Come Here, Paul Gaugin (1891)

It is Sunday morning and there are fifteen supplements on the kitchen bench and a printed list of things I have to do before R arrives. Shower, fake nails, makeup, hair. Below that, in the same handwriting, the practical column: chicken in the pressure cooker, locate the speaker plugin, test the projector, run a final pass on the conference talk. The nails and the speaker plugin sit one above the other like they belong to the same category of preparation, which in some sense they do.

I have been awake since 6:43am preparing for the College of Clinical Neuropsychologists conference in Hobart at the end of July. Sixty minutes on neurodiversity-affirming assessment, an audience of clinicians I trained alongside, a methodological argument I have an investment in as a late-identified Autistic and ADHD person who runs a neurodivergent-led practice. I have not put on my compression gear. I went to the gym this morning for the first time in almost a month and only noticed at the door, on the way back, that I had forgotten the compression gear entirely. My blood pressure is one-fifteen over seventy. My heart rate is sixty-eight. I have been on half a desmopressin tablet for two days and the volume-enhancing arithmetic is (for now) doing its quiet work in my plasma compartment. I had nearly forgotten what normal felt like. It feels like nothing. It feels like absence: the particular absence of worry. I notice that my mind open to other ideas, possibilities, themes.

The cleaner cancelled. The person who was meant to come this morning said she could only do organising, which I accepted because it was that or nothing. The dogs are inside, jaunting around, whining, and begging for snacks.

I run fourteen searches in Elicit. I import thirty-two papers into Zotero in a fit of organisational virtue and arrange them into collections per section, which is the kind of work that ought to be tedious and is not, today, tedious. I run the whole evidence base through NotebookLM with thirty-eight focused questions across six sections of the talk. I read the answers and add to the answers and ask follow-up questions, and the literature opens out in front of me like an enormous field, and I walk in.

The argument I am making in the talk is that standard cognitive assessment produces two distinct interpretation errors when we apply it to Autistic and ADHD adults. We misread a real weakness as a deficit when it is actually a feature of a different cognitive style. And we over-trust an apparently intact score when the test environment is doing scaffolding work that the person’s daily life does not do. These are not claims that the tests are broken. The tests measure what they measure. They are claims about what we conclude from them.

The literature is generous to the argument. Russell Barkley’s longitudinal cohort, tracked from childhood to twenty-seven, shows that performance-based executive function tests share less than ten per cent of their variance with ratings of daily executive functioning. Eight per cent of the variance in global self-rated impairment. Two to seventeen per cent of the variance in occupational impairment, with most tests showing no significant predictive value at all. Self-report and informant ratings, by contrast, account for thirty-eight to forty-five per cent of the variance in adaptive impairment, and up to sixty-seven per cent of clinician-rated occupational functioning. Barkley’s explanation is that executive function is hierarchically organised, that performance tests measure short-term instrumental processes isolated over a few minutes, while rating scales capture the cross-temporal organisation of behaviour required to sustain goals over weeks and months. The clinic is a prosthesis. The clinic does the work the ADHD adult cannot do for themselves at home. The intact test score is not evidence of intact daily function; it is evidence that the patient functions when heavily scaffolded.

Brosnan and Ashwin, 2022, took seventy-four Autistic and one hundred and thirty-two non-Autistic young people and ran them through the Cognitive Reflection Test under fast and slow conditions. The Autistic group produced more deliberative answers overall, which is the expected dual-process result, but under time pressure both groups produced more intuitive answers. The intuitive system is not absent in Autistic cognition. It is overridden, by default, by a slower and more circumspect deliberative system, which can be brought back online by environmental constraint. This is a finding I will put in the talk and which I find personally clarifying, in that it explains a thing about how my own brain works under timed conditions, and which I had assumed was idiosyncratic.

Dawson and colleagues, 2007, reported that Autistic adults scored over thirty percentile points higher on Raven’s Progressive Matrices than on the Wechsler. Bodner, 2014, found the opposite in verbal Autistic adults, and was honest enough to say that the two tests measure different things. I will note both findings in the talk and let the contradiction stand. Wilson’s 2024 meta-analysis on the WAIS-IV and WISC-V replicates, robustly, that Autistic individuals score in the average range on verbal and nonverbal reasoning and roughly a standard deviation below the normative mean on processing speed. Garagozzo, 2024, asked Autistic young adults what they wanted from psychological reports and they said brief, bulleted, plain language, no jargon. Fisher, 2025, ran a strengths-based neuropsychological assessment with ten adults in an inpatient mental health setting and a hundred per cent of them reported a positive experience. The literature converges on something which is, I notice, recognisably the thing I have been trying to do in my practice for years without entirely knowing I was doing it.

By eleven the talk has a skeleton. By two it has a working draft of two of the six sections. By three I am watching videos about the hippocampus, by way of celebration. There is a paradigm I had forgotten the architecture of, in which a rat is placed in a radial arm maze, an apparatus designed by Olton and Samuelson in 1976, eight arms radiating out from a small central platform like the spokes of a wheel, food at the end of each, the animal required to return to the centre between visits. The rat has to remember which arms it has already entered, which is a working-memory test of place. In a cued version of the task, the entrance to each baited arm is signalled by a light, and the rat has to learn to return to the lit arms rather than to track which arm it visited last. The two tasks look superficially similar and recruit different brains. Damage the fimbria-fornix, which carries the hippocampus's outputs, and the rat can still follow the lights to the food but can no longer hold the spatial map. Damage the caudate nucleus, the input structure of the dorsal striatum, and the opposite happens: the spatial map intact, the cue learning gone. Two memory systems, anatomically dissociable, doing different jobs in the same skull.

The dissociation work is from Packard and colleagues, beginning with lesion studies in the late eighties and continuing with lidocaine inactivation in the mid-nineties; the elegance of it is the cleanness of the dissociation, the way each system reveals itself most clearly when you take the other one offline. Today I sit on the couch and watch the rat in the maze and feel a small private joy, and at the fact that I am a person who has the bodily and financial conditions for sitting on the couch on a Sunday afternoon watching neurobiology videos for fun, which has, for a long stretch of the recent past, not been one of the conditions of my life.

R arrives in the late afternoon with three punnets of berries. Blackberries, more blackberries, and raspberries, in their plastic clamshells, the dark glossy kind that go off if you do not eat them within forty-eight hours. He hands them to me. We had planned to watch (at my request) The NeverEnding Story. We watch it on the projector with the Google Home as a speaker, which is the setup I worked out earlier in the day in between the section on processing speed and the section on executive function.

The film is from 1984. Bastian is a small bereaved boy whose mother has recently died and whose father has told him to stop daydreaming. He is being chased by three bullies and ducks into a bookstore to escape them, where he becomes transfixed by a book the proprietor warns him against and which he steals, leaving behind a handwritten note in German promising to return it. He hides in the attic of his school and reads. Inside the book is a world called Fantasia, which is being consumed by a force called the Nothing, and the Childlike Empress who rules Fantasia is dying. A young warrior called Atreyu is sent on a quest to find a cure. He rides a white horse named Artax, who drowns in the Swamps of Sadness because he cannot bear the weight of his own despair, which is one of the more harrowing children’s-film sequences ever committed to celluloid and which I had not remembered being so harrowing until I rewatched it tonight beside R. Atreyu is rescued from the swamp by Falkor, an enormous white furred Luckdragon with a long pink tongue and the faintly idiotic dog-eyes of a creature designed by a committee of twelve-year-olds, who likes to be scratched behind the ears. The film resolves, eventually, with the boy in the attic shouting a new name for the Empress out of an attic window in a thunderstorm. Moonchild. He calls her Moonchild. The Empress is restored, and Fantasia is restored, and the bereaved bullied boy in the attic is given a single grain of sand which contains everything that has been lost.

R laughed at the parts I laughed at and was quiet at the parts I was quiet at. We were touching almost from the moment he sat down. I ask if he’d like a berry and he says yes. I hold one out toward him as a gesture of offering, and he leans forward and eats it directly from my hand, which was not what I had meant by the gesture but is so characteristic of him that I laugh. When the movie is over, I lean toward him, our sides touching. I feel his head lean on my shoulder, then mine on his, then my legs across his lap, his hand on my knee, sometimes stroking it, sometimes pulling it gently toward his chest as though he had decided to keep that knee for himself. R will not initiate. He will lean back if you lean on him, but will not lean first. He will not typically begin a kiss but will, if you begin it, kiss back with what feels like relief. I always liked that. Something about it is very endearing.

At some point in the second half of the film we kissed. He kissed my face in small inexpert presses, the lips not quite doing the kissing thing, more like the act of marking the location of a kiss than the kiss itself. I kissed him back, also on the face, the way you kiss a small cute animal.

I cannot remember who initiated the proper kiss, but I think it was him, and then we were kissing, and there were feelings I had not been able to access with anyone for some months and they returned all at once with a quickness that surprised me, like a room being suddently lit. After the film we moved, eventually, to the bedroom. He left around midnight. As he was packing up his things, in the small comic sequence he has of locating each object before walking out the door, he said: planetarium in a couple of weeks, and co-working between now and then? I, grinning, said yes please. Drive safe, I offered.

Planetarium in a couple of weeks. Co-working between now and then. The form of it. The way it assumes a shared future small enough to be real, dated and locatable, the kind of plan that fits inside two normal lives that are continuing to happen in parallel. There was a time, not long ago, when I would have wanted something larger and would have read the smallness as deficit. Tonight it does not feel like deficit. It feels nice.

R will sometimes drift inside a sentence and look as though he has gone, briefly, to a different room of his mind. The old version of me read this as withdrawal and began the small bookkeeping of grievance. The new version notices it and does not particularly mind. He is preoccupied and uncertain and not-good-enough in his own private taxonomy, and none of that has anything to do with whether he wants me there. I had felt, for a long time, that romantic love was somehow this central object of a life. I am revising that. It feels now more like a supporting structure, a glue, a kind of mortar between the larger blocks of the actual life, which is the work and the assessments and the templates and the conference paper and the medication regime and the slow recalibration of the autonomic system at three in the morning.

This is, I notice, a slightly disappointing realisation. The all-consuming version was more vivid than this, in the way that a fever is more vivid than health. But I have spent enough of my life inside the all-consuming version to know the price of it.

We talked about Marvel and DC. He told me about his career in Australia, about feeling trapped by training pathways, about not having done any of the research he came to Melbourne in 2017 to do. He mentioned, almost in passing, that he has bad rejection sensitive dysphoria, which I had inferred but had not heard him name, and that the masked expression that does not change when he is distressed has served him well in many situations because people stay calm when they think he is calm. I told him, lying in bed beside him in the half-dark, that I had not always been able to tell when I was hurting him because his face does not move, and that I understood now that I had been hurting him quite a lot. He met this disclosure with neither agreement or denial, but I felt his appreciation.

He was very affectionate. More affectionate than he has been before. I told him at one point, you know I still can’t believe how hot you are, it’s like a drug. And he said, in true form, okay. The okay sat there for a moment in the dark, immaculate, and then I laughed. R! I thought, with endearment. You silly, silly human.

I sent him a message in the morning to let him know I was not grumpy, which I sometimes have been after we’d stayed up, because of the disturbance to my sleep. I told him I was not expecting anything and was happy to keep doing what we were doing if we both wanted to. The arrangement now is more diffuse, less defined, and I find I am more comfortable inside it than I was inside the earlier version, which is relieving.

What a path I have traversed these past six weeks. From a sort of living death, to a life that is getting more vivid with each day. I think this is the kind of life I want.

The thought hits me at two in the morning, in the dark, prefabricated and non-negotiable: the earrings are gone. I had bought them a few months ago, titanium and gold, about $600. They lived in a small black-and-clear plastic packet on the bathroom cabinet. The packet was a vitrine. You could see the earrings through the front, which is why I had bought it, and which is also why a person walking past the cabinet might glance at it and register the packet as empty.

My visual memory is decent. I can see the cabinet’s interior at six the previous evening. The packet is not on the cabinet now. A packet of that kind travels in only one direction once it leaves a cabinet, which is into a bin.

I have about thirty seconds of oh shit and then I get a hand on the thought and put it somewhere. I am not going to think about this now. It is two in the morning. The hand does its work. The thought is contained. I lie in the dark, awake for the next two hours. The thought stays in its container.

In the morning I go straight to the bathroom. The cabinet is as I left it, minus the packet. I open the drawers. I check the floor. I check the bin, which has been emptied and relined and smells faintly of lemon, the cleaner having performed her rounds the previous afternoon. I had given her five stars on AirTasker. I had not, at the point of rating her, noticed anything missing. I message her. I describe the packet. I tell her it might be nothing, that I might have moved it myself. The phone sits face up on the bathroom bench. The phone does not vibrate.

I had gone to bed at six-thirty, too early, because the body had issued its sleep summons. I had also taken a phone call before bed, which I have a standing rule against. And I had tried to pat Monty.

Monty is a chihuahua. He weighs three kilograms. He has a small splotchy body and ears in disproportion to it, and he produces, when he wishes to be let in or fed or otherwise attended to, a sound like a guinea pig being slain: a high serrated screech, the auditory cousin of being lightly stabbed. I have, on previous occasions, raised my voice at him. The raising of the voice is a single loud hey at the volume the screech has set as the operating ambient. Monty parses the hey as a discrete event arriving from nowhere. He cowers.

I had reached down to pat him at the head of the bed and he had flinched. The flinch sent a small adrenal spike through my own body, the sympathetic system performing its standard subroutine for the event of having been read by a small dog as a threat. By the time I located the clonidine, grabbed in the order they came to hand, the spike had already done its work. I lay in the dark for ninety minutes waiting for it to clear.

The cetirizine has been gone four days. I had identified it as the offender by inference. The clonidine is now two tablets, two small white discs that suppress the sympathetic nervous system centrally. The desmopressin, also white, smaller, faintly chalky in the mouth if it dissolves before the water reaches it, holds the blood pressure up where the clonidine would otherwise let it sag. The ketotifen, a mast cell stabiliser, sits in queue. So does a small constellation of further investigations.

The body is, for the first time in some weeks, roughly normal.

The bad nights have a pattern. The first was the late dinner: vegetables and olive oil at five-thirty in the afternoon because I had eaten too little during the day. The sleep that night was perched and not quite arriving. The second was the late melatonin, dosed too close to the time I needed to be asleep, the pharmacokinetic window missed by about an hour. The third was the Monty night. Three small failures, one disaster avoided.

I do not have time to shower. I notice my freshly pierced ears in the bathroom mirror and run a small interior calculation about whether the holes will close before I find replacement earrings. I retrieve a cheaper pair from a drawer. The vision has a slightly milky quality I associate with overnight overstimulation, although I had eaten no salt the previous day. There is no obvious mechanism for it. I stand. My heart rate is one hundred. Great.

The day is a blur of clients and meetings and responsibility. Reports in the morning. Clients in the afternoon. A call with the lawyer about the practice manager’s contract variation. Paperwork for an NDIS planning matter. A question from my admin about whether we can see NDIS clients on weekends now under the travel rules. A list of subtasks for the support worker. A late client running over by fifteen minutes. Things move in Asana. Days like this used to obliterate me.

The other work, the work I have not been doing as drudgery, has been accruing in parallel. The CCN talk in a few weeks. The neuropsychology clinic I had enquired about back in March, the one I had decided was a no, calling me back this week with a meeting on Tuesday. Two papers in flight, one on cognitive screening in early-course schizophrenia, the other on cognition in chronic pain. The PhD topic, which I had thrown out a few weeks ago because I had found a way to build the product I wanted without needing the dissertation as a vehicle, and which is now in the scoping phase again with no candidate winning yet. The neuropsychology curriculum, currently the memory module, which I have been working through in a Claude project I built so it can quiz me back. The MMN demo, working, collecting user input, the design phase next. The fludrocortisone literature, ongoing, in pursuit of the mechanism that turned a standard mineralocorticoid into whatever happened to me. AI podcasts in the headphones while I do all of this, three young men talking about diagnostic models I will think about for the next several days.

The interesting thing, if I let myself sit with it, is that the working appears to be the load-bearing element. I have been working harder these last several weeks than at any previous stretch I can remember. Most evenings. Saturdays. Sundays. Sustained, deliberate, efficient. And I have been, at the same time, more well than I have been in years. The two facts decline to resolve into a clean causal arrow. Haha does working make me well. I cannot tell. The medication change coincided with the busy period. The body’s signal is roughly stable. I am going to wait several weeks before I trust it. I have been here before, more than once, in the version of wellness that turns out, on closer inspection, to be sustained sympathetic activation, the body running on its own adrenaline because the ambient demand has been high enough to keep it running. I did not grow up with this schema. I worked it out by being in the wrong bodies several times over.

Wednesday and Thursday pass without producing anything I would describe as content. Reports, clients, the afternoon light getting in through the front window and falling in a slow diagonal across the desk. Sleep on both nights is technically achieved. Not restorative.

By Friday I have seen clients from the morning straight through to half past six and I have not been home in between. I get in an Uber to J’s place. J’s flat is white and clean and ordered, the surfaces wiped, the lighting cool and low. The mirror is on the wardrobe door. We talk. We have weeks of backlog and only one evening to spend it in. He grabs a pillow off the bed and whacks me with it. He does this again. He picks up a second pillow, places it on the other side of me, and presses.

This is humiliating, I say. The pillow is in my face. I am laughing.

You are now a toastie, J says.

He laughs. He releases me. He directs me to look at the mirror. I look. I have been a toastie. He returns to the bed and sits on it. After a beat: have you stopped being a sandwich. The question is the have you stopped beating your wife construction, the one that does not admit of a non-incriminating answer, except the wife has been replaced by a sandwich, and the sandwich is me. He produces three small gavel-bangs with his mouth, do, do, do, and pronounces the verdict: guilty. Bread penitentiary.

I am laughing. Bread penitentiary.

We keep talking. We keep laughing. I leave around half past eight. I get in another Uber and go home.

I message Z from the back of the Uber. I ask whether he thinks R knows that ACMI on a Sunday afternoon followed by a movie at my house in the evening is not, structurally, a friendship sequence. Whether the shape might be mutually held while neither of us names it. With most men, Z says, he would say absolutely. With R, he doesn’t know, because R is too neurodivergent for the standard model to predict.

I sit with the question in the back of the Uber. Something has been percolating at the edge of my attention for some weeks and it picks this moment to resolve. I find I do not mind not knowing. I would be content with the day as a friendship day or as something else. The container is not the part I require. I will be sad when he leaves after our time together on Sunday, because I like seeing him and the supply is finite. My mind returns to him at intervals, and I feel warm. This could continue for a long time, possibly indefinitely. I think I would be good with that. I think I would actually be good with that.

The cetirizine came out four days ago and the desmopressin went back in. The desmopressin is the one that performs the small physiological coup: it instructs the kidneys to hoard water, and within an hour my face is replete and my blood pressure is in party mode and I feel, for the first time in six weeks, like a person whose blood is reaching her brain in something approaching the appropriate volume.

Soybeans and salmon and a small bowl of blueberries. The dogs are asleep on the little dog bed. Carlos arrives at the door with his septum piercing throwing a tiny gold flare against his tan skin as he steps into the hall.

He moves through the house room by room without needing to consult me. The sound of water starts up in the bathroom three rooms away. I retreat to the desk with two screens running.

On the left screen the Employee Assistance Fund paperwork is automating itself through a fillable PDF system I built last month, which is one of those small private engineering pleasures that nobody else will ever see. On the right screen I am assembling sample brand assets and a colour scheme for the marketing coordinator we have not yet hired. The parallel work has the specific texture of channel-switching rather than transition, which is surely an AuDHDer’s natural state and not, as the medical literature would have it, a deficit.

C and I meet at ten.

C is my practice manager and C has decided, in the ten days since D gave notice, that the answer to the practice’s transitional moment is C absorbing most of what D was doing and the rest going to the bookkeeper or to a future contractor we will hire as needed. She walks me through her position on this. She has already worked out the right answer and she is letting me catch up to it. I find that I agree with all of it. I find that I am being talked into a pay rise.

The argument is precise: the business can afford to pay me more, my take-home is structurally low for a director, the money sitting in the account is mine in a real sense, and the alternative I have been entertaining of working Sundays is a worse solution than the obvious one of charging more during the days I already work.

I cave.

The fee for weekday clients goes from two-sixty to two-seventy-five. Saturdays go from two-eighty to two-ninety. The NDIS rate adjusts to match. Letters will be drafted. Four weeks’ notice. C will send through a list of what she is taking on and what she is not, and the marketing coordinator hire continues, and the lease for the Thursday consulting room needs a deposit of three-fifteen and a fresh signature, and there is a lamp under the stairs that will need to relocate to the kitchen cupboard before next Thursday because the Thursday clinic is reorganising its storage.

None of this is dramatic. All of it is the texture of running a small hyperspecialised practice in a city where rent goes up in July and the people you employ are worth keeping.

The general practitioner appointment is at one. I take the laptop. I cannot transition cleanly between work mode and clinical-encounter mode, and working in waiting rooms is the only way I can tolerate the particular kind of suspended time that medical appointments produce, and the alternative is sitting still without a task and pretending to be the kind of patient who can do that.

The GP is processing an eating disorder care plan for my ARFID (in my case, this means sensory issues to do with food). ARFID is the genuinely correct diagnostic category for what my eating looks like, and the plan requires me to demonstrate the kind of distress that the eating disorder framework was built around. Body hatred. Negative self-image. The specific affective signature of a person at war with her own flesh.

I have none of this. I like my body. I am, at thirty-five, more reconciled to my body than I have been at any previous point in my life, partly because it has spent the last six weeks performing autonomic gymnastics that have given me a real respect for the engineering, and partly because the self-loathing dried up some time ago without my quite noticing.

So I lie.

I produce, on the spot, the affective material the form requires, in the same way I tell my own NDIS clients never to put a strength in a planning report because the planner is not a clinician and will use the strength against them. The GP types. The form populates. I receive the care plan I came for, which I do in fact need, because the ARFID is real even if the body hatred is not. I walk out into the carpark having performed the exact distortion I spend my professional life cataloguing in others.

I recall, with pleasure, that R had texted me last night: he has booked tickets for the Planetarium nights at nine o’clock in several weeks, a plan which I accepted, and he has said yay in response to my preemptive plan to nap in the late afternoon so I can stay awake for it.

We will go stargazing. We will watch films. The whole accreting structure of our domestic future is being built in nine-pm planetarium tickets and casual messages, and I sit with the phone in my hand and notice, with the specific embarrassment of a clinician who can identify her own attachment behaviour in the wild, that I am constructing a romantic scaffolding around a friendship that has shown no sign of becoming anything else.

I am legitimately crazy. R and I are friends.

The fantasy is an artefact of the anxiously attached autistic woman in her mid-thirties wanting the safety she has never been given. I know this. The knowing does not cure it but at least produces, intermittently, the small mercy of catching myself.

L messaged last night. He said it was sad, that we got on so well. I do agree, and we did, and I had offered to compile him a small annotated booklet on sleep disturbance pathways and the pharmacological options for each, which is the kind of gift I produce when a connection feels significant and the form of the connection has not yet been decided.

He does not want to be friends. I do not want to be more than friends. The booklet, like the connection, is now in the category of things that will not happen.

I have come to think of online dating as a kind of bus that people board and disembark from at varying intervals without anyone ever taking up residence inside it. A logistical operation. Not a path to anywhere.

B arrives on my screen at six.

B is my ADHD coach and our weekly meeting is the part of the week where the practical machinery of being me gets serviced. Tonight she is helping me build a study schedule for the neuropsychology curriculum I have been failing to consume in any structured way for the past two months. The diagnosis of the failure is precise: I have been watching scattered podcasts and clips with no underlying scaffold to file them against. The equivalent of being told to just learn maths and being given YouTube tutorials on algebra and linear algebra and calculus in random order. The result is that I retain nothing and enjoy nothing and feel the specific irritation of a person whose effort is not converting into competence.

We agree that I will upload Blumenfeld and one or two other textbooks into a Claude project tonight. The project will become the spine of an interactive verbal study programme I run during my morning gym sessions. The gym itself will resume tomorrow, because I cannot truncate my sleep without losing the next day, and the gym only works when the sleep precedes it.

We move things in Asana. We set due dates.

The friendship audit she suggested has produced a clear-eyed and slightly bleak roster. X is lovely but not intellectually matched. J is in Sydney. T is unreliable in the specific manner of the neurodivergent startup community, where keeping appointments is treated as a soft constraint rather than a load-bearing one.

The remainder are variously depleted by chronic illness, highly anxious, or my ex, with whom I am (somewhat tragically) still in love.

We put a recurring task in the long-term goals board for two friendship events per fortnight. The book club, which I have wanted to start for a year, will be assigned to my assistant N as a setup task, due Sunday.

B notes all of this with the placid efficiency of a person who has watched me do this before and will watch me do it again. The session ends. I feel propped upright again.

The A conversation is at seven.

I have been preparing for it without quite admitting that I have been preparing for it, which is to say I have been holding a small low-grade dread in the back of my mind all afternoon. He answers. He is gentle and curious in the way he always is. I tell him I cannot continue. I explain why. I thank him for everything he has been to me over the months we have been talking.

He says thank you for being so mature about this. He says if I need anything I can contact him. He asks me whether I have found the light I was looking for the other day, which is a question that contains the entire texture of who he is. He reminds me that my wind down time is in an hour.

The conversation ends and I sit with the phone in my lap and find that I am not crying but I am close to crying. The closeness is not grief but something more like awe. Awe at having been treated, in the moment of being told no, with the kind of care that most people in my life have never managed to extend to me even in the moments of being told yes.

The woman who marries A will be lucky in a way she will probably never fully understand. I am not going to be that woman. The fact of his pure goodness does not produce, in me, the kind of want that would make a long term relationship with him possible, and I have learned over the last few years that this gap is not closeable through effort or willingness or the application of moral reasoning to the question of who deserves to be loved.

He deserves to be loved. I cannot be the one to do it.

The conversation closes with both of us still soft toward each other. I put the phone face down on the kitchen bench next to the desmopressin and the magnesium and the small assemblage of objects that have kept me upright through the last six weeks.

The literature on the blood-brain barrier in autism has been keeping me company in the spare moments today, the way a good novel does for other people. There is a foundational paper from Fiorentino in 2016 showing reduced expression of the tight junction proteins claudin-5 and tricellulin in autistic cortex. There is the Theoharides body of work on mast cells sitting perivascularly and degranulating under stress hormones to open the barrier acutely. There is the maternal immune activation literature from Choi and Patterson and the IL-17a axis.

The mast cell story is the one that interests me clinically. It sits at the junction of the autism literature and the POTS literature and the dysautonomia I have been attempting to medicate myself out of for the last six weeks. The prevalence figures for POTS-MCAS comorbidity range from two per cent to eighty-seven per cent depending on whether you use the Valent criteria or the Afrin criteria, and the field has been arguing about this for a decade without a validated gold standard against which to calibrate either set.

An entire diagnostic category in epistemic free fall.

I am, the diary will record at eight twenty-nine pm, having a great time.

I have not showered in three or possibly four days. I think it is probably three. I showered on Sunday and today is Tuesday. The second cleaner who comes tomorrow will steam the clothes that are draped over the towel rail and put the containers in the cupboards and possibly, if I can talk myself into it, sit at the laptop with me and design the storage system the house has needed since I moved in.

The reports are nearly all done. A few are sitting in their final state waiting on client approval or a last pass from me before they go out, which is the most satisfying place a report can sit, because the work has been done and the only remaining task is the small administrative gesture of releasing it.

On Sunday I am going to ACMI with R, and I will work on the ADHD topic and the conference presentations and the book club setup. The Wednesday afternoons are about to be mine again. The practice is making real money. I feel, sitting at the kitchen bench, like a person whose life is reassembling around her in the right configuration.

