1. I ask my therapist if I’m too old to not know I’m bipolar. “Not necessarily,” Mary says. I’m settling onto her couch. I take off my scarf and my coat and put my gloves inside my hat. “Have you ever taken a mood stabilizer?” she asks. I shake my head, and the ache in it stabs me in the side of my skull. “Or, no. I took Seroquel once in college when a dealer ripped off my friend,” I say and explain that Brian knew he wasn’t being handed the painkillers we’d asked for but decided to take the big white pills anyway. The guy already had our money. We Googled the imprint, read about the drug, and ate one each just to see what an anti-psychotic would do to us. I heard voices and fell asleep for thirteen hours. Brian took his right before he left Gainesville for our hometown in the Florida Panhandle, a six-hour drive. He had to pull over on the side of the road because the trees were dancing. He told me they looked like those balloon men with extra long arms. But Seroquel is an antipsychotic. I don’t know if an antipsychotic is at all similar to a mood stabilizer, and I can’t listen to Mary explain how mood stabilizers work because what if I’m bipolar? I wanted my therapist to say that of course I’m not bipolar, that if I were I’d have exhibited symptoms before I turned thirty. “How would I know if I needed a mood stabilizer?” I ask. Mary draws a diagram on her whiteboard. Next to a line near the top, she writes ceiling. Another line represents the floor. She scrawls squiggly waves that model the mood shifts I’d experience if I had each of the three major types of bipolar disorder. The third type sounds indistinguishable from depression to me: a long period just above the floor punctuated by intermittent attacks that lay the sufferer so low Mary’s marker hits the bottom edge of the whiteboard. It looks like what I’d have drawn had she asked me to show her how I’ve felt over the last three weeks. I don’t say that. Instead I say, “I don’t know how much stability I want in my moods.” Mary shrugs like I’ve made a valid point.
2. The mom thinks the opiates I take for my chronic headaches make me negative and depressive. My friend Rob says I obsess over them. “You want me to tell you it’s okay to take another one, like you need me to sanction every pill,” he said once, which isn’t true. Rob thinks my headaches’ cause lies in the way I relate to people, how I orient myself in the world. He says if I engaged differently with my pain, I wouldn’t feel it; if I didn’t obsess over how many pills I have, I wouldn’t need them. He doesn’t understand that I have to obsess. Pain management requires discipline. If I always took the amount I need to not have a headache, my prescription wouldn’t last through the month. I’m accountable to the doctor who writes my oxys, and I have to think about whether another doctor will write the same quantity later. I’m not going to live in Southwest Virginia forever. I don’t want to up my tolerance until I’m back to taking ten 30-milligram oxycodone pills a day like I did before I detoxed with Suboxone, got dependent on ibuprofen, and figured if my brain could learn to need an over-the-counter NSAID I might as well go back to the drug that worked. I’m obsessed with the calendar, the clock, and the calculator in ways I wouldn’t be if I weren’t taking a highly-regulated narcotic that’s more closely associated with addiction than analgesia. Most of the time, I have to decide which part of the day I can spend in pain. When I lived in New York, I rarely took more than one oxy over nine hours at work; it felt wasteful, taking valuable painkillers when I’d feel miserable no matter how mild my headache. In my MFA program at Virginia Tech, I applied the same logic to teaching: whether I took one or two oxys when I woke up, the pain returned about 15 minutes into my morning composition class, sickly and bulbous or angular, stabbing; feverish or cooly brittle like a dry wind; and always pulsating, always tight, tense. Sometimes I decide to fuck it, take as many pills as I need to write all day or sleep or watch my Sunday premium-cable shows free of head pain. I can make it up later, take fewer on other days. Some months my regimen works, and others I spend the last week or two with an icepack pressed to my forehead, taking judicious doses of Advil to calm headaches on which I can’t expend narcotics or I’ll come up short before I can fill my new script. You’ve only got so many days to “make it up” before you run out.
