturing the facade of normalcy we all worked carefully to preserve, and, within a month, my family had become a theater troupe improvising their first performance, an intimate Truman Show designed to deceive its protagonist.

At 78, there was no point in performing surgery or chemotherapy on Guo Zhen anymore, and any new miracle drug that might land in the world would only arrive in China years after its introduction on the American market. Besides, the decidedly optimistic belief that cancer will soon become only a chronic illness rather than a fatal one is more of an American specialty — its arrogant nature evident when President Nixon declared a “War on Cancer.” The Chinese counterpart to that phrase illustrates a different approach. As one local newspaper put it, “One third of cancer patients die of fear, one third die of its treatment, and only one third die of the illness itself.”

Since there wasn’t much territory to be won in terms of Guo Zhen’s illness or its treatment, we shifted our efforts to shielding her from the first possibility. As soon as doctors saw the dark spots on Guo Zhen’s X-rays, Fu Yuan instructed them to follow our script. “Don’t let the lao ren” — the elderly — “know,” he said, emphasizing Guo Zhen’s status as a senior to make clear that she was no longer a caretaker but the one who was cared for.

“If a man die,” William Carlos Williams wrote, “it is because death / has first possessed his imagination.” Grandfather Pu Cheng, unaware of the American poet, has long touted his own version of this phrase. Boasting about how he’s never stepped foot in a hospital for himself, he’d say, “Nine out of ten people die from fear.” Even though Pu Cheng was also left in the dark about his wife’s disease — we didn’t trust him to keep a secret from his partner of 60 years — we abided by his logic that a doctor’s diagnosis could be a death sentence in itself. By shielding Guo Zhen from the weight of the doctor’s words, we took over the burden of her illness with our own shoulders.
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The Dead End on My Record Shelf

Steven Errico / Getty

Christopher C. King | An excerpt from Lament from Epirus: An Odyssey into Europe’s Oldest Surviving Folk Music | W.W. Norton & Company | May 2018 | 16 minutes (4,346 words)

A time-traveler, a person from the twenty-first century, stands on a cliff overlooking a mountain pass in southern Europe, in northwestern Greece, a few thousand years after the end of the last Ice Age, having traveled back in time by way of some technology unknown to us. This traveler is observing human beings while they interact with one another in this challenging, remote environment.

Something is happening among these proto-Europeans. One person places a long wooden shaft, holes bored along the side, to his lips, producing sound. Other sounds exit the mouths of the surrounding people. The collective sound appears fragmented to the listener — the time-traveler — standing above. At times the voices and the flute notes appear smooth, mellifluous, but then disjointed and abrupt. During this flood of sound, members of this group move in cryptic yet intentional ways. When this lush cacophony ceases, so too do the movements of the people.

What is going on down there?

Any of us could be this time-traveler. And any of us would realize — based on our observations — that these people are communicating. We perceive sound and movement, assuming cause and effect. The question that should linger in our minds is this: are we observing a use of language, a use of music, or something else — an alien and impenetrable behavior? Read more…

The Miracle of the Mundane

Sheet music discovered in 2009 identified as part of a childhood creation by Mozart, Kerstin Joensson / AP. Penguin Random House.

Heather Havrilesky | What If This Were Enough? | September 2018 | 16 minutes (3,976 words)

 

On a good day, all of humanity’s accomplishments feel personal: the soaring violins of the second allegretto movement of Beethoven’s Symphony no. 7, the intractable painted stare of Frida Kahlo, the enormous curving spans of the Golden Gate Bridge, the high wail of PJ Harvey’s voice on “Victory,” the last melancholy pages of Wallace Stegner’s Angle of Repose. These works remind us that we’re connected to the past and our lives have limitless potential. We were built to touch the divine.

On a bad day, all of humanity’s failures feel unbearably personal: coyotes wandering city streets due to encroaching wildfires, American citizens in Puerto Rico enduring another day without electricity or potable water in the wake of Hurricane Maria, neo-Nazis spouting hatred in American towns, world leaders testing missiles that would bring the deaths of millions of innocent people. We encounter bad news in the intimate glow of our cell phone screens, and then project our worries onto the flawed artifacts of our broken world: the for lease sign on the upper level of the strip mall, the crow picking at a hamburger wrapper in the gutter, the pink stucco walls of the McMansion flanked by enormous square hedges, the blaring TVs on the walls of the local restaurant. On bad days, each moment is haunted by a palpable but private sense of dread. We feel irrelevant at best, damned at worst. Our only hope is to numb and distract ourselves as well as we can on our long, slow march to the grave.