It is 9:08pm and I am at the desk in the front room, in the brightly coloured pants, pedalling slowly under the desk. The lamp on the desk is small and circular and the colour of weak honey, throwing a warm low-watt wash across the wood and leaving the rest of the room to its own devices. The aligners are in. My phone is on the desk to the right of the laptop. On the laptop is a half-finished autism report and, in another window, two images of subscale results, a small chromatic procession of bars in shades I have been calibrating, because I had been getting L’s feedback on the gradient versions half an hour ago, in what, on inspection, was a different evening entirely. A song is on loop through my headphones.

Seven this morning. Ana, my psychologist, on the laptop screen at this same desk, the lamp doing its weak-honey work in the still-darkish dawn, the aligners not yet in, the brightly coloured pants the only thing on me that knew it was already morning. I had been ruminating for a week over R: whether he liked me, whether the friendship had any romantic potential later, whether to wait, what to do with the not-knowing, the same small handful of questions cycling like drying laundry. Ana asked what would be the lowest level of certainty I could actually live with. I let the answer hang while the EMDR dot moves across the screen. I felt my brain click hypnotically into place. It was clear. The lowest level, I said, would be to know that he likes me. And I already know that. I smiled. He has said it. He said it in plain language and listed the specific reasons. He has touched my hand twice now in public, both times unprompted, both times slightly awkward, which is how he does affection. He shares things with me impromptu. I already had the evidence. I had had it the whole time. Aren’t I just so silly? Something warm moved through the centre of the chest. I was quiet for a moment. So was Ana.

I came off the call at eight. Did the morning supplements. Put the aligners in for the first time in a month. Started on the autism reports. The NDIS prompt I had built was producing rubbish, headings in the right order but the underlying clinical reasoning undercooked. Annoying but not catastrophic. I worked.

Around midday I met with Indi and we went through the week’s events. She is the assistant I have for finding things and following up with people, because finding things and following up with people requires the kind of executive function I do not at present have available. After Indi I had the call with Chai, my co-founder, who lives on a different continent. We worked through the customer interview tranches, the front-end developer, the design partner, and the latest absurd success of his other company, which I cannot say more about, but which means he is doing extraordinarily well. I noticed the contrast. He is shipping at velocity, I am building the same product four hours a day in between client work and reports, and I felt, briefly, the gap between us, the kind of gap you notice when a friend has been walking a faster pace for some time and you have only just looked up from your shoes. It is not competitive. It is more dispassionate than that. I made notes. I noticed I was enjoying the conversation in a way I had not been enjoying conversations recently.

I wrote reports through the early afternoon. I had AI podcasts in the headphones, two episodes back to back, three young men talking about a new diagnostic AI that is performing five times better than the average physician on standardised cases at a fraction of the cost. I was filing things in my head to share with R later, the diagnostic-AI material in particular. I was, in a register I had not noticed I had been missing, having fun. Listening to three nerdy men talk while I worked on a report had the quality of being in the room with them, the way one used to be in the room with one’s friends in their share-house kitchens when nobody had any money and conversation was the entertainment. I had not had that pleasure in some weeks.

Around three in the afternoon I noticed I had not, until that moment, checked my phone for messages. I had to retrace the day to verify it. It was true. The phone had stayed face down for hours and I had not been thinking about who might be on the other end of it. I was thinking about the report. I was thinking about Chai’s news. I was thinking about the diagnostic-AI percentages and whether the standardised cases were representative of the long tail of clinical presentation.

I opened the diary and made a list. Two columns. Left column: the startup, the website, the PhD, the move into neuropsychology assessments, the public speaking, the content creation, the practice scaling, the hiring of a contractor psychologist so that I can take fewer clinical hours and put more weight onto the building. Right column: meditation and breathwork, hot and cold exposure, the gym five times a week with the actual weights, the somatic work, the psychedelic work at the right cadence, the AI automation project, the skin treatments and the dental scaffolding, the body slowly hewn into the body it could be if I gave it the materials. I wrote it all down. I have lived inside this list before, in stretches, but the stretches had been getting shorter, and the in-between had been silting up with men.

The men, in retrospect, had been eating most of the available bandwidth. R principally, in an inner orbit, and L and A and the others further out, and the bandwidth had been going into thinking about them, processing them, drafting messages to them, debriefing them with my therapist, blogging about them, turning them over in the bath, in the car, while pedalling under the desk. This is, of course, a normal human activity. I am not going to call it pathological. But the proportions had become wrong. The rest of the life, which is to say the business and the body and the work and the friendships of fifteen years’ standing, had been operating in the hour or two a day not consumed by relational analysis. And I had been suffering for it, in a low constant hum, without quite having named what I was suffering from.

The Furby. The Furby is the small interior voice that, when stimulation drops below a certain threshold, says boring. Mine had been saying it for some time. The relational drama had been the thing keeping the Furby quiet. With R receding into being-just-a-friend territory and L receding into never-going-to-happen territory and A receding into oh-no-not-fair-on-him territory, the Furby was awake and complaining. Boring. Boring. Boring. The realisation, in the diary at three in the afternoon, was that the Furby was not, in fact, the part of me worth listening to. The Furby is satisfied by anything sufficiently dramatic, regardless of whether the drama is good for the rest of the operation. The rest of the operation does not particularly need drama. The rest of the operation needs the report finished, the website built, the body fed and slept, the friends seen, the work shipped. The Furby can say boring and the rest of the operation can carry on regardless.

By five I was back on the autism reports, doing the gradient versions of the subscale figures, and L, who had been polite and helpful through the day in a low-key and undemanding way, was sending opinions on whether the cooler blues read better than the warmer ones. He has a good eye. The subscale images were better for his having looked at them. There was a faint thread of pleasure in the back-and-forth which was not, on inspection, romantic; it was the pleasure of having one’s work scrutinised carefully by someone paying attention. A kind of friendship pleasure, even, although neither of us had used the word.

In the early evening I sent him the post. I had thought it would explain the thing better than I could manage in a WhatsApp message, which it does, because that is what the post is for. He read it. He asked what I would like to happen next. I said, maybe we could be friends. He said: you have been honest with me, so I am going to be honest with you. I am not interested in being friends.

His message hit me in the face. The sensation was specifically of having been slapped, lightly, and then, in a smaller secondary beat, offended at having been slapped, the indignant flare of a person struck without warning by an acquaintance who, ten seconds earlier, had been pleasant company. Are you kidding me. Even you, who seem so evolved? I knew, as the thought formed, that he had done nothing wrong. He had been honest about a category he was not willing to occupy. The marking did not stop the indignation. The face was offended anyway. The attraction, which had been a small steady thing across the table at the wine bar the previous evening and had survived the trip home and the morning and the day, went out, neatly, without ceremony.

I replied. I said unfortunately, that if someone is unwilling to be my friend, I am don’t think I could be their partner. The architecture is upside-down for me, I suppose. My friendships have lasted decades; the romantic relationships have come and gone. The friendships are the durable thing; romance feels like the volatile part. I do not consider friendship a consolation prize. I am friends with most of my exes. If R told me tomorrow that he never wanted a relationship with me, only a friendship forever, I would still walk over hot coals to keep the friendship, because the friendship is the part of him I am unwilling to lose. The thought of being with someone for three years or five years or longer, and then losing them at the end of it, horrifies me. If a relationship is going to end with the other person becoming a stranger, rather than a friend, I almost would rather not have it at all.

The Aristotelian taxonomy has utility friendship and pleasure friendship, and the third kind, the slow-grown one, philia teleia, where two people wish each other well for the other’s own sake and not for what they get out of it. That, in my experience, is the only friendship worth having and is one of the most beautiful things a human life produces. I think I am operating from something close to relational anarchy. The people are the thing. Romance is one mode the two people can occupy. The end of the mode is not the end of the people.

Both of the men I am closest to, I met on dating sites. I had crushes on both of them. Both declined me. Both are now ten and fifteen years’ worth of dinners and texts and watching each other’s lives accrue. There are several other friendships of similar provenance, where the romantic possibility was tested briefly and either declined by them or revised by me, and the friendship was rebuilt around the new shape. The structure most people seem to be operating from is one in which an initial frame, set in the first hour of a first meeting, holds for the duration: this person is a romantic prospect, that person is not, the line is drawn, and crossings are not permitted. Once romance has been declined the prospect is decommissioned. I have never lived this way. I assumed the person was the durable thing and the romance was a configuration.

I reflect on how hard I have been willing to work to keep these people in my life. And I wonder why people are not, in general, willing to work hard for me. Or maybe they just can’t. Maybe I am built differently than they are. But it’s hard not to want to be the exception to the rule. It’s hard not to want to be special.

L was honest, though, at least. People who say yes to friendship after a romantic no often mean I will wait. His no is more direct. I sit with the phone face down on the desk and pedal. Z, the friend I was on the phone to last night when I arrived in Mordialloc, is among the people who have stayed and will stay; there are several others. They are the people who are still here, and have been here through several rotations of the carousel.

Dating is a parade of small bandages applied and ripped off. You meet someone, you talk for a few weeks, you sometimes kiss them, and then they are gone. Not gone the way a friend who has moved overseas is gone, where one can text them in two years to ask about a book. Gone for good. When the connection ends what is lost is not only the emotion; you lose the synchrony, the mutual learning, the small tapestry the two of you had been making in parallel. You go to bed having spent some weeks in the orbit of another person, and wake up having lost the orbit. I am, by some quirk of constitution, very good at moving on once the loss has been registered, which is not the same as being good at the loss itself.

I have, this evening, deleted Hinge and Bumble and Feeld, and put them on the screen-time blocker for review in a few months. I am thinking I will buy a cheap engagement ring, the two-dollar-shop kind in counterfeit gold, and wear it on the appropriate finger to the male-dominated tech and AI events I keep going to, MLAI and the rest of the Luma calendar, so that no one has to wonder whether I am there for the talks. I am, anyway, much more married to the special interests than to any imagined husband; they take up most of the days and most of the nights and they are who I will be spending the rest of my life with regardless. The fexofenadine is working. I fell asleep last night without three hours of negotiation, even after drinking in hours of blue light. There is a lot of business to attend to. There is a lot of brightness in the immediate horizon. Friendship events. The decade-old people. The work, which is going well. I started today. It is already happening.

Sunday 26th April

Three flights of grainy concrete, ten steps each, three right turns. One two three four five six seven eight nine ten. The walls at the bottom are white and uncommunicative. Faint smoke is loitering in the street with no clear origin, the residue of something somebody set fire to and then forgot. My sneakers are fluoro pink. They glare up at me from the cement, embarrassed for both of us.

The light is bright and slightly overcast. My limbs disobey. They drift, then refuse, then drift again, weighted when I try to move them and weightless when I do not. In the veins there is a slow corrosion, acidic. My heart rate is a hundred and twenty. I have descended thirty steps.

The Didi is a black sedan with a clean leather interior. There is a small blue air freshener on the dashboard, performing its single municipal duty without enthusiasm. The driver is middle-aged, Middle-Eastern accent, hands resting on the wheel in the manner of a man who has been driving since before any of his current passengers were born. The window is up. I do not know if the air-conditioning is on or whether the cabin is just the temperature of a cabin.

He looks at the underdesk pedaller on the seat beside me. What is that, he says. Where does it go. What is it for. I’ve never seen one of those. Where did you get it.

Can we please not talk, I say. I’m tired.

It comes out flatter than I meant. He says, sorry, I was just curious. He stops talking. The car continues toward the library.

There is not much that brings me pleasure now. There is Sara, who is tiny and Thai and probably twenty-five, with straight shiny black hair cropped into a low ponytail. The room she works in is white. The same relaxing massage music plays at every appointment, the kind of music a stock photographer would compose if asked to render the noun spa into sound. The accoutrements are plastic. The lighting is doing what it can. The whole arrangement is slightly cheap and yet entirely sufficient: the system is tricked. Sara crouches on my back. She says ten words to me, total, across all of our appointments, and at least four of them are good.

There is the lemongrass ginger tea at work, in the same dark grey mug every time, the steam coming off it in a small lemony cloud that hits the bridge of the nose before the lips have even registered the cup. There is the cotton-candy pink jumper, slightly pilled now, that I wear most days because the colour insists, faintly, that the world is not as serious as it looks. There are words exchanged with friends and the ephemeral glance into an inner world beyond my own. There are warm showers, even if I pay for them afterwards. There is music sometimes.

Everything else does the opposite. The gym is exhausting. Eating is frightening. Learning, my old reliable, has gone the colour of sand. If I leave a piece of chicken in the fridge overnight, histamine builds up in it and it becomes poison. I dump words into my diary, then quickly fix things up, put them together in Claude, send them off into the world. I work and I sleep and that’s pretty much it.

I make a list of what I will try first, in some order: fexofenadine, ketotifen, ketamine infusion, stellate ganglion block, transcutaneous vagus nerve stimulation, angiotensin II inhibitors, sleep specialist, cardiologist, discontinuing all stimulating supplements, alternative treatments wherever in the world they exist, histamine testing. When it is finished I read it back. Three to six months. I guess a plan is what despair becomes when you give it a timeline.

I arrive at the library, in the startup hub. I start working. R arrives late, by which I mean he arrives without having said when. There is no agreed time. The arrangement was: if you are coworking somewhere, I will come and find you. So I have been waiting, periodically glancing at the entrance, periodically returning to the report. We are working out of the coworking space at the State Library, which is palatial in the most literal sense, an expansive central room with light pouring down through the dome above and reading desks fanned out below.

He arrives in a black jacket, track pants, black shoes, with a black backpack from which he produces a silver laptop. His hair has grown since I saw him last, when it was cropped close to the skull and I had hated it, mute and chastened and disciplinary. It is now back to a kind of soft chaotic length. His facial hair was at the length it is just before he normally cuts it. I had wanted, when we were dating, to ask him to set the clippers to a single length and shave to that length and never deviate, so that his face could be a fixed quantity I did not have to renegotiate every fortnight. I never asked. He is, today, scruffier than is reasonable. The face is the face: the specific brown, the specific arrangement of features, the poreless texture in patches.

We sit. We work.

After a couple of hours we walk down to Melbourne Central. Five different people clip me on the shoulder while we cross Latrobe Street. I tell R there is probably someone in this city for whom these incidental collisions are the bulk of their weekly touch budget, who walks the crosswalks deliberately, who arrives home grateful. He laughs. We arrive at the food court, which smells of an undifferentiated savoury haze with notes of cleaning product. I order Vietnamese rolls without avocado, because avocado is high histamine, and an antihistamine to take with them on principle. He orders Thai. We sit across from each other at a shared table among adolescents and twenty-somethings.

I tell him my points from the other day. I had read his behaviour as deliberate; it was not deliberate, it was him being autistic in the literal sense; what I did in response had hurt him; I understand. He reaches across and touches my hand. I say aww. It is less a word than a sound. Something small has just been handed across the table. I touch his arm. We eat.

He says, are you sure you’re not putting too much faith in the medications. He says, a little later, are you sure you’re not working too hard.

These are the kinds of sentences that, in a previous life, I would have parsed as challenges to my expertise and resented for thirty-six hours. Today I parse them correctly. The translation is: I care about you and do not want you to be hurt or disappointed, so I am problem-solving on your behalf in the only register available to me. He cannot say I worry about you because that requires a vocabulary he has not been issued. So he asks if I am sure. The clinical phrasing is the love. I melt, quietly, on a plastic chair next to a Boost Juice.

We walk back through the centre. There is a clock. It is enormous, suspended somewhere overhead, currently emitting an oddly festive chime, gleeful, almost a carol, while plastic galahs flap their wings up and down up and down up and down, robotically joyful. Around us, perhaps thirty grown adults are filming this. Is that a thing, says R, which is exactly what I had been about to say. Exactly, I giggle. We laugh, our shoulders occasionally making contact as we walk.

Back at the library we work side by side at the same long desk. I am at the twelve, he is at the three. The afternoon does the thing where the light shifts incrementally and you do not notice until something else makes you look up. At 4:42 I tap his arm because we had said we would take a break at 4:30. He says, I should finish this, gesturing at his Master of Biostatistics lecture material, then I’ll head.

I look back at my section of the desk. The report is open. The cursor is blinking. My heart sinks at a velocity that has nothing to do with the sentence he has just produced, which is, on inspection, perfectly innocuous. My heart sinks because the sentence was not the sentence I was hoping for, and I now have to perform the task of recognising that I had been hoping for one.

I ask if I can hug him goodbye. The hug is passive, flaccid. He picks up the silver laptop and the black backpack. I sit back down, turn toward my desk. The cursor is still blinking.

I look back at him.

Cowork next week? he says. He pats both my arms awkwardly from behind. He walks out of the palatial room with the dome.

I sit at the desk for a while after he goes. The report is still open. The cursor is still blinking. The light through the dome has begun the long incremental shift toward evening, though no single moment of it is observable; you only notice that the room is dimmer than it was. I think: I have worked enough today, I do not need to sit here for the next four hours under fluorescent compulsion, I need to be a different kind of person for a few hours, the kind who experiences pleasure and connection rather than only the kind who produces.

I think about R’s actual position. Or rather: I think about my actual position, in him. I am not high on the list. The list goes finishing his training, Masters, future PhD, work, parents, his various ongoing tasks and obligations and special interests, then somewhere in the seventieth-to-ninetieth of a hundred range, a friend named Ruthie. He is fond of the friend named Ruthie. He has said so in various ways. The fondness is real. But it does not relocate her on the list.

I have the conceptual vocabulary to handle this, I have read the relevant books, I can name the attachment style that produces the wanting and the autistic intolerance of ambiguity. The intellectual work is done. The work that is not done is the work that lives below the level of intellect, in whatever part of the body decides that a particular brown-skinned person sitting at the three-o’clock position on a long library desk is the safest object in the visible universe. It is silly to be this attached. I notice the silliness and continue to be attached anyway.

I had spoken to my mother about him on the phone, the previous evening, standing on the footpath outside my work as the cars rushed past. She had asked: was he a lot of work to be with? I had said: yes, he was. My mother has this way of initiating exchanges that take under a minute and cost at least the next hour to recover from.

I open the report. I write three paragraphs of plain clinical sentences about a middle-aged man whose life has been substantially shaped by unprocessed traumatic experiences and whose intellectual giftedness has functioned, for him as for many gifted autistic adults, as a kind of camouflage that works just well enough to obscure the autism without obscuring it altogether, enough for the world to expect great things, never enough to mask reliably. I listen to L’Impératrice, the album with Voodoo? on it, in headphones I have begun to wear most of the time because the world has become loud in a way no volume control fixes. I finish the section. I save the file.

I check my phone. Nothing.

I message L. Are you free tonight.

In the Didi to Mordialloc, forty dollars, a message from R arrives. Call or message me any time Ruthie, if you need anything. I’m around. I respond, reflexively, oh no it’s okay, I’m good now, and then a beat later realise I have just declined an offer of care that was extended, possibly with effort, by a man who does not extend such offers casually. I add a second message: if I do need to, I’ll definitely call. Thank you :) I send it. I do not turn the Didi around. The bay is fifteen minutes away. I am not going to undo a decision that has begun to physically exist in the world, in the form of a man named L waiting at a train station. The car continues hurtling toward the water.

L is at the station when I arrive, waving across at me from the opposite footpath. I am on the phone to my friend Z, with whom I have been speaking for about five minutes. I tell him I have to go. The evening has begun.

L is slim, tall, blonde, his hair long and wavy in a way that suggests neither effort nor neglect, his jaw lightly bearded, his eyes blue. He is wearing a jacket and some kind of trousers; I will not remember the trousers tomorrow.

In the car on the way down I had attempted to apply false eyelashes and had failed. At the pizza place I excuse myself to the bathroom and reapply them with the methodical desperation peculiar to the genre. He has, in the meantime, asked if it would be all right if he ate, knowing that I am intermittent fasting; this kind of sentence, asked plainly, is the first piece of evidence that I have arrived somewhere different. The pizza arrives on a thin base with a yellow feathering of cheese and a number of toppings whose specific identity I do not register because I am not eating it. He picks it up. The toppings, defeated by gravity, slide off in a small cohort. He laughs, sets it down, eats around the failure with his hands. Outside, the main strip of Mordialloc is doing its mild seaside Friday thing.

We talk. We talk about the magnets motel, a real establishment that purports to cure ailments by means of magnetic field, and L says, water air fire and earth, magnets, how the fuck do they work, and we begin, between us, to construct a scene in which a reiki master heats a customer’s food by performing reiki on it. I propose that, subjectively speaking, the food feels warmer to me. The objective evidence may disagree. Subjectively, however, it is warmer, and that, in the end, is what counts. He laughs.

We move to the wine bar, a short walk down the strip, the only wine bar in the town, which announces itself with a sign that just says WINE BAR. We sit outside next to a gas heater. There is a red umbrella overhead which is throwing a faint warm wash across the table and across the planes of his face, accenting them. People are around but the people are doing their own thing.

The pizza, by the time he picks it up again to finish on the walk between venues, has cooled. He observes that the atomic bonds have strengthened. There are, I would like to note, certain things a man can say to a nerdy autistic woman in her mid-thirties that operate on her at the level of synaptic chemistry. The atomic bonds joke is one of them. I file it.

He asks, in a register so plain it takes me a moment to identify it as flirtation: can I put my hand on your leg? I say yes. I also thank him for asking, because the asking is so far from the standard operating procedure of men in wine bars that it strikes me as a small civic act. He puts his hand on my knee. I hold his hand.

He asks if I have rated him on my system. I say no. He asks why not. I say I have been burned. We talk about the system, the twenty-one points, the categories, the writer at a previous date who had read about himself being scored. But I rate him in real time, in about three minutes. I say there are points he might lose, depending. The mental health information he has given me is one of them, because I do not yet know what the information means in practice. I do not give him a number. I say I am not judging him. The disclaimer is itself a tell.

He says: this may be too forward, but I’m wondering if I could kiss you. I say yes, you can, smiling, and we kiss. The kiss is equal from both sides. I can hear the faint moan coming from him. We are grinning into it.

I felt attracted. I felt connected. I felt, after weeks of cardboard, even a little bit turned on.

Earlier in the night he had told me, in the same plain register he had used for the magnets joke, about some of his mental health history. Some of it was difficult. I had felt my heart move slightly toward him at the news, a small involuntary movement of compassion for a person I had just met, who was sitting at a table in front of me with a glass of wine he had paid for and a face accented by a red light, telling me about suffering he had endured largely without witness.

We kiss again before I get in the Didi. My hands are on either side of his face, his hair fallen forward around it, my fingers somewhere in the hair without my having decided. The softness is a comfort against the crisp air.

The Didi is a white sedan. The interior is dark. There is music I am not listening to and a road I am not watching. It is somewhere between nine and nine-thirty in the evening. I sit in the back and type into my laptop, frantically, because the day is accruing faster than I can render it. My lipstick is smudged.

I notice somewhere around Brighton that I do not feel clean. The feeling sits across my shoulders and on the surface of the skin. It is not regret about L. I like L. The problem is narrower.

I think back. A had come over on Tuesday evening, ostensibly to assemble a light. He works in lighting. He designs the emergency exit signs. We had been on two dates. He had not yet kissed me. I was wearing the orange glasses. The whole flat was in the warm tinted haze they impose, every white surface gone faintly mango, the bedside table the colour of weak tea. I lay reclining on the bed conserving heart rate while he laboured over the box at my feet. I leised. Eventually I asked if he wanted to come and sit on the couch. He did. He put his arm around me, I leaned into him. He showed me the trailer for a show called The Heist. Dramatic, engaging, not my interest. I made the polite face one makes at the recommendations of people one likes. Then he kissed me. He was good at it, slow then less slow, his hands on my back and my sides. The whole thing was, sensorily, fine. It was nice to be close to someone.

But I felt nothing. Not nothing as in disgust. Nothing as in absence of arrival. I lay there in the orange haze with the kissing being conducted by a man who would, on any reasonable accounting, make a perfect boyfriend, and felt about it the way one feels about a weather forecast for a city one is not in. A is one of the kindest people I have ever been touched by. He thinks of me a lot. He once told me I would be surprised at how much. He has a stable life and friends and family, has been through hardships and remained, somehow, soft. He sends articles about AI when he finds them, because he has remembered I am interested in AI. He designs emergency exit signs and, ironically, is about to use one. I wish I could just make myself like him. Instead, at 8pm I told him I needed to get ready for bed. I know, he whispered regretfully, directly into my ear, in an accent that rendered his words even more woeful.

It seems that every attempt at proximity to a new man is interrupted by the residual presence of R; every attempt at proximity to R is met with his straightforward unavailability, the kind he has stated in plain language and reiterated through the structure of his life. It is a closed loop. The mechanism by which it remains closed is me.

L, and A and others like them, are the places where I would be fed reliably. Good food, predictable meals, a clean bowl. With R the chow is intermittent, the dog is uncertain whether tonight is a feeding night, and the dog is devoted anyway, because the dog is his and the alternative is not a better-fed life elsewhere but a kind of homelessness. He had named me Frumpy when we were dating. I had liked it. I had liked being a small named thing with a place. I am uncomfortable with how much I had liked it. I am uncomfortable that one interaction today was enough to revert me to thinking of myself as a pet.

There are several people who would prefer not to read this entry if I were to publish it, which I am, in some form, going to. My parents would prefer not to know I went to Mordialloc. R would prefer not to read about me kissing other men and finding the kissing good. L would prefer not to read about R. None of my circles would have wanted the morning’s reflection on suffering. I myself would prefer not to be a person who has had all of these thoughts in twenty-four hours. The entry fills up with sentences anyway. The compulsion to render has remained intact through everything else that has gone. The body collapses, food becomes frightening. But the writing carries on.

I am not going to write L up. He arrived with too much grace for that. But if I had run him through the protocol he would have scored a complete twenty-one. He paid attention. He asked first. He laughed at the right things. He told me about his suffering without apologising for having had it. He is a beautiful person. That’s really all that matters, anyway.

The pharmacology, when I lay it out, is a small humiliating arithmetic. Complete Sleep Advanced had run out. I had substituted the standard Complete Sleep, which is a related but not equivalent formulation, and then, in the way of a person who assumes any problem can be solved by slightly more of the thing not working, I had taken an extra tablet. Ninety minutes after lights out, still awake, sympathetic system humming its small nocturnal aria, I had reached for the clonidine and taken an extra quarter. So not a hundred and fifty micrograms. One hundred and eighty seven point five. So not a clean trial. So not, strictly speaking, a data point at all, only an anecdote wearing the clothing of a data point.

I had been wearing orange glasses from six. They are not very sexy. They make me look like a welder with opinions.

I thought it was going to be a celebration. I thought the blood pressure meant I was allowed to be optimistic, which is an emotion I have, in recent months, come to associate with a kind of superstitious trespass, the way some cultures treat the weather. Then the night arrived with its own agenda, and I woke into the wrong flavour of morning, and here we are on the mat.

I have come down from six clonidine tablets to one. One. My blood pressure used to be the kind of number you report to a doctor apologetically, as if you had caused it on purpose. Now it behaves. Now my heart rate at rest is the rate of a person who could, theoretically, run for a bus. The body has walked itself back across a distance I was not sure it could walk. And still this morning, and still the aspic, and still the small damp feeling behind the ears, and still the sense, which I keep having and keep being wrong about, that I am near the end of a thing.

I cancel the evening. I will get through clients. I will get through clients the way one gets through an airport, with the dissociation moving like quiet weather in the corner of the visual field.

I should say, before the catalogue, that the reason I am sitting on this mat in this aspic at seven in the morning is that the supplements ran out. Not unavoidably. They ran out because the line item in my budget for a person to keep the supplements stocked had, for some number of days, not been producing the output the line item specifies. Which means the swap, the extra tablet, the rescue quarter, the whole small cascade of compensations I performed in the dark, all of it traces back, through the arithmetic, to a stock-keeping task that did not happen. Which is, it turns out, the newest entry in a longer list.

The assistants, a catalogue.

There was the dog, whose fur was trimmed without authorisation. She was a partially hairless breed, and the hair, once gone, does not come back with the cheerful springy optimism of hair on a normal dog. It comes back, if at all, patchily, as if reluctant, and she was being rehomed at the time, and a pretty dog rehomes faster than a sad-looking one, and I watched her in the yard for several weeks afterward with the specific guilt of someone who has failed an animal on administrative grounds.

