Flare
by Madeline McFarland
Just after the New Year, I left early in the morning from Brooklyn for my next Botox appointment. It had snowed in the soft, heavy way the night before, and the sun had just risen, casting the street of brownstones in a light blue glow. The scene was still and mostly undisturbed—I traced only a few crunchy footsteps in the snow. The powder dusted the skeletal trees and the Christmas trees discarded on the uneven sidewalk between them.
For medical reasons, I always hurried to tell people about the injections. For migraines. Though I was, of course, also aging. Generally prone to misunderstanding and misinterpretation, for at least a year of my treatment, I was hazily under the impression the medication used the venom of bees. In my defense, the procedures felt uncannily like their stings. The trails of chronic pain aren’t well marked or mapped—to be sick is to be born again, to pick up a new language through intuition like a toddler, to feel slick walls with clumsy hands.
I generally hated taking the subway before coffee, averse to the light and noise and jostling without liquid protection, but that morning, I didn’t mind; I had been looking forward to the injections for weeks. Always, in the weeks before my appointments, the pain returned––creeping, then stomping, like a trembling, guilty ex-boyfriend. I spent a fair amount of time—at work, in appointments, to lovers or friends, and in my many wasted and aimless hours—thinking of words to capture the pain. Not just because it was purely difficult to describe, although I’d read the essay by the famous British author declaring the poverty of language for illness and I agreed, but because it was also so boring, so obvious, as well as so varied.
Sometimes the pain was like rug burn on the inside of my skull; sometimes it was sudden, sharp, and harsh, like gunshot, like lightning. I read online: thunderclap. Ice pick. Often it was dull. Tight. Heavy, so heavy, in the back of my head, like I was pulled down by my hair back onto my bed. Pulsing. Echoing, as if shot from a black cannon. Slicing, severed, so the top, the left, of my head seemed pulled off and away. Flashing! Twitching from behind the eye, the ear. Mostly, most stupidly, exhausting. Really, I had some level of belief, which I nursed the way I used to daydream of crushes or cities or occupations, that if I could just sleep enough, I could wake unharmed. I would imagine a tall and secret water tower which would deprive me completely sensorially, provide the dark and quiet that could heal me forever. I’d admit that after five years it still felt like harm; I looked around for the person to blame.
On the train, though, I waited patiently, reveling in the day, already beautiful to me. I smiled at my shadowy reflection in the window above the long blue bench. I read a little of my library book, feeling indulgent, since I’d taken the morning off work. At the pauses in stations, internet accessible briefly, I searched online for the definition of inveterate.
I switched trains at Grand Central. A singing couple boarded with me and bellowed love songs into a microphone above the din and screech of the rails. I looked around; few people gave them money. A woman who’d recently cried—pink eyes, wet cheeks—ignored them completely. I wondered if I’ve ever cried on the subway; surely, I thought, I’d remember. An elderly couple across from me clutched each other tightly. The rest wore headphones.
My head began to beat my pulse as clearly as could my fingers in my neck or my chest; I closed my eyes. The pain was slowly, newly vociferous. It would soon be layered, constant. I disembarked minutes later, and walked uphill in the chill.
In the hospital, looking too young and healthy, I said, yes, yes, I had an appointment; seventh floor. I took a sticker, disinfected my hands with clear gel, and rode the elevator to the windowless, fake wood-paneled waiting room for the Department of Neurology. The receptionist, Summer, smiled at me. “How are you today?”
“Hi, Summer,” I said. “Good, how are you? Nine AM appointment with Tiffany!”
Tiffany, the nurse practitioner, had administered my injections for years; she worked with the neurologist I had only been able to schedule my introductory appointment with when the doctor joined my ex-boyfriend’s mother’s ceramics class. I loved Tiffany. She was wonderful. She took the train down the river from the countryside every day, ninety minutes each way.
