Open Heart (19 page)

Age-adjusted mortality figures give us a basic measure of the genuine progress achieved: whereas, in 1950, there were 307.2 deaths from diseases of the heart for every 100,000 people, by 1998 the figure had fallen to 126.6.
^*
And when, in September of 1998, the
New England Journal of Medicine
noted in an editorial that “over the past 30 years, mortality from [coronary heart disease] has declined by more than 50 percent,” it emphasized that such a decline was “best explained by the joint contributions of primary and secondary prevention.”
^*

Although the news may not be as good as the drug companies and media would have us believe, and although we may sometimes do ourselves a disservice by glorifying biotechnologies, or by idealizing a mythical doctor of years gone by—and though we may not now understand the ultimate causes of most diseases—we do, in fact, know some things.

And what we know, I begin to understand in the months following surgery—whether about heart disease, AIDS, brain trauma, cancer, or depression—happily, in our time, when utilized wisely, and when tempered by our knowledge of what we do
not
know, does give us the wherewithal to do a great deal of good: not merely to palliate the harsher symptoms of disease, but to enable us to survive diseases that previously did us in, and to do so in ways undreamt of in our parents' and grandparents' philosophies.

8

They Saved My Life But…

W
HEN ELI WAS EIGHT
or nine years old, and the UMass basketball team was ranked number 303 out of 309 Division I teams, we began celebrating the rare UMass victory by going out to breakfast together the next morning. Our favorite place was the Miss Flo Diner in Florence, Massachusetts, and by the time Eli was in high school and UMass was on its way to a number 1 national ranking, we were eating breakfast there several dozen times a year.

One morning when Eli was ten or eleven, we sat down in a booth across from the short-order cook, and the waitress, setting down cups of coffee in front of us, took out her pad, looked at Eli, and asked: “The usual?”

Eli nodded nonchalantly, but as soon as the waitress left, he beamed and spread his hands sideways, palms up in a gesture of triumph, as if to say. Hallelujah—I've
arrived!

“So: many many thoughts and feelings,” I write on March 9, 1999—my first journal entry following surgery. “Mostly they come down to: I feel v lucky to be here, and to be alive. And v blessed in my children and friends. Miriam telling me again and again how much she loves me, how happy she is that i am alive, how scared she was that i might not live. And Seth is wonderful with her, and with me. Aaron not waiting to be asked, but simply telling me that he is moving back home and will be taking care of me, and making sure i dont do
things at my usual pace. And Eli, here my first w/e home, reaching across table and taking my hand in his, at miss flo diner, and telling me, moist-eyed, how happy he is that i am alive.”

I see friends, I attend synagogue, I sleep ten to twelve hours a night, I take naps, I go for longer and longer walks each day, I read (Myriam Annisimov's biography of Primo Levi, Ron Rosenbaum's
Explaining Hitler
), and I write (reworking a novel I had completed before surgery). Members of my synagogue in Northampton deliver meals each evening for six or seven weeks; students—past and present—call, send cards, and visit.

Four weeks after surgery, Aaron drives me down to Connecticut for checkups with Dr. Cabin and Dr. Hashim, and when both doctors say I can drive again, Aaron moves back into his own apartment.

Within another week or two, I am walking a few miles several times a day, doing stretching exercises and sit-ups, and putting in a regular workday at my desk. Whereas before surgery I averaged five to six hours of sleep a night, I am now—still—sleeping eight, ten, or sometimes twelve hours a night, and also taking afternoon naps.

What I find perplexing is that I am more tired in the early morning—more
physically
tired—than I am during the rest of the day, when my energy and stamina seem to be at higher levels than they were before surgery. I ask Rich if it's possible that while I'm asleep my body is taking advantage of my being away, as it were, to work as hard as it can to repair itself. Rich says it's possible—who knows?—but assures me there's nothing to worry about.

The first week in April, I take the train down to New York City, spend time with Eli, meet with my editor and publicist, and begin looking for an apartment. Two weeks later, in Northampton, walking past Smith College on my way into town, my chest itches, so I unbutton the top button of my shirt, reach in, and scratch. A second or two later, I realize, happily, that this is the first time in two months I have experienced
any
sensation in my chest.

