Tamara has retreated to bed. She hears an echo of a knock at her door. No one is there. It is merely the ghost of a particular concern: that her six-year-old daughter Lily, whom Tamara has tucked in, may never have fallen asleep, or may have arisen from sleep in a nightmare state and left her bedroom to stand outside Tamara's door: wanting, needing.

Tamara is ill. Not terminal, but incurable. Spirochetes and parasites are everywhere that her blood has gone during the last four and a half years. It began with a tick bite. The organisms multiplied, thrived, will not be defeated. They do not date back to Lily's birth. They have nothing to do with Lily. Tamara thinks: the object of my concern has been displaced. Still she is terrified of disturbance, her daughter recounting what happened in her own mind during sleep—a thing that, Tamara knows, children often feel the need to do.

Tamara hasn't dreamt in months. She takes pain medication that, tonight and most nights, she puts off ingesting. She has come to equate herself with pain; and so, her body without pain is a world without her. "You are not alone," is a thing that people have been telling her. She thinks of how true those words are, but not for the reasons people intend. Tamara is not alone because there is a child who does not know how Tamara suffers, who is largely naïve to the meanings of self and other, who has never left herself to travel upwards or outwards so that she may truly see her mother. Tamara's anticipation of her daughter is her constant companion; she must rouse should Lily knock, hold her and smooth her hair, and listen to dreams about toothless old women, ancient monsters of the deep, menacing ghosts—all of them older than Tamara hopes ever to be.

On Tamara's lower abdomen, resting upon her uterus, she supposes, is a book of poems that she loved in college. She has come to detest the book's cover, which shows a male poet in profile, his nose like a bird's beak jabbed into the literary canon. She puts the book on the bedside table, sips water, and places the glass atop the book, knowing a watermark will form. For many years before her illness, Tamara loved flings: a succession of enchanting crescendos, which she abandoned before the inevitable diminuendos. Lily's father had been one of them. Tamara was always the flinger, never the flung. The doctor who treats her, an elderly man who looks vaguely like the poet, has earned her sympathy for his tireless efforts to help. Tonight, sympathy seems a foolhardy sentiment. She has no patience for men anymore, a fact which renders her boring to herself.

Tamara lost the lid to the bottle of pain pills days ago, so the bottle sits open beside the book and the water glass, always in that spot, day and night, which is not a safe thing when you have a curious child at home. This awareness is vaporous, wafts away. Pain burns Tamara's muscles and inside her shoulder and hip sockets; yet it is not pain, but some other, automatic drive that leads her arm to extend, her finger to pluck one, two pills from the amber bottle and deposit them in her dry mouth. Tonight there is what Lily called a "hangnail moon," through a mouthful of toothpaste froth. It took Tamara aback. She had never heard Lily say it before. Where did she learn it? Tamara has always used this phrase, just never aloud. The pills on Tamara's tongue have begun dissolving despite a lack of saliva. The memory of a knock is not a knock, she tells herself. The disintegrating pills are bitter.

Tamara wonders whether her sister Carmen, who lives in Arizona with three rescue dogs and a pot-bellied pig, childless, would—if she had a daughter, and if she were chronically ill—feel the same desire that Tamara feels now: a yearning for solitude in a life, a house, a mind, which makes solitude, in all of its crisp and airy and boundless splendor, an impossible thing ever to have. Tamara lifts the water glass in her hand, fingers tingling with neuropathy. The pills have softened and fluffed on her tongue. She hears an echo of Lily's knock, which she knows is just a memory of all the times Lily has ever knocked. The pills taste of doom or dregs of a certain liquor the dead male poet may have liked. "Shut up," Tamara whispers, immediately fearing that even this utterance might create molecular vibrations that could wake Lily. An event inexplicable without a grasp on quantum physics. Tamara has no such grasp, and this strikes her as perhaps the greatest tragedy of her thirty-four years.

She has sipped water and swallowed the pills without realizing it until now. It is time to surrender. Her mouth cool, she can discern only a trace of bitterness. Lamp switched off, covers pulled up, head lowered onto the soft pillow. Eight or ten minutes do not pass by Tamara so much as move through her. Racking pain becomes a throb becomes an ache becomes a gentle reverberation. It is always disturbing to her how quickly the drug takes effect. Not a new medication, but an old one—a staple of the canon.

Tamara's eyes shut. Some writers have likened sleep to death, but she knows otherwise. Sleep is the direct route to wakefulness under yet another sun. She hears an echo of a particular knock, one after which Tamara had soon deduced, from Lily's frantic head scratching and what first appeared to be dandruff, that her daughter had lice. Tamara is without shape or form, having entered into the realm of half-sleep, half-living, but still, half-listening. It is only when she lets go completely, slipping like a fish into darkness, that finally—mercifully—a knock comes.