Open Heart

by Jay Neugeboren

  I tell Dr. Cabin and Rich that Dr. Hashim wants me on Norvasc for a full year. “Surgeons!” they each exclaim, shaking their heads; they both say they think Dr. Hashim is being overzealous in order to protect his “artistry,” and that in their opinions I could stop taking the Norvasc now.

  “If the arteries didn’t spasm in the first four weeks, they probably won’t spasm for the rest of your life,” Rich says. Still, I continue taking the Norvasc. When I tell Rich of my decision, he laughs.

  “It’s amazing,” he says. “Here you are, a bright independent-minded guy who actually has researched these things and knows a good deal, yet even you succumb to the infamous ‘authority of the doctor.’ Do you see what power we’re invested with? Can you imagine how awful it is—and I see it every day—when this power is coupled with arrogance and, too often—though not in your case this time, thank God—in the least competent doctors?” He sighs, says something about surgeons being brilliant from the wrists down, and then: “Your reaction’s a sobering reminder of just how vulnerable and defenseless patients are most of the time.”

  After the trip to New York, I go on an “author tour” (Boston, Washington, D.C., Chicago), do some local readings, and continue to work on new projects, to swim and to play tennis and basketball, to spend time with family and friends, and to help Miriam and Seth plan their wedding.

  On May 30, I celebrate my sixty-first birthday (“Peaceful happy day for me. V quiet, and that seems right: transition between lives. And now and now—the rest of my life”). And the next day: “Hard to recapture this a m the easy, peaceful, deep reflective feel of my new life, new sense of life: love talking with my old buddies, they get me through.”

  And then this: “In absence of an on-site family, these guys are my family it would seem…suspect this is so for many of us these days: friends doing for us what extended families used to do.”

  Arthur agrees. “I’ve done a lot of thinking about friendship,” he says. “Like you, I’m a man who has always enjoyed the company of women, and I have, generally, found women more interesting than men. But it’s very hard to have a long-term relationship with a woman if you’re married. This doesn’t have to be the case, of course. If I were a different kind of man I might have had more women friends. And I did, and do, have women friends, but the friendships were not of the same order as they are with you and me, with Phil, with Jerry. I mean, think about this: how many women that you were friends with in high school have you kept in touch with? And why not?

  “We maintain no women friends from high school, and lots of male friends, and I think part of why this is so comes out of what I think of as a general cultural experience, which is that men have a way of relating, for the most part, that is different from the way women relate. Women are much more likely to talk about their feelings about each other with each other. ‘I was very disappointed that you didn’t come to my party,’ a woman will say. ‘It hurts me. All the important parties that I have—somehow or other you don’t come to.’ Now, a man’s response in the same situation is not to say anything, but, instead, to take a step back. Men titrate the distance rather than work through an issue directly, and for the most part this makes relationships easier.

  “There seems to me a kind of unspoken agreement among men—and remember: this is in my experience, in my friendships—that we don’t confront each other about the mishegas— the craziness—that goes on in our relationships day to day. Most of my friends, like you, are Brooklyn men, and we went to the same high school, the same college, have the same cultural background, the same value system pretty much—our politics, our way of looking at the world. And there is a kind of implicit assumption that life is hard for all of us—we get our balls busted at work, and in a variety of other ways, and our friendships are a place to be in a nonjudgmental, let’s-take-what-we-can and enjoy-what-we-can-from-life attitude, whether it’s talking about women, whether it’s burping, whether it’s recalling happy days.

  “Because it’s like a vacation from life, and it is not going to be intruded upon by confrontations that involve expressed verbalizations of negative feelings—‘You hurt my feelings, I never treated you this way, et cetera, et cetera.’ And I think women are much more likely to try to talk through conflicts, and the more you try to do this—I’m talking primarily about men—the higher the tension level, and the less you do it, the less likely there will be discomfort, and the easier the relationship will be.

  “Okay. So it’s interesting to me in the ways this relates to being a psychologist, because many of the most constructive parts of a relationship in psychotherapy involve providing a caring, neutral presence where there is no judgment—where there is an acceptance of people for who they are and where they are, and where there are also high hopes. Now, our responsibility in the professional area is to help people achieve their goals. But the really interesting question to me, in a personal vein, is that I was very competitive in high school, and all the men who are now my adult friends were the guys I was competing with: to get good grades, to make the team, to get the girl, to get into Harvard or Columbia—and it should have worked against that, and it didn’t, and I don’t fully understand it.”

  I suggest that what we have in common as friends is not only the texture of the life we shared—coming out of what was essentially the same apartment, with the same mother and father—but the fact that we have all survived that life, and have done more than survive.

  “I agree,” Arthur says. “I think the relief we felt when we were together—relief from the intense, sometimes incestuous, conflict-ridden homes we came from, and to be talking about baseball and basketball and girls—this relief muted some of the competitiveness. You might be competing with a guy to get into Cornell, but he’s also a guy you could talk to about the Dodgers, and he’s not nagging and bugging you about a thousand little things the way we were bugged in our homes. And there’s also this: that we could choose one another as friends, as opposed to family, where we were stuck.

