We used to have this quilt in the family room—on the couch in front of the television—and the quilt had these spaghetti-like fringes, these thin little strips of fabric that came off the edges of the quilt, and I used to like to put these little fringes up my asshole. Sometimes I’d put just one in there, slipping it in and swirling it around, but more often than not, I’d shove as many in there as I could. I’d go gradually, string by string, but eventually, I’d have so many in there that my asshole was expanding and it was beginning to hurt a little bit. And then I’d slowly pull them out, all the fringes, making sure I felt every sensation, making sure I prolonged the pain and pleasure for as long as I could take—it was a black blanket, by the way, black with specks of white, and it wasn’t cashmere, but it was a very soft wool—and then once the fringes were all the way out, I’d bring them up to my nose, and I’d smell them.

Oh, they were wonderful!

How to describe the smell of your own shit?

How to describe the smell of someone else’s shit?

Left lingering on the fringes of our family room quilt, my shit smelled like ravioli. Like salt. It smelled like sweat and cheddar cheese.

Like ME, I guess you could say. The purest expression of me. It smelled like the smell I was always meant to smell.

And, of course, I should be more accurate and say that only sometimes did I truly enjoy the smell of my own shit. Sometimes I had the “normal” reaction: I thought it was disgusting. I wanted it as far away from me as possible. I wanted to clean the quilt immediately—and my god, did I clean that quilt. When I think of my childhood, I think first of cleaning the quilt in secret, using the hand soap in the front hall bathroom and the little towel hanging on the wall and vigorously scrubbing away at the quilt in an attempt to erase any evidence of the shameful paste I had left behind—but other times I found the shit-smell delightful. Intoxicating. It took me many minutes of smelling the quilt, really inhaling the quilt with my shit fibers still trapped in its fabric, before I had the good sense to clean it off for my family.

Why, some of the time, was the smell of my shit so intoxicating, and why, other times, was it so disgusting? Why, some of the time, did my shit-smell seem like the clearest indication of my unique essence, my unique goodness, and why, other times, did it seem like the clearest indication of my unique depravity?

This, in many ways, has been the central question of my life, the central confusion in my identity.

Have you ever had the experience where you’re waiting for a train—you’re on the platform—and then the train comes, and all of the cars look packed, but one car looks almost completely empty? And so you go to that car—the empty one—you stand in front of the car, and you wait for the doors to open, and then right when the doors open, right when you’re stepping into the car, a wave of shit-smell hits you? It’s like you’ve entered into a world of shit? And you look to the end of the car and there is one dirty person—a person who seems to be made of dust and burlap sacks—slumped over a few of the seats, sleeping, or just sitting there, thinking god-knows-what, having god-knows-what experience of life, clearly the source of the smell?

You walk into this car and immediately you walk back out. Perhaps there are some people who got on with you who stay—either out of pity or politeness or fear that they won’t be able to exit the car and make it to another one in time before the doors close—but you and mostly everyone else who got into this car bolt right out because you find the smell to be so assaultive. You recognize immediately that you couldn’t possibly share the world with this smell for a single second longer.

And why? Why?

I think the answer is simply that the shit-smell is coming from someone else. From the smell of it, it’s been years and years of built-up shit-smell. This person has been shitting in their pants, and rolling around in shit, and never bathing, and letting the shit compound on itself until it’s shit-upon-shit-upon-shit.

But I’m convinced that if it was my shit-smell, if it was me who filled the car with equal parts shit and oxygen, I might just be fine in there. Not just fine—I think it might just be my favorite place in the world. I might be able to stay in there for hours, happy to be alone, sleeping like a baby in a cocoon of my own shit. A shit-womb. A shit-incubator.

In a way, it’s not rude at all to exit the car and leave the person alone in there. Sure, they might be offended—sure, you might be confirming for them that they stand apart from society, that their smell is just another indicator of their failure to meet the basic requirements for inclusion—but presumably, if they’ve gotten to the point where they smell like they do, they probably don’t have many things in the world to call their own. In all likelihood, they don’t have any space that belongs solely to them. And so why not let the person have complete domain over the car for however long it takes before the authorities kick them back out onto the street? Why not leave them alone in their shit-cave? Communing with themselves in a sauna of shit? Owning the space with their stench?

I guess I should also say that it’s not really “shit,” that I enjoy the smell of. I mean, it is shit, that’s what it ultimately amounts to—that’s what someone would call it if they saw me putting my finger in my asshole and bringing it back up to my nose—but I’m almost never interested in the shit when it’s constituted as shit. By which I mean I’m not about to pick a piece of shit up out of the toilet and smell it. No, the smell I like comes specifically from the little shit-residue that builds up around your asshole. You know, sort of like the mucus in your nose. The real mucus is deep inside you lining your stomach, but the stuff we like to pick and smell and sometimes put in our mouths is the stuff that hangs on the outside, exposed to the air and yet still unmistakably one of our deepest products, one of our most personal substances. I like the partially-dried shit-residue that hangs on the fringes of my asshole—the stuff that smells best right before I have to take an actual shit and worst right after. The stuff that lingers in my fingernails even after I wash my hands, waiting in reserve for me to sniff it.

So: me.

I have this patient. I have this one patient whom I can’t seem to get out of my mind.

It’s not unusual, you know, for someone to stick with me—in my line of work, you will often come across someone who, for whatever reason, burns themselves deep into your consciousness—but this person…well…I find her continued presence to be a little…disturbing. I don’t quite know what to do with it.

I used to be in private practice. I suppose that’s worth saying. I would take care of my country’s wealthy for considerable sums, preventing death, and easing death, and sometimes, against my better judgment, prolonging death.

I went to a fine college, an even better medical school, and for my first few years of being a doctor, practically all of my salary went to paying off my loans.

Then a magical moment came: my loans were paid. The years had passed, and the money had rolled in, and all of a sudden, I was a wealthy person, just like my patients. I was able to keep the lion’s share of the vast sums they gave me to treat their ailments.

And so I went nuts. I bought everything. I ate whatever I wanted. I drove around in fancy cars. I stayed in hotels even though I had a perfectly beautiful house. I stayed single, of course—I still am—and so I never formed any attachments that would require me to spend my money on anything other than myself.

I had five partners in my practice and we ran our own little small business of sorts. We shared everything, all of the profits, and so naturally each of us thought that we were doing the most work, dragging the others along with us.

But for the most part, we all did fine.

Some of my partners formed attachments—had kids, got married—and so they were often jealous of the way I got to throw my money around.

But again, for the most part, we all did fine. And we liked each other. How could we not? We were all riding a wave of prosperity, using our hard-won skills to keep the people alive who could afford to pay us handsomely to do so. It’s amazing how grateful people can be when you save their lives. It was as if the money they paid us wasn’t enough to make them feel like we had been fairly compensated. They’d take us on trips with their families. They’d take us golfing. Sometimes, they’d give us free clothes from the stores they owned, free cars from their dealership chains, free computers and software from their tech companies. Each week, my calendar would be full of outings and dinners and weekend getaways provided to me free of charge by the people whose lives I had saved. And it was wonderful.

I would do pro-bono work too every once in a while. My partners and I all did it. We took turns. It was something we’d quibble about here and there, but ultimately we were glad to do it, our little bit of philanthropy.

We’d go down to the state hospital, the free hospital, each of us about one day every two months, and the poor people would be crowded in the waiting room, each with their lottery number, and we’d pick a number out of a hat and whosever number we picked, that’s who we’d treat. Usually, we could get around to seeing five or six of them before the day was done—a lot of them had very complicated ailments—and then we’d go back to our lives in private practice, back to our world of wild compensation.

Of course, the poor people were just as grateful to me for saving their lives. Some of them even tried to pay me back in the same way my wealthy patients would. They’d send me gifts on my birthday and invite me to their birthdays and their daughters’ weddings and holiday parties, but I rarely ever showed up to those kinds of things. I was happy to just treat them and get back to my life, back to my wealthy patients with unhealthy bodies.

My interest in my asshole doesn’t just stop at the smell of shit. The smell of my shit might be the ultimate goal, you know, it might be the main course, but there are other pleasures along the way that at this point feel just as deep, just as essential a part of the experience.

For example, sometimes when I’m wiping myself after going to the bathroom, I’ll just keep wiping, even after I’ve absorbed all of the poo. My butt will be clean, the paper will have served its purpose, but still, almost subconsciously, without making any real decision to do so, I’ll find myself still wiping, harder and harder, more and more vigorously, until my asshole is raw and little streaks of red start to show up on the paper.