On a good day, humankind’s creations make us feel like we’re here for a reason. Our belief sounds like the fourth molto allegro movement of Mozart’s Symphony no. 41, Jupiter: Our hearts seem to sing along to Mozart’s climbing strings, telling us that if we’re patient, if we work hard, if we believe, if we stay focused, we will continue to feel joy, to do meaningful work, to show up for each other, to grow closer to some sacred ground. We are thrillingly alive and connected to every other living thing, in perfect, effortless accord with the natural world.

But it’s hard to sustain that feeling, even on the best of days — to keep the faith, to stay focused on what matters most—because the world continues to besiege us with messages that we are failing. You’re feeding your baby a bottle and a voice on the TV tells you that your hair should be shinier. You’re reading a book but someone on Twitter wants you to know about a hateful thing a politician said earlier this morning. You are bedraggled and inadequate and running late for something and it’s always this way. You are busy and distracted. You are not here.

It’s even worse on a bad day, when humankind’s creations fill us with the sense that we are failing as a people, as a planet, and nothing can be done about it. The chafing smooth jazz piped into the immaculate coffee joint, the fake cracks painted on the wall at the Cheesecake Factory, the smoke from fires burning thousands of acres of dry tinder, blotting out the sun — they remind us that even though our planet is in peril, we are still being teased and flattered into buying stuff that we don’t need, or coaxed into forgetting the truth about our darkening reality. As the crowd around us watches a fountain dance to Frank Sinatra’s “Somewhere Beyond the Sea” at the outdoor mall, we peek at our phones and discover the bellowed warnings of an erratic foreign leader, threatening to destroy us from thousands of miles away. Everything cheerful seems to have an ominous shadow looming behind it now. The smallest images and bits of news can feel so invasive, so frightening. They erode our belief in what the world can and should be.

As the first total solar eclipse in America in thirty-nine years reveals itself, an email lands in my inbox from ABC that says The Great American Eclipse at the top. People are tweeting and retweeting the same eclipse jokes all morning. As the day grows dimmer, I remember that Bonnie Tyler is going to sing her 1983 hit “Total Eclipse of the Heart” on an eclipse-themed cruise off the coast of Florida soon.

Even natural wonders aren’t what they used to be, because nothing can be experienced without commentary. In the 1950s, we worried about how TV would affect our culture. Now our entire lives are a terrible talk show that we can’t turn off. It often feels like we’re struggling to find ourselves and each other in a crowded, noisy room. We are plagued, around the clock, by the shouting and confusion and fake intimacy of the global community, mid–nervous breakdown.

Sometimes it feels like our shared breakdown is making us less generous and less focused. On a bad day, the world seems to be filled with bad books and bad buildings and bad songs and bad choices. Worthwhile creations and ego-driven, sloppy works are treated to the same hype and praise; soon it starts to feel as if everything we encounter was designed merely to make some carefully branded human a fortune. Why aren’t we reaching for more than this? Isn’t art supposed to inspire or provoke or make people feel emotions that they don’t necessarily want to feel? Can’t the moon block out the sun without a 1980s pop accompaniment? So much of what is created today seems engineered to numb or distract us, keeping us dependent on empty fixes indefinitely.

Such creations feel less like an attempt to capture the divine than a precocious student’s term paper. If any generous spirit shines through, it’s manufactured in the hopes of a signal boost, so that some leisure class end point can be achieved. Our world is glutted with products that exist to help someone seize control of their own life while the rest of the globe falls to ruin. Work (and guidance, and leadership) that comes from such a greedy, uncertain place has more in common with that fountain at the outdoor mall, playing the same songs over and over, every note an imitation of a note played years before.

But human beings are not stupid. We can detect muddled and self-serving intentions in the artifacts we encounter. Even so, such works slowly infect us with their lopsided values. Eventually, we can’t help but imagine that this is the only way to proceed: by peddling your own wares at the expense of the wider world. Can’t we do better than this, reach for more, insist on more? Why does our culture make us feel crazy for trying?

