Writhing at night, close to hyperventilation, he mouthed a few of the mantras he'd developed until he found one that seemed to work. "All of my electronic devices have abnormally long battery lives," he repeated, lips noiselessly scraping the pillow until his breathing began to slow and a rare moment of calm overtook the ragged nerves that often seemed on the verge of snapping through his skin in one final, manic flare-up. Other freak-outs required variations on the theme. "I'm a white man with a pale Germanic complexion living in a state with harsher than average gun laws. I have better medical coverage than the majority of nightlife industry workers. My frequent customer card at the local deli is one hole-punch away from a sandwich valued at up to $10. In the event of any significant hair loss my head is nicely shaped and conducive to shaving." The talismans that, with varying degrees of success, held back the will to sickness that permeated his waking hours and dreams that were always about running, running that was never accidental or recreational.
The fear had nothing to do with stress, anxiety, substance-related neurosis, or any other mental deficiency, he told himself. This time it was purely physical, something was finally wrong. At 25, his body was failing.
As a kid (and an only child) he'd admittedly been a serious headcase. There were the first night terrors that started at age four or five, when not being able to sleep led to the near-unshakable belief that death was imminent, a panic that could only be relieved by lengthy parental back rubs and the promise that Mom and/or Dad would not leave the adjacent TV room, just in case. The time when he'd vomited Raisin Bran before school and for the next three months, automatic reflex, he'd wake up around dawn and start dry heaving, sometimes making it to the toilet but usually not, a routine that was squelched by a trip to the doctor and a prescription for what he years later found out was high-end Pepto-Bismol that tasted like red velvet cake. And the vacation to the North Carolina shore where on the first day there he watched a local news story about a girl who underwent an emergency tracheotomy to remove a nickel she'd swallowed. He spent the next week choking himself because he might have inadvertently come into oral contact with some change when his father was paying tolls on the Jersey Turnpike. Middle school and high school were better. The formidable vortex of sports, stashed VHS porn, jazz band, and AOL Instant Messenger elicited a vitality that had no time for bodily witch hunts – too many pubescent discoveries made the outside world a far more interesting focus for his thoughts. College and grad school, bemused by the daily shirk of the usual toxic distractions like so many astronauts before him, he allowed his systems to acquiesce to the battering of youth, confident that its effects would be negligible in the long-term. A small fee for a long ride down the wacky tunnel of "experience."
The plunge came almost immediately after the last graduation. It wasn't so much a change as the absence of change. Holding an expensive and fairly worthless M.A. in European history, he still bartended at the same place where he'd worked while finishing his thesis, still lived in the same shitshow of an apartment with the same revolving menagerie of coked-up cretins, still stalked the same ex-girlfriends and would-be-girlfriends on social media. Late that summer he went on a fishing trip back in Connecticut to celebrate his father's retirement. Afterwards, they sat in the garage, cleaning the fish they'd caught and swatting flies away from their Budweisers. His watched his father examine his subpar work, the messy fillets that were plentiful of bones and skin fragments, the perfectly good chunks of flesh he'd accidentally flung into the blood-crusted bucket reserved for organ gunk and skeletal remains. He braced for the usual diatribe but his father stayed quiet, placed his fillet knife on the cutting board and stared at him with a melancholy that was worse than anger.
"It's my fault," his father said. "I should have taught you better. When I'm gone, who's going to show your kids? I won't be here forever."
Death had returned to the forefront again, if not an imminent presence, then surely an inevitable one. Without the familiar structure of the academic calendar, what else was there to look forward to besides the slow descent into a geriatric coma or a quicker, unexpected snuff-out? That night in his childhood bedroom in his parents' house, he looked at yearbook pictures of someone he didn't recognize. There would be no career analyzing ancient nautical maps for archaeological firms and/or government agencies, and even if there was, it wouldn't matter. The end game was the only game that mattered.
He couldn't bring up this new implosion with his friends, or his roommates, who were firmly and happily entrenched in the fields of finance and legal pharmaceutical distribution. They'd offer him a beer or a joint and tell him to man the fuck up, which normally would suffice. But this was heavy. His mother shrugged off his twitching hands at breakfast. "I'm the one that should be worrying," she said. "You're too young to be thinking about any of this. If I was given a chance to go back to any age I'd probably pick 35, and you've got a long way to go before that," which only reinforced his belief that nobody looked forward to the real darkness, no matter how resolved they seemed, that the desire to return even a few years was always preferable to time's decimating trudge.
