Allergic Reaction

If you get ill after eating or touching something that didn’t make anyone else sick, you may be allergic to it. Especially if there’s a rash. Allergies are caused by your body rejecting substances it doesn’t like. There is no treatment but to avoid those substances. Fortunately, only a few types of allergies can kill you. Nut allergies, for instance. Bee stings. But I imagine most people with fatal allergies to common things have died by now.

I am allergic to wool, soy, peanuts, and pollen. Only my peanut allergy can kill me.

Appendicitis

There is an organ in your body called the appendix, and sometimes it goes bad and kills you. The only treatment is to cut it out of your body. I don’t recommend trying this. You’ll bleed to death. On the other hand, death from appendicitis is long and excruciatingly painful. So maybe try surgery. There’s something to be said for the quicker death.

Bears

Bears aren’t so bad. They can kill you very easily, but mostly they leave people alone. Also, they keep wolves away. After Lauren died, I settled in Gualala because grizzly bears had been sighted in the area. Most people were afraid of the bears, but those people were idiots. Bears are so much better than wolves.

If you encounter a bear, move away slowly. If that doesn’t work, drop to the ground and play dead. You want the bear to lose interest in you and go away. But if a bear wants to kill you, it’ll kill you. There isn’t much you can do about it. I suppose that’s what scares people about bears. But if you think about it, the same thing is true of everything that can kill you.

Beriberi

This has a lot of names in different places: the shakes, the bone dance, calf legs. It starts with feeling weak and fatigued, then progresses to numbness in the arms and legs, inability to walk, facial tics, and dementia. Sufferers may also have a rapid heartbeat and shortness of breath.

As complex and frightening as these symptoms are—and I’ve seen them enough to know how scary they can be—the cause is a simple vitamin deficiency. Unless it’s progressed too far, a diet of fresh meat, green vegetables, and brown bread (not anything made from the white flour or white rice found in the cities) should take care of the problem. Also, drink fresh clean water instead of beer if possible. If none of this is possible, beriberi can easily kill you.

As we traveled up the coast, back in my traveling days, Lauren and I started to see more and more stick-thin sufferers of beriberi, sometimes even in the larger settlements, and we were told more and more often that our diagnosis was useless. Where was anyone going to get fresh greens, when all the local farmland had turned poisonous and chalky, and even the trees in the woods were whitening? People got angry, they refused to pay. That was one of the things that made us think we ought to give up the traveling medicine work and settle somewhere, if we could find a healthy place that would take us.

Blood Poisoning

There are a lot of ways blood can get poisoned. Stepping on a rusty nail. Getting cut by a sharp piece of old metal. Always wear boots and gloves when foraging in the cities.

If you get an infected cut and start having spasms, especially in the jaw, you have tetanus. Tetanus can easily kill you. The only treatment we have these days is bed rest. Some people try bloodletting to release the poison, but I’ve never seen that work. The sickness isn’t caused by poison, anyway. It’s caused by bacteria that live in dirt.

You can also get blood poisoning through a tooth abscess or other dental problems. That’s what got Lauren. She had a toothache and she let it go, and let it go, and one morning her whole jaw swelled up and her body was on fire. She died a few days later. That was when I had to start looking seriously for a place to settle down, because I can’t travel alone, not with my allergies and my fibromyalgia. (Fibromyalgia is a painful disorder of the muscles. It’s not worth going into here, because it can’t kill you.) It took me three days to dig a grave in a nearby redwood grove, a safe distance from any source of water, and then I cried a little, and then I got the wagon back on the road and headed for the nearest settlement.

Keep your mouth as clean as possible, and pull rotten teeth before the rot spreads.

Botulism

Botulism causes cramps, vomiting, and breathing problems. There is no fever. You usually get it from food that’s been improperly preserved. It happens sometimes with smoked and cured meats, but is most common with canned goods. If you find canned food, check the can carefully for dents or swellings. Do not eat food from damaged cans, no matter how rare and delicious it is.

There used to be a cure for botulism, if treated quickly enough, but we don’t have it anymore.

When I worked at the trading post in Gualala, I threw out dozens of cans that people had salvaged from San Francisco and Berkeley. Most canned food from the old days is no good anymore. A lot of people got angry at me. Fortunately, Evan, who ran the trading post, backed me up. He’d dealt with botulism before, and he knew it can kill you.

A man once threatened to shoot me for destroying ten cans of Vienna sausages he’d found. I should have just let him eat the diseased meat. What kind of person wastes a bullet over spoiled Vienna sausages? I know how hunger grinds at you, especially if you’re coming up to trade out of the dead places, but eating bacteria just makes things worse.

