We’re thrilled to present “On Being and On Being the Right Size” in five parts for the next five weeks. You can read all the sections of the essay here.
They pulled away the sheet.
I’ve looked up how chest ports are supposed to be inserted. There are two incisions, one to guide what happens in the other, but this doctor made only one and then felt it out or intuited it somehow, running a tube through an artery and into my heart. I lay there and thought about my family while willing my body not to move. Then they pulled away the sheet. A tube was sticking out of me, set into a plastic patch, taped down. I looked at the doctor and the nurses on either side of him. They were splashed with blood.
The port meant more solutions could be poured into me, solutions as in liquids and as in hopefully eliminating problems. I could hear them talk about the different things they wanted to try, incantations of pharmaceutical ingenuity, names that merge Greek and Latin with corporate synergy, needles as wands, clear plastic pouches and syringes standing in for doeskin and divining rods.
In “On Magic in Medicine,” Lewis Thomas reminds us that in the early days of medicine, “hostile spirits needing exorcism were the principal pathogens, and the shaman’s duty was simply the development of improved incantation.” The manufacture of medications involves a long tradition of trying shit and seeing what works and what doesn’t. The successes come in shocking bursts. Felix Hoffmann, a chemist at Bayer, invented or found or synthesized or summoned or alchemized both heroin and aspirin. What’s more, the two discoveries took place around ten days apart.
Bayer loves to tell the story of the aspirin but is less keen to discuss the heroin.
Haldane’s essay “Pain-Killers” comes toward the back of the collection. Again, this is an indicator of bad things. Haldane is a fan of heroin, writing that it “is remarkably useful in dealing with the intractable tickle of a severe cough.” He acknowledges that some people enjoy the psychological effects but claims he isn’t one of them, even as he also admits to having “taken a large dose of heroin four times a day for ten days or so without getting any ‘kick’ out of it or losing an hour’s sleep when I stopped taking it.” He is convinced that the drug’s addictive properties are more troubling for Westerners and that no Communist would ever be addicted, as their systems are just too powerful.
Haldane writes that until recently, “there were very few ways of killing bacteria in a body unless they were concentrated in a small wound or abscess or in some special region such as the urinary tract.” He discusses the new drugs that had been created. Mostly, he celebrates them, although he is leery of how dangerous they are, particularly something called Prontosil. It’s a name I find hilarious, perfect corporate nonsense. I can imagine the ads. When you need help pronto, you need Prontosil. Haldane writes that it “has cured a number of cases of septicaemia (‘blood-poisoning’ and puerperal fever) in the most dramatic way … but it is a dangerous drug, and has killed a number of people.” This is a man who boasts about heroin, wary of oral antibiotics and particularly of those taken by way of injection.
“For the dose needed to kill a man is only a few times greater,” he writes, “than that needed to disinfect him.” To disinfect him.
They decided to dump everything they could into the port that led directly to my heart. But there were problems with that, too.
My heartbeat remained inconsistent. It would rise and fall, flutter and pound. Rhythmic issues. The heart muscle wasn’t getting adequate oxygen. One nurse would listen to my chest with a stethoscope and then ask another to do so, then doctors, a conga line of step forward, bow down, pause, next one up. Bum-bum-bum-bum-BUMP.
It was decided to put me on an adrenaline drip, the strongest shit they had. If you look up intravenous adrenaline use, pretty much every doctor warns against it. The consensus is that it will create more cardiac problems, that it will do more damage than good. Every patient who has died as a result of adrenaline was given it intravenously, on a drip. The nurse injected a thick syringe of it into the bag of my saline line, adjusted the flow, and walked off to see another patient, assuring me he would be right back.
It’s tempting to think of medications as little soldiers swooping though our innards, protecting whatever our various parts are in this strained metaphor. Villagers or prized buildings or something. But most treatments are more brutish than that. They take out anything in their path. Recently, scientists were able to get photographic evidence of orcas killing a blue whale. A group of researchers filmed a pod of killer whales relentlessly attacking the largest creature ever to live, tearing it to pieces. Much was made of the attackers swimming into the blue whale’s mouth to eat its tongue as it tried to fight them off. There are accompanying photos of the scientists in the carnage’s aftermath. They are delighted, grinning, ecstatic. One gives a thumbs up to the camera. We did it, they seem to be saying. Of course, what really happened is that the researchers got lucky and the blue whale didn’t.
