Tag Archives: the human animal

On the Sunrise View

About six months ago, I took a hard fall on a wet road. I wasn’t doing anything heroic—just coming back from taking the trash out at the field house in the foothills of Rainier where my advisor and I were staying that weekend, with seven undergraduates taking her fall quarter community ecology class. In my memory, I managed to slip spectacularly on a shoelace that was tucked inside my boot. All particularities of my gracelessness aside, the upshot (downstruck?) was that I fell, decisively, on my right knee. Stars were seen; breath was lost; tears were shed. Some combination of embarrassment, bravado, and a feeling of responsibility—I was the TA for the class and didn’t want to be the cause of delay or inconvenience—prevented me from mentioning much about this to anyone else. I limped over forested slopes with our students for the rest of the morning, and later drove over a hundred miles back to Seattle with my un-rested, un-iced, un-compressed knee twanging like a banjo and crunched into a very un-elevated position.

I had some x-rays taken, after three months with little improvement in pain. Here they are:

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“On the sunrise view,” wrote my doctor, “there is a stepoff consistent with fracture, but this is not evident on the lateral. On the anteroposterior view there’s a subtle lucency superomedially…consistent with a longitudinal fracture of the patella.”

Aside: I love sunrise view. It’s an x-ray taken with a bent knee, so you can see between the patella, rising like the sun, and the horizon of the femur. It’s the bottom right image here.

Surprisingly enough, I didn’t write this post to describe my knee injury. I wrote it because what I did to my knee that day is going to be something I carry with me for the rest of my life. The bone damage has likely healed, but joint fractures are quite prone to post-traumatic arthritis, and it seems likely I also crushed my patellar cartilage. (Alas—adult cartilage doesn’t repair itself.) Six months of rest and physical therapy later, I’m back on my bike every day and in the mountains every weekend, and most of the steps I take are pain-free—but I still feel a knife in the kneecap whenever I squat deeply or take a steep step up or downhill. It’s also taking a long time to unlearn the sneaky habits I formed in the immediate aftermath of my fall, when I started favoring my right leg to avoid the pain of putting weight on it.

I know I’m burying the lede here—not entirely unintentionally—but as my knee goes, so goes my brain. It’s no particular secret to most people who know me well that I have lived most of my adult life with depression. Major recurrent depression, according to the lovely Berkeley psychiatrist I was lucky enough to see several years ago.

Aside: I used to hate psychiatrist, but after I knew that the Greek iatros, which means “healer”, may come from iaino, “to heat, warm, cheer”, it became easier to appreciate. I take a small pink tablet each night, and so light a little warming fire under my soul.

What I want to say about depression, because I think it bears talking about even though, or perhaps especially because, I am currently quite well, and very grateful for my life—is that for those of us who have it, it never fades into memory.

Depression can bring acute pain, and this takes different forms for different people at different times. Once, I stared at a tear-slurred face in the mirror in a hotel bathroom in Hong Kong, attempting a smile but succeeding only in a terrifying rictus. I remember grabbing my cheeks in both hands and moving my muscles roughly around, in search of the person to whom the face used to belong. I was utterly unrecognizable to myself. That injury was fresh.

But these days, things are good. They have been for many, many days past; and this month, in fact, they’re great. I passed my PhD candidacy exam 11 days ago, which means if nothing else that five people whom I respect immensely believe I’m probably going to be capable of finishing what I started. I won a few small awards this season that I can use to fund my field research. My lab is changing, and while I’ll miss my amazing lab mates who are graduating soon, I’m so proud to be part of this lineage—and amazed and excited that I get to play the role of “older grad” to those who are joining us. I’m doing what I love, in a city I love, I have a climb of Mount Baker on the calendar for early June, and I might get to see my whole family again in December. Of course, I know that every hill rolls inexorably down to a valley, but this is my life right now: steady, satisfying.

And yet, while most of the steps I take these days are pain-free, depression continues to show itself. I honestly don’t think about this very much, because I’m so used to it. But when I woke up in the middle of the night last week with the most cynical, jaundiced, privative thoughts running through my mind—at a time when I should have been feeling proud and relieved—I think I finally realized how deep this scar tissue runs.

