Dana Spiotta - Stone Arabia

How could I have missed how things had begun to escalate? He had developed a swollen foot, which made standing difficult for him. I determined it was a kind of rheumatoid arthritis — what they used to call gout. I came by to bring him some prescription-strength anti-inflammatory pills that my doctor prescribed for what he used to call premenstrual syndrome but now depressingly calls perimenopause syndrome. Nik had called me, complaining of a tremendous pain in his toe. I dismissed him at first, but it soon became clear he really was in terrible pain. He didn’t have insurance, of course, how could he? And he felt too stupid to go to the emergency room over a sore toe.

I got off the phone and went straight to work. I made my diagnosis through the internet. I spent several hours (it was never less than that when I tried to figure these sorts of things out) online. I typed symptoms into search engines (inflamed toe highly painful) and then tried to evaluate the vast responses such searches returned. I would “refine” my search and try again, as instructed. Eventually I reached a stasis, a sameness and repetition factor, that would lead me to a hypothesis. I figured that if enough people said it (wrote it) in enough places, that had to mean something. I thought it was gout. I plugged gout in to Wikipedia. Here is what I found:

Gout (old name: podagra) is a form of arthritis caused by the accumulation of uricacid crystals (due to hyperuricemia) in joints. It is an immensely painful disease, which in most cases affects only one joint, most commonly the big toe. Patients with longstanding hyperuricemia can have tophi (uric acid stones) in other organs, e.g. the cartilage of the ear.

Historically known as the “The Disease of Kings” [2]or “Rich man’s disease.” [3]

I also found the Wikipedia boilerplate medical disclaimer:

Wikipedia contains articles on many medical topics; however no warranty whatsoever is made that any of the articles are accurate. There is absolutely no assurance that any statement contained in an article touching on medical matters is true, correct or precise.

I was, out of necessity, less rigorous than Wikipedia. I concluded that the prescription-strength nonsteroidal anti-inflammatory, coupled with Preparation H liberally applied to the swollen toe, would offer Nik some relief.

I stopped by Nik’s house, his “hermitage,” aka Western Lights in the Chronicles, which in actual life is an eight-hundred-square-foot apartment over a dilapidated garage studio. I liked the last part of the long drive from my house to Nik’s apartment: up and over the winding Calabasas pass to get to the secluded and forgotten corner of Topanga Canyon where he had lived the last twenty-odd years. The best thing about the place was it was set back from the road, hidden behind several gnarled canyon oaks and clumps of shrubby manzanitas. Nik had divided the upper space into two large rooms by building a wood screen. One was the bedroom. The other was the living room/kitchen. One wall offered mottled light through a row of prefab aluminum-framed sliding windows that were characteristic of the flimsy warm-weather structures built in the fifties and sixties, back when Topanga was still a rustic, bohemian paradise full of artists and disaffected underground movie actors. The edge of the yellow-and-brown vinyl linoleum kitchen floor had up curled at the threshold join to the main room, so it caught your shoe and tripped you when you walked through; the Formica counter was cracked and peeling; and the kitchen ceiling had radiating cycles of ancient water-damage stains. But it was not dirty — Nik always kept things clean and in working order. The double garage underneath was given over to Nik’s use, so he had room for his recording studio and for storage. Nik spent most of his time down in his garage/studio or at his worktable. The upstairs rooms underlined how the rest of his life (eating, sleeping, fucking) had become increasingly rudimentary. He had never been single for more than a month until these last few years. His last (known to me) girlfriend was Alize. Alize was okay, I guess. She was a washy blonde, very thin, very aloof. After their first inseparable year of lap-sitting and private jokes and finishing each other’s sentences and cigarettes, they didn’t get along at all. They continued on and off for several more years; she kept turning up so much I thought she might last forever. But two years ago she finally got married to someone else, and I wasn’t sure, but I was pretty sure, that they no longer saw each other. (Alize was still on the short list of people who got CDs. She was number three, I believe.) I never got very close to Alize. She was forever trying to enlist me in emotional manipulations of my brother, trying to get him to “get real.” Which was really funny coming from anyone who knew Nik at all. She once suggested we do an intervention, a cruel and crude ganging up on someone by every known and trusted intimate in his life. I refused.

“This is a person, if there ever was a person, who will not change. I promise you, what you have is all you will ever get,” I told her. But she knew that. We all knew that. It was just very hard to take, his obsessive work habits that yielded (what felt like) willful esoterica combined with his truly unsustainable consumption habits. Accepting a person like that in the long term is hard even for a sister, but beyond hard for a lover. Especially as Nik got older, the real issue, I think, although no one will admit it, became Nik’s lack of resources. He lived with no financial future, a middle-aged dive-bar worker with no ambition about money. Few women could accept that. I used to dream he would meet a very rich artsy widow who would fall in love with him and his work. She would sponsor and keep him. I remember even counting on it as a real possibility — for many years his wide-set gray eyes and his angular hollows made him a prodigious male beauty (albeit the oddball/bizarro type) — but the rich benefactress never appeared. Not even close.

The door was open when I arrived. I found him lying on the couch in sweaty, red-faced pain. I could smell that Nik had been drinking (to alleviate the pain, of course). He couldn’t put a sock on and certainly not a shoe.

“You gotta go to the doctor.”

He laughed.

“What?”

“I’m really broke right now. I’ve already missed a week of work.” I nodded. I tried to put the Preparation H on the swollen sausage toe. He yelped. I gave up.

“Maybe you should go to the emergency room,” I said. “They won’t make you pay. I can take you over there.” He shook off this suggestion. He took a sip from a glass filled to the brim with a caramel-colored liquid and a few melting ice cubes. As he swallowed, he closed his eyes and took a sharp breath in.

“You know, drinking really makes it worse.”

He nodded, as if to say, No doubt.

“But especially beer. You can give up beer, can’t you? Don’t make me tell you about tophi and what unleashed urates eventually will do.” And I also knew, but did not mention, that this gouty arthritis could often develop in tandem with much more serious illnesses, this feature being sweetly termed comorbidity . Not wanting to alarm him, I did not mention the list of possibilities delivered to me via the flowing and all-leveling directionless coursing of my online research. But the huge amounts of repetitive medical data, the folk guesses stacked next to scholarly papers, the self-help encyclopedias by the pay-per-access medical advising sites, the automatic diagnostic tools that led to the badly designed sales sites of holistic treatments — all of it — were not directionless, actually. They all led back to you and your lonely, sad little search. Each decision you made, each click or go-back button, each time you put one more thing in the search box or bookmarked a page, this was your desperate, pathetic self applying some insular logic and order to the information, however inadequate it might be. It exhausted you because you got lost in the flow of endless data, and it exhausted you because you never stopped trying to find your way in it, to apply some little spit of personal agency to it. It was a fucking war, that’s what it was.