Open Heart Page 9

  “I think it’s viral,” Dr. Flynn tells me again just before I leave.

  Back home ten minutes later, I telephone Dr. Flynn’s office and say that Dr. Flynn said I should set up an appointment with Dr. Beck for an angiogram. The secretary tells me that Dr. Beck is booked for several weeks. I can make the appointment now, or call back. Although I am wild with anxiety and rage, I remain outwardly calm. Talking on the phone with a stranger who works for a doctor I have never seen, and feeling mildly panicked—if I let the anger fueled by my helplessness show, will they simply tell me to go to another doctor? will I have to go through the whole routine again?—I am persistent and insistent: I want an appointment as soon as possible. When the secretary looks through the schedule for a third time, she tells me she can squeeze me in for a brief office visit with Dr. Beck in the middle of next week—not for the angiogram, but to confer about setting up an appointment for an angiogram.

  I hang up and telephone Rich, who had called earlier and left a message asking me to call him as soon as I got home, and to have the doctor fax him the results of the exam right away. I go over what has happened, beginning with Dr. Flynn telling me, first thing, that I’ve already had a heart attack—and when I get to the end of the story and tell Rich that the last thing Dr. Flynn said to me was that he thinks the problem is viral, Rich explodes.

  “It’s not viral, goddamnit—I want you in the hospital as soon as possible!” he exclaims, and he now insists I go to Massachusetts General Hospital, and not Bay State, because Massachusetts General is “the best” and because he knows several excellent cardiologists there. He will call ahead and help with arrangements. Catheterization is no big deal, he says, but if they have to go beyond catheterization and do angioplasties or a bypass, he wants me where he knows the doctors and knows they are “the best of the best”—the most experienced surgeons, the best diagnosticians.

  (“My medical antennae were tingling with that sense I always get when I know something’s terribly wrong,” Rich will later tell me. “My initial goal was to keep you from total panic while getting you to Mass General, and as time went by, my anxiety deepened—thus the more frequent calls. But I knew how serious the situation was, and there I was, three thousand miles away, agitated as hell. I knew the clock was ticking, and I knew where you could get the best help—two hours down the road.”)

  We talk for a long time, and Rich goes over everything with me carefully, continuing to insist that I go to Massachusetts General Hospital. He is concerned about my ongoing discomfort, but—to reassure me?—says that the fact that I have been able to swim so strongly is a good sign.

  “I want you to know I am here for you one hundred percent, Jay,” he says, but, alas, “here” is southern California, and what is imperative now is “to get the very best and most expeditious help” for me he can, and as soon as possible.

  He also talks about how fortuitous our reconnecting after many years apart has been, and about how much this has meant to him. (After having read Imagining Robert, Rich wrote me a long letter—not only about how moving he found the book, but also about how touched he was by our many affinities, and how close he felt—much like a brother—to me.)

  In my memory, Rich—high scorer on our synagogue’s basketball team, undefeated in singles through three years of varsity tennis at Erasmus, hard-hitting third baseman for the Tufts College baseball team, and a guy who helped put himself through college and medical school by winning substantial sums of money at poker—was a tough, fiery ballplayer, as competitive as any guy I knew. Though he had a most winning smile off the court, in the schoolyard he was all business—all elbows, hips, butt, and shoulders under the basket—a guy who would go through the proverbial brick wall after a loose ball—and, on the perimeter, a guy with a soft, deadly touch on his jump shot.

  Now, however, as I’ve been learning from conversations and letters, and from manuscripts he’s been sending me, though he still plays tennis regularly and competitively, he has mellowed in unforeseen ways. In his talks with me, and during our times together—in Massachusetts, Denver (where his two children live), and California—especially with his children, and when talking about his patients, he will be the most attentive and patient of listeners, the most thoughtful and gentle of men.

  In his life away from the hospital and medical school, in his home in Redondo Beach, he now devotes significant portions of each day to Buddhist meditation, to practicing piano (Chopin, Beethoven, Mozart, Schubert), and to that reading and writing by which he is attempting to understand what to him are the real, mysterious, and often mystical relationships of our minds to our bodies.

  A brilliant researcher and clinician who has authored several textbooks on cardiology, along with several hundred medical journal articles, and who pioneered studies in angiography, electrophysiology, and nuclear cardiology, in recent years Rich has become especially interested in those forces, beyond scientific measurement, that he believes frequently prove crucial in matters of life and death. He is, in fact, well along in the writing of a book that describes how many of his patients have lived on against all ordinary rules of medical diagnosis and prognosis—and how others are able, in what are for them most uncharacteristic ways, to come to peaceful accommodations with illness and with death.

  “Rich urges me to call anytime, just to talk,” I write. “This is very important, he says. And explains to me why i am going to be okay—the really good news is that we have no localized damage to any part of the heart so far, it seems, and what we want to do most is to preverve as much of this muscle as possible.”

  Rich has become such a sweet new age type, for such a brilliant, formerly competitious Brooklyn boy: says he feels our reconnecting was meant to be…and this is why, etc…he has felt strange and definite sense of communion with me.