Here is the prosaic truth: I’ve gotten very good at batting away its attack, but every single day, multiple times a day, something inflames my immortal mosquito of fatigue and self-loathing.

Occasionally, this strikes me as deserved—because I think I am, in fact, all the things it accuses me of being. More often, it strikes me as ridiculous. Ungrateful. Unproductive. But most of the time, it doesn’t strike me for very long as anything at all, because I forget about it in a moment…until the next time.

I don’t really know where this is going. I really just wanted to share it because I know that from the outside, I generally look like I have a good head on my shoulders, and I can take stairs on my bad leg. I have been incredibly lucky—or as Ross says, unlucky to have the brain chemistry I have, lucky that it responds to treatment. And I still have to listen to this crap from my own brain. So if you hear it, too, or more, you’re not alone. And if you don’t think you know someone who does, remember: Some things are only visible on the sunrise view.

On Living Without Windows

If I look to my left as I type at this moment, I see the whispering canopy of a European white birch some 40 feet tall, its branches dangling boas of diamond-shaped, tooth-edged leaves. I see the straight line of a utility cable weaving through the crazy puzzle of the tree’s profile. I see the nose of a silver sedan parked on the street below, and if I crane my neck to look over my shoulder I can see another birch, another cable, and a clutch of houses rising on the curve of Phinney Ridge, the neighborhood northwest of the one where I live. I see these things through the nearly full-length windows I am lucky to have lining the wall by my desk.

These are my windows; they are part of my apartment. It is simple enough to say, as you do: This is my view.

On Thursday morning Ross and I woke in the half-dark and drove two about and a half hours north of Seattle, picking up our friend Susie along the way. The goal for the day was to hike to a place called Hidden Lake Lookout, which lies just over the border between Mt. Baker Snoqualmie National Forest and North Cascades National Park. Susie had hiked this route before, several years ago, and had in general sung the praises of the landscape through which it climbs—a part of the Cascade mountain range that Ross and I had not yet visited.

Nothing about the hike disappointed. The vegetation was everywhere riotous and everywhere changing; as we moved from forest to open cliffside, the dappled ferns and mosses fell away and we started seeing spikes of fireweed, starry asters, lupine, mountain ash, paintbrush and false hellebore. At times the giant, hairy fans of cow parsnip—cousins of the hundkex (“dog biscuit”) I encountered in Sweden—nearly pushed us off the path. And after Susie pointed out the ripe wild blueberries that lined the trail, every new patch became an excuse to pause and pluck a half dozen tiny bright beads, tart as anything and more satisfying than water.

We saw and heard pika as the terrain got rockier (each call like a fraction of a red-breasted nuthatch). Four white-tailed ptarmigan, brown summer plumage fading sooner than I would have thought into winter white, stood clucking softly on a steep outcrop near the top, as high as snowfields. Near the top of everything, the first glimpse of Hidden Lake appeared like a crazy mirage shining low in the throat of the mountains around it, and here there were ravens. Always ravens in high places.

This is Hidden Lake, no longer quite so hidden.

But windows are my subject today.

Ross and I left Susie napping on a boulder in the sun and half-hiked, half-scrambled up another few hundred feet to the top of a narrow peak above. The views here, if possible, were even more expansive. We could see, though we could not have named all of these mountains at the time, Mount Shuksan. Big Devil Peak. Eldorado. Mount Baker. Johannesburg. Mount Sahale. Boston Peak. Mount Forbidden. Glacier Peak. The sky was close enough to touch and nothing for miles around, it seemed, was hidden from us—except perhaps the place where we had started from that morning, down below the shadows of the trees.

We found a place to stand, to twirl around and take it in. And then we turned our attention to the structure that gives the trail its name: a wildfire lookout built in 1932, decommissioned a few decades later, and currently maintained as a first-come, first-served camping shelter.

The Lookout.

Five or six other parties were at the top when we arrived, including a pair of young backpackers who had been lucky enough, they told us, to nab the space just as its previous occupants were leaving. The couple had arranged their sleeping bags and foodstuffs in the lookout, a little wooden cabin tethered to the rocks at very nearly 7,000 feet, and were now sitting just outside it. Ross, before me, hesitated on the doorstep. The lookout was, of course, public property—but even at that height, a certain canon of possession held.

