It is difficult to describe the awful pain of gout. Each of the periodic attacks continues in flaming flushes for four or five days, during which the sufferer is assailed by horrible thoughts of amputation, shooting off the inflamed toe and suicide.
Apart from the folklore concerning gout, the doctors also told me certain substantive facts: ‘The villain in the foods that induce gout seems to be a complex compound called purine, found in concentrated form in surprising things like lima beans, anchovies and champagne. There’s a simple blood test that warns about high levels of purines, and that’s a signal to watch your diet. Incidentally, you ought to find a copy of the eleventh edition of the Encyclopaedia Britannica. It contains an entertaining essay on gout.’
When I consulted the remarkable essay, I learned about the famous men who had suffered from the disease, and it was an impressive roster, but it gave me scant comfort.
After my introduction to this disease I had four violent attacks in two years and thought that the rest of my life was going to be recurring hell, and I found what comfort I could in tactics devised by gout sufferers through the centuries: a stool to keep the toe elevated so that the throbbing diminished, drinking gallons of water to flush out the purines, and cutting away most of the front part of a shoe so that I could hobble about. And I did sleep at night with that little tent over my toe because I learned the truth of a famous description of gout: ‘Even the fall of a silken handkerchief on a gouty toe produces pain unbearable.’
I had at this time a housekeeper who had a marvelous empathy for people in trouble, and it pained her to see me suffering. Calling upon old country remedies, she did what she could to help, and then told me one day: ‘You know, I have a sister who knows someone who can cure gout.’
I visualized a witch with blood of newt and hair of newborn calf and told her: ‘No, my doctor has it under control.’
‘It doesn’t look like much control to me,’ she said as she huffed off, and some days later when the pain was at its maximum, she repeated sternly: ‘I have a sister who can help you,’ and in my despair I cried: ‘All right! Call your sister!’ That night an unusually beautiful young woman in her twenties came to my bedside and said: ‘I work as a nurse for a famous doctor in Philadelphia, and his team has produced a cure for the gout.’
When I appeared before this miracle worker he said: ‘We’ve developed within the past two years a drug that specifically cures gout. Work was done in Sweden by some clever men who hooked radio isotopes to the purines of lima beans and took x-ray photographs as they worked their way through the body. They found that gout is caused by the malfunctioning of a tiny gland others had overlooked and when our completely new medicine is taken, that gland is encouraged to perform its normal function.’ He then handed me a small vial of pills and a prescription that would get me more at any pharmacy. The pills were called Benemid and the instructions were simple: ‘One a day for the rest of your life. About every seven years a residue of purines will build up, and you’ll have a mild attack, which you can handle with colchicine.’
Breathing free and smiling at the wonder-working sister of my housekeeper, I had one nagging question: ‘All the books say that gout is caused by riotous living, rich food and excessive drinking of champagne. I’ve always lived on a simple Pennsylvania Dutch diet and I’ve never touched alcohol.’
He broke into a laugh: ‘Throughout history the legend has persisted that gout is the disease of profligates. But all that time doctors knew that exactly half their patients were as abstemious as you say you are. We’ve never really accounted for this contradiction, we just called cases like yours “poor-man’s gout” ’
His predictions that day were completely accurate. One Benemid a day, no more gout, no necessity to restrict my diet and yes, every seven years or so I have a real toe-grabber, which I can handle by taking a minute white colchicine every half hour until I vomit. I usually start throwing up at pill nine, and thank my patron saints that my housekeeper had a sister who worked for a bright doctor who set me free from a terrible affliction.
One September afternoon in 1965 I finished a fine three-set doubles match with my longtime tennis partner, Mary Place, a wizard with the drop shot, went home, did a little work on a novel on the siege of Leningrad and went to bed. At four in the morning I was stricken with such a violent case of what I thought was indigestion that I telephoned a doctor, who said: ‘Take bicarbonate of soda and call me in the morning.’ I took the bicarbonate and I remember going into the bathroom shortly thereafter and seeing a ghostly figure staring back at me from the mirror. Feeling that I was about to faint, I said to myself: ‘Come on, kid, pull yourself together. Not now. Not now,’ and I made it back to bed. But the presence of a doctor was imperative, and when one arrived at a quarter to six he took one look, felt my pulse and called the ambulance.