Gualala was a good place, though. Still healthy, but well protected from raiders. Evan gave me acrylic wool the traders brought in and I’d sit on the porch of the trading post and knit. I got a reputation as the person to talk to if you were sick or injured or were planning a big journey. People were always planning trips north, over the mountains, following rumors of healthy cropland and even operational cities up in Oregon. I don’t know why they wanted to talk to me about it, since I always said the same thing: Forget it. So many things in the mountains can kill you. I advised against it every time.

Almost every time.

Childbirth

The best way to avoid dying in childbirth is to not get pregnant. If you do get pregnant, pennyroyal tea is an effective abortifacient. It can be dangerous, but the safer alternatives don’t always work. If pennyroyal fails, find a woman with midwife skills and ask her to help. Do not try to perform an abortion on yourself unless all other options have been exhausted.

When Lauren and I were on the road together selling medical care, abortion was the most common service we were asked to provide. We got to be very good at it. We could usually stop a pregnancy with herbs; surgery was not often needed.

We also oversaw childbirth, of course. That was much more difficult. With the toxins people pick up from the infected areas, a lot of women go into shock during pregnancy. They used to call that eclampsia. It will almost certainly kill you. There are many other ways childbirth can kill you, but that one is the most common right now.

If you do insist on having a baby, get to a large settlement the moment you realize you’re pregnant. So many women die giving birth in the middle of nowhere, without a midwife or even another woman around. What if it’s a breach birth? You and the baby will both die.

People get angry at me for talking this way about childbirth. What about our duty to carry on the human species, they say.

People are idiots.

Cholera

The colony where I grew up was wiped out by cholera. It’s a stupid way to die.

It was an early colony, from before things really fell apart. Some smart people saw the trouble coming and pooled their money and bought an island, a little island off the coast of Mexico. My mother was invited to join because she was a doctor. That was a sign of how stupid these smart people were, that they thought one doctor would be enough when things got bad. One doctor and no medical resources except what she brought with her, which fortunately included a little electronic book with a whole library of books inside it.

The colony did all right for quite a few years, longer than it really should have, but some people just wouldn’t dig proper outhouses. A hundred scientists and businessmen and millionaires all died because they kept using the river as a bathroom, and that’s how cholera spreads. So don’t poo in the river.

There, you’re smarter than a scientist.

Diabetes

An old disorder of the blood. Without insulin, the only way to manage it is with a starvation diet. I doubt anyone has diabetes today.

Dysentery (Bacterial)

Don’t get poo in your mouth.

Dysentery (Amoebic)

Don’t drink nasty water.

Normally I don’t have patience for people who lack the common sense to stick to clean water or beer, but I have to admit that accidents happen. For example, a man traveling up the coast might stop and make camp at Clearlake, not knowing that the two settlements that used to be there recently wiped each other out in a war over the last fertile fields. And they sank corpses in the lake to poison the water, and the streams in the area may look clean, but they’re crawling with bacteria. It’s maybe not a man’s fault, under those circumstances, if he drinks the water.

For both forms of dysentery, the treatment is the same as for cholera. It’s not as bad as cholera, but if you’re already sick or weakened it can kill you. I’ve nursed a lot of people through it. I know what to do. When the patrol guards hauled Dr. Spendlove onto the porch of the trading post, I knew.

Dysentery is not a romantic disease.

Exposure

All my life, I’ve avoided places where the temperature drops below freezing. As far as I’m concerned, that’s the best way to prevent death by exposure, just like not getting pregnant is the best way to prevent death by childbirth. Don’t go north. It’s so simple. Especially don’t try a mountain crossing late in the year, when the air in Gualala is already crisp and cold at the height of the afternoon, and there are no stars in the night sky.

But, as with pregnancy, sometimes things happen. Sometimes you find yourself in the mountains of Oregon in December, in a shattered wagon with the snow starting to fall all around and your fibromyalgia acting up. It’s not smart. Maybe it turns out you’re pretty stupid after all. But it happens.

If you’re caught outside in the cold, the first thing to do is build a shelter. Put pine needles or other cushioning between yourself and the ground, because the frozen earth sucks out heat. Get out of the wind and into some kind of insulation. Straw is good. I could use a pile of straw.

Share body heat.

Feral Dog Packs

Anyone who’s ever gone into a city with a foraging party knows to pick up rocks to scare the dogs away. Because most dogs will slink away at the first hint of a threat, people often underestimate the danger of dog packs. People are stupid. They worry about bears and snakes and so on, but when you get down to it, truly wild animals are glad to ignore you. They don’t care about humans. Dogs care. And they know us.

Not all dog packs are scared little clusters of skinny sucker dogs. Some are big and organized and know how to hunt. And I’ve seen normally harmless packs turn dangerous when fighting each other over territory. So play it safe. If you hear barking, turn and walk the other way.

People ask which are worse, dogs or wolves. Don’t ask questions like that. If you’re smart, you’ll never know.

