Twenty Days

By Rey-Philip Genaldo

The first thing I told the ER doctor over at St. Francis Memorial Hospital was I had appendicitis. I knew this because of WebMD, obviously. My pain, I explained, was like a dagger in my stomach that kept sinking lower and to the right. That’s got to be appendicitis, I said. The doctor, however, disagreed. He said the radiologist who looked at my CT scan was an expert, and that expert concluded there were no kidney stones, so it was probably just the stomach flu.

It’s my appendix, I repeated. Trust me. I’m a teacher.

I was just joking around, of course, trying to make light of the vicious pain ruining my stomach. Unfortunately, the doctor didn’t find me funny. If anything, he looked confused. It seemed he couldn’t make up his mind about whether I was telling a bad joke, or if I was serious and just plain stupid. I’m familiar with this look because I get it a lot.

Ultimately, the ER doctor chose to ignore me, and this struck me as pretty rude. As an English language teacher, I always went back and forth on what was worse—to be heard but ignored, or to be heard but not understood. The answer, I realized, was obvious.

So I gave up.

Okay, the stomach flu, I said. Well, Doc, then what’s next?

He replied by writing me a prescription for a painkiller called Norco and sending me home. The pain, he assured me, would subside given time.

But the pain did not subside given time. In fact, the pain became intolerable. It was around this time that my appendix had perforated and was now poisoning my body, but I didn’t know this just yet.

Here I’d like to say my choice to take more Norco than was prescribed was a decision made in pain-clouded judgment, but the truth is this is just something I do. It’s so me to ignore doctor’s orders, to ignore rules and recommendations and advice. Immediately after swallowing four times the prescribed dosage, I could imagine all my friends shaking their heads at me, and saying, Oh Phil, you bonehead.

I woke up a few hours later in convulsion. My jaw had locked tight, my teeth grinding so hard it sounded like the cracking of icebergs underwater. My limbs contorted in opposing directions, and I accidentally kicked my girlfriend awake. She screamed, at first in anger, but then in the scary realization that something very bad was happening.

I was self-conscious about my pajamas when the ambulance arrived, because I was wearing my Superman sweats, but the paramedics were not bothered by it. What they were bothered by was how many pills I took.

Are you stupid? one of them said. This made the other one laugh.

I would’ve been offended, but I understood they were just letting off steam. Their job seems pretty difficult, so every once in a while, when they get a dummy like me, they’ve got to keep it light.

I tried to play along. Do you like my Superman pajamas? I asked with a weak smile.

Neither answered, and the rest of the ride back to St. Francis was spent in relative silence.

Again, what’s worse, to be heard but ignored, or heard but not understood? Sometimes I wonder if I’m actually talking, or if I’m just thinking the words but forgetting to say them.

Much to my embarrassment, in St. Francis I found the same crew of nurses I’d seen just the day before. I waved hello to one of them, a white woman, but she didn’t recognize me, so I was left hanging. One of the Filipina nurses, however, did recognize me. Or if she didn’t, she pretended to. At first she spoke to me in Tagalog. I smiled because she reminded me of my mother, but I don’t speak Tagalog, so I just shrugged. Oh, so you’re one of those Filipinos, she said while laughing. I said, Don’t blame me for not knowing the language, blame my parents. She patted me on the shoulder as the paramedics wheeled me past and said, Aye ‘sus naman. Joker, joker naman.

After a few hours of waiting, the ER doctor finally visited. This time, the doctor was a woman. You shouldn’t have taken that much Norco, she said. That said, everything you’ve told me about your stomach pain seems to be pointing at appendicitis.

So it’s not the stomach flu.

Well, I sent the CT scan you took the other day to a surgeon. All we can do now is wait to hear back from her.

So, I waited. It was four in the morning. I watched a homeless lady pretend she was sick so she could sleep in one of the beds. A couple hours later, I watched two police officers escort that homeless lady out. She was kicking and screaming and cursing so hard they had to lift her off the ground and carry her out by all four of her limbs. She managed to squirm out of their grip a few times, and at one point she kicked the double doors, setting off bright red alarms. If there were no curtains to hide me from the other patients, I imagine we would’ve looked at each other and laughed at the escalation of it all. A little later, a man about my age was brought in for abdominal pains. They wheeled him out for a CT scan, then wheeled him back in, and then I heard the doctor tell him it was probably just the stomach flu and let him go.

