Sensing Light

by Mark A. Jacobson

  “If you had asked them if it was OK for you to go in to work today, what do you honestly think they would have said? ‘Sure, no problem’ or ‘Gee, that doesn’t sound like good idea?’”

  “Never mind.”

  A compassionate victor, she said, “Isn’t it possible, honey, that your judgment is a bit off right now? Let’s take it one step at a time, OK?”

  Cecilia set a hand on his knee and started the car. He looked out the passenger window and worried.

  Once home, he called the ICU and was told another pulmonologist had already come in to round with the residents. Herb wanted an update because he indisputably would be at the hospital tomorrow. In addition, he wanted to test his ability to remember details about old patients and search his fund of knowledge for relevant facts when told about the new ones. After hanging up, he couldn’t point to any glaring cognitive deficits. He was also aware he hadn’t second-guessed a single decision made by the back-up attending.

  Herb tried to nap that afternoon but couldn’t stop fretting over his mental acuity. He kept multiplying and dividing numbers and recalling names of interns who had rotated through the ICU.

  He got up and found Allison studying for a history test. He quizzed her, repeating each question after four minutes to check his own short term memory until she demanded he leave her alone.

  Just before dinner, Martin shouted from upstairs, “The bathroom sink’s stopped up.”

  Herb found Martin inspecting his face in the mirror, clearly unhappy with what he saw. His adolescent growth spurt was underway and had started with his nose. Herb had heard Cecilia assure him the rest of his face would catch up soon. It appeared he was losing faith in her infallibility, too.

  “What are you going to do, Dad?”

  It was more an accusation than an inquiry. Herb looked at the sink full of soapy water. His mind went blank. To buy time, he asked Martin what he thought.

  “Gee, Dad,” Martin exploded. “Can’t you even fix a clogged sink?”

  Afraid the answer was no, he stalled.

  “I’m curious about how your mind works, how you’d approach the problem.”

  Martin turned away. Herb knew he had compounded his error. Martin most definitely did not want his father to have a clue as to how his mind worked. Herb had to answer the question or suffer a quantum drop in his son’s esteem. He noticed a toilet plunger.

  “Let’s try this,” he said, picking it up.

  Martin had thought of using the plunger but hadn’t suggested it, fearful it would be a gross sanitary violation. Among other things, his father’s unassailably superior grasp of this mysterious and embarrassing subject galled him.

  Cecilia came in the bathroom, took one look, and said, “I’ll phone a plumber in the morning.”

  Of course, Herb chided himself. Why didn’t I think of that?

  Martin glanced at Herb. His eyebrows were furrowed. It was an expression Herb had seen recently. He couldn’t place where or when.

  XVI

  HERB WAS AT WORK Monday morning, supervising his fellow as she performed bronchoscopies. He hovered behind her, looking through the second eyepiece, ready to step in if needed. Mostly, he re-oriented her while she steered the instrument tip inside the patient’s lung, reminding her to suction whenever fluid accumulated and clouded their view. At the same time, he was explaining disease mechanisms to the resident and medical student assigned to the pulmonary consult service that month and letting them peek at airway abnormalities.

  The first two procedures went smoothly. Herb wasn’t encouraged. He knew that before the accident he could have been doing both clinical and teaching tasks and simultaneously planning the outline of a manuscript.

  A problem occurred during the third bronchoscopy. The fellow, attempting to direct the tip into a small airway, got stuck. She tried unsuccessfully to retract it, which made the patient cough violently. Herb couldn’t think of any advice to give her. Meanwhile, she told the resident to administer more sedation and kept maneuvering the lever. One minute later—a very long minute for Herb—she freed up the tip, redirected it to another part of the lung, and adroitly completed the procedure.

  “Thanks for letting me work it out, Herb,” she said afterwards. “That was a real confidence builder.”

  “Well, part of training is learning how to get out of trouble, isn’t it?”

  As his team was exiting the suite, he overheard the resident whisper to the student, “See what I mean? That’s why he’s a legendary teacher.”