3. I tell Mary about the day before, when I called the Samaritans. Their website says you don’t have to be suicidal to call, but the counselor didn’t seem to know what to do with me. “That must be hard,” he kept saying before he parroted back to me what I’d just said. “It must be really hard to be in pain all the time” or “It must be hard doing all that alone.” I asked him what the hotline was supposed to do for me. “I already know it’s hard,” I said. I try to describe to Mary the way I’m crawling out of my skin at the same time that I’m burrowing further into it, but when I talk, it doesn’t sound like enough. “I can’t stop crying,” I say. “I’m sad, and I’m angry, and I’m sick of everything. It’s the end of winter break, and I’m still so tired.” She asks me for specifics, examples. “I miss the routine,” I say. “I want my life to have structure again. I don’t have anything to do but write, but I don’t have enough pills to write more than a few days a week, so what do I do on the other days? And then there’s nothing on TV at night, and I hate reading in artificial light.” Mary asks me what I’ll do when school starts that I don’t do now. “That’s the thing. Nothing, really,” I say. “Or, no. I mean, I’ll have the structure. It’s easier to feel motivated when I have to plan what I want to do around what I have to do. Like, when getting to write feels special. But mostly I’m bored. I’m sick of myself. I want to see people more, and that won’t get easier.” Mary knows I don’t drink and that drinking is about the only thing my friends here do. “I’m alone too much, I guess,” I say. I’m telling the truth, but none of what I tell Mary describes what’s bothering me specifically. “I don’t want to do anything; I don’t want to think about anything. I don’t want to get off the couch, but I’d like to get out of the house more, spend time with my friends. I’m in my head all the time. It’s a shitty place. I wouldn’t want to hang out with me.” I pause. “But I want to be a person who does things. I have a whole list of stuff I want to write. My brain won’t turn off. I don’t get how I can feel so overwhelmed and so fucking bored at the same time.” I’m aware that I sound manic. I wonder if Mary is assessing me for bipolar symptoms. “If I could write, I don’t think I’d feel like this,” I say. “But I don’t have enough painkillers to write.” Mary says I should tell my primary care physician exactly what I’ve told her. “You can’t live like this,” she says. I nod. I know.
4. I started writing again because I had headaches. I wrote all the time as a kid. I placed in some giant Scholastic contest my senior year in high school; only when a letter came in the mail did I remember I’d submitted a story. I made it exactly to the level at which I received a certificate and got my name on a list but did not have my story published. I was relieved. I didn’t quit writing because I didn’t think I was good; I quit because I couldn’t invite people to see my insides. I was too scared to take creative writing classes as an undergraduate. I had never shown my work to anyone, and I didn’t know that I wanted to do it with strangers when I had a grade at stake. And what the hell did I have to say? I was happy enough with academic writing, I told myself. But in New York I was miserable. I worked a job I hated, or I guess it was two jobs; neither nonprofit could afford a full-time employee, so they split me. I felt unappreciated and overworked, like a sitcom character who books two dates for the same night. Except everyone know I played two roles. I had one coworker who came in for four hours twice a week. I liked him, but it was lonely in my cubicle, and one of my bosses snapped at me for every mistake I made. The city noise, the subway cars and children’s screams and all the sirens, crowded my head. I felt like the concrete and metal had gotten inside me somehow and were scraping pieces off my brain. I was reading more than I had since grad school; my commute gave me time and incentive. I’d missed all those words, their shapes and sounds. Once, I had loved them like they were mine, sculpting everything into language until I forgot about my body. For the first time in ten years, I wrote something. I read it at a Brooklyn bookstore in front of maybe eighty people. The audience clapped in earnest. I almost won the bottle of wine awarded to the most-applauded reader, which I couldn’t have drunk anyway. “You’re clapping away your wine,” I told my friend Jen as she clapped for another writer. But I didn’t care much whether anyone liked what I’d written. In that room, I was a writer, and I’d found my people.
5. Every fourth Thursday, I see Dawn, the P.A. who refills my painkillers. Today I get to her office an hour early. I keep my sunglasses on so the lights won’t make my headache worse. I have cream cheese and chive sandwich crackers in my purse and Ben Lerner’s second novel, 10:04, to read. I keep trying to read it, but I don’t feel like reading. I haven’t felt like reading in almost a week. I’ve never not wanted to read. It’s what made me think my symptoms were bipolar. I’m a third of the way through 10:04. I want to finish it, but I don’t want to read it. I like the book; I even feel a kinship with it. Lerner says he planned to write a story “involv[ing] a series of transpositions: I would shift my medical problem to another part of the body [and] change names.” He writes of his planned next novel, “Everything will be the same as it is now […], just a little different.” But Lerner couldn’t get excited about transposing his experience into fiction. He ended up writing a book about writing a book, about time and subjectivity and mortality. I spent a year trying to fictionalize my life, too. I’d have the me character meet Ryan, the 22-year-old opiate addict real-life me met in her last year of high school, in college. College could explain my character’s motivations for dating him, which I’m still not sure I know. I wrote two chapters, but getting my characters to do anything felt like moving clay figures through mud. When I decided to just write what happened, the whole thing opened up. So, I want to read the book. I probably need to read the book. But I’m just holding it while I fake a nap in the waiting room. The book makes me want to write, and I can’t, so the book makes me cry, and I’m sick of doing even that.
