Issue 42 - Columbia: A Journal of Literature and Art

giving him diuretics to get the fluid off, and morphine for the pain
and to help him breathe. But he is continuing to drown, his fingers
and toes are turning blue, his blood is stagnating, he is on the verge of
collapse. We infuse a medicine to try to dissolve the blockage in the
artery supplying his dying heart muscle. But this is also in vain.
Nothing worked as planned. The pants man's circulation continued
to fail; his lungs filled with more fluid as his extremities sank
into a deeper violet. He would not live the night if we could not open
that artery. He needed more than could be found in the slot. He
needed someone to go in and manually unclog the blockage. He
needed an angioplasty. So with a team of practioners in tow, we took
our patient up to the fifth-floor and slowly woke up the cath lab from
its weekend sleep.
The cath lab was was nothing like being in medical school, where
whenever I was gowned-up it was in an operating room, and I
always felt out of place. Back then, I held retractors. I held them so
long over open chests and abdomens that my neck cralnped and my
shoulders ached. I tried to give as much exposure to the operating
field as possible in the hope that I would disappear. I focused on trying
to help as much as I could. Get this, do that, keep moving.
Inevitably the chief surgeon would ask some mortifying question
like, "What do you make of the mouse model of hernia repair?" or
"What Shakespeare play does this line come from?" My inability to
answer was crushing. There could never be any doubt about who
wielded the power over me: the nurses, the other doctors, and the
open body in that room.
But that night in the cath lab, there were no impossible questions.
It was just business as usual. As dye was injected, we took pictures.
Pictures of the arteries and blockages, pictures of a small balloon
blowing up inside an artery, and then the trickle of dye that said the
blockage was gone. All of this recorded on what looked like old
Super 8 film, a sort of home movie of the heart.
When all was done that could be, and the catheters were
removed, it was my job to make sure that the large hole we made in
the femoral artery closed. This meant applying firm but constant
pressure on my patient's groin. I thought this was going to be the
final act, the triumphant denouement after the climactic angioplasty.
We had opened up his artery, and restored blood-flow back into:,
his heart, but the man was still dying. His heart muscle -like a '
child gone limp after a beating - had been so stunned by the sudden
and complete lack of oxygen that it would not contract. The
pants man's eyes began to dull and blood tests showed a dangerow:
buildup of acid.
A last attempt was made to save him by putting in an intraaortic
balloon pump, which actually did the trick. So after hours
of effort using the best available high-technology interventional
cardiology - something based on the physics of a party favor
that would save this man.
After what seemed like an eternity (but more like five hours), I
brought the pants man, his IVs and balloon pump up into the cardiac
ICU. He was stable; I was exhausted. By then I had spent hours
pulling, poking, prodding, and probing his body. I had made hiln uri
nate, thinned his blood, put my hands in his groin. I was intimately
aware of him, yet I knew very little about him. It was like I had been
looking at the photographic negative of someone. Details, size, texture
had all been perfectly represented, yet remained uninterpretable,
It relninded me of my own father.
When I was around my sons' ages, my father and I spent countless
hours together. Not just at synagogue, but doing many of the usual
father-son things available in a New York City suburb: mowing the
lawn while straddling a wheelhorse tractor, pulling weeds from the
garden at the front of the house, raking leaves, driving from place to
place looking for shrubs or plants or more mulch. In the summers he
wore ripped jeans and a white T-shirt. There are pictures of me on his
shoulders as a young boy, but I cannot remember being there.
What I do remember is his belly loosely hanging out over the rim
of his jeans, and the embarrassment of seeing his jeans fall down as
he bent over to plant seeds or bulbs. I can still see the patches of
psoriasis there and on his arms. The same patches that drove our
family from open beaches to desolate sandy places where he could
take off his shirt in private.
I was always aware of his psoriasis. I noticed how he never talked
about it, how lny mother would say, "We can't go there because of
your father."
I knew from quiet, careful surveillance that at night he wrapped
himself in Saran Wrap after covering his skin in cremns to try to abatl
the seemingly endless propagation of the thick plaques.
When we worked in the garden, I could see how the medicine
made his skin diaphanous in places. How cuts that on lne would be
mere scrapes would, for him, be bleeding wounds. Though we spent
many hours talking, we never spoke of this. We talked about soil and
dirt and rocks. We talked about water tables and the differences