Hospitalized in Utopia


Diana looked out the window at the sky. It was a good sky, she liked looking at it, but she couldn’t look at much else. If she turned her head the other way she could see only pale blue walls, medical equipment, and a glimpse of that machine in the hallway that went beep! beep! beep! She couldn’t imagine what it did—and she had tried.

Supposedly her window actually had a lovely view of half the green city. All those rooftops with rooftop gardens visited by honey bees and hummingbirds. All the streets and pocket parks shady with fruit trees and now, in May, musical with nesting birds. She could see none of it. She had only the one viewing angle. She couldn’t lift her head, let alone sit up in bed. She could make her bed sit up, but then she’d slowly slide down the incline until her breasts rested on her belly-button and she’d have to call an orderly to come sit her up again.

Diana was not a truly a quadriplegic, she had the use of her arms, but she didn’t have much else.  She had no trunk control.

The kicker was that until recently, she’d had all the physical control she needed. She’d been paralyzed in her twenties, back before the collapse of the old civilization, but for decades now she’d worn robotic exoskeletons, each model better than the last. Only lately the port in her spine by which the machine plugged in had begun to degrade, eroding her flesh as it went. If the inflammation reached her neck, she’d lose control of her arms, maybe even her lungs. If it reached her brain she would die. Add to that the further ills that came of being seventy-six and having been unable to feel or use most of her body for forty years, and she’d been in sorry shape.

So she’d landed here, in New Jersey, in the region’s best and only major hospital, the centerpiece and raison d’etre of one of the first modern, fossil-fuel-free cities in the world, for a series of surgeries and therapies and tests and more surgeries and therapies and tests. She wasn’t done yet. She turned her head and looked again at the sky. She liked looking at it.


June, now, and changes coming. Supposedly, she’d be let out soon, and though her doctors and therapists gave her conflicting reports as to when, it wasn’t her decision, so she didn’t have to worry about it.

Throughout her stay, everyone had been so nice. The nurses remembered her birthday and brought her take-out Indian food, the orderlies got the hospital IT people to fix her tablet so she could work, and the doctors answered her questions and cracked jokes with her. One had even sat and listened while she geeked out about stratospheric temperature variation, letting her be a climatologist again, not just a hospital patient, a kindness she did not see how he had time for. Were all healers this nice? What about the first time she was hospitalized, right after the accident? She couldn’t remember. She’d had too much on her mind back then to notice. 

That had been back in the other, older world, when life-saving treatments depended on having medical insurance and she could hear cars going by in the road outside and the thump! thump! thump! thump! of the blades of the medical helicopter coming in low over the roof…. Her parents had been alive, then, but on the other side of the planet, home in Mumbai. The one thing she’d really needed, she couldn’t ask of them anyway—some hint of how she to live without rock-climbing, without sex, without every single assumption she’d ever made about how her career and her life would go. She didn’t remember the hospital staff from then at all, no. 

Maybe that’s why the loss of the old civilization had not bothered her so much; she’d had practice at reinvention.

The orderly of the morning, Kathy, came in with breakfast, shattering Diana’s reverie, making her smile by smiling and joking with her about the quality of the food.

“Do you want more water?”


“Do you want me to take this stuff?”

“Please—except leave me those papers, just put them over there.”

“Sure. Oh, is this a letter? My sister used to send those….I don’t have the patience. Listen, Mallory is out sick, so it’s Trish today, she’ll be in to see you in a bit. Did you get your schedule updated this morning?”

The food actually was excellent. Without fossil fuels, shipping had gotten slow and expensive, so the hospital cut costs by having its own farms, gardens, and greenhouses, plus kitchen staff who knew what to do with fresh food. Only problem was some crops in season grew to excess. This week there were way too many strawberries. Diana had volunteered to do her part by eating as many as possible, and she was pleased to see she’d been given a huge bowl of the fruit, sliced and honeyed and flavored with cardamom powder. The yogurt was plain, unsweetened, as per her request, and the small bowl of oat bran—done up in a porridge like gray grits—had a pat of butter melting into the top. A little tray of pills, mostly vitamins, rounded out the meal.

