Open Heart (3 page)

Now, and later on during my recovery, when I once again rely on these friends to get me through matters both medical and personal, I will find myself seeing us as boys, back again in Brooklyn and doing what we loved most of all: playing basketball. I see us in our favorite place—Holy Cross schoolyard on Church Avenue—and I imagine that we are a team: Phil and Jerry at the forwards, Rich (who is six-foot-two and played college basketball and baseball) at center, me and Arthur (who once scored 59 points in a league game when he was thirteen) in the backcourt.
Four Doctors and Neugie
, I think—five pretty good ballplayers ready to take on all comers: five guys who loved nothing more than to be away from our homes, sweating it out on a baseball field, or in a gym, or a fenced-in schoolyard—five guys who loved nothing more, win or lose, than to hang out together afterward, talking and laughing about shots made and missed, about passes threaded and passes gone wild, about girls we were going out with or dreamt of going out with—five guys who would have loved nothing more than to have gone on talking forever about those things—sports, girls, the Erasmus basketball team, and
the Brooklyn Dodgers chief among them—that mattered most in the world to us in those days.

The next morning I telephone my brother Robert, who has been a patient in state mental hospitals for most of the last thirty-seven years and for whom I've been primary caretaker. I tell him (and the chief of psychology at Bronx Psychiatric Center, where Robert is this time) about the surgery. Robert is silent for a few seconds, then asks if my children will be at the hospital and who will be taking care of me at home after the operation. He says he will say a prayer for me.

Miriam and Seth arrive in the morning and, with Eli and Aaron, stay with me until I am taken to the operating suite. According to them, the last thing I say before I am wheeled away is that they should use my credit card when they go out for lunch.

The surgery lasts six and a half hours, and my heart is stopped, my blood processed through a heart-lung machine (during what physicians refer to as “pump-time”) for one hour and fifty-five minutes. Dr. Hashim and his team perform a quintuple bypass (
five
grafts, one more than planned; when I tell this to Arthur, he laughs: “You were always an overachiever,” he says), and there are no complications. When Rich calls after he has received faxes of Dr. Hashim's postoperative report, he is very pleased and tells me the surgeon was absolutely first-rate.
^*
But that's based on his own report, I say. How do you know how good he was? “Several things—but most of all, the pump-time,” Rich replies, referring to the amount of time my heart was detached and my blood cycled through a heart-lung machine. “One hour and fifty-five minutes for five grafts is incredible. The man is terrific.”

When I wake the next day, tubes and wires protruding from my chest, stomach, arms, neck, and mouth, my children and Seth are there, and I am able to get out of bed and take a walk with them along the hospital corridor. I feel very sleepy—and very happy. I fade in and out, and at noon I watch a nationally televised UMass basketball game. I have taught at the University of Massachusetts as writer-in-residence since 1971, and for most of those years my children and I have had season tickets to UMass games. We have also
traveled to other cities—Albany, Worcester, Boston, Philadelphia, Washington, D.C.—to see games, and our home, where my friends and my children's friends would gather when the UMass team was on TV, was dubbed “Hoop Central” by the sports editor of the local newspaper.

“When I told you the game was on TV,” Eli later tells me, “you got very intense and excited suddenly—as excited as anyone could be, given where you'd been less than twenty-four hours before. You'd fall asleep during commercials, but when the game came back on, your eyes would snap open.”

It is only now, the operation over and successful and my children seeming so happy—and relieved—to be with me (none of us upset, as we ordinarily would have been, to see UMass lose a crucial end-of-season league game), that I realize just how frightened they had been, and—but why the need for such reassurance?—how much they do love me. The depth of their affection, like that of my friends, seems an unexpected revelation.

“We were pretty relieved your children were staying with us for the weekend—and that you
weren't”
Jerry says. “Your children were lovely, but they were walking into walls, they were so stunned. I remember that Gail made this great minestrone soup, with tons of fresh vegetables, and Miriam warned us that Seth had a very funny, quasi-religious thing about vegetables—he
never
ate them—but he just kept spooning the stuff in, one bowl after the other.”

