by Ayad Akhtar
If not fully reformed by the reversal of fortune, Father was certainly chastened for a time. He returned to his position as a professor of clinical cardiology at the university and threw himself back into a career of research, for which, despite his misgivings, he was clearly suited. Indeed, after just three years back in the academy, he found himself once again at the top of his field and on an awards dais, handed a medal for his recent studies of a little-known disorder known as Brugada syndrome. It was the second time he’d won the American College of Cardiology’s Investigator of the Year award, making him only the third physician in its history—and likely the most insolvent—ever to be honored twice in a career.
It was Father’s work on Brugada, a rare and often fatal arrhythmia, that led to his first meeting Donald Trump.
* * *
In 1993, Trump’s troubles were still legion. He’d gone to his siblings to ask if he could borrow money from the family trust to pay bills. (He would go back for more a year later.) He was forced to give up his yacht, the airline, and his stake in the Plaza Hotel. The bankers overseeing the restructuring of his holdings put him on a strict monthly allowance. And in the press, there was no relief: his mistress, Marla Maples, was newly pregnant, and his press-canny, now finally ex-wife was destroying him in the court of public opinion.
In short, he was going through a lot. So it wasn’t entirely surprising to either Trump or his doctors when he started to experience heart palpitations. As Trump described it to my father, he first felt the alarming sensation while golfing on an unusually hot morning in Palm Beach; he felt something strange in his chest, like a pounding on a distant drum; then he felt faint. When he sat down in the golf cart to rest, the pounding neared, grew more intense: “It felt like my heart was being slammed around inside that big empty drum.”1
A few days after the palpitations on the golf course, Trump was having dinner at the Breakers, then the premier luxury resort in Palm Beach. He hated the Breakers—or so Father recalls him explaining at some length during their first patient exam—but had to go to the dinner there because he was meeting a member of the city council who, Trump thought, knowing how much he hated the Breakers, had probably scheduled dinner there on purpose. Trump’s application to turn Mar-a-Lago into a private club was still pending, and he needed all the support on the Palm Beach city council that he could get. So the Breakers it was, even though he said the food was gross and overpriced. “Just wait ’til I get my club running. We’re going to bury the Breakers.” He’d ordered a bone-in rib eye—“Always well done, Doc. Because I don’t know the kitchen, and I don’t know what filth they’ve got back there. Who’s cooking what. Touching the food. The only way to be safe—steak, fish, whatever. Well done. Unless it’s my kitchen, and we’re gonna have a great restaurant at Mar-a-Lago, the greatest, but see…I’ll still have it well done there, too. I just think it’s better that way”—and just as the food came to the table, Trump said he started to feel faint. He got up and excused himself to go to the restroom, where he couldn’t believe how pale he looked. Once again, he felt that sensation he’d felt on the golf course, his heart rattling around as if inside the skin of an empty drum. He knew something was wrong. He knew he needed to get home.
It was a short distance to Mar-a-Lago—just three miles—but as soon as the car pulled out of the parking lot, he started to feel worse. Along Ocean Boulevard, he asked his driver to stop the car, and that was it. The next thing he remembered was lying on the sidewalk, hearing the waves. His driver would later tell him he collapsed facedown into the rear footwell. The driver would get out and turn him over, finding Trump’s eyes rolled back into his head. He couldn’t find a pulse on Trump’s wrist or neck, couldn’t hear a beating in his chest. The driver shook him hard, and then, just as abruptly as he’d fainted, Trump came back to. Color rushed into his face; the veins in his forehead started to pulse. Dazed, he got out of the car and lay down on the sidewalk along the beach. Listening to the steady rhythm of waves washing onto the shore, he would later tell my father, seemed to make the strange beating in his heart subside.
Doctors’ examinations over the following days and weeks pointed to a cardiac event, but Trump’s heart muscle itself was healthy, his coronary arteries clear of any occlusion. A further battery of tests resulted in a pile of EKG strips that showed an occasional pattern the specialist in Palm Beach had never seen before. It had the vague contour of a shark fin. Even as late as 1993, most cardiologists didn’t know that this is what Brugada syndrome looks like.
