The Endgame

Newsletter #56 - The kingdom of the sick (1)

Toronto, February 25, 2024

The kingdom of the sick (1)

It was a Saturday morning. I was lying face down on the floor, unable to move, soaked in sweat, semi-conscious. What had happened to me? I had no idea. I was frightened. I couldn’t think straight. My wife was out for a walk. I was alone.

It was about an hour before my wife came home, happy after a walk in the winter sun. She looked at me lying on the floor and said, “I’m calling an ambulance.” I mumbled, “I must have a shower first.” She said, “I think we’ll skip the shower.” She told me later that she thought I’d had a stroke. (It wasn’t a stroke. It was double pneumonia.)

The ambulance took me to the emergency department of a downtown Toronto hospital. There I entered what Susan Sontag, in her 1978 essay Illness as Metaphor, calls “the kingdom of the sick.” Sontag writes: “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” 

In the kingdom of the sick you have no agency. You cannot act on your own will. You cannot shape your circumstances. You are powerless. “I am ill,” you say to the workers in the kingdom. “Please do what I cannot do myself, make me better. And, to that end, and in exchange, I will follow your directions. I am scared and I am sick. What choice do I have?”

In the kingdom of the sick you do what you’re told. You obey complex rules set forth in medical language you cannot understand (unless you have unusual health literacy). You obey these rules because you believe obedience is for your own good. You obey them because you believe that if you don’t you may never leave this place. You obey them because you have no choice. That is the bargain between you and the kingdom. Give us obedience in exchange for a chance at health.

In the kingdom of the sick you are confined physically. I spent my first two days in hospital on a gurney. The sides of the gurney could only be lowered from the outside by someone else, not by me. Wearing a skimpy hospital gown, I was swathed in wires and tubes, hooked up to a heart monitor, an oxygen tank, an oximeter measuring blood oxygen levels, a blood pressure cuff, and an intravenous drip delivering antibiotics and fluids. I couldn’t move without help.

During my third and last night in hospital, in the middle of the night, with sleep elusive again (no one sleeps much in hospital), with my fellow-patient in the two-patient room raving, inches away, on the other side of the curtain that separated us, rationality deserted me and, like Joseph K. in The Trial, I was seized by panic. “I must get out of here,” I thought.

At three o’clock in the morning I went on the Internet. Was a patient free to leave a hospital without being officially discharged? I knew the answer—of course I was free to leave—but I looked it up anyway. But how can I leave, I thought? It’s the middle of a winter night. I have no winter clothes, no money or credit cards, no identification (the hospital tells you to leave your wallet at home). If someone asked for me at the front desk, and the hospital said that it had no such patient, who could gainsay it? Haven’t I seen a horror movie that starts that way?

Some hours later, a smiling nurse came into the room and said, “We’re sending you home.” Such sweet words.