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 obese, 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 happen 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!”
When I call and tell Miriam what’s happened, she is silent for a long while, and despite my efforts to keep things as low-key and optimistic as possible, says little.
Eli responds warmly. An hour or two after our talk, he “leaves a lovely loving message on machine,” I write, about “how he is thinking of me, etc., and how i have a good heart even if…”
“Yet when he calls back at midnite,” I note, he is “upset somehow bec mom’s mom and dad died of heart stuff, and your parents did (me: my mother’s still alive), and aaron has his problem…as if: he has recd a genetic bad deal.”
“I’m still here,” I write. “A long day, and what to say? I am getting used to being a man who has a v imperfect heart living within him. Good talks with Jerry and Rich, and by tonite, they will have a plan for me. Like the notion that my old friends will be talking with one another about the Neug…oh my but I do bask in their affection and regard for me!”
Between errands, talking with my children, and talks with Rich and Jerry, I get other things done: I work on a review of a book about families coping with mental illness; I complete a report to a foundation that awards fellowships to fiction writers; I read a new novel by my old friend Jerry Charyn (“vintage Jerry”); I take a nap.
Yet all the while I am at home, working most of the time in my third-floor office, each time I hear a car approaching I find myself going to the window to see if the car is stopping in front of my house or turning into my driveway (I live on a quiet, dead-end street of private homes), and I realize, despite my having told her I didn’t think it was a good idea for us to get together today, that I am hoping I will see Ellen get out of her car, smile, and wave up to me.
Early the next morning Jerry calls and says he and Rich have decided it is best for me to come down to Yale, where, in his words, he can be an ombudsman for me.
“Who do you know in Boston?” he asks. “You’ll get lost in the system, but if the staff at Yale knows it is accountable to me, that will maximize your chances for getting the best possible care.” He tells me I will be receiving a call from Dr. Henry Cabin, who is his cardiologist, and with whom he has already talked.
My friends Sam and Elaine Rofman drive in from Boston for the afternoon, and we go to a UMass basketball game together. UMass wins, and afterwards, walking across campus and up a steep hill toward the parking lot where I left my car, Sam—an M.D. several years younger than I am—is soon out of breath and cannot keep up with me; he laughs and assures me again, as he has been doing for the previous few weeks, that I have nothing to worry about.
Back home, there is a message on my answering machine from Dr. Cabin, saying he is looking forward to meeting me, telling me he will be doing the angiography, asking me to bring along the results of the EKG and the film of the echocardiogram, and alerting me to the fact that his secretary will call on Monday to set up our appointment.
The following morning, at exactly 9 A.M., Dr. Cabin’s secretary calls and informs me she has scheduled me for the angiogram at Yale-New Haven on Thursday morning. She walks me through everything else: the blood work they need to do, where I am to go, what I should bring, and, should they find significant blockages, their plan to go ahead with angioplasty and stenting immediately following the angiogram.
Phil and Arthur call, and they each talk with me for a long time. I telephone a few other friends, including Doug Whynott. It wasn’t a rotator cuff problem, I tell him. A half-hour or so after we talk, his wife Kathy calls. She and Doug offer to drive down to Northampton. They can stay over at my house, she says, or, if I prefer, I can drive up to Walpole (New Hampshire) to be with them. Doug also offers to drive me down to New Haven on Thursday. They are, Kathy tells me, stunned by the news.
Rich calls and tells me he is “thrilled” to see that there are no “Q waves” on my EKG (it took three calls and three days to get Dr. Flynn’s office to fax it to him), which means that there is no evidence of any serious localized abnormality, of a previous heart attack, or of any significant damage to the heart muscle itself. This is very good news, he says.
When Eli calls again, he tells me that he and his sister have been talking frequently, and that Miriam cried for a long time the night before. When I give him the good news Rich has given me, he seems reassured; still, he wonders if maybe after this I will “slow down a bit,” and he talks to me about how I don’t realize how hard I work, how many responsibilities I have, how busy my life is.
I spend the next few days taking care of things at home and at the university. I talk frequently with Rich, Jerry, Phil, and Arthur. I write in my journal, work on my novel, imagine various scenarios (“my prediction: they will find some blockage that has been inducing the discomfort/cramping in back…will angioplast it, and within 2 weeks, i will be swimming”), and think more about living alone than I do about my heart and what might be wrong there. I think, too, about what I have learned while working on Transforming Madness— how for people who have been afflicted, long-term, with a serious mental illness, and for those family members and friends who care for them, the isolation in which they too often live becomes at least as deadly as the condition itself.
When I get a copy of the echocardiogram results, Rich interprets them for me. That my ejection fraction is within a normal range is an excellent sign, he says, for it means the heart is basically sound. “Also,” I write in my journal, “he thinks the general weakening [cardiomyopathy] may be paradoxical good sign: the heart slowing down so as not to rupture—recognizes that oxygen and blood not flowing as they should, and so self-protects [by pumping with less force].”
“Wake feeling queasy, back cramping a bit: nerves for sure—along with side effects, i suspect, of the 2 new meds. dont like that stuff,” I write on the morning of February 10, 1999. “wake feeling v slow—moving with measured pace, and with sad heart.”
“Strange too: the emotions dont transform to words this morning,” I tell myself, “but this is not bec there is a dearth of feeling, i am overwhelmed by feelings, by my mortality… washed away by both sadness and fear…and then, at times: by goodness—the kindness of others, the good luck despite the bad news: i have survived whatever happened, and this is an area of medicine that is wonderfully advanced, etc…and i should be able to move into a few more decades of good and rich life.”