  “Safety was going outside the home, where your friends became your family—you didn’t want the same tsuris outside your apartment that you had inside—so once I left my house early in the morning, I was home free!”

  It was the same for me, I say, and friends I’ve known across a lifetime—Jerry, Phil, Rich, others—have been like brothers to me, but without the sibling rivalries and emotional gook that pervaded family life.

  “Well, we’ve all had long lives,” Arthur says. “We’ve survived, and we are also, all of us, people who never gave up.” He laughs. “Listen: we’re so old now, Neugie, that we can’t die young.”

  “But we do have these things in common, and we’ve been through stuff together,” he continues. “So when you have heart trouble, I have heart trouble. You have cancer, I have cancer. I’m fine today and I have a brain tumor tomorrow. We know that’s how life works. We’re under no illusions. We’ve stayed the course, we’ve deferred gratification, we got the job done despite the pain, et cetera. When we were fifteen or twenty, though, we didn’t give a thought to this. We thought about where to go to college, how to survive our families, hitting a clutch basket, going two for four, whatever.”

  As the weeks and months pass, I continue to feel stronger and, after a while, less fatigued in the mornings. My stamina, when swimming and playing tennis, is better than it’s been in years; my weight stays steady at about 150, my body fat constant at about 12 percent; my cholesterol scores are ideal, my blood pressure within normal parameters, and my heart, at rest, now pulses consistently at about fifty beats per minute. (For the first several months following surgery, however, it beats at a rate that is, for me, unusually high: between seventy-five and ninety beats per minute; Rich tells me higher pulse rates are a common postsurgical event, and are of no concern.) Nor have I suffered any of the side effects, memory and cognitive losses in particular, that many people who have been through bypass surgery experience.

  Through these months, and the mont
hs to come, my four friends remain a constant presence in my life. At the end of May, Rich flies in from California, and stays with me in my Northampton home. When I go down to see Dr. Cabin and Dr. Hashim for checkups, I stay in Guilford with Jerry and Gail. Hardly a day goes by when one of my friends does not call, and on some days (the same is true at this writing, three and a half years later) I talk with all four of them. We talk less and less about my surgery and recovery, and more and more about the things we usually talk about: our children, our work, our plans—and always, too, about what’s new (and old) in the world of sports, about times past, about people we know and what they’re doing, and about who has seen which old friend recently.

  Arthur and his wife Paulette attend the reading and party for my book in New York City, and I find that Arthur and I are once again talking regularly in the way we did nearly a half century ago when we were at Erasmus, so that on days when, alone in my house, and later in my two-room sublet in New York City, I feel waves of sadness that, despite the knowledge of my good fortune in being alive, still recur, few things in life cheer me as much as a familiar boyish and enthusiastic voice on the other end of the phone saying, “Neugie—it’s The Rude,” followed usually by, “Listen. I was thinking about you earlier today when…”

  In early July, I fly out to Denver, rent a car, and Phil and I drive four hours north, to Columbine, Colorado, for his daughter Elizabeth’s wedding (Phil’s wife and three other children have driven there a day before). We trade jokes and stories, and talk easily—about my surgery, about the book, about Phil’s work (patients I’ve met and how they’re doing), about former girlfriends and ex-wives (Phil has been married three times and divorced twice; I’ve been married twice and divorced twice), and about our friends (Arthur intends to retire from his private practice within the year, and Phil is concerned about him—about what life for such an energetic, intellectually curious guy will be like without the regular work he’s been doing most of his adult life).

  I stop in Denver again at the end of July, on my way back from a two-week trip to Alaska, and I visit with Rich this time (Phil is out of town), who has arranged to be there to see me, and has coordinated his trip with a visit to his two children, Sharon and Steve, both of whom live and work in Denver.

  On September 1, 1999, my brother Robert, after six consecutive years of living in state mental hospitals, much of this time in locked wards and on isolation, moves into a supervised residence on West 48th Street, in the Hell’s Kitchen section of New York City. The next day I move into my sublet in the same section of the city, six blocks north, on West 54th Street. It is the first time in thirty-three years Robert and I are living in New York City at the same time, and one night during our first week back, we have dinner together in a Chinese restaurant on Ninth Avenue.

  “He keeps smiling at me,” I write the next morning, “and when i say something re nice to see him with a smile on, he beams and says, Its because im so happy to be here with you… and then: i was looking forward to this all day, Jay.” At lunch a week or two later, I mention that one of our cousins’ children is going to be married, and tell Robert there’s going to be a family function. “But Jay,” he says at once, “our family doesn’t function.”

  “Another day, and some gains, but boy am i lonely and at sea,” I write during my first week back. “The grayblack clouds hover, and surely i feel the isolation as punishment for some wrong i have done, bee if i have done no wrong, why am i being punished by being so isolated from others?”

  Such moments, however, occur with decreasing frequency. More often I come upon sudden expressions of joy: “what a time in my life! the surgery and, the further i travel from it, the sense of great good fortune—the realization, barely articulate, that i nearly died, and that everything, here to the grave, is a gift,” along with descriptions of the peace and pleasure particular moments now bring.