“Go on in,” the couple said, with jovial magnanimity (a relief to me, since a trip report I had read about this hike made mention of a party that had commandeered the house and tried to prevent day hikers from entering the lookout even for a peek). “Go take a look!”

And so we did. And as we entered, both of us—entirely involuntarily—gasped. “Oh, my god.” Here’s what we saw:

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I’m not sure if these pictures made you gasp, too. It’s hard for me to know how I would feel about them if I didn’t have in my mind the memory of what it was like to step over that small threshold onto clean, peeling floorboards, thinking of nothing in particular except the sun and the air, feeling only a mild curiosity about what the inside of a fire lookout might be like, and to all of a sudden see that view, through those windows. It was quite genuinely breathtaking.

Not that the view outside the lookout’s walls had been less breathtaking—at least, it made no sense for that to be the case. By definition, what you could see through the windows was circumscribed and what you could see outside was not. Nothing ought to have been more spectacular than the 360 degree panorama we had beheld from the exterior, turning on our heels and back again until we all but lost our balance. A few pieces of wood and glass ought not to have improved on our eyes’ best evidence.

And yet, as soon as you walked through that doorway something made you gasp. It happened in exactly the same way to the people who stepped in as we stepped out—a stopping in their tracks, a sharp inhalation. “Oh, my god,” a woman said.

Reemerging from the lookout I was slightly irritated by the extra awe I’d felt on entering the structure. It took me a while to understand. At first I thought it must be something about the way the windows framed the mountains; perhaps they gave the overwhelming beauty of the scene some shape, I speculated. Perhaps they somehow emphasized the vastness of the landscape by placing onto it a sense of human scale, making the peaks seem even bigger and more majestic than they already were.

There may be something in that, but now I think the simpler, more direct, and more frustrating explanation is that windows make us feel as if we own what we see through them. And what a possession this would be! Everyone who stepped into the lookout that day, I think, immediately entertained a fantasy of moving into that irresistibly charming wooden cabin—of making it their home. That table, theirs. That bare bed, theirs. And that sublime, extraordinary view: theirs.

I often wish, spoiled as I am by having grown to love the outdoors through fieldwork at sites that were very nearly empty of other human beings, to be more alone when I hike. I grumble, quite unjustifiably, about having to share the trail with people who love wild places just as much as I do. This selfish impulse, I know, is another thing I share with many of those same people. I wouldn’t try to change it—solitude is precious, and we all deserve to seek it. But I would like to let go of the hunger to see the view through those windows, and of the silly, seductive sense that a place like that lookout was somehow the best possible vantage point from which to pass a night in the North Cascades.

I don’t want to want to own the mountains.

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(But I do kind of want to be in that lookout during a lightning storm. Wouldn't you?)

(But I do kind of want to be in that lookout during a lightning storm. Wouldn’t you?)

 

The Nearer Your Destination

In the vocabulary of rock climbers, a problem is the physical space between where you are right now and where you’d like to be in just a little bit. A solution is any one of the set of ways in which you might traverse that space. The joy of climbing, you immediately understand, lies in both problems and solutions: A particularly beautiful solution requires an especially interesting problem.

I wouldn’t call myself a rock climber, but I’ve done enough of it in the gym to have collected a small stockpile of techniques—I have a sense of how to stretch, and twist, and push on, and pull with, various bits and pieces of my body in order to make a seemingly inaccessible position accessible. I have a sense of how to approach the physical mass of a rock face, how to see hand-holds and foot-holds and how to exploit my contact with the rock itself so that friction and reaction forces give me extra leverage.

