In-flu-enza: A post in several parts

A multi-part post in which I alternately stand on my soapbox and step down to muse a bit.

There was a little bird

Her name was Enza.

They opened up the window,

and in-flew-Enza.

--American jump-roping song popular in 1918-1919

PART I: Flu on my mind.

I've been debating for months whether to add my voice to the cacophonous bluster about flu that fills our media these days. I'm writing about it here because the whole pandemic influenza thing is not a new worry for me. I've been wary of it for many years, probably because it hits all my sorespots of worry and illness and control. I'll get more into that in the third part of this post series. For now, hang on for a bit while I hop up onto my lecture/soapbox and explain a few of my thoughts on it.

If you know me, you might well know that I have been, at times in my life, a fantastic worrier. But I'm also pretty damn willful, and I've been willing myself to let go of that worrying tendency. Over the past five years, I'd say it's actually starting to work.

Sometime in my anxiety-ridden twenties, I discovered completely by accident that I loved reading about history. And it brought an added benefit: visiting and studying the past was soothing, comforting. I am nostalgic at heart, and a sucker for a story--it's amazing it took me until my twenties to cultivate an interest in history. As I read more, I found myself not only drawn into the stories, but also calmed by the greater fact of history: the fact that life goes on.

Of course, looking to the past presents other problems. History is unconcerned with neat endings or safe outcomes. The past is, in its essence, a place peopled with figures who, right or wrong, with dignity or with disgrace, lived--and died. To embrace history is to make the admission that we, too, recede into the past; our lives will become simply remnants of stories, bits of ephemera that fade away.

Did I say earlier that I had willed myself away from worrying? That history soothes? Because that last paragraph is nothing if not melancholy. But as I consider history, I find a strange comfort in the juxtaposition it presents. Thinking about the past offers that rare chance to hold in the mind, simultaneously, the ideas of both mortality and hope.

The events of the 1918 influenza pandemic distilled these feelings for me, when I stumbled onto it. As I learned more about it, I had the feeling of discovery, as though I had unearthed some weird secret of the recent past. Of course, it's getting its fair share of play right now, but for decades, it was a largely forgotten story.

My interest in what happened in 1918 fostered a curiosity about influenza in general. And what I hope to do with this next posts is to share some of my thoughts and attempt to make some sense out of pandemic flu since I started thinking about it years ago.

Pandemics are nothing new. And--this part is important--pandemic does not necessarily mean deadly. Pandemic just means a disease significantly "spread worldwide." Simply because a virus has a high infection doesn't always necessarily mean that it's deadly for many people.

But influenza is a tricky virus, and it *can* be deadly. It's that unknown element that makes it frightening.

The past 900 years of European history is peppered with accounts of entire countries or continents being besieged with deadly respiratory disease. We would certainly consider these pandemics today. Many of these aren't well documented, but the descriptions that do exist bear a striking resemblance to what we know as novel influenza. Of course, the most well-documented pandemic in history is the one of 1918, which killed upwards of 50 million people worldwide. As a comparison point, consider this: 675,000 Americans died as a result of the 1918 influenza, more than twice the number of Americans who died fighting during World War I.

When I first encountered them, these figures stunned me. I mean, come on. Flu. Everyone gets flu once in a while, right? A sore throat, a fever, a few days of rest---and it's gone. Flu is no big deal, right? I was incredulous that the flu actually killed so many otherwise young and healthy people. My initial, childish reaction to these accounts came from fear and ignorance: I scoffed at the limits of medicine at the time. What a long way we've come since then, I reassured myself. Nothing like that could happen today.

Still, my curiosity had been piqued, and I read anything I could about 1918. And then anything I could about influenza in general.

The picture that started to form in my mind was less ill-informed, and more frightening. The pandemic of 1918 was a perfect storm of circumstance, and it was not unlike what is happening now with the 2009 H1N1.

I want to be clear: I'm not implying that history is repeating itself. The H1N1 virus of 2009, while similar in makeup to the virus of 1918 , is not the same virus, and the scenario is obviously different. I do not believe that the strain of influenza (Novel H1N1/2009) circulating at this point in time will kill 6% of our population. I do not believe we are seeing the beginnings of story to rival The Stand, or the bible (how strange to see those in a sentence together). Still, some things happening now with the current strain of H1N1 give me pause. And my alarm bell, though admittedly prone to go off, has started ringing.

Part II: A Primer on Influenza

Part III: An Anti-definition of Influenza

And to skip to the reason on why I, in particular, am concerned:

Part IV: The Tricky Part for Me: Making Sense of Risk

The shifting nightscape of my insomnia

I sometimes have insomnia, the kind where you find yourself wide awake at 2 am, mind racing.

