The paper is much folded. It has picked up a patina of dirt over the years, mostly along the fold lines. Some of the print has been rubbed into near extinction from too much handling, but the words aren’t important. I sit on my bed, fingering the softened edges, placing my hands where you must have placed yours as you filled it out, staring down at your handwriting. As long as I can do that, it doesn’t matter whether the form itself has faded entirely away.

I look over at the clock, knowing that I will have to leave soon. I breathe in deeply and blow out through pursed lips, attempting in vain to quiet the butterflies cavorting in my stomach. I start to write you a letter. “Dear Anne,” it begins. This is a familiar beginning for me; beside my bed there is a stack of journals filled with letters beginning like this, filled with my handwriting, angular and jagged, nothing like your even, rounded hand.

If you’d told me that last day we met that you would, in absentia, become my confidant, I would never have believed it. Even though you offered.

You are beautiful to me, in a strange sort of way. You walk down the hallway gracefully, with the posture of a dancer or an actor, not a pediatric nurse practitioner. With a job title as preposterous as that one, it seems incongruous that you are so elegant. I bow my head, both in homage and because I don’t want you to notice my trembling.

You busy yourself doing Important things, but you finally turn, a swirl of white coat and stethoscope, and beckon to me. I, numb, cold, shaking, trail along in your wake, taking each step as though I am uncertain if my foot will ever again reach firm ground.
As I follow you into the exam room, I smell even more strongly the acerbic scent of antiseptic and latex gloves and my stomach lurches. You sit down in a swiveling computer chair, leaning back slightly with your ankles crossed in front of you, curly dark hair flopping forward into your round, gentle face. The chair I am sitting in is hard and rigid and I tap my foot nervously on the floor. I wonder if you notice that my voice is too loud and my hands are waving too wildly as I talk.

You ask me if I have any questions for you and I hesitate.

“I was wondering…I cry all the time for no real reason. Is that…normal?”

I duck my head, staring at your square-toed, sturdy black shoes, awaiting your reply. You make an encouraging noise and look at me curiously, leaning towards me. I absently wonder if this is all some Good Listening 101 thing.

“Well, what do you cry about?”

I shrug. “Stupid things.” I am prevaricating, and I know it, but I can’t force the words out of my mouth.

“Why don’t you give me an example of a time you cried for no reason?”

I blush furiously, looking at your shoes again. Most people look at their own shoes when they’re embarrassed, but I get to see my shoes every day and so yours are more interesting.

“Shots make me cry. I guess you remember,” I add miserably, knowing that you must indeed remember and, if not, are currently clicking through your memory, searching for those other terrible, hysterical days, when you tried in vain to comfort me and I tried in vain to breathe.

I am full of phobic terror, full of sharp panic like electricity, sparking at a touch. I wait for you to condemn my hopeless fear, the same condemnation I have heard from doctors all my life. I know your kind, Anne-lady. Perhaps I spend an abnormal amount of time looking at your shoes, but your colleagues prefer the ceiling, or even my mother, back when I used to allow her to follow me to these sorts of things. Anything but me, really. The louder I cry, the louder they talk, and by the time they pull out the pointy objects, they’re looking away from me so assiduously that I’m surprised they don’t miss my arm altogether.

You just look at me, directly at me, and there is no condemnation in your eyes. You are quiet for a moment.

“So not for no reason, for a reason that doesn’t upset other people, so you think it shouldn’t upset you.”

I nod.

“You know, if you ever need to talk to someone about anything, I’m always here. I’m not a professional or anything, but I can listen to you.”

I think if I ever sent you the volume of letters that I’ve accumulated over the years, you would be in a position to regret that offer of yours.

It is a long walk to our current doctor’s office, longer for the fact that each step I must thwart anew the desire to just turn around and walk away. The struggle doesn’t end with simply reaching the place, either. Then I have to walk in. Once I’ve walked in, there’s no getting out again, and I avoid taking those final steps through the doorway for as long as I possibly can.

I hate waiting rooms. The air smells like latex and disinfectant, a peculiar amalgamation that never fails to set my nerves on edge. There are only a few chairs so I end up sitting on the floor, pinched between an old woman with a hoarse cough and a large plant, which thankfully does not have any visible ailments. I have brought with me at least five different diversions, from music to video games to a good book, but none of them holds my attention for more than a moment and I end up just sitting there, watching the door. By the time I hear my name called, there is a fully-grown butterfly colony in my stomach. My hands are shaking, ice-cold and tingling-numb. I am certain that I have a terrible pallor, am blushing brilliant red, or am doing both at the same time, a special talent of mine.

