Mary Cappello

by Swallow: Foreign Bodies

  For sixty years, a patient named Andrew C. suffered from chronic dysphagia (difficulty swallowing). In 1995, his wife, seeing that it would take him between one and two hours to finish a meal, urged him to visit a doctor. That doctor was Botoman, who identified a congenital esophageal stricture that had gone untreated all of his life and that Botoman endoscopically dilated, effecting an essential cure. While taking his history, Botoman learned that C., who now lived in Fort Lauderdale, Florida, had been treated by Chevalier Jackson at Jefferson when he was nine years old. It was 1935, and he had gone to the clinic after swallowing a peanut that had become impacted in his esophagus just above the stricture. Andrew C.’s unusual stricture was something he had been born with, Dr. Botoman explained to me, and though Jackson often treated more pronounced forms of stricture in children who had accidentally swallowed lye, the technology available to Jackson would not have enabled him to treat this particular narrowing even if it had been noted. Fascinated by the link to the great predecessor, Botoman asked Mr. C. if he would be willing to record what he remembered, if anything, about his childhood experience in Jackson’s care.

  C. delivered the following written account:

  To the best of my recollection, I was Christmas shopping in downtown Philadelphia with my mother. It was evening and she bought me a bag of salted peanuts. For some reason, one of the peanuts became lodged in my throat. I could breathe but could not swallow anything liquid or solid. We tried cocoa and water but nothing worked. Mom took me to the Jefferson Hospital Emergency Room. They tried to dislodge the nut with no results. I was admitted for an overnight. They tried different things but to no avail. I was admitted for an overnight stay.

  The next morning I was taken to the operating room. They anesthetized me and when I woke up the peanut was gone. I remember the nurse saying how lucky I was that Dr Chevrolet Jackson was available to remove the peanut otherwise I might have had a more complicated surgery. I have never forgotten his name.

  Andrew C.’s narrative supplies the otherwise mute fbdy—something so unremarkable as a peanut kernel—with an aura. It’s the detail of eating salted peanuts at Christmastime on an evening in the city with his mother that accords a life to the object. It marks it as a genre of trauma that most of us are familiar with—call it holiday catastrophe, the accident that is overlaid with extra pathos and a sense of injustice because you should have been having a good time. We agree to suspend routine for a day and let a spot of time become remarkable, so when harm befalls us on such days, we feel betrayed by our desire to have it otherwise. For Jackson, there’s his own father’s death one Christmas Day that would mark every Christmas thereafter.

  So there’s holiday mishap here, but also charm, because you can’t not love Mr. C.’s mis-transcription of Jackson’s name as Chevrolet rather than Chevalier, followed by his poignant misassumption, “I have never forgotten his name.” Is this a mistake on C.’s part? Not really. I want to say he did and did not misremember his name because Jackson, by 1935, was as constant as a trademark, and his practice easily conflated with a metallic shiny object—not a fender, but a scope. He was as famous as a Chevy—why not? He was a kind of Chevrolet offering a new purchase not on the American landscape but on the American body. “Maybe I did forget the details,” Andrew C. might say, “but I never forgot that something unforgettable happened to me. I was saved by an unforgettable man.”

  When I find Andrew C.’s case history in the National Library of Medicine (which is a little like finding a needle in a haystack, however neatly organized), I’m both moved and stumped. I’m moved by a peanut kernel—I’ll admit it—because its postage-stamp-size photograph seems so large, because it makes the culprit voluble, because it resembles the sharp tip of a weapon struck off or a piece of shrapnel, and it is accompanied by a horror: the report of the child’s total inability to swallow. The date of the accident was December 18, 1935; the date of the examination was December 19, 1935; and C. was ten years old, not nine. The record is shorthand: “when eating peanuts—tried to swallow a handful—some difficulty—unable to swallow.” If it were up to Jackson, parents who fed peanuts to children without molars would be drawn and quartered, the manufacture and sale of peanut candy to children of any age would be considered a willful act of violence against the young, and peanuts would only be made available to adults with a special masticatory license, so often did he remove this particular foodstuff from the bodies of adults and children alike.

