Sunday, October 4, 2009

Sudden Death, or Breeze - NYTimes.com

It was the third week of the fall semester. I was teaching two courses, and I'd already been absent twice. I was trying to figure out how to carry my book bag.

A few months earlier, I flunked a genetic test and learned that I inherited a mutant protein from my father. He was 44 when he died. I was 45 and healthy by conventional cardiovascular measures, so the first symptom would probably be my sudden death.

I opted for an implanted defibrillator. As a bonus, I was given a staph infection. In September, I puffed up, my surface temperature soared and an emergency explant surgery (the defibrillator was contaminated) left me once again at risk of sudden death. In a few months, the doctors would stuff another device into me — which also had to be yanked out (product recall). But for the moment, I just had a hole in my chest, a catheter sticking out of my forearm and a month's supply of syringes and antibiotics. I couldn't use either hand for lifting.

For one week, illness trumped every topic. Even the visiting nurses started dropping hints like, How about those Red Sox? My partner, Peter, offered to sling my bag over my shoulder and get me out of the house.

I occasionally shoved myself aside to think about Binny, the sister of a friend. I met her only once, but I was bowled over by her spirit. Binny's own adventures in medicine culminated in a heart transplant — and she became one of the first transplant survivors to bear a child. Then her second heart failed, and her only hope was another heart and everything that surgery entailed. While I was in a hospital in Boston, Binny was in a hospital in New Hampshire, choosing not to undergo another transplantation. She died.

Peter was recalibrating my injection schedule so I wouldn't have to shoot up on campus when I said, Binny.

Peter nodded.

I said, It's hard to say if she chose to die, or if she chose her life. Peter didn't say anything.

I said, I know I can't imagine what she endured, but I think I got a little taste. It's intolerable, and yet you can tolerate it. That's what I learned. But tolerance is a failure to respond. And if you don't respond to most of what you feel, what makes you know you are alive?

I could not articulate exactly what I knew, but I was certain I knew it.

I drove to campus, parked and grabbed my bag. I felt a sting in my arm near the catheter. To get the book bag on, I knelt beside the car and looped the strap over my shoulder. When I stood up, I was sweating.

Students streamed by. Maybe it was the expectant air they gave off, or maybe cooler weather was blowing in, but the breeze dried me out. I looked up at the true-blue autumn sky through the limbs of a midlife maple, its still-green leaves quivering like jazz hands, and I didn't think, I just said, Oh, Binny.

Maybe life is not a lesson, or maybe I am a bad student, but I knew nothing but how sweet it is to catch an unexpected breeze.

I was early to class. One young man was there to watch me shrug off my bag. He said, I'm glad you're back.

I said, I'm happy you turned up again, too.

He smiled. He was wearing shorts. Maybe he'd had an accident, or maybe he'd also inherited his loss. Somewhere above the shin, most of one of his original legs was missing. He had a handsome steel prosthetic.

I said, Is that as good as it looks?

This one is good, he said, as if he'd had a few.

As class ended, I saw a former student. I waved her in. When we were alone, she said, Are you O.K.?

I said, I'm fine.

Oh, not your operation, she said. I mean the blood.

During class, I'd shoved the cuffs of my sweater past the catheter. A streak of dried blood ran from my elbow to my wrist. I remembered that jab of pain when I'd grabbed my bag. It's O.K., I said.

She said, Do you need a tissue?

I said, It's not bleeding now.

She seemed nervous, as if she were responsible for my well-being. I was sure she was going to offer to walk me to my car.

Anyway, she said, could you write a recommendation letter for me? No rush. It's for study abroad.

No rush.

I don't remember where in the world she wanted to go, but I do remember how happy I was to be there.

Michael Downing is the author of "Life With Sudden Death: A Tale of Moral Hazard and Medical Misadventure." This essay is adapted from the book, due out this month.

http://www.nytimes.com/2009/10/04/magazine/04lives-t.html?ref=magazine&pagewanted=print