“I don’t know, like, I’ll be at the cafeteria and I’ll start thinking about how, like, there are all these things living inside of me that eat my food for me, and how I sort of am them, in a way—like, I’m not a human person so much as this disgusting, teeming blob of bacteria, and there’s not really any getting myself clean, you know, because the dirtiness goes all the way through me. Like, I can’t find the deep down part of me that’s pure or unsullied or whatever, the part of me where my soul is supposed to be. Which means that I have maybe, like, no more of a soul than the bacteria do.”

“That’s not uncommon,” she said. Her catchphrase. Dr. Singh then asked if I was willing to try exposure response therapy again, which I’d done back when I first started seeing her. Basically I had to do stuff like touch my callused finger against a dirty surface and then not clean it or put a Band-Aid on. It had sort of worked for a while, but now all I could remember was how scared it had made me, and I couldn’t bear the thought of being that scared again, so I just shook my head no at the mention of it. “Are you taking your Lexapro?” she asked.

“Yeah,” I said. She just stared at me. “It freaks me out some to take it, so not every day.”

“Freaks you out?”

“I don’t know.” She kept watching me, her foot tapping. The air felt dead in the room. “If taking a pill makes you different, like, if it changes the way-down you . . . that’s just a screwed-up idea, you know? Who’s deciding what me means—me or the employees of the factory that makes Lexapro? It’s like I have this demon inside of me, and I want it gone, but the idea of removing it via pill is . . . I don’t know . . . weird. But a lot of days I get over that, because I do really hate the demon.”

“You often try to understand your experience through metaphor, Aza: It’s like a demon inside of you; you’ll call your consciousness a bus, or a prison cell, or a spiral, or a whirlpool, or a loop, or a—I think you once called it a scribbled circle, which I found interesting.”

“Yeah,” I said.

“One of the challenges with pain—physical or psychic—is that we can really only approach it through metaphor. It can’t be represented the way a table or a body can. In some ways, pain is the opposite of language.”

She turned to her computer, shook her mouse to wake it up, and then clicked an image on her desktop. “I want to share something Virginia Woolf wrote: ‘English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache. . . . The merest schoolgirl, when she falls in love, has Shakespeare or Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.’ And we’re such language-based creatures that to some extent we cannot know what we cannot name. And so we assume it isn’t real. We refer to it with catch-all terms, like crazy or chronic pain, terms that both ostracize and minimize. The term chronic pain captures nothing of the grinding, constant, ceaseless, inescapable hurt. And the term crazy arrives at us with none of the terror and worry you live with. Nor do either of those terms connote the courage people in such pains exemplify, which is why I’d ask you to frame your mental health around a word other than crazy.”

“Yeah,” I said.

“Can you say that? Can you say that you’re courageous?”

I screwed up my face at her. “Don’t make me do that therapy stuff,” I said.

“That therapy stuff works.”

“I am a brave warrior in my internal Battle of Valhalla,” I deadpanned.

She almost smiled. “Let’s talk about a plan to take that medication every single day,” she said, and then proceeded to talk about mornings versus evenings, and how we could also try to get off the medication and try a different one, but that might be best attempted during a less stressful period, like summer vacation, and on and on.

Meanwhile, for some reason I felt a twinge in my stomach. Probably just nerves from listening to Dr. Singh talk about dosages. But that’s also how C. diff starts—your stomach hurts because a few bad bacteria have managed to take hold in your small intestine, and then your gut ruptures and seventy-two hours later you’re dead.

I needed to reread that case study of the woman who had no symptoms except a stomachache and turned out to have C. diff. Can’t get out my phone right now, though—she’ll get pissed off—but did that woman have some other symptom at least, or am I exactly like her? Another twinge. Did she have a fever? Couldn’t remember. Shit. It’s happening. You’re sweating now. She can tell. Should you tell her? She’s a doctor. Maybe you should tell her.

“My stomach hurts a little,” I said.

“You don’t have C. diff,” she answered.

I nodded and swallowed, then said in a small voice, “I mean, you don’t know that.”

“Aza, are you having diarrhea?”

“No.”

“Have you recently taken antibiotics?”

“No.”

“Have you been hospitalized recently?”

“No.”

“You don’t have C. diff.”

I nodded, but she wasn’t a gastroenterologist, and anyway, I literally knew more about C. diff than she did. Almost 30 percent of people who died of C. diff didn’t acquire it in a hospital, and over 20 percent didn’t have diarrhea. Dr. Singh returned to the medication conversation, and as I half listened, I started thinking I might throw up. My stomach really hurt now, like it was twisting in on itself, like the trillions of bacteria within me were making room for a new species in town, the one that would rip me apart from the inside out.

The sweat was pouring out of me. If I could just confirm that case study. Dr. Karen Singh saw what was happening.

“Should we try a breathing exercise?” And so we did, inhaling deeply and then exhaling as if to flicker the candle but not extinguish it.