Andre M. Pietroschek

That Bumpy Ride of Ours - Of Sickness, Drugs, Medical Bills & Dyin

That Bumpy Ride of Ours - A Not-So-Fictional Novella
© Andre Michael Pietroschek, all rights beyond display on the websites are reserved.

Disclaimer: No warranties! This narrative is crafted in the spirit of mourning the departed. It offers cautionary tales to the young. The story is wholly fictionalized to navigate possible legal entanglements. It also shields me from the tears that memory can evoke.

Note: Russian malware forced a hard drive format. Soon after, my laptop died. I had to rely on older backup files. As a result, some nuances in phrasing and proofreading may have been lost.

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Chapter 1: The Opening World

Her hand unfurled, fingers stretching, seeking tremors that remained concealed. None were visible, yet the tremor resided deep within, entwined in the very fibers of muscle, nestled in an autonomic system that had learned to remain vigilant, even in slumber. Especially in slumber.

The hospital waiting room lay in stillness at five in the morning, a calm before the inevitable storm. Soon, the staff would arrive, families would take their places, the fluorescent lights would hum their sterile tune—neither vibrant nor lifeless, merely sustained by the pulse of electricity. But for now, in this fragile hour of anticipation, the room existed as mere infrastructure. Plastic chairs designed to thwart repose, a linoleum floor, and the pervasive scent of industrial cleaner mingled with an underlying odor—a scent that clung to hospitals, the scent of human decline.

A magazine lay abandoned, its pages worn soft by countless hands, dated August 2018. The world it chronicled had slipped into obsolescence, archived and forgotten. She chose to leave it undisturbed.

Across the city, on a construction site on the east side, men began to gather. The dawn had yet to break, yet they arrived early, for the promise of work sometimes hinged on the mere act of being present. Coffee thermoses, retaining the chill of 4 a.m., served as their lifeline. Among them stood a large man clad in a work coat, his movements stiff—his knees, his right shoulder—bearing witness to a lifetime of labor. He had toiled for thirty-four years, since the age of eighteen. Simple arithmetic revealed his age: eighteen plus thirty-four equals fifty-two. The body, by now, was expected to be worn, yet it persisted in fulfilling its purpose.

In the ICU, a nurse was nearing the end of her twelve-hour shift. Her shoes had surrendered their cushioning around hour eight, and her back began to communicate its grievances around hour ten—not in words, but in the familiar dialect of fatigue and strain. Four more hours loomed before her next shift commenced. Sleep was a luxury she could not afford. Home beckoned, where coffee and messages from her sister awaited, a brief respite before the cycle began anew. Her body burned with exhaustion; she understood the science of burnout, the grim statistics of nurses’ mortality rates, knowledge that loomed like an inevitable shadow, real yet unchangeable.

Meanwhile, three miles away, a woman prepared her car in a dimly lit parking garage. She checked the oil, a skill imparted by her father when she was sixteen, when she believed that mastery of practical skills would shield her from life’s harsh realities. The car, with 187,000 miles etched into its frame, emitted a sound from the transmission that it hadn’t made the previous week. She had noticed this sound during her last three deliveries. Valued at perhaps $3,400 in the secondary market, she found herself $4,200 in debt. The numbers simply didn’t add up. Yet this car represented her lifeline; without it, income vanished, and the arithmetic of survival spiraled into chaos. She slid into the driver’s seat, and the engine roared to life. For now, that would suffice.

In a modest two-bedroom apartment, a man perched on the edge of his bed, waking abruptly at 3 or 4 a.m. for the past six months, consciousness striking him like lightning with no gentle transition. His chest felt constricted, a sensation he had been aware of for longer than six months—perhaps a year or more. He didn’t track it meticulously; he simply coexisted with the tightness, ignoring it as one might dismiss other wrongs, navigating through the day as though the discomfort belonged to someone else.

These lives were not disparate tales; rather, they formed a singular narrative, seen through the prisms of different bodies. The infrastructure of their existence bore striking similarities: precariousness, systems engineered for exclusion, bodies bearing the weight of accumulated consequences. Strangers to one another, they would soon find their paths converging. The relentless logic of survival in a faltering society would draw them into each other’s orbit.

But that was a story for another time. For now, the scene was set: an early morning before clarity emerged, before workspaces filled with those seeking employment, before the slow accumulation of hours began, before waiting rooms became crowded with anxious souls, before the rhythm of night nurses transitioned to day nurses, propelling the machinery of human decline forward once more.

Now was the moment—a breath held before pressure resumed.

Now the body was awakening to pain that had roots in childhood, crystallized through adolescence, and metastasized into adulthood. Knowledge lay dormant, embedded in the nervous system, much like fear, whispering that today would mirror yesterday, and tomorrow would echo today. The framework that governed possibility was irreparably flawed, compelling individuals to devise coping mechanisms for their broken realities rather than striving to mend the structure itself.

The city remained cloaked in darkness, the October air beginning to chill, a prelude to the inevitable winter. Each inhabitant had forged their own strategies to confront the cold—some more effective than others, some barely sufficient, others tragically inadequate. Yet they would endure, those destined to persist. The rest would find themselves relegated to the margins, seeking refuge in shelters, emergency rooms, and jails—the places where the precarious sought solace when all else failed.

But that was merely the narrative, the tale recounted in hindsight, a chronicle of cause and effect. What unfolded now was simpler: a hand unfurling, a tremor dwelling deep, a burning back, a car engine igniting, a constricted chest, an empty waiting room. This was the world before anything truly began.

Chapter 2: Diane’s Beginning

She was twelve years old, standing in the kitchen of her mother’s house, when she understood that something was wrong with the way her mother spoke. Not wrong exactly. Altered. The words were there, but they moved differently through the air and arrived at their destination with a kind of lag, as if the instruction were traveling a longer pathway from her mother’s brain to her mother’s mouth.

“Did you eat?” her mother said. Not a question, really. The inflection was flat.

“Yes,” Diane said. She was watching her mother’s hands. Her mother’s hands were steady, or steady enough. But the kitchen smelled particular. Diane had learned to recognize this smell, the smell of pills dissolved in saliva, the smell of someone’s chemistry being rearranged by a substance that wasn’t supposed to be there.