I return to New York City the first week of May, this time for a reading and party to celebrate the publication of my new book, and while I'm there, I take a sublet for the coming academic year. (Arthur
to me: “Listen, Neugie—I know you're a mature man and all that, but if you want me to take a look at the apartment with you—I might notice some things you might not see—just say the word.”)

Then, on May 7, 1999, two days after my return to Northampton, for the first time in three months (and not four weeks after surgery, as I initially recalled after the event), I walk to the YMCA, change into my bathing suit, take a shower, and head into the pool area. I set down my towel, sit on the side of the pool, put on my goggles. My hands, I notice, are trembling. Am I really here? I feel a pressure-like pain in my chest—the first time this has ever happened—and tell myself to take deep, slow breaths, in and out, in and out. I run my forefinger along the scar on my chest, as if to remind myself that what happened really did happen, and then, nervous, eager, and mildly terrified, I slip into the pool.

“I swim for the first time! I swim, I swim again,” I write. “Fearful before going in—as if worried i will have shortness of breath again, no problems tho. arms not sore, no stiffness or awkwardness. Easily do a half mile, and then stop, so thrilled, delighted, eager…”

Two days later: “i swim 44, easily, am about to go to nautilus, but hear sound of bouncing ball, and instead go into gym and shoot hoops for about 20 minutes, dont leave until i hit 3 long jump shots in a row…oh my it is good to be alive! home and watch some hoops, repair bathroom floor, mow lawn, etc…”

(Two years later, however, visiting friends who have a lakefront home, and swimming in choppy water, the water sloshing into my mouth, I will panic. Each time I swallow water, I gasp. I switch from the overhand crawl to the breaststroke so as to be able to keep my head above water, and, as my friends get farther and farther ahead of me—we intend to swim about a mile out before returning—I want to cry out,
“Help me help me—it's happening again!”
Although, swimming alongside them in an olympic-size pool, as I have previously, I am usually ahead of them, this time I stay behind, and even while I continue to move arms and legs, I vow that if I survive, I will never
macho
it again—that at the
first
incidence of breathlessness, I will stop and get out of any body of water I'm in. I swim more slowly—regain some confidence—and a moment or two before I decide that yes, I am going to call out that I'm turning
around and heading back to shore, my friends turn around, and we swim to shore together.)

Sometimes, washing in the morning, or getting ready for bed at night, when I look at my arm, chest, or leg, I am surprised: How did these long, fresh scars get here? And: Do they really belong to me? When I touch them, it occurs to me that it has been only the briefest of intervals since my body was cut open, my arteries and veins harvested and relocated. (When the bills for surgery arrive, I wonder, too, why it is, since the spare parts the surgeons used for the five grafts were taken from my own body, I have not been given a discount.)

At my first postoperation checkup, Dr. Hashim examines the scar on my forearm, where the radial artery was removed. “The plastic surgeon did that one,” he says. Then he runs his finger down the scar on my chest—the so-called zipper all survivors of open-chest bypass surgery wear. “I did this one,” he says, smiling. “It is much better work—much finer, don't you think?”

He tells me to continue taking Norvasc (a calcium channel blocker used to decrease blood pressure by dilating blood vessels). This is a precautionary measure, he says, calculated to protect the internal mammary arteries he used for two of the bypass grafts. “Mammary arteries are God's gift to cardiosurgeons,” Dr. Hashim tells me. They have wide openings, do not collect plaque, and, like the appendix, seem no longer to have any biological function within our bodies. They are composed of smooth muscle tissue that can contract and relax involuntarily, however, and in the immediate postoperative period, having been surgically traumatized—cut, touched, drained, moved, manipulated, and stitched—they become notoriously susceptible to spasms. “By lowering your blood pressure slightly,” Dr. Hashim explains, “we will keep them from spasming.”

I tell Dr. Cabin and Rich that Dr. Hashim wants me on Norvasc for a full year.
“Surgeons!”
they each exclaim, shaking their heads; they both say they think Dr. Hashim is being overzealous in order to protect his “artistry,” and that in their opinions I could stop taking the Norvasc now.