6. I have this memory of myself crying in the shower; I must have been eleven or twelve. I’d stand under the running water and just fucking bawl. I didn’t think anyone could hear me there. The mom came upstairs once to ask me what was wrong. “I don’t know,” I said. “I don’t know.” I felt wretched, and I had no idea why or what about. I don’t think I shocked the mom. I’d always been a tightly-wound child. But I don’t think she knew what to do for me either. When I was seven, our pediatrician blamed my headaches on self-inflicted stress. No one ever suggested that I see a therapist or seemed concerned that a child put so much pressure on herself. My parents didn’t fight; they never beat or neglected me. I did well in school. I had friends. There was food on the table. There was always a table and a roof under which to put it. I had no apparent reason to worry the way I did. I want to know what I was worried about, why my brain works this way. I want to know what might have happened to my headaches—to me—if I’d had the opportunity to articulate what I felt to someone who knew how to help.
7. I’m nervous when the nurse calls me into the back. I put my purse and jacket on a chair so that she can weigh me (I’m at 106.4 this time; I fluctuate with each visit). We go into a room that’s filled mostly by an exam table, white paper smoothed over its leather upholstery. I sit on it while I have my blood pressure taken—the nurse gives me the numbers, but they don’t mean anything to me—and answer a few questions. When the nurse leaves, I move into a black leather chair that looks like the moon waxing gibbous. I give up on 10:04 and examine the photocopied records I picked up from the Blacksburg Center for Pain Management before Dr. Bivens, the pain specialist I used to see, closed his office. Bivens’ notes sum me up in 100-word paragraphs. He says I have obsessive compulsive tendencies. He misquotes me. He notes the “significant relief” I got from lidocaine injections even though I quit them because the lidocaine just numbed my head for four hours, and when it wore off, I got this squeezing headache that felt like my pain rebelling against the treatment. I devour every page, every footnote, weighing what each one says about me and whether these descriptions match the way I see myself. When Dawn opens the door, she says she’s sorry for making me wait; she’s been running late all day. “It’s okay,” I say. My voice lacks inflection. Usually, when I see Dawn, I’m upbeat or, put in the terms Bivens uses in his notes, I exhibit “high affect.” Today, I am weary, and I expend none of my usual effort to hide my dejection. I’m afraid that Dawn will think the central nervous system depressant she writes me depresses my psyche, too, if I do not appear fresh and bright at my appointments, gesticulating with energetic hands while I update her on my classes, joke about the oxy I watched skitter out of my hand and into my printer, pretend that I prefer sitting at home to attending the reading or friend’s party in which my headaches most recently prevented me from taking part. Today, I tuck my hands between my thighs and let a dull expression settle on my face. I have not showered in three days. I am tired. I am depressed. This month, I don’t find anything funny. My pain is not under control, and it’s taking its toll on me. “I have to up my dose,” I say. Dawn and I have been trying to keep me on four five-milligram pills a day for the past six months, but I can’t fully function on four five-milligram pills a day. I tell her I’m exhausted by the running pill count I keep in my head and tired of suffering to make the numbers work. “And I can’t write,” I keep saying. “I’m in a writing program. I have to be able to write.” Dawn asks me how much longer I have before I finish my MFA. I have a year and a half, but I’m adamant that it’s not about school. “I need to write,” I say. “I’m going crazy. I feel dead inside.” I start to cry, and Dawn hands me a box of Kleenex. “This can’t be my life. My head hurts all the time. And if I can’t do the one thing I really care about…” I decide not to finish the sentence. I can’t tell the person who writes me a potentially lethal drug that I think about death all the time. I wipe my eyes and shake it off. “I have to up my dose,” I say again. Dawn writes me a prescription for 130 pills, fifteen more than I had the month before. But she has to refer me to pain management. If I need to up my dose, she explains, the practice needs to send me to an expert.