Her mother had hurt her back the year before. Fell on the porch steps. Nothing broken, but the pain was real, Diane’s father said. The doctor gave her pills. Vicodin. That was the word. Diane had looked it up in the library at school. Opioid. Schedule II narcotic. Highly addictive. That was what the literature said. The literature was abstract. The concrete thing was her mother, standing in the kitchen, speaking around the lag, and Diane, aged twelve, beginning to understand that her childhood was about to change into a different kind of thing.

She didn’t say anything. She was the kind of child who understood, by instinct or by temperament, that speaking would make the thing true, and while it was becoming true regardless, there was something to be said for postponement, for the small mercy of not-yet-naming.

Over the next few weeks, Diane began to observe. Systematically. Not with malice, but with the precision of someone whose safety depended on understanding what was happening in her environment. She noticed when her mother slept too much. She noticed that her mother’s friends called less often. She noticed her mother’s hand shaking not always, but in patterns, notably worse in the mornings, notably better in the afternoons when the pills had been taken.

By age fourteen, Diane had found the bottles. She knew where they were hidden, had memorized the number of pills in each bottle, and was tracking the refill dates from her mother’s purse. She had adopted a framework for understanding this information. The framework was clinical because it was manageable. Addiction. Opioids. Dependence. Tolerance. The terms gave her the illusion of control, as if naming something was the first step toward managing it.

What the terms actually did was allow her to stand outside of her experience while living inside it. She could think about her mother’s addiction while simultaneously maintaining the household, managing school, keeping the secret from neighbors and relatives, and the truancy officer and the welfare caseworker who visited once and saw nothing because Diane was extremely good at creating the appearance of normalcy.

She was also extremely good at not sleeping. Or at sleeping so lightly, so alertly, that her body never fully relaxed. Hypervigilance was the clinical term. The experience was different. The experience was a kind of constant low-level dread that something would go wrong and she would be unable to respond, or that something would go right (her mother would stop, would get help, would become the person she used to be), and then the loss of that possibility would be worse than the ongoing reality.

By forty-eight, having spent thirty-four years learning not to expect her own needs to be met, having trained her nervous system into permanent alertness, having built a career on managing other people’s chaos, Diane was exhausted in a way that sleep didn’t touch.

She was washing her hands in the bathroom of her apartment. It was 6 a.m. She’d been home for an hour. She was washing them methodically, the way a surgeon would, the way she’d been trained to in nursing school. She was watching the skin of her hands, middle-aged hands, capable hands, hands that had learned to be useful when usefulness was survival. She was noticing the small shake that appeared when she held her hands under the water, steady or not-quite, the tremor of someone whose nervous system had been calibrated for emergency for so long that the default state was now a kind of permanent low-grade fight-or-flight.

She dried her hands. She looked at herself in the mirror. She was noticing the lines around her eyes. She was noticing her hair, which she’d been graying into, not dyeing, because that felt like an admission of vanity she couldn’t afford. She was noticing that she looked tired. She was tired. She was tired in a way that was bone-deep and probably permanent.

Her phone was on the bathroom sink. It lit up with a message from her sister. A picture of her sister’s feet. Swollen. The message said: still retaining. Diane looked at the swollen feet. Her sister was forty-three. She had type 2 diabetes. She had failed to manage it, or had failed to have access to management, or had failed to believe it would matter, or had made the same calculus that many people made: that the cost of managing illness was higher than the cost of living with it.

Diane didn’t respond to the message yet. She would. She would call. She would schedule an appointment with her sister’s nephrologist. She would try to figure out the financial aid options. She would do what she had been doing since she was fourteen, which was manage someone else’s crisis while her own body spiraled slowly toward its own crisis.

She had learned, by age twelve, that her mother would not be a mother in any meaningful sense going forward. She had adapted. She had become an adult. She had done what needed doing. And now she was paying the tax of that adaptation, which was the tax that early parentification always extracted: the knowledge that your own needs were less important than other people’s needs, the knowledge that your body’s signals could be ignored if there was work to do, the knowledge that rest was not a category that applied to you.

She made coffee. She drank it black. She went to work in three hours. She would work twelve hours. After her shift, she would call her sister. She would not mention her own insomnia, her own stress, her own body’s distress signals. She would focus on her sister’s feet. She would research nephrology. She would be useful. This was what she did. This was who she was.

Chapter 3: Gus’s Violent Inheritance

He was eight years old. His father was enraged. This wasn’t the first time, but it felt like the first time, the way each moment of violence felt new and sudden despite the pattern being established. His father was shouting. The words didn’t matter because the tone was the thing. The tone was a physical force in the room.

His mother moved in front of him. She was small. His father was large. The geometry of it was already predetermined. Gus watched from the space behind his mother’s body, aware that he was being protected and aware that the protection was temporary and would not hold.

His father hit her. brutally not compared to what was possible. But the sound was brutal. The sound was enough. Gus’s body went rigid. He couldn’t move. He couldn’t look away. His sympathetic nervous system was completely activated. He was flooded with adrenaline. His heart was pounding. He was eight years old, and his body had learned what violence looked like and what it required.

His mother didn’t scream. That was the thing that stayed with him. She didn’t scream. She absorbed the impact, and she spoke calmly to Gus’s father, negotiating the violence downward, trying to prevent what was coming next, managing the crisis with the expertise of someone who had managed it many times before.

The violence stopped. It always did. And then there was the aftermath, which was a different kind of terrible. The quiet where the violence had been. The shame that came after the rage. His father crying, his mother comforting him, the entire apparatus of damage and repair operating at high speed.

Gus was sent to his room. He lay on his bed, and he understood, with the cognitive precision of a child, that the world was not safe. That people he loved could hurt people he loved. The unpredictability of adult behavior was the basic condition of existence.

By sixteen, Gus had learned to become violent. Not toward his parents, he’d learned the hierarchy of risk and knew that wasn’t viable. But toward other kids. Toward the world. He’d been arrested twice. He’d been suspended. The trajectory was already written.

