Let me begin by sketching a few of the delusions or hallucinations I experienced while I was under. Where I was, I could only guess. I can remember being turned over often. Someone was pounding me on the back and ordering me to breathe. This happened in the intensive-care unit of Boston University hospital, or on the floor for recovering patients.
I am wandering about, having a heavy time of it. I’m in a city, and I seem to be looking for a place to spend the night. At last I find it. I enter what was once in the ’20s a movie palace. The ticket booth is boarded up. But right behind it, on a tile floor sloping upward, are folding Army cots. There is nothing playing here. Hundreds of seats are empty. But I understand that the air is treated and that it will be good for your lungs to breathe it in. You get points toward your recovery for spending the night here.
A second recollection:
I am in a bank, a very classy bank, the walls are of polished marble, and I’m talking to an officer of the bank. We stand before two coins sunk in the wall. One is a dime. The other is a huge coin, much bigger than anything I ever saw. One of my ex-wives is present. They all begin to talk to me about the advantages of this unheard-of banking offer. I’m supposed to submit to being frozen for a century or so. This is going to be a cryonic triumph. At the end of that time, my dime will have grown to the dimensions of the other huge coin, about a yard in diameter. So my ex-wife says, “Think how rich we’re going to be.”
I said, “But which of us goes first?”
“You go first, and I will follow.”
I said, “No, it’s against my religion. I won’t do it.”
Even before my release from the intensive-care unit, I climbed out of bed thinking that I was at home in Vermont and that one of my granddaughters was skiing around the house. I was annoyed with her parents for not having brought her in to see her afflicted grandpa. It was a winter morning, so I thought. Actually, it must have been the middle of the night, but the sun seemed to be shining in the snow.
I climbed over the bedrail without noticing that I was attached by tubes and needles to hanging flasks containing all kinds of intravenous mixtures. I saw as if they were someone else’s my bare feet on the sunny floor. They seemed unwilling to bear my weight, but I forced them to obey my will. Then I fell, landing on my back. At first I felt no pain. All I was aware of was my helplessness. An orderly ran up and said, “I heard you were a troublemaker.”
I had been out for many weeks. I was then on heavy doses of heparin (blood thinners), and my fall was dangerous. The nurses put me into a restraining vest. I asked my grown sons to call me a cab. I said I’d be better off at home soaking in the bath. Instead I was shipped down from medical intensive care, and in a matter of days I found myself in a regular room “on the floor,” in hospital lingo.
That night, the chief neurologist appeared–I think it was after midnight–and examined my wife, who was sleeping on a chair. And then he examined me. I had been treated for pneumonia, plus heart failure. But on the floor, there were new problems. Let me say, quite simply, that I was not functioning and that my future was uncertain.
The senior neurologist came with a packet of pins–he discovered that my upper lip was, to put it in his own way, lame. Even when I spoke, the lip was strangely immobile. He put me through some simple tests. I failed them all. At various times afterward, he asked me to draw clock faces. I was unable to draw anything. My hands were useless. I had no control over them at all. It was impossible for me to sign my name or eat my soup. My symptoms seemed, to Dr. X, due to poisoning.
My wife and I had gone on holiday to the Caribbean, and there I ate a toxic fish. I by now was willing to believe the worst about the Caribbean. The doctor I saw there had diagnosed my trouble as dengue, a disease transmitted by mosquitoes. But (after I was moved to Boston), an Australian expert on ciguatera toxin described that disease to Dr. X (who decided ciguatera was it). Some of X’s Boston colleagues did not accept the diagnosis. I was partial to Dr. X, however, for reasons that had very little to do with medicine at all.
To put matters plainly, I now had to decide whether I should, or should not, make efforts to recover. I had for long weeks been unconscious. My body was wasted, unrecognizable. My sphincters were haywire. I could not walk. I had lost the use of my hands. The extent of recovery possible could not be estimated by anyone. I would soon be 80 years of age.
