The wounded woman gets called a stereotype and sometimes she is. But sometimes she’s just true.
–Leslie Jamison, “Grand Unified Theory of Female Pain,” The Empathy Exams*

On the day before New Year’s back in 2021, I found myself riding the train to work when, one stop after mine, a vaguely familiar woman got on. Or maybe I should say, struggled on. She was, I guess, in her sixties, heavy-set, apparently in pain, though not from any obvious cause, and was struggling with a shopping cart full of possessions. At first, in a reflexive reaction to the shopping cart, I took her to be a homeless person, but that turned out not to be the case. She clearly had trouble moving, and had trouble getting the cart onto the train. I half got up to help her, but not knowing how my gallantry would be received, sat back down and watched her struggle. It was rush hour, just before 8 am.

She wasn’t well-dressed in any conventional sense of the term, but also not as ill-dressed as you might expect a homeless person to be. She sat down heavily, sighing, took out a cell phone, and began to speak. She had a loud and grating voice, which she poured into the phone in the direction of someone named David on the other end, evidently a partner or something like it.

My first reaction was annoyance. I hate noise. I hate noise on the train. I particularly hate noise on the train when I have to work the day before New Year’s. You wonder why people can’t wait to have their fucking conversations off the train rather than on it. But it was, for once, hard to feel wholehearted annoyance. I wasn’t sure why. The woman was, as I say, vaguely familiar, and I sat there a moment trying to figure out how I knew her.

The call with David didn’t go well. It started out OK, at least from the part of it I could hear. The woman told David, with a muted but sort of touching pride, how well her day was going so far. It had apparently started out several hours earlier in East Brunswick, a non-descript town nearby, where she had, with her cart and all her stuff, taken a bus to the train station at New Brunswick, a local train hub. Arriving at New Brunswick, she’d managed (I gathered) just barely to race up the stairs and catch the train to New York, where (I gathered) both she and David lived, though in different places. All in all, she’d managed rather well, hadn’t she?, she asked. Here she was, sitting on the train to Penn Station, making good time. She’d be there by 9.

I started to soften a bit at this point, my annoyance giving way to an odd sort of protectiveness. The woman’s pain briefly became real to me–accentuated I suppose, by the incongruous pride she took in her rush hour accomplishment, and the possessive care she exercised over her shopping cart. Maybe this is a special brand of commuter empathy, but for a moment, a vivid image of her came to mind, dragging the shopping cart around East Brunswick and then New Brunswick, straining against whatever pain she was suffering to make the bus and the train, precious cargo in tact. It’s no picnic lugging all that stuff around during rush hour on New Jersey Transit. Add chronic pain to the mix, and you get an ordeal. Something in me wanted, briefly, to make contact with her–touch her shoulder, offer a consoling word–but discretion suggested otherwise, so I didn’t.

The phone conversation continued. She was, the woman said, going to arrive in New York within an hour, and would be home maybe an hour after that. What did David think about the idea of her coming over to spend New Year’s together?

He clearly thought it was a shit idea, and said as much. He made plain that the woman was a burden and a bother, and made plain that he wanted her to fuck off and leave him alone. It seemed to take awhile to explain why.

I saw the woman’s face crumple, then harden, then crumple, then harden again. From hopeful expectancy, she fast-forwarded over grief and settled into rage. Why, she asked out loud, did David have to be such an asshole about everything? Was it such a crime to want to spend this supposedly celebratory night in company, rather than alone again, suffering in her apartment? Did he not understand what it was like to suffer chronic pain? Did he not see the achievement she’d managed so far that day? Did he not see that they would both be gone some day, and regret the missed opportunities for connection?

He didn’t seem to give much of a damn about any of that. The woman’s rhetorical questions continued, seemingly for an eternity, punctuated by profanity on both ends of the line. Though perched at the edge of tears, she managed somehow to stave them off, and sustain her rage for the rest of the call. Eventually, her rage exhausted, she hung up on David and called a female friend, maybe a sister, to vent. The friend was clearly more receptive to the woman’s message than David had been, allowing her to pour her anguish into the phone without interruption. I started to tune out at this point. My stop was coming up, and I needed to remember to get off and go to work. It was also starting to dawn on me why the woman seemed so familiar, and I wanted to be off the train once the realization hit.