I knew when the surgeon had arrived because all the nurses started looking at me. The surgeon was an older woman who exuded a deft and quiet confidence, but that wasn’t the only reason I liked her. I liked her because she listened to me. Whatever questions I asked, Dr. Bailey considered with utmost seriousness and then answered with that same gravity, measure, and pace. She did not waste words, but she did not hide words either.

Luckily, before Dr. Bailey arrived, they had me change out of my Superman pajamas and into a hospital gown.

After she confirmed my appendicitis and explained how an appendectomy works, I asked how the radiologist from the other day could’ve missed this. If they caught this earlier, I said, I could’ve had the surgery before my appendix burst, right?

Dr. Bailey thought about my pain, then shrugged and said, Honestly, I don’t know.

Being a worst case scenario kind of guy, I can tell you that, more often than not, I don’t actually want to be proven right.

Okay, that’s a lie. I did take some joy from it, because as soon as Dr. Bailey left to prep for the surgery, I texted my friend.

Me: I was right. It is my appendix. Doctors should use WebMD more often.

My friend: You’re 34. Isn’t appendix issues for 12 yr olds?

Before I can reply, a nurse arrives and takes my possessions, and then the rest happens this quickly. They wheel me up to surgery and the anesthesiologist gives me something, then I blink and I’m in the recovery room, surgery complete. I wake up hyperventilating, so the nurse tells me to slow down, but how can I when everything around me is going too fast? I tell her I’m trying to catch up, and she promises me everything went well. She puts her hand on my chest and tells me to just breathe. You’ll be out of here in no time, she says. She’s lying.

To be fair to this woman, given ideal circumstances, an appendectomy can be and often is an outpatient surgery, assuming of course they remove the appendix on time. Unfortunately for me, my gangrenous organ had ruptured between the CT scan and the correct diagnosis. The sick liquids leaked from my slit appendix and infected my blood, which in turn infected my neighboring organs. This is called sepsis, and can kill you. Even so, a hospital is—or at least should be—equipped to deal with this, as it is a common thing. When treated promptly with the correct antibiotics, the patient is usually out of the hospital in two to three days.

They brought me up to the ninth floor and gave me my own private room and everything. The nurse who wheeled me in said, Welcome home.

I started out with two doctors. There was of course my surgeon, Dr. Bailey. I trusted her with my life but couldn’t imagine how she was outside the hospital, as, like, a human being. My second doctor, the hospitalist, was a portly but pragmatic South American about my age. I trusted him less but enjoyed his company more. During one visit, instead of talking to me about me, the hospitalist launched into this long tangent about his love for Game of Thrones. He showed me photos of an event he’d gone to just the other day, where a live orchestra played to the show’s war scenes projected on large screens above. The hospitalist and I agreed emphatically that this was the future of symphony.

There was a third doctor, a younger-than-me Vietnamese woman. She was not interested in Game of Thrones. She was only interested in discussing my supposedly speedy progress. Her words were so encouraging that I began to suspect we were talking about a different patient. She even wrote me a doctor’s note a couple days into my stay, which stated I was going to be ready to return to work the following week. Once that week passed, I realized she had no idea what she was talking about. I think she realized this too, because she stopped visiting. I began using her doctor’s note as a bookmark.

Two or three days after the surgery, around the time I expected to go home, my surgeon popped in for a visit. What you have, she explained, is postoperative ileus, which is expected and should fix itself any day now. I had questions for her, obviously, like what is postoperative ileus and how will I know when it’s gone. She nodded to my questions, but did not answer because she noticed something wrong with my IV. In grim soliloquy, she asked herself, Who ordered these antibiotics? I was never supposed to hear her say this, and I didn’t want to be rude, so I didn’t ask her what she meant. But I did have a lot of time to think about her words and come to my own conclusions, none of which were good.

This being my first ever stay in a hospital, I assumed this was just how things were supposed to go. A turnstile of doctors. Antibiotic miscommunications. Enthusiastic Game of Thrones discussions. Unrealistic promises of progress and free bookmarks that would make for funny stories. Despite being located in the center of San Francisco, St. Francis Memorial Hospital was its own foreign country with its own foreign culture and I was going to be its resident for a while. So I hunkered down, paid attention, and reminded myself that I’m the immigrant here, so don’t ask too many questions.

My parents came to America to raise an American, and they did. I got degrees in the humanities, a very American thing to do, and carved out a nice-enough American life for myself in San Francisco. My life consisted of American friends and American food and American bars. I had an apartment with a rooftop view and cable TV, a PlayStation 4 and a graphic designer girlfriend. I was well on my way.

