Open Heart (10 page)

I called for an appointment that day, and I saw Dr. Katz three weeks later. Dr. Katz did an EKG and, based on our conversation and my having noticed that the pain, which could last anywhere from one to ten minutes, sometimes occurred in the middle of the night, or when writing had drained me and I needed food, concluded (this from his notation in my medical record): “cardiac etiology of the pain is extremely unlikely. Thoracic [chest] aneurysm also unlikely. Most likely etiology may be gastrointestinal such as esophageal reflux or spasm.”

Looking back, one wonders if this pain—persisting for at least
four years—was related to what may then have been, or have been becoming, coronary artery disease. I recall, too, and describe for Dr. Katz—as I now do for Rich—a time when, flying to Europe two years before this on my way to teach for a semester at the University of Freiburg in Germany, I awoke in the middle of the night in a very dark, quiet, and mostly empty plane (I was stretched out across several seats), to find my heart pounding away. I was sweating profusely, and felt a pain so severe in the middle of my back—along with dizziness and faintness—that I recall thinking, as if it were the simplest fact:
I am dying
. And then, as if from a Henry James story:
So—is it here, at last, the great thing?
I remember being afraid to get up and walk to a flight attendant to ask for help (afraid I was so weak and dizzy I might not make it), or to buzz for one and thereby create a crisis, and I recall thinking too:
Well, Neugie, if this is it, this is it
.

I had had some champagne before the in-flight meal, a glass or two of red wine with the meal, and cognac after the meal, and at the time I attributed the pain, dizziness, and weakness, along with the booming of my heart and the distinct sensation that if I did not simply lie there and wait—if, instead, I rose and tried to do anything—I would keel over and die, to a variety of possibilities: to the mixture of champagne, wine, and cognac; to being apprehensive about being on my own for the first time in many years; to a touch of the stomach flu; to in-flight turbulence while I was asleep; to a nightmare—night terrors?—I'd had but could recall only vaguely; to being in transition from the known (my life as single parent in Northampton) to the unknown (life as a single guy in a city and nation foreign to me), and to who-knew-what-else.

So I lay there quietly, and after a while I sat up, put my head down between my legs, and waited. In about seven or eight minutes, the physical symptoms, and the fear, passed.

Like Dr. Katz, Rich doesn't see any connection between this experience and what I am experiencing now. But who knows? Rich says. Maybe the pain in my back two years before was a symptom of coronary disease, and maybe it wasn't. And yes, he says, given the manner of your uncle's death, your father's heart attack at fifty-nine (which he survived), your symptoms, and
your
age (fifty-nine), the
doctor probably should have ordered a stress test for you back then. But hindsight is easy, and the main thing now is to pay attention to the symptoms, and for us to stay in close touch with each other.

And this—staying in close touch with Rich about my symptoms—is exactly what, in my memory, I believed I had been doing all along.

When, after surgery, I begin telling my story to others, I am certain I was talking with Rich nearly every day beginning with the day on which I first had an episode of shortness of breath. More than this: in my memory, not only had I called Rich as soon as I came home from the YMCA, but I had also immediately telephoned Arthur, Jerry, and Phil, and then had begun checking in with each of them regularly.

When I go through my journal, however, I discover that it was not until I had seen Dr. Katz—four weeks
after
the shortness of breath first occurred—that I began talking with Rich and my friends about my symptoms and anxieties. I discover, too, that once Dr. Katz told me that what I was describing didn't seem to indicate major heart problems, rather than being reassured, I became
more
convinced than ever that I
had
heart disease.

What was happening, I now believe, is that I was trusting what I was feeling more than what my doctor was telling me. Was I, as we commonly say, “listening to what my body was telling me”? Perhaps. But what I was experiencing in my body was in no way separate from what I was, in my mind, thinking—and what I was thinking seemed in no way separate from what I was feeling. More exactly: I found myself believing that my fears, anxieties, and premonitions, along with my bodily symptoms, were not unrelated to what I knew to be true; and what I knew to be true came to me in words that seemed quite plain: physically
and
spiritually, I was suffering from a sickness unto death.

On the day I first call Rich to talk with him about my concerns and about Dr. Katz's diagnosis, I also talk with my father, who died at the age of seventy-two in 1976.

Ever since his death, when I'm especially troubled or have had especially good news, and usually when driving, I will talk with him, and our conversations invariably help me through to seeing things
as they are and to understanding and articulating what I'm feeling about them. Conjuring up his presence—“Hey, Dad, it's me again,” I'll begin, aloud—I will look upward through the windshield and usually find him floating in the sky, Chagall-like, just above the car. In our talks I'll generally report, first, on what's going on with my children (his grandchildren), with Robert, and with my mother (his “Shugie” who, afflicted with Alzheimer's since 1992, has been living in a nursing home). Giving him basic family news, though, is merely prelude.

Although my father was a failure in worldly matters—he never earned a living from his own businesses, went bankrupt before he was fifty, and spent the rest of his life as a clerk in a stationery store—and ineffectual and submissive at home, his judgment always seemed to me sound, and he seemed never to complicate things more than was necessary. Given the grim and unhappy nature of so much of his life, it was a mystery and wonder that this was so.

“Shit or get off the pot,” was his routine response if I expressed indecision. If I invited his opinion about a specific situation—should I do A, or should I do B?—he never turned the question back to me (as in: “Well, what do
you
think you should do?”), but instead would give a direct Yes or No answer—Do A, don't do B—and if I asked for reasons, he gave them without elaboration: C, D, E, F, G.

