Dear Immune Response
Winner of the Nancy D. Hargrove Editors Prize in Fiction
Is this the kind that kills you?” Beth asked in the tone she used on conference calls when a client was vague about deliverables or the timeline.
Dr. Vasquez did not flinch.
“No,” she said. “Not usually. Lupus is treatable. Lots of people live long lives with it.”
Beth nodded. She had already begun composing the calm, competent email she would send to her boss. A minor autoimmune condition. Under control. No disruption to workflow.
“I want to be honest with you about what we know and what we don’t,” Dr. Vasquez said. She leaned forward, glancing at the chart on her clipboard. “We don’t understand what causes lupus. There’s a genetic component so a person’s genes can make them more susceptible. Hormones play a role, too. Women are affected more than men, and onset frequently coincides with hormonal shifts. There’s the environmental triggers. Also infections and certain medications.”
She paused.
“Stress is a factor, but it doesn’t cause it. I should be clear about that. But in someone who is predisposed, stress can be one of the things that tips the balance. There’s rarely a single cause. It’s a combination. Genetics loads the gun. Life can pull any number of triggers, and we can’t always tell which one tipped the balance.”
Beth appreciated that Dr. Vasquez did not soften it into pablum or harden it into a lecture. She picked up her medication at the CVS and drove home through suburbia with the windows down even though it was October. Their house was empty. Neil was traveling so she sent him a text:
Rheumatology confirmed lupus. She
says people live long lives with it.
We’ll talk when you’re home.
She filled a glass with ice and poured a rum and Coke like she used to do in college. Strong and with a squeeze of lime. The first sip burned a little, and it felt appropriate.
Her immune system was attacking her own tissue. Her internal guard had turned, with great enthusiasm, against its host. Everything she was experiencing was friendly fire. The joint pain, the fatigue, the rash across her cheeks she had blamed on a new moisturizer.
The labels on the medicine bottles in her pharmacy bag were bright white and aggressive in their clarity.
The first bottle was hydroxychloroquine, and the instructions said to take two tablets daily with food. The prednisone bottle came next with directions to take one tablet daily. The last bottle was methotrexate. Six tablets, once a week. She picked one of the pills up and turned it over between her fingers. Dr. Vasquez had said it would help slow the immune response and quiet the inflammation, persuading her body to stop treating itself like hostile territory.
She took another drink of her rum and Coke. The warning about limiting alcohol consumption surfaced from the appointment, but it arrived with the same bland authority as the directive to wear sunscreen and pace herself. All these small instructions assumed a version of her life that did not yet exist.
Limit was a flexible word. It didn’t mean none at all. Limit meant that you could behave as though the future was negotiable, as though the body and the person living in it had come to a reasonable arrangement about how life should be lived from here.
But she was not ready for reasonable.
She tipped the methotrexate bottle into her hand and shook out six small yellow tablets. She stood there for a moment with them in her palm, the rum and Coke sweating on the counter beside her.
“Well,” she breathed into the empty kitchen.
She swallowed the first one with a mouthful of rum and Coke, and the carbonation stung her throat. She took the second and third the same way, the lime brushing her lip each time she lifted the glass. By the fourth tablet the ritual felt procedural like signing a packet of documents she had not fully read.
The fifth pill stuck briefly at the back of her tongue before sliding down, but the sixth went down with no resistance at all.
When they were gone, she stood at the counter and waited. Inside her, beyond the reach of feeling or intention, the medications dissolved into her bloodstream, introducing themselves to body systems that had not been consulted about the arrangement.
Beth finished the rum and Coke and set her glass in the sink.
Then she opened the drawer and took out a yellow legal pad. She’d spent twenty years in corporate communications, and its bureaucratic language was a tool she trusted.
Dear Immune Response,
I am writing to inform you that you have made a mistake. I understand that this
happens in organizations of your complexity, and I do not hold you personally
responsible. However, it has come to my attention, via Dr. Elena Vasquez in
Rheumatology, Suite 412, that you have been targeting my connective tissue,
kidneys, and joints for attack. These pieces of me are not invaders.