The strips were sent to Mount Sinai Hospital, in New York, where a cardiologist on staff referred them to my father, in Milwaukee. Considered the leading specialist in Brugada in the States, second in the world only to the Brugada brothers, who had identified the syndrome at their labs in Belgium, Father was accustomed to EKG strips and patients pouring into his lab from across the country—and, later, from the Far East. Indeed, Trump wasn’t even the first person of some fame whose case had come his way. The year prior, Father was flown first class to Brunei, where he examined the sultan himself in a lab that had been outfitted to Father’s specs by the time he’d touched down in Bandar Seri Begawan. Though Trump was no monarch—at least not yet—he wasn’t about to get on a plane for Milwaukee, either. So Father was flown—again, first class—to Newark, where Trump’s helicopter was waiting for him. He flew into a heliport along the Hudson River, where a car picked him up and drove him to Mount Sinai. Ushered into one of the exam rooms, where the equipment was set up for a battery of tests—the usual twelve-lead EKG, followed by a stress test, and if neither induced the Brugada arrhythmia, there was an option to inject an alkaloid through an intravenous line—Father waited for his patient to arrive. But Trump never showed.
That night, in the room at the Plaza Hotel that had been arranged for him, Father’s bedside phone rang just as he was falling asleep. It was Donald himself. What follows is my approximation of their conversation, shaped by Father’s recollection of, above all, the man’s solicitousness:
“No one seems to know how to say it, Doctor.”
“Nothing new there.”
“How do you say it?”
“Ak-tar.”
“So Ak, like in Oc-topus.”
“That works.”
“But is that how you say it? Where you’re from?—Where are you from?”
“Pakistan.”
“Pakistan—”
“And we pronounce the name differently there.”
“I’m talented. I can say it right.”
“So we say Akhtar.” Father reverted to the native kh guttural sound that no white American in his experience had ever been able to master. There was a moment’s silence on the other end of the line.
“Oh, that sounds hard. I don’t know about that, Doctor.”
“Ak-tar is fine, Mr. Trump.”
They both laughed.
“Okay, okay. Ak-tar it is. And you call me Donald. Please.” Trump then proceeded to apologize for missing his appointment. Disarmed by his warmth, Father demurred. Trump asked if his room was big enough: “It’s New York City. Hard to feel like you ever have enough space. But I had them put you in a nice suite. Do you like it? We redid those rooms when I bought the place—”
“Mr. Trump—”
“That hotel is a masterpiece, Doctor. The Mona Lisa. That’s what it is.”
“Mr. Trump—”
“Call me Donald, please—”
“Please excuse me, Donald, but I didn’t come to New York to stay in a nice hotel. I came here to help you. I’m not sure you understand how serious this problem with your heart could be. If you have Brugada, I’m not exaggerating when I say you are a walking time bomb. You could be dead tomorrow.” There was silence. Father continued: “I’m flattered to receive the royal treatment from you, Donald. I am. But I just came from Brunei, where I treated the sultan of Brunei. He is a king, and he was on time for his appointment. Because he understood that if he doesn’t get it taken care
of, he might be dead tomorrow.”
“Okay, Doctor,” Trump said blankly after a short pause. “I’ll be there. What time?”
“Eight a.m.”
“I’m sorry I missed it today. I’m very sorry, Doctor. It wasn’t respectful of you. Or your time. I apologize. I mean it.”
“It’s fine, Donald.”
“You forgive me?”
Father laughed.
“Okay, good. You’re laughing,” Trump said. “I’m sorry about today, but I will be there tomorrow. First thing. I promise.”
