Open Heart Page 25

  “Vietnam is the one year of my life I can remember in complete detail because it was alien, and in an infinite number of ways, and I think the core of my experience there would ultimately translate into some of what I’ve been talking about—that life isn’t fair, that you can die in the next minute even if you’d done everything right, and that you’ve got to live in the present and not postpone or defer gratification the way we were trained to do.

  “When I came back home after a year, I found myself having symptoms of the sort I was seeing in patients. They were coming out of nowhere, and they were frightening to me, and they were confusing. They made me feel that I really had to get my own stuff cleared up if I was ever going to be of use to anyone else, and this led to my analysis.

  “I found myself intensely concerned about my health, and I had never thought about my health before. And when you begin thinking about your health, you find parts of your body you never knew existed. It’s like when you go through a terrible experience and you do fine, but then afterward you tremble and shake, you know?”

  Arthur talks very quickly now—when he talks about his experiences in Vietnam, I have noticed, his words come faster than at any other time in our conversations—and says that the nature of his defensive structures was such—compartmentalized—that he had no clue for a year or two as to what was going on, or that the symptoms he was suffering from—with his health, with bodily obsessions, with driving a car—came under the heading of what we now know as post-traumatic stress disorder.

  “I just thought I was probably screwed up and that I never realized just how neurotic I was, but that maybe I should speak with someone about it. Now we all have the same body parts, but the configurations make each of us different, and I began to see that there were few things that came to my doorstep as a therapist that I hadn’t experienced in my own way. Because I have felt sexual longing, fear, despair, helplessness, anger—because there were things I was frightened of and ashamed of, I could tap into that fear, anxiety, and depression for the people I worked with.

  “So that the changes I worked through in myself came to help me in my work with others. No one was going to come to my office, especially if they came with issues relating to shame, embarrassment, vulnerability, or self-esteem, tell me something, and not have my internal reflexes not work for them. I understood. ‘Poor baby,’ I’d think, though I wouldn’t say that to them, of course. I’d maybe look poker-faced, but I believe that what I understood from my own life was informing the process with my patients all the time. At some level they knew they were not being judged—because I had been there, and worse, and in my chosen profession that was a gift to me.

  “And there’s this too: that the reason I made a living was because the former custodians of these things—of healing—were representatives of the ministry. And ministry is informed by ‘oughts’ and ‘shoulds’ and the Ten Commandments, and my Bible is different from their Bible and I didn’t judge, and I really tried to understand, and to give compassion, and with empathy, and with the best I could intelligently give to people to help them cope with the parts of themselves they were ashamed of, and had difficulty with—because I had been there too.”

  “No quality of human nature is more remarkable, both in itself and in its consequences,” David Hume wrote nearly three hundred years ago, “than that propensity we have to sympathize with others, and to receive by communication their inclinations and sentiments, however different from, or even contrary to our own.”*

  When I think of us as young men, it occurs to me that the quality of human sympathy that Arthur has always given to his friends—a quality enhanced by his Vietnam experience, which made him indelibly sensitive to the vulnerability of others—he has also, for nearly forty years, been giving to his patients.

  “This principle of sympathy is so powerful and insinuating a nature, that it enters into most of our sentiments and passions,” Hume explains, “and often takes place under the appearance of its contrary…The sentiments of others can never affect us, but by becoming, in some measure, our own; in which case they operate upon us, by opposing and encreasing our passions, in the very same manner, as if they had been originally deriv’d from our own temper and disposition.”

  In a world where so much remains mysterious, even—especially!—in medicine and science (If we know so much about the genome, for example, why is it that 90 percent of DNA has no seeming purpose?), the quality of human sympathy—like the quality of mercy?—is one that, in joyous times or troubled times, and whether between friends or between doctor and patient, seems as rare as it is precious.

