Metagnosis and the Fall
By Mary Pan
Met•ag•no•sis, n. [/ˌmɛtəˈnəʊsɪs/]. Etymology: from μετα- across, changed, different, after + γιγνώσκειν to learn to know, perceive.
1. The revelation of a longstanding undetected condition effecting a change in the terms of knowledge
Fall used to be my favorite season. The sudden bite of cool in the air, the store shelves stacked with crayons and spiral notebooks, the family schedule coalescing around a more predictable routine. Even the heightened emotions that accompany going back to school: tears at drop off, parents tearing themselves away from gesticulating children. I like cinnamon and the contour of a freshly picked apple in my hand. I like crisp denim and unsullied backpacks too large for slight shoulders. Something refreshing about a cooling down, the reverberation of school bells sounding, even if it means decay of foliage, the approaching end of another year.
My husband always had a hard time with fall, even in college, even when we were young. We met my senior year, as he was preparing to leave for the Air Force. Our first date was the year before 9/11. We were twenty-one and thought the world was stable, that we knew all that was necessary to proceed in life, our college degrees in hand, our love and lives laid out before us like a sturdy path. We had ambition, we clung to our plans. He was to be a fighter pilot, I was to be a doctor. We both wanted children, wanted to innovate the world but remain perpetually in the promise of spring.
I always liked fall colors best: evergreen and maroon, burnt orange and goldenrod. Why have color if not for richness? Why waste the retina on wan pastels? Give me depth of pigment, a breakdown of chlorophyll, a kind of active rest in order to process. Give me splendor, even if it means decay.
The fall my husband turned 40 we had three children, all five and under. I reserved tables at a local family-friendly brewery, ordered barbecue catering, greeted friends and family as the guest of honor bounced our 5-month-old on his lap. I ignored his furrowed brow, his creased lids, his weak conversation. He’s just tired, I told myself. None of our small children slept. We laid them carefully down and snuck out of their bedrooms with an army crawl, or collapsed curled up beside them, on a nest of blankets my 3-year-old piled with pillows and stuffed animals. He felt safer surrounded by cushions but wouldn’t remain there through the night. At that stage of our lives, caring for incessant needs of little ones, we constantly ached for rest.
In the fall of my high school freshman year, my volleyball coach told me she hoped I would learn to stop and smell the roses. “I don’t have time to smell the roses,” I replied, missing the whole point. Instead, I charged on to do too much, found my worth in ambition. I collected accomplishments like beads on a string: three varsity sports, two foreign languages, advanced placement calculus and creative writing, first chair clarinet in the band, varsity cheerleading, student government, volunteer tutor. I became valedictorian and homecoming queen, honed my grip on perfection. I was a good kid with good friends, sharing privilege and shelter in the Seattle suburbs. I evolved from a pimply, overweight, bookish, mixed-race preteen outsider to an accomplished, legalistic, effusive teen. I never learned to let go, to trust in the process of renewal. I never learned the value of letting decay and active rest refine me. Instead, I gathered perfection around me like a shield. It protected me, and trapped me in.
Soon after his 40th birthday, my husband told me he couldn’t stop thinking about how to kill himself. A car wouldn’t do it, he reasoned, but a bus — a bus would certainly cause death. He couldn’t bring himself to step in front of a bus, though. Our oldest daughter, our five-year-old, she loved buses. She waved to the drivers, liked clambering on, one hand on the slim handle, pink boots reaching high to the next step. She liked sitting all the way in the back, getting off at a coffee shop or a park or a downtown department store, really anywhere at all. It was the communality she craved, the smiles from other riders, the clink of the change as people boarded, getting to pull the string to signal a stop. It was the journey she wanted the most.
Two and a half years after my husband’s descent into severe depression, after his hospitalizations for suicidality, after a common antidepressant prescribed at his initial hospitalization caused his first hypomanic episode, after they then diagnosed him with bipolar disorder, I attended a medical humanities conference in Paris. I sat on a green bistro chair in a courtyard dotted with sunflowers, covered with soft grass. Academics surrounded me, a middle-aged man with a well-worn briefcase asked me what I was presenting, where I teach. I said I’m just attending, a physician only. I am in primary care outpatient medicine. He nodded politely and excused himself.
