One Saturday, “two attractive women” came into the store who were “dressed provocatively.” He didn’t remember if his father had a fitting room but he said these women didn’t seem to mind whether people saw them trying on a dress or undergarment right there in the middle of the store. “While Pa was fitting them, I watched very closely from behind a row of ladies’ wear because I had never seen a woman’s breasts exposed before.” It was “quite a revelation” for an adolescent boy—and, he said, “more than an adequate reward” for giving up a Saturday to help out at the store.
Now, sitting in the nursing home, I had the brief temptation to make some passing mention of his father’s store to see what other memories it might perhaps arouse. But Daddy’s voice had trailed away after saying what he did about learning how to sew. And he was getting drowsy—it was nearly time for him to go to bed. Whatever else was brewing still within that “life beneath the life,” floating somewhere in that dreamlike state, I had no way to know.
CHAPTER FIVE
Clinical Considerations: “All Tests Negative”
My father underwent a sudden crisis in his health in the autumn of 2001. It was the first time I was forced to face the possibility of losing him.
He had been having stomach difficulties of a mild nature for a week or more, until several days went by in which he passed no stool. Stomach problems of this kind, if not corrected promptly, are among the commonly precipitating causes of mortality in people of his age. Other familiar causes are infections of the urinary tract and swallowing and respiration difficulties. For this reason, vigilance in recognizing early warnings of these dangers is regarded as a matter of the highest order.
But the doctor who supervised the care of patients at the nursing home either wasn’t made aware of my father’s situation in a timely manner (his relationship to patients seemed to be quite indirect and, as Lucinda had confided in me, he was seldom there) or, knowing about it, chose to issue no instructions to the staff. For whichever of these reasons, the personnel on duty failed to make adjustments in my father’s diet or administer a routine kind of enema before the problem grew severe. As a result, a blockage had developed in my father’s rectum with an extensive backup into his large intestine.
I was in Seattle and Los Angeles that week. Lucinda was with her children on a holiday in Arizona. Alejandro also was away, and Silvia was preoccupied with funeral arrangements for one of her relatives. A new attendant, who was filling in for them, apparently did not have experience enough, or feel she had authority, to intervene.
When the medical director finally grew aware of how advanced the problem had become, he ordered an extreme and dangerous procedure in which a tube was forcibly inserted in my father’s rectum and then as far as possible up into his colon.
My father, according to the temporary helper, “was screaming from the pain,” but the person who was handling this instrument kept right on and thrust it into him more deeply. I was never able to find out from anyone responsible the sequence of events that followed next. It appeared, however, that the pain my father underwent, possibly compounded by damage to the lining of his colon from the penetration of the tube, had sent him into shock.
“The instrument they use for this,” according to a doctor who explained this to me later, “is not only very long, twelve to sixteen inches typically, but it also has to be inflexible enough to break right through impacted stool, which can be as hard as stone, or get around the stool somehow to penetrate the colon. This is why procedures like this, which involve excruciating pain, need to be avoided.
“Well-trained doctors never use this method anymore. We teach our students to ‘dis-impact’ a patient’s stool by hand, which does not incur the risk of causing a perforation of the colon and introducing an infection to the patient’s bloodstream.
“In any event,” he said, “so long as you monitor the patient very carefully, you shouldn’t need to get into this situation. Especially for someone of your father’s age, what he was subjected to was, frankly, inexcusable.”
I was on the plane returning from Los Angeles on the day that all of this occurred. As soon as I landed, I found on my phone an urgent call from Silvia telling me to call the nursing home. When I did, someone at the nurses’ desk told me that my father had been put into an ambulance, which, she believed, had taken him to Mount Auburn Hospital in Cambridge.
Upon arriving at the hospital, I was told that he was in Intensive Care. Once I was identified as my father’s son, one of the nurses brought me to his side.