* * *
Early in the campaign for the 2016 election, when there was all the anatomizing of Trump’s character and his style—and the speculation about his real chances—one thing much repeated was that Trump did not know how to apologize. As he careened from one lie and ill-advised faux pas to another, it was endlessly remarked that the man seemed incapable of saying he was sorry, even when it might have helped him. To admit you were wrong meant to show weakness, and this, it seemed, ran contrary not only to his every business instinct but also to the very rule of his being. An unmistakable contempt for weakness is what I gleaned from every boardroom firing of The Apprentice I ever saw. Invariably, the contestant who ended up on the other side of Trump’s jab-and-sack signature line, spat out onto Fifth Avenue, forlorn, ferried—via black limousine—far from the Olympian suite near the top of Trump Tower, where the remaining aspirants sipped Champagne and celebrated the wisdom of Mr. Trump’s choice; invariably, that contestant was the one too willing to share blame, too willing to admit that a team failure was probably just that, failure of a team, not of a sole individual. In his on-screen role, Trump’s bewilderment over such displays of levelheadedness and camaraderie struck me as bizarre. Was it really possible he believed blaming someone else to save face was a legitimate business strategy? Of course, we now know it to be much more than that, something closer to the summum bonum of the Trumpian Weltanschauung. It’s likely that the real role he played was with Father that night on the phone—and the next morning, when he showed up to his examination on time with two cups of coffee and a small white gift box containing a LOVE LIFE! lapel pin, which he hoped Father would accept as a token of his contrition. My father would never forget the gesture.
To think: all it took was a worthless trinket Trump probably pilfered from the gift shop at Trump Tower for Father to feel justified, years later, in dismissing all that chatter about the man’s not knowing how to apologize: “If they only knew him,” he would hiss at the pundits on TV—and usually by way of yet another reminder about that lapel pin: “If they knew him, they wouldn’t say these things. They would know they were wrong.”
* * *
It would take years to get to the bottom of Trump’s malady. Though Father still thought Brugada was possible, he wasn’t sure. There was little margin for error: Brugada, untreated, was usually fatal. But the only treatment was an implanted defibrillator, which Trump didn’t want unless Father was absolutely certain it was necessary. Father couldn’t give him that assurance, for the shark-fin form characteristic of Brugada hadn’t recurred on any of the Holter monitor strips or during the biannual exams Trump flew Father to New York to perform. There were no further fainting episodes, though Trump did continue to report feeling that strange empty rattling in his chest from time to time. He would feel it, get winded, then sit down and wait for it to pass. Certain that these were incidences of arrhythmia, but perhaps not of the Brugada variety, Father prescribed a mild beta-blocker and a daily hydrating regimen. For four years these seemed to keep the troubling symptoms at bay.
By 1997, innovations in gene testing made it possible to know for certain that Trump did not have the life-threatening heart condition that his earliest EKG strips had been thought to reveal. With a diagnosis of Brugada off the table, the rationale for Father’s trips was gone. The visits stopped. Trump never called again. In truth, Father never had all that much face time with the man outside the exam room at Mount Sinai. Apart from the morning heart tests, there’d been the occasional lunch or dinner, the comped suite at the Plaza, the one trip to Atlantic City, where he sat at a baccarat table and lost $5,000 in ten minutes while Trump looked on over his shoulder. It wasn’t reasonable for Father to feel as close to Trump as he did, but such things are rarely reasonable. He went into a kind of withdrawal—mourning, really. The simple mention of Trump’s name—on the nightly news, or in the daily paper—could conjure his gloom and send him into brooding silence.
