Originally published in the March 11th, 2019 edition of The New Yorker.
At the end of his life, my father went from doctor to patient, from scientist to subject.
By James Marcus
We like the heart to behave—no skipped beats, no atrial flutter, just the regular, precious, plodding cadence. For this we will sacrifice much. The medicine my father began taking for his irregular heartbeat, in 2014, could have turned his skin gray, or caused him to grow breasts, or collected in tiny granular deposits behind his eyes, so that everything he looked at would have had a blue halo. None of this happened to him. Instead, he was cold all the time.
Inside my parents’ house, a century-old structure north of New York City whose thin walls testified to the golden age of cheap petroleum, he took to wearing a heavy tweed overcoat. He wore it when he watched television, or napped on the sofa, or read through old copies of the Times which he kept in the basement. He wore it at meals, also donning gloves and a hat. He peeled off the overcoat only when he went to sleep, under several blankets and a stout covering my parents called Milty the Quilty. Of course, they could have turned up the heat. But old habits of thrift got in the way, as did the psychological complexities of a long marriage. My mother had wanted to move decades ago, my father had run out the clock in his typically charming and infuriating manner, and now remaining in the chilly house was punishment for him, not for her.
Finally, in February of 2015, they resolved to move to a two-bedroom apartment in a nearby town. By then, however, it wasn’t just the cold that tormented my father. At eighty-nine, he was a bundle of maladies. The curvature of his spine made him stoop, his legs were weak, and he got around with the aid of a two-wheeled walker, which he hated. For more than a year, he had pinned his hopes on a chimerical operation that would relieve the pressure on his sciatic nerve and allow him to walk comfortably again. A fast-talking young surgeon in New Haven gave him the bad news: the procedure couldn’t be done, he was too likely to die on the table.
“I’m going to be a cripple forever,” my father told me. He rarely complained, always insisting that he took “the macrocosmic view of life”—and only a supremely buoyant man expects to live forever, even in a crippled state. But the surgeon in his immaculate green scrubs had delivered a bad blow. Optimists are the least prepared for the loss of hope.
My father’s spirits sagged. He was a physician and a scientist, who had spent decades pursuing the secrets of blood: how it flows, pools, clots, conducts intracellular conversations with itself. Too frail for what had been a daily commute into Manhattan, he was still running his laboratory in absentia. He kept up a voluminous correspondence, which meant many hours speaking into his beloved treadle-activated Dictaphone. He wanted to find a new treatment for stroke, wanted to fly to South Africa and test out his compounds on cheerful, doomed baboons, wanted to win the Nobel Prize and wear his tuxedo to accept the check from the King of Sweden.
Increasingly unsteady even with the walker, he would fall, sometimes knocking over pieces of furniture, creating great crashing sounds that were hard to attribute to such a small, smiling man. Every time, he got up off the floor—with assistance—and declared that he was fine. He didn’t break an ankle, a hip, a leg, the injuries that so often lead to a death spiral in the elderly. “You can knock me down, but you can’t kill me,” he liked to say, dusting himself off.
What eventually happened was a subdural hematoma: bleeding in the brain. When it happened we don’t know. Possibly he banged his head during one of those falls, the ones that couldn’t kill him; possibly a blood vessel in his brain just gave way. He began to have visionary moments, time-travelling moments, when he spoke to his dead best friend, Ed Booth, or happily sang selections from the hit parade of 1938—“Flat Foot Floogie” or more sentimental tunes that he directed at my mother. “Your father has turned into a songbird,” she said. In retrospect, these may have been early effects of the bleeding. Or maybe they were just specimens of longing.
On March 31st, however, he was too weak to get out of bed, and, when my mother brought him breakfast on a tray, he began drinking coffee from an imaginary cup. With one finger hooked through the invisible handle, he brought the cup to his lips, took a sip. He was no longer singing. My mother summoned an ambulance, and he went to the hospital.