I had never seen my father in a state like this before. His eyes were open, but his face was very pale. I leaned down close to him and spoke into his ear, and he looked up and seemed to try to speak; but he could not. When one of the residents took me aside to prepare me for the worst, I went out to the terrace of the hospital in order to decide if I should call my mother. I knew she’d want to see him if it became likely that he would not survive, but I didn’t want to frighten her if I didn’t need to. Instead, I tried to reach Lucinda but had no success—I didn’t know at that time that she was away. With that exception, I remained there in the ICU or in a waiting room nearby. At some point after midnight I was told he had been stabilized and was no longer critical.
The following day I made up my mind to have him transferred to the MGH, which, as I realize now, was almost certainly unnecessary. I suppose I’d simply been conditioned by my father’s long involvement with the MGH to believe that this must be the very best and safest place for him to stay while he was recovering.
In less than a week, he had returned to what physicians spoke of as his “baseline,” a term employed to indicate his physical and mental state prior to the crisis he had undergone. At that point, I had to decide whether or not he should continue living at the nursing home.
In view of the apparent dereliction of the medical director, this was not an easy matter to resolve. It was only after talking with Silvia and Alejandro that I decided it would probably be best not to search around for another nursing home but to return him to a place that was familiar to him. I knew that Lucinda, now that she was back, would be looking after him with more than her usual attentiveness. I also knew that the companionship she gave him was not likely to be replicated in another institution, where no one on the staff would have her knowledge of his past experience and her understanding of his personality to draw upon in providing mental stimulation for him.
All in all, I think it was the right decision. The possibility, however, of a very different kind of alteration in the setting of my father’s life would develop slowly in the months to come.
—
One afternoon a few weeks later, I opened up a number of the large sealed crates my father had insisted upon shipping to my house about twelve years before. Until this time, I had never felt the will to look into those boxes. Now, in the wake of the crisis he’d been through, I felt a sudden longing to immerse myself in whatever memories those packages might hold.
One of the crates I opened first contained a collection of notes and notebooks, case records and reports from his years in medical school and the years just following. Among these items, in an inexpensive frame, was my father’s medical diploma. His day of graduation was June 21, 1934. In the same crate, also framed, was a certificate attesting to the period of time in which he’d done his internship at the MGH and stating he had “faithfully served as the East Medical House Officer in the Massachusetts General Hospital during the 19 months ending January 31, 1936.” Under this certificate was a pile of file folders, held together by thick elastic bands, containing papers and case histories he’d written between 1936 and 1938, when he did two residencies, first at the Boston Psychopathic Hospital (now known as Massachusetts Mental Health), then at the Phipps Clinic of Johns Hopkins Hospital in Baltimore.
One of these papers, which I read with difficulty in his original handwritten version, was titled “A Case of Thalamic Syndrome Treated by Excision of a Cyst.” The first
section was the medical history my father had prepared, which described the patient, “a thin, frail, middle-aged woman,” as having been admitted to the hospital “because she had complained of paroxysms of spontaneous pain” and “in hope of finding how much [of the] patient’s pain is real or imaginary.”
The patient, “the second of non-identical twins,” my father had written, had been “a transverse presentation” and “was delivered after much manipulation and instrumentation.” Following birth, “there was considerable delay and difficulty before breathing was established….In 1900, at the age of five, she was seen at the Children’s Hospital in Boston, where multiple contractures were observed on the left side of her body. Palliative surgical procedures were begun. Since the age of seven, there had been convulsive seizures, usually nocturnal….
“Examination of the cranial nerves” showed that “odors are poorly or not at all recognized through the left nostril. Vision is poor in the left eye….There is atrophy and paresis [i.e., partial paralysis] of the left side of the face….Hearing is diminished on the left. Taste on the left side of the tongue is less acute than on the right side, and at times is absent. Sensation on the left is also markedly abnormal. Once any sensation is produced, it is characterized by an unpleasant, at times painful quality….There is no discrimination between sharp and dull objects….A warm object is not described in thermal terms, but when ice is applied the patient screams that she is being ‘burned.’ ”
He concluded that the pain of which the patient had complained was by no means imaginary. An electroencephalogram he administered two weeks later led him to believe there was a cyst on the right side of the woman’s brain. A senior physician he called in for consultation believed that it had “almost certainly resulted from birth injury….A decision to operate was made after much discussion. The patient readily consented….”