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Facebook Isn’t the Same as “The Internet” Except When It Is

Philippine President Rodrigo Duterte, second from left, poses for a selfie with the crowd following wreath-laying rites at the Heroes Cemetery to mark National Heroes Day Monday, Aug. 27, 2018. (AP Photo/Bullit Marquez)

Davey Alba‘s BuzzFeed investigation into the ways Philippine President Rodrigo Duterte’s government uses Facebook to spread propaganda and destroy political opponents is a frightening look at what happens when a tool created by a bunch of developers in California becomes the go-to news source for a country 7,000 miles away.

Just how ubiquitous is Facebook in the Philippines?

In 2012, 29 million Filipinos used Facebook. Today, 69 million people — two-thirds of the population — are on Facebook. The remaining one-third does not have access to the internet. In other words, virtually every Filipino citizen with an internet connection has a Facebook account. For many in one of the most persistently poor nations in the world, Facebook is the only way to access the internet.

Which is pretty much how Facebook wants it. Maria Ressa, the CEO of the news website Rappler, told BuzzFeed News that during an April 2017 meeting with Facebook, she mentioned to Mark Zuckerberg that 97% of Filipinos who had access to the internet also had Facebook accounts (which was true at the time). Zuckerberg frowned, Ressa recalled. Then he asked: “What about the other 3%?”

Facebook’s Internet.org effort has floundered embarrassingly in more than half a dozen nations and territories. But in the Philippines, the social media capital of the world according to global media agency We Are Social, Facebook rushed into a culture that unquestioningly assimilated it.

“We were seduced, we were lured, we were hooked, and then, when we became captive audiences, we were manipulated to see what other people — people with vested interests and evil motives of power and domination — wanted us to see,” de Lima wrote to BuzzFeed News. “It was a slow takeover of our attention. We didn’t notice it until it was already too late.”

Neither did Facebook.

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Mega-drought and Me

Sebastien Gabriel / Unsplash, Paul Robert / Unsplash, Photo illustration by Katie Kosma

Zoe Fenson | Longreads | September 2018 | 18 minutes (3,732 words)

I kick my heels against the end of the exam table, feet dangling as if over the edge of a dock. One hand on the opening of the gown, the other holding the drape to my lap.

First time seeing this new doctor, now that the old practice closed. I’d expected older, brusque, lab coat, but she is warm and cheery in her crisp blue scrubs and gray hijab. Legs splayed on the low wheeled stool, elbows on knees, clipboard. Reading.

It’s all there on the form, in my handwriting. Age: 29. Reason for visit: annual exam. Smokes: No. Drinks: two to three per week. Wears a seat belt: always.

The drape slips off my lap — why does it always do that? I catch it, shift carefully, try not to tear the paper liner under my bare bottom.

Number of sexual partners in the past year: one. Gender of partner: male.

“So, you’re in a relationship?” She looks up from her clipboard. “How long?”

“Six years.”

“Wow, congratulations!” A warm smile. “So, are you thinking about kids?”

The gears in my brain catch and stop turning. My forehead is suddenly jelly. The drape slips and I pull it closer, keenly aware of my nakedness underneath.

“We’re kicking that can down the road,” I say.

She laughs. “Understood. Just wanted to bring it up, because …”

“I know,” I say. It’s all there on the form.

* * *

My first memory. I am standing at the far end of the hallway, square in line with the bedroom door and the four-poster bed beyond it. There are lights in the canopy, three yellow hollows, and they reflect spaceship beams in the mirrored headboard. I am small, and the floor is close, and the lights are high and bright.

The walls and ceiling are dark and distant. I can feel them looming, hear fantastic hissing creatures in the corners. The bed is a spaceship, and I am standing in the dark, my heart beating cold.

She’s there, in the bed. My mother. I can just make out the pink swell of her belly over the rumpled patchwork quilt. Maybe a sliver of pale forehead above it, and a mop of pillow-mussed dark curls above that. Or maybe not. I am 3 years old and will remember this only in gulps and shivers.