  After I talk with Rich—he is going to call people he knows as soon as we hang up, and I am to call him back that evening, 9:30 West Coast time—I telephone Jerry, Arthur, and Phil.

  Phil and Arthur say that they defer to Jerry and Rich, and Jerry suggests I come down to Yale-New Haven instead of Massachusetts General, where he can arrange things for me, and where I can stay over at his house before and after the angiogram. He says he will make calls to cardiologists he knows in both New Haven and Boston, and this is when I say to him—as I will to Rich when I call him back—that he and the other guys should just talk with one another and then tell me what to do.

  Sharon, a woman I have known for several years—we’d been friends, but within the past several months our relationship has become romantic—is supposed to come by for dinner, and our times together, our telephone conversations (she lives in Boston), and the warm, eager way we look forward to being together are, I tell myself, proof either that I am correct in my conviction that things are definitely over between me and Ellen—or that I am more profoundly shallow than I care to know. Not for nothing, I remind myself, am I in these matters, as my friends keep telling me, perhaps the world’s oldest living teenager.

  Ellen calls, and during our conversation, I tell her about what happened at Dr. Flynn’s office. When she asks if I would be willing to have lunch with her the next day, I say no—that I don’t think it would be a good idea (for me); when she asks if there is anything she can do for me, I say no again, that there isn’t.

  Shortly after I hang up, Dr. Katz calls and tells me he has spoken with Dr. Flynn. “david katz v concerned,” I write. “Says he is surprised and shocked, really, think he may feel he missed this some [by] not thinking coronary disease for a few weeks.”

  “Well,” I comment. “He is human too,” and add: “so are we all so are we all.”

  5

  Coronary Artery Bypass Graft Times Five

  WHY IS IT, I wonder in the hours following the exams in Dr. Flynn’s office and at Cooley Dickinson Hospital, that some people who smoke and drink at will, eat whatever they want and in great quantities, live under large and constant pressures, never exercise, and are ob
ese, live to ripe old ages in good health and without loss of faculties, while others, who do all those things touted as leading to long and healthy lives, suddenly find themselves cut down in the prime of life?

  The answer to the age-old question—“Why me?”—I remind myself as I walk from room to room in my house, wondering how and when I will give the news to my children, seems the same as it has always been: “Why not you?”

  I think too of my father’s prescription for longevity: If you drink a malted every day for ninety-nine years, he used to tell me, you’ll live to be very old.

  Sharon arrives late in the afternoon, and though we have planned to go out for dinner, we never leave my house. Sharon’s mother, living alone in a small town near the Connecticut border an hour west, is quite ill, and Sharon tells me she will probably need to spend the night there.

  We sit on the couch in my living room for a while, messing around—kissing, talking, playing—and then I make supper. Several times I start to talk about what happened earlier in the day, but stop each time, afraid that if I give Sharon the news, it will frighten her away, and while we eat, I find myself recalling the time, less than two months before my nineteenth birthday, I was operated on for what I would learn, many years later, was Hodgkin’s disease.

  Near the end of my sophomore year at Columbia, I noticed that some swollen glands in my neck were not going away, and one Sunday afternoon while visiting my cousin Leatrice, a doctor then doing her residency in pediatrics, I asked her to feel them. She told me to get myself to the Columbia Health Services, located in St. Luke’s Hospital, the next day. After classes the following afternoon, I walked across the street to the Health Services, where a young doctor felt my glands, and then called in an older doctor. The older doctor examined me, told me he wanted me in the hospital on Friday for a biopsy, and that I should plan on staying overnight.

  At the time I didn’t know what a biopsy was—I thought it was probably some kind of test to see why my glands remained swollen. When I arrived home, in Brooklyn, I told my mother I’d be going to St. Luke’s on Friday for a biopsy, and that I might have to stay overnight. After my father arrived from work, my mother drew him into their bedroom, where, behind closed doors, they shouted, wept, and argued. Within a day, my mother, a registered nurse, had arranged for the biopsy to be performed, not at St. Luke’s, but by a doctor she knew at a hospital in Brooklyn.

  A week later, the doctor operated on me, took out all the glands he could reach—stripped them, in the words my mother used—and for several months after this I received cobalt radiation treatment at St. Luke’s. At the time—this was 1957—I was not informed of my diagnosis. My mother told me that the pathologists, including Sidney Farber, director of the Child Cancer Foundation in Boston, to whom the specimens were sent, reported that the tissue from the glands was benign.

  Why then, I asked, was I being given radiation to both sides of my neck? That, my mother explained, was merely a “precaution”—to “burn out a few suspicious cells” the surgeon couldn’t get to during surgery, “just to be on the safe side.”

  I received weekly checkups for a while, then monthly checkups, and, during my last two years of college, checkups every three months, the exams administered by Dr. Carl Wise, director of Columbia’s Student Health Services. All information about my condition was channeled through my mother. Those were years when, if somebody was diagnosed with cancer, the word, when used at all—or the initials (as in: “Aunt so-and-so has CA”)—were whispered.

