CHAPTER ONE

Locked In

On a warm October afternoon in 2018, Olivia Lewis wrapped up an assignment and walked from the campus library to her bike. A month earlier, she'd started her senior year at Virginia Commonwealth University with a clear resolution: to stop making such a big deal about her health issues. For nearly a decade, she'd been periodically plagued by a strange constellation of symptoms, including vision problems, facial numbness, dizziness, and crushing migraines. She was a regular at the doctor's office, but more often than not her symptoms would resolve while she waited for her appointment to begin, and the doctor would tell her that there was nothing actually wrong with her. Her friends, too, had grown impatient with her over the years; sometimes she noticed them sigh or roll their eyes when she told them of yet another headache. She hated the idea that her anxieties about her health might be taking a toll on her relationships. She told herself she would just have to toughen up.

But as she bent down to unlock her bike from the rack, she felt a sharp twinge in her neck. When she stood up, little gray and black specks appeared in her field of vision. A dull headache set in. She shook her head and got on her bike to go grab some lunch. It was probably nothing.

That evening, though, at a friend's house, Olivia again felt strange. She'd just plopped down on the couch to watch American Horror Story when, as the show's moody theme song filled the room, her face went numb. She began to feel faint and nauseated. She excused herself and slowly made her way to the bathroom. When she looked in the mirror, she saw black splotches where her reflection should have been. She blinked hard, then splashed water on her face. She looked at the mirror again. The black splotches were still there. She cast her eyes around the room, but the splotches followed her gaze. Maybe she needed to take a few breaths and calm down. She knelt on the floor, leaned her forehead against the bathtub, and closed her eyes.

A few minutes later, she cautiously opened her eyes. She could now see her legs clearly. The splotches were gone. Relieved, she picked herself up and fixed her hair in the mirror. As she walked back to the living room to rejoin her friends, she was grateful that she wouldn't have to make a scene in front of them.

Olivia had only recently started to feel like her peers accepted her. Growing up, she'd attended a private school where she was surrounded by kids from wealthy families. Olivia's family was middle class—her parents had taken out loans and cobbled together the money to afford the tuition—and her background made her stand out. Her classmates made fun of her clothes and the things she liked. They disparaged her modest home and her family's minivan, with its dents and missing hubcaps. In the fifth grade, Olivia was voted "ugliest girl" on a list that circulated in her school.

But in the past few years it seemed as if things were beginning to go her way. She had built a tight-knit circle of friends in college—just a week ago, she'd invited them over for a dinner party where they feasted on a big pot of spaghetti while sharing stories and laughing late into the night. She and her boyfriend from high school, Shawn, had maintained a long-distance relationship, and she was looking forward to visiting him in a few weeks. She was also on track to graduate with a degree in communications and planned to get a master's degree in copywriting. After so many years of feeling inadequate, Olivia could finally see an exciting future taking shape before her.

Later that evening, as she and her roommate drove back to their apartment, Olivia rolled down the window, took in some fresh air, and let the serenity of the night sky soothe her nerves. She reassured herself that she was fine. Now her focus was on getting to bed. She had an important class in the morning, and she had a habit of sleeping through her alarms. She took a quick shower and then performed her nightly ritual: setting six consecutive alarms on her phone starting at 8 a.m., spaced ten minutes apart.

It was just after four in the morning when an excruciating sensation coursed through Olivia's body. It ran from her spine into her head, jolting her awake and causing her to lurch upright. As her body seized up, she fell out of her bed, and her skull crashed directly onto the hardwood floor. Her head throbbed. She needed help.

She tried to reach for her phone, which was dangling off the side of her bed by its power cord, a mere inch above her face. But her arm wouldn't move. She tried to yell for her roommate. Her mouth wouldn't move, either. Suddenly, a cascade of fluids erupted from her body. A warm, thick substance oozed out of her ears. A puddle of urine formed beneath her. A mixture of vomit and blood bubbled up in her mouth. If she hadn't landed on her side, she thought, she might have choked on it. Though she was not particularly religious, she found herself talking to God: Is this it? Am I just going to die like this? She lay frozen in place for about two hours, fighting to keep herself awake. Then a strange sense of peace descended upon her. She allowed herself to drift into the darkness.