The city of lights, the city of love. For the first half of Semana Santa, I vacationed in Paris, the political and cultural center of Western European history. From its philosophical developments that defined the Enlightenment to its artistic and literary icons, from its Revolutions and Imperialisms that redefined modern Europe to its present reputation as romantic paradise, Paris was my quintessential European visit.

Thus, emerging from the metro stop at Notre Dame, I envisioned cultural luminescence and mimes in the streets and that musical language with accordion accompaniment, because for whatever reason American movies all depict Paris to accordion accompaniment, and I climbed the last step with anxious anticipation to the wondrous sight —of grey. All grey. Grey buildings, grey skies, grey concrete streets. Cigarette butts littering the sidewalks, tossed by Parisians huffing billowing grey clouds. A hazy smog from diesel engines blanketed the city, such that the illuminated nighttime Eiffel Tower shone against it like a spotlight.

The city of lights, the city of love, the city of dirty grey.

I met an old friend studying in France —naturally, my tour guide and translator. His task: embodying Parisian culture. But to his chagrin, every waiter and shop owner would begin their conversation in French, hear his accent, and switch to English. They rejected his foreignness. I empathize; when Spaniards do it with me, I become irrationally insulted: “How dare you?! Don’t make my life easier!” My friend even asked one waitress to address him in French and me in English. Given that my French is a mispronounced “bonjour,” I happily accepted.

We swept the city, enjoying tourist sites and charming cafes. However, as a Catholic on Semana Santa, whose high school European history teacher had lauded Gothic architecture, I had one main request: churches. Churches, churches, the Louvre, and churches. In particular, Gothic ones. In my opinion, Gothic architecture is the embodiment of stereotypical Catholicism: grandeur, power, gargoyles to instill fear and guilt, thirteenth century masterpieces now crumbling like the Church’s influence.

Breathe in the dust of cathedral ruins —ah, yes, the smell of Catholicism.

We waited two hours to walk Notre Dame’s tower, the crowning glory of Gothic cathedrals, and thirty minutes for St. Chapelle. I was determined. After my friend returned home, I even ventured out to St. Denis, Europe’s first Gothic church, alone. Which was hard. Fifteen euros in wasted metro passes and three subway changes later, I finally divined the route to it: incidentally, it’s outside the city. And then, arriving in Paris’ outskirts with little sunlight left, I detrained into a swarm of four dozen peddlers. I then realized that St. Denis was a disadvantaged migrant town. And I was the only white boy in sight.

“You’re fine, Nolan,” I said, drawing my sleeve over my Apple Watch. “Don’t worry. You’re safe. I’m sure. Sure, sure.” Every conversation sounded like the plot to kidnap me —I couldn’t know; I don’t speak French. But I was determined. I donned a poker face, power walked to the church, snapped a selfie, then power walked straight back.

I trembled inside the train. Heaved from relief. But here I am, alive to tell the tale.

My more harrowing experience in Paris, however, came later that night: ordering pizza. Without my translating friend and now hobbling on one foot, injured from power walking, I opted for an easy night in. And by easy, I mean American: Domino’s Pizza, ordered online with Google translate, delivered to the apartment. But it didn’t occur to me until late in the ordering process that I had no French phone nor, of course, any means of bartering with the delivery man once he arrived.

As a result, I spent twenty minutes fidgeting in my seat, next to the door, flinching at every sound on the staircase. Hiding like a fugitive. And jumping out of my skin when the delivery man rang, I apparently decided that speaking in Spanish —in a city of French and English— was definitely the best option. I mimed a credit card, which was promptly denied, then danced around the apartment until pirouetting before him with a twenty euro note.

I had ordered the wrong pizza. I frowned. I watched The Dark Knight and ate it anyway.

Little by little, though, Paris grew on me. The Eiffel Tower at night was breathtaking, although Parisians jogged around it —and around me, the tourist— with haughty indifference. The Louvre and Musée d’Orsay inspired awe, drawing me through four hundred years of French artistry like Delacroix and Van Gogh and entrancing me in a timelessness that only broke when Louvre staffers ousted me at closing. And in my last hour in Paris, as I crossed a bridge with love locks, the ones that couples plant to represent their everlasting passion, I caught a glimpse of that cinematic Paris: contented couples walking the turquoise Seine, street artists selling colorful Van Gogh recreations, a shimmering sunset basking the Louvre in gold —all until my free time expired and a grey subway car whisked me away.