Diana raised her bed and tucked in. Later there would be physical therapy, then a meeting with the interim housing coordinator and the pharmacy liaison, and then check-ups with Wound Care and Holistic Care. If none of those appointments got rescheduled or preempted, they might let her out tomorrow.


Some last-minute problem setting up housing delayed her two days. She had several weeks of out-patient procedures before she could get her new neural port, and she planned to stay in the city the whole time. Transporting humans had gotten nearly as expensive as shipping fruit, so there was a whole block of boarding houses and hostels reserved for patients and their friends and families—not an old-fashioned city block, either, but the half-mile-on-a-side square district used for planning in this heavily-planned place, carved out as it was of a moonscape of abandoned sprawl, then planted and made to live again.

Everybody who had kept Diana going these last few months dropped by to say goodbye, and then an aide dressed her and wheeled her and her bag of personal things into an elevator and then out to the lobby. Once there, the aide helped her transfer to her sleek, blue, rental wheel-chair, the kind with no motor. She wanted to move under own power as much as she could. 

The doors opened—she was almost afraid that they wouldn’t—and she rolled out into a blast of humid heat so intense it felt like some gummy liquid. The hospital buildings weren’t air-conditioned, of course, but an older technology, passive cooling, kept the interior under eighty-two degrees. The occupational therapists had carefully acclimatized Diana, but the difference still startled. A whole sudden summer world of growing things all loomed towards her.

Well, then.

She looked both ways and rolled off into real life.


In her own rented room at last, tired and hot from her long roll, Diana wanted a shower and a nap, but couldn’t do either without help. She wasn’t in the mood to summon a boarding house aide. Instead, she opened the package of groceries she’d had delivered and found a jar of instant tea powder. She mixed herself a tall glass, washed her face and hands, and soon felt more or less human.

She left her room, exploring. The building had a back door, so she went through it and found herself in a big, green park. The block was only ringed around by the large boarding houses and hostels. The entire interior of the block was open, more than an acre of lawns, native flowering shrubs     and shade trees, mostly oaks older than the city. Packed-gravel paths for the convenience of those on wheels snaked throughout, past benches and bat houses, from a playground in one corner to a marshy little frog pond in the other. And everywhere there were people, children running, older adults enjoying the shade, a couple of bird-watchers….Many of these people carried drinks or snacks. Diana inquired and learned the block had a small commercial area—a general store, a gym, an indoor swimming pool, a children’s learning center, and, yes, a tea-shop. 

She bought herself cold sorrel tea and a Danish and parked herself under a tree. She noticed, rather belatedly, that she was smiling.


The next morning, Diana got up early and went to the tea-shop for breakfast. She sat out in the park to eat it. She’d intended to put in a full day’s work, reviewing student papers and emailing colleagues, but all of a sudden she didn’t feel like it. The day was lovely, sunny but still cool, and it put her in a rebellious mood. She inquired again among the people around her and soon had the name of a well-recommended pedal-cab driver able to hitch her wheelchair to his bike. He also offered scenic routes with tour-guide service, for a higher price. She decided to splurge.

“Take me to a restaurant!” she ordered, imperious, magnanimous. “Any restaurant, provided it is excellent and we don’t arrive before lunchtime!”

The street, one of the two major north-south arteries, was very wide and very busy, mostly with pedestrians, bicycles, and wagons pulled by bored-looking mules, but there was the occasional bio-Diesel-fueled emergency vehicle, plus big public buses pulled by teams of massive Clydesdales. All the animals wore tail-bags, so the packed gravel of the road stayed clean. The edges of the road and the wide median strip were dense with trees—more tall, old oaks, but also new plantings, the cherries, apples, walnuts, and chestnuts that would someday turn the street into twin green tunnels, sequestering carbon, providing additional local food, and keeping the city cool.