Because we’re Filipino, my mother—who flew from LA to SF to stay with me—insisted that if we needed something, we ask a Filipina nurse and we ask in Tagalog. Since I don’t know Tagalog, it was up to my mother to make sure I got everything I needed. That’s the thing about the Filipino connection. We always think we’re doing each other special favors. Even when we’re not, we act like we are. So my Filipina nurse would come in and give me my morphine, the very same morphine any other nurse would’ve given me, but because her name was Nicetas—“Nice” for short—and she was from Cebu, it was a special kind of morphine, laced with the flavor of our archipelago motherland.

The first time Nice saw me wearing my glasses, she gave me a kind of knowingly sexual look and said, You look cute in glasses.

Years before all this, I was a host family manager for an ESL school, and ninety-nine percent of my host families were older Filipinas whose children had grown up and left the nest. I was not just good at my job, I was the best, because I understood something all other host family managers did not. I understood that ninety-nine percent of my job was to give these empty nesters company over the phone. I listened to these older women go on and on about their lives for ten, twenty, sometimes thirty minutes at a time. It was inevitable that some of these middle-aged women would grow attached to me and flirt. A few even visited me at school, bearing gifts of fried Filipino foods, logs of lumpia with little bowls of dipping sauce, platters of adobo and rice. Some of my coworkers called what I did weird and a little creepy, but I disagree. What I did was honorable in its own way. I was not in the business of placing students with families. I was in the business of helping lonely people feel a little less lonely.

Older Filipinas flirting with me happened so often that I became both numb and analytical. Out of either genuine insight or laziness, I decided that what was happening to me was a broader cultural phenomenon. Maybe this is just what older Filipinos do with the younger ones. Maybe flirtation is the only way we know how to communicate. We have islander’s passion in our blood, after all. To this day, I’m not sure if I’m right about this or not. Maybe it’s not a Filipino thing. Maybe it’s just a me thing.

One night, when I was feeling particularly lonely, I looked at Nice differently. Shambling through the hospital hallways, I found her standing in the nurses’ bullpen in the middle of the floor. Under those perpetual fluorescent lights, it occurred to me that Nice was not unbeautiful. Her face plain and pure Filipina, slightly upturned nose, dark skin, freckles and wrinkles of the sun. Barely able to stay standing without the help of my IV stand, I found myself nonetheless transfixed.

There were many places to hide in St. Francis. My floor had so many vacant rooms I often thought I was their only patient. I shuffled past these rooms during my walks. They were dark and cold, but clean, with beds just waiting there for the weight of the sick. I wondered what it might be like if I told Nice to meet me in one of these rooms. Would she risk it, and would my injured, staggering body be up to the task?

In her mid-forties, Nice was an older woman, but this didn’t matter. Darkness is a time machine. An equalizer. It makes people the age you want them to be, the age you’ve always pictured in your head. She’d be my age and I’d be hers, and she’d tell me to lie down, and she’d undress herself because I was too weak, and I’d just watch.

Nothing worked down there, of course. It had been a week since the surgeon told me what ileus was, and I still had it, even after they fixed my antibiotics. My stomach didn’t work, my guts didn’t work, and my dick didn’t work either. Still, her flirtation scaffolded my broken body, empowered my animal mind.

Nice noticed me staring at her, there under the fluorescent lights that evaporated all shadows. She smiled, so I shambled in her direction like the undead. Without flinching at my sad appearance, she asked how I was doing.

Can’t sleep, I said. So I’m walking instead.

You’re wearing your glasses, she said.

Yep. Helps me see.

You look cute in glasses, she said.

After hearing this for, like, the hundredth time, I finally realized that this was the only compliment Nice had for me, and when that’s all you’ve got, the only reason you keep repeating it is out of pity. I have to admit, it was tough having my delusions come face to face with the cold truth. Nice didn’t want to fuck me in some dark vacant room. Nice pitied me—pitied everything about me, from my stomach to my guts right down to my broken dick—and she lacked the creativity to hide this pity.

So, what can I do for you? she asked.

After my walk, Nice, I’m going to be hurting.

Okay. I’ll bring you some painkillers then.

Six milligrams of morphine, please. Not four.

What’s your pain level?

Seven of ten. Maybe even eight.

I returned to my room a little deflated, but it didn’t matter because just a few minutes later I found myself sinking into a warm ocean of morphine.

