Pain is just not enough word. It can’t possibly cover this. This is more than pain. It’s different. It’s transformative, identity-shaking, disorienting—an absolute, permanent loss so profound that I may no longer be me. It doubles me over, as if gravity has tripled, and when I fall to the tile floor the stages of grief pass by in a single, tragic, nauseating millisecond. This is a tectonic shift in everything I understand to be true about my body, physics, the universe.

  Fundamental things about me no longer work.

  From outside my body I listen with mounting alarm to the soprano wreck of noises coming from my throat. Then, turning to the booth, I see Jeff's wild eyes riveted to the screen in front of him and I realize I’m not the only one screaming.

  * * *

  I am floating into a pool of light on wobbly clouds, moving toward faint sounds of machines. Everything seems very far away—my hands, my feet, the room, people. I try to speak and my voice is far away. It may not even exist.

  I don’t remember anything that isn’t crazy. I know that something’s wrong, something’s happened, something awful, but that's all I know. All I have is a muscle memory of cold hands grabbing my spine from the inside and pulling me down.

  My awareness gutters like a candle, and through the uncombed cotton of my mind I hear voices—confident and educated voices—and words I struggle to recognize. Catastrophic. Surgery. Paralysis. The words are musical syllables choreographed like Ziegfeld girls, harmonized and trilling and sparkling around my head. I have no anchor in time. I have even less anchor in meaning, they’re just sounds cascading down staircases wearing feathers as I drift in and out among them.

  Sometimes the voices are accompanied by the noise of machines—staccato ticks, rhythmic beeps. Cold things skip across the skin of my face or my hand, and I feel a great squeeze on what might be my arm. Mumbled numbers repeat themselves in my dreams.

  Occasionally I hear voices I know. My husband Rob’s calm baritone. Dear friends I want to reach up to but can’t, whispering lightly and sometimes cooing very near my ear. The nurse who's stopped by to check on me. My neighbor. These are the voices I listen for. They are the sounds that remind me I’m not lost.

  * * *

  I am awakened from sleep by cold pressure on my back, then a sharpness that climbs through the center of me to a terrible, icy peak. The pain is yellow behind my eyes, chaotic and loud, like screaming children beating the skins of snare drums.

  There are hands on my face. Familiar, cool hands.

  And then her voice.

  “Leigh Ann, baby.”

  A sweet, tidewater drawl, heavy and long, like satin ribbons dipped in wet plaster. She whispers, but her words echo in my head, melodic and jarring and harmonizing with the cacophony of my pain.

  “Leigh Ann, baby doll, can you hear me? Do you know who this is?”

  Of course I know her. How could I not? Hers was the first voice I’d ever heard. It has been with me all my life.

  “Mama,” I croak, a broken rasp of a whisper.

  I open my eyes to her wet, puffy, desperate face.

  “I'm here to take care of you, Leigh Ann. I know it hurts, but when you're better I'm gonna take you home with me. Fanny Helm's daughter will get the best care possible, I swear. You won't want for anything.”

  I’m not comforted.

  I know that something is wrong but I can’t remember what. It's more than just the fact that I’m in a hospital bed aching and unable to move. Something about her is wrong. I know it’s important, and I almost have it, but then I feel a sharp stab in my back that violently disrupts everything and I lose the thought. Something is pressing my bones through the mattress and towards the floor. I lose track of her, of the room. There is only pressure and pain and breath and then darkness and the memory of Mama’s voice.

  * * *

  I see toes at the end of the bed, covered with a blue hospital blanket. I see tubes and wires connecting me to bags of fluid and illuminated monitors.

  There is also this…this thing. This figure. A shape. Not like a person or an animal. Like a symbol. It’s faint and translucent. A curve sweeps out to the right at the top and bows down and to the left before turning back to the center at the bottom. It’s like a question mark scrawled by a child. Though it moves around, it persists. It’s always somewhere in the room.

  I see it everywhere and not everywhere all at once. It appears in the folds of the blanket. It floats in front of the curtains and walls.

