Open Heart (9 page)

In the absence of any clear organic causes for distress, my usual tendency is to look for physical causes for physical problems—I'm out of breath because I'm out of shape and getting older; I'm tired because I'm not sleeping well—and for emotional and psychological explanations for emotional problems, and for those conditions, often physical, that I believe are being brought on, at least in part, by emotions: I am worrying about my heart, then, because I am beginning to believe that loneliness and loss have worn me down in some irreparable way, and because, having recently ended the relationship with Ellen, I fear my heart may finally, in some terribly literal way, be breaking.

On December 30, I set down my last entry for the year:

In this final entry for 1998, I look back over events of the past year, talk with myself about things I am looking forward to in 1999—the publication of a new book (
Transforming Madness
), Miriam and Seth's wedding, getting started on a new book, Robert's discharge from the hospital—and I close by wishing myself a happy new year. “So, here's to a good and safe trip, and to a healthy, happy, surprising 1999 for all those I love,” I write, and add: “and for me too.”

On our third or fourth day in London, Miriam, Seth, Eli, and I climb to the top of St. Paul's Cathedral—629 steps, the last section a long, narrow, spiral staircase—and I do so without having to stop
at landings and without difficulties. The day after this, in chilly weather and at a brisk pace, we walk for five or six hours across the city—from our house in DeVere Gardens, across Kensington Gardens, Hyde Park, Green Park, St. James Park, all the way to the Tower of London and London Bridge, and then along the Thames and back home again—and I do so without experiencing any pain, fatigue, or shortness of breath.

I have arrived in London on the last day of 1998 (Seth, Miriam, and Eli fly in on New Year's Day), and I spend New Year's Eve with friends. In my first journal entry after returning to Northampton, this: “spend time with donna and bob [Donna and I grew up together; she babysat me and Robert when we were children], and that is deliteful. gorgeous dinner at Stanley and annabel meadows for new years eve, and then a party afterwards, where a gorgeous young woman comes on to me…”

Months later, when we know that on New Year's Eve my coronary arteries were nearly 100 percent blocked, we will wonder what angel was looking after me when I made the choice I made that night. For at the New Year's Eve party I spend most of my time with an attractive young woman (“She looks just like that actress—Jennifer Jason Leigh,” Donna whispers to me) who appears to be in her late twenties or early thirties. We talk, flirt, dance, touch, laugh, and drink lots of champagne. About an hour and a half into the New Year, Donna and Bob come to me while the woman and I are dancing, to wish me a Happy New Year again and to tell me they're leaving.

“I'll leave with you,” I say.

Donna and Bob can't believe it. Nor, when I wish her a Happy New Year and say good night, can the young woman, who urges me to stay. The next day I will tell Donna that happy and ardent as I was feeling, it seemed a good idea at the time to follow a suggestion Miriam, now thirty years old, made some years before: that I never go out with women younger than her.

And after the surgery, we will recall that at our New Year's Eve dinner, Stanley Meadows had told a story about Joe E. Lewis and Benny Hill and how, one night when the three of them were performing together in a London music hall, and Benny Hill had finally
prevailed upon a very beautiful and much younger woman to go out with him after the show, Joe E. Lewis had smiled and, waving goodby, said to Benny: “If you get lucky, she'll kill you.”

“A brief welcome home entry, with more to come,” I write on January 8, 1999, my first morning back in Northampton. I tell, in summary fashion, about the New Year's Eve party and the lovely times with my children, then add: “yet i am doleful, sad, in the extreme at times.” A few lines later: “concerned re the breathlessness, and possible heart stuff, damn! fuck.”

For the next ten days I keep scrupulous track of how many lengths of the pool I swim, how often I have to stop, how well or poorly I am sleeping, how much pain I am having between my shoulder blades, and, given my emotional state, now labile in the extreme, I spend more and more time, in longer and longer entries, indulging in and rationalizing away my fears:

“Annual physical today—first in 2½ years!—and eager to get david's diagnosis, if any, re shortness of breath,” I write on the morning of January 18. The next morning I report the results.

I give Dr. Katz a detailed description of my symptoms and also talk with him about the breakup with Ellen and my feelings of depression. Since I have never had a stress test, Dr. Katz suggests I schedule myself for one with a local cardiologist, Dr. Flynn, and if that proves negative, as he expects it will, we might see about a pulmonary function test. Noting that the quality of the air in our region of New England is especially bad (pollution from industries in the Midwest settling over the Connecticut Valley), and given my below-average score when I blow into a tube (he jokes about the cardboard tube, called a peak flow meter, being state-of-the-art technology), his best guess is that I am suffering from a mild case, not unusual in our area of Massachusetts, of adult-onset or exercise-induced asthma. He gives me a prescription for an inhaler and suggests, should the shortness of breath continue or increase, that I take one or two puffs from it before swimming.