I’ve seen dogs do this before. Ha! I’m a little like a dog, aren’t I? I’ve seen dogs, after they’re done taking a shit, wiping their bottoms vigorously against the pavement, scraping themselves raw, seemingly rather enjoying the sensation even though it must be starting to hurt.

And I don’t really know where it comes from, this impulse, but I’m a slave to it nonetheless. No matter how many times I have to walk a little funny afterwards, no matter how many times my asshole stings like a knife in the shower as the water pours over it, no matter how many times I catch myself mid-wipe and think: “What am I doing?” still, I find myself in the same old familiar situation, going past the point where the wiping feels good, past the point where I’m relieving an itch, all the way to the place where I’m zeroing in on a pain and making it deeper and deeper, creating little tears and ruptures on the outer skin of my asshole, whittling the toilet paper down to a sharp white husk.

She’s looking at me with her fat face.

What on earth is she thinking behind all that blubber?

Her eyes are the only parts of her that remain expressive.

“Do it, Doctor.”

“Do it,” they say.

Do what?

I can’t pinpoint exactly when it happened, but there was a moment when this patient, the one who disturbs me, started to…enjoy what I was doing to her. At first I thought she was putting it on as a part of the point she was making, but now I’m convinced that she actually likes the procedure. She actually looks forward to it. She walks into the room led by the guards, all smiles, and they don’t even have to force her into the restraint seat—she just sits right down as though I were about to give her a massage. And then she smiles at me, like I’m her best friend, and she says: “Doc, let’s do it!” And the whole time the food solution is pumping down through her nose and into her stomach—the entire hour or so that it takes to complete the procedure—she moans and writhes and says “mmmm, mmmm” and “More! Gimme more!”

I’ve really never seen anything like it.

Some of the others moan and writhe. Believe me, they do. And with good reason. The whole procedure is incredibly painful.

I underwent the procedure once myself—we all did as part of our training—and I don’t think any one of us lasted more than a few seconds before we were screaming to have the tubes taken out of our noses. In fact, I’m pretty amazed by the way some of my more veteran patients just sit there and take it.

The usual trajectory, I’ve found, is wild, violent refusal for the first couple of sessions, which then transforms into a sort of a smoldering contempt, which then eventually gives way to a peaceful, almost monk-like acceptance.

And yes, there are some patients who spitefully pretend to enjoy themselves, you know, who say things like: “Wow, what a great guy you are!” or “Mmmmm, can’t wait!” or even “Please, sir, I want some more.” But with these patients, it’s always very easy to tell that they’re being sarcastic. The way they say it, I can easily discern that they’re telling me to go fuck myself.

But to actually like it, to actually enjoy it…it just seems unfathomable.

She even told me the other day: “Doc, ”—we don’t give out our names—“Doc, I’m not even refusing to eat anymore. I’ve just come to love this so much, the way you feed me, I’ve come to enjoy this so much that I couldn’t possibly go back to the regular way. I just want to be fed like this for the rest of my life.”

And so I’ve started giving her larger portions. Believe me, I would never do it unless she was practically begging me for it. With the other patients, we’re supposed to stop after we’ve given them what’s considered the minimum needed daily nutrition—any more is considered cruel—but she keeps asking for more, and so what can I do? No one’s said anything that would lead me to believe it’s against the rules. I can’t see why it would be. The guards don’t seem to mind or notice. I’d resigned myself long ago to dealing mostly in unpleasantness—to having mostly unpleasant interactions with my patients, carrying them through an entirely unpleasant process—but who am I to stop a little pleasantness from taking root in my medical room? Who am I to deny someone’s enjoyment of what I do? I’m mostly unsettled by the whole thing, sure, but there’s a part of me that feels…I don’t know…glad that someone actually looks forward to seeing me. There’s a part that feels a twinge of the old pride that I used to feel every time I sent a newly healthy person back into the world.  

Because back when I was in private practice, practically all of my patients were happy to see me. Every time I walked into the consultation room, I was greeted with an eager smile, a relieved sigh. At the very least, a look of anxious excitement. After all, I was a lifesaver! I saved people’s lives.

And I still do, I guess you could say, though it’s an open question whether it counts as saving someone’s life when what they really want is to die. It goes without saying that part of what made it so pleasurable to save my wealthy patients was that they desperately wanted to be saved. So desperate that they were willing to pay me insane sums to save them. So grateful afterwards that they felt compelled to keep paying me with their gifts and friendship long after our professional relationship had ended.

But I’ve found that there’s really not much joy in saving someone’s life who doesn’t want to be saved. I’ve found that afterwards you feel sort of…dry. Sort of tired. It’s not fun, saving these people’s lives. In fact, it can be pretty exhausting.

Sometimes, I wonder whether I purposely eat foods that will cause certain sensations in my asshole. For example: spicy foods, or nuts. I know that spicy foods will cause a sort of burning sensation along the rim of my asshole as my stomach processes them, especially as they’re on their way out, and I know that nuts for the most part leave me constipated. Ooh, and coffee. I find that coffee always makes things interesting.

There will come a point every day when I’m eating my lunch in the rec room where I’ll pass the point of full—I will have gotten all of my nutrition—but I’ll still have a little bit of my food left, or I’ll see that in the office pantry, there’s still a whole jar full of chocolate covered nuts, and so I’ll keep eating the food in front of me, or I’ll go over to the pantry, or I’ll convince myself to have another cup of coffee even though I’m fully alert and my thirst is fully quenched, and then about thirty minutes will pass and I’ll find that my asshole is in turmoil. My stomach simply doesn’t know what to do! There’s too much going on. And so all of this pressure will be built up around my asshole, but I won’t quite be able to shit because of the odd mixture of stuff that’s swirling around inside of me, and so my asshole just kind of throbs. It just kind of pulsates—this amazing, burning, throbbing sensation. And it almost kind of…itches. It’s not really an itch, but it’s close enough to an itch that I’ll feel like I have to scratch it. But of course, you know, I’ll be sitting there in the rec room, or looking over charts at my desk in between seeing patients, and I won’t really be able to reach my hand down and give it a good scratch, so I’ll do this thing instead where I just kind of shift back and forth in my chair, rubbing my asshole against the cushion. Back and forth, first slowly, then faster, subtly opening my legs wider so that my butt cheeks spread out and the greatest possible surface is exposed to the rubbing. What’s really happening is that the fabric of my pants and my underwear are getting pushed up inside of my asshole, and as I shift back and forth on the chair, they scrape around in there, scratching the surface. Actually, there’s multiple parts to this process, multiple little phenomena that I get to experience.

For example, when I actually do go to shit, my asshole is so raw and torn up and my shit is so hard from all the nuts and chocolate and coffee that it feels like I’m passing a rock through a tiny little opening. My asshole already has little cuts and tears on it because of all the shifting back and forth I’ve done, and now this hard piece of shit causes more tears and cuts as it pushes its way out. And then, once the whole process is over—which takes a long time by the way, and it’s actually worth mentioning that just sitting there for that long on the toilet takes its own toll on your asshole, since the seat is designed to sort of stretch your asshole open in a way that is slightly unnatural to it—but once the whole process is done, I get to wipe. And by now, even touching the paper to my asshole gives a great stinging sensation. Really, it’s as though the paper were doused in rubbing alcohol, or lemon juice. In fact, some of the paper that’s meant to be extra soft, you know, the paper that they infuse with a moisturizing lotion, is the kind that causes the most pain, because the lotion interacts in a strange way with the little cuts and tears on the skin and it causes the burning sensation to become even more intense.

And so then for mostly the rest of the day, my concentration is always half on the task at hand, half on my asshole. I’ll go through procedure after procedure, barely really looking up at the patients, barely even hearing their yelps and cries, barely even registering their quiet hatred. And then when my day is done, I’ll go home, and I’ll pick my underwear out of my asshole—I’ll really have to pull it out of there, because the mixture of semi-dried shit and blood makes the fabric sort of stick to the surface—and I’ll take my underwear off, and I’ll look at the multi-colored stains on the inside, and I’ll bring this patch of fabric up to my face—damp and a little sticky—and I’ll smell it. Just like the quilt. It never fails to make me feel at home. Even though some days it smells better than others, and sometimes, miraculously, it doesn’t really smell like anything at all—even though sometimes it makes me feel proud of my smell and sometimes it makes me feel ashamed—no matter what, I always feel at home. I always know, beyond a doubt, that the body that produced the stains is the same body that’s smelling them. And that makes me feel…I don’t know. I don’t know how it makes me feel.

The room is silent except for the beeping of her various machines.

The smell emanating from her body is overpowering—she’s like some ancient sulfur mine, some giant, ungodly volcano.

