An Affair of the Heart

October 19, 1988. From Wee-enna, as the driver says, to Auden’s grave in Kirchstetten. A photograph of W.H.A. is encased in the gateway to the small church and surrounding cemetery, where the stone, head against the wall and shoed-in between two other plots, is both sadly out of place and as unkempt as he was himself. An iron marker doubly identifies the poet as a “Man of Letters,” a description that would have appalled him. The “Audenhaus,” at the end of Audengasse, is undergoing much-needed repairs. Difficult to picture him in this melancholy village, with its crossroads crucifixes, to imagine the orgies, the gramophone blaring Wagner. At nearby Melk, the steep staircases leave me pale and panting.

20. While climbing steps at [my son] Alexander’s pace in the Secession Building—the Assyrian W.C., as the Viennese call the mysterious, temple-like structure—I feel sharp chest pains, dizziness, and shortness of breath. We push on, nevertheless, to the abodes of the great. Whereas the pilgrims to Schubert’s birth-place and Beethoven’s Pasqualati house are mostly Japanese, the only addresses in the guestbook at Freud’s apartment are in New York.

A rainy evening. After a birthday dinner at the Imperial Hotel, we tour a neighborhood in the Gürtel where prostitutes with their leather mini-minis, white stockings, red blouses, and white umbrellas might be a “chorus” from a Broadway musical.

25. New York. Lenox Hill Hospital. After four hours of tests—radiological, chemical, electric (EKG), supersonic (the echogram), Dr. Moses, my cardiologist, diagnoses stenosis of the aortic valve with the diktat immediate (open heart) surgery. I am terrified.

November 8. Back in Florida, solar plexus of Baudelaire’s “Eldorado banal de touts les vieux garçons,” I enter North Ridge General Hospital, Fort Lauderdale, for the cardiac catheterization test. After processing in the lobby—the photographic exhibition here, “The Many Faces of Percutaneous Transluminal Coronary Angioplasty,” might be a one-man show at the Whitney—a volunteer worker two decades older than I am wheels me to room 227, where I am glued and wired with electrodes, fettered with a transistorsize recorder, and plugged in for teletromic monitoring. Next come rubber tourniquets and puncturings for blood (more misses than hits), specimen gathering, pulse taking, blood pressure pumping, and a nurse’s far from shy shaving of my groin. My roommate, a deaf elder tirelessly fond of TV soaps, suffers from, whatever else, permanent hiccups.

9. A 5:45 reveille for measuring and weighing reveals that I am neither taller nor shorter, nor heavier nor lighter, than last night. Not until 9 AM is a five-hour delay in the angiogram scheduling conceded, and four more hours elapse before I am sedated and rolled to the operating laboratory—through a corridor decorated with bloodcurdling pictures of cardiovascular systems. Inside, four insouciant young nurses in shower caps and surgical masks begin to prepare me, placing a green towel with surgical instruments on my chest, a substitute tray. One of them inquires about my profession (that dreaded question, here as from the passenger in the next seat in an airplane: if I say “writer” she will ask the titles of my most famous books, and if “musician,” what instrument I play; but fibs, such as “engineer,” always lead to difficulties). I feel almost no effect, certainly no ataraxia, from the medications. But why am I so frightened? Werner Forssmann slid a catheter inside his heart as long ago as 1929, and won the Nobel Prize for it.

Dr. Ali Ghahramani, Nehru-style hat and green butcher’s apron, enters offering facetious observations for the regalement of the four admiring women, but their response suggests that the jokes are not new. Going briskly to business, and clearly enjoying it, he talks about foods and vintages during some of the operation, but in the most intense part hums softly, interrupting himself only to warn me of upcoming painful moments, and to encourage me with such remarks as “only one more needle” and “the worst is over.”

Above the operating table, narrow and tight-fitting as a pod, colored cables, braided together, loop and curve from the ceiling like a python. The eye of the X-ray fluoroscope is directly over my heart, and to my left are four television screens and a computer flashing blood pressure measurements. Local anesthetics are applied, one of them daubed externally with a rubber spatula. Ghahramani punctures my right arm, probes near the elbow, hits a nerve, withdraws and sews up the excavation with two sutures.

Turning to the groin, he flourishes a catheter, larger in circumference than I had imagined and very unpleasant during the first part of its passage through the femoral artery. After this, a machine reminding me of an old-fashioned hand-cranking laundry wringer winches the plastic tube to my heart, where, as the intruder enters, a shadow seems to fall. The TV screens are switched on, the room is darkened, and the explorations of the catheter, a slender black snake, one of Anselm Kiefer’s vertical serpents, are filmed. Ghahramani moves it to the aortic valve, blocked by calcium deposits, one of which he pries loose, whence it resembles a rock floating weightless in outer space. He passes the filament through the valve, which is like threading a needle at long range, a tricky maneuver and not immediately successful. With the suffusion of the dye I should expect sudden warmth and nausea, he says, but the burning sensation, throughout my body, disappears as quickly as it began.

