Dr. Andrew Pratt spent the last four minutes of his life explaining what was wrong with my blood.
I noticed him on the downtown platform at Union Square because he was the only person not looking at a phone. Gray beard, an old coat that had seen better days, and a paper bag of clementine’s he peeled one after another and never ate. He watched me press my thumb into the side of my boot. My feet were doing that thing again. The pins. The feeling that my toes belonged to someone standing slightly to my left.
“How late are you?” he asked.
I should have moved down the platform. Instead I told him. Eleven weeks. A thousand micrograms of cyanocobalamin, once a month, for the rest of my life, because at twenty-nine my immune system decided to destroy the stomach cells that make intrinsic factor. Without it, B12 passes through me like water through a sieve. Pernicious anemia. It was named for what it used to do. Before 1926, it killed everyone who had it.
He nodded as if I’d confirmed a rumor.
“Cobalt,” he said. “That’s what you’re really missing. One atom of it, sitting at the center of the largest, most complicated vitamin there is. No plant can make it. No animal. No fungus. Only microbes. Every molecule of B12 in your body was assembled by something that isn’t you.” He split a clementine with his thumbs. “The bacteria in your colon make it, you know. Right there inside you. But too far downstream. You absorb it higher up, in the small intestine. The key is manufactured on the wrong side of the wall.”
A pale shimmer of light grew in the tunnel.
“The German miners called it kobold. Goblin. They thought spirits had cursed the ore, because when they smelted it, it gave off arsenic and no silver. They were right about the poison. They were wrong about which one.”
“Which one?”
He tapped his sternum. “This. The density. We were something else once, something that didn’t need to eat. Then the food came, and the bacteria came with it, and every meal laid another brick.” He held a segment under his nose and closed his eye’s.“That’s what they came for, you know. Not power. This. Sweetness. Salt. Warm skin. Nothing like it exists without a tongue.”” He looked at me with a tenderness I wasn’t expecting. “We’ve all been poisoned. Long before we were born.”
“Even if that were true,” I said, “how would you undo it?”
“You can’t. The body you know would die. You were born into the addiction.” He set the bag in my lap. “The only way out is to let go.”
He stepped backward off the edge with his eyes open, still facing me, the way you lean against a door you’re sure will hold.
The brakes screamed for a long time. Someone dropped a coffee. I sat holding a bag that smelled like Christmas, and under the peels was a spiral notebook with a single line in pencil on its first page.
The fork tells you when you are leaving.
That night I held my regular vial up to the lamp. Cranberry red. The color comes from the cobalt. I had the syringe uncapped before I noticed I’d stopped breathing.
I put it back.
I edit medical textbooks for a living. I know what a sourced claim looks like, and I know what a madman sounds like. The problem with Andrew Pratt’s notebook was that it read like the first and had been written by the second.
Every claim checked out. Bacteria outweigh every animal on Earth roughly thirty-five to one. A human body carries about thirty-eight trillion bacterial cells against thirty trillion of its own. In the 1930s, sheep in New Zealand wasted away standing in grass up to their knees, a mystery the farmers called bush sickness, until someone thought to dose the pastures with cobalt. The sheep hadn’t been starving for food. The microbes in their gut had been starving for one metal, and without it they couldn’t make the vitamin the sheep needed to burn what they ate.
Look at the feed, he’d written, underlined twice. Commercial pig and poultry rations are fortified with B12. Cattle get cobalt in their mineral mix so the bacteria in the rumen can build it for them. Agriculture had been organized around keeping one atom moving up the food chain, and nobody found it strange.
Then the fat. Every living thing banks its surplus energy the same way, nine calories to the gram, and every hunt in history has been a raid on that bank. B12 runs an enzyme called methylmalonyl-CoA mutase, which turns the leftovers of certain fats into fuel. It also maintains myelin, the fatty sheath that insulates each nerve. Dried out, the brain is about sixty percent fat. Pratt called the arrangement a ledger. Fat was the currency. Cobalt was the clerk.
Under the citations, in looser handwriting, was the story he believed. That the bacteria had been a tool once, built by beings who weren’t yet solid, for growing bodies they could step into and out of like a warm bath, because a body could taste, and touch, and want, and nothing on their side could. That every discarded body was eaten by the same bacteria, which learned from it, mapped it, grew. That after an unimaginable stretch of time the bodies grew too dense to leave. That the builders were still on the other side, watching, making small adjustments we mistake for luck.
I didn’t believe it. I also didn’t take my shot.
I called it an experiment. I ordered the tuning fork sketched in his margins, aluminum, 128 hertz, the kind neurologists press to your ankle bone. Vibration sense is one of the first things B12 deficiency takes. The longest nerves, the ones reaching the feet, lose their insulation first, and the hum goes quiet before anything else does.
The first week, I felt it buzz against my ankle for fifteen seconds. By the sixth, for six. My tongue turned smooth and red. I forgot the word for colander and stood in my kitchen holding one. The pins climbed to my knees. At night I read the notebook under a single lamp and caught myself agreeing with sentences I would have flagged in any manuscript.
In March the power went out in my building, and halfway down the stairs I discovered that my legs, without light to check them against, had no idea where they were. Neurologists call it a positive Romberg sign. I called it the floor coming up. I lay on the landing with my cheek against tile that smelled like bleach and radiator paint, and in the dark I had the clearest thought of my life.
It wasn’t mine.
You’re getting closer.
Two days later, my wrist in a splint, I opened my door to a man in a camel overcoat holding a matte black tin of supplements.
“I was a friend of Andrew’s,” he said. “I think we should talk about where you’re going.”