Telling someone else about your pain is like trying to explain your dreams. They can’t understand; they weren’t in your head. It all becomes relative to something else. When I had those kidney stones, I told the doctors my pain was at a seven or eight out of ten. I had never felt anything worse but certainly imagined that it could be worse. It can always be worse, which is encouraging in the moment and horrifying at any other time.
I now know what a ten is on the pain scale.
Regular pain—cuts and burns, muscle pulls and broken bones, break ups and humiliations—are terrible but real pain is something else. It’s an existential kind of horror and, evidently, it is pretty rare. Thomas writes about death in an essay called “The Long Habit.” He recalls that David Livingston experienced near death, caught by a lion, ribs crushed in its jaws. He was saved by a friend who fired what turned out to be a miraculous shot. Livingston later described what he felt in those moments: “the extraordinary sense of peace, calm, and total painlessness associated with being killed.” It led him to conclude that all creatures contain in their neurochemistry some kind of emotional armor, an analgesic of the soul. Thomas, who has seen much death, writes that only once has he witnessed a person die in agony, and it was due to rabies. Thomas suggests that rabies must switch off whatever mechanism protects us from the agony of the end.
A similar switch must have been thrown in me.
Imagine your skull has been cast in iron, like an old bell. And, like an old bell, the pour had its problems. There are hiccups and bubbles, cracks. The seams are visible and the sound is wrong when struck: instead of a clear bright tone, you hear a skittering screech with some impossible low grumble, a dischord. There had been a mistake, a fuse lit, and my heart detonated. Not once, but a string of detonations, one after another, more quickly than can be understood, thrumming like a hummingbird’s but concussive, enormous, elephantine.
In “Joyas Valadoras,” Brian Doyle discusses the hearts of hummingbirds and whales. A hummingbird’s heart is the size of a pencil eraser, and it beats ten times a second. A whale’s heart is enormous, so big “a child could walk around in it, head high, bending only to step through the valves.” He doesn’t mention the heart rate, but it can be as slow as two beats a minute.
People often say they feel their heart hurt, but it’s a trick our minds play on us. I have felt my heart against my ribs. An animal panicked and trapped, smashing against splintering bars.The contractions had such fury I could feel the cast bell of my skull clang, every heartbeat a hammer. My skull strained and pulled along the seams where it had fused long ago and I worried it would rupture, spill my brains to the floor. My lungs ballooned, my guts seized, my muscles screamed with a desperate power. I could have torn the world in half.
I knew that I was dying. This was it.
“Something’s wrong! Help me!”
According to the bromide, there are no atheists in foxholes. The idea is that in the moments of real desperation, we turn to whatever well of faith is there, drink from it, plead for it to save us, for God to smile down and grant mercy.
For me, it was the opposite. I knew I was alone and that anything that came next wouldn’t be as good as what I had. I knew that only the doctors and nurses could help me. And I knew I was ashamed, that for all I had, I wanted more, things both selfless and greedy.
The team came running in. They couldn’t understand it. Then, someone glimpsed the IV bag and saw it draining. They could literally observe the flow. It was not a gentle trickle. Someone had made a mistake, opened it up in full, and my body was slurping down the adrenaline, an hour’s worth or more in maybe a minute.
A nurse adjusted the flow wheel and closed the line. I kept crumpling into a ball and then flattening myself, rolling up, spreading out. I was screaming but no sound was coming out, veins as thick as pencils, nightcrawlers.
I’m pretty sure I never closed my eyes, even when the sheet was over my head. I barely blinked. If I did, I felt certain, they would never open again.
There were apologetic looks but no one wanted to take responsibility. I don’t blame them. I don’t know that I would have either.
Then someone asked what all of us were thinking:
“How is he still alive?”