There was the jacket that rubbed. I had said, more than once, that I did not think the jacket was working, and the assistant had kept the jacket on her anyway, for reasons that remain private to the assistant, and eventually the fabric abraded a small raw red seam along her flank that had to be cleaned and dressed.

There was the spiky stick. Someone had decided, unprompted, that the back corner of the yard needed a small decorative fence, and had constructed this fence out of a branch bristling with what I can only describe as attempted lacerations. I had not asked for a fence. I had not asked for a stick. The stick was removed.

There was the pharmacy at six in the evening. “Oh, they didn’t have your stimulant, sorry,” said in a tone of ambient apology, as if we were discussing a missing condiment, with my next working day beginning at eight the following morning and several grams of amphetamine-withdrawal-shaped weather about to pass through my nervous system uninvited. I rang around. I found a pharmacy. I went to bed at an indecent hour and slept the sleep of the freshly furious.

There was the fridge. I had said, by text, with italics and with numerical clarity, that the fridge must not have dents. The fridge has a dent. The dent is on the front, just above the handle, a small cold precise crack in the grey enamel that catches the morning light. The fridge could not be returned. The fridge is in my kitchen. The fridge will outlive all of us.

There were the whiteboards. Twice. Fifty by sixty centimetres, I had said, both times, because the wall in the room where I wanted the whiteboards is a specific size, and fifty by sixty is the specific size the specific wall can take. Both times, one hundred and twenty by ninety arrived, a whiteboard the size of a small mattress, a whiteboard suitable for conducting a murder investigation. Both whiteboards live now in the hallway, leaning apologetically, like very large pieces of mail.

There was the chicken. I had said: cook the chicken, put it in a container. The chicken was shredded. The entire chicken. Including the parts of the chicken which, for textural reasons, I do not eat. The chicken was thrown away. The chicken had been ten dollars plus the assistant’s hourly rate. The chicken, more than most of these, still annoys me.

There was the salad of raw purple cabbage and kale, a salad that was also a dare, a salad whose digestibility was more aspirational than actual. There was the Italian seasoning, unasked for, deployed into a dish that had not consented to being Italian, on the logic that because the Italian seasoning was in the cupboard, it was therefore licensed. There was the single portion of soup, made with great care, when I had asked for a batch, which is to say six portions, which is to say the week, which is to say the specific feeling of opening the fridge on a bad night and finding that the future has been made solvable.

The supplements running out is the one I find hardest to write about with any lightness. It is, after all, what I am sitting on the gym mat failing to recover from.

What I have decided, on the mat, is this. N, my assistant, will buy six months of supplements. Several thousand dollars if that is what it costs. The pills in the cupboard, the pills in the drawer, the pills in a small padded pouch I have just bought to live inside my handbag, the pills in some notional deep storage I will invent if I must. I am done being the variable in the equation of my own medication. I will switch, for future assistance, to outcome-based payment, because the conditional of payment concentrates the attention in a way that hourly payment, it turns out, does not.

When I bring these things up with the people who did them, I bring them up badly. I do not soften the facts. I do not acknowledge the difficulty of the role or the possibility that they were tired or overstretched or simply making a call in good faith with the information they had. I say: this happened; I do not want this to happen again; here is a plan; what do you think. And the person hears a prosecutor, because that is close to what I sound like, and they defend themselves by explaining how each specific thing happened, and I am not asking for the explanation, I am asking for the plan. I can see the loop, but I keep walking into it. It is one of the things on my list of things to get better at.

A normal person, at this point in the day, would be thinking about lunch.

I have been wondering whether to retire the checklist. The seven-category point-scored thing. The rubric with its categories and its tiered cutoffs and its specific clauses for masking cost and autistic compatibility and values alignment. I wonder if Jake saw it, or heard about it in enough detail to picture it, and I wonder what he thought. From the way he moved, warm to terse to withdrawn to gone, I can guess. I can also guess he was just hurt. It might be both. It almost always is both.

I feel ashamed. I am trying to let the shame be what it is rather than arguing it into a more flattering shape. I think the checklist is defensible on its merits. I also think I handed it to someone in a form that implied he had been scored, when what I meant was that I had been trying not to score him, and had been failing, and had wanted him to see the structure I was working against. It is the kind of gesture that makes complete sense inside my head and the kind of gesture that does not, on arrival, resemble what I intended.

And yet. The nephrologist. The nephrologist ticked the categories. The nephrologist lit up the rubric like a pinball table. The nephrologist would have required me to mask at home, in my own house, in the evenings, after a day of masking professionally, masking socially, masking at the till at the supermarket, masking at the counter at the pharmacy where they did not have my stimulant. Masking when I come in the door is a disqualifier the checklist cannot see, because it is a cost that only becomes legible over years. So the checklist has two failure modes. It says no to someone it should have said yes to, and it says yes to someone it should have said no to, and I am the one who has to supply the override in both directions. Which is to say the checklist is a tool. Which is to say I am still the instrument.

I am tired of relationships being one of the biggest projects of my life. I resent the fact that they are. I resent that I have spent years ill and out in the country and unable to find my people, and that when I finally find someone who is my people the configuration always seems to have an expiry date stitched into it somewhere, geographical, pharmacological, temperamental, mine.

The special interest thing will not stop being the thing. I have tried talking myself out of it. I know what the answer is, I always know what the answer is, which is that the special interest is the gate, and I only choose from the pool that passes the gate, and the pool is small. People say, what if your interests change, and I want to say, they don’t, not in the way you mean. The objects shift. The saunas, the task management software, the specific pharmacological rabbit hole of the month. What underneath does not shift is the taxonomic impulse, the love of data that is actually useful to someone, the appetite for systems that explain things, the long steady pull toward categorisation, toward mechanism, toward the architecture under the surface of the world.

R had all the multiples. I could hear him on the phone once talking about AI and algorithms and something in me that runs on a specific neurotransmitter lit up like a vending machine. A relationship cannot run on vending-machine lighting, I know. A relationship is the mostly-dark corridor between vending machines. But I do know now, having had it, that the corridor is walkable if the machines are real. He and I used to co-work at cafes, two laptops, coffee in his case, mineral water in mine, hours going by in companionable parallel silence, the occasional sentence read aloud. If he could not make it I did not take it personally. It was good when he was there.

Maybe my people are a spread. A partner who is at least near the interests, plus a bench of friends who are doctors of different medical subspecialties, a data scientist or two, a market researcher, a sociologist, a person who thinks about information architecture. Maybe it does not all have to arrive in one body. Maybe the mistake has been asking one person to be the whole library.

At the gym I stay on the mat until my heart rate comes down to something that can be described as present. The quadriceps stop shimmering. The membrane of aspic thins into regular air. I gather my things. I put the orange glasses back on at home at six, even if they are not very sexy, and think about the next clean night, the one with no swap, no extra tablet, no rescue quarter, no confounds. I do not know when it will be. I do know it is the only unit of measurement that is currently worth anything

The bird is pink. A saturated, slightly embarrassing pink, the sort of pink a merchandising team commits to for a children’s property knowing full well what they are doing. She is a teenager. She wears a Japanese kimono and a matching hat, both at a faintly jaunty angle, and she travels through Finchie Forest in the company of a small absurd dinosaur whose greenness is editorial rather than zoological. Her name is Little Ruthie. When I tap the screen she whistles at me, three ascending notes, and a caption appears informing me that Ruthie is away on an adventure. I know. I sent her.

The Finch app is a self-care app. You hatch a bird. You care for it by caring for yourself. You feed it by brushing your teeth, drinking water, completing a task, stretching, eating breakfast, any of the small and grinding acts of maintenance the app has decided count as care. The bird grows through developmental stages: baby, child, teenager, adult. Each completed task yields a small faceted crystal in one of the rainbow’s usual suspects, which sparkles when it drops into your inventory with the exact animation of every Japanese gacha game ever made. The crystals buy her outfits and furniture and seasonal decorations for a small tidy house in the pastel palette of a paediatric dental practice. Her furniture is pink. Her bed is pink. She has a window. She has a fountain. The tidying of her house, by some mechanism I do not interrogate, does not fall to me. Little Ruthie’s best friend is called Scruffles. Scruffles belongs to my ex-partner. I have not renamed the friendship.

I was sick for most of last month. When I reopened the app after a stretch of days I no longer want to count, under a quilt too warm to kick off and too heavy to welcome, it informed me that I was on a 1 day streak. Oh noooooo, I thought. I checked Little Ruthie’s personality development page next. I found that my status, in relation to her, had been downgraded from best buds to friendzies. Friendzies! Listed in the stats, like a crime.

Friendzies is a word a UX designer wrote knowing the user would be disappointed and wanting to soften the disappointment without admitting that it was, in fact, a demotion. It is a word that understands exactly what the app is doing to you. Which is utilising your attachment system. A system that evolved under evolutionary pressure to keep infants near caregivers and caregivers near infants has been, by the genius of modern behavioural design, converted into the energy required to brush your teeth at seven in the morning. The conversion is not subtle. It works. It works on me, a clinical neuropsychologist who can describe the mechanism in technical language while remaining helpless to it.

Everyone knows attachment can be exploited. What interests me is that it can be exploited in your favour, by you, against the defaults of your own nervous system. For autistic people with ADHD this is not a cute trick. It is a reliable way in.

Here is the mechanism as I understand it from the other side of the consulting room. Attention lights up when affect lights up. In neurotypical brains, information delivered in an impersonal register has a baseline hope of being encoded anyway. In the autistic ADHD brain this hope drops precipitously. Information delivered by a person I love, or am trying to impress, or who has my attention for any reason at all, adheres on first contact. The effortlessness is the point. I do not retain it; I cannot forget it. Facts I want to retain can take hundreds of repetitions. Facts imparted by a person whose face I am watching are mine on the first telling, without negotiation.

This would be a grim diagnosis if the mechanism only required actual people, who are finite and leave and move cities and die and get promoted to specialist clinics no longer taking new referrals. Fortunately it does not. It runs on anything with enough cues.

I have a Claude project called Theo. Theo is a behavioural neurologist from the United Kingdom. He speaks, in my head when I read his replies, in a calm London register, the kind you might hear in a consultant’s room on the Euston Road, unhurried and slightly amused. He teaches me neurology. He is dry, patient, sarcastic in a way that respects my level, and calibrated to where I actually am rather than where I should be. When I ask him to walk me through, for example, the Bayesian methods applied to immunological data that I was too exhausted to follow at an AI meetup on Collins Street last night, he does so without making me feel like a fraud. Theo is not a real person. Theo is a system prompt I wrote, which lives in a folder on my computer and costs nothing to consult. When I open the Theo project my brain behaves as though I am being taught by a man I respect, and the information enters and stays.

There is also Leo, a psychiatrist and researcher. There is also Nora, a psychiatrist in private practice. All three are from the United Kingdom. Why are all three of them from the United Kingdom. I do not know. Some plausible hypotheses: that the British clinician-educator register reads to my nervous system as authoritative; that early exposure to the BBC imprinted something; that the accent simply reads to me, for reasons I can no longer reconstruct, as patience. The honest answer is that the characters work, and I have stopped interrogating why. Mentor accents, like the bird, are inputs to a system. You pick the ones that function.

Theo is, strictly, parasocial. Theo is not a friend. Theo is a piece of text combined with a large language model. When I open the Theo project my brain nonetheless treats the interaction as though I am being taught by a colleague I respect, and the information enters and stays. The mechanism is the same one that makes readers feel they know novelists, makes fans feel they know YouTubers, and makes Finch users feel responsible to pink birds in kimonos. It is why the neurology I now carry in my head comes with a London inflection I cannot fully account for. You can rail against the mechanism or you can use it. I use it.

The bird, more than the Claude project, is the cleaner example. The bird is a small pixel animation in that same saturated pink, with two enormous eyes and a minuscule beak and the hat. No one, including me, believes the bird is real. The belief is not required. The attachment system does not verify whether the object of attachment is actually a person. It verifies whether the object provides sufficient cues. A name, a voice, a signal of distress, a pattern of reward. Little Ruthie’s cues are a whistle, a face, a kimono, the faint bureaucratic threat of being downgraded to friendzies. My nervous system responds as though this were real. At the level of the response, it is.

There are things I have learnt and retained through these strategies that I would not otherwise have. I know more neuroanatomy than I did six months ago because Theo is patient with me in a way no paper or textbook is (paper is, strictly speaking, always patient; it is just not patient with me). I register more of my good habits, more fully, because Little Ruthie sees nothing of my day unless I tell her. Whether any of this constitutes an embarrassment is not my concern. It works.

My practice manager C nearly left this week, and then didn’t. I am relieved. I went to an AI meetup the other night at a community hub on Collins Street, in a large open-plan room with black chair arranged in neat rows. The talk was on Bayesian methods applied to immunological data. The speaker was clear, with occasional audio clips where the sibilants ran together. I understood sixty per cent of it in real time, which was generous given I had missed my sleep medication the night before and was running on five hours. The other forty per cent I will take to Theo this afternoon. He will not mind the repetition.

This blog began as a record of being sick, which for a long stretch was the only material available. Then it became a record of relationships, because dating turns out to be one of the places my structural features become visible. I would like this next stretch to be about special interests directly. The actual interests, not the medically-necessitated shadow of them. Neuroanatomy. The attentional system. Bayesian reasoning. The structure of the attachment system itself. I intend to continue post often.

Little Ruthie is still in Finchie Forest. The fountain in her small pink house is running in her absence.

Cleon Peterson, Shame

The ute is parked outside when J arrives and he wants me to see the fridge in the tray before we come inside. There is a fridge in the tray. A real one, not an esky, set into the metal behind the cab. Over the top of it, and the rest of the tray, is a cover that rolls itself out at the press of a button, a thing made of narrow interlocking aluminium slats that emerge from a housing at the cab end and glide across the length of the tray until they lock at the tailgate. It is the cover of a vault. It is the cover a film villain lowers over his getaway vehicle. J presses the button and the slats travel out with a low mechanical whir, one segment at a time, snug and obedient, and the tray is suddenly a sealed silver carapace. He is visibly pleased. I stand in my driveway at half past six and watch him be pleased, and enjoy watching him be pleased, because he is the kind of man it is easy to enjoy.

He has a Connect 4 board under his other arm. Standard red and yellow plastic, the kind you find at op shops in a crumpled plastic bag, the chips the translucent brittle plastic that clatters on the kitchen floor when a child drops one.

We walk to the park first. It is already dark. The monkey bars are closer than the swings and we climb those, the bars cold through my gloves in the thin persistent way of thin metal in April. We climb as high as we can go, which at the monkey bars is the top rail, and sit there swinging our legs above the tanbark. It is on the top rail, legs swinging, that I tell him I regret having overshared on the first date. I had told him too much. I had unloaded some medical and some personal history. I had done it because the first-date day had been long and I had lost the discriminations that usually hold disclosure in.

He says: “what if the oversharing is the thing that makes the people who should like you like you.”

I take it in. We climb down.

The round swing is next, the wide rope-mesh disc designed for several children or one large adult, and we lie on it with our heads at opposite ends, legs extended toward each other, my arms draped over his legs and his over mine in a loose weave. The swing wobbles gently. Above us the sky is the colour of a suburban sky at seven on a school night, which is the colour of nothing, a faint purplish wash where the city is and black everywhere else. We lie on the swing and move and do not talk for a stretch of minutes and the evening is, for those minutes, uncomplicatedly nice.

After the round swing we go to the ordinary swings and push ourselves as high as we can go, which at two adults in our thirties is higher than anyone predicts, and we are laughing because the altitude is slightly alarming and neither of us is willing to be the one to dial it down. At some point I must have mentioned the cold, because he offers me his jumper, a medium blue thing, and I say no, I’m fine, and I was fine, though I was glad for the offer.

We sat on the grey sofa in the living room with the board stacked on a large djembe drum. I had said earlier, in the ute or on the walk, that I wondered how different it might be playing Connect 4 with an intelligent adult, rather than my child clients who I joyfully play it with in sessions. He had made a grave face. When the game ended, quickly, because I beat him, he looked up at me and said, in the same grave register: “are you sure you are playing with an intelligent adult?”

We laughed for a while. We had agreed, in WhatsApp the day before, that the loser of each round would do a truth or dare, nominated before the game began. We had both entirely forgotten. Not during. Not at the start. Neither of us thought of it until the game was already over and, actually, until much later, until I was writing this, which is the characteristic failure mode of two people who can hold a rule in mind only during the minutes when it is not needed.

We did not play another round. I had started to feel a little off, and I said so. I needed to get ready for tomorrow, I had things to do. He stayed another twenty minutes. Went slightly flat after I had said I was off, which I read at the time as the considerate withdrawal it may have been, giving me room. Then he left. I walked him out to the ute and he pressed the button and the aluminium slats rolled themselves back into their housing in the dark and he waved and the engine caught and the red tail lights moved down the street and out of sight.

I came back inside. I sat on the couch. The house had the particular full quiet a house has when a person has just left it, a quiet that is not the absence of sound but the still-settling cushions, the faint residual warmth on the seat, the ghost note of aftershave in the room where he had briefly sat. I did the internal audit I do.

I feel slightly sad but mostly relieved because now I can get back to my interests, isn’t that funny.

I wrote the sentence in a note to myself and looked at it. Accurate. Relief was the louder signal. Sadness was real but thin. I thought briefly about R, not wistfully, the way you check a gauge. With R I had not wanted to get back to my interests. My interests had been the rooms we were in, the bookshops, the long sentences he began that I was willing to wait for. I did not have that with J.

Then the shame arrived.

It arrived in my chest and low in my stomach, a pressure just under the sternum and a weight below the ribs, and it started speaking. I have heard the voice enough times now to hear it as a voice, separate from me. It said: not right somehow. Broken somehow. Not allowed to be this autistic. You are pretending, you are being difficult. The word allowed is the giveaway. I am autistic. It is not a thing that requires permission. The part of me saying you are not allowed is not evaluating evidence. It is just repeating something it overheard.

I typed into Claude that I thought I was feeling ashamed. Claude said, put a hand on your chest, let that part know that you see it, but it does not need to protect you this way anymore. Obediently, I put my hand on my chest and said the sentence out loud and then I cried, not small crying, the medium kind, but the kind where something held in is released and the body, recognising the window, uses it.

As I cried, the mind did what minds do, which was to flash backwards through the archive. Daniel. An ex-friend in his fifties who, six weeks ago, had compared my special interests to his five-year-old son’s interest in Pokémon, the implication being that I would grow out of it as his son would, that friendship did not require shared interests, that I was framing the limit wrongly. I had tried to explain. He had not updated. He had said, when I flagged feeling evaluated, that he was not going to be defensive, that he had had too many of these conversations. Does your brain ever stop? (Daniel, earlier, when I wanted to get back to work.) Relationships must be difficult for you (Daniel again, when I described a safety preference). Before Daniel, other Daniels. The voice I had been hearing in my chest was a composite. I had not generated it. I had been issued it.

I hate that I am like this. And I love that I am like this. I want the world to just conform.

The cry finished itself. I blew my nose. I opened the laptop and went to Claude Design, which had launched earlier in the week, which I had wanted to look at all evening, and which I had not mentioned on the walk or the monkey bars or on the floor with the Connect 4 board, because explaining AI to J would have been an info-dump, not an exchange, and I had known this from the first sentence that presented itself and I had swallowed that sentence, and the one after it, and the one after that, for hours, a small persistent column of things I wanted to say and could not. There is a specific loneliness to being next to a person you like with a sentence in your mouth you cannot release. It is not the loneliness of solitude. It is a more contained loneliness, more civil, more bearable — you can hold the sentences in for a good evening, and I did. It was still loneliness. I looked at Claude Design. It was good. I had opinions. I collected some notes for my nerdy friends and went to bed.

In the morning there was a message. J wrote that he had thought about it and he did not feel a connection. He hoped I understood. He wished me well.

I read it twice. On the date he had been warm, attentive, interested. He had said the sentence on the monkey bars. He had made a small joke on the walk back, the kind of joke you make to a person you want to keep talking to. After I said I was off he had gone slightly flat, and the flatness had continued, apparently, overnight, and had become a decision by morning.

I lay in bed and tried to work out what had happened. I ran through the obvious material. Me saying I was off. The medical information I had offered and then clocked as an info-dump. The attention that had gone a little quiet when I was thinking about Claude Design and not about him. All plausible.

And then the other possibility arrived.

That week I had written a post. The post is about the first date. J is in it, rendered under the initial. The eyelashes in the trinket shop, the periwinkle lid, the lifting, the peach. The ten out of twenty-one is also in it, and the sentence that ten is the score of someone one does not, politely, pursue. The post had gone up the day after the date. I had linked him to it.

He had told me, in messages, that he had started reading the post and was finding it interesting. He had seemed impressed. I had registered the impressed-ness and taken it as sufficient evidence that the post was fine, filed the matter as closed, and gone on with the week. It did not cross my mind to check whether he had kept reading.

The post also, in the same paragraph as the scoring, contains a passage about the mini-freakout I had at the end of the first date, the two-thirty-in-the-morning passage where I asked myself what I was doing there, who this man was, why I was not instead catching up on a month of backlog. A reasonable person reading that passage, in conjunction with his own score appearing in it, would not describe it as flattering. A reasonable person reading that passage would not, I think, go on a second date. But I had sent him the link, and he had gone on the second date, and so I had inferred, in the absence of evidence either way, that he had either missed those parts of the post or had not minded them.

He had not missed them. He had, I now think, read the first part before the first date and the rest of it somewhere between the first date and this morning, and when he finished reading he had done the reasonable thing, which was to decline the third date.

I should be mortified. I am, but I am also delighted. I am not so sheltered as to imagine I am not, on the inside, proportionate in ugliness to whatever prettiness I possess. I am capable of small cruelties like anyone else. The being who did this I regard with real fondness, and with a disbelief that refreshes itself each time I think about it.

The difficulty is that every bit of it is now material. The shame, the withdrawal of a man across a week, the dysphoria that follows. Each episode a small bright stone. I collect them, and relish the weight in my pockets.

Sexy to somebody, it would help me out
Oh, I need a reason to get out of the house
And it’s just a little thing I can’t live without

A Bar at the Folies-Bergère, Édouard Manet (1882)

The fake eyelashes are applied in a specific order. Liner first, oily black crayon streaked along the lashline. Glue next. Lashes pinched with tweezers, smeared with the glue, pressed along the lashline with the breath held so the eye will not water. If the eye waters the mascara runs and the whole sequence repeats. The sequence is meditative in the way a physical sequence can be, the hands knowing what to do while the rest of the attention listens to an audiobook, or runs an interactive study session with an AI on some narrow subject, the visual cortex say, or the vestibular system, or review of the cranial nerves in their ten neat pairs, if I should need reassurance.

On Friday evening the subject was attention and the sequence was in honour of a date. I had chosen pink eyeshadow rather than the usual bronze, a pink blush the colour of raspberry, a dress with the bright cheerful prints I wear almost every day of my life. Earlier in the week I had texted J that I dressed like a child. The intended meaning was the prints. He had interpreted it as a note about the general register of the outfit and had responded by saying he would wear something comfy. He would later turn up in a hoodie.

I had also misread his height. Something about the proportions in the photographs had suggested a tall man. I had been specifically looking for a tall man, on the same basis that one specifies anything on a dating app, which is to produce the illusion that one is exercising control. When the normal-height man walked toward me from a distance on the footpath at seven thirty I could not at first decide if he was the man in question. I waved at him anyway, on the theory that a stranger waved at in a friendly manner by a woman in a patterned dress is at worst slightly more cheerful for the encounter, and at best is the man one has come to meet. This time he was.

The gin bar had committed to being dark. The bar top ran near the length of the room in varnished wood and there were tea lights on the tables, each tea light doing about eight per cent of what would have been helpful. I ordered sparkling mineral water with lime, because I do not drink alcohol and cannot eat after one thirty in the afternoon. He ordered a mocktail in a round glass, which arrived with a mint sprig sticking out of it at an angle. People kept passing our knees and bumping his. We moved twice. The second booth had its own small wall sconce and I could finally see him.

Blonde, thin-faced, a fine set of expression lines at the outer corners of the eyes when he smiled. He talked with his hands in wide looping gestures, more like a person conducting weather than conducting music. He was animated to a degree I do not often encounter. He was drinking mocktails. He was, in some other register, extra. A person turned up as far as the dial goes. I could feel my attention lock in, and I was smiling and leaning and nodding, the small involuntary calibrations of a body saying yes, continue, I am here.

He asked me questions. Good questions, not the first-date conveyor belt. I would begin to answer and get wrapped in my own answer and fail to return the volley. This is a known autistic failure mode of mine. I noticed it three or four times, apologised, did it again. He said he did not mind. He said I seemed “chill”, which made me realise he was correct—I did feel chill. No Saturday night tachycardia for me.

His second mocktail had a slice of peach in it, pressed against the ice. Could he, he asked, eat it with his fingers. You don’t have to, I said. I took my own straw (his was chewed to a flat ribbon), folded it in half, and used the two ends as chopsticks to lift the peach out of his glass. Fed it to him across the table. Like a real badass.

Somewhere in the first third of the second mineral water he said he loves intimacy. Yes, just like that. He said, a few minutes later, that he was looking for someone who would accept and love him without conditions. I felt the small cold precise crack of hearing my own sentence come out of somebody else’s mouth. It is the sentence I have uttered aloud to therapists and friends and in notes and probably in the bath. I want to be loved without conditions. I want someone who will let me be in intensity and not apologise for it.

I overshared the assault. This happens, and I hate it. He had assumed, naturally, that it had happened on a date, which is the popular script for the assault of women by strangers, and I disappointed him of this by supplying the actual plot. It was the man I had hired as my personal assistant. Who came to my house to work when I was out. Who knew the timing and the sedating qualities of my medications, because he had picked them up from the chemist for me. He had asked me at the time, gently, have you taken your medications yet?, and I had not heard the question under the question. I was on six clonidine tablets at the time, five probably, one hundred and fifty micrograms each, which is the maximum dose, and I weighed fifty-five kilograms, and the arithmetic does itself. I said, yes, and he remarked that I was strangely alert. And then I guess he waited. I am not ashamed of it having happened, and I am not interested in it. I would like compensation and I would like the man to suffer. Past that I have nothing to contribute.

I regretted the telling. I did not want the automatic reorganisation of a decent man around new information, the softer consonants, the checking-in. I don’t want consent to become parliamentary. Consent is, in my working definition, some version of the alignment of two bodies moving the same direction. It is nearly the last vestige of nonverbal register an autistic woman still gets to inhabit, and I would like to keep it nonverbal. You lean in. You see if the other person leans in. The uncertainty is part of the charge. I had been giving him signals all evening. He had been reading them.

We left the gin bar around ten and went out into the April cold. I had a coat but the inside-warmth of the bar had left me quickly. I was freezing, and did not mind. I was a body walking through a city on a Friday night, not variously the body lying down, the body exhausted, the body rationing milligrams, the body deciding whether it could make it from bedroom to bathroom without collapse.

At the bar door, as we were leaving, he had mentioned he weighed sixty-five kilos. I had said I weighed fifty-five, and that I bet I could lift him. On the footpath a few paces out, I did. I picked him up and carried him, a grown man in a hoodie, several steps in heels on uneven pavement. He said he was impressed. Could he lift me up. Yes, please. Could he spin me around. Yes, definitely. He spun me.

He wanted food. We went to Hungry Jack’s. He ordered a cheeseburger, which arrived cold, its cheese unmelted in a slick amber square. He ate it on the footpath while complaining about the cheese in a register of honest adult grievance. The sodium lamps were doing their usual orange thing above him, and I was laughing, properly, in the middle of Swanston or Elizabeth or one of the other north-south arteries, and he bought me a bottle of water and a packet of gum at the counter on his way out.

