Includes a New Afterword
A New York Times Book Review Editors' Choice
When hard-living, middle-aged American writer James McManus gets a three-day executive checkup at the Mayo Clinic, he is immediately forced to confront his mortality. Will he survive his own cardiovascular system and genetic inheritance long enough to see his young daughters grow up? With great candor and wit, McManus explores not only his own health but also that of the health care system itself and the political realities that have hamstrung stem cell researchwhich could help his eldest daughter's diabetes. Physical is an unabashed, wrenching, and often hilarious portrait of unwellness in America.
|Edition description:||First Edition|
|Product dimensions:||5.50(w) x 8.50(h) x 0.61(d)|
About the Author
James received, the author of Positively Fifth Street and four novels including Going to the Sun, for which he recieved the Carl Sandburg prize. The portion of Physical serialized in Esquire was chosen for The Best American Science and Nature Writing, The Best American Magazine Writing, and The Best American Political Writing. Currently at work on a history of Poker, McManus teaches at the School of the Art Institute of Chicago.
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PHYSICALAn American Checkup
By JAMES McMANUS
Farrar, Straus and GirouxCopyright © 2006 James McManus
All right reserved.
Chapter OneTHAT'S THAT
I looked away to the hills Above the river, where the golden lights of sunset
And sunrise are one and the same, and I saw something flying Back and forth, fluttering its wings. Then it stopped in mid-air. It was an angel, one of the good ones, about to sing.
-MARK STRAND, Dark Harbor, XLV
I would kiss the diamondback if I knew it would get me to heaven.
-LUCINDA WILLIAMS, "Get Right with God"
The truth is, I don't think I'm going to die. Not today, not tomorrow, not in 2067. Not me. To begin with, I'm careful and lucky enough not to get hit by a bus. An SUV maybe, or the culture of SUVs, or the cult-but no bus. I'm also immune by dint of heredity to most forms of cancer, by passport to snakebite and tropical maladies, by suburb and commuting pattern to Al Qaeda, by neck of the woods to tsunamis and hurricanes and earthquakes and floods, and by basic straight wholesome good old-fashioned solid moral American core family values (or at least a fear of needles) to overdose and sexually transmitted diseases. I'm bulletproof. At the same time, I try pretty hard never to imagine those eight hyphenated integers after my name or under my black-and-white photograph. No, not my zip code or social security number-those both have nine. Phone number? Ten. I'm talking 1951-20whatever.
Right now I'm fifty-four, a baby boomer gone mostly gray on the top and squishier than I'd like through the middle. I'm no Orson Welles or Chris Farley, no late Brando or early Belushi, but the small of my back, well, it isn't so small anymore. Otherwise I seem to be in reasonably half-decent shape for a fellow my age. Plus I'm bulletproof, baby! So it doesn't really matter, you see, that my father had his first heart attack at forty-six and a fatal stroke at sixty-one. Or that his father, the man for whom I was named, died of a heart attack at thirty-five, when my father was seven months old. Or that my kid brother Kevin, who was named for our father, died at forty-one of complications after a marrow transplant at Johns Hopkins, the best leukemia treatment center on the planet. A funny, athletic, warmhearted guy who wrote features for The Washington Post, he was in such bionic shape that it took a couple of weeks for even total renal failure to kill him, and his wife and mother and siblings got to watch every minute. "How'm I doin'?" he gasped upon briefly emerging, blind and desperate, from his final coma. "How're the kids?" My doubles partner, an ophthalmological surgeon, developed frontal lobe dementia and doesn't recognize his wife and children anymore, let alone me; needless to say, he no longer plays tennis or practices medicine. My caustically hilarious editor at Harper-Collins died in 2001 after a long illness. The woman who taught me how to play poker died on her ninetieth birthday. On his way in through a Wrigley Field turnstile in September 2004, my office mate and fellow geezer dad's hyper, magnificent brain was drowned in its own blood by an aneurysm. In 1999 my fourth child (third daughter) made an unexpected footling breech presentation, got her neck lodged between her mother's abdominal muscles during the C-section, and almost snapped her spine or strangled herself getting born. Two years later my son, a scorchingly talented guitarist who was named after me-me, who has less than zero musical talent-died of a drug overdose in a mental health clinic at age twenty-two. Suicide? it would not have been the first time he tried. Medication mistake by a nurse? Autopsy report inconclusive; lawsuit pending. At least two pharmaceutical companies who made antidepressants prescribed for him, Wyeth and GlaxoSmithKline, had lied about data suggesting links between their drugs and suicide in teenagers; lawsuits pending. Not that legal maneuvers or money can bring James back to us, or retroactively soothe all the pain he was in. Executing by hand the persons who manipulated the data and made the decisions to keep pushing those antidepressants wouldn't accomplish that, either, though I'd still love to do it. In any event, I sure miss my beautiful son. I've read and heard people say that losing your child is the worst thing you can ever experience, and I can't disagree. I'd also assumed it would kill me.
