On Sunday morning, Jerry phoned to say that he and Rich had decided I should come down to Yale and that Dr. Cabin would be calling me at home (as he did) to arrange for the angiogram.
Now, less than a week later, Rich says that, barring the unforeseen, he feels certain that the bypass surgery and the recovery from the surgery will go swiftly and smoothly. He asks about my children, and I tell him I’ve spoken with each of them and that they will all be arriving at the hospital before surgery the next morning.
Aaron is already on his way down from Northampton by bus; Eli is on his way from New York City by train; and Miriam and her fiancé Seth will be taking a three A.M. train from Washington, D.C., and will arrive early the next morning. I tell Rich I was surprised that they didn’t hesitate, and will be with me—I note that I didn’t ask any of them to come—and Rich tells me he is surprised that I was surprised. Why wouldn’t my children want to be with me at a time like this?
After supper, Dr. Hashim stops by and talks with me for a while. Dr. Hashim is Lebanese and therefore, I expect, speaks French. I tell him I lived in France for two years some thirty years ago, before and after my first child, Miriam, was born, and Dr. Hashim and I proceed to talk with each other in both French and English. Although he describes the surgery and explains the possible risks attendant to it, such as stroke, retinal damage, cognitive losses, and infection, and says that, given the excellent state of my health, he sees no cause for concern, it is our conversation about things ordinary and familial that calms my fears and reassures.*
When I comment on his name and its possible biblical origin, he tells me that yes, he believes he is a descendant of families that inhabited the ancient Hashemite kingdom. He asks about my name and I tell him my father’s family came from Ryminov, a shtetl in the Carpathian Mountains—from a region now part of Ukraine—and that they had been in the butter-and-egg business there, as they were after they came to the United States. When, in the Austro-Hungarian Empire, civil servants assigned family names to Jews, probably at the end of the eighteenth century (so that we would no longer be Jacob-son-of-David, or Jacob-Mordecai-of-Ryminov), a state official, seeing thousands of baby chicks running around the family property, according to family lore, gave us the name Neugeboren, meaning, in German, “newly born.”
Dr. Hashim says something about the appropriateness of my name, and then, to my surprise, reaches down, lifts the bedsheet, and takes my hand in his.
“Twenty or so years ago,” he says, “I could not have done anything for you.”
Phil Yarnell, with whom I’ve been talking regularly, and who has been offering me diagnoses by phone and conferring with Rich and Jerry about me, telephones from Denver. Phil started out as a neurosurgeon but switched to neurology early in his career. Before moving to Denver and becoming chief of neurology at Denver General Hospital and of the Neuroscience Division at St. Anthony’s Hospital there, he taught at the University of California at Davis; since 1993, in addition to being in private practice, he has been clinical professor of neurology and neurosurgery at the University of Colorado School of Medicine.
Phil grew up on the same block in Brooklyn where I lived until I was two years old—across from Prospect Park—and though neither Phil nor I have clear memories of having done so, we like to imagine we played together back then: in front of our apartment houses, in the park, and in the sandbox and on the monkey bars in the playground that was directly across from my parents’ building.
Phil moved to Denver in 1971, the same year I moved to Northampton, and has lived there ever since. He and his wife Barbara also own a 160-acre ranch in Kiowa (“That’s one-quarter the size of Prospect Park,” Phil says), a small town an hour east of Denver, where they keep cows, horses, and llamas. At a lean five-foot-ten-inches tall, with a full head of white hair and a broad white mustache, and wearing a bolo tie at home and at work, Phil could pass for sheriff of a Western frontier town. His accent and blunt, slangy way of talking about things, however, remain pure Brooklyn.
He tells me he was surprised to hear from Jerry that I have heart disease and that it is so far advanced, but he’s glad I’m in Jerry’s hospital, where Jerry can keep an eye on things. This, he says, is very important, agreeing with why Rich and Jerry have decided upon Yale instead of Massachusetts General, where Rich originally wanted to send me. Given the routine and often lethal miscommunications and other slip-ups that prevail in hospitals, Jerry wanted me at Yale, where he could monitor matters and where doctors and staff involved in my care would be accountable to him.