It hit full force somewhere between the train and a nearby parking garage. I hid underneath a stairwell, crumpled into a heap, covered my head in my hands, and let it all wash over me, sobbing, until it left. The woman on the train was the ghost of my late wife. She looked like Alison, or like an older version of her. She sounded like Alison, and somehow acted like her. Same chronic pain. Same shopping cart. Same struggle with the shopping cart on mass transit. Same need to lug her life’s possessions with her everywhere she went, like a homeless person. Same insensitive asshole of a partner, tired of her, tired of life, contemptuous of the holidays, desperate to have the world fuck off for a change and leave him alone.

I don’t believe in ghosts, of course. I just mean that, dreams aside, this woman’s presence on the train was as close as one gets to seeing a ghost. The woman was Alison had she lived another five or six years. And, crumpled there under the stairwell, I couldn’t suppress the thought that this–the woman and David–is what we would have been, had there been another five or six years. The consoling fantasies evaporated in that moment, the wishful belief in the amicable friendship we might have had if only Alison had  survived–a fantasy made plausible by the fact that there was no testing the hypothesis now that she was dead. Easy to forget that this is how things were when she was alive: this is the “empathy exam” I failed when passing or failing was a live option, as it no longer is.

Alison committed suicide in Toronto two years ago, after nine months’ estrangement from me. She’d suffered for almost a decade from chronic back pain produced by a failed laminectomy performed in an expensive, prestigious hospital in New York. An unsecured piece of equipment had fallen directly on her spine during the surgery, causing permanent damage. When she woke up, she was effectively crippled–unable to walk for months, unable to function for years, alone for most of her recovery, and saddled with chronic pain until the last moments of her life. She often told and re-told the story of her experiences in the hospital after the surgery: the duplicity of the surgeon; the insensitivity and neglect of the staff; the despair at the thought that she was, in the end, entirely on her own to cope with a form of torture invisible to everyone else, but unremittingly real to her. She could probably tell the story in her sleep. I knew it by heart.

It was the problem I was supposed to have solved. We’d been friends in the late 90s, but had had a falling-out around 2004. We re-connected twelve years later, and jumped headfirst, as middle-aged people do, into a torrid romance. But this was romance with a middle-aged twist: not just sex, not just fun, not just intoxication and excitement, but a sober attempt to grapple with the future, through friendship, companionship, and care. Neither of us would be alone again to deal with life’s travails. No more lonely nights of struggle and despair. The protective knight in shining armor was here, armed with Horizon Blue Cross PPO. Or so the theory went.

She was, when we re-connected after a long hiatus in 2016, still in physical therapy from the procedure, just getting to the point of something like recovery, but looking for something besides opioids to damp down the pain. She needed another surgical procedure to repair the damage done by the first one, but as the sole proprietor of a private therapy practice, couldn’t afford it on her Obamacare plan. We got married, in part, because as a salaried employee at a university, I had the kind of health insurance that would cover a dependent for such a procedure. And so, in early 2018, she got the second surgery–a Nevro HFX spinal stimulator inserted into her back, “a nondrug, FDA-approved, treatment option for long-term chronic pain relief…a small device, placed in a same-day outpatient procedure, that safely works inside your body to significantly reduce your pain and restore your quality of life.”

Except that the device didn’t quite perform the miracles it had promised to perform. And so the quest for pain relief continued for years after the surgery, each office visit necessitating yet another one to yet another specialist of some kind, each tweaking the failures of the last without ever getting us to the promised land of clinical success.

Which explains why Alison left our marriage and our home the way she did. I had, in May 2020, quit my job in protest at fraud I had discovered at my university, fraud that my Dean explicitly ordered me to cover up. What I regarded as a commitment to principle, Alison regarded as a betrayal. My “commitment to principle” had deprived her of the health insurance and access to health care that was her lifeline. In the grips of that rage, and likely in the grips of the manic phase of bipolar illness, she stole my car, stole a couple thousand dollars, abandoned all of her financial obligations (the mortgage, the HOA payments, the insurance payments, the taxes, the sewer bill…), and fled to Canada, where she had dual citizenship. She somehow managed to sweet-talk her way over the border at the height of the pandemic, without a passport, without proof of citizenship, and without a Canadian home address. “I just told them I had come home,” she said in explanation, “and they believed me because that’s how Canadians are.” I found it inexplicable, but then, I’m an American. What would I know?

