By EMILY NEMENS
She was running along the Manhattan side of the East River—this was in the bucolic “before” times, prior to when the city tore up the East Village’s riverside park, chucking its eighty-year-old trees and modernist amphitheater and ebullient perennial flower beds in the name of future flood mitigation—when she felt a curtain being snapped up the back of her left calf, krrrrrik! More lightning than pain. At first. Then, it became very painful. A hot pain that ran an invisible line down the meat of her calf, like those sexy stockings with seams, but the seams had turned carnivorous and were nibbling at her flesh with tiny razor teeth. Running farther, even slow-jogging the 1.3 miles home, was out of the question (her mental math: more pain multiplied by less time in transit, or less pain times more minutes; the latter had the lower sum), so she slowly limped back from the river, putting as little weight on her left foot as possible. She wondered what she would do.
In the beginning, the earlier beginning, she wasn’t a runner—she was a big kid, by genes and by daily decision-making. She loved food (her sister called her “Cheese Puff” after her favorite snack); opted to be the goalie at youth league soccer (in the goal box, she’d have to run very little); picked the bari sax in middle school, both for the Lisa Simpsonness of it and because here, her comparative bulk—her preteen frame was taller than many of the boys’, and she outweighed them too—was an asset.
At sixteen, at her still-historic heaviest and until-then unhappiest (little did she know the pain that life would wreak!), she decided to make a change. She started jogging, using the stopwatch function on her Walkman Sport tape player. Two puffing minutes. The next week three, then four. She ran along a gravel path in a park that was nice but in a neighborhood and a city wherein nearly everyone preferred treadmills or trail running—minimal effort or hard core—so she had the drizzly path to herself.
As she huffed and puffed, she knew she wasn’t ever going to be skinny, nor would she become a marathoner, but she found, with her Walkman (blasting bootleg tapes of Pearl Jam, because she had a location/era-appropriate thing for Eddie Vedder), she could eat and run and run and eat and reach some equilibrium. Also, endorphins: those were great. She went fifteen minutes, twenty. Thirty. She stopped worrying about the minutes. She ventured off the park loop. At the edge of the neighborhood was a paved trail that had been a railroad line; on it she could run to and then along the edge of the lake.
Next she ran in Providence, most often the level exit off of College Hill and up Blackstone Boulevard, to the riverfront cemetery or to the stone marker that delineated the southern border of Pawtucket. This routine was interrupted by six months of running in Madrid. She hadn’t realized how much she missed a horizon line until it vanished behind the crowded Madrileño blocks, the old stone buildings jammed shoulder to shoulder, so that even the grandest buildings tightly loomed. In time, she figured out her yearning for wide-open vistas was some kind of animal need, like salt and fat and sunshine.
Up next was Brooklyn, where she reached the apex of her running powers. At twenty-five, she could cross the Williamsburg Bridge, the Manhattan, feel the thrill of the growing endurance that allowed her to do both in a go. (And those vistas! On top of the world, or at least skimming the crown of New York.) Marathons were never in her sightlines, but halfs were newly possible; she ran the Brooklyn race, pounding triumphant down the boardwalk of Coney Island. She’d told herself she’d never be one of those people who did destination races, yet with only a little nudge from a friend, there she was, traveling to Vermont, exclaiming at the verdant New England view and the muscle burn and the local IPAs. This race zigzagged not just two iconic bridges but crossed a dozen covered ones, all of them historically designated and cutely quaint.
(The following year, the majority of those same lovely bridges were washed out in a hurricane that ventured what seemed, at the time, freakishly northward and inland. The destruction was worse for locals than it would ever be for her, but the storm’s damage was rattling. Was this the first time the climate crisis thumped her on the chest? She didn’t stop to process it; she only kept running.)
Then she jogged in Louisiana, usually around a series of man-made lakes that were rimmed with live oaks and Spanish moss. She noticed how most of her new near peers (college-educated women in their thirties) were already responsible for the health and wellness of several small children and a large dog and thus were not looping the lakes in the mornings for their own health and wellness. The few times she competed in organized races, there were few others in her bracket, and so she finished near the front of her age/gender subset. At the front. Chintzy medals, certificates with gold stickers—nothing she asked for, but she did quietly relish them, as she did her new seven-minute-mile pace.
With all this running, she’d slimmed into curvy, down from Rubenesque (which had, at the time of first volley—the back of a school bus, middle school—offended her; in retrospect it was pretty spot-on, and she was impressed by her twelve-year-old taunters’ knowledge of the Flemish Baroque tradition). No one called her a proper athlete—being the fastest thirty-to-thirty-five-year-old woman in the Pennington Medical Center’s 5K Hat Run for Skin Cancer Awareness is hardly a peg big enough to hold one’s sun-protecting hat—but people knew she liked to run, liked all sorts of sports. She was writing a book about baseball, for heaven’s sake! Jock seemed too strong, but all this running, her knowledge of the SEC, her capacity to work physically and sweat unabashedly was somehow essential to her being. She wasn’t so strident about her practice as Murakami and his marathon training—she read What I Talk About When I Talk About Running and wanted to throw it and its sanctimony across the room—but running had become a vital, steady part of her life.