My friends had seen a lot of hospitals and doctors, and until you had, they said, you could not believe the difference there was between excellent care and care that was less than excellent. It was, more frequently than anyone dared acknowledge publicly, the difference between life and death. (And this was ten months before revelations appeared in front page articles around the country, based upon a report from the Institute of Medicine of the National Academy of Sciences, that as many as ninety-eight thousand Americans die every year in hospitals from preventable medical errors—a figure Rich thought grossly underestimated the reality.* “That figure is just the tippity-tip of the iceberg,” Rich said, “and includes only the most gross and undeniable errors.”)
Early that evening my son Eli arrives (Aaron arrives an hour or so later), and while he is with me another old friend from Erasmus, Arthur Rudy, calls. I considered Arthur my closest friend in high school and have been talking with him regularly in recent weeks. Eli, who remains close with many of his high school friends, says something about how lucky I am to have remained friends with guys like Arthur—smart, successful, menschy guys who grew up rooting for the Dodgers and who have turned out to be delightfully quirky: Where’s the downside? he asks.
Arthur was vice president of Erasmus when we were juniors and, when we were seniors, in a class of more than twelve hundred students, was voted Boy-Most-Likely-to-Succeed. (Jerry Friedland was elected our senior class president.) Arthur, too, is a doctor, though not an M.D. He is a psychologist, formerly chief of psychology at Roosevelt Hospital in New York City and now in private practice. He tells me that Jerry called him with the news. Jerry and Arthur, good friends at Erasmus, roomed together for a year in an Upper West Side apartment during our college years (the three of us went to Columbia together), and though both acknowledge they made lousy roommates, they have remained close friends ever since. (Arthur was best man at Jerry and Gail’s wedding.) Arthur and I talk for a while, and—as with Phil, Jerry, and Rich—though I’m happy to have him calling to wish me well, what pleases more than anything we say is the knowledge that, before and after our talk, he, Rich, Jerry, and Phil will be talking with one another about me. How’s Neugie doing? I hear them ask. And: The Neug seemed in such great shape, and things seemed to be going so well for him…
Given that, unlike my four friends, I have been living without a wife or companion for the past dozen years, the thought that while I am asleep in the operating room, my chest open and my heart disconnected, these four guys who have known me, and one another, for nearly a half century will be taking care of whatever needs to be taken care of, provides more than comfort. Largely because I cannot know but can only imagine what they will think, feel, and say, my sense of their concern and affection enables me, even before my heart is emptied of blood, to see myself in a life that will be mine after my heart is repaired. Among other pleasant fantasies, I picture myself at Miriam’s wedding, scheduled eight months hence; and, too, I watch myself at my desk, alone in my third-floor office after my return home, going through notes and sketching out scenes for a new novel.
Now, and later on during my recovery, when I once again rely on these friends to get me through matters both medical and personal, I will find myself seeing us as boys, back again in Brooklyn and doing what we loved most of all: playing basketball. I see us in our favorite place—Holy Cross schoolyard on Church Avenue—and I imagine that we are a team: Phil and Jerry at the forwards,
Rich (who is six-foot-two and played college basketball and baseball) at center, me and Arthur (who once scored 59 points in a league game when he was thirteen) in the backcourt. Four Doctors and Neugie, I think—five pretty good ballplayers ready to take on all comers: five guys who loved nothing more than to be away from our homes, sweating it out on a baseball field, or in a gym, or a fenced-in schoolyard—five guys who loved nothing more, win or lose, than to hang out together afterward, talking and laughing about shots made and missed, about passes threaded and passes gone wild, about girls we were going out with or dreamt of going out with—five guys who would have loved nothing more than to have gone on talking forever about those things—sports, girls, the Erasmus basketball team, and the Brooklyn Dodgers chief among them—that mattered most in the world to us in those days.