At this stage I realize that all these events were horrific but not that unusual, and certainly more are to come. More? All of us will surrender our health, our standing, our marbles, our self soon enough, or so I've been given to understand. Yet the most forceful and eloquent part of my soul still insists I will be the exception. I'm still alive, after all.
Mind you, I do understand the basic biological facts, and I do not believe in the soul. I was raised Roman Catholic, of course, but have spent the last forty years as a secular humanist. Folks like me get branded unbelievers, atheists, heretics, educrats, ethical relativists, Jews, Brights, effete blue-state feminists, eggheaded patched-tweed-and-rimless-bifocals-wearing faggots, French, and much worse; more affectionate terms include freethinker, agnostic, lapsed Catholic, progressive, existentialist, reader of novels, queer, beatnik, and honorary Jew. I'm not sure which label fits best, but I do have a great deal of faith that our bodies-our brainwaves and actions, commerce and science and art, words and children-are pretty much all there is to us. Religion evolved to help us cope with poverty, imprisonment, fear of death, and other bad things, and that's fine. But is some white-bearded guy named Jehovah or Olodumare, God or Allah, really out there? In here? On a throne up in heaven, above and to the left of Cloud 9? Or is he perpetually verging a gazillionth of a nanometer beyond the periphery of a cosmos expanding at 299,792,458 meters per second, frantically tap dancing along the edge of this most naked of all singularities? Was his word, his final solution, on eros, ethics, weaponry, territorial boundaries, contraception, evolution, and somatic cell nuclear transfer inked onto crinkly multilingual papyrus manuscripts a millennium or two ago? My answer to all these is, "Please." I also have faith that there ain't no infernal conflagration after death (unless you want to count the forging of my cremains), no purgatorial scorching of my incorporeal personhood, no seventy-two black-eyed virgins or eighteen choirs of nineteen-year-old lingerie-modeling Brazilo-Scandinavian cherubim waiting on me up in paradise. Nor will I be reincarnated as a wild but eventually Triple Crown-winning black stallion; a granite-jawed southpaw with a 101 mph cutter I can paint the black of the plate with; or the twenty-third century's Abraham Lincoln, let alone its most potent singer-songwriter-guitarist. Even my hero Dante Alighieri's sizzling twelve-year-old girlfriend, Beatrice Portinari, won't really be spinning around no Empyrean in perfect equilibrium with Him. (Sorry, D.) Because once my blipping EEG line goes flat, it's going to be all she wrote. In the meantime, my life will be sweet in a number of aspects, a boot in the testicles other times. Sooner or later a Hummer will squash me like Wile E. Coyote. Either that or my heart and maybe another vital organ or two will break down and I'll suffer, piss and moan not a little, then purchase the farm. I've already made the down payment.
As far as the suffering goes-how soon it starts, how long it drags out-I used to be confident that what's called Western medicine was riding full speed, or almost that fast, to the rescue. I knew Western medicine consisted of millions of creative, altruistic, expensively educated women and men, many working in laboratories and hospitals and clinics well to the east and south, but sometimes the term made me picture a single Asian cowgirl in snowy white lab coat and Stetson, bandolier of specimen vials jangling against her modest cleavage as she clutches in one hand the reins of a galloping stallion, in the other a glass pipette delicate enough to boink a healthy cell into the place of a sick one. In another daydream, she wields a titanium lasso delicate enough to snare a 15 mm polyp three and a half feet up my rectum, her motto tattooed in racy arabesque just below either her navel or the base of her spine: Time to cowgirl up, take your medicine.
