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We need merely factor in television to see how little has changed over time. How much space does the spiritual take up in most modern agendas? With well over a century's distance from this story, we realize that the games played in Ilych's world are still being played today. Can it really make a difference (to me, to you) whose performance gets an Oscar, whose song is ranked number one, whose ball goes first or most into the hole, through the hoop, or between the goal posts? Moreover, the monstrous grip of professionalism is, if anything, more brutal and distorting in our postindustrial, global-marketplace age, than it was in Tolstoy's rural Russia of the nineteenth century. The education that takes place in

the elite institutions of the West is not very different from the "training" that Ivan Ilych received: how to master the rules and conventions that regulate secular success. (My university works tirelessly and at considerable cost to furnish its graduates with credentials so that they might find a niche in society; we teach no courses about the soul or about preparing for death.) Death—fear of it, certainty of it—comes as an obscene intruder here, not only crashing the party but exposing the utter nullity of the party. Only now, as Ilych watches the smug complacence of his own doctors, does he grasp the alienness of the entire consort, the mammoth yet intricate web of social custom and action that has been the exclusive focus of his life; he sees, because he is getting ready to fall into it, the abyss that exists between socioprofessional discourse and human fate. As he approaches death ever more closely, he finally asks himself the key question for Tolstoy: have I lived wrong? have I lived at all? At the moment of death, after three days of ceaseless agony and screams, Ilych, we are told, sees the light. Do we?

A proto-existential fable, I said. And also a very unnerving one. I have often wondered exactly what makes this novella so virulent, and I don't think it only has to do with Tolstoy's philosophy. After all, Ilych does see some kind of light, and it has been shrewdly argued that this story is a perennial favorite in "literature and medicine" partly because it presents dying as a positive learning curve. Nonetheless, this story gnaws at us because the author, after ushering us into his decorous narrative, then locks the door and forces us to see these events as Ilych sees them. And what we see gradually builds into a kind of mania. Once Ilych develops what we today would call "chronic pain," the story starts to feel virtually penitentialjust as chronic pain itself is penitential. Ilych experiences his gradual dying as an ever-tightening trap, and the tighter it gets, the more absurd and capricious his entire life starts to appear. And neither he nor we get off the hook. All the goodies he has spent his life desiring and acquiring go up in smoke. Why? Because the man is dying. And when you are dying, when you
know
you are dying, what else can possibly be of interest?

Tolstoy makes us squirm, not only because he exposes the evasiveness of all human pursuits but also because he has the bad taste to lock us into Ilych's position. Not only are no dodges possible but everything now appears to be a dodge. We know that the most frivolous, superficial question devised by humankind is: "How are you?" And we also know how distasteful, how obscene, it is when someone actually starts to give a serious and somatic response. Most of us are sufficiently acculturated to rise to the occasion when this question is put to us: we blithely speak of weather, family, or profession. Maybe a hint of our pain or discomfort, but quickly enough we see that this type of response is not much appreciated. Ilych, however, can think of nothing else, can speak of nothing else. He breaks all the rules, and even though he remains largely controlled in his utterances—he does not shriek or truly go off the deep end—he is constantly thinking about the unthinkable, constantly making us think about it, leading us to the horrid conclusion that he is dreadfully logical, that of course we would all obsess about dying if we actually knew it was happening. (How sublimely thoughtful of nature to keep us in the dark here, for years and decades; and how awkward that our current diagnostic culture gets the bad news out to us ever earlier now, even when no adequate therapeutic responses may exist for our now visible maladies.) There is a stench in this brief novella, like a fart in a crowded room, and it reeks of mortality, of somatic thralldom, of a
huts clos
that no one exits.

LONG LIVE THE KING

Literature's testimony about death and dying is most often sought in fiction and poetry. What about drama? Is the stage particularly suited to represent medical issues? We know that medical school (like all schools) is surprisingly theatrical in its actual modus operandi. A professional performs in front of an audience, and this enables learning via spectating. Or consider the doctor-patient relationship as a kind of the-

ater, a (strictly orchestrated) set of roles, punctuated by dialogue, through which, at least sometimes, life-and-death questions are asked and answered.

