A Season in Hell (24 page)

I believed them when they said I’d had a heart attack, but since I had felt a mere pinprick, I assumed it was extremely mild. So I was dismayed when I found that after rising late, making tea and toast, cleaning up the kitchen, dressing, and making my bed, I felt an overwhelming need to lie down for a half hour. I find enervation extremely disconcerting—as I did during radiation.

The cardiologist was a decent man. He sent me for a stress test, which for me—unable to walk well enough to work a treadmill—required the injection of a radioactive isotope into the blood. A scanning device tracks the isotope as it moves through the heart, to find areas where blood flow is impaired. I had this test on October 18 and saw the cardiologist again on the twentieth.

I date the beginning of my present state of being to that appointment. The doctor told me I had congestive heart failure. He suspected that the radiation had damaged my heart enough to cause the attack. There was no way to repair it. Unlike some heart ailments, it could not be helped by a bypass or plastic valves or any other surgery. Half of the heart was dead. He showed me pictures from the stress test, showing the bottom of my heart in black, while the rest was in brilliant color, fluid reds and blues and purples. I have never cried in a doctor’s office, nor did I then, but I had to make a great effort to control myself that day. Because at that moment I realized that through all my disasters, I had unconsciously been telling myself that bad as everything else was, my heart was strong. My mother, who had had a silent heart attack in her seventies, had lived to eighty-two (her heart attack had been a mild one); my father was still well and vigorous at eighty-eight. I believed it was my heart that had kept me going through all the setbacks of the last two years. But now my heart was half gone, damaged beyond repair.

The doctor prescribed various medications but suggested no physical regimen for me and banned no activities or foods. He probably assumed I knew about fat and cholesterol (I did) and that if I had questions, I would ask them. But I do not ask questions if I think the answers might conflict with my desires. I mentioned only in passing that I was planning a trip abroad the next week, careful to speak in such a way that the cardiologist would not feel I was asking advice; I did not want him to tell me to cancel it. I was supposed to go to Sweden and Norway, then to Germany, to promote
Our Father
. I warned my hosts that I had had a heart attack and was not up to my former energy level; I asked them to keep my schedule light. My Swedish publisher scheduled five events plus a formal dinner each day—far less than I used to do but really more than I can do now. I didn’t know that then; you discover what you can do by trial and error. My Norwegian publisher scheduled only two events plus a formal dinner, yet by the sixth day of my tour, my second day in Oslo, I was exhausted to the point of feeling sick and almost passed out during a hot, airless couple of hours signing books in an Oslo department store. But I thought I would be rested before my tour in Germany started, because I first had a week on my own.

I stayed at the Brenner Park in Baden-Baden, a great hotel with a fine dining room. Guests were given a tour of its magnificent kitchen. I am a cook but had never realized what it means to use
no
prepared foods in a kitchen—as was the case at the Brenner. They made not just their own stock for soups and the bases for sauces (as I would have expected) but their own breads and rolls and melba toast, even their own noodles. The huge kitchen was filled with men working, although the dining room never seemed crowded.

The streets of this resort town are charming, and there is a beautiful park behind the hotel, still colorful with leaves in October. I walked along its path bordering a little river, the Oos. The park extended for miles along the riverbank, with houses set back in quiet privacy. There were native walkers as well, at whom I smiled and nodded; but they returned forbidding glares. Perhaps it was the way I was dressed, although the outfit was beautiful to my eye—a heavy matching pullover and cardigan in white, navy, and fawn, with fawn pants and shoes. But the women who walked their little dogs all wore dresses, coats, hats, stockings, and semi-high heels, along with their disapproving expressions. The men, too, many with dogs, dressed as if for a formal occasion and acted aloof. I swam in the marvelous hotel pool and took chauffeured day trips through the Black Forest and to Heidelberg and Strasbourg. The countryside and villages are exquisite in this part of Germany, which seems, from the look of it, to be prosperous and to have a history of prosperity. The beauty and the wealth of the area contributed to my puzzlement over why it had been so enamored of Adolf Hitler.