Thusly, her presumed Achilles tear—because what else could that curtain snap be?—posed a real problem. She was no longer winning local races—she was thirty-eight, back in New York after her Southern sojourn, and even the thirty-five-to-forty-year-old female category was here swarmed with speedsters—she was just trying to fit into her pants, get some fresh air, catch a horizon, and swallow a dose of her beloved endorphins. She found running to be a solitary, expansive activity in this many-personed city, a ritual that she relished. That she needed.
And so, this wincing injury was random, unfair, incomprehensible. Because she read and wrote for a living, she often turned to literature in moments of quandary. In the annals of the Russian greats, she found a helpful beacon. She thought her current situation was not so unlike the start of Gogol’s “The Nose.” The story opens with a barber, Ivan Yakovlevich, waking up from a normal night of drinking. He bickers with his wife and is served a loaf of fresh bread with onions, which he slices into, and “to his astonishment saw something white.” Yakovlevich pokes and prods. “‘Solid!’ he said to himself. ‘What could it be?’” The reader may recognize this foreign object as the story’s eponymous nose. It belongs to a client of his, one collegiate assessor Kovalyov; even in a loaf of rye, Yakovlevich recognizes its contours. His wife is certain the appearance is Yakovlevich’s own fault—he is mindless in his work, slapdash and forceful. “I have already heard from three people that you jerk their noses about so much when shaving that it’s a wonder they stay in place.” Yakovlevich makes a plan to drop the nose into the river from St. Isaac’s Bridge. Something this awful must be solved quickly. Does he think of Kovalyov, the nose’s owner, as he hatches his plan? He does not. She, the runner, did not think of Kovalyov either, not right away, just the strangeness of something so sudden as an unexplained rip in her body’s functioning. The extended metaphor would come in time, with extended injury. For now, she still believed quick solutions existed. Yakovlevich and his convenient bridge.
She called her doctor, got a referral for an ultrasound at an office across from the NYPL’s Fifth Avenue headquarters. She thought it was odd to have such nice real estate for a medical practice. And what a view: leafy treetops, the carved entablature—Astor, Lenox, Tilden—at eye level, Patience and Fortitude below, wearing giant diaper-looking masks over their stone snouts, because in May 2021 the pandemic was only sort of over. She hoped, as she offered her arm for a blood pressure cuff, the swank address and impressive view wouldn’t inflate her bill, but she also knew her bill would be puffy if she was in a subbasement or staring at a brick wall. This was Manhattan. This was America.
During her appointment, no one was looking at the bright foliage across the way—everyone was watching the small black-and-white screen as they ultrasounded her calf. She thought of her friends and their prenatal ultrasounds. She was in the middle of a spate of babies, procreation despite the worldwide pandemic, because they’d all put it off for so long already, having postponed families for graduate degrees and fickle men, for actively reckless stretches and those years they’d spent grinding toward their perceived earning potential. Her present stakes, painful as they were, felt lower than theirs. She and her care team weren’t looking for dangerously mislocated fetal cells (a friend had recently been rushed to the ER for an ectopic pregnancy) or devastating genetic abnormalities; they were just scoping out the damage done to a lower extremity. But it also felt somehow greater: this was her leg. A pregnancy was everything, the future immemorial, but with pregnancies you could do a hard restart (at least in New York, at least until the next devastating Supreme Court decision). There were no redos on her leg, unless she went bionic.
Contemplating a running-free future, she reminded herself there were worse things than losing her distance runs and going up a pants size; her friends, that spate of new moms, were doing it all the time! She herself was the beneficiary of a very swish wardrobe after a friend’s twins made returning to a size 6 all but impossible. Bodies change, she told herself. But she had believed change was trading one thing—your pre-baby body, say—for another thing. Like a baby. Swapping endorphins for the mountain-lion-love chemicals of motherhood. Change wasn’t breaking, the peptide drip run dry. Or it was, but wasn’t supposed to be yet. She and her friends were geriatric in obstetrics, but in every other way they were young, young, young!
The PA saw the little rip, pointed to it on the screen. Called it a “micro tear.”
“Really.” She was still prone on her belly, head cricked awkwardly to watch the gray-white image. She said it with an inflection that was maybe requesting confirmation, maybe a polite version of no fucking way. Because, to her, whatever was happening down there felt bigger than “micro.” She explained again the blinding pain, the curtain snap.