He'd never considered himself crazy or depressed enough to warrant a psychological evaluation but talking to another human seemed more productive than talking to himself. When he got back to the city where he lived he made an appointment with a shrink with a vaguely ethnic name who was loosely affiliated with the university where he'd received his masters. He signed in with the doorman in the lobby of a non-descript building, read headlines on the elevator flatscreen about a man falling 65 feet to his death at a baseball game and the Dalai Lama's website inflicting viruses on its visitors. He got off on the sixth floor where there would be an office with a comfortable couch in a dimmed setting, a spectacled Morgan Freeman type with the poise and wisdom of two centuries of psychoanalytic progress. But what he walked into was a hospital-light cubicle, a small window with a fire-escape view and barely enough room for two computer chairs and a desk. Behind a purring laptop and a Kleenex box sat a mousey Asian woman who couldn't have been his senior by more than half a decade.
The shrink scrunched her nose at his confusion. "I'm Dr. K¬—," she said, standing up and extending a diminutive, well-manicured hand. "Please have a seat and tell me what's going on."
The near-clinical florescence of the overhead light accentuated the shrink's mottled, ghostlike complexion and his chair was uncomfortable but he didn't hesitate. "I've been thinking a lot about dying," he said, eyeing the tissues. "Actually it's pretty much all I fixate on. Not just my own death. I think about my parents getting old, the elderly people I see limping alone down the street, fat kids gorging on McDonald's. It's like, palpable. I think I'm losing weight. I mean, you can see the circles under my eyes. My mother says they're hereditary but I never really noticed until recently. I don't want to die."
"Are you religious?" the shrink asked.
"No, not really."
There was a long pause. The shrink cleared her throat and for a second her lips curled into a nearly imperceptible grimace. "This is something that people have been wrestling with since before the language existed to express it. The ultimate hang-up. There aren't any real answers."
It was the response he'd expected but it still stung to hear it. Morgan Freeman's voice wouldn't have made it sting any less.
She asked him about his childhood, his education, his hobbies, his dating preferences, covering the main bullet points of New Patient 101, and his answers were gossamer, predictable. "I know you might not realize it now, but you've had a great life and you've got a lot going for you," she said at the end of the session, glancing at notes she'd typed on the laptop. "You've got to try to stay in the moment, in the present, stay busy. If the negative thoughts start to creep in, think of something positive in your life, you'll find it's not that hard. After a while I think you'll find that it's much more enjoyable to be your own architect than to focus on things no one can control."
The existentialist pep talk was hackneyed, but when he left the office/cubicle and watched the video streaming on the elevator's flatscreen about a circus bear in Azerbaijan who had learned to ride a motorcycle, his hands had stopped shaking. In terms of demographics, pigment, and the geography of his birth, it was hard to argue against his being incredibly lucky. He stopped smoking pot every day, lifted free weights a few times a week, had coffee with friends he hadn't seen in a while whom he considered "optimistic" and "encouraging." He initiated conversations with women at the bar where he worked and at the bars where he drank and these encounters were occasionally successful. He sat on public benches (in areas that tended to be void of tweakers and misanthropic Shih Tzu walkers) and re-read the Eastern philosophy textbooks that he'd been drawn to as an undergrad and that now made the tattoos that said "BE HERE NOW" in Sanskrit on his hip and the Chinese character for Tao on his back a little less like callow mistakes and more like the fulfillment of a promise he'd made without knowing it. If everything existed in one moment, before might be irrelevant, and more importantly, maybe there wouldn't be an after.