She ended up totaling my car while ogling the CN Tower in traffic–”you know how much I love that building”–then trying to commit insurance fraud by collecting on the payout, ignoring the fact that it wasn’t her car, and wasn’t her policy. Geico owed her the money, she insisted, because it was undeniably her accident. It’s a miracle she didn’t get arrested. But then, it’s a miracle she got into Canada. Odd how Alison’s miracles tended to solve her problems by abetting them.

Having totaled the car and committed insurance fraud, Alison then decided to initiate a contested divorce action against me. The lawsuit led to a predictable ban on communications between us. Months of eerie silence ensued, interrupted only by intermittent violations of the ban on both sides, when one or the other of us got sick of waiting for some lawyer to do this or that trivial thing. People sometimes ask me what the “contested” part of the divorce was about, but despite having read the filing over and over, and having spent tens of thousands of dollars to resolve it, I still have no idea. Neither does my lawyer. Neither, I guess, did the judge, who eventually dismissed the case. Unfortunately, it took a year to get to dismissal, by which time she was dead, and I was nearly bankrupt–but widowed rather than divorced, if anyone’s keeping score.

But I’m getting ahead of myself. Dismissal was well in the future; it didn’t happen until late fall of 2021, months after Alison’s death. Meanwhile, back in 2020, there was more stuff to lose. Having lost the car in the fall of that year,** we ended up losing our home in late 2020, averting foreclosure by two weeks by selling the house at the very price at which we’d bought it, just breaking even, but at least getting it off our hands. I vacated the house the day Alison drove down from Toronto with the cat to collect her things. We crossed paths for five, final acrimonious minutes. The cat, disoriented at first, suddenly bounded up the stairs in long-lost recognition of me, and jumped into my lap. Alison didn’t quite follow suit. Her dismay at seeing me in the house–I was supposed to have left by then–was only too apparent. She started screaming. I screamed back. We both called our lawyers. Mine advised me to leave the house immediately, so I did. I wasn’t done packing, but no matter. I lost whatever remained.

It really didn’t matter, actually: I’d already moved everything of importance to me. Things were different for her. Her whole life was in that house–patient records, keepsakes, favorite books, private journals, screenplays never quite written, research never quite finished. She was too ill, mentally and physically, to move any of it. And no help was forthcoming, either. I was under orders to leave, and in no mood to help. The stalwart friends who were supposed to show up to help never did. So she was under pressure, and on her own. The lawyers, the real estate agent, and the buyers all demanded that she pick up the pace and clean the place out, “per the contract.” The closing was a week away, and no, it wasn’t going to be delayed. Hundreds of thousands of dollars were on the line. No one was in the mood for excuses from a sick, deranged “Karen.” People who encountered Alison that December later told me that she acted very “oddly,” screaming, crying, dropping things, forgetting things. They didn’t seem that sympathetic. They’d always found her odd. Now she’d gone over the edge. Best to keep one’s distance. No telling what she’d do.

A video I later discovered of her on Instagram from that time depicts what looks to me very much like a dress rehearsal for suicide. She stares directly at the viewer, smiling enigmatically. She positions herself carefully in bed, then lies back, slowly, seductively, closing her eyes, until she comes finally to rest, eyes closed. The video ends. Some of her newly-found Instagram friends interpreted the video as a come-on. One commenter couldn’t stop with the lurid fuck-me pleas, months after her death: “you are so pretty! I would love to be yours for you cook me with butter in your oven, and than, you will bite chew me, you will eat me slowly, heal me and eat me!!” I eventually had to tell him to stop.

My last physical memory of Alison was the day we lost the house, December 17, 2020. I had vacated a week earlier and was supposed to surrender my key at 10, so I watched surreptitiously from behind a nearby fence at 9:30 as Alison loaded the last of her things into her rental car–pointlessly, given what was about to happen–put the cat on the front seat beside her, and drove off. I can still see the scene, her grim profile rushing by fifty yards away from me as she drove away. I often wonder if she saw me. I wonder what she thought if she did.