Lay off it for a while, he said with a shrug. Do some stretches. He gave her the options of at-home or in-person physical therapy, which was, at that time, also a choice between safety and contagion. She picked at-home, independent stretching. The movements he showed her seemed simple enough, and she began them dutifully that same night. As her partner got stoned on the couch watching Jeopardy!, she stood behind the sofa, on the ball of her left foot, and pushed up to her tippy-toes, again and again and again. (It did not occur to her to repeat the exercise on her right foot. No one said anything about symmetry, and besides: that foot was fine, that calf not at all mangled, that leg shapely and strong.) This was progress, she thought. She would heal! She lifted her left heel off the ground one hundred times, then padded into the kitchen for some snacks.
It felt like a stabbing. It felt like a burning. It felt like a dull ache, then a sharp one, then it radiated all the way down and around her ass, cupping her cheek like a flirt. It was in the muscle, then in the bone, then tingling like it’d gotten a hold of her nerves and chewed on them with its molars. The pain moved around the lower left quadrant of her trunk, but it seemed to center on the peak of her iliac crest. It was strange how the pain came and went, how it felt one way and then like an entirely different beast. It wasn’t blinding and specific like the Achilles pain of a few months prior, but it was bad enough to make her stop talking midsentence and purse her lips. If she was sitting, she would stand and shift her weight from one hip to the other, rotate like she was attempting to suspend an invisible hula hoop.
It was inexplicable, as random as a proto-surrealist story, as strange as waking up one morning to find a stranger’s nose burrowed into your loaf of freshly baked bread, as disquieting as waking up with no nose at all. She turned, once more, to that nose story, because what was the Russian literary tradition if not a way within which we understand the world? Although now she questioned her prior vantage: with this second injury so close to the first, she felt less like the surprised finder and more like the startled loser. Sure, the barber in Gogol’s tale must scheme the nose’s hasty disposal, but what about the newly noseless? How does he feel at his shock?
The text explains how Kovalyov wakes to his incomplete face: He is understandably upset. He leaves the apartment and, more than a little pissed, walks to his regular coffeehouse with a scarf over his face. “But perhaps I just imagined all this,” he thinks to himself. “A nose cannot disappear in this idiotic way.” He finds a mirror, checks. It has. A paragraph later, he sees his nose exiting a carriage, wearing the gold-embroidered uniform of a state counsellor. Kovalyov trembles with horror and amazement.
She was trembling too, if not with horror and amazement, then with their cousins, frustration and fear. Like Kovalyov, who’d deigned to do something so disagreeable as wake up one morning, she’d been doing nothing at all when disaster struck. And yet, some fundamental part of herself was vanished.
Her partner was patient, concerned with her new and debilitating, unrelenting pain. He didn’t complain when she flopped around the bed, a fish in its death throes. She discovered some relief by spreading out her legs and arms like a starfish and wondered if her whole life now was aquatic metaphors.
Losing one night of sleep to the pain was bad; a second made her teary. By the third sleepless night she was an overtired toddler, ready to throw a tantrum. What was causing it? She searched for clues, for patterns and behaviors. The Achilles injury had been awful, but it had also been clear: she was running, and something snapped. At some bleary-eyed point, she wondered if it was maybe caused by her lopsided leg-lifts, but by then it was maybe also caused by a dice roll, by an unjust universe, by someone with a pin-cushion doll version of her and some sinister pins. She had enemies—who doesn’t?—and in her pained and paranoid state, she wouldn’t put revenge past them. (Kovalyov, similarly, had been sure the culprit behind his nose removal was the mother of a spurned suitress. We all need causality; we all need reason.)
By the end of the second week, she had switched from feeling toddlerish tempestuousness to the bleary sleep deficit of a new parent. Now I know how my friends with infants feel, she joked (not thinking of the ultrasound, the other recent time she was reminded of the forking path of motherhood and un-). She knew that she didn’t know what it felt like to be a new mom; the pain was making her irrational. Her friends had vaginal tears and mewling babies, tiny helpless creatures they had to keep alive twenty-four hours a day, including at 2 and 4 and 6 a.m. She didn’t have any of that, just a nebulous, shape-shifting pain that would peel open her eyelids and a string of sleepless nights like multiplied fractions, one-half times one-half times one-half until she felt like only one-sixty-fourth of herself. She wanted the mewler or the scars; she wanted something to show for this slow-moving catastrophe. She missed her endorphins, her wide horizons. She even missed that particular waft of the East River in summer, but between the half-healed calf and the sleep deprivation and the ice-pick sensation in her back, she knew it’d be imprudent to lace up her sneakers.
It would pass, she was sure. Everything does.
But the pain in her back did not pass and had not passed when, several weeks later, she had her annual with her gynecologist.
That she and her partner were not having kids had years before been agreed upon, and so her agenda for these yearly gynecological appointments was brief: a renewal of her birth control prescription, making sure everything looked okay down there. She wanted to know, based on the most recent literature, if her chosen method of BC was adding to her cancer risk or reducing it; the opinion seemed to swing back and forth like a pendulum.