  But Jackson is nowhere to be found in this case report—and that’s what stumped me, even if C.’s case is listed in one of Jackson’s foreign-body diaries. According to the scantly detailed case history, Dr. Louis H. Clerf was the endoscopist in Andrew C.’s case, and he was assisted by a Dr. Baker. Chevalier Jackson, who often appears as a consultant even when he didn’t perform the operation, is nowhere mentioned here. My guess is that he wasn’t even in the room.

  I suspect that a postoperative mantra came to be part of the ritual of being treated in any of Jackson’s clinics: I imagine the nurses were instructed to tell survivors of endoscopic procedures that Chevalier Jackson was responsible for saving their lives. It was a way of anointing every patient with a sense of medical history being made on the spot. Maybe Jackson wasn’t exactly available to Andrew C., but the very fact that the doctor once lived is what he could be thankful for. In this way, Andrew C. was and was not treated by Chevalier Jackson, Jackson was and was not present.

  In a presentation made for the American College of Gastroenterology’s Seventieth Annual Scientific Meeting titled “First Endoscopic Dilation of a Documented 60 Year Old Stricture: The Legacy of Chevalier Jackson,” Dr. Botoman said: “We measure the greatness of this man by his extraordinarily vivid impression he made on a then nine-year-old frightened patient in 1935. ... Our patient’s uncanny recollection of this great man brought him to life for us, and helped us learn and understand Jackson’s many accomplishments in early endoscopy. Chevalier Jackson should be remembered not just as America’s first otolaryngologist but also as American’s first endoscopist.”

  Even without the good fortune to meet and help Andrew C. so many years after his treatment in one of Jackson’s clinics, Dr. Botoman would have been inspired to find a collegial spirit worth emulating in the life of Chevalier Jackson. When I contact Dr. Botoman to discuss the details of this case, he warmly shares a territory he could rightly call his. Botoman explains that in a profession now defined (at least in the United States) by insurance strangleholds and bureaucratic red tape, overladen with medicolegal and regulatory issues that take up a good part of any doctor’s day, to say nothing of his spirit, he wants to learn how to keep front and center the humble respect Jackson had for his patients.

  What makes Andrew C.’s recollection rich and also uncanny is its necessarily being laced with paradox, gaps, a sense of something momentous having occurred that is beyond the reach of memory but not of the imagination. “They anaestheticized me and when I woke up the peanut was gone.” According to his account, Andrew C. doesn’t remember the procedure because he was asleep for it, but children were rarely given general anesthesia in Jackson’s clinics, and the record shows that he was treated with a local anesthetic of 10 percent cocaine, a spray that would act as a numbing agent but not knock him out. Asleep or not asleep, asleep and awake: what is that place where we reside psychically when our body is being invaded in the name of cure? What is its time? Insouciant twilight during which part of you leaves while another part stays in the room?

  As a glorious afterthought, as though he weren’t sure that his account gave quite enough credit to Jackson as hero, with no room left on his page, Andrew C. added a sentence that runs like a ticker tape up the margin of his remembered case history: “Note. Dr. Jackson is the ‘Babe Ruth of Throat Doctors.’ ” In which case, Dr. Jackson comes into an arena in which everyone is eating peanuts and makes them forget they are eating them by his spectacular acts. In which case, Dr. Jackson is himself a candy bar made almost ent
irely out of peanuts.

  Jackson was and was not present; all that I have described here did and did not happen; Andrew was asleep and was not asleep when he was scoped. An archive is a dreamspace, full of evidence, brimming.

  A Peculiar Chap

  He was a teetotaler, attended no social functions if he could possibly avoid them, was considered “cold” even by many of his admirers, and conceded that he had no friends in the usual meaning of the word.