Isolated, eventually cut off from her American health insurance, disillusioned with Canadian Medicare, with only spotty access to her pain medications, increasingly unable to communicate in a clear or cogent way, unable to keep up her therapy practice, and unable to cope with COVID, Alison fell into despair. I saw this in her Instagram posts, discovered long after her death–full of anguish, full of cryptically disturbing messages about death and violence, dotted occasionally with coded references to suicide. Though I wasn’t aware until after her death that she was on Instagram, many of the posts read as though addressed to me, as though she hoped or was somehow confident that I would see them, but could only address me by stealth and indirection. It was the behavior of someone less familiar with me than afraid of me, as though caught in a labyrinth and exchanging messages with the Minotaur, as though in the futile hope of posthumously eliciting his empathy.

From an Instagram post of November 3, 2020:

The sun is setting on a lovely day. When the sun rose today, I regained my mind. I lost my mind over the last few days. To anybody I offended, I am deeply sorry. I have been too long in pain. I have missed my family and my friends more than I can say. I have particularly missed those I hold dear. Although there is a lot of music in the world, and stories in black-and-white and colour and in words, and our cats and dogs we love dearly, there just can’t be enough true friends, because true friends come along [only a] few times in a lifetime. And we know them when we meet them usually. There’s just that something that happens almost right away it seems. Even if you are, I am, my own best friend–and I need to be, to survive this sometimes dark, deadly world–there is no replacing those dearest to me. And I think I hurt some of those people. My profound apologies. I offer this beautiful picture I took this evening [of her neighborhood] as a way of saying what I need to say to those people. I’m so very sorry.

I wonder how much of that, if any, was meant for me.

Three years earlier, however, things had been very different: we’d been best friends and in love. Months after her death, I discovered a post of hers dated September 19, 2017, underneath a photo of our then-newborn kitten Hugo. For a long while, I thought it was addressed to Hugo:

Your smile. Your eyes. The way you laugh. The way you talk. The way you walk. I could stare at you forever.

It took an effort of will to grasp that cats don’t laugh or talk, and that she was using Hugo to talk to me–in the full knowledge that I wasn’t on Instagram, that I didn’t know she was on Instagram, and that there was no guarantee I’d ever encounter the outpourings of her heart, whether before her death or after it.

One of her last posts, a few weeks before her death, advertised her presence at a Death Café:

A Death Cafe is a scheduled non-profit get-together for the purpose of talking about death over food and drink, usually tea and cake. The goal of these nonprofit groups is to educate and help others become more familiar with the end of life.

My personal experience has been a lessening of anxiety relating to death. I think I actually need a “life cafe” to deal with my anxieties related to life!

Alison died somewhere between March 3 and 4, 2021. It was her second suicide attempt within the last few weeks of her life, and as far as I know, the third attempt she’d ever made, planned so as to coincide with a building inspection that was scheduled to take place on the 4th. She’d clearly chosen the 4th to ensure Hugo’s survival in the wake of her death, leaving a terse, hurriedly scrawled “suicide note” for whoever found her: “Please take Hugo (my cat),” with her father’s name and number underneath. Hugo, her baby, was the only one there with her at the end, the only witness to her final breaths.

I thought of Alison, even before she died, every time I set up a spinal case when I worked in the operating room at Hunterdon Medical Center, my first job after I lost my academic one. I’d go into each operating suite after we were done with a case, “making sure” in paranoid, Cartesian fashion that nothing had been left amiss. Bed locked, lowered, and level, and prepped correctly for the next procedure. Anesthesia table in proper order. Nothing on the floor. Canisters in place, attached to suction. Nothing loose or liable to fall down in the middle of the procedure. It had less to do with my official job description than with my Sisyphean quest for redemption.

I couldn’t begin to tell you what good it did, if any. It certainly didn’t do her any good. Alison died by her own hand, alone, in pain, without access to needed medications, haunted by the past, in despair about the present and future. And, Sisyphean histrionics aside, my own role in all this was hardly angelic. It wasn’t just that the woman on the train reminded me of Alison, but that David reminded me of me. Like David, I’d been consumed by my own worries–my mediocre academic career, my listless career prospects, the unapologetic corruption of my university–and had more than once acted out the role of self-absorbed asshole that David had: obsessive, insensitive, quick-tempered, verbally brutal.

