American Sycamore, page 10
Bliss was it in that dawn to be alive,
But to be young was very heaven!
In the kitchen, with my cup of tea, I felt very heaven! This is life, I thought. This is what existence as a human being is at its core. It is love, it is gratitude, it is love of another greater than love for one’s self. This, for me, defines life’s spiritual and human essence. It’s odd. I have never been much of a crier, but now I tear up at the slightest emotional cue. I cry out of joy at you being here with me.
14
Wash the Oxycodone Down with Scotch
The day after Thanksgiving, the pain was intense. Chen had mentioned that some patients developed scar tissue after surgery that could persist even after removal of the catheter. Rob didn’t say anything about it that morning at breakfast when Julia was about to drive up to Maine to visit a friend for the day. He wanted her to enjoy herself, not worry about him. She needed the break from him and the cancer-related stress. Ray, he knew, was in an all-day conference at the medical school for international students, and he didn’t want to interrupt something so important. But as the day progressed, it worsened. After surgery, he had taken the prescribed pain medication, oxycodone, as directed. He had a few caplets left and took one that morning, but its effect was minimal. He called Chen’s office and asked whether he should up the dosage but was cautioned by the nurse not to do so.
“But I’m in a considerable amount of pain,” he said.
“It’s best to follow the doctor’s recommendation especially with an opiate,” she said. She was condescending, talking to him as though he was an idiot, a nuisance in her day.
“Could you ask Dr. Chen to call me, please?” Rob said.
“Dr. Chen is in surgery back-to-back all day,” she said.
“Oh, okay,” Rob said. “How about one of the other doctors in the department? Could you have one of them give me a call? I seem not to be conveying properly the degree of pain I’m experiencing. I really do need to consult with a doctor.”
“Well, Dr. Woods is away at a conference,” she replied wearily. “I could have him call you next week.”
“Is someone covering for Dr. Woods?”
“Dr. Gillespie.”
“Do you think you might impose upon Dr. Gillespie to call me for two minutes so I can get this dosage increased?” He was failing to conceal his irritation.
No return call came from Dr. Gillespie or anyone else throughout that day. These fucking doctors, Rob thought. They always said it was about the patient or patient-centered or other PR phrases, but that was bullshit. It was about them and what worked for their schedule and what was convenient for them. Ray had told him this a million times, and now Rob understood. He felt powerless, standing alone outside the castle, the gates shut, drawbridge up, alligators patrolling the moat. He couldn’t penetrate the system, and it made a man who was rarely angry quite angry. Rob had experienced anger so infrequently in his life that it nearly always came as a surprise, and he found himself inept at handling it.
At 5:00 p.m. Rob called Ray and explained the situation. Forty-five minutes later Ray came through the privet with a single malt and a pocket full of painkillers. “It’s all about the metrics,” Ray said. “All the hospitals want to be the one to prescribe the fewest opioids. It’s cowardice. They claim they’re patient-centered, and then when the patient is suffering, do they relieve the suffering or do they worry about their own opioid count for the year? Imagine doctors being perfectly content to let patients suffer. I got a call from a patient whose wife had a knee replaced and she was in a lot of pain, which obviously is common, and they told her to take Tylenol. She was crying with pain. Fucking Tylenol when she’s at nine on the pain scale.”
“So what did you do?” Rob asked.
“Same thing I’m going to do for you, Rob,” said Ray. He handed Rob a prescription container with sixty oxycodone pills.
“Take as much as you need to make the pain go away,” Ray said. “You’ll figure it out. Stay ahead of the pain. Take the dose that works for you at regular four-to-six-hour intervals. Stay on that dose, whatever it is, for the next few days, and then, only if you feel relatively pain-free, you can experiment with a lower dose. You’ll know if you’ve taken too much—you’ll feel really shitty, and you might vomit. You will get very constipated, so I also brought the laxative that works well. Make sure you take it.”
“Could I get addicted?” Rob asked.
Ray laughed. “I don’t see that happening. But if it does, I tell you what, we’ll send you to rehab.”
