"You're Very Lucky It Lit Up at All..."

The drive to the clinic was blessedly short—made shorter by the fact that I could see the tower at the University of Texas pointing toward the rainy sky like a lightening rod. The campus, of which the tower was the centerpiece, had been the site of my greatest achievements. But its strength and straightness had become a mockery. My undiagnosed illness had rendered me impotent, not just mentally but physically. I could barely feel my numb hands as they clutched the steering wheel (I hadn’t driven in weeks). Blood must not be reaching my extremities. Did this have something to do with the swelling? Did this have something to do with my dizziness? Questions such as these floated through my mind, as I tried to hold my head still enough so that I could fend off the dizziness and focus on guiding the car through the hard rain drops while not further injuring myself or putting the other drivers in the state I was in.

The parking lot that faced the main entryway was full as always. I’d have to park in the structure and then cross the parking lot, check in, get my blood drawn for what seemed like the thousandth time, and then take the elevator to King’s third-floor office.

When I entered the structure, I started to count the levels that passed as I tried to find a parking spot. I thudded the car to a halt on level three—not as bad as usual—and proceeded to make the all important decision of whether I’d lose less energy climbing down the stairs, which were closer to my car, or taking the elevator, which was located a good fifty yards in the other direction, up the ramp. I also had to consider how much breath and leg power I’d have to use to cross the parking lot in the pouring rain, not only to make it to the clinic’s front desk but also to be able to talk to the receptionist once I’d made it there. I decided to take the stairs, concluding that I’d lose less energy walking down the stairs than marching up the ramp.

I willed myself to the stairwell door and clutched the railing with my bloated right hand and fingers. As I slowly moved down the stairs and felt the railing imprinting itself on my palm, I had the odd sensation of pulling myself downwards while simultaneously fighting off the urge to pass out.

Managing to keep the dizziness at bay, I made it to the ground floor and swung open the door—and the rain immediately almost knocked me over. If my wife were with me, my ordeal would have been a lot easier. She could have dropped me off at the entrance, but now I was drenched, freezing, and gasping for breath. And I’d still have to traverse the car-inhabited landscape if I were going to check in, have my blood drawn yet again, and have King examine me. I put my head down and started my march, feeling that the best way to make it to the receptionist was not to look at the sliding glass doors behind which she worked.

My strategy worked the only way it could have. When I arrived at the desk, I was wheezing and coughing—this time, coughing up phlegmy red mucus, which stained the blue oxford that I used to wear to teach but now wore to visit King. When I careened into the receptionist’s desk to prevent an utter collapse, I even got some mucus on the back of her computer, which I rattled with the blow of all my weight. Hugging the computer so that I could pull myself upright, I announced my name, appointment time, and doctor’s name. But my voice, I soon realized, was a hacked rattle of ragged syllables, which the receptionist couldn’t possibly decipher. Ignoring the blood on her computer, she asked me,

“Are you, okay?”

I, my hands now purple from clutching the edge of her desk in my attempt to stay upright, just nodded my head repeatedly, frantically, and desperately.

“Well,” the receptionist said, “I’m going to call for a wheelchair, so that you can get your blood drawn before you see Dr. King. I don’t think that it’s safe for you to be walking anywhere in your condition.”

I protested and said that I felt well enough to walk, but I was already in the wheelchair, my dizziness returning as the volunteer pushed me into one of the series of open blood-testing rooms—or, rather, closets; the rooms were big enough just to hold myself and the phlebotomist, whom I thought I recognized from one of my many previous trips to what I called “the blood bay.”

But she had no idea who I was, so instead of a smile of recognition or one of those knowing looks, which had become such a common part of my life, that both of us were aware of the danger of my situation but engaged in the small talk that 9/11 had already become, she made it clear that she was meeting me for the first time. I understood that this was a first encounter because after she’d rolled up the sleeves of my oxford and she’d noticed the scabs and needle scars on my arm, she said,

“You’ve had a lot of blood drawn lately, haven’t you?”

And, without waiting for my response, she began to tap both of my exposed arms, in search of a vein—anything that would pop up and into which she could insert a needle.