On the afternoon after the UMass game, walking back and forth by myself from one end of the cardiac care unit to the other while my children have gone off to eat lunch, and feeling a bit stronger, though still groggy from the anesthesia and pain medications, I think of how lucky—and happy!—I am to be alive, of how good it feels simply to be walking (“Listen, Neugie—keep breathing in and breathing out,” Arthur advises. “It's the secret of staying alive”), and of how dear my children and friends are to me, and then of how strange, swift, and mysterious the entire experience has been: of how little we know about how and why I nearly died.

2

All the Time in the World

W
HEN
RICH
CALLS
ON
Saturday evening, and after he tells me how great my surgeon was and how happy he is and that things went well, I talk with him about some of the notions my experience, before and after surgery, has set in motion.

If, I say, we know so little about the heart, which, in comparison to other organs—to the brain!—seems a relatively simple pump of flesh and blood, and which, in the context of the infinity of interactions not only within the brain or heart (consider, for starters, that the body replaces about a million cells per second and that there are more potential synaptic connections in any one brain than there are particles in the known universe), but also between the brain, the heart, the nervous system, and the immune system, how vast must be the realm of our ignorance. And yet, and yet… despite how little we know, how extraordinary and good it is that we know enough, sometimes, to be able to heal the body and the mind of disease and, as with me, to restore life when death has all but found a dwelling place.

“Oh yes,” Rich says. “We know how to fix what was wrong with you—and thank God that we do—but about the rest we know very, very little. Despite all our researches, you see, we don't really understand the fundamental cause of your illness. We don't truly know how to prevent it. We don't know how to reverse it. We can't treat it very well short of invasive interventions such as stent angioplasty
or bypass surgery, treatments we usually employ when the disease becomes life-threatening. And without catheterization we can't even diagnose it accurately, especially when we need to know the true severity of the problem and the magnitude of the threat.”

Despite decades of intensive research, he says, atherosclerosis—the closing off of coronary arteries—remains the number one killer of both men and women in our time. And though theories abound, and though cardiology is generally considered to be the medical specialty wherein we have made the greatest progress in recent years, we really, he repeats, know very, very little.

“The first thing I tell my medical students,” Rich says, “is that they should never be afraid to say ‘I don't know.' It is far better to say ‘I don't know' than to be comfortable thinking you understand something—or to think you're comforting your patient by
pretending
to know something—because then you're not open to possibility. Because if you think you already know something, you stop listening to the patient.

“In the end,” Rich explains, something he will emphasize repeatedly in our talks, “—and the reason I became so alarmed and kept urging you into the hospital as quickly as possible—the surest way of diagnosing coronary disease now is exactly what it was when I started out as a doctor forty years ago: the patient's report of his symptoms over a period of time, and the pattern of those symptoms as reported by the patient. It was the progressive nature of your symptoms that worried me most.”

We talk about the conversations we'd been having since the afternoon I first called him seven or eight weeks ago. In the course of talking about other things—mostly about a book Rich was writing (about the unexpected consequences, in his life and career, of saving the life of a Mafia Don) and that I was helping him with—I asked if he minded if I checked some stuff out with him about my own health. I also tell him that I had become aware that as time passed he was calling me with increasing frequency.

“I'll tell you this, pal,” he says. “Despite all the progress and gains we've made—and I don't minimize them, for, especially in cardiology, I have seen miracles come to pass that now save hundreds of
thousands of lives each year—medicine, even in cardiology, is still essentially an art, and one wherein the key element remains the relationship between the doctor and the patient. Most of what we know, and the basis for our decisions as to diagnosis and modes of treatment—despite all the advances in diagnostic testing—still comes from you: from what you tell us, and from our knowledge of how to judge new information when put into the context of our more general knowledge of who you are, and of your history.”