Verbally brutal: my last conversation with her took place at 2 am on a weeknight, maybe three weeks before her death, and about half an hour after I’d come home from a ten hour shift in the OR, cleaning rooms full of COVID, MRSA, HIV, and C Diff. I was exhausted, as was the day’s Virtue Quota, and operating on Moral Auto-Pilot.

She called me out of the blue, violating our lawyers’ ban on communication, desperate both to come clean about what she’d done with the car, but also incapable of resisting the urge to prevaricate and demand my complicity in one last, petty fraud. The legalities were confusing, she’d lied to me too many times, the police had stopped me too many times, and I was too tired and fed up for patience or civility. I ignored her sincerity, fixated on her prevarication, and let her have it. I still remember what I said: it came so reflexively that it’s hard to forget. “I want you to stop calling me, shut the fuck up, and leave me alone,” I yelled. “I don’t want to hear what you have to say about anything. I don’t give a shit. I don’t care. Every word out of your mouth is a motherfucking lie. Everything you do is a scam. You want to communicate about the car? Have your lawyer talk to mine. End of story. Because just to be clear: when all this is over, I’m going to blot you out of my fucking life. So how about we start now?”

How about we start now. It was the last thing I ever said to her. I hung up without waiting for an answer. There was a month of silence. Then she was dead.

It’s hard to dwell on pain, especially someone else’s. Our minds don’t seem to be designed that way: we’re built to turn away from it, not to face it. You get sick of it after awhile, no matter how real it is for the other person. Their pain becomes a pain. Their life becomes a drag. So easy to overestimate your own capacity for patience or compassion until the moment comes, followed by another, and a third, and a fourth–endless cries of distress, an endless traffic jam of demands. I couldn’t help wondering whether that was the inevitable fate of the woman on the train. Another despairing soul, languishing somewhere in New York City? Another death of despair, care of the painkillers meant to make life bearable?

I once tried to assuage a friend’s moral worries about something with the thought that she had no cause for guilt or regret, because she had in the end, “done her best.” She brushed my claim aside with impatience. “How can we ever know that we’ve done our best?” she asked. Of course we could, I said. It’s self-evident. Either you did or you didn’t. Just ask yourself whether you did, and out pops the answer. No, she said, it’s not self-evident. Bestness involves a potential infinity of moral effort, a “more” beyond every “enough.” There’s always more you can give, so it’s always an open question whether there was a further quantum of effort toward bestness you could have put in that you didn’t. Far from being self-evident, it’s always an open question whether you really did your best. You can never really know.

The thought seemed preposterous to me at the time–like some weird bullshit out of Kant***–but no longer does. I wonder what my best is, whether I can ever know what it is. Did I fail the empathy exams, or did I pass? Was it a fair test, or was it rigged against me? Did I just squeak by, or did I do any better than that?

I sometimes stare awhile at Alison’s last photo and sink into it as though in expectation of an answer, but never get one. She just stares back mutely, withholding whatever it is she thinks. I see grief, resignation, exhaustion, and despair there, but surely at least a tincture of reproach. I think of it as her last, cruel gift to me. She was malicious enough to know that her suicide would leave me forever in agony and doubt about the role I played in making it happen. But she loved me enough to think, sincerely, that the agony would do me some good. And I still believe in her enough to think that it will or has. Whether I did my best, I don’t know. Whether I’m doing it now, seems clearer. At times when I finally reach clarity, I come to a stop. Eventually, I think, moral effort reaches its terminus, leaving no further effort to make. That, I guess, is the best I can do. After that, there’s just the calm after the storm, the ache of loss, the will to learn from the past, and the will to move on.

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*My title is an allusion to Leslie Jamison’s The Empathy Exams: Essays (Graywolf, 2014), which I highly recommend. The book’s final essay, a “Grand Unified Theory of Female Pain,” could practically have been written for Alison. Though I bought the book in 2014, I didn’t read it–late as usual–until well after Alison’s death.

**Ludicrously, I lost our other car–her car–by driving it straight into a flash flood during Hurricane Ida. But that’s a story for another day.

***As in Kant’s conception of the opacity of the human psyche: “The depths of the human heart are unfathomable,” Immanuel Kant, The Metaphysics of Morals, Doctrine of Virtue, I.1.2.2 (§22), Ak. 447. See Owen Ware, “The Duty of Self-Knowledge,” Philosophy and Phenomenological Research 49:3 (November 2009), pp. 671-698.