In the town where I grew up, I was often asked by store clerks and hairdressers where I was from. Not the way the Texan had been asked; I have always had a soft Caucasian Middle American appearance. It was about the way I spoke. My mother had what I later learned to call a transatlantic accent—again rhymed with pain—that morphed into a Midwestern twang only after I left for college. And half my words I learned from books and didn’t know how to pronounce. Even after college and into medical school, I sounded like English was my second language, June and the Texan said.
Words weren’t all I picked up from books. The cigarettes, for one example, were straight from between the fingers of Salinger women lounging wanly beside telephones. And I got ideas from teen magazines I never could have invented: that you can use your fingers to induce vomiting or cut yourself with razor blades in the event of unbearable suffering. I tried this in high school, along the lines of my hands—to hide it, to try to avoid lasting consequences. Years later, at a street fair, a palm reader called me out. These are just scars, she said, with a tone of soft disgust. But she gave me a fortune regardless: Try to make some money of your own.
An early memory of being a young participant in a welfare scam. We were brought to this woman’s house—I think her name was Delores—my brothers and I, and with her own little daughter and a few other kids, she claimed a clan of nearly eleven. And who came was something like the state inspector for welfare, and the host was one of my mother’s boyfriends. He said: This is my wife, and these are my children. Later we got a cut of shipment food from the government, everything canned, with white stark labels in a plain serifed font that said MIXED FRUIT or CORN or RED SAUCE. The woman’s real daughter, she had only one, taught me you could eat the small yellow flowers that grew up in the cracks of the sidewalk. Not as food, but because it was fun, a chance to take the world at large and put it in your mouth.
Weren’t you ashamed? This was the country-house kid, the odd man out in anatomy class. We were studying together the nerves and bones of the hand and arm. Not beside the body, in the lab, but from books, out in the sun. He was tutoring me, trying to get me to carry my weight. We had gotten to talking about how we had arrived here, he from an Ivy League, of course. Having started early, he was the youngest in our class. I’d told him—I often say too much—how in my application essay I wrote about being poor, about growing up the way I did and never seeing doctors. I am still afraid when a fever or a long cough or a burning when I pee forces me to the health center. I can’t get used to letting people touch me. But during the interview, no, shame had not occurred to me. Before I’d said a word, the doctor sent to judge me told a long story about a brother she had who was born with that thalidomide body, with crab-claw hands and nearly no legs, standing less than a table’s height full grown. Although she was the daughter of a very rich man and had never known a poor kid’s want, it had hurt her so much to see her brother suffer, it placed her apart from the world forever, and in that way she ended up in psychiatry. She said, I know how it feels to protect someone. But who did she think I was protecting?
When I ask my mother about the past, she refuses to answer, or, when she is feeling more generous, she states she does not remember. I have, though, a light touch of prosopagnosia, face-blindness, and from this I lightly deduce I was not shown many faces as an infant. As a child lying in bed at night, I realized I could not call faces into my mind, or I could, but only as pieces, only one feature at a time. They would shift and pulse when I tried to assemble them. I can sometimes remember a face only exactly as it appears in a photograph that I own personally and have studied over time. Still, I was cared for enough to live and breathe, and that is plenty.
I wonder, though—do you know a face if you know it only as a photograph? I read a philosopher once who railed against the projected world of perspective drawing, where you align all the edges of things to a single point in the infinite distance. This is considered realism, but in what way is this realistic? These landscapes, he said, have an air of decency, remain at a distance, do not involve or require the viewer. But this is not how the world appears when we encounter it in perception.
This controls the movement of their unfolding, he said, yet kills their trembling life.
We ran into the woman from the welfare scam a decade later, my mother and I. We were buying food at the poor people’s grocery store. She had grown obese and looked pained just by walking and looked aged awfully from the smoking I supposed she did all day. She or my mother nodded and the other nodded back. They knew each other from AA, so the rule was to keep quiet. Her daughter just died, my mother said when the woman was out of earshot. Her daughter was two years older than me, so sixteen at the time of this story. She had hanged herself in a closet. I remembered the way she had taught me to tie flat sheets high on the trunks of trees and make hammocks to rest on in the unrelenting sun, despite the traffic on their two-laned street and what the drivers would think, the two of us eating flowers from the sidewalk cracks and sleeping up in the trees.
That last time my mother was pregnant, the time with the doctor, I came home one day to find her sitting on the dining-room floor. There was a gun in her hand, that big square gun that shoots staples into the wall, the one we used to tack plastic over the broken windows. She didn’t look up. She was shooting staples into her arm, making her way from elbow to wrist, unflinching with the sharp shots, ticks like marking time.
Reverence is almost certainly wrongheaded, but I have never believed in suicide as a moral failure. In medical school, we learned suicide as the end stage of a specific illness and not at all a serious question of philosophy. I think a lot about one attending on a crowded hepatology service who sighed to himself constantly, audibly: Oh, kill me. Oh, slit my wrists with a knife.
If you get short of breath and find yourself wanting to explain the sodium again, looking away from a mother whose son is brain-dead, try to remember that you are afraid, and remember where the fear comes from. Not from this, not from the particulars of what your mother did or didn’t do or how she stood, drunk, in the frozen-foods aisle of the poor people’s grocery store flicking a lighter until an old man said, Ma’am, you are lighting the wrong end of a cigarette. Don’t settle on the smallest story you can live with. We all hurt, hurt in the bones, have hurt for each other since the day we were born. Best not blame our mothers for it.
How would you do it? the therapist asked. Now I know what not to say. Back then, I had roof rights on a six-floor walk-up and said so. That’s how you get committed, a three-day hold for wanting to and saying it out loud. What else can I say about that place, that room, that I haven’t said already? The TV, the armed guard, the woman who didn’t speak English and didn’t get spoken to, the way she cried and cried. When someone asked if I had a history of abuse, I told them all about it. And for all that, all I got was an appointment to enroll in a research study.
The interview was nearly over when I asked the psychiatrist if we should talk about my qualifications for medical school. No, she said. You are already accepted. I think what she saw in me was a trait we must have shared, a knowing, in our bones, how easily our lives could have been different. Still, I hear my classmate ask, Weren’t you ashamed?