The doctor did the requisite poking and prodding and palpating. Anything else? the doctor asked with her standard efficiency. She brought up the back. It wasn’t exactly her ovaries, but it was radiating from somewhere pretty near them. She pointed toward the general area. Could it be something? She was thinking of a friend who had gotten pregnant and felt some low back pain and it’d ended up being pancreatic cancer; the prognosis was bleak. The doctor looked at her patient like she’d been asked to bake a soufflé, recommended a GI specialist, then excused herself to her next appointment.
Alone again, she made a face like Kovalyov must’ve when he first confronted his nose. The morning he’d spotted the offending nose exiting the carriage, he’d followed it into a nearby church. There, amid the pews, Kovalyov had tried to explain to the nose its right place, but the nose could not comprehend his entreaty. It insisted they had never met. “I understand nothing. Make yourself more clear,” it said. For his part, Kovalyov felt much consternation and chagrin.
Sitting in the empty exam room in her paper gown, she felt similarly put out. She played back the conversation with her doctor. Could she have made herself more clear? She could not find a suitable answer, and so, after gingerly redressing, she placed the paper gown in the trash and turned for the exit.
Her primary care doctor was more patient, more used to her catastrophizing. In their three years together, she’d brought him one malady after another: UTIs and the aforementioned Achilles tear; last winter she’d thought she had COVID toe (it ended up being a bad flare of Raynaud’s, for which he’d referred her to rheumatology). She knew that fundamentally she was a healthy, anxious woman who just wanted everything to work well, and that eventually something would stop working, either slowly, predictably, or all of a sudden, in some shocking and destabilizing way. The abstract uncertainty of any given ailment tipping her into disaster scared her as much as the present ice-pick feeling or last year’s gray and swollen toe. She knew that rationally, but remember that the pain had gnawed through reason, leaving frayed wires behind. In other words: the risk of shock, of short circuit, of destructive flame. Her reason was toast.
Now, he listened to her talk about the frightening onset and frustrating persistence of her pain, nodded as she blubbered about back soreness and pancreatic cancer and her now-dead friend (it’d been six months, diagnosis to death). He ordered her tests—another ultrasound, an X-ray—to eliminate the possibility that her pain was also cancer. He acted like he was doing her a favor, which maybe he was.
As she made her way to imaging, she thought of Kovalyov’s dogged pursuit of his nose, how it sends him running around the city. Because, after the encounter at the church, he tries to find a policeman; when that doesn’t work, he heads for the newspaper office. He has a new, if imperfect, solution: He’ll place an advertisement, describing his nose, asking for any details of its last known whereabouts. Kovalyov is fearful that, without others looking on his behalf, the search “might drag on, God forbid, a whole month,” and he’s unsure how long he can go on without the centerpiece of his face. She was feeling a similar kind of uncertainty.
When the imaging report came back clear, as they both knew it would, her doctor offered her physiatry or pain management or PT. She didn’t understand the first word (and the in-network person wasn’t taking new patients, so it was moot), the second offended her slightly (did he think she was a wimp?), and so she selected the third, and this time she wouldn’t do it at home, shouting questions at Mayim Bialik as she did her reps. She was referred to a stinky gym-like space off Union Square, where, in her eval, she was told her legs were different lengths and she was, apparently, standing ten degrees off plumb. Her decades of running had strengthened all the wrong muscles; for all the power in her quads, she was very weak in some core way she didn’t entirely understand. They asked if she’d ever had scoliosis.
The questions, the leg yanks and hip rotations, the clarity of her therapist’s diagnosis of her flawed body felt as rattling as what Kovalyov faces at the newspaper office. There, the clerk does not understand why Kovalyov wants to place an advert—“Did this Mr. Nosov rob you of a big sum?” When Kovalyov fully explains his predicament and desire, the clerk thinks hard, purses his lips… and rejects the ad. “The paper might lose its reputation. If everyone were to write that his nose had run away, why… As it is, people say that too many absurd stories and false rumors are printed.” Once the clerk sees proof of Kovalyov’s pancake-flat face, he suggests not an advert but a general-interest piece, “for the benefit of the young.” Kovalyov leaves deeply discouraged.
She, too, felt discouraged by the therapist’s assessment, but she accepted her program of restorative pelvic thrusts, movements that might have been alluring if they weren’t so clinical, if she weren’t doing them on a floor that needed vacuuming. Meanwhile, she changed the routines of her already circumscribed life. Lumbar support, a standing desk. She embraced the doctrine that the best posture for your back is the next one—always be moving. She moved all the time. Just more slowly, more carefully than before. She thought of Kovalyov, standing outside the newspaper office, contemplating his noseless future.
When she mentioned to friends what was going on with her back—the stopped running and throbbing pain, the visibly crooked spine and general misery—they were confused. She looked fine. It’s not like she was Kovalyov, running around town without the front end of her face. She knew part of their befuddlement was because people assumed a certain haleness from her, a heartiness that was not the same as beauty, but had become a good substitute for a woman who didn’t have the patience to keep up a complicated makeup routine and a diet of underdressed salads.