Ross and I let our Berkeley rock gym memberships lapse quite a while ago, but we like using these skills to scramble. If you’ve never heard of scrambling you can think of it as the middle ground between walking, which generally requires no skill or equipment—and technical climbing, which requires both training and gear. Yesterday the two of us spent a few hours inhabiting that middle ground in Sunol Regional Wilderness, a gorgeous park that lies just east of the Calaveras fault (part of the San Andreas fault system) and is blessed with an abundance of otherworldly blue-green serpentine and rich brown-black basalt rock erupting at intervals out of rippling hills. We scrambled in the sweet, clear waters of Alameda Creek, which has so many good-sized boulders in it that you can go nearly a mile straight through the creek itself and only occasionally have to hop over to one or the other bank. We scrambled up Rock Scramble Trail, whose nature does not belie its name.

I was having bouts of lightheadedness that day, on which more in a moment, but the weather was fine and the problems were interesting and the solutions satisfied. The daily push ups I’ve been doing for a few months helped me strong-arm my way up at least one rather tall boulder. I made a couple of singularly enjoyable moves that involved getting nearly horizontal, hands pressed to one whorled stone surface and boots pushing back against another. I got sweaty and I slipped and I ate a fly, and I thought: I wouldn’t mind it if the world were all boulder.

The lightheadedness was a thing of some note, though thankfully it was not only mild but almost enjoyable, in the way that, if you’ve ever gone under, the first flush of anesthesia hitting your veins can make you understand why “giddy” has two meanings. Sunday was the first time I became aware of it, though it’s continued through today and I imagine it may take a little while to subside. About ten days ago, I don’t mind explaining, my physician and I agreed that it was a good time for me to start transitioning off the medication I’ve been taking for the last 14 months. I was given a list of “discontinuation symptoms,” some of which were moderately terrifying and most of which I have very luckily avoided. But I’m pretty sure that this is where the lightheadedness came from.

The only other effect I am experiencing as a result of going off the drug is also of some note.

I have noted it in a conversation with Ross, and today in a letter to my dear friend Sarah, but I find it difficult to note it here, for some reason; perhaps that it requires telling you about one of the parts of myself I find the ugliest. The past 14 months have been good ones, and because of that and possibly because, I now realize, of the medication I’ve been on, this ugliness has not manifested itself very much at all. But it surfaced this past Saturday, while I was studying for an upcoming physics exam and struggling to call upon the concepts and equations I’ve been learning quickly enough to solve my list of practice problems in a reasonably finite period of time. And it surfaced on the drive back from Sunol yesterday, when I made several wrong navigation moves in a row on a busy highway.

Ugliness, in this case, is a sudden, blooming unhappiness—a kind of black choler rising in me like a force of nature—or at least, that is how I thought about it for most of my life. Ugliness is the choler itself, which is usually triggered by the sense that I’ve done something wrong or that something has gone wrong. It is also a secondary sense of outrage and panic about being infected with this feeling, and the desire to cut it out of myself as expeditiously as possible. And it is the almost automatic projection of both of these unhappinesses onto someone else, preferably in a way that has them wronging me—so that even if I have to be miserable, it doesn’t have to be my fault.

I was alone when it happened on Saturday, so Physics Itself took the brunt of my projected unhappiness, which was quite mild anyway and fortunately didn’t last very long because I had to shut my books and head off to meet an old friend. I noticed the choler, though, because it had been so long since I had felt it. Huh, I thought. It’s you. I haven’t missed you. It felt, a little, like a slipping.

On Sunday, of course, Ross was next to me in the car. It wasn’t exactly pleasant for either of us, but I’m very glad to be able to tell you that even without the smoothing benefits of a serotonin-norepinephrine reuptake inhibitor, and even though I could feel the ugliness growing like a little massif between my ribs, the whole thing blew over within a couple of minutes. My old friend hasn’t changed, but I have. After an initial convulsion of frustration, I clued Ross—who’d been, understandably, mainly focused on helping us navigate safely home—in on what was happening with me. It took several minutes more before I could say I was no longer angry, or unhappy, or vehemently desirous of not being in the wrong, but I didn’t push those things onto him and I didn’t gorge myself on them.

There was a space between where I was right then and where I wanted to be in just a little bit. There was a set of ways to traverse that space. And I don’t know if it was beautiful, but I found one.