‘Heart attack,’ he said. ‘They often come in these early morning hours.’
When they studied the cardiograms, the hospital experts said it was a major myocardial infarction, meaning that the supply of blood to a portion of the heart had been cut off by a blockage of some kind in the blood vessels feeding the heart. Most men who suffer such attacks prior to the age of fifty die of them and those past fifty who do not get to a hospital immediately die, too, but the doctors said that in my case, although I was in my late fifties, an unusually strong physical condition and the fact that I had continued to exercise long past the time when most men quit had enabled me to absorb the effects of the massive attack.
This chapter is not intended to be an account of a heart attack; it is meant to offer an explanation of how health problems affect a writer, and this part of the story is quickly told. At the Doylestown Hospital in which my aunt Hannah had sometimes worked, skilled local doctors did what was necessary, and in their decisions they were assisted by Paul Dudley White, who flew down from Massachusetts as soon as he heard of my attack. When he came into my hospital room, it was as if we were resuming our conversation in Leningrad: ‘Well, now you know how chances work out. Not a single warning indicator. But I’m sure that a man with a structure as tough as yours is going to survive.’
Those were words I had wanted to hear, and he told me: ‘Jim, if you survived the first three hours, your chances are great for surviving the first five days. And if you survive them …’ His voice trailed off. It was to be a step at a time. Then he said: ‘In the old days we’d have made a basket case out of men like you. In bed most of the time. Never climb a stair. No big meals. Avoid sex. Become a vegetable out on the front porch. No more. When you get out of this bed, and I’m sure you will, I want you to do everything you ever did before. In moderation. But as returning strength permits, try everything. Because if you do drop dead, you were probably going to do so anyway.’ He was not going to baby me and I was not going to baby myself.
Under his benign care and aided always by the good local men, I would recover, and travel several times around the world, play vigorous tennis again, write eight of my best long books, and serve the nation in a wide variety of fields. I would also refrain from ever losing my temper violently, or forging ahead when I suddenly felt tired, eating eggs of any kind, or whole milk or large amounts of cheese. And each day whenever possible I would take an afternoon nap and get to bed by eleven at night. It was a rigorous regime, which I followed to the letter and which has brought me both productivity and happiness.
But there was one moment in my recovery that terrified me, and still does. When I returned from the hospital after six weeks of relative immobility, I was careful to get back into my normal routine in easy steps, and on a day when I felt that I had regained my strength and my control I went into my study and picked up the pages of the Russian novel I had been working on before I was struck down. To my horror I could not focus on the material, nor could I recall where I had stopped in the narrative and certainly not where I had intended to go. Desperately I tried to make sense of the material, speaking to myself as I had that crucial night
in the bathroom: ‘Come on, kid, don’t lose it here.’ But the pep talk was to no avail. Some major change had taken place in my life and I left the study distraught.
For more than a week I lived in fear that I might never be able to regain intellectual control over my writing. When I regained some confidence I returned to my study only to find myself as blocked as before. The Leningrad novel on which I had done so much work was lost forever. Regretfully, but without self-pity, I closed the notebooks on which I had been working, put aside forever the chapters I had finished on the Leningrad book. Afraid that I might never write again, I applied myself to a slow, steady course of rehabilitation consisting of long walks with my dogs, care of the trees I had planted on the hill and a quiet resumption of social meetings with my supportive friends. One day I even guardedly tried some tennis with Mary Place, who must have known how important the effort was to me, even though I accomplished little. One of my doctors, hearing of this improvement, asked if I would help with one of his patients. ‘Talk to him,’ they begged, ‘and tell him what Dr. White told you,’ and I went to the hospital to meet with the patient.