I somehow manage to stand up and find my way into the examining room. Well, it’s supposed to be an examining room. There is exactly space for a small counter with a wall-mounted cupboard above it, a scale, and one of those long tables covered in a sterile white paper sheet. I eye the table. I hate those things, but if I stay standing I am in danger of being knocked unconscious by the door when the doctor finally shows up. I weigh the relative merits of a concussion versus the table. I pick the table, but only after some deliberation.

The doctor finally does arrive but he doesn’t stay long, handing me a set of paper clothing and instructing me to put it on before tactfully exiting again. Honestly, Anne, I have never understood the whole paper clothing thing. It’s always seemed like nothing more than pointless degradation to me. It’s a painless, bloodless sort of degradation, though, so I try not to mind too much when I can’t find the ties, when I manage to rip the thing half to shreds trying to unfold it with my clumsy, shaking hands.

Dr. Raffinan comes back. He’s your successor, inheriting my medical records and my charts, my back problems and my mental problems. If you had read all those letters I’ve painstakingly penned over the years, you’d remember him, I imagine. In between tales of teenage woes, I think I told you the short tale of our first encounter, a cursory sort of thing involving a sinus infection. I told you then that I wouldn’t be able to judge him until he pulled out the sharps.

He quickly skims the form that he will have to fill out.

“Well, the good news is that it doesn’t look like you need any shots, but bloodwork, I think, and definitely a PPD test.”

The truth is that telling me about all the things that aren't going to be stuck into me today is very similar to telling me, as a rampaging elephant is about to run me over, that it's all right because there are five other elephants living in the city who aren't going to run me over today. That is to say, it is of absolutely no comfort to me at all, because one elephant is quite dangerous enough.

I know these tricks, the good news and bad news, the attempts to balance the scales, skew the data. I know these tricks because you, too, were adroit at playing that sort of game.

“Well, the good news is that you don’t need any shots today, and no TB test either,” you tell me, pausing for a moment.

I am not stupid enough to hope. I wait.

“I’m afraid that I do need to take a tiny bit of blood.”

Your words hit me like blows, one at a time, raining down on me, echoing as you pinch your fingers together to show me how truly small the amount in question is. It doesn’t help and I think you know it, but I am abjectly grateful to you for trying.

Dr. Raffinan notices me wringing my hands together and asks me if I’m too cold, a perfectly earnest look on his face. I stop myself and hold my hands quiet in my lap. I tell him that I’m warm enough, and my tone is only slightly caustic.

Walking up towards his office today, I didn’t think it was possible to miss you any more, but as I wonder what words I can use to explain why I am pale and shaking, I want you to be here so much it’s painful. If you were here, I wouldn’t have to explain. Then again, if you were here as well, this room would almost certainly exceed its maximum holding capacity.

“I have a bit of a doctor thing.”

I try to laugh as I say it, as though it is no big deal, but my voice betrays me and all I manage is a squeaky, strangled giggle. This, apparently, triggers some sort of on knee-jerk reaction in Dr. Raffinan.

He begins a cheerful monologue. Perhaps it would please your professional pride to know that you were better at playing the comforting monologue game; he is really just an amateur. It doesn’t matter, though, I’m caught up in my own rhythm anyway, the not-so-minute tremors in my hands, the tap-tap-tapping of my foot against the table, the cramping of my stomach. It’s a catchier tune than his, and a more familiar one.

You, too, were given to pontificating on the nature of arm veins and stethoscopes and things of that sort, as you poked me with your fingers and your cold instruments. You would try to calm me down, telling me that it was all right, to try to relax, explaining everything as you went along because you thought it might help. I always thought that your voice was a little like music.

You finally step back and face me.

“We’re almost done, you know, and you did so well, we just have one more little thing to do and then you can go,” you say to me.

I know what you’re about to tell me, and I’m sick inside with the knowledge of it. This is the part where my face usually begins to crumple into sobs, but today I’m not going to cry. You open your mouth again and it seems to take an eternity for you to let my doom fall from your lips.

“I’m just going to take a little blood, and then we’re all done and you can leave.”

I don’t want to leave, really. I promise, I’ll sit here forever and ever if only you won’t hurt me. I feel the world tipping underneath me and then narrowing to the two of us in this room. There is no other world right now but you and me.

When I’m sitting on this table we’re almost the same height, but I feel like I’m looking up at you. I always seem to be looking up at you, staring into your eyes as though you can protect me from, well, you. You’re a fixed point in an unsteady universe, and I am very small and dizzy.

“You’re feeling nervous, aren’t you? You look a little nervous.”