In my journal, this: “go for a swim, and feel again the constriction start in throat and chest, high up—also: cold weather and asthma discomfort go together, as with me. but: schedule for stress test [the first appointment I can get is in three weeks time: for February 5]… and may or may not get breathalizer, to see if that helps.”

Despite the fact that Dr. Katz, like his nurse four weeks before, sees little likelihood of coronary artery disease, and nothing urgent about my condition, my own sense of urgency—fueled by my loneliness—mounts.

“Busyness will only stave off loneliness for so long,” I write, a day after the exam. “Nobody to talk to about the ordinary stuff of life on
an ordinary day. Miss that dearly…MLKing jr day [and] i weep away, while listening to spirituals: Marian Anderson and others—‘Give me Jesus' ‘Deep River'… i am washed away with feeling…just so so sad sometimes…” The entry ends with a two-word paragraph: “sadness reigns.”

I continue to keep a record of my problems while swimming and exercising, and for a few days I try to believe—who wouldn't?—that Dr. Katz is right: what I have is asthma, and not heart disease.

Less than a week after the exam, the shortness of breath while swimming coming more often and at shorter intervals, I decide to try the inhaler. I telephone Dr. Katz to tell him about my concerns. In my medical record for this day, Dr. Katz's entry:

The inhaler, alas, doesn't help, and when it doesn't, I return to my sense that there is something terribly wrong with my heart, and with my life, “worried re my heart,” I write, “tho david thinks it is asthma, but i take puffs of the stuff and it doesn't seem to make a diff. I do 14 lengths pretty easily, but then the pool goes from 6 lanes to 2, and I am not up to fighting and circling and the rest… a bit of panic, apprehension, anxiety here.”

At the same time that my anxieties about my heart are increasing, I continue to record everyday occurrences that, in their happy abundance, would seem to belie anxiety. Among other events itemized on the day I first use the inhaler, for example: I talk with Miriam about wedding plans; I talk with a friend and former student, Bret Lott, whose novel has been chosen by Oprah Winfrey for her book club; I
work on a course in Jewish American literature I'll be teaching in the spring at UMass; I make final revisions on my novel. I also write about looking forward to driving down to New Haven the next day, where I will give a talk at the medical school, spend time with Jerry and Gail, and attend the closing on their new house with them.

Despite what seems a full, rich, and good life—and despite my trying to convince myself that it
is
a full, rich, and good life—my loneliness continues bone deep, and for the first time I find I am asking the same question Phil will ask: “but i do feel so alone, and with the drug not making a diff (on the first day), the isolation leads to that other realization:
Who will take care of Jay?”

Ellen telephones, and talks about how she wants to get back together, and to care for me. Given the burdens in her own life (a ten-year-old son with a disability that requires constant, exhausting attentions), this seems to me as impossible in the future as it has proven to be in the past. (“I didn't want to say anything before,” Miriam says to me in London, “but after all the years of raising the three of us and taking care of your brother and of Grandma, what were you doing with a woman with a disabled son?” A busman's holiday? I reply. Miriam smiles, and repeats what she and her brothers have said before: “It's your time now, Dad.”)

On January 26 I report on a conversation I have with Robert's social worker, who urges me to talk with Robert about how he will spend his days when he's back in the city.

But if I'm in such good shape, and if I have little in my history that suggests the possibility of coronary artery disease, and if my doctor diagnoses asthma and sees no urgency about checking out heart disease, why, even while in part of me I was rationalizing away
symptoms, did I, at the same time, feel more and more certain that something was gravely wrong? Why, that is, were my intimations of mortality at least as strong as my inclination to denial?

On January 27, before I drive down to New Haven, I telephone Rich.

During our conversation, I also mention that once before—a year and a half ago—I had gone to see my doctor about pain between my shoulder blades. The pain had been there, on and off, for some time, and I had ignored it until, during a talk with my cousin Jerrold, who lives in Jerusalem, I had asked about his father's death. Had it been peaceful? Jerrold said it had—that his father (my father's younger brother, and the youngest of nine), eighty-two at the time, had been sitting at the table with them, eating and talking, when, after complaining of pain in his back, he had suddenly slumped over, and died.