Hospital corridor. Courtesy of Wikimedia Commons, public domain.

When I entered the emergency room at 3 A.M., I knew only that the fragment of crab shell in my throat could not be swallowed, extracted, or solved with marshmallows (the glottal escorts recommended online). The actual solution was morphine and emergency surgery; up until I recovered consciousness, my visit to the hospital represented some of the most pleasant hours of 2024. When I woke, it was to a body with several new ports of entry, established so that my most tender innards could be tethered directly to the hospital bed. My gown was essentially a garrote with modesty bib attached, and mysterious things had been taped to my arms and legs; a tube to nowhere emerged from one nostril. I spent what felt like multiple twilit days wriggling up and down the bed, orienting myself by proximity to beeps, until my exovascular system got so tangled the nurses (themselves attracted to beeps) came running. I had been out of surgery half an hour.

The nurses unwound me, retrussed me, and stupefied me with fentanyl just as a pack of surgeons materialized to deliver complex and consequential information about my health. A total of six surgeons comprised my “team,” and all six could have played background Kens in the Barbie movie. I remember humming to myself to drown out their talking; I do not remember repeatedly whispering “I’m asleep” while making eye contact with the lead surgeon, but I defer to his sober account. They summarized our morning: After extracting the fragment of crab shell in my throat, they found several smaller shards in my stomach, which they took for good measure. Then they glued shut the centimeter-long tear, as esophageal tissue is too fragile for stitches. They had pictures on their phones.

While the hole in my esophagus healed, the doctors commanded I eat by tube, and presently introduced the week’s single continuous meal: a beige substance in a wobbly bag that joined my proboscis at a threaded connection with which I was immediately desperate to tamper. My eating has qualified as disorderly since childhood, and my diet represents a deranged détente. I regard eating as a game to be won by wringing the most time and flavor out of the fewest nutrients. It is a game I play with vats of broth and salads big enough to stuff pillows; tubular delivery of calorically dense slurry to my stomach is absolute and demoralizing defeat.

The looming food replacement—Peptamen 1.5, manufactured by the Nestle corporation, who online brook requests for samples—resembled wood glue and smelled like vanilla synthesized by a chemist. I was scheduled to absorb two bags every twenty-four hours.

Forced feeding turned me into a feral goblin; I would not have behaved worse had I been hooked up to a bag of sewage. I clamped the tube with a bobby pin, but that set off alarms and invited scrutiny from the nurses; I then detached myself from the feed bag entirely, but I failed to find a stopper in time to keep it from leaking a buttercup puddle that fused my gown to the bed and earned me a vigorous, side-eyed sponge bath. Next I tried reprogramming the machine to feed me a single milliliter of substance every day (a thimble of sewage still vile but preferable to the utility bucket prescribed). The difficulty in this scheme was the vigilance required to restore the machine to regular settings every time a hospital employee entered my room. I considered confessing my interference to every nurse who looked as though she might “get it,” but I lost courage in rehearsal; there is no chill, low-key way to position either the death drive or the tenuous matrix of superstitions I relied on to distract from it. I doubted my ability to convince medical professionals that I alone am not helped but harmed by nourishment.

I had a very busy body in the hospital and, like an incapacitated president, could merely observe as its executive functions were delegated down the chain of command. The inefficiency of sustaining a life by committee is staggering; a single day in the hospital required the constellated efforts of a team of thirty. Incoming seemingly at whim were IV fluids, painkillers, antibiotics, medicine to cure me of salivation, and an enchanting pink papaya enzyme used to sluice my feeding tube. Besides hourly monitoring of my vital signs by Care Partners, nurses administered finger-pricking blood-sugar tests every three hours, a phlebotomist drew blood every six, and technicians irradiated my torso every morning at four. (Classical sadists managed the scheduling.) Last and sweetly least were visits from the Care Extenders, a fleet of hospital-issued teenagers in khakis who roamed the floor without supervision or particular skill. Every few hours one would appear in my room to ask if I needed “anything,” a category that seemed to include only ice chips and fiddling with the in-room iPad.

All of which is to say: anticipation of caregiving traffic made sleep impossible. I tried to watch TV but kept falling in love with the advertised food; I texted my friends asking to be DoorDashed crab salad, the greatest comedy masking the deepest pain, et cetera. As my mouth was airlocked without saliva, I repeatedly licked the only food I had in my possession, a wedge of Rice Krispies bar discovered at the bottom of an overnight bag last used at Christmas, but I found that in disuse my mouth had the native flavor profile of a limestone quarry. The more hours I spent awake, the longer each one got, until the interval between midnight and dawn dilated past the point of cohesion; I entered the realm depicted on childhood Trapper Keepers, a timeless void delimited only by a neon grid extending to the horizon. I jolted awake at the constriction of a blood pressure cuff and discovered my feed machine running, my bag of glue depleted. On the morning of my fourth day of hospitalization, I called the internal social work department and left a message inquiring into discharging myself against medical advice.