Not all the rocks we scrambled in Sunol had taken their place there as a result of the tectonic forces at play beneath our feet, but this is true of a lot of the park’s most remarkable and interesting problems. Because the fine-grained, iron-rich basalt that dominates the ocean floor is heavier than the the phaneritic (large-grained), silica-rich granite that makes up most of the Earth’s land masses, an oceanic plate will slip-slide below a continental plate when the two have a contest of borders. Down in the mantle, the subducted basalt will melt, be reformed, and alter in character before some of it is unearthed by other geologic events.

Zeb Page, a petrologist at Oberlin whom I do not otherwise know, has won my heart by pointing out that these rocks represent the only material in the world that was once subducted but is now available for study. This is rock that came from the depths of the Earth’s core, became part of its skin, was pushed back under for a second spell in that fundamental forge none of us will ever see, and then returned again.

And we get to climb on it. We get to practice getting nearer to our destinations—even if, after all, Paul Simon was a little bit right about that slipping and sliding thing.

 

The Lost Panther

Preface and Disclaimer: The following is an account of one family’s experience with a complex childhood malady. It is in no way intended to represent universal facts about anorexia nervosa, infantile anorexia, or the diagnosis known as failure to thrive. It is published here as a gift to Regina, whom I “met” last year when I was researching hunger and who opened her life to me with extraordinary generosity. Any errors in the science are mine; any truths you may find in it are due to her honesty. I hope you find Regina and Eicca’s story as compelling as I did, and that you approach it with respect.

I think that this is largely why people have children:

You think of hunger as a panther with a step like snowfall, prowling at the edges of your sight. You think of hunger as an itch yawning across your skin, demanding to be scratched. You think of hunger as a man cracking a whip, and you its slave. The way you know hunger is the way you know pain, the way you know fear, the way you know love: as a force that inhabits the body. It lives in the spasming of muscles in your gut, the strange internal seething of gases and fluids. You do not think of hunger as something you must find—like a lost ring buried deep beneath a sofa cushion. Like a little boy gone astray.

The sensation we recognize as hunger is the result of a deft physiological machinery: invisible to us, but nevertheless highly efficient. Dozens of chemicals of varying importance are believed to be involved in the complex play of reactions that results in the arousal of appetite, not all of them yet identified by science. A few central pathways, though, we can describe with reasonable confidence—a few guides for those who seek to find.

Here is one, for example. Go long enough without eating, and cells in the gastrointestinal tract secrete a chemical comprising a single chain of 28 linked amino acids, first discovered in 1999 and known in the scientific literature as ghrelin (but immediately christened “the hunger hormone” because of the role it plays as a messenger for an empty stomach).

Ghrelin seems to work by stimulating specialized receptors at the end of an abdominal branch of the vagus nerve: a bundle of fibers that wanders a remarkably long and complex path through the body and connects, at its zenith, to the brain. With these receptors activated, a signal vibrates up the length of the vagus nerve until it reaches an appetite-controlling center in the hypothalamus. The message it carries is as simple as it is insistent: We’re running on empty!

And then, before you know it, there you are. Losing your train of thought. Feeling saliva prickling at your mouth like tiny bees. Arrested by the memory of a particular sandwich you once ate in a restaurant in Boston, sweet with cranberry chutney and salty with Havarti cheese that melts like cream on your tongue.

This is how it works, how it’s always worked. You are born with the blueprint for hunger tattooed onto your cells, an appetite for food that is inseparable from the appetite for life. This is how it works—until it doesn’t.

*******

It is an icy January day in Oulu, Finland, on the eastern shore of the Baltic sea, when the most wanted child on earth is born. His safe arrival has been a long time coming—following, as it does, eight years of attempts to conceive, four intrauterine inseminations, two cycles of in vitro fertilization, one miscarriage, and 38 weeks of anxious pregnancy. The mother of the most wanted child on earth touches her son’s warm cheek: soft as a rising bun under her finger. She whispers his name: Eicca. She whispers munkki, my little munkki: the Finnish word for doughnut. She thinks: I have loved you from all time. She does not know that, in one way at least, this baby is incomplete: he has come into the world without his hunger.