I, as I always did, looked away, not wanting to see what she was doing. I focused my attention on a corner of the “blood closet,” where the dirty brown carpet met the dirty brown wall. I understood that the carpet and wall couldn’t possibly be exactly the same color, but I couldn’t see the difference. Becoming confused again, I felt my eyes misting over with tears—and I felt the struggle coming on again: the struggle to breathe, the struggle to see through the windshield on my way to the clinic, the struggle to comprehend how my life had been reduced to this single moment, in which the results of this blood test, unlike all the others, could reveal what was wrong with me and save me.

A feeling welled up inside me—a feeling unlike any he’d ever felt before. Like Kafka’s dung beetle, I’d metamorphosed into the other. It wasn’t just that a dividing line solidified my position as a sick man—a pariah who had to endure what other people of my own age group didn’t but also as a text, a series of medical records, charts, lab results. And all these series formed another dividing line. Because my liver, kidney, and other functions whose names I didn’t know or understand came back in red print—that is, in the “abnormal range”—my body was divided in function and not just in its swollen and, as King had told me previously, paradoxically anorexic state. I was starving to death and weighing more than I ever had in my entire life, and I couldn’t get how this impossibility could possibly be possible.

Reason failed me, as it did when the phlebotomist noticed my eyes, glassy with tears.

“Is something wrong?” she asked—and for the first time, I looked at her. She was an African-American woman, perhaps close to me in age, perhaps younger or older. I couldn’t tell. All I could notice was that her hair was tied back tightly on her head. I could see stress tearing creases in her eyes, forming deep, indelible ridges that went in all directions on her face, some disappearing into her cheeks and others vanishing in the point at which her nose rose from her face. She was wearing pink scrub pants and a white scrub top that was covered with Mickey Mouse, Donald Duck, and other cartoon characters.

I remembered the similar scrubs that his nurses at Children’s had worn—those women who knew me and my body better than anyone else, those women who’d complimented me for my bravery. I was bathed in memories of fellowship and a certain kind of faith that at the ages of three and four I didn’t know I had, but now in my illness, I knew that it was this very faith that had sustained me for my entire life until I had mysteriously taken ill again a few weeks ago. It was the faith of innocence—the faith of a time when my recovery from cancer had seemed final and, somehow, predestined. It was the faith of a recovery that seemed just as promising as Noah’s rainbow, of which I’d read in the hospital rooms at Children’s. It was the faith that had transformed my terrifying first memory of the glaring lights blinding me through my closed eyes as I entered the operating room for my nephrectomy into an assurance that all would be well, that all was meant to be well, that the suffering that I barely remembered would survive only on the scar on my stomach, which would divide me from my classmates and make me the object of their jeering but would simultaneously ensure me of my triumph over them as they lived protected lives without the benefit of the deep awareness that immortality was bought at the unfathomable price of courage, pain, and endurance and not through money, teasing, ignorance, and finger pointing.

But this Austin phlebotomist and her canyon-like creases? She led me farther down the rabbit’s hole of confusion. Did she truly have empathy for me? Was she, like millions of other Americans, in mourning for what had happened three days before in New York? Did she have a friend, loved one, or even slight acquaintance who’d choked to death in the fire, was burned alive, or jumped to a death hundreds of feet below the office building whose safety they’d never once questioned?

Ashamed, I felt myself a failure in that moment. My heart sank within my chest as I realized that both the phlebotomist and me—separated by our social roles in this particular situation—couldn’t ask each other that simple question that Marvin Gaye had to fight Barry Gordy and all Motown Records to have the right to ask: “What’s going on?” Maybe if they’d—separated also by race and probably economic status—could somehow have met at some Austin restaurant, bar, waiting room, or elevator, we could have overcome the lines that divided us and achieved the kind of communication that Gaye sought.

But not today. My blood drawn, I had barely enough time to thank her before the volunteer whisked me away on my wheelchair—and, as I was pushed swiftly down the hallway toward the elevator, already late for my appointment with King—the woman’s face quickly vanished from my mind, leaving a scant trace that I’d one day recall in the shadowlands of words and nightmares.