Not that I expected Western medicine to let me live forever-just an extra decade or so, with a little more spring in my step. What I really really wanted, daydreams aside, was for people like my daughter Bridget, who has suffered from juvenile diabetes for twenty-two years, to get a fair shot at their biblical threescore and ten. But in August 2001, as Mohamed Atta and Osama bin Laden and Khalid Sheikh Mohammed finalized their plans, our Bible-totin' president, squinting out from his sun-blasted spread down in Crawford, took it upon himself to forbid further use of embryonic stem cells in the effort to cure diabetes, Parkinson's, cancer, MS, and a dozen other vicious diseases. Pretending to split the difference between ultraconservative Christians and the rest of us, the president's "compromise" effectively amounted to a ban on embryonic stem cell research. He said that "more than sixty genetically diverse stem cell lines already exist" and that the NIH would be permitted to fund research on these existing lines only. Less than a dozen of them would ever be made available to scientists, most of them genetically limited to people who tend to use in vitro clinics-the white, the infertile, the wealthy. Not that there's anything innately wrong with these categories, but researchers will need thousands of lines, perhaps even one for every patient, to provide genetic matches for the entire population.
Bush claimed to have given biomedical research "a great deal of thought, prayer, and considerable reflection," but in one fell swoop he'd dammed the flow of a decade of medical research robustly encouraged by President Clinton and a host of Nobel laureates and teaching hospitals. He had stripped my infinitely resourceful cowgirl of her most promising protocol, forcing her to ride sidesaddle on a stubborn Texas mule better equipped to trudge across deserts and oil fields than gallop off into the future. And I couldn't allow that to stand. If this pious, votemongering embarrassment didn't change his position real soon, I might have to do something rash.
In the meantime, in April 2002, a stitch along the left side of my abdomen suddenly graduated into an aching throb. I'd turned fifty-one in late March and was just beginning to get my feet underneath me again after James's death. Life after 9/11 was quite a bit easier to cope with, for me, by comparison. I had tenure as a lit and writing professor, my second marriage was flourishing, and my book about poker was scheduled to be published the following March. While making final revisions to the book and teaching my Literature and Science of Poker class, I felt pretty good about things, as long as you didn't count the abscess in my soul where my son lived.
But within a couple of days the thorn in my side, as I thought of it, had me walking hunched over like a little old man with bad knees and end-stage cirrhosis, not exactly the image I like to project to the world. I much prefer to swagger from success to success like a book-learnt but still macho cowboy: bowlegged, big-cocked, in saddle-worn denim-denim not broken in or sandblasted ahead of time by underpaid foreigners. As the throbbing intensified, I gulped down more Advil and prayed-I mean, worried. I'd been taking Zocor, which helped lower my elevated bad cholesterol, for almost two years, this while neglecting to get my liver function tested. Lynn Martin, my primary care physician, had told me to have it checked after three months on the statin because the possible side effects included "nephritis and liver damage," but I somehow forgot. I knew I'd been drinking too much and dosing myself far too liberally with Advil for headaches and hangovers, so my self-diagnosis was "liver failure," though the phrase I used with my wife, Jennifer, was "some liver thing."
Scared by the fatal possibilities but also of hearing them confirmed by Dr. Martin, I finally at Jennifer's insistence made an appointment at our HMO's lab to have my liver enzymes tested. I also stopped drinking-not unheroically, I decided-and, "in spite of the crippling pain," as I phrased it to myself, stopped taking Advil, even though I understood the damage was already done. "Oh, and another thing, Braino," Jennifer said after kissing me, wishing me luck, and dropping me off at the lab. "Your liver's on your right side, not on your left."