In my head, I had imagined a Disney-esque, romantic Paris, with accordion players on every street corner (I saw one), berets and black-and-white pinstriped sweaters, attractive couples holding hands and kissing on the riverside. Instead, I encountered a much starker Paris, heavy with its prideful history and exasperated by its tourism. Where foreigners were, Parisians weren’t. Besides tourist locales that made tired efforts at the illusion, Parisians rejected whatever image their visitors imposed on them. They did so emphatically. They chastised foreigners that marred their language; they smugly overlooked gawkers that doubted their cultural genius.

This is Paris: The city of grey, the city of pride. A city whose inhabitants have deposed a half dozen governments in violent revolutions, whose literary and political prowess has disregarded expectations, sparked cultural revolutions, and commanded Western thought. The spirit lives on. Paris doesn’t care. This isn’t Disney’s Paris. It doesn’t belong to fairytales. It’s bloody. It’s dirty. And its dirtiness makes it Paris: trailblazing into the abyss, into the cultural and political jungle, returning with dirty shoes to prove it.

Patient of 19 years presents in the emergency room of Hospital Universitario de Madrid on March 14, 2016, at 22:30, reporting throat pains and suspecting an obstruction by foreign object. Patient reports swallowing a salmon spine. Patient reports no preexisting medical conditions nor allergies to medications. Medical professional inspects the throat and oral cavity. He visualizes no obstruction but cannot visibly inspect deeper than the oral cavity. No specialists are available to investigate further. Patient is instructed to take ibuprofen for pain and to return the following morning for specialist attention.

Patient of 19 years presents in the emergency room of Hospital Universitario Fundación Jiménez Díaz on March 15, 2016, at 01:30, reporting throat pains, suspecting a foreign object. Patient reports difficulty swallowing and breathing, has not experienced increased salivation. Doctor inspects the throat and oral cavity but visualizes no obstruction. Cervical and lateral x-rays of the throat and oral cavity reveal no obstruction. Endoscopic inspection of esophagus by ENT reveals no obstruction. Patient is instructed to strictly avoid pain and anti-inflammatory medications. Patient should return if he experiences immunological response (inflammation) during the next 5 days, in the event that foreign object is present.

While eating dinner Monday night, I swallowed a forkful of salmon and went pale: a bone had become lodged in my throat. Staving off the initial panic, I mustered through the meal, eyes watery, returned to my room and attempted to write homework —to do anything, to deny the dread. But I was disconcerted. Distraught. Sweaty. I panicked. I solicited advice from my parents and host family and swallowed mountains of breads and liters of water to dislodge it and paced the hallway neurotically until requesting that we visit an emergency room.

There was a fish spine stuck in my throat.

In the emergency room of a private hospital, my host father and I waited two hours for attention. I squirmed in my seat. I stared pensively forward, maintaining my head for fear of pain, denying my predicament. My host mother and IES negotiated by phone with hospital professionals, all for the frustrating end of a doctor’s pawing my throat and prodding my tongue with a depressor. They had no ENTs on call. They sent me away, to return the following morning.

“Yes, well, sorry,” said the English-speaking doctor. She said little more.

Eyes drooping from exhaustion, emotional distress prolonged well into the night, yet aroused by the persisting pain, I wobbled into a taxi en route to a public hospital. There, with the program director from IES, we waited another two hours for more appropriate attention: an x-ray, inspection by an ENT, endoscopic examination, all in a fifteen minute flurry. I could feel the bone. I waved fingers at the location. Like a spiny bridge whose supports dug into opposite esophageal walls. Help, please.

But he couldn’t see it.

