This REFUSAL short story was originally accepted elsewhere but was withdrawn by the author in protest.

Author’s content warning and invitation: This short story contains suicidal ideation. Anyone experiencing suicidal thoughts can text THRIVE to +1-313-662-8209 to reach Thrive Lifeline, an anti-carceral/abolitionist 24/7 crisis support line.

This piece enters a world marked by greater tragedy than I could have imagined while writing it. In addition to the genocide of Palestine and escalation of israeli attacks on Lebanon, people across the u.s. South and Appalachian regions face climate disaster and state abandonment in the wake of Hurricane Helene.

You can donate to on-the-ground efforts to support affected communities, and learn about other ways to help out, via Mutual Aid Disaster Relief. Do not look away.

◆

Dr. Josh says nothing feels quite like saving a life, except, maybe, drowning, and that’s why he started ending them instead. He first entered my own life-death right as we all wandered into tropical storm season, as Rhode Island summer people fled their beach homes in droves, driving deep inside our Connecticut, displacing us like ice in water.

I was in flight, too, leaving my childhood home while also planning my next attempt to leave my body.

(It could be a good time to end things, I had typed at my friends.
Thumbs up, agreed.
What better time to part with the body than when everything else is
parting, too?)

I signed the lease on my first apartment the same week I graduated half-college, which is what we were in the habit of calling our local Associates’ degree program. I wasn’t the first in my family to attend college, but I was the first to take five years to get my AA in Humanities (Unspecified), having spent the first two also ping-ponging between psychiatric programs. It began when I was seventeen, rushed to the ER and then an inpatient unit after that first, failed bid for absolute autonomy. Much to my embarrassment, three-and-a-half years later, a near-identical series of events –– same old prescriptions, same old technicolor puke all over my chin and sternum –– landed me in the same unit, and ultimately in an intensive outpatient program I had only recently escaped.

I joke with my friends that the one thing I learned in rehab was how to say I don’t want to end my life and make it believable, but the inward-migration of the summer people on moving day really tests me. When I said “kill me now” to my dad in the UHaul cab, stuck between several layers of Rhode Island vanity plates, he looked at me like he’d seen a ghost and the ghost was me. I knew that being crazy meant I was always using language in the wrong way. It also meant that, in my mouth, hyperbole did not, could not, exist.

“You know I don’t mean it like that,” I said as we neared our turn. My dad put on his turn signal and sighed.

“I don’t make assumptions anymore,” he said. I wanted to scream, or at least, switch spots with him, so that I could be the one to punctuate my sigh with a turn signal. But then we were in the duplex driveway, and a young woman waved at us from her pink-purple garden, trowel spitting dirt into the air.

“I bet she can do yours, too, if you ask nicely.” my dad said, pointing at my half’s empty plot.

“That’s an assumption,” I said, fishing the new key from my pocket. Inside, my phone screen lit with a message. I didn’t sense a friend. It was probably Dr. Josh, but I’d let him wait.

My side of the duplex had a sizable front window, a small kitchen and equally tiny living room, and a bedroom directly above my empty plot. When I woke the following morning, I found that if I opened the old curtains in the bedroom just right, I could sit at the end of my bed and bathe in the light without getting the sun in my eyes. Out of the glare, I opened my friends.

I’m in my new place, I told them. The sun feels so good.
–– I miss the sun. Been in here almost six months now. How’s that for
a 72-hour hold.
–– window’s dont count unless at least 3rd floor lol
“Window’s” are good for more than killing yourself with, I wrote back. Some of us want a nice view before we croak.
Sour, I switched to Dr. Josh’s message from last night.
––Did you hear about the storm coming Sunday?
I recalled the recent swam of summer people. Today was Friday.
Yeah obviously.
–– You want to get started this week then? Next week looks like a
wash. “Wash” haha. Get it because of the storm…
 Still on for the finger? I typed, ignoring him.

Three typing bubbles emerged and disappeared once, then again. Suddenly, I felt so dizzyingly lonely I got goosebumps, and my stomach dropped to my toes. I turned off the screen.

I should have been grateful for Josh. I was grateful. Perhaps it wasn’t rare to find a doctor who secretly liked to hurt more than help –– I had certainly had plenty, heard secondhand about plenty more. It certainly was rare, though, to find one who’d admit it openly, so openly that he’d write a whole internet listing about it, and then maintain it for –– if my friends’ consensus could be trusted –– at least three years now.

