Prologue

      ON THE EVENING OF JULY 4TH OF 2011, I STARTED VOMITING and found it impossible to stop. I was just back from two weeks of teaching a fiction writing workshop in Portugal, where I’d felt a little worse each day. At first, I thought I was just tired because of the time difference between Rhode Island and Europe, then that I had a cold, then that maybe it was flu. I slept more and more, felt increasingly disoriented. I was having trouble breathing, but I told myself this was just an indication that I was out of shape, that the more I walked the better I’d feel. On the back of my story collection Windeye there’s a picture of me standing in the palace of Sintra where if you look closely you’ll see my eyes are glassy, my face filmed with sweat. I’m smiling, but desperately so. I was trying to act like I was fine. I was, after all, the teacher. I was there to be the one who helped others, not the one who needed help.

      By the time I was convinced I needed a doctor, the workshop was almost over. Since I found daunting the idea of going to a doctor in a country where I didn’t speak the language, I opted to stick it out and wait until I got home.

      But standing in the Lisbon airport early in the afternoon of Saturday July 2nd, I realized that things were much worse than I had supposed. I couldn’t stop sweating, I had no appetite, I felt increasingly disoriented, and I was suffering from paracusia, beginning to experience auditory hallucinations. The last time I’d had paracusia had been three or four years earlier when I’d had the flu and had driven with my then-girlfriend from Oklahoma to Rhode Island without adequate sleep, desperate to make it home to my own bed. Maybe it was flu after all, I thought, and then hoped the worst of the symptoms wouldn’t strike until I’d landed.

      The Sata airlines flight home seems to me now more of a hallucination than an actuality, in that disconnected and partial way that you (or at least I) remember things when you’re very drunk indeed, as scattered bits and pieces with a kind of absence where you yourself normally reside—a few moments you can cling to, a great deal that’s just lost and may come back later or not at all. I had not been drinking. I had had nothing to drink except water, and very little of that, and nothing to eat for some hours. It seemed a very long flight to me, and I have no memory of the three hour and forty minute stop we took in the Azores, at Ponta Delgada, despite some of the workshop participants on the same flight telling me later that I’d participated coherently in several conversations, that they’d had little sense that something was wrong with me.

      I do remember landing in Boston, exhausted, and my then-girlfriend picking me up and then the two of us driving home. I don’t remember if she drove or I did—I suspect the latter since I almost always did the driving, but I can’t be sure. I believe I told her that I’d been feeling poorly, but, as I often did (and still sometimes do), downplayed how ill I actually was.

      Once home, I collapsed. Perhaps a night at home in my own bed would be enough to revive me. I slept deeply for a few hours, then restlessly, then not at all. I had a pain in my right side, just below my rib cage, and was having trouble breathing. When I stood, I felt dizzy. I wandered the house delirious as my then-girlfriend slept.

      And yet, now that I was back home, despite my experience on the plane, despite what I was feeling, I tried to tell myself it was nothing to worry about. It was as if I could stop myself from being ill just by force of will, by convincing myself I wasn’t ill. When I had been a Mormon missionary decades before, I’d bought a punk cassette which I no longer have and the name of which I no longer remember at a flea market in Marseilles (we were forbidden to listen to anything but hymns as missionaries but that rule, like so many others, I didn’t keep). It included a sung parody of a “diagnostic rite for health,” with someone screaming “I have been ill, I must get better!” over and over again. Early on the morning of July 3rd, I was thinking about this song, repeating it obsessively over and over again in my head as I waited for the sun to rise.

      It was Sunday. I did not feel human. The paracusia had returned and it felt like several people were standing just outside of my field of vision, mumbling something that, I began to feel, was about me. Every once in a while, a voice would rise up out of the mumbling, its tones clearer and pitch higher but still not legible. I could recognize it as an individual voice, but could not recognize what it was saying. You’re going mad, I told myself, but another part of me knew I was not going mad, that I was ill, that I had experienced this before, and that once I was better, the paracusia would end.

      It was that as much as anything that got me to the doctor—an eagerness to end the auditory hallucinations. I walked down the hill to the end of our street and went right a half block to the clinic located there and then, since I hadn’t realized the clinic opened an hour later on Sundays, and couldn’t face the thought of having to walk back up the hill only to walk down again in an hour, found a place to sit and wait until it did open. When it did, I went in, signed in, waited,