When oral antibiotics are no longer effective, the narrator grudgingly consents to begin a six-week course of intravenous antibiotic therapy with Rocephin (a powerful, broad-spectrum antibiotic). She has an infection caused by spirochetes. The illness has been festering for as long as ten years but has only recently been diagnosed. It causes joint pain and stiffness. Her daughter has already been successfully treated for the same infection.

Every morning in her kitchen, the narrator performs the same ritual. She cautiously infuses the antibiotic and imagines that the golden fluid is extinguishing the corkscrew-shaped microbes. At first she experiences a drug reaction, but the event only convinces her that the treatment is actually working.

She senses that her husband and her friend are repulsed by the treatment (especially the syringes and IV apparatus). A visiting nurse, Ginger, comes to the house to perform minor maintenance on the intravenous line. She upsets the narrator with grim information about the infection and an account of a patient suffering from the same disease who is currently in awful condition. Dr. Kennicott, the narrator's physician, has not been so forthcoming about the course of the illness or pessimistic about the prognosis. The narrator chastises Ginger. Both women are now distressed. The narrator's immediate goal is to control her emotions and avoid crying.


Although the spirochetal infection afflicting the narrator of the story is never actually named, all clues point toward Lyme disease. The description of the placement, utilization, and upkeep of the narrator's peripherally inserted central catheter (PICC line) is quite interesting. The PICC line is a constant reminder of the severity of her illness and also symbolizes danger for the narrator. The story mentions a prominent drug reaction that develops shortly after starting intravenous antibiotic therapy. This response (known as the Jarisch-Herxheimer reaction) occurs when massive numbers of spirochetes causing Lyme disease (or syphilis) are destroyed with an initial dose of antibiotic.

The portrayal of nurses is noteworthy. The office nurse who inserts the intravenous line before the narrator's treatment commences is described as "pleasant and perky, rather glamorous" (108). The visiting nurse who checks on the status of the IV line during the course of treatment, however, is described as "powerful and clumsy" and also "breathy, fleshy, bulky" (117). The narrator fears that the presence of the visiting nurse is contaminating. Although the nurse provides factual clinical information, the narrator does not want to hear about (or accept) the possibility that the treatment might fail.

The tone of the tale is a mixture of alarm and isolation. The terror of chronic disease stalks the narrator. Hope of a cure seems counterbalanced by the fear of futility. She acknowledges how a healthy body is a luxury (and often taken for granted). She recognizes the vast space separating sickness and health. Illness alters her expectations and her mood. In the beginning, she boasts, "I was prepared for everything, anything" [p 108], but near the end of the story, she is struggling and her aim is much more modest: "I want only to control my tears, to keep from breaking down" (121).


The story was first published in the September, 2002 issue of The Atlantic Monthly.

Primary Source

A Perfect Stranger


Random House

Place Published

New York



Page Count