  Wonderful day, and v happy to be here—deeply, slowly, savoringly so. wake a bit past 5 AM, and cant fall asleep again: so eager for life—for the day to begin: to be out doing things, being with friends, talking with people, working and eating and all ordinary and extraordinary things…

  Late one morning near the end of my third week in New York, I walk to the local post office two blocks away. I wait in line until a middle-aged black woman, opening her station, waves me over.

  “How are you today?” she asks.

  “Just fine,” I say. “And you—?”

  “Oh, I’m having terrible cramps today,” she says.

  “Really,” I reply, without missing a beat.

  “Listen,” she says to me. “In my next life I’m coming back as a man—”

  “Interesting ambition,” I say. “Only you should know that it’s not all good for my gender.” I put a manilla envelope on the scale, and mention that I’ve been doing some research on heart disease—thus the envelope I’m mailing off, to a friend who’s written a book on women and heart disease—and offer the information that once the condition that causes cramps passes, women need to be more wary than men, since from this point on—postmenopause—heart disease will affect them at least as much as it affects men, but without as many traditional warning signs.

  “Like I said, next time I’m coming back as a man,” she says. I pay and, leaving, tell her I hope the rest of her day is less painful. She smiles, wishes me a good day. “And hey—a good life for you too,” she adds.

  I walk back out into the street, look up at the sky, blow a kiss to the heavens, and think: I’m home.

  When Miriam was a child—before she began kindergarten—she would dress up in silk and chiffon scarves and spend hours by herself, dancing to music—Tchaikovsky, Mozart, Debussy, Gershwin—and I would peek into her room sometimes, or enter to change the record, and I would marvel at her self-possession and her grace. Now, on the evening of October 30, 1999, at her wedding, toasting her and Seth, I recall this moment, and make what seems the obvious remark: that from now on she will not have to dance alone. She and Seth dance, after which, our friends and family surrounding us, Miriam and I dance. A few weeks later, I receive a letter that begins, “Dear Dad: It’s not possible to put into words how much I want to thank you, but I hope you know that without your endless generosity the day I dreamed about would never have been the reality it was—it was truly the most beautiful day of my life…”

  A month later, on the day before Thanksgiving, I drive down to see Dr. Cabin at his office in Branford, Connecticut, and when the exam is over he tells me that the surgery is “a complete success” (blood pressure normal, ejection fraction estimated at 50–55 percent), and that I don’t need to see him for a year. (From his letter to Dr. Katz: “[Jay] is doing quite well and seems to be fully recovered…I have suggested to him that he come see me on a once a year basis if he wishes just for routine follow-up.”)

  When I give Rich the results of the checkup, I say something about the swimming and playing ball having had a seemingly paradoxical effect: having masked the severity of my symptoms while at the same time keeping me alive—and about how I seemed, before surgery, to have been living on the collaterals I’d developed from regular exercise. Rich responds by saying that being in good shape, and having a positive attitude (something he never discounts, unquantifiable as it is), probably helped save my life, and surely helped me through surgery and in my recovery from surgery, but that we really don’t know if the swimming and exercise built up my collaterals.

  Rich published a study on collateral blood vessels in the New England Journal of Medicine many years ago that excited a lot of controversy, he tells me, and he explains that the collaterals seem to be genetically predisposed channels that open up, often, when the coronary arteries shut down. Whether or not it is exercise that induces them to do so, though, is not yet clear.

  What is clear, he says, is that exercise conditions the entire cardiac muscle so that, in his words, “it can do more with less,” and this, he believes, is a major reason I was able to survive the
occlusions in my arteries, and why my recovery has been so swift and full.

  He compares the heart muscle to the skeletal muscles—to the difference, for example, between two people who have to run a long distance to get to safety, one of whom is a regular jogger, and one of whom is not. The jogger will have a better chance of making it because his muscles have been conditioned to do more with less. So it was with me, he believes, and though he was seriously concerned about my survival, what encouraged him all along was the fact that despite the nearly total blockage in my arteries, my ejection fraction—the figure that represents the force and efficiency at which the heart is pumping blood, and thus best tells us about the general condition of the heart muscle—remained within normal parameters.

  I also tell Rich that Dr. Cabin’s assistant, while doing the echocardiogram, noticed something nobody had remarked on before: evidence of some slight heart damage. “You suffered a minor hit on one wall, I think—a small part of the muscle that is hypokinetic,” she tells me. “It might have been there before, and we didn’t notice it, or it might have occurred during surgery.” It is, she and Dr. Cabin—and Rich—assure me, “of no consequence.”

  Although I find, once I have had my four-week checkup with Dr. Cabin, and more so after this nine-month exam, that I rarely, in my journal, refer to my health again, I notice that what I am learning about disease and medicine seems at times, when joined to old habits, to have little effect on how I act.

  When both my cardiologist and family doctor recommend that I continue to take Lipitor, and my doctor-friends disagree, for example (Rich says that he thinks bad—LDL—cholesterol should be lowered when several blood tests in a row show that it’s significantly elevated, but since my numbers are low, he advises against), I am once again, as with Dr. Hashim and the Norvasc, in a quandary.