Compelled to Expel

on antibiotics & antifragility

The sordid affair began at the bathroom sink, one hand on my ear, the other clutching a glass of bubbling orange liquid. Imagining the fluid would taste as enticing as it smelled, I sipped my antibiotic to get a lay of the land. I quickly doubled over in revulsion, releasing the clasp of my ear and using the hand to pinch my nose, helping me down the medicine in one fell swoop.

The distaste for the prescription was tolerable compared to the infection in my ear, caused by a dunk in a thermal mud bath. Ignoring the signs posted all over the perimeter of the spa, Do Not Go Underwater, the petulant tween in me decided that the mud at the very bottom of the basin, trampled by hundreds of dirty feet a day, would be the best to smear all over my face and head. When my ear clogged with bacteria, I didn’t hear the end of it (the effervescent ringing made it impossible to decipher my mother’s speech).

Since then, antibiotics have felt like a central narrative running through my otherwise healthy life as a young adult. After that infection, several others befell my tween ears in quick succession. In high school, I was on doxycycline for about a year, an antibiotic that supposedly doubled as an acne remedy (not for me). The pretense felt different for that stretch of the road—I saw the medicine for its effect and not its classification. I wasn’t yet bound to antibiotics on a psychic level.

In college, that changed. The affair really got hot and heavy. During my first three years, I picked up a proclivity toward streptococcal infections and did several courses of oral amoxicillin varietals. The coup de grâce happened senior fall when I contracted a streptococcal mitis so advanced I spent two nights in the hospital and a subsequent month with a mid-line in my upper left arm for a daily intravenous cocktail. September was spent journeying to the hospital near campus, getting friendly with the nurses in North Seven: the infusion clinic wing.

That strep mitis infection was a major turning point in both my life at large and my life as a hypochondriac. The doctors didn’t have any explanations for me. The provenance of the infection was as nebulous as my bloodstream. And without any semblance of an answer, I was left in limbo—cured of my physical symptoms but plagued with doubt. My fear of illness grew like the cancers I constantly imagined myself to have. I began to see paper cuts as gateways to pathogens, entry points for nefarious bacteria. I brought Neosporin everywhere, and at the first sign of fever, I would head straight to urgent care.

Once, in July of 2024, after nursing a 100-degree fever for ten days straight, I made three visits to urgent care and, on the third, managed to guilt the medics into excessive tests and protocols.

“You don’t understand. This is how my infection last year started,” I wailed from a prone position in the medical high chair. “I’m immunocompromised. I need to make sure I don’t have bacteria in my system.” Exhausted from my delusions, the attending PA reluctantly prescribed me a course of five-day antibiotics for what turned out to be parvovirus (I had taken antibiotics for nothing).

A month after my parvovirus fluke, I set off to visit family in Italy, hoping that the lifestyle on the Italian continent would rid me of all my bodily evils, like a suspected tuberculosis patient heading to the mountains for curative air particles. It only took one week of being there before I got my first-ever UTI. With no medical team, in the middle of the countryside, on a Sunday (of all days!), I typed into ChatGPT: How do I fix a UTI in Italy RIGHT NOW? They spewed out a disclaimer about medical advice before suggesting I look at doctorsinitaly.com, where, for only forty euros, sick Americans could be connected almost instantly with a licensed doctor. Equating the amazing branding on their website with safety, I woke up the next morning at 9:00 a.m. for my video.

The visit took three minutes from start to finish before I was given a two-day antibiotic powder that “shoulda fiiix the eeesh-you eeasily” said the grinning doctor after making the easiest buck of his life. He sent me the script to my WhatsApp, and I got it filled by noon.

It should come as no surprise that, without a urine culture, the powder he had given me was only a stopgap. In a week’s time, my discomfort came back, and, fixated on expediency over efficacy, I managed to coerce a pharmacist into giving me another run-of-the-mill antibiotic, this time a seven-day course. Relief barely lasted a week, but in the meantime, I was on a Paris-bound plane over the Alps.

My first day in the great capital was spent hustling to find a doctor, and this time, doing the medically smart thing and getting some actual labs run. Having studied abroad there, I knew Doctolib to be a reliable and quick way to get help. I managed to get an appointment the morning after my arrival at an office above the Levi’s store on the Champs-Élysées. The next antibiotic—a WWII-grade penicillin prescribed to me by a Polish doctor in a Parisian clinic—was handed over only after thorough chastisement over my mismanagement of the prior two antibiotic regimens.

“Beaucoup d’eau,” she said in a thick Eastern European accent. And that I did, practically waterboarding myself as I clenched my pelvic floor across the grande boulevards, stopping at every other café to use their public toilettes, s’il vous plaît.

“Don’t you think that’s why you’re having issues getting rid of the UTIs in the first place? All those public bathrooms?” read a text from a concerned friend. They had a point. French people aren’t quite known for their cleanliness.

The last time I was in Paris, in the fall of 2022, I was also grappling with a slurry of health issues. After a major concussion from an ill-advised electric scooter ride, I discovered the concept of antifragility, put forth by Nassim Nicholas Taleb in his 2012 book Antifragile: Things That Gain from Disorder. Given my personal circumstances, the read struck a chord in my noisy, shifty mind (or I should say "listen," since I had to consume all my literature in audiobook form during my concussed delirium).