When I received my German schedule it frightened me a bit. My publisher had scheduled ten straight days of promotion; she had included only one or two interviews or formal lunches a day—a far cry from what I had done on my last tour. She probably felt she was asking little, but she had scheduled a reading
every night
, as during my German tour in 1992. A reading a night may not sound like much, but it involved dressing by five-thirty to prepare, leaving the hotel about six o’clock, riding for an hour in a car to a bookstore. The reading would begin at seven-thirty and last forty-five or fifty minutes; questions from the audience would take up another half hour. Then I was expected to sign books (Europeans love signed books)—another forty-five minutes to an hour—and then drive back to the hotel. I would arrive there at ten-thirty or eleven, having had no dinner and too tired to eat—not that restaurants in rural hotels were open.

After three days of these five-hour ordeals, I feared another attack. I felt extremely enervated and weak, as I had after the first attack. The young women escorting me took me to a local clinic, by which I was pleasantly shocked. Large, airy, immaculate, beautifully furnished, and
empty
, it could not have been more different from American emergency rooms—although the ER in Fairview Hospital, Great Barrington, is often empty. In Germany, the doctor had to be telephoned at home. He arrived swiftly and greeted me with grace and charm; courtly as a Southern gentleman, he ushered me into the examining room. He did a few tests, then made a call summoning a senior doctor, who was equally gracious. After doing an echocardiogram, the two men together approached me very gently. Usually, they said, people who came to their clinic in the middle of the night citing chest pains had indigestion and were sent home. It was a rarity, but in my case, they were very sorry, they regretted deeply the necessity of telling me that I should sign myself into the hospital, as my heart was in terrible shape.

I said I knew it was bad and was planning to go home the next day. It was clear to me that if I continued to do promotion, I would die. I could not go through one more long night. The next day, I made a flurry of arrangements, feeling sorely disappointed with myself for letting the publishers down—letting myself down, for that matter. I had made one arrangement on my own, a speech at the college in Mainz. I’d been looking forward to it, but had to cancel that too.

I went home chastened and saw Edie almost immediately. When she asked why I had not told her I was going to Europe, I said I didn’t want her to tell me not to go. She didn’t have to advise me to keep my activities to a minimum. In the future I would listen to my body with even more attention.

The heart attack ended my days of delusion. I never again imagined that I would regain my old strength, my old body, my old energy. The extreme tiredness continued for months. Eventually, the quickness that had previously characterized my movements returned—for a year or so. Then other problems grew worse, and that energy faded. I no longer think in terms of recovery but only of small gains and getting through.

Although blood in my urine no longer panicked me, it led me to urge my urologist to remove the stent late in 1994. Knowing I was going south soon, he refused. In Florida, the bleeding became more serious, and I began to have pain during urination, so I had to fly up in March 1995 to have it removed. I had new and unpleasant urinary tract problems—an intense need to urinate just about every hour, and pain during urination. But Dr. Lowe seemed uninterested. This surprised me—he had been an extremely friendly doctor; he would stop in to visit me at St. Luke’s–Roosevelt even when I was there for reasons unconnected to his specialty. He seemed now to feel there was nothing more he could do for me.

While I was in New York, I had another endoscopy at Sloan-Kettering. It was my sixth and my
last
. When I came out of the anesthesia, Dr. Gerdes, with a big smile, informed me that my esophagus had healed. He was jubilant, and so was I, but I wondered why I still had the symptoms, still had difficulty swallowing. He explained that chemotherapy and/or radiation damages all the body’s soft tissues, and that my esophagus had probably lost its elasticity, its peristaltic power. He prescribed a pill to help it, to be taken a half hour before eating. I flew back to Florida pleased with myself for my one bit of recovery.

I had this year done something I’d long wanted to do: for years, I’d talked of painting in watercolors. I had bought paints and paper during one of Jamie’s visits and asked her to teach me. She claimed not to know how—she painted in oils (which did not prevent her from tossing off beautiful watercolor sketches when she sat down with the paints). I had tried it on my own, but I knew I was not handling the paints properly. So for Christmas 1993, Jamie had bought me paints, paper, brushes, a board and easel, and five lessons with her friend Ophrah. It had taken me the entire year to manage to take the five lessons, but I had very much enjoyed them.

