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Without my help—though I’ve offered to help—Ray prepares for the trip to the ER. He doesn’t want me to fuss over him, even to touch him, as if his skin hurts. (This is a flu symptom—isn’t it? Our Pennington physician makes me uneasy at times, so readily does he prescribe antibiotics for Ray when a “bad cold” is interfering with Ray’s work; I worry that an excess of antibiotics will affect Ray’s immune system.)
The cats stare after us as we leave the house. Still so early in the morning, scarcely dawn! Something in our manner has made them wary, suspicious. And then how strange it seems, to be driving our car with my husband beside me. Rarely do I drive our car—we have just the single car, the Honda—with Ray beside me, not driving; unless we are on a trip, then we share the driving; still, Ray does most of it, and always difficult driving in urban areas and on congested roads. I am less anxious now, for we’ve made a good decision, obviously; I am in control, I think. Though our Princeton friends without exception insist that only in Manhattan and (possibly) in Philadelphia can one find competent medical treatment, this ER is the closest by many miles, and the most convenient; there Ray will be given immediate treatment, and he will be all right, I’m sure.
He isn’t taking anything with him to suggest that he expects even to stay overnight.
On the drive into Princeton Ray gives me instructions about work he needs to have me do: calls to make, book orders to process, his typesetter in Michigan to contact. Though he’s ill he is also—he is primarily—concerned with his work. (It has been a matter of concern to Ray in the past year, a cause of both anxiety and hurt, that in our declining American economy, in which libraries have been cutting budgets, fewer small-press books are being bought and subscriptions to Ontario Review are not increasing.) His breathing is hoarse and his throat sounds raw and when he falls silent I wonder—what is he thinking? I reach out to touch his arm—I’m moved to see that he took time to shave. Even in physical distress he hadn’t wanted to appear in the ER unshaven, disheveled.
I am thinking that this is the right thing to do of course. And I am thinking that it’s a minor episode—just a visit to the local ER.
I love him, I will protect him. I will take care of him.
Ray has been to the Princeton ER before. A few years ago his heartbeat had become erratic—“fibrillating”—and he’d stayed overnight for what seemed to be a commonplace non-invasive cardiac procedure. Then, everything had gone well. He’d come home with a fully restored “normal” heartbeat. I knew that Ray was well when I’d entered his hospital room to see him scowling over the New York Times Op-Ed page and his first remark was a sardonic complaint about the hospital food.
This was a good sign! When a husband complains about food, his wife knows that he has nothing serious to complain of.
And so today’s ER visit will turn out well also. I am sure. Driving on Rosedale Road in early-morning traffic—to State Road/Route 206—to Witherspoon Street—with no way of knowing how familiar, how dismayingly familiar, this route would shortly become—I am certain that I am doing the right thing; I am a shrewd and thoughtful wife, if an unexceptional wife—for surely this is the only reasonable thing to do.
Knowing of my dislike of high-rise parking garages—these ascending and descending labyrinths with their threat of humiliating cul-de-sacs and no-way-out—Ray offers to park the car for me. No, no!—I bring the car around to the ER entrance so that Ray can get out here; I will park the car and join him inside a few minutes later. It is just 8 A.M. How long Ray will be in the ER, I estimate a few hours probably. He will be home for dinner—I hope.
What relief to find a parking place on a narrow side street where the limit is two hours. I think, I may have to come outside and move the car, then. At least once.
In this way unwittingly the Widow-to-Be is assuring her husband’s death—his doom. Even as she believes she is behaving intelligently—“shrewdly” and “reasonably”—she is taking him to a teeming petri dish of lethal bacteria where within a week he will succumb to a virulent staph infection—a “hospital” infection acquired in the course of his treatment for pneumonia.
Even as she is fantasizing that he will be home for dinner she is assuring that he will never return home. How unwitting, all Widows-to-Be who imagine that they are doing the right thing, in innocence and ignorance!
Chapter 4 “Pneumonia” (#ulink_60e3a20e-ce6b-5a7c-8b86-e6f8de690e4c)
This is unexpected!
