White Life

White Life

by Michael Stein
     
 

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His relationship with George Dittus, an unforgettable patient, leads up to the visit. In trying to save Mr. Dittos, the doctor's eye is drawn to the unexpected, the contradictory, the ecstatic. He learns that if medicine is an assembly of facts, then doctoring is making sense of the unnamed, and his work is a marriage of the two. Caring for George Dittus finally makes… See more details below

Overview

His relationship with George Dittus, an unforgettable patient, leads up to the visit. In trying to save Mr. Dittos, the doctor's eye is drawn to the unexpected, the contradictory, the ecstatic. He learns that if medicine is an assembly of facts, then doctoring is making sense of the unnamed, and his work is a marriage of the two. Caring for George Dittus finally makes it unbearable not to take the journey home.

Editorial Reviews

New England Journal of Medicine
What general internist Michael Stein does in this novel is to offer, with resonant intelligence and the generous irony of Walker Percy or Milan Kundera, scenes and questions of medicine to the world at large, a world he suspects is bereft of metaphors for its own meaning. This local story about minor medical events in Providence over a four-day period in June enlarges, by virtue of the author's gift, to embrace and illuminate the perils, the abandonments, the dark joys, and the giddy celebrations of being human.
Publishers Weekly - Publisher's Weekly
Physician Stein has written a little jewel of a second novel (after the praised Probabilities), an unsentimental, assured, informative look at what doctors do. Like the author, narrator Dr. Peter Cave works in a New England teaching hospital, which, like all hospitals, is "white," that is, antiseptic and cold. The understated, beautifully controlled story follows the treatment of a difficult but interesting patient. Retired bachelor George Dittus, who has checked into the hospital complaining of chest pains, reminds Cave of his father, who died of a heart attack when Cave was 13. Cave believed then, and believes now, that his father's physician, one Dr. Gresser, was his father's "killer," in the sense that "not enough was done." Like Cave's father, Dittus won't take advice; he wants to go home. Dittus's conflicts with the hospital bureaucracy give readers a fully developed sense of the material contexts of medicine: we learn not just what doctors do, but who does what, and where they do it, and how and why. After Cave nearly kills Dittus by accidentally administering the wrong drug dose, he decides he must confront his father's doctor and settle accounts. Yet his meeting with Gresser is oddly unsatisfying; as a physician himself, he understands Gresser's explanations for omissions in his father's treatment, yet emotionally he feels they are empty rationalizations. Meanwhile, Dittus is refusing to take his medication, and a social worker feels he must go to a nursing home. Stein interpolates insightful mini-essays into the narrative, explaining the process of "taking a history," for instance, and musing on the relationship of surgeons to other doctors. There is a candid assessment of the sexual tension between doctors and the patients they examine. Even as he suggests moral and ethical questions, Stein sustains the psychological tension. His narrative succeeds both as a tale of sons and fathers, and as an uncommonly knowledgeable and eloquent look at the complex emotions involved in practicing medicine. (July) FYI: Stein is a son-in-law of the authors Anne Bernays and Justin Kaplan. Copyright 1999 Cahners Business Information.
Library Journal - Library Journal
On a spring day, a doctor whose aging father died when he was a young teenager decides to visit the doctor who cared for his father but lost him to congestive heart failure. For the previous few days, the young doctor has confronted many of his own demons as he treats cardiac patient George Dittus, not a mirror image of his father but close enough to bring out his own insecurities, especially when he mis-doses Dittus, who almost dies. What marks this novel, however, is not the story, which is less than consequential. Stein (Probabilities, Permanent, 1995) is a doctor as well as a novelist; his strength resides in the medical insights he brings to his writing, an existential drama with overtones of Camus though without that author's absurdism. The powerful, anguished, evocative prose of Stein's second novel is not to be missed; he brings to his fiction the vividness and immediacy of a memoirist. Recommended.--Harold Augenbraum, Mercantile Lib. of New York Copyright 1999 Cahners Business Information.
Kirkus Reviews
Physician and second-novelist Stein (Probabilities, 1995) offers a wistful account of a young internist haunted by his father's death and troubled by his patients' illnesses. "Life is great until you weaken," declares Dr. Peter Cave. "I am weakening. I believe that my work is weakening me." Cave works in a teaching hospital in an old New England city (Providence, perhaps) and has daily charge over a ward of 15 patients. One of these is George Dittus, an elderly man with a weak heart who may not be able to care for himself much longer. Cave takes a particular interest in Dittus, hoping that he can help the old man back to the normal routines of home and friends that mean so much to him, but it looks to be more of a losing battle each day. There's not much you can do once the heart starts to go, as Cave knows from bitter experience: His own father died of heart disease while Cave was a still a teenager, marking the boy for life and inspiring him to study medicine. "Although I call my work The White Life, in some ways I think of the hospital as dark. Darkness implies the unseen and that's how I imagine the sick live—puzzled, and in pervading obscurity." Clearing the darkness is Cave's consuming goal. Now, after 25 years, he has finally obtained a copy of his father's autopsy, and he's even more convinced than he was as a boy that his father died needlessly. He manages to locate the physician who treated the patient and arranges to meet and confront him. Can the past be redeemed? What begins as a search for truth quickly becomes a quest for justice. In the end, however, Cave sees that what he's been pursuing is compassion. A modest success, compellingly told with grace andfeeling. Stein wisely sidesteps the melodrama of crisis for the more engaging medical dramas of grief and despair.