He discharged me. He didn’t show me the x-rays or endoscopic images, he barely conversed with me, he didn’t reassure me. He spit out a diagnosis and sent me home. I was bewildered. He was wrong. It betrayed the obvious and painful reality —I could feel it there, swallowing, breathing, prodding. There was a fish spine stuck in my throat. That night I barely slept, exclusively preoccupied that my throat would inflame itself at any moment and I would surely suffocate in the night. By the fish spine.

Two stories. Two accounts of the same reality. One is lying.

In my latest run-in with the Spanish healthcare system, this time featuring brick-and-mortar establishments of the private and public variety, I happened upon a diagnostic dilemma that plagues medicine: when medical “reality” contradicts patient “reality.”

In the United States of Certain Distrust for Doctors, Americans frequently disagree with (and ignore) their medical professionals. We stop antibiotic courses when we “feel better,” despite strict orders and the bacterial resistance it breeds. Stories of cancer patients and paralysis victims that “proved the doctors wrong” permeate our media, even though the majority pass away or purchase wheel chairs without notice. Our nation harbors reactionary attitudes towards vaccinations and medications, patients opt for “alternative medicine,” and many die because of it. Beyond the States, I can’t be sure. But given Spain’s homeopathic bend, the same likely applies there as well.

Perhaps our individualism and “can-do” spirit has generalized to medicine —we believe our will can supersede even medical fact. But our emotions and experiences contribute too. In my kerfuffle with the salmon spine, I was truly convinced that it remained lodged in my throat, even after damning evidence to the contrary, conjuring delusional scenarios in which the spine had burrowed into my esophageal wall far enough that it therefore remained unseen.

Two stories. Two accounts of the same reality. Which one is lying?

Having unequivocally survived the fish spine without immunological response nor suffocation nor death, I must admit: my story is lying. That is, medically lying. The doctor’s reports far more accurately detail the physical reality. But what about the emotional one? What about the patient’s perceived reality? At the time, my story —as I perceived it— wasn’t a lie. It was my truth. Invented in my head, yes, and misled by the lingering pain of swallowing (and completely consuming) a fish spine, yes, but still the perceived truth.

The medical reports were lying too.

In the unthinkably complex reality —all including, all excluding— we cannot perceive anything purely or objectively. That’s the human reality. But in the case of medicine, where our closest approximation of objetive reality is king, this creates conflict. Because patients don’t believe it. Because humans are subjective. Humans are emotional. Humans swallow fish bones and panic and envision their suffocation in their sleep because, although medicine is rational, they aren’t.

When skepticism meets medicine, when patients with armchair medical degrees (or WebMD) dismiss their doctors, the issue is often patients. But it’s doctors too. It’s the non-empathetic forty-something that begrudgingly woke at three o’clock to check a paranoid tourist’s throat, rushing the tests and patient out the door. It’s the insufficient reassurance and, often, insufficient emotional services —why do cancer patients reject doctors’ diagnoses? Surely, the answer is emotion. And surely it’s better resolved with chemotherapy and psychological therapy. It’s a lack of education, too, when doctors’ tight schedules prevent the detailed consultations necessary for patients to understand their pathology, their test results, and (if applicable) why their treatments matter.

This fish spine is the story of modern medicine: miscommunication. And it offers a lesson in the empathetic, interpersonal arts: that reorienting and retuning our communication between patients and doctors might forward public health more than any breakthrough could.

Sometime around midnight, when the moon rises over Michigan, when I’ve finished the day’s readings and arrow-pushing mechanisms and essays, I walk. Under the starlights and streetlights, among the scurrying student groups that scribble chalk on sidewalks. I draw South Quad’s doors into the chilly night with headphones in-ear, and Kelly Clarkson serenades me forward.

Depending on the night, and how overwhelming the week, I stumble here and there. I’m not paying attention. My eyes are watery. Sometime around midnight, you start to feel the campus, being at Michigan, because sometimes you crumble under the stress because nobody has it figured out, because sometimes your responsibilities and accomplishments and memories sneak up on you and smear a cold sweat and silly smile across your face, because emotions are complicated.

