Article — From the December 2011 issue

American Vespers

The ebbing of the body politic

( 2 of 5 )

A few months after the event, Dr. Jeffrey Tepler apologized for, as he put it, “slapping you around.” If he was not the gentlest of men, an oncologist whom David Blumenthal described as “a brilliant chemist” and Jerome Groopman (How Doctors Think) praised for his humanity, I would have found it easy to accept Jeffrey Tepler’s account of the slaps. But I know him. We talk to each other now and then, when I forget that I am stealing his time. The conversation often turns to music. He still plays the piano, though he no longer finds the time to practice much; yet every morning he programs the music his patients will hear as they sit through the hours of the slow drip of chemicals. It will almost always be Mozart but rarely if ever the “Jupiter”; the pianist programs music for the piano.

I remember the moment of return: Jeffrey Tepler held me in his arms, my hands high above my head, and said my name loudly again and again, calling me back, raising me up. I recognized the tightening in the corners of his eyes, his sorrowful response to the pain of others. I breathed.

“They think he might have had a little stroke,” my older son said to my wife. It was the gentlest thing he could think to say.

Neurologists came and went; they ordered a study of the electric impulses in my brain to see what was left; they asked questions and greeted my responses with pin sticks and little taps of a rubber mallet. Death is a curiosity.

I could not sit or stand. I drank through my veins. Someone had inserted a needle between my toes. Creatinine collected in my blood, a sign that the kidneys would die before the heart.

I said to David Blumenthal, “I am willing to sign a DNR.” He shook his head; I was still a person, he would not devalue my life. “Hospice,” I said. He would not answer.

In the middle of the night, when the hospital is in its deepest dusk, a confusing loneliness sets in. If there is no motion in the room, no sound, no sense of life in the pallid darkness, the little tremblings stop: in the perfect stillness, hope subsides; death presents itself in the guise of an analgesic. As if she knew this about the night, Sasha Stanton appeared carrying a small cup of lemon ice. It was the first food I had eaten in some days, and I took it not for hunger but for company.

Death was growing inside me. It defies the mind, like magic, for it was only death because of what had been described as the immortality metastasizing within. I was overcome by a kind of attraction to it. Nothing else had ever beckoned so! Not even the love of my wife or the faces of my sons.

We cry out from pain, not from death. One is heightened, the other heedless. I wanted only to lie down again, a decadent.

“We have the pathologist’s report,” Jeffrey Tepler said. “We’ll start the drip in the morning.”

“Thursday,” I said, as if I had not lost the order of the days.

The radiologist slides a disc into the machine to read the results of a PET scan; the radioisotopes in the glucose emit gamma rays in sufficient amounts to be absorbed by a scintillator, which will emit points of light in the general location of a part of a body using or collecting a large amount of glucose. This sugar-hungry place may be the bladder, where all the used sugars cleansed from the blood by the kidneys will be stored until they are excreted; or the brain, which converts sweets to thoughts at an astonishing rate; or malignant cells, the restless, immortal mistakes of nature. In the case of metastases, the body appears on a computer screen festively: lights in the evening of a life.

I was a Christmas tree.

“Tomorrow,” Dr. Tepler said.

In the night I was awakened by a coldness that began in my toes and crept upward, targeting my heart. The image of the ironic old Athenian lying on what I imagined was a slab of stone appeared to me. I could not find the call button. I lay dying in the night.

Dr. Daniel Libby arrived in the morning to treat the pneumonia. He drained quarts of fluid from my chest, surprised by the quantity. Much later he would say to me, “You’ve had it about as rough as it gets,” and I would not know if it was proper to smile.

The systems worsened: the gut, the kidneys, the bone marrow were failing. David Blumenthal and my older son formed a bond: they met in the morning and spoke at night. I do not remember exactly when I began to think again, for I do not know if shame is thought or mere sensation. I saw in my wife’s face the suffering I had caused her, and I was ashamed. “I’m fine,” I said or thought I said, but I could not reach through the bars on the side of the bed to take her hand.

I became a thing, disgusting to myself and anyone near me. I ate only lemon ice and hot chocolate. My wife watched while I withered. She waited when I was wheeled away to other rooms where technicians examined the inert flesh. I could not sit up or turn over onto my side; no command could bestir me. I dreamed that she would be waiting when I returned. My sons came to visit. What was there to say?

I reached for meaning. If I could discern a path, it seemed to me, I would then be able to grasp the railings of the bed and lift myself up. The night did not come again. The evening lasted a very long time. One afternoon an ambulance came; the drivers took me home and dumped me on a couch. And there I stayed, motionless, thoughtless, a stranger in my own house. There would be nurses and my older son would organize the medicines and therapists, but the burden of care would fall now to my wife. It would last for months, a test of love like no other. If she wearied, if she failed, if she fell, I would die.

founded the Clemente Course in the Humanities. His book about it, The Art of Freedom: Teaching the Humanities to the Poor, will be published in 2013 by W. W. Norton. He was awarded a National Humanities Medal in 2000.

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