Open Heart (2 page)

I tell him I'm feeling a little groggy, and very lucky—lucky they found what they found and that, as I've just learned, they
can
get me into surgery in the morning. (Later, Jerry and Gail tell me they felt lucky too, since Dr. Cabin had suggested that if Dr. Hashim was unable to perform the surgery on Friday they might take me home for the weekend. “Oh my God—what do I remember about CPR?” Gail, a registered nurse, asked Jerry when he told her of this possibility.)

Jerry tells me that after Dr. Cabin saw the results of the angiography, he had paged Jerry and they had discussed what to do next. Jerry says that
he
was surprised—very much so—at what the angiogram revealed, but that he is pleased to learn that Dr. Hashim will be performing the surgery in the morning. The sooner the better, he says, and he tells me that my swimming and being in such good shape have probably saved my life.

“It seems you've been living on your collaterals,” Jerry says, and he explains that the collateral blood vessels I'd probably developed by swimming a mile a day for the past twenty-five years—hundreds of small steady-state blood vessels that lie between and connect the coronary arteries and that cannot expand and contract the way coronary arteries can—had been supplying the blood and oxygen to my heart and lungs that my coronary arteries were no longer providing.

Jerry then describes what he saw on the monitor. “A second or two after the blood stopped flowing into your heart, the entire bottom of the TV screen—the lower part of your heart—lit up, just blossomed with the glow of all those collateral blood vessels,” he says. “It was an amazing sight.”

We talk about telling my three children about the surgery, and this gives me pause—unsettles me for the first time since I arrived at the hospital. For a full half minute or more I cannot speak. Jerry smiles down at me. He is a strikingly handsome man, five-foot-eleven and about two hundred pounds, with a trim silver beard, a full and wavy shock of silver hair, and penetrating gray eyes that remind me of Jewish actors such as John Garfield and Paul Newman
who have had the same captivating mix, in their looks, of toughness, intelligence, savvy, and tenderness. When, seeing my reaction, Jerry puts his hand on top of mine, I melt. Is this
it?
I wonder. Is the big basketball in the sky really about to fall on me?

Although Jerry's presence comforts, it is also sobering, since he does not hide the seriousness of his concern, and when he asks if I would like
him
to call my children, I shake my head sideways and see myself, a small boy again, sitting on the floor of my office at home, sorting through my baseball cards and glancing up now and then toward my desk, where the light is on but nobody is working.

For more than a dozen years, I have been a single parent to my three children. By this time, however, the last of my children having left home the previous spring, I am, for the first time in three decades, no longer an
on-site
single parent. All three have graduated from college and are living on their own: Miriam, at twenty-nine, in the Washington, D.C., area; Aaron, at twenty-six, in Northampton; and Eli, at twenty-four, in Brooklyn, not far from where I was born and from where Jerry and I grew up.

I had told each of my children about driving down to New Haven for the angiogram but, not wanting to alarm or burden them, had minimized its importance: everything seemed fine, I'd said, and I was still swimming a mile a day, but some anomalies had shown up on an electrocardiogram, and we thought it best to check things out further, so I'd decided to have an angiogram performed at Yale-New Haven. That way, I explained, I could also spend some time with Jerry.

When I find my voice, I tell Jerry that
I'll
telephone my children. Jerry says that he'll call them also and that they can stay at his house (into which he and Gail moved two weeks before) for as long as they want.

Jerry also tells me he's spoken with Rich Helfant and that Rich agrees about the need for emergency bypass surgery. Rich, too, is an old high school friend, and I've known him even longer than I've known Jerry, since, starting from a time when we were seven or eight years old, Rich and I went to the same Hebrew School (we later played together on our synagogue's basketball team). Rich is a cardiologist now living in California—most recently he served as chief of
cardiology at Cedars-Sinai Medical Center in Los Angeles; before that he was director of the Philadelphia Heart Institute and chief of medicine and cardiology at Presbyterian-University of Pennsylvania Medical Center—and these past few weeks he and I have been talking nearly every day. In the week to ten days preceding the angiogram, a fact I found both welcome
and
disquieting, he had been calling me
several
times each day.