  In the mid-sixties, in New York and California, I was active in the antiwar movement, organizing marches and protests, giving speeches, and writing articles in which, among other things, I encouraged those of us above draft age to commit civil disobedience in support of those of draft age who were refusing to serve. During these same years, Arthur was in the army, first at Walter Reed Hospital, and then at Fort Monmouth and in Vietnam. We corresponded regularly, talking about the usual—our families and friends, books and sports—and in our letters we also debated American policies and actions.

  This, then, in one of Arthur’s letters—from Nha Trang, Vietnam, dated Monday, June 20, 1966, and written at a time when Arthur was living in a place where, he wrote, the temperature was “easily 110–130 consistently,” where he was separated from his wife and daughter, and where he was constantly fearful for his own life:

  Little question in my own mind that Noog of all people should not be required to serve in Viet Nam theater—your efforts on behalf of a more sensible solution to this whole mess speak well for the legitimacy of your contentions in this regard—G-d knows, I’ve written Marcia [Arthur’s first wife] about this just yesterday—I empathize with the tremendous bind you’re in (may not be too clear above—I wrote that I particularly felt for you, Jay, because if you’re called upon to serve it would not only be a bitter separation experience, a frustrating personal experience, but perhaps most significantly, an activity in polar contrast to beliefs you’ve been committed to for several years now). Of course, this is all the Rude and if he were in the Pentagon he would have absolutely no compunction about crossing Noog off the list, if he were on the list…

  After giving me detailed advice on what I should do to establish Conscientious Objector status before I was called to serve—the extreme fears he lived with in Vietnam seeming only to intensify his ability to empathize with and be helpful to others—and advising me not to “irrationally get hung up on hopes” but instead “to get to work,” this: “I’m scared shit so often—to a great degree quite unreasonably for thank G-d I’m safe as a human being in VN can be—that the anxiety just rolls off me.”

  A few weeks later, shortly after the publication of my first novel, Big Man, a story set against the background of the basketball fixes of the early fifties, Arthur comes across a review in Time magazine and writes to tell me “how very very thrilling it was to see you—my buddy Noog—among the premier new novelists. I’m sorry that it had to be a Time publication but these are the burdens of the more public posture you have assumed. In any event, you must know how very exciting it was for me—in the wilderness—to see my boy Noogie looking at me.” He writes that he has not received his copy of the book yet, but hears from another Erasmus friend that “Yudi Rudy is among the cast of characters—mucho thanks—I’m sure, with due respect to the models, that this guy goes well to his left & is an outstanding court figure!!!

  “Life is routine here—work challenging with much sadness always,” he continues, “—but I can help—I see that now—I am useful and at least feel that way (my use being relevance to my patients, rather than the organization I work for)—and this provides some meaning for me in the midst of the madness I see around.”

  Two months later I write him a letter in which I set forth what I see as reasonable arguments about why and how we should get out of Vietnam (a letter in which I also suggest,
“Why not play the VC a game of stickball—the winner gets the country. Is this any less sensible than what’s going on?”).

  On October 25, when his tour of duty is about half over, he writes back: “My response to your political letter—you’re right!” Then, after disagreeing with me, point by point, about several political issues I’ve raised, this: “But overall I agree that the whole thing makes no sense with the rights and wrongs so unclear.”

  “By the way,” he adds, before signing off, “Phil was remarried last week.”*

  13

  It’s Not the Disease

  I’M JUST A PATCHER-UPPER,” Phil says about his work as a neurologist.* “I mean, I’m like the shop mechanic. You come in and there’s something wrong with your car and you want me to fix it. I may tell you I don’t find anything very wrong with it, or I may tell you that it needs a minor overhaul, or I may tell you that there’s a serious problem, and we have to investigate further, and that I have to keep the car in the shop—or you in the hospital—longer. These are the things that I do.”