“I’m curious where you get these drugs,” Rob asked. “Wouldn’t the pharmacy people get suspicious if you’re prescribing all these pills for yourself?”
“Oh, of course,” he said. “I would never do that. I get them straight from the pharma sales reps. They give me whatever I want.”
“Wow,” said Rob. “Is that kosher?”
Ray laughed heartily. “Of course not. You just sit and relax.” He went into the kitchen and returned with two glass tumblers. He poured a few fingers of scotch into each glass.
“Wash the oxycodone down with scotch,” Ray said. “Gives you a jump-start.”
“Really?” Rob said skeptically.
“Christ, when I have bad insomnia it’s my go-to.”
They chatted for about an hour until their drinks were finished.
“Feels better, doesn’t it?” Ray asked.
“Wow,” Rob said. “I feel so much better. Thank you.”
“Mission accomplished,” said Ray. “I have to get back to school for a reception for the international kids so I’ll see you tomorrow. Any issues, call me.”
After Ray walked back through the yard and the privet to his home, Rob remained sitting in the garden. Light from the house illuminated the terrace, but most of the yard was in shadows or darkness by now, and though the temperature was falling, he didn’t want to go inside. This was where he belonged, where he was destined to be. He was feeling quite pleasantly pain-free, but his mind was troubled by the idea of cancer. What a terrible word. The doctors said that they had removed all of the bad cells, that they had caught it early, that prostate was one of the slowest growers, that they had excellent treatments even in the event that the cancer should reappear, which the doctors believed unlikely, and on and on. And yet, he couldn’t help but wonder what it would be like to find that the disease had accelerated, made its way to the bones and through them to his major organs, and then there would be nothing that could be done.
His fears receded within the embrace of the drugs and alcohol. He recalled the propofol from surgery, and soaring over Fenway and the Emerald Necklace. He felt a bit like that now. His gaze fell upon the thorny, brownish stems of the rosebushes in full retreat from the cold. But Rob could see the roses now as they had been in summer, clutches of roses climbing the trellis, and he felt he could see how deeply red they were, a color that seemed aggressive, even martial, given to drama and violence. He liked roses very much, but he preferred peonies and the richness of their shade of white, something out of a painting by John Singer Sargent. He summoned an image of the oak leaves, dark green, nature’s signature. He liked the fact that there were thousands of them replicated almost exactly alike throughout the tree. Maybe tens of thousands. He marveled, as he so often had, at the longevity of the trees. That particular oak, just beyond the sycamore, had flourished in this very place for at least a century, perhaps longer. How sturdy these mighty trees were against the intrusion of winter. The oak and sycamore had been rooted here during World War I, the Great Depression, World War II, the sixties, Vietnam, 9/11. It seemed kind of amazing, but in Rob’s condition, almost everything at that moment seemed kind of amazing. What a marvelous sensation to be shielded from pain or discomfort. Earlier in the day he had been feeling sorry for himself, and he didn’t much like that. He thought of all those people on the second floor at the Cancer Center awaiting their blood work. He thought of Rita B and wondered how she was faring. There were people in there with cancers of the brain, cancers of the pancreas, diseases that had a kamikaze aspect to them—kill the host at any and all cost and do so as quickly as possible. He, on the other hand, had a more controllable, less lethal cancer. At least in theory.
15
The Chief
On the first day of December, Rob and Julia settled into comfortable chairs to listen to a radio broadcast of the day’s argument in the United States Supreme Court in the case of Dobbs v. Jackson Women’s Health, more colloquially known as the latest Roe v. Wade case. Rob had read the briefs from the petitioners and the government, and he had read a number of the amicus briefs as well. In fact, he had edited and revised one such brief submitted by a women’s health organization in Cambridge. The issue at hand was whether it was constitutionally permissible for the state of Mississippi to prohibit abortion after fifteen weeks, the “gestational age,” in the Mississippi law, with no exception for rape, incest, or the life of the mother. The fear among many constitutional scholars was that the court’s conservative majority could use the case to go further than deciding that question. That, in fact, the conservative justices might use the case as a way to overturn Roe. Rob said very little during the course of the two hours of argument before the court. Justice Kagan summarized the liberal position succinctly: How could the court now consider “fifty years of decisions saying that this is part of our law, that this is part of the fabric of women’s existence in this country”? Julie Rikelman, an attorney representing the Mississippi abortion clinic, told the justices that the central issue was the right of a woman to control decisions about her own body. “For a state to take control of a woman’s body and demand that she go through pregnancy and childbirth, with all the physical risks and life-altering consequences that brings, is a fundamental deprivation of her liberty,” Rikelman said.