I had no reason to distrust them, my friends. We were working toward the same goal, freedom, a kind of autonomy that was especially sweet in that it was terminal. Though we came from all over, we lived in one place, a forum whose URL I won’t name but which is styled similar to an off-brand Reddit. Jeffy, its late, fabled founder, had started the thing on Reddit, only to be kicked off amid a larger crackdown on self-harm related content. Strictly speaking, read an old Jeffy post, Suicide is about self-killing, which is distinct from self-harm as such. Reddit did not find this compelling.

Fortunately for Jeffy, the removal of the forum –– dedicated to the theory and practice of suicide, as well as “unbiased and unconditional” support for those in the process –– from Reddit turned out to be a boon. The usual free speech moral panics ran their course, and, in the process, exposed more people (myself included) to the existence of the forum. By the time Jeffy finally achieved terminal autonomy a year later, its user base had grown exponentially, and the number of subforums had grown from a meager three to over thirty, including one titled Wanna Help? (With reviews!).

Dr. Josh wanted to help. Or, he wanted to hurt and kill creatively, which was, in this case, a form of helping. He was a local, freshly minted MD, though he’d begun advertising on the site when he was still a resident. His services were free. The compensation was non-monetary.  Seeking a creative exit? read his ad. Look no further.

Among those advertising were the standard pill-pushers and morphine dealers, Dr. Josh distinguished himself by specializing in dismemberment. I could choose a speedy or “protracted” package, depending on personal preference. How long would I like to live with less and less of myself before dying for good?

I chose protracted. I had rushed last time, failed, gotten trapped in the dual purgatories of day program and community college. This time, I would take control of my life. My death. I’d keep it until I was gone.

Still on for the finger, I typed.
––I’ll pick you up tomorrow where we said, he replied near-instantly. Bring the contract.
Ok.

◆

In the evening, when the outside heat had not quite broken, I sat in the yard and watched my neighbor garden. I kept my phone screen facing upward on my thigh, but didn’t expect Dr. Josh to message me. He wasn’t one for chit-chat –– not, he had told me during our consultation –– since the first girl. Obviously, a statement like that had led me to pry, ask about all of the usual things you ask someone with a niche hobby: why do you do it? How did you start? Dr. Josh explained that, after the first girl and much soul-searching, he came to realize that the consensual dismemberment process had salutary effects on his own life, so long as he did not become too attached to his clientele.

“Most med students start really burning out around their third year. I had to find a way to stick it out, to get where I am now. What better way to get that, I don’t know, external validation? The feeling you get when you get to fix someone’s problems? It’s hard to stick around when everything’s so thankless. I considered dropping out.” He said this readily, and I got the sense that it was his usual script. I felt as if I was being pacified, and as if –– though I knew what was happening to me –– I was readily swallowing it. It tasted nice.

“So you started ending lives instead in order to save yours? From…burnout?” I asked.

He assured me that it was nothing quite so dramatic. Asked if I’ve ever heard of compassion fatigue. “It’s a real epidemic. Doctors feeling more useless and frustrated, and on top of that, feeling less for our patients. I needed a way to feel something again, to really help people.”

I had heard of it, though I wasn’t sure where. I told him this, and he agreed that mental health was a big thing these days.

“Actually, the psychiatrists are some of the most burnt-out bastards I’ve ever met,” he continued, affecting a thoughtful expression. “And after my psych rotations, well, I don’t blame them.”

Knowing my own history of hospitalization, he was quick to assure me that I was nothing like those patients.

I thought about compassion fatigue for hours after we ended that initial call. Later, eating spaghetti with a plastic fork and no knife across the table from my parents, I realized I had learned about compassion fatigue the same place I’d learned about the forum: the news. It had been a fifteen-year retrospective on Hurricane Katrina, a disaster that had occurred at the precise time in my life in which I was old enough to understand magnitude, but not stakes. That is to say, the canal-streets and tiny people screaming for help had appeared to me like an unbelievably scary video game.

On YouTube, I found a pastiche of staticky local news clips from Louisiana in Katrina’s immediate aftermath. At 22:29, a reporter held his microphone out to a slim, blond woman.