Despite my one-sided dalliance with this nurse from Cebu, most of my hospital time was spent being pretty much one hundred percent American. I watched Karate Kid like an American. I watched Saving Private Ryan like a fucking American. When Fury came on I watched that, and then I watched Rocky III, the one where Rocky knocks out Mr. T. I watched Hook and rooted for Rufio, which is admittedly very Filipino of me, but then Karate Kid came on again, and like some great American erasure, I forgot all about that doomed Lost Boy. After all, who has time for a cocky Filipino kid who gets himself killed, when you can watch a cocky American kid overcome all odds with an all-American crane kick instead?

And so it went for days, watching whatever movies were playing on AMC, every four hours clicking the nurse’s call button until it became muscle memory, asking for painkillers. The nurse would ask me to rate my pain on a scale of ten, and I’d know that if I wanted the full 6 mg of morphine, I needed to say my pain was at least six of ten, maybe even seven. Victorious always, I’d watch as she inserted that plunger into my IV. The bed sinks into that sudden cradle of warm hands and you can’t help but smile—you drugged-out American—staring out the weathered American window as the red American sun sets over America’s ever-changing San Francisco skyline.

This was the time I remember the least. The morphine rolled over me like the fog over my city. I wish my parents took away my iPhone, because during this period I often awoke to find I had made several phone calls, to friends, to family, to my girlfriend. A good friend of mine would later tell me I called to pitch him the idea of bringing VR into hospitals. A cousin would later tell me I called and we talked for hours about basketball. I don’t even like basketball. These people swore I seemed perfectly lucid, aware, present. I wasn’t, though—whoever they were talking to, it wasn’t me. It wasn’t not me either, though, because although I never remembered what I talked about, I did always wake with a lingering taste of conversation in my mouth. Sometimes this taste was sweet and warm, as if I had risen to a sunrise. Sometimes this taste was cold, like returning to a damp, dark room. With my girlfriend, the taste in my mouth was always sad—sad and angry, very angry—but I was never sure why, not until the very end.

And then about halfway through my stay, the nurses stopped giving me six mg of morphine and didn’t tell me why. Like they thought I wouldn’t fucking notice. My dosage dropped to four mg, and then two mg. My outrage was silent, because I didn’t want to seem like some whacked-out druggie throwing a drug tantrum, even though at the time, I was. So I just watched. I pressed the call button, asked for painkillers, and watched the morphine get smaller and smaller like some fading lover who only ever had one good thing to say about you.

A new doctor began to appear. This doctor was either the reincarnation of James Gandolfini, or a very good Tony Soprano cosplayer. He was a kidney specialist, I learned, and between his wheezing he explained that my kidneys were failing. You’re lucky we caught it, he told me in this matter-of-fact way that almost convinced me this was not their fault. I asked him how this happened. After all, I didn’t come to the hospital for my kidneys. Again, in that matter-of-fact way that disassociated oneself from guilt, Tony Soprano gave me three reasons. Dehydration, malnutrition, and over-medication.

Ah, so there it is. Over-medication. The reason behind my disappearing morphine supply.

Tony Soprano would continue to visit until the day of my discharge, but after that first visit he was laconic, to say the least. He’d wander into my room, shake my hand and pat my knee. Then he’d speak with the finality of a mob boss. Your kidneys are improving, he’d say. Then he’d leave, off to his other job running a strip club in New Jersey, I imagine.

A few days later, Dr. Bailey visited me again, this time bearing awful news. My entire digestive system was still not working. When I asked if this was connected to the kidney failure, she had no straight answer—all she had was the truth.

Maybe, she said. Or it could be all the morphine. Or it could just be the way your body works. She shrugged.

Whatever the reason, one thing was clear. Liquids and air were backing up in my stomach. Nothing was getting absorbed.

We need to run a nasogastric tube through your nose, down your esophagus, and into your stomach to suction out all the liquid.

Up to this point, the hospital’s gross incompetence was for me an amorphous cloud, casting shade over everything while not attracting too much attention to itself. It was more than anything a feeling, a suspicion, a wire of static. With the CT scan misread, for example, because I never met the radiologist responsible for this mistake, the only thing I could really do was shake my fist at the sky and curse St. Francis himself. In a way, this abstraction of blame made it easier for me to forgive.

Nurse Terry, however. There was nothing abstract about her.