She had several friends a generation older, in their sixties and seventies, and they spoke frankly when they heard about her pain. They kept telling her to be careful. To take care of her back, like it was some moral failing that she’d insufficiently done so. With a tone nearly scolding (much more impolite than her parents or in-laws, who tiptoed around the topic because they had future family gatherings to consider), these friends spoke of her pain like she’d gotten herself this far down a dead-end road and now she’d have to figure the way out, whether it meant eking out an eighteen-point turn or backing up the whole nervy length of the rutted road. She was still so young, they’d say (she was not yet thirty-nine), the implication being that she’d have to live with this for a very long time.
Younger friends, the still pain-free ones in their late twenties and early thirties, listened to her gripe with bland, sardonic sympathy. She also saw on their unlined faces an assumption: Of course she was becoming decrepit; that was what happened when you approached forty.
With friends her age, no one had heard of a tilted pelvis (her new diagnosis). They joked that it sounded quirky (though maybe, and to be fair, she described it with references to Gogol and other witty deflections). Besides, even if her pain was like the miter-saw-to-the-hip-bone she described, it wasn’t any worse than what they’d been through in childbirth. That was painful, that was scary, that was when they might die. She didn’t disagree. Childbirth was a big deal, an acute, life-threatening moment in time. But couldn’t women of childbearing age experience other kinds of pain? Might pain extend forward and back, be decoupled from that defining moment? Her friends blinked at her like they could not imagine it. She touched her nose to make sure it was still there.
Her sister, a firefighter, was the only one who regularly asked how she was feeling. Maybe it’s because her job was something like ten percent fighting fires, ninety percent medical calls. What’s your pain level, one to ten? The sister had asked this question to so many people, often on the worst days of their lives. This was not the worst day of her life; it was just persistent pain, sliding along a scale from uncomfortable to debilitating, tumbling down the hill from fine to fuck me most days, in her own demented version of sundowning. Three, she’d answer one morning. Manageable, five, another afternoon. I love my lidocaine patch, she’d joke, not joking, nearly every night.
Even when she ran, which she had barely started doing again, now that her Achilles was healed, and she noted how her jogs amplified the pain, she thought she could handle it. She thought she would handle it, because she loved running. Seven, eight, she’d have said to her sister on those days, through clenched teeth, because that kind of repetitive motion, even on gravel, even with her lame, extra-cushy, orthopedic-looking shoes, inevitably pounded whatever détente her lumbar spine and hip bone had reached far out of whack. Afterward, she’d be near immobilized, and she’d think of Kovalyov, the only person, real or fictional, who knew what she was going through, who at one point opines, “What have I done to deserve such misery? Had I lost an arm or a leg, it would not have been so bad; had I lost my ears it would have been bad enough but nevertheless bearable; but without a nose a man is goodness knows what; he’s not a bird, he’s not a human being; in fact, just take him and throw him out the window!” Kovalyov is speaking hyperbolically, she knew. But when the pain was so bad, so unending, the window held some appeal. How could this innocuous, ubiquitous architectural element become an instrument of death? She didn’t know, but she knew she was teetering, teetering close to danger.
At a year of ice picks, when the pain-inflicted sleep deficit entered into the space of the surreal, she decided to go for the pain management option that her GP had dangled out there several seasons before. She picked the chair of the department at a major teaching hospital, but the first person she saw during her intake appointment was his resident, who diagnosed her with sticking her butt out too far. When the real doctor entered, handsome and confident (also striking her as the kind of guy who had prescribed opioids readily when that’d been socially acceptable), he listened to her symptoms and her teary flummox at his young colleague’s diagnosis. He gave his resident a withering look, then turned back to her, all empathetic eyes: Are you a klutz? he asked. Yes, she admitted, taken aback. Not four months earlier, she’d slipped during a mild hike and broken her front tooth. (She’d finished the trail, bloody-mouthed, because she was stubborn and there was a waterfall at the end; they were nearly there!) Do your joints click? Some, she nodded. How’s sex? She mumbled a demurral, that it was fine, though in truth she’d had to negotiate both her pleasure and pain over the past year. Have you dislocated anything? She explained how, for several years in adolescence, her jaw would unhinge and lock out to the underbite of a bulldog.
Hypermobility, he said, like it was written across her forehead. The ligaments weren’t holding her bones taut enough, so they were sliding out of alignment, hitting each other, getting stuck in positions they shouldn’t. It explained the new angle of her spine, why her low back sounded, at times, like a symphony’s auxiliary percussion section. She was too stretchy. Why now? she asked, desperation creeping into her voice. Sometimes it happened, he said, to women of childbearing age. Shifting hormones, chemical compositions. I don’t have kids. He explained it could happen whether she bore children or not.