One night he burrowed deep in a Wikipedia hole that started with Vajrayana Buddhism and ended with dozens of open tabs related either generally or explicitly to transhumanism, which, he read, was "a class of philosophies that seek to guide us towards a posthuman condition, including radical life extension to the point of biological immortality, fostering a respect for reason and science, a commitment to progress, and a valuing of human (or transhuman) existence in this life." The idea that he might, in the tangible future, be able to overcome his physical limitations through radical technologies that were already being funded, to diffuse his body's death switch with the aid of a benevolent Artificial Intelligence, was outlandish and undeniably riveting. For the better part of a week he surged through websites that explained and extolled concepts that sounded like they'd been pulled from Star Trek episode subtitles but were very real: nanomedicine, mind uploading, postgenderism, cyborgization, artificial wombs, chemical brain preservation. And he skimmed through the less interesting rebuttals from neo-Luddite haters bitching about the trivialization of human identity, hubris, coercive eugenicism, and dozens of other killjoy buzzwords. Techno-utopia or Terminator sequel, the coming era was going to be wild.
His parents were probably screwed, but he wouldn't forgo any measure of extremity to ensure that he would still be healthy in 2045, the estimated year of the Singularity, when things were supposed to really start going down, transcendentally speaking, when negligible senescence wouldn't be limited to lobsters and jellyfish. He joined Beta Race, an organization that published a monthly e-magazine aimed "to deeply influence a new generation of thinkers who dare to envision humanity's next steps" and began following the group's transhumanist lifestyle recommendations. He would practice caloric restriction and supplement his mostly raw and vegan diet with up to 50 daily supplements that performed a variety of useful functions, such as increasing mental clarity, reducing cortisol release, and promoting optimal health and energy in convenient, antioxidant-rich doses. His friends and coworkers started calling him PT, short for Purple Teeth, for the red wine he consumed daily (up to three glasses) in order to maximize his resveratrol intake, and he would ask them what they wanted him to wear at their funerals. He would never leave his apartment without his smartphone, which would act as his memory and math prosthesis, his on-demand Google cortex, and his task scheduler for days and weeks that were regimented with military precision. He would learn to use group collaboration tools and visit personal networking sites to meet and communicate with other proto-posthumans. He would download an app that would turn his phone into a recording device to supplement his memories, constantly recording conversations and other audible events. He purchased insurance from the Freelancers Union that was more than he could realistically afford but would ensure that the co-pay would be low enough for the regular examinations and blood tests he would have to undergo ad nauseum.
His stomach would convulse when he'd pass a pub, anticipating the succulence of animal fat, the release of hard liquor, but these were necessary casualties of the focus on everlasting survival, an essential quality in the robot nirvana he was destined to inhabit.
One afternoon he was jogging in a park on a trail that was almost the exact distance that would, if run every day, lower his blood pressure to an optimal level for his body mass index. He avoided eye contact with the idle dying he passed – an liver-spot man reading a newspaper to a neck-lolling woman in a wheelchair, a trio of emo kids smoking cloves, an otherwise hale-looking guy wearing a Ballpark Franks tee shirt thereby declaring his affinity for nitrate-induced gastrointestinal carnage – specters for whom the best dream had already disintegrated without any awareness of it. Close to a personal best time, he built up speed for the last few hundred yards, glancing at the occasional female runner heading in the opposite direction. The expressions he received ranged from surprise and disgust to what appeared to be genuine concern. One girl slowed down, eyes wide, pointed at his midsection, sort of giggling, and resumed her original pace. It was humid, he'd sweated through his shirt and there were probably some serious swamp ass issues going on, but he was exercising outdoors during an abnormally warm autumn. Water transfer wasn't just normal, it was necessary. Bitch.
He pulled off his ear buds, turned to flag down the runner who'd made the offensive gesture but stopped when he felt an unnatural squishing between his sock and cross trainer. He looked down at the athletic shorts that had been Carolina blue but were now crotch-covered in brownish stains, at the thin red stream that was coursing down his right leg, congealing on his leg hairs, pooling under the tongue of his darkening shoe. His heart rate tripled.