“If the arteries didn't spasm in the first four weeks, they probably
won't spasm for the rest of your life,” Rich says. Still, I continue taking the Norvasc. When I tell Rich of my decision, he laughs.

“It's amazing,” he says. “Here you are, a bright independent-minded guy who actually has researched these things and knows a good deal, yet even you succumb to the infamous ‘authority of the doctor.' Do you see what power we're invested with? Can you imagine how awful it is—and I see it every day—when this power is coupled with arrogance and, too often—though not in your case this time, thank God—in the least competent doctors?” He sighs, says something about surgeons being brilliant from the wrists down, and then: “Your reaction's a sobering reminder of just how vulnerable and defenseless patients are most of the time.”

After the trip to New York, I go on an “author tour” (Boston, Washington, D.C., Chicago), do some local readings, and continue to work on new projects, to swim and to play tennis and basketball, to spend time with family and friends, and to help Miriam and Seth plan their wedding.

On May 30, I celebrate my sixty-first birthday (“Peaceful happy day for me. V quiet, and that seems right: transition between lives. And now and now—the rest of my life”). And the next day: “Hard to recapture this a m the easy, peaceful, deep reflective feel of my new life, new sense of life: love talking with my old buddies, they get me through.”

And then this: “In absence of an on-site family, these guys
are
my family it would seem…suspect this is so for many of us these days: friends doing for us what extended families used to do.”

Arthur agrees. “I've done a lot of thinking about friendship,” he says. “Like you, I'm a man who has always enjoyed the company of women, and I have, generally, found women more interesting than men. But it's very hard to have a long-term relationship with a woman if you're married. This doesn't have to be the case, of course. If I were a different kind of man I might have had more women friends. And I did, and do, have women friends, but the friendships were not of the same order as they are with you and me, with Phil, with Jerry. I mean, think about this: how many women that you
were friends with in high school have you kept in touch with? And why not?

“We maintain no women friends from high school, and lots of male friends, and I think part of why this is so comes out of what I think of as a general cultural experience, which is that men have a way of relating, for the most part, that is different from the way women relate. Women are much more likely to talk about their feelings
about
each other
with
each other. ‘I was very disappointed that you didn't come to my party,' a woman will say. ‘It hurts me. All the important parties that I have—somehow or other you don't come to.' Now, a man's response in the same situation is not to say anything, but, instead, to take a step back. Men titrate the distance rather than work through an issue directly, and for the most part this makes relationships easier.

“There seems to me a kind of unspoken agreement among men—and remember: this is in
my
experience, in
my
friendships—that we don't confront each other about the
mishegas—
the craziness—that goes on in our relationships day to day. Most of my friends, like you, are Brooklyn men, and we went to the same high school, the same college, have the same cultural background, the same value system pretty much—our politics, our way of looking at the world. And there is a kind of implicit assumption that life is hard for all of us—we get our balls busted at work, and in a variety of other ways, and our friendships are a place to be in a nonjudgmental, let's-take-what-we-can and enjoy-what-we-can-from-life attitude, whether it's talking about women, whether it's burping, whether it's recalling happy days.

“Because it's like a vacation from life, and it is not going to be intruded upon by confrontations that involve expressed verbalizations of negative feelings—‘You hurt my feelings, I never treated you this way, et cetera, et cetera.' And I think women are much more likely to try to talk through conflicts, and the more you try to do this—I'm talking primarily about men—the higher the tension level, and the less you do it, the less likely there will be discomfort, and the easier the relationship will be.

“Okay. So it's interesting to me in the ways this relates to being a
psychologist, because many of the most constructive parts of a relationship in psychotherapy involve providing a caring, neutral presence where there is no judgment—where there is an acceptance of people for who they are and where they are, and where there are also high hopes. Now, our responsibility in the professional area is to help people achieve their goals. But the
really
interesting question to me, in a personal vein, is that I was very competitive in high school, and all the men who are now my adult friends were the guys I was competing with: to get good grades, to make the team, to get the girl, to get into Harvard or Columbia—and it should have worked against that, and it didn't, and I don't fully understand it.”