The next morning I telephone my brother Robert, who has been a patient in state mental hospitals for most of the last thirty-seven years and for whom I’ve been primary caretaker. I tell him (and the chief of psychology at Bronx Psychiatric Center, where Robert is this time) about the surgery. Robert is silent for a few seconds, then asks if my children will be at the hospital and who will be taking care of me at home after the operation. He says he will say a prayer for me.
Miriam and Seth arrive in the morning and, with Eli and Aaron, stay with me until I am taken to the operating suite. According to them, the last thing I say before I am wheeled away is that they should use my credit card when they go out for lunch.
The surgery lasts six and a half hours, and my heart is stopped, my blood processed through a heart-lung machine (during what physicians refer to as “pump-time”) for one hour and fifty-five minutes. Dr. Hashim and his team perform a quintuple bypass (five grafts, one more than planned; when I tell this to Arthur, he laughs: “You were always an overachiever,” he says), and there are no complications. When Rich calls after he has received faxes of Dr. Hashim’s postoperative report, he is very pleased and tells me the surgeon was absolutely first-rate.* But that’s based on his own report, I say. How do you know how good he was? “Several things—but most of all, the pump-time,” Rich replies, referring to the amount of time my heart was detached and my blood cycled through a heart-lung machine. “One hour and fifty-five minutes for five grafts is incredible. The man is terrific.”
When I wake the next day, tubes and wires protruding from my chest, stomach, arms, neck, and mouth, my children and Seth are there, and I am able to get out of bed and take a walk with them along the hospital corridor. I feel very sleepy—and very happy. I fade in and out, and at noon I watch a nationally televised UMass basketball game. I have taught at the University of Massachusetts as writer-in-residence since 1971, and for most of those years my children and I have had season tickets to UMass games. We have also traveled to other cities—Albany, Worcester, Boston, Philadelphia, Washington, D.C.—to see games, and our home, where my friends and my children’s friends would gather when the UMass team was on TV, was dubbed “Hoop Central” by the sports editor of the local newspaper.
“When I told you the game was on TV,” Eli later tells me, “you got very intense and excited suddenly—as excited as anyone could be, given where you’d been less than twenty-four hours before. You’d fall asleep during commercials, but when the game came back on, your eyes would snap open.”
It is only now, the operation over and successful and my children seeming so happy—and relieved—to be with me (none of us upset, as we ordinarily would have been, to see UMass lose a crucial end-of-season league game), that I realize just how frightened they had been, and—but why the need for such reassurance?—how much they do love me. The depth of their affection, like that of my friends, seems an unexpected revelation.
“We were pretty relieved your children were staying with us for the weekend—and that you weren’t” Jerry says. “Your children were lovely, but they were walking into walls, they were so stunned. I remember that Gail made this great minestrone soup, with tons of fresh vegetables, and Miriam warned us that Seth had a very funny, quasi-religious thing about vegetables—he never ate them—but he just kept spooning the stuff in, one bowl after the other.”
On the afternoon after the UMass game, walking back and forth by myself from one end of the cardiac care unit to the other while my children have gone off to eat lunch, and feeling a bit stronger, though still groggy from the anesthesia and pain medications, I think of how lucky—and happy!—I am to be alive, of how good it feels simply to be walking (“Listen, Neugie—keep breathing in and breathing out,” Arthur advises. “It’s the secret of staying alive”), and of how dear my children and friends are to me, and then of how strange, swift, and mysterious the entire experience has been: of how little we know about how and why I nearly died.
2
All the Time in the World
WHEN RICH CALLS ON Saturday evening, and after he tells me how great my surgeon was and how happy he is and that things went well, I talk with him about some of the notions my experience, before and after surgery, has set in motion.