“There’s this thing psychologists are calling ‘compassion fatigue.’ The idea that, at a certain point, feeling the pain of others is just too much. You get tired. Tired of it, too. Tired of being overwhelmed, scared, devastated…and you just shut down, you can’t figure out how to care anymore.” His face was fuzzy onscreen, but his voice was earnest.

“I can’t care about every single person’s suffering,” said the woman. “For a couple days, all of us were overcome with fear, sadness… but then I thought, I can either sit around being sad, or I can get back to doing real stuff. So I told myself, okay, you can send your donations, then you step away. I can’t possibly care about everybody. I don’t want to care about everybody.”

“Surely, that’s too tall an order for any reasonable person,” agreed the reporter. “Seeing the truth requires healthy distance.”

In Dr. Josh’s professional opinion, we would start small. A single, straightforward finger. It was easy to return to the land of the living with a finger gone, especially a pinky, and I would have as many opportunities to return to that land as possible. Later, we’d graduate to two fingers, then three. We’d consider the whole hand after that, and then onward until most of me was gone, until I was better off, as Dr. Josh put it, out of my misery.

The process could take months, but usually no longer than a year. Much longer and the terminal shrinkage would become too obvious, too stinking. Much shorter and he would be betraying his self-imposed obligation to patience. With this model of “protracted choice,” he was thus relieved of the need to sit up worrying that he’d gone too fast, too soon, too carelessly; I would, in turn, have the guaranteed opportunity to be slow, measured, and deliberate with my decision. These guardrails, as he called them, protected us each in different ways: it protected me from losing my autonomy, and him, of course, from committing a murder. I’d have plenty of outs, plenty of moments to relieve him of his duties. He acted like some enlightened college boyfriend, tiptoeing around my body: I just don’t want to make you do anything before you’re ready. I’m ready. I’m ready. I said this to him in a more roundabout way, in more words, and hoped it was enough that he learned to believe me.

◆

            On the day of the pinky, the storm was close enough to make bad clouds overhead. The weatherman on TV had called the latest drivers inland “sneakers,” as in, sneaking out of paradise just in time to avoid its collapse. I got dressed in clean linen pajamas in front of the T.V., watching a crystal-clear image of a young reporter in a purple raincoat, trudging beneath a dark, sputtering sky. Here, the sun was still out, but it was a threatening sun that illuminated inbound clusters of grey-black.

When he texted arrived, I slipped on my sandals and walked three streets, finding his truck exactly where he had said it would be: parked across two spots in front of Cumberland Farms.

“I got you some juice from Cumby’s,” he said. I thanked him and watched him take a long sip of his slushie. When I made to get in the passenger seat, he pointed me to the tiny backseat area with a grey picnic blanket.

“Sorry, can’t risk it. But the drive’s barely half an hour.” I looked around for fear of sneakers spotting me, but they were more concerned with the gas pumps. I climbed into the backseat floor. We drove in silence to jazz on the radio.

Dr. Josh, as it turned out, operated inside a modest shed on a small patch of land owned by his friend, a self-taught tattoo artist whose flash –– stylized images of hearts, roses, roaring panthers and lions, the occasional sword –– hung the perimeter. The entranceway featured two long windows that cast light on a beige half-wall. The area behind the wall, which held the bed, the tools, two garbage cans, and a large biohazard box, was dim and windowless until Dr. Josh turned on a blaring overhead light.

He laid me on the bed. He put on a surgical mask, but for the moment, it stayed tucked below his chin.

I want to keep it casual, he had mentioned on the forum. You can give it whatever gravitas you want, but for me, this is just an activity I do it because it makes me happy.
Don’t make it what it’s not.

At the time, I had assumed that this was a way to ward off the inevitable fetishists, the inevitable contingent turned on by limbjobs. My friends, however, had swiftly corrected me.

–– he doesn’t give af if you’re a freak lol. He butchers people as a HOBBY
–– He just wants to make sure you know he’s not a monster, that he can’t be a Mengele if
he’s helping people achieve their goals and stuff…

 

“You ready?” Dr Josh asked. His mask was up over his mouth and nose now. He had slipped out and back without noticing, changed out of his clothes. He looked silly in his poorly-fitted scrubs and purple shower cap.

“Yes,” I said. He readied the local anesthetic.
“No, wait,” I said, just to see what he’d do. I was in it for the autonomy, too.
“What is it?” He asked.
“Just a test.”
“Let me know when I’ve passed.”