Her belly is full of my siblings. A brother and a sister. They will emerge soon, my father keeps saying. In the meantime, she’s not feeling well. She needs to stay in bed. Later. You’ll see her later.

I watch her breathing. This is not my mother, my fluttering mother, always dashing from room to room, picking up this, noticing that. This is not my playful, silly mother, who reads picture books aloud with an actor’s breathlessness and uses her bare hands to crush cornflakes for salmon patties.

This still, barely-breathing, exhausted creature is not my mother. She is resting, not quite asleep, and I am not allowed to go to her, to see for myself what she really is. Or maybe I am allowed, but terror roots me to the floor.

* * *

Growing up in Silicon Valley, we learn the word “drought.” Drought comes in cycles. There’s less and less and less rain, over a year or two or maybe three. We ration our water use, turn off the tap when we brush our teeth, time our showers. Then suddenly the winds shift and the currents change and everything is blessedly watered again.

For years, I assume that “drought” is synonymous with “summer.” The season of no water, ending each year with the autumn rains. I watch the grasses in the hills turn from plump and green to dry and brown.

I know intellectually that droughts can stretch over years, that rain is relative, that brown grass thrives in summer. But still, I breathe a tiny sigh of relief when the first raindrop hits my nose every fall.

* * *

I’m kicking my feet at the end of the exam table. My mother sits in a chair alongside. Age: 13. Reason for visit: Missed periods. Number of sexual partners: zero.

This is the doctor I will see for 15 years before the practice closes. Dark hair, pink lipstick, lab coat, stethoscope. White clipboard. Low stool. Reading.

“So, how long has it been since your last period?”

“Ten months.”

The doctor raises her eyebrows. “It’s good you waited this long before coming in. At your age, menstruation can be extremely irregular. Just … not this irregular.”

“I know,” I say. It’s been over a year since the first streak in my underpants at summer camp, so dark I mistook it for dirt. Since then, I’ve menstruated twice: once in September, once in January. It’s now October. I’ve started wearing red sweatpants on airplanes, just in case. My mother tucks menstrual pads into the pockets of all my jackets and suitcases, a habit I will keep up — unnecessarily — for years.

“Well, there’s a couple things that could be going on. If you’re OK with it, I’ll do a visual assessment here and then send you to Pat down the hall for a blood draw.” She pulls a pair of blue vinyl gloves from a box on the wall. “Do I have your permission to conduct an external pelvic exam?”

I have no idea what an external pelvic exam is. “Sure.”

She pauses, puts her hand gently on my arm. “Oh, one more thing. You’re not pregnant, right?”

My forehead is jelly. “Right.”

“OK, good.” She breaks out in a hearty laugh. I laugh too, as cheerily as I can manage.

* * *

Throughout my childhood, there are galloping fires in the mountains each summer. We hear about them on the news: ignited by a lightning strike or a smoldering campfire or a cigarette butt, fattened on the sticks and straw left from months of waning water. Sometimes, on road trips, we see the aftermath of a smaller fire: a swath of black hillside, pierced by naked trees.

Each fire is a renewal, I’m told, a violent stripping of the old to make way for the new and green. There are some plants in the California chaparral that reproduce only after the intense heat of a wildfire. Pine cones release seeds; oak trees sprout fresh stems from burnt trunks; wildflowers germinate and bloom.

Her belly is full of my siblings. A brother and a sister. They will emerge soon, my father keeps saying. In the meantime, she’s not feeling well. She needs to stay in bed. Later. You’ll see her later.


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* * *

“You see these two numbers here? The ones labeled FSH and LH?”

The lab sheet is dense with text. I follow the doctor’s pen as it traces around the two numbers. I am 13, and last week I had my feet in stirrups for the first time and needles sipping blood from my veins.

She explains, scratching diagrams and doodles on the back of the lab sheet. Hormone ratios, triglycerides, body mass index (I press my hands together between my chubby, chafing thighs). She draws a little ovary studded with cysts — a string of pearls winding around a grape.

Polycystic ovarian syndrome, she says. It’ll keep me from menstruating, make it hard to keep off the weight I’m already gaining. The most urgent thing now is to make sure I’m shedding the uterine lining each month; if it sits undisturbed for too long, it could grow cancerous.