If, I say, we know so little about the heart, which, in comparison to other organs—to the brain!—seems a relatively simple pump of flesh and blood, and which, in the context of the infinity of interactions not only within the brain or heart (consider, for starters, that the body replaces about a million cells per second and that there are more potential synaptic connections in any one brain than there are particles in the known universe), but also between the brain, the heart, the nervous system, and the immune system, how vast must be the realm of our ignorance. And yet, and yet… despite how little we know, how extraordinary and good it is that we know enough, sometimes, to be able to heal the body and the mind of disease and, as with me, to restore life when death has all but found a dwelling place.
“Oh yes,” Rich says. “We know how to fix what was wrong with you—and thank God that we do—but about the rest we know very, very little. Despite all our researches, you see, we don’t really understand the fundamental cause of your illness. We don’t truly know how to prevent it. We don’t know how to reverse it. We can’t treat it very well short of invasive interventions such as stent angioplasty or bypass surgery, treatments we usually employ when the disease becomes life-threatening. And without catheterization we can’t even diagnose it accurately, especially when we need to know the true severity of the problem and the magnitude of the threat.”
Despite decades of intensive research, he says, atherosclerosis—the closing off of coronary arteries—remains the number one killer of both men and women in our time. And though theories abound, and though cardiology is generally considered to be the medical specialty wherein we have made the greatest progress in recent years, we really, he repeats, know very, very little.
“The first thing I tell my medical students,” Rich says, “is that they should never be afraid to say ‘I don’t know.’ It is far better to say ‘I don’t know’ than to be comfortable thinking you understand something—or to think you’re comforting your patient by pretending to know something—because then you’re not open to possibility. Because if you think you already know something, you stop listening to the patient.
“In the end,” Rich explains, something he will emphasize repeatedly in our talks, “—and the reason I became so alarmed and kept urging you into the hospital as quickly as possible—the surest way of diagnosing coronary disease now is exactly what it was when I started out as a doctor forty years ago: the patient’s report of his symptoms over a period of time, and the pattern of those symptoms as reported by the patient. It was the progressive nature of your symptoms that worried me most.”
We talk about the conversations we’d been having since the afternoon I first called him seven or eight weeks ago. In the course of talking about other things—mostly about a book Rich was writing (about the unexpected consequences, in his life and career, of saving the life of a Mafia Don) and that I was helping him with—I asked if he minded if I checked some stuff out with him
about my own health. I also tell him that I had become aware that as time passed he was calling me with increasing frequency.
“I’ll tell you this, pal,” he says. “Despite all the progress and gains we’ve made—and I don’t minimize them, for, especially in cardiology, I have seen miracles come to pass that now save hundreds of thousands of lives each year—medicine, even in cardiology, is still essentially an art, and one wherein the key element remains the relationship between the doctor and the patient. Most of what we know, and the basis for our decisions as to diagnosis and modes of treatment—despite all the advances in diagnostic testing—still comes from you: from what you tell us, and from our knowledge of how to judge new information when put into the context of our more general knowledge of who you are, and of your history.”
Six days after surgery my son Aaron drives me home to Northampton and informs me that he is moving back in with me for a month. (“I’m not asking you if I can move back this time,” he says. “I’m telling you.”) The next day, Eli arrives for the weekend, and two days after this my cousin Madeleine drives down from Syracuse, New York, intending to help take care of me for a few days but discovering to her surprise that I am already making meals for myself and going up and down the stairs of my three-story house without difficulty. I am also back at work, writing a few hours a day in my third-floor office.
While Madeleine is with me, a team from the television program Nightline shows up to tape an interview with me. The interview, scheduled before the surgery, is for possible use in a special Ted Koppel will be doing about Moe Armstrong, one of the people I’ve written about in a book for which I’d corrected page proofs a few weeks before surgery and which is scheduled for publication in early May.
Whatever the book’s virtues or deficiencies, or the response to it in the world, one undeniably good thing about it, I say to my cousin—the best thing, for sure—is that it is not going to be published posthumously.
Open Heart Page 2