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Product Details

ISBN-13:
9781579620257
Publisher:
Permanent Press, The
Publication date:
09/28/1999
Pages:
173
Product dimensions:
5.58(w) x 8.46(h) x 0.41(d)

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Chapter One


TODAY, FRIDAY JUNE 5, I am going to meet the man who killed my father. This afternoon I will drive three hours to the town I grew up in and where he still lives. I am going alone, though in many ways I would like to have my family along for the calming effect they have on me; I expect that my reaction to seeing the man will be anything but calm.

    He has filled my imagination for years. I have thought of him too many times, at work, when I attended the 1987 NBA playoffs, while watching our cat rip the yellow feathers from a finch he caught last summer, his wide jaws shaking with pleasure, more than once with cotton jammed into my mouth at the dentist's office, when speaking with my uncles at the annual oppressive family occasion. When I've thought of the man I haven't wondered about his emotional well-being or whether he's a good Christian, a hard worker, a devoted family man. I couldn't care less. Yet I've always had an imagined intimacy with him.

    For two decades my mother has sent me pieces of my father: a photograph of the two of them at a sepia Swimming pool; his army identification card and tin, braille-punched dog-tags; a small oil painting of him at thirty-five-years old in a heavy gold frame, which makes me wonder why he had a portrait of himself done at that age, what he was thinking. These packages arrive without warning and I am glad they come sporadically, rather than all at once, because the surprise is almost always a nice one. Just before she moved into a tiny apartment two years ago, my mother mailed me a copy of my father's death certificate and autopsyfindings that she found while cleaning her files. I read through the six pages quickly, mute with the rage that had always been part of my memory of my father's last night. On the bottom of the last page was the name of the man who had killed my father: Gresser. I recognized it immediately, although if you had asked me what it was before I would not have been able to tell you. I put my father's autopsy report in my drawer with no plan to look at it again.

    It was only after the events of the last four days, that I took the envelope out this morning (digging under the paper clips and postage stamps and checkbooks) to review the report. Where my name and address were, I saw my mother's distinctive cursive script which for the past two years had only arrived on thin letters, a birthday check for my children, an itinerary for an upcoming trip. The envelope bulged. The pages inside were slippery old mimeographs; the type looked like antique Smith Corona. My mother had included no note of her own.

    I remember what my wife said the day I first opened the letter and showed her the contents. I believe she was as stunned as I was. She said, "Leave it to your mother to unload something like that on you without even a word." But I remember I didn't feel my mother was "unloading" anything. In fact, I thought it should have been mine all along, and I wasn't sure what my mother could have written with this enclosure that would have been appropriate, so I said, simply, "Pretty strange, huh?"

    After I read through the report, slowly, more carefully this time, I found myself calling a telephone operator in New Jersey to get Gresser's number. I assumed he would be where he lived twenty years before. His work was there, his family was there, and if he was alive, I knew that he would be there. It was impossible to imagine anything else. It turned out that I was right—his number was easy enough to find—and presumably he had not died, although he was sure to be a man in his late seventies by now. Yet when I finally had the number written on my pink sticky pad next to the area code that I had known well from my childhood (I remembered my old New Jersey number surprisingly easily), I was not sure exactly what I was doing with it.

    I have always thought of Gresser as my father's killer. I know this is leftover from my childhood, and childish. Killer is a big word and I do not mean to imply that Gresser shot my father, or stabbed or strangled him. After all, I am not going to a penitentiary to see him but to his suburban house which probably has an eagle door knocker and a rubberized black welcome mat. When I say he killed my father what I mean is this: not enough was done.

    I'm sure he doesn't think of himself as a killer, but rationalizes, as nearly all doctors do, that what happened was simply beyond even the best effort of his profession. Gresser had seen many patients before my father ever went to him and saw thousands more in his career, but I had no doubt that he would recall my father's name when I said it to him on the phone. Some patients you don't forget.