He was, I recall, a graduate of Cornell and a ski enthusiast. Many years younger than I, he had suffered a major heart attack at a time in his life when I knew it to be extremely dangerous. Sitting in his hospital room, I said: ‘Dr. White, the one who saved Eisenhower, told me that at the ages twenty to thirty, a heart attack is almost invariably fatal because the shock is too great for the heart to absorb. Thirty to forty it’s usually deadly. Forty to fifty the odds are about sixty-five to thirty-five that it will be fatal. My age group, fifty to sixty, the odds favor recovery. And sixty to eighty, many men have heart attacks and don’t even know it. Recovery time for them is about the same as with a bad cold.’
The Cornell man was not impressed with anything I had said, but he did ask casually: ‘Why the difference in ages?’ and I said: ‘Because as you grow older the heart has experienced a lot of knocks and set up alternative feed lines against the day when something even harder comes along.’
‘Did you have a bad one?’
‘One of the worst, they tell me.’
‘And have you recovered?’
‘No. But I’m moving in that direction. If you take it easy, like the doctors say, I’m sure you’ll make it, too.’
‘I’ll be back on the ski slopes within a month,’ he said arrogantly, not even bidding me farewell and certainly not thanking me for my efforts in trying to help. He did go back to the ski slopes within the month and he did drop dead.
· · ·
When the shock of not having been able to resume the work on the Russian novel and my fears of never being able to work again had been brought under control, I decided that the time had come for me to test the strength of my new heart and my reconstructed mind. I had always wanted to write about my deep affection for Spain and my appreciation of the slow, stately experiences I’d had there, and it occurred to me that I could work nowhere better in a test of my capacity than in the splendid country whose history and mores I had come to know so well.
As a young man, as I have said, I had traveled for a while with a group of bullfighters—one of whom was Domingo Ortega, who later became famous—and now I wanted to see Spain again, to run with the bulls at Pamplona and to make the traditional journey to Santiago de Compostela, the ancient holy site in the northwest corner of the country. I felt that if I could do those things comfortably, I could work my way back into a writing career. My return to Spain was a spiritual and physical pilgrimage of the utmost importance.
I was accompanied during parts of the extended journey by three delightful companions of former days: Robert Vavra, the distinguished nature photographer who would ultimately illustrate my report with his pictures; John Fulton, an American bullfighter who had taken his alternativa (bullfighting doctorate) in Seville; and Kenneth Vanderford, the bearded petroleum expert who looked exactly like Hemingway. We traveled everywhere and renewed acquaintances with men and women we had known years before. We went to Pamplona for the running of the bulls, and I recall a brush with death that I had miraculously survived. It was the result of an act of plain foolishness on my part. Because of my love of Spain and my acquaintance with bullfighters there and in Mexico, I had become an aficionado of Pamplona’s famous festival in honor of San Fermin, a saint who had performed some holy act now forgotten. His day chances to be a remarkably lucky one, the seventh day of the seventh month—July 7—and this became the occasion of a grand eight-day festival in which at seven each morning, wild bulls are coursed through the narrow streets and alleys from the corrals at one end of town to the bullring more than a mile away. Brave young men run a few inches ahead of them. Ernest Hemingway’s The Sun Also Rises, and especially the motion picture made from it with Tyrone Power, Ava Gardner and Errol Flynn, featured the festival in a manner that caught the fancy of millions, who dreamed of running with the bulls of Pamplona.
In my late sixties I had decided it was time for me not to watch but to run; I ran, it is true, but only briefly, for when the bulls bore down on me I would duck into the doorway of a hospital and stand there as the seven bulls went roaring past. Even watching from the safety of my doorway it was a thrilling experience, those great, deadly animals practically stepping on my toes as they flashed past.
