Several years ago, Sheila Heti was given a shallow blue cardboard box by her friend, the artist Margaux Williamson, who discovered it in a pile of free stuff on someone’s lawn. On the box was a sticker with the words “Make a Picture Story” and inside were 21 paper backgrounds and 67 paper dolls. Created in 1947 by the US psychologist Edwin S. Shneidman, the MAPS test was used with disturbed adolescents and "adults of at least dull intelligence" with an aim of understanding "the individual psychodynamics" in any given patient.

Santiago is a movie-star-handsome man in his 50s. Women fall for him easily, want to be with him, sleep with him. Men, too. He has been offered money for sex (he has never taken it) and has had far more sexual partners than he can count. He was a drug addict for many years, and suicidal during the worst of it. Perhaps because the female body is nothing he isn't used to—and access to it is easy—seeing a naked woman splayed on a bed doesn't first make him think about sex or cause sexual arousal. As we will see, the associations the naked woman evokes for Santiago are of sickness, sorrow, and death. Perhaps because he has been desired for so long for his physical attributes, he relates to the beautiful woman. He sees himself in her. She is not an Other. In the end, the fantasy he reveals is a fantasy of being loved, cared about, and, ultimately, mourned. He is the naked woman (the vulnerable one) whose fate it is to perish alone.

Tell me what you see in this picture, Santiago.

Well, this guy on the far right is that woman's husband, and that's the doctor. The doctor has his watch in his hands, and he's just tested her pulse to see how she's doing. That's what he's got the watch for—to check her heart rate—and it doesn't look good. Her heart is slowing down more and more. And it's been slowing down over a period of several weeks. It started out being normal, then got slower and slower and slower and slower. Her heart is still flowing—uh, her blood is still flowing—but everybody knows that eventually, and it might be days or it might be months, her heart rate is going to slow down so much that she's going to die. And the husband is really sad about it. He doesn't feel so great.

Why is she naked?

Because this condition—you would think it makes you very cold but it makes you very hot—so she can't stand to have any clothes on.

And the husband's not looking?

The husband is stricken with grief, so he's turned his face away. The doctor came by and he's got nothing but bad news.

Is the woman awake or asleep or what?

She's holding her stomach, and she's conscious, but only barely.

What's going to happen in the next instant?

The doctor's going to walk away and the husband's going to walk away. The husband can't stand to be in the room with her, so she's just going to lie there dying very slowly.

Is it the same doctor who comes every time?

This might be the first time the doctor's here. I don't think the husband intends to call the doctor back. He knows which way the wind is blowing.

Is it a rare condition or a common one?

I get the idea that it's known to medicine, but medicine is not very advanced in the kind of place where these people live. So it doesn't come as any surprise when somebody gets an illness that nobody's ever heard of before.

What is this "illness that nobody's ever heard of before"? Why is medicine "not very advanced in the kind of place where these people live"? Does Santiago really think that suffering, pain, the agony of being is something "nobody's ever heard of before," its cure so impossible to find "in the kind of place" he lives? What kind of place—or body—does he inhabit? One that cannot soothe its own pain, because the source of his pain, while perhaps "known to medicine," is not known to medicine "in the kind of place" he's in.

One gets the sense that Santiago (for Santiago is also the husband, also the doctor—all these people are representations of Santiago's psyche) handles his pain by walking away from it—as the husband walks away from his wife. He "can't stand to be in the room" with it. Pain can be dealt with in many ways: It can be something a person tries to empathize with, to investigate, or to heal, but for Santiago, it's something he is "going to walk away" from. Drugs are one sort of walking away, suicide another.

Santiago's condition (his pain) is something that you would think "makes you very cold but it makes you very hot." Is he referring to his veneer of aloofness, which he wears to encounter everyone he meets? Santiago seems to be "very cold." But he has a temper, is very sensitive, and is ever on the edge of exploding into a rage—the slightest thing can set him off. So his condition, his pain, actually makes him "very hot." This evident suffering and sensitivity is likely part of what makes him attractive to so many (people intuit it subconsciously or, if attentive, can see it beneath his mask). It makes him hot in both senses—angry and attractive. (Why are we so attracted to people whose pain is so clear? Why does pain make a person "hot"? And why do the people we consider "hot" often present socially as "very cold"?)

When what is killing us is pain, it does not kill us in an instant, but slowly: "It might be days or it might be months." One's heart doesn't simply stop because of whatever one is suffering emotionally. Her "heart is still flowing." However, it is "going to slow down so much that she's going to die," which is "nothing but bad news."

Ultimately, Santiago is "really sad about it. He doesn't feel so great." No one wishes this condition on themselves. Even the suicidal can be "stricken with grief" over their own pain. There is no course of action but to turn his face away, to leave the room.

What happens in the next instant is that "the doctor's going to walk away and the husband's going to walk away." Santiago's psychic triangle (composed of a sufferer, a healer, and a witness to the suffering) finally splits. The witness and the healer—characters who could temper the pain—leave, while the sufferer remains alone in her suffering. Santiago is aware of all this, but only barely. He is an intelligent man, but he doesn't examine himself. He is "conscious, but only barely." recommended

Sheila Heti is the author of several hard-to-categorize books, including the novel How Should a Person Be?

Don't miss the rest of this series, including "What Do You See When You Look at This Attic?" "What Do You See When You Look at This Bridge?" and "What Do You See When You Look at This Square?"