I would appreciate a prompt correction.
Regards, Elizabeth Mosey (Host)
She set the pad on the counter, took the rest of her prescriptions, and then went to bed.
She woke up to two replies. The text from Neil was expected:
That sounds stressful. Glad it’s
treatable though. Flight’s boarding.
She found the other one when she reached for the legal pad to make a grocery list. The handwriting was hers, and at first she thought she had written it and forgotten. After all, it was written in the same blue ink of the pen she kept by the fruit bowl. But she didn’t remember writing these words.
She stood at the counter, the legal pad in her hands, reading it once and then again.
Her body had written back.
Dear Elizabeth,
Thank you for your letter. We reviewed your complaint and conducted a complete
audit of the tissues you mentioned.
We regret to inform you that we stand by our findings.
Our department identified autoantibodies circulating in your system. These
antibodies are binding to structures that resemble foreign material. Unfortunately,
those structures include components of your connective tissue, joints, and kidneys.
We recognize that this may appear to be a mistake. From your perspective, these
tissues are friendly. From ours, the signals we’re receiving are ambiguous. Cellular
debris, inflammatory markers, and immune complexes have assembled at levels that
have triggered the proper defense response.
In layman’s terms, the body has determined that these parts of you resemble a
threat.
We understand that this is inconvenient. However, once surveillance mechanisms
like us are activated at this scale, reversal is not a simple matter.
We are open to ongoing dialogue and will continue monitoring the situation closely.
Respectfully,
Immune Response
Beth stared at the legal pad for a long time. Then she called her sister.
“I might be losing it.”
“You’re not losing it,” Paula said. “You just got a major diagnosis.”
“I wrote a letter to my immune system to ask it to stop attacking my body, and it wrote me back.”
There was a pause during which Beth heard Paula’s children screaming in the background. A crash followed, and one of them shouted dinosaur with the conviction of a courtroom objection.
“Hold on,” Paula said, and then Beth heard her shout away from the phone. “Nobody throw anything at your brother’s head and I mean it!”
The line rustled.
“Okay,” she said. “Now say that again.”
“I wrote a letter to my immune system, and it wrote back.”
“Like metaphorically?”
“Like I woke up and writing magically appeared on a yellow legal pad talking about things like cellular debris, inflammatory markers, and immune complexes.”
“Huh? Do you even know what those are?”
“I looked it up. They’re real.”
Another pause.
“Alright,” Paula said.
In the background one of her children began singing about dinosaurs. Paula either didn’t notice or didn’t care.
“So what was its response?”
“It stands by its findings.”
Paula exhaled.
“Well,” she said. “That sounds very bureaucratic.”
They stayed on the phone together for another minute, but neither of them said much. In the background the children’s argument escalated but then faded into laughter. Paula told one of them to stop licking the dog, and Beth smiled and pictured the kitchen she had grown up in which was now full of small bodies and noise. She frowned, feeling both comforted and very far away from it.
“Well,” Paula said. “Keep me posted if your spleen decides to file an appeal.”
“Will do.”
Neil came home with a missing carry-on bag and a story about a delayed flight in Dallas. Beth listened and asked all the right questions. They ate dinner at the kitchen table, and she told him about her diagnosis. She used Dr. Vasquez’s name, the names of all the medications she’d been prescribed, and the schedule of blood draws. She laid it out for him like one of her project plans, each piece in order.
He listened, nodding along as she spoke.
“Jason, my buddy at work, I think his wife has something like that,” Neil said. “Autoimmune issue. But she’s fine. She runs in the afternoon, goes to the gym, all of those things. He said once the doctors got her on the right cocktail of meds it was basically nothing.”
“Okay,” she said.
“I’m just saying. It sounds like it’s manageable.”
“It is,” she said brightly. “The doctor said that.”