  Often I see it on the back of my eyelids in the darkness, like a sigil marking a terrible, invisible doorway.

  * * *

  I hear my husband’s voice, my Rob, the cadence of his questions to the doctors, intelligent and patient, cataloguing everything. I can’t follow what they say for very long—the drugs are too thick. But I know when he’s nearby, so I have the space to relax and let it all happen around me. With him I’m always safe.

  His warm, thick hands hold mine for a long time. I listen to him breathe and I breathe with him. I’m accustomed to this, no words between us, just comforting warmth, safe and solid. The weight on me is lifted, and I can float within that cloud and sleep.

  * * *

  Here is Mama’s voice now, a familiar sandpaper whisper accompanied by her cool hand on my arm. She talks close to my ear about me getting better and coming home with her. I want to believe her. I want her to save me.

  When she’s with me my body feels different, especially weighted down, pulled and stretched into the bed. Her presence makes me nauseous. I brace for something awful to happen, and the pain blooms and throbs throughout my body.

  I’m not so far gone that I don’t know why, of course. This is Mama. She has always been problematic.

  She has always been my burden. I took care of her even when I was a child. We all did, but for reasons I never understood, out of all the family I was the indispensable one. I was her “special baby,” and it was my job to keep her calm. Entertained. Distracted from whatever it was that made her sad or angry or sent her searching for weakness in those around her. It was my job, when everything and everyone else failed, to stay next to her and hold her hand and take it.

  Her voice summons all my memories of her.

  Mama on the farm at Easter, when I was three, my navy blue dress matching hers like I'm a silent echo, a little Fanny doll made to match everything laudable about her, and on the way home her long list of my transgressions.

  Mama smoking in the den, drinking a glass of sherry in the headache of late afternoon, the rest of the house braced for a storm that may or may not come.

  Mama screaming at everything that was wrong in the world, scattering the cats to far corners of the property and leaving me paralyzed just inside her blast radius waiting for her hand to come down on my face.

  Mama in her bedroom, in the dark, a cool cloth on her head, crushed by the weight of her sadness, reciting all the ways I let her down. Sometimes she would gesture for me to lie down with her, and she would squeeze me like a rag doll, my teenage body grinding against itself as she desperately pressed her weight and strength onto me.

  Mama in the hospital, surrounded by pinging machines, her cool fingers squeezing mine until they felt like they would pop out of my knuckles.

  And again the feeling that seeing her here is wrong.

  Her hand squeezes mine constantly. Her fingers, I know, communicate our lifetime covenant: never leave, never leave me alone. It’s how she designed us, what she wanted, and Mama always got what she wanted, one way or another.

  I think we all want our parents to be good parents. Despite everything, despite decades of proof to the contrary, I’ve spent my life hoping somehow she could learn to be the Mama I needed or, failing that, that I could teach her how. If I was just wise and calm enough, then she would understand and become my good Mama, a Mama I’d never really known but missed every day of my life.

  Hearing her voice now, I remember that hope and also the disappointment into which it always dissolves.

  When I struggle to understand it all—her presence, our life together—the pain moans like whale song, like a failing suspension bridge, and my architecture bows as the weight of her pulls itself hand over hand up my spine.

  It’s all so heavy.

  I welcome, again, the blankness of sleep.

  * * *

  “I’m here, Leigh. Don’t worry. I got you. I’m in charge now.”

  Rob.

  I’m not sure I’m actually smiling—I don’t know if I can—but I imagine all the warmth and relief I feel beaming out the top of my head. That phrase, “I’m in charge now,” that’s what he’s always said to me when I can’t sleep. He knows I’m the vigilant one who can never sleep when there’s something for which I need to be responsible. He learned early to take the burden and hold onto it himself. We both know it’s just a metaphor, but it’s our signal, the way we make it okay for me to rest.