Right from the moment I met her, I couldn’t figure Nurse Terry out. She spoke too loudly, so I thought maybe she was deaf. As a result, I found myself speaking too loudly to her. No one else spoke to her like this, and she seemed to hear them perfectly well, so I began to suspect that the reason she spoke too loudly was because I was speaking too loudly and she thought I was deaf. At times she looked at me with a mother’s concern, yet at other times that look seemed manufactured, as if practiced too long in front of a mirror. During those manufactured times she was never looking at me directly. She was always looking slightly past me, like she was lost in thought and smiling not at me but at that thought. Though her hair was too wiry, her appearance too disheveled, there was still something very Stepford Wives-y about her. It was the way she idled when she wasn’t doing anything. I found myself going for walks specifically to see her stand in the hallways blankly, staring out at nothing, waiting for something to do. It wasn’t that her movements were deliberate, because if anything they were too scattered, too frazzled to be robotic. It was that her stillness was too still. If she idled in Madame Tussauds, tourists would stop and take photos with her. If she idled in Disney’s Hall of Presidents, tourists might wonder which president had a nurse.

The night before she unsuccessfully stuffed a tube up my nose, I overheard my next-door neighbor yelling at her. She yelled back, I’m doing my best! And her voice shook, like she was about to cry.

Since no matter how often I question it, I am in fact Filipino, I do have several cousins who are nurses. And so I know from their stories that the insertion of a nasogastric tube is supposed to be uncomfortable but not traumatizing. There are ways to ease this discomfort, like the use of lidocaine jelly to numb the patient’s nose, and the pre-curling of the tube so that it easily curves into the nasal passage down into the esophagus. The insertion of an NG tube is supposed to be a common procedure, much like an appendectomy, much like the careful monitoring of hydration and nutrition to ensure a patient’s kidneys don’t fail.

The clear tube was a little thicker than, say, my MacBook’s charging cable. Dr. Bailey watched from the background more as a gaping rubbernecker than as an anchor of reassurance, and Nurse Terry slid some jelly onto the end of the tendril, but the jelly had no numbing qualities and was wiped clean off anyway by my thick nose hair.

At first, having a tube inserted into my body felt silly, like a stranger was picking my nose. But all too abruptly it became serious. That stranger had pushed her finger too far. My eyes lost focus on the object entering my body, so I was forced to stare at the woman guiding it in, and it was apparent in Terry’s eyes that she too was scared.

Things went wrong pretty much immediately. The nose is a deceptive thing; the nostril’s passage to the throat is actually horizontal to the nose’s entry. This is something Nurse Terry didn’t seem to know. As she pushed the tube, she did so at a vertical trajectory, slamming the end of the tube into the roof of my nasal canal. When she hit that obstacle, rather than change course, she pushed harder, as if the roof of my nose was a wall she needed to break to get through, and break she did. The tendril jabbed so hard at something inside my nose that I heard a crack, and I screamed not in pain but at the sound, that terrible, horrible, no good, very bad sound. The pain followed afterwards, with a gushing of blood. My mother, who was bedside with a towel, was doing her best to wipe the blood before it went into my mouth. She even tried to lighten the mood with a joke. Your mustache is absorbing all the blood, she cracked. Nobody laughed.

I began crying, sobbing, begging for it to stop. I was not built to deal with pain or blood, my constitution too fragile, my imagination too monstrous. I gagged as I cried, gargling the thick blood in the back of my throat. My panic only added to nurse Terry’s, so she jabbed that tendril harder upwards, then jabbed again. All the while, her eyes widened with the understanding of her failure.

Dr. Bailey stepped closer, now at the foot of my bed. Is it going in? she asked. Nurse Terry shook her head. No, it’s not going in, she replied. No, it’s not going in. It’s not.

Dr. Bailey must’ve heard what I heard—the wire of panic hanging in nurse Terry’s voice—because she moved in and took the tube from Nurse Terry’s hands and ordered her to leave and get a cup of water and a straw.

Seeing Dr. Bailey was now in control, I pleaded for her to help me.

Put it in the other nostril, I begged. Please, the other nostril.

Dr. Bailey agreed. She said, Okay, in a calm I can only describe as oceanic, and she pulled that tendril from my nose with the proficiency of, well, a surgeon. Then, without asking for my permission—without even warning me—Dr. Bailey reinserted the NG tube, this time into my left nostril, which I’ve known all my life is my superior nostril.

Nurse Terry returned with a cup of water and handed it to me. Dr. Bailey ordered me to sip the straw, so I did. As I swallowed the water, she slid the tube further down. I could feel it against the back of my throat now.

Again, she said.

Again I sipped the water and swallowed, and again she slid the tube further down.

