In the Fartbox, by Michael Nagle
The nurse was being extremely tactful.
“I think,” she offered tentatively, “that the oxygenation in the room would really be improved if you opened the door to the main hall.”
We were in a private room at Tarzana Providence Cedars-Sinai, a hospital just west of L.A. A $600 million construction project so new that the staff had just moved in the week before, filled with overcomplicated panel-controlled lights that no one could figure out how to operate and electronic HVAC controls whose temperature couldn’t be changed without calling a tech.
I was nearing the end of what would be a grueling 12-day stay.
“Just for five or ten minutes, that’s all.” She knew I didn’t like the noise from outside, even though my room was, mercifully, at the end of the hall.
“Ok,” I mumbled. I’d been sleeping, a rare treat in hospital-land, and was agreeable to pretty much anything that meant I could get back to slumber.
After she left (leaving the door wide open) I turned to my friend Janine, who herself was crashed out on a plastic couch-like thing underneath the window (which, of course, you couldn’t open.)
“She means it smells like farts in here, right?” I asked.
“She means it smells like farts. I think we all knew that,” Janine replied.
“Right, ok.” Most of my nights in the hospital I hadn’t slept. Instead I watched the night pass by, hour by hour, the analog clock mounted on the wall directly in front of me slowly ticking towards the somehow comforting return of daylight, when it at least made sense to be awake.
I laid my head down and tried to get back to sleep.
I was in Tarzana because L.A. was home, where I’d grown up, a place that would always feel like home. I’d had a gut instinct that I needed to go home a few weeks earlier. I’d been in Oakland then, staying at Janine’s apartment while she and her partner were traveling. I’d started feeling really sick, in a way I couldn’t put my finger on or make sense of, and I needed somewhere calm to stay. Somewhere to be ill, be quiet, and figure out what was happening to me. Janine didn’t hesitate to offer.
I spent three weeks at Janine’s. Most of that time was in bed. I became too weak to grocery shop. Some days I was too weak to clean the dishes. I’d rapidly lost 15 pounds earlier that month, going from 165 to 150, with no clear explanation, and after realizing I was badly calorie-deficient, was now frequently vomiting up food and, more scarily, liquids. I was puzzling through it as best I could. It didn’t feel like a typical infectious disease. One friend who had been through her own GI troubles coached me on the basics of the BRAT—banana, rice, applesauce, toast—diet for rebuilding calories on a sensitive gut and made me two fresh batches of congee, Asian rice porridge, with bone broth added. She wasn’t someone I knew very well, which made her full hearted-kindness all the more touching.
The other deep help I got was from one of my best friends, Alex, who checked in most days and made frequent grocery runs for me. Through serendipity he discovered fresh-cut honeydew melon was something that soothed me, especially after I’d just thrown up.
One day he was about to leave after a visit when I asked him a question.
“Hey,” I started, “does it smell in here?”
He shuffled uncomfortably. Averted his gaze from mine. “Yeah. I wasn’t going to tell you. You should try opening the windows.”
“I have. All day!”
Alex feeling ashamed to tell me I’d been farting up the room really struck me. We talked about everything. That day we’d been talking about how my sex drive had vanished when I fell sick. I hadn’t come, hadn’t had an erection, anything, in a month now.
I’d made my point by telling him how I’d had a twink over earlier that summer. The sickness was only showing in bare symptoms then—loss of appetite when I didn’t expect it. The twink spoke in an endlessly supplicating vocal register he must have learned from watching too many daddy-son videos on Pornhub.
“I’m just so horny all the time,” he said. Fawning behavior in sexual mode.
“Uh huh.” I was not hiding my disinterest. “Even at Stanford?”
“Oh of courrrrrrrse.” He drew his words out like he was on .5x playback. “Even in the bathroom.”
“Would you fuck me in the bathroom?” he said, like a boy coaxing an early birthday gift from a parent. I took so much glee in my response it thrilled me.
“No,” I spat, my judgment thick and freeing. “No, I don’t want to have sex in a bathroom.”
And then the simpering went quiet.
Given that this kind of story, told in exacting detail, was common for Alex and I to share with one another, I was particularly struck that somehow farting or smell caused hesitation.
We could talk about the gross parts of sex but we couldn’t talk about farting? Or how bad I’d made the room smell?
I hadn’t realized how low on the shame ladder farting ranked.
I’ve looked for words for what these farts smelled like. Rank. Squalid. Miasmic. When I would go to the bathroom, alone with my naked groin, I would think, “I smell like I’m fermenting.” But honestly, I’m not a dog with his supernose and his hundreds of millions of olfactory receptors. I’m just me.
What got my attention about my farts was their sheer olfactory volume. If farts were sounds, it was like painfully loud Nickleback was coming out of my anus every twenty minutes. Normally my farts or body odor or the accumulated smell of my homes were things I never even noticed, let alone felt ashamed of. Just part of the background.
But these farts? Even I could tell. They were fucking gross.
I wanted to just bring a jar of farts to the doctor when a friend took me to urgent care.
“This smell,” I would say, pointing at my freshly filled jar of foul evidence, “I know it means something. I know something’s wrong. What does it mean?”