8. For as long as I can remember, I’ve been a writer. In kindergarten, I made my sisters and a friend perform my adaptation of Little Women in our living room (we never got around to staging Anne of Green Gables). After her dad died, my mom found a poem I’d written for him. She heaped praise on it, said it had made her cry. I should have thanked her and let her keep the poem. Instead, I snapped at her for reading my stuff. On our family’s first computer, I typed up something called “Sixth Grade is the Pits” and stuck a clipart piece of pizza on the front page. It’s somewhere in the suitcases where I keep my novels. Mostly, I wrote novels. I spent hours cutting pictures out of magazines and filling index cards with character traits. My novels were almost invariably about girls a couple of years my senior who ran away from bad homes; the girls always met and fell for sweet, gentle older guys who offered up their couches to my reluctant protagonists. Sometimes I varied the formula: the girl met an asshole first, and his roommate or a coworker or a random man on the street took her under his wing when the first guy kicked her out or tried to fuck her. I don’t know where these stories came from. Surely they were escape fantasies, but why did I write so many versions? Why were the details so specific, and what do they say about me? I wrote those stories in middle school and early high school, when I also kept a giant bottle of Extra-Strength Tylenol in my locker. We were supposed to get permission from the school nurse to take any kind of medication, and I was always afraid someone would find my stash; I’d get in trouble, and it would go on my permanent record, a lie in which I wholly believed. I slipped pills into my pockets and walked to a water fountain like a bullet, the way I walk now when I just want everything to end. Pain made me different; it isolated me, though I never called what I felt by its name. I think I’ve always written from a place of depression, spurred on by pain I don’t understand. I think I’ve been running from pain all my life.
9. I walk into my house and beg someone to kill me. “Just let me die. I just want to die,” I hiccup out between sobs. I don’t know to whom I’m addressing my pleas. I don’t believe in God or a sentient universe. No one and nothing will answer my call. I stand in my kitchen and scream. I don’t use words. I do it twice, and then my head feels worse. I drop to my knees and ask again to die. “I don’t want to do it anymore,” I say. My voice is quiet and hoarse. I know I’m going to get up off the floor. I know I’ll wake up tomorrow. I can’t inflict pain on myself, and I’m afraid of brain damage. If I tried to overdose and it didn’t work, no one would write me a narcotic prescription again. These aren’t suicidal thoughts. I’m not thinking about the best ways to kill myself. I don’t really want to die. I just don’t want to be alive. It’s different.
10. When the new first-year MFAs arrived at the beginning of my second year at Virginia Tech, I’d look at them sometimes and really see how young they were: 22, 24, 25, even 27 possessed this tangible aura of youth that I couldn’t find in myself anymore; it felt like muscle, like a pumping vein, and also like vapor. I was jealous. Why didn’t I do what I wanted when I still had that energy? I was incredulous. What did these people have to write about? Where was their self doubt, their anxiety, their fucking cynicism? When I was 22, I thought academia could satisfy my need to document everything, to write it down and shape it. I did an M.A. in Women’s Studies. I wasn’t really getting headaches anymore, or I didn’t get them often; when I started taking Ryan’s Xanax and the opiates he tricked doctors into writing him and, after we broke up, smoking weed in my apartment every night, I stopped having all but occasional headaches. When I had them, I’d lay on my back in my hallway and cry. But more often, I cried because I was lonely; most of my friends had moved away, and I spent too much time by myself. But I couldn’t be depressed, I told myself, because I was happy. I was in Gainesville; I loved Gainesville. There was always a party, and I could still drink without inviting a migraine into my skull. I did grad school the way you’re supposed to do grad school: I was focused and serious yet still young enough that I could snort a gram of cocaine on Thursday night and head straight for my computer on Friday morning to work on my thesis. I went to class stoned and still managed to speak coherently about Judith Butler. I published a paper. I went to conferences. “And I could take days off to clean my apartment!” I told people while I applied to MFA programs. I’d spent five years working for nonprofits, and I was exhausted. I remembered college and grad school as these oases of happiness. Those years feel like someone else’s life. I thought I could be that person who did those things again. I thought I’d be able to drink once I got off Suboxone and that I wouldn’t have headaches anymore. I thought I’d be able to clean my house. But I couldn’t drink, and my headaches didn’t go away. I had to hire a maid service to make my apartment look presentable for my leasing company’s inspection. I watched other people do grad school the way I’d done grad school, and I had no idea how their bodies withstood it. I couldn’t remember ever being that young or any of the million ways I’d once been invincible.
