However reluctantly, I flew back to London. After Terri’s surgery, Paul phoned with the lowdown: the surgeons had discovered a patch of aggressive “sarcomatoid” cells, which meant Terri’s prognosis was bleak.

  I will give myself this grudging credit: I did fly back to visit Terri for Thanksgiving that November, and for a while I kept in faithful touch, ringing weekly and following every grisly detail of her punishing chemotherapy. But this is not a boast about what a wonderful friend I was in Terri’s time of need. This is a mea culpa.

  Little by little, I’d notice that it had been a fortnight since I’d rung New Jersey. I’d kick myself. But some book review would be due that afternoon, so I’d vow to ring tomorrow. Time and again some immediate task would seem more urgent, and I’d tell myself that I should ring Terri when I was settled and concentrated. Watch out whenever you “tell yourself” anything; it’s the red flag of self-deceit. Long hours of being “settled and concentrated” mysteriously failed to manifest themselves.

  I stuck a Post-it note on the edge of my desk: ring terri! Over the months, the note faded, much like my resolve. On the too-rare occasions I acted on the reminder, I had to put a mental gun to my head. But why? This was one of my closest friends, and she was dying. While she was still on this earth, why was I not battling to maximize every moment? Surely the problem should have been my ringing too often, whizzing back to the States too many times, making a pest of myself.

  Granted, our conversations were sometimes awkward. My own life had never gone more swimmingly, while Terri’s was circling the drain. I was embarrassed. I found myself editing from our discussions anything I’d done that was exciting or fun. When I returned from an author’s tour of Sweden, I portrayed the trip as a drag. This sort of cover-up reliably backfired. So I felt sorry for myself—for going to Sweden! When Terri could rarely leave the house.

  I make no apologies for this, since this is what novelists do: at some midpoint in Terri’s decline, I decided that my next novel would draw on this encounter with cancer. At least I had the humanity to refrain from taking notes during our phone calls, thereby relinquishing many a “telling detail” and much “great material.” Consequently, I had to do an enormous amount of research on mesothelioma later, and this is what I do apologize for: not having done all those Web searches on her treatments—the surgery, the drugs, the side effects—when Terri was still suffering through them. Now I’m mortified to have Googled “mesothelioma” only when the search was for a book.

  When I returned to the United States that second summer, Terri had alarmingly deteriorated. Thin to start with, she’d lost weight. She was gaunt and weak, her skin tinged a dark, unsettling orange: a chemo tan. It was obvious where this was headed. But whenever anyone acted as if she wasn’t going to make it, Terri grew enraged. She resented the “sentimental” testimonials her friends and relatives recited at her bedside; she thought they were delivering a death sentence. Though she wouldn’t have put it that way. I wonder if throughout her illness I ever heard her say the word “death” aloud.

  On this one count alone could I blame Terri herself for my increasingly deficient friendship. Her refusal to admit she was dying meant that we couldn’t ever talk about the macabre elephant in the room. Pretending that the treatments were working and she was going to come through this injected an artifice in our relationship at odds with the confidences we’d shared for twenty-five years. Days I did visit, afternoons I did ring, we’d end up talking, lamely, about recipes. Indeed, on a brief trip from London back to New York in November 2006, I visited Terri in New Jersey; it was the last time I’d ever see her, and I knew this instinctively at the time. Yet we spent an appalling proportion of that final visit talking about mashed potatoes.

  When her husband rang me in London a few days later with the news, he was consumed with a steely rage. Obviously, Paul was angry that he’d lost his wife. But he was also angry at other people. Oh, he expressed his disgust in general terms, as a disillusionment with the human race, a good riddance to our whole species. But I knew what he meant. Paul’s fury was aimed at Terri’s friends and family, who had almost universally made themselves scarce for months. His fury was also aimed at me.

  I thought I deserved it. I had visited, some. I had rung up, some. But not nearly often enough, and in truth one of my best friends perishing before my eyes had instilled a deep aversion, an instinctive avoidance, a desperation to flee.