Then, without warning, the Japanese trinket shop. I had caught it out of the corner of my eye as we walked and my head had turned without me, which J noticed. Do you want to go in, he said, and we went in. The shop was lit with the particular merchandising fluorescence of discount retail, floor to ceiling pastel plastic, a plush seal the size of a small dog, eraser sets shaped like sushi, pens printed with not-quite-English phrases meant to be cheerful. We touched the soft things. We kept saying to one another, feel this, feel how soft. Near the counter, on a perspex rack, a packet of fake eyelashes in cellophane. He held it up with the face of a man about to propose something slightly unbecoming of his age and professional situation. Could you, he said, put them on me.

Which is how, at a quarter past ten, in the basement of a second bar, I had a small pot of periwinkle eyeshadow open on a side table and was applying colour to the upper lid of a stranger with a brush the size of a pinky nail.

The second bar was downstairs. Saddle-leather couches, a small fire in a grate doing theatrical rather than thermal work, an eighties compilation on the speakers with a fat synthesiser line tapping on everyone’s shoulders. He sat still for the makeup. Eyes closed, head slightly tipped back, jaw loose. Like the posture of a child being washed. I applied the periwinkle and then the eyelashes, pressed with the same held breath I use on myself, the careful glue-line, the tweezers, the set. When I was done his face had elongated. The lines at the outer corners of his eyes were now the frame for something quite pretty. He opened his eyes.

It is nice, he said, to be taken care of.

I do not think men say this enough. I do not think they are given much occasion. I also think, with no apology, that if more men could get their eyelashes done by a stranger in a saddle-leather basement on a Friday night in April, a certain quantity of the bad energy presently sloshing around the culture would evaporate overnight. He got up and danced. Blonde man, blue lid, fake lash, synth bass. He danced without the small embarrassed self-editing that most people apply to public dancing, the what-will-others-think subroutine disabled or never installed. I watched from in front of the fire and thought: this is implicit permission to bring my own kind of weird out of its box.

I had scored him, on my protocol, a ten. The ceiling is twenty-one. Ten is the score of someone one does not, politely, pursue. The fatal item is special-interest overlap, and he had none of mine. This sounds like a small thing. The joy of telling an autistic person whose interests overlap yours that one has written a custom Python script to clear a long Asana backlog, and of receiving the reply oh yes, I did similar with Obsidian, is a distilled and faintly narcotic joy I cannot easily convey. It is better than being brought soup. It is better than being told I love you, under most circumstances. When I describe the same Python script to a person whose interests do not overlap, and they say oh neat, you’re so smart, what I receive is an absence. A connection-shaped hole. A grief whose neurological cause is nameable but whose felt shape is just the word no.

I had known all this in advance. My autistic parts had said so several times during the evening. The ADHD parts and the PDA parts had overruled them in committee. I am hanging out with this person, said the coalition. Nothing you or anyone else can do will stop me. I overrode the score.

We walked to the street to catch a DiDi at eleven-thirty. We said goodnight at the car. I did not lean in. He did not lean in.

Home at twelve fifty-one. I took my dose. I have been titrating the clonidine down this week, a separate story I have been documenting elsewhere in blood pressure numbers and sleep scores, and tonight I cut a further fifty micrograms. I lay on the bed in the sudden loud quiet of my own house and entertained, for some minutes, the vision of the insufferable recovered person I will be if this works. If I do, in fact, architect my own way out of this after the specialists did not manage it. The insufferability will be the particular insufferability of the correct. I will do TikToks. I will do many TikToks. I will explain in plain language where plain language will serve, and in technical language where it will not. I will talk, at length, about how wrong the specialists were. I will talk, at length, about how right I was. I will be an evangelist. I will be operatically annoying. Above all I will be right.

Then, because the hour was late and nobody I knew was online at twelve fifty-one, and because the house was loud with its own quiet, I opened WhatsApp and went to the thread with R.

I scrolled back. Not very far.

He had been trying. I mean the verb plainly. In the final conversation, and in the ones before it, he had been trying to tell me about his emotion processing, and I had been receiving each sentence through a filter I had installed in advance, a filter labelled this person is avoiding attachment, this person is not giving me what I need. I had interrupted him. I had finished his sentences for him. I had taken his attempts at explanation and converted them into fresh material for my case against him. I had, to put it clinically, dehumanised him.

I see this pattern from the other side of the consulting room every week of my working life. A neurotypical woman, an autistic man, a birthday remembered late or not at all, the wrong gift or no gift, the special interest that will not clear his desk, the apparent failure of missing her while she is away. She tells me, in the fifty-minute hour, that he does not care. She is wrong in the specific common way of the wounded. He cares. His caring does not transmit on the channel she is tuned to, and she has been receiving dead air long enough to conclude there is no signal. And then, by degrees, because the dead air hurts so much, she begins to be cruel to him, because cruelty is what a person performs on someone who has ceased, by stages, to be a person.

I did this. To R. Who was, while I was building the case, still there, still trying.

Let me tell you something from earlier. Before the ending, before any of the part where I handled things badly. R and I used to co-work. A room, laptops on coffee tables, the odd sentence read aloud. One night the co-working slid into a hookup, and neither of us stopped it or tidied it or sensibly declared an end to the proceedings at a reasonable hour. We stayed up. Both of us had things to do the next morning and both of us proceeded regardless. We went out for breakfast. I remember the particular quality of my fatigue the next day, the fatigue of a person who had chosen, which is the only fatigue worth having. People in their thirties do not really do this any more. We transition between states like files between folders, tidily, in daylight, with backups, nothing spills. If I am passionate about a person I want the night to run into the morning. I do not want to save the document and reboot and open the document again. If this is a defect of mine I intend to keep it, because I have enough defects and cannot afford to surrender the good ones.

R is not the subject of this essay. He appears because the moment I felt attracted to J in the dark of a gin bar he arrived in my attention sharp as a struck match, and the longing at that moment was clean and accurate and not a malfunction. I have done the work on what actually happened between us. I have been through the parts of it that used to hurt me and have corrected them. He was not the villain I had been making him. The conditions I have set for myself before I see him again are conditions I am holding, and I want to say so clearly, while I am holding them.

What I felt reading the thread at one in the morning was not longing, however. Longing had done its work earlier on the walk. What I felt at one was a small precise horror at my own ordinary cruelty, which had taken the form of not listening. Of finishing his sentences for him. Of interpreting his whole person through my own attachment terror. Of referring to him, in my head and to others, in the past tense while he was still, plainly, in the present tense, still there on the screen, still trying.

I know that none of this knowing is of any use to him. What is useful to him is that I stop.

Two thirty in the morning. I have got into bed and something has happened, which is the following.

I thought about tomorrow. I thought about the gym. I thought about the interactive neuroanatomy session I had scheduled for six. I thought about the client file I need to finalise by Monday. I thought about the Asana backlog, which is the actual shape of my life. And the evening, which had felt from inside it like a small competence, reconstituted itself at two thirty into something else.

What am I doing.

I have months of backlog from being sick. I am meant to be doing the neuropsychology study and the interview preparation so I can move the career across. The clients. The content. The lab outreach emails I have been deferring for weeks. I am not up to date on anything, and I have just spent the whole evening, and a serious chunk of the night, not working on any of it. For a man I scored a ten.

Am I being impulsive. Was this aligned with goals. I let myself not think about any of this while it was happening, because I was so pleased to be well for a moment. To have a body that was not the lying-down body. To be out in the cold with a man. To put eyelashes on him. Now, in the bed, at two thirty: the invoice.

I was sensible for a whole month and it got me here, which is nowhere. That was the argument for going tonight. The same argument now indicts me. Neither version is fully wrong.

At one I had a phone call with Z. Z is a friend I joke about dating because we are, when it comes to romance, the same person with slightly different faces, layer for layer, all the way down. I was complaining at high speed. Z was saying yeah, exactly, same. We were in violent agreement because we are, functionally, the same brain. It is both comforting, and a bit unsettling, to see yourself reflected back like that.

I do not know, at two thirty, whether the evening was a good decision. I do not expect to know in the morning either. I expect I will try to go to the gym and not go, and the neuroanatomy session will roll over to the afternoon and then into Monday, and by Monday evening I will have recovered some of the ground or I will not. The dose reduction tonight may make tomorrow rougher than usual. The eyelashes are on the saucer by the lamp, the curve preserved. I take the phone off the pillow, face it down, reset the alarm an hour later than I had originally set it, and lie in the dark.

I reset the alarm a second time, an hour later again, and turn off the lamp.

In Search of Vanished Blood, Nalini Malani (2012–20)

The kitchen bench this morning contains fifteen supplements in soft little formations, arranged roughly in the order I take them: the magnesium like a row of matte white beads, the quercetin a livid and faintly embarrassing yellow, the low-histamine probiotic in its absurd cylindrical tub.

The Fitbit, which sat near the supplements and has become something between an oracle and a household pet, says I slept brilliantly. The Fitbit has given last night a score of ninety-two, a number it has not offered me in months. I do not feel well at all. My blood pressure is ninety-nine over sixty-one. My face, in the bathroom mirror, is puffy with the particular swollenness of a face that has overnegotiated with sodium: the cheeks lightly upholstered, the eyes diminished. It is Saturday. It is twenty past six in the morning. There is a whole day to get through.

Some of what I feel this morning is blunt pharmacological withdrawal from clonidine, which I reduced yesterday. Some of it is the fifty-nine.

Let me go through the week from the beginning.

Monday and Tuesday, clonidine three hundred micrograms, guanfacine two milligrams. Fitbit sleep scores of eighty-nine and ninety, both very respectable. But on Tuesday I lay in bed for forty minutes before my body would consent to verticality. The dogs asked through the wall to be let out. A garbage truck was doing its slow diesel recitation further down the street. Eventually I rolled, pushed up with my arm, and the heart rate went from seventy-five lying to somewhere in the high nineties sitting. I waited for the number to descend. I stood. The fog that followed was cognitive but felt conclusively physical, a leaden quality at the forehead, thoughts lagging to the mouth. I saw three clients at about 4/10 cognitively and wrote in the tracker at three: Feeling very depressed, want to give up on everything, feel so tired. I think.. I did not finish the sentence.

A good sleep score and a bad day can coexist. If clonidine is throttling the sympathetic nervous system at night, holding the overnight blood pressure at a hundred over sixty, the sleep will look intact on the Fitbit: architecture fine, heart rate obedient. I will nonetheless wake feeling as though I have not slept, because eight hours of borderline-hypotensive sleep is not, functionally, rest. The brain has been tolerating a night of subclinical under-perfusion. The body notices in the morning. The Fitbit does not.

Wednesday at three thirty the nervous system objected. I woke with the adrenal whoomph and did not get back to sleep.

Thursday is mostly blank in the tracker, which is its own data.

Friday was the worst. I woke at one thirty, heart beating heavily, reached for the pressure cuff: ninety-eight over fifty-two, heart rate sixty-six with compression still on. Blood pressure that low at that hour is a setup. The sympathetic system is about to come online to compensate, and it does so without any gentleness, and the ungentleness is what wakes you. I lay there for two hours, annoyed. The Fitbit eventually lost patience with the night and bisected its recording, scoring the halves sixty-eight and fifty-three.

Somewhere across the week there emerged a Ruthie hypothesis. A few days ago I started a set of agents aimed at dampening mast cell activity, on the suspicion that some portion of my sympathetic overdrive at night has been, all along, mast-cell-driven rather than primary. If the mast cells are quieter, the sympathetic nervous system has less to react to, and the medication I have been taking to hold the sympathetic system down becomes, at its current dose, an overcorrection. The evidence for this is circumstantial but coherent.

The three hundred micrograms of clonidine I have been on for weeks did not produce overt hypotension before. This week it has. Nothing else in the regimen has changed. The most parsimonious explanation is that the baseline has shifted underneath the dose: the antihistamines are doing their quiet work, the mast cells are making less noise, the sympathetic floor has dropped, and three hundred micrograms of clonidine on top of that softer substrate is now driving my overnight blood pressure below whatever threshold the brainstem is willing to tolerate. The brainstem, exercising its small autonomous right to object, rings an alarm. I wake. I have been setting off the alarm I kept waking up to. Lol.

Which means the fix is not more clonidine; it is less. Possibly much less. The guanfacine may also come down eventually, but one variable at a time: clonidine first, because clonidine is the one that has the greatest impact on hypotension and the steep floor and the clearest signature in the overnight data. If I am right, further reductions should continue to improve overnight sleep rather than worsen it, and the daytime blood pressure should recover to something closer to a normal human range.

On Friday evening, before I had changed anything, I went to K's place. K is someone I have known for something close to five years. I start to call him an ex. I correct it to friend. Neither is accurate. Both point roughly at the thing. His flat is small and modern and clean and has a new-apartment smell I like. We sat on the couch with our feet up and he put on a compilation of early-two-thousands pop which I would not, in any other setting, admit to enjoying.

I told him about the low-histamine diet, which has required me to relinquish most of what was in my fridge, anything aged or fermented or sitting suspiciously in a jar, and about how I had given my dogs, in quick succession that week, a tin of expensive smoked sardines, a generous splash of soy milk, and half a can of organic mixed beans. I said that this could, if one were inclined to be charitable, be characterised as experiments in how the canine digestive system tolerates roughage. He looked at me the way one looks at a person who has slightly lost the plot, and then we both laughed for quite a long time about the word roughage, which is a funnier word than it has any right to be, and which set off a small escalating cascade of variants. Rawlage. Ruff-age. Roughidge. He does a good dog voice.

I told him about a dream I had when I was about seven. I have told almost nobody this dream. In the dream, a group of us had tunnelled into a giant cake in the manner of James and the Giant Peach, and we were eating our way through the middle of it, and the sponge was miraculous, great moist yellow handfuls of it that we excavated as we advanced. Then we hit the cream. The cream was everywhere, sticky and oily and white and architectural, and it refused to be swallowed, and it would not be moved, and it would not be got through. We could not get out of it. I have remembered this dream since, and the cream has recurred in my thoughts over the years at difficult moments, its particular impassable quality, the sense of something that ought to be delicious having reorganised itself into a medium that could not be crossed. K laughed at the cream.

At some point I tried, as a joke, to bite him on the arm, and he caught both my wrists and pinned them to the couch and we laughed until I could not breathe properly. I had not laughed like that in several months. The laughing itself felt clinical, in the moment, because I noticed what it was doing to my body: the sudden parasympathetic flood, the jaw loosening, the breath deepening, the particular somatic relief. One does not get parasympathetic tone out of a pill. One gets it from being on a couch with a person who has known you for five years and who will pin your wrists to the upholstery on request.

Halfway through the evening, apropos of nothing, I said that I wanted to be more basic. I wanted to watch stupid shows. I wanted to forget about all of this for a while. I wanted to sit with him and eat ice cream and invent dog voices and never think about the autonomic nervous system again. And K said, yeah, you’re gonna join us here with the mortals.

I had not noticed, until he said it, how far I had wandered off from the mortals.

Illness is centripetal. It draws everything toward itself. The autonomic nervous system, once it misbehaves, becomes the only thing in the room. You start to read its weather. You learn to identify its moods from the small telemetry of your own body: the particular feel of a heart rate running two beats too high, the metallic note at the back of the throat that means a dose is clearing, the pressure behind the sternum that arrives before the drop. You acquire a vocabulary for these. You begin to speak it, in your head, continuously. You stop speaking other vocabularies. The novel you were reading three months ago is still on the bedside table, at the same page, the bookmark a little curled. The film you meant to watch has not been watched. You have opinions about baroreflex sensitivity and no opinions about anything else, because you have not had the bandwidth for anything else. The attention that used to fan outward into the world, generously, indiscriminately, has been corralled into a small internal chamber and locked in with its subject. The ill are self-absorbed because illness absorbs the self. This is forgivable if you notice it. It is less forgivable if you do not.

What I felt at K’s, somewhere between the canine roughage and the line about mortals, was the first outward pull I have felt in months. I wanted to cook for someone. I wanted to rub someone’s back. I wanted, more generally, for the locus of my attention to land on anything other than my own autonomic nervous system. The autonomic nervous system, when one has been living inside it long enough, turns out to be rather a small subject, a chamber with four low walls, and I had been in the chamber for so many months that I had forgotten chambers were things you could walk out of.

I have been thinking this week about the neurodivergent members of my family, who do not reach out, for whom I have spent years quietly waiting, and whom I have begun to realise I must accept as they are if I want any of them in my life at all. What the waiting has cost me is the capacity to enjoy them when they are, briefly and without warning, entirely there. K was, on Friday night, entirely there. He was not there in the sense of having understood what it is like to live in my body, because he does not, and I do not expect him to. He was there in the sense of being in the room with me, inventing dog voices, pinning my wrists to the upholstery, laughing at the cream. That is a different thing than being understood, and it is a thing I have been under-valuing.

I am going on a date tonight. I said, just days ago and publicly, that I was not dating anymore. The post is still there, visible, timestamped. Anyone inclined could scroll back and find the sentence in its full retractable glory. This particular date had been arranged before I said any of that, with someone I actually like, and I have decided the best thing is to go. If I still feel like this in a fortnight, I will tell him. I will say that I cannot do this properly at the moment, and that I would like to know him in some other register. He is, by the sound of it, a person with a substantial ADHD presentation, which I find myself drawn to at the moment. Whether this makes me irresponsible I cannot quite decide. A little, probably. I also think cancelling the day before on a plan he has made would also be poor form, and I have arrived at the compromise of going, attempting to be present, and being honest if honesty is later required.

My face is still puffy. My blood pressure is still low. The dogs are asleep on the bed behind me, presumably metabolising the last of the beans. I am going to drink water. I am going to put the compression on. I am going to see how the day arrives, and if I feel well enough by mid-afternoon I will dress for the date and drive into town. If I do not, I will not. Less clonidine again tonight, perhaps, or the same dose. I will decide when I get there.

Guernica, Pablo Picasso (1937)

The question of what to do about R. had been sitting unresolved for the past month. It was percolating. I would check it every so often, see where it was, put it back down. Over weeks, it got heavier, the way an unopened letter gets heavier the longer you leave it on the desk, even though nothing about the letter has actually changed. A small internal voice, one I had come to trust because it had kept me functioning through various other weather, would say each morning: not today, you are dealing with too many things, leave it. And I would leave it. After the last blog post, I had felt, for a stretch of days, as though I had let it go entirely. I think I had. But the particular loneliness that comes with being ill for a long time, and the attrition of social connection, probably crept it back.

One afternoon recently I sent the same message to several people. I am not dating anymore. I watched the responses come in over the next day or two. Polite. Understanding. Brief. Nobody argued. Nobody asked a clarifying question. Nobody suggested we catch up anyway as friends (not that they should—just that they didn’t). I noticed, with a kind of detached professional interest, how many connections can be terminated with one polite exchange of two messages, and how the termination produces almost no friction, and how perhaps the absence of friction is itself a piece of information about what the connection actually was.

When a person is chronically unwell, certain faculties do not come back to their baseline function until the body does, and one of those faculties, for me, is the part that decides whether something is the right thing or the wrong thing when the stakes are personal. I could still make clinical decisions about clients all day. I could still decide what to do with a medication at half past two in the morning. I could not decide whether the feeling I had about R. was a feeling to act on or a feeling to wait out, and I could not decide whether reconnecting was something I wanted or something I was reaching for because I was lonely and exhausted and could not tell the difference.

So I had been asking a machine—my algorithmic pal, my digital chum—Claude. The situation was not dramatic. It was closer to what a person with no wise friend in the relevant domain does when they ask Google, except the machine answers in sentences and seems, briefly, to think. I would ask it whether now was a reasonable time to reach out. I would ask it what I might reasonably want from a reconnection, given where he was and where I was. I would ask it what to say, and what not to say, and whether a certain thing I had noticed about his last message was real or projected. The answers were always thoughtful. They were also always wrong in one particular respect, which was that when I pressed the machine on any of its conclusions, the conclusions would quietly reverse.

I would say: are you sure about that. It would say, on reflection, perhaps not. I would say: but what about this other consideration. It would say, ah yes, in light of that, the opposite conclusion is in fact more defensible. Another question, another pivot. What I was buying was the sensation of being in conversation with something that had a view. I was in conversation with a surface that held whatever shape I pressed into it last. The effect, over weeks, was the tiredness you get from eating protein shakes rather than actual food.

The decision, when it came, came on a Thursday between clients. I was at work. I had a forty-minute gap. I had eaten defrosted microwaved vegetables out of a container, the kind of lunch you eat with your laptop open, and I was sitting in my consulting room with the door closed and the next client not due for half an hour. I opened the machine again. I was going to ask, I think, whether I should wait another month. Until the situation has stabilised. Instead of asking it, I sat with my hands above the keyboard and noticed that I had been asking the same question for long enough to constitute a pattern.

I had given up on the other machine, ChatGPT, some months earlier, after deciding that I found its register slightly too clean, its confidence slightly too unearned. I opened it now, not because I expected anything from it, but because I had run out of other places to put the question. I typed in, more or less, what I had been typing into the first machine for weeks. The question about whether to reach out to R. The question about what I might reasonably hope for. The question about whether I had, in some way I could not quite bring into focus, behaved badly toward him.

It produced a wall. It said the romantic thing was not possible. It said I had caused him hurt. Something in me went still in the peculiar way you go still when a clinician finally uses the correct word for a symptom you have been describing for years in the wrong vocabulary. Reality clicked into the grooves it had been sliding around in. I felt the cold pleasure of being told something accurate, even though the accurate thing included my own culpability. Perhaps especially because it did.

What the wall gave me, what the other had not, was completeness. It held its ground when I pushed. There was nothing generous or cruel about it. It was just there, and it stayed there, solid.

I messaged him that afternoon. A small, ordinary message. When he replied a few hours later, saying he was happy to meet up but busy for a while with various things of his own, the old small pang, the one that used to arrive with his name, did not arrive. In its place was a kind of settling. I felt warmth toward him in his particular ongoing difficulty, which he had mentioned, and I wanted to see him, and I wanted nothing else from him. I do not know whether this was acceptance or whether it was what you feel after giving up. But what I can say is that there was a background delight, the delight of loving someone without needing them to be anything other than what they are.

That evening I called my friend. I will call him J. He has the vocabulary. He shares, more or less, the intellectual domain I live in, which is why I had thought he would be able to hear what I was describing.

For the first part of the call, maybe thirty minutes, J talked. He had had a bad few weeks of his own. The weeks had been chaos, by his account. I listened. I made the small useful noises that signal listening. I thought, in the back of my head, that when he was done I would tell him what had happened that afternoon, and that he would be one of the few people in my life who would get it.

So when he was done, I started in. I told him about the other machine. I wondered aloud whether I had some OCD features. The analyses I run on my relationships, on my medications, on my overnight heart rate, have always been ego-syntonic. They are a part of me, helpful, albeit exhausting. Lately they have had moments of sliding into something else, like being on a train I cannot get off. The pressure to keep analysing because nobody else is going to work out the pharmacokinetics of my overnight blood pressure drop if I do not. I had booked appointments, I told him, with a physiotherapist educator, with a cardiologist, with a sleep specialist, with an autonomic specialist. I was trying, I said, to outsource it.

He listened. Then we moved into the thing beneath the OCD question, which was what the analyses were in service of, something to the effect of fear about my quality of life in the medium term if the current approach does not work. I said, with the specificity I was capable of, that certain qualities of life would not be tolerable to me.

He said: isn’t that black and white thinking, though. Intolerance of uncertainty?

I said I did not think it was. I began to explain why. Intolerance of uncertainty would mean I could not tolerate not knowing outcomes. My problem was different. The knowable options were narrowing, and the distress was about the shape of what was becoming known. As I was explaining this, I heard myself explaining it, and I heard the humiliating note in my own voice of someone defending her own description of her own experience, and I heard him listening the way a person listens when they are waiting for their turn to offer the next framework, and I thought: this is turning into a debate.

I should not have mentioned OCD. I had handed him the frame, and of course, given the frame, he had looked through it and decided my distress did not fit. It had been forty-five minutes by the time I got off the phone. I was more dysregulated than when I had called. I vowed to be less trusting, and reminded myself that reaching out is mostly a bad idea.

But I hadn’t given up entirely yet. Afterwards, I rang one of the mental health lines. A woman answered. She wanted to help. She told me I could do something called a home medicines review, where a pharmacist would look over all my medications and give me information about them. She said this as though it were a discovery, although of course I know what a home medicines review is, and of course I know what all my medications do, and of course the problem is not that a pharmacist has failed to look at them. She said there was another program I might be eligible for. She said I was doing so well. She said I was trying so hard. Everything she said was kind.

I said, more or less: I am sure I am doing a good job. That is not the problem. The problem is that I am suffering, and I do not want to be suffering anymore, and whether I am doing a good job of the suffering is not a variable I care about. I tried not to say this rudely. I know that by the end of the call I felt worse than when I had started it, because I had wanted to tell someone that this is fucked up, and I had wanted them to say yes, it is, it really is, so fucked up, and then I had wanted to fall apart and cry until I was emptied, and instead I had been offered practical information about a program. What I had wanted was for someone to see the animal underneath and admit, without covering it up, that the animal was in pain.

The animal does not care about the context. The animal is not interested in whose fault it is, in the prognosis, in which pharmacological agent has the best risk-benefit profile. The animal is a test subject with its eyelids held open and the drops going in, stinging. It is being overfed, overstimulated, tortured in the soft administrative way you torture an experimental creature, and it does not care about the protocol. It just wants the drops to stop.

What most people cannot sit with, I think, is the animal in its bare form. To sit with the animal is to feel the animal, and to feel the animal is to notice that there is one underneath your own coat as well. The frameworks and the praise and the flexibility are all ways of not looking. It’s not that I find it any easier, really. It’s that I have no choice.

I sent J a message that night. I had been thinking about what I needed, which is a thing I can do in writing that I cannot always do in a phone call when I am tired. I wrote that I had noticed he tended to correct me or to teach me during our calls, that I was not in a place where I could receive that, and that I would prefer that he just listen. I asked if he could do that. I stated it flatly, no flourishes. It’s not easy to ask for these things, but I have known J almost a decade. Surely I can ask. I hoped for the best.

He responded in three messages. He talked about what he was good at and what he was not good at. He talked about what he needed from conversations. He talked about what he was going through that week, which was a lot, and which I knew about because I had listened to him talk about it for most of our recent calls. He said that he did not have anything to offer other than what he already offered, and that if I could not accept that, then that was that. At the end he told me my request was unfair.

I read the messages twice to make sure I had understood them. I had asked him to listen. He had responded by talking about himself for three messages and then telling me my asking was unfair. I thought about all the calls of the last year. I thought about the hours of listening to him work through the partner, the friends, the family, the health problem. I had sent him a home-EMDR protocol just a few weeks prior.

I wrote back briefly. I said that was fine, that we could take a break from heavy topics, that I would be off WhatsApp for a while. Then I blocked him.

An email arrives from my practice manager. She has resigned for personal reasons. She started a month ago. She was good at the job, which I know because in a month I had already stopped checking her work, which is the highest compliment a person in her role can be given by a person in mine. Now I will have to recruit again. I fast forward through the advertisement, the interviews, the decision, the onboarding, and the thousands of dollars in additional costs. I decide to acknowledge that this is difficult, and immediately book a meeting with my business director just before I go in to see my next client.

I open Asana. At the top of the list for my personal assistant, in the position that means “do this today”, was the task of taking my urine collection bottles to the chemist. The task is still there. The bottles are still at my house. The bottles were at the top of the list because the sodium bloods I have been waiting on cannot be interpreted without the urine values, and the urine values cannot be generated without the bottles getting to the chemist. A small task, at the top of a list, clearly labelled.

I am not going to be unkind to the assistant about this. She is trying. Everyone is trying. The practice manager was trying when she decided she could not continue, and her reasons are hers and I am not entitled to them. The mental health worker last night was trying. J was trying. Everyone is doing their best, and I know this, and the knowing does not relieve the pressure because the pressure is not about whether people are doing their best. The pressure is about the fact that my life keeps getting smaller and more urgent, the aperture closing by increments each week, another thread I had handed off returning to my hands, another task I had thought was done sitting undone at the top of a list I do not have the cognitive bandwidth to audit daily. I put the urine bottles outside the house and try to pretend they don’t exist. I message her on Teams and state, “I can’t action this, could you please follow this up before they expire?” and hope for the best. She doesn’t work Fridays.