  Ashamed by being complimented when he wasn’t even capable of doing his job competently, Herb thought, I don’t need a neurologist’s help. He knew what he had—a cognitive dysfunction in problem solving, relatively mild in severity but incapacitating for this occupation. And he knew what a neurologist could do about it—absolutely nothing. It would get better, or it wouldn’t.

  Herb had no difficulty seeing the irony here. He had applied his skills and insight to his own problem and identified the correct solution. He would have to go on sick leave. He decided to allow himself one more day before concluding he was too impaired to work.

  His pager beeped and displayed the lung clinic phone number. He had forgotten Sister Anna was coming at eleven for her airflow to be measured.

  Sister Anna was in a jovial mood.

  “God is giving me a last laugh, Herb,” she said. “I told the bishop I have AIDS. He was utterly befuddled. So I said, ‘the gay plague.’ Oh, Lord, was the expression on his face a treat! I could see the wheels turning. He must have been imagining me humping a bisexual man. Then I told him about the transfusion. My, my, did the color in his cheeks rise. Guilt, no doubt, for having those sinful thoughts of me in flagrante delicto.”

  Herb smiled, though in his current distress he was reacting to Sister Anna’s ability to speak in whole sentences without catching her breath rather than sharing her amusement.

  “How’s the breathing?”

  “A tad better with the new inhalers. The cough and fatigue are the same, annoying but manageable. I suppose this is as good as it’s going to be from here on out.”

  He heard no trace of self-pity. She spoke of her misfortune as if it was another’s, someone she didn’t even know. The clarity with which she saw her future froze him. He couldn’t formulate a reply.

  “I know I don’t have much time, Herb. It’s all right. I’m at peace with it.”

  “I believe you. You seem so serene. It’s impressive.”

  “There’s no deep secret involved,” she said, coughing. “No religious mystery. I’m not anticipating an ecstatic afterlife. I’ve had a good run. That makes me content. But I can’t claim to have achieved any higher spiritual state.”

  Herb wanted to ask her more but checked himself. She was his patient. He wasn’t hers.

  She gazed soberly at him.

  “What’s bothering you, Herb?”

  Her question unfettered him. He told her the story of his accident and subsequent troubles.

  “It must be very frightening,” said Sister Anna, her tone contemplative.

  “It is. Everything I do here is at stake.”

  “You seem normal.”

  “You’re being deceived by appearances.”

  She started to speak and stopped. He had a presentiment she was holding back something of great importance.

  “What are you thinking?” he asked.

  “Have you thought through the worse case scenario?”

  “Not…in any detail.”

  “Your intellect isn’t the only way to be in the world, Herb. There’s love. You’ve got that too, don’t you, with your family and friends?”

  He looked away.

  “I see. Perhaps not as much as you could have if you applied yourself to it, like you do to making the right medical decisions.”

  Herb felt naked, more than naked, as though a supernatural surgeon had painlessly opened his chest and exposed the vulnerable truth inside.

  “Thank you, Sister
,” he said in a rush. “I value your advice. I truly do. I’m sure it’s the best I’ll get.”

  After Sister Anna left, Herb was relieved he had forgotten to bring up her talking to the press. The blood banks would change their policies soon whether her story made the news or not. She didn’t need the satisfaction of embarrassing them. Neither did he.

  XVII

  HERB WENT FROM CLINIC to the monthly department meeting, Ray’s last before his sabbatical began. Since Ray wanted him to counsel the young assistant chief of medicine who would be in charge during his absence, he had to attend. Though able to follow the discussion, Herb made no comments about the department’s ongoing financial woes, despite several prodding glances from Ray. As he was leaving, Kevin stopped him.

  “Are you OK?”

  “I’m fine.”

  “Really?”

  “It was a little concussion.”

  “Then…do you have time for coffee? I need your advice about the suramin trial.”

  “To be honest, Kevin, my mental powers are not quite back to a hundred percent yet. You sure you want advice from me?”