Everything I have described so far seems to have happened to somebody else—to somebody else’s father. But the death of a parent happens to you, and, once it starts, it never stops. It dislodges everything. “Is he sick?” my friend Peter asked me a few days after my father drank from the invisible cup. “Or is he dying?” At that moment, it occurred to me with absolute certainty that he was dying, and I said so. I felt the truth of it, and also a terrible sense of disloyalty, as if I were abandoning my father.
I hurried to the hospital the next morning with my mother. My father was in a peculiar state: completely articulate and completely delusional. The blood in his brain was displacing gray matter, and this small compression of physical stuff—a few ounces of wrinkled tissue, hardly more substantial than cotton wadding—had spirited him away to a parallel universe.
He was happy to see us. He was less happy at having received a visit, earlier that morning, from some sinister and illusory Big Pharma delegation. “They wanted to sign me up,” he said. “They offered me a job. But I know what’s going on here.” As he explained it, the doctors and nurses and paramedics were all frauds, pretenders, and he was being held against his will. He had to expose the conspiracy to the top brass, assuming that their hands weren’t dirty as well. “Go find the director of the hospital,” he instructed me. “Tell him he needs to get down here as soon as possible.”
I was new to this game. I didn’t yet understand that I needed to meet my father on his own turf. “Dad, I can’t do that,” I said. “These people are giving you excellent care.”
My father looked distressed. “I can’t believe my own son won’t help me,” he said.
This conversation was the last truly cogent exchange we ever had—which is to say that it involved grammatical sentences uttered by two people on the opposite sides of an abyss. It still causes me enormous pain. I now see that I should have reassured my father: the director was coming, the grifters would be exposed. It would have been a kindness. Instead, I maintained my completely pointless probity.
One of the staffers, more adroit than I was, agreed to fetch the director, though of course he never did. That afternoon, with the aid of a nurse, my father walked up and down the ward, greeting the other patients with a big smile and a wave of reassurance, as if they were his constituents. He seemed delighted. It was almost like being at work again. But once he got back in bed, his public persona fell away and he was again a sick, frightened man in a smock.
The doctors came, the doctors went. They all addressed my father with a hint of guild solidarity. He was, after all, a medical man. He was used to discussing the human body, and the many things that could go wrong with it, without mincing words. While his condition had transformed his sense of reality—allowing him to commune with the dead, making visible what was invisible to others—it was also a mechanical problem. It could be solved by mechanical means. The doctors would drill a hole in my father’s skull and attach a drainage tube. With the pressure on his brain relieved, he would rejoin us in the consensus kingdom where a coffee cup was a coffee cup and he was himself.
Of course he agreed. Or, at least, he failed to protest. The procedure would take place the next morning. That night, I went home with my mother and brother, to the old house where I had grown up, which was now being emptied in preparation for the move.
The emptying took a long time, because my father collected objects, or, anyway, objects collected around him. Some were functional—fans, space heaters, humidifiers, dehumidifiers—but he required them in enormous numbers, and they formed a miniature history of low-end industrial design. When you plugged them in, they hummed, as if they had been devised for a different electrical grid, and gave off bad smells. Other things he collected were luxuries: fountain pens from Germany, shoes from Chicago, leather-bound editions of Darwin and Einstein whose footnotes alone might take him years to absorb. And the shirts! These he had accumulated by the hundreds, as if there might be a shirt blight down the road, and he stored them on shelves in the attic, wrapped in brown paper and neatly labelled with the date they had last come back from the dry cleaner.
His itch for accumulation must have been fuelled by his boyhood during the Great Depression. He was born in 1925. His father worked in a grocery, then sold candy from the trunk of his car to mom-and-pop stores throughout Brooklyn and the Bronx. The family was not exactly poor, but there was some privation. The fear of losing everything—the conviction that the rug would be pulled out from under your feet, and that you might deserve it—stayed with him. But I think there was more. I think he felt a deep unease, a panic about his place in the world. I can say this because I feel it myself, sometimes. On such occasions, I am convinced that I have fallen off the edge of the Earth, that I am already in a posthumous phase and have somehow failed to notice until now. When my father was confronted by such feelings, his remedy, always, was to buy something. This may be the dumbest of all coping strategies, but there is a crude logic to it: the body crumbles away, but a fountain pen with a golden nib is forever. The inanimate outlasts the animate. My father is gone, but I still have his patent-leather shoes, which just about fit me and are so shiny that I can study my reflection in them.