The first response of the afflicted man—“I’ve never had pneumonia before.”
The first response of the wife—“Pneumonia! We should have known.”
Naively thinking This is a relief. Not a stroke, not an embolism, not a cardiac condition—nothing life-threatening.
Quickly Ray is checked into the ER. Quickly assigned a cubicle—Cubicle 1. Now he is partly disrobed, now he is officially a patient. The essence of that word has to be patience. For the experience of the patient, like that of the patient’s wife, is to wait.
How long we must wait, how many hours isn’t clear in my memory. For while Ray is being examined—interviewed—his blood taken—re-examined—re-interviewed—another sample of his blood taken—I am sometimes close by his side and sometimes I am not.
The minutiae of our lives! Telephone calls, errands, appointments. None of these is of the slightest significance to others and but fleetingly to us yet they constitute such a portion of our lives, it might be argued that our lives are a concatenation of minutiae interrupted at unpredictable times by significant events.
If I’d known that my husband had less than a week to live—how would I behave in these circumstances? Is it better not to know? Life can’t be lived at a fever-pitch of intensity. Even anxiety burns out. For now after the urgency of the drive into Princeton it has come to seem in the ER—in the cubicle assigned to “Raymond Smith”—that time has so slowed, it might be running backward. Waiting, and waiting—for test results—for a doctor-specialist—for a real doctor, with authority—until at last the diagnosis is announced—“Pneumonia.”
Pneumonia! The mystery is solved. The solution is a good one. Pneumonia is both commonplace and treatable—isn’t it?
Though we’re both disappointed—Ray won’t be discharged today after all. He’ll be transferred into the general hospital where it’s expected he will stay “at least overnight.”
Of this, I seem to hear just overnight.
If I have occasion to speak with friends I will tell them Ray is in the Medical Center with pneumonia—overnight.
Or, with an air of incredulity, as if this were entirely out of my husband’s character—You’ll never guess where Ray is! In the Medical Center—with pneumonia—overnight.
Why the diagnosis of pneumonia is so surprising to us, I have no idea. In retrospect it doesn’t seem surprising at all. Ray reacts by questioning the medical workers about pneumonia—asking them about themselves—speaking in such a way to suggest that he isn’t fearful, and has infinite trust in them. Like many another hospital patients wishing to be thought a good sport, a nice guy, fun! he jokes with nurses and attendants; through his stay in the Princeton Medical Center he will be well liked, a real gentleman, sweet, fun!—as if this will save him.
So much of our behavior—our “personalities”—is so constructed. The survival of the individual, in the service of the species.
Our great American philosopher William James has said—We have as many personalities as there are people who know us.
To which I would add We have no personalities unless there are people who know us. Unless there are people we hope to convince that we deserve to exist.
“I love you! I’ll be back as soon as I can.”
Yet what relief—at mid-afternoon—to leave the ER at last—to escape the indescribable but unmistakable disinfectant smell of the medical center if only to step outside into a cold cheerless February day!
I feel so sorry for Ray, trapped inside. My poor husband stricken with pneumonia—obliged to stay overnight in the hospital.
A multitude of tasks await me—telephone calls, errands—at home I sort Ray’s mail to bring to him that evening—Ray tries to answer Ontario Review mail as soon as he can, he has a dread of mail piling up on his desk—as a Catholic schoolboy in Milwaukee he’d been inculcated with an exaggerated sense of responsibility to what might be defined loosely as the world—repeatedly I call the medical center—again, and again—until early evening—to learn if Ray has been yet transferred to the general hospital and always the answer is No. No! Not yet.
