This Is Where We Came In

by Lynne Sharon Schwartz

  Collateral damage as a result of surgery is quite different, of course. The patient is far from dead. Rather, the patient’s entire body is analogous to the nation under siege, and regrettably, individual parts of the body unrelated to the main arena of attack are made to suffer.

  The Hippocratic oath enjoins doctors to do no harm. But my surgery did harm; not only the sawing and hammering open of my chest and all that went with it, but the onslaught of fear—called depression by the professionals—that took me by surprise a couple of months later and that allegedly strikes 30 to 40 percent of heart surgery patients. So technically the doctors violated the oath. But of course they must, in order to do their work. Every painful treatment could be considered a violation of the oath. On the other hand, if my faulty valve caused my death within a couple of years (as the sweet-faced cardiologist predicted), and if the doctors had a remedy that could have averted that and yet they withheld it, that too would be doing harm. Arguably even more harm. You can’t win: harm is done either way. Again, it’s a matter of motives and results, means and ends, a slippery subject. Maybe the problem is with the oath itself, but of course no one would consider rescinding it, because who knows what doctors might do, left to their own devices.

  With all this, our fate here in the hospital hinged on the doctors. We revered them and resented them, at least I did. I didn’t resent them because they were helping me, as in, No good deed goes unpunished. No, I’d probably resent anyone I had to revere. Reverence is simply not part of my makeup. I dislike hierarchies, though I know they are ubiquitous in the animal kingdom. Long ago I worked for several years as a secretary for a Quaker organization and learned that Quakers don’t use titles, even such common ones as Mr. and Mrs. (or now, Ms.). I was instructed, when I typed letters, to address the recipients, no matter how distinguished, by both names, for example, Dear Albert Einstein, or Dear Nelson Mandela. Also, while the secretaries called each other and our own bosses by first names, we addressed all the other executives by their full names. I liked that. I still write letters that way. But I do call doctors Dr., despite the Quakers’ practice of full names and feminism’s eminently sensible policy: if the doctor calls you Lynne, you call him Joe. I don’t want to get that chummy.

  I shouldn’t have been surprised that the people in the waiting room weren’t discussing sports and earthquakes. They were relatives and friends of patients, and like those of us wearing the gowns, they were affected, or afflicted, by the hospital atmosphere, in which nothing is of any importance except living or dying. The awareness of the body’s vulnerability, which normally doesn’t need constant acknowledgement, is perpetual here. Anyone who ends up in a hospital bed is by definition in danger. No wonder it’s hard to focus on anything else.

  At least that was so on the cardiac floor; maybe on less serious floors—broken bones, knee replacements, gallbladders—it’s different. Here, we’ve come to be saved, to go on living. And we’re rooting for each other, our sisters and brothers ambling through the halls dragging their IV poles, clinging to their slender dancing partner. There’s a heartfelt camaraderie, a pure, unambiguous feeling you won’t find in many other groups forced together by chance and circumstance. Most of us will probably live to go home—they certainly don’t want us dying here—but how long after that?

  “YOU WILL SWALLOW THE TUBE”

  Less than two weeks after the surgery, I find myself being prepared, in an extremely small room crowded with medical equipment, for a TEE, a transesophageal electrocardiogram: a tube with a tiny camera at the end goes down the esophagus and behind the heart in order to see if there has been any stroke activity back there, any pieces—“grunge matter,” one doctor called them—broken off during surgery that traveled to the brain. The TEE, one of several tests for stroke, is happening because a few days earlier, barely back home after my bonding with the anonymous horse, I looked down at the strips of tape bisecting my chest—some strips halfway off, some hanging longer than others, an ungainly tangle of tape—and asked why they were there. I never keep myself in such a messy state. My husband immediately realized, especially after a few more weird remarks, that something had gone wrong in my brain. Next stop, the emergency room of a nearby hospital, not the hospital where my “nasty valve” had been replaced.

  I had either had a stroke or a TIA, a transient ischemic attack or mini-stroke. A TIA is better because it lasts only a short while and leaves no permanent neurological deficits. In my case, by the time we got to the ER, I had recovered and might have been better off going home.

  The days were filled with tests or waiting for tests. They never took place exactly when scheduled. Some of the tests were very simple, such as the neurologist asking me to touch my nose then touch his finger, or to walk a straight line down the hospital corridor. Some were elaborate and involved sophisticated machinery, such as this upcoming TEE or yesterday’s MRI. I tried to do well, as I had always tried on tests in school, even when there was nothing much I could do. Except during the MRI there were moments when the technician said, “Don’t swallow now,” and perversely, those were the moments when I felt the greatest need to swallow, and did. The heart has its reasons.

  Some people can tolerate being slid into a tube like a roast going into the oven, followed by the sensation of being buried alive to the sound of jackhammers, and some can’t. I assumed I’d be in the latter group, yelling to be freed. I was offered a sedative beforehand, but it came with a paper to sign that said one possible result of the drug was death, so I chose to pass it up. As it happened, I surprised myself: I didn’t mind the MRI too much. My daughter was in the room with me, and the technician, Pedro, arranged a small mirror at the end of the long tube so that I could see her and not feel totally cut off from the world of the living. This was kind of him, but he couldn’t get the mirror in exactly the right position, so that I saw only a segment of her face, oddly angled, as in a Picasso painting.