Did all his conversation have to do with electrocutions, or was the universe converging toward one zapping, flickering light?
She was expecting pain pills, harder to come by than before but surely still available for the neediest cases, of which she was certainly one. So she was startled when he announced they’d instead burn the nerves. He explained how ablation worked: the mobile X-ray like a ring light pointed at her back; the course of needles with numbing agents; the course of bigger, heated needles that would fry the nerve endings attached to her lumbar vertebrae until they could cause her no more misery. As he described this, he was also on his cell phone, negotiating with a telephone operator at ConEd, toggling between conversations. A windstorm several days earlier had downed a live wire in his neighborhood, so he was requesting an electrical technician to his street. She listened, perplexed. Did all his conversation have to do with electrocutions, or was the universe converging toward one zapping, flickering light?
Leaving the office, she imagined her upcoming procedure like a glowing sword that would magically slice away every sensation below her sternum (except, she hoped, for those in her female parts). It was not that. The next week, the nerves were temporarily deadened by all that voltage, yes, but there was still migratory muscle pain that waxed and waned with the position of the sun, the phase of the moon. The bones of her low back still clicked together like castanets, sometimes locking into misalignment; when it happened, she’d have to sit down and try rising all over again, hoping for a different result. She expanded her crazy quilt of pain patches, stretches and saunas, heat pads and lidocaine roll-ons and traction exercises. She kept wiggling her hips like she was spinning that invisible, essential hula hoop.
Another friend had a pregnancy-related health scare. This time, the baby was healthy, and childbirth had gone fine (a scheduled C-section), but some weird malady had come up postpartum, with her gallbladder or appendix or another tiny organ near her uterus. The condition seemed super serious—and it was very dire—but after weeks in and out of the hospital, so many stumped doctors, it ended up being solved with a short and simple enough laparoscopic surgery, the scar like a dime on her belly.
Anyway, before the pregnancy and again after she’d healed, this friend ran. (In fact, the two of them had run together for a while, back when they’d both been Brooklyn residents and crossing two bridges was a Saturday’s idea of fun.) And this friend discovered, after the second kid and the scary surgery, that she was faster than ever. She could go long too. A phenomenon, she said casually, when describing her dominoing PRs, the good excuse to leave her infant in her husband’s care for the hours required for her mileage runs. Some women get faster as they age, especially after childbirth. Something about hormones? And so the friend ran marathons in Alaska and New York, qualified for Boston, readily admitting that pushing up to the forty-plus bracket had helped. Her humble amid the brag.
Hearing this, she was happy for her friend, but envious too. That she had taken all the risks of pregnancy and come out unscathed. Or scathed, yes—the friend had two scars on her belly, the dime and the smile, to prove it—but no worse for wear. Better. That some problems could be solved, that some injuries healed, that for some people, things got better… it all made her quietly livid. The maw of Kovalyov’s window widened, inch by inch.
She moved, with her partner, to a new state, to a house that was large enough for full-size sofas (in the East Village, they’d made do with a love seat). She was eager for full extension. She spent a lot of time lying down on her new sectional and in her backyard hammock, writing prostrate, reading supine.
Not long after they’d unpacked their new life, she went abroad for work. There she starfished as much as she wanted, alone in a borrowed bed. She tried running and regretted it, as it resulted in searing pain, a day spent curled whelk-like in her short-term faculty apartment, an ocean away from anyone who cared that she was hurting. She ran again anyway, because she was lonely and wanted the endorphins, because she hoped to see more of the city than she could feasibly encounter by walking. Because it was a gorgeous fall and a mild winter, at least until it was not. She ran along the city’s canals and felt good and then, back at the apartment, had a flare and hated her life. She bought herself silly boozes she wouldn’t have kept in the house (sweet vermouth, really? Even if for a wintertime Negroni…) and worked her way through the bottles, which helped in some ways but not in others. She swore off running, she swore off booze, she was glad she could still walk across the city and write on her belly, arms out like Superman. She watched a lot of Ted Lasso and thought about being stuck far from home. Contrary to critical assessments, she did not find the show too sentimental, but she was also in a tender mood.
When she returned to America, she found a new doctor in her new state that took her new insurance. This woman, younger than her—for the doctor, she was a cautionary tale of middle age—sent her to a physiatrist at an orthopedic practice, a youngish man who seemed pleasant enough but somewhat dismissive of her pain, more upset by the fact that the last doctor, the handsome one with the downed wires, hadn’t ordered an MRI before doing his ablations. This was somehow her fault, but why have magnetically resonant imaging, she wondered, when what was wrong had been so plain? She touched her nose again. Still there.
The new doctor ordered many images of her lumbar spine.