When Regina is hungry, it is the junk food she grew up on in San Francisco that tugs at her thoughts. She dreams of Cheese-Its the crackling color of a neon traffic sign, Carl’s Jr. fries that leave a film of hot, delicious oil on her fingers. She has an especially fanatical affection for the sweet-salty taste of Reese’s Pieces. But because she has always been overweight, Regina usually tries to hold herself in check. In time, she will wonder about this. Could her own lifelong struggle to combat what sometimes feels like an immoderate hunger somehow have affected Eicca’s appetite? Could he have inherited a subtle, invisible disposition to quell his hunger? These questions, when they come, will be at once utterly absurd and completely irresistible. But that will be later.

At 27 weeks, Regina is nervous. The time has come for her to take a glucose challenge test to see how efficiently her body processes sugar. Because of her weight, she is at a high risk of developing gestational diabetes, a temporary form of high blood sugar that only occurs during pregnancy. It doesn’t usually threaten a pregnant woman’s health, but if left unchecked gestational diabetes can lead to problems for the baby she carries, including jaundice, excess growth, or respiratory distress. The night before, Regina and her husband Marco sit together and eat an entire box of chocolates, piece by piece. If she fails the test, Regina reasons, this will be the last time in months she’ll get to indulge her sweet tooth. She had better savor this night while she can. The Finnish chocolates are no substitute for Reese’s Pieces, but she is nearly seven months pregnant and she is hungry and she is not ashamed to say that they are good. When the box is empty, Regina laughs. She puts her hands on her belly, full of chocolate and Eicca. Then she fasts for ten hours. By the time the little cup of glucose slips past her lips, she is starving. But she passes the test with flying colors.

For Regina, as for most of us, food is temptation and memory and indulgence and pleasure, all at the same time. This is how it works, how it’s always worked. This is how it works, until it doesn’t.

*******

In retrospect, the signs that Eicca’s hunger is missing are present almost from the start. At Regina’s breast, he drowses instead of drinking. When he does suckle, it is slow and fitful, and very quickly he stops, turns his head away, and falls asleep. It is as if eating is a pointless tedium instead of what it should be: the central occupation of his life, the drive behind the doubling of his cells and the development of his brain, his heart, his reaching fingers.

Even when he has gone three or four hours without feeding—the length of time it takes most infants’ stomachs to empty to the point of discomfort—Eicca shows none of the behavioral marks of newborn hunger described in a set of child feeding guidelines issued in the European Union. No increased alertness or activity, no rapid eye movements, no hand-to-mouth and suckling motions, no soft cooing or sighing, sucking sounds, no fussiness. Watching Eicca as time stretches out since his last sip, the last second is the same as the first. At night, it is the sound of her alarm that startles Regina awake for feedings; Eicca never wakes or cries for food.

You do not think of hunger as something you must find.

*******

Soon, Regina and Marco switch to feeding Eicca bottled breast-milk, supplementing it with a store-bought formula. Even so, at five weeks he is drinking less than seven ounces of food every 24 hours, a fraction of the recommended daily intake for an infant of that age. But since he is growing, if slowly, Regina puts aside her concern.

At seven weeks, a nurse comes to the house to check on Eicca and weigh him—standard practice in Finland’s universal health care system. Though all seems well at the appointment, the next morning brings a call—the voice on the other end of the line brooding and uneasy.

“I’ve been up all night worrying about your baby,” the nurse blurts out.

*******

The word anorexia literally means “without appetite;” but for most adolescent or adult sufferers of the disorder the label is precisely false. What studies of women with eating disorders show is that ghrelin levels in the blood plasma of anorexics are significantly elevated compared to healthy subjects—and they don’t drop after meals as in normal controls. The findings help to explain why many anorexics, especially in the early stages of the disease, report feeling an almost constant sensation of hunger. Besides a distorted view of your own body, this might be one of the deepest reasons for someone to deliberately lose an appetite—to push it deep beneath the cushions—the fear that if you once began to eat, you would never stop.

It’s clear, of course, that this terror is groundless—pathology, not prescience—but it has an ancient precedent. We have lived for millennia with a dread of the hunger we harbor. In Greek myth, when the mortal Erisichthon strikes down an oak tree beloved of Ceres, she sends Famine to breathe herself into his veins, like poison, as he sleeps.

