August 27, 2021—Philadelphia

Yesterday, walking in the city, nearly breathless in the heat, I was observing the way passing gusts of eucalyptus, gink-go, dog shit, geraniums, and box, and cold urine drafting up from the subway entrance took on palpable qualities of chilliness, nausea, heat, and disgust as they seemed to reconstitute in the humid air, enter into my body, and merge with my sweat. This was always my sense of the city, that I inhaled it and perspired it, that it became mingled with my body odors and clung to my clothing. The city was the hard feeling of it under my feet, and the sound of it, polyphonic, and the sights of it, kaleidoscopic, now random, now patterned, always colorful. I never walk in the city in order to make friends, although every encounter, for the most part, is a friendly one in the city. I am an old woman now, and the city has been ravaged even more than I have been, by death and sickness, by neglect and violent desperation, so I have the sudden realization that it has always been the city itself I have loved, the city itself that has been my friend. I could walk there in the singularity and privacy of my own form, among others just like me, going somewhere or nowhere but needing to be there in the city and walking, and feel, at the end of the day, that I had been with an old friend and had caught up with all her changes and reassured myself that she was still there and that at any time we could pick up where we had left off. And now, suddenly, I see it as fragile and mortal as myself, not eternal, but finite.

The brownstone where Dr. Epstein has his rheumatology practice is redolent of the old Institute of the Pennsylvania Hospital at Forty-Ninth Street, a place where psychoanalysis had a home until the late 1980s: the high ceilings, the moldings and plaster details, the wide staircases, the hidden bathrooms, the assorted art and photographs on the walls, the warren of transomed offices carved out of a nineteenth-century mansion, and elevators that require f