Dear Dr. ________:

Thank you for examining me so thoroughly at the Center for Connective Tissue Disorders last month, and for assuring me that the photograph you took of my tongue would be cropped so as to exclude any of my other distinguishing facial features. Thanks also for copying me on the report you filed of your findings. I appreciate your assessment that I am tall and thin, and I will abashedly accept “casually groomed,” since I suspect this means sloppy, which would certainly describe my attire and hair style on many days, including, indisputably, the day I take off from work once a year to meet with you and your trainee-of-the-moment at the Human Genetics Clinic. And while I am peculiar looking, with rather large features and dark coloring, and have been assumed to be of everything from Italian to Indian descent, and while I sometimes see reason to take issue with even the most practical categorizations of persons on the basis of race, I accept also your classification of my race as Caucasian.  Where I take issue with your report is in your determination that I was, or am, “In No Distress.” Perhaps this assertion, which appears at the very top of your lengthy report, refers to my condition at the onset of our appointment—at the moment when I “presented,” as you are wont to put it. But since the report is ultimately a summary of my condition as it was understood once your examination was complete, I must object to this facet of your conclusions. If I consider my condition at the end of that meeting—indeed, if I consider my condition as I write this, my own report of my condition at this very hour, an hour just as important to me, if not more important, than the ones spent in your clinic, I must insist that I am, if nothing else, a person In Distress.

I am not, nor was I ever, In Distress over the question you posed (among many others) at our initial meeting: Have men ever told you that you have soft or velvety skin?  I believe my lack of distress was apparent when I replied “Sure, but they say that to all the girls,” indicating with the smile on my face that I found both this question—put to me, of course, by a female physician, in the presence of her male apprentice—and my answer to it to be quite funny. I was, however, In Distress when, late that evening, once you were in your office dictating your report of the day’s findings into your digital recording device, you gathered that I live with a woman and put two and two together and immediately picked up the phone to call me at my home, full of apologies for what you called your insensitivity, insisting that some of your “most respected friends” are homosexual. This episode, however, amounted only to a small amount of distress on my part, so perhaps it does not, scientifically speaking, negate your overall assessment.

Slightly more significant is my distress at the fact that it is you I must rely on to grant me the care that might alleviate my chronic pain, you I must trust to determine whether any of my organs will spontaneously rupture or my eyes lose their sight, you who will decide what should be done about it. Here I am indeed In Some Distress. Factoring in the likelihood that this distress is common to all of your patients, however, I gather that this may be the sort of variable, scientifically speaking, that cancels itself out.

But these statistically insignificant distresses cannot compare to the distress I have felt since our first meeting, when you sketched my family tree, stark squares for the men, circles for the women, and a hastily penciled slash through the square signifying my young cousin who had died, the cousin whose own diagnosis had sent me to you. When, through a series of questions intended to trace the course of a syndrome secretly present, in your view, from my very beginnings, you retold the story of my life, skillfully detangling its threads and re-binding them so tightly your knots resist every attempt I make to loosen them. You uncovered it all: every tiny hurt, every mishap, that time when I had to wear a soft collar because I’d twisted my fragile four-year-old neck in my sleep, a kindergartner who in my mind—at least until our meeting—had dreamed hard, dreamed real, who had the capacity to be wounded by her own imaginings. The absurd injury I’d sustained when two eighth-grade classmates in Jerusalem decided to play a teasing tug-of-war with my body, one at my arms and one at my legs, and something popped in my chest, and the memory of how I lost language at that moment, how the Hebrew that I’d conquered fluently was thrown from me, and the English barely there, and all I could do was breathe, painfully, feeling my insides as I’d never felt them before, and then thrilling to the realization that I was trapped not in wordless terror, but in the terror of wordlessness. And the morning after my college graduation, when I took my first few steps into the world—breaking into a run, Madonna propelling me onward through Sony-yellow earphones—and I strode almost immediately into a hole, my foot turning blue, my body resisting its impending catapult into subways and paychecks and proper grooming, turning me back to books and words once again. The pain of impact when I’d written too hard, too long, the keyboard’s letters becoming part of me until the whole machine—hot screen, pounding arms—cried with ache. These moments I’d collected and woven, as best I could, into a writer’s life, but, handed over to your care, they were unraveled, and then knitted back together in cellular patterns, double helixes, pathologies and dangers that now form the connective sinews of a person I barely know, a woman ailing, predestined, and yet In No Distress.