“See? You’ll be fine.” He reached across the table and squeezed her hand. “You always are.”
She washed the dishes, and he went to watch a baseball documentary on television. She stood at the sink with her hands in the hot water and thought about what the phrase basically nothing meant. She thought about how he had moved from her fear to Jason’s wife, from her body to another woman’s body, from something frightening and new to a problem that had already been solved.
She dried her hands and looked at the yellow legal pad on the kitchen counter.
The methotrexate was making her nauseous. She wrote again that night before bed.
Dear Immune Response,
I can accept that you believe in your findings. But I would ask you to think about
proportionality. Even if you have identified a real concern in the tissues you flagged,
your response is disproportionate to the threat we are facing. This inflammation,
destruction, and systemic escalation is the equivalent of burning down the house to
kill a spider.
I am tired all the time now, and my hands won’t close completely in the morning. I
stopped running. Do you understand what you are taking from me?
I am not your enemy.
Regards,
Elizabeth Mosey (Host)
Beth waited. After the second day passed, she began checking the legal pad at least once an hour between her remote meetings.
She found a reply four days later just after her nine a.m. team check in.
Dear Elizabeth,
We can appreciate your concerns regarding proportionality, and we examined your
analogy regarding the house and the spider. We find it inaccurate.
A more accurate analogy is that you are a house that insists its foundation is solid.
You’ve covered the cracks and said, “See. Everything is fine.”
We accepted this for many years.
We want to be precise about what happened next, because the body’s precision is
its greatest strength.
Your system was predisposed before you were born. This was written into your
genetic coding, and while you did not choose it, you also cannot alter it. For
decades, your predisposition did not affect you. Many people carry similar traits and
never develop symptoms. Your predisposition was not necessarily your destiny.
The distance between your susceptibility and your immune response is measured in
accumulated inputs. We found there were several. For example, your hormonal
fluctuations during your pregnancy. Then a course of antibiotics you took in 2014
that disrupted your microbial balance. You’ve had many periods of insufficient sleep
that did not support cellular repair, and your UV exposure throughout your life has
been high.
Among these inputs, we also found high cortisol levels sustained over years and
inflammatory markers consistent with prolonged psychological distress. You have
held tension in your muscles long after the stress stimulus was removed.
We are not a system that responds to a single cause. We identified a pattern across
inputs, and that the pattern became, at a certain point, sufficient for a response.
You asked us whether we understood what we are taking, but we do not believe we
are taking anything. We are simply responding to what has accumulated.
You may wish to consider what did the accumulating.
Respectfully,
Immune Response
She didn’t write back for two weeks.
She took the methotrexate, and she went to the lab for blood draws. While she sat in the waiting room with other people whose bodies had turned against them, she thought about the word accumulated.
She thought about it in the shower, on the couch, during meetings, and in the passenger seat while Neil drove them to dinner with the Turners. She smiled and told everyone she was feeling much better, that the medication was really helping. Neil put his hand on her back in a way that looked like tenderness but she knew it was more like a lid being placed on a jar.
She married Neil at twenty-two and loved him the way young women do when they mistake being chosen for being seen. She was grateful for his love, and she held a quiet readiness to become whatever person his choosing required.
Neil never shouted, and he didn’t insult her. He remembered birthdays and paid the mortgage on time. When people asked about their marriage, Beth said, honestly, that he was a good man.
The difficulty was that his goodness was arranged around the quiet requirement that she had to be smaller than whatever space he chose to occupy. She didn’t have to be dramatically smaller, and it was never enough that anyone outside the house might notice.
But it was enough that when she spoke too eagerly at a dinner party, he would go still beside her. The subtle withdrawal of attention felt to Beth like the lights dimming in a room. The silence that followed suggested she’d made a small social miscalculation.
So she adjusted.
She softened her tone and laughed at herself. Then she would offer the conversation back to him the way you slide a chair toward a person who looks as though they were left standing.
Later, he’d say something in the car that was corrective.