Six days after surgery my son Aaron drives me home to Northampton and informs me that he is moving back in with me for a month. (“I'm not asking you if I can move back this time,” he says. “I'm telling you.”) The next day, Eli arrives for the weekend, and two days after this my cousin Madeleine drives down from Syracuse, New York, intending to help take care of me for a few days but discovering to her surprise that I am already making meals for myself and going up and down the stairs of my three-story house without difficulty. I am also back at work, writing a few hours a day in my third-floor office.

While Madeleine is with me, a team from the television program
Nightline
shows up to tape an interview with me. The interview, scheduled before the surgery, is for possible use in a special Ted Koppel will be doing about Moe Armstrong, one of the people I've written about in a book for which I'd corrected page proofs a few weeks before surgery and which is scheduled for publication in early May.

Whatever the book's virtues or deficiencies, or the response to it in the world, one undeniably good thing about it, I say to my cousin—the best thing, for sure—is that it is not going to be published posthumously.

A week after I arrive home—two weeks after surgery—Seth and Miriam fly up from Washington, D.C., for a few days, and we drive with friends to Amherst to watch UMass play Temple in the last home basketball game of the regular season. We park about three-quarters of a mile from the UMass arena and walk at a brisk pace, and in icy weather, to and from the game. (UMass wins 57–49.)

By the time Miriam and Seth leave, I am doing what I have been doing for most of my adult life—waking early, making myself breakfast, and then going up to my third-floor office, turning off my phone, and working at my writing. By the end of the following week, as I initially recall this period of my recovery, I am walking between five and ten miles each day, and a week after this—four weeks after surgery—I am back in the pool, once again swimming a mile a day.

My recovery is as swift and full as my crisis was sudden and surprising.

“You've had a true near-death experience,” Phil says to me several times, but though I feel happy to be alive, and though I'm aware that friends and family also seem happy that I'm still here, what has happened, I tell Phil, hardly seems real. The moment when, two days after surgery, I was walking along the hospital corridor by myself, though, stays with me and seems
very
real—and the words that came to me then sing to me now, intermittently and insistently:
How little we know
.

But for some good fortune, good friends, and good doctors, I keep reminding myself, I could just as easily not be here, and I wonder if, for purposes of telling this story, I can do what I need to do for that moment to take root and—like collateral blood vessels?—begin to blossom.

Novels and stories have often come to me this way: moments, words, or voices, seemingly dissociated, attaching themselves to fragments of memory, or imagined scenes, or dimly lit and half-hidden faces, images, or remembered pieces of dreams—or to odd bits of diverse and arcane data, along with a curiosity concerning matters unknown and half-known that I long to know more about: of how certain things are or were or might be, and of how and why things work or happen the way they do. These seemingly random elements spin around in my mind, conspire in my imagination, and fire my desire
to know
. When the words, pictures, and dramas that take up residence within my consciousness become more real to me than the external world, I yield to them. Then, in and through the writing itself—the making of stories—I have sometimes been able to make sense out of what for me would otherwise remain senseless and confusing. It is largely through this process that I have, through
most of my adult life, been able to make peace with matters disparate, disturbing, and often terrifying.

I talk with my brother Robert several times. Although he is designated as mad by the world (the consensus of the staff at his present hospital, as at his previous residence, South Beach Psychiatric Center on Staten Island, is that he will
never
be able to live outside the locked ward of a hospital), in his conversations with me he seems very realistic and very loving.

He says he is relieved and happy I have survived surgery and am back home, and he asks about my new book—the one about to appear—and if I am going to stop writing about
him
and go back to writing novels again. When will he be able to see me? I tell him that I'm already back at work on a novel, and that the doctors want me to wait four weeks before I drive again—not to protect my heart, but to ensure that my chest, stapled, sewn, and wired back together, won't experience undue strain. As soon as I'm given the green light, I say, I'll come down to visit him.