When Dr. Spendlove was a boy, he had a dog as a pet. Its name was Jacob. He talked about it while we sat around the fire at night, watching the trees for movement. Nights like this we could use a warm dog at our feet, he said. I’ve read books with that kind of thing, but it’s hard to picture.

Foraging

Lauren and I were good at foraging. Summer and autumn up in the Berkeley Hills, foraging all day and cooking in the granite-countertop kitchen of some abandoned house at night, those were the best times. With all I’d memorized from my mother’s little electronic library, I knew what to gather and what to avoid.

Without a library, it’s harder. You have to be careful, because lots of things that look good can kill you. It’s as true with food as it is with the rest of life.

What I ought to do here is put in some drawings of poisonous things, mushrooms and hemlock and all kinds of nightshades mostly. But I’m not much of an artist, and I’ve got a deadline coming up fast. Lauren could have done it. That’s why you pull rotten teeth.

Frostbite

In the cold there are so many things that can kill you. Wolves, for example. And things can go wrong in too many ways. Take frostbite. As if it wasn’t bad enough on its own, it can lead to gangrene, which can lead to blood poisoning, which can kill you.

There are treatments, I know. Easy ones. If the frostbite is moderate, you can chafe with snow to remove the damaged skin. If it’s more severe, you have to amputate the dead parts of your body. But still, it bothers me. The skin gets so black, and it feels like fire and ice at once. It’s not a good way to die.

Toes and fingers go first. If I have to amputate my fingers, I’ll never finish this book.

Heatstroke

If you exert yourself out in the heat and you don’t drink enough good, clean liquids, your body may become unable to handle the heat normally and go into heatstroke. A common sign is losing the ability to sweat. A person suffering from heatstroke should be moved to as cool a place as possible and kept hydrated. Cover them with damp sheets, splash them with water, make them drink.

Heatstroke can kill you, but it can also cause long-term health problems. Dr. Spendlove has a weak heart from bouts of heatstroke as a child. His family was one of the ones that stayed in Salt Lake City after the evacuation, back when the trouble started. It was a hard life of hot, dry death. But at least he escaped the worst of what was happening in the outside world, just like I did on the island off Mexico.

Still, his heart is weak. That’s why I agreed to go north with him. He might have had another spell, and where would he have been without me?

Hypothermia

When you get cold enough, your body starts to freeze. If this goes on long enough, it will kill you. But don’t panic. Stand too quickly, and the cold blood could rush up from your legs and give you a heart attack. Especially if you have a weak heart.

Move slowly. Try to shiver under the blankets. Blow on the little yellow fire. Keep writing.

Malnutrition

I’m sure I don’t need to tell you the symptoms of malnutrition. Anyone who’s ever lived around the dead places has seen it, and most places are dead places these days. Now that the white plague has spread everywhere and the cities are mostly picked clean, feeding people has gotten harder and harder. Outside of a few good places, everyone’s starving to some degree or another.

The human body is funny. You can live a long, reasonably comfortable life without ever getting enough to eat, your body always eating itself a little but never too much. Or you can drop dead from the lack of a single vitamin. For most people, though, malnutrition kills sooner rather than later. There is no cure but to eat, and to eat as varied a diet as possible.

I’m sorry. That’s all I have. Until there’s more food, that’s it.

Mites

Use only oat or wheat straw in chicken coops, and never line coops with wet straw. Keep the coops away from your house and away from your source of fresh water. This is another thing people never take seriously until they start getting sick.

Reading my mother’s library when I was younger, I always thought this was the kind of thing that would kill me. Pet a chicken and pick up mites, sip a cup of cloudy water and get a tapeworm, prick your finger on a needle and the lockjaw sets in. Some tiny thing that slips into you and grinds the gears of your biology to a halt. I am a small, quiet person. I am made for a small and silly death.

And yet here I am, with my allergies and my fibromyalgia, impossibly far from the green-and-yellow island where I used to sit in the shade and pore over my mother’s library. I’ve made it a long way. All the way up here. Somehow, without meaning to do anything but stay alive and keep others alive if I can, it seems I’ve climbed to a big death after all.

Mountain Lions

They’ll eat you if they’re hungry, but they’re usually not hungry enough, except in the most badly infected of the dead places. Not as bad as wolves, or even as bad as bears. Just avoid them, and if you see one, don’t bother it. Why would you even want to bother a mountain lion? I’ve seen people do it. Stupid people.

A mountain lion carried off a child in Gualala. A little girl. Tell your kids to leave strange animals alone. Simple as that.

I saw mountain lion tracks this morning when I left the shelter for water and fuel. They don’t worry me much. Not as much as the wolves I heard howling last night.

Pollution

I was going to have Dr. Spendlove write this section. Pollution, even if we’re just talking man-made pollution, is a big topic, and it’s not one I know that much about. There are just too many kinds, in the air and the water and the ground. That’s why people fight so viciously for the land where crops still grow.