Later that afternoon Rich calls and says he is not at all surprised at what the angiogram revealed and that, based on his talks with Jerry, he has every confidence in Dr. Hashim and the people at Yale. He reminds me that he had been urging me into the hospital—gently, gently, so as not to scare me—for several weeks.

When my family practitioner, while not excluding the possibility of coronary disease, thought the symptoms that had made me call for an appointment—some occasional shortness of breath while swimming—were due to adult-onset or exercise-induced asthma, and when a local cardiologist, finding some anomalies in an electrocardiogram
and
an echocardiogram, while also not excluding coronary disease, thought the problem was probably viral, Rich had exploded. “
It's not viral, goddamnit!
” he had exclaimed, in the first burst of exasperation I'd heard from him since I'd begun talking with him about my concerns. “I want you in the hospital as soon as possible.”

The local cardiologist had recommended that I have an angiogram done at Bay State Hospital in Springfield, but when I called his office to make an appointment, the colleague who performed the angiograms was booked for several weeks. I was persistent and secured a “brief office visit” a week later, not for the angiogram, but to confer about setting up an appointment
for
the angiogram. Then I had telephoned Rich, Jerry, and Phil.

“Listen,” I'd said to Rich, as I had to Jerry the day after I'd received the results of the EKG and the echocardiogram, “why don't you guys all talk with one another and then just tell me what to do?”

On Sunday morning, Jerry phoned to say that he and Rich had decided I should come down to Yale and that Dr. Cabin would be calling me at home (as he did) to arrange for the angiogram.

Now, less than a week later, Rich says that, barring the unforeseen, he feels certain that the bypass surgery and the recovery from the surgery will go swiftly and smoothly. He asks about my children, and I tell him I've spoken with each of them and that they will all be arriving at the hospital before surgery the next morning.

Aaron is already on his way down from Northampton by bus; Eli is on his way from New York City by train; and Miriam and her fiancé Seth will be taking a three A.
M
. train from Washington, D.C., and will arrive early the next morning. I tell Rich I was surprised that they didn't hesitate, and will be with me—I note that I didn't
ask
any of them to come—and Rich tells me he is surprised that I was surprised. Why wouldn't my children want to be with me at a time like this?

After supper, Dr. Hashim stops by and talks with me for a while. Dr. Hashim is Lebanese and therefore, I expect, speaks French. I tell him I lived in France for two years some thirty years ago, before and after my first child, Miriam, was born, and Dr. Hashim and I proceed to talk with each other in both French and English. Although he describes the surgery and explains the possible risks attendant to it, such as stroke, retinal damage, cognitive losses, and infection, and says that, given the excellent state of my health, he sees no cause for concern, it is our conversation about things ordinary and familial that calms my fears and reassures.
^*

When I comment on his name and its possible biblical origin, he tells me that yes, he believes he is a descendant of families that inhabited the ancient Hashemite kingdom. He asks about my name and I tell him my father's family came from Ryminov, a
shtetl
in the Carpathian Mountains—from a region now part of Ukraine—and that they had been in the butter-and-egg business there, as they were after they came to the United States. When, in the Austro-Hungarian Empire, civil servants assigned family names to Jews, probably at the end of the eighteenth century (so that we would no longer be Jacob-son-of-David, or Jacob-Mordecai-of-Ryminov), a state official, seeing thousands of baby chicks running around the family property, according to family lore, gave us the name
Neugeboren
, meaning, in German, “newly born.”

Dr. Hashim says something about the appropriateness of my name, and then, to my surprise, reaches down, lifts the bedsheet, and takes my hand in his.

“Twenty or so years ago,” he says, “I could not have done anything for you.”

Phil Yarnell, with whom I've been talking regularly, and who has been offering me diagnoses by phone and conferring with Rich and Jerry about me, telephones from Denver. Phil started out as a neurosurgeon but switched to neurology early in his career. Before moving to Denver and becoming chief of neurology at Denver General Hospital and of the Neuroscience Division at St. Anthony's Hospital there, he taught at the University of California at Davis; since 1993, in addition to being in private practice, he has been clinical professor of neurology and neurosurgery at the University of Colorado School of Medicine.