By twenty-five, he’d spent seven years incarcerated. The violence had calcified. His body had learned to respond to perceived threat with aggression. His nervous system was permanently calibrated for attack. The prison system had reinforced this learning. You had to be violent in prison. You had to be hard. You had to be ready.

At fifty-two, Gus was standing on a construction site, about to place a beam. His coworker was a kid, maybe twenty-four, who moved like someone who was already practiced at being aggressive, who had the muscle tone of someone prepared for violence. Gus recognized something of himself. The kid moved around the authority incorrectly. He was bristling. He was ready.

Something the foreman said triggered the kid. Not something harsh, just a direction. But the kid’s body language shifted. He was about to respond badly. Gus saw the trajectory. He saw the way the kid’s nervous system was wired for conflict. And he thought about warning him. He thought about saying: This is a path. This is where it leads. It leads to doing time. It leads to your body being forever changed by the expectation of violence. It leads to you being fifty-two years old and unable to relax completely, even in your sleep, especially in your sleep.

He didn’t say anything. What would be the point? The script was already written. The kid’s childhood had written it. His father or his trauma or his poverty or the particular alchemy of all three had created a nervous system optimized for attack. Knowledge didn’t change that. Warning didn’t change that. The trajectory was physics now.

By that evening, Gus was sitting in his studio apartment, drinking whiskey. His knees were hurting worse than usual. The cold was coming in through the window frame, which he’d caulked three times and which never stopped leaking. He drank more whiskey. The whiskey helped with the knees. It also helped with the knowledge that he’d spent seven years incarcerated, that he would never have certain kinds of employment available to him, that his body was breaking down, and he didn’t have the resources to manage the breaking down.

His father had drunk too. That was the other inheritance. The violent response and the chemical self-medication. His father had believed he was different. He’d believed he could use alcohol without becoming addicted to it. His father had died at sixty-seven, from complications related to alcohol use. Cirrhosis, though they didn’t say it that plainly. They said liver failure. They said his organs had given out.

Gus was fifty-two. He was doing the math. Fifteen more years if he was lucky. Maybe twenty. He was drinking to manage the pain. He was also drinking because it worked, because it was available, because it was the strategy he knew.

He was also drinking because his father had drunk, and the inheritance went deeper than behavior. It went into the neurology. It went into the way his brain was wired to seek chemical solutions to pain. His body carried his father’s neural pathways. The drinking was both choice and not-choice, both agency and inevitability.

He drank more. The whiskey was cheap. It burned going down. His body had stopped noticing the burn. The burn had become normal. Most things had become normal. Violence, self-medication, and the knowledge that the trajectory was predetermined. Normal.

Chapter 4: The Inheritance Explained

The meeting was in the basement of a church on Cass Avenue. The folding chairs were arranged in a circle. The coffee was bad. The people who arrived were there because something in their bodies or their lives had demanded they look at the inheritance directly.

The literature on the wall was clinical. Adverse Childhood Experiences. ACEs. The studies were from the CDC. They showed, with statistical clarity, that people who experienced childhood trauma had higher rates of chronic disease, higher rates of death, higher rates of addiction, incarceration, and mental health crises. The pathway was not mysterious. Chronic stress activated the allostatic system. Cortisol became elevated. The body developed inflammation. Over time, the inflammation calcified. The heart developed arrhythmias. The brain developed mood disorders. The nervous system became fundamentally altered.

It wasn’t punishment. It wasn’t morality. It was biology. The developing brain under stress learns to prioritize survival. The amygdala becomes hyperactive. The prefrontal cortex, the executive function center, becomes suppressed. The body becomes optimized for threat. This is adaptive if you’re living in genuine danger. It is maladaptive if you’re living in an environment that has moved from acute danger to chronic low-grade threat, and then into adulthood, where the threat is ostensibly gone but your nervous system hasn’t received the update.

One of the people in the circle talked about her mother. Her mother had been on heroin. She’d died when her daughter was nineteen. The daughter had spent her childhood in and out of foster care. She had developed anxiety that manifested as panic attacks. She had spent fifteen years in therapy. She was now forty-six. She still couldn’t tolerate loud noise. Her body still went into fight-or-flight at unexpected sounds.

Another person, a man, maybe fifty, talked about his father. His father had been an alcoholic. His father had been violent. He’d been incarcerated at twenty-one, released at twenty-eight, incarcerated again at thirty-two. He’d been released twelve years ago. He was working as day labor now. He was drinking daily. He said this without irony. He said: I’m becoming my father, and I know it’s happening, and I can’t seem to stop it.

No one in the circle tried to comfort him. That was not the function of these meetings. The function was to name the pattern. To place it in a context that was larger than the individual. To understand that the damage was not a personal failing but a structural consequence.

Diane was there. She wasn’t usually there. She’d come because she was about to break, or was already broken, and the breaking needed to be witnessed by someone. She was listening to the man talk about becoming his father. She was thinking about her mother. She was thinking about the way she’d internalized her mother’s inability to function, the way she’d become functional in compensation, the way she’d burnt herself down to ash, maintaining that compensation.

She was also thinking, clinically, about the pathophysiology of this. The ACE scores were correlated with epigenetic changes. The DNA itself didn’t change, but the expression of the DNA changed. Genes were turned on or off based on environmental input. Trauma turned on the genes associated with inflammation. Chronic stress altered the methylation patterns. The damage was written at the molecular level. It was transmitted to the next generation. It was biological inheritance.

The mechanism didn’t make it less devastating. But it did make it less personal. It did make it less about individual moral failure and more about systems, economic systems, health systems, and family systems that had failed to interrupt the cycle.

The meeting ended. No solutions were offered because there were no simple solutions. The people who attended filed out into the October cold. They went back to their lives. They went back to their jobs. They went back to managing the inheritance, to watching their bodies account for what their parents’ bodies had accounted for, to living in a system that was not designed for their recovery.

What they had, maybe, was the knowledge that they weren’t alone. What they had was the understanding that the damage was not their fault, even though they had to live with it anyway. What they had was the witness of others who understood, who saw the trajectory, who recognized the inheritance.

It wasn’t redemption. It wasn’t healing. It was just the small grace of being seen.