I had read an advice column in the newspaper about the ethics of using personal connections to see certain doctors, and I felt bad, but it felt physically better to be ashamed than to be perfect—I had scrolled through the article at my day job, the one I worked after some years of on-and-off short-term disability. The column itself reminded me of a time I saw an old friend from high school on the street with a newly puffy, glazed face, and told her I’d started treatment.
“Aren’t you worried about contributing to unfair beauty standards?” she had asked me.
“Oh,” I said. “Maybe. No, actually. What are you talking about?”
At parties, people said they were jealous, that their wrinkles were horrible, or that they had migraines, sometimes, too—though, perhaps they’d mention, they hadn’t had a bad one since they were six or sixteen. Sometimes I said, “I’m so lucky, good luck with your wrinkles,” or, “Stay safe, everyone!” Other times I said, “Oh, well, if it’s helpful, you have to have at least fifteen migraines a month. It took eighteen months to get approved, two or three other treatments need to fail first. I tried amitriptyline, I tried topiramate—” and then that person sidled away, nodding, churning themselves like butter.
At the hospital, Summer checked me in; we chatted, then I took a seat under the glass-framed headshots of the hospital’s neurologists. I watched the news about the governor’s sexual harassment allegations, read more of my book. Then Tiffany came out of the beige swinging doors that led to the backrooms of brain science, looking frantically and calling out my name.
“They didn’t call you? They were supposed to call you.”
“Hi, Tiffany,” I said, standing. “Is everything okay?”
“Your pre-approval got denied last week. They should’ve called you, saved you the trip up here. I told them to call you—they were supposed to call you.”
I sat back down. “Oh, no.”
“I’m sorry, honey,” Tiffany said, shaking her head. “We’ll keep trying. We’ll appeal.”
“But I’ve been getting the same procedure for three years,” I said. “But I have the same insurance I’ve always had.”
“Can you hang on for a few more weeks? Let’s get you set up with the people to talk to.”
I groaned and shivered. Stars shot from hell, not heaven. I made myself move. On the subway, I cried, subtly then fully; now, I thought, I’d always remember that I had.
I called the neurology department, and got Summer’s coworker, Courtney, who had spoken with the appeals team. My head was crunchy, my neck pivoting as if between two stones. “I think it was a coding error. Something was up with the code.”
“Can you re-code it? I mean, can you, uh, use the same code that you used before?”
“We’re re-filing for the appeal. I think they had ‘general headache pain, unclear cause,’ not ‘chronic migraine.’ We’ll go ahead with the old code, see what happens. We’ll know more in a couple weeks.”
The injections were five thousand dollars without insurance. My head cracked, my forehead collapsed. I thought I might fall forward and asleep. “Okay,” I said. “I mean, all right. Thank you very much, Courtney. I really appreciate it.”
“We’ll call you,” she told me. “And you can always check in with us, at any time, using the hospital’s app. Do you have the app downloaded?”
I had the app downloaded. Two weeks. “Thank you again.”
The next Wednesday, I walked to cognitive processing therapy from my office in Midtown at six PM. I had therapy once a week. I didn’t tell anyone at work, not because I was ashamed to be in therapy, but because it was explicitly for trauma—people would ask what had happened to me. Also, everyone I knew thought the word trauma was overused.
“If everything’s trauma, is anything trauma?” someone would ask. And it wasn’t even that I disagreed. But my diagnostic code was post-traumatic stress disorder. For homework, I filled out worksheets called trust stars, where I evaluated how much I trusted everyone in my life and in which dimensions, provided for free by the federal government to veterans. A diagnostic criterion for PTSD was that your body or life was physically threatened; what a thing, I thought, to reveal in Midtown. Or anywhere.
Sometimes, down Sixth Avenue, I walked into beautiful sunsets. Fresh air helped my head, especially after hours of fluorescence, that slow uptick in compounding pain. I tried to walk every night, if I could. For months, I’d walk so much that my legs grew thin and strong; then months passed where I just made macaroni and cheese from purple paper boxes, and my legs grew swollen and soft. That night, it poured, and because it had been a dry morning, I held my jacket above my head until I could buy a small black umbrella from a man on the corner for $10 in cash.