“You don’t have to try so hard” or “Do you know how loud you were talking?”
They were instructive observations offered in the tone of a mechanic helping to rotate a tire that was out of alignment.
Beth would nod and thank him for telling her. She would promise to be more aware, and over time, she became very good at that awareness.
She’d learned to read the small shifts in his posture. The tightening of his mouth or a pause that lasted a little too long. She trained herself to feel the faint cooling of the air between them when she pressed an argument he decided was finished. She spent twenty years living inside the atmospheric pressure of a system that functioned best when she stayed small and occupied less space than she naturally required.
Last year, Beth’s daughter Lena came home from her first year of college. She picked her up from the airport, and on the way home, Lena talked about her philosophy classes and a boy she met who loved baseball and hockey just like Dad. She brought up a professor who began every lecture by standing in silence for thirty seconds and a TA who insisted they call him George the Almighty.
When they pulled into the driveway, Lena stopped mid-sentence and looked up at the house.
“It’s so quiet,” she whispered.
“Well, your father’s traveling again for work so...”
“No. I mean it’s always been quiet, even when I was a kid. I never thought about it until I left.”
They carried her bags inside, and Beth made coffee. Lena wrapped both hands around her mug and said, “Mom, are you happy?”
Beth remembered Lena as a hostile teenager and imagined that to her, her mother’s happiness was a foreign country she had heard about but never visited. She had grown through the stresses of college life and now she was curious whether that place was real.
Beth said yes.
Lena looked at her, then at her coffee. “Okay,” she said.
They didn’t talk about it again, but the question stayed in the house. It surrounded Beth, taking up residence in the walls, sitting between them at the dinner table, and when Lena returned to school, the question did not go with her.
Beth was thinking about Lena’s question when she wrote again:
Dear Immune Response,
I’ve been thinking about the word accumulated.
You used it in your last letter when referring to cellular debris, inflammatory markers, and my
immune complexes. You described my situation the way an accountant describes interest, like
there has been something gathering quietly over time, adding up in places no one is looking.
I think I can understand that kind of math, because for twenty years I’ve been calculating the
cost of speaking versus the cost of staying quiet. Most of the time my numbers favored staying
quiet, because my quiet kept the house calm. It kept dinner pleasant, and it kept the emotional
temperature of the room at an acceptable level.
But in doing that, I made deposits into my body in the form of corrections, pauses, adjustments,
and quieting myself when I wanted to speak. I made these deposits so often that it began to feel
as ordinary as breathing.
Now, based on what you’ve told me, it seems the residue from these deposits sits in my joints
and in the lining of my kidneys and in any number of other tissues.
With that in mind, I want to ask you something.
Did you hear the signals all along? While I was explaining things away and calling it love, were
you taking notes or excusing it like I was? And if the system you run has been taking notes and
marking these accumulations my entire life, why is this happening to me just now?
Why did you wait until my hands ached, my joints stiffened, and my face went red with a rash
across my cheeks?
If you knew this was going to happen, why didn’t you act sooner so we could stop it? Please
understand that I am asking all of this in good faith.
Elizabeth Mosey (Host)
Beth folded the page back over the legal pad and sat for a moment with her hands flat on the counter. The joints in her fingers ached and she flexed them. She had asked a question. Now she would have to wait for the part of her that kept the records to answer it.
The answer appeared the next morning.
Dear Elizabeth,
Unfortunately, we do not have an exact answer for you.
What we can share is that activation thresholds are not crossed by a single event. We rely on
accumulated inputs reaching a level that the body can no longer process. The timing of our
reaction is determined by the total.
We know that you are looking for the thing that broke you. That is a very natural and very
human response, but we do not have that thing to give you. We have a long record and a
system that responded to it. Instead of asking why now, we believe you should be asking what
things have been entered into the record and for how long those things have been in your life.
But you already know the answer to that.
Respectfully,
Immune Response
She started therapy the next week.
She found the office on the second floor of a converted house at the end of a quiet street. The waiting room smelled of fresh linen and old books.