Though for most of his married life he was consumed by frustration and rage (he had a violent temper, and would often slap me and knock me around)—ashamed because he could not support our family and give our mother the life he wanted to provide for her, and humiliated regularly by my mother for his failure to do so—and though he and I, until the last few years of his life, were seldom able to have an easy, extended conversation, I had come to count on his direct, no-nonsense opinions and responses. More often, though, fearful of coming to him with a problem since doing so could make him attack and humiliate me, I relied on what I imagined he
might
have said to me had he been capable of being the man he wished he could be, and the man I wished he would be.

And so, when times are especially good, or particularly difficult, I conjure up his spirit, and we talk. At these times, though imagined,
he is totally present; though kind and loving, he is brutally honest; though idealized, he is the most realistic and practical of men.

We talk most of the way down to Guilford to Jerry and Gail's new home and on the way back from New Haven the following day, and words, feelings, and tears flow easily and in abundance. As often happens during these conversations, his good judgment and his kindness—both having increased enormously with the passage of time—help me through.

After giving him news about his grandchildren, his wife, my forthcoming book, and Robert, I tell him that all is not well: that I am becoming more and more certain my heart is fatally diseased—broken, flawed, failing—and that I am frightened I am going to die soon.

I immediately apologize for complaining—of course I realize how blessed I am: in my work, my job, my home, my friends, my children—and I start talking about people I know who have
real
troubles and who don't have the wherewithal in life I have, and when I do, my father interrupts me. “Listen, sonny boy,” he says, “it doesn't matter what troubles—what
tsuris
—others have. Your
tsuris
is still your
tsuris
and you shouldn't bury it.”

Do I remember a radio play I was in, he asks, called “No Shoes”—about a man who complained because he had no shoes until he met a man who had no feet?

“Well, it's certainly not so hot to have no feet,” my father says. “But if you have no shoes—like now, in the middle of winter—that's not so hotsy-totsy either.”

“Not a lot of time to dwell on the sweetness of being with Jerry for two days, [or] my talk to Yale doctors,” I write on my return, and then: “my ride there and back, alone. Weeping when i talk with my dad and tell him just how scared i am—that I might have heart problems and nobody to take care of me…this is what hurts more than the problems.”

The day after this, I take myself to my psychotherapist's office for the first time in more than a year. “Going to session with D. v v helpful: a way of talking here that i cant quite do with friends,” I write. “And we agree that i will go for 6–8 weeks, and get some work done
on me—not my children, not Ellen, not etc…but me, and the elusiveness of what i have always desired so deeply: love and companionship.”

The next day I travel down to New York City by train, where I meet with my editor and publicist and spend time with Eli. I also, this week, begin regularly telephoning Arthur, Jerry, and Phil.

Two days later, upon my return to Northampton:

I now write at greater and greater length in my journal, and do so not only first thing in the morning, but in the evening too. I keep itemizing all the things I have to be happy about, as if to convince myself there is no reason to be depressed, and I write about my talks with my friends (“all the buddies call back—sounds to [Phil] like exercise induced asthma, the stress test will show…also suggests chest xray [to check for dissection of aorta], and to call him after, sure you worry, he says, one day, you're fine, and suddenly…”).

I telephone Dr. Katz, who suggests I get some nitroglycerine, and that I take it when the pain comes and see if it stops the pain. He is now more inclined, given my descriptions, to suspect coronary disease, and he advises me to go easy between now (Tuesday evening) and Friday morning, when I am scheduled for the stress test.

During the three days between my call to Dr. Katz and the stress test, despite moving as fast as I can on long winter walks, I do not get anything resembling the kind of acute pain I'd been having, and when mild pain does come and I put a nitroglycerine pill under my tongue, it makes no discernible difference.

In Brooklyn the previous week, however, walking with Eli near Prospect Park, the burning sensation in my back becomes so severe that I find frequent pretexts to stop so as to give myself respite from the pain—I remark on the architecture of some building, or an item in a store window, or somebody passing by, or I share a memory with Eli of what Brooklyn was like when I was growing up here.

I read the sections on heart disease in Sherwin Nuland's
How We Die
, and these are “encouraging, longterm,” I write. “It is natural for the system to begin to run down; and [what Rich has been telling me] does seem true: lots of things we can do for the heart to ameliorate problems, to prolong life, etc…a major area of progress, biomedical.”

More sobering, though, is Nuland's description of the very ruse I have been using to disguise my condition. Writing about the common pattern by which severe coronary disease manifests itself, Nuland describes a patient of his, and says that while he observed him and listened to him, he was reminded of a practice commonly resorted to by so-called cardiac cripples in order to disguise the advanced state of their illness: A patient feeling the onset of an anginal attack while on his daily stroll finds it useful to stop and gaze with feigned interest into a shop window until the pain disappears. “The Berlin-born medical professor who first described this face- (and sometimes life-) saving procedure to me called it by its German name of
Schaufenster schauen
, or window-shopping.
^*
The
Schaufenster schauen
strategy was being used by Giddens to give him just enough respite to avoid serious trouble…”

When Rich calls—and he is calling once or twice a day now, to ask how I am doing, and—his pretext?—to talk with me about the book
he
is writing—I tell him about my time in New York, and
about
Schaufenster schauen
and Nuland's description of the behavior of “cardiac cripples.” To comfort myself, I try also to use some of what I have learned during the past few years from people I've met who have recovered from long-term mental illness, and apply it to heart disease—that is, how to live with a condition that is sometimes distinctly unpleasant and frequently terrifying, but, like any long-term condition that comes with being human and having a full and complicated life, manageable.