Page 25 of The Anthropocene Reviewed

Unlike meningitis caused by bacteria, viral meningitis is rarely fatal and usually resolves on its own within seven to ten days. This sounds like a reasonable period of time to be sick, until you’re actually inside of it. Sick days do not pass like well ones do, like water through cupped hands. Sick days last. When I had the headache, I felt certain I would have it forever. The pain of each moment was terrible, but what made me despair was the knowledge that in the next moment, and the next, the pain would still be there. The pain is so entire that you begin to believe it will never end, that it cannot possibly end. Psychologists call this “catastrophizing,” but that term fails to acknowledge that pain is a catastrophe. The catastrophe, really.

For many people, including me, the initial period of viral meningitis is followed by several months of occasional headaches, which arrive like the aftershocks of an earthquake. Over a year or so, my headaches grew more infrequent, and by now they’ve almost entirely subsided. I can hardly even remember what the headaches felt like. I remember that they were terrible, that they circumscribed my life, but I cannot return to my pain in any visceral or experiential way. Even though I myself had the pain, I can’t fully empathize with the me who had it, because now I am a different me, with different pangs and discomforts. I am grateful that my head doesn’t hurt, but not in the way I would have been grateful if, in the midst of the pain, it had suddenly disappeared. Maybe we forget so that we can go on.

I became sick with meningitis just after returning to Indianapolis from a trip where I visited both Ethiopia and Orlando, Florida. My neurologist told me I probably caught the virus in Orlando, because, and I’m quoting him here, “You know, Florida.”

I spent a week in the hospital, although they couldn’t do much other than keep me hydrated and treat my pain. I slept a lot. When I was awake, I was in pain. And I mean in pain. Inside of it.

Of course, aside from the fact that it doesn’t usually kill you, there is nothing to recommend about viral meningitis. As Susan Sontag wrote, “Nothing is more punitive than to give a disease a meaning.” The virus that spread through my spinal fluid had no meaning; it did not replicate to teach me a lesson, and any insights I gleaned from the unsharable pain could’ve been learned less painfully elsewhere. Meningitis, like the virus that caused it, wasn’t a metaphor or a narrative device. It was just a disease.

But we are hardwired to look for patterns, to make constellations from the stars. There must be some logic to the narrative, some reason for the misery. When I was sick, people would say to me, “At least you’re getting a break from all that work,” as if I wanted a break from my work. Or they’d say, “At least you’ll make a full recovery,” as if now was not the only moment that the pain allowed me to live inside. I know they were trying to tell me (and themselves) a tightly plotted and thematically consistent story, but there’s little comfort to be found in such stories when you know damn well they aren’t true.

When we tell those stories to people in chronic pain, or those living with incurable illness, we often end up minimizing their experience. We end up expressing our doubt in the face of their certainty, which only compounds the extent to which pain separates the person experiencing it from the wider social order. The challenge and responsibility of personhood, it seems to me, is to recognize personhood in others—to listen to others’ pain and take it seriously, even when you yourself cannot feel it. That capacity for listening, I think, really does separate human life from the quasi-life of an enterovirus.

I give viral meningitis one star.

PLAGUE

THE OTHER DAY, in the midst of a global disease pandemic, I called my pharmacy to refill my Mirtazapine prescription. Mirtazapine is a tetracyclic antidepressant medication that is also used to treat obsessive-compulsive disorder. In my case, it is lifesaving. So anyway, I called my pharmacy only to learn the pharmacy had closed.

I then called a different pharmacy, and a very sympathetic woman answered. When I explained the situation, she told me everything would be fine, but they did need to call my doctor’s office before refilling the prescription. She asked when I needed the medication, and I answered, “I guess in a perfect world, I’d pick it up this afternoon.”

There was a pause on the other end of the line. At last, stifling a laugh, the woman said, “Well, hon, this ain’t a perfect world.” She then put me on hold while talking to the pharmacist, except she didn’t actually put me on hold. She just put the phone down. And I heard her say to her colleague, “He said—get this—he said in a perfect world he’d pick it up today.”

In the end I was able to pick up the prescription the following afternoon, and when I did so, the woman behind the counter pointed at me and said, “It’s the perfect world guy.” Indeed. It’s me, the perfect world guy, here to regale you with a plague story—the only kind I find myself able to tell at the moment.

In 2020, I read about almost nothing except pandemics. We often hear that we live in unprecedented times. But what worries me is that these times feel quite precedented. For humans, being in uncharted territory is often good news, because our charted territory is so riddled with disease, injustice, and violence.

Reading about cholera in the nineteenth century, for instance, one finds many precedents. Amid fear of the disease, misinformation was widespread and common: Cholera riots broke out in Liverpool as rumors spread that hospitalized patients were being killed so that doctors could have corpses to dissect.

Then, as in 2020, opposition to public health measures was rampant. One American observer wrote in the nineteenth century that isolation measures “embarrass with unnecessary restrictions the commerce and industry of the country.”

Then, as in 2020, the rich abandoned cities en masse: As the wealthy fled New York amid the cholera outbreak of 1832, one newspaper wrote, “The roads, in all directions, were lined with well-filled stage coaches . . . all panic struck, fleeing from the city.”

Then, as in 2020, outsiders and marginalized groups were blamed for spreading the illness. “By means of Irish vagrants from Sunderland, the cholera has been twice brought among us,” read one English account.

