Medical Heroism

NPR, PBS Newshour, and The New Yorker recently featured Atul Gawande discussing the importance of primary care physicians who offer what he calls "incremental care." He cites statistics that show while primary care physicians are among the most poorly remunerated and least well treated by insurers, their care has the most profound impact on improving the quality of and length of our lives.

I saw my PCP a few days before reading and viewing Gawande. In his comments I recognized my own doctor. I've lived in many places, and I've had many physicians, but none has been a better listener and adviser than he is. I am one of the lucky ones.

I only wish in this time of healthcare uncertainty that every other citizen could have the same access to this basic human right: quality, continuing care. We'd all be better for it.

Doubleness

I keep seeing what's inside and what's outside. In a firehouse door or in a person. Inside I'm the same person I was at 16 or 35, but outside I'm older than my mother ever was. Even the outside of my face isn't a true reflection of me since surgery altered its structure some years ago.

Reading too is an act of doubleness, once for the first time (and perhaps other readings) and thinking (in the act and again and again afterwards). Donald Hall's essay "Double Solitude," published recently in The New Yorker, is a reflection of another kind altogether. And it is beautiful.

At eighty-seven, I am solitary. I live by myself on one floor of the 1803 farmhouse where my family has lived since the Civil War. After my grandfather died, my grandmother Kate lived here alone. Her three daughters visited her. In 1975, Kate died at ninety-seven, and I took over. Forty-odd years later, I spend my days alone in one of two chairs. From an overstuffed blue chair in my living room I look out the window at the unpainted old barn, golden and empty of its cows and of Riley the horse. I look at a tulip; I look at snow. In the parlor’s mechanical chair, I write these paragraphs and dictate letters. I also watch television news, often without listening, and lie back in the enormous comfort of solitude. People want to come visit, but mostly I refuse them, preserving my continuous silence. Linda comes two nights a week. My two best male friends from New Hampshire, who live in Maine and Manhattan, seldom drop by. A few hours a week, Carole does my laundry and counts my pills and picks up after me. I look forward to her presence and feel relief when she leaves. Now and then, especially at night, solitude loses its soft power and loneliness takes over. I am grateful when solitude returns.

Born in 1928, I was an only child. During the Great Depression, there were many of us, and Spring Glen Elementary School was eight grades of children without siblings. From time to time I made a friend during childhood, but friendships never lasted long. Charlie Axel liked making model airplanes out of balsa wood and tissue. So did I, but I was clumsy and dripped cement onto wing paper. His models flew. Later, I collected stamps, and so did Frank Benedict. I got bored with stamps. In seventh and eighth grade, there were girls. I remember lying with Barbara Pope on her bed, fully clothed and apart while her mother looked in at us with anxiety. Most of the time, I liked staying alone after school, sitting in the shadowy living room. My mother was shopping or playing bridge with friends; my father added figures in his office; I daydreamed.

In summer, I left my Connecticut suburb to hay with my grandfather, on this New Hampshire farm. I watched him milk seven Holsteins morning and night. For lunch I made myself an onion sandwich—a thick slice between pieces of Wonder Bread. I’ve told about this sandwich before.

At fifteen, I went to Exeter for the last two years of high school. Exeter was academically difficult and made Harvard easy, but I hated it—five hundred identical boys living two to a room. Solitude was scarce, and I labored to find it. I took long walks alone, smoking cigars. I found myself a rare single room and remained there as much as I could, reading and writing. Saturday night, the rest of the school sat in the basketball arena, deliriously watching a movie. I remained in my room in solitary pleasure.