“I don’t wanna see you all get sick,” he yelled to sell his wares. “Don’t get sick!”
My therapist, Isa, was very pretty and kind, and I craved her approval immensely, so much that it could be hard to focus on evaluating my relationship to trust, intimacy, power and control, self-esteem, and safety. My friends said I was experiencing transference. I didn’t think they were wrong about that, either, but I was still looking for the point in that, too. I found no harm in looking forward even slightly to my self-interrogations. In a way, I told myself, my condition was chic. Distress and tragedy in beautiful youth; like being divorced in your 20s.
As part of the therapy course, I wrote an impact statement. In the statement, which I thumbed into existence on my phone, I wrote not what had happened to me but why I thought it had happened; then I read it out loud to my therapist in halting, uncertain segments. We identified stuck points in the narrative; each week, and as homework, I filled out additional worksheets on each stuck point.
That Wednesday, we discussed the stuck point, my trauma is my fault. I hung my wet coat on the hook behind the door, wiped my glasses with the tissues meant for tears.
“What is the evidence for this stuck point?” Isa asked me.
“Uh, I got too drunk. I wasn’t watching where I was going. I went to hug my friend… I thought I was being funny. I thought the whole thing would be funny. I got too drunk. I should’ve been more careful? No—um, I could have been more careful.”
“What is the evidence against this stuck point?”
“It was an accident? It was an accident. Accidents happen. No one can watch where they’re going every time. Anyone can hit their head. People injure themselves constantly. Injuries are a part of life.”
“Is your stuck point a habit or based on facts?”
It stumped me. “Neither? Both? I mean… I mean it feels… feels like facts. Then again, it is a habit… I’m always getting into—no, I was always getting into—such bad situations.”
I thought about the day after the concussion. I’d woken up at eight AM in another borough, before the rest of the group, my head aching for the very first time and quite nauseous. It rained lightly outside, and my clothes were on the floor: light jeans, large black mock neck sweater. Red puffy jacket.
The Uber driver, Veronica, had to pull over three times for me to puke on the side of the road. Once, we barely made it over the Kosciuszko Bridge; my vomit was yellowed, a brain injured gin and tonic muddle.
Veronica let me move up to the front seat after the first time. “Are you pregnant?” she asked me.
“No, no,” I said, shaking my head, thinking of the metal apparatus implanted within me.
“Do you have a boyfriend?”
“No, no.”
I threw up again.
“How old are you?”
“Twenty-three,” I told her, although I was only eighty-five percent sure. People asked me later what a concussion was like, mentally, subjectively; it’s like jet lag, or a hangover, I said. You’re most of the way there. You’re never completely sure. You realize mistakes six hours later.
“You’re pregnant,” she said, clucking. “Have you taken a test?”
“No,” I said. The vomit had precipitated tears. There were toys in the car; small pink plushies hanging from the rearview mirror. “Do you have kids?” I forced out.
“Two,” she said. “Do you?”
“No.”
“This is your first,” she said, laughing a little. “This is your first.”
When she dropped me off outside my building, I thanked her. She urged me to take a test. I said I would; I tipped her five dollars. Then I took a shower and went to the doctor. And, I thought in Isa’s office, looking now at the freckles under the brown frames of her glasses, wading through what was left of my facts, I hadn’t stopped going to the doctor ever since.
A week later, Judge Judy played in the windowless waiting room at the Women’s Health Center at the teaching hospital around the corner from my apartment. The receptionist had already told me they were quite backed up; only one doctor was in that day.
“Okay,” I said, “sounds good,” shrugging, and sat down. I had worked from home for the appointment; I could edit my documents later.