Dr. Martin was booked or on vacation, and the first appointment I could get was with her partner Dennis Hughes. Tallish, maybe forty, all business, Hughes glanced at the blood test results, felt around where I'd told him it hurt, asked a few questions, and told me I probably had diverticulitis. "Your liver's functioning perfectly." On the crinkled foot-wide sheet of sanitary paper I'd just been sitting on, he sketched a penisless outline of his patient that featured instead a detailed blowup of my large intestine, complete with hairpin turns and what looked to be wormholes mottling the inner walls. "Diverticulosis. Quite common in people your age." What the hell was that supposed to mean? As I stood there squinting down at my elderly intestines, Hughes continued, "When a seed or food particle gets trapped in one of the holes and becomes infected, it's called diverticulitis." I nodded. Diiiiiiii-ver-tic-u-liiiiiiiiiiiiii-tis, I couldn't help thinking, as the little old woman from Brooklyn used to funnily pronounce it on Letterman. And now here I was, in my unfunny new demographic.
Hughes e-mailed scrips for painkillers and antibiotics to my Walgreens and secured me an appointment for a CT scan of my abdomen, which would confirm his diagnosis. "The colonoscopy two weeks later will confirm that it's all healed up nicely." I nodded. Had I missed something? The practice had just been computerized, and Hughes was happy to demonstrate how my records, medications, new prescriptions, CT appointment, and so on, were "all in the system. The referrals for your scan and colonoscopy are already at Evanston Hospital."
The antibiotics killed the infection, or at least the symptoms, in a couple of days, so I was able to squirrel the unused painkillers into my party stash. When I called in to report the good news, a nurse reminded me I still needed to get a colonoscopy, just to make sure. "Dr. Martin says you needed to get one anyway."
"I'll make the appointment soon as I hang up," I told her, then sat down to breakfast, all better.
Days went by. Maybe a week. The pain was long gone, and I'd heard all about colonoscopies. You fasted for two or three days while slurping battery acid; step two involved a fully articulated four-foot-long aluminum bullwhip with a searchlight, a video camera, and a lasso at the tip getting launched a few feet up into your large intestine while you watched on a monitor. Not to worry, however. They used really super-duper lubrication.
While discussing some unrelated business with Lewis Lapham, the editor of Harper's, I happened to mention my little gastrointestinal adventure. Next thing I knew, Lewis was proposing that I go to the Mayo Clinic for what he called their executive physical, then write a big story about it. Now, this was a guy who had already changed my life for the good and forever by sending me to cover the 2000 World Series of Poker, so I had every reason to trust him-in spite of the fact that he'd aggressively promoted Ralph Nader's run for the presidency in 2000, effectively electing George Bush. Yet the Mayo proposal triggered a whirlwind of panic about the state of my health. Accepting this plummy assignment would more or less guarantee I'd be told things I did not want to hear. The good news, Mr. McManus, is you've got almost five weeks to live. The bad news is we started counting over a month ago. Not really a hypochondriac, I was more a putter-off of nonurgent chores. I changed the oil in my car just before trading it in, and religiously made dental appointments on the thirteenth of Never, to keep me from ever forgetting. And look what had happened to Letterman. During a routine checkup, an angiogram revealed he had a blocked artery and needed an emergency quintuple bypass. This was a fifty-two-year-old guy who ran forty miles a week and looked to have about 1 percent body fat, and that was with TV cameras putting an extra ten pounds on him. What if the Mayo clinicians insisted that I needed to have my rib cage sawed open star, or discovered a tumor the size of a Titleist wedged inoperably between my pons and my creative left hemisphere? What if, as they certainly would, they made me swear off alcohol, tasty food, and my nightly postprandial Parliament Light? Or I had to start running 26.2 miles every morning?
Excerpted from PHYSICAL by JAMES McMANUS Copyright © 2006 by James McManus. Excerpted by permission.
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Table of Contents
That's That 3
Lourdes MN 15
Impedance Plethysmography 43
A Foot and a Half in the Grave 63
Pearl Jam 81
The Soveraigne Weede, Pounded Small 103
Nukular Transfer 131
Woo Suk Hwang, Suzi Leather, Miodrag Stojkovic, Lu Guangxiu, and the Generous, Farsighted Cowgirls 161
Midnight in the Garden of Good and Evil 171
Open-Globe Trauma 185
Hey McMoron 207
No Schmutz in Here 223
Afterword to the Paperback Edition 247