I used to wear a mask in the room with her to keep myself from throwing up, but now I’ve come to get used to the smell. There’s a certain intimacy to it—it’s a smell that only she and I know.

Maybe she wants nothing.

Maybe she’s entirely content, having become more like a mountain than a person.

But still, I can’t shake this feeling.

Her eyes move to the left.

What is she looking at?

What’s over there?

The story of how I came to practice the kind of medicine that I do is that one day I received an email from the President.

Or, well, I’m sure it wasn’t the actual President who drafted the email and I’m sure it’s not his personal address, but in the “From” line of the email it had the President’s name and at the bottom there was his signature, and the subject was: “Doctor, will you help me?”

I guess the President, or the President’s people, must have seen that my partners and I did our pro bono work at the state hospital with a little more professionalism than the other groups. It’s really incredible how most of the other groups would deal with their shifts: they would show up drunk or high, and a lot of them would spend the whole day doing just one simple procedure because they would take breaks in the middle to call their friends and watch TV, and meanwhile the people in the waiting room would be going crazy with their lottery tickets, wondering whether they’d receive their operations. I’ve even heard stories about some doctors who would use the state hospital shifts as a way to test out new methods for doing certain procedures, or who would try to do “abridged” versions to save themselves time and effort.

Frankly, I’m not sure that I took my pro bono work so seriously out of some deep concern for the poor and their situation so much as I just became a little addicted to the actual process of saving people’s lives—to the feelings of pride and purpose I would get every time I prevented someone’s body from taking its natural, fatal course. I saw the pro bono work as just another way to get that gratification, even if it wasn’t necessarily matched by an equally gratifying amount of money or gifts.

Which is not to say that I would have done all of my work for free. I mean, it’s not to say I would have been happy doing the hard work that I did without receiving at least some wild compensation, but I guess it didn’t bother me that much to save people’s lives for free on the relatively rare occasions when I was called upon to do so. In a way it was more thrilling, more affirming to take care of the poor, because without the transaction standing in between us, I could fully invest in the idea that I was a lifesaver—I could un-problematically conceive of myself as a person whose function in the world was basically a good one, whose work was fundamentally worthy of some praise. And then when I’d go back to treating my wealthy patients, this feeling of affirmation stayed with me. I’d feel much less conflicted about accepting praise from others when they gave it to me and much less ashamed about giving praise to myself.

Anyhow, because of our track record, the President in his email seemed to be under the impression that my medical group was especially caring towards the less fortunate and that I in particular was the kind of doctor who was drawn to medicine for its altruistic purposes or who believed in something like service to my country or community.  

And as you can imagine, I was very flattered by all this. I mean, it’s not every day that the President sends me an email. Or, well, I suppose it is every day that the President sends me an email, but not one that’s addressed specifically to ME.

And I think it helped that it was precisely at this point in my life when I had decided to really like the president. You know how sometimes you just make that decision? I forget when it was exactly, but at a certain point, I just said to myself: “You know what? I like this guy.” And from that moment on, I believed everything he said in his speeches and everything he wrote in his emails. So much so, in fact, that I stopped listening to the speeches and I stopped reading the emails for the most part, because it just didn’t seem necessary anymore. I’d glance at the subject lines, and I’d briefly scan over the body of the email, and if there was a button he wanted me to click at the bottom of the page to show my support for something, I would, but for the most part I just left the President free from my gaze and assumed he was doing the same to me.

So again, you can imagine my excitement when I learned that the President was not only watching me in my world of life saving and wild compensation but was smiling down on my life with approval. I was really tickled by it. It gave me a sort of high.

Of course, I would later learn that the reason I in particular was singled out and not any one of my partners was that unlike them, I hadn’t formed any real attachments, and so the President, or his people, figured that I would be much more open to the idea of relocating myself however many miles it takes to get to the base and taking a significant pay cut. It also didn’t hurt, I would learn, that as a result of all my button-clicking, I seemed to be a very active supporter of virtually all of the President’s policies, whereas most people just immediately put his emails in the trash bin or marked them as read.

But still, the President had specifically singled me out for what seemed like a very important undertaking, and although he didn’t really describe this undertaking in his email, because he was the President and because I had decided that I really liked him, I agreed to get coffee with one of his “recruiters.”

She’s starting to get bigger.

At first I thought it was just a trick my mind was playing on me, but now it’s clear: she’s actually gaining weight.

Today, when she was led in by the guards for the procedure, I noticed as they strapped her down in the seat that her wrists and ankles looked a little less bony and emaciated. And after the procedure was done, before I let them escort her back to her cell, I actually made her step on a scale so that I could weigh her. She’s gained 10 pounds since I first started seeing her—news which, oddly enough, seemed to please her immensely. She couldn’t stop smiling.

This is all, I suppose, a cause for celebration, but it’s fairly unprecedented. The aim of the procedure, I was told during my orientation, is not to bring people back to full health, not to ensure that they’re getting their optimal nutrition, but rather to keep them just far enough away from the edge of starvation. We do this, odd as it sounds, for the patient’s benefit, since allowing them to remain hungry has actually prevented most of them from attempting suicide by other means. Contrary to what you might think, the procedure doesn’t leave anybody feeling completely satiated. Most people spend the time in between feedings feeling just as hungry as if they weren’t being fed at all. Again, though, we do this for their benefit, since it is important that they feel they have the right to be hungry, even if they don’t ultimately have the right to die.  

Of course, the goal for most of them is not to kill themselves. I am convinced, as I have always been, that nobody actually wants to die. The goal, it has always seemed to me—and who knows if I’m right—but the goal of this type of protest has always seemed to be to put pressure on the people who are holding you to change your situation—to tell them that what they are doing to you is equivalent to starving you to death—and to hold them hostage in their compassion, essentially making them feel responsible for your continued suffering by taking it upon yourself to make your suffering even worse, to make your situation truly life-threatening.

Frankly, I’ve always seen this tactic as a little unfair—a little childish. It’s always seemed to me like being in a fight with a lover who keeps threatening: “I’ll kill myself if you leave me.” Or: “Look what you’re making me do! Look what you’re making me do!”

But I’m not really in a position to judge why someone’s life is in danger—it’s just my job to make them better, to make sure that they don’t die. When I was in private practice, plenty of my wealthy patients were endangering their lives in ways that would have been entirely preventable if they just could have controlled themselves. Some drank too much, some smoked, some took too many drugs or ate unhealthily and never exercised. I could tell them that it was my medical opinion that they should change their habits, but it was never my job nor my place to judge them—at least not past a certain unavoidable knee-jerk reaction.

Sometimes, I wonder whether my interest in my asshole is all about the body’s insistence on healing itself. For some reason, the asshole seems to be very resilient. Have you noticed that? If I scratch my arm until it bleeds, there will at least be a scar for a couple of days and the spot might be kind of painful to touch, but I’ve found that my asshole is remarkably quick to heal. It always bounces right back, no matter how much I abuse it. And maybe it’s just that the asshole is out of sight and so I don’t ever really get a chance to see the little scars and marks from what I’ve done to it over the years, but I’m inclined to say that there’s something special about the way the asshole deals with minor injuries.

Of course, I think the trick here is that I never quite let my abuse of my asshole slip over into anything actually harmful or dangerous. It’s a bit like the difference between tonguing a canker sore on the inside of your mouth and just biting right through your cheek. If you want to keep playing with the canker sore, if you want to keep giving yourself pleasure from perturbing it, you can’t ever go all out. You can get close—you can certainly get close—and it’s definitely true that part of the fun is the danger, part of the pleasure is the closeness to real harm, real damage to yourself, but you can’t ever go fully overboard. Not just because you’ll ruin the whole thing and have to deal with the annoying complications, but I think because it actually wouldn’t be that pleasurable if you did it.

And I’ve seen this countless times as a doctor. Countless times, especially during my pro bono shifts, people would come into the emergency room with all kinds of sinister things shoved up their assholes: knives, sharp and prickly plants, anal beads that stretched their openings just a little too wide. Some claimed that others had forced them to do it, but most of them told me they had done it to themselves. And every time I’d see them, every time they’d come in, desperate to be saved, I’d always shake my head and think: why couldn’t you just stop a couple steps earlier? Why’d you have to go over the edge?  

Food?

You always want more food. That can’t be all you’re saying.

Besides, I just fed you. I’m feeding you the most that I can.

Do you not like it anymore? Is that what you’re trying to say? Do you want all this to stop?

But then how come “do it”? How come your eyes keep saying: “do it”?

I’ll do whatever it is that you want, but I just need to understand.  