    I know this; I am a doctor too.


* * *


    White is the color people think of when they think of doctors and hospitals, but to me it is also the color of old age, of japonicas, of everything that is empty, of ice and robes. A white stone among the Romans marked a joyful day; offering a white belt was the deepest pledge of honor among the Iroquois, and the white dog was sacred. In the vision of St. John, a white robe is given to the redeemed. White is an imperial color, one of royal preeminence. White is the color of lilies, of pearl earrings left on a bedside stand, of albumin, incandescence, fury, of well-intentioned lies and the leukocyte, it is the kind of magic practiced to counter evil and the antagonist of black infections.

    Zeus was a white bull. Interrogation rooms are always white, as are exam rooms. Tuberculosis was the white plague. Angels, ghosts and the power of sorcery all glow white. What could be more ghostly than a hospital, a world without plants and bedspreads and paintings? White-outs occur when heavy clouds hang over fallen snow so that light from above equals the light reflected; there are no shadows. The first girl I ever kissed had white threads fraying from a hole in the knee of her jeans through which my finger touched her skin.

    White was the color of the albino whale. Melville wrote, "There yet lurks an elusive something in the innermost idea of this hue, which strikes more panic to the soul than redness which affrights in blood." Ghosts, our kings of terror, are white and exert over us some sorcery, but Melville feared the white phantom albatross: "through its strange eyes, methought I peeped into secrets which took hold of God."

    When I was a child, my father told me that a white falling star meant someone was dying.

    The painters of hospital corridors obviously believe the scientists who claim that colors are subtle deceits, not inherent in substances but laid in from without. As I walk the hospital halls I often remember that other line from Melville, that white "by its indefiniteness ... stabs us from behind with the thought of annihilation." The White Life, I call my work.

    The laundry room is the whitest place in the hospital. It is a single room inside a beautiful Victorian brick building with stained glass windows. I pass it every morning on the way to the wards.

    Inside, large, white baskets on wheels axe piled with sheets and blankets and towels. Soiled Linen Only or Clean Linen Only are stenciled on their sides. Hanging from the ceiling like great white carcasses are bundles on pulleys. Everywhere are industrial-size containers of softener and whitener to get rid of dried blood on stiff pillowcases. If you squeeze in, you can see the washers. They are like jet engines, turbines turning hundreds of pounds of wet cloth. They make the sounds of hearts. I can feel a great stain being swallowed here; the place is primitive, has fallen far behind medicine.

    A single line of long filament bulbs lights the room and the smell is hot and wet like earth. The pipes that bring and take water are dusty near the ceiling. The floor is a mess of ripped white sheets and empty rubber gloves.

    Wash, iron, rewash. Day after day. An endless preparation for the new citizens who never stop arriving.

    The nights when I get home late from the hospital, my wife is awake. After a decade with me, she is available at my odd hours and she is charitable. She has her own night accent and the heat of an oven under our comforter. Where she's turned gray, it's only more interesting. If I quit my job, I would spend all my time with her.

    When she asks about my day, I tell her what I've seen in the hospital using the gorgeous assembly of names and facts we call medicine. I tell her what I've been thinking, and the people I've met and how they want meaningful moments with me. I tell her about the little tactics of deception the visitors of the sick and I use, and how what we are all after, all we want, is to affect the sick lover-brother-friend-patient physically. That's all we want. Families do it through love, and I do it through doctoring.

    While I'm with patients, I'm interested in medical facts, and poise. I try to speak with the rhythm of a running boat. What I tell them is often painfully imprecise, when all I mean to do is give them confidence. But in their gowns they're dressed for ruin. Between my visits, in the moments of pause among the terribly busy and the hectic, when I'm thinking of patients, I'm thinking about love.

    I do not mean love in a sentimental way, or in the sense of the drastic, nasty doctor falling in love with the patient who later reports him to the medical board—driven by love herself, and her inability to separate him finally from his wife—although there is certainly that kind of love in my place of work. I mean companionship, respect, affection, attention, attachment, possession. Some patients have love affairs with their illness because illness has an obligatory grandeur, my friend Anatole used to say. Some patients feel the life of love they've missed when they are finally alone in the hospital. I use `love' here in the way the Greek language uses fifty different words for love's distinctions (father-son, brotherly, between spouses, of God, of art, narcissistic). The English options are more limited, all meanings packed into our one inadequate syllable.