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Now the doctors had saved my life, and I was grateful to them. Therefore it would be normal to suppose that they would be concerned about the extent of my recovery. Two of the ICU doctors still visited me, but I no longer was their patient. During a full month in intensive care I had unconsciously, or in a dim state of consciousness, resisted death. But matters were different on the floor, when I was aware that I couldn’t feed myself, couldn’t walk, couldn’t read, that my memory was impaired, that my muscles had shrunk, that I was often incontinent, and that I was shamefully reduced, weak.
What were my resources at this stage of recovery? It is often clear to me that I owe as much to my wife, Janis, as to the doctors. It was Janis who saw that I was in bad trouble and flew me back at once from the Caribbean; Janis, who would not leave the hospital during the long crisis and slept on chairs in the ICU cubicle, who watched over me and kept notes throughout.
While I struggled to breathe, she would lift the oxygen mask and swab the inside of my mouth. It was when the respirator was brought in, and she saw that she could rely on it, that she went home for an hour or two to change into clean clothes.
I joked with her about the presence of death. So that in addition to what 19th Century old-timers called aviditas vitae, the craving for life, I had to keep going in order to deserve a wife who put up such a fight for my not-so-precious life.
I sometimes longed for a doctor to tell me that, in time, I might be normal again.
The one physician who came regularly was Dr. X, the senior neurologist. He would say, “Draw me a clock with the time of 10:45.”
Or, “What is today’s date? Now, don’t tell me that you live on a superior plane and you don’t have to know exact dates. I want specific answers from you.”
Or, “Multiply 72 by 93.”
Or, “Divide 5,322 by 46.”
Thank God, I had kept my multiplication tables in good order.
Dr. X also had Janis bring my recorder (the musical instrument) to the hospital. He learned that I had taught myself 60 years ago to play it, and he may have thought it was good for paralyzed facial muscles.
He had no wish to discuss deeper questions with me, or questions relating to the extent of my recovery. I had been through a similar process of recovery at the age of 8 from a combination of peritonitis (inflammation of a membrane in the abdomen) and pneumonia. Returning from the hospital I then had to decide whether I was going to be a lifelong invalid with two older brothers hating me for monopolizing the affections and concern of our parents. . . . How such decisions are made is beyond my comprehension. I see now, however, that I chose almost consciously not to be a weakling.
I turned up a book by the famous coach Walter P. Camp on physical fitness. And I did, as the famous football coach himself had done, carry full coal scuttles up and down the stairs at arms’ length. I chinned myself. I ran. I worked out with a punching bag and with a pair of dumbbells. I told everybody that I was in training. And the truth is I had no gift whatever for sports. In high school, I was an effortful miler on the track team. I got there without grace, and a letter was the reward for my doggedness.
Anyway, the choice I had made at the age of 8 seemed to remain effective some 70 years later. Whether Dr. X had any interest in my tenacity, I can’t say. We didn’t talk about that. He steered me toward other subjects, books, music, anything except my dilapidated biological foundations. But he came several times a day to see me at odd hours and what I picked up from his visits was that my death was not an event scheduled on his calendar.
He asked me in great detail about a course I was giving in the next term. He wanted to hear all about the reading list. And before I knew it, he had me outlining my lectures. These preliminaries were not enough. He brought me back to the subject again and again with great cunning. The course already had been canceled, but he drove me to meet my seminar in my own apartment and so I eventually did.
I was still pushing a walker in the corridors, intent on getting back the use of my legs. I was being held upright in the shower, soaped and rinsed humiliatingly by kindly nurses who had seen everything and were not shocked by my body. I assumed that my senior neurologist and good angel had seen conditions like mine over many decades and that he knew exactly where I was.
You learn, also, during a long illness how much you have in common with everybody else. It’s only now, writing these notes, that I come to understand how much tact there was in the doctor’s conduct, and to see that he knew perfectly well how much I needed him to see me through.
At my age, one has had a considerable experience of all the ins and outs and dodges that accompany self-interest. All such considerations are necessarily mixed. The neurologist was a crack diagnostician, I considered, but also his diagnosis had been challenged and disputed by other doctors, so he had an additional interest in confirming his diagnosis. He would be right, and he would cure me.
I was able up to a point to separate his professional motives from his other interests. The fact was that he knew I needed his personal visits, his daily presence and that I depended on them.