When I went to go meet the recruiter, I was surprised to find that the coffee shop where I had been instructed to go was a hip little place in one of the younger parts of town. I walked in, and there was a man in his 20’s with blonde dreadlocks behind the counter explaining to another young man the difference between a few varieties of organic coffee beans—where they were grown, how the workers were compensated, where the beans sat on the flavor scale. On a bulletin board on the wall, there were posters for different local bands that were playing that night, as well as a number of handwritten classified ads for roommates, bicycles, and romantic partners with little tabs you could tear off that had contact numbers and email addresses.

I scanned the room for what I imagined would be one of the President’s people—a middle-aged man in a suit and tie with a black briefcase—but I was waved over instead by a young woman who seemed to fit in perfectly with the rest of her surroundings. She was hip, casually dressed with a warm smile, and she had a plastic clipboard with her as though she were campaigning for a local cause. Her hair was tied up in a little bun with a wooden pencil holding it together, and she wore a pair of vintage eye-glasses with big frames.

After we got through all of the introductory small talk and went over the Frequently Asked Questions on the little information sheet she had given me, she said:  

“We can’t tell you what any of these people are being held for or how long they’ve been in our custody, and in fact, you will be strongly discouraged from seeking out this or any other information about them on your own, but the bottom line is that these people are hurting themselves, Doctor, and you are in a position to help them. We’ve seen your track record, we’ve seen the kind of work you’ve been doing at the state hospital, and we think that you’re exactly the kind of person we need for this job.”

When I expressed some lingering reservations, she said:

“Think of it this way: What greater test could there be of your commitment? What greater challenge of your character than to save people who are not only unable to give you compensation, but who are completely unable and unwilling to appreciate what you’re doing for them? What greater obstacle could you overcome than to diligently save people who will hate you for doing your job?”

When I worried out loud that the procedure might get a little repetitive and boring, she said:

“Think of the sacrifice. You and I both know that the greatest heroism in the medical profession is not always found in the most daring, complicated procedures. Often, the thing that is hardest to do is the most humdrum and uneventful. Often, it is endurance, not virtuosity, which marks a true professional.”

When I worried out loud for my safety, she said:                          

“Don’t worry, Doctor. There are people whose job it will be to subdue the patients before, during, and after the procedure. The patients will be awake, of course, but all precautions will be taken so that their arms and legs are restrained and their heads are held back in a harness for the entire duration. The guards will do their work, and you will do yours.”

She’s gained another ten pounds.

I could tell when she was led into the medical room today that she was even bigger than last time, but I didn’t realize by how much.

It’s not as though she’s overweight now—to the contrary, she looks very healthy—but still, it’s a little striking given the state of the other patients in here. She sticks out like a sore thumb.

It actually took quite a while for me to get used to the way that nobody’s appearance would change. Day after day, my patients would come to see me, and although I was feeding them, pumping essential nutrients into their bodies, none of them ever gained any weight—they all continued to look just as emaciated and unhealthy as they did on the first day I met them. It felt a bit like catching people in a net every day as they tried to jump off a building and then throwing them right back up on the ledge, leaving them there with the same insurmountable problems in their lives, the same unresolved urges to jump.

But, of course, this is the kind of thing the recruiter was talking about: No more grand recoveries. No more fruit baskets. No more children and yachts named after me. No more banquets held in my honor.

I have to say, though, I’m inclined to keep feeding her more and more. She looks healthy, after all, and what harm could it possibly do to have one satisfied customer? Nobody said all of my patients had to hate me. Nobody said I couldn’t be greeted by one smiling face.

She even told me today:

“Doctor…you’re the only thing that’s keeping me alive. I don’t mean just literally—I mean you’re the only thing I have to look forward to, the only thing that keeps me going. What you do gives me such pleasure, such divine pleasure, it almost makes the whole rest of the ordeal worth it. God bless you, Doctor. God bless you.”

What am I supposed to say to that? What am I supposed to do?

I have a decent-sized bedroom here. It’s actually more like a little studio apartment with a kitchen and a bathroom. Most of us all live in the same building toward one side of the base, and the apartments all came fully-furnished with some pretty utilitarian furniture—not so much like a hotel as a monastic cell—but a lot of the doctors opted to redecorate at their own expense.

I decided to keep my apartment more or less the way it was issued to me, I guess because I wanted to follow through with the “service” idea of the whole thing and treat this like a complete departure from my former life, a complete change of pace.

I think about my money sometimes, floating around in my bank account, sitting in reserve, waiting for me to come back to it. For the most part, it’s almost as though it doesn’t exist. It’s meaningless to me here, purely theoretical.

Doctors are welcome to commute back to the mainland on their own if they want, and there’s a weekly organized trip to a place with shopping and restaurants and city life where a lot of the other doctors will go and spend money on a nice meal or an expensive club, but for the most part, I’ve been staying on the base. After a while, the food here stopped bothering me—it’s actually kind of good—and I’ve come to really appreciate the silence and the solitude that my room affords me.

Most nights, I live in a world of my own shit. 

I have some TV shows that I like that I’ll put on in the background, but mostly I’ll just get naked on my bed and spread open my ass cheeks wide and then plunge my nose right into the center.

I’ve become very flexible over the years, and I could probably get my nose a few centimeters deep in there if I really wanted to, but I’ve found that it’s best to hang back a little bit, hovering over the opening so that the fumes can come forth into my nostrils. It’s actually not so different from when you take the first sniff of a glass of wine. You get your nose in there—really deep down into the glass—but you stop right before you reach the surface of the liquid.

As the night progresses, I’ll eventually stick my pinkie deep into my asshole, lining it with shit-residue, and then I’ll run it under my nose, painting a little bit of shit-paste on the skin right at the opening to the nostrils. I’ll then use that same pinkie to pick at my boogers, letting the shit particles fuse themselves onto the mucus particles—a fusion which can last for days, trapping the scent in there. I’ll do this a couple times until my asshole is completely dry, or until it starts to hurt a little too much, listening all the while to the comedies playing out on the comedy channel and half-watching the fictional murders that are playing out on the crime channel and sniffing and picking more intently and with a little more anxious energy as the plot starts to thicken on the drama channel.

Sometimes, I’ll just absentmindedly pick at the spot between my asshole and my privates—that odd little valley—digging my nail deeper and deeper into the grooves in the skin, half of the time doing a series of slow, methodically paced-out picks, half of the time doing a rapid flurry of picks and then resting for a bit on the bed, bringing my attention back to the screen.

At some point every night, I’ll get the sudden intense urge to take a shower. It’ll be just like it was with the quilt: I’ll suddenly catch myself enraptured in my own filth, trapped in shit, and I’ll feel instantly uncomfortable and disgusting. I’ll want to return immediately to a completely blank slate, to get absolutely clean. I’ll even lie to myself: Never again. I’ll tell myself: This is not how a human behaves. This is not acceptable behavior.

And of course, I can’t ever get fully clean, because shit particles, as it turns out, are very resilient, just like the asshole itself—it takes quite a bit to destroy them. Even after I’ve scrubbed like a mad person under my nose and more or less snorted soap into my nostrils in order to flush out the remaining fibers, I can still smell the traces of what I’ve done. On my hands, there will still be just the tiniest layer of shit-residue that can’t be scraped off no matter how hard I try. And under my nose, perhaps trapped in the little hairs above my lip, there will be a few stubborn shit-flakes still hanging on for dear life. And in the moment, I’ll be upset by this, but it won’t take long before I’m glad about it later. The next day, as I’m waiting in between procedures, I’ll instinctually bring my pinkie up to my nose to smell whatever’s left over, and I’ll instantly feel at home. It helps me locate myself in my body, to feel myself existing in the world.

Now, there is a question which oddly doesn’t plague me very often in my life—it doesn’t hang on my mind nearly as often as you might think—but when it pops up, I am always surprised by the extent to which it troubles me, and that question is: What would I do if someone were to catch me doing all this?

Let me be clear: I don’t just mean scratching my asshole. Plenty of people do that for all different kinds of reasons, and no matter how vigorous or deep the scratching, I could always theoretically say that I was relieving an itch, explaining it away within the realm of normal human behavior.

What would I do, though, if someone were to catch me methodically playing with my opening? Methodically sniffing my shit?

Sometimes, I wonder whether this has been a determining factor in my decision to live a life free of any real attachments to other people. After all, if someone were to get close enough to me, eventually it would become very hard to hide all of this from them. I’d have to go really far out of my way to give myself the time and space I needed to indulge my compulsion in secret. In fact, I’d probably have to just give the whole thing up in the end out of concern for their comfort and hygiene. And while I can see how that might ultimately be a good decision for me, I guess there must just be some part of me that doesn’t want itself to die, some deep corner of my being that desperately wants to protect itself from obliteration.  