I had brought a book by a Chilean author I had read less of than I should have and which I had only started after a mustached guy I went out with wanted to talk about the writer—his favorite author—extensively and I had gestured and acted demure, tucked my hair back, focused on the icy brown cocktail, and pretended he would text me again. Of course, I’m not—I’m never—too sick to have crushes. Just another form of illness, although it’s controversial to use metaphors with illness. I usually didn’t drink in a flare-up, and almost never just before treatments, but exceptions had to be made for men above six feet. I’d slid faintly through the next day of work like a garden snake.
Really, I read!! I could have texted him then. But who cared? Inspiration was everywhere. It was oppressive, I thought, the idea that life had to be subtle.
I was waiting to have my intrauterine birth control device replaced. It had been seven years since the last time I’d had one inserted and seven months since I’d had penetrative sex. Still, of course, it was time. The hospital was the only place with an opening near the expiration of my device. I’d taken ibuprofen before I’d walked over, but I’d just realized that, this time, no one had prescribed me the pill to widen my cervix and minimize the pain.
I’d had the former IUD inserted just after the president was elected the first time; I had made an appointment later that week. Because of my geographic and financial position, I was mostly guaranteed to be at least proximate to choice, but I had felt it was the principle of the thing, to say nothing of the potential. In my documents, I often changed principal and principle back and forth.
Which was actually what Judge Judy was saying on the television, because of course I had put my yellow novella away and was now closely watching her mediate a dispute between an estranged heterosexual couple. I wasn’t supposed to watch TV without my screen glasses, as the blue light caused me headaches. But I was far enough away that it felt vaguely safe.
The woman had a pierced chin and dyed blonde and blue hair. Her ex-boyfriend, across the room, had a goatee and excessively thinning black hair—one would hope, I thought, Judge Judy would tell him it’s time to give up, to be dignified.
“I don’t understand. You say he was harassing you, that you knew he had a weapon, and you went outside alone in the middle of the night? And you report it as stalking?”
The woman tried to respond; her ex-boyfriend nodded. Judge Judy continued, “It doesn’t make sense, it doesn’t make sense. And the police find nothing? And you decide to come on Judge Judy about this?”
A few minutes later, she dismissed the case, and after a commercial break, a new romantically broken couple in dispute entered the courtroom.
A grinding headache had already begun when my name was called by the nurse. The nurse inflated the blue pump to take my blood pressure and indicated I’d gained weight since my last visit a couple weeks before.
Another hour later, they replaced my IUD. A male doctor asked me twice to state why I was there that day and thrice for my age. 28; 28; 28. I signed paperwork, wondering if I needed to further clarify my case. A female nurse and the doctor started fighting with another, female doctor, in the room ostensibly to supervise, but rubbing her head, eyes closed. They raised their voices; I winced and gaped.
“Okay!” the male doctor said, taking inventory. “Device, speculum, solution—”
“Non-stop chattering—” the female doctor interrupted, as the female nurse handed the other doctor the instruments.
I stared at them. The nurse asked me another time to state why I was there. “IUD.”
“Ready, my dear?” the male doctor finally asked me slowly, looking down with what felt like an elaborate sympathy. “You’re going to feel a lit-tle discomfort when I insert the speculum. That’s it, one, two—”
I yelled motherfucker in the middle of the procedure. It was much worse than I expected, and much worse still than what I’d remembered. FUCK! I said again. Still, it wasn’t as bad as it had been for my younger sister, who, at 21, threw up and passed out. After they finished, the female doctor suggested the nurse get me some juice and a lollipop. I wondered if my age was even in my file. I wondered if anyone had read my file.
My stomach felt ruptured, as if it had been clawed by a squirrel from the inside. Because I felt badly that everyone had been fighting, I asked the female doctor, to cut the tension, how much worse it would be to give birth.
“Not even close,” she told me. “I’ll put it this way—that IUD is the size of a quarter. A baby is a watermelon. I’ve been doing this for 20 years, but I still look away, and say, aaaah! when I deliver kids. I could never have my own.”