  —from “Chevalier Jackson: A Notable Centenary,” Eye, Ear, Nose, and Throat Monthly, November 1965

  The footfall of a deer is intercepted by a crash, light as a bundle of balsa wood muffling the bright edges of a frozen pond. Birds skitter, unalarmed, and a plume of cloud dabs the sky like a lock of the boy’s hair peeking down his hatted forehead, mute witness to his quiet trial as he pushes and falls, reaches and topples, braces himself and buckles, flies and meets the ice face down. Snow collects in corners, and the blunt edge of a skate keeps the boy looking down as he tries to circle and listen to a made-up voice preaching the cardinal rules of skating principles. He talks about nothing, to no one. He is pure thought, glistening, careful as ice, on ice. He recollects his body, he collects himself, because unlike the next boy, he records the number of his falls in the hope of coming home with something other than bruises: fifty-nine in the first hour. At first the pond is the notebook that he scores with statistics; later, as he pulls the skates after him on level ground, his own mind fills with number as with song. Does he have fire and dash, is he enterprising? No. This boy is meticulous, methodical, his own accompanist in record keeping; with no one looking, he pushes a barn door open and tests a pair of roller skates on the hayloft floor. He’s teaching himself to walk again, but this time with a burdensome apparatus that promises flight. He leaves and records, exits and notes, turns and is struck down, studying himself; after so many trials on the ice and on the wood floor, he becomes a kind of engine that stops at nothing and whose product is a lesson, the moral to a parable that greases the gears and tells him to try again.

  There was this solitude, noble as the red slash across a woodpecker’s crown, moody as birch bark, not always wanted but craved. There were these small boy’s fingers nimble with numbers that he sculpted, engraved loops and lines, hands that couldn’t have known they would someday write with immense control, with indifference bordering on pluck, of surgical nicks, slanted cuts, torn walls and incisings: “with one sweep of the scalpel an incision is made from Adam’s apple to the suprasternal notch.” He begins in furtive solitude making himself up out of sums. He appears alone but with another boy in abeyance, like an imaginary friend whom he turns to with the thought of finding himself in his story.

  Jean Morange. Lemon meringue. Orange tanager. Mother’s father.

  Kitty Clyde: a name for a ship. Fairbanks: the name of a captain. Bordeaux: the name of a place so far from the pond and from Penn’s sylvania, latitude and longitude lost in smoke clouds. Captain Fairbanks’s promise (the year is 1804): to return the ten-year-old boy, Jean, to his mother after four years of service on the Kitty Clyde. But oceans take years to cross; the captain is tired and settles in Dedham, Massachusetts. Jean Morange never sees his mother or France again. Young Chevalier keeps the idea of his grandfather near, the unfulfilled promise handed down in perpetuity. And a key. And a crockpot. And a machine shop. The boat is rolling, but that doesn’t stop the crew from drinking, thus supplying Jean with a chance for distinction: Fairbanks entrusts him with the key to the liquor cabinet, and Chevalier imagines that he’s inherited the key. From his grandfather, he’ll find himself in abstinence—this is what he tells himself. Was it any wonder that he also built cabinets and confiscated keys? That he became a keeper and a warden of lost Things? From his grandfather, he decides, he has inherited a love of cooking (even if he’s not too fond of eating), “not merely the broiling of a steak or the melting of a rarebit, or the mixing of a salad, but the grand art of soups, entremets, rotis, hors d’oeuvres, galantines, casseroles, salmis” (LCJ, 194). He’ll take after Jean Morange for mechanical ingenuity as he’s come to believe that, without his grandfather being called to Pittsburgh to work as a machinist and an engineer, nails would never have been mass-produced but would have been forever hand-forged. I am never entirely alone, the boy on the eve of a century, on the edge of discovery, on the slantwise plank of becoming, tells himself and forges types of columns: “roller skates: first hour: seventeen falls.”

  As objects, personal effects are different from bequeathings. In one case, objects as a hasp without a hinge. Dead matter. Still life with watch, wallet, sunglasses, cell phone, keys. In the other case, the illusion of enduring in a trace. Both of these are different from the things marked PERSONAL, like the envelopes now stowed in an archive in which Chevalier Jackson kept “violets that Alice gave me”; the clovers folded inside a fold inside a fold inside a fold of tissue paper; the “leaf that Alice gave me,” grainy and shriveled as a once-living heart; and the list for every year of love, “31 years of love to Alice, 32 years of love to Alice, 33 years of love to Alice,” followed by “Love to Alice forever.” Personal: those objects that cannot be shared, contraverted, or traversed. Those Things that can’t be found.