That evening, in the mostly empty house, my brother went out to his station wagon and dragged inside his upright bass. I found my old nylon-stringed guitar, and we played a few things in the front hallway, right under the lighting fixture that I had broken when I was eleven. The bass was booming and assertive, the guitar scarcely more than a whisper.
My brother played “What a Little Moonlight Can Do,” humming the melody but mostly concentrating on the bass part. I could see how much he looked like my father. He had the same broad face and reddish hair and piercingly blue eyes, all of which made him seem like a proxy, or a genetic ambassador. The sound bounced off the old oak floors, stained and varnished to tempt potential buyers. Eventually, my brother ran out of steam and leaned the bass against the wall in the entryway. It looked precarious: would it fall? Then we went to sleep on a blow-up mattress and an old sofa cushion, as if we were camping out in some strange and disquieting place.
When we arrived at the hospital in the morning, my father was still in bed, calmly sharing his hallucinations. A man in a brown suit had accosted him and demanded some proof of his identity. What upset my father the most, it seemed, was his confusion about who had the better claim—what if the other guy was him?
Underneath the canary-yellow blanket on his hospital bed, he didn’t look too bad, aside from the tubing taped to his arm and the cannula streaming oxygen into his nose. Eventually he was wheeled away for the operation. In the cafeteria with my mother and brother, I ate food and drank coffee that tasted like nothing. I can’t remember how long it took. I assume that the actual procedure, the business with the drill, was over in an instant. What takes time is before and after: the downward dip of consciousness as the anesthesia kicks in, the coaxing back to life of the patient who has more or less visited the anteroom of the dead. Eventually, a nice surgeon came to find us and tell us that the operation had been a success.
We all know that doctors speak a specialized language. As a doctor’s son, I was well aware that “success” was a particularly slippery word. It meant only that the great calamity had been deferred, at least for the moment. Still, we were ecstatic. The pressure on my father’s brain had been relieved, and he would probably be lucid again in a few hours, no longer harassed by Death in brown Hickey Freeman tweeds.
He was returned to his room, with a square of gauze on the top of his head. A length of plastic tubing issued from the gauze. There was blood in the tube, flowing into a transparent plastic bulb—a crude conduit between the inside of his head and the outside world. None of this felt real. But it seemed like a reasonable price to pay for escaping the netherworld and living on Earth a bit longer. We gathered around the bed and looked at him, waiting for his return.
He never really did return. For the final weeks of his life, he remained in a fog, from which he very occasionally emerged for a minute or two, and never when I was there. One day, when my mother was sitting by his bed, he woke up. He told her that he had been visited the previous afternoon by Uncle Eddie, his adored role model whom the F.B.I. had tried to recruit nearly a century before, and who had lived in a gilded apartment on East Tenth Street with a secret office behind a faux bookshelf.
“Aaron, your uncle died fifty years ago,” she said.
“I know,” he said. “But nonetheless.”
There, in a single word, is the best argument on behalf of the afterlife that I have ever heard. The dead may walk among us simply because we insist that they do. They just keep circulating, those beloved, resented, lamented figures, our better selves and interlocutors of choice, with whom the conversation never ends.
Meanwhile, life flowed on around him. A few days after the procedure, in early April, the movers came to the house, loaded whatever remained onto a truck, and brought it to the new apartment. I was back at work, so my girlfriend, Nina, volunteered to sit with my father at the hospital. The drain had been removed from his head. He had just enough strength to climb out of bed and deposit himself in a chair by the window. At one point, Nina later told me, he leaned forward in the chair and began shuffling his feet. He was intent: he seemed to be in the midst of some small journey.
Originally published in the March 11th, 2019 edition of The New Yorker.