Dr. Spendlove knows a treatment for the white plague in the soil. Or so he says. He found a paper on it while camping in the ruins of Berkeley, collecting data from the old days. He thinks he can use it to cook a cure. That’s why we risked this mountain crossing, to get this information to the lab that Dr. Spendlove is almost certain still exists in Eureka.

We could have waited for spring. Probably. If I’d been smart, I would have insisted on waiting. But he was so eager, and his heart was so weak.

I’ll come back to this section later. Maybe when we reach Eureka. Maybe when Dr. Spendlove comes to.

Snakebite

Here in the northwest, there aren’t many poisonous snakes. It’s not worth worrying about. Anyway, they’re like most animals (except the dogs, except the wolves)—leave them alone, and they’re usually happy enough to leave you alone in return.

In Mexico, when I was a girl, one of my summer jobs was killing coral snakes out in the fields. They were beautiful snakes, with thick shimmering stripes the color of a campfire. Their bite could kill in twenty minutes. We stabbed them with pitchforks. Some kids saved the bodies and made the skins into belts or satchels, but I never wanted to touch anything with that much venom. For a while, before I got used to the work, I had nightmares about a coral snake brushing my foot with its fangs.

Now that I’m older, I’m a little nostalgic for coral snakes. Such a quick, warm death, and so beautiful.

Stab Wounds

People worry too much about animals. When I traveled with Lauren, and then later at the trading post in Gualala, people always asked me how to survive animal attacks. What about mountain lions, they’d say. What about snakes. What about bears.

You want the truth? Animals that can kill you are rare and mostly don’t want to meet you. People that can kill you are everywhere, and they’re looking for you.

Everyone knows about the raiding parties that hide in the mountain passes. Usually they’ll just steal what they can and ride off. But in the winter they get hungry, just like everything else in the mountains. In the winter they get desperate. And if they’ve managed to scavenge, borrow, or steal a cache of weapons, maybe they’ll just kill your party instead of robbing you.

It was a raiding party that took my mother’s library, years ago. They rode out of the hills in Jeeps. There was gasoline back then. I was working on a sweet-potato farm near the ruins of Pasadena, and they rode out of the hills and grabbed as many of us as they could. They took my library and my boots and let me go. I guess raiding parties have hardened since then.

It used to be that gunshot wounds were the type of death you most had to fear from your fellow man. But with the old guns falling apart and bullets, even the homemade kind, getting precious, most bandits attack with knives. Clean stab wounds and bind tightly. The wound must be washed regularly, because there are many ways to die of infected wounds. Staph. Gangrene. Tetanus. It used to be uncommon for someone to die of infected wounds, but most people today were born after vaccines, so now it happens quite a lot.

I kept Dr. Spendlove’s wounds as clean as I could, but the wounds were deep and the knife was filthy.

Thirst

You find out where the clean water is, and you drink that only. If there isn’t enough clean water, you make beer. Lack of water will kill you long, long before lack of food. Everyone knows this, but some people still insist on working all day in the heat without enough to drink, or leaving the ice on the well uncracked until they can’t break through. Fetch water. Drink. Fetch more.

I am eating snow now. It seems to be sufficient, but my lips are deeply cracked. Not bleeding. This may be a bad sign. I wish I had my library.

Typhus

Typhus! That’s what I should have died of! It’s common along the coast nowadays, especially as you get further up north. It’s a bacterial disease spread by lice and fleas, often carried by rats. Symptoms are everything that means sickness: muscle ache, headache, vomiting, coughing, fever, chills, delirium, a pink rash that turns dull red as the typhus gets worse. A whole library of ills.

It’s easy to prevent typhus with basic hygiene: Bathe regularly, keep your house clean, trap rats and feral animals, and, especially, don’t let rat poo collect where you eat and sleep. But people don’t do it, won’t do it. We used to have many cures for typhus, but we lost them, and now there are none.

It’s the perfect thing to kill me. With the wide range of symptoms, I could keep busy observing and honing my diagnosis right up to the end. And it’s such a little thing. A flea bite. A flea bite that wouldn’t have happened if people had any common sense.

Instead, it looks like I’ll die of hypothermia. What a personally stupid way to die. It’s my own fault for going up into the mountains, fibromyalgia and all, to follow Dr. Spendlove’s fluttering heart.

I’ve read that hypothermia is pleasant. You go numb and drift to sleep and that’s the end. It may be the kindest of all the things that can kill you. If I stay here, curled against Dr. Spendlove in our makeshift shelter, it will take care of me, slow and gentle and white as the death that’s creeping over the planet. It feels pleasant now, and even writing is starting to feel like too much work.

Or I could stand and walk. I won’t get far. There’s nowhere to go anymore. But I could stand.

Wolves

There is something to be said for the quicker death.

—To Pancha, for knowing all the things.