Another consideration is the cunning of the patient who is continually seeking to drink up the doctor’s attention. It may occur to him that the physician must portion it out, and therefore one recognizes a special need to get ahead of one’s sick rivals. The doctor, naturally, has to protect himself against these monopolizing instincts of people who are almost blindly recovery-bent and who have the deep and special greed of the sick when they elect to fight for recovery.
But Dr. X was no beginner. He came and went as he saw fit. I never asked him when he was coming back.
Also, it was clear to me that much of what I understood and felt was curiously occult, and I avoided the mistake of trying to communicate the many curious things I was experiencing, or thinking, like having to take thought for the tactics involved in getting down from bed or climbing into it again–actions that normally need no planning and which now caused unfamiliar kinds of calculations and pains.
At this stage of my recovery, when I picked up a ballpoint pen, the best I could write was a small cramped circle. Then within days, I was performing the long divisions and multiplications set by the doctor.
It took me back to childhood to work at sums. For my fingers, too, they were therapeutically helpful, and I was soon able to sign checks and begin to pay the hundreds of bills that had accumulated.
Dr. X, the senior neurologist, adopted a rough style in dealing with me.
“What day of the week is it?”
“Tuesday.”
“It’s not Tuesday. Every adult knows what day it is.”
“Well, it must be Wednesday then.”
“Yes, and what’s the date?”
“I have no idea.”
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“Well, you’re ready to make a stab at it, but from now on, you’re going to know the date like any normal person. You’ll check it out every morning, and you’ll be sure from now on to know the day of the week as well as the exact calendar date.”
Then he pinned a calendar to the wall. He had observed that my days were a morass of negligence and that I was demoralized and drifting, and losing heart in slackness and disorder.
In preparing my talk, I rejected at once the temptation to tell a convention of doctors how to conduct themselves with their patients. A team of doctors at Boston University hospital saved my life two years ago. Some of them seem to have taken my survival seriously, but I would sooner have had them effective than compassionate. That is, if I were to have a choice. All in all, I’m glad to have a few years left to attend to matters that I had set aside for a future solution.
No one can tell doctors what to do. Or how to limit the emotional ground they are bound to surrender when patients die. We can’t possibly tell human beings, adults, to be caring, compassionate, sensitive; to interact, to enter into intimacies from therapeutic motives, et cetera.
As for the doctors who saved my life, some of them were briefly interested to hear of what had become of me after I graduated from intensive care. Still I think I might not have managed things at all without the support of Dr. X. He didn’t think that I was bound for a chronic care facility. He believed in reading the signs as an Indian scout on the plains in the last century might have done. Somehow he sized me up as capable of making a comeback. I wonder what medical practice would be like if doctors were to dismiss such intuitions. But, like a skillful scout, Dr. X pressed his ear to the rail. Often this would result in nothing but a dirty ear. But now and then, you might hear the far-off locomotive. That far-off locomotive was recovery.
Survival is, after all, only a prerequisite. It is the indispensable condition for resuming life. But recovery is what the patient wants. He wants to crawl back, or limp back, or maneuver himself back to the life that preceded his illness. The team of doctors, I found, can keep you this side of death, but what the patient learns is that he needs someone to talk to.
No other person can value your life as you do. Nor should you demand, or even expect such a valuation from anybody else. There are so many people in the world already. And this vast increase in numbers diminishes the significance of the individual.
Some person may take it upon himself or herself to assist in the recovery, to see you through. I am deeply grateful to my wife and to the doctors and nurses, but I wonder whether I would have been able to come back without Dr. X, and I have given Dr. X a lot of thought. And what I see for him goes something like this:
The doctor’s outlook–if you prefer, his ideology–is humane, but his training is in science, and science does not see nature as having a soul. But the neurologist, Dr. X, did have a soul. He was capable of compassion, although in nature there is no compassion, so he came early in the morning and late at night and on the weekends.
Nothing is more disheartening or killing than a sickness late in life when your capacity for recovery is getting dim. I understood my condition in the widest sense, beyond blood pressure, beyond the loss of muscle mass, beyond the nerve damage. I can’t say that Dr. X understood the source of his own understanding, or that he was conscious of it, but that is the difference behind his kind of work and my kind of work.