Phil grew up on the same block in Brooklyn where I lived until I was two years old—across from Prospect Park—and though neither Phil nor I have clear memories of having done so, we like to imagine we played together back then: in front of our apartment houses, in the park, and in the sandbox and on the monkey bars in the playground that was directly across from my parents' building.

Phil moved to Denver in 1971, the same year I moved to Northampton, and has lived there ever since. He and his wife Barbara also own a 160-acre ranch in Kiowa (“That's one-quarter the size of Prospect Park,” Phil says), a small town an hour east of Denver, where they keep cows, horses, and llamas. At a lean five-foot-ten-inches tall, with a full head of white hair and a broad white mustache, and wearing a bolo tie at home and at work, Phil could pass for sheriff of a Western frontier town. His accent and blunt, slangy way of talking about things, however, remain pure Brooklyn.

He tells me he was surprised to hear from Jerry that I
have
heart disease and that it is so far advanced, but he's glad I'm in Jerry's hospital, where Jerry can keep an eye on things. This, he says, is
very
important, agreeing with why Rich and Jerry have decided upon Yale instead of Massachusetts General, where Rich originally wanted to send me. Given the routine and often lethal miscommunications and other slip-ups that prevail in hospitals, Jerry wanted me at Yale,
where he could monitor matters and where doctors and staff involved in my care would be accountable to him.

My friends had seen a lot of hospitals and doctors, and until you had, they said, you could not believe the difference there was between excellent care and care that was less than excellent. It was, more frequently than anyone dared acknowledge publicly, the difference between life and death. (And this was ten months before revelations appeared in front page articles around the country, based upon a report from the Institute of Medicine of the National Academy of Sciences, that as many as ninety-eight thousand Americans die every year in hospitals from preventable medical errors—a figure Rich thought grossly underestimated the reality.
^*
“That figure is just the tippity-tip of the iceberg,” Rich said, “and includes only the most gross and undeniable errors.”)

Early that evening my son Eli arrives (Aaron arrives an hour or so later), and while he is with me another old friend from Erasmus, Arthur Rudy, calls. I considered Arthur my closest friend in high school and have been talking with him regularly in recent weeks. Eli, who remains close with many of his high school friends, says something about how lucky I am to have remained friends with guys like Arthur—smart, successful,
menschy
guys who grew up rooting for the Dodgers and who have turned out to be delightfully quirky: Where's the downside? he asks.

Arthur was vice president of Erasmus when we were juniors and, when we were seniors, in a class of more than twelve hundred students, was voted Boy-Most-Likely-to-Succeed. (Jerry Friedland was elected our senior class president.) Arthur, too, is a doctor, though not an M.D. He is a psychologist, formerly chief of psychology at Roosevelt Hospital in New York City and now in private practice. He tells me that Jerry called him with the news. Jerry and Arthur, good friends at Erasmus, roomed together for a year in an Upper West Side apartment during our college years (the three of us went to Columbia together), and though both acknowledge they made lousy roommates, they have remained close friends ever since. (Arthur was best man at Jerry and Gail's wedding.) Arthur and I talk for a while, and—as with Phil, Jerry, and Rich—though I'm happy to have him calling to wish me well, what pleases more than anything
we say is the knowledge that, before and after our talk, he, Rich, Jerry, and Phil will be talking with one another about me.
How's Neugie doing?
I hear them ask. And:
The Neug seemed in such great shape, and things seemed to be going so well for him…

Given that, unlike my four friends, I have been living without a wife or companion for the past dozen years, the thought that while I am asleep in the operating room, my chest open and my heart disconnected, these four guys who have known me, and one another, for nearly a half century will be taking care of whatever needs to be taken care of, provides more than comfort. Largely because I cannot know but can only imagine what they will think, feel, and say, my sense of their concern and affection enables me, even before my heart is emptied of blood, to see myself in a life that will be mine
after
my heart is repaired. Among other pleasant fantasies, I picture myself at Miriam's wedding, scheduled eight months hence; and, too, I watch myself at my desk, alone in my third-floor office after my return home, going through notes and sketching out scenes for a new novel.