But the conservative justices were having none of it. One after another expressed comfort with the Mississippi law. More than that, it was clear that the consensus among them was to use the case to overturn Roe.
“There’s only one hope,” Rob remarked toward the end of the argument. “The chief has to persuade them to answer the simple question in the case: Is the Mississippi law constitutional? Period. Don’t answer unasked questions.”
“And the question of Roe is not asked?” Julia asked.
“It is not asked in the original filings by Mississippi,” he said.
As if on cue, Roberts said, “The thing that is at issue before us today is fifteen weeks,” making it clear that his preferred option was to uphold Mississippi’s law and stop there.
“Why answer a question that is not explicitly present in the case?” Rob asked.
When Roberts accused the Mississippi attorney general of a baitand-switch tactic, Rob was heartened. In the state’s petition seeking Supreme Court review, the Mississippi attorney said that “the questions presented in this petition do not require the court to overturn Roe.” But the state changed tactics once the court agreed to hear the matter and mounted a full-on assault to overturn Roe.
“The chief doesn’t like that kind of tactic,” Rob said.
Rob had predicted months earlier that Roberts would seek a compromise position—precisely as he was now doing. This thrilled Julia. “Rob!” she exclaimed when the chief said the court should allow Mississippi to set a fifteen-week limit on abortion but not decide Roe. The way in which the chief calmly laid out this option seemed reasonable. It would solve the Mississippi case, stop well short of overturning Roe, and avoid an all-out culture war.
“Do you think they’ll do it, Rob?” Julia asked.
“What the chief is suggesting?”
“Yes.”
Rob nodded. “I do.”
16
“My Dad, Doc . . . I’m All He’s Got”
On the first Saturday in December, under a cold mist, Ray and Rob set out for a walk through the Mount Auburn Cemetery, a sprawling landscape serving as the afterlife residence for Winslow Homer, Longfellow, and others in the intellectual elite. This acreage by the Charles River was a sanctuary for Ray, a place for reflection and a good walk that got the heart beating faster. Once within the cemetery, they followed a perimeter road past carved granite memorials more than a century old. The narrow internal roadways were lined with oak and elm, ancient trees that had remained sturdy as many thousands of humans had been buried beneath their shade.
“In here I can feel the quiet,” Ray said as they walked along, past one grave marker more ornate than the next. “I get a sense in here of peace that we think of as beyond the grave, but it is also here, the aura of this place. I wonder whether it could be a hint of the peace you feel on the other side.” Ray turned to Rob and could not help but laugh. “These are the deep thoughts one has in a cemetery,” he observed sarcastically.
Ray had his binoculars strapped around his neck, even though the conditions for spotting birds was less than ideal. Then, suddenly, he hoisted the glasses and studied a bird in the distance. “American goldfinch,” he said. They walked on and without the aid of the binoculars Ray spotted a northern cardinal as well. He turned to the side, moving past the first row of headstones to the second, where a large monument occupied a patch of ground where B. F. Skinner lay. “After he retired, he was still around here,” said Ray, “and I had an idea when I was a junior faculty member to solicit his support for a grant proposal I was writing that integrated some behavioral issues into a study of people with complex chronic conditions. So I get all my material together, work through other faculty to get an audience with the great man. I go over there—he kept an office just off the square—and we meet and I explain my idea, and I will admit in retrospect that it wasn’t one of the great intellectual breakthroughs of all time, but it wasn’t nothing either.” Ray laughed at the memory. “He thought that my approach to the grant was the stupidest thing he had ever heard! He belittled me—though he did it in a very quiet, restrained voice. I left there and the only thought I had was, I hope I have just had the worst meeting I will ever experience.”