It is amazing that this dyad—doctor-patient—has not been turned more often into theater: raucous, potentially obscene theater. You lie on a table or sit up straight or bend over, and the (impassive, professional!) physician palpates, listens, probes, inserts. The appointment with the doctor must rank up there with the visit to the barber or the masseur as one of society's few sanctioned opportunities for truly hands-on behavior, for being actually touched and felt and exposed in ways unallowable under any other circumstances. Here is physical intimacy with a vengeance, all in the name of science. And what about the stint at the radiologist's? You sit or lie there with your half-opened gown, freezing and frightened, while folks in white suits calmly read you, follow the barium trail or the nuclear track, print out what is going on there under the skin, foretell your future, terrify you. Sometimes they hand you an imposing manila envelope, sometimes they suavely inform that you will hear from them when the results are known. Drama here.

The great gift of theater, it seems to me, is to offer up a tangible, flesh-and-blood world of living creatures occupying a space in front of our eyes. Here is a form of presence and immediacy that the printed page does not possess. I have been saying all along that art helps us to a more vivid sense of what sickness and death entail, and it is therefore a bit puzzling that so few major dramatic texts with medical subjects come to mind. Some do exist. As I argued in Chapter Two, "Living in the Body," Sophocles'
Philoctetes
is a key instance of injury and pain being at the center of dramatic events, and a number of Moliere's best comedies focus on the issues of hypochondria and affectation when it comes to either sickness or doctoring. (The ante is considerably upped when we remember that the ailing Moliere himself played Harpagon in
Le Malade imaginaire
and that he was to die shortly after one of the performances.)
King Lear,
as mentioned, is a chronicle of old age ap-

preaching dissolution, even if sickness per se is not present. Great tragedy frequently finishes with somebody dead somewhere, and there are always lessons for us. Hamlet muses on the skull he discovers to be Yorick's, and in the light of this longitudinal bad joke that life plays on the living—leading him to ponder the truly egalitarian fates of Alexander and Caesar, now imagined filling up bungholes—he moves toward his sublime moment of acceptance: "If it be now, 'tis not to come; if it be not to come, it will be now; if it be not now, yet it will come. The readiness is all" (V.ii.195-197).

These examples, rich as they are, might be construed uncharitably as foreplay, as preparation for the bloody business truly at hand: dying itself.
Hamlet
finishes with a mess of cadavers, swords, and poisoned chalices. Could we go directly to the quarry?
Angels in America
goes direcdy into the hospital, as does Margaret Edson's splendid recent play
Wit,
to depict terminal disease, but could you devote an entire play to the
staging of dying?
It may seem that no playwright in his right mind would elect such a severe theme, but the truth is otherwise. The Romanian dramatist Eugene Ionesco—erstwhile prince, along with Samuel Beckett and Jean Genet, of the theater of the absurd—has supplied us with an answer in his fascinating play
Exit the King.
This full-length drama sets out to choreograph the movements of dying, to show just how spectacular such an exit is. The protagonist, Berenger, is a king, because the conceit of Ionesco's play is that all of us are kings and that every death is a form of regicide committed by nature. With characteristic wit, Ionesco informs us that this king is a bit special: he has built Rome, New York, Moscow, and Geneva, has founded Paris, is the inventor of gunpowder, of airplanes and automobiles, of harvesters and tractors, is, it seems, responsible for much of the progress of the human race. His death is, well,
absurd.
How can such a figure die? How indeed?

Well, because he has to. King though he is, he will vacate the scene. Ionesco seems to have heeded Freud's view
of King Lear,
for his play is about the necessity of making friends with death. In Shakespeare the

death of the king is a seismic event with huge political reverberations; in today's culture as well, we are morbidly attentive to the dying of the high and mighty, as if mesmerized by the final erasure that life metes out to all. As Pascal cheerfully put it,
"Le dernier acte est toujours sanglant, quelque belle que soit la comedie en tout le reste"
("The last act is always bloody, however fine the rest of the play is").