The surgery, my father wrote, turned out to be successful (“since excision of the cyst…, patient has been free of sensory discomfort and has had no further seizures”), although he also noted adverse side effects and he appended several qualifications in speaking of the favorable outcome. “One’s enthusiasm” for the procedure that had been undertaken should, he wrote, “be tempered” for these reasons.
Why did this material and the other cases in those file folders seize my fascination? The simplest reason, I suppose, is that they enabled me to follow my father in such a detailed way through several hundred hours of his work at a time, five months before I came into the world, when he was developing the clinical self-confidence as well as the cautious and self-critical capacities that won him the respect of the older doctors whom he looked on as his mentors. I noticed, for example, many phrases he’d crossed out, apparently because he felt that they were not sufficiently supported by the evidence of his examination. It was also obvious that he took a liking to the patient—“friendly and sociable…, an interesting raconteur…, she enjoyed conversations,” a notation similar to many he would make in its appreciation of a patient’s amiable qualities, if he thought the patient had such qualities, in case studies he would write for years to come.
Another set of documents, one I read with even greater interest, was a collection of my father’s long summations of the cases of some thirty patients he had treated at Johns Hopkins, where he spent the following year on a Rockefeller grant under the direction of a Swiss-born psychiatrist, Dr. Adolf Meyer, who was one of the seminal figures in American psychiatry in the period when my father worked with him. (Dr. Meyer is generally credited by medical historians with having moved psychiatry in the United States “out of the asylum” and into the world of academic medicine.)
Under these summations, I discovered three large charts my father had made by pasting sheets of paper to a cardboard backing, each of which was three feet high and more than three feet wide, and which he’d apparently posted on his office wall to keep track of the progress of these patients. Each case had been described in eight sequential categories, starting with “Complaints and Symptoms,” moving on to “Physical Findings,” “Situational” and “Conditioning” factors, “Personality,” “Heredity,” “Treatment,” and “Results and Follow-up”—all of which ran across the full length of the charts and under each of which he’d crammed as many details as the space would hold.
In one of the seemingly less complicated cases, a woman, eighteen years of age, “hasty marriage, premarital pregnancy, difficult labor,” had complained of a “choking feeling in [her] throat…, gasps for air, hands get numb, feels as if going to faint. Very much afraid.” Under “Physical Findings,” he had written, “Pt. is asthenic [i.e., of slender build] and underweight. Pulse 110. Reflexes ++. Blood pressure 125/60. E.E.G. negative.” Under “Treatment”: “Explain to pt. [that] physical findings [are] negative. Candid discussion w/ patient of probable causation. Anxiety attacks appear to be induced by fear of second pregnancy. Contraceptual diaphragm prescribed.” Under “Results and Follow-up”: “Uses diaphragm. No more numbness, choking sensation. No more fears. ‘Not a single attack since….’ Very happy now w/ husband.”
In another case, that of a man twenty-seven years of age who had recently been fired from his job, “pt. suffers panic attacks, fear of death, palpitations, tingling [in] both arms, urge to defecate, profuse perspiration.” Following his job loss, “sexual anxiety, insecurity. Pt. in love w/ woman in Florida, [but] fear of gonorrhea. Feels compulsion to escape, ‘get up and get out of this relationship.’ ” Under “Treatment”: “Discussion w/ pt. delineating factors precipitating [these] attacks. Explain etiology….” Under “Results and Follow-up”: “Much improved. Fewer attacks.” In a second follow-up, dated some months later: “Affair in Florida going nicely. Expects to marry in one year….”