“I don’t know if I’m cut out for it,” I said honestly.
“And that’s okay,” she said, which made me regret it.
They said I could leave and come back in a month to check the strings. I thought, no way in hell. I’d know if the strings come loose; maybe they’d create a spike and impale someone, who would screech and inform me.
I put my clothes back on, and, leaving, noticed small pools of my blood on the yellow linoleum floor. It was a darker red than I expected or remembered; my periods had stopped a month after my first device. I hurried up and walked home, groaning. I spent the rest of the day on my couch, cramping and moaning. I never wanted to see my blood again.
I tried not to feel sorry for myself in general. I tried to remember that I was just a person, like many others, with a disability; in fact, my situation, like my version of womanhood, was conferred with vast advantages, and I should likely only feel sicker with remorse in comparison. It really was true.
I even had the sick and twisted thought that it had been, briefly, almost refreshing to feel a new kind of pain, somewhere else in my body. For a moment, I thought, I had experienced life just as another person might—with the entitlement of shock at pain.
At the hospital, Tiffany called me back from the waiting room. “We did it, finally,” she said, smiling with perfect teeth. I smiled back, thrilled, ready. “The problem was we had it labeled ‘post-concussive,’ not ‘chronic migraine.’ You know—” She shrugged.
I nodded; I knew. The back room was small and familiar: pale blue walls, squishy brains for supportive clamping during procedures lined on the desk next to the needles and small injection bottles, labeled in orange.
Tiffany asked me about my pain (0 to 10? Number of migraines/week?), my family, my job. I asked her about her commute, her son, her job. We had an ongoing dialogue through the years; it was, in part, like catching up with an old friend.
“I’m doing okay, actually, like, generally,” I said after quantifying the pain of the previous weeks. I had been caught by my neurologist and physical therapists downplaying my pain several times. “Work is okay, everyone is okay. I’m going back to work after this.”
“Good, good,” she said, moving around, filling the needles. “Ready?”
I put my hair in a ponytail. “Ready.”
As she injected—one tiny prick after the other in a clean sweep of my forehead, neck, shoulders, back of head, top of head—I squeezed the blue plush brain, tapped my foot on the tile. I thought about the strangeness of the situation I sat in, the thorough and mysterious jabbing. They didn’t know why Botox worked on migraines; it wasn’t fully researched, funded, or cured. The migraine patients who happened to receive Botox treatments had reported fewer migraines, I told people; the process had just gradually became medically insured. “All done,” Tiffany said.
I sighed and forgot everything else. “Thank you so much, Tiffany.”
“Of course.” She grabbed some gauze. “Oh—you’re bleeding. You’re always a bleeder!”
The pain lifted slowly, my shoulders sagging into release, my skin and hair numb and smooth. My head softly throbbed. I blinked and smiled. I gathered my things, said good-bye to Tiffany, and scheduled another appointment twelve weeks later. It worked, it worked, it worked, I thought. Again, again, again.
On the way back to the subway to the job that sponsored my healthcare, I bought myself, as always, two glazed plain donuts as my private reward. I finished them before the train came, eating in a monstrous and ecstatic way on the platform.
At work, no one asked about my forehead, covered in small raised bumps and marked with tiny dark red pricks; noticing later, I washed my face quickly. In my documents, I left several comments indicating that I removed gratuitous commas.
In another life, in another country, I thought, I freelance. I’m late on rent; I’ll make it work. I try new things; I take risks. I hug freely; I have sex carelessly. I’m not trapped by my body—I’m not even just safe in it. I’m free. I write; I’m a writer. In fact, I’m working on a novel. Then again, in my life, in my office, I let myself have an extra cup of hot coffee in my small, secret celebration, head relaxing, and I thought, I have exactly ten good weeks to write that now.
Madeline McFarland is a writer living in New York. She has an MFA in Fiction from New York University and is currently working on a novel and a collection of short stories. Find her online here.