At about 6:30 P.M. as I am about to leave for the medical center, bringing things for Ray—bathrobe, toiletries, books—at his end of our living room coffee table are the books he is currently reading or wants to read—as well as manuscripts submitted to the magazine and the press, a burgeoning stack of these with self-addressed stamped envelopes for return—the phone rings and I hurry to answer it assuming that it’s the medical center, telling me the number of the room Ray has been moved to—at first I can’t comprehend what I am being told Your husband’s heartbeat has accelerated—we haven’t been able to stabilize it—in the event that his heart stops do you want extraordinary measures to be used to keep him alive?—
I am so stunned that I can’t reply, the stranger at the other end of the line repeats his astonishing words—I hear myself stammering Yes! Yes of course!—gripped by disbelief, panic—stammering Yes anything you can do! Save him! I will be right there—for this is the first unmistakable sign of horror, of helplessness—impending doom—blindly I’m fumbling to replace the phone receiver, on our kitchen wall-phone—a sickening sense of vertigo overcomes me—the strength drains out of my legs, my knees buckle and I fall at a slant, through the doorway into the dining room and against the table a few feet away—the sensation is eerie—as if liquid were rushing out of a container—the edge of the table strikes against my legs just above my knees, for in my fall I have knocked the table askew—heavily, gracelessly I have fallen onto the hardwood floor—I can’t believe that this is happening to me, as I can’t believe what is happening to my husband; behind me the lightweight plastic receiver is swinging on its elastic band just beyond my grasp as I lie sprawled on the floor trying to control my panicked breathing, instructing myself You will be all right. You are not going to faint. You will be all right. You have to leave now, to see Ray. He is waiting for you. In another minute—you will be all right!
Yet: my brain is extinguished, like a flame blown out. My legs—my thighs—are throbbing with pain and it’s this pain that wakes me—how much time has passed, I can’t gauge—a few seconds perhaps—I am able to breathe again—I am too weak to move but in another moment, my strength will return—I am sure that this is so—sprawled on the dining room floor stunned as if a horse had kicked me and the realization comes to me
I must have fainted after all. So this is what fainting is!
Six o’clock in the evening of February 11, 2008. The Siege—not yet identified, not yet named, nor even suspected—has begun.
Strangely, the Widow-to-Be will forget this telephone call. Or rather, she will forget its specific contents. She will recall—with embarrassment, chagrin—some small worry—that she “ fainted”—in fact, she “ fell heavily onto the dining room table, and the floor”—“but just for a minute. Less than a minute.” An ugly bruise of the hue of rotted eggplant and of a shape resembling the state of Florida will discolor her upper legs, her thighs and part of her belly—she will wince with pain—sharp pains—from crashing to the hardwood floor without cushioning the fall with her hands—but she will forget this terrible call, or nearly. For soon there will be so much more to recall. Soon there will be so much more to recall, from which mere fainting onto a hardwood floor will be no reprieve.
Chapter 5 Telemetry (#ulink_1e1f3062-4727-55fe-a176-6ebadd30fd1a)
Now into my life—as into my vocabulary—there has come a new, harrowing term: Telemetry.
For Ray hasn’t been moved into the general hospital but into a unit adjacent to Intensive Care.
Telemetry!—my first visit to the fifth floor of the medical center—to this corridor I will come to know intimately over a period of six days—imprinted indelibly in my brain like a silent film continually playing—rewinding, replaying—rewinding, replaying.
These places through which we pass. These places that outlive us.
Vast memory-pools, accumulating—of which we are unaware.
Telemetry means machines—machines processing data—machines monitoring a patient’s condition—and I am shocked to see my husband in a hospital bed, in an oxygen mask—IV fluids dripping into his arm. Both his heartbeat and his breathing are monitored—through a device like a clothespin clipped to his forefinger a machine ingeniously translates his oxygen intake into numerals in perpetual flux—76, 74, 73, 77, 80—on a scale of 100.
(When a day or two later I experiment by placing the device on my own forefinger, the numeral rises to 98—“normal.” )
It’s upsetting to see Ray looking so pale, and so tired. So groggy.
As if already he has been on a long journey. As if already I’ve begun to lose him . . .