Antifragility describes systems, entities, and processes that actively grow stronger when faced with shocks and volatility. It stands in direct contrast to fragility—easily damaged by stress—and robustness, which resists damage but does not improve.

The main tenet of antifragile theory is to have a positive response to chaos. Taleb repeatedly uses bodily metaphors to illustrate the point: when you break down your muscles during physical exercise, they grow back stronger; when you get a vaccine, your immune response improves; when you tackle a challenging puzzle, your brain becomes more neuroplastic.

Taking antibiotics, however, is perhaps the antithesis of antifragility. Overuse of antibiotics can lead to bacterial resistance, where pathogens evolve to become less responsive to future treatments. While your body does not become resistant to antibiotics, excessive use can weaken your natural microbiome and reduce overall immune resilience, making future infections harder to fight.

I was made painfully aware of this fact after suspected UTI number four in as many months. After the French penicillin nuclear bomb obliterated my gut flora, I managed to stave off infection for another month. My urinary tract, at least, had the decency to wait until I was back on American soil to flare up once more. After seeing a urologist, I discovered that it had been one type of bacteria all along—resistant to most commonly prescribed antibiotics—that seemed to gain strength with every excessive treatment.

The antibiotic prescribed for my bacterial strain was doxycycline, coincidentally something I had been prescribed two days earlier for an infected wasp sting. “Two for the price of one!” I quipped to my urologist, who responded to my enthusiasm with the following concerned disclaimer:

“Since this is a naturally occurring bacterium, it’s only an irritant in large quantities like yours. I don’t always prescribe medication for it. But given the past few months you’ve had, I’d make sure to take the entire course to avoid further complications.”

“To avoid further complications.” Words you should never say to a hypochondriac. Words you must always say to a hypochondriac. It’s the delicate balance of validating concern while offering reassurance—a self-fulfilling prophecy.

The final straw (for now, at least): I got home and downed the magic pill, knowing this time the tests were on my side. When this regimen was finished, my troubles would be flushed down the drain. In the meantime, I had to reckon with doxycycline’s side effects. The doctors had warned me it would be particularly brutal on the stomach, but after two months of a scorched-earth approach to my bacterial flora, the reality was worse than I had imagined.

Bent over the toilet bowl, clutching the pearls in my diaphragm, I thought of my Franco-Caribbean literature class, of all things. We had read Maryse Condé’s Crossing the Mangrove. During one discussion, we spoke of the motif of hiccuping and vomiting. Many of the characters experience overwhelming nausea, a need to expel their internal toils—externalizing the discomfort brewing within. Hiccuping, vomiting, and nausea are involuntary bodily responses, signaling that the characters cannot suppress the effects of all they repress and resist.

In Condé’s novel, this physical discomfort arises from the legacies of colonialism, the internalized trauma that spills over into the fraught ties binding the characters in Rivière au Sel. To cope with all the personal and historical conflict that cannot be digested, the characters confront their unrest through involuntary expulsion—a catharsis when direct confrontation is not necessarily possible.

What inside me was demanding expulsion? Well, nothing—it’s a side effect, that’s all rings the cacophony of internalized medical jargon from the depths of my brain. But intuition parts through the medic mist and I find my unshaken belief in the psychosomatic link, analyzing my post-antibiotic physical discomfort the way a psychic might read tea leaves. Why am I getting all these infections? Why is my immune system so unruly? What in my life could be causing this physical burden?

This line of thought brings me face to face with two contradictory ethical positions: the need to expel versus the need to integrate discomfort. The former is the tactic of Condé’s characters; the latter, the ethos of antifragility. What are the benefits of integrating our hardships, of building resilience around containment? Is that even possible? Or is it precisely this rigid commitment that landed me in front of the toilet bowl in the first place?

Expulsion versus integration. It seems, firstly, like a matter of privilege. Who has the time and resources to persist? Who gets to "cleanse," and who is forced to "expel"? Questions for another time (though I can give you a hint: it’s classed, gendered, and racialized!). And for the record—who is trying to force integration in the first place?

But expulsion also seems divisive in some ways. Individualist society promotes this mentality. Cut them out! Do the things that make you happy! Set your boundaries! Say no to people! The self-starter in a society eroded of communal commitment is convinced into thinking that by eliminating outside stressors, they can come out victorious. Refreshed and revitalized after taking the easy way out of their hardship, like you can cut out family and friends from your life while waiting for a facemask to dry, while running a bath. 

As is often the case, one comes to an impasse with binary opposition, realizing that neither end of the spectrum will be the cure to your maladies. It takes effort to distinguish what things in your life should be integrated functionally and which things should be regurgitated back onto the source of their provenance.

At the end of the day, it once again seems wrapped up in a question of conscious consumption, not of goods and services in the traditional sense, but of the byproducts of your situation. The socio-historical context you were born in, your family, and the conditional challenges in your past, present, and future.

For now, despite daily malaise, I am trying, as one friend once told me, to “stop being health capitalism’s greatest consumer.” I’m attempting, at least for now, to stop buying into the latest treatment, remedy, and cure-all. I turn my attention, instead, to my internal landscape. Assessing my mind like an attic, trying to decipher what’s of value in all that I’ve accumulated. Should this stay? Should this go? I’m sure I’ll throw some things out I’ll regret. I’ll definitely keep onto things I should discard. I tell myself, ultimately, that what’s important is that I get a better sense of all I have stored.