  It would be a far better thing if I were a lone shithead amid an ocean of altruists. And surely some folks really do step up to the plate when a friend or relative falls mortally ill—wonderful people who keep popping by with scones to the very last day. I have a new admiration for such stalwarts, as well as a new appreciation for the Christian duty to “visit the sick.” Yet I fear this suddenly-remembering-somewhere-you-gotta-be is a common failing of our time. In fearing and avoiding death, we fear and avoid the dying.

  I’ll risk sounding preachy, since I’ve paid for my sermon with a regret that never leaves me. Most of us will experience the afflictions of our nearest and dearest perhaps multiple times before we’re faced with a deadly diagnosis of our own. So be mindful. Disease is frightening. It’s unpleasant. It reminds us of everything we try not to think about on our own accounts. A biological instinct to steer clear of contagion can kick in even with diseases like cancer that we understand rationally aren’t communicable. So the urge to avoid sick people runs very deep. Notice it. Then overcome it. There will always be something you’d rather do than confront the agony, anxiety, and exile of serious illness, and these alternative endeavors seem terribly pressing in the moment: replacing the printer cartridge, catching up on urgent work-related email. But nothing is more pressing than someone you love who’s suffering, and whose continuing existence you can no longer take for granted. So never vow to ring “tomorrow.” Pick up the bloody phone.

  “My Teenage Diary”

  The Guardian, 2015

  [The radio appearance I mention in this essay kicked off the sole instance of my trending on Twitter because the social media crowd liked something.]

  In my teens, I eyed my adulthood with trepidation, as if stalked by a stranger—one who would seize control as if by demonic possession and regard my fledgling incarnation with contempt. I was terrified of growing up to become the anti-me, maturing into a woman whom I would not recognize, and who wouldn’t recognize her younger self. I doubt I was alone as a teenager in seeing adulthood as a lurking betrayal, an impending death. That may be one reason why teen suicide rates are so high: for many adolescents, growing up presents itself as a form of bereavement anyway, so it seems as if there’s nothing to lose.

  Asked to fill the painfully comic Radio 4 slot My Teenage Diary, I scrambled into my attic recently to dig up the damp, furry-cardboard covers of the journals I began keeping when I was twelve. Before rereading them for the first time in forty-some years, I worried that I would be embarrassed. Instead, I was infuriated.

  I didn’t write entries with nearly the faithfulness that I remembered, and I recorded all the wrong things. I often omitted the date. I rarely described what happened: what people said, where I was, what awful incident had driven me despairingly to this notebook. No, what I mostly wrote down was feelings.

  Sod the feelings! What was your life like? In those days, I disdained a daily “Dear diary” format, in which a girl traditionally included what happened at school, what hurtful remark from a best friend especially smarted, what punishments parents meted out for which offense, what she had for dinner. Know what? Now I would love to know what I had for dinner.

  All those small, irretrievable details of the everyday would be invaluable to me now: word-for-word dialogue between classmates, the blow-by-blow of family altercations, my response to larger historical events such as the assassination of Martin Luther King Jr. These journals lack sensory information, too; I would have loved to know what my teens smelled, tasted, looked, sounded, and felt like. Even in private, I was too shy to write about sex (God forbid I should mention masturbation, at which I was already, if you will, a dab hand, but over which I suffered self-excoriating shame) or what it was like, say, to get my first period.

  What I did record at length, alas, was woe-mucking about a classmate named Roger Cook. I wasn’t a girl who flitted from one crush to another. I had one crush, which I sustained for five or six years, starting at age eleven. That suggests an innate constancy from which my husband now benefits. Nevertheless, I had no idea that all the textual outpouring about my unreturned affections would prove so trying decades later. Preparing for My Teenage Diary, I couldn’t bring myself to read most of these sections, and not from embarrassment. I was bored to death.