Chapter 5: Raymond’s Decay

He was three years old when his father left. He didn’t remember it. He remembered the absence. He remembered his mother’s exhaustion. He remembered the smell of the apartment, which was always slightly damp, because his mother couldn’t afford to keep it properly heated, and the moisture accumulated in the walls and the fabric and the air itself.

His father was genetic. Raymond had his father’s eyes. He had his father’s build. He had his father’s nervous system, calibrated for anxiety and hyperarousal. He didn’t know the last part, but he experienced it. He experienced the way his body moved through the world with a kind of low-grade dread. The way he was always slightly too alert. The way relaxation felt foreign to him.

His mother worked double shifts at the hospital. She was a nurse’s aide, which meant she made very little money and came home exhausted and smelling of bodily fluids and institutional cleaner. She was a good mother within the constraints of her circumstances. She was present when she was home. She was engaged. But she was also depleted, and her depletion was ambient, and Raymond absorbed it the way children absorb everything.

By the time Raymond was nineteen, his mother had died. Stroke. The medical chart said it was related to unmanaged hypertension, but Raymond knew it was related to the chronic stress of raising a child alone, of working double shifts, of living in poverty, of managing the world’s indifference toward her. The stroke had occurred while she was at work. She’d had maybe twenty minutes of consciousness. Then she was gone.

Raymond had been seventeen when they told him to come to the hospital. He’d known what it meant. He’d known his mother was sick, but the knowing and the comprehension were different categories. The comprehension was arriving now, in the form of his mother’s body, failing, and his own body responding with the knowledge that the person who had mattered most was about to be gone. Forever.

She’d died at fifty-six.

By fifty, Raymond had replicated the trajectory. Not exactly, he hadn’t died yet. But he was tracking toward it. He was working as a day laborer. He was uninsured. He was living alone, in a small apartment, with a roommate, who was also living by economics rather than by choice. He was single, having failed at marriage twice. He had an adult daughter, who wouldn’t talk to him anymore. He had no family that functioned as family should.

His body was beginning to fail. He knew this. He knew it the way someone knows they are going to die; The knowledge is abstract until it becomes concrete. The chest pain had started two years ago. He attributed it to work. He attributed it to stress. He attributed it to the natural consequence of aging. All of this was true, and none of it was the reason he didn’t go to a doctor. The reason was economic. The reason was that a visit to an ER, without insurance, could cost him thousands of dollars that he didn’t have. The reason was that, if he was sick, he couldn’t work, and if he couldn’t work, he couldn’t pay rent, and the arithmetic of survival didn’t include medical crisis.

He was waking at 3 a.m. with his heart racing. He was lying in bed, aware that something was happening in his chest, aware that the happening was nothing. He was doing nothing about it.

The night before he would be hospitalized, he sat on the edge of his bed at 4 a.m., feeling the tightness in his chest, and he thought about his mother. He thought about the way her body had betrayed her. He thought about the way his body was beginning to betray him. He thought about the genetic inheritance, the way DNA carried information across generations, the way his mother’s dead heart was beating inside him, metaphorically, and maybe also literally, the patterns of his cardiac system learned from hers, the predispositions, the vulnerabilities.

He drank some water. The water didn’t help. Nothing helped. He lay back down. He waited for sleep, which didn’t come. He was waiting, without knowing he was waiting, for the moment when his body would stop negotiating and would simply fail.

He had maybe twenty-four hours left before that moment. He didn’t know it. He just knew that something was wrong and that he’d learned, over fifty years, not to interrupt the trajectory. He’d learned that knowledge without action was the status quo. He’d learned to live with the harbinger.

Chapter 6: Diane in the Hospital

The ICU smelled like her entire life. The hum of machines was familiar. The particular institutional aesthetic was familiar. The way the fluorescent lights bleached everything was familiar. She had spent the last eighteen years in ICUs. She had absorbed the smell into her skin. Her clothes smelled of it. Her hair smelled of it. When she was home, the smell faded, but it never entirely left. It was part of her now.

She was working a night shift. It was 2 a.m. She was in Room 4, managing a patient whose body was actively failing. The patient was seventy-three. He’d been in here for five days. The prognosis was not good. His kidneys were failing. His heart was struggling. His lungs were filling with fluid. Every intervention delayed the inevitable but didn’t change it.

She was changing his IV site, moving with the economy of motion that came from years of doing this work. Her hands knew the procedure. Her hands were excellent at this work. The rest of her was catastrophically failing.

She hadn’t slept properly in six weeks. The insomnia had begun with anxiety about her sister. Her sister’s kidneys were beginning to fail. Kidney failure was expensive. Dialysis was expensive. All of it was expensive, and none of it was prevented or cured, just managed, expensively, permanently. Her sister had accrued debt. Diane was helping manage the debt. The debt was not manageable. They were managing anyway.

She moved to the next patient. This one was fifty-eight. Cardiac event. The family was sleeping in the waiting area. There were five of them, spanning generations. She envied them not their situation, but their presence for each other. She was managing her mother’s medical care from a distance. She was managing her sister’s medical care from a closer distance. She had no one managing her medical care. She had no one noticing that she hadn’t eaten since yesterday morning. She had no one noticing that her hands were shaking. She was noticing. She was noticing and doing nothing about it.

At 4 a.m., she made a medication error. It was caught. It caused no harm. But the fact of the error meant something. The error meant that she was operating at capacity exceeded. The error meant that her competence, which had been the primary thing she’d built her identity around, was beginning to fail her.

She sat in the break room for ten minutes. She drank water. She didn’t eat anything because eating felt too complicated. She thought about her mother. She thought about the way her mother’s brain chemistry had been altered by opioids, and the way her own brain chemistry was being altered by the chronic elevation of cortisol, the way stress hormones in sustained elevation could mimic or create mood disorders, the way she was becoming increasingly unstable not because of personal failure but because of the basic physiology of being under chronic stress while managing other people’s crises.

She thought about calling in. She didn’t. She returned to the floor. She completed her shift. At 8 a.m., she went home. She didn’t sleep. She made coffee. She called her sister.

“How are you feeling?” she said.

