by Lewis Thomas
That evening I was visited by the anaesthesiologist for the brief but always reassuring explanation of the next day’s events, and in the morning I rolled down the hall, into the elevator, and down to the operating room, pleasantly stoned from Valium. The next things I saw were the clock on the wall of the recovery room and the agreeable face of my friend the nurse in charge, who told me that it had gone very well. I have no memory of the operating room at all, only the sound of the wall switch and the hissing of the automatic doors as my litter entered the place.
That was my first personal experience with the kind of illness requiring hospital technology. Thinking back, I cannot find anything about it that I would want to change or try to improve, although it was indeed, parts of it anyway, like being launched personless on the assembly line of a great (but quiet) factory. I was indeed handled as an object needing close scrutiny and intricate fixing, procedure after procedure, test after test, carted from one part of the hospital to another day after day until the thing was settled. While it was going on I felt less like a human in trouble and more like a scientific problem to be solved as quickly as possible. What made it work, and kept such notions as “depersonalization” and “dehumanization” from even popping into my mind, was the absolute confidence I felt in the skill and intelligence of the people who had hold of me. In part this came from my own knowledge, beforehand, of their skill, but in larger part my confidence resulted from observing, as they went about their work, their own total confidence in themselves.
The next two course offerings were trauma. I’d never had real trauma before in all my life—or only once, when as a small boy in grammar school I’d been hit on the head by a pitched baseball and knocked out for a moment. The next day my head began to itch, and I went around the house and back and forth to school, scratching my head incessantly and complaining to everyone that the baseball had injured the nerves. My mother was skeptical of this, as she was about most self-diagnosis, and took a close look at my scalp. I was infested by dense families of head lice, caught perhaps from somebody’s cap at school. In no time, but with a great deal of anguish caused by neat kerosene and larkspur shampoos, endless rakings with a fine-tooth comb, and finally a very short haircut, I was cured, although I’m not sure my mother ever thought of me again as quite the same boy. Anyway, that was all my trauma until I was sixty-six years old.
I was in the surf at Amagansett, floating in a high leisurely wave, and turned to catch it for a clean ride to the beach, when suddenly something went wrong with my right knee. After some floundering and swallowing a lot of water, I made the trip in under breakers and tried to stand. I couldn’t, and had to wave for help. I was hoisted out and horsed along by friends, unable to place my weight on my right leg. On the way up the beach I was met by Dr. Herbert Chasis, a Bellevue colleague, and his wife, Barbara. Herbert knows more about kidney disease and hypertension than anyone I know, and Barbara had served as chief of the psychomedical wards during my years at Bellevue. They were sympathetic of course, but also to my surprise highly knowledgeable about knees and, like all good Bellevue people, ready to help. Indeed, Chasis had in his beach bag a proper knee brace, which he helped me put on, and explained to me that I had undoubtedly torn a knee cartilage (which he had done some years earlier; hence the equipment). Presently, crutches were provided as well, and off I went, home to get dressed and into Manhattan for a visit to the Hospital for Special Surgery. X rays again, and to my astonishment, another fiberoptics instrument, this time an arthroscope for looking into the interior of joints. In it went, moved around this part and that of the knee, and then it stopped. “Care to take a look?” asked the surgeon, handing me the eyepiece. I stared, transfixed, at the neat geometry of cartilage lining the joint, gray and glistening in the light, and then I saw what he had seen, a sizable piece of cartilage broken and dislodged. “Thank you,” I thought to say, “what now?” “Out,” he replied. So, Valium again, the unremembered operating room, and a long elliptical incision stitched with countless neat threads which I saw directly the next morning when the dressing was changed and I was commanded to get out of bed and stand on the leg, pain or no pain. Good for it, I was told, but I forget why. Teach it a lesson, maybe. Then on crutches for a few weeks, a single crutch for a few more, exercises thrice daily—lifting heavy weights by my foot (which I did for a few days and then began telling lies about)—and finally full recovery except for the odd pain now and then. Another triumph. I began to feel almost ready to write a textbook.
One more, and then I’ve finished, I trust. I was invited to give an evening lecture at the Cosmopolitan Club in New York, a place filled with dignity and intellectual women, including my wife. I prepared a talk on symbiosis, with a few lantern slides to illustrate one of my favorite models of insect behavior, the mimosa girdler. Halfway through the talk I called for the slides, the lights went out, I approached the screen to point to the location of the mandible-work of the beetle—and fell off the platform into the dark. Hauled to my feet, I found myself unable to move my left arm because of pain in the shoulder. I felt for the shoulder with my right hand and found an empty cavity. Someone brought a chair and sat me down while I caught my breath, and several sympathetic voices suggested that I cancel the evening. I wanted to finish the girdler story, however, and hunched back to the podium. It must have been a painful talk for the audience. I thought no one would notice the shoulder, and I droned on to finish the lecture, sweating into my eyeglasses and onto my manuscript, bracing my elbow against the podium, thinking that I was getting away with it nicely. Then I noticed that Dr. André Cournand, the great cardiologist from Bellevue, had moved from his seat in the front row and taken a chair alongside the podium, watching me carefully. I remembered the old anecdotes about that hospital, the car crash, the exploded street, and the figure of authority thrusting through the crowd: “Stand aside, I am a Bellevue man.” If I topple, André will catch me, I thought.