  Some things we’ll just never know—like how Chevalier Jackson came to court and marry Alice White. The chapter in his autobiography devoted to “Marriage” only takes up half a page, though it refers to a relationship that lasts for over fifty years. There are novels waiting to be written about romances that begin in medical consulting rooms, but Jackson never wrote one, nor told of how exactly he and Alice came to fall in love. His description of the meeting makes it sound as though he married her entire family, and in a way he did, since they all lived together after Jackson’s marriage: “A patient, Josephine W. White, when coming for treatment brought her sister Alice and their mother with her. They were all charming people. I married Alice” (LCJ, 114). The End.

  Jackson wrote his Life of Chevalier Jackson in direct response to so many people wanting to know something about who he was. People were fascinated, so he agreed in 1938 at seventy-three years of age to give them a full-fledged descriptive narrative and lavishly illustrated account that included color reproductions of his oil paintings, some of his drypoint etchings in black and white, documentary and home photography, and delicate line drawings in miniature with which he whimsically closed particular chapters. It’s not as though Jackson had made no autobiographical forays before then: the object collection itself can be understood as a record of his life (a kind of “foreign body” diary), and his showpiece of a textbook, Diseases of the Air and Food Passages of Foreign-Body Origin sketches the life’s course of Jackson the obsessed collector in its meticulous documentation of the foreign bodies he secured.

  This act of self-documentation would, however, be different. It would fill in gaps and explain intentions. It would reckon with what others saw in him, and try to understand how he came to be the person who he was. As a backward glance, it would attempt to compensate for all that lingers, unresolved. It would collect things—eccentricities and peculiarities—that, in making Jackson into a curio, could still keep him (unintentionally) at a distance. It would reveal things—the powerful undertow of childhood trauma in particular—and this troubled him. In spite of a lifelong tendency toward reticence and withdrawal from something like “the social body,” he invited contact with the intimate details of his childhood in Life of Chevalier Jackson. But he also feared its repercussions, citing its composition as the only possible regret of his life: “If I have made any momentous error it is the writing of this book” (216).

  Who was that man? According to his 1938 autobiography, Jackson was a man who purposely ordered his clothes oversize. In order to get a tailor to mismeasure him, he arrived wearing three suits of underwear. The result of oversize collars was a head and neck that he happily described as resembling those of a turtle, while “shoes must be large to the point of sloppiness, their le
ngth requiring eternal vigilance lest I trip over my own feet” (LCJ, 172). It’s as though Jackson didn’t like for his clothes to hold him or make him feel himself, as though he preferred not to be sheathed, but to be free to slip out of a protective skin at any moment. Clothes necessitated an exertion of vigilance.

  By his gloves—“thin grey silk to be taken off at meal time” in summer—you will know a very special set of hands (LCJ, 168). The only thing that enabled Jackson not to collapse beneath the undue strain of trying to relieve the suffering of children unable to swallow or breathe, he told us, was an utter trust in his hands. Chevalier Jackson was a man who didn’t trust much of anything in the world except his eyes and hands, and he protected his hands with gloves much of the time. “Sealing an envelope, opening a package, or turning the page of a manuscript,” he explains, “would cut deep enough to draw blood.” By his own account, Jackson is literally thinskinned—the gloves were not, as his colleagues supposed, a protection against scars caused by Roentgen burns.

  “Caution is natural and extreme with me,” he confessed, “ ‘take a chance,’ has no appeal. I would not take a chance on anything. One day when I said so, Doctor Ellen J. Patterson added, ‘nor anybody’” (LCJ, 174). Jackson avoided placing his bare hand on a doorknob for fear of infection, thought the “Oriental bow” should replace the “Western handshake” as a polite form of greeting, and believed that gauze should be placed over all telephone receivers to halt the spread of TB. He took the idea of defensive driving to an extreme, feeling that “one should drive a motor car on the principle that every other driver on the highway is deaf, dumb, drunk, or demented” (LCJ, 174). He angrily eschewed a trust in Providence: “Trust in Providence: keep powder dry—Providence won’t keep powder dry, Providence won’t keep insts in order, delicate instruments, delicate bronchus of a child.”