Before I knew it, I was sitting in my wheelchair in King’s office, apologizing to the nurse, who also worked as a receptionist, for being late. I could speak somewhat more coherently now that I’d been sitting for a while, and the nurse could understand me. But she seemed disinterested in my story of why I was late—how I had to make such an excruciating rain-soaked walk through the endless parking lot, how the phlebotomist had drawn ostensibly endless vials of blood.

The nurse, Kay, was a shorthaired woman with blond hair. She didn’t wear scrubs and instead sported a white lab coat that hid her entire body—a lab coat that dragged on the parquet floor as she led me, who’d had to give up my wheelchair because the volunteer was needed in another part of the clinic. The floor merged into hallways that, despite their leading to various destinations of examination rooms and offices, went on forever—a nightmare out of Alice in Wonderland. While Kay buzzed in the background about one thing or another, she created a dissonant musical tide, on which my equally dissonant breathing increased into gasps that threatened to shatter my teeth and ribcage. I was so tired—the march through the parking lot in the rain had really done me in—that I could feel my consciousness slipping away from me. I, for what must have been the millionth time over the past couple of visits, felt my brain swimming away from me in a whirlpool that led to oblivion.

Kay, with me in tow, made it to the examination room, and she took my vitals. And, again, I was grateful—grateful for the touch of a human hand on my grateful skin—as I felt her fingers on my wrist in what I knew would turn out to be a frustrating and ostensibly endless search for my pulse, which had been almost impossible to find in recent weeks. Despite all her attempts and efforts, Kay wasn’t able to find it. She left the room to find a blood pressure machine.

I was alone, but comfort warmed me. Even as my soaked clothes chilled my skin and bones—chilled them through, so that they became icepicks, painful and cold at the same time—I opened myself up to the sounds and movements of King’s clinic, which was a hive of activity. And this activity produced an energy that told me that here at least, even though I was a paying customer, were people who would check in on me, care for me, and empathize with my pain. It didn’t matter that they were on salary; it meant that they were there for me. At this point in my ordeal, I couldn’t question, be critical, and, when it came down to it, be myself. I didn’t have that option. My life depended on the support of others, in whatever form that came.

With remorse hitting me for the way I’d thought of King earlier that morning, I heard the door latch click open and Kay enter the room. It was then that I realized that my eyes had been closed the entire time I was in the examination room—they were closed for a host of reasons that blended together: to stave off dizziness, to pretend that none of this was happening, to fall asleep, to meditate, to allow myself to trust others more deeply, in a way that I felt sight might compromise.

Kay connected the blood pressure machine to my arm—and I knew that the usual results would show up. I neither looked at the machine nor asked Kay for my numbers. That old feeling of not wanting to think of myself as a statistic or a splotch of printer ink on a chart came back. I wanted to be Paul—the old Paul—nothing more and nothing less. But I knew that all the blood pressure readings and ink splotches would do nothing for me. After the knowledge of my suffering, I could never go back to the person I once thought myself to be—because, as Kay told me that my blood pressure was low and that my resting heart rate was well over one hundred beats per minute, I was forever changed.

Kay put her hand on my chest, told me to put on a gown and to lie down on the examination table until Dr. King, who was very busy this morning, would be able to see me. After she left the room, I got out of my clothes, which left a puddle of water on the parquet floor. I lay down, only keeping my eyes open for as long as necessary, my feet dangling off one end. I heard the door latch click—and then the room was dark.

I could hear my heart beating. It was like I’d never heard it before—this engine that drove my life. It had a heavy and haunted sound, irregular and sluggish. I could visualize the thin cloth of the blue gown rising and falling, rising and falling. I knew that if my heart were a spike, it would cut right through the fabric and splatter the ceiling with blood.

So I tried to focus on slowing the pace, controlling the rhythm. My mind had never let me down before (my chapter on the villanelle sequence of A Portrait had been masterful, good enough for a conference presentation), but no matter how hard I tried, I just couldn’t will my heart to regulate. But, regardless of my fear and frustration, I heard the tread of the staff on the hallway just outside my room; I heard voices, laughter, togetherness, and camaraderie. And, sick as I was, I felt like a human being again in the presence of others, irrespective of the door and wall that physically separated us.