Then, as in 2020, the poor were vastly more likely to die. In nineteenth-century Hamburg, the poorest people were nineteen times more likely to die of cholera than the richest people. This statistic has only worsened: In the twenty-first century, poor people are thousands of times more likely to die of cholera than rich people. Cholera kills at least ninety thousand people every year, even though there is a safe and effective vaccine and the disease is almost always survivable with proper fluid replenishment. Cholera continues to spread and kill not because we lack the tools to understand or treat the disease as we did two hundred years ago, but because each day, as a human community, we decide not to prioritize the health of people living in poverty. Like tuberculosis,* malaria, and many other infectious diseases, cholera is only successful in the twenty-first century because the rich world doesn’t feel threatened by it. As Tina Rosenberg has written, “Probably the worst thing that ever happened to malaria in poor nations was its eradication in rich ones.”

Disease only treats humans equally when our social orders treat humans equally. That, too, is precedented. After plague, caused by the bacterium Yersinia pestis, swept through England in the fourteenth century, one chronicler noted, “Virtually none of the lords and great men died in this pestilence.”

In that pestilence, perhaps half of all humans living in Europe died between the years of 1347 and 1351. What was then usually called “the pestilence” or “the mortality” is now known as the Black Death, and this torrent of plague also devastated Asia, North Africa, and the Middle East. As the Egyptian historian al-Maqrizi noted, the plague “did not distinguish between one region and another.”

Al-Maqrizi’s hometown of Cairo was the world’s largest city outside of China in 1340, with a population of around six hundred thousand. But at least a third of Cairo’s residents died in an eight-month period beginning in the summer of 1348. The famous world traveler Ibn Battuta reported that at the height of the pestilence in the city of Damascus, 2,400 people died every day.

To many, it felt like the end of humanity had arrived. The historian Ibn Khaldūn wrote that it felt “as if the voice of existence in the world had called out for oblivion.” In Christian communities, the devastation was seen as more final and total than even the Great Flood. The chroniclers of Padua wrote that at least “in the days of Noah, God did not destroy all living souls and it was possible for the human race to recover.”

It’s hard even to fathom the scope of the loss. Cities from Paris to London to Hamburg saw most of their residents die from the plague and resulting systemic collapses. In Dubrovnik, the death was so unrelenting that the government ordered every citizen to fill out a will. In Florence, a city of more than one hundred thousand people, one recent estimate concluded that about 80 percent of the city’s population died in a four-month period. In Ireland, a Franciscan friar named John Clyn described life as “waiting amid death for death to come.”

Near the end of his plague journal, Clyn wrote, “So that the writing does not perish with the writer, or the work fail with the workman, I leave [extra] parchment for continuing the work, in case anyone should still be alive in the future.” Beneath that paragraph, a brief coda appears in different handwriting: “Here, it seems, the author died.”

In Florence, Giovanni Villani wrote of the pestilence, “Many lands and cities were made desolate. And the plague lasted until . . .” and then he left a blank space that was never filled in, because he died of the plague before the plague ended.

To read about the Black Death is to glimpse how it may end with our species—in longing and despair and panic and also ineradicable hope, the kind of hope that makes you leave sentences unfinished and extra parchment in your book, in case anyone should still be alive in the future. As William Faulkner once put it, “It is easy enough to say that man is immortal simply because he will endure: that when the last dingdong of doom has clanged and faded from the last worthless rock hanging tideless in the last red and dying evening, that even then there will still be one more sound: that of his puny inexhaustible voice, still talking.” Faulkner went on to argue that humans will not merely endure but will prevail, which these days feels a bit ambitious to me. I, for one, would be delighted to merely endure.

The historian Rosemary Horrox wrote of the Black Death, “The very enormity of the disaster drove chroniclers to take refuge in clichés. . . . The same comments appear in chronicle after chronicle,” and indeed, around the plague world, the stories become repetitive. We read, for instance, that corpses lay in the streets of Florence and overwhelmed the graveyards of France and choked the Nile River in Egypt. Chroniclers also focus on the suddenness of it all. One day, a single nun is sick; within a week, her whole community is dead. And the rituals around death must be changed. The bells are no longer tolled for the dead, because they would toll without ceasing. And as one writer put it, “the sick hated to hear them and it discouraged the healthy as well.”

But for me, the most gutting repetition in plague accounts is the abandonment of the ill, who were often left to die alone due to fear of contagion, especially in Europe. After the poet Joy Davidman died in 1960, her widower C. S. Lewis wrote, “Nobody ever told me grief felt so like fear.” But to grieve in a pandemic is to both grieve and fear. “For fear of infection,” one writer noted, “no doctor will visit the sick, nor will the father visit the son, the mother the daughter, [or] the brother the brother. . . . And thus an unaccountable number of people died without any mark of affection, piety, or charity.” In the Byzantine capital of Constantinople, Demetrios Kydones wrote, “Fathers do not dare to bury their own sons.”

In fear of death and hope of survival, many left the sick to die alone. To do otherwise was to risk your own life, and the lives of whatever loved ones you had left. The Black Death was vastly, incalculably different from our current pandemic—it was orders of magnitude deadlier and far less understood. But infectious disease continues to separate us in our most vulnerable moments. Too many of us, sick and healthy, were forced into isolation. Too many died apart from those they love, saying goodbye over video chat or a telephone line. In the New England Journal of Medicine, one physician wrote of a wife watching her husband die over FaceTime.