Why I Can’t Just Meet You for Dinner The Reality of Post-Exertional Malaise Fred Rossi Nov 07, 2025 The conversation always goes the same way. Someone asks if I want to join them for a meal, grab a drink, go to the movies, or some perfectly reasonable social activity that healthy people do without thinking. And when I hesitate, or decline, or try to explain why a Tuesday evening gathering might not work when I’m working Wednesday morning, I can see it in their faces and hear it in their voices: they think I’m making excuses. I’m not making excuses. I’m doing accounting. What PEM Actually Is (And Why “Tired” Doesn’t Cut It) Post-exertional malaise (PEM for those of us who live with it intimately) is not tiredness. It’s not even exhaustion. It’s a systemic crash that occurs after physical, cognitive, or emotional exertion that exceeds your body’s brutally reduced energy envelope.