I said he had. His eyes were amused. I could tell he was smiling. He administered local anesthetic, applied the tourniquet to my pinky, just below the second knuckle. Soon, I felt the empty space enter the fullness of the digit, even before it was gone. I felt the need to use verbs like administered and applied around Dr. Josh, call it a digit when I could say finger. I had always been good this way, asking the right questions to make my doctors feel helpful and unthreatened, yet also impressed by my intellect and savvy. Nothing like those patients.

The cuts sent tingles up my forearms, into my chest. In a long moment, the tingles became chills. I looked away. I was always looking away. I imagined I was outside, it was a calm day, I was surrounded by pine trees surrounding Dr. Josh’s parked truck. I looked at the trees, at some pigeons picking around the truck. Maybe there was something dumb and gentle in the truck bed, an old cooler or pool toy. Maybe I’d remind him, hey, take that out before all the rain, bring it inside.

Dr. Josh hummed as he separated me. And then the finger was gone. He cleaned me, opened the juice, gave me a straw. I sipped and watched him remove the mask, strip the cap from his head, disappear into the small bathroom and emerge in jeans and a t-shirt. As it turned out, he did have a cooler, but it was a small one, into which he placed the remains of my pinky. He carried it out like a briefcase, and I followed.

He gave me a bag of supplies when we got back to the truck, which was sickly hot with sun and sticky with humidity. The air was thick, too thick for the air-conditioning to keep up with. I cradled my fingerless finger on the truck floor and tried to ignore the sweat creeping from my hairline and into my eyes.

The silence we had in here was special, just Josh and me and the big hazy sky out there where I couldn’t see. My body began to notice that it was in pain, and more than that, in bewilderment. My head felt as if I’d gone a day without eating, past the heart-pounding, head-rushing stages of hunger, of pain, and directly to a place of oblique, intoxicating distance. I’m a lady in the sky, I dreamt, watching a cloud become a floating woman through the sunroof. I darkened and rolled with her.

(What sunroof, I asked myself into the hot grey blanket. What kind of fantasy are you under, here?)

“Why would saving a life feel like drowning?” I asked Dr. Josh.

“What?”

“You said that in one of our conversations earlier. That when you think about saving lives, or actually have to, you feel like you’re suffocating. Like someone is holding you underwater.”

“It’s not really the saving part, but what comes next. There’s something about watching someone come in incapacitated, but wander away alive. I’m watching them like Frankenstein, like, ‘what the hell have I made? What are they going to do?’”

“You didn’t make anyone. They’re already here,” I said. Even as I said it, I wasn’t sure I believed myself.

I heard him turn in his seat, felt him looking back at the lump in a blood-stained blanket that was me. I wanted to scream at him, turn around, there could be cops, but I had no voice.

“I didn’t make them as they were, but I am responsible for what they are –– that they’re still around at all,” he said. I breathed a sigh of relief when he turned back to the road. I did not want to die in a car accident.

“When I kill someone who wants to die, I know I can succeed. There will come a time in which that process is complete, no mess. I’m done and can move on. When I save anonymous lives, I’m releasing who-knows-what into the world. I’m creating the opportunity for those people to come back, have more problems, get worse. I can’t handle imagining all those people, anticipating their futures. I’m just not built to think that big.”

◆

            The storm was like a story this time. I was up to my ankles in lukewarm mud. When I looked in my five-foot mirror, I looked like a comical christ, walking on water with my stubby, footless ankles. Then, I would turn again, and the illusion would be gone: the floor was damp, not deep, my area rugs were soaked but mostly salvageable. I had gone to sleep together with my tugging fear, matched not with images of my own home but of sick, sinking hurricane homes, wandering away from their moorings. The people on roofs and boats, left out with no choice. No, no. I was none of these things. I was dreaming, and I woke to my aching phantom pinky.

The lights were out, the wind was hard. My bedroom window rattled dangerously. According to my phone, it was 7:18 am, and it looked like the middle of the night. I plugged it into my emergency battery, and back-read old notifications from my friends as it did. I had told them that my operation was yesterday, confirmed when I arrived home that it had gone successfully. I sorted through the expected messages of congratulations and curiosity. I wrote my handle and the date on a piece of paper and held my left hand beside it, taking a picture to upload as “proof.” Doctors like Josh relied on reviews to get clients, and after the power was back, I would follow this teaser with one of my own.