The river of thoughts that rushes through me at these hours used to be frightening. I would torture myself with a full spectrum of what-ifs, which spun my nerves more tightly with each round, until it was all I could do to lie flat on the mattress. During the first years of our marriage, my poor husband would sigh as I slid out of bed and fled toward the study. There, I would turn on a light and read or write, and wait for a feeling of "normal" to pull me back into my life.

This habit of getting up and doing something became an easy habit for me, and one that only made my insomnia worse. If I could grab a last hour or two of sleep before I showered for work, I felt like I had "slept." To my surprise, I managed; in fact, I thrived during the day. The light itself was a tonic, a revelation that everything was okay. And in the middle of the daylight I marveled at how clean and safe everything seemed. It felt impossible that the shadowy loneliness of my wee hours could coexist with the happy days I experienced. I look back at that time, and I know that I must have propelled myself through the world on sheer nervous energy.

The funny thing is, I never dreaded going to sleep. I loved our room, our home, our cozy life. I fell asleep as soon as my head hit the pillow, and my dreams were mostly rich and sweet. It was the slow, dark hours I hated, while I worried myself into a frenzy, my mind buzzing at the low frequency of the traffic on the interstate outside our loft.

In college, years before I had my own sleepless nights, I shared a dorm room with a girl who had chronic insomnia. She was the first person I'd ever met who talked about it and accepted it as a part of her life. When I woke to use the bathroom at the end of the hall, the half-light from our window revealed Lisa in the bed across the room, her eyes wide open and fixed on some spot on the ceiling. Almost always, she would roll over on her bed to greet me in strangely chipper yet sotto voice, "Hi Kirie!" Amazingly, sometimes she would start to engage me in conversation, as though I had just returned to the room after a class.

Lisa was probably only 20 years old, but she was as sensible as a real grownup. She never complained, but instead just took her insomnia on her own terms. Her solution: the radio on her Walkman. During those post-midnight hours, she tuned her radio to AM talk radio hosts, and they lulled her off to sleep just before light each day.

Knowing what I know now, I probably would have made a point to waken just to talk to her. The hardest part of my own insomnia was the loneliness. The otherworldly feeling of the wee hours comes not from the darkness so much as the absence of other people. No wonder Lisa welcomed my waking so eagerly. How I would have loved to wake my husband to talk with me on those interminable nights in the loft!

My insomnia pursued me through several moves, the arrival of our oldest daughter, and some practice with meditation. But, by some stroke of grace, once I got into my mid-thirties, the river of thoughts started bringing fewer and fewer anxieties with it as it coursed through my 2am bedroom. The darkness started feeling less oppressive, the dusky forms of our dresser or the curtains less threatening.

I stopped retreating to a lighted room, and resolved to instead feel the night settle around me each time I woke at odd hours. And on many of those nights, something resembling a calm came to me. Sometimes, I would even find that I could get myself back to sleep. By some small miracle, more and more of my nights were spent sleeping. Insomnia has now become only a sometime companion for me, and for that I am grateful.

When the formula in my life is right, the river of thoughts resumes its path through my night room. But bobbing along with it now are ideas, plans, things to puzzle through. When I wake up at 2 am these days, I am not buzzing with what-ifs. I am dreaming of projects, I am mind-writing, I am hearing music in my head. A few weeks ago I even caught myself practicing the fingerings for a song I'm learning on the piano. It is still otherworldly at night, but now the world feels charged with possibility instead of dread.

When I was younger, waking to the knowledge that I was the only one conscious left me gasping. And far from comforting, my husband's rhythmic breathing made me only all the more aware of how far away he was when sleeping, as though he had receded from me and into his dreams. My panic was practically tangible, like a whispered, frantic mantra of "I'm alone! I'm alone! I'm alone!"

Something has shifted since then, certainly. And perhaps it's because I'm distracted by my burgeoning list of projects, but I no longer feel so lonely when I'm up with my thoughts. Or perhaps I feel more secure in my marriage; fifteen years with my soulmate has taught me something more about trust, and I no longer feel he has fled from me in his sleep. The house itself offers its companionship. Far from frightening, the house at night envelops me, welcomes me, and nurtures some excellent ideas for all the things I enjoy making.

There is still the silence, but it is laced with the sounds from the woods outside our window, the foghorn on the bay, the thrum of the cats as the sleep on the bed. When I do want for a facsimile of human interaction, I find I crave voices. Last year, I realized I could, like my old college roommate, listen to stories through headphones, and I started using my ipod during my night wakings.

Hearing the whisper of a storyteller is intoxicating. I've found that with these voices in my ears, I'm soothed to sleep, but at the same time, inspired by the stories themselves. I've been discovering an unexpected energy in the spoken word, an energy that carries over into my perceptions of the next day. And, most surprising, I have actually started relishing my sleepless hours as quiet opportunities to just listen and dream my waking dreams.