I bring this up only because today I came very close to being discovered—I think the closest I’ve ever gotten since I was a child.

I was going over charts in my office in between procedures—I had just eaten lunch about thirty minutes earlier, and the food was still fresh in my digestive system, infusing my shit with its flavor—and I felt relatively safe and alone, and so I plunged my pinkie deep into my asshole and I brought it up to my nose to smell it. The shit-residue was perfect—just the right amount of wetness, just the right level of intensity—and I guess I was so transported by the smell that I didn’t pay that much attention to whether anyone was approaching me. I usually wouldn’t do this while I’m at work—I can usually get by on the previous night’s traces—but today I was feeling a little extra on edge, and I needed something to calm me down, to bring me back to myself.

You see, the patient, the one who disturbs me, has gotten even bigger—she’s gained fifteen pounds this time—and I’ve been incredibly worried that someone will notice and get upset with me, especially since she’s now actually starting to look a little portly—something which, around here, has been almost unthinkable.

To make matters worse, the person who barged in on me was the Commander, seemingly excited about something.

This is not an altogether rare occurrence. The Commander will often barge in on me in between my regular sessions in order to tell me that I’m needed urgently to take care of someone who’s in critical condition. In fact, when the Commander comes in like this, it’s usually a welcome intrusion—it means that the monotony of my daily routine will soon be broken. He’ll whisk me away to a room at the back end of the base where there is a prisoner who’s experiencing internal bleeding or whom they’re having difficulty reviving after what looks like a bout of asphyxiation or drowning. Sometimes, the prisoners will have cuts all over their arms and chests, or bruises around their faces and stomachs, and I won’t be told the full circumstances of what’s happened to them, but I’ll be given a basic rundown of the injuries they’ve sustained and I’ll be asked to do my best to revive them, and when I do, the prisoners are often rather silent and sullen, as I’ve come to expect, but the Commander and the rest of the staff will be very grateful to me, sending me back to my regular duties with smiles and pats on the back.

So again, it’s not that the sight of the Commander on its own is particularly surprising or upsetting, but here I was with my pinkie finger under my nose, more or less covered in shit, and I was looking over the chart of my now fairly overweight patient, feeling more than a little compromised, and I had literally just removed the pinkie from my asshole and brought it up to my nose when the Commander barged in.

“Doctor!” he said.

I practically fell out my seat in surprise, horrified that he had seen the whole thing.

“Digging for gold?” he said, which put me at ease that he had only caught me with my finger in my nose, not in my asshole.  

I smiled awkwardly, worried that any minute he’d start to smell the shit.

He sat down right across from me at my desk, and he seemed to be very excited about something. I assumed he was about to detail the state of some patient he desperately needed me to attend to, but instead he took his tablet out from his pocket, put it in front of me on my desk, and said:  

“What do you know about this woman? The one who’s getting fatter?”

I looked at the picture on the screen. My heart sank.

It was, of course, a picture of the patient who disturbs me, the same one from the file I had open on my computer. There was her face from when she first arrived: sullen and angry, and significantly thinner than it is now—I had been looking at this face all day; I barely even needed to glance at it now in order to conjure all of its contours and features in the front of my mind—and I looked up at the Commander, who seemed to be buzzing with energy, and I took the chance that he didn’t already know everything about what I’d been doing in the medical room, and I lied to him.

I told him that I too had noticed she’d been getting bigger and that I too had no idea why. I showed him the same file I had open and said that, coincidentally, I was just about to come talk to him about her situation. I told him I’d been feeding her the same food solution as everybody else in exactly the same portions and that the only possible explanations I could think of for why she’d gotten bigger were that her body was reacting in some strange, unprecedented way or that she was getting additional food from another source.

The Commander smiled—this seemed to be exactly the explanation he had been hoping for—and, very excited, he said:

“Listen, Doctor, I want you to start feeding her more and more. In fact, I want you to make a food solution for her that’s more saturated in fats and proteins. I want this woman to get big—I mean, really big. I know it sounds a little strange, but it’s clear to me that this woman is not being honest with everybody here. It’s clear to me that she’s been sneaking food in on the side somehow and yet she’s still coming to you every day as though she’s part of the protest. What will happen, though, when her fellow protesters realize that she’s been breaking ranks all along? How will her commitment look then? It’ll only be a matter of time before the whole thing starts to look silly and they’ll all decide to just suck it up and quit. What do you think?”

I briefly ran this all over in my mind. I was greatly relieved that the Commander wasn’t here to demand my resignation—or even my imprisonment—for what I’d been doing, and it seemed to me that the solution he was proposing was one in which everybody won, and so I said it sounded like a great idea and that I would of course do it.  

I asked what I should do if she started to get really obese, and he said:

“Keep feeding her, Doc. Just keep feeding her.”

I asked what I should do if, in my medical opinion, her weight started to endanger her life, and he said:

“I doubt it’ll get that far, Doc, but I guess if it does, she’ll be the first person to die in here from gluttony.”

At the doorway, he turned around and sniffed the air a few times and said:

“Did you eat lunch in here or something? It smells delicious.”

And before I could respond, he was gone.

You may be wondering how it is that the Commander didn’t already know exactly what was happening between me and my patient in the medical room. After all, you’d think in a place like this, practically everything would be under constant video and audio surveillance—stored away forever on a server in the clouds—and for the most part you’d be right, but the medical room has recently become a zone free from any sort of electronic gaze.

The reason for this, funnily enough, is that not too long ago, a hacker got hold of the video feed that used to come from the medical room, and she posted the full video of a procedure online. You can’t really see my face, but it is certainly me in the video doing the procedure, and of course the hacker chose to upload a particularly difficult feeding session instead of one of the more routine ones, and so the guards in the video look like they’re really holding down this squirming patient, and I look fairly flustered and incompetent, and the whole thing just looks pretty terrible. I can see why, if you only had that one piece of evidence, you might think that it’s a horrible thing that happens in there, but if the hacker had posted a video of me feeding that same patient a few weeks later, it would’ve been quite a different scene—the whole thing would’ve looked a lot more like a trip to the dentist.

In any event, the video went viral, and there was quite an outrage about it amongst the community of people who usually get outraged by that sort of thing, and it created quite a headache for people like me and the Commander and, of course, for the President. Last I heard, they’re still hotly pursuing that hacker in order to put her on trial for espionage and interfering with a security operation, but anyhow, in the end it meant that the higher ups at the base no longer felt it was prudent to keep video cameras in any of the rooms where things like my procedure take place.

I often wish I could take a look at the video feed from my patients’ cells. I can’t say exactly why, but I’d just be so fascinated to look at them in there. I wonder what they do all day. I mean, I know what they DO—nothing, or at least not very much at all—but I wonder what it actually looks like. Do they just sit there? Do they spend all day praying? Are some of them reading and writing? Is anybody just picking their asshole, smelling their shit?

That’s of course what I’d do if I were in their situation, but I’m not even sure what my shit would smell like if the only food I was processing all day was the solution that I feed them. It’s not really even food—just “nutrition”—and I find that you need things like grease and garlic and spices to make for interesting-smelling shit. In fact, their shit might not smell like anything at all—it might just come out as an odorless lump, devoid of any personality. Even worse, it might just smell like shit. Like shit and nothing else.

In a way, I envy them, eating the same thing every day. I spend so much time obsessing over what I’ve eaten that I sometimes wonder if a standard, regimented diet would be a good way to eliminate one of my great sources of stress. I obviously don’t envy the method by which they get fed, but I do envy the regularity. I wonder, if the responsibility for feeding myself were taken entirely out of my hands, whether I’d be able to focus my energies more productively on other things, to make better use of my mental activity. As it stands, between work and my asshole, I don’t really have much room for anything else.

She’s looking over at the cans of food solution.

I’m not sure she can even hear me, so I decide to write things down on a piece of paper and hold them up to her.

“Do you want to start eating the normal way?”

She looks at me with eyes that seem to say “no.”

“Did I give you too much last time? Does your stomach hurt?”

Again, her eyes seem to say “no.”

“Do you want me to leave? Do you want to be left alone?”

“No.”

“Are you still hungry?”

A glimmer, something. Maybe I’m just imagining it, but I notice a change.

I look over at the food solution.

I look back into her eyes, and they seem to be gleaming.

I start to prep her for another feeding.  

She looks almost comical now. She’s gotten bigger—much bigger—but she doesn’t quite look like a fat person. There’s something…off about it. Her body is bloated in some places, small in other places. She looks like a balloon animal. She looks like she’s been blown up.