  “Herb, if you’re functioning at twenty percent, that’s better than me with all eight cylinders firing.”

  They sat in a corner of the empty cafeteria. To postpone having to deal with another intellectual challenge, Herb asked about Kevin’s weekend. His probing, warm curiosity surprised Kevin. Herb gave an apologetic shrug. He hadn’t meant to pry.

  “It was pretty intense,” said Kevin.

  “What happened?”

  “I was in Boston, at my father’s funeral.”

  “Oh, I’m sorry. Was his death unexpected?”

  “Hardly. He lived for three years after being diagnosed with inoperable lung cancer. It must have been a joy for my mother to have it drag out that long.”

  “You sound angry,” said Herb, leaning forward, elbows on the table, chin resting on his interlaced fingers.

  “I know. I shouldn’t be.”

  “No?”

  “He wasn’t a kind man. In fact, he was a stubborn bastard. But I never took the initiative to work things out. I assumed he’d eventually accept who I was and want my forgiveness. That never happened.”

  Herb’s forehead wrinkled as he concentrated.

  “What do you think, Herb? If I didn’t try to repair things between us, do I have the right to be angry at him now?”

  “Why not? He was the parent. In the big picture, didn’t he have a bigger share of responsibility for the relationship than you?”

  Kevin thought for a moment and said, “Maybe you’re right.”

  Hoping he was on a roll, Herb said, “And if you’re like me, you’re probably mad at yourself, too.”

  “Huh…you think?”

  “Definitely. And I know what I’m talking about.”

  “How so?”

  “I didn’t have much of a relationship with my father. That’s an overstatement. He never showed me affection. Then he died when I was twenty-one. Nothing was resolved—I mean for me it wasn’t. I’m sure he never saw any problem between us.”

  “You still sound angry.”

  “Just sarcastic. I got over it. Other people came into my life. His significance receded.”

  “Gee, that’s inspiring.”

  “Sorry if I sound flippant, but it’s true. If nothing else, age does give one perspective on stuff like this. I was angry well into my thirties. Now I think I should have been grateful. Growing up as the only Asian kid in an all-white suburb of New York City had to be far better than living through World War II in China.”

  “Was your dad just indifferent or abusive?”

  “I’d say he took indifference to a level that approached cruelty. Here’s an example. He traveled a lot for work, but he did happen to be in town the weekend I graduated from high school. And, by the way, my class had voted me most likely to succeed. He didn’t bother to come to the ceremony. It wasn’t important to him. I was just another piece of furniture at home, nothing more.”

  “And you’re not still angry?”

  “Oh, I guess there’s a spark or two left. But mostly when I think of him, I’m sad. He was such an unhappy person.”

  “That’s a lofty view. Wish I had it.”

  “You will. And when you do, you’ll accept that you weren’t responsible for what happened. Neither was your father. Shit happens. And when there’s no love, it’s not rational to feel loss or guilt.”

  “I don’t think that attitude is going to work for me. I have a few good memories to feed the guilt.”

  Kevin could hear his father’s voice, shouting and laughing, “Kev, this is gonna be a huge problem!” At the end of the first summer Kevin spent in the garage, his father had tested the twelve-year-old boy’s mastery of the socket wrench. Kevin scooted under a car and unscrewed oil pan bolts while his father called out five second intervals. He slid back out, oil pan in hand, in eighty seconds. “That’s faster than Jones,” his father had said sotto voce with a wink. “I can’t fire him. He’s got three kids at home. He needs the job more than you do.”

  Kevin’s nostrils flared. His eyelids turned red.

  Herb had been running on pure emotion. Now he was at a loss for the right thing to say. He had to start thinking again.

  “Then you’re lucky, Kevin. I don’t have a single fond recollection.”

  “But you’ve got so much confidence. Isn’t that supposed to come from good fathering?”

  “Who knows.”

  “Maybe we should be in a self-help group.”

  They both laughed, but Herb couldn’t sustain the humor. The desolation of his childhood felt too close. Wanting to hold onto his connection with Kevin, he confided the difficulties he had been having since the accident.