Painting was—is—almost exactly the opposite of writing for me: I feel it to have no moral/political content (which I do not believe about anyone
else’s
painting); I like almost nothing I produce (I usually do like what I write), but—and this is rare for a perfectionist—I enjoy the process enormously anyway. Occasionally, I feel I am improving; I always feel I am learning: but it does not matter.
It does not matter how well or ill I do.
I have never felt that about writing, not even when I first started to write daily. I always judged myself by my writing and put tremendous weight upon it. Painting was easy, not a burden, since poor performance did not matter.

After returning from Florida, I saw Edie, who in an effort to treat my new urinary tract problems arranged for me to see a nephrologist she respected highly, Sheldon Glabman. (It was Dr. Glabman who later wakened me, mornings at Mount Sinai, with a hand on my forehead. I had liked him before that—he is an extremely cultivated man—but that endeared him to me.) He in turn sent me to a new urologist. He ordered another sonogram, which revealed my kidney stones but showed no cancer. The urologist gave me belladonna to ease the pain, but it did so only slightly and did not reduce the frequency of urination or the bleeding at all.

I had no sooner settled in in the Berkshires for the summer than I developed pain in my side and a slight fever. I had come to expect kidney infections on holidays, and sure enough, it arose over the July 4 weekend. Thankful that my daughter was with me and could drive me to New York—I did not want to take another horrible superexpensive ambulance ride—I went this time to Mount Sinai Hospital, my new doctor’s base.

Indeed, I had another kidney infection, and this time they had trouble dealing with it. After they got the infection under control, Dr. Glabman prescribed some medications that would, he hoped, dissolve the kidney stones. Why these had not been prescribed before, I do not know. He said it might take a year, but I should get rid of the stones and then have no more kidney infections.

My frequent hospital stays changed my behavior. Acting agreeable and docile was a thing of the past. On the other hand, perhaps I was never as patient and docile as I thought. Certainly Edie and Lucy thought of me as properly tough on doctors—Edie called me “feisty”—and I castigated more than a few nurses and doctors at St. Luke’s–Roosevelt. But I was probably more docile at S-K.

A young Indian doctor at St. Luke’s, a mere girl really, had been told to give me a TB test. It involved being stuck with a needle. The next day, she approached me with a flat metal board covered with needles, which she wanted to press into my arm. During this period, I was constantly being tested for pulmonary emboli, and I felt like a pincushion. I told her I didn’t want the second TB test. I didn’t like the look of the thing, and I’d been stuck enough. She insisted. I said that if I refused a treatment, that was that. She continued to insist, and I gave in, but I cried when she hurt me. If the young doctor had had any notion of what I had been through, she might have been a little sympathetic (like the guy who gave me the thoracentesis), but instead she reproached me. Weeping, I said I didn’t want to be hurt anymore, I wanted to die. She was shocked.

“How can you say something like that!” she scolded, this twenty-something twit. She nodded at Rob, who was visiting me that day. “Look at you! You are a lucky woman! You have a son, and he comes to visit you! You should be grateful! A woman should be grateful to have a son! You should not say such things!”

The blast she got then blew her out into the hall. I never saw her again, but I heard about her dismay from Edie and Lucy, who wondered what had happened. When I told them what precipitated my explosion, they exchanged half-smiling glances.

Strange doctors who led processions to my bedside, expecting obedient submission to orders to examine me publicly en masse, got short shrift. But the doctors I most often reprimanded were overbearing men who bullied or were rude toward my roommates, often poor women on Medicaid. I intervened because the women accepted this treatment in silent passivity (as poor women usually do). Doctors are especially detestable to poor women of color, and I derived great pleasure from challenging this. Once, at Mount Sinai, eight men (professional visitors: they were too old to be students) stood around the bed of my roommate, a beautiful black woman in her thirties, regarding her poor carved-up body (she had had so many operations that she looked as if she’d been used for experiments). The headman told her she needed another operation. When I loudly warned her not to believe him, to get a second opinion, a young doctor in the entourage snickered. She had a parade of physicians—the same one rarely returned twice. Another day, a doctor said her pain (which she had complained about for days but that no one had treated) was in her head, and he asked how old she was. When she told him, he said, “Well, you’re too young for menopause, but you’re still imagining things. How is your mental health?” She looked at him in bewilderment.