When he awoke, his hunger was raging…What would have sufficed for a city or a nation was not enough for him. The more he ate the more he craved. His hunger was like the sea, which receives all the rivers, yet is never filled; or like fire, that burns all the fuel that is heaped upon it, yet is still voracious for more….at last hunger compelled him to devour his limbs, and he strove to nourish his body by eating his body, till death relieved him from the vengeance of Ceres.

Bulfinch’s Mythology

Inhabited by this ancient fear, anorexics train themselves to master hunger. Some even grow to love the painful, drawing sensation of an empty stomach for what it represents: a virtuous triumph over desire. One textbook on anorexia quotes a patient whose symptoms first began at 17. The immediate effect of self-starvation, she explains, “was a feeling of exhilaration verging on euphoria. The hunger was hell…but the hell was far outweighed by the reward.”

You think of hunger as a man cracking a whip.

*******

When anorexia occurs in infants, its rewards—if they exist—are much harder to understand. First described in detail by pediatric researchers Irene Chatoor and James Egan in the 1980s, infantile anorexia typically makes an appearance when a child reaches 3 to 6 months of age, a critical point of transition between bottle-feeding, spoon feeding, and self-feeding. The disorder originates, Chatoor has asserted, in a pattern of maladaptive interactions and conflict between an infant and his or her caretaker, and reflects a young child’s growing struggle for independence. “The infant refuses to eat in an attempt to achieve autonomy and control with regard to the mother,” she wrote in 1989, “a maneuver that serves to involve the mother more deeply in the infant’s eating behavior and to meet the infant’s need for attention. Mother and infant become embroiled in a battle of wills over the infant’s food intake. The infant’s feeding is directed by his emotional needs instead of physiological sensations of hunger and satiety.”

While this description doesn’t fully explain the source of Eicca’s troubles—which start much earlier than those of the infants in Chatoor’s studies, and seem almost congenital—its dour pronouncements seem to grow more accurate over time, as a vicious circle of insistence and refusal forms. The more preoccupied Regina becomes over her son’s lack of interest in food, the longer and more fraught mealtimes become, until she is literally trapping him into his chair with one stiff, outstretched arm while she spoons carrots and peas into his mouth with the other. While he screams. They are on vacation in Hawaii, the air coming through the windows fragrant with frangipani, and every morning it is on the schedule. Force-feeding Eicca in paradise.

Though infantile anorexia is considered a psychiatric disorder, it is not infrequently associated with physical conditions like gastroesophageal reflux disease, the abnormal tendency for stomach acids to flow backwards to the gullet and cause food regurgitation. By the time Eicca is six months old, he is vomiting as often as ten times a day, sometimes several times an hour, despite being on Zantac: a powerful ulcer medication designed to block acid production in the stomach. The air in the apartment acquires the sharp, sour smell of vomit; you can smell it as soon as you walk in the door. At last, driven by a kind of exhausted pragmatism, Regina begins feeding Eicca in the bathroom, watching him closely in the mirror for signs of an imminent purge. When he throws up, she holds him over the bathtub, tears streaming down her face as the hot milk splashes onto the sleek porcelain. Then she wipes him clean and tries again.

In early 2009, just before Eicca’s first birthday, he and Regina move into a tiny room at the hospital—Marco, who has to work, sleeps there with them at night. Every day, five times a day, for three weeks, three pediatricians, a gastroenterologist, a speech therapist, and a bevy of nurses orchestrate Eicca’s feedings. They film him eating. They time his meals. They measure and record what he consumes. And all the while they watch him for signs of hunger or aversion, like wildlife biologists encountering a new species. Some days are good: once, Eicca consumes 100ml of milk, 50ml of blackcurrant soup, 80 spoonfuls of pureed mango yogurt, meat, and potatoes, 20 spoonfuls of porridge, a few bites of cheese, and the corner of a piece of bread. Regina cannot believe her eyes.

But mostly, meals are just like they are at home. The very next day, he eats nothing except for a few bites of pear, a few bites of bread, and a few sips of milk. At the end of three weeks, Eicca is still turning his head away from food. He has lost one kilogram.