  What was interesting: I had forgotten quite how massive an upheaval my older brother caused in our family, and it is this saga that profitably occupies many pages—sometimes with details, with dialogue! Three years my senior, Greg dropped out of school and left home at fourteen. That was 1968, and his rebellion naturally involved drink, drugs, and sex. You gotta hand it to Greg for shacking up (as my mother would say) with not one but two fetching seventeen-year-old girls, with whom he had regular threesomes. My morally conservative parents were hysterical. While they had knock-down drag-outs with my brother, I felt sidelined—especially when he pitched up again:

  Gregory’s home. You can tell. He walks in and you are small. The air of importance and self-confidence enters the room; a well-traveled, experienced man. Everywhere I go, “Are you Gregory’s sister?” . . . I am just a stagnant shadow. Just a small child groveling up the glory left behind by my older brother.

  Their eldest out of their control, my parents fiercely pressured my younger brother and me to “not turn out like Gregory.” At any sign that I, too, had wayward leanings, my mother would sob. In fact, both remaining kids were constantly subjected to my mother’s moist, mucus-drizzling fits of weeping—literally on our shoulders—while we would feel trapped, hot, and secretly unmoved.

  As for the writing style, of course, it’s frequently lofty and affected. Take the exhortation to my older brother, in a poem written at the age of twelve: “Oh, Gregory! / Love is not gone. / It would simply flourish under / Recognition. / Yes, conversation with that which / Is three years younger may not / Be intriguing, but ought not to be ignored.” With that which is three years younger? Please! And sure, my spelling (charade = “sherade”) is atrocious. Sometimes I try out a word and I don’t quite get what it means, but other times I’m impressed: I clearly understood the definition of “osmosis.” I concocted my own goofy slang (a “schmerdie” was a jerk or a nerd), which turns out to have been good practice for my novel The Mandibles, in which I invent a new colloquial vernacular of the near future.

  I suspect most of us objectify younger versions of ourselves, passing judgment, sometimes with surprising harshness, as if turning our backs on a friendship gone sour: “You idiot. How could you have squandered so much energy on that guy? He’s just not that into you! They made a movie about it!” But is that impotent chastisement from the Ghost of Christmas Future really a betrayal?

  As a teenager, I ached to grow up even more than I dreaded to. I craved escape from my parents’ impositions on what I believed. I was determined to become a writer. I yearned to fall in love, and I constructed a fetishistic romantic ideal out of one real, perfectly nice, but probably rather ordinary boy.

  Over time, I achieved all these purposes: maturity, independence, literary career, and a love of my life. I once feared that I would abandon my true self when I grew up, but the adult’s pursuit of those same goals, decade after decade, has entailed a powerful loyalty to the girl. I may have tried to discard a few aspects of the 1970s Shriver: self-conscious affectation, high-flown histrionics, a weakness for unrequited infatuation. Otherwise, I wager that my younger self would recognize this wary, hazel gaze in a heartbeat. I don’t think she would be too disappointed by how she turned out.

  “The Big Story”

  Financial Times, 2013

  The precise inspiration for a novel can be tough to pinpoint. Yet Big Brother derived from a single paralytic moment.

  Home in London in November 2009, I wrote a column for Standpoint about the rise of America’s “fat pride” movement. While glad to relax our literally narrow definition of attractiveness, I felt queasy about the interest group’s assertion that one could be “healthy at any size.” Though I’d never cited my older brother in journalism before, Greg made an irresistible example of someone whose size was anything but “healthy.” Oh, I’d seen enough low-rent documentaries like The Half-Ton Man to recognize that, merely pushing four hundred pounds at five feet, seven inches, my fifty-five-year-old brother wasn’t breaking any records in the weight department. Nevertheless, he had untreated high-blood-sugar diabetes, hypertension, and such swelling in his feet that some mornings he couldn’t get his boots on. Not long before, he’d nearly died from congestive heart failure. These lines would soon haunt me: “Every time I talk to my brother, I wonder if it’s for the last time. Planning to see him during an author’s tour in March, I’m counting the days, actively anxious that he won’t still be with us a whole three months from now.” In short order, I’d stop counting those days.