His grandmother had been afflicted by hemorrhoids for most of her later years, referring to them as her "piles." As a kid he'd been careful to avoid the slime-capped Preparation H tubes and stool softener bottles that resided openly in her bathroom. The source of his current discomfort wasn't anything like the gargantuan protrusions he'd seen in waking nightmares while listening to his grandmother complain, a relief that did nothing to ease the throbbing flap that made it impossible to sit down. Curled on his side in bed, Internet ablaze, he learned that fifty percent of Americans would suffer swollen veins in the anal canal at some point in their lives, usually after age 30 and usually due to the strain of soft bowel movements, constipation, obesity, or pregnancy. Though initially painful, the prognosis was rarely serious, and could usually be corrected by a combination of increased fiber, drinking more water, drinking less alcohol and caffeine, exercising frequently, and applying an over-the-counter ointment when necessary. Which didn't sound awful, except he wasn't certain that what he had was actually a hemorrhoid. He was too young, he didn't drink coffee, he'd been laying off the booze for the most part, and his diet had been endorsed after years of studies by Beta Race's team of board-certified nutritionists. The bleeding could also be caused by a similarly shaped polyp, tumor, or abscess, all symptoms of colorectal and/or anal cancer. He analyzed the risk factors for each disease. He initially ruled out colorectal, as he wasn't genetically predisposed, he probably didn't have Crohn's disease, and he'd never been excessively sedentary. But he had, until recently and for as far back as he could remember, been an unconscious guzzler of red meat, processed cheeses, all of the sodium-enriched staples of Americana that were as ubiquitous as churches and far more appealing. And the nightly infusions of distilled happiness that, though diminished, had gone on for so long that total regeneration might be an impossible goal. Anal cancer was scarier. Roughly seventy percent of his penetrative experiences had been sans condom, meaning that HPV was more a certainty than a possibility (he'd never been tested). The human papillomavirus also accounted for approximately ninety percent of anal cancer diagnoses, and the four dozen or so partners he could remember made his risk exponential.
He looked up reviews of the primary care physicians in his neighborhood. He found the office with the best rating and was about to schedule an appointment when he remembered his hemorrhoidal grandmother telling him in a brief moment of opiate-free clarity before she succumbed to the tumors that had spread to her marrow, to "never go to a doctor. I didn't for twenty-three years and it wasn't for lack of aches, there were plenty of those. It was because I knew, deep down, that the second they started prodding around they'd find something. You can't find anything if you don't look for it. Here I am, a few months past eighty, feeling okay, and I have the nerve to listen to your goddamn mother. A simple check-up. It'll take a load off everyone's minds, she says. Now look at me. Fucked. Take Advil and get enough sleep and you'll be fine."
She died two hours later.
He would wait.
But every morning there was the same blood-streaked shit, the clicked WebMD links that shone with paranoid urgency. One day he noticed two identical lumps behind his ribs on each side. They might be tumors, the cancer already spreading from his pelvic region. Maybe they weren't lumps, but areas of organ-related swelling. Early onset kidney failure was a possibility, according to the symptoms posted on the blog of a respectable TV surgeon. There had been the tinge of nausea in the mornings, his skin crackled at the joints, a bit of fatigue. He began documenting the frequency of bathroom visitations, checking each urine deposit for blood, opaqueness, bubbles, activating the stopwatch app on his phone to get an accurate measurement of its duration. He checked his semen for blood and other potential abnormalities with the thoroughness of a tea-leaf reader, cupping it in his hands, sniffing. While pressing his fingers to his jugular to confirm suspicions of an abnormal heart rhythm, he pressed on something like a growth that clicked when he moved it – a clear indication of a thyroid disorder that might lead to hyperactivity, irritability, memory problems, psychosis, and paranoia. Brief episodes of dizziness became fluid on the brain. A shoulder ache became an aneurysm in-waiting. He couldn't stop clicking the links. Sleep was occasionally possible, but only after the numbing repetition of the glass-half-full self-talk recommended by the shrink, the positive phrases that always lost their logic with the terrible jolt of the alarm clock. "You can't find anything if you don't look for it."
One day he stopped looking.
There was no point in continuing a transhumanist regimen if he wasn't even going to be around for the next iPhone upgrade. WebMD could go fist itself. He disconnected his laptop and buried it in his closet. He stopped responding to texts. Afternoons consisted of bong rips, HBO, and delivery from whatever menu happened to be on top of the expanding pile. Nights, he drank with a fervor that his friends initially encouraged, until the black-outs reduced him to an elastic shell of cussing slobbery. More often than not, his roommates would come back from work and tell him how they'd stopped him from flinging his phone into the street after another sidewalk puke session on the way home. He'd shrug, change the channel. Mornings didn't exist. His cross trainers were ashtrays. At least he was sleeping.