“Swollen,” her sister said. “My feet. My face. Everything.”

“Did you check your blood sugar this morning?”

“Yes. It was 267.”

Diane made calculations. She made treatment recommendations. She navigated the healthcare system from her couch, on behalf of her sister, while her own body sat beside her, silently failing.

Chapter 7: Susan in the Machinery

The shopping list was for someone with disposable income. Organic vegetables. Imported cheeses. Grass-fed beef. Brand-name cereals. Wine. The kind of shopping list that meant someone was eating for pleasure, for nutrition, for the full experience of food as something other than fuel.

Susan was compiling the list while her own pantry consisted of eggs, rice, and the last container of peanut butter. She’d been living on that rotation for three weeks. She’d known people who’d eaten less. She’d known people who’d lived on food bank goods, the canned vegetables, the surplus dairy, the items that nobody else wanted. She wasn’t there yet. But she was aware of the trajectory.

The delivery would pay her $8.47. The distance was moderate. The customer had never tipped. Susan calculated the gas cost. The delivery time. The income-to-time ratio. It was always negative. The math never worked. But it worked more than not working, and not working meant no income at all.

She was forty-five. She’d been doing gig work for the last eight years. Before that, she’d worked retail, and before that, waitressing, and before that, temporary data entry. She’d never held a job for more than two years. The reasons were various economic instability, health issues, family crisis, the simple fact that entry-level work didn’t provide stability or advancement, and the wear of it eventually necessitated moving to a different form of instability.

She had two children. She’d had them with two different men, neither of whom she was still in a relationship with. Both of the men had primary custody. This was not because Susan had abandoned the children. It was because Susan couldn’t afford housing that would accommodate them. It was because the system presumed that the person with more economic stability should house the children. It was because poverty and custody were intimately linked, and poverty had made her unable to mother in the way the system understood mothering.

She thought about her children constantly. She visited them when she could afford the transportation. She paid child support, which was a modest amount but which represented a significant percentage of her income. She lived with the knowledge that she was failing them, that the failure was not personal but structural, and that the knowledge of structural failure didn’t reduce the feeling of personal failure.

The car was making a new sound. Susan had been driving with anxiety for three days, listening to the particular grinding noise coming from the transmission. The car had 187,000 miles. It was supposed to be used up. Susan needed it not to be used up, not yet. She had $4,200 of debt on it, and it was her entire means of income, and the math was broken, and she was driving anyway.

She was driving to a food bank near downtown when the palpitations started. Not the first time. She’d been noticing a rhythm in her heartbeat that was off. Irregular. She’d researched it online. Atrial fibrillation. Arrhythmia. The conditions were serious but manageable if you had healthcare. Susan didn’t have healthcare. She had a health insurance card from a coverage plan that cost $189 a month and had a $5,000 deductible, and covered nothing until the deductible was met.

She pulled into the parking lot. She sat in the car for a few minutes. She felt her heartbeat trying to regularize. It didn’t. She sat longer. The palpitations faded. She got out of the car. She walked into the food bank.

The person distributing the items knew her. They didn’t say anything. They just packaged her allocation: canned vegetables, surplus pasta, milk that was approaching expiration, bread, and cheese. Susan accepted it. She put it in the car. She drove to another delivery.

That night, she sat in her studio apartment and ate eggs. She thought about her body. She thought about the knowledge that something was wrong with her heart and that she had no way to address it. She thought about the way poverty accelerated aging, accelerated disease, accelerated the trajectory toward irrelevance and invisibility. She thought about her children. She thought about the way she was living in a state of permanent low-grade crisis that never quite became acute enough to demand intervention, but that was also never resolved.

She fell asleep around midnight. She woke at 3 a.m. with her heart racing again. She lay in bed and waited for it to settle.

Chapter 8: Gus in the Fragments

The memories came without warning. He’d be working, lifting something heavy, and suddenly he was eight again, his mother’s body between him and his father’s rage. The feeling was actual. The adrenaline was real. His nervous system didn’t know that fifty-two years had passed. His nervous system was still in 1980, still in the apartment with the orange shag carpet and the sound of his parents fighting.

Or he’d be in the grocery store, and another man would bump into him accidentally, and his body would respond with threat-response, muscles tensing, blood flooding his system, rage rising before he could intercept it. He’d learned to walk away. But the response was still happening. The response was the baseline. Being calm was the achievement. Being non-violent required constant effort.

He had seven years inside. That was the official record. That was the number that appeared on background checks, that disqualified him from certain kinds of employment, that branded him. Seven years for aggravated assault, breaking and entering, and a parole violation related to substance misuse. Seven years from age twenty-one to twenty-eight.

What seven years inside did teach you that your body was not safe. That other people’s bodies were threats. That violence was a language that others spoke, and that you needed to be fluent in it or you wouldn’t survive. The prison system was designed to incarcerate, not to rehabilitate. It was designed to manage the poor. It was designed to create permanent underclasses. It succeeded at all of these things.

When Gus came out, he had nowhere to go. He had a mother who was still alive but who had aged badly in the seven years he was inside. She’d developed diabetes. She’d developed high blood pressure. She was working as a home health aide at age fifty. She didn’t have much to give him. He understood. He moved into a basement apartment. He started doing construction day labor.

That was now twenty-four years ago. He was fifty-two years old. He’d stayed out of prison. He’d gotten seven years sober once, then relapsed, and had been cycling through sobriety and drinking ever since. He wasn’t using heroin like some people. He was drinking. The drinking was self-medication for the pain (knee, shoulder, back, the accumulated wear) and for the knowledge (that he was following the trajectory his father had followed, that his body was beginning to fail the way his father’s body had failed, that he probably had maybe ten more years before the complications would start).

He was at work. A young guy, maybe twenty-three, was showing the signs. Aggression beneath the surface. Readiness for confrontation. The peculiar hyperarousal that came from a childhood spent in a threat-environment. The kid was about to be fired, to quit, or to escalate until there was a physical altercation.

Gus saw it. He’d lived it. He understood the trajectory the way you understand something that has already happened to you. The script was written. The kid’s early childhood had written it. The poverty had written it. The lack of intervention had written it.