Eventually, though, the trips to New York resumed. Under the pretext of attending some medical conference or other with only the most tangential connection to his field, he would fly himself first class; book a room at the Plaza; have dinner at Fresco by Scotto (where he and Donald once slurped spaghetti and meatballs); head to a fitting at Greenfield Clothiers in Brooklyn, where Trump’s suits were tailored and where the staff still referred to Father as Mr. Trump’s doctor; and call the person I would later gather he missed even more than Trump himself—a hooker by the name of Caroline. I wouldn’t learn of her existence until after my mother died, and when I did, I admit I was taken aback. Not that he’d been unfaithful but that he’d been paying for it. I grew up with the image of my father as an oversize Boy Scout, a feckless if well-meaning puer aeternus, bumbling along on the force of his natural gifts. He was not, I’d have said, much interested in the seedier side of life. I was wrong. Father’s first visit to a prostitute required little more in the way of goading than some “locker-room talk” between procedures one afternoon, which had Trump waxing jubilant about the surpassing solaces of professional sex. Noting Father’s saucer-eyed interest and divining his lack of experience, Trump gave him a number. I don’t doubt Father probably hung up a few times before he replied to what I imagine was a silken greeting from the other end of the line, a madam’s voice at a private club in the East 40s—a brownstone not far from the UN—where, on the second floor, Father picked his poison, a petite, buxom blonde with a long face whom Trump, too, had apparently “known” and who was reputed to have a mouth of velvet. Father fucked Caroline for fifteen years—exclusively, I would later gather (aside from my mother, of course). I would learn of her existence when I discovered I had a half sister in Queens, though this is not the moment for that Pirandellian tale. Suffice it to say Trump’s faux largesse—or, rather, Father’s longing to live in a tawdry, gilt-and-gossamer penumbra that masqueraded as largesse—this has had an outsize effect on the Akhtar family. And it accounts for something no one understands: my father supported Trump’s election, and he supported him well past the point that any rational nonwhite American (let alone sometime immigrant!) could possibly have justified to himself or anyone else. And, yes, the blow-by-blow of Father’s enthrallment with candidate Trump, first nascent, then ascendant, then euphoric, then disappointed, then betrayed and confused, and finally exhausted, a gamut of intensities whose order and range are proper to the ambit of all addiction—yes, a granular account of Father’s addiction, his ceaselessly shifting emotions, his evasions and avowals and disavowals, the steady shedding of his civility, the daily obsession, the ad hoc rationalizations—all this might be of value to note, to show, and, in the process, through this unlikeliest of American Muslim lenses, to reveal the full extent of the terrifying lust for unreality that has engulfed us all. Yes, it might be of value, but I don’t know that I can bear to pen it. I love my dad. I think he’s a good man. I can’t bear to invest a writer’s weeks and months—let alone years!—on a portrait of my father as menacing dolt. And so an afternoon’s glancing views will have to do.
To wit:
A breakfast place in Waukesha where we were the only nonwhites enjoying brunch the weekend after Trump entered the race with those infamous remarks about Mexican immigrants being rapists and murderers. “I don’t know what you’re so worked up about. He’s a showman. He’s drawing attention. He doesn’t really mean it.” “Then he shouldn’t say it.” “You’re not a politician.” “Neither is h
e.” “That remains to be seen.” “You’re not telling me you think this is a good idea.” To which Father didn’t respond, only gestured at the busboys in their Mexican football team jerseys: “Anyway, these people need to learn English.”
And:
His avid, mounting glee during the primary debates, as Trump insulted the other candidates. “Look at them. Wax dummies, every one. Empty suits, empty words. They deserve every bit. He’s just saying what everybody already thinks.”
And:
Trump’s proposal for a Muslim database, for which, oddly, Father didn’t believe he would have to register. “I don’t pray; I don’t fast; I’m basically not Muslim; you’re the same; he’s not talking about us. And anyway, I was his doctor, so we don’t have anything to worry about.”
And:
The mental contortions he performed to make sense of Trump’s nonsense, which made me wonder if he was going senile. “Everything he says about the media is right. It is rigged. Rigged to make money. Think about it. They don’t report news. They sell it. And what do you think they’re selling? Hmm? That Donald can’t win. That he won’t win. But the more votes he gets, the more that story isn’t true. Everybody knows this is a lie. He’s rising. They’re trying to keep him down. He’s a fighter. You know what a fighter does? He fights. That’s why we love him!” (Huh?)
And:
The eruption of bigoted views I’d never known he’d espoused. That whites were lazy, and all they really cared about were their weekends away and their summer vacations; that blacks didn’t like to pay their medical bills because they still had a slave’s mentality and saw the system as a master to be rebelled against; that women had a deeper understanding of life because they had to give birth and were built to suffer, which is also why they wouldn’t care that Trump said nasty things about them—they ultimately expected it; that Muslims were backward because the Quran was nonsense and the Prophet was a moron; that Jews were neurotic because their fathers didn’t know how to shut their wives up so the mothers drove the children crazy; and that’s just what I remember without having to think too much about it.