11. The last time I didn’t have a headache, I was on acid. The time before that, I’d eaten mushrooms. I chewed and swallowed a rubbery handful in the AllSaints Spitalfields dressing room and spent $612 on a leather jacket and a white sweater dress with a billowy skirt and structured top. I threw up in front of the Canal Street Q station, wiped my mouth, and rode the train for hours. I stared at the speckled subway floor that swirled beneath my boots. Something felt off. I kept checking my bag, convinced I’d lost something important. But I hadn’t dropped a glove, misplaced my ID or a credit card, set down that $612 shopping bag and forgotten to pick it up. My pain had gone missing. My head felt flung open, like that first spring day when you can open your windows. I laughed in disbelief and awe, alone on a baby-blue bench. I touched my head, searching for the tender spots that weren’t there anymore. I got off the train when I stopped recognizing street names, walked up to the sidewalk, lit a cigarette, and watched the smoke glitter in the light of a bodega’s red neon sign. A guy in a black Navy peacoat told me I was in Queens. I’d have to ride all the way back up to 42nd Street to get a train back to Brooklyn. Unlike all the other times I’d fucked up my route or gotten off at the wrong stop, I didn’t curse my stupidity or kick the thickly-painted forest-green stanchions that lined the tracks. I went back down into the subway and waited unperturbed for the next uptown train. So this is what it’s like, I thought, to be a regular person.
12. The day after I fill my new prescription, I get a migraine and my period. The migraine lasts four days, and for at least another week my headache is rigid and sickening; nothing touches it. I keep taking pills and hoping they’ll make me feel better, but they don’t. It’s such a rookie mistake, wasting drugs on pain that’s proved itself immune to them, and I’m angry at myself for having made it. I imagine my head as a bucket of vomit too heavy to turn over, like it’s a separate entity that really could throw up if it wanted to. I’m cold in my bones even with tights on under my jeans. Even in my house with the heat on. Cold tenses my back and shoulder muscles, which strains my neck so my head absorbs the pressure. I have the pills I need now, but my head hurts too much, and I still can’t write. I tell myself I’ll feel better the next day and then the next day and the next until I do, sort of. I’m going to write if I have to take twice my dose. If I don’t, my bones will break through my skin. I can feel them pushing and pushing, and I don’t care anymore that there’s no way my prescription will last more than 21 days. Dawn and I say it should last 28. But I didn’t get back on an addictive painkiller so that I could stay on the couch moaning. I got back on opiates so I could write. Dawn will have to understand.
13. I see Mary a week later. I tell her maybe I feel better, but maybe I don’t. I’m not sure. I cross my legs and lean forward with my elbows on my knees. “If I say this, you have to promise not to tell any of my doctors,” I say. She nods. “I think it’s the opiates. I think I feel like this because of the opiates.” I would never say this to my mother. I’ve never really said it to myself. And it’s more complicated than that, I explain to Mary. “It’s not like I wouldn’t be depressed if I weren’t taking them. I just think… Am I doing this to myself?” My voice breaks at the end of the question. “But what am I supposed to do? I mean, do I think I’d feel better if I never got to not have a headache?” Mary nods and says it’s hard; the opiates likely do impact my moods. She holds her hands up like a scale. “But, you know, there’s negatives to everything,” she says. “You have to decide what’s right for you. And you’ve got to get your pain under control if you’re gonna deal with the other stuff.” I shrug. I can’t look at Mary when she agrees with me. “I know,” I say. I’ve been saying it for years.
