Jacob Brogan

The world is always ending

Healing: I. Self-care

            There was a prescription for Percocet in the papers I was handed when I left the hospital. I had been told that I likely wouldn’t need to fill it. Pain management? You’ll be fine with Tylenol. Probably. We’ll give you something else just in case. Still thrumming with anesthetics as I signed the discharge forms, I was unconvinced. Five days later, I realize to my puzzlement that even the aspirin I took at first was largely unnecessary. My neck had been open on an operating table. Catherine saw blood on the surgeon’s shoes. Shouldn’t I hurt more?

            We are creatures of sensation. What are we when we are without feeling? I have shrugged off pain medications for most of my life, but not because I am particularly tough or resilient. Watch me whimper as the nurse pulls out my IVs and you’ll know how weak I can be. To the contrary, I have neglected narcotics because I can’t convince myself that they’ll do any good. Perhaps at some level, I am also afraid of going numb. If I flee from my pain, don’t I also flee from myself? In this question I bury a belief that pain makes me. How, then, do I care for myself in the wake of a procedure that leaves me feeling almost nothing at all?

            In the absence of pain, surgery itself does not seem entirely real. It had taken time for the emotional reality of cancer to set in. Now I find it difficult to believe that the disease is actually gone. I am not entirely free of discomfort, of course: Something in my neck occasionally throbs. Once in a while I have difficulty swallowing. But these feelings are nothing new, hardly distinct from the spare symptoms of my sickness. Mostly I ache, and in aching know that aches are as distinct from pain as they are beholden to it. Aches are nothing if not the body’s longing for a more acute species of feeling.

            In the first days after I came home, even aching eluded me. My discharge papers indicated that I should call in if I noticed a tingling or numbness in my lips. This would signify a calcium deficiency caused by the temporary displacement of my parathyroids. While I understood the risk intellectually, I was not prepared for the disappearance of everything below my nose and above my Adam’s apple. Plunge your fingers into ice water and you can still see them, even if your body refuses to acknowledge their presence. The same is not true of our features. At lunch with Dave, I prodded at my face, trying to remind myself that my jaw was still there, that I was still there.

            Staving off this numbness had consequences of its own. At my surgeon’s instructions, I began to take a massive daily dosage of calcium, a dosage so large I also began a regimen of clinical strength vitamin D to help me absorb it. These supplements, distributed throughout the day at regular intervals, have largely done away with that terrifying non-feeling. Just after I began to take them, however, I was overcome by a depressive exhaustion. This, at least, I recognized: I had felt it during the first onset of Hashimoto’s disease. These were signs of hypothyroidism. As best as I can tell, the calcium tablets were interfering with my levothyroxine, the medicine I take to replace the thyroid hormone T4. The next morning, I was able to avoid the effect by waiting an hour between my first wave of pills and the second of supplements. And so began a process of rigorous diurnal organization.

            Discipline. My day segments monastically. This is my Horarium: Three whitish pills of increasing size with Prime. Two orange ones and a chalky tablet in place of Lectio Divina. More chalk at Chapter, Sext, and Vespers. Shots of clear insulin injected throughout. Introspective self-evaluation, both biomedical and emotional at all times. Two more orange pills after Compline. More insulin and chalk too. Then to bed.


            Such ordered restrictions might easily feel like restraints on our very personhood, but they need not. In his final works, Michel Foucault suggests that a commitment to self-making was at the heart of ancient stoic self-care. Preoccupied with issues of regularized appearance and comportment, the stoics sought to structure the ways that others saw them. No mere quietist submission, these routines were designed to delimit any claims the world might make on those who practiced them. In the process, stoic rituals allowed philosophers to better understand their own capacities and limitations. Stoic self-care, Foucault proposes, was ultimately a matter of deliberate self-formation.

            Selves are not made in the fact of feeling, but in the ways we negotiate what is and is not felt. Chronic illness invites rituals of self-care. Passing sickness disrupts those rituals, and in disrupting remakes them. Merely staying on my feet demands discipline, but in discipline I feel myself moving, breathing, surviving.