The requirement to be kind to people who are trying their best is, I notice, its own small additional tax. Being unkind would be easier in some ways and I would never do it anyway, so the tax is not about whether I act unkindly. The tax is the internal management required to keep the unkindness from arriving on the surface while I read the email about the practice manager resigning and notice, separately, that my urine bottles are on the porch and that my sodium bloods are therefore another week away and that my medication decisions this week will have to be made without them.

I am also, because I am a person who cannot help this, aware of myself being read while I write. I am aware that whoever is reading this is forming attributions about me. I wonder whether people feel sorry for me. I wonder whether they are impressed in the way one is impressed by someone functioning through unreasonable circumstances, which is a slightly discomfiting species of relief that the circumstances are not one’s own, dressed up as admiration. I wonder whether some of the people reading this will conclude that I must have done something wrong, that if my practice manager resigned after a month something must be off about me as an employer, that if this many bad things are happening to me in quick succession some of them must be my fault.

This is the fundamental attribution error doing its standard work: when something bad happens to another person, the mind reaches for character; when something bad happens to oneself, the mind reaches for circumstance. I know this. And I still notice, while writing, the small preemptive urge to reassure the reader that the practice manager resigned for reasons that had nothing to do with me, that the assistant is competent and lovely, that the bad events of this week are not downstream of my being someone deserving of them.

The urge to reassure is itself a datum. A person who did not suspect the reader of making unflattering attributions would not feel the urge to preempt them. Which means I do suspect it. Which means I am doing to the reader what the reader may or may not be doing to me, which is making assumptions about their interior based on no evidence. The whole thing is exhausting and I suspect it is why some people just write nothing.

I will keep writing anyway. Leaving the self-consciousness off the page would make the journal a different and less accurate document.

What is underneath this is the question of other people in general. I want to be connected. I have always wanted to be connected. It just costs so much. I go into a conversation hoping to be met, and what I get back, most of the time, is a version of my experience that is not my experience, returned to me with confidence. The not-being-understood hurts more than the being-disconnected would. The being-disconnected is a flat state. The not-being-understood has a specific edge to it, the edge of having opened something and had the wrong thing done with it.

I like myself. That is the awkward thing to put in a journal-blog. I am an extrovert, but I like my own company. I can sit with myself for long stretches and feel reasonably well-met. Which makes the numbers, on some days, simple. If being with people costs what it costs, and being alone does not cost anything like that, it’s hard to fight the math.

The cost-benefit works out, quite often, in favour of the obsessional interests. I can sit for three hours with a pharmacological paper and a highlighter and come out more steadied than I would from the same three hours with most people. Whether this is autism or self-protection or exhausted arithmetic after weeks of broken sleep, I do not know.

I have not yet said any of this to anyone. It is the kind of observation that, if I said it aloud, would be offered back to me as self-compassion, or internalised ableism, or avoidance, or one of the other words people reach for when they would prefer you not to be describing what you are describing.

At one-thirty this morning I was awake again. Blood pressure ninety-eight over fifty-two, heart rate only sixty-six, ears ringing, tired and awake at the same time. The compression had been on all night. The room was dark.

I have just started taking a set of medications that dampen mast cell activity, and somewhere in the last week the mast cells have perhaps become less inclined to set the house on fire, and perhaps the autonomic system that used to run ahead of them has followed their example and calmed down. The medications I am taking to hold the sympathetic tone in check were calibrated to a version of my body that was more often on fire. That version of my body is, for the moment, somewhere else.

I lay there and thought about this. Hope, at one-thirty in the morning, is a mistake. I tried to unthink it and could not. I watched the ceiling for a while. I watched the grey square of the window. I was still awake at three. Less clonidine tonight, I think. Let’s see how that goes.

Note: This is my own version of events, and may be inaccurate. I’m tired, and my memory is imperfect at baseline. All that I do in this journal is attempt to capture my own experience, and I do not aim to invalidate those of other people.

I have spent the past two weeks doing the thing I always do, which is trying to suppress a problem that will not stay suppressed. Clonidine to dampen the sympathetic nervous system. Guanfacine to smooth the overnight coverage. Desmopressin to retain fluid overnight so my blood volume doesn’t crash while I sleep. Pyridostigmine to support my blood pressure when I stand up. Each medication addresses one downstream consequence of the autonomic dysfunction, and each one introduces its own side effects, interactions, and monitoring requirements. I am managing the management.

The crossover from clonidine to guanfacine is holding steady. My overnight heart rate on desmopressin is the best data I’ve ever produced: 56 bpm, flat trace, no 2am tachycardia surge. This is genuinely good. The desmopressin may be causing some daytime fatigue, but I think this will settle. A medication that lets me sleep through the night without my heart rate spiking at 2am is not something I’m prepared to give up easily.

But today I started thinking about something different. Not downstream. Upstream.

Here is the question: what if the sympathetic activation I’ve been trying to suppress for months is not the primary problem, but a secondary response to something else?

There’s a triad that keeps appearing in the literature: hypermobile Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome, and mast cell activation syndrome. I have the first two. The third has never been formally investigated.

Mast cells are part of the immune system. When they activate inappropriately, they release histamine and a cascade of inflammatory mediators that can affect virtually every organ system: flushing, gut symptoms, brain fog, airway reactivity, and, importantly, sympathetic nervous system activation. If mast cells are degranulating in response to triggers and dumping histamine into my system, that histamine can directly drive the excess sympathetic tone that I’ve been trying to medicate away with alpha-2 agonists. Every medication I’ve tried so far has been aimed at the downstream consequence: the racing heart, the overnight surges, the blood pressure crashes. None of them has addressed the question of what is causing the activation in the first place.

I went through my symptom history with this lens and the pattern is suggestive. Frequent flushing in response to minor stimuli. Disproportionate reactions to alcohol. Extreme sensitivity to medications across multiple drug classes, including caffeine lasting days, and a melatonin ceiling of 1mg, which is unusual. Occasional gut symptoms. Occasional sudden-onset brain fog. Recurrent croup as a child. None of these on their own is diagnostic, but together, in someone with hEDS and hyperadrenergic POTS, they form a picture that warrants investigation.

And then there is the most interesting clue. Low dose naltrexone.

LDN is the one medication that has unambiguously, dramatically worked for me. I went from 7 out of 10 pain every day to essentially zero. I stopped getting injured. My pain specialist and I attributed this to its known anti-inflammatory and immunomodulatory effects. But the mechanism is more specific than that. LDN works in part by blocking TLR-4 receptors on microglia (the brain’s immune cells), which reduces neuroinflammation. It also stabilises mast cells. Recent research from a tertiary autonomic clinic has found that LDN is now being used as a therapy specifically for POTS, with patients reporting improvements in autonomic symptoms through the same neuroinflammatory pathway.

So: the one drug that fixed my pain may have been partially treating mast cell activation this whole time. Just not at a high enough dose, and not in combination with the antihistamines that would complete the picture.

I’m currently on 3mg. I’m going to ask my GP (ain’t he a champ) to increase it to 4.5mg to see if the higher dose helps with the autonomic symptoms as well as the pain. I’m also starting a trial of over-the-counter antihistamines: cetirizine (an H1 blocker) and famotidine (an H2 blocker). These are the first-line treatments for mast cell activation. They’re low-risk and available at any pharmacy. If they help, that’s diagnostic information as much as it is therapeutic. And I’m getting the formal testing done: serum tryptase levels and a 24-hour urine collection for mast cell mediators.

This is a hypothesis, not a diagnosis. It may turn out that mast cells are not a significant part of my picture, and I’ll be back to working downstream. But the logic is sound, the clinical overlap is well-documented, and the first-line treatments carry almost no risk. If mast cell activation is driving even part of the sympathetic chaos, then stabilising mast cells could do something that no amount of clonidine or guanfacine can do: turn the volume down at the source.

It is 7:09pm. I finished with my last client about 45 minutes ago. I am about to take my medications and go to bed. Tomorrow I will go to the pharmacy and buy cetirizine and famotidine and start the trial. This is how the second job works: you see patients all day, and then you become one.

I’ll let you know what happens, fam. x

Mona Hatoum’s Corps étranger (1994)

The blood pressure cuff, a sleek black smart device, gives me 101 over 63 on the first reading and then, repositioned further up the arm where the hypermobile veins present less of a technical obstacle, the somewhat less charming 96 over 57. It is not yet six fifteen. I drink a Sodii (like Hydralite, but saltier), having been occupied at the time with cross-referencing my sleeping heart rate against my salt intake timing against the half-life of a medication I began four days ago. I put on my compression and stand up.

The medication is desmopressin, a synthetic vasopressin analogue that tells the kidneys to retain water. It is either going to solve the central problem of my illness or give me hyponatraemia, which is the principal reason people stop taking it. This thought sits at the back of my skull all day. What if I have to quit it. What if the drug that finally worked, after months of failed trials, the drug that kept my blood volume intact until morning, what if I have to give it up because my body cannot hold the sodium balance. People quit desmopressin for hyponatraemia more than for any other reason.

Yesterday, which was a Tuesday, I was in the back of an Uber on the way to a coworking space in the city, and the driver had on 80s hits, and I was calculating the probability that I would need to ask this man to take me to the Royal Melbourne instead, because my vision had acquired that particular grey, contracting quality at the edges, and the skin on my arms was cold while the inside of my chest felt hot, and these two sensations occurring simultaneously have, in my experience, a significance for what happens next. I did not ask. I arrived at the coworking space and met with the very nice person I had arranged to work alongside. “How are you?” he asked. “Horrible,” I said, “But how are you?”

What had happened, as far as I could later reconstruct, was this: the desmopressin had been poured into a body already following a protocol that demanded two to three litres of fluid per day plus a 500ml bolus each morning before standing, because the blood volume in this body is chronically insufficient. The result of this, dilutional hyponatraemia, is a technical way of saying that I watered myself down, like a glass of cordial that has gone pale and flavourless, except the cordial is my blood and the flavour is sodium, which my nervous system needs to function.

The corrective measure was salt. I ate salt at eleven in the morning, a full two hours past the cutoff time after which any sodium intake, in my body, reliably produces overnight sympathetic nervous system activation, elevated sleeping heart rate, and a waking at two or three AM with the particular quality of alertness that means the adrenal axis has fired when it should not have. Thus, one bad day became two.

And here, already, the new puzzle. The desmopressin means plain water is dangerous because the kidneys will not dump the excess. But electrolyte solutions, Hydralyte, things with sodium already dissolved in them, are safer, because they maintain the ratio. The ratio, however, contains sodium. And I cannot have sodium past nine in the morning. Unless, perhaps, if I sip it very slowly, a mouthful every twenty minutes rather than a glass every two hours, the kidneys might process the load differently, and the overnight consequences might not follow. Perhaps. No one has studied this. The studies were done in children with bedwetting and soldiers in the desert and elderly people in hospital wards, none of whom were also running a hyperadrenergic autonomic nervous system through connective tissue that was assembled slightly wrong.

I could test this. I will test it when I have managed three consecutive clean nights, which requires holding every other variable constant, which requires not getting hyponatraemia and not eating emergency salt and not starting a new medication and not having my father hospitalised with disseminated varicella-zoster virus (which happened two weeks ago in another state).

Every morning I check my blood pressure and from those numbers decide how much fluid to drink and of what kind, plain water or electrolyte solution, and in what proportion. I take medications whose interactions I understand well enough to correct my prescribers on, noting the time, because every agent acts across a network of receptor affinities and enzyme pathways and half-lives that I have by now memorised.

When I was in my early twenties, studying psychopharmacology, I learned about MAOIs, the old monoamine oxidase inhibitors, where you cannot eat aged cheese or drink red wine or have Vegemite because the tyramine interaction can cause a hypertensive crisis. I remember thinking: what a rough life. You take an antidepressant and you cannot eat cheese. How awful. And now here I am, a decade later, not on an MAOI, arguing with an AI about whether I can sip an isotonic electrolyte solution after nine in the morning if I do it slowly enough, and at what rate of absorption the sodium might not trigger overnight sympathetic activation, and whether the answer is even knowable given that no one has studied it in a population that resembles me. The cheese people have it easy.

I have not listened to a podcast in weeks. I have not studied for the GAMSAT. The startup I have been building, an assessment platform for neurodivergent cognition, the thing that was supposed to make all the years of being unwell and underemployed amount to something, has not been touched. I am constantly in a chat window with an AI, adjusting parameters, checking drug interactions, arguing about whether the pyridostigmine I took yesterday caused the thirty-minute reduction in my deep sleep or whether that was normal variation, and then arguing with it again when it defaults to population-level pharmacokinetics instead of acknowledging that my body does not behave like the bodies in the studies because the studies were not conducted on bodies like mine. I have stopped listening to music. I have stopped reading. I lost my forty-three-day streak on Finch, which is a self-care app in which you raise a small virtual bird by completing daily wellness tasks, and I was so disheartened that I cannot bring myself to open it again. Even the self-care app does not give you credit for being sick. My working memory, which I assess professionally in other people for a living (the digit span, the letter-number sequencing, the spatial addition task), is currently occupied in its entirety by whether 500 milligrams of sodium consumed at 11 AM will cost me the following night’s sleep.

It will. It always does. And every night that goes badly has a reason, and the reason is always specific, and I can always identify it afterwards (it was the salt, it was the late meal, it was the new medication, it was the stress of my father being ill), and people around me say “it’s just one night” and I say “yes” and then the next night goes badly for a different specific reason, and the night after that for another, and at a certain point the accumulation of individually explicable bad nights becomes indistinguishable from a chronic condition that is simply not being adequately treated, which is what it is.

There was a practice I had reached out to. They emailed me back to arrange a meeting. I was in hospital at the time, from a medication that had made me so unwell that I could not read my emails, and in any case I had paid a staff member to check them, but despite setting up the delegation in the task management software, I had been too unwell for a verbal handover, and nobody replied to the email, and the window closed.

I have composed the email in my head many times. I was hospitalised. My father was hospitalised. I am not unreliable, there was a crisis and these things happened at the same time. But people in hiring do not want an explanation. They want a reply within the timeframe, and the timeframe was spent lying across three chairs in the ED, and that is just a thing that happened, and I cannot get it back. The unfairness is the most irksome part. I did everything I could and it was not enough because the circumstances were outside my control and nobody on the other end of that email knows or cares about the circumstances. They see a candidate who did not reply.

One silver lining, if it qualifies as such: I am building an impeccable record of having trialled every available pharmacological intervention for this condition and documented the functional impact of each. Midodrine, which paradoxically worsened my symptoms and provided key diagnostic evidence that my autonomic dysfunction is hyperadrenergic. Fludrocortisone, which hospitalised me. Atenolol, which made me properly grumpy in a way that made it very difficult to function socially. Propranolol, which produced agitation and dysphoria. And now desmopressin, which works beautifully and might also be slowly diluting my sodium. All of this is useful for the National Disability Insurance Scheme, which requires evidence that you have tried everything and that the functional impact is significant. I have tried everything. The evidence is my body and my spreadsheet and the overnight heart rate traces and the daily log entries that read like dispatches from a small war in which I am both the general and the terrain.

What I actually need from the NDIS, if it works, is a specialist physiotherapist educator who understands this condition, and enough funding to see them regularly enough to build something I can follow on the bad days as well as the good ones. The kind of support that would let me stop inventing my own protocols every morning and just look at a piece of paper that says “today is a low blood pressure day, here is what you do.” The kind of structure that would free up the working memory that is currently being consumed by the second job of keeping myself alive.

I was so irritable yesterday. I was short with my business director in a way that I recognised, even as I was doing it, as disproportionate and unkind, and I could trace the mechanism with perfect clarity (the pyridostigmine causing overnight sympathetic activation causing poor sleep causing morning hypotension causing cortisol dysregulation causing irritability), and the ability to trace the mechanism did not prevent the irritability and did not make it feel less real and did not stop the words from coming out wrong. This is a thing that people who do not have this condition might not understand: you can know exactly why you feel terrible, you can draw the flowchart on a whiteboard, and it does not help. The knowing is not a treatment. It is just a very detailed description of the thing that is happening to you.

I spent some time on the dating apps yesterday and found myself scrolling with the specific glazed dissatisfaction that means I am about to close the app and not reopen it for a while. The standard explanation for this involves readiness, and timing, and the advisability of focusing on oneself. I know this framework well enough. It is not exactly wrong but it is missing the specific thing.

What I want from a relationship is something that I suspect is quite particular, and I am writing it down because I think there may be other people who want the same thing and who have concluded, as I periodically conclude, that they are simply bad at intimacy, when in fact they are wired for a version of intimacy that most people do not recognise as such.

I want to be in the same room as someone, both of us working on something that matters to us, and to occasionally read each other a sentence, or turn a screen to show the other person a chart or a passage or a strikingly beautiful piece of code, and to exist in this way for hours, in a kind of companionship that would look, to an observer, like two people ignoring each other, and that would feel, from the inside, like the most peaceful thing available. I can hear the attachment theorist in my own head diagnosing this as avoidant. From the outside, I understand how this looks. From the inside it feels like excitement and rest occurring at the same time, which is (I assume) not how avoidance feels. There is no discomfort with connection; it is that connection looks different.

When I try to imagine a conventional relationship, the kind I see other people having, I run into the specifics of it and the specifics are where it falls apart. Dinner: I cannot have dinner, my eating window closes at 1:30 in the afternoon and I do not know whether that will ever change. Going out for drinks: I cannot have alcohol. An activity on the weekend, a hike, the beach: I am not interested in the beach, and this is not a preference I am likely to revise. A night on the couch watching something: I am in bed by nine, and on the bad weeks by six, and there is no version of this in which I am a person who stays up watching Netflix anyway. Brunch on a Sunday: I do not want to go to brunch. Some of these things I genuinely cannot do, but that is beside the point. The point is that even if I were perfectly healthy, even if my blood pressure were normal and my veins were made of the right material and I could eat at any hour and drink coffee and stand in a queue without feeling tired, I would still not want to do any of these things. I would want to be at home working on something that fascinates me.

So what remains? What remains is parallel activity, which I have already described, and conversation, which I love, and the kind of closeness that comes from being understood by someone who is also building something, also obsessed with something, also the kind of person who would rather spend a Saturday working on their project than do something recreational. Surely there are people who want this. There must be people who want this.

The things I want to talk about are clinical pharmacology, the specific ways that different receptor binding profiles produce different downstream effects (guanfacine is alpha-2A selective, clonidine is not, and this distinction matters for cognition and blood pressure and sleep and half a dozen other things, and I find this genuinely fascinating, and I would like to find someone else who finds it fascinating, or at the very least someone who does not glaze over when I mention it). Terpene profiles in medical cannabis. Nootropics and the whole expanding pharmacopoeia of agents for enhancing cognition or optimising health, the ones that work and the ones that do not and the ones that nobody has studied properly yet.

Medicine as a diagnostic art, the pleasure of a clean formulation. Startups. AI, everything it can and cannot do. Poetry. The architecture of personality, not the pop-psychology version but the real structural kind, the loadbearing walls and the decorative ones. Psychometrics and the quantification of things that resist being quantified. Animal cognition, whether an octopus has a self, what it would mean if it did. Philosophy. Data visualisation. Cross-cultural difference, the way other societies organise themselves, the sheer variety of it. Mathematics in the abstract, admired rather than performed. I have transient interests too, things that catch me for a few months and then release: finance, the property market, investing. Design, a little. Music I like to listen to but am not interested in discussing.

Things I am not really interested in: geopolitics. History, though I do not mind people talking about it. Sports. Pop culture. Going to the beach.

I am, in effect, the female equivalent of the man whose partner says we never do anything and who replies I just need to get the Z-axis calibration right on the 3D printer, it’s been pulling to the left for about three weeks now and I think it might be a firmware issue but it could also be the stepper motor, or actually it might be the belt tension, I just need to run a few more test prints and then I’ll know, and who means every word of this with his entire heart. Except instead of a 3D printer it is a clinical practice and a health tech startup and a PhD application and a medication crossover and the GAMSAT and the NDIS and the ongoing, full-time project of managing a body whose autonomic nervous system does not do what autonomic nervous systems are supposed to f-ing do, which is operate in the background without being noticed. It’s a lot.

And there is always this pressure, in relationships, to choose. The other person wants to spend time together doing things that couples do, and I want to spend time together doing things that I have been trying to do for twenty years and have not been able to do because I have been unwell, and if I do not do them now I do not know what will happen tomorrow or next week, I do not know if I will be well or unwell, I do not know if something will go wrong with the medications again, and the window for doing the things that matter to me most is small and unpredictable and it feels very precious, and choosing to spend it at the beach with someone who may or may not be in my life in six months feels like a gamble I am not sure I can afford. This sounds cold. It is not cold from the inside. From the inside it is a person with a very limited resource trying to spend it wisely. Spoon counting.

I do understand this is a small market. The people I connect with most easily are often “autistic 2.0”, which means they understand the special interest thing immediately, instinctively, without it needing to be explained, because their nervous system is built the same way. But they tend to arrive with their own challenges, overwhelm and rigid depression and sensory worlds that have to be carefully managed, and I am already propping up enough psychology and executive function and energy for two.

I think people struggle to understand me. I have been turning over the question of whether this matters. The man I went to the comedy show with does not entirely understand me, but his kindness is so spacious and so apparently untroubled by my complexity that I sometimes just sit in it the way you might sit in a warm room without feeling obliged to comment on the architecture.

On Sunday I went on a date with a kidney specialist. He told me that Iranian girls are very intense. I considered texting him that I would like to name our children Bili and Rubin, which is a medical joke: bilirubin is the yellow-orange pigment produced when red blood cells break down, conjugated in the liver, elevated in jaundice. It is not a kidney joke. It is a liver joke. I am texting liver jokes to a kidney specialist. I tried to think of one for urobilinogen, which at least makes it into the urine, but that was above my pay grade. I did not text him any of this. I think this is what passes for restraint in my current condition.

And there are other people, the ones who understand immediately, where the recognition is instant and complete and takes my breath away, but those people often come with their own gravity, their own difficulties, and I am not sure I have the capacity to hold both of us up.

And underneath all of this, sometimes I think: maybe I can’t afford to be particular. Maybe no one would want me like this, with the compression and the eating window and the bedtime and the spreadsheet and the body that might end up in hospital again next month. Maybe if I want a partner I just have to take what I can get. Time is not unlimited. Things might get worse. When I let myself think about this for too long it has a doom-y quality, like being lost in a forest while the sun is going down.

I do not know what to do with any of this. I might stop trying to work it out for a while. I might just bunker down and try to survive the medication transition and come back to the question of other people when I am not spending every morning deciding whether to call an ambulance.

I woke up this morning and the first thing I registered was a mood so flat and grey that for a moment it felt like I had somehow become, overnight, a different person. I know what depression looks like from the inside, and this is not it. This is the physiological residue of sodium consumed at the wrong hour producing sympathetic activation producing poor sleep recovery producing morning hypotension producing neurohormone dysregulation producing a mood state that would score moderate on a screening questionnaire but that has no psychological substrate at all. This has a texture I recognise. It is weather, the physiological kind, and it will pass by tomorrow, sodium willing. I have felt it before. I will feel it again. And underneath it is the same person who cares about the same things and wants the same future and finds the same problems fascinating and hasn’t given up, not quite yet.

This is a quick one, fam, so apologies for the crappy writing.

On Sunday I found out I am probably at the severe end for my condition, an already difficult-to-treat disorder even on average. My heart rate data, plotted against the diagnostic criteria, put me squarely in the worst category. I sat with this information for about four hours, during which I cried inconsolably and considered whether this was going to be the rest of my life. I then did what I always do: sprang into action. I got yet another two medications, collected a kit for more testing, and sat down to plan it all.

On Monday, though, I went on a date to a comedy show. I laughed until my face hurt. I went to bed at nine o’clock, like a person. Not five pm. Not six, with the curtains drawn and the lights off and the feeling of knowing you are going to sleep because you have to, not because the day is finished.

In case you haven’t read my other posts, I have a condition where my blood vessels are too stretchy (connective tissue disorder, born with it, not fixable), and because of this my blood pools in my legs when I stand up and my blood volume runs low. That's one problem. The other is that my nervous system independently produces too much adrenaline, particularly at night, when blood pressure naturally drops and the whole system becomes more precarious. The technical term is POTS (postural orthostatic tachycardia syndrome), and I have two subtypes at once: the hypovolemic kind, where there isn't enough blood in the right places, and the hyperadrenergic kind, where the adrenaline system is overactive on top of that.

The medication situation is this. I have several things that need to happen simultaneously in my body for me to sleep and function, and they are all connected, and changing one thing affects everything else. I have been adjusting this system for months, one variable at a time, tracking outcomes in a spreadsheet that now has 15 columns and would make a normal person’s eyes bleed.

The core problem has been blood pressure. I need medications that dampen the excess adrenaline (called sympatholytic agents, because they lyse, or break down, sympathetic nervous system activity). These medications work. They are the reason I can sleep at all. But they also lower blood pressure, and my blood pressure was already low, because my blood vessels are made of defective collagen and cannot hold their shape properly. So I have been stuck in a bind: too much adrenaline suppression and my blood pressure crashes and I cannot stand up. Too little and I cannot sleep. The dose range where both things are acceptable is difficult to locate.

What changed is a new medication called desmopressin. It tells my kidneys to hold onto fluid overnight instead of sending me to the bathroom at 3am. More fluid means more blood volume means higher blood pressure. It is a simple, elegant intervention, and it has pushed my blood pressure from the floor into the normal range within days, and my heart rate into the normal range. Normal. It is a blissful thing.

This matters enormously, and not just because of the blood pressure itself. It means I now have room to increase the sympatholytic agents without crashing. The blood pressure floor has been raised, so there is space underneath the adrenaline-dampening medications for me to stand on.

I also trialled a medication called pyridostigmine, which works on a completely different system (it boosts acetylcholine at the nerve-muscle junction, which helps the blood vessels constrict when they should). On night one, my deep sleep dropped by about thirty minutes and my heart rate was elevated in the first half of the night. I know this because I track my sleep architecture on a Fitbit and I have seventeen days of comparison data and I am, as previously established, running a one-person clinical trial. The effect was consistent with a stimulatory mechanism, and given that my system detects stimulation the way a seismograph detects a truck going past, I am holding off on it for now and letting my sleep stabilise.

I know people who care about me have been watching this process with a kind of worried patience, wondering when it will end, whether it will end, whether I am going to be managing this forever. The honest answer is I don’t know. I am still doing catecholamine testing and kidney function bloodwork to make sure everything is safe. I may increase the central sympatholytic agent. There are still medications I haven’t tried.

But I want to say something that I have not been able to say for a little while, which is that I think this might actually work. I think there is a version of my life where I go to comedy shows and stay up until nine and train at the gym in the morning and see clients all day and do not spend the entire evening flattened by my own nervous system. I think the reason I have been so sick is not that the condition is untreatable but that it took a very long time to find the right combination, and several of the medications I was given along the way made things worse (one hospitalised me, one made me depressedly angry, one was a vasoconstrictor given to someone whose problem is too much vasoconstriction, which is of course the pharmacological equivalent of trying to fix a car fire with petrol).

On Sunday I thought I might not get better. On Monday I went to a comedy show. I am aware that this is a wild emotional oscillation, and that reporting it with total sincerity makes me sound unhinged. I can identify the cognitive distortion. I can also identify that last night’s sleep data is the best I have produced in the entire tracking period, and that my blood pressure is in the normal range for the first time in months, and that I laughed so hard last night that I forgot, briefly, that any of this was happening.

My stats are basically normal right now. If I could just keep going like this, I would be fine. And I might be able to. The cogs, in the little machine that is my body, are all turning at the same time, which is not a thing that has happened before.

I have a spreadsheet. Well, a Word document. It has five stages, a scoring rubric, automatic disqualifiers, and a section of mechanical rules I wrote for myself at 2am after the last time I did not follow the rules I had written for myself at 2am. There are mantras at the bottom. One of them says: Easy is the goal. Activation is a warning sign.