  Although Phil is one of the smartest guys I’ve ever known—when we graduated from Erasmus, he received full scholarship offers from both Princeton and Cornell—and though the list of his honors, achievements, and publications is long and impressive (he was chief resident in Neurology at Bellevue, chief of Neurology at Denver General Hospital, chief of the Neuroscience Division at St. Anthony Hospital in Denver, et cetera), he remains so modest, blunt, and direct—so boyishly unsophisticated and unpretentious—that one can be fooled by his plain speech and unassuming manner into not recognizing just how brilliant and insightful he is.

  What I did with Phil on my first visit in 1988—going on rounds with him at hospitals, and spending the rest of the day with him in his office—I have done the other half-dozen times I’ve spent with him in Denver. He introduces me to patients, family members, and staff, as a friend from high school who is a writer, and he always asks—Jerry does the same when I spend days with him—if it’s all right for me to be present during their talk and/or examination. We usually start the day on the intensive care unit at the Trauma Center, where most of the dozens of patients I have seen are unconscious, suffering from major head injuries, and, usually, from severe damage to various limbs and organs. The majority of the patients are young, often in their teens, and the majority of these young people are in the hospital because they have been in car accidents. Several times, after he has examined a patient and reviewed test results, when the patient asks what he or she thinks is the problem, or its cause (“If it’s not carpal tunnel, Doctor Yarnell, what could it be?” a woman has asked earlier on this day), I have been surprised at the easy way he simply shrugs, and, without missing a beat, says, “I don’t know.”

  Or—this to another patient during afternoon office hours—“There are some abnormalities in your hand, thumb, and finger, but I can’t make a diagnosis.” He will, then, as with this woman, discuss what might be going on, and when, at the end of the visit, he records his notes into a tape recorder, he invites the patient’s collaboration. “Now listen to me, Shirley,” he says. “I’m going to talk about you and I want you to correct me. I’m going to talk about your illness.”

  “I could confirm—yes—” he tells me afterward, “—but I was no help to the lady.”

  “Because neurology, you see, is where cardiology was maybe forty years ago,” he explains. “When I was in medical school we didn’t have intensive care units. There was no treatment for a severely damaged heart other than digitalis. Bypass was just in its infancy. The heart-lung machine had a very high mortality rate, and there was no transplantation.

  “So all these things are what we’re trying to find for the brain. But we’re in our infancy. In cardiology, if you have an abnormal rhythm, Rich may put in a pacemaker. If you have an abnormal brain rhythm, we give you some medicines to try to stabilize it, but we don’t have a pacemaker for the brain.

  “No one really has a good way to make the brain heal—it’s the great mystery.* We don’t have the antibiotic that cured pneumonia. We don’t have an aid like portable oxygen—I mean, you see people carrying portable oxygen because their lungs don’t work. You don’t see people carrying around anything if they have Alzheimer’s—maybe a note pad, and they make notes. But you need a certain amount of cognition to do that.

  “That’s why right now all our efforts are to prevent complications of the injury, to prevent too much pressure on the brain, to prevent inadequate oxygenation of the body. If someone bruises your arm, it may heal, but if you injure the brain in certain places, it can make you paralyzed, and nothing will change that. We don’t have a treatment for coma, no way of making that better, so all our efforts are to make the milieu the best for adequate healing.

  “We don’t have a splint for the brain, or a nutrition for the brain.* You can’t say, ‘Take this diet and you won’t get brain problems.’ You could say, ‘Control your blood pressure and you’re less likely to get a hemorrhage, and you probably won’t get a stroke,’ but once you get a stroke all we can do is try to teach you to maximize your life with what you have left. If you’re a paraplegic, my job is to try to teach you how to live the best life you can in a wheelchair, and if anything gets better than that, it’s extra.”