One morning in residency, I came home from a 12-hour overnight ER shift to find my husband had rearranged our living room furniture. He sat on our beige couch, face wide, eyes bright. Isn’t this so much better? I got started and just lost track of time. I liked the new configuration: TV to one side, couch facing the window rather than the fireplace. It seemed open, welcoming. At the time, I smiled. So silly. Up all night moving furniture. Years later, I’d wonder. Years later, he will be admitted to that same ER, the one I worked in that night of rearranged furniture, in four-point restraints, each wrist and ankle shackled to a hospital gurney. Years later, the attending doctor I trained under will pull me aside—now as a patient’s wife—to warn me about my husband’s appearance, the restraints necessary to ensure he doesn’t run away again, doesn’t try to flee the ER and attempt to kill himself. They will wheel him out of the back room I used to work in, pulled curtains back to take patient histories, felt distended abdomens and examined rashes. It was just one night—a rearranged living room. How much of that scene is tainted, retrospectively, by his diagnosis?
Near the end of the Paris conference, Columbia University’s Danielle Spencer gave a talk on metagnosis, or lived retrospective diagnosis, the question of perceived identity before and after a medical diagnosis is made. She talked about coming into awareness of a longstanding disease and the impact of this revelation: “an awareness based on a change of knowledge, a shifting knowledge of identity.” I sat in the back of the wood-paneled lecture hall, nodding and jotting down notes. She was describing my husband. She was describing all I’d wondered about who he is, who he was, who he continues to be. Was he always this way? What is defined, and therefore formed or revealed, though diagnosis? Did the sleep deprivation, did the antidepressant medication trigger this all? Or has he always had Bipolar II Disorder, a tendency to be overly enthusiastic or hypomanic, a tendency to sadness that clings and dampens, like wet leaves on a concrete sidewalk?
Two years after his hospitalizations, my husband signs the whole family up for tennis lessons. He buys all five of us new racquets, even the two-year-old. That fall he purchases an expensive membership to an indoor tennis club. He wants us to enjoy something together, recreational, as a family. He buys new tennis shoes, red, with matching Nike shorts, a pocket for the neon green balls designed specially into the garment. I acquiesce when he wants to stop at a boutique store to find me new shoes, a tennis skirt, measure my grip to ensure a proper size racquet. I like tennis well enough, but a question looms over my husband’s sudden devotion to the sport: is this just healthy enthusiasm for a family activity, or a sign of pathology? I grit my teeth as I enter the dressing room, my 4-year-old trailing behind. I pull on a white tennis skirt and notice the framed poster of a baseball field on the wall. Its presence doesn’t make sense. My son asks if it’s of people playing tennis. All other signs point to this reality: we are in a tennis store. I tell him no and wonder to myself why the poster is here: the groomed field, the diamond bases. What does it signal, what have I missed? I realize I’ve begun to question myself all the time. As a wife, as a physician, as a person, I should’ve known. I should’ve understood who my husband was, even without a diagnosis, a label. In the retrospective examination, I question my own identity.
Now the fall season is ominous; it carries a weight. I buy new rain boots for my kids, sign them up for soccer, procure Halloween costumes, bake plum almond tarts with the bounty of the overproducing trees in our yard. I watch the leaves yellow, the sky gray to opaque, feel the chill of a cycle coming to its end. I’m wary of the change. I wonder: who will he be this fall, this season of darkness descending? I wonder: is this who he always was, who we’ve always been, together? I wonder: does it matter what we call it? It just is. He is, we are, who we are. And we move forward in that knowledge or without it.
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About Author
Mary Pan is a writer and physician with a background in global health and narrative medicine. Her work has appeared or is forthcoming in Fourth Genre, Creative Nonfiction, McSweeney’s, Intima, and elsewhere. She has been selected for workshops, retreats, and residencies with Tin House, Hedgebrook, Kenyon Review, and Centrum, and is a Harvard Media & Medicine alum. The recipient of a 2019 Artist Trust Grants for Artists’ Projects Literary Award, she was runner-up for AWP’s 2020 Kurt Brown Prize for Creative Nonfiction. She is currently working on a memoir in lyrical essays. You can follow Mary on X and Instagram, or find her on her website.