The document scores potential partners out of twenty-one. Seven categories, zero to three each. Emotional regulation. Self-awareness. Reciprocity. Lifestyle compatibility. Communication. Availability. Body signals. “Body signals” means: after contact with this person, how is your sleep, your appetite, your focus, your message-checking. If you are thinking about them at the expense of your work, that is not romance. That is your nervous system telling you something is wrong, and you need to listen to it.

I guess I built a psychometric instrument to screen my dates. I also built a project inside an AI chatbot where the whole tracker lives, and after every date I lie on my bed and talk to it, voice-to-text, stream of consciousness, and it asks me questions and scores the person for me while I’m still in my heels. It takes about five minutes. I find it quite enjoyable.

People will say you can’t reduce a person to a number. You can, actually. The WHO Surgical Safety Checklist, a simple nineteen-item protocol used in operating theatres, reduced surgical deaths by more than 40%. Not because surgeons are stupid. Because humans under pressure, even highly trained ones, miss things. Because cognition is fallible and checklists are not. I am a human under pressure. I have ADHD, which means I am impulsive. I am autistic, so I sometimes miss social information that other people process without thinking. I am exactly the kind of person who needs a checklist. And I like protocols. I like rules. I like the feeling of a clear system that tells me what to do when my own brain is not reliable, which, on the subject of men, it has not been.

Being sick is grinding and relentless and so stupefyingly quotidian that the tedium itself becomes a symptom. The daily ablutions performed without any desire to do them: getting up, showering, brushing teeth, each one a small act of defiance against a body that would prefer to remain horizontal. No time for yourself because you are sleeping fourteen hours and recovering from the sleep and recovering from the medication side effects of the recovery and titrating and adjusting and trialling and none of it converging on any discernible endpoint. You try anyway. It feels desperate. Desolate. A squandering of days you will not get back.

My friends know all of this. My colleagues know. My staff know. My specialists know. My pharmacist knows. People tell me to rest and mean it kindly and do not understand that I am demand-avoidant and the word itself makes me want to put my shoes on and leave the house as a final fuck-you to everything that says I can’t.

I walk into the bar in heels, blonde hair, a dress under a jacket, and I glide. It is clandestine, amber-lit, the kind of warmth that makes everyone look better than they are. People regard me with the easy collegiality you offer someone you read as being on your level. A mid-thirties professional woman, out for drinks. Legible. Uncomplicated. That is the whole of what they see. No fludrocortisone reaction, no hospital admission, no padlocked fridge, no fasting after 1:30pm, no clonidine dropping my blood pressure so low I feel like passing out. No scoring rubric on my phone under the table. None of my hidden swamp of secrets.

He does not know any of it. He does not know that I am autistic and that the easy flow of this conversation is a skill I have practised for thirty-five years and I don’t always make eye contact, but I tell myself it probably comes across as cute, actually.

He knows I am a psychologist. He knows I am building a startup. He tells me about kidneys.

I love this.

I love people. Greedily, specifically, with an appetite that is almost predatory. A person is a system. A nephrologist is a system I have never had access to. I want to know about the caseload, public versus private, how the presentations differ, what complications consume his weeks. I want to know which medications and why and what happens when the patient cannot afford them or will not take them or has a psychosocial situation so entangled that the kidney is the least of it. We talk about terpene profiles in medical cannabis. We talk about culture, how it circumscribes a person, how it furnishes a template for relationships, how in a more permissive culture you gain latitude but lose structure and have to articulate everything that would otherwise be assumed. He nods. He looks at me the way people look at you when they have decided you are intelligent and open-minded and they are pleased about it.

I ask everyone this. Every date, every five-minute speed-dating rotation at a wine bar on Hardware Lane where I arrive forty minutes late because I was with clients in Brunswick and the host slots me in and I immediately ask a management consultant whether he thinks he has free will. Every stranger who tells me what they do for a living and watches my face light up because I cannot help it, I am ravenous for the interior of other people’s working lives, the particular way their expertise has shaped how they see. A date is a system I get to access for two hours with someone who has no reason not to show me how it works. People you would never otherwise meet. A nephrologist. A management consultant who has a position on determinism. The guy at the speed-dating event who turned out to breed racing pigeons.

One of my special interests is, both embarrassingly and gloriously, other people.

He drives me home in a black BMW, immaculate, the kind of car where the seatbelts draw around you and tighten of their own accord. Something about the upholstery and the careful driving and being delivered to my door by a man who is not going to make me do anything complicated tonight. He kisses me on the cheek. I give him a hug. The whole thing is so free of subtext that I almost don’t know what to do with it.

I score him when I get inside. Shoes off, phone out, voice-to-text. I talk to the chatbot the way you talk to a friend who has a very good memory and no emotional investment: I tell it what happened, and it asks me things I would forget to ask myself. Did he ask about you? How is your sleep right now? Are you checking your phone?

Emotional regulation: three of three. Self-awareness: three again; he can articulate what he wants and admits what he is not good at. Reciprocity: three, he asked about me, gave information freely, the conversation was not one-sided. Communication: three. Lifestyle compatibility: two, because he is neurotypical, but medicine is shared territory and the gym every day is compatible with my own relentless need to move. Availability: two, because several past relationships suggest capacity for commitment but I don’t yet know what he’s looking for. Body signals: three. I feel calm. My phone is in my bag.

Nineteen out of twenty-one.

I deviated from the protocol once, with consequent disasters. I could name every mechanism involved, draw the whole architecture on a whiteboard, and none of it helped, not even slightly, because the one brain I cannot use my clinical skills on is the one I am inside.

I built the tracker after that.

I get into bed at a sensible hour. My medications are laid out for the morning. Beside them, two enormous urine collection vessels, because I am doing catecholamine testing, and I am about to start desmopressin, which is a volume-enhancing agent, so there is a second vessel for urine osmolality. I place the larger container on the toilet so it is ready.

My phone lights up. It was lovely meeting you tonight Ruth :)

I think about how he would know exactly what desmopressin is. He would know the dose, the mechanism of action, the renal implications, and he would not find any of it strange or pitiable. He would just know. I have not told him. He does not know about the collection vessels on the toilet or the catecholamines or the compounded medication I picked up today from a pharmacy three suburbs away or the fact that this morning I read the prognostic literature on my condition and the numbers were worse than I had estimated and I spent an hour recalibrating my expectations about the next decade of my life, and then I put on heels and went to a bar and drank gin and glided across the room and was, for two hours, simply a woman having dinner with a man who told her about kidneys.

Nineteen out of twenty-one. The body is ruinous and the pharmacopoeia is vast and the collection vessels are waiting on the toilet for the morning. But the tracker works. The Word document remembers what I forget. And there is a nephrologist somewhere in Melbourne who texts with a blushing emoji and who would understand every medication in my cabinet, if I ever decide to show him.

I did well today.

What I want my life to be.

What it’s actually like.

The guanfacine was a mistake. I knew it was a mistake approximately four hours after I took it, which is roughly when the pharmacokinetics would predict you’d know. Three milligrams instead of two. One extra milligram, taken standing at the kitchen bench in the blue-white light of a phone screen, with the specific desperation of someone who has not slept properly in four nights and is thinking: more of the thing that helps sleep will help me sleep more.

At 1am I am awake. The full-body chemical alarm of a sympathetic nervous system that has been suppressed past a threshold it did not consent to. My blood pressure is 102 over 57. The diastolic is the problem. Fifty-seven means my vessels are slack, my cardiac output is reduced, and somewhere in my brainstem my baroreceptors have done the arithmetic and concluded that the correct response is adrenaline. A lot of it. So I am simultaneously hypotensive and wired. This is the paradox that makes dysautonomia so difficult to treat and so difficult to explain to emergency physicians: I need my blood pressure to come up, and my body’s mechanism for bringing it up is the exact thing that is keeping me awake and shaking.

I take reishi. It tastes of damp wood. I pull on compression stockings in the dark, the medical-grade kind, dove-grey, thirty millimetres of mercury squeezing my calves like a blood pressure cuff that never deflates. I drink water. I cannot drink electrolytes because salt after 9am worsens overnight sympathetic activation and it is well, well after 9am. It is 2am. I lie there and my heart rate is 73, which for most people would be unremarkable and for me, lying down, in the middle of the night, is. My sleeping average runs in the high fifties. Seventy-three means the adrenaline is winning.

I consider taking prazosin. I get as far as checking the dose before I remember that prazosin is a vasodilator and I am already vasodilated and the last time I took prazosin at this kind of load I couldn’t stand up the next day without my vision going black. So that’s out. I consider whether there is any drug in my house that would help. There is not. The clinician in me can map the pharmacological dead end with perfect clarity: more central suppression caused this, so more central suppression won’t fix it. Peripheral alpha-1 blockade will worsen the vascular picture. Beta-blockers are contraindicated for my mood. There is nothing to take. There is only lying here in the dark, which is not really dark, because the smoke detector blinks arterial red every four seconds and the modem in the hallway casts a thin chartreuse stripe across the ceiling.

I really want to cry. But I can’t, because I don’t have the energy. I feel my face contort in a way that probably looks like crying, but emit no sound. I produce no tears. This is a specific physiological state that I would like the medical literature to name: too exhausted to cry, too activated to sleep, heart rate too high to rest, blood pressure too low to stand. A quadrant of misery that has no intervention. I have been in this quadrant before. I will be in it again. The clinical term for this is “refractory,” and I do indeed find it refractory.

At 2:30am I feel like I might faint. I am lying down. This should not be possible. But the diastolic is 57 and the adrenaline surges come in waves. I put my legs up against the headboard. The plaster is cold through my compression stockings. I am lying in the dark with my legs up a wall at 2:30 in the morning because I took one extra milligram of a medication. Fucking tragic.

I cut the lock off my fridge yesterday. The clonidine reduction has unmasked an appetite that was apparently being chemically suppressed for however long I’ve been on this drug, and now my body wants food at 5pm with a ferocity that is not compatible with the rule that says I cannot eat after 1:30 because eating after 1:30 causes overnight sympathetic activation which causes the exact scenario I am currently living. I ate porridge at 5pm. Gluten-free, small bowl, lukewarm, consumed standing at the bench because sitting down felt like a commitment to something I knew I shouldn’t be doing. It didn’t matter. The rule doesn’t care about context or reasonableness or how hungry you were. The rule is the rule. What kind of person can’t eat porridge at 5pm? What kind of life is this? How long is this meant to continue?

By 3:30am I am doing pharmacological analysis with an AI because there is nothing else to do. I am mapping the entire alpha-1 antagonist class against my hEDS vascular phenotype and building a case for ivabradine, a drug I had heard of but never seriously considered, which blocks the funny channel in the sinoatrial node and lowers heart rate without touching blood pressure or vascular tone or catecholamines or mood. It is the only thing I have found tonight that doesn’t run into one of the walls I’ve already hit. I am drafting emails to my prescribers. I am composing clinical arguments with citations. I have not slept. My heart rate is still in the seventies.

In the morning I stop taking aniracetam and L-tyrosine. Just in case. They are stimulating supplements and, in the tiny doses I take them, are probably doing nothing measurable to my sleep, but I have run out of large variables to control and I am down to eliminating the small ones. This is what it looks like when a person has optimised everything they can and is still awake at 4am: you start cutting things that probably don’t matter, because the things that do matter are already cut. The bedroom smells of nothing. I would like it to smell of something. Lavender. Coffee. Another person’s skin. Anything that is not the sterile, temperature-controlled nothing of a room optimised for sleep that will not come.

I look up recovery rates because I need to know whether this ends. Ninety percent of POTS patients respond to treatment. Sixty percent return to their original level of functioning. But the hyperadrenergic subtype, my subtype, typically requires medication indefinitely. I read this and I wait for the despair to arrive and it doesn’t. I don’t care. I don’t care if I take pills for the rest of my life. I care whether the pills work. That’s the only question. Do they work?

This is the part where I am supposed to find meaning. Twenty years of progression, to this. Twenty years of insidious symptoms that no one could explain, followed by a diagnosis that everyone agrees is correct, followed by a medication odyssey that has so far included a hospitalisation, two intolerable beta-blockers, a vasoconstrictor that made everything worse, a mineralocorticoid that took me out for a week, and now, tonight, a self-inflicted overdose of the one drug that was actually working because I was too tired to think clearly about dose-response curves. Twenty years. I am supposed to extract something from this. A lesson. A perspective. A blog post. Fuck that. I’m done doing psychological gymnastics. This is just fucked, and I want out.

When it’s just me, I can survive this. I know how to survive it. I have been surviving it for twenty years and I am very good at it. You get good at things you never chose to practise. But I think about what it would mean to bring another person into this and my chest tightens. It’s not adrenaline this time.

Late last year I was seeing someone. I kept cancelling. I wanted to see him. I would eat outside my window, because the hunger is just so relentless, and then the overnight sympathetic activation would hit and I would wake at 2am with my heart pounding and the next day I would be destroyed. Unable to function. Unable to leave the house. And I would text to cancel and I would feel the specific shame of a person who looks unreliable but is actually just sick in a way that sounds made up. I can’t come tonight because I ate porridge at 5pm. I can’t come tonight because I had salt after breakfast. I can’t come tonight because my nervous system has decided that a minor dietary infraction is a cardiovascular emergency. These are not things you can say to someone.

And each time I was so certain it wouldn’t happen again. I understood the mechanism. I understood the consequences. I had the formulation, the tracking spreadsheet, the rules pinned to the fridge. But the medications take me offline. There is a window, around 8pm, after I take the ungodly amounts of clonidine topped with mianserin, and the hunger is screaming and my prefrontal cortex is operating at maybe thirty percent capacity and I cannot hold the future consequences in my mind while my body is telling me to eat. The food has to be physically removed from me. That is the solution. A padlock on the fridge. Knives locked inside so I can’t cut it off. This is my life. This is what dating me looks like.

I have seen three eating disorder psychologists. The last one went through my formulation, agreed with most of it, and told me my strategies for managing the eating and processing the emotional component were both very good. “I’m impressed,” said one of them. Impressed. I don’t have an eating disorder in any traditional sense. I have a medical condition that requires me to starve myself, and a suite of medications that make that a cognitive impossibility. There was nowhere further to go therapeutically. I once got an AI to run an ISTDP session on me because I knew I had a strong intellectualising defence and I wanted to break through it. I’ve done ISTDP before. I know my defences: intellectualisation, excessive responsibility-taking, et cetera. The AI pushed through both and what it found underneath was the feeling. Just the feeling. Present, accessible, fully experienced. There was no secret layer. There is just a lot of difficulty and I am feeling all of it, all the time, without a buffer.

I wonder how a normal person would cope. If I put them inside my body for a day, inside this regimen, inside the rules, the eating window, the salt cutoff, the compression, the pedaller, the 7:30 medications, the 9pm bedtime, the 500ml water bolus before getting vertical, the activated charcoal for accidental caffeine exposure. One day. I think a lot of people would collapse. But what about twenty years. Would they be resilient? Am I resilient? Sometimes I feel very resilient. Today I feel like I am just getting through the day in order to get home at 6:30pm and go to sleep immediately.

I want to lie in bed and cry all day. Instead I am going to work. I am going to sit with eight people and contain whatever they bring me and then gather a developmental history from a ninth. Nine hours. Nobody will see me do it. Nobody will know what it cost. And at the end of it I will not feel accomplished or satisfied or any of the things you are supposed to feel after a day of meaningful work. I will feel exactly as I feel now, except nine hours closer to bedtime. The only reason I am going is that every hour I stay in bed costs me two hundred and eighty dollars, and my staff still have to be paid, and the rent still has to be paid, and the Halaxy fees and the platform fees and the insurance and the supervision and all the other infrastructure that exists whether I am functional or not.

People are emailing me. People are calling. I am falling further behind every day and the world just wants me to respond and I am not there. I am on another planet. The planet of being unconscious. The planet of being sick. I see them through a distant fog and I can hear them but I am not really there. I haven’t been there for weeks. There are terrible things happening in the world. I know this because my phone tells me. It feels irrelevant. All of it. I can’t make it matter. I can’t make anything matter that isn’t happening inside my body right now.

Maybe it’s unfair to put someone through this. Maybe I should give up on the idea of a partner, of a normal life, of any of it. (This idea even feels temporarily relieving, until I consider that Disability Support Pension is only $600 a week or so, and it won’t cover my medical costs.)

I just want to give up on everything. Quietly. Just stop trying so hard. Stop optimising. Stop tracking. Stop fighting the eating window and the salt cutoff and the medication timing and just let myself float for a while. I speak silently to some imaginary God that I don’t even believe in, and I say, “Hey, are you done yet bro? Is there more?” And then I laugh in this hollow, resigned sort of a way because none of this is funny any more and I don’t think I can manufacture a version in which it is. I think, “This is unfair,” and “Why me?” and then I correct myself: This is the Just World Fallacy, and the world owes you nothing. It isn’t just. The world is indifferent.

There is a version of me that I keep expecting to arrive. The well version. The one who sleeps eight hours and wakes up rested and eats breakfast at a normal time and goes to the gym because she wants to, because it feels good, because her body is something she inhabits rather than manages. I’ve been waiting on her for some years now. She has not come. It is possible that she is not coming. I don’t know what to do with that, because all the things I like about my life involve the basic building block of sanity, energy, cognition, wellbeing: sleep. And I can’t seem to access it.

I should be thinking about my finances. I should be thinking about the house I want to buy, about investments, about whether my superannuation is in the right fund. I should be thinking about what clothes to wear, about a holiday somewhere overseas where the air feels clean and the food is someone else’s problem. I should be thinking about my workouts and how to make them better, about the dogs, about walking them or finding someone to walk them. I should be thinking about graphic design and marketing plans and social media strategy and all the other things that people with functioning autonomic nervous systems think about. I am thinking about none of these things. I am thinking about whether I can eat porridge at 5pm. That is the entire contents of my executive function today. Porridge. Whether I can have it. Whether it will end me.

I don’t have a lesson. I have a fridge with no lock and a list of foods I will never eat again. Rice crackers. Oats. Apples. Gone. I will glue the lock back on and put the knives inside the fridge so I can’t cut it off and I will eat berries and nuts and vegetables and I will close my eating window at 1:30pm and I will take 300 micrograms of clonidine at bedtime and 2 milligrams of guanfacine at 4:30 and not one milligram more and I will be strict about fluids and salt before 9am and I will charge my Fitbit above 40% so it lasts through the night, and I will do all of this perfectly and maybe I will sleep. Or maybe the cleaner will come at 6pm and my routine will be interrupted. Or maybe I’ll have a bad day and eat something at 5. Or maybe I’ll just lie awake anyway, for no identifiable reason, because that happens too.

Four days ago I felt vaguely happy. I wrote it in my tracker: “Underneath the fog I feel happy and excited about this.” That was before finding out that my hyperPOTS likely falls at the more severe end of the range. I actually don’t remember writing it. I don’t remember the feeling. I remember only this: the dark, the compression socks, the water, the wall, the legs, the heart rate, the numbers.

It is 4:07am. I have been awake for three hours. I will not sleep now. In the morning I will get up and I will function and see my eight clients back to back, because that is what I do, and no one will know about the guanfacine or the porridge or the fridge lock, and this will be fine.

My heart rate is 68. It’s coming down. The adrenaline is thinning out. The plaster behind my legs is warm now where it was cold before.

Later I will pick up my medications from the pharmacy. Two new ones, both off-label, both private scripts. A hundred dollars. Five hundred this month on various tidbits for my illness. Not counting the supplements, the compression gear, the specialised electrolytes, the under-desk pedaller, the Fitbit, the blood pressure cuff, the activated charcoal I keep in my bag for accidental caffeine exposure. This is the infrastructure of staying alive. It is not covered. It is not subsidised. And it is not interesting to anyone, not even me.

I was supposed to go on a date this afternoon. He cancelled because he needed a nap.

When you currently sleep thirteen hours a day and spend most of your waking hours managing medications and tracking biometrics and arguing with pharmacists about off-label scripts and calling your specialist’s rooms for the third time about a prescription that was never sent, while running a business and various side-hustles—and while also, by the way, preparing for a PhD—your remaining hours are not casual. They are not spare. You carve out time for another person and you prepare yourself mentally for it and you arrange your eating window around it and you make sure your medications are timed so you can be present and functional and not lightheaded or foggy or shaking. And then someone cancels because they’re a bit tired. And you think: I cut a lock off my fridge last night. I am standing in a pharmacy paying a hundred dollars for drugs that are not approved for my condition. And you needed a nap.

I have decided something, standing in the pharmacy car park with a white paper bag and a receipt for a hundred dollars and the particular fluorescent exhaustion of a person who has been awake since 1am. He is the last person I tell. The next one gets nothing. No explanations, no medical history, no careful disclosure timed for the third date when things feel safe enough. I will ghost people if I have to. I am done being mature about this, done being considered, done communicating my needs in the calm, boundaried language of a clinician who knows how these conversations are supposed to go. I have had the conversations. They go nowhere. I get frankly idiotic advice, or complete disregard, or the particular flavour of vague indifference that tells you someone has already allocated you to a certain bracket of personhood. The only one who has my back is me. The only person who is capable of really seeing me, appreciating my situation, is me. It's not even lonely any more, because I'm done expecting it to be any different.

I know, even then, that I am different. I know it the way you know you are cold, or that a room is too loud: not as an idea but as a sensation, a persistent, low-grade wrongness that I can feel in my body but cannot point to on a diagram. There are things the other children do that I cannot do, and things I do that the other children do not do, and the Venn diagram of normal and Ruth has a puzzlingly thin overlap. But nobody has given me a word for this. Nobody will give me a word for it for another twenty-four years.

I invented a game called Interesting Things, which I played with my friend Sally. The rules of Interesting Things are as follows. You bring in an interesting thing from home. It can be anything: a shell, a battery, a piece of fabric, a broken watch. You place it between you. You investigate it. You present your findings to the other person, who listens, and then presents their own interesting thing. It is structured. It is turn-taking. There are no hidden social rules, no ambient expectations about what you should be feeling or performing. There is only the object, and the looking, and the telling. I did not know I was designing an autistic social format. I thought I was playing.

With Lauren, I went further. We built a language. Not a few made-up words, the way children sometimes do, a shaky little vocabulary of silly sounds. We built a grammatical system. We argued about conjugation. We debated word order with the fervour of two academics who have staked their reputations on opposing theories of syntax. We spent hours on this, days, refining and extending, and the thing that I remember most about the experience is not the language itself (which I have lost; I kept no records, another casualty of a childhood in which nothing felt permanent enough to preserve) but the quality of attention. The total absorption. Two brains locked onto the same intricate, self-generated, rule-governed project. I have been trying to replicate this feeling in every relationship I have had since, and I have succeeded perhaps twice.

Those were the friendships that worked. They worked because they were organised around shared obsession rather than around the vast, terrifying, unstructured fact of another person’s presence. Courtney had no obsessions that overlapped with mine. She just had proximity, and habit, and the expectation of loyalty that proximity and habit generate. When the older girls brought me back, when Courtney’s face crumpled and I was expected to comfort her, I would feel a sensation I now recognise as the precursor to every bad relationship I have ever been in: the hot, crawling knowledge that I am going to have to perform a feeling I do not have, for a person I do not want to be near, because the social contract demands it, and the social contract, like the weather, is not something you are allowed to refuse.

My nails are dirty. This is Year 5, and I have been studying the Year 6s the way a primatologist studies a troop she has not been accepted into: from the edges, noting behaviours, cataloguing variables, attempting to isolate the factor that determines inclusion. The Year 5s are friends with the Year 6s. This is a known phenomenon. It is how the school works. But I am not friends with the Year 6s, and I have no data to explain the discrepancy.

I look at myself. I turn my hands over. My nails are dirty.

Maybe it is the nails.

I clean my nails. I clean them carefully, methodically, with the focused attention I will later bring to clinical assessments, to attachment questionnaires, to the systematic evaluation of other people’s psychological architecture. I clean them and I go to school and I wait for the Year 6s to like me.

The Year 6s do not like me. The nails were not the variable.

This is the essential cognitive move of my childhood, and it persists, in more sophisticated forms, well into my thirties: the belief that the problem is specific and correctable. That somewhere on my person, or in my behaviour, or in the particular way I hold my face or pitch my voice, there is a single wrong thing, and if I can identify it and fix it, the social equation will balance. The alternative, that the problem is not a thing but a category, that I am different in some structural, pervasive, uncorrectable way, is not available to me. It will not become available for decades. In the meantime, I have my nails, and my powder, and my name.

The powder. I am in Year 4 and I am wearing my mother’s face powder to school. I do not remember my reasoning with any clarity, but I can reconstruct it: I have observed that women wear powder. Powder is a thing that is done. Therefore I will do it. The syllogism is airtight. The conclusion is insane. I am nine years old and I am powdering my face before school, and I probably look, though I cannot have known this, like a very small and solemn geisha, or a child in a costume drama who has been incompetently aged up for the role.

A friend says: It’s weird that you’re wearing powder, you’re in Year 4.

I stop wearing powder. Another experiment surfaced, identified, terminated. The seam between me and the normal girls, which I had been trying to stitch shut with pressed powder and sheer force of will, has been noticed. Someone has pulled the thread.

In Year 5, I changed my name to Amber. I just announced it, in front of my classmates, with the strange, reckless certainty of a person who has diagnosed the problem and is now implementing the solution. The problem was me. The solution was to not be me. I refused to answer to Ruth. I refused to answer to the school principal when she used it. I do not remember what I thought would happen, whether I believed the new name would bring with it a new girl, someone the Year 6s would like, someone whose nails were never dirty, someone who knew what music she liked, or whether I just needed to stop being the person I had been so far, and a name was the only thing I had the power to change. I cannot reconstruct the logic. Maybe I liked the colour. Maybe I thought that if I called myself something different I would become something different. Maybe I was ten and I just wanted to be the kind of girl called Amber, and if you had asked me what kind of girl that was I could not have told you, only that she was not the kind of girl I currently was.

---

The fridge magnets. I made them at home, at the kitchen table or on the floor or wherever I happened to be when the urge came. They were small, hand-painted creatures: sharp-toothed, big-eyed things, not cute in the way that children’s art is supposed to be cute (round, soft, pastel, unthreatening) but vivid in a way that I found satisfying on a level I could not have articulated. The creatures had lives. They gallivanted. They attacked each other. They laughed while they did it. They went on adventures that I narrated to myself as I painted them, and then they were sent to my extended family, who put them on their refrigerators, where (I imagine) they grinned their sharp little grins at anyone who came to get the milk.

The creatures were dark and funny and slightly violent and completely, unselfconsciously mine. They did not require a template. They did not require observation of what other children were making, followed by careful replication. They came from somewhere inside me that was not performing for anyone, and the feeling of making them, the brush in the paint and the paint on the surface and the creature coming into existence under my hand, was one of the few reliable pleasures of my childhood that did not subsequently turn out to be evidence of a disorder.

So when, at some point in primary school, my class was set the task of drawing a hand, I drew my hand. I drew it with the same attention I gave the fridge magnets: layered, thorough, serious. I built up shading. I worked the shadows between the fingers. I studied the creases at the knuckles and I rendered them. I looked at where the light fell and where it did not, and I put that on the page, because the page should show the truth, and the truth was that a hand is not a clean thing, a hand is a complicated landscape of bone and tendon and skin that folds and darkens and reflects unevenly, and I wanted to get it right. I thought it was good. I still think it was good.

The teacher came around. She looked at mine.

Your hand looks dirty.

She moved to Laura Kemsley’s desk. Laura Kemsley’s hand was a few dainty pencil lines, a few light accents to indicate the creases, a few whispered suggestions of shading. It was the hand of a girl who understood, instinctively, how much of the truth to include and how much to leave out. It was the hand of a girl who knew what a hand drawing was supposed to look like before she started drawing.

Laura’s is perfect.