He wanted to warn him. He didn’t.

Instead, he went to the bar after work. He sat at a barstool. He drank whiskey. The whiskey was mediocre but functional. It dulled the pain. It also dulled everything else. By the time he finished the second glass, he was less angry. He was less aware. He was in the space between consciousness, which was the only place he’d learned to rest.

He thought about his father. His father had drunk the same brand of cheap whiskey. His father had sat at the same kind of barstool. His father had died at sixty-seven. Gus was fifty-two. The math was simple. Unless something changed, unless he found some intervention that he didn’t believe existed, he was approaching the endpoint.

But he’d learned something from his mother, who was still alive at seventy-six. She had managed the inheritance differently. She’d gotten the diabetes, but not the substance abuse. She’d gotten the high blood pressure, but not the violence. She’d survived longer. The trajectory could be modified, but the modification required intervention that Gus didn’t have access to, because intervention was expensive and he was poor, and the two things didn’t ever co-exist in any meaningful way.

He drank more. The bar was mostly empty. There was a television playing a game. No one was watching. Everyone at the bar was in their own private crisis, their personal and private calculation of how much longer they could continue.

Chapter 9: The Crumbling Center

The church basement was colder than it should have been. The thermostat was broken. The landlord wasn’t responding to repair requests. The temperature was around sixty degrees. People kept their jackets on. They drank coffee to stay warm.

The meeting had an informal structure. People shared if they wanted to. The facilitator, an older woman, maybe sixty, with the particular composure of someone who’d done the work of recovering from her own inheritance, opened with the basic information. She talked about the patterns. Adverse childhood experiences. Intergenerational transmission. The physiology of trauma. The statistics on mortality and morbidity.

Then people spoke. A woman talked about her father. A man talked about his mother. Another woman talked about becoming what her parents were despite conscious resistance. The familiar litany of inheritance, of the body enacting the scripts that childhood had written.

Diane was sitting in the circle. She’d come alone. She’d been reluctant. She still wasn’t sure why she was here, except that something in her had fractured, and she needed to witness something being named that she’d been carrying without naming. Gus had been reluctant too, but a friend had asked him to come, and Gus had learned that occasionally, when someone asked, the request mattered enough to say yes. Susan had seen the flyer at the clinic where she’d gone for her health anxiety. Raymond hadn’t come. Raymond wasn’t ready to name his inheritance yet.

The woman talking was in her fifties. She had the careful diction of someone who’d spent time in therapy. She talked about her mother’s addiction and her own anxiety and the way her body held the knowledge of her mother’s unreliability. She talked about how, even now, even at fifty-four, she couldn’t fully relax. She couldn’t trust that people would be present. She couldn’t believe that safety was a stable condition.

When she finished, there was silence. Not the silence of indifference, but the silence of recognition. Everyone in the room knew something of what she’d described. Everyone had inherited something similar. The particular damage that comes from parental addiction. The particular damage that comes from early trauma. The particular damage that comes from living in systems that were never designed to heal you.

Gus spoke. He rarely spoke at these meetings, but something in him responded to the woman’s account. He said, “I thought if I just didn’t hit anybody, I’d be different. I thought that was the bar. Not hit anybody, get sober, work a job, show up. I thought that was success. But my body still does the violence thing. My body’s still ready. And I’m drinking, same as my father, and the timeline’s the same. I’m going to probably check out at the same age he did. So I don’t know what the success is.”

No one tried to tell him he was wrong. No one offered platitudes. The silence continued. This was what the meetings did. They named the things that were true, that people usually hid, that sounded devastating when spoken aloud.

Susan said, “I can’t afford to be sick. That’s the thing. My body’s doing something that’s not right, but I can’t afford to find out what it is. So I’m just… waiting. Waiting for it to resolve or to get worse enough that I can’t ignore it anymore. And when it gets worse enough not to ignore, then the system will be forced to intervene, but by then it’ll be expensive, and I’ll be in debt, and I’ll be more precarious. So I’m in this place where the best-case scenario is that nothing gets diagnosed until it becomes catastrophic.”

Diane listened. Diane understood. Diane was also understanding something else, which was that she was burning out, that she was about to break, that the competence that had structured her entire existence was about to cease being sustainable. She didn’t speak. She just listened.

After the meeting ended, the three of them stood in the parking lot. It was October. The cold was advancing. Winter was coming. The conversation was brief, but something shifted. They recognized each other. They exchanged numbers. They didn’t make specific plans, but they understood that they might call. That they might meet again. That there was something about being witnessed by people who understood, who weren’t family, who simply recognized, that mattered.

In the parking lot, someone mentioned Raymond. One of them knew him tangentially. They’d worked together or known him through a friend. The word came up: sick. That’s when the worry crystallized. Someone said, “He’s really sick. Chest pain, but he won’t go to a doctor.” The knowledge of Raymond’s risk entered the conversation. The knowledge that one of them, a fellow traveler, was in active danger, and that the danger was going uninterrupted.

Chapter 10: The Crisis Compounded

The first morning. Raymond woke at 4 a.m. with his chest tight. He’d been waking like this for weeks. He lay in bed for an hour. He got up. He made coffee. He made the calculation: miss a day of work or risk. He decided to work. He always decided to work.

The same morning. Gus woke with pain in his right shoulder. He’d injured it fifteen years ago, doing construction. It had never fully healed. It healed periodically and re-injured periodically. This was one of the re-injury mornings. He drank whiskey with his coffee, though it was only 5 a.m. The whiskey helped with the pain enough to make work possible.

The same morning. Diane was waking from a sleep that felt less like sleep and more like unconsciousness, like her body had shut down out of sheer necessity rather than the body achieving rest. She’d slept four hours. That was better than recent nights. She had twelve hours of hospital work ahead. She made coffee. She showered. She noticed the tremor in her hands was worse.

The same morning. Susan was checking her car. The transmission sound was worse. The grinding was louder. She called her mother, they’d maintained some relationship, attenuated but present, and asked if she could borrow $200 to get the car looked at. Her mother said no. She couldn’t afford it. Susan didn’t ask again.