The area just in front of where I stood is confined on the left by a long, unbroken high stone wall, and here the very bravest men run or congregate, because about every fourth year some errant bull, leaving the others, runs his left horn along that wall—limpiando la muralla, washing the wall it is called—and knocks men down, causing wounds and contusions. On the first three mornings of the festival that year I had comfortably made it to my safety spot as the bulls thundered past, but on the fourth morning one of the bulls washed the wall, became disoriented, veered across the narrow lane and killed a man not six yards from me. He then turned wildly and killed a second man, who fell at my feet. Now totally confused, he hesitated for a terrifying moment, his horns six inches from my chest, and then he snorted and galloped after his mates.
Three or four Pamplona photographers who were patrolling that spot happened to photograph the bull just as it approached me; they did not catch him at the point when he was closest to me but they did get stunning photographs of a confused bull facing a man who is standing very still. When we were in Pamplona years later and admiring Spaniards brought me their copies of Esquire with the series of photographs, I could not believe that it was I in that doorway or that the bull had spared me and trotted peacefully on.
I took the pilgrims’ route to Santiago de Compostela, where I spent more than a week studying the great sculptures that grace the porch of the twelfth-century cathedral, and then in a surge of reassurance started to write the book of mine that will probably live the longest, Iberia, a testament to a land I loved and to my own regeneration. The book will live not because it’s especially well written nor because I wrote it, but rather because it deals with a country that will always be of interest to Americans and Europeans from cold climates. Iberia is my letter of gratitude to my notable forebears: George Borrow, who wrote The Bible in Spain, one of the noblest of all travel books; Prosper Mérimée, who after the briefest of visits wrote his novella Carmen, and Georges Bizet, who set the tale to imperishable music; and Miguel Unamuno, the philosopher who wrote of Spain’s attitude toward the world.
Iberia played a focal role not only in my rehabilitation as a writer but also in my introduction to the mysterious relationship between writer and reader. The book became widely used throughout the United States as a collateral text in the teaching of the Spanish language and culture, and in due course I began to receive a large amount of mail from readers who had either studied the book or taken it with them during a trip to Spain. So consistently were three episodes referred to that one might have thought they had been printed in red.
The first was an account of how English marmalade was made from Valencia o
ranges, a fascinating tale but in no way exceptionally told. The second was the amusing story of a Texas traveler eating potted pheasant that hadn’t been well cooked—a mere bit of trivia, really. And the third was an account of arriving at dusk at a small Romanesque church in the tiny mountaintop village of Cebrero on the way to Compostela. I had taken some care in revising and polishing these paragraphs, but I never felt that I had accomplished anything special. Yet these were the segments of the book that readers referred to again and again, both in writing and verbally when I chanced to meet them.
The author is never a good judge of what he deemed inconsequential will be cherished by others, nor what successful passage he slaved over will be ignored. No better illustration of this can be found than in The Source. The novel contains one of the best bits of writing I’ve been able to do, the account of the impact of King Herod upon the Jews. It is an original and well-crafted book, but in all the years it has been in circulation not one reader has ever written or told me personally that he or she found the tale rewarding on a serious level.
But at the same time my readers were ignoring the fine story, they were settling like honey bees on a rose on a purely accidental thing I had more or less thrown into the book. Needing the name for a young Jewish woman involved in the story of King David, I vaguely recalled a biblical passage about the Brook Kerith, and I remember that even upon first reading I liked that name and thought it exceptionally attractive, although I had no concept of where the brook was nor of its significance.
Decades after first seeing it, the name came back to me and I christened my character with it, without giving much thought to the selection. But as soon as the novel appeared I began getting letters of inquiry about that lovely name, how I had come upon it and what its meaning was. Usually the writers said: ‘We are naming our new daughter Kerith, and when she grows older we want to share your explanation with her.’ In fact, I received so many such inquiries that I had to draft a form reply that went out to the parents of scores of little Keriths.
The World Is My Home: A Memoir Page 56