I checked the bandage with my phone’s flashlight. No leaks, manageable soreness; slow death stayed boring. Sitting alone in the dark, I resisted the urge to google more disaster videos. Instead, I googled “compassion fatigue.” I was served first with colorful, uncomfortably cheerful infographics detailing the warning signs.

Symptoms of Compassion Fatigue:
You may feel odd or different all day.
You may withdraw or feel numb or blah, which is actually a protective device.
You may experience nightmares of being powerless or stumbling through a
destroyed landscape.
You may get headaches.
You may cry more easily.

Below the infographics and PowerPoints were a series of stock photos, mostly featuring models in medical scrubs, making pained expressions or holding their heads in their hands. Several rows on were images of disasters themselves, small, low-quality captures from TV news: a field engulfed by flame, an aching family’s home in wooden tatters, tides storming beaches and turning houses to sand.

When the rain went from pounding on the roof to tapping, my dad sent me a text.

––How’s the new place holding up? All good here, just thinking of you. Looks like things are calming down a little.

All safe here. Doubt the flowers next door made it.

–– Always next year!

Haha, if you say so.

All at once my stubby fingerspot turned into a bouncing jack-in-the-box extolling the virtues of suicide. Who knew what I’d say next. The sky had gone from black to blue-grey and hunger tugged at my stomach. I told my dad goodnight, just to be on the safe side.

◆

The morning after, I carried my old milk and leaking frozen dinners to the dumpsters with everyone else, walking past my neighbors’ mottled flowerbed and several skinny, uprooted bushes. The treeless pseudosuburban street bore minimal damage; no trees meant no crushed cars or roofs, less debris on the road. Driving right-handed, I followed a line of cars out of the neighborhood and into the downtown, where stranded summer people and locals alike wandered the puddled sidewalks in bewilderment.

The summer people were always red-faced and bothersome, always in their beachwear at Big Y, picking furtive grapes from their plastic packages to test their ripeness. They were especially bothersome now in the storm’s aftermath, puttering through the aisles in search of flashlights and water jugs, loading carts with canned corn they’d keep until Thanksgiving before handing to the church food drive.

I walked through the barren aisles, snaking between complaints. There was no bread, so I added some spinach tortillas as a distraction. I passed the emptied, strange-smelling coolers, all dripping with condensation and stray, soaked green beans. A teenage employee passed me with a cart loaded with dumpster-destined cheese. I turned around my cart and headed to the registers, picking out an impulse Snickers from the checkout rack.

“How are you holding up?” Asked the teenager behind the register. I froze before realizing that he was asking about the storm, not my finger.

“Can’t complain,” I said.

“Me neither. Compared with some of the stuff people get hit with…”

“Yeah, I really can’t imagine.”

He finished scanning my items and handed me the Snickers. I opened it and took a bite.

“Can’t complain or imagine. Cash or card? Whoa, you okay?”

The bar was in my left hand. There was now a tiny swoosh of chocolate on the gauze.

“Yeah, just an accident from before the storm. But I’m fine. I have a Snickers.”

Back at home, I placed the still-bagged groceries on the counter. I made myself two raw spinach tortillas with hard cheese and ketchup. Then, I logged back into the forum, which served me with a reminder to leave a review or risk a temporary account ban for untimeliness.

The system was well-organized, with designated spaces for each piece of information, though these were more difficult to read on my phone’s screen. I used my right thumb and left index finger to zoom in on every text box: forum handle, age, region, provider. For the latter, I wrote Josh and hoped that that was enough.

Before the button marked “proceed to review” was a red checkbox with the title “Safety First.”

By checking this box, I hereby affirm that I consent to sharing the following information, and that this review represents my experience truthfully, to the best of my ability. I understand that this review is uneditable and will remain online in perpetuity.

In that moment, I entered an ocean. Maybe the river rose to me. The current batted my windows. I watch the sunshine outside. The sunshine watches my furniture and me unmoor. This is unreal, yet I am thrashing, begging my gauze to stay above the water. My friends watch in familiar, abject horror, because all disasters are really one disaster in many different shapes.

Yes. I consent.

I am ready, with floating road-fish begging like puppies at my toes.