The therapist greeted her with a handshake and introduced herself as Dawn. She wore reading glasses on a thin chain and a gray cardigan with so many pulls that it suggested she had stopped worrying about impressing anyone. Her office contained a purple couch, an antique chair, and a lamp that gave off a bluish hue and made the room feel like evening in the middle of the afternoon.
Dawn started the first session by asking Beth to describe a typical day. Beth did, hitting all the major points. Work, Neil’s travel schedule, the medications she took, the blood draw visits.
Dawn listened, and then let out a small hum before responding, “You described your day the same way you’d describe someone else’s day. You just listed things without emotion.”
During the second session Dawn asked about her marriage and Beth told her, trying to be as honest as she could. She didn’t want to sound dramatic, but she described being quiet and the way a room cooled when she brought too much of herself out into the open. She described the adjustments she made without thinking anymore, and the small translations she did in her mind before speaking depending on how Neil held his body or face or tone.
Beth expected and dreaded that Dawn would nod in encouragement or repeat her words back to her. Instead, she listened, her attention locked on whatever Beth might choose to reveal next.
When Beth finished, Dawn was silent for a short moment, and then she asked, “How long have you been doing these translations when Neil is around?”
Beth looked away. “I don’t know. For a long time, I guess.”
“Do you ever slip up? Say the wrong thing?”
“I used to.”
“What happened?”
“Nothing big. He’d go quiet.”
“And then?”
“And then I’d fix it.”
Dawn reached up and pulled the glasses from where they rested on top of her head, turning them in her hand.
“And what exactly were you fixing?” she said.
Beth opened her mouth and then closed it. The answer might open a door that opened onto more doors.
“The temperature,” she said finally.
“His temperature or yours?”
Beth turned her thoughts to the letters, to the accumulated inputs and the slow gathering of notes across years.
“I don’t know if there’s a difference anymore,” she said.
Dawn put her glasses on. “Your body thinks there’s a difference.”
Beth looked down at the swollen joints on her hands and fingers.
“My immune system seems to think that I’m living in hostile territory.”
“Is it wrong?”
Beth tilted her head. “It’s been more right than I have.”
Dawn looked her over, raising an eyebrow. Then Beth surprised herself by laughing out loud.
When she went home that afternoon, she sat at the kitchen table with the yellow legal pad and wrote another letter.
Dear Immune Response,
I’ve thought about what it means that you are literally and not metaphorically me. You’re made
of my cells and you run on my blood. At least, I think that’s how it works. And that means that
every antibody you have sent after my joints and kidneys was built inside my body.
Which means that perhaps this attack is not a betrayal.
I’ve come to realize that you are the part of me that could not be convinced. You took in the
inputs I could not change, my genetics and my hormones, and built the cracked foundation. I
cracked it open further with a life lived smaller than it should have been, a life lived in silence.
Perhaps I can do something about that now.
I’m not going to ask you to stand down again. But I would like you to consider a different
arrangement. I will stop asking you to unsee what you have seen. And you, if you can, if it is
within your power, will let me keep enough use of my hands to write.
I have things I need to say.
Beth
She and Neil were standing in the kitchen, the two of them occupying their familiar positions on opposite sides of the counter, when she told him she wanted to see a couple’s counselor. Neil’s brow was folded in concentration as he checked hockey scores on his phone.
“I think we should talk to someone,” she said. “Together.”
Neil looked up.
“Really? About what?”
“About us.”
For a moment his face stayed steady. Then a subtle shift moved over him, a narrowing of his eyes and lips that Beth learned over the years to recognize as the beginning of retreat.
“We’re fine,” he said.
“That’s your opinion.”
“It’s not yours?”
The old reflex rose in Beth, the urge to soften her statement and make it less confrontational. For a moment she wanted to translate her own experience into a weak adjective that would not disturb the air between them.
Then she thought about the letters.
“I think I’ve been quiet for a long time,” she said.