“Was it?” Rob asked.
Ray shot Rob a look of incredulity. “You know what faculty meetings are like. They’re painful enough to merely attend. I have to preside. It’s getting a tooth drilled without novocaine.”
“No different at the law school,” Rob said. “Maybe worse.”
“Worse than senior physicians at Harvard teaching hospitals?”
They walked in silence for some distance until Ray pointed out the impressive marker for the grave of Felix Frankfurter. Rob, of course, knew the justice was at rest here; in fact, had visited the grave on a couple of occasions.
“What a mind,” Rob remarked.
“Here, too,” said Ray as they next approached the marker bearing the name Winslow Homer. They circled down toward where the cemetery abutted the river, then made their way up the steepest part of the property to a stone chapel, elegant in its English lines, something out of a Cotswold village. From the top of the hill they started down a gently descending pathway.
“So let’s talk about the elephant in the room, Rob,” said Ray. “Cancer is the one word that can derail anybody. It’s the malevolent response of the universe for the creation of life. But we have to look at the bright side. If it was pancreatic, you’d be dead in ninety days. Unless they trapped you in a trial and tortured you with rat poison, which is the current standard treatment. I have complete confidence that you will get through this.”
They continued on, both zipping up their jackets against the cold, the mist having turned to rain.
“I want to show you something,” Ray said, turning to a remote section of the property. They moved along until they came upon a flat piece of stone on the ground with the inscription:
MCGEORGE BUNDY
BORN MARCH 30, 1919
DIED SEPTEMBER 16, 1996
BOSTON, MASSACHUSETTS
Ray stood quite still, head slightly bent, gazing at the grave marker. “He hides here,” Ray said. “He hides here, Rob, so no one will notice. So no one will stop to consider what he did. He was one of Halberstam’s best and brightest. Gifted intellect but, like so many of that ilk, his self-belief outstripped the reality of his capabilities. He pushed Kennedy on the Bay of Pigs, was in the room for the Cuban missile crisis. But most of all he was there to convince Kennedy, then Johnson, to go all in on Vietnam. More troops, then more still. More nineteen-year-old marines. In America we had an inexhaustible supply. Bomb the north, then bomb them some more.”
Ray shook his head slowly, as though he was unable to fathom what Bundy had wrought. “He and the others were raised to believe in their own destiny as the elite among the elite who would make decisions others lacked the intellect and moral authority to make. Hubris was the disease of that era, and he was infected. Terminal case. I wonder whether he ever came to understand the harm he had done. I wonder whether he ever visited the wall, read the names. If you don’t read the names and think about their young lives and their promise, then you can’t understand the tragedy of it. Fifty-eight thousand. Average age twenty-one. What kind of people send their young men to such a fate?”
After Vietnam Ray had tried to “get well,” as he had once put it to Rob and Julia. He had married, but seven months later he begged his young wife for forgiveness for, as he put it, “the way I am.” She knew he was right. How could you live your life with such a tortured soul? He tried therapy, meditation, acupuncture, hallucinogenic drugs, and religion, and found that faith, a focus on God’s grace and the afterlife, helped more than anything. He believed in eternal peace. He came to believe that a just God would have a place where peace was the nourishment for his marines and their families. But the war haunted him.
In 1971, Ray Witter was assigned to a medical-surgical hospital unit in Phu Bai, forty miles south of Hue. Lieutenant Witter landed in Saigon on a blistering day in May looking splendid in his bleached white uniform and gung-ho to contribute to the war effort. He seemed during that time to resemble a character out of central casting—tall, lean, fresh haircut—with the easy manner common to the confident, to those with an intellect that simplifies the cognitive side of life. He was a young man ready for the world, destined for important work in the field of medicine, comfortable in his skin.