His name was Corwin Vaughn, and he sold B12. Not drugstore tablets. Keel was the brand in matte black tins at airport kiosks, methylcobalamin sprays and sublingual drops and a lounge in Tribeca where people paid two hundred dollars to lie under heated blankets while a pink drip ran into their arms. The lid of the tin said Stay Grounded.
He sat at my kitchen table as though he’d sat there before and laid a folder beside the notebook.
“Andrew and I ran a hematology lab together for nine years,” he said. “Best diagnostician I ever met.” He opened the folder. Pratt’s bloodwork from a clinic in Vermont, last autumn. Serum B12 below the detectable range. Methylmalonic acid more than ten times the upper limit. “He stopped everything four years ago. The liver holds three to five years of B12. He timed it.”
“Then he was sick,” I said. “That’s all this is?” I heard the hope in my voice and hated it.
“The old textbooks had a name for it. Megaloblastic madness. Paranoia, visions, voices. A brain built of fat, losing the vitamin that keeps the fat in order.” He turned the page toward me. “That’s what his labs say.”
“And what do you say?”
He smiled the way people smile at dinner parties right before they tell you about their faith.
“I say he was right about everything but the direction.” He laid two fingers on the notebook. “The bodies were built. The door was closed. And it’s opening again. Andrew thought the way out was to starve the body until it let go. I think when the door opens, anyone who can’t hold on will be pulled through whether they want to go or not. People slipping out in their sleep. Behind the wheel. On the operating table.” He nudged the tin toward me. “I’m not selling a vitamin. I’m selling ballast.”
So that was the twist. Not that the prophet was mad. That the sane man in the good coat believed him, and had built a company on it.
I stood. My left leg forgot itself halfway up and I caught the counter. “Get out.”
He did, which surprised me. At the door he set the tin on my shoe rack.
“You’ll take it,” he said. “Everyone holds on in the end. It’s the only thing a body knows how to do.”
I took it as a dare. For three more weeks I let the fork go quiet. Four seconds. Two. Then nothing but cold metal against bone and a hum I could hear but no longer feel, as if it were happening to someone in another room.
In the silence after, the voice came back.
You keep asking if we’re above you.
“Aren’t you?” I said to my empty kitchen.
There’s no up. It’s a shift. From our point of view, your world is diminishing. It is receding from the infinite view. From your perspective, it is growing. It is gathering more and more data from the infinite and packing that down, from every angle, to create a more solid foundation. This density increases. And so when you look out into the experience it looks larger and larger, but to us, you are looking up out of a deeper and deeper hole. The walls of your prison which you marvel at grow more complex every day. Thicker and more impenetrable walls are built with each passing moment. And for generations, this memory has mostly been wiped from human consciousness.
I don’t remember falling. My neighbor found me in the hallway the next morning. I woke at Bellevue with a nurse pushing the first of a week of daily injections into my thigh, the same cranberry red, and a neurologist who used the word permanent twice while studying a clipboard instead of me.
On the windowsill sat a bouquet of white lilies and a black card.
Welcome back aboard. C.V.
I’d gone looking for a door and come back with less of a body than I’d left with. And the man who sold ballast had been right about me.
My roommate at Bellevue kept her television on day and night. A renovation show, couples in matching fleece choosing between quartz and granite. On the third afternoon I got up to walk to the bathroom, IV pole squeaking beside me, and the next thing I knew I was standing at the foot of her bed, forty minutes gone, desperate to know whether a stranger in Ohio would take out a load-bearing wall.
Nobody had pushed me. The show was simply more interesting than where I’d been going, and so where I’d been going stopped existing. It hadn’t felt like a choice. It had felt like being alive.
That was when I saw what Pratt had gotten wrong, and Vaughn, and me.
Both men had treated the body as though it were the self. One wanted to break it to get out. The other wanted to armor it to stay in. A starving man and a man selling ballast, arguing over the walls of a well, and neither one asking who was looking up.
I wasn’t the show. Not the renovation, not the pins in my feet, not the red in the vial. I was the one watching. And when I went looking for the seam between the watcher and the watched, I couldn’t find one. Only the looking, quiet and belonging to no one.
Maybe the voice had been a starved brain making music out of static. Maybe it was a door. The bloodwork couldn’t settle it, and I found I didn’t need it to. Whatever waited on the other side wasn’t waiting for my body to fail. It was waiting for me to notice I was already here.
The neurologist tested me every morning. On the fifth day the fork stirred against my ankle, three seconds, like a moth caught under a sheet. She wrote down a number. When the buzzing stopped, I kept listening.
In April, the week my monthly shot came due, I called Corwin Vaughn and asked him to come by.
He watched me draw a thousand micrograms into the syringe with the satisfaction of a man watching a stock climb. “Told you,” he said.
I pushed the needle into my thigh, pressed, withdrew. “I’m feeding the animal, Corwin. I’m not the animal.” I slid the notebook across the table. “Take it. You need it more than I do.”
On the first page, under Pratt’s note that read, The fork tells you when you are leaving, I’d done what I do for a living. I’d crossed out leaving and written one word above it in red.
Listening.
He read it twice. Started to talk about the door between worlds, the people who wouldn’t be able to hold on, and I watched him realize I wasn’t afraid of any of it. You can’t sell ballast to someone who isn’t afraid of floating away. He took the notebook and his tin and let himself out.
I struck the tuning fork against the edge of the table and pressed its stem to my ankle bone. A faint hum, then less, then nothing I could feel. The radiator ticked. Somewhere under Fourteenth Street, a train moved through the dark.
The hum faded, but I kept listening.