  After the MRI, we had to wait a long time for an orderly to wheel me back to my room; it was the week of New Year’s, so the hospital was understaffed. I was more than willing to walk but that wasn’t permitted. I was starving and the candy machine in the hall didn’t work. We asked Pedro if he had anything around to eat. He said apologetically that all he had was a few pretzels. He gave us an enormous plastic jar with a red lid and a few pretzels way down at the bottom. We reached in, our arms in the jar practically up to our elbows. They were great pretzels—I can taste them to this day.

  The preparation for the TEE is being done by a nurse with minimal English. One of the innumerable things I learned during my two five-day stays in different hospitals, one for the surgery and one for the TIA, is that the caretakers of hospital patients are nearly all immigrants. Why is this? Are immigrants particularly good at hospital care, or is it the only job they can get? We certainly should not complain about immigration because without it many of us might be dead or neglected. Not only nurses and attendants, but doctors as well (though not my all-American surgeon).

  As with the angiogram, the preparation for the TEE takes a very long time, longer in fact than the test itself, and involves, among other things, the nurse spraying some foul-tasting stuff into my throat to numb it. She apologizes profusely for the taste, which I find puzzling: with a tube about to travel all the way down my esophagus to photograph the back of my heart, who gives a damn about a bad taste?

  After a while the doctors arrive, a man and a woman, both very young, the man wearing a yarmulke. They barely acknowledge me lying on their table, no more than one would greet a sausage (kosher, in his case) brought in on a plate for your breakfast, in fact maybe less, and they talk to each other in low tones. Maybe they’re talking about me, but then again they might equally be talking about football scores or last night’s blind date or problems with their aging parents. The nurse continues to explain the procedure to me, so thoroughly that I could probably perform one myself in a pinch. Definitely a case of too much information, especially as there’s a
partial anesthetic so I won’t be fully awake or aware in any case. They must be obeying a new law of full disclosure.

  The key part of the explanation regards the tube. While the young doctors continue their murmuring, the nurse holds up her second finger and says, “We use a tube like this, about this size, to go down your esophagus with a little camera at the end.” It is amazing where they can put cameras nowadays, but I reserve that line of thinking for later. I’m interested in this tube.

  “You will swallow the tube,” she says.

  “You must be kidding.” I don’t actually say it, though.

  Noting my consternation, the nurse says with a smile, “Are you good at swallowing big things, big pieces of steak or chunks of banana?”

  “No!” It happens that I’m very bad at that sort of thing. Even large vitamins are uncomfortable to swallow. As the child of civilized parents, I was taught to chew. Moreover, ever since a teenager in our building almost choked to death on a melted cheese and sausage roll, I’m afraid of choking. Her father, seeing her turning blue, tried the Heimlich maneuver, and when that didn’t work, he flipped her upside down and held her feet and shook her until the gob popped out of her throat.

  But before I even deal with the prospect of swallowing a tube the diameter of the nurse’s finger, I am appalled that she addresses me in the future tense, employed as the imperative. The future tense in this context is worse than the imperative itself, which would be, at the proper moment, “Swallow the tube!” If she were very polite, she might add “please.” “You will swallow the tube” is a prediction. How dare she predict what I can or will do? Well, I have to be culturally sensitive, even at this stressful moment; she’s obviously not expert in the nuances of English tenses. Still, she could do better. There are plenty of preferable locutions she might have used. She might even have said, “Please try to swallow the tube. But if you can’t, we can use an anesthetic to get it down.”

  She never mentioned that option, but I learned later from my brother, who had the same procedure, that with anesthesia they can get the tube down the throats of reluctant swallowers. I should have known. If they can take out your heart for a few hours then put it back in with a little piece of horse stitched on, getting a tube down your throat must be child’s play. Anyhow, I have no memory of swallowing the tube. It must have gone down one way or another, though, because I remember very clearly its coming out. The sound. I felt and heard the tube emerge from the back of my throat with a soft pop, like a cork deftly extracted from a bottle of wine.

  Besides the choking incident with the Heimlich maneuver and the upside-down caper involving the sausage roll, the other thing on my mind after the nurse said, “You will swallow the tube,” was a terrific movie from Colombia I’d seen not too long ago, called Maria Full of Grace. A young girl, very beautiful, pregnant and in desperate need of money, agrees to work as a drug mule and fly to the United States with sixty-two pellets of cocaine in her stomach. Each pellet is 4.2 centimeters long and 1.4 centimeters wide. Naturally you can’t just swallow them, one, two, three. You have to learn how, rehearse. One of the most harrowing scenes in the movie is Maria being trained to swallow objects of that size. A man gives her enormous black olives to practice on, and at first she chokes and gags. But she’s desperate, so eventually she learns to swallow the olives whole. Before her flight she swallows all sixty-two pellets. We see her do a few and we infer the rest. Later she has to gather them when they come out the other end—this is not shown but left to the viewer’s imagination. However distasteful, it can’t be as bad as swallowing them, I suppose.