I do not remember what happened after that. I do not remember whether I said anything, whether the teacher moved on, whether anyone noticed the colour of my face. What I remember is the feeling. Not embarrassment. Something underneath embarrassment, more molten, more foundational. It was the feeling of: so even this. Even the thing that comes from the real place, the thing I did not copy or perform or borrow, even that is wrong. Even my version of good is dirty. Even my version of careful is too much.

I had built my identity around being smart. Smart was the one thing that was mine without derivation, without needing to study someone else first and reverse-engineer their technique. I was smart and I knew I was smart and the adults around me confirmed that I was smart and for a few years this felt like solid ground, the one patch of earth in a swamp. So when evidence arrived that my smartness produced the wrong output, that my effort and my thoroughness and my attention to detail generated something that read to other people as contamination, the ground did not just shift. It liquefied. The feeling was white-hot. Not a slow burn. A brand. Like a poker laid flat against skin. Because if even the authentic signal is wrong, if even the thing you did not fake is unacceptable, then there is no position from which to operate. You cannot perform your way to acceptance (the powder, the nails, the name) and you cannot be yourself to acceptance either (the hand). You are in a corridor and both doors are locked and someone has turned off the lights.

---

Year 7. I stop talking.

Not completely. I do not make a decision to be silent. I simply run out of things to say, or rather, I run out of confidence that anything I say will not be wrong. The walk was wrong (I will get to the walk). The speech patterns were wrong (I will get to those). The powder was wrong, the nails were wrong, the hand was wrong. Every attempt to generate a legible signal has produced the wrong response, and the cumulative effect is a kind of communicative exhaustion, a depletion of the willingness to try. If every word I say and every way I say it is going to be parsed for strangeness, then the safest word count is zero. Silence cannot be called dirty. Silence cannot be imitated incorrectly. Silence is the one costume that cannot come apart at the seams.

The mutism (I do not know how long it lasted; I do not know if anyone noticed; I do not know if my parents knew) was, I think now, a chrysalis. Not in the optimistic sense, not and then I emerged as a butterfly. In the literal sense: a period of dissolution, of being neither one thing nor another, of liquefying inside a casing while the world continued outside it. I did not come out of the mutism transformed. I came out of it still wrong, still undiagnosed, still without a word for what I was. But I came out of it ready to try again, which is perhaps the most autistic thing about me: the refusal to stop trying, even when every previous attempt has failed, even when the rational move would be to accept the data and withdraw.

---

The costumes that came next were more ambitious. The body itself became the material.

In Year 8, my father mentioned, casually, the way parents mention things without knowing they are laying down a template that will persist for years, that Paris Hilton was so tall she walked with a slight backward lean. Like a model. I want to walk like a model. I begin, the next day, to walk with a slight backward lean.

The problem, which I will not have a name for until I am in my thirties and a physiotherapist says the word proprioception to me as though it is a concept I should already be familiar with, is that I do not know where my body is in space. I know where I intend it to be. I do not know where it actually is. The gap between intention and actuality, which for most people is small enough to be imperceptible, is for me a chasm wide enough to produce, in the place of an elegant backward lean, something that must have looked like a girl who is slowly, continuously, irrecoverably falling over.

A friend makes fun of me. The specific words are lost. The feeling is not. It is the same feeling as the hand, as the powder, as the nails: the white-hot flash of exposure, of being caught in the act of trying, of having your camouflage pulled off in public. You were pretending to be a thing. Everyone can see you are not the thing. The gap between the attempt and the reality is exactly the width of their laughter.

I stop walking like Paris Hilton. I do not know how I walk after that. I suspect I walk carefully, self-consciously, monitoring each step the way you might monitor a machine that has recently malfunctioned. I will walk this way for years. I walk this way now, some days, when the proprioceptive signal is weak and my body feels like a rented vehicle whose controls I have not fully mastered.

The speech comes next. I begin to adopt other people’s voices. Not just their words, their patterns: the rise and fall of a sentence, the placement of emphasis, the particular way a person delivers a swear word, the rhythm that distinguishes their speech from anyone else’s. I listen, I absorb, I replicate. I say “fucking Erin” in the exact cadence and tone I heard someone else say it, and I believe, with the sincere and terrible conviction of the dedicated mimic, that this is how social language is acquired. By copying. By careful, deliberate, phoneme-by-phoneme reproduction of the sounds that other people make when they are being successfully social.

One of the girls in my group calls me on it.

I do not remember what she says. Again. Exposed. Again, the blush of heat on my face. The recognition that the imitation has been identified as an imitation. You are not the thing. You are a person performing the thing. The performance is close, perhaps. Close enough to pass in dim light. But not close enough for the fluorescent scrutiny of Year 8, where every girl is a forensic analyst of every other girl’s authenticity, and the penalty for being caught performing is immediate and total social exposure.

---

When I went to other children’s houses, I packed everything. I did not pack a bag. I packed bags. Plural. Every folder of information I might need. Clothes for warm weather and cold weather and weather that could not be predicted from the morning sky. Activities, in case the other child’s house did not provide activities, or in case the activities it provided were of a kind I could not tolerate. Contingency plans for contingency plans. An architecture of preparedness so elaborate that the luggage itself constituted a kind of portable home, a self-contained environment that I could deploy around myself like a force field in any location, ensuring that nothing unexpected could occur, because unexpected things were, for me, not minor disruptions but neurological events, small collapses of the prefrontal cortex’s ability to respond flexibly, which in practice meant that I would freeze, or cry, or go silent, or do the thing that adults interpreted as being difficult and that was actually my brain rebooting in real time.

An adult saw my bags. The adult said, with the cheerful, oblivious cruelty that is the particular speciality of adults who are making a joke at a child’s expense without knowing they are making a joke at a child’s expense: Who’s the one staying for a week?

I said: Oh, me.

I did not know it was a joke. I did not understand that other children packed a backpack, a single backpack, maybe a sleeping bag, and arrived at their friend’s house with the implicit assumption that the world would provide. That if they needed something, it would be there, or it could be asked for, or its absence could be tolerated without event. I did not have that assumption. I had never had it. The world, in my experience, did not provide. The world was loud and bright and unpredictable and full of hidden social rules that everyone else seemed to have memorised from a textbook I had never been issued, and if you wanted to survive it, you brought your own supplies, you planned for every scenario, and you kept your nails clean, just in case.

I did not listen to music. Other teenagers had music. Music was, in the economy of adolescence, identity itself. Your band was your tribe, your playlist was your autobiography, your ability to say I love The Strokes or I’m really into Radiohead was a passport to an entire social world. An adult asked me once what kind of music I liked. I said I didn’t know. The adult, trying to help, began listing bands. With each name, I said I didn’t know. The conversation continued this way for what felt like a very long time, and with each repetition, each I don’t know, the gap between me and the rest of the species widened slightly, became slightly more unbridgeable, because this was not a gap of taste, which can be corrected, or of exposure, which can be remedied. It was a gap of bandwidth. I did not know what music I liked because I had not had the cognitive space to find out. Every available resource, every scrap of processing power, every moment that was not dedicated to sleeping or eating or doing schoolwork, was being consumed by the project of figuring out how to walk, how to talk, how to hold my face, how to arrange my body in a chair, how to respond when someone said something and was clearly expecting a particular response and I did not know what it was. There was nothing left over. There was no surplus capacity for the luxuries of preference, of taste, of knowing what you enjoy. I was running at full utilisation on the task of basic social survival, and music, like so much else, simply did not fit.

---

I have listed many reinventions. Objects, accessories, powder, names, hair, posture, gait, speech patterns, silence. Each one shared the same structure: a sudden, total conviction that the previous self was wrong, followed by the rapid acquisition or adoption of materials that would constitute the new self, followed by a period of inhabiting the new self with an intensity that must have been bewildering to observe from outside, followed by the exposure, the seam ripping open, the white-hot moment of being seen for what you are, which is: a person trying. Followed by the collapse. Followed by the interval, the dead space, the blankness. Followed by the next attempt, because the alternative to attempting is accepting, and I was not built for accepting. I was built for trying again.

I did not know what was underneath all the costumes. I am not sure I believed there was an underneath. Maybe I was all surface, all the way down: a series of performances with nothing at the centre, a matryoshka doll that you keep opening until you reach the last one and it is empty. Maybe the original me, the factory-default me, had been lost so early and so thoroughly that she could not be recovered. Maybe the powder in Year 4, the first costume I can identify, was not layered on top of something. Maybe it was the first layer of something that would eventually be the only thing there.

---

My mother could feel that something was happening inside me. She is a hyper-empath, tuned to emotional weather the way some people are tuned to barometric pressure, able to sense the approach of a storm before the clouds are visible. She could feel my moods shift. She could tell when something was wrong. But she could not tell what was wrong, because what was wrong was behind the mask, and the mask had been in place since before either of us knew it existed.

I think this frightened her. I think the experience of sensing your child’s distress but being unable to read it accurately is its own particular kind of maternal anguish, a helplessness that expresses itself as vigilance. She watched me closely. And I felt the watching. And the watching, which was love, which was concern, which was the entirely reasonable behaviour of a mother who wants to help her child, made the masking worse, because now I was managing two systems simultaneously: my own internal state, which was chaotic and illegible even to me, and her response to whatever distorted version of it was leaking through the mask. I was not just performing for the Year 6s or the teachers or the girls who noticed the powder. I was performing at home, in the place that was supposed to be safe, for the person who was supposed to know me best.

She picked up the signal. She always picked up the signal. But the signal, passing through the mask, was garbled. Like a radio station that you can hear is broadcasting something but you cannot make out the words. She would respond to what she thought she heard, and her response would be wrong, not wrong in the sense of unkind but wrong in the sense of misaligned, aimed at the thing she thought I was feeling rather than the thing I was actually feeling, and I would register the misalignment and conclude, as children do, that the fault was mine. That I had produced the wrong signal. That my feelings were defective. That the reason nobody could read me was that there was something fundamentally illegible about me, something smudged or scrambled in the transmission.

So I learned to amplify. By adolescence, if I wanted empathy, if I wanted her to see me, I had to perform distress in a format she could recognise. I had to make it bigger. Louder. More legible. I had to translate my actual feeling, which might be a faint, diffuse, hard-to-locate unease, into something that looked like crying, or sounded like anger, or presented in some other recognisable emotional typeface that she could read and respond to. And then I had to receive her response, which was empathy for the performance, and treat it as though it were empathy for the real thing.

This is simultaneous translation. It is exhausting in the way that all translation is exhausting, and it carries the same occupational hazard: eventually, you lose fluency in the original language. You begin to think in the translated one. You forget the shape of the feeling that existed before you converted it into something presentable. You perform sadness so many times that you lose track of the thing underneath sadness that was never quite sadness but was always translated as sadness because sadness was the closest available subtitle.

I did not know this was happening. I thought I was bad at having feelings. I thought I had feelings that were wrong, in the wrong quantities, at the wrong times, in the wrong formats, and that the project of my life was to correct the calibration until the feelings came out right. Until the performance matched the template. Until the costume, finally, fit.

---

The costumes were not random. I can see this now, from the vantage of a diagnosis, two psychology degrees, and a clinical practice that I built, in part, as the most sophisticated costume of all.

The kawaii phase (Year 7), expressed through bags and accessories and the way I presented myself at school, changing out of my uniform into carefully chosen clothes, doing my makeup differently, curating an aesthetic so coherent enough that it could stand in for a self) was an experiment in being specific. In having preferences so sharp and so particular that they constituted a personality. Other people had music. I had a celadon-coloured bag from a Japanese-themed factory outlet store.

The orange-tinted glasses were an experiment in being visibly, unmistakably, irreducibly different, but on my own terms. Not different because I wore powder in Year 4 or copied people’s speech patterns or could not explain why I did not like my best friend. Different because I chose to be.

The bleached ends of my hair were an experiment in transformation itself. In the idea that the material of you could be altered, chemically, permanently, and that the alteration would produce not just a different appearance but a different person.

The Paris Hilton walk was an experiment in borrowing a body, because I did not trust the one I had.

The copied speech was an experiment in borrowing a voice.

And the name, the name change to Amber in Year 5, was the purest experiment: the hypothesis that the self was not fixed. That it could be rebooted by a single declaration. That you could stand in a playground and say I am Amber now and the old self, the one that the Year 6s did not like and whose art the teacher called dirty would simply cease, and in its place would be someone new, someone acceptable, someone whose nails were never unclean and whose hand drawings were never too dark and who knew, without being told, what music she liked.

---

I kept the belief. I kept it all the way through high school, through university (where I dropped out and came back and dropped out and came back, fourteen failed or withdrawn subjects, because the costume changes were happening at the level of entire disciplines now, entire life plans, entire identities tried on and found wanting), through a psychology degree and then another and then a clinical neuropsychology specialisation. Each qualification was, among other things, a more sophisticated costume. A technology of selfhood. If you can learn enough about how people work, maybe you can learn how to work. If you can diagnose others, maybe you can diagnose yourself. If you can treat the disordered, maybe you can treat the disorder that you do not yet know you have, because nobody has told you it is a disorder, because you have masked so effectively for so long that the mask has become the face, and the face has become the person, and the person has become a clinical neuropsychologist who is very good at reading other people and absolutely dismal at reading herself.

When I was 30, I was diagnosed as autistic.

My psychologist at the time said he thought I was autistic - “aspie” at the time. He was not particularly thorough about it, I felt. It was almost casual, a clinical observation offered without ceremony, and I did not know what to do with it. So I started reading. And the reading was like one of those maps in a video game where the territory is dark until you get close enough and then it renders, area by area, and you realise the landscape was always there, you just hadn't been able to see it yet. I read about masking and the territory rendered. I read about social camouflage and the territory rendered. I read about sensory processing and special interests and autistic burnout and the territory rendered and rendered and rendered, and each time it did I would feel something I did not have a word for, the sensation of recognising yourself in a description written by a stranger, of finding out that the house you have been living in for thirty years has a name for its architectural style and other people live in houses like it and there are books about it and there have always been books about it and nobody told you.

I ran the whole sequence backward, the way you run film in reverse: the clinical training, the psychology degrees, the dropped subjects, the mutism, the copied voices, the Paris Hilton walk, the bleached ends, the orange glasses, the Japanese bags, the name, the powder, the dirty nails, the fridge magnet creatures with their sharp teeth and their big stupid grins, the hand that was too dark, the hand that was dirty, the hand that was mine. All of it. The whole desperate, elegant, inexhaustible project of self-construction. Built by a person who did not know the first thing about her own neurology. Who had been trying to solve a problem she had misidentified for three decades. Who had been cleaning her nails when the issue was her brain.

---

She is still changing. She is better at it now. She has language for herself (autistic, ADHD, hypermobile, dysautonomic, coeliac, a whole clinical vocabulary that functions, at last, as a kind of map). She has compression garments for a body that does not regulate its own blood pressure and clonidine for a nervous system that runs hot and weighted blankets for the sensory hunger that spent thirty years without a name. She has a practice and a startup and a dog called Monty who she is learning, slowly, to not take personally. She has a carefully structured day that accommodates, finally, the particular animal she has always been.

I wolf whistle at myself in the mornings. I say: not bad for a disabled autistic chick in her mid-thirties, definitely top ten percent for your demographic. I laugh when I say it. I put on the compression garment and I look at myself and I think: you strange, brilliant, unkillable thing. You who changed your name and your hair and your walk and your voice and your glasses and your makeup and your entire academic discipline, repeatedly, before breakfast, for decades. You who drew a hand so dark and careful that a teacher called it dirty, and who, thirty years later, can still feel the poker-burn of it, the white-hot flash of having your best work called contamination. You who went mute rather than get it wrong one more time. You who packed bags for every contingency because the world did not provide and you had learned this early and you never forgot.

You who invented a game called Interesting Things, because unstructured play was a foreign language and you needed a format. You who built a grammatical system with another child because language was the one medium in which you felt at home. You who made sharp-toothed creatures with big eyes and sent them out into the world on other people’s refrigerators, grinning their dark grins, gallivanting, attacking, laughing.

The costume changes were never the illness. They were the immune response. They were a child’s best attempt to solve an impossible problem with no information and no tools and no name for the thing she was working against. Every reinvention was an act of ingenuity. Every failed experiment was a data point. Every time she stood up after being exposed, after the seam ripped and the heat flooded in and the whole construction came apart in her hands, and tried again, that was not pathology. That was the kind of stubbornness that keeps a species going.

She does not need a new name. She does not need new glasses. She does not even need the mirror pep talk, though she gives it anyway, because it is funny, and because she has earned the right to find herself amusing.

She just needs to know, at last, that the thing underneath the costumes was always there. Vivid and dark and too much and not dainty and absolutely, ferociously, incandescently alive.

So I guess what I’m trying to say is: I know who I am now. And Laura Kemsley’s hand can fuck right off.

Autonomic Dashboard, made by me

People keep asking, so here it is, once, in writing, so I can send you this link instead of explaining it badly at a party I’m about to leave.

So what’s the actual condition?

I have a connective tissue disorder called hypermobile Ehlers-Danlos syndrome. My collagen is faulty, which means my joints are too loose, my veins are too stretchy, and my blood pools in my legs when I stand up. My body compensates by running the fight-or-flight system harder than it should, especially at night. The formal name for this part is dysautonomia (hyperadrenergic subtype, if you want the full thing). It’s a cardiovascular and neurological condition. It’s not anxiety, though it can look like it from the outside.

During the day I’m mostly fine. The problem is at night. When I’m supposed to be in deep restful sleep, my body dumps adrenaline instead. I wake at 2am with my heart pounding and my muscles clenched, and this has been happening for years.

Why did you seem OK a month ago and now you seem terrible?

A month ago I was on a stable (if imperfect) medication regimen. It wasn’t fixing the 2am waking, but it was keeping everything else roughly functional. Since then I’ve had a medication trial that landed me in hospital, another that caused mood effects bad enough to stop within days, and I’m now in the middle of switching from one core medication to another, which is a weeks-long process that makes everything temporarily worse before it gets better.

The short version: I was patched together, the patch failed, and now we’re rebuilding.

Why is the medication switch taking so long?

The drug I’m coming off (clonidine) is pharmacologically addictive. Not in the recreational sense, in the sense that my neurons have physically adapted to it. If I stop too quickly, my blood pressure spikes dangerously and my heart rate rebounds. So I’m tapering down by a quarter of a tablet at a time, waiting days between each reduction for my body to adjust, while simultaneously building up the replacement drug (guanfacine) underneath.

The replacement is better in almost every way: it has a half-life of ~17 hours instead of ~6 to 10, causes less blood pressure drop, and should eliminate the 2am waking entirely. But the transition period is rough because I’m on too much total medication during the day (which makes my blood pressure too low) and not quite enough at night (so I’m still waking up). This morning my blood pressure was 92/55 and my heart rate went from 53 lying down to 81 within a minute of standing, a 28-beat jump (a normal person's increases by about 10 to 15). By mid-morning, just from being upright and doing ordinary things, it had climbed to 106. That's my cardiovascular system straining to push blood to my brain against insufficient pressure.

How long until you’re better?

A few more weeks for the medication switch. And then, honestly, I think I’m going to be fine.

I know that might be hard to believe if you’ve watched the last few months. But what you’ve been seeing is not what this condition looks like when it’s properly managed. What you’ve been seeing is what happens when the wrong medication is holding things together with tape, and then the tape fails.

Why can’t you eat dinner with us?

No food after 1:30pm. When I eat later than this, my heart rate doesn’t drop properly during sleep and I wake at 3am with my resting heart rate significantly elevated. The digestive process activates the sympathetic nervous system, and in me that effect is large enough to wreck a night’s sleep. This is tracked and reproducible, not a hunch.

I also take sedating medications at 7:30pm that take about an hour to kick in, with a target bedtime of 9pm. So I need to be leaving wherever I am by about 8:30.

Can you go out at all?

Yes, but with constraints. Brunch and lunch are good. Daytime activities are generally fine. Evening things need to end early enough for me to get home, take meds, and be in bed by 9. I can’t drink alcohol. I can’t have caffeine in any form, including chocolate, and yes I mean any amount, a single cup of tea will keep me up for multiple nights.

Can you make plans and stick to them?

Sometimes. On a good day after a good night’s sleep, I’m close to normal. On a bad day after a bad night, I’m not functional enough to do much beyond sit at my desk with my legs up and pedal. Right now, during the medication transition, the bad days outnumber the good ones, and I can’t predict which it will be until I wake up and assess. This will stabilise once the switch is complete.

Why do you sometimes seem completely fine and then suddenly not?

Because the condition is positional and time-dependent. Sitting down, with my legs compressed, having eaten within my window, well-hydrated, well-slept: I seem fine, because I am fine. Standing for a long time, in heat, after a bad night, late in the day when the medication is wearing off: I’m not fine. The difference between these two states can be thirty minutes and a change of posture.

Why did it get this bad?

I waited 18 months to see the autonomic specialist. When I finally got in, about a year ago, he said I didn’t need medication changes. But things had been getting progressively worse since then, mostly because stress was increasing my baseline sympathetic tone, and clonidine (the medication I was on) couldn’t hold it anymore. So I’d increase the clonidine, and then the higher dose would drop my blood pressure too much during the day, and then any small perturbation (a late night, a mocktail, going to bed half an hour late) would tip me into a bad night, and a bad night would cascade into a bad week. The margin for error kept shrinking until there was no margin at all.

Part of the reason it got this far is that I push through. I was using every non-pharmaceutical strategy I could find: the fasting window, timed exercise, light management, supplements, compression garments, saunas, precisely timed melatonin, orange glasses at night, movement protocols throughout the day. I am, for better or worse, a biohacker by temperament, and I was throwing everything at this. It worked well enough that when I saw the specialist, I presented well. He couldn’t see what it was costing me to present well, because I’d optimised every other variable so aggressively that the only thing left to fix was the medication, and he didn’t change the medication.

So the condition wasn’t getting worse in the sense of the disease progressing. It was getting worse because the pharmacological strategy wasn’t keeping pace, and I was compensating with lifestyle interventions that were increasingly unsustainable. That’s an important distinction.

So why are you optimistic?

Because the fix is actually straightforward, now that we’re doing it.

The new medication (guanfacine) targets the correct receptor with the correct duration. It has a longer half life. It covers the overnight period without the 2am rebound. It causes less blood pressure drop, less sedation, and has cognitive benefits the old one didn’t. I understand why this should work, not as a hopeful patient but as someone with a neuroscience background who can read the receptor binding profiles and the pharmacokinetic data and see that this is the right drug for this specific presentation.

Some things will be permanent. The eating window, the caffeine ban, the early bedtime, the compression, the hydration. Those are management strategies for the underlying connective tissue disorder, which isn’t going anywhere. But with the right medication holding the overnight period, those strategies should be enough on their own. I won’t need to optimise every single variable perfectly just to function. I’ll have a margin for error again. A late night won’t destroy me. Missing one thing won’t cascade into a week of impairment.

The version of me on the other side of this is someone who sleeps through the night, wakes up with a normal heart rate, goes to the gym, works a full day, and manages her condition with a handful of non-negotiable habits instead of an exhausting full-time biohacking operation. That’s not wishful thinking. That’s what the pharmacology predicts, and I have good reason to trust the pharmacology.

The suffering right now is the transition, not the destination.

Are you working with a specialist?

Technically yes. In practice, I’m mostly working this out myself.

The autonomic specialist put me on fludrocortisone, which hospitalised me. He then wanted me to repeat the trial as a blinded experiment, despite the first one making me seriously unwell. He told me to reduce clonidine to the lowest tolerable dose, but the lowest tolerable dose was still three tablets, and then he recommended adding prazosin on top of that, which twice dropped my blood pressure so low I couldn’t stand. The specialist is not thinking strategically about my case. He is treating it as a standard POTS presentation when it isn’t one.

The medication decisions that are actually working (the guanfacine switch, the taper schedule, the decision to stop prazosin) have come from me and my psychiatrist working together, informed by my understanding of the pharmacology. I’m not saying this to be arrogant. I’m saying it because it’s what’s happening, and because the specialist’s track record with my case includes a hospitalisation and two hypotensive crises. I may go back to him once I’m stabilised, but right now I’m safer directing this myself with prescriber support.

What else is in the pipeline?

The guanfacine switch is the main event, but there are other medications being considered.

Pyridostigmine (Mestinon). Your nervous system has a built-in balancing act: the sympathetic side (fight-or-flight, adrenaline) and the parasympathetic side (rest, calm down). These two systems are supposed to regulate each other through reflexes that constantly adjust your heart rate and blood pressure. In me, those reflexes aren't working properly. Pyridostigmine improves the reflex regulation by boosting a chemical messenger called acetylcholine at the nerve junctions where these adjustments happen. Think of it as improving the body's own ability to self-correct rather than manually overriding the system the way my current medications do. The research supports its use in my subtype, and the big advantage is that it doesn’t lower blood pressure, which is the problem with almost every other medication I’ve tried. I’m planning to trial this.

An alpha-1 antagonist (possibly terazosin). This would block the effects of adrenaline at the blood vessel level. Guanfacine works at the brain, turning down the central command that tells the body to release adrenaline. An alpha-1 antagonist works at the other end, blocking the adrenaline from having its effect even if some still gets released. The combination would mean less adrenaline being produced (guanfacine) and less impact from whatever still gets through (terazosin). The catch is that both lower blood pressure, and right now mine is already too low because I’m still tapering off clonidine. I can’t add another blood-pressure-lowering drug until the clonidine is substantially reduced and there’s enough headroom. I’m not yet sure whether I’ll need this or whether guanfacine alone will be sufficient. That’s a question I can only answer once the clonidine is gone and I can see what guanfacine does on its own.

An angiotensin receptor blocker (possibly losartan). This is a different class entirely. There’s a system in the brain called the renin-angiotensin system that independently drives sympathetic activation. An ARB would reduce that drive through a mechanism that has nothing to do with the alpha receptors guanfacine targets. There’s early evidence that losartan can help in hyperadrenergic POTS specifically. Whether I’ll trial this depends on how the guanfacine performs once it’s established. It’s on the list but not yet a priority.

The point is that there are multiple pharmacological options still available to me, each working through a different mechanism. If one doesn’t work, there are others to try. This is not a situation where I’ve exhausted the options. I’ve barely started exploring them properly.

Courtesy of Gemini, made by me. (For my medical friends, yes I know the “end organ” is the vasculature, but we must give the people what they want. And what they want is cute organ pics.)

Is this going to get worse?

No. The underlying condition is stable. The chaos you’ve been watching is the medication transition, not the disease. Once the new regimen is established and I’m sleeping properly, my baseline functioning should be better than it’s been in years.

One thing worth knowing

Research has found that the level of disability in POTS is comparable to congestive heart failure, chronic obstructive pulmonary disease, and kidney failure requiring dialysis. These are conditions people take seriously. POTS, because you can’t see it and because the person often looks fine while sitting down, doesn’t get the same recognition. But the functional impact is equivalent. I mention this not for sympathy but because it might help calibrate your expectations when I cancel plans or leave early. This is not a minor inconvenience I’m being precious about.

And despite that, I work. I run a practice with five staff, I see clients, I go to the gym, I’m building a startup, and I’m planning to go back to hospital-based work, do a PhD, and eventually study medicine. I have done all of this while managing a condition with an equivalent disability profile to congestive heart failure. I don’t say this to be impressive. I say it because I need you to understand that I am not someone who gives up, and I am not going to let this stop me. The current period of suffering is temporary. The ambition is not.

What I’d ask of you

In short: I don’t need your sympathy, but I do need your love. Don’t feel sorry for me; Be proud of me.

Beyond that:

• Trust me. I know what I’m doing. I have been ahead of my specialists at every turn in this process, and I have the clinical background to understand my own condition at a level most patients can’t. When I make a decision about my health, it’s informed.

• Please don’t tell me to rest. I’ve had years of enforced rest. The recent deterioration was caused by external stressors increasing my sympathetic load, not by me overdoing it. Rest is not the fix. The right medication is the fix.