Sometime around midnight, or maybe ten past, I reach the Dental Building. It’s ugly. That 1970s architecture and beige brick. Why am I here? Why Dental? Maybe it’s the habit: I commute back and forth —South Quad, Dent, South Quad, Dent— rhythmically, unthinkingly, day in and out. I practically live in the Dental Building for research. That must be why. As my eyes skitter up the research tower, the stars above steal them instead, entrancing me in the infinite purples and glittering whites, although only for a second, because the humming Blue Buses at C. C. Little and the giggling chalk-scrawlers inevitably jolt me back.

Sometime around midnight, or maybe twenty past, I cross the MoJo Bridge and loop around Palmer Commons. All around, dorm windows flicker. Life. Students chat and drink, or frantically pull their hair, studying, sexing, crying over relationships or grades or applications for futures that haven’t convinced them yet. They should close their blinds. You never think about that. Blinds. A random detail. Whatever they’re doing better commands their attention anyway. More than blinds. I shouldn’t shortchange them; maybe they feel some inherent interconnectedness that commands them to publicize themselves. To show themselves to the world, to walk around at midnight, watery eyes and hearts on sleeves. For all to see.

Sometime around midnight, or maybe thirty past, I glance down. I startle. Out of the trance. I catch myself. My feet skirt the Diag M, tracing its outlines with tentative toes and wavering over its serifs. I rarely look down; you don’t get far by looking at your feet. Except now. You are never to violate campus traditions; you are never to touch the Diag M, because when a university shapes and remakes you like this one, when it reinvents and inspires and hypnotically trances you for midnight walks and stadium-full spectacles, and when you find yourself humming its tune like a melodic music box at midnight, or maybe thirty past, without purpose, without thought, emotionally stirred, you believe in magic. Magic that exists in the singular tradition of never touching that M. Because it isn’t some sidewalk paver. It’s a tradition that has triumphed and changed the world and expunged high schoolers and replaced them with leaders for more decades than you have years. Like it’s doing to you too.

So you walk around it. You pay it respect.

Sometime around midnight, when the moon rises over Madrid, I stir in my bedroom and push aside the grammar workbook and reach for my headphones; Kelly Clarkson serenades me forward. I rummage for my favorite shoes and the appropriate jacket and whatever else I bring on walks —I couldn’t tell you, it’s become so habitual— and I open the apartment door, starlight and streetlight spilling inward, cars and pedestrians scurrying all about.

As I stand there, before crossing the threshold, my eyes skitter up the building’s facade like always, or what feels like always, the stars above clouded by urban smog, taxis buzzing in my ears. They annoy me now. Didn’t they before? My eyes reach the topmost windows and I’m suddenly disoriented. All around, apartment windows flicker. Life. Spaniards chat and drink and emphatically express themselves to one another, arguing, sexing, romanticizing the details of their personal lives and personal worlds like always. Like always? This isn’t right.

I startle. Out of the trance. I look down.

Why did I look down?

My feet skirt the apartment threshold. Marble steps and stone sidewalks. Safe this time. Safe to look up again, because you never get far by looking at your feet. Madrid extends endlessly before me, an urban metropolis of centuries-old stones juxtaposed with concrete modernity, a tunneling maze of organically grown alleys and underground subways and an unpredictable populace whose culture marries old and new. I’m entranced. Like magic. That word doesn’t taste right. Magic. The chilly air brushes my cheek and I shutter, but I press onward, closing the hefty apartment door behind me because even though Ann Arbor is safe, South Quad still has impressive security, heavy doors, key-card entry, always patrolled by one security guard or another, and I push one foot beyond the threshold and anticipate that midnight Michigan when I realize that I don’t walk at midnight anymore.

I don’t walk at midnight.

I startle. This is a trance. I don’t catch myself. I look back down. Did I step on it? I anticipate that symbol of optimism and tradition and home, The Victors twinkling in my head like a melodic music box, without purpose, without thought, emotionally stirred, like magic, but my head tilts sideways, and the music fades out, and my eyes fill with tears because instead of glimpsing student groups scribbling around that emblematic M and seeing my feet trace its outlines and waver over its serifs, I don’t. I don’t see it. I see sidewalk pavers. Stone sidewalk pavers.