I feel like this is obvious, but I am grateful that you ask, that you bother to notice. I want to beg you to hold my hand, to help me, because I’m sinking pretty fast, the water roaring as it closes over my head, but I only nod silently, wretchedly.

You look at me with sympathy in your eyes. “What are you nervous about?”

I look down at my feet, dangling off the edge of the table. I don’t want to say anything, even though you and I both know the answer, even though I’ve already admitted it.

“It’s the needle, isn’t it?” you ask, so gently that I can believe that you understand.

I nod, cheeks heating, shame burning in the pit of my stomach.

“It’s all right,” you tell me, “I know that this is hard for you. We’re going to do this together.”

You’re looking at me and I’m looking at you and although I know that this is the last peaceful moment before the storm hits us full force, I can almost believe that it really is going to be all right.

You walk away from me, opening up the cabinet where I know you hide all your sharp objects.

You turn around and walk the few steps back to where I am sitting, carrying a clear, plastic-wrapped package. You open it and lay the contents down beside me. I quietly edge away a few inches.

You ask me to give you my hand, and I stick it out, palm down, thrusting it at you quickly. You turn my hand gently over and tie a rubber glove around my arm. I am almost amused because it seems an incongruity, having a rubber glove tied around my arm. You wipe off my arm with something wet, telling me that it will feel cold, and I hear the unstated subtext in your words, ‘but it won’t hurt.’

You pick up the needle in one hand, supporting my arm with your other hand. Your fingers are cool and dry and gentle and I notice that you wear two rings on your ring finger, one on top of the other.

“This is called a butterfly needle,” you tell me. “You see, it’s almost shaped like a butterfly.” You’re right, it is, but it has more pointy bits than any butterfly in its right mind. It’s all edges; hard, geometric and plastic-y blue. I think to myself that the butterflies in my stomach must look a little like that, pointy and flapping.

“I need you to take a deep breath for me,” you tell me.

I try to take a gulp of antiseptic-scented air to please you. I swallow the air more than inhale it, my gasping loud against your soft encouragement. I can’t hear what you’re saying, only the tone of your voice, bright and unwavering but blurred, as though I’m listening to you from very far away.

I can hear it when your tone changes, becomes worried as you wonder aloud why you can’t get any blood, and I try to focus again.

“I need you to hold on to this,” you say to me, handing me a tangle of tubing and empty vial, still attached to my arm. I look at it, then back at you. You return my stare, solemn.

“I know that you aren’t comfortable with this equipment, but I need to go and get something.”

I tell you, in my head, that you have just made the understatement of the century, but for you I can try to be brave. My unwilling fingers grasp the vial gingerly, holding it between thumb and forefinger as though it might explode. As you turn, you tangle your hand in the tubing, jerking it to the side and sending a sharp jolt of pain shooting through my arm. An involuntary whimper forces itself between my gritted teeth and you are instantly contrite.

“I’m sorry, I didn’t mean to hurt you.” The words that time lie between us, unspoken yet present.

You pick up another needle with more blue plastic wings like a demented butterfly after all, and still you cannot get anything out of my veins. You unfasten my watch and I clutch at your trailing white sleeve with my free hand.

“It’s all right, I’m just taking off your watch. I’ll put it right here next to you.”

You try on a smile. “I know we didn’t have this problem last time. Are you telling your veins to hide from me?”

I gaze up at you, stunned silent, taking the facetious remark seriously. “No.”

I know that you’re trying, I know that you don’t mean to hurt me so much, but that knowledge does me little good. I’ve given up on trying to think because it’s too hard to string words together, even in my mind.

You ask me how much pain I’m in, and I don’t understand the question, blinking up at you in confusion. You realize then, I think, that it’s all I can do to stare up helplessly into your kind eyes, and you don’t ask again.

When Dr. Raffinan finally makes his way to that part of the visit, he decides that he wants to know how I feel about needles. I flinch at the sound of that hateful word and I am so surprised by the question that I remove my gaze from the wall behind him and actually meet his eyes.

What does he think has been making me so nervous all this time? Perhaps he thinks I have a phobia of cold temperatures, or small rooms, or paper clothing. I guess I should grant him some credit for trying, but I can’t help thinking bitterly that you would know the answer without needing to ask.

How do I feel about his insect horde, his army of blue butterflies, trailing tubing like ribbon?

A dozen responses flash simultaneously through my racing mind, ranging from sarcasm to more honesty than anyone but you would get out of me. I decide that this is a conversation best censored and I settle for a middle ground.

“That’s what’s bothering me,” I tell him, gauging his reaction. He seems indifferent, not knowing how hard it is for me to form those words. I try to meet his gaze, needing something to hold on to, but his eyes seem devoid of understanding. I look past him again, staring without seeing at a list of common pharmaceutical abbreviations.