A surgeon-delegate arrived within minutes and dismissed all other hospital personnel in the room. His preamble contained three phrases that all meant “Now I will tell you the truth.” It was essential that I remain in the hospital, he explained, because while my esophagus had likely sealed cleanly, the slight chance that it hadn’t left me vulnerable to imminent heart failure in the wild. Just four more days, he said. But in the half hour since early release had occurred to me, it had attained inevitability, and I was pained to consider the prospect of four more days unbroken by sleep or solid food. They were willing to work with me, he said, in three different ways. He asked what I liked to do in real life.

Make tiny contraptions out of resin and fishing lures, shown to no one; incubate and raise various barnyard and exotic fowl; eat crab recklessly. Those were the real answers. Instead I tried to imagine what a wholesome autonomous human would say and came up with “Going to CrossFit class every day,” a counterfactual that if nothing else provided my surgeon with the opportunity to respond mercifully by ignoring it. “Do you like dogs?” he asked “We could try to schedule a therapy dog for you. Or how about Reiki? Or a massage?” I had expected a stick and so was unprepared for the carrot offered instead; I found I didn’t want to be a goblin anymore, and I agreed to the schedule of captivity. Standing in the threshold of my hospital room and readmitting the various people waiting to Care for me, my surgeon offered a final cryptic kindness. “I’ll let the nurses know you’re cleared for courtyard.”

It was the dog I wanted most, and I spent the day buoyed into tolerance of the hospital routine, giddy at the imminent visit. I suspended my campaign against nutrition, which freed me to sleep; when I awoke, it was with my capacity for appropriate behavior freshly restored, and I greeted even the 4 A.M. X-ray tech with the good news of my dog and sundry perks. “They said you’d get all that today?” he asked, then held up one finger, left the room, and remotely doused my torso with ionized photons. “Doctors promise anything to keep you from leaving early.” When the day nurse came on shift, she clucked and confirmed the technician’s skepticism; she had only ever seen a dog in the children’s ward and, moreover, did not care for dogs. “They cleared you for courtyard, though, so you can go down to the lobby after bloodwork at eleven.” She emptied a syringe of Pepto-Bismol into my wrist IV as I assimilated this news.

At the appointed time, and at a pacing reminiscent of movie scenes depicting the hours preceding coronations and swan songs, my ports were disconnected and my gown shed. Nursing attendants guided my raised arms through the armholes of a T-shirt and my feeding tube and head through the collar. I was granted an hour on the courtyard, gateway to the world.

I was through the courtyard and off hospital grounds within minutes, speeding both to maximize my time and avoid prolonged observation. Simply walking felt phenomenal; I met the sunshine, breeze, and variegated branding positions of corporate America with childlike wonder. In a grocery store, I gazed upon all my favorite snacks; in a coffee shop, I bought a single shot of espresso and then scurried away, holding it up to my face and huffing atomized caffeine. On a park bench, in my last ten minutes of liberty, I watched a rippling black pit bull slip her collar and sprint toward the grass, where she dove and rolled jubilantly. “Damn it, Khaleesi,” muttered her owner, an elderly man hobbling after her at top speed who nonetheless nodded kindly at my idiot grin.

I was discharged on schedule, three days and eight courtyard forays after admission. In tomograph and fluoroscope, my esophagus was once again a perfect tube, the luminous doodles of my digestive and circulatory systems crisply defined and exactly where they belonged. The surgeon who’d promised me the dog, scarce since our negotiation, arrived to perform the final step of my release, the removal of my feeding tube, and clearance to eat and drink. I received the most perverse mercy of the whole week when he shone a penlight up my nostril to determine whether my tube had been sewn into my nose. God being good, it was not. He told me to close my eyes and, with a resolve that redeemed all earlier treachery, pulled a foot-long and hideously hot silicone worm out of my nose. My sinuses burned with stomach acid, my discharge papers were signed, and I returned to the world with untrammeled glee.

Freedom and retrospection softened my memories of the hospital, and the next day I emailed the head surgeon to thank him for saving my life and allowing me to leave. Would it be possible to send me the photograph of the crab shell he’d removed, to be hung above my desk as a reminder of the banality of evil? Six minutes later, one of his nurses responded with boilerplate text and this chilling portrait of my enemy.

Kate Riley’s story “L. R.” appears in the Winter 2022 issue of the Review.