A friend I’ll call Mary labeled it her “shriveled plant moment.” In 2003, Mary was the director of a development organization that operated in a group of indigenous villages outside León, Nicaragua. Mary had witnessed plenty of dramatic scenes since she came to Nicaragua in the aftermath of Hurricane Mitch in 1998. But the shriveled plants—brown, desiccated fruit trees, vegetables, and flowers in the garden of her friend Sonia—signified a different kind of disaster.

Just before Sonia’s plants started shriveling, the kidneys of many of the men who worked in the sugarcane plantations that surrounded the indigenous land had also started to shrivel. Grainy ultrasound images of damaged kidneys began circulating through the area. These images were stapled to the clinical discharge forms the men were handed as they started the journey home. The front pages of these forms had one word printed in boldface: EPICRISIS.

Doctors had no good explanation for the epidemic of renal failure, but for Mary and Sonia, the shriveled plants offered a clue. Villages in the area were increasingly being showered with agrochemicals, released from airplanes and helicopters by the sugarcane company to promote the rapid maturation of the cane. At harvest time, houses were routinely enveloped in smoke that drifted from the fields as company workers burned the brown stalks. Neither Mary nor Sonia had much medical training, but it made sense that what was happening to the plants and what was happening to kidneys had something to do with what was happening to the sugarcane.

In Spanish, epicrisis means a clinical report, but more literally (in Spanish and English) it simply means “the crisis after the crisis.” The shriveled plant moment, after all, seemed to come after the shriveled kidney moment.

Nicaragua’s sugarcane plantation zone is a site where capitalist economies of scale meet small market and subsistence systems. Here, a precise accounting of labor time, economic inputs, and technical work meets with a host of unknowns. There’s the mystery of the weather, and the inexact science of predicting El Niños. Then there are the vicissitudes of the market, for both cane-related industrial products like refined sugar and ethanol and locally grown food crops like mangoes and chayotes. The shriveled plant moment brought another unknown into the frame: the uncertain impact of agrochemicals on plantation workers’ kidneys and small farmers’ crops.

In rhetoric, the word epicrisis refers to an annotation or speculation. The suggestion that toxic exposure was killing plants and people could not be proven: it was an epicritical suggestion, a notion after the fact.

Contemporary (critical) theory (e.g., Berlant 2007; Nixon 2011) reminds us that the discourse of crisis—whether applied to the prevalence of obesity in low-income children, to the warming of the planet, or to financial markets—tends to make chronic conditions appear as if they are sudden, singular events. In the near term, talk of crisis can help marshal resources and attention, but in the long term, talk of crisis can occlude our appreciation of slower forms of violence.

These critiques aside, those I have spoken to about the epidemic of renal failure and the rash of small crop failure in the plantation zone frequently describe those initial sightings of shriveled plants and shriveled kidneys as crisis, that is, as momentary, startling events. Since 2003, however, the facsimiled ultrasound images of compromised kidneys and the oral descriptions of shriveled plants have kept recurring. What started as a moment has now become a genre.

Epicrisis, as a form of clinical reporting and a form of speculative figuration, seems like a useful way of understanding ecology and embodiment in the late industrial agrarian Anthropocene. Though they cannot prove it (and still have not to this day), activists like Sonia insist on interpreting the twinned messages from farm plots and urinary tracts as signs that toxic chemicals are killing humans and nonhumans. The shriveling was not only explainable, it was unjust.

But epicrisis is also a temporal term: the crisis after the crisis. This is where things get tricky. As I suggested above, it first seemed as though the plant shriveling had come after the kidney shriveling: a kind of epicritical message from the botanical side of the plantation world to the human side. But now that so many years have passed, and now that the shriveling of the plants and the shriveling of the kidneys have melded into one reliably repeated condition, it seems worth asking if the shriveling is actually the outcome of something bigger, slower, and altogether more menacing. Some (including me) have suggested that Nicaraguan plants and kidneys are the local manifestations of global climate change.

Yet the reverse could also be the case. It is just as plausible to argue that a crisis called climate change is the result, rather than the cause, of the shriveling. Not only are many of the most influential people in the world not convinced that climate change is a crisis, many of the most influential actors in Nicaragua, including major sugarcane firms, remain unconvinced that plant death and kidney failure have anything to do with them. The stakes of epicrisis are high— politically, economically, and biologically.

As one looks for evidence that climate change causes illness in plants and people, one is at the same time looking for evidence of climate change. This means that trying to identify linear, material connections between pesticide drift, the burning of sugarcane, and death may be a misguided approach. A better approach might be to work back and forth across the multiple levels of epicrisis. This means amassing an archive of clinical and environmental reports, but it also means making more room than we might normally make for annotation, commentary, and speculation, all while holding in abeyance the urge for proof that one thing follows from another.