Toward the end of The Lives of a Cell, Thomas has an essay that is uncharacteristic and makes the rest of the book feel less reliable. It’s like one of those pieces by Haldane that make you wonder how much to believe of what he writes. To his credit, Thomas is just recounting something he has read but even that feels irresponsible, like a literary form of gossip. The essay is called “The Iks,” and in it, he describes a book by an anthropologist who spent two years living with the Ik tribe in Uganda. The Ik are, as described, beyond loathsome. Thomas calls them “an irreversibly disagreeable collection of unattached, brutish creatures, totally selfish and loveless.” He attributes the behavior to the Ik having lost their homeland.
The anthropologist’s book, apparently, suggests that all humans are like the Ik at heart, but Thomas, bizarrely, doesn’t mention the title or the name of the author. I had to look it up: The Mountain People by Colin Turnbull. It was adapted into a play by Denis Cannon and Colin Higgins and staged by the occasional genius and constant provocateur Peter Brook. The New York Times ran a review by Mel Gussow in October 1976, not quite two years before I was born. Gussow writes that the plotless action includes a “young girl, on the brink of starvation … buried alive by her parents in a grave of twigs. Having nothing to eat, a boy calmly swallows stones. Another steals food out of his sister’s mouth. A mother offers food to her son, holding it over a fire so that the child, reaching for it, is scorched. The mother howls with delight.” It sounds ghastly. Thomas recounts the same events and notes that the Ik “share nothing. They never sing.” He says they “breed without love or even casual regard.” See that word, breed? See how Thomas, the great humanist-scientist, uses the most demeaning, animalistic term?
“I cannot accept it,” Thomas writes, but he is not referring to the Ik’s behavior. Rather, he is referring to the Ik themselves. “I do not believe,” he goes on, “that the Iks are representative of isolated, revealed man, unobscured by social habits.” They don’t represent us, in other words. They are both anomalies and animals. Yet where is his critique of Turnbull? The selfishness described here makes no sense. In 2011, Cevin Soling released a documentary, Ikland, that challenged Turnbull’s book and its conclusions. The Ik are shown as friendly, singing, inviting, even as they fight off heartache and despair.
But everyone believed Turnbull. They didn’t question what he said for a moment. Some answers and assertions are so comforting that we will believe them regardless of the facts. So much the better if they justify our worst thoughts and prejudices, if they allow us to feel smug, if they are difficult to check or counter.
So much the better.
Some things are just inexplicable.
With the adrenaline drip off, my pulse slowed, and my breathing returned to bad as opposed to catastrophic. The seams in my skull began to knit. Blips and bubbles floated through my consciousness. There were concerns about brain damage so I was asked a few questions but they were easy. It didn’t seem like much of a test. My body stabilized and I seemed to come back to the shores of the living, waves licking at my feet instead of drowning me.
Being the only patient in the ICU wasn’t bad.
I wasn’t on dietary restrictions, had no broken bones, wasn’t bleeding or being careful not to rip out stitches. I was waiting for my heart to fall into its old rhythms, for my lungs to drain, for some strength to return. I was so weak I could barely support the handheld urinal to piss. But mostly, I—all of us—were waiting for answers. Until we knew what was going on or what had happened, and if it would happen again, every day was full of tests, which involved getting wheeled here and there, attendants moving my tubes as they positioned me. Every two hours they took blood samples, stabbing me anew for each one. I got to the point where I could sleep through it. Just another needle.
I say that, but everyone was worried. I shrugged in response to any medical talk.
My parents flew in, frantic, booking tickets when it still seemed like I might not make it. They sat by my bed in shifts. My wife came, of course, arranging for someone to look after our sons while she was there. Children weren’t allowed and, in any case, it wouldn’t do for them to see me like this. Four days into my stay, I stabilized enough for them to see me. They were terrified. I tried to smile but it was hard. I smelled terrible.
And so on.
A couple of ER nurses, including the one with the reddish-brown hair, came to see me. It was the end of my first day in the ICU. Or maybe it was the middle of the night? The ICU had no windows. No clocks within my view. They had been talking about me all day, how strange it was, the night before.