The one shift at the bar that he didn't get covered was cut short by his manager after reports of multiple smashed bottles and complaints from customers that they'd been bullied into taking swigs from a bottle of Maker's Mark, most of whose innards could be found soaking through their bartender's Oxford.
"Get some rest and get your shit together," his manager said, trying to stay calm, veins bulging. "Or don't come back."
He grunted, crab-walked into a cab, got out after a couple minutes and went into a bar. He met a girl whose face he wouldn't remember and who was almost as toasted as he was, but who sobered up fast a few hours later at his apartment when he asked her if she wouldn't mind biting a mole off his back that he assumed was malignant. He woke up alone in piss-heavy boxers, the howling pain emanating from his swollen liver announcing that his time had come.
The clinic's waiting area was well-lit, featuring plush couches, a large flatscreen silently broadcasting a BBC news program, and an impressive selection of entertainment magazines. The only noise as he filled out his insurance information came from the ambient nature sounds pumping from invisible speakers and a little kid making fun of his brother for coloring outside the lines in a book in the children's play area. A hefty, non-smiling nurse entered from a side door and pronounced his name wrong. He took his last breath of willful ignorance and followed her into the examination room.
He didn't remember the questions that she asked him, brusquely, and he didn't remember his shorter answers. She made him sit down, wrapped a blood pressure machine around his arm and shoved a thermometer under his tongue.
"Ninety-eight-point-three," the nurse said, dryly, after removing the pen-shaped instrument from his mouth. "Very good." She frowned a little as the blood pressure machine relaxed from his arm. "BP's a little high."
"I'm always nervous," he said. He didn't add, "when I'm in the office of a medical professional who is about to determine that my life expectancy has been cut down significantly."
She nodded, jotted something on a clipboard, told him to roll up his sleeve. It took her four attempts to find a vein and another minute to extract enough blood for all the tests he'd asked to have administered. He watched the bag expand with murky fluid, the truth juice from which no faulty gland, organ, or clandestine STD could hide, that would be centrifuged into submission.
The nurse silently divided the blood into various tubes with different color caps, slapping stickers on each with her sausage fingers. Walking out of the room, not making eye contact, she told him strip down to his underwear and that Dr. E— would be in shortly.
The man who walked in a few minutes later was tall, thick with the traces of what must have once been an impressive musculature, with an unassuming salt-and-pepper beard and a dignified hairline. He introduced himself with a deliberate, Julep-swilled drawl and a mitt-shake that was rigid but oddly pacifying. The doctor motioned for him to have a seat on the examination table and began flipping through the papers on the clipboard that the nurse had given him.
After a long time, the doctor looked up with a scrutinizing smile. "You decide to request all these tests yourself?" he asked. "Seems a little comprehensive for someone your age without a history of…" he looked down at the clipboard, "…anything."
He wondered if the doctor had noticed the tremors that were coursing along both of his hands. "I've done a lot of research, and given my distinct set of possibilities, I think that all of the tests are necessary."
The doctor shook his head, stood up and reached for a box of latex gloves in a nearby cabinet. "Well all right then," he said. "Which of these possibilities are we going to start with?"
Laid out on the table, he guided the doctor's hands toward every perceived abnormality and inflammation, watching for a glitch in the doctor's serene face, the flowering of concern, but nothing changed. He was asked to flip over and assume a position normally reserved for canine submissives so the doctor could get a look at the scabbed-over blight whose throbbing existence couldn't be denied by even the most untrained eye.
"Aww yeah, that's a real big one," the doctor chuckled. "This looks pretty straightforward but I'm still going to check your colon for any irregularities. This will be uncomfortable."
The ache of the lubed-up probing session almost made him forget the anticipation of disease that had been building. He clenched at the release of pressure and the snap of glove removal.
"Everything's fine in there," the doctor said, marking something on the clipboard. "You're probably going to want to get the big guy removed for hygiene purposes. Shouldn't be too painful since it's mostly external. No rush, though. In the meantime, make sure you're eating vegetables and drinking lots of water."