In one apparently more complicated case—a man forty-three years old “in business in Manila” who was suffering “constriction in [his] throat,” “feeling of impending death,” “anxiety attacks since 1928”—my father had asked Dr. Meyer to participate in the examination.
“Pt. describes attacks to Dr. Meyer: ‘[Feels] the way a man would feel if he had just fallen off a tall building. Terrified. Nothing can be done. You are finished. Just waiting to hit!’ ” Further along, my father noted, “Pt. raised by hysterical aunt….Continually taken to doctors in [his] childhood. Lifelong hypochondriasis. Pt. indic.s castration fears….” Under “Heredity,” he had written, “Paternal uncle: suicide. Father alcoholic. Mother carefree, luxury-loving, eloped w/ another man [and] deserted children. Pt. the youngest. One sister: beautiful, extravagant, married 3x….” My father’s residency, it appeared, had come to an end before the case had been resolved. His last notation was the name of another doctor, perhaps another resident, to whom the patient’s care had been assigned.
A neurologist in Boston to whom I later brought a number of these documents indicated that the emphasis and language in these clinical reports would in very few respects be regarded as archaic nowadays as a result of recent breakthroughs in our understanding of brain physiology. He also noted that the entries on these charts were of much historic interest because they reflected with fidelity the holistic theories for which Meyer was known and which incorporated “situational and social factors in the genesis of illness”—and not exclusively, or even primarily, episodes of trauma during childhood. These contemporaneous factors, he observed, were all too frequently dismissed by “rigid psychoanalysts” who were “blinded and dogmatic followers of Freud.”
Perhaps, he said, one of the most important contributions that Meyer had made was his insistence upon highly detailed record keeping, which was not a common practice in American psychiatric institutions prior to his day. The diligence my father had invested in the preparation of those charts, which were so long they had been folded over several times in the first crate I had opened, set a pattern of exhaustive detail in the writing of case histories to which he would adhere for his entire career.
—
There were many
far more personal items and idiosyncratic treasures buried in that crate. There were letters, for example, from people he had treated while he was a resident at the Boston Psychopathic who, upon recovery, had sent him notes of gratitude, apparently believing that a young physician less than two years out of medical school must deserve the credit for having worked “a miracle,” rather than the more experienced physicians who were his superiors. Indeed, as early as 1931, when he was in medical school but was working part-time in the evenings at McLean, one of the patients he had helped to care for, a woman from Connecticut, wrote to ask if he’d have time to provide a “follow-up consultation” to her and her husband if they came up on the train to Boston! Attached to the letter by a rusted paper clip was the draft of a good-natured note in which my father had explained to her that he was only a medical student and not yet a doctor.
Incongruously packed into the midst of all of this was a pile of letters, tightly wrapped in a thick piece of cord, that my mother had written to my father while he was doing his internship at the MGH, as I gathered from the postmarks on the orange two-cent stamps that were on the corner of each envelope. I counted exactly fifty-one letters, which my mother had mailed to him every single day during a period when they were apart, except for one day when she sent two letters. I opened only three of them, feeling like a spy. They were love letters of a very tender and old-fashioned kind. Beneath the letters was a slender book of mischievously romantic poems by Edna St. Vincent Millay. I couldn’t tell which of them had given it, or sent it, to the other.
In the subsequent weeks, whenever I had time, I gradually looked through several of the other boxes stored here at my house. Of all the items I discovered in these boxes, the one that awakened by far the most nostalgic memories was the old black doctor’s bag my father carried with him when he was seeing patients at a hospital or sanatorium. The bag, which displayed all the signs of wear and tear one would expect from being used for all those years (patches of medical tape had been applied around the handles where the leather had peeled off), was still secured by a heavy metal clasp. My father had attached the key by a piece of wire when he sent it to me.
The Theft of Memory Page 6