14. I spent a year “clean” after I stopped taking opiates, when I’d finished my Suboxone detox. The worst part was not the acute withdrawal. The acute withdrawal lasted ten days, maybe fourteen. Since I had someone to take care of me, acute withdrawal was like having a bad flu on vacation. I binge watched the mom’s premium cable and read all day; I ate only mint chocolate chip ice cream, lentil soup, and cheeseless pizzas topped with onions and black olives. I took the most sublime shits. I hurt all over the entire time, felt edgy and anxious despite not having to worry about the money the mom and I spent on my detox, missed work, oily hair, children or a spouse—not even a pet; the mom fed my cat when I couldn’t get out of bed to do it myself. Acute withdrawal has a definitive beginning and fuzzy but palpable end. You know what you’re getting into, how you should feel, what you’re moving toward. Post-acute withdrawal creeps up on you even if you’re expecting it. In post-acute withdrawal, you’re feeling your brain reestablish connections you severed when you started giving it synthetic dopamine. You’re listening to a voice in the back of your head whisper reminders that, eventually, you’ll have to live like a person again. Post-acute withdrawal can last anywhere from a week or a month to years; for some people, it never ends. I was starting an MFA program in a month. I didn’t have forever. I moved to Virginia exactly thirty days after I slipped my last Suboxone tab under my tongue, and I still didn’t feel like a person; I still had trouble living like one on my own. I spent my first semester and a half at Virginia Tech depressed and foggy and then despondent, sure I was one of the people who spend their entire lives in a post-acute withdrawal haze. Unless I was reading, I couldn’t concentrate for more than thirty consecutive minutes. To sit at my computer strained my weakened muscles and still-recovering brain. I couldn’t identify the words I needed to translate the images in my head onto a page. Some days, the images didn’t even come. I was in a writing program, and I couldn’t write. I didn’t know this version of myself; I’d never not been able to do something. And I did do it, just slowly and with effort that took all the energy I had. No one knew I was still in withdrawal unless I mentioned it. But I recognized that something had gone missing in me even if the people around me didn’t. They didn’t know what had once been there, and neither did I, not fully; whatever had absented itself—some aura or spark—I’d taken for granted when I had it. But I knew I didn’t feel like anyone I’d ever been. When I started taking opiates again, I felt some piece of my self return to my body. That loss, whatever it was, still haunts me more than the easy misery of acute withdrawal. If I had to get off opiates again, I could handle the gradual Suboxone detox and the week or two in bed, but the post-acute anxiety and emptiness, the disassociation from the craft that gives my life a shape and a meaning and from the pieces of a personality I cram together and call me—I know that lack too well to live through it again.
15. I used to look for myself in books and movies and academic literature. “Chronic daily headache” barely brings up results on Google. You have to wade through WebMD and Mayo Clinic pages on migraine before you find the pages actually dedicated to “Chronic Daily Headache,” which are few and usually generic, their information slim. I don’t do it anymore. It’s not worth it. Pain specialists tout their special cures—lidocaine injections and nerve blocks and reiki—but there isn’t a cure for my pain. I can manage it. I can live with it. But I can’t banish it. In New York, my doctor always said, “There’s not going to be a magic bullet.” I tried to believe otherwise. I hoped until I couldn’t anymore. There’s only so much you can hope before your stores just dry up. My psychiatrist once asked if I was happy depending on pills to “get through the day.” He has this tone of voice like he’s condescending to you even when he’s not; I yell at him all the time for the way his voice sounds, the implications it carries, even though I know now that he can’t help it. This time it was the phrase “get through the day” that set me off. “You say that like I’m just taking this stuff to pass the time,” I snapped. “I’m taking it for pain.” I told him he couldn’t talk to me that way until his head hurt all the time like mine did and he couldn’t find anything else to do about it. Then I said I didn’t mind at all taking Klonopin and oxycodone every day. “I’d be happy if doctors and pharmacists weren’t such fucking fascists about it.” I know that’s not true, but I wish it were. I wish I could point at something and say, “Now that, that would make me happy.” But I know that no such thing exists. I’ve accepted that I’ll always have headaches, that I can’t sustain happiness, that I will live my life on my knees, and I depend on that pessimism for survival. I crawled to the edge of hope and found comfort in its absence. My pain, the loneliness it engenders, my sometimes hysterical despair, chronic melancholy, the anger like a still black lack in my chest—those things haven’t and presumably won’t go away. I’ve gotten used to what no one should have to get used to, and from down here on the ground, hopelessness has proved itself the more prudent orientation.
Photo by Ana C.
Painting of The Librarian by Baxter Wilson
