Love and Ravioli Part 1


Will I live long enough to see the Broncos win the Superbowl?

I woke up. My back was stiff and painful, not in the bones, but in my organs. I’d had a fun weekend, eaten ravioli, now I would pay the price. Now Sauron was awake, rampaging through my guts with heavy siege and cavalry. I dressed and headed in to work.

“You’re moving slow,” my boss turned his chair to face me. The guy was a millionaire who had amassed his wealth pinching pennies until their atoms split. If time was money, then he was looking at the clock.

“I’m flaring,” I leaned back in the office chair. My face went dark as the pain intensified. This could ruin everything.

“What’d you eat?” Eric’s eyes narrowed.

“I don’t know,” I lied, remembering the delicious pockets of glutenous cheese, the pint of vodka, the tender prime rib.

“Take a pill,” he turned back to his computer and fired an email off to some distant, artless client.

“I haven’t got a pill.” My shields were down. Terror spread through my limbs. “I ordered two bottles. They both got sent back.” For the past three years I had been regulating my Crohn’s disease with diet, exercise, and the occasional dose of steroids. The method was effective. I’d been symptom free long enough to grow complacent.

“The SMP is through the roof!” My boss hit his desk excitedly, “Hey, Beary!” He called over the cubicle, “the markets are crushing!”

“I didn’t hear you saying anything two weeks ago,” Beary growled.  Beary’s real name was Brian. My boss nick-named him Beary because he was always trying to beat the market by selling short. “The fundamentals are out of whack,” Beary held his philosophical ground, “it’s only a matter of time before everything crashes.”

“You can attend my clinic next weekend,” my boss nudged me with one elbow and winked. Brian knew more about stocks than anyone, especially my boss. “I’ll be going over my key strategies with a break at noon for lunch.”

“Shove it up your ass, you fucking prick.” Beary had anger issues. Making him yell was one of Eric’s favorite pass times.

“You got those files yet?” He turned his chair back towards me.

“Working on it,” I clicked around anemically in Photoshop. Aesthetic decisions come slow when you’re in pain.

“Hey, Danny,” Eric called over the cubicle, “you got your meds on you?”

Danny was a big lug with a kind heart. He came into our office, confused and annoyed. He didn’t like my boss shouting about his disease, “What?” He asked in a hushed tone.
“Nate Dog is crohnsing,” my boss stuck his thumb in my direction. “Can he have one of your pills?”

Danny had Crohn’s disease as well. He looked down at me and sort of took a step back. He was a rich guy from a wealthy family and didn’t want my bad luck splashing on his shoes. “I don’t have any pills on me,” there was fear, or maybe concern, in his eyes. “Call your doctor.”

“I did,” a stabbing ache shot through my back, “but I haven’t seen him in three years.” I drummed my fingers on the desk rhythmically, trying to ignore the increasing pressure. “Plus, he’s a dick.”

“What did he say?” Danny backed out of the cubicle.

“I’m waiting for the-” Danny disappeared around the corner, “-call back.” I finished quietly to myself.

“What’d you say?” My boss asked. He was writing another email while listening in on a conference call.

“I’m going to lunch.”


I wandered up Lafayette, past crumbling buildings constructed somewhere between the Victorian and modern eras. The half-hearted facades represented a transitionary period, with arched windows and Doric columns molded from concrete. Form was giving way to function, embellishment to the bottom line, a young country’s first attempt at architecture.

“Hello?” I picked up my phone.

“Yes, Nathan, this is Trudy from Dr. Kugelmaas’s office.”

Doctor Kugelmaas, my ancient foe. Three years ago Sauron escaped my belly and possessed the evil gastroenterologist. In human form, the Lord of the Rings prescribed me prednisone, a steroid with terrible, unpredictable side effects. The resulting delusions gave birth to four books, madness spilling out my fingers like spoiled wine. “I was a patient a while ago,” I began to explain, “and I have Crohn’s disease and I’m having a flare up so I was hoping I could get a prescription for prednisone.”