She hands my mother a prescription for progesterone. “Just to get things started, and then we’ll switch to oral contraceptives for the long term.” And to me, “When you want to get pregnant, we’ll need to talk.”

I nod. My siblings and I were conceived via fertility treatments when my mother was in her 30s. I have time.

* * *

The progesterone makes me sob furiously. My hormones swell and peak each time I take a pill. When I switch to birth control, the crying eases. In its place I feel a growing restlessness, an urge to move out of my body and find a new one.

Over time, I get used to the routine. Every year, a pelvic exam, a panel of tests. I learn to grit my teeth and look away during the blood draw, waiting for the deep sting of needle meeting vein. Sometimes the phlebotomist misses — my veins are slim and deep — and I walk away with bruises.

I stay on birth control throughout high school and college. Twice a month, I get vicious cramps; once a month, I bleed. Each time, it becomes easier to pretend it’s the real thing.

* * *

I am 3 years old, standing in the hall, and there are things I do not understand. I do not understand that my mother is small too, only five feet tall, and that my siblings are straining her body to its limit. That the contractions began in month five — before the babies could survive outside her body — and start up again every time she stands. That she is lying in bed because her body is in revolt, and bed rest is what’s keeping my siblings alive.

I do not yet understand that she has been through this before. A fraught end to her first pregnancy with me, a first bodily revolt. In her seventh month she began having trouble removing her wedding ring. The vision in her left eye slowly dulled, until she couldn’t see out of it.

I was due in March; her water broke on New Year’s Eve. When she arrived at the hospital, the doctors diagnosed preeclampsia, a dangerous spike in blood pressure that had inflated her fingers and muted her vision. The only cure was to birth me. But I was too small to be safely born.

The philosophy behind bed rest is simple: Counteract gravity. My mother was laid flat for a week in the hospital, kept in a state of suspension while the doctors carefully dosed me with steroids and waited until my tiny lungs could pump air on their own. Then they let her contrary body take over, pushing me into the stark hospital light, scrawny and wide-eyed and — fortunately — screaming.

‘Polycystic ovarian syndrome,’ she says. It’ll keep me from menstruating, make it hard to keep off the weight I’m already gaining. The most urgent thing now is to make sure I’m shedding the uterine lining each month; if it sits undisturbed for too long, it could grow cancerous.

* * *

As I grow older, I can feel the summers getting longer, hotter. The rain takes longer to arrive each fall. The hills dry up faster, turning from spring green to summer brown before I can fully register the change.

There are fewer small fires. When the forest ignites — as it inevitably does — the fires leap up hotter and higher. We hear of flames crawling closer to the homes and towns that push into the forest.

* * *

The summer before my senior year of college, I go to Russia for six weeks. Without consulting my doctor, without telling my parents, I decide not to bring my birth control pills with me. I’m 21, single, and curious. Just curious.

Without a complaint, my body simply dries up. No bleeding. No cramps. For a whole summer, no movement in my reproductive tract.

* * *

We’re on our way from Pskov to Nizhny Novgorod. The van bumps and rattles on the rutted road. The other students are asleep or lost at the windows.

I’m chatting with the director of the program, an elegant lady with close-cropped dark hair. We talk about the cold summer rain that lashes St. Petersburg, how I still get startled seeing rain in the summer.

I lift my eyes to the view outside, watch the chilly mist collect on the van windows. “If I ever have kids, I’m going to adopt,” I say, more decisively than I feel.

Her eyes widen. “Good for you,” she says.

* * *

I come home from Russia and start the pills again. My body obediently bleeds.

* * *

Mega-drought. A drought lasting decades instead of years. In the 12th and 13th centuries, the area that we now call California went dry for hundreds of years. We see the evidence in the ring patterns of thousand-year-old tree trunks; the trees grew tall in dry lake beds, then drowned when the rains returned.

In the 1930s, the Dust Bowl — our closest memory of catastrophic drought — scorched the Great Plains for most of a decade. It turned farms into windy wastelands and sent families fleeing west to California. That was an ordinary drought. Mega-droughts last three, four, five times as long. We do not remember what it’s like to live for 50 years without rain.

* * *

“Are you in love with him?”