  “It’s terrifying,” he said at the end of his account. “This is how I’ve made my way in the world. I can’t let myself imagine what it would be like if I don’t recover.”

  Kevin grabbed Herb’s wrists and squeezed. Herb didn’t withdraw.

  Looking him straight in the eyes, Kevin said, “You’re going to recover completely. You’ve got to believe that, Herb. I do. I’m absolutely sure of it.”

  XVIII

  FROM THE CAFETERIA, KEVIN drove across town to the Department of Public Health. Entering the building required passing through a gauntlet of protesters who carried placards reading “Out of the Baths, Into the Ovens.” They shrieked curses at him.

  His mouth was dry as he opened the conference room door. Sixty people were inside, all standing though there were more than enough empty chairs to accommodate everyone. Members of two gay Democratic clubs, enraged by each other’s presence, appeared ready to throw punches at the least provocation. One was pressuring health department officials to shut down the bath houses. The other waved the American flag and Bill of Rights, charging that closure would violate their constitutionally guaranteed freedom. While Gwen usually handled AIDS policy issues for their program, a gay man had to represent them here.

  Both sides heckled him, shouting, “Where do you stand on this, Bartholomew?”

  Kevin trotted to the front of the room to take refuge with the rest of the speakers.

  An attorney for the bath house owners, a man in his early thirties wearing a three piece suit and designer eyeglasses, followed him.

  “What’s your position, Bartholomew?” he screamed.

  Kevin refused to respond.

  The lawyer pulled at Kevin’s sleeve and screamed at a higher pitch, “Doctor, I’m talking to you!”

  Kevin yanked his arm away.

  “You’ll hear what I have to say, publicly,” he replied coldly. “I’m on the schedule.”

  Kevin found it baffling that any educated gay men believed bath-house closure was a threat to individual rights. Every sane person he knew thought knowingly transmitting the retrovirus was de facto homicide. How could permitting unsafe sex to go on in public bath houses be different from abetting murder, he would argue.
The data were incontrovertible. For a gay man living in San Francisco, the more bath-house sexual encounters he had had, the greater his risk of being infected with the AIDS virus. Kevin had no ambivalence about taking sides in this dispute.

  After his turn at the microphone, Kevin knew he had come across as uninspired. He had cited statistics and made analogies. The bath houses were as causally linked to AIDS as mosquito swamps were to yellow fever. It was that simple. But neither his delivery nor his rhetoric had been compelling.

  The other side didn’t mention the one argument for keeping bath houses open that might make sense—the damage had already been done, the majority of bath-house patrons were probably already infected. Gwen and Kevin had been briefed by the health department about a recent survey. One out of twelve men interviewed in local bath houses reported persistent swollen lymph nodes, an almost certain sign of HTLV-III infection in the ARC stage of disease, which meant an even larger proportion must be infected and asymptomatic, invisible below the iceberg’s water line, continuing to transmit the infection. The health department had also hired private detectives to document what practices occurred in bath houses. They reported most sexual activity included anal intercourse, almost always sans condom. Soon, the only people whom closure could protect would be the next generation of young gay men.

  When Kevin left the meeting, the slick attorney followed him into the hall.

  “You’re disgusting, Bartholomew,” he taunted.

  “Excuse me?” said Kevin, his hands involuntarily forming fists.

  “You think you’re some selfless, compassionate healer, don’t you? That’s a convenient delusion. You’re really a self-loathing homosexual. You want to take away the freedom of others to rationalize your own guilt. I bet you’re a Catholic, aren’t you?”

  Kevin smirked. His fists relaxed. The dart had missed its mark. Catholic guilt was at the bottom of his problem list now.

  “And you’re a lawyer, right?” he said with contempt. “Isn’t that supposed to be someone who can defend his position by arguing on the basis of rules, facts, and logic? And the best you can do is a scummy slur. How pathetic. Where did you go to law school? One of those places that advertises inside a matchbook cover?”