She’d paid for tour-guide service, but she couldn’t hear most of what the cabbie said over the road noise. The route certainly was scenic, though. They zipped between planning blocks, this one dedicated to apartment buildings, that one to the factories that, powered by landfill gas and renewable electricity, made the various things a hospital needs in quantity. The city wasn’t fully self-sufficient—commerce had not been abandoned—but the expense of transport made local production much more competitive and kept the city’s unemployment numbers low. At least, so said Diana’s pamphlet.

The buildings looked strange. It took her a moment to figure out why—they were all artfully assembled from bits and pieces of the suburban sprawl they had replaced. Nothing, it seemed, was wasted anymore. Even the murals were mosaics made of old trash, brightly-colored shards of glass, plastic, ceramic, bits of metal sparkling in sunlight.

The day was getting hot, but the air smelled amazing, clean and fragrant—only a hint of animal dung, no exhaust, no smoke, the air felt good to breathe, not like in any city Diana had ever been in before. Of course, Hospital City wasn’t like any city that had existed before. 

Never before in the history of the world had any society existed without fossil fuel but with the internet. That combination had changed everything. 

Mostly it had changed society into a very rural place. Really large population centers require lots of cheap energy simply to feed themselves, and carbon neutrality had come too late to save most of the old cities from sea-level rise and heatwaves anyway. People had moved inland, moved north, spread out, living in farms or small villages set lightly on the land but interconnected and coordinated through the internet. Physical objects moved as slowly now as they had in the eighteenth century (except when speed really mattered, such as for the bio-Diesel ambulances), but for information and ideas and requests for help, distance didn’t matter at all.

And yet some worthwhile activities need cities to work properly. It’s hard to run a national government or a major museum complex without a certain population size and density. Advanced medicine is simply another example. Although every farming community had its own little clinic, there is a limit to what a part-time medical staff can do, especially with rare or difficult cases. Hence the building of Hospital City. 

The city, the city, everybody kept calling it a city, but the place had fewer than thirty-thousand residents. Diana had known towns bigger than that before the collapse, back when she could still wriggle her own toes. Cities had crowds. Cities had smog. Cities had slums.

And yet this place felt urban anyway. Maybe it was the fact that all thirty-thousand must do their business here, rather than driving off to some other place with more people and more services. There was no other, larger place. The services were here. Anyway, the place did have the other, better things cities ought to have. There were good ethnic restaurants. There was an entertainment district. There were skate parks and dance halls, breweries and jewelers’ workshops. There was more than one of each kind of store, all in vibrant competition, plus weird, specialty places—Diana had heard of one that sold eggs, just eggs, but eggs of every imaginable kind.

And it smelled nice. And it was pretty.

They pulled up to the vegan soul-food place the cabbie had recommended. After he unhooked her from his bicycle, she invited him to lunch, her treat. In two months she would get a new neural plug and a new, improved exo. She’d be able to invite men like him to go dancing, possibly even rock-climbing.

She still liked her body, limited as it was by injury, illness, and age. She liked seeing what it could do. She liked this modern world, for the same reason. 

The Age of Fossil Fuels was over—a victory she hadn’t expected to ever see. And indeed, there had been no way to carbon-neutrality; instead, carbon neutrality was the way. That decision made, the only trick had been adapting economically and culturally to it.

But the decision had been triggered by the collapse, not the other way around, and the collapse had been terrible. Many had died. Much was lost. The key was how to build back.

Civilization had fallen. Ultimately it had landed here, and here was a good place, a living, sustainable, hopeful place. Just as she had fallen, shattered, and landed here, in her real life, rather than the one she had once imagined living. And she had a good life. Even if she couldn’t get a new implant, she had a good life.

Should she then be grateful for the fall of civilization or of her own body?

“Do not ask me that,” she said to herself. Then she went to lunch.