Anyway, I finished it, although I’m not sure anyone was listening. An ambulance had been summoned, and I was carted off once more, on a litter, to Memorial. An X ray showed the shoulder dislocated and fractured (“Care to take a look?”), and my friends set about trying to get it back in place, me lying on my stomach buzzing with morphine, with the left arm hanging down, Ted Beattie (chief of surgery at Memorial) on the floor pulling down on my arm, but it wouldn’t slip back in place. Finally, after a half hour of tugging, it was decided that I would have to be fixed under a general anaesthetic, and a call went out for the head of the anaesthesia department, Paul Goldiner. It was now 10 p.m., and Paul was at home in Westchester County. He hurried to his car and started the drive along the parkway to New York. Five minutes from home he passed the scene of a car crash and noticed a man lying prone on the grass. He stopped, went over to the man, found him pulseless and not breathing, and set about resuscitation. Anaesthesiologists are the best of all professionals at this skill, and shortly he had the man breathing again and conscious. He ran back to his car and set off again for New York. By this time, Beattie’s maneuvers had snapped my humerus back into its joint, but it was too late to call Goldiner and tell him to stay home. He arrived at the door to be informed that his trip had been unnecessary, then told his own jubilant story; the trip had been the best he’d ever made. It is not often given to chiefs of anaesthesiology to save a life on the open highway, and Goldiner was a happy man. I have often wished I could locate his patient someday and have him take Paul Goldiner and me out to lunch.
That was the last of my trial runs as patient, up to now anyway. I know a lot more than I used to know about hospitals, medicine, nurses, and doctors, and I am more than ever a believer in the usefulness of technology, the higher the better. But I wish there were some easier way to come by this level of comprehension for medical students and interns, maybe a way of setting up electronic models like the simulated aircraft coming in for crash landings used for pilot training. Every young doctor should know exactly what it is l
ike to have things go catastrophically wrong, and to be personally mortal. It makes for a better practice.
I have seen a lot of my inner self, more than most people, and you’d think I would have gained some new insight, even some sense of illumination, but I am as much in the dark as ever. I do not feel connected to myself in any new way. Indeed, if anything, the distance seems to have increased, and I am personally more a dualism than ever, made up of structure after structure over which I have no say at all. I have the feeling now that if I were to keep at it, looking everywhere with lenses and bright lights, even into the ventricles of my brain (which is a technical feasibility if I wanted to try it), or inside the arteries of the heart (another easy technique these days), I would be brought no closer to myself. I exist, I’m sure of that, but not in the midst of all that soft machinery. If I am, as I suppose is the case at bottom, an assemblage of electromagnetic particles, I now doubt that there is any center, any passenger compartment, any private green room where I am to be found in residence. I conclude that the arrangement runs itself, beyond my management, needing repairs by experts from time to time, but by and large running well, and I am glad I don’t have to worry about the details. If I were really at the controls, in full charge, keeping track of everything, there would be a major train wreck within seconds.
And I do not at all resent any of the parts for going wrong. On the contrary, having seen what they are up against, I have more respect for them than I had before. I tip my hat to all of them, and I’m glad I’m here outside, wherever that is.
21
SCABIES, SCRAPIE
My wife said: “How can you possibly spend four hours talking about scabies?” This was just before I got into a London cab on my way to a seminar in 1981. Not scabies, I said, scrapie, but then the door closed and I had lost the chance to explain scrapie and the remarkable properties of the slow viruses of brain disease which infect today and may not produce symptoms of brain damage until twenty-five years from now, and the overwhelming interest everyone, including my wife, ought to have in forms of life that can replicate themselves without, so far as has yet been discovered, any DNA or RNA at all, one of the greatest puzzles in biology today. Halfway along on the London streets it occurred to me that maybe the virus of scrapie is simply a switched-on, normal gene, and the presumably protein agent that causes the disease may not be alive after all, only a signal to switch on a gene in brain cells which is supposed to be kept off. The notion swamped my mind for most of the cab ride, still does, and I couldn’t wait until I got home to explain all this to my wife.
But later in the day, Beryl had her inning. She was reading several books at once, as usual: one by a Cambridge University visiting professor from Poland, with whom we had dined several evenings earlier, on the history of law and religion in the ancient East. Did I know that the Black Stone in Mecca long antedated Islam and that it was supposed to have been pure white originally? Did I know about the Four Dogs of Genghis Khan? Would I like to hear about a fourteenth-century political philosopher named Ibn Khaldun? I would. We went on with it, scrapie from my side of the net, Mesopotamian river basins and their cultural centers from hers.