At college, dormitory suites had single and double bedrooms. For three years, I lived in one bedroom crowded with everything I owned. During my senior year, I managed to secure a single suite: bedroom and sitting room and bath. At Oxford, I had two rooms to myself. Everybody did. Then I had fellowships. Then I wrote books. Finally, to my distaste, I had to look for a job. With my first wife–people married young back then; we were twenty and twenty-three–I settled in Ann Arbor, teaching English literature at the University of Michigan. I loved walking up and down in the lecture hall, talking about Yeats and Joyce or reading aloud the poems of Thomas Hardy and Andrew Marvell. These pleasures were hardly solitary, but at home I spent the day in a tiny attic room, working on poems. My extremely intelligent wife was more mathematical than literary. We lived together and we grew apart. For the only time in my life, I cherished social gatherings: Ann Arbor’s culture of cocktail parties. I found myself looking forward to weekends, to crowded parties that permitted me distance from my marriage. There were two or three such occasions on Friday and more on Saturday, permitting couples to migrate from living room to living room. We flirted, we drank, permitting couples to migrate from living room to living room.We flirted, we drank, we chatted–without remembering on Sunday what we said Saturday night.

After sixteen years of marriage, my wife and I divorced.

For five years I was alone again, but without the comfort of solitude. I exchanged the miseries of a bad marriage for the miseries of bourbon. I dated a girlfriend who drank two bottles of vodka a day. I dated three or four women a week, occasionally three in a day. My poems slackened and stopped. I tried to think that I lived in happy license. I didn’t.

Jane Kenyon was my student. She was smart, she wrote poems, she was funny and frank in class. I knew she lived in a dormitory near my house, so one night I asked her to housesit while I attended an hour-long meeting. (In Ann Arbor, it was the year of breaking and entering.) When I came home, we went to bed. We enjoyed each other, libertine liberty as much as pleasures of the flesh. Later I asked her to dinner, which in 1970 always included breakfast. We saw each other once a week, still dating others, then twice a week, then three or four times a week, and saw no one else. One night, we spoke of marriage. Quickly we changed the subject, because I was nineteen years older and, if we married, she would be a widow so long. We married in April, 1972. We lived in Ann Arbor three years, and in 1975 left Michigan for New Hampshire. She adored this old family house.

For almost twenty years,I woke before Jane and brought her coffee in bed. When she rose, she walked Gus the dog. Then each of us retreated to a workroom to write, at opposite ends of our two-story house. Mine was the ground floor in front, next to Route 4. Hers was the second floor in the rear, beside Ragged Mountain’s old pasture. In the separation of our double solitude, we each wrote poetry in the morning. We had lunch, eating sandwiches and walking around without speaking to each other. Afterward, we took a twenty-minute nap, gathering energy for the rest of the day, and woke to our daily fuck. Afterward I felt like cuddling, but Jane’s climax released her into energy. She hurried from bed to workroom.

For several hours afterward, I went back to work at my desk. Late in the afternoon, I read aloud to Jane for an hour. I read Wordsworth’s “Prelude,” Henry James’s “The Ambassadors”twice, the Old Testament,William Faulkner, more Henry James, seventeenth-century poets. Before supper I drank a beer and glanced at The New Yorker while Jane cooked, sipping a glass of wine. Slowly she made a delicious dinner—maybe veal cutlets with mushroom-and-garlic gravy, maybe summer’s asparagus from the bed across the street—then asked me to carry our plates to the table while she lit the candle. Through dinner we talked about our separate days.

Summer afternoons we spent beside Eagle Pond, on a bite-sized beach among frogs, mink, and beaver. Jane lay in the sun, tanning, while I read books in a canvas sling chair. Every now and then, we would dive into the pond. Sometimes, for an early supper, we broiled sausage on a hibachi. After twenty years of our remarkable marriage, living and writing together in double solitude, Jane died of leukemia at forty-seven, on April 22, 1995.

Now it is April 22, 2016, and Jane has been dead for more than two decades. Earlier this year, at eighty-seven,I grieved for her in a way I had never grieved before. I was sick and thought I was dying. Every day of her dying, I stayed by her side—a year and a half. It was miserable that Jane should die so young, and it was redemptive that I could be with her every hour of every day. Last January I grieved again, this time that she would not sit beside me as I died. 