The position of the bed is changed several times to provide a variety of camera angles, fascinating but also frightening to watch: a look at one’s mortality. Ghahramani flashes several pictures of what might be textbook illustrations of tuberose roots but are outlines of the coronary arteries, clean in my case, he says, adding that I should count myself lucky in that the faulty valve is the aortic and not the more difficult to replace mitral.

The longest part of the procedure is the last, stopping the femoral bleeding. For about twelve minutes, until a clot has formed, the most muscular of the nurses presses her thumbs on the area of the incision, winds thick bands of tape around the groin and leg, and places a five pound bag of highest grade Florida sand on top to remind me to keep flat and motionless for six hours.

Ghahramani, who claims he performs an incredible five or six of these operations a day, laughs (no doubt for the fifth or sixth time that day) about the rusty knife he has been saving for his next patient, a lawyer specializing in malpractice suits, and departs referring to the job on me as “a piece of cake.” “How do you feel?” he asks, and, not wishing to belie his bonhomie, I pretend that I wouldn’t have missed it for the world. A half-hour later, Dr. Baratta, my cardiologist, says that the implant can be avoided in favor of balloon valvuloplasty.

18. Volte-face, a bollix. Baratta says that the improvement from the ballooning would be insufficient, that surgery is the only course.

29. New York. Meet with Dr. Ronald Drusin, Joseph Brodsky’s cardiologist, a tall dark balding man, soft-spoken, dour, un-pin-downable except to the statistic that 5 percent do not survive. I arrange for the operation on January 5, and come away feeling relieved.

December 7. Meet with Dr. James Malm, the surgeon, who introduces himself to me, as no doubt to many others before me, with “I feel I know you from the inside out.” He outlines the operating procedures of the implantation, the bisection of the sternum, and shows me the synthetic valve I am to receive, a black-ring, made of pyrolytic carbon and double-velour Dacron—in preference to a pig valve, which rarely lasts as long as a decade and often causes problems of immunology and rejection. Mine should stay with me all the way.

January 1, 1989. In the hours before his departure for Copenhagen, Alexander is unusually affectionate, alternately hugging, lunging at, and shadow boxing with me, but he cannot bring himself to speak—or, when he does, can only implore me not to risk the operation. He does not say “goodbye,” but telephones from the airport, blurts out “I love you Dad,” and cradles the receiver before I would have been able to respond (I couldn’t have).

3. At Harkness Pavilion (Columbia Presbyterian), my two bags, stuffed with books and weighing about two hundred pounds, are taken to the tenth floor in a wheelchair, while I walk alongside, feeling foolish. My room, a dusty cell with a small hard bed, dirty and chipped walls, a dart board to pin up “get well cards,” is reminiscent of a jail. Yet the same quarters at the end of the corridor are occupied by the partly living body—her eyes open from time to time but do not focus—of “Sunny” Von Bülow, tended there in macabre routine by physical therapists who exercise her atrophied leg and arm muscles, fed by nurses through a nose tube (the digestive system works), coiffured (probably by a mortician), and protected by a revolvered guard seated behind a screen. The hospital seems to be directly under the Berlin airlift. I dream that I am reading my obituary.

4. Most of the day is spent in coaching sessions with the cardiologist, the surgeon, and the anesthesiologist, intended to prepare me for mentally confused moments on regaining consciousness.

5. At about 7 AM my entire body is painted with an iodine solution and wheeled to the operating theater; I picture myself as a red Indian. The anesthetizing process takes two and a half hours, with six ingredients in the mix. One of them, a synthetic curare, adds further associations of the Amerindian world, being itself South American in origin and in function erasing the patient’s image of human sacrifice to the Mexican sun god—or any image of men poised with knives (Banquo: “It will be rain tonight”; 1st Mur.: “Let it come down”)—for the operating table, like the Aztec stone on which the victim’s heart was cut out, elevates the chest, suspending head and shoulders over the top.

A suffocating twist of the tracheal catheter brings consciousness and with it. the first unprepared-for shock, the awareness that my body is “dead,” in rigor mortis, that it will not move, incline to one side or the other, or even budge, strongly as I will it; I am an effigy on a catafalque. The second, greater shock is in the simultaneous awareness that I can neither breathe nor speak, and that therefore my heart and lungs must be functioning on mechanical controls. But without the participation of these organs, am “I” still “I”? And is my mind not, in the strict sense of this disincarnation, posthumous? With the increase of awareness, I transform my body image and become an Indian in a burial canoe.

At about 6 PM I am transferred to intensive care (the surgery was completed at 1:30 but the IC unit had filled up with emergencies which kept me in the operating room waiting for a vacancy; later, too, I learn that Dr. Malm had emerged from the operation waving his arms like an orchestral maestro, to indicate that I would conduct again). The anesthetic paralysis begins to dissipate soon after, and, able to use my arms, I make a dumb show of writing and motion for pen and pad. Incredibly, my scribbles, most of them complaints, are legible, since the one about dryness of mouth immediately results in a swabbing with water.