If the question came from anyone else, I would bristle. But this is my mother’s childhood friend Pam, whom I’ve known all my life. She’s the daughter — adopted — of my grandmother’s best friend, a woman with a raucous laugh and wild storytelling streak. I grew up knowing Pam’s vivaciousness, so like and yet unlike her mother’s. She has a daughter my age who shares her soprano speaking voice, her waterfall of red hair.

I’ve been seeing this guy, the guy who will eventually inspire the new doctor to ask me the question. Pam holds her wine glass with both palms, looks at me expectantly.

“I guess I am,” I say.

* * *

We’re driving in the rain, the two of us. The road is slick, headlight reflections blurring into lane lines. I’m 26, he’s 27, and I’m testing him.

“So, if you end up wanting biological kids, that’s going to be … complicated with me. Because of my health stuff.”

“I mean.” He shrugs. “I’m not opposed to kids, but I’m definitely not ready for them right now. We have time.”

“I understand that. But we’ll need to decide eventually, and it will actually be a decision, you know? We can’t just wing it.”

“That’s fine. I’m happy to take my cues from you.”

“But that’s the thing. I don’t know what I want. And you’ll have equal say in whatever path we decide to follow, so …”

“Now, hold on.” He turns to look at me. “I do not have equal say. It’s your body. We can do exactly as much or as little as you want.”

He’s passed the test. And yet I’m slightly deflated that he’s not throwing me a rope.

* * *

“So, that’s why I’m not eating honey right now. Because of the baby.”

I hear my friend over my shoulder, from the kitchen where I’m pouring myself a drink. At first I think I’ve misheard her, or she’s making a joke. She’s sitting neatly tucked into the table, so I can’t sneak a peek at her belly.

I thought I’d imagined her looking fuller and smoother, though her complexion is of the luminous kind anyway. It all clicks together — the new wedding ring on her finger, the house she and her partner just bought.

“I thought the honey thing is after the baby’s born,” I offer, feebly. We’re all so clueless, the people at this party. Young, urban professionals with cats instead of children.

She’s telling someone the story. It was an accident, a hiccup in birth control. She didn’t realize it for months, until the doctor at her annual exam said, “You didn’t tell me you were pregnant!”

I cup my wine glass in my palm and stare numbly across the room. I can feel the weight of my dry uterus, remember what happened when I played fast and loose with my pills.

When I get back to my boyfriend’s house after the party, I drop onto the couch and sob.

As I grow older, I can feel the summers getting longer, hotter. The rain takes longer to arrive each fall. The hills dry up faster, turning from spring green to summer brown before I can fully register the change.

* * *

There’s a mega-drought coming, scientists say. It’s the swing of a natural cycle, made more violent by the weight of humans on the earth. Dust Bowl refugees sought relief here in the West, and someday we will be seared hotter than they ever were.

I wonder how long California will be livable, how long we’ll be able to drag water into the desert.

* * *

She knew, going in. After me, after the illness, the early birth. She chose to become pregnant again, not easily, with medical help. And in my first memory I am forever 3 years old, standing in the hall, and there are two babies in a body that already fought back against one.

Eventually they, too, will make an early entrance under the hospital lights, screaming. My father will take me to see them in their hospital bassinets, one pink bundle and one blue bundle. One pair of brown eyes and one pair of blue, staring back at me through the nursery window.

They are small, too, but larger than I was, pinker-cheeked and plumper. They will be fine. She will be fine.

* * *

He zips the wedding dress up my back. I step back from the mirror and take myself in. They’re all there, the signs of PCOS, written on my body over the years: the heavy hips and arms and face and belly, the thicket of dark hair above my upper lip, the bald spots in and among my carefully pinned curls.

“You look gorgeous,” he says, and kisses my neck.

During the ceremony, our friends’ surprise son — now nearly 3 — begins shrieking with excitement. I’d expected this, half-hoped for it, and I laugh to see the joy in his eyes. The rabbi gently jokes about being upstaged, and the child’s father whisks him away to run circles on the lawn.

* * *

Every so often, I catch glimpses of imaginary children. Sometimes in our bedroom, standing in a pile of clothes, wriggling tiny arms into jacket sleeves. Sometimes in the kitchen, perched on a stepstool, clutching a wooden spoon in one hand.