  He’s whispering to me, a litany of the day’s events spoken to my eyelids, a steady patter of all the dumb things. Lunch. Nurses. Coffee. Home. The cats. His business. Our friends. The plot of a terrible movie he’s seen. His best friend’s love life. The things he has to accomplish tomorrow. I can stay here and listen to him, feel him, for a very long time. With him, the pain subsides. I can feel the drugs pushing the ache away. It’s still there, but it doesn’t grip me so tightly.

  As he talks I drift in and out. His voice makes my fog pleasant and allows me to let go and float among the listing clouds. When I return, there he is with his soothing voice. I let it hold me, make me warm, for as long as I can remain aware.

  * * *

  In my dream it’s summer and we’re hot, even with the breeze. She’s singing a corny love song and dancing with me in the living room of our old house in Virginia. I’m a toddler at most, diapered and vulnerable, tucked on her hip as we sway around the room. I recognize the tune, but the words are muffled. Something about love and bushels and wrecks. I try to ask what it means but I can’t talk. The tune is a swing I can sit in and rock, though, so I relax into the back and forth of it as she dances more and more vigorously through the house.

  After a while the swing goes too high.

  Suddenly, my location shifts back to the hospital room. I feel a grinding sensation and the sound of gravel underfoot. With each crunch of rock upon rock I feel a new spark of pain up the center of my spine.

  Now there are many noises. A loud, urgent beeping, Rob's worried bellow for help, then concerned, professional voices speaking about heart rate and blood sat and blood pressure. Numbers, more numbers clearly spoken, but they mean nothing to me.

  Then next to me, Rob and a woman with great authority in her voice.

  “…deteriorating quickly…act soon…”

  “…you said she isn't strong…”

  “…too much for her heart if we wait…”

  “…but the risks…”

  “…you've seen the lateral distortion…”

  “…I know, like a question mark…”

  “…so you must understand…”

  And then the crack of fear in Rob's voice as he says, “Look, you don't understand. This condition, this surgery, is the reason her mother is dead. I can’t lose her like that.”

  I’m awake now, from the pain and the activity around me, adrenaline and alarm inflating me until I can speak.

  “Rob. ROB!”

  He turns to me and kneels by the bed. “Leigh, you're awake. I was so scared—”

  “No, Rob, listen. Tell me... Mama... She’s dead?” My head is exploding with hot ache.

  “Yes, of course. Are you feeling okay? Do you know where you are?”

  My words slide around in my mouth like oysters. “Not dead, Rob. Not dead. Mama…”

  I hear a hot, red alarm next to the bed, accompanied by agony slicing through me. Everyone in the room leaps into action, and darkness closes in. The last thing I hear is Rob whispering in my ear, “Stay with me, Leigh. You’re going to be all right, just stay with me. Okay?”

  I feel movement. The bed is rolling quickly, surrounded by running feet. My vision narrows to a pinpoint and then pops out of existence like an old TV picture.

  * * *

  I’m standing in a large, black space. A fragile old woman is facing away from me in a powder-blue hospital gown that leaves her back and thighs exposed. Her shoulders stoop forward and her frame leans unnaturally to the right. She’s holding tight to one of those four-footed nursing-home canes.

  Her figure is awful but familiar. A twisted spine threads in and out of her muscles below the skin, surrounded by flesh squeezed into unnatural shapes as it conforms to her back’s meandering line. It’s difficult to imagine that her back can carry her weight, the muscles and curves and knots of vertebrae squeezing right and then left bend her into a question mark.

  On her papery skin there is a faint image, as if projected by the dusty and unfocused lens of an X-ray machine. A fuzzy, wide line starting at her neck follows her spine out to the right just below her shoulder before sloping down and slashing diagonally across her back. Above her left hip it curves back to center.

  Of course. This is where I’ve seen that shape before.

  “Mama.”

  She turns her head, using her cane to keep steady, and shuffles around to face me. “Leigh.”

  Memories crowd my mind like panicked horses—the last five years of her life spent in crippling pain, her back slowly collapsing under the weight of her flesh, getting from doctor to doctor, the increasingly strong narcotics that left her depressed and frightened and more angry than normal. She lost six inches in height, my tall and powerful Mama shrinking into desperate frailty.

