Article — From the December 2011 issue
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Article — From the December 2011 issue
My descent toward death began in a San Francisco hospital where toilets overflowed and a centenarian man lay dying in the next bed surrounded by his children. “Where is the money?” his sons and daughters said.
“Aarrggh,” the old man replied.
It was autumn in San Francisco, a holiday. While doctors golfed and dined out in San Francisco, winter came to the old man in the bed beside me.
I found a doctor there in California, a stranger who treated me by phone, for there was no attending physician in the hospital.
“Once before,” I said. “Non-Hodgkin’s. Four.”
“When?” he asked.
“Two thousand and one.”
“Well, you had nine good years,” he said.
We left for New York City the next day—my wife, my pretty green tank of oxygen, my swellings and effusions, my failing kidneys, my fever, and me. With the California hospital behind us, I did not think of death. Soon I would be back in the care of Dr. David Blumenthal. I had been his first patient. He may still have been the chief resident at NewYork–Presbyterian Hospital when we met. We had shared a career: cardiology and pills, books and music, social work. I had written about him once: the subject was ethics. Now I am older, interested in death and the decline of men and nations.
He was angry when he saw me. The diagnosis was in his glance, the twist of his mouth. They had let it go too far in California. I was dying. The effusion leaking from the lymph nodes was filling up my chest, I had pneumonia, the oxygen flowing through my nostrils was not enough. In the emergency room, Dr. Stanton, the resident on duty, asked for a pressure mask. “My name is Sasha,” she said. Through the thick plastic of the oxygen mask I saw people moving, the machine began to breathe for me, I held my wife’s hand. In that moment I thought of my brother-in-law, who had gotten out of his black-and-white early one morning to investigate an abandoned car along the highway when a drunk driver came careering round a bend and crushed him there on the side of the road. According to his partner, his last words were, “Tell my wife that I love her.” That is what I would have liked to have said too, but it is impossible to speak through a pressure mask. Cops are romantics.
What is known in medicine as an “event” happened in the early morning after David Blumenthal had made his rounds. There was no pain, no darkness, no peace. No deathly hour, no minute comes to mind.
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.
Weeks later, as I lay on a transfusion couch to receive two more pints of blood, the remnants of a huge man sat in the next chair. A tall Asian doctor, very lean, like a person who had been pressed inside a book, came and stood over the remnant beside me. “The sodium,” the man said.
“It was an experimental treatment,” the doctor said.
“Is there anything else?”
“That was our last,” the doctor said softly, hurriedly.
Neither the doctor nor the remnants of the huge man spoke. The bags of blood emptied slowly. The man was still. I heard his quiet weeping.
One evening in winter, I was the last one left in the transfusion room. There had been problems; the chemicals diminish the veins, the needle had to be sunk deep into the flesh. Reading had been difficult; the needle moved with the turning pages. I strained to see out of the windows behind me. The day had died in shades of gray. There was no music in the room.
I had progressed from a stretcher to a wheelchair to the walker that now leaned against my transfusion couch. Until that evening my wife had come to help me home after the transfusions. It was the rule: in the language of hospitals, no one could leave without an escort. But that evening I was determined to go home on my own. I did not know how long my wife could bear the burden of my care.
Plato had it wrong; the proof of the existence of the immortal soul is not waking and sleeping and waking again. Duration is the proper measure: waking 20,000 times together, and then, for reasons philosophers cannot understand, she, waking on one more morning to begin the dreadful day beside a sickly, hobbled thing. It was not without reason that I broke the rule and left for home alone. If the nurse would just help me up, I could get down the hall to the elevator and sit on the bench for a while, and then down to the lobby floor and through the long halls to the rotunda to rest again, and then to the taxi stand, where I could sit on the iron bench to rest until a taxi stopped for me.
Once outside, I breathed the awakening air. The transfusion was doing its work: there was oxygen again in my blood. I felt a passion to live. It was dizzying, a marvel of the kind that arrives in dreams. Had the feeling been pure, I would have been euphoric, like a child at the dawn of a new season. But death, once tasted, never leaves; it waits, and it is not patient.
Heidegger thought the expectation of death was the chief distinction between humans and the rest of the animal world. Modern scientists tell us how somewhere near the bottom of the order of living things, immortality reigns. It exists in cells of malign intent and perhaps in the hydra, that strange early-metazoan beast seen under the microscope by generations of high school biology classes. With this in mind, I now conceded to nature that the essential engines—heart and mind—are inefficient. We are condemned to entropy, losing our heat like cups of tea left too long while a poem is read or the Mets give up two in the sixth. Call it decay.