But, for the twentieth-century Ionesco, the death of the king is a brilliant, often hilarious meditation on kingship of a different sort altogether: the miraculous power that life
lends
us for a while but then takes away. This leads to an unforgettable view of life as an affair of dress and undress, astonishing us with its view of how much clothing we can remove. Theater can tell this story since dress and undress are its basic currency. The playwright achieves stunning effects as we see this all-powerful man systematically and sequentially stripped of his powers. You might expect this to be brutal to the extreme, as we indeed experience it when we visit friends and loved ones who have suffered strokes or who have Alzheimer's, who are
shrinking
in front of our eyes and being divested of all their accoutrements: use of limbs, memory, speech, and the like. But Ionesco surprises us. The leave-taking he chronicles gives rise to a tender kind of poetry, as Berenger discovers—only through his losses—the miracle of his possessions. Walking upright, speaking, utilizing arms and legs: these are the vestments of kingship, but you don't realize it until they are taken away from you. Even pain is now understood as precious, as we see when the maid Juliette grumpily rehearses all her aches and troubles, while Berenger rapturously hangs on her words, celebrates the bodily inventory at hand:

Juliette: I do all the palace laundry in the wash house. It hurts my

hand and cracks my skin. king
(rapturously):
And it hurts. One can feel one's skin. . . . Juliette: I empty the chamber pots. I make the beds. king: She makes the beds! Where we lie down and go to sleep and

then wake up again. Did you ever realize that every day you woke

up? To wake up every day . . . Every morning one comes into the

world. Juliette: I polish the parquet floors, and sweep, sweep, sweep!

There's no end to it. king
(rapturously):
There's no end to it! Juliette: It gives me the back-ache. king: That's right. She has a back! We've all got backs! Juliette: Pains in the kidneys. king: And kidneys too! (60)

Dying is imaged here as a systematic form of dispossession, a rigorous cashiering—one by one—of the goodies, the freebies, that one has had, used, and squandered all one's life, without ever thinking about it. Ionesco's genius stems from this insight that is a brilliant kind of hindsight: we cannot value, we cannot even see what we have, until it is being removed. And theater turns out to be wonderfully apt as a setting for making this new regime—a regime of raids and losses, a weighing in of incapacity, a program of sequential dysfunctionalities (what's going to go today?)—visible. We watch this final striptease that life deals out to the dying, and there is nothing pornographic about it.

But there are some surprises. The beauty of this unveiling scheme is that it enables the playwright to show us just how much amazing luggage we have been carrying around all this time. We may have been born equipped only with appendages and organs, but life has turned us into shrewd consumers who get hold of all the paraphernalia it takes not to get too banged up and hurt as we go through. Here too Ionesco achieves a kind of creatural poetry as he reveals the enormous amount of bric-a-brac that we have acquired to make our way: the crutches, the weapons, the shields, all the equipment and armor, that a lifetime of dodging and slithering through have necessitated. In a feat of theatrical magic, Ionesco contrives to make us actually
see
this, see the incredible assem-

blage of aids that we have fashioned, all the maniacal but invisible handicraft and bricolage that has been necessary for us to manage.

There are more conventional vocabularies for all this: Freud has told us about our psychic defenses and the survival strategies and the injuries we make or sustain in order to live; other, still older discourses speak blithely of maturation, growth, adapting, coming to terms, and the like. You will note that there is nothing remotely visual in any of these concepts. True, the vocabulary is telling: "defenses," "survival," etc., but who ever stops to think about what this might look like? The fact is, we live in the dark, change in the dark, evolve in the dark, and never have a clue as to what a spectacle our life might be. Try to imagine the sheer quantity of
alterations
you have gone through from infancy to maturity. A scrapbook might reveal a few of the exterior changes, but what about the others, the ones that take place on the inside? Ionesco creates a theatrical, choreographic language that is shockingly material to show us these "things," to show just how hoary and amazing they turn out to be when we come to the end and have to discard them. The theater as art form is paying its way in full here by showing us what we cannot see on our own and by suggesting, rather sublimely, that
dying
(usually thought of as morbid, darkening) is the source of all this illumination. We see this most clearly in the final moments of the play as Berenger's queen leads him through his last paces, helps him in his final bout of disrobing:

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