Thinking back over forty years of marriage, I estimate that I have learned more from her, although she has acquired, for better or worse, for richer or poorer, some of my obsessive concerns, including all of Montaigne, lots of Wallace Stevens, some schoolboy Homer. She probably knows more about endotoxin and the Shwartzman reaction than any academic wife in our acquaintance, although I’m afraid it comes up as a lively topic for conversation only from time to time. I, by contrast, have learned all sorts of things I wouldn’t have picked up by myself. Beryl not only reads everything, she remembers everything she reads, and likes to tell me about items as she goes along. I would never have started my way through Jane Austen without this subtle guiding and goading. At one time I bobbed along in her wake, getting partway but never all the way into Proust. Next month I shall start George Eliot, or sometime soon anyway, having watched her elation across the room, evenings, through one novel after another. It was only when I heard her hooting with laughter in the middle of Michael Frayn that I realized what I’d been missing. Some places I’ve not been able to go: Anthony Powell and all those books of conversation, all the Paul Scott, medieval cathedral architecture, any number of the English detective stories she collects like porcelain, Scottish history, French history, English history, David Cecil’s Melbourne (a favorite of hers), the Restoration poets. I rely on her for knowing what colors go with what other colors, and when a particular shade of rose or green in a curtain or a rug or a painting is a particularly good color. I am not color-blind but color-deaf.
I am a skilled gramophone player, better at Bach, I think, and I like to fill the house with the Beethoven late quartets, late nights, full blast. I went through a time when I couldn’t have enough of Bartok and Elliott Carter quartets, played over and over again at high volume. A while back I bought a Sony Walkman, an electronic marvel on which I can play cassettes in loud stereo inaudible beyond my ears, but Beryl is not fond of this instrument, preferring me to make music openly and honestly even when—as I suspect—she might like the silence better.
Living together has been like an extended, engrossing, educational game. We have been exchanging bits of information, tastes, preferences, insights for so long a time that our minds seem to work together. My firm impression is that I’ve come out ahead so far, in the sense that I’ve been taught more surprising things by her than I’ve ever stored up to teach in return. But, even asymmetrically, it has continued to work both ways.
On balance, I believe this kind of family education is something women are better at than men. It is surely better accomplished by women for the children of a family. All the old stories, the myths, the poems comprehended most acutely by young children, the poking and nudging and pinching of very young minds, the waking up of very small children, the learning what smiles and laughter are all about, the vast pleasure of explanation, are by and large the gifts of women to civilization. It is the women who remember and pass along the solid underpinnings of culture, not usually the men. The men may come in later with their everyday practical knowledge of what they see as the great world, sometimes with the necessary ambiguities and abstractions, but they cannot fit their contributions into expanding, exploding young minds unless the women—the mothers and wives, the aunts and grandmothers, the elder sisters—have done their work first. I’m not even sure that a child can discover what fun is, and how to have it, without first being led by the hand into fun by a woman.
While I am at it, I might as well tell the whole truth about the sexes, giving away the whole game. It is my belief, based partly on personal experience but partly also arrived at by looking around at others, that childhood lasts considerably longer in the males of our species than in the females. There is somewhere a deep center of immaturity built into the male brain, always needing steadying and redirection, designed to be reconstructed and instructed, perhaps analogous to the left-brain center for male birdsong, which goes to pieces seasonally and requires the reassembling of neurones to function properly when spring comes. Women keep changing the upper, outer parts of their minds all the time, like shifting the furniture or changing their handbags, but the center tends to hold as a steadier, more solid place.
I am, in short, swept off my feet by women, and I do not think they have yet been assigned the place in the world’s affairs that they are biologically made for. Somewhere in that other X chromosome are coils of nucleic acid containing information for a qualitatively different sort of behavior from the instructions in an average Y chromosome. The difference is there, I think, for the long-term needs of the species, and it has something to do with spotting things of great importance. To be sure, most women tend to fret more than most men over the small details of life and the rules of behavior, they tend to worry more about how things look, they are more afflicted by the fear of mi
ssing trains or losing one glove, they cry more readily. But on the very big matters, the times requiring exactly the right hunch, the occasions when the survival of human beings is in question, I would trust that X chromosome and worry about the Y.
This brings me to a proposal. Taking all in all, the history of human governments suggests to me that the men of the earth have had a long enough run at running things; their record of folly is now so detailed and documented as to make anyone fear the future in their hands. It is time for a change. Put the women in charge, I say. Let us go for a century without men voting, with women’s suffrage as the only suffrage. Try it out, anyway. Write into the law, if you like, a provision that men can begin voting again after a hundred years, if they still want to at that time, but in the meantime, place the single greatest issue in the brief span of human existence, the question whether to use or get rid of thermonuclear weapons of war, squarely in the laps of the world’s women. I haven’t any doubt at all what they will do with this issue, possessing as they do some extra genes for understanding and appreciating children. I do not trust men in this matter. If it is left in their charge, someone, somewhere, answering some crazy signal from a Y chromosome, will start them going off, and we will be done as a species.