Each of us, in reveries, comes to see his own life as a grand and revealing metaphor of the world: a breath becomes a decade, a cough replicates a war, a birth betokens the invention of language, and illness explains the fall of nations. But the metaphor fails. Death is only a spur to life, not life in a different guise. In the months of recovery, I reconsidered the value of my life. While I was among the missing, the world did not come to an end, the loss of me was unremarked.
A year later, Jeffrey Tepler asked, smiling, “Did you see a light at the end of a tunnel?”
“No,” I said. “Nothing. Neither darkness nor light.”
Death shines a revealing light on the decay of both man and his social world. The hope for heaven recedes, replaced by the hope for home. In the dark hours, the business of death is to tell secrets, imaginings, histories marked and histories yet to come. The work of dreams, which in the death-ridden room are few, is to extol the generations and give them time and place: city, country, days, and decades. As Augustine said, “Love means I want you to be.” Coming back, I saw America with surprising clarity, as if it were a picture made of innumerable pixels crowded onto a tiny screen. Because death makes skeptics of us all, I questioned this clarity, fearing that it was not clarity but a kind of blindness, the glare of suffering.
But the world had changed. I perceived that I no longer lived in the beloved time of my childhood in America. Was that nothing more than an old writer’s regrets? I thought of Paul Valéry, “ni vu ni conn,” and looked again at what he had written in 1919, in The Crisis of the Mind. “The military crisis may be over,” he wrote. “The economic crisis is still with us in all its force. But the intellectual crisis, being more subtle and, by its nature, assuming the most deceptive appearances . . .” He went on to detail his perception of the crumbling that came after the deaths of 2 million German soldiers and almost 4 percent of the entire population of France. Death was his muse.
Valéry was the end of the line of writers of decadence, those elegant critics of the ghastly bourgeoisie: Rimbaud, Verlaine, Poe, Swinburne, Wilde. At the end of the nineteenth century in Europe they had first called themselves Decadents, by which they meant the loss of vigor in the society, the descent into gluttony and frills, not their own work, which was brilliant and original art and critique. Valéry blamed the decline (the original meaning of “decadence”) of the continent on what he called the virtues, a disorder of the mind grown out of “conscientious labor, the most solid learning, the most serious discipline and application adapted to appalling ends.” Too much science and too many virtues, he said, defining decadence in what was then the modern world.
He could have been writing about America in our time. I am an observer. I lie alongside my country, patriot of my body and my home, dying from an enemy within. Evening had come for me as it has come for America. How similarly we failed!
There was a moment in the Sixties when it was not madness to speak of a “Great Society,” when art ran ahead of the time and the new Decadents—Warhol, the Grateful Dead, Ginsberg, Kesey—were making a world of artifice, as Richard Gilman had described Decadent art. If they did not have the serious lives of critics, like Baudelaire and Huysmans, they were much like them in the vehemence of their detestations and the intensely decorative aspect of their work. It was decadence that the artists in France found in the consumption of vast amounts of goods produced by the new industrial revolution, as it is decadence that art and literature find now in political, social, economic, and artistic conservatism. They sing of it, paint it, write about it as a country without the courage to resist those who do not want it to be. Decadence wears a thousand costumes; it can call itself the “leader of the free world” or, like Lady Gaga, can tell Anderson Cooper on 60 Minutes, “Everybody wants to see the decay of the superstar.”
Decadence is the word of evening, vespers said by artists about the lives of men and nations.
In 1980 I attended the Republican National Convention in Detroit. Since the nominee was a movie actor, I wrote a screenplay about it that appeared in this magazine. Had it been greenlighted, by his second term the film would have borne the title It’s Morning in America. It was not. The moment was magical: a moderately successful movie actor who had hopped from left to right under the tutelage of his wife becoming president of the United States. I did not know then that evening was coming to America.
Perhaps I had missed a clue. It could have been this: Reagan’s “kitchen cabinet” assured me during the convention that their man did “not read books. He reads reports.”