Close Punctuation

I
A new term learned today from Mary Norris' "Confessions of a Comma Queen" in the February 23, 2015 issue of The New Yorker:

The New Yorker practices a "close" style of punctuation. Or, as E. B. White once put it, "Commas in The New Yorker fall with the precision of knives in a circus act, outlining the victim." (Norris, 2015, para. 32)

Commas separate or mark off sentence parts with precision and tact and art.

II
Precision isn't something we experience with Tennessee weather.

In the transitions from season to season, the parts -- temperature, humidity, precipitation, sun -- jumble together like words in a rambling sentence, which defies logic or clarity.

To wit: a high of 66 today and a predicted low of 26. Fog, rain, ice pellets. Sunshine on Friday with a high of 38 and low of 22. Then back up to 52 on Sunday.

III
In language, I like a close style, but in seasonal shifts I prefer messiness and unpredictability, so much closer to life as it is lived rather than life as it is made in words.

IV
Besides, the crocus don't mind, so why should I?

On Writing and Wishing

Twenty-three days to go, and I am no nearer a Christmas book than I was when I felt the spark of an idea about two weeks ago.  The annual panic has set in, consuming me live like the no-see-ums dragonflies feed on so rapaciously.  

I am told that an insect doesn't suffer when dying: it shuts down, goes into a kind of physical stasis.

Not me.  

When the composition disease strikes, I become itchy-titchy and distracted, latching on to any impulse pulling me in any off-target direction.  It's not enough, for example, to walk the lake and take photographs (umpteen more of Autumn Meadowhawks as though the hundreds I have already shot aren't sufficient), but then I come home and play with them, using Photoshop as a delaying tactic without equal.

I have an image I like now.

But it's not enough to like this image.  I am not writing about dragonflies for Christmas (though I wish I had written this description published in this week's New Yorker: "Green Darners never attack people, but they have been seen bringing down hummingbirds.  They are the Bengal tigers of the microworld.").

Mine is another topic altogether, and words fail me.

Today, I am no Bengal tiger: I am a hummingbird, and the looming deadline, a Darner.  

The New Yorker

When I was 15 and bored, a Brooke Hill librarian saved my reading life: she introduced me to Scientific American, Time, and The New Yorker.

I well thumbed every new issue of all three magazines through the rest of high school. I'm not sure how much I understood of the first, though I had aspirations of studying molecular biology. I do know I read the second thoroughly. As for the third, I loved it in 1962 and I still love it today, though in some ways it is not the same magazine.

One thing hasn't changed: the way I read The New Yorker for the clever cartoons, and the beautiful (and sometimes controversial) painted covers.

I turn every page, noting the events and table of contents, studying each cartoon, enjoying the filler-drawings (and I love the continuing narratives implied by them in today's magazine), glancing at marginal advertisements (I usually skip the whole-page ones), reading the poems, and, today, laughing at the cartoon caption contest on the last page (I even sometimes go online and vote). Then, I go back and read the reviews (books, TV, film, and plays), selected long articles, and skim "The Talk of the Town." (Before these pieces were signed -- was that during Tina Brown's tenure? -- , I read them all for the famous "New Yorker style." I liked those talk-pieces better than most today.) I rarely read the short fiction, with the exception of works by writers in whom I'm interested. I do remember a fairly recent, terrific and strange story by Tony Earley and Annie Proulx' "Brokeback Mountain." I miss some columnists whose work was regular. (I especially enjoyed Jamaica Kincaid's gardening columns, of all things. I'm not a gardener myself.)

My favorite part of the magazine is the cover. I miss the brown-wrapper mailing days because then the cover was always pristine. I frequently saved the covers to decorate my dorm rooms in college, and then I saved them for decoupaging my guitar case, and then I saved them to post in my classroom. Now, I can't get the dadgum label off without stripping off some part of the cover design. Each is a left-framed work of original art worth saving.

(As I write this, I remember the fabulous pool house owned by friends of my parents. The "powder room" was wallpapered with New Yorker covers, not the originals but some fancy wallpaper popular in the early '60s.)

I thank all librarians for saving restless teens like me and the New Yorker publishing corporation for maintaining the magazine since its inaugural issue in 1925, especially since so many other magazines have died.