  It is late at night, and I am sitting in Phil’s office with him in his home in Greenwood Village, Colorado, just outside Denver. I often think of Phil’s office, a large room he and his wife Barbara added on to the house on the far side of the garage—fifteen feet wide and twenty-five feet long—as being the Brooklyn/Southwest annex of the Victoria and Albert Museum. It is filled to overflowing with an extraordinary assortment of things, including sculptures (bronze, wood, clay), paintings and prints (the American West), family photographs (some life-size), baseball and sports memorabilia (especially about the Brooklyn Dodgers), Judaica (menorahs, the Tablets of the Law), geometric forms (bright yellow plastic cubes, rhomboids, cones, pyramids), encyclopedias, medical books, magazines, skeletons, skulls, spinal cords, geodes, rocks, exercise machines, bicycles, skis, sculptures-in-progress, four-pound plastic jars of chocolate-covered raisins (Phil never eats lunch, but snacks on these all day), and lots of cartons filled with who-knows-what.

  His desk abounds with a similar variety of items, along with medical papers, articles-in-progress, partly completed clay sculptures, several dozen model cars and trucks (Matchbox reproductions of racing cars, pickups, forklifts, et cetera), and lots of rocks. Phil has had a long, sustained interest in geology and archaeology (on my first visit with him in Denver, in 1988, he took me out of town to a highway cut on Interstate 70 in order to explain the geology of the region to me), and a passion for sculpture. He has made most of the several dozen bronze sculptures that are in his office and around his home, as well as those in his Denver medical office—abstract creations, along with sculptures of heads, skulls, torsos, hands, spinal columns, brains, children (Sibling Trio), baseball players and objects (Broken Bat), athletes (Women Volleyball Players), and scientific subjects (Showing the Moebius).

  (After I reported on my visits with Dr. Haight and Dr. Melman, he sent me a one-and-a-half-inch-tall African sculpture of a man making love to a woman. “Note the straight organ—may it ever be so!” he wrote in an accompanying note; when I called to thank him, he told me he hoped to be able to send a life-size version of the sculpture soon.)

  There are also, around the room, more than a dozen different sculptures Phil has made of Phineas P. Gage, foreman of a railroad construction crew in Vermont, who, in 1848, survived an explosion that propelled a three-and-a-half-foot-long crowbar through his head—it entered below the cheekbone and left eye, and exited through the top of his skull. Although, after the accident, a doctor could make his fingers meet if he put one finger through Gage’s cheek and another through the top of the skull, Gage lived for another twelve years without suffering any paralysis or physical disability (other than the loss of sight in one eye). Phil has w
ritten about Gage and the personality changes the trauma induced: in effect, Gage suffered the inadvertent effects of a frontal lobotomy, and his case became seminal in the history of neurology for it allowed doctors to begin filling in data on functional brain localization by revealing relationships between physical damage and personality and character change.*

  Since my arrival a week before, Phil has done his best to avoid having me tape a conversation with him—he keeps saying that he’s not articulate or good at this kind of thing, that he won’t have much to say that’s interesting—and I recall that at the time of his daughter Elizabeth’s wedding the previous summer I was able to record a conversation with him only by turning on a tape player while the two of us were on our way to and from a local shopping center to pick up pizzas.*

  Now, however, when I tell Phil about some of my talks with Arthur, he responds easily

  “For a period of ten years, you know, Arthur and I didn’t speak to each other,” he tells me.

  I say that I did not know this—they had been good friends in high school and during the years when Phil was at Bellevue and Arthur was getting his doctorate at Columbia, so I assumed they had remained close ever since.

  “I was very hurt about what happened,” Phil says. “After he and Marcia got divorced and I was friendly with both of them, he married Paulette, and he heard me once say, or I think he thought I said, or I may have said, that I liked his first wife very much and that I didn’t really know Paulette.

  “And also he felt that I didn’t understand his illness, which I didn’t at the time. I didn’t understand that he had had a major posttraumatic syndrome, and that this had led to the divorce.”

  I say that Arthur has talked with me about how his experience in Vietnam and its aftermath, along with his analysis, led to profound changes in the way he looked at the world, and that for the first time he came to think of divorce—unthinkable before Vietnam—as an alternative he could seriously consider, even though he knew he was married to an absolutely lovely person.