“We couldn’t believe you never lost consciousness,” one said.
“I didn’t want to.”
“What made you come in?”
I told them I wasn’t sure. My mind was still full of gray, like it is now but more so.
“If you had waited even ten minutes, your family would have found you dead.”
It’s hard to know quite how to react to that. I nodded. I was grateful my oldest son didn’t find my body, try to shake me awake. It would have been him, without a doubt. The nurses promised to come again but I didn’t see them. I may have been sleeping. It may have been during one of the tests. They would bring the x-ray machine to me but roll me out for scans. Everything was always inconclusive.
“Does that mean everything is okay?”
“It means we can’t tell.”
“So I’m not okay?”
“We don’t know.”
A cloud of blackbirds flew into the ground a couple of days ago in Mexico. They were yellow-headed blackbirds and a security camera captured footage of the flock, like an inverted wave, a dark ocean falling from the sky into the street, onto sidewalks, smashing against rooftops. Hundreds of them. Most got up and flew away but not every one. They were, perhaps, fleeing in unison from a predator and miscalculated. It could be that pollution addled them. Dr. Richard Broughton from the UK Centre for Ecology and Hydrology said he was 99% certain a predator was behind it. But who knows? A couple of hundred starlings crashed into a road in Wales in 2019. Everyone agreed on the predator from above theory in that instance as well, but there’s no way to know. In September 2021, some three hundred birds smashed into One World Trade Center in Manhattan. It was thought that the lights in the building had confused them during migration. The Daily Mail attributed a “volunteer” with having picked up and collected the dead birds to count them. There is an accompanying photo, birds organized in rows by size and species, sparrows, some blackbirds, hard to tell. They look like they are in some kind of sleepy regiment. Maybe the cause was reflections on the windows. But windows aren’t new in New York.
Who did that person volunteer to? Would one have needed permission to do such a thing? Here’s the thing I most want to know: What did they do with those small carcasses after the photo? What is more absurd: a series of bird funerals or some custodian sweeping them up, placing them in garbage bags? Alley cats feasting?
Sparrows aren’t native to New York; maybe that’s the problem. They were introduced in 1850 to address a tree worm problem which, I suppose, must have worked. The tree worms were like caterpillars. There were so many that they would drop out of the trees onto Sunday strollers. This was unacceptable. Meanwhile, the sparrows flourished. So much so that people started to trap and poison and shoot them, about twenty years after bringing them in.
Eventually, I was dismissed from the ICU and put in general care for one night. My oxygen levels had climbed; my children had mostly stopped worrying.
In “The Long Habit,” Thomas suggests most of us prefer to believe that death is, somehow, avoidable if only we keep eliminating causes. That we will exist in perpetuity if we can just continue diagnosing and treating things. People choose to believe this, he notes, “despite the evidences of the absolute inevitability of death that surrounds their professional lives. Everything dies, all around, trees, plankton, lichens, mice, whales, flies, mitochondria. In the simplest creatures it is sometimes difficult to see it as death. … Flies do not develop a ward round of diseases that carry them off, one by one. They simply age, and die, like flies.”
My parents and my wife and I were eager to leave the hospital, but I felt something was missing, some kind of ceremony or ritual. We don’t have enough in the way of rituals. That, I think, is the root of many of our problems, although I don’t have any way to diagnose it. Maybe marking the shift from one state of being to the next would help.
A nurse came in and took out the IVs, pulling off the tabs and stickers, ripping out chest hairs while making small talk. The pain wasn’t terrible, nothing like what I’d experienced, but I found myself yelping anyway. She told us to wait for final orders and left herself.
The port was still in my chest. When another nurse came with my release papers, I asked about it.
“Oh, yeah,” she said. “No problem.”
Then, without pausing to wash her hands or put on gloves, she went to work. I didn’t lay down, just sat still while she peeled away the adhesive and pulled out the port. The line came with it, wriggling and twisting like a tree worm, longer and thicker than I would have guessed.
What had it been? Five days? The dismissal papers had no instructions because, still, no one knew what had gone wrong.