Despite the oxygen mask and the machines, Ray is reading, or trying to read. Seeing me he smiles wanly—“Hi honey.” The oxygen mask gives his slender face an inappropriately jaunty air as if he were wearing a costume. I am trying not to cry—I hold his hand, stroke his forehead—which doesn’t seem over-warm though I’ve been told that he still has a dangerously high temperature—101.1° F.
“How are you feeling, honey? Oh honey . . .”
Honey. This is our mutual—interchangeable—name for each other. The only name I call Ray, as it is the only name Ray calls me. When we’d first met in Madison, Wisconsin, in the fall of 1960—as graduate students in English at the University of Wisconsin—(Ray, an “older” man, completing his Ph.D. dissertation on Jonathan Swift; I, newly graduated from Syracuse University, enrolled in the master’s degree program)—we must have called each other by our names—of course—but quickly shifted to Honey.
The logic being: anyone in the world can call us by our proper names but no one except us—except the other—can call us by this intimate name.
(Also—I can’t explain—a kind of shyness set in. I was shy calling my husband “Ray”—as if this man of near-thirty, when I’d first met him, represented for me an adulthood of masculine confidence and ease to which at twenty-two, and a very young, inexperienced twenty-two, I didn’t have access. As in dreams I would sometimes conflate my father Frederic Oates and my husband Raymond Smith—the elder man whom I could not call by his first name but only Daddy, the younger man whom I could not call by his first name but only Honey.)
Is the cardiac crisis past? Ray’s heartbeat is slightly fast and slightly erratic but his condition isn’t life threatening any longer, evidently.
Otherwise, he would be in Intensive Care. Telemetry is not Intensive Care.
Unfortunately room 541 is at the farther end of the Telemetry corridor and to get to it one must pass by rooms with part-opened doors into which it’s not a good idea to glance—mostly elderly patients seem to be here, diminutive in their beds, connected to humming machines. A kind of visceral terror overcomes me—This can’t be happening. This is too soon!
I want to protest, Ray is nothing like these patients. Though seventy-seven he is not old.
He’s lean—hard-muscled—works out three times a week at a fitness center in Hopewell. He hasn’t smoked in thirty years and he eats carefully, and drinks sparingly—until two or three years ago he’d risen at 7 A.M. each morning, in all vicissitudes of weather, to run—jog—along country roads near our house for forty minutes to an hour. (While I lay in bed too exhausted in the aftermath of turbulent dreams—or, it may have been, simply too lazy—to get up and accompany him.)
How nice the nurses are, in Telemetry! At least, those we’ve met.
An older nurse named Shannon explains carefully to me, as she has explained to Ray: it’s very important that he breathe through the oxygen mask—through his nose—and not through his mouth, in order to inhale pure oxygen. When Ray does this the numerals in the monitoring gauge rise immediately.
There is the possibility—the promise—that the patient holds his own fate in his hands. In his lungs.
Once we’re alone Ray tells me that he feels “much better.” He’s sure he will be discharged from the hospital in a few days. He asks me to bring work for him in the morning—he doesn’t want to “fall behind.”
An anxiety about falling behind. An anxiety about losing control, losing one’s place, losing one’s life. Always at the periphery of our vision these icy-blue flames shimmer, beaten back by our resolute American sunniness. Yes I am in control, yes I will take care of it. Yes I am equal to it—whatever it is.
Ray clasps my hand tight. Ray’s fingers are surprisingly cool for a man said to be running a fever. How like my protective husband, at such a crucial time to wish to comfort me.
A young Indian doctor comes into the room, introduces himself with a brisk handshake—he’s an ID man—“infectious disease”—he tells us that a culture has been taken from my husband’s right lung—it’s being tested to determine the exact strain of bacteria that has infected the lung—as soon as they identify the bacteria they will be able to fight the infection more effectively.
In a warm rapid liquidy voice Dr. I_ speaks to us. Formally he addresses us as Mr. Smith, Mrs. Smith. Some of what he says I comprehend, and some of it I don’t comprehend. I am so grateful for Dr. I_’s very existence, I could kiss his hand. I think Here is a man who knows! Here is an expert.