Again, she said.

In this way, she reined me in with a rhythm. Her work was musical, a great symphony, an opus. Before I knew it, the tube was as deep as she needed it, and I could see the suction starting to work because a thick green liquid rose up the tube as if up a silly straw, and began to fill a large container they had hanging behind me.

The process of inserting the tube was now over, but this was not the end. They cleaned me up, wiped my tears and blood and changed my gown. Dr. Bailey assured me that I would soon get used to having a tube in my throat, but I found myself gagging for hours. Still, I felt relief because, as far as I could tell, the nightmare was over.

They sent an X-ray guy over to check on the tube. Shortly after he came and left, Dr. Bailey returned to tell me the bad news. See, right before the tube’s insertion, Nurse Terry had measured the needed length for it to reach my stomach. Apparently, her measurement was six inches too short. Dr. Bailey took a black marker and marked six inches of the exposed tube coming from my nose. We need to advance it by this much, she told me.

This time, Nurse Terry was nowhere to be found. A different nurse, a Filipina I didn’t know, came to help, but I no longer wanted anyone’s help. I wasn’t exactly thinking clearly, but the way I saw it, there was no way I could do a worse job at advancing the tube. So, without even telling them, as they put on their latex gloves, I took the tube dangling from my nose and began shoving it further into my body by myself. The nurse and Dr. Bailey did not try to stop me. In fact, as I approached the length marker, Dr. Bailey told me I was almost there. Just a little bit more, she cheered. And then, it was done. I was done. The NG tube was now six inches deeper into my stomach, the suctioned green liquid now much more decisive up through the tube. This was the proudest moment of my entire stay.

I asked how long this tube needed to be inside me, and Dr. Bailey told me as long as my digestive system didn’t work. The stomach, she explained, produces about a liter of liquid a day. This liquid needed to go somewhere, so for now, it was going through a tube and coming out my nose.

How do I know when my digestive system is working again? I asked.

Well, she said. Have you passed gas?

Nope. Haven’t farted in forever.

Have you had any bowel movements?

Nope. Haven’t pooped in forever.

Well, when you do, that’s when your digestive system is starting to work again.

I remember going for a walk that first day with the tube dangling from my face like some shameful elephant trunk. The looks those nurses gave me, the pity ripe as the stench of rot. From that point on, every nurse—every single one with no exception—would ask the same two questions whenever I’d pass. Have you passed gas yet? Have you had a bowel movement?

These were the darkest days of my stay. The days I finally saw myself the way the nurses had always seen me. I was just another sad patient trapped inside this sad hospital. All illusions that I might be special or charismatic or desirable to any of these nurses evaporated after that NG tube. No more snarky remarks. No more silliness.

I counted the hours in episodes of Friends, Seinfeld, Family Guy. Every three episodes I needed to use the bathroom. Every eight I could ask for more painkillers. I knew the day was coming to an end not when the world outside the window darkened, but when I traded Ross for Kramer, Rachel for Elaine. If TV was my clock, then the other patients of St. Francis were the ticks and the tocks of the clock. When I first arrived, there was an elderly Asian man I’d see on my walks, hacking up a lung in bed. I got so used to seeing him, I just assumed he’d be there forever. And then one day he was just gone. Poof. Soon after his disappearance, there was a mental patient who was only moved to my floor because the mental ward, which was on Floor Three, was full. At night I listened to her erect these elaborate, visceral threats aimed at no one in particular, her voice possessed not unlike the boy from The Shining. Yet whenever I passed her room during the day, I found not some demon with bat wings and curled horns, but a normal-looking senior citizen staring calmly out the window. And then, one day—poof—she was gone too, and so were her rousing rants against people who did not exist.

I felt myself regress, return to the humorless times of my teenage years, when I was ruled by the base fears of a boy who took himself too seriously. I walked the halls without smiling, without stopping to talk at the nurses’ bullpen, without imagining any secret trysts in the vacant rooms of my floor. All delusions lost to shame, I was now face-to-face with a series of very serious questions. If I do not have my overly loud confidence or my over-ambitious charm, then what do I have? If I do not have my bad jokes, then who am I?

I imagined myself a ghost. I wished to be a ghost. No one asks a ghost if he’s farted. No one asks a ghost if he’s pooped.

In this way, three weeks passed.

And then, one day, my digestive system began to work again. It happened without warning in the middle of one of my walks. I remember the sensation of bodily reanimation as a tingling, like the electric air before an avalanche. Excited at the sensation, I stopped walking and pushed, eager to pass gas for the first time in weeks. But it was not just gas.