Of course, what actually happened at the urgent care visit?
I got a quick physical exam, was told this was too complicated for urgent care and I needed to find a primary care doctor, and then sent to do a quick chest X-ray and some routine bloodwork.
It felt like a waste of time.
The urgent care did call me the next day.
“Your bloodwork concerns us so we wanted to call,” the nurse said.
“Oh. What did you notice?”
“Well, your electrolytes are all low”
“Sure, but I’ve been throwing up a lot, that doesn’t surprise me”
“And some of your immune markers are elevated. We think you need to take this to a doctor, but if you don’t have one here”—I’d been nomadic, moving location more than yearly since 2020—“we suggest just going to the ER. They can help you figure out how to pay for it if you don’t have insurance.”
And I didn’t have insurance. I was still waiting back on an application for state health insurance. The idea of an uninsured ER visit frightened me.
“Ok. Got it, thanks.”
The next week was mostly logistical. I decided to move home with Mom for a stretch of time in L.A. She offered to get me private health insurance, though it wouldn’t start for about three weeks. A cousin of mine who lives in L.A. flew up, got me and my car, and drove us all back to L.A. that day.
I thanked Janine’s apartment profusely before I left.
The day after I got home to L.A. is simultaneously etched into my brain forever and a complete blur. Mom learned that the state does have a provision for emergency coverage for ER visits and that it was approved within hours of us arriving at the Tarzana ER that day. The ER was like a Matryoshka doll of waiting rooms. A big crazy one on the outside admitted you to what felt like smaller and smaller ones on the inside. I was always in a room full of strangers no matter where I was in the ER. Someone who worked there would come, draw blood or ask for a urine sample or whisk me off for a CT scan, but most of the visit was just being shuffled from waiting room to waiting room. I got a discharge speech from a doctor there, one whose boyish personality didn’t seem to quite fit inside his adult male body.
“Your bloodwork doesn’t look that bad to us, and we’re just waiting back on the CT scan, which we figure is just a formality.” He proceeded to give me pretty generic GI advice that I’d mostly gleaned already from reddit. Boy Doc assured me I’d be on my way in an hour, max.
I texted Mom: I’m just waiting on my CT scan.
They are just trying to run up the bill.
What?
Leave now.
Mom.
Say you want to leave now.
Mom. Just give me an hour.
The first time I heard the words metastatic cancer, it was painfully, unforgettably vivid, and also a complete and total blur. Like the forgotten arm of boxing—being hit so hard from a source you couldn’t imagine would hurt you. Everything in my mind blurred and sharpened at the same time.
Boy Doc was the one to tell me.
“I know this is the last thing we expected to be talking about, especially given how young you are, but you’ve got a mass in your intestines and what could be mets”—already I was being given jargon for metastasized tumors—“in your liver and we have to admit you right away. We’re getting you a room.”
I was stunned.
Boy Doc deposited me back in the waiting room I’d been in for the past few hours.
I texted Mom in a response to her typically fiery messages of earlier: Something’s wrong. They’re admitting me right away.
Now was she stunned: Oh no. Followed by a covering-face emoji.
I’ll call you as soon as I can.
I cried silent, choked-back tears in this room full of strangers, one of whom had been groaning every minute in nonstop agony as he passed a kidney stone. I gave Mom the news over the phone when the room had a quiet moment.
But I didn’t burst out wailing until I was admitted to my own room.
So ten days later, when the nurse tactfully told Janine and me that my room “needed more oxygen,” so many medical interventions had happened that it was no longer clear why my farting was so rank. I was used to living in the fartbox by then. Janine apparently was, too, even as a hospital visitor. My shit had cycled from solid to water and back three times by then.
The first was from receiving three days of IV antibiotics—given because my temperature was like a roulette wheel, bouncing from 98 to 101 and back again based on seemingly nothing detectable. I had no other fever symptoms. Eventually it was determined this wasn’t from an infection. It was just a side effect of liver cancer.
The second was a twenty-four-hour project of drinking blue Gatorade Zero mixed with way too much Miralax until my shit turned to bile, what a friend aptly named “butt pee.” Standard prep for the colonoscopy the next day, whose biopsy continued to confirm the initial suspicion of cancer. The high-speed bullet train to confronting my mortality showed no signs of slowing down.
And the third—once all was confirmed and diagnosed and the cancer was indeed official and metastatic—was receiving the first round of chemotherapy in the hospital. This was the oncologist’s solution to the urgency of both what the diagnostics showed and my health care not kicking in for two more weeks: do the first chemo in the hospital where I was still covered by the state. The treatment was 48 hours of a continuous IV drip of cytotoxic chemicals particularly focused on killing my intestinal cells. No surprise that my stools turned back to rancid-smelling tatters.
In between every intervention, I would wolf down probiotics and watch my stools restitch themselves back together, only to see the next cancer intervention tear them apart again.
But I finally knew what my farts meant.
Michael splits his time between California and Portland, Oregon, and is currently undergoing treatment for metastatic colon cancer in his hometown of Los Angeles. The happiest time in his life was as an educator designing and running an alternative school in Cambridge, MA.