  Near the end she found a surgeon who said he could rebuild her spine using a titanium mesh cage. She begged me to come stay with her through the many surgeries required, emailed me her terrifying X-ray—that horrifying, distorted question mark that inhabited her body—and I flew back east to her. I knew that it wouldn't be—couldn't be—pleasant, but it was my job. Taking care of her had always been my job.

  Mama had never been emotionally resilient. She was always ready to tumble into panic or fury at the least provocation, a condition I was all too aware of as I was usually the target of her rage. She had always been weak and dependent and very, very mean. However, before each surgery, she became more terrifying and predatory than ever—teeth bared, claws unsheathed, sniffing out vulnerability and biting viciously at everyone around her. The closer you were to her, the meaner she got.

  Rob had tried to shield me from her, but he couldn't. He didn't understand that I’d been raised for this. I was the one she had created to bear her weight. I was the one who had to take the punishment.

  When Mama wasn’t in surgery, I sat and held her hand, taking the terrible blows of her anger and fear. She dragged out my every failure for everyone to see, blaming me for everything wrong in her life and in mine, inventing elaborate wrongs from the everyday facts of our lives.

  I couldn't leave without sending her into a fierce rage, so Rob brought me coffee and juice and covered me with blankets when I fell asleep at her side.

  Just before the last procedure we fought. The topic, as usual, was my profound inadequacy as a daughter—how I had continually abandoned her, tortured her and disappointed her. She accused me of leaving her for Rob, whom she lambasted as no-account, stupid, pussy-whipped, weak. It was as if she knew this would be her last chance to hurt me.

  She died on the operating table a few hours later.

  I was ashamed at how much relief I felt.

  Seeing her now, that relief shrivels and blows away, replaced by an old, familiar dread.

  Mama had always haunted me. I laugh now at how nothing changed with her death. She has found a new way in. Once again, my life is no longer mine. Literally, in fact. My spine, the structural center of my being, now belongs to her.

  “Mama. Why are you here?”

  “Because you're hurting, Leigh.” Her voice is that perfect Southern combination of kindness and condescension. She leans in to touch my cheek.

  “But Mama, you're—”

  “Shhhhhhh.” Her finger crosses my lips. “Don't talk. You need your strength to get better so we can go home.”

  “But, Mama—”

  “No, baby. Don't be confused. They have to keep you see-daaaaaay-ted.” Her accent stretches the word out like taffy.

  I take her hand from my face and hold it in mine, searching for the right things to say to loosen her grip on me. Grief and resentment battle behind my reddening cheeks, and I fight the temptation to crush her cool, brittle fingers. Perversely, I have missed her but I know she is lying, trying to convince me to hold onto her distorted version of a world where she is never wrong. I follow her without question. This is the world in which she feels safe.

  “You're dead, Mama.”

  Slow, fat tears spill over her bottom lids. “No, baby doll. I'm here to take care of you. Don’t be mean.”

  My breath audibly leaves my lungs as my chest compresses with the emotional weight of her. “Do you not know, Mama? You died. Four years ago. Can’t you remember?”

  “Sweetheart, no. It’s all those drugs they have you on. Once you’re home, we can take care of that and get you strong the old-fashioned way.”

  I step back, releasing her hand. “Mama, stop this. You died. We buried you. What are you now? A memory? A ghost?”

  My gorge rises as I say the word, its wrongness lingering on my palate. I begin to cry just like her, silent and wet like a heartbroken young girl.

  I’m terrified and full of rage, though I’m doing my best not to show it. This feeling is old, very old. It’s the panic of a child whose responsibilities exceed her power. I’d had this panic at seventeen, at fourteen, at twelve, seven, four. This is the constant condition of being her daughter, knowing that I would be asked to answer for something I had no control over, made responsible for something I couldn’t affect. I know her state of mind is still my job, and this time, especially, I won’t be able to please her.