That night. Raymond did work. He worked through the chest pain. He attributed it to muscular. He attributed it to stress. He attributed it to age. At the end of the day, when he got home, the pain was worse. He sat down. He took ibuprofen. He drank water. He thought about going to the ER. He did the math. ER visit. Diagnostic tests. Possible hospitalization. Thousands of dollars. Money he didn’t have. Money he couldn’t borrow. Money that didn’t exist in his economic reality.

He decided not to go. He would wait. He would see if it resolved.

That night. Gus went to the bar. The shoulder pain was significant enough that he was drinking more than usual. By the time he left the bar at 10 p.m., he was drunk. He drove home. He shouldn’t have driven. He knew he shouldn’t have driven. He drove anyway.

That night. Diane was still at the hospital. She was working a double. She’d called in sick initially, then called back and said she’d come in after all. She was running on coffee and the particular adrenaline that comes from managing a crisis while your own crisis is ongoing.

That night. Susan was doing a delivery when the palpitations came worse. She pulled over. She sat on the side of the road. She was aware that her heartbeat was severely irregular. She was aware that this might be serious. She also had $8.47 to earn by completing this delivery, and $8.47 was part of the rent, which couldn’t be skipped. She waited for the palpitations to subside slightly, then continued the delivery.

The second morning. Raymond woke and couldn’t move his left arm. The pain was radiating from his chest into his arm and his shoulder. He understood, finally, what this meant. He understood that this was cardiac. He understood that he was having a heart attack. His first thought wasn’t to call 911. His first thought was: I can’t afford this. I can’t afford this right now. I don’t have insurance. This is thousands of dollars. I can’t.

His body made the decision for him. The pain became too intense to ignore. The thought process stopped. He called 911.

The second morning. Gus was hungover and hurting. He didn’t go to the day-labor site. He called in. He lost a day’s pay, which was approximately $180. He sat in his apartment and drank beer because he’d run out of whiskey. He was thinking about his father. He was thinking about the way he was becoming his father. He was thinking about the age his father had died. The math was getting closer.

The second morning. Diane was called. Raymond had been hospitalized. He was in the ICU. Someone, Gus, had called the hospital and gotten the information. Gus had called Diane. The network is activated. The knowledge spread among people who knew Raymond, who understood his trajectory, who recognized what hospitalization meant. It meant his body had finally enacted what they all knew was coming.

The second morning. Susan got a message from Gus. “Have you heard about Raymond? He had a cardiac event. He’s in the ICU.”

Chapter 11: The Reckoning

The waiting room at 3 a.m. was empty except for the four of them. Raymond was in the ICU. He was sedated. He was being monitored. He was alive. The presumption was that he would remain alive, at least for the next few hours. After that, the future was unwritten.

Diane was sitting in one of the plastic chairs. She’d changed out of her work clothes and into something neutral. She looked exactly as exhausted as she was. Gus was pacing. He’d been pacing for an hour. Susan was on her phone, checking work messages, aware that she had a shift starting in five hours and that missing it would cost her approximately $80, which was the difference between making rent and not making rent.

“We need to rotate out,” Diane said. “If it’s going to be a long wait, we need to actually sleep.”

No one moved. The knowledge that rotation was necessary existed separately from the willingness to execute it. They were bound to this place by the knowledge of what Raymond represented. Raymond was the first one to hit the wall. Raymond was the visible consequence. Raymond was showing them what waiting for your own body to betray you looked like when the betrayal finally arrived.

“I called his ex-wife,” Gus said. “She didn’t answer. I left a message.”

“Will she come?” Susan asked.

“I don’t know. They’ve been divorced for eight years. She might not.”

A nurse emerged from the ICU. She looked directly at Gus. “Raymond’s stable. His cardiac markers are still elevated, but they’re not rising. That’s good. The angiogram is scheduled for tomorrow.”

“What does that mean?” Susan asked.

“It means they’re going to look at his arteries. They’re going to assess whether there’s a blockage that needs intervention.”

After the nurse left, no one spoke. The information was being processed. The operation of hospital systems was becoming visible. The protocols for managing cardiac crises. The interventions that would either extend Raymond’s life or would extend his suffering, or both.

“My mother had a cardiac event,” Diane said. She was not responding to the nurse’s information. She was responding to the knowing. “At fifty-three. Not a heart attack. A stroke. But the same mechanism. High blood pressure, unmanaged. The stress, the poverty, it all accumulated in her arteries.”

She stopped. She didn’t say: I’m going to die the same way. But everyone understood that was what she was not saying.

“We were supposed to get away from this,” Diane said.

Susan asked: “Did any of us ever think we would?”

No one answered immediately.

“I thought I’d be different,” Gus said. “I thought if I just didn’t do what he did, I’d be different. But I’m drinking the same amount he drank. I’m the same age he was when the problems started. I’m following the trajectory like it’s written.”

“It is written,” Raymond was going to have said, if he were conscious, if he were present. But Raymond was sedated, and his voice was represented by the absence of voice, by the fact of his body in the ICU, by the monitors that were tracking the functioning of his heart.

“There’s nothing to escape to,” Susan said. “That’s what I’ve realized. Like, we could get better jobs. We could have better lives. But the health problems are still there. Poverty is still there. The systems are still designed to exclude us. Getting out of this requires not getting sick. But we’re all getting sick. Our parents got sick. We’re getting sick.”

It was the most direct that Susan had spoken about the trajectory. It was also the truest thing anyone had said in the waiting room.

“I’ve got to call in to work,” Susan said. She stood up. She made the call to her gig-work app. The cancellation went through. The loss is registered. She sat back down.

“I can take tomorrow,” Diane said. “I’ll call out. I’ll stay.”

“Someone should go home,” Gus said. “Someone should sleep properly.”

No one left.

The waiting room remained the same. The uncomfortable plastic chairs. The fluorescent lights. The ambient sounds of the hospital, the beeping of machines from the ICU, the overhead pages, the sound of footsteps, the sound of an institution managing human decline at scale.

Around 5 a.m., a nurse came out and said that Raymond’s daughter was trying to reach the hospital. Did they have contact information? They didn’t. Gus gave them the names of people who might have contact information. The system would try to notify her. The system would make the attempt. Whether she would respond was separate from the system’s ability to make the attempt.