Between the physiatrist’s appointment and the imaging one, she fell on the stairs while carrying laundry (that medical-grade klutziness, rearing up again; this time served with the smacking insult of domestic obligation). The fall knocked the wind out of her, made a loud noise. Her partner hurried over from another part of the house. A few stammering tears, more for the fright of it than pain. She accepted a Kleenex, wiped her eyes, blew her nose, stood tentatively. It hurt, she admitted, but its loud gong vanished quickly, and, standing taller, she noted a happy accident: her kerplunk had knocked her low back and hip into some better alignment. That part, the ongoing pain, was improved for several days after the tumble, while the red-hot aspect of the fall reared up only if she lay on the ground, rounded her back, and rolled over a very particular spot. She found that spot, tested it, then avoided it assiduously.
The day for the pictures came. She lay in a tube, thinking how easy ultrasounds had been in comparison, just a nosy wand and some cold gel. Inside the narrow tube, she wanted to starfish her limbs or hula-hoop her hips, but knew she could not move a muscle. She had taken the technician’s suggestion of classic rock in her headphones, and tried to block out the machine’s banging with a suite of Bruce Springsteen’s greatest hits.
The doctor called and asked for more pictures, which made her nervous. She thought of her dead friend with back pain that was actually cancer and told herself to stop being a wuss. Lightning did not strike twice, and if another bolt was going to fly down from that particular angle, she’d already have been long dead.
After the second round of imaging, her doctor told her that she had fractured her sacrum, and showed her an image with a nearly clean horizontal line from one side of the bone to the other. She was shocked. Do you wear a cast for that? she wondered aloud. He laughed awkwardly and agreed, you couldn’t cast your butt. She noted that this man took the injury to her sacrum seriously; only when she said that the fall had felt like a fraction of what she’d been experiencing for the past two years did his face register a flash of empathy. But then, just as quickly, the doctor’s nose was back in the MRI report. She was missing half a vertebra, he said, but that was lower than where the referred pain presented: probably congenital. But this small bulge here—he pointed at something she could not see—might be a herniation, potentially calcified, or ossified, or otherwise problematic. That might be the source. He sounded unsure.
Her back popped and she wanted to kiss the woman.
The new doctor sent her to another PT, her fifth across three practices. A blessed, blissed-out woman, older than her, and wearing those rubberized shoes with toe slots, calmly looked at her chart and at her back and had her do exactly one stretch during their first session. Her back popped and she wanted to kiss the woman. (She also wanted to bend forward, or to the right, but both of these motions were verboten, as was anything as high-impact as running.) Do only this, and do it hourly, the therapist advised.
She followed those instructions for three months, paying no heed to her earlier maybe-lesson about lopsided strengthening. She made some progress, in terms of pain and popping. (Later, her seventh PT—the sixth was maybe AI, maybe a real person in Asbury Park; it was hard to tell—would say this advice had been bullshit. While she was protecting her spine, several important muscle groups had atrophied precipitously.)
Did you think, among all the doctors’ offices and stretching sessions, she’d forgotten about Kovalyov? Of course not. His was a metaphor that kept giving, a storyline that offered, if not comfort, at least company. While she’d been moving from one appointment to the next, Kovalyov has been busily running around the city, in search of his lost nose. In time, he finds it. He finds it!
Dear reader, mute those celebratory trumpets, because, as Gogol reminds us, “there is nothing enduring in this world, and that is why even joy is not as keen in the moment that follows the first; and a moment later it grows weaker still.” Case in point: Kovalyov, again in possession of his nose, has another freak-out: What if the nose doesn’t fit back on his face?
Alas, it does not. He calls the doctor.
The doctor’s assessment of nose reattachment: “Can’t be done. You better stay like this, or we might make things even worse. I daresay, I could do it right now for you, but I assure you it’ll be worse for you.” Kovalyov is insistent. He’ll hold it up himself; he promises not to dance or otherwise jostle his schnoz. The doctor is equally insistent back at him: Let nature take its course.
The quick-dissipating euphoria, the easier-to-say-than-to-do patience prescribed to Kovalyov, felt all too familiar as the efficacy of her beloved stretch dimmed. She was the possessor of an unattachable nose, close but inordinately far from her goal. And so, with her PT’s qualified encouragement, she scheduled an epidural to numb the nerve pinched by the suspect vertebra. Then she canceled it—cold feet, because plenty could go wrong. Then she had a flare, and scheduled it a second time. It was August again (two years from the first ice pick) and the air conditioning was broken in the procedure room; for her, forever cold, it wasn’t a problem, but the doctor, with his heavy X-ray vest, had a disconcertingly damp forehead. Even as she understood it was an HVAC issue, the clamminess was unnerving.
The first epidural didn’t do anything except keep her from partaking in a friend’s pool party because she had been told to avoid swimming or baths for forty-eight hours. When she described the procedure’s lack of effectiveness at a follow-up appointment, the doctor nodded. We can get closer, he assured. She wanted to ask why he’d not gotten closer the first time, but thought that might sound rude, aggressive. She needed this man to like her, to believe her, to think her legitimate. Or he already didn’t, but she didn’t want to make it worse. She wouldn’t be so argumentative as Kovalyov with his doctor; she knew better.