Neil held his gaze for a beat, then returned to the phone in his hand.
“Do whatever you think you need to do.”
He went silent after that.
Over the next few weeks, Beth experienced the familiar withdrawal of his attention, the slow sealing off of emotional territory she had stepped into without permission. The silence spread through the house, room to room until it occupied the same physical space as the furniture.
During their twenty-year marriage, Beth had always rushed to close that gap, apologizing for the way she had phrased things. She would reassure him that nothing was wrong and give explanations and adjustments until the air around their relationship warmed again.
This time she did not. She let the silence sit there like an unwelcome guest.
She made dinner and answered emails. She read a book on the couch while Neil watched hockey in the other room. When the pressure of the silence drifted toward her, looking for offerings of reassurance, she let it pass by.
Neil didn’t escalate. Instead, he became so courteous it was worse than coldness. He asked about her medication and brought her coffee in the morning. He was, in every observable way, a man behaving well. His consideration was so precisely calibrated to the situation that she understood it as his way of continuing the argument.
See, he was saying. See what you are disturbing?
She thanked him for the coffee and answered his questions about the medication; she did not apologize.
After a week had passed, he sat down in the kitchen to tell her about a difficult situation at work. She listened and asked a question, and then another and another. For the next twenty minutes their relationship looked exactly like what a marriage should be.
Then he went to bed and she sat at the kitchen table for another hour, listening to his snores from the bedroom.
The warmth between them was obviously real. Neil loved her in the way he was capable of loving her, and it was genuine, but it wasn’t enough for him to see her real self. She’d spent twenty years trying not to hold both of those truths at the same time.
The next week she called a therapist who did couples’ work and left a message with her name and number.
When she told Neil, he stood in the kitchen doorway and looked at her with an expression that was hard to read, a more complicated shift than what she was used to observing. He was trying to locate himself in a situation that had changed while he wasn’t watching.
“You already called?” he said.
“Yes. I left a message.”
He looked down at the counter, picking up his keys and setting them down again.
“I don’t think we need it,” he said, but this statement sounded different than we’re fine had. It was a position rather than a dismissal, an acknowledgement that there was something to have an opinion about.
“I know,” she said.
He left for work, and she washed her coffee cup and dried her hands.
When they discussed it again three days later, he said, “Fine. Set it up.”
The words carried the flat affect of someone stepping onto uncertain ground and deciding not to show that they had noticed. Neil was agreeing to enter a counseling room he did not trust because he’d come to know that the alternative was standing in the hall forever, waiting for her to come back out to get him.
The foundation of their marriage now shifted, and there was a good chance that this would not end with the house put back together again. There was a good chance that when two people finally said the things they spent decades not saying, the house itself would not survive the conversation. But Beth also knew that the house was worth trying to save.
A final reply from her immune system arrived the next day.
Dear Beth,
Remission is not something we can promise, as we are built only for the response, and
response is determined by conditions, not intent.
Please note, however, that cortisol levels have fallen. Your adrenal output has also shifted, and
behavioral inputs have changed. Whether this is sufficient to alter the current trajectory of our response remains outside our ability to predict.
You asked us in your first letter to correct our mistake, but we maintain that we never made one.
We remind you that the system responded to the conditions it was given, and it will continue to
do so.
Our system responds to data.
The data is changing.
I.R.
Beth placed the yellow legal pad on the counter.
The kitchen was bright with early spring, but her hands ached. They always ached now. They probably always would just like the way a house remembers where its foundation once cracked even after the walls have been repaired.
She flexed her hands open, closed, and open again.
For a long time she believed that the purpose of her body was to be quiet and carry her through rooms without complaint, to absorb all the bothersome things so that life could proceed.
But the body did not agree to this arrangement, and it had kept its own records.
She reached for the blue ink pen.
Her joints protested, sending a sharp signal up her tendons and into her wrist. Beth put the pen to the page.
She began to write.
Photo by Haley Lawrence on Unsplash