My other patients have, of course, started to notice, and as the Commander had hoped, it seems that there’s already been some grumblings amongst them about what’s going on with her. Some people are rather upset about what looks like a betrayal by one of their most committed members. Others think that her puffiness is just another product of her continued starvation—they think that her body is trying to compensate for the lack of nutrients by puffing itself up, and that if they keep at it, the same thing will happen to them.  

Of course, whenever I see her, she’s happy as a clam. I never really know exactly when she’s going to turn up in the medical room—they tend to keep the daily schedule fairly irregular—but every time she does, she’s more ecstatic and intense in her gratitude towards me. Yesterday, she even tried to kiss me when she came in, and the guards had to subdue her, pushing her down into the seat and strapping her in.

Today, she brought me a gift. It took me a moment to realize that that’s what it was, but she whispered to me: “It’s for you, doctor, for all that you’ve done.”

I looked down and saw that what she was placing in my hands was a book—a fairly well-known collection of erotic short stories that has become a popular entry on the prisoners’ book request lists—and on the first page she had written a little inscription: “Life-giver.” That’s all it said.

When I got home, I noticed that she had dog-eared a page for me. I was naked on my bed, lazily fingering my asshole with the TV going in the background, and I absentmindedly looked over to the night stand where I had put the book down next to my glass of water. I saw the bent little corner of the page staring at me through the small thicket of paper, and I opened up the book to the title page of a short story: “The People Who Fuck Themselves.”

The story ended up being about a group of people who frequented a techno club where it was common for the patrons to fuck each other on the dance floor. Unlike the other club-goers, however, the main characters in this story fucked themselves with pieces of their own shit.

In the days leading up to the club, they would save any shits they took that were especially solid and healthy-looking by freezing them in a plastic bag, and then when they got to the club on the weekends, they’d take the shit out of the bag, stand in the middle of the dance floor, and fuck themselves with it until it thawed and disintegrated. Over the course of the night, their hands and the area around their assholes would be covered in shit, and shit droppings would be all over the floor, mushed into the tiles by the other dancers’ feet.

After reading the story, I had so much energy and built up excitement that I may have gone a little too far with my asshole tonight. I don’t know why, but something just came over me. I lost myself. I scratched and scratched with my nail until I saw bits of blood on my fingertips, and when I let the water run over me later in the shower, I practically screamed out in pain. It was like being burned with a laser beam.  

Scratching myself, though, I felt…wonderful. Amazing. I could feel myself dissolving into the air.

She has now become the biggest person I have ever seen.

Or, well, not the biggest. I’ve watched the TV specials with people who weigh over two thousand pounds and who haven’t left their couches for seven years—and actually, a good number of my patients back when I was in private practice were fairly obese for one reason or another—but I think there’s something about her bigness that feels more…intense, more striking. Again, she doesn’t look fat. To me she looks more like a blimp, like some kind of demented piñata.

Looking at her today, I actually had a sudden craving for Foie Gras. I know it sounds silly—I mean, Foie Gras has been illegal in most places for several years—but feeding her, seeing her giant body with the tube in her nose, I just couldn’t help but think of that amazing delicacy you used to be able to get by artificially stuffing a goose or a duck with corn until its liver became rich and buttery.

I started to think how funny it would be if the Commander’s secret motivation for wanting to feed her more and more was actually just that he wanted to eat her.

I told him the other day that I worry that all of the food solution is starting to erode away at her organs and that we’ll start to cause irreparable damage if we continue on this path, but he just smiled and said: “Keep feeding her, Doc. Just keep feeding her.”

I felt a momentary impulse to resist—I mean, really, I can’t help but feel a little strange giving her portion after portion of unnecessary nutrition—but then I remembered the decision I had made to really like the President, and I remembered that a fundamental implication of this decision is that I really like all of the President’s people. In other words, I really like the Commander, and I can only assume he has a good reason for giving me the orders that he gave.   

What a funny rumor it would be, though, don’t you think? If people started to believe that what we were really doing here, what we were really up to in this facility, was stuffing prisoners to be eaten? Someone would believe it. I’m sure a whole number of people would believe it.

She gave me another gift today.

It’s kind of hard for her to get words out now, so she tries not to talk unless she has to, but she very laboriously put something in my hand as she was led in by the guards, and I looked down and saw that it was a roll of toilet paper—the rough and prickly kind they put in all the prisoner’s cells.

I didn’t tell her how much I enjoyed the short story she had dog-eared for me, but I got the impression somehow that she knew.

It’s hard for her to express excitement or enjoyment without getting winded, but while I was feeding her today, she seemed, as always, to be enjoying herself. She moaned and groaned with the same feelings of gratitude and pleasure, if perhaps not with the same vigor. And when it was all done, as she was being led away in her new, specially-fitted handcuffs, she even managed to get out: “You’re a lifesaver, Doc. A lifesaver.”

Tonight, I used the paper to wipe myself.

I was sitting on my bed again—half listening to the TV, half hovering over my ass cheeks—and I made a little fart. Well, no, it was a big fart. A big, awful fart, actually.

A fart pretty much always serves to disrupt the pleasure of smelling your own shit, because when you fart, the shit-particles that have been hanging, semi-dried around the rim of your asshole all of a sudden break open with the force of the wind, and their newly activated smell can be very jolting and unpleasant—a reminder of just what exactly it is you’ve been smelling.

Today, this was made all the more unpleasant by the fact that I was staring right into my asshole when the fart came, and so I could actually see a little piece of shit starting to crown at the opening. This fart, it turns out, was not just a preview of coming attractions, but was in fact an urgent “coming up next.”

I rushed into the bathroom, having gotten the sense from the fart that this shit was just about to burst, and I sat down on the toilet.

This was my least favorite kind of shit—the kind that is not one long, drawn out tube of sludge but is instead like little pebbles, odd-shaped little pebbles that come out in stops and starts, cutting and tearing the asshole in especially sharp and painful ways as they pass through the opening. And then when they drop into the toilet, these pebbles cause some of the water to splash back upwards, stinging the asshole on contact.

It had to have been thirty minutes before I was done, and by the end of it, my asshole had been thoroughly abused. It felt good in a way, but for the most part it just kind of hurt, and the smell was awful.

I reached over for some toilet paper, but I was surprised to find that the roll on the dispenser was completely depleted. I couldn’t believe I hadn’t checked before I sat down or noticed during the whole time I was struggling there, but I looked, and my eyes were greeted by just a sad tube of brown cardboard with only a tiny trace of white still left on it.

Still sitting on the toilet, I opened the cupboard beneath the sink to grab a new roll, but I was surprised again to find that they were all gone. For the life of me, I couldn’t remember using them all up, but still: there was nothing in the cupboard except an extra container of hand soap and the torn-open plastic package that the rolls had come in.

I remembered her gift.

I hadn’t been planning to use it—in fact, I had decided staunchly against it since I had no idea what she might have done to it, and I couldn’t imagine the toilet paper from the prisoners’ bathrooms would be all that sanitary or safe—but now it seemed that it was my only option. Any toilet paper is better than no toilet paper, after all, and given the kind of shit I had just taken, I wasn’t about to wipe myself with a piece of my clothing or with a towel. 

I hobbled out of the bathroom and into the bedroom, and I found the roll sitting there on the nightstand on top of the book of erotic short stories. I had placed it there earlier without much thought—not necessarily trying to create a little shrine of her gifts to me, although that’s certainly what it was starting to look like—and I grabbed the toilet paper and tore off a substantial portion, wrapping my hand in it like a boxer wrapping his hand before a fight. Right there in the middle of my room, not bothering to hobble my way back to the bathroom, I brought my hand with the toilet paper down to my asshole and started to wipe.

The stinging was awful—perhaps the worst I’ve ever felt. This paper was of such poor quality that it not only felt like a nail file whenever it rubbed against the skin, but it actually gave me the sensation that little sharp bits of paper were dislodging themselves from the wad and penetrating into my asshole, hiding themselves away in the little crevices and tears so that they could cause further disturbance in the future.

The pain reached such a level that I felt myself leaving behind the rest of my consciousness and entering a world made up entirely of sensation. It engulfed me, fusing with my being. The pain stopped corresponding to any rational state in my mind and existed instead as its own complete reality. I wiped harder and harder to the point that the wad of paper was not just spotted with streaks of red but was in fact fully dripping with blood. And as I tried to soak up the blood with more paper, I would only exacerbate the problem, creating new tears and cuts with each wipe.

I kept wiping, making it worse and worse, drawing myself deeper and deeper into the vortex, until finally I lay down on my bed from exhaustion and dropped off to sleep.

I finish feeding her again.

I take the tube out of her nose and set it aside.