  Some two dozen years later, driving home from UMass one afternoon, I heard a report on the radio stating that new studies showed that children and young people who had once been irradiated on the neck or throat area with dosages now deemed excessive (often following tonsilitis, or for acne) were at risk for throat or thyroid cancer and should have a thyroid scan. Shit, I thought, and recalled a joke about a man walking along the side of a road when a pickup truck zooms by and knocks him into a ditch. The truck brakes to a stop thirty yards down the road, and the driver sticks his head out the window and yells: “Look out!” “Why?” the man in the ditch asks. “Are you coming back?”

  I called a radiologist I knew, who scheduled me for a thyroid scan and asked me to send for my records. I did, and received, among other documents, a copy of a letter Dr. Wise had written to the doctor I was seeing after my graduation from college. For the first time I saw the unequivocal findings, confirmed by several pathologists, of Hodgkin’s disease (“giant follicular lymphoma”). I was, according to Dr. Wise’s report, given 1,000 roentgens to each side of my neck, “with disappearance of the glands in question.” (And, two decades later, without the radiation having caused any new cancers.) “Mr. Neugeboren has never been told the extent or diagnosis of his condition,” Dr. Wise wrote in the last sentence of his letter, dated February 29, 1960, “but I believe he is aware of what is going on.”

  And so I was. Believing that cancer would do me in before my twentieth birthday, I did what I had, for some time, been wanting to do: during the next few months I wrote and completed my first novel—the first of what would be, until the publication of Big Man in 1966, when I was twenty-eight, eight unpublished books.

  I also believed, as I do once again this Friday evening forty-two years later, that revealing to a woman that I am afflicted with a fatal disease will make me more interesting—exotic, desirable, tragic. (I think of the story Susan Sontag tells in Illness as Metaphor, about Lord Byron looking into the mirror and saying, “I look pale. I should like to die of a consumption.”* Why? asks his friend Tom Moore. “Because,” Byron replies, “the ladies would all say, ‘Look at that poor Byron, how interesting he looks in dying.’”)

  At the same time that I hope to excite a desire in Sharon equal to my own, I also tell myself that telling Sharon what Dr. Flynn has told me—revealing to her the fragile state of my heart—will give her reason to do what I lack the desire, or will, to do: to act sensibly so that I will be saved from myself—from that angel of death colluding happily with my sudden and supreme loss of judgment. (Old schoolyard joke: Why do men often give their dicks affectionate nicknames? Answer: Because they want to be on a first-name basis with that entity that makes all their major decisions for them.)

  After supper, I talk about what has happened, and I am aware that everything I say, while nothing if not, given my condition, heartfelt, is also calculated to achieve the end I long for: that, moved by my tale, Sharon will be kind to me in ways that will finally (finally?!) bring peace and forgetfulness.

  We kiss, and kiss again, and after a while I suggest we go upstairs to my bedroom. We lie together on my bed while I conjure up, in fully scripted scenes, mundane complications that may follow from what I hope we will soon be doing (phone calls to friends and family; the arrival of ambulances, police, and my rabbi; my brother decompensating extravagantly). I recall old schoolyard jokes about guys dying-in-the-saddle, visualize reunions in heaven where I trade stories with those celebrated men who have gone before me in the same way (Nelson Rockefeller, John Garfield), and I imagine how others—friends, family, students, colleagues—will react to news of my death.

  We begin to remove our clothes, and the knowledge, both that I may be risking my life for a brief moment of pleasure, and that my fantasies about the aftermath of this moment are remarkably banal, does little to stop me from the longing I have to slip quietly and happily from this world—from one heaven to another?—and while so doing, to wonder: Will anybody care if and when I’m gone? Will anybody miss me?

  Caught between feelings of passion and despondency, I tell myself that this is as good a way to go as any, while at the same time another voice—not my father’s this time—talks to me: “Are you out of your mind, Neugie?” it says. “Are you out of your—apt adjective —fucking mind? Stop and get up. Come on. Just stop and get up and let this dear, kind woman go take care of her mother, and then do whatever you can to make the time pass until you call Rich and find out what’s going to h
appen next.”

  An hour or two later, without having taken extraordinary risks, we dress and go back downstairs. Sharon telephones her mother, who, Sharon reports, is feeling lonely, weak, and frightened. “I can identify,” I say. A short while later, Sharon leaves.

  I telephone Rich after midnight—at 9:30 California time—and he says he and Jerry have spoken, that Arthur and Phil have talked with each of them too, and that so far the consensus is that I should go to Yale-New Haven for the angiogram and for any possible follow-up procedures. He and Jerry will talk again in the morning. He asks how I’m doing, and I tell him that I’m doing okay—some nervousness, but no pain or discomfort—and that as far as I can tell, the best news is that I’m still here.

  In the morning I walk into town and get a haircut, and then find Aaron at La Fiorentina, an Italian pastry shop where he works part-time. He has arrived early, and is drinking coffee and reading the New York Times. I tell him what the doctor said, wording the news in a way I hope will minimize alarm: something has happened in or to my heart, but they’re not sure what—obviously it’s not fatal: I’m here, right?—but they want to run some more tests, probably later this week. Visibly upset, Aaron scoffs at the idea that anything can be wrong with me or my heart—“Just look at what great shape you’re in!” he declares. “You’re in better shape than most twenty-five- or thirty-year-olds!”