Open Heart (33 page)

“No quality of human nature is more remarkable, both in itself and in its consequences,” David Hume wrote nearly three hundred years ago, “than that propensity we have to sympathize with others, and to receive by communication their inclinations and sentiments, however different from, or even contrary to our own.”
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When I think of us as young men, it occurs to me that the quality of human sympathy that Arthur has always given to his friends—a quality enhanced by his Vietnam experience, which made him indelibly sensitive to the vulnerability of others—he has also, for nearly forty years, been giving to his patients.

“This principle of sympathy is so powerful and insinuating a nature, that it enters into most of our sentiments and passions,” Hume explains, “and often takes place under the appearance of its contrary…The sentiments of others can never affect us, but by becoming, in some measure, our own; in which case they operate upon us, by opposing and encreasing our passions, in the very same manner, as if they had been originally deriv'd from our own temper and disposition.”

In a world where so much remains mysterious, even—especially!—in medicine and science (If we know so much about the genome, for example, why is it that 90 percent of DNA has no seeming purpose?), the quality of human sympathy—like the quality of mercy?—is one that, in joyous times or troubled times, and whether between friends or between doctor and patient, seems as rare as it is precious.

In the mid-sixties, in New York and California, I was active in the antiwar movement, organizing marches and protests, giving
speeches, and writing articles in which, among other things, I encouraged those of us above draft age to commit civil disobedience in support of those of draft age who were refusing to serve. During these same years, Arthur was in the army, first at Walter Reed Hospital, and then at Fort Monmouth and in Vietnam. We corresponded regularly, talking about the usual—our families and friends, books and sports—and in our letters we also debated American policies and actions.

This, then, in one of Arthur's letters—from Nha Trang, Vietnam, dated Monday, June 20, 1966, and written at a time when Arthur was living in a place where, he wrote, the temperature was “easily 110–130 consistently,” where he was separated from his wife and daughter, and where he was constantly fearful for his own life:

After giving me detailed advice on what I should do to establish Conscientious Objector status
before
I was called to serve—the extreme fears he lived with in Vietnam seeming only to intensify his ability to empathize with and be helpful to others—and advising me not to “irrationally get hung up on hopes” but instead “to get to work,” this: “I'm scared shit so often—to a great degree quite unreasonably for thank G-d I'm safe as a human being in VN can be—that the anxiety just rolls off me.”

A few weeks later, shortly after the publication of my first novel,
Big Man
, a story set against the background of the basketball fixes of
the early fifties, Arthur comes across a review in
Time
magazine and writes to tell me “how
very very
thrilling it was to see you—my buddy Noog—among the premier new novelists. I'm sorry that it had to be a
Time
publication but these are the burdens of the more public posture you have assumed. In any event, you must know how very exciting it was for me—in the wilderness—to see my boy Noogie looking at me.” He writes that he has not received his copy of the book yet, but hears from another Erasmus friend that “Yudi Rudy is among the cast of characters—mucho thanks—I'm sure, with due respect to the models, that this guy goes well to his left & is an outstanding court figure!!!

“Life is routine here—work challenging with much sadness always,” he continues, “—but I can help—I see that now—I am useful and at least feel that way (my use being relevance to my patients, rather than the organization I work for)—and this provides some meaning for me in the midst of the madness I see around.”

Two months later I write him a letter in which I set forth what I see as reasonable arguments about why and how we should get out of Vietnam (a letter in which I also suggest, “Why not play the VC a game of stickball—the winner gets the country. Is this any less sensible than what's going on?”).

On October 25, when his tour of duty is about half over, he writes back: “My response to your political letter—you're right!” Then, after disagreeing with me, point by point, about several political issues I've raised, this: “But overall I agree that the whole thing makes no sense with the rights and wrongs so unclear.”

“By the way,” he adds, before signing off, “Phil was remarried last week.”
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13

It's Not the Disease

I
'M
JUST
A
PATCHER-UPPER
,” Phil says about his work as a neurologist.
^*
“I mean, I'm like the shop mechanic. You come in and there's something wrong with your car and you want me to fix it. I may tell you I don't find anything very wrong with it, or I may tell you that it needs a minor overhaul, or I may tell you that there's a serious problem, and we have to investigate further, and that I have to keep the car in the shop—or you in the hospital—longer. These are the things that I do.”

Although Phil is one of the smartest guys I've ever known—when we graduated from Erasmus, he received full scholarship offers from both Princeton and Cornell—and though the list of his honors, achievements, and publications is long and impressive (he was chief resident in Neurology at Bellevue, chief of Neurology at Denver General Hospital, chief of the Neuroscience Division at St. Anthony Hospital in Denver, et cetera), he remains so modest, blunt, and direct—so boyishly unsophisticated and unpretentious—that one can be fooled by his plain speech and unassuming manner into not recognizing just how brilliant and insightful he is.

What I did with Phil on my first visit in 1988—going on rounds with him at hospitals, and spending the rest of the day with him in his office—I have done the other half-dozen times I've spent with him in Denver. He introduces me to patients, family members, and
staff, as a friend from high school who is a writer, and he always asks—Jerry does the same when I spend days with him—if it's all right for me to be present during their talk and/or examination. We usually start the day on the intensive care unit at the Trauma Center, where most of the dozens of patients I have seen are unconscious, suffering from major head injuries, and, usually, from severe damage to various limbs and organs. The majority of the patients are young, often in their teens, and the majority of these young people are in the hospital because they have been in car accidents. Several times, after he has examined a patient and reviewed test results, when the patient asks what he or she thinks is the problem, or its cause (“If it's not carpal tunnel, Doctor Yarnell, what could it be?” a woman has asked earlier on this day), I have been surprised at the easy way he simply shrugs, and, without missing a beat, says, “I don't know.”