I take the bag down and put it on my little table.

We look at each other.

Are you happy now?

Her eyes don’t seem to be giving me any clue.

She looks over at the pile of food solution again.

She looks back at me.

She looks back at the food solution.

“More?” I ask, forgetting to write it down because I’m so surprised.

She looks back at me.

“Yes,” her eyes seem to be saying.

It’s working.

My other patients have stopped their protest for the most part, and they’ve begun to accept the food that is given to them. There are a few stragglers who are still hanging on, but almost everyone has given up by now, terrified that what’s happening to her will soon happen to them.

As a result, I have very little to do these days besides feed her and track the now almost complete deterioration of her body. Most of the other doctors have been sent home—back to the world of private practice, back to the land of gifts and praise.

Her vital organs have all sustained more or less irreversible harm, and all but a few of her arteries are permanently clogged. A few times a day, I will go to her cell with a team of nurses to administer special ointments and creams to help ease the pain from her constantly stretching skin, and since some of the muscles in her sphincter are no longer operating properly, we also have to administer a complicated douching procedure in order to get her to shit. When the shit comes out, it’s lumpy and odd, with an almost cottage-cheese-like consistency, and it smells a bit like a cleaning product. The color varies day to day. Sometimes it’s white, sometimes it’s green. Once, it appeared to have a slightly purplish tint, although that could have just been the lighting in the room.

I’ve proposed multiple times to the Commander that we stop all this and begin to slowly transition her back onto a more normal diet in order to salvage whatever might be left of her health, but he’s been sticking to his usual refrain: “Just keep feeding her, Doc. Just keep feeding her.”

It’s actually hard to tell whether she’s even refusing normal food anymore. She’s gotten so big and immobile that she couldn’t possibly feed herself if she wanted to: she’d need help getting the food up to her face. And it’s been a while since I’ve been able to understand the words coming out of her mouth. Mostly, it’s just grunts and gurgles, the meanings of which are entirely unclear.

Still, though, as a formality, before I begin each procedure, I have to present her with whatever is on the menu that day in the cafeteria and ask her one last time if she’d like to eat that instead of being fed by me through the tube.

She makes a slight motion with her head and grunts, which we’ve all come to accept as a “no,” and then one of the guards throws away the tray with the food on it after maybe taking a few bites of it himself.

Then the procedure begins.

I’ve recently been tasked with creating my own food solution from scratch, since the company that used to supply us—a foreign food conglomerate that is the world leader in baby formulas and nutritional supplements—has come under pressure from various rights groups overseas to stop selling us their Formula 26 for use in the feeding of prisoners.  

Thankfully, it wasn’t very hard for me to reverse engineer Formula 26—a popular meal-replacement shake generally used by athletes, the elderly, and patients recovering from oral or esophageal operations—and come up with a solution which is more or less identical. Actually, now that I’m making it myself, I can more easily adjust the levels of each nutrient to the Commander’s request, putting in more or less fiber, more or less protein, more or less fat.

He seems to want her to keep getting bigger. Despite the fact that her skin seems barely able to hold together as it is, and despite the fact that her appearance at this point resembles more of an elephant or a marshmallow than a person, he still asks me to make the solution denser and more filling—“Chock full of stuff,” he says.

My intuition tells me that he won’t want to take the foot off the gas pedal until every last one of the protesting prisoners gives up their fight and it’s just her being fed every day. Given the drop-off rate I’ve been seeing recently, I can’t imagine that day is very far off in the future. Even some of the most hardened prisoners—the kind that used to greet me with particularly sharp fuck yous and particularly smoldering glares of contempt—have recently been approaching the medical room with trepidation, even outright horror. Yesterday, I didn’t even have to start the flow of solution into one patient’s stomach before she was screaming to have the tube taken out of her nose and begging one the guards to fish the cafeteria food out of the trash can and give it to her.

My asshole is taking a little longer than usual to heal.

To make matters worse, I have this horrible eye infection that I can’t seem to get rid of—I think because a few shit particles got onto my retina when I was staring into my asshole the other night and farted into my face. The entire area around my pupils has turned a deep red, and on the skin around the eyes, there is a large red outline with strange little bumps.

This, of course, doesn’t help assuage my patients’ fears that something sinister is going on with me—the few remaining people who come in to see me look at me like I’m some kind of dark shaman, or a demon just now revealing its true image to the world. One patient started crying at the door of the medical room the other day when he saw me. He was trembling and muttering to himself: “It’s true! It’s true!” before he took the cafeteria food off the tray and devoured it.

I’ve started wearing a diaper.

Not the kind used for babies, but a diaper nonetheless. My asshole has been bleeding somewhat irregularly, and I don’t want it to bleed through my underwear and ruin my pants. Every time I think the bleeding is done for good, it starts up again, and so until I can be sure that it’s over, it looks like I’ll have to continue wearing these things.

I’ve applied the usual gels and creams—the petroleum jelly, the diaper rash ointment—and I’ve tried the various other home remedies that I would usually recommend to a patient for this kind of thing, but nothing seems to be working.

I suppose eventually, I’ll have to take a good look at it in the mirror and diagnose exactly what’s wrong, but I’ve been a little reluctant to take that step, I guess because I know that if I have to get any sort of work done, it’ll have to be another doctor that does it. Operating on my own asshole would be incredibly difficult, if not impossible, and I’m sure you can understand why I’d be hesitant to let another person so deep into my world like that.

As the food solution pumps into her stomach, I can’t believe there’s still room for it in there.

She’s like an endless pit, a landfill.

With all the tubes that are in her, she looks like a science experiment—a potato that I’m shooting through with electrical current in order to turn on a light bulb.

I finish the procedure and look at her.

Her eyes still feel unresolved.

Have I been getting it wrong? Does she want something entirely different?

She looks over again to the pile of food solution.

She looks back at me.

“No,” I say. “No way.”

But she looks back over there.

I shake my head: “Absolutely not.”

But she keeps looking. She just keeps looking.

What can I say to that?

What am I supposed to do?

She is now my only patient, and I am the only doctor.

She’s been moved permanently into the medical room since it is no longer practical to transport her twice a day from her cell, and while I am still called away every once in a while by the Commander to deal with some sort of injury or another in various corners of the facility, I now spend the lion’s share of my days sitting in the room with her.  

Her size, by which I mean her volume, seems to have stabilized—I don’t think there’s any more room left for her skin to expand—but presumably she keeps getting denser. I stopped weighing her a few days ago, and we’ve actually stopped offering her the cafeteria food before each feeding. In fact, we’ve done away with quite a bit of the standard operating procedure: the guards don’t even wait there in the room with me anymore—they’ve all been called off to other parts of the prison, presumably to be put to better use there.

The Commander, of course, is ecstatic.

I have asked him again multiple times whether he thinks we can stop feeding her like this, but he insists that we push forward indefinitely.

I’ve told him that any further change in her physique will be almost entirely imperceptible, and that since she’s no longer transported to and from her cell every day, the other prisoners don’t even have a chance to see her, but he seems not to care. “It’s enough that they know it,” he says.

I’ve told him that if we keep going, she will almost certainly be dead within in a few weeks if not days, but he’s said that it would be best if we could keep her alive for the foreseeable future. “Whatever it takes,” he says, “so long as she doesn’t lose any weight. She’s a beauty, doc. She’s like a piece of art. I want to keep her just the way she is.” I’ve told him I will do my best.

Her blood pressure is through the roof, she’s had multiple strokes in the past couple days, and she’s developed type 2 diabetes. What started as a bout of asthma has now turned into a much more serious respiratory problem, and so I’ve hooked her up to a breathing machine. Between that, the catheter, the douche, and the feeding tube, pretty much all of her holes are plugged up at one point or another during the day. Her ears may still be working, but there’s no real way to test it. She can’t confirm for me whether or not she’s heard what I said, and it’s not uncommon for people in these kinds of situations to suffer from hearing loss.

I do, of course, wonder, whether she still enjoys what I’m doing to her.

I know it seems silly, but I look at her sometimes. I try to look deep into her eyes for a sign that she’s ready to stop, that she’d accept the normal food if she could. Except for when she’s sleeping—which is more or less half of the day in stops and spurts—she returns my gaze.

I can’t imagine what she’s thinking in there, but I stare into her eyes nonetheless. Whenever I’m not tending to her, that’s what I’m doing—staring into her. I’m almost sure she’s trying to speak to me, but I can’t pinpoint exactly what it is she’s saying.  

What did she used to like to eat?  Before all this, what was her favorite food?

I picture her sometimes, sitting down to a leisurely meal with friends, ordering something off the menu in a restaurant.