  For a few hours after I filed that column, my parents rang from the States. Once again, my brother was in hospital.

  Because it had become too awkward for him to fly, the day before Greg had taken Amtrak from his home in North Carolina to visit our parents in Manhattan for Thanksgiving. My mother described how, shuffling thirty meters between the taxi and the elevator in their lobby, he’d had to stop and rest twice. Since my brother collected vices as some people do stamps, he was a lifelong smoker with emphysema, by then obliging him to drag an oxygen tank behind him wherever he went (which he disconnected from his nose only to light another cigarette). There was only so much paraphernalia he’d been able to drag with him on the train, so that night when he went to sleep, in the living room armchair that he preferred to a proper bed, he didn’t have his sleep apnea machine.

  The next morning my parents were unable to rouse their son. He was disoriented and incoherent. Consulting the laminated list of prescriptions and emergency numbers Greg had painstakingly printed and looped around his neck for the train trip—he had learned to prepare for medical crises—my mother rang his doctor, who urged her to get him to hospital immediately. Sleep apnea—another bane of obesity—can build up poisonous levels of carbon dioxide in the blood, and that’s why he was delirious.

  Yet getting Greg to hospital was easier said than done. Once the ambulance crew arrived, they were unable to lift him and had to call for a second crew to help. As both crews knelt beside that chair to hoist their unconscious, wide-load patient, my mother overheard one paramedic whisper to another, “How does this happen?”

  At Saint Luke’s, a few blocks away on the Upper West Side, Greg was kept sedated, because he hated to be constrained, and whenever he awoke he fought the nurses and tore the tubes out. His condition worsened when he contracted an infection, which the poor circulation and overburdened heart of a man his size made it hard for him to fight.

  I was my brother’s designated health proxy, meant to take medical decisions on his behalf if he was incapacitated. Eight days after Greg entered intensive care, his doctor rang me in London to say it finally seemed that Greg was out of the woods and to consult me on what came next. Saint Luke’s is renowned for its treatment of obese patients, so I asked if my brother was a candidate for bariatric surgery. Yes, the doctor said, he would be well suited for a gastric bypass, and the hospital would be willing to do the operation and to undertake the protracted follow-up treatment. But there was a caveat: Greg would need someone to take care of him, and he would need somewhere to live in the New York area.

  Standing in my London kitchen, I took a deep breath. I knew that my elderly parents would be unable to house and nurse Greg for many months of surgical recuperation and supervised weight loss. But my husband and I have a house in Brooklyn. It even has a “granny flat” in the basement, with a separate bathroom and kitchenette. I’m a freelance writer, professionally mobile. Was I being called to invite him to stay with us? But my brother was very difficult! Did I love him that much? Would my husband put up with him? Could I put up with him? Would Greg fit through our doorways? Would our midget downstairs toilet crack under the strain? In times like these, even a committed atheist reaches for the metaphors of a Christian upbringing, and I thought: Take this cup from me.

  That is the moment. That is where Big Brother comes from.

  As it happened, my brother’s condition abruptly plummeted again, and he died two days later. I never had to face down whether I was kind enough, loving enough, self-sacrificing enough, to take my brother on, to take my brother in. I got out of it.

  Big Brother is not autobiographical. About a sister who risks her marriage by setting up housekeeping with a morbidly obese older brother to help him lose weight, the novel expressly describes what didn’t happen. Still, my brother’s loss was fresh. Like the topics I’d chosen for several previous books, the issue of obesity combines the social with the profoundly private. Fat seemed like my material.

  After all, I could appreciate that weight often interacts with a host of emotional and other medical problems. Greg had never been heavy until two terrible accidents in quick succession: being beaten up with a metal baseball bat and broadsided on his moped by a car. He was left in chronic pain, clinking with titanium and barely able to walk. He could hardly keep off the pounds by jogging. Disability dishearteningly curtailed his professional opportunities, further inclining him to seek what gratification lay within reach (large jars of pickled sausages).