In any other situation, in any other place or time, I’d feel deep humiliation for what happened next, of this I have absolutely zero doubt. The splash on the floor. The shaky-kneed jog to my nurse. The trail I left in my wake. The smell. In any other world, I would’ve killed myself in embarrassment, but this was no ordinary world. This was the hospital, and here in the hospital my soiling was a moment of victory. I was, finally, me again.

The doctors waited for a day to make sure my digestive system was in fact moving again, then they gave the order to remove the NG tube. I asked the nurse, another Filipina, if I could do it myself, because the event felt significant. She said yes.

Pulling the tube out of my body reminded me of that one scene where Neo is taken out of the Matrix for the first time, and not just because he too pulled a tube from his esophagus. The action of its removal is an emergence, an awakening, and then, most importantly, it is a long, long, long slide down into the cold lake of reality.

In the hospital, your pain is your life. That’s it. You have a button you can press that summons a person who gives you painkillers if you hurt, or an extra blanket if you’re cold, or maybe just some company if you’re lonely. You sleep for ten hours and then you say, Damnit, today I’m going to walk. So, you get off your ass and you pull that IV stand alongside you and shuffle those damn hundred steps end-to-end like a boss. And as you do it, you pass those nurses and they cheer you on. This continues right up to the exit of the hospital. A Filipino nurse collects you in a wheelchair and pushes you to the elevator. Every nurse you pass congratulates you, and you shake their hands and wave goodbye as you enter the elevator and the doors close. The doors open and, for the first time in twenty long days, you see the first floor of the hospital, the floor of entry, the floor of exit. The Filipino nurse, he comments on how nice the weather is, and tells you God is rewarding you for making it to the end. He pushes you right up to the threshold of the hospital and stops there as if, by some sinister magic, he was not allowed to leave. The glass doors slide open and the wind hits your face. Your parents, who are there, take a photo of you standing up from the wheelchair, and the nurse encourages you to be careful but also congratulates you as you step out into the sun. Your pain is your life, and every moment that passes, no matter how small, is a win.

And then, that very moment your foot touches the other side of those doors, all those wins vanish, because your pain is no longer your life. Your life is your life now, and pain is just a consequence of living. You’re winded walking across the sidewalk to get into the Uber and nobody cheers. The Uber driver doesn’t congratulate you for opening the door or getting in and closing the door and putting on your seatbelt. He doesn’t ask if you’ve passed gas today. He doesn’t ask if you’ve had a bowel movement.

The hospital is its own universe, with its own set of rules, physics, and standards. No one in the hospital cared how much you made a year, or whether you drove a Tesla or a Nissan. All that was important to the people in St. Francis were the things moving around inside your gross little body.

You remember everything you’d forgotten the past three weeks. You don’t drive a Tesla. You don’t make six figures. In fact, you’re well below the poverty line. You were “With Her,” and with her you lost the presidential election to a man who looks like something from a child’s coloring book. The US just dropped the largest non-nuclear bomb ever used in the history of war, and China and Japan are sending battleships toward North Korea. This real world is big and external and absolutely horrifying.

Your thumb searches for the bed remote. Feels nothing but the phantom pain of a call button you no longer have. Where is your nurse when you need her? Where is your morphine?

My mother and my father help me out of the Uber and back to my apartment. At the front door, I tell my parents to wait a few seconds. I want to go in without them, to soak in my old life and reckon with its change. I do this because I know what to expect, and the moment I step in, I receive exactly my expectation. A vast and empty silence. A complete and terrifying loneliness. Somewhere in the middle of the living room is where I break down and cry.

I had a girlfriend here once. We lived together for a few months before I entered the hospital. She’s the one who called 911 twice, brought me to the ER twice, and managed our life while I was unwell. At least for a little while.

After only about six days into my stint at St. Francis, she gave up. She just stopped everything. I vaguely remember some morphine-fueled phone argument, but I no longer remember what was said and with what ferocity. All I know is that afterwards, my girlfriend stopped texting. Stopped calling. Stopped visiting. Stopped being my girlfriend.

It was too much for her, all this. Maybe she did love me, but she clearly didn’t love me enough. I was able to get her on the phone around day twelve, but only so she could tell me she was moving out of the apartment. She just couldn’t take care of me, and she wasn’t going to pretend she could.