The second epidural hit its mark: she could feel a strange sensation shooting down the nerve, all the way to her heel. It was marginally helpful. At the follow-up, the doctor explained the relief might hold for a few days, a few weeks, a few months. She was going away for work again, to the top of a mountain this time, and worried about a flare hitting when she was a long way from everywhere. He gave her a large packet of steroids and said that if the epidural didn’t hold up, she should take them. The next step, upon her return, was surgery.
At surgery she started crying. She’d read books about the back pain industrial complex, about the long recovery and relatively low success rate of spinal fusion, about the godforsaken expense and the cyclical nature of back operations—one meant she’d probably have two, three, four, that she’d be dealing with this the rest of her life. She was only forty! She thought of backing up a car with very bad sightlines, that eighteen-point turn. The doctor didn’t have anything like Kleenex in the exam room; he handed her a fistful of scratchy paper towels. Watching him, she thought: Who broaches the idea of back surgery without access to tissues? Was she the only person with chronic pain to succumb to tears? Surely not.
But impossibility seemed more possible now. Because her pain, at twenty-six months, was toddling along, stringing together words that could be generously construed as sentences. Two years of utter discomfort, of inconvenience and disrupted sleep and lame sex and foul moods and not moving her body the ways she wished to. She, who had learned to run from nothing, had stopped running, and nothing had swallowed her again. The anxiety of the unknown had been replaced by the certainty of the ongoing, which was even more exhausting, more isolating than those early, confused days. She was a different person now: not a runner, not a mother, not a person living in the land of wellness. She would have to accept that she was no longer someone who ran along lakes and across bridges, who returned home sweaty and strained but feeling that all was right, or right enough, in the world. She collected the steroid prescription and resolved never to speak to that doctor again.
She went to that North Carolina mountain, walked slower than she’d have liked through flame-leafed hills that would, exactly a year later, be sloughed away in their own cataclysmic deluge. She came home to a life, for better and worse, different than what she’d imagined for herself.
She found a new doctor, another PT, and did the slow work of getting stronger. Her partner learned to tell her pain level by the scowling variations on her face; he acted kindly, plugged in heat pads ahead of her approach on days her pain reared up to howling levels. She accepted, grudgingly, that she would regularly forfeit focus to her injury, that she’d drop whole days of productivity to pulsing discomfort. Her life became correspondingly smaller, less ambitious.
Unable to run, she walked across reclaimed meadows in her new town, watching hawks dive from the sky. She finished writing a book while sprawled on her belly. She had lost something she’d thought vital to her being, but she was not dying, not yet. Her pain turned three, trundled toward four.
After the diagnosis of the sacrum fracture—she had literally broken her back!—friends finally started asking how she was feeling. Where have you been for the last several years? she wanted to ask, or yell, or yell-ask in justified indignation. My pain is legitimate, even without confirmatory imaging! They nodded sympathetically, but also told her to work on her cognitive behavior, or to go to this surgeon, or to avoid surgery at all costs. She stopped talking about it, unless someone asked directly. Her jealousy for her mom-friends and friendly runners dimmed; the rage, though still present, retreated into a small blue flame.
She was sure that this was not how things were meant to go, but she also remembered the end of “The Nose.” After Kovalyov’s madcap and maddening run around the city trying to reclaim his nose, after it is found and the doctor says it cannot be mended, after Kovalyov is pushed, pushed to the edge… he awakens one day and his nose is back where it’s meant to be, right between his two cheeks. He gets a shave from a similarly dazed Yakovlevich, then steps, staggered, out into the city. Life on the streets is normal, even if the shadows of his torment remain. In closing, the narrator—maybe Gogol himself, maybe some unbodied voice in the sky—admits that Kovalyov’s ordeal could have been real, as unreal as it sounds. Cities flood, bodies break, noses disappear. “Where aren’t there incongruities?” Gogol’s narrator asks. “Whatever anyone says, such things happen in this world; rarely, but they do.”
She needed that to be true: both for Kovalyov’s continued companionship along her surreal journey, but also so that one day she, too, might wake up to a world where nothing bad had ever happened—not storms, not pain, not a universe set on dismissing her…. Such an outcome was improbable, yes, but here was something she knew for sure: While the pen was mightier than the sword, it also offered the world’s most soothing balms, relief stronger than the highest-voltage needle. Gogol’s pen could—it would—carry her to that day. And on that blessed morning, when she awoke, the window would again be just a window, a sashed wooden frame and a pane of glass showing her a sky that was cloudless and blue.
Emily Nemens is the author of two novels, Clutch and The Cactus League. Emily spent a decade editing literary quarterlies, including leading The Paris Review and serving as co-editor and prose editor of The Southern Review. She teaches at the Bennington Writing Seminars and lives in New Jersey.