  I thought of that poor girl swallowing all sixty-two, while I had to swallow only one. Plus she was far from home and pregnant and moneyless. I should consider myself lucky.

  Things turn out all right in the end for Maria, who delivers her cargo, has her baby and lives in an apartment in, I believe, Queens. Not so for a friend of hers on the same mission: one of the pellets bursts inside her and she dies an agonizing death.

  The other movie that comes to mind, inevitably, is that old porn flick Deep Throat, about a woman with astonishingly ample sexual capacities, but this was the last thing I wanted to dwell on at the moment.

  All during the preparation the two murmuring doctors kept fussing over some equipment on a table. I wanted them to acknowledge my presence as something more sentient than a slab of meat waiting to be carved, so I said, “Do you actually do these procedures all day long?”

  “Yes,” the woman answered, barely looking up.

  It was on the tip of my tongue to say something about the Nazi doctors; more than the tip, the words were nearly on my lips. After all, I thought, there’s a certain superficial similarity: the Nazi doctors also performed sadistic procedures all day long, though without anesthesia. Of course the crucial difference is that their goal was not to heal but to destroy. That difference is pretty crucial, no doubt about it. Enormously, infinitely crucial. But setting aside the goal, the activity itself seems not so different. I don’t mean to compare myself to the victims, but merely to note again the conundrum of similar actions with widely different motives—as in the contradictions of acting on the Hippocratic oath.

  But then I noticed the yarmulke. That was what restrained me from commenting. I didn’t want to offend this obviously Jewish doctor, an observant Jew. Strange as it seems, there I was, a slab of meat awaiting his instruments, at his mercy, and I didn’t want to offend him. Not that I feared his retaliation—I gave him more credit than that. But a remark like that would be in extremely poor taste, especially to a Jew. I was proud of my restraint. After the procedure was over, I told my husband and daughter, who were waiting outside, the little joke that I discreetly restrained, about the Nazi doctors. They were not amused. My husband said a remark like that would be in bad taste to any doctor, Jew or not, it didn’t matter. I should keep such outrageous comparisons to myself. Had I not been lying exhausted on a gurney, he would have told me to develop some perspective, to see things in their proper proportions. He often tells me this when I’m in good health and of course he has a point.

  All the medical people were pleased at the results of the procedure, which showed that I hadn’t had a stroke; no little pieces of grunge matter had detached and swum to my brain. This was very good news to me too and I was happy, sort of. But my happiness was diluted by the imperative mood of the nurse’s order—“You will swallow the tube”—which kept echoing in my ears. I suppose I’m oversensitive about language, and everything else.

  For instance, I once tried to count how many people in the hospitals had handled my body. How many hands? I felt almost like a prostitute, having been touched intimately by so many strangers—and not even getting paid for it. I got up to about fifteen, unsure whether I should count the aides who came in several times a day to take my blood or my blood pressure. Those aren’t very intimate or intrusive procedures. But I decided to count them as well. Another uncertainty was how many people had been in the operating room during the surgery. I’d imagine three or four at the very least. If it took four to do the angiogram, probably there were more in the OR. “We reach in.” Two to reach in and . . . and what? Remove the heart? Work on it in place? Another two to attach me to the heart-lung machine at just the right moment, before the brain is deprived of oxygen and lapses into vegetation. After a while I lost count, couldn’t keep them all straight in my mind. Let’s just say a lot of hands.

  In between all these tests I would walk down the very long hall, south to north—it covered two city blocks—until I reached the big picture window at the north end. This second hospital was very near my home, only a block and a half away. I’d had dealings here before: I’d visited a neighbor with appendicitis and a friend’s daughter who had a baby; I’d telephoned the public relations office to complain that employees arriving for the seven a.m. shift were shouting under my window, where they parked their cars. I’d been to the emergency room a few times, nothing serious, most recently for a mys
terious black-and-blue blotch on my eyelid: the doctor suspected my husband had hit me but I assured him that wasn’t so. I’d brought my children to the ER for the calamities of childhood—falling off a bike and losing a piece of finger, getting a shard of glass in the foot . . .

  So it was our familiar local hospital, and as I reached the north windows at the end of the corridor, I realized I could see my apartment very clearly, its southern side, living room, study, dining room and bedroom windows. I longed for wings, so that I could fly through the window and across to the comfort of my apartment. So near and so unattainable. “You are a patient.”

  By the end of the tests, I found my thoughts turning to leeches. In many movies set in the nineteenth century, and in the many Victorian novels I read in college and afterwards, there are scenes of sick people being treated with leeches that suck their blood. The patients lie on their stomachs, and the leeches are applied to their backs. I was always sickened by the shiny black leeches, the bloodsuckers that would gorge themselves on bad blood. Watching them in films or picturing them while reading, I would begin to shift and shrug in my chair, feeling tiny tentacles scraping at my back. I felt so sorry for the patients treated in this way, and so superior too: look how ignorant people were then, they didn’t have any better treatments, they didn’t know the leeches were useless. (Although I believe I read somewhere recently that leeches do have some salutary effects.)