The doctor said they were done, that he could put his clothes on. They'd have to wait for the blood work results for everything to be definitive, but all of his vitals were well within the healthy range for someone his age, with the exception of his blood pressure, which they would chalk up to nervousness.
"On a one-to-ten, how confident are you?" he asked, bending over to tie a shoe. "I mean, I've read that misdiagnosis rates can be as high as forty-seven percent in a preliminary examination setting like this."
The doctor sighed, stared at the phone he'd taken out of his pocket. "This is the golden age of hypochondria," he said. "You should get back into a more consistent workout routine and maybe find a couple hobbies that aren't alcohol-related. Make an appointment with a rectal surgeon to get that hemorrhoid removed. Otherwise, keep doing what you're doing."
He left the office as he'd entered it, trailed by a rotting, skeletal version of his dead grandmother's face mouthing the word fucked on constant repeat. Three days later, sleeplessly camping on the couch amidst untouched plates of disintegrating Pad Thai, he got the call.
"Hello, is this C—?"
The high-pitched, girlish twang belonged to someone who introduced herself as Holly from somewhere called Clinical Imaging & Diagnostics who sounded like she was barely qualified to read lottery numbers, but at least she was bubbly. That might have been the point. Melanoma with a smile!
"So, um, I'm going to read you the blood work results from your recent visit with Dr. E—. Please let me finish before you ask any questions, but honestly honey you're not going to freak. All the blood cell counts are great! Liver, thyroid, and kidney function are good…"
She read off every result and she was right, he wasn't going to freak. She was "like, super jealous of your cholesterol," and his STD panel was "totally negatory!"
She finished and he hung up, scooped noodles into the garbage, and went into his room to find his cross trainers.
The next day he called his manager and told him he wouldn't be coming to the bar that night, or ever. He'd be careful with his savings while looking for jobs at museums, historical organizations, and cultural think tanks. He started running a little every morning because it felt good to be outside and moving. When he got tired he stopped. He shaved every day and dabbled in some of the facial products his roommates recommended. He bought groceries at a store that didn't sell kombucha or wild broccoli and supplemented his non-organic vegetables with ground beef or boneless pork chops or whatever he felt like cooking. His phone resided in charger purgatory and then the closet when the retro flip model he purchased on eBay arrived in the mail. He donated most of his philosophy books to a thrift store. Whether everything was one big moment whose meaning would shine perpetually or a collection of seconds adding to nothing, he didn't care.
He was alive.
One afternoon he was getting ready for happy hour drinks (two or three, max) with an environmental lawyer he'd met online whose pictures were all taken from questionable angles but who came across as "relaxed" and "balanced." The phone rang, unknown number, but he was expecting a follow-up from the interview he'd had the day before for an archivist position at a genealogy website. Or it might be the lawyer, XOXO-Jennie88, calling because she had to work late or something.
He picked up.
"Hello, is this C—?"
Monotone, rehearsed. Telemarketer scum.
"Mm-hm?" His thumb slid along his well-moisturized cheek toward the hang-up icon.
"C— this is Holly from Clinical Imaging & Diagnostics. I'm calling again in regards to some blood work you recently had done."
The twang was gone. His thumb slid back, gripping.
"I'm glad I was able to reach you. I've been trying to get in touch for the past week but your inbox is full."
"Well, I'd like to apologize for the inconvenience but there was a mix-up in the lab regarding the samples we received. A simple but obviously undesirable administrative error. These things are rare but they do happen, and we make it our primary responsibility to notify those affected as quickly as possible. There's probably no need to be super concerned just yet – your cholesterol is still excellent – but there were minor incongruities in a few of the readings and we'd like you to make another appointment to draw more samples and to discuss with your doctor the possibility of –"
"I have surprisingly good credit for someone my age and it increases with every punctual student loan payment I make."
"I'm sorry what does that have to do with anything I've just told you?"
"In the event of a natural disaster my apartment is ideally situated along a major evacuation route."
He thought, "I have three point five times as many Twitter followers as the international average. The shoe store on West 4th is finally having its annual end-of-summer clearance next week and the mid-cut suede boots that match most of my collared shirts and a fair number of my jeans will be sixty to seventy percent lower than their current value. My cholesterol is still excellent…"