So, after twenty days of being gone, I returned to a gutted life. The apartment was empty. All the familiarity gone. All the warmth. Where was the background chatter of some random talk show? Where was the smell of noodles and dumplings boiling over the stove?

I didn’t stop crying, not for a while. My parents knew to leave me alone, so they entered gingerly and tiptoed past me. My mother, in passing, kneeled and put her hand on my shoulder. I didn’t respond, so she let go.

My life, my American life, was gone. Where did everything I had put together and cultivated these past years disappear to, and how did it all disappear so quickly, so easily, and without guilt?

That’s when I finally understood something I had always known. None of this would’ve happened to a real Filipino-American. A real Flip would have the tightest of support networks. He’d come home to his Flip girlfriend and she’d give him a huge Flip hug and kiss, and his crew would be there too, maybe four or five other Flips, rowdy with Welcome Home balloons and a cake and a big thing of lumpia. And once you get past them you see right behind are the older Flips, all the aunts and uncles and social aunts and social uncles, and they’d all be waving you over for kisses, so many kisses, because that’s what it would be like for a real Flip, kisses and hugs and people and a Welcome Home party.

I told my father I needed some water. My mother reached down to me again—I didn’t realize she was sitting next to me—and she put her hand back on my shoulder. I put my hand on hers and, looking at my father, I said, You’re both here.

During one random night in St. Francis, my morphined brain rediscovered a memory I hadn’t considered in a long, long time.

I wasn’t popular in high school. Didn’t know sex or drugs until college. I was one of those kids who discovered Radiohead before anti-depressants, but ended up an adult on both. When I was fifteen, however, I was given a chance. One random day, a Filipino dude named Peter Bon threw me a bone and invited me to his party.

What first struck me was how straight-up ghetto Peter Bon’s life was. His house looked a second away from collapse. A basketball hoop duct-taped loosely to its backboard. Paint peeling from all walls inside and out. Mold so thick along the ceiling it seemed the ceiling had its own shadow.

The American me was disgusted by the state of my classmate’s life. I looked down on such poverty and worried that, if I entered, some of it might rub off on me.

But the Filipino me could hear the distinct sounds of Tagalog coming from the back. With piqued curiosity, Filipino me entered through the garage, cut through the kitchen, and ended up in the backyard. There, Filipino me found other Filipinos, happy and laughing and circling tables filled with log cabins of lumpia and mountains of fried tilapia fish. Multiple rice cookers on blast. A thing of chocolate meat, a thing of Sinigang. Paper plates and ketchup spaghetti. Red cups and an unsurprising lack of drinking games. Real Flips don’t need drinking games. Real Flips have each other, and hip-hop music, and a makeshift cardboard dance floor. For all the breakdancing, of course.

A fat Filipino named Gilbert was surprised to find me there, watching them all. He extended a joint in my direction, realized who he was offering to, then rescinded the offer. Nah man, he said. Ain’t even worth it. He repeated this, over and over again. Nah man, ain’t even worth it. Nah man.

There are things I want to tell Gilbert now, things I didn’t know back then. I want us to sit together with that joint, and talk about what it means to be Filipino. Maybe he’s never had to articulate this before, but I want him to now, and I’ll wait patiently for his answer because I sure as hell have no idea. That’s the thing, I want to tell him. I’m not Filipino, but I’m not American either, you feel me? I’m some sort of strange cultural hybrid, and if there’s one thing I’ve learned from movies, it’s that hybrid creatures are either gorgeous objects of desire, or monsters.

Instead of saying all this, I left Gilbert, overwhelmed and rejected, and called my mother. She answered on the first ring; she was probably waiting by the phone the whole time. A few minutes later, I was safely in her car, on my way home. As we pulled into our driveway, I took stock of the differences without looking for the similarities, because I believed there were none. My family lived in a well-maintained, two-story house. My sister was in her room, watching her TV. My father was in his room, watching his. In the backyard, my golden retriever sat pressed against the sliding door, panting in the night’s darkness. My mother kissed me goodnight, told me there’s leftover adobo in the fridge if I’m hungry, and warned me not to play video games too late because we have church in the morning. She turned off the living-room lights and disappeared, and Filipino me and American me, blind in the dark and alone, tiptoed hand in hand through all that pointy furniture.

Rey-Philip Genaldo was raised in Orange County, but has moved around a lot. He has an MA in American Studies from the University of Amsterdam, and an MFA in Writing from the University of San Francisco. Currently, he lives in the Inland Empire with his dachshund, Chalupa Batman.