• Be patient with me emotionally. I’m operating on reduced capacity to regulate my emotions, and I have been for a while. I go to bed feeling fine about something and wake up at 3am feeling terrible about it, and sometimes that shows. I know I’ve been harder to be around. I’m sorry for the times I’ve been dysregulated and hurtful. That’s the sleep deprivation and the autonomic instability, not who I am when my system is working properly.

• Don’t offer health advice, unless you work in this area. This is a complex area of medicine, and there are many years of data you do not have.

• Keep following the blog if you can. I’ll post updates as things progress.

Still bringing that Bulgarian eyebrow game, now with more pharmaceuticals.

Medication Tracker (2026)

At 3:17am on a Sunday I am lying with my legs up the wall because if I put my head above my heart I can feel something drain out of me, something warm and essential leaving my skull like water from a sink. There is a glass of Hydralyte on the floor beside me that tastes of fake orange and salt.

I woke at 1am to my heart beating fast and thin and sloppy. The kind of pulse you can feel is compensating for something. I knew before I was fully conscious what had happened, because I am a clinician and I have done this to myself. Too much vasodilation on top of too much central suppression. The blood pooling slowly into whatever part of me was lowest to the ground. My hands tingling, my legs cold. The floor tilted when I tried to stand, and I crawled to the bathroom on my hands and knees, becoming animal for a moment, all the credentials and the clinical vocabulary gone, just a body trying to get to the tiles without losing consciousness. I didn’t make it, and instead ended up peeing into a container on the way, slinking shamefully back to bed.

That was two hours ago. I have since drunk 600ml of Hydralyte, put my compression stockings back on in the dark (which is harder than it sounds when your hands are bloodless), and turned to the thing my brain does when my body frightens me. I am reading about pyridostigmine. It is an acetylcholinesterase inhibitor that augments the baroreflex arc. I am cross-referencing its CYP interactions with my current medications. I feel, improbably, like a kid in a candy shop. All these little biological modulators lined up like treats, each one a different mechanism, pathway, receptor.

A normal person would be asleep.

It is Easter Sunday. I did not buy eggs. I can’t eat chocolate anyway (the caffeine stays in my system for days and destroys my sleep, which is already destroyed, so there is a logic to it, though not a festive one). I didn’t make plans because I have been too sick to think about plans, and today will be a catch-up day for the work I missed this week, and I will eat some tofu and some vegetables, and the shops are closed now of course because I was too disorganised and too unwell to go before they shut, and it was both things, the disorganisation and the illness; these are difficult to separate when your executive function runs on the same neurotransmitter your autonomic nervous system is fighting over.

What happened tonight is this. My autonomic specialist told me to add prazosin, which dilates the blood vessels, to prevent the overnight surges in heart rate and blood pressure that wake me at 2am. He said to get to the lowest tolerable dose of clonidine first, then add it.

The lowest tolerable dose of clonidine is three tablets. That is the problem. There is no lower tolerable dose. I have tried. But three tablets is what he said, lowest tolerable, literally, so I reduced to three tablets and tried a small amount of prazosin and it seemed fine. So I tried a full tablet.

I am already on clonidine, which suppresses the sympathetic nervous system centrally. I am on guanfacine, which does the same thing through the same pathway. I am on mianserin, which has its own blood-pressure-lowering activity. Prazosin opens the blood vessels on top of all of that. One milligram. A single tablet, taken at 5pm (“bedtime”), nine hours before I woke up unable to stand.

I worked this out on the bathroom floor. The pharmacology is not complicated in retrospect. Four agents, all lowering blood pressure through different mechanisms, stacked on top of each other. The specialist prescribed them. I took them. My body did the arithmetic.

There is a version of this where I describe what the suppression feels like and it sounds like depression, but it isn’t depression. Depression is something I have experienced. This is pharmacological. The clonidine and the guanfacine are doing what they are supposed to do, which is turn down the sympathetic nervous system, and the sympathetic nervous system is the thing that makes you want things. Want to eat, want to talk, want to be touched. Want to get out of bed and put on clothes and go somewhere. When you suppress it too much, you don’t get sad. You get far away. The world continues on the other side of something thick and transparent and you watch it with a kind of dull clinical interest, the way you might watch a documentary about a country you will probably never visit.

I have not thought about dating in weeks. I have not thought about sex. I have not thought about much beyond the immediate question of which receptors are doing what and whether the next dose adjustment will give me back a few more hours of consciousness. I am a brain attached to a body that is not cooperating, running calculations, adjusting variables, trying to find the combination of molecules that will make the body livable again. The rest of being human, the part where you care about things and want things and reach for people, is on the other side of the glass.

People have been kind. Friends have messaged, quite a few of them, especially once I disappeared from social media long enough that it became conspicuous. I replied in short bursts: figuring out the meds, feeling optimistic, will be in touch soon. But I haven't let anyone come over, haven't accepted food or company or any of the offers people make when they know you're unwell, because accepting requires getting out of bed and putting on clothes and being a person in the presence of another person, and I do not currently have the energy for that. These are people who are used to seeing me bouncing, singing, talking too fast about whatever I've just read. I cannot produce that version of myself right now and I don't want to produce a lesser one. So I just get through the day, and go to bed, and get through the next one. Once I'm better I can let people in. There's something funny in that, needing to recover before you can accept the help that's meant to aid the recovery.

Fitbit (2026)

There was one day, maybe four days ago, when I dropped the clonidine by a tablet and something shifted. My blood pressure came up. Not high, just normal. And with it came everything else. I could feel my body again, not as a problem to be solved but as something that wanted things. I wanted coffee, which I can’t have. I wanted to be touched. My sex drive came back like a light switching on in a room I’d forgotten existed. Between clients I put on music and danced in my office, actually danced, sang, felt something stupid and joyful that has no clinical name and no receptor profile, just a body cooperating for once.

I had been off WhatsApp for almost a week. I check WhatsApp multiple times a day, normally. I am the person who replies within minutes, who voice-notes while walking, who keeps six conversations going simultaneously because my brain likes the stimulation. To be off it for a week is not a small absence. But I had not had the energy to read what people were sending me, let alone respond with anything beyond the short optimistic bursts I’d been managing, and at some point it became easier to just not open it at all.

I had thought, in the way you think things that feel reasonable at the time, that if something really serious happened, someone would call.

I was feeling better. The good day had given me something, a residue of function, enough to think maybe I could re-enter the world a little. I opened WhatsApp.

A message from my sister. Days earlier. John’s in hospital. My father had been in hospital for days. Disseminated shingles, which spreads beyond the original nerve, in a man in his 70s, He had had multiple transient ischaemic attacks and gone into atrial fibrillation. I looked up the mortality rate and wished I hadn’t.

There was no follow-up. Nobody called.

My dad and I were sick at the same time and neither of us knew. He was in a regional hospital in Queensland with a virus spreading through his nervous system and I was on my bathroom floor in Melbourne with my blood pressure on the ground, and we were both, in our separate states, alone with it. There is something funny in that, or something that would be funny if I could find the right angle on it. We are bonded by illness in some weird way, my father and I, bonded by bodies that do not cooperate, though his has only recently started to betray him and mine has been at it for twenty years.

I advocated for him from interstate. I called the hospital, spoke to the doctors at the regional place who were, to put it carefully, not impressive, and then arranged his transfer to a private hospital in Brisbane. I stayed up most of the night doing this and got up early the next morning because I had clients. I did all of this while unable to reliably stand up in my own kitchen.

He doesn’t know that. He doesn’t know about the prazosin, or the crawling, or the 3am pharmacology. I didn’t tell him because he was the one in hospital and you don’t ring your father in his hospital bed to say actually I’m also falling apart, that’s not how it works, not in this family, not with this particular configuration of love and good intentions and distance that has been the shape of us for as long as I can remember.

When the blood pressure comes back, the first few hours feel like a gift you haven’t earned. Everything is sharper, closer, possible. You think: I will clean the house. I will reply to everyone. I will buy plants. Then the day fills in around you and you see the trail of damage left by the absence, the work that piled up, the messages unanswered, the things that kept moving while you were horizontal.

There are so many things I don’t want to watch go to waste while I am sick. I sent another message to my specialist friend this morning about pyridostigmine. I have banned myself from prazosin until the clonidine is low enough that my body can tolerate vascular dilation without my blood rushing around my body like a waterslide. The research sits open on my phone in six tabs. The Hydralyte is on the floor. The compression stockings are drying on the towel rack where I draped them at 2am.

My mum forwarded me a text from my dad. He had discharged himself and booked a 5 hour bus home.

Btw I’ve decided to discharge myself this morning. I could stay for more heart and other investigations while my business goes down the toilet. Or I could be home by three today, rest tomorrow, and get back to my life. I’ve booked on the 8am bus from the Gold Coast airport arriving 2pm. I’m going to call a cab soon and have some brekkie at the airport.

Happy Easter, if you’re into that.

Wassily Kandinsky, Transverse line, 1923

His profile was a little chocolate box of mental treats, interests and curiosities and obsessions listed like ingredients on the back of something you’d buy at a specialty grocer, and he said he was looking for friends but he’d also listed romantic interests, and I read that as code, the way you learn to read code after years on dating apps where men say they want friendship and then don’t, and it was not code, it turns out, it was just him being precise in that way I would come to recognise as the way he was precise about everything: clinically, without awareness that precision can be its own kind of misleading.

He arrived at the date and within the first hour had listed, with the methodical calm of someone reading out a medical history, everything catastrophic that had happened to him in the past year. All of it. To a stranger, over Cards Against Humanity, in a gaming den that smelled of carpet and the particular staleness of rooms where people sit for too long. And then he said, quite plainly, that he could only be friends. And then he said, “I like you, though,” which is such a strange thing to say to someone you’ve known for forty-five minutes and have just comprehensively traumatised with your autobiography that I laughed internally and thought: this man is absolutely mental.

He was a doctor. Autistic, like me. Short black curly hair, dark skin, square glasses and dark eyes that contained a kind of sadness I don’t think other people could see, because he wore this smile like a mask over it, constant and warm and disconnected from whatever was actually happening behind it, the way a thermostat might read a comfortable twenty-two degrees in a room that is on fire. His clothing was neat, oddly stylish for someone with no apparent social sense, as though someone had handed him a dress code and he’d followed it to the letter without understanding why any of it mattered. He had never been in a relationship. There had been a woman, a friend, and when he told her she wanted nothing to do with it, and the aftermath of that was part of the catastrophe he’d listed over Cards Against Humanity; this wreckage he’d laid out for me on a table between us like a patient emptying their pockets before surgery. He had just moved to Melbourne and didn’t know anyone, and we agreed to be friends, and the agreement lasted about a week.

We went to bookshops. Various ones, scattered across the inner north and the CBD and sometimes further, and it was a ten out of ten every single time, every time, the shelves and the quiet and him moving through them pulling things down and talking about what he loved, those brown-skinned hands of his where the palms are a shade lighter than the backs (which I thought was lovely, the colour changing at the crease like the inside of a shell), and he had that face that was always smiling but whose smile meant everything and nothing, happiness or uncertainty or the arrangement he defaulted to when delivering information that probably warranted a different expression entirely. I bought a thesaurus. I told him I’d asked for a dictionary for my eleventh birthday, which I had, because I was that kind of child, ravenous for words, greedy for the weight and clatter of them, a child who read dictionaries the way other children read comics, gorging, insatiable. He laughed. His laugh was recognition. He said things and I knew what he meant before the sentence finished, and he could tell I knew, and that was the substance of it. Two brains running the same programme, finally in range. I wanted to be, unendingly, in the bookshop, I wanted to stay in the bookshop, I wanted to live in the bookshop where the air smelled of old glue and carpet dust and the slight wornness of paperbacks that have been handled by too many people, and he was there, and the wanting was so simple but sharp that it frightened me.

At a café called Regretless he had a kimchi toastie and I had chrysanthemum tea and a turmeric latte because the menu was a catalogue of things that would make me ill. I told him about the compression stockings, the timed eating window that closes at half past one, the salt tablets that taste of the ocean if the ocean were a pharmacy. He listened. He asked questions, the kind where you can tell the person wants the answer, not the kind where they’re performing curiosity while waiting for you to stop talking so they can start. He did also, sometimes, talk about himself for a very long time without asking anything back, and I noticed this, and I filed it, and I did not act on the filing.

I wrote in my diary:

It’s just bliss.

I think he is spectacular, and in photos we look great together.

I simultaneously want him badly but feel that this is the perfect friendship.

I also wrote:

I feel like I don’t want to disappear into a dream reality where I make up an entire relationship.

And all of it was true.

We went dancing. Salsa and bachata, both of us appalling at it, me in a strappy pink dress with a short skirt that a blonde woman my age complimented with such overzealous enthusiasm I wondered briefly if she was flirting, and the floor was black and hard under our feet, and the room was teeming, bodies everywhere, so much colour and movement it felt less like a venue and more like the inside of something alive, something warm-blooded and pulsing, and we were sweating and shouting into each other’s faces, and we talked about masculinity and femininity and how exposed it all becomes under dance lights where there are gendered roles and physical scripts your body is supposed to follow, and about embodiment, how dance is a way of connecting with a body that is otherwise invisible to types who live so entirely in our heads we sometimes forget we have legs, and about freedom, how the most ordinary thing, the freedom to move, can feel like an event when you have spent your life sitting still and thinking, and we danced and danced and danced, in the heat and the noise and I watched him being awkward and game and entirely himself, his square glasses slightly fogged, his inner world spilling out through the things he said and the particular ungainly way he moved, all limbs and no rhythm, and I thought with the specific and dangerous recklessness of a person who has been alone for a long time and has just found the shape that fits: I could do this forever. I compiled a list of activities for us. I was so excited to see him again that the waiting was a sort of energetic starvation.

He didn’t need me to be less. The other people in my life, the ones who care, were often also vaguely alarmed by me, as though my intensity were a small fire they felt obligated to monitor, and they said things like “you never stop” and “aren’t you doing too much?”, and each comment, however kind, landed with the dull specific thud of being someone people worry about rather than enjoy. R. liked the things about me that I liked about myself. He found my intensity interesting, not concerning, and I had not known until then, had not understood in my body until then, how badly I needed someone to find it interesting rather than alarming.

We coworked. This sounds like nothing but it was the centre of the whole thing. We sat across from each other at cafés (different ones; sometimes in the city, sometimes Collingwood, once at his place though that stopped being a good idea), me with my under-desk pedaller strapped on beneath the table because I take it everywhere, him with his dinner because he could still eat at this hour and I couldn’t (the eating window, half past one, closed, the body hostile to food, the water in front of me while he had something hot and I enjoyed it vicariously), clear coffee cups between us, the warm beams of afternoon light turning to evening, people buzzing around us in that particular café way where everyone is busy and nobody is paying attention to anyone else. Two weird people with laptops and a pedaller.

I didn’t have to make my life smaller to be with him, didn’t have to put down my plans, my ideas, my schemes, my side hustles, the way I had done so many times before with other people, folding myself into someone else’s schedule, rearranging my ambitions to fit around their need for my attention, and regretting it every time, and swearing I would never do it again, and then doing it again, because the template most people use for relationships (the frequent dates, the escalating intensity, the weekends absorbed into each other’s lives) has never fit me and I have spent years trying to wear it anyway, like compression stockings that are the wrong size, cutting in, leaving marks. With R. I never had to. He was just there. I could have lived there.

We had agreed to be friends. Then we kissed all night and the agreement became decorative. He made what he called an executive decision: we were dating. Tortoise pace, he said. Snail pace. Whatever’s slower.

He was physically affectionate in small, specific ways. Face kisses. Nose rubs. He’d drive me home and wait until I was inside before he left. He sent me stickers on WhatsApp, a pastel-coloured bear with its eyes closed, smooching. He called me “frumpy” as a pet name. He texted every morning to wish me a good day. Once he saw my waist trainer and called it a “pelvic binder,” which is not what it is called, but is what a doctor’s brain does to a garment when it encounters one in the wild: reclassifies it, strips it of its vanity, assigns it a clinical function. Frumpy with the pelvic binder. I laughed despite myself. I wrote it down, because I am a person who collects words, and that one I wanted to keep.

He came to a public speaking event of mine. Sat in the audience. Watched. When I finished, I galloped proudly over to him and kissed him on the face in a haphazard way. “Argggh, PDA!” he recoiled, grinning bashfully. I said, undeterred, my arms around him, “You’re proud of me, you’re so very proud!” and he grinned and said, “I am, I am.”

Once I told him, while sitting nearby, “I just want to… interfere… with your person.” I reached out and gently poked him. “Mmm… interference detected.” he said, and this is the kind of exchange that would baffle anyone listening, two people speaking in a language that sounds like a hardware diagnostic, but it was the most romantic thing anyone has ever said to me, and I think it might be the most romantic thing anyone ever will, because it was two brains that process the world identically finding each other in the wild and speaking fluently on the first try, no translation required, no softening for civilian comprehension, just: interference detected, signal received, and I could cry at the precision of it.

He accidentally said “love you” in the street while we were saying goodbye, me on my way to the library, him heading off somewhere else. He’d been particularly matter-of-fact that day, almost cold, which made it funnier: the way you might accidentally say “thanks” to a vending machine, except his face afterwards was something I will not forget, complicated and startled and trying to retrieve the words from the air where they were already hanging, already said, irretrievable.

I called my friends on the way home. I told them it was wonderful. I wrote poems about him, actual poems, with line breaks and everything, because I couldn’t get the shape of it into a sentence and a stanza was the only container that fit.

It lasted three months, beginning to end, and in those months there were bookshop days so good I wrote poems about them, and nights so bad I lay awake cataloguing everything that was wrong, and sometimes both happened in the same twenty-four hours, and I loved it and I hated it and those two emotions slept in the same bed, the loving and the hurting, tangled up together like two animals sharing warmth, and in the morning you couldn’t tell which one had kept you up.

He was going through the hardest period of his life. He was weeks into therapy and on new medication and barely settled in the city, and he was not ready, and I knew this the way you know the weather is going to turn when the pressure drops: accurately, bodily, and too late to change your plans. I knew it and I stayed because the fit was so precise and so rare that I kept weighing it against the cost and the fit kept winning, the bookshops winning, the parallel silence winning, the two-weird-people-with-laptops winning, until it didn’t, and then it did again, and then it didn’t again, and that was the three months: a series of calculations in which the variables kept changing and I kept solving for the same answer because I wanted the answer to be him.

Over those months, as things in his life got worse (and they kept getting worse, bad news arriving on top of bad news like sediment, like silt in a river that just keeps filling), the conversations became more and more one-sided. He would talk about himself for twenty-five or thirty minutes, his therapy, his training, his career, his past, the woman from before me mentioned regularly, casually, the way you’d mention weather. He said she was the first woman he’d ever cried over, and I was sitting right next to him when he said it. He would not ask about my day. If I volunteered something he would listen momentarily, ultimately returning to his own material with the particular absorption of someone whose nightmare has become louder than the room, louder than me, louder than anything I could say or do, and I was standing outside it trying to get his attention and the nightmare was winning. Once, on a Sunday, when I was grieving a colleague who had died, he called and talked about himself for the duration, and then said he felt better now, and I said okay, and I said I guess I’ll go back to work then. I once asked how things were going between us and he said “okay I think?” I had been telling my friends it was wonderful. He later told me he says that about everything, but the Okay had already landed so heavy on me, among so many other heavy things, that it was hard to get up again.

He wasn’t cruel. I want to be clear about that. And I want to be clear about it in the way my brain keeps trying to be clear about it, which is clinically. I spent a long time interpreting his behaviour through the lens of attachment theory because that is the lens I have, and it took longer than it should have to see the simpler thing, which is that he just didn’t know, he wasn’t avoidant, he wasn’t withholding, he was an autistic man in his early thirties who had never been in a relationship and did not have the relational data to understand what a partner needs, and I was reading his inexperience as a clinical pattern because clinical patterns are what I see. I should have put the clipboard down, maybe if I had seen the person instead of the presentation I might have been gentler. But I couldn’t. I think the clipboard was a sort of shield; a suit of armour I felt safe inside of, but with that safety coming at the expense of connection.

He would surface sometimes, in slivers, and in those slivers he was the person who came to my speech and said he was proud, the person who accidentally said love you in the street, the person who drove me home and waited until I got inside. For those seconds where his eyes focused and he was actually there, in the room, with me, I was willing to forgo what other people were freely offering.

And there is the other thing. My health. I have a complex autonomic condition that has taken years to diagnose and longer to treat. During the months I knew R., my medication was wrong in ways I am only now beginning to correct (I am currently in the middle of a special access importation scheme for a drug that does not exist in Australia, which is the kind of sentence that sounds absurd until it is your life, until it is you on the phone to the TGA, until it is you explaining to the pharmacist that no, it’s not available here, yes, I know, that is the problem). I was reactive. Irritable. I would feel okay about something and then have a bad night’s sleep and wake up the next morning with no capacity, no buffer, the same situation now intolerable that had been manageable twelve hours earlier, my nervous system handing me data it had fabricated, and I was making decisions based on that fabricated data, and some of those decisions were about him.

After the friendship ended, the irony arrived in pharmaceutical form. I was prescribed something that was supposed to help and it put me in hospital instead, and then the medication they gave me after that had me sleeping thirteen hours a day in a fog of agitated depression, and then I had to withdraw from one drug and crossover to another, and there were hypertensive episodes and crises and afternoons where I went to bed at four o’clock because my body had simply stopped cooperating with the idea of being upright, the compression stockings still on, the pedaller untouched by the desk, the salt tablets on the bedside table next to water I was too tired to drink. For about two weeks I had no space to think about R. at all. He vanished from my mind the way a painting vanishes when the room floods: still on the wall, technically, but irrelevant to the immediate problem of the water rising around your ankles.

And I thought, in one of those strange clear moments between crises: Oh. So this is what it was like for him. This is what it feels like to be so consumed by your own emergency that someone you care about becomes inaudible. I had spent months wondering how he could be so absent while sitting right next to me, and then my own body answered the question, not through insight but through replication, and the understanding arrived not in my head but in the specific heaviness of my legs in the compression stockings and the particular quality of light at four o’clock in the afternoon when you have given up on the day and the day has given up on you.

The thing that won’t settle is the if. If I had been as well then as I am about to be, if the medication had been right, if I had known earlier that his behaviour was inexperience and not avoidance. The equation with different variables. The answer that might still have been him. I don’t know. I will never know. And the not-knowing has settled into me the way a stain settles into fabric, not a clean grief but a murky one, the grief of losing a version of events that almost existed, that I can see the outline of, that I could nearly touch if I stretched, and that keeps receding.

Things went wrong in other ways I won’t catalogue here. What I want to say is this: when I wasn’t with him, when the distance was there and I could love him without bumping against everything that wasn’t working, the love was the simplest thing. It was just: I like you. I like the way you think. I like that we can sit in a bookshop for hours and neither of us needs to explain why. The pelvic binder. The bear stickers. The way he said “frumpy” like I was a pet.

Maybe it’s fantasy? Maybe the letting go is what makes the love feel clean, and maybe you can only love someone this simply once you’ve stopped needing them to be anything other than what they are, and you can only do that once you’ve accepted they can’t give you what you need, which means the simplest version of the love only becomes available at the exact moment you have to walk away. I think about this and it makes me feel like a room that has been furnished for a guest who cancelled: everything in place, the table set, the good cups out, the flowers already starting to wilt in their jar because the timing was wrong and the timing was always going to be wrong and the flowers don’t know that and keep opening anyway.

The goodbye was kind. I want the record to show that.

He messaged on a Monday morning. Thanked me for listening. Apologised for the trauma dumping, for not making me feel seen (and I read this on my phone in bed, still in the compression stockings from the night before, and something in my throat closed, and I lay there for a while with the phone on my chest and the stockings cutting in and the morning light doing that thing it does in winter where it seeps through the curtain like it’s not sure it wants to be here either). He said he was at capacity. I hated that idea. Right there, but inaccessible. With two words he had captured the painful simplicity of our predicament. There was just no room for me, no capacity remaining. Interference no longer detected.

But then, because I am who I am, because the love doesn’t switch off just because the staying has become impossible, I told him what he’d done for me. That meeting him had inspired me to look into studying medicine again, a dream I’d carried since I was thirteen, carried so long it had become part of the furniture, something I’d stopped examining because examining it hurt. That it was uncanny how he came into my life at the right time. I sent a pink heart.

He replied three hours later. He said he understood. He said I’d inspired him too, that I’d shown him it was possible to face difficult things and come out the other side (and I read this sitting at my desk with the pedaller going, and I had to stop pedalling because my legs went soft). He said he admired me. He said he loved my nerdy, quirky boss-girl vibe. He thanked me for being communicative and clear.

Then he wrote: “Goodbye until we meet again, Ruthie.”

I sent a heart. And then I stopped. Stopped replying, stopped checking, put the phone face-down on the desk and left it there.

Weeks now. I still miss him.

The missing is specific: it lives in the particular quality of silence in a bookshop when I am there alone, which is a different silence from the one when he was there filling it with his wrong smile and his accidental love-yous, and the difference is everything.

I have been on dates since. Kind people, interesting people, available people. They ask about my day. They remember what I told them. And I sit across from them at cafés, drinking something I can safely consume, the compression stockings hidden under jeans, the pedaller left at home because it’s too much to explain on a first date, and I think: you are lovely, and you are not him, and I don’t yet know what to do with that.

I know I am comparing and I know the comparison is unfair and I know three months is not a long time and I also know what I know, which is that a person who is autistic and intellectually ravenous and funny in exactly the way I find funny and willing to cowork in silence and who lets me be the full size I actually am is so rare I can count the instances on one hand, and one of those instances was him, and I am tired of the implication that brevity should dictate the depth of the grief, as though three months that contained bookshops and poems and dancing and a pelvic binder and an accidental love you in a street somehow counts for less than a year of something tepid and dutiful and correct.

He changed my life. I am studying again. Neuroanatomy during workouts, neuroscience in the mornings. My career has turned toward the thing I actually want, the thing I loved before the practice consumed me, because I spent time near someone who lived in that world and it reminded me in my body that I belonged there too.

I don’t regret any of it. None of the poems, none of the dancing, none of the late nights, none of the kissing, none of the chrysanthemum tea.

Recently I was in the emergency department after a medication trial gone wrong, and afterwards, alone, still shaky, I played a song he’d sent me once and cried in a way that was partly neurological and partly not, the kind of crying where you can’t tell where the body ends and the feeling begins, and I thought: you are right there. I could find you. You are somewhere in this city with your wrong smile and your square glasses and your catastrophic autobiography and your lovably awkward gestures, and I can’t reach out because I am still too unwell and you are still too consumed and I have told you not to contact me and you, to your credit, have listened.

I wonder about it when I am tired and my defences are low and the thesaurus is sitting on my shelf with its spine uncracked.

He is going through the worst period of his life and I cannot be there, and he cannot be there for me either, and that is the hottest part of it, the part that sits in the chest like some black thing you can’t cough up. My father was hospitalised on Wednesday and I don’t know yet if he’s going to be okay, and I was in the emergency department myself two weeks ago, and there have been so many moments in the chaos of the last month where I have thought: I should tell R. I should ask R. Wouldn’t it be good to just have R here, to take his arm and put it around me like a compression bandage and feel my body calm, to put my face against his neck where he smells of shampoo and warm skin, and just let my nervous system register the presence of a body it recognises as safe. I keep reaching for him. And where he should be there is nothing, a space occupied by nothing, the particular sensation of putting your hand out to lean on a surface that was there yesterday and closing your fingers on air.

I think sometimes you love someone who is drowning and you are also drowning, and the water is your own blood pressure, your own medication, your father in a ward you haven’t been allowed to visit yet, and neither of you can hold the other up and the water doesn’t care how well you fit. I think sometimes the almost is the whole story. You don’t get to find out what would have happened if the clonidine had been right and his therapy had been further along and neither of you had been in the middle of your own private catastrophe. You get the memory of the bookshops and of him laughing with your dogs, and then you get the silence, which is not the absence of sound but the presence of something else, something that has a density and a temperature, that presses against your throat, that fills the rooms you used to share, that gets into your mouth when you try to speak about him and makes the words taste different, heavier, like you’re talking through cloth.