But is the Widow-to-Be misguided? Is her faith in this stranger in a white coat who walks into her husband’s hospital room misplaced? Would there have been another, happier ending to this story, if she had transferred her husband from the provincial New Jersey medical center to a hospital in Manhattan, or Philadelphia? If she’d been less credulous? More skeptical?
As if she too has been invaded—infected—by a swarm of lethal bacteria riotously breeding not in her lungs but in that part of her brain in which rational thought is said to reside.
Chapter 6 E-mail Record (#ulink_99b9e861-a140-5750-9f14-2affe61063a5)
February 12, 2008.
To Richard Ford
At this moment, Ray is recovering from a nasty cold that morphed into pneumonia without our somehow noticing . . .
Much love to both,
Joyce
To Leigh Bienen
Ray is recovering—slowly—from a severe pneumonia that began as a bad cold . . .
Much love to both,
Joyce
February 14, 2008.
To Gloria Vanderbilt
Ray’s condition improves—worsens—improves—worsens—I have almost given up having responses to it. But the doctors say that over all he is definitely improving—it’s just that the pneumonia is so virulent, through most of one lung.
(I know little of infectious diseases, but am learning rapidly.)
Love
Joyce
Chapter 7 E. coli (#ulink_5017cb82-8ac8-5b17-bc61-b7b727251d28)
February 13, 2008. The bacterial infection in Ray’s right lung has been identified: E. coli.
“E. coli! But isn’t that associated with . . .”
“Gastro-intestinal infections? Not always.”
So we learn from Dr. I_ . Again we’re astonished, naively—there is something naive about astonishment in such circumstances—for like most people we’d thought that the dread E. coli bacteria is associated exclusively with gastro-intestinal infections: sewage leaking into water supplies—fecal matter in food—insufficiently cooked food—hamburger raw at the core—contaminated lettuce, spinach—the stern admonition above sinks in restaurant restrooms Restaurant employees must wash their hands before returning to work.
But no, we were mistaken. Even as, invisibly, a colony of rapacious E. coli bacteria is struggling to prevail in Ray’s right lung with the intention of swarming into his left lung and from there into his bloodstream to claim him, their warm-breathing host, totally—as totally as a predator-beast like a lion, an alligator, would wish to devour him—so we are learning, we are being forced to learn, that many—most?—of our assumptions about medical issues are inadequate, like the notions of children.
It’s liquidy-voiced Dr. I_—or another of Dr. I_’s white-coated colleagues—(for in his scant six days in the Telemetry Unit of the Princeton Medical Center Ray will be examined or at least looked at by a considerable number of specialists as itemized by the hospital bill his widow will receive weeks later)—who explain to us that E. coli infections, far from being limited to the stomach, can also occur in the urinary tract and in the lungs. Escherichia coli are found everywhere, the doctor tells us—in the environment, in water—“In the interior of your mouth.”
Most of the time—we’re assured—our immune systems fight these invasions. But sometimes . . .
Patients with E. coli pneumonia usually present with fever, shortness of breath, increased respiratory rate, increased respiratory secretions, and “crackles” upon auscultation.
(Why do medical people say “present” in this context? Do you find it as annoying as I do? As if one “presents” symptoms in some sort of garish exhibition—Patient Ray Smith presents fever, shortness of breath, increased respiratory rate . . .)
Now the exact strain of bacteria has been identified, a more precise antibiotic is being used, mixed with IV fluids dripping into Ray’s arm. This is a relief! This is good news. Impossible not to think of the antibiotic treatment as a kind of war—warfare—as in a medieval allegory of Good and Evil: our side is “good” and the other side is “evil.” Impossible not to think of the current war—wars—our country is waging in Iraq and Afghanistan in these crude theological terms.
As Spinoza observed All creatures yearn to persist in their being.
In nature there is no “good”—no “evil.” Only just life warring against life. Life consuming life. But human life, we want to believe, is more valuable than other forms of life—certainly, such primitive life-forms as bacteria.