Or—this to another patient during afternoon office hours—“There are some abnormalities in your hand, thumb, and finger, but I can't make a diagnosis.” He will, then, as with this woman, discuss what
might
be going on, and when, at the end of the visit, he records his notes into a tape recorder, he invites the patient's collaboration. “Now listen to me, Shirley,” he says. “I'm going to talk about you and I want you to correct me. I'm going to talk about your illness.”

“I could confirm—yes—” he tells me afterward, “—but I was no help to the lady.”

“Because neurology, you see, is where cardiology was maybe forty years ago,” he explains. “When I was in medical school we didn't have intensive care units. There was no treatment for a severely damaged heart other than digitalis. Bypass was just in its infancy. The heart-lung machine had a very high mortality rate, and there was no transplantation.

“So all these things are what we're trying to find for the brain. But we're in our infancy. In cardiology, if you have an abnormal rhythm, Rich may put in a pacemaker. If you have an abnormal brain rhythm, we give you some medicines to try to stabilize it, but we don't have a pacemaker for the brain.

“No one really has a good way to make the brain heal—it's the great mystery.
^*
We don't have the antibiotic that cured pneumonia.
We don't have an aid like portable oxygen—I mean, you see people carrying portable oxygen because their lungs don't work. You don't see people carrying around anything if they have Alzheimer's—maybe a note pad, and they make notes. But you need a certain amount of cognition to do that.

“That's why right now all our efforts are to prevent complications of the injury, to prevent too much pressure on the brain, to prevent inadequate oxygenation of the body. If someone bruises your arm, it may heal, but if you injure the brain in certain places, it can make you paralyzed, and nothing will change that. We don't have a treatment for coma, no way of making that better, so all our efforts are to make the milieu the best for adequate healing.

“We don't have a splint for the brain, or a nutrition for the brain.
^*
You can't say, ‘Take this diet and you won't get brain problems.' You could say, ‘Control your blood pressure and you're less likely to get a hemorrhage, and you probably won't get a stroke,' but once you get a stroke all we can do is try to teach you to maximize your life with what you have left. If you're a paraplegic, my job is to try to teach you how to live the best life you can in a wheelchair, and if anything gets better than that, it's extra.”

It is late at night, and I am sitting in Phil's office with him in his home in Greenwood Village, Colorado, just outside Denver. I often think of Phil's office, a large room he and his wife Barbara added on to the house on the far side of the garage—fifteen feet wide and twenty-five feet long—as being the Brooklyn/Southwest annex of the Victoria and Albert Museum. It is filled to overflowing with an extraordinary assortment of things, including sculptures (bronze, wood, clay), paintings and prints (the American West), family photographs (some life-size), baseball and sports memorabilia (especially about the Brooklyn Dodgers), Judaica (menorahs, the Tablets of the Law), geometric forms (bright yellow plastic cubes, rhomboids, cones, pyramids), encyclopedias, medical books, magazines, skeletons, skulls, spinal cords, geodes, rocks, exercise machines, bicycles, skis, sculptures-in-progress, four-pound plastic jars of chocolate-covered raisins (Phil never eats lunch, but snacks on these all day), and lots of cartons filled with who-knows-what.

His desk abounds with a similar variety of items, along with medical
papers, articles-in-progress, partly completed clay sculptures, several dozen model cars and trucks (Matchbox reproductions of racing cars, pickups, forklifts, et cetera), and lots of rocks. Phil has had a long, sustained interest in geology and archaeology (on my first visit with him in Denver, in 1988, he took me out of town to a highway cut on Interstate 70 in order to explain the geology of the region to me), and a passion for sculpture. He has made most of the several dozen bronze sculptures that are in his office and around his home, as well as those in his Denver medical office—abstract creations, along with sculptures of heads, skulls, torsos, hands, spinal columns, brains, children (
Sibling Trio
), baseball players and objects (
Broken Bat
), athletes (
Women Volleyball Players
), and scientific subjects (
Showing the Moebius
).

(After I reported on my visits with Dr. Haight and Dr. Melman, he sent me a one-and-a-half-inch-tall African sculpture of a man making love to a woman. “Note the straight organ—may it ever be so!” he wrote in an accompanying note; when I called to thank him, he told me he hoped to be able to send a life-size version of the sculpture soon.)

There are also, around the room, more than a dozen different sculptures Phil has made of Phineas P. Gage, foreman of a railroad construction crew in Vermont, who, in 1848, survived an explosion that propelled a three-and-a-half-foot-long crowbar through his head—it entered below the cheekbone and left eye, and exited through the top of his skull. Although, after the accident, a doctor could make his fingers meet if he put one finger through Gage's cheek and another through the top of the skull, Gage lived for another twelve years without suffering any paralysis or physical disability (other than the loss of sight in one eye). Phil has written about Gage and the personality changes the trauma induced: in effect, Gage suffered the inadvertent effects of a frontal lobotomy, and his case became seminal in the history of neurology for it allowed doctors to begin filling in data on functional brain localization by revealing relationships between physical damage and personality and character change.
^*

Since my arrival a week before, Phil has done his best to avoid having me tape a conversation with him—he keeps saying that he's
not articulate or good at this kind of thing, that he won't have much to say that's interesting—and I recall that at the time of his daughter Elizabeth's wedding the previous summer I was able to record a conversation with him only by turning on a tape player while the two of us were on our way to and from a local shopping center to pick up pizzas.
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