“Well,” the nurse went into my file, “I’ll run it by the doctor, but he generally doesn’t prescribe medication to patients he hasn’t seen in this long. Would you like me to set up an appointment?”

“I live in New York now,” I felt my heart sinking. “Do you think he could send the script to a pharmacy out here?”

“I’ll…” she paused. It was a stupid question, one she already knew the answer to, “… run it by him, but you should probably go to the Emergency Room.”

The Emergency Room, that horror show of needles and debt. Three years ago I’d stumbled through those white-washed walls and been pumped full of psychosis and misery. I didn’t want to go back. I needed prednisone, not CT scans.

“OK,” I lied. Maybe she would ask the doctor. Maybe he would come through.

Sauron laired in the front of my intestines, on the left near my groin. The little ulcer, if antagonized, was strong enough to send me into convulsions, but now the pain was radiating from my lower back. The damage was spreading. What if I broke into a pharmacy and stole a bottle of prednisone? Did they alphabetize the prescriptions or were the medications sorted by type? It would be hilarious to see the news reports that night, confused policemen trying to come up with a motive for my desperate crime.

I stopped in a tree-lined area full of concrete tables for chess players. A bum had set up one of the boards with pieces made out of garbage. The array was haphazard and erratic; wild knights stood next to towering rooks, tiny pawns defended the front lines. None of the pieces were the same color. The bum was alone, surrounded by garbage bags containing everything he owned, waiting for someone to join him. Another stab shot through my back. I continued down the street.

The sky grew dark with clouds. Last time I’d suffered for eleven days, vomiting until I shriveled down to nothing. Last time the pain had almost killed me. Was I getting weaker or wiser? Were the two synonymous? Uninsured and helpless, I limped towards Urgent Care, hoping to find a doctor that would have pity on my soul.

“How can I help you?” The friendly receptionist looked up from her computer.

“I have Crohn’s disease,” I touched the small of my back reflexively, “and I’m having a flare up.” The pain sort of twisted inside, sending my neck into a barrel roll that ended when my ear hit my shoulder. I leaned forward and rested my elbows on her desk. “Is there someone here that can write me a script for prednisone?”

“We can get you into a doctor.” She gave me some forms to fill out, “The visit will cost $125.”

“What are the odds I’m going to get this prescription?” Fear crept into my eyes.

“We won’t charge you if the doctor can’t help,” sympathy and another smile.

I stood as straight as I could and walked over to the waiting room chairs. I’d been buying prednisone from retailers in India for $100, no prescription necessary. I took micro doses whenever I felt like cheating on my diet. But I wasn’t in India and it took weeks for the packages to sneak past customs. Sometimes they didn’t make it. The ache grew louder. It was getting hard to think. I filled out the forms, turned in the clipboard, and began pacing around the waiting room, trying to outrun the pain.

Where are you? My boss texted.

lunch at urgent care. I replied.

Whoah. Hope you’re okay.

So long as I was on a lunch break, he wouldn’t hold it against me, but if the ordeal spilled over, I would have to make up the hours. Sometimes he tried to convince me he was human, “I care about you. I really do.” But mostly he talked about the stock market and the price of various items he had purchased.

Ten minutes passed. A cute nurse in black scrubs led me into a room and took my vitals. She asked a bunch of questions about my family history and allergies to medications. The questions were irrelevant. I had Crohn’s disease. I needed steroids— not enough to send me screaming down the rabbit hole— just a little to get me over the hump. The nurse recorded my answers, then left to find a doctor. I sat on the cushioned table covered in butcher paper and tried not to moan.


The doctor burst into the room, pushing the door open with a fierce intensity. “You look pale,” he said immediately, his fervent eyes darting about like some sort of medicinal genius. The way he entered, the way he moved, it felt like he expected to catch me doing something wrong. “Typically steroids are not the first line of defense.” He advanced towards me like a fighter in a ring. I wanted steroids. It was an unusual request. “Lie down on your back.”