My heartbeat is so strong that it twitches my head on its pillow. Late in the evening (?) I begin to hallucinate: colored patterns kaleidoscopically rearranging themselves, red and gold speckles of what might be sand, scorched landscapes, malachites, square patches of light blue with the texture of feathers. But this does not last, and instead of the amnesia the doctors had warned about, my mind swarms with anamneses, intense moments from my entire life. I listen to tapes of Sacre and Act I of Così, but the assymmetries of the former, as much as the symmetries of the latter, are exasperatingly predictable.

6. By late morning I am breathing with my own lungs; and my heart, in place, is my own repaired one, I begin to think of the operation as a journey, like Don Quixote’s aerial one that never leaves the ground, into unknown realms of the mind that the anesthetics have both opened up and made frustratingly unrecallable.

7. Tremendous late-night ructions, loud voices, TVs screaming in several channels simultaneously a nightmare in an inhuman place. In the cubicle next to mine, under freezing fluorescent light, a team of medics is struggling to revive someone in cardiac arrest.

8. The scar, like a filleted, still blood-flecked Dover sole except that the bone is a single zigzag line—the Inca snake figure—is surprisingly small. Beneath and to either side is an incised “H,” the surgical artist’s colophon, as it were, but actually drains for medications and solutions used in the operation. A slight vest-pocket bulge in my left abdomen is explained as a storage cell for the wiring system of a pacemaker should one ever be required. In the afternoon, transferred to my own room, I telephone Alexander.

9. Constant checking of vital signs, breathing exercises, and a brief giddy buckling-knees walk in the corridor. From behind several doors comes an exotic muffled drumming (a communications system in ancient Mesoamerica?), actually the sound of physical therapists’ fists pounding the ribs of postoperative cardiac patients to clear the lungs and prevent pulmonary complications. By my count, an average of 180 blows are inflicted a minute, for two-minute periods.

The night nurse cannot let well enough alone. If I have found a bearably uncomfortable position, she urges me to find another, unbearable one. If I am asleep, she wakes me to ask if I want a pill.

10. Trip to radiology, on a suspicion, as I learn afterward with alarm, that I may have a collapsed lung.

I am becoming aware of crunching sounds in my chest, as loud to me as the “snapping” of a double-jointed knuckle. Is my body rejecting the new valve?

My walk today in the corridor brings back pictures of Stravinsky when, after his 1956 stroke, the marvelous spring in his legs disappeared. The discussions of blood chemistry, too, of prothrombin time, platelets, and hematocrit levels, are forcing the idea of a parallel between my new way of life and that of his later years.

11. I have begun to time Drusin’s tours of inspection. They average ten seconds and he first appears—with the warm greeting, “Any questions?” (“Yes, Admiral, but, as you say, you’ll be by again later”)—while I am still hungover from the narcotics (Percoset) of the night, Both he and Malm are not so subtly preparing for long weekend getaways, familiarizing the names of assistants and signing in-advance, in-the-eventuality discharge papers.

12–13. PAIN in the colon, constant and unchanging—not rhythmic or periodic, not increasing or diminishing, not with any variation in quality but only a steady intensity. I moan, I cry out, I see little burning threads of electricity when I close my eyes. Nothing else exists, and pain cannot be “killed,” but only the mind dulled. This new pain adjusts the perspectives of the old ones, and the severed muscles and ligaments in the area of the sternum that make coughing an agony must be downgraded to a severe soreness. Finally, after fourteen hours of appealing to the hospital system and letter-of-the-law nurses, I am given a local anesthetic, but I am more tired tonight than three days ago; pain exhausts even on the cellular level.

Dr. Todd, chief vascular surgeon, diagnoses the new affliction as first-degree prolapse of the colon, the most aggressive instance of it he has ever seen, and for which I would have had to be hospitalized if I had not been here already. Though unknown as a consequence of valvular transplant surgery, it obviously is that in my case. But surely it is also simple bodily ecology; one area is violated and another breaks down in automatic reaction. In Chinese medicine (which has a poesis if no physiology), my collapsed Qi (Chi) is a result of the temporary “death” of the interconnected heart and lungs. According to Kaptchuck’s The Web That Has No Weaver, “This implies that the Qi can no longer hold organs in place. When there is collapsed Qi such disorders as prolapse may occur.” A palpation of the excrescence reveals—cruel chrysalis—that it is shaped like a vulva (aut vultus aut vulva). I will again have to change my body image, at least momentarily, to hermaphrodite.

14. Dr. Todd says that the prolapse must be shrunk before I can be paroled and that I must also wait for the stabilization of the blood, or, rather, of the formula that will regulate a slower coagulation time: clots form more readily with a prosthetic device in the heart, and the blood must be kept thinner. I shall have to try to avoid accidents and live like a hemophiliac Habsburg, in whose one-time domains this story began three months ago. Meanwhile, I lie here propped on a mound of ice like a lobster in a restaurant.