    When I think about love, I mean passion. In the hospital, with death closing in, left in the power of an enemy, patients often feel most fully alive. And so do I as I match their intensity on the way towards life or death. They are passionate in their conflicts and their pleasures, and I am not only a witness but a participant. The very sickest make me fearful for them; at the same time, excitement runs through me, a preoccupation with every minute of their suffering. At the end of a hospital stay I know their intimate business—I have seen them vomit and bleed and piss and fight—things I previously knew only about my wife and kids, people I love.

    Illness has lodged itself in the American Imagination as a metaphor for the ultimate experience. And illness has some deep and often odd connections with the hospital setting and the idea of love. "You'll get over it," people say soon after an affair has ended; the same expression is used when one is sick. I once knew a woman who would not make love in bed—she preferred rugs and benches, tiles and grass. Beds are for hospitals, she said. Hospitals used to be built on the tops of hills so as to be separate from the world, a sense of isolation that love shares. Doctors and patients are as irreversibly intertwined as lovers: they can destroy each other, and a complex ecology of domination and subjugation happens every day inside these buildings on the tops of hills. The French call the marriage of doctor and patient un couple malade.

    I worked for a while in a hospital called Charity. In the Emergency Room, I would count the ambulances and think of the name printed on the patients' johnnies. Charity: tender-hearted, kindly, loving. As a doctor, my job is to love them, I told myself: in other words to make them less anxious about both the unknown and the obvious, to overlook their weakness and inability to show gratitude. Love made me useful.

    As a young doctor I was not good at love. Like most young men, I found it troublesome and I did not know what to do with it at work or outside. Only when I came to recognize what I was seeing each day at the hospital—sometimes not easily visible amidst the dark arguments and bitter accommodations, the razor-wire defenses, the deteriorations and attritions that the domestic life carries along when it moves into the hospital—did I discover a talent for love. And it took more years until I realized how the loves in my private life were related to what I was witnessing in my medical life. It was not what I was expecting.

    Doctoring is the only serious work I know of where the work and the reward come at exactly the same moment. And it is this connection that brings me pleasure. Any doctor who thinks for a minute can tell you about the many ways that love enters their days. I love my patients because they need me. I love them because they want me to save them and because I can't.

    As a witness of love (and how it changes), I have become aware of the many things I love about The White Life: the objects in my place of work, the mood of the halls, the rituals, the mail I receive, the memories some patients evoke, the students I teach, and the secrets I hear, the sense of being in two places at once—among the known and the strange. I wait for revelations but it is difficult to overstate the stretches of tedium. My work is like a car ride through a seaside town, checking out all the convenience stores and clamshacks and bait shops while waiting for the tidal wave. I work in a very strange (and sometimes familiar) white land.

    It was only this morning—after a sleepless night reconstructing and writing down everything I can remember of this week and how my patient George Dittus has, since Monday, permanently changed my view of The White Life, which has perhaps (if it's not already too late) affected my way of doing things—that I re-read my father's autopsy report and called Gresser.

    I came to The White Life because of my father, although I didn't know it until years later. Illness held a special place for me because he died when I was thirteen. Love saves people, and so do doctors, and when I think of saving I think of my father and I think of medicine.

    As I eat my turkey sandwich and drink an iced tea before getting into the car this Friday afternoon, I think maybe I can just begin to understand what I want from Gresser, although I am not certain, of course, what I will say to him once I get there. I want to know the events of my father's last night. Only Gresser knows the details, and I want Gresser to have a chance to explain.

    I didn't realize that I was afraid of him until this morning when I hung up the phone and told my wife my plan to drive three hours south today.

    I said to her, "It's a weird thing. I'm angry and I'm sad—sad for myself and for my father. But it's all been secret and private."

    "Your father's dying was the major event of your life," she said, "Other than meeting me."

    I smiled, but I was afraid to the point of collapse.

    "Oh, go ahead and meet him," she said. "You like explanations. You and Gresser have been silently colluding for years. He's made you who you are. You might as well talk to him. If you come back sadder and angrier, it happens. I'll rub your neck."

    She put her hand on my shoulder, steadied me.

    She knew it would be a long day. Then she found for me part of a Frank Bidart poem.


The love I've known is the love
of two people staring
not at each other, but in the same direction.


    She smiled when she read it. She knew this was how I think of medicine.

    Sometimes I think about the temporary disturbances in our ten years of marriage and how it's not all been splendid leisure. My wife has taken my distress and distance over the past ninety-six hours in good faith. She knows the state I'm in, although not all the reasons. She won't be drawn into my self-pity. Before I left for work and Gresser, she put in my bag a newspaper advertisement for a support group called Emotions Anonymous which I have just found: "If you want to live in serenity with unsolved problems, join us. 863-5555." My wife wrote Hah! on the bottom.

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