Evening did not begin at that convention, nor during the election. The cell that multiplies, the killing thing, lies beneath the observable world. Reagan began his campaign in Mississippi, with a speech at the Neshoba County Fair, close to the place where three civil rights workers had been murdered in 1964. “I believe in states’ rights,” Reagan said there, close by what some Americans would call hallowed ground. “I believe that we’ve distorted the balance of our government today by giving powers that were never intended in the Constitution to that federal establishment.” He soothed and sweetened what had only the day before been moral disgrace. It was as if all the decadence of centuries had been gathered into a few sentences and said in the jelly-bean rhetorical style of Ronald Reagan. He carried forty-four states.
The ultimate effect of the work of the man with no philosophy was to be a philosopher: he removed ethics from politics. Everything followed on his elegant excision, an operation performed so deftly on the body politic that it did not feel the wound.
The disease that Reagan brought into the American mind was like the terrifying shadow the patient sees in X-rays clipped to a light box. It came from nowhere and appeared in the body of the country. There is a magic quality to the decline of men and democracies. Historians and histologists study the tissue, identify markers, but only after the decline has begun can they do their work. No doctor, for all that she might wish to heal the heart or soul, can predict the onset of the fouling of the tiniest part. One cell must be the first to sicken and then sicken another. The beginning is the magic.
The origins of evening must have begun in some undiscovered place. I have heard a surgeon searching. “The node is near the carotid artery and a very important nerve,” he said as he began cutting into what had been the brightest light on the Christmas-tree pattern of the invasion of my body. He said they all appeared to be knotted together inside a muscle under the skin.
Aristotle said that the political body is nourished by ethics, but he did not persuade me that a lack of ethics would bring down the darkness over the grand American experiment. I thought that a democracy so blessed, so brilliant, could survive without ethics. I was a young man then, and I did not believe in death. At the Republican Convention in Detroit, I laughed during the speeches and interviews and did not shiver as I had in San Francisco when Barry Goldwater urged the country, in his furious, slightly crazy way, to abandon reason in the defense of reason. The Detroit convention did not have an aura of seriousness: a movie actor could not waste the ethical nourishment Roosevelt and Johnson had given to the body. Hadn’t I stood with the speaker of the House, Sam Rayburn, and Lyndon Johnson and heard Rayburn say about the candidate for vice president, “Lyndon Johnson is following in the footsteps of Franklin Delano Roosevelt”? Only sixteen years after Goldwater was made into an American laughingstock by a television commercial showing a little girl counting down daisy petals to the instant of nuclear holocaust, Reagan went to Mississippi to say good riddance to ethics. Hadn’t I been there in the room with Reagan when he spoke to the Republican black caucus and could not remember the name of a single person present? Why should his remarks at the Neshoba County Fair have been a surprise?
In the eighteenth century Francis Hutcheson had said that the greatest good is the happiness of others, and Reagan’s philosophers—Kristol, Cheney, Bush, Podhoretz, Falwell, Strauss, and Bloom—had said it is not so. Benevolence disgusted them. They spoke of natural law, but what really occupied their thoughts was a return to the Hobbesian state of nature in which every man is pitted against every other and the only duty a person has is to himself.
Without ethics, politics has no limits. America broke the rules of living systems, and lost its balance. All the oxygen flowed to a smaller and smaller section of the body politic. The history is brief and unquestionable: close to toppling, the society momentarily pulled itself upright, and then became even less ethical, less balanced, more endangered than ever as a lawless financial system came back from death, and like a foolish patient after a heart bypass operation, continued in its old ways. With no ethical component to national politics, President Obama could deliver his 2011 State of the Union speech without ever mentioning the word “poverty,” although one in every five American children lived in poverty. Without a commitment to Hutcheson’s idea of the greatest good, which is at the core of the original American philosophy in Jefferson’s drafting of the Declaration of Independence, this may no longer be the brilliant experiment. If happiness is for the few and it produces unemployment approaching that of the Great Depression, then the shadow of evening is here.
Death is the moment when evening passes into night. I know. There is no surprise, and it often comes after a long sickness that is worse than death. When I died, I died of many things: the failing systems; the weakening of age; the exhaustion of the long war against dying. Finally, I succumbed to the lack of ethics in a California hospital, killed by filth and neglect.
I have wished for many years to be a physician to my beloved country. The means to care for it is clear. I was revived by love and ethics. And I am not unique: no man, no woman is a metaphor; that is the place of gods. I do not know who will take America in their arms to revive her.
No nation is forever.
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