They never have faces, these children. All I can see is the backs of their heads, the color of their hair. Sometimes dark brown, like my husband’s and mine. Sometimes blond, sometimes black. I try to turn them around, to paste on facial features, my husband’s full lips, my amber-brown eyes. Is the color of their cheeks lighter than mine? Darker? About the same? I never can tell. They evaporate too quickly.

* * *

I am 30 years old. It rained all winter, and in the spring the wildflowers carpeted the hills so thickly you could see them from space. Now it’s summer, and the temperature has shot up and melted the newly fallen snowpack, dried fresh undergrowth into tinder.

Nature seems especially ferocious this year. I am hearing stories of extremes: too much rain in wet areas, and too much heat in dry ones. Along the crowded coasts, hurricanes are striking with frightening violence. Work colleagues in Houston and Florida are living out of suitcases, their homes flooded. In Puerto Rico, residents are living without power, drinking contaminated water.

And there is fire, too, closer to home. In the Pacific Northwest, whole swaths of the Cascades are ablaze. My friends in Portland and Seattle say the smoke is so thick that it eclipses the sun.

* * *

“I keep thinking about time,” says the man I married. “I already feel like I don’t have enough time to do a good job at all the things I’m currently doing. How will I be able to do all of that, and have a kid?”

He’s curled into himself on the couch, his voice thick with tears. He’s afraid to tell me this. Afraid that he’s somehow saying the wrong thing.

I don’t know how to respond. How to tell him that it’s about time for me, too. Time on my body’s clock. Time ticking down until a switch flips and I can definitively say “I want this” or “I don’t.” Historical time, the Dust Bowl, how we don’t know what it’s like to see our home turned from cozy to crucible. Geologic time, and knowing how soon the earth will reject us altogether.

I don’t know how to say these things to him. Instead, I pull him in for a hug, kiss his eyelids, make soothing noises.

* * *

“Twenty-seven years,” my father says. “Can you believe it?”

My brother grins, and my sister rolls her eyes. It’s a familiar script, one we all act out every year around this time. They lean together, two curly, brown heads, and blow. The candles flicker and extinguish in parallel trails of smoke.

My mother picks a candle out of the cake, pops the unburnt end in her mouth to lick off the chocolate frosting. “Of course,” she adds, “it was a challenge keeping you guys inside long enough.” This is it, the closest she ever comes to a complaint. She gives each twin a one-armed hug, a kiss on the head.

I wonder how sharp her early inklings must have been. She fought to become pregnant, twice, and her body fought back. And when her troublesome babies were born, she told us the stories of our births in her amazed actor-voice, full of warmth and wonder.

I have none of her certainty. I have only faceless glimpses of imaginary children, and they frighten me. But if I imagine a life without them, I feel chilled and unmoored. I think of the kindly new doctor in her gray hijab, and exhaustion washes over me. I’m tired of the needles, the questions, cataloging signs of illness in the mirror.

I think of the mega-drought, and of my mother in bed, and of Pam and her lively mother and red-headed daughter. It occurs to me that these things may never truly coalesce into “want.”

* * *

The day after the twins’ birthday, Sonoma County catches fire. 100 miles to the north of us, towns and vineyards burn to the ground. People tumble out of their cozy homes, grand estates, mobile home parks, and flee. Hundreds are overcome by the smoke, or outrun by the flames. Newspapers publish aerial shots of blasted neighborhoods: orderly rows of flattened houses, shade trees stripped of their leaves.

When the winds shift, a soupy haze blows south over our neighborhood. The street lights blur in the evenings, as if the usual morning fog got its daily route confused. The air tastes like ash and rubber.

My husband and I go out dancing on a Friday night, the night of the thickest smoke. We walk down the street with our sleeves held to our faces. The dance floor is nearly empty; he takes me in his arms and we waltz in sweeping circles.

This is a new ash-cloud, a warning. The planet groans with people, and someday it will become too hostile for more. The mega-drought is looming, and my insides are dry.

The world is burning, and I am 30 years old, and soon I will have to decide.

* * *

Zoe Fenson lives and writes in the San Francisco Bay Area. Her essays have appeared in Narratively, The New Republic, The Week, SELF, and elsewhere.

Editor: Danielle A. Jackson