“We should pray,” Gus said. It wasn’t really a suggestion. It was something that emerged from him without his deciding to say it. None of them was particularly religious. But the impulse was there, the impulse to gesture toward some force larger than the systems that had structured their lives, some force that might intervene.

They didn’t pray. They sat. They waited. They held the space of Raymond’s hospitalization together, these four people who had become each other’s witnesses without ever deciding to do so, without any formal agreement, simply through the recognition of each other.

There was nothing redemptive about it. There was no moment of revelation. There was no crisis that resolved into transformation. There was only the waiting and the knowledge and the continuation.

Around 6 a.m., a doctor came out with updated information. The angiogram was scheduled for 9 a.m. The doctors would assess whether intervention was necessary. The information was delivered factually. The doctor went back inside.

Susan checked her phone. She had a message from her ex. One of her children was sick. The message was informational, not accusatory, but it arrived as another item in the impossible list. Her child was sick. She was in a waiting room with a man having a cardiac crisis. She had no income because she’d cancelled her deliveries. The arithmetic of her life was spinning. She was trying to manage it. The management was not succeeding.

None of them left. They stayed through the morning. They stayed through the beginning of visiting hours. They stayed through the updates from the medical team. They stayed through the knowledge that Raymond’s prognosis would be determined by his cardiac anatomy, by the presence or absence of blockages, by the decisions the interventional cardiologist would make about what could be stented, what could be medicated, and what would persist regardless of intervention.

They stayed through it all because they were bound together now by the evidence of consequence. Raymond’s body was showing them what their bodies would eventually show. The inheritance was not metaphorical. It was written in arteries and neural pathways. It was written in the accumulated stress of living under conditions designed for their exclusion.

Around noon, the doctor came out and said the angiogram was complete. There was a significant blockage in the left anterior descending artery. They were going to place a stent. The procedure was scheduled for 1 p.m. The survival rate was high for this type of intervention. Raymond would likely survive.

“He’ll survive,” Diane said to no one in particular.

“Until the next time,” Gus said.

Susan didn’t say anything. She was doing the calculation again. The hospitalization cost. The stent cost. The follow-up care. The medications. The impossible math of surviving a medical crisis while poor.

They waited through the stent placement. Around 2:30 p.m., they learned that the procedure had been successful. The stent was in place. Raymond’s blood flow was restored. His risk of another cardiac event in the short term was significantly reduced.

The relief was brief and insufficient. The relief existed alongside the knowledge that this was temporary, that the underlying conditions (stress, poverty, lack of healthcare, the inheritance of cardiac risk) hadn’t changed, that Raymond would need to take medications he might not be able to afford, that the stent would eventually need to be managed or replaced, that the fundamental trajectory had not been interrupted.

But he would live. At least for now. At least for today.

Around 3 p.m., Raymond’s daughter called. She was en route. She lived three hours away. She’d gotten the message from the hospital, and she was coming. The fact of her presence was unexpected. She and Raymond hadn’t spoken in years. The cardiac event had reactivated the relationship in the way that mortality sometimes does.

“You should go,” Susan said to Diane. “You should rest before tonight.”

Diane didn’t want to go. But the practical truth was that she had a shift starting tomorrow at 7 p.m., and she needed to sleep, and she was so exhausted that she was no longer functional. She stood up. She hugged Gus. She hugged Susan. She didn’t know if she would see them again. The odds were that she would, because the systems they lived within were continuous, because the inheritance was ongoing, because they would likely continue to intersect.

She left.

Gus said, “I’m going to head out as well. I need to work tomorrow. I need the pay.”

He left.

Susan stayed. She told herself it was because someone should be there when Raymond woke up. She told herself it was because the obligation had not yet been discharged. She sat in the waiting room. She pulled up her gig-work app and looked at the available deliveries. She calculated how many she could complete if she left now, if she rushed, if she prioritized volume over precision.

She didn’t start any deliveries. She sat. She waited. She watched the hospital function around her. The systems that were supposed to heal people, that often couldn’t heal them, that could only extend them, manage them, delay the inevitable.

When Raymond’s daughter arrived around 4 p.m., Susan was still there. Raymond’s daughter was fifty-three. She had Raymond’s eyes. She looked at Susan with confusion, wondering who this woman was, why she was present in this moment that was supposed to be family. Susan stood up. She said, “I know Raymond. I wanted to make sure he was okay.”

It was not the full truth. It was not the lie either. It was the kind of statement that people make when they’re attempting to protect something without being able to name it directly.

She left.

She got in her car. She checked the transmission sound. It was still there. She drove away from the hospital. She went to a delivery pickup point. She did deliveries until 9 p.m. She made $67 in that time. She went home. She ate eggs. She slept.

In the ICU, Raymond woke from sedation. He saw his daughter. He saw that his chest hurt, and his body was monitored, and his arteries had been opened and restored. He saw that he had survived something that was supposed to kill him. He saw that survival came with cost, with debt, with the necessity of managing the consequences for however long he would live.

He would live. He would survive. He would persist. This was the achievement. Not redemption, not healing, not transformation. Just the continuation. Just the ongoing. Just the fact of being alive after the moment when being alive was no longer guaranteed.

The inheritance had manifested. The consequence had arrived. The body had enacted what childhood had written. But the story was not concluded. It would continue. They would continue. The four of them and the millions of others, who had inherited damage and who were now living inside it, managing it, surviving it, one day at a time, in a system that was not designed for their recovery, that was designed for their exclusion, that functioned most smoothly when they were invisible.

They would continue anyway.

THE END

post skriptum:
Poverty sux, and I am too old to go unpaid happily!

Even with AI support and proofreading, such a story takes more than 6 hours of unpaid work, and that is the writing, proofreading & editing only: The audio (AI voice) adaptation takes 4 more hours, and narrators also prefer getting paid, instead of reading or hearing how preferred to AI voices they supposedly are, yet not earning a fucking cent!

All rights belong to its author. It was published on e-Stories.org by demand of Andre M. Pietroschek.
Published on e-Stories.org on 04/11/2026.