The man was young, with dark wavy hair, glasses, and Indian features. I laid down and let him poke and prod, “Breathe in.” Poke. “Breathe out.” Prod. He scanned me with suspicious, genius eyes, looking for what, I did not know. “You’re a tough guy.” He said after a barrage of finger jabs. “You hide the pain well.”

I wanted to explain that I wasn’t hiding anything, that the ache was deeper than his fingers could reach, but the words wouldn’t form. I was in too much pain. My silence made me look tough. In reality, I was praying for death.

“Your stomach is not distended,” he stepped back and put one finger to his chin. “And there’s no bloating. “Has there been blood in your stool?”

“No.” There had been blood on my toilet paper, but that was from extra wiping in the wake of my recent ravioli dinner. The doctor was asking about a deeper kind of blood.

“I don’t think you’re having a flare up,” he kept staring at me, those forceful eyes weighing every possibility, “but there’s another test I can do.” My heart sank. The idiot was going to make me go to the Emergency Room. “It involves a physical examination of the rectum.” He held up two fingers like an obscene benediction from a wayward Pope.

“Seriously?” I felt my sphincter palpitate.

“Or you can go to the Emergency Room for a CT scan.”

CT scans were the worst. They made you drink obnoxious liquids that turned your insides radioactive. Then they pumped you full of costly chemicals and scanned your insides with a donut made of science. I was still paying off my first one from three years before.

“Does she have to be here?” I nodded towards the cute nurse. She left the room immediately. I guess the feeling was mutual.

“Pull your pants down to your knees and roll over on your side,” the intense doctor spread a butcher paper blanket over my lower half. “Do you engage in forms of anal intercourse?” He pulled a turquoise latex glove over one hand.


“Then this is going to be uncomfortable, but it won’t hurt so long as you relax into it.”

Don’t think about pink elephants. Don’t worry about cute nurses. Don’t clench your butt cheeks as a grown man penetrates your rectum. The doctor shoved an unknowable number of fingers up my ass. For the briefest moment it didn’t feel so bad. “Your prostate is fine,” he massaged something somewhere that had never been touched. Then he rotated the menagerie 180 degrees, splaying his fingers in every direction. It hurt. The space was shockingly cavernous. I couldn’t believe how much room there was in there. I’d always pictured a little tube, but the doctor was exploring some massive hollow. I tried to remain still, but awkward groans escaped my lips. I thrashed reflexively, and bit my tongue. “Almost done,” the doctor held me like a flopping halibut, pushing deeper with his merciless fingers, searching for blood and intestinal sloughing. Eventually, impossibly, he removed his fingers. “You can pull your pants back up.”

He wiped the offending digits on a test strip and squirted liquid on the surface. I hoped the humiliating experience had saved me from the Emergency Room. “This is the control,” he showed me the strip, pointing to a blue section that had changed color when liquid hit its surface. “If you were flaring, there would be blood, and the blood would have turned blue.” He pointed to the still-white test area, then he threw the test strip into the garbage. “You need a CT scan,” he took off his gloves and turned to face me, “but we don’t have one here. The source of your pain could be almost anything—  kidney stones, appendicitis, anything.” He sat down and began filling out paperwork.

“I’m uninsured,” I looked at my feet, embarrassed.

“Go to Bellevue.” The doctor kept writing. “The wait is longer, but they’re set up to handle uninsured patients. The staff rotates in from NYU and they’re great about not sending people to collections.” He finished the transcript of our brief, forceful meeting, and left the room. I followed his lead, “Good luck.”

“No charge today,” the girl in the waiting room printed out the doctor’s findings, “You want me to look up the address for Bellevue for you?”

“Sure,” I leaned against the desk. There was no way I was going to the Emergency Room. Kugelmaas would call. The nurse would convince him of my need.

But if she didn’t…

On the walk back to the office it started to rain. The drops fell on the paper with instructions from my doctor. By the time I got back to my cubicle it was soggy and torn.


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