He takes my arm, insects trailing along with him and buzzing loudly enough that I can hear them in my own ears. His grip is firm, distant, impersonal.

“Just sit back and close your eyes,” he tells me. “You don’t have to look.”

He doesn’t understand that, in fact, I do.

I’ve tried mostly everything over the years: conjugating Spanish verbs, spelling the longest words I know, counting. Not much helps. This time, I think about you.

The image that leaps instantly to my mind is of you writing me a pass to come back after lunch so that the pediatrician who works with you can try to draw my blood. You think that she will have better luck, or maybe you just realize that it is nearing the point where even you can’t pull me back from the edge of hysteria.

I can almost picture you, your dark curls falling forward into your face as you write.

You pick up the form from its stack of identical siblings and scribble with the pen, over and over until the ink comes out. You write, in the space for teacher, “Clinton School,” the ‘l’ looping so large that it consumes the ‘o’ next to it. In the space for date and time, you fill in ‘5/12/03,’ the date slanting up at a sharp angle. You add beside it, ‘(Monday),’ the word floating above the line like an afterthought. You miss out the ‘c’ between the ‘S’ and the ‘h’ in my last name, a misspelling I do not notice until much later. Would you have been more careful if you’d known that this form would follow me through the years after you were gone?

“Are you going to be all right?” you ask me as your pen races along the lines.

“Yes,” I say stoutly, though I know that in just a few moments, after I have fled, I will go and collapse in the stairwell before going back to class, and it will probably take me a long time to get my breath.

“Are you sure?” you ask dubiously.

“Well, no,” I admit.

“So, will you be all right, then?” you ask again.

“Yes.”

You sigh and hand me the pass, our fingers almost, but not quite, meeting.

I wish that your last memory of me didn’t involve me curled in a ball of shaking wretchedness, a muddle of Band-Aids and needles, after the third sharp blue butterfly missed my vein. Then again, maybe you don’t remember me at all.

You’re not here, Anne, and it’s hard for me to forgive you that. The best I can do is create a pale simulacrum in my mind, a guiding spirit to hold my metaphorical hand. I often have a hard time recreating your image, except in dreams, where you are always as picture perfect as you were the last time I saw you.

Today, however, as though in response to my need, you appear before me easily, fully formed, square-toed black shoes and wide black pants below a long white coat, the stethoscope around your neck a visible symbol of your power. Your face is always the hardest to recall, but today I can find that too.

You aren’t here, so I’ll have to play your part as well as mine. What would you say to me, if you were here right now? You would tell me not to stop breathing. Practical advice, but harder than it looks. I try to think about that, holding on to your face in my mind as I clench my fist around the paper sheet on the examining table, leaving a mark I will hurriedly try to smooth on my way out.

In those silly stories they write to comfort small children, with titles like “Freddie Visits The Doctor,” things always turn out so nicely. There is always a grand anticlimax, an epiphany, a discovery that, in fact, blue butterflies are quite harmless, don’t hurt a bit. There are smiles all around, then, and sometimes Freddie gets a bright red cherry lollipop, a special prize for being a good boy and not feeling a thing.

I’m still waiting on that epiphany. And I don’t think I’m ever going to earn a lollipop.

“There, that wasn’t so bad, was it?” Dr. Raffinan asks brightly, when it’s all over and I can reclaim my abused, freshly bandaged arm. I wince because you would have known not to ask me that question, you would have known without asking that it had been very bad indeed.

When I stand up to leave, without answering the question, he shakes my hand and tells me he is proud of me. Proud of me for being afraid and trudging along anyway, he says.

What else would I have done? Did he expect me to just give in, turn into a ball of sobbing misery? It is worth the fight to speak, to be present, to be more than an object, a thing to be poked at. You taught me that, hidden among your speeches about stethoscopes and panic attacks. It was enough for you to look me in the eyes and really see me to teach me that I could look back at you, see through the blue butterflies swarming around you.

I gather up my things and try to stand up, falling heavily against the doorframe and then walking straight into a wall as I try to regain my balance and find my way out.

When I make it home at last, I sit up on my bed and stare at your handwriting again, as though it is a mystery I can puzzle out. I run my finger reverently along the softened edge of the pass you wrote me, two whole years ago, then finish the letter I began earlier, telling you all about Dr. Raffinan. This letter is going to be a long one. My letters tend to ramble, as you’d know if you read them. But you don’t. I try not to think about that.

As I sign my latest letter, sharp jagged script so very different from yours, I wonder if you would be proud of me.