*******

Sharman Apt Russell, author of Hunger: An Unnatural History, explains that motherhood made her searingly alive to the improbability and injustice of a hungry child: “I gave birth to my daughter and fed her my body. Later, I had a son and he, too, drank from me. I was feeding the world. This was not aggrandizement so much as myth. At the center of our life, we are Eve or Prometheus or Odysseus. At the center of my life, I fed the world, and yet children were dying.” At the center of her life, Regina offered her son the world, and he refused it—would, if she hadn’t fought with him, have died for lack of all she had to give. The improbability, the injustice of this.

The Oulu University Hospital doctors who counsel Regina and Marco about Eicca have a mantra. They will repeat it over and over through the months and years of hospital visits, say it so many times that hearing it will make Regina want to scream. You must let him find his hunger, the doctors insist. Just give him a chance and he will find his hunger. As if Eicca’s appetite has been accidentally misplaced, forgotten in a corner like one of the toy train cars he loves to race around the house. As if sooner or later he will simply realize that he needs it, this hunger of his, and go looking. As medical advice, it borders on the magical. But—at least for the moment—it is all that science has to offer.

As he gets older and continues to show almost no interest in food as a source of pleasure, Regina and Marco sometimes resort to spooning butter into his mouth, letting him dip both hands into a jar of pure sugar and smear the grains onto his tongue. The rules of healthy childrearing that normal parents set for themselves—give your child lots of proteins and vegetables, keep them away from junk food—are nothing but mythology. When Eicca is two years and seven months old he falls briefly in love with a particular brand of Finnish shortbread cookie, stuffed with a hazelnut cream filling and sprinkled with chocolate chips. Regina is overjoyed.

Love, of course, is relative. Falling in love, for Eicca, means he will cry to have a package opened, then eat one tiny corner of one cookie before turning his head away. And yet it is a blessing. A glint, perhaps, of some lost bright thing that might someday be found.

flan de queso

Noticing

There is so much I do not notice. Even expecting you, I disregard your approach. When you arrive I receive you with surprise, as if struck by a drop of rain from skies as blue as Prussia. So much passes without scrutiny. I am aware of its passage, but only vaguely. The weight of the things to which I do not attend is enormous. A great ocean swell crosses overhead, far distant from the seabed sands in which I am burrowed.

Most days I fail to notice anything at all.

Waiting for the number 6 bus on Columbus Drive today, there was Superman. There wasn’t much to identify him; he looked like an old man, twig-thin. Too-short pants and too-big ski jacket. Leather satchel bleached and worn. Beard halfway to Gandalf, twice as wild. But behind the generosity of his glasses I could see his eyes, and they were made of cobalt and tin.

They weren’t quite piercing, not anymore; not like when he was a young whippersnapper and still working for a living. Someone had poured milk over them in the gone-by years. But there was still metal behind that milk, and I could see it when he walked past me. He did so three, four times. That’s how I knew who he was, I guess. He danced around the stop like he hated to waste time, like he had someplace more important to be. Or like he was measuring something. Pacing to size up the little house he used to want to build someday for him and Lois.

Superman got on the bus ahead of me and sat down next to someone else. Some nobody burrowed in the seabed, not noticing him. I saw him switch seats once. Maybe there was something he had to see out of the east window, some evil he wanted to keep an eye on. Or maybe he just wanted to be alone.

I looked away. Across from me a man wearing earphones was teaching himself English. Beijing said his skull cap in Chinese and I am new here and I like it said his face and The sands of time are passing said his mouth, as he listened to the little computer on his lap and repeated the common English phrases it pronounced to him.

I am lying to you. I did not really hear what his mouth said, although I noticed its movements and strained to read them. He spoke too softly and I saw too slowly.

But what you do not observe, you must imagine. So: I can read the writing on the wall, I imagined him repeating. Please call me back at your earliest convenience. Take it or leave it, baby. I am chilled to the bone. I will pay you back in kind. With the most joyful of smiles he repeated these things, or others; I did not imagine the smile.

Superman got off the bus outside a corner where a school stood, and disappeared into a crush of children let loose. English got off four stops before my own. I watched him walking westward till the wheels pulled away from the sidewalk.

waiting for the number 55