I picture her tearing off a piece of bread and dipping it in olive oil.

I picture her trading a bite of whatever she’s got for a bite of whatever the person sitting across from her has got.

I picture her ordering something sweet to cap off the night.

I picture her calling over a waiter and having him wrap something up for her to go.    

I picture her later in the night, or the next morning, sneaking a cold bite from the fridge.

I picture her bringing the leftovers to the office the next day, provoking the oohs and aahs of her coworkers as she warms them up in the microwave.

The apartment building is mostly a ghost town.

With all the other doctors gone, the silence is deadening. My TV feels like an animal howling in the middle of a desert.

Most of the shows I started watching when I got here are now in their second or third seasons. A few of them have spin offs.

I watch them with just a sliver of my attention—my mind stays behind in the medical room, thinking about her in there with the lights off, wondering if she’s asleep or just sitting there, waiting in the dark.

I haven’t been smelling my shit all that much.

I’ve tried, but every time I stick my finger in my asshole and bring it back up to my nose, all I can smell is blood.

The bleeding itself has gotten less intense for the most part, but the smell is still there. It completely overpowers the shit and it makes everything feel kind of pointless—like picking at some anonymous orifice. The whole thing has become entirely too medical.

I’ve been avoiding scratching my asshole or playing with it too, since I want to make sure it’s all healing correctly.

This is now the sixth time I’ve fed her.

What if she’s fully lost her mind?

What if she just keeps looking at the pile of food solution as an automatic movement—her brain is making decisions for her, without her consent?

While the solution is dripping into her, her eyes seem totally at peace. I’m almost worried that she’ll drop off to sleep in the middle of the procedure.

She looks up lazily at the feeding bag as it slowly depletes with what seems like eager anticipation, greedy hunger.

Think of all the liquid sitting in there. She’s like a septic tank, a reservoir.

I pull the tube out of her nose once the bag is depleted and I look into her eyes. They seem happy—perhaps finally content, finally full.

I sit down in my chair—I’m exhausted now. I could almost take a nap—but she looks back over at the stack of cans.

“What?” I say. “More?”

Could she actually want that?

Could she actually still have room?

She looks at me.

“How much more?” I say.

She looks back at the stack.

What can I do?

I took a picture of my asshole today and sent it to one of my old partners, a specialist in this kind of thing.

I told her it was a picture of one of my patients and that I needed a second opinion on a diagnosis.

I had to try a few times with the camera in order to make it look like I wasn’t taking a picture of myself, but in the end I think it’s pretty convincing. The shot is close up enough, obviously, and there are no other identifying features.

She responded fairly quickly and said that she doesn’t completely know what the best course of action would be but that it looks bad enough that it might require anal reconstruction surgery. She recommended that I get the patient immediately to a specialist in the nearest major city, though she wasn’t sure what transportation was like in the village where I was stationed.

She doesn’t know where I am.

I had to tell my old partners that I was off doing aid work in various parts of the world, since technically, my job here is secret. I told them I would be hopping around all over the place, bringing quality medical care to the corners of the globe where it was most scarce.

At the end of her email, she said she’d love to talk to me about coming back to the practice whenever I was done with my trip. The new person they hired to replace me wasn’t working out, and I was sorely missed.

I told her thanks for all the help and that it was great hearing from her.

On the way to the medical room today, I stepped in dog shit.

Usually the guards are good about cleaning it up, but today I stepped right into a big pile—it was particularly wet and bright orange. It looked like a thick vegetable curry, or like that clay they use to make pueblos.   

I dragged my foot behind me as I walked, trying to scrape it off on the ground.

There were still thick traces of it on the sole of my shoe by the time I got to the medical room, and so I had to take my shoe off and run it under the sink, wiping it down with paper towels and slathering it in sanitizing lotion.

She looked at me while I did all of this—making no discernible movement, of course, which made it hard to tell what she was feeling—but she can’t have been very upset by the smell.

Compared to the smells she emits now, dog shit is subtle, understated.

I’ve come to kind of like her smell, though, especially now that I can’t smell myself.

Seven cans.

Eight cans.

Nine cans.

Ten cans.

She keeps asking for more, and I keep feeding her.

On the fifteenth can, I stop.

“There’s no way your body can withstand all of this,” I say to her.

I look into her eyes for a sign, but there’s nothing: just the same old greedy hunger, the same old look of helpless desire.

She looks over to the cans.

“I can’t give you anymore. It’s impossible.”

But she keeps looking.

“How many do you want? Sixteen? Seventeen? Eighteen? The whole stack?”

She looks at me.

“Please,” she seems to be saying. “Please.”

Nineteen.

Twenty.

Twenty-one.

Twenty-two.

It’s nice being back.

I’ve saved a few lives this week, all of which have been very rewarding.

Yesterday, as a token of gratitude from one of my patients, I received a prototype of a brand new handheld device that his company has been developing. I’m not sure what it does yet, but I can’t wait to open the package.

Today after work, I’m going up in a hot air balloon for a wine tour of the city with a media magnate and her husband.

Twenty-three.

Twenty-four.

Twenty-five.

Twenty-six.

Twenty-seven.

I see what you’re doing now…

Twenty-eight.

Twenty-nine.

Thirty.

“I see what you’re doing,” I say.

Thirty-one.

Thirty-two.

My new asshole has been wonderful.

It seems to work a lot better than the old one, and I’ve been treating it with a lot more care.

I think the fact that it’s new makes me feel kind of protective of it, you know? In a way that I wasn’t of the old one?

I’ve started eating better too, and my bowel movements have been very smooth, very uneventful.

As I tell my patients again and again, that’s the way it should be.

Thirty-three.

Thirty-four.

Thirty-five.

“Are you sure this is what you want?”

Thirty-six.

Thirty-seven.

Thirty-eight.

“Are you absolutely sure?”

We didn’t immediately know what to do with the body.

When I told the Commander, he was, of course, very upset, but I reminded him that I had been warning this was the inevitable outcome.

He asked exactly how it happened, and I said she probably had a heart attack.

Since I was the only doctor left on staff, he had to take my word for it.

Her body had gotten so big that we couldn’t get it through the door all in one piece, and besides that, she was far too big for any sort of cremation machine.

She sat in the room rotting for a few days before a special team was brought in to cut the body up into manageable pieces and cart them out to a crematorium off site. The smell of her body decomposing was, of course, horrible, and it prompted many complaints from the other prisoners, none of whom were told exactly what was happening, though they all had their ideas.

I wasn’t in the medical room for the cutting up of the body, but I’ve formed a very convincing picture in my mind.

When they carted the pieces out, I stood in the hallway lined with the prisoners’ cells, and I watched with them as a procession of small boxes was wheeled out to a truck outside.

I rode along with the Commander to the cremation site and watched as box after box was burned up in the machine.

When it was all over, the Commander asked the person performing the cremation whether all of the ashes could be combined in a single large urn so that he could take them with him back to the base.

Riding in the truck again, I told him I would be leaving the facility at the end of the week. He smiled and said: “You’re gonna miss her, aren’t you? Why don’t you take some of this?”

And, smiling, he reached into the large urn by his side, grabbed a handful of her ashes, and dumped them into my lap.

“A parting gift,” he said.

At thirty-nine, the food solution starts to pour out of her mouth.

Some of it starts seeping out of her ears and even out of the nostril that isn’t plugged up with the tube.

I look into her eyes to see if she wants me to stop, but they tell me: “Keep it going, doc. Keep it going.”  

I watch as the bag continues to deplete.

From underneath her chair, there is another puddle of wetness forming—it must be coming out her asshole too.

The liquid level in the bag goes down farther and farther and her body becomes a slow-trickling fountain.

Out of every hole pours the solution I specially made for her—the solution that is extra saturated in life-giving nutrients.  

I look into her eyes to make sure she’s OK, and she seems happy, at peace.

Well, no. She looks terrified, but still her eyes tell me: “Keep it going. Keep it going.”

The bag completely empties out, and the food solution continues to pour out of her holes.

After a minute or so, it stops. The liquid has travelled all the way across the floor. My shoes are covered in it.

I go over to her and look into her eyes.

There’s nothing.

They’re completely devoid of information.

Her head is cocked back like someone relaxing at the spa.

I look down on the floor, and I see blood.

It’s coming from me.

I forgot to wear my diaper today.

This afternoon, I received an email from the President.

It popped up on my screen, and I read the subject line:

“Thank you,” it said.

I’m not sure whether it was addressed specifically to me or whether it was a mass email he was sending out to all his donors and supporters, but in any event, I didn’t read it.

I opened it, scrolled to the bottom, and clicked the little box that said:

“You’re welcome.”