“Make calls here and there,” I write at the close of this last entry before the drive down to Jerry’s house, “love talking with my old buddies—what bright, sweet guys we were and are! me, phil, rich, jerry, arthur…”
I spend the day taking care of business: get the book review and the foundation report in the mail; teach my classes at UMass; talk with students; have a meal with a former student who is in transition between teaching and acting jobs; revise a chapter of my novel; and write out a note to my children about what to do and where things are and who will take care of what in case I don’t return. I leave the note, in a sealed envelope, to one side of my desk.
“So: will tend to business re the book, re novel, re packing—leave here at 6 [P.M.], for CT,” I write, “and the day will pass, and by this time tomorrow, my guess, i will be in hospital, recovering from an angioplasty that will give me many more good years, blessings, neug. we love you.”
Only when I wake from the anesthesia and Dr. Cabin shows me the results of the angiogram and tells me he wants me in surgery as soon as possible, and only when I learn that I am at least as gravely ill as I’d been believing I was—only then: when I know— do my fears depart. Only when I am sitting on a table in the room where Dr. Cabin has performed the angiogram do I feel, for the first time in several months, not merely relieved, but eager to get on with things: with the surgery, with whatever follows from surgery—with life! I am not only, as Jerry will later say, positive and optimistic, but I am also feeling a new and wonderfully liberating sensation: at peace in a way I don’t quite understand. All will be well, I think—not despite the surgery and what has made it necessary, but because of it—and I know this as surely as, for the previous few months, I have feared the opposite.
In that small aseptic room where my clothes lie in a neat pile on the floor, and in the hours that follow, when I move from one hospital room to another, I take stock of things, and think: I would love nothing more than to hold on to the life that is still mine and that, when all is said and done, I don’t have a great desire to leave. I don’t want to die, but if my time here is near its end, and—the thought occurs in an easy way, as if it is merely a fact like others: whether it will rain or snow, or whether UMass will or won’t win its next basketball game—if I do not, tomorrow, wake from surgery, that seems all right too. I find myself without regrets, whether for things done, or not done.
And when, the next morning, I am readied for surgery, and when I am wheeled into a narrow hallway outside the operating room, I am acutely aware of being neither depressed, afraid, nor alone.
I recall feeling vaguely sleepy, somewhat nervous, and distinctly exhilarated—bypass surgery is simply high-tech plumbing, I tell myself: something doctors are experienced and proficient at, so let’s do it as well and quickly as we can—and I recall, too, while I lie under a sheet, being fascinated by the way a member of the surgical team attends to my left arm and hand: securing the arm to the operating table, palm up, while taping my fingers down in what seems a weirdly intricate way—some fingers bent upright at curious angles, others fastened down as if to get them into position for forming a tricky chord on the neck of a guitar. (What the man is doing, I realize afterward, is preparing my arm for the removal of its radial artery, which will be stitched into my heart.)
I recall how drab and institutional the corridor we wait in is, how numerous, efficient, and busy are the people on the surgical team—nurses, aides, technicians, surgeons, anesthesiologists, all robed in lime-green sterile gowns—involved in the surgery itself, and with what incredible swiftness—like life itself?—time seems to move. Neugie, I remember saying to myself, this is not a first draft.
When I revisit this moment, though, what I see first of all and most of all is the way my daughter Miriam, closest to the gurney I am lying on, follows me with her eyes. Her brothers and her fiancé Seth beside her—Jerry, in hospital lab coat, standing slightly behind—Miriam stares at me with the steadiest, saddest, most loving of gazes, so that, as I am rolled away into the operating theater, my spirits, helped along, doubtless, by medications, soar, and the feeling of calm and readiness—the faith that all will be well—spreads through me. What can be amiss, I think, with having lived a life wherein one ends without regrets and with the unwavering affection of those one holds dearest?
In the weeks and months that follow surgery, when I consider how and why it was, without typical symptoms or risk factors, I nearly died—and when I explore these questions in conversations with my friends, and through the reading and researches our conversations lead to, I am, again, surprised by what I find.
My life has, blessedly, been saved by what is generally considered the most spectacular success of twentieth-century medicine: coronary bypass surgery—the ability doctors have to open my chest, shut off my heart, harvest veins and arteries from my own body, use them to bypass occluded arteries, start my heart going again, and return me to the world in better condition—and with, in all probability, many years of healthy, productive life ahead—than I was in before they put me to sleep.
The advent of what is often called heroic medicine—high-tech life-saving and life-prolonging biomedical interventions such as open-heart surgery, organ transplants, genetic engineering, and neonatal procedures—is surely, in many instances, as in mine, not only welcome, but so technologically dramatic as to seem miraculous. In the lives of those who are the beneficiaries of these successful interventions—adults who without transplants or bypasses would otherwise die or live out their lives as invalids; children who would otherwise perish or be permanently disabled—their effects are, day to day and year to year, quite real. (That this is so gives tangible proof to a favorite saying: “The rabbis tell us that a person who does not believe in miracles is not a realist.”)
Yet what I begin to discover after surgery is that when it comes to life and death in matters medical, what has made and will probably continue to make the greatest difference for most of us remains distinctly low-tech.
This is a revelation to me, as it is to most people I talk with during and after my recovery. But it is not news to the four friends who attend to me through this period of my life.