But, when King entered the room, the connection was snapped. He turned on the lights so suddenly that I woke up—yes, I was finally sleeping—and almost fell off the table, my eyes wide open and my heavy breathing filling the room.

King, with Kay behind him, rolled up to me on a squeaky stool that barely held the large man’s weight. His stomach plummeted down between his knees as he leaned over to examine my chest and stomach. After he’d listened to my heart through the gown, he asked me to slip it down to my waist. Kay covered my shoulders with a heated blanket as soon as she’d noticed that I was shivering, and, just as she did so, I could see my own chest clearly for the first time in what seemed like months.

Something else was out of whack. Something else was terribly wrong. I, King, and Kay could see my heart trying to release itself from my chest. The heartbeats were so hard—so jarring—that they showed their power to break through my skin at their own will.

King asked me, “How long has this been going on? Why didn’t you tell me about this before?"

I wheezed out: “I didn’t notice that anything was strange there.”

But I didn’t know whether my statement was accurate. Maybe on one of the endless nights of my ordeal, I stared for hours at the bathroom mirror, with the lights on full blast. I thought constantly and circuitously that the dizzy spells and the lack of sleep were compromising my memory. That was why I couldn’t put together lesson plans or write that essay on Radiohead.

Then, as King’s hand further explored my stomach, I remembered for what might have been the first or thousandth time that I’d had similar symptoms—breathing problems, insomnia, intense fatigue, and an accelerated heartbeat—in the mountains of Colorado that very same August. But my family and I had decided that these were the symptoms of high altitude sickness. My vomiting and crouching with exhaustion at the top of Vail Mountain was what could possibly happen to anyone who’d recently arrived in the Rockies after living for years in the lowlands of Wisconsin and Texas.

On the trip to Colorado, I first felt the desperation of exile. Because the shortness of breath had continued to plague me well into the night, I thrashed around in bed—a fish flopping on a pier without water gliding through its gills. I turned the lights on and off, trying to get comfortable, while my wife got more and more annoyed as each minute passed. Soon she was telling me that if I couldn’t sleep, I should go to the bathroom to read. I did so, dragging along Markson’s Wittgenstein’s Mistress—one of David Foster Wallace’s favorite books. But the unbearably hard bathroom floor and the glaring lights didn’t help my cause, and my eyes gaped toward oblivion as I sat cross-legged, with my back leaning against the side of the bathtub.

Morning seemed to come late the next day. I had spent the entire night awaiting its arrival, but it seemed tardy and angry in its unwillingness to end the night’s torments. And the unnatural fatigue that flooded my body along with it forced me to contend with what my family wanted to do that day. I didn’t know what this was, but my body screamed at me, admonishing me not to do anything at all.

So I limped—for some reason, I couldn’t walk normally—to my parents’ hotel room, not caring whether they still slept and leaving my wife behind, sound asleep in the mountain light that blazed through the blinds. With the high altitude sickness diagnosis still firmly entrenched in their minds, they advocated that a day of rest at the hotel was all that was needed for a full recovery. My father decided to stay with me and watch the British Open on television. I soon felt better, hungry even, when just a few hours earlier, the thought of eating breakfast brought on the need to vomit.

Now, back in King’s examination room, I heard my doctor say in a surprised and annoyed voice (which I’d come to associate with my wife), “What the hell is that?”

Blasted out of my Vail reverie, I opened my eyes and looked from King’s face to his hand, from which a finger pointed at the scar that, after twenty-five years, still felt like a fresh gouge, cavernous and incredibly apparent to everyone who came into contact with me, as if they had special powers that allowed them to see through the fabric of whatever shirt I was wearing at the time.

I scrambled: “I had kidney cancer when I was three. They had to remove one of my kidneys. I mentioned this on the form and even told you about it when I started coming here.”

King’s pupils, encircled by the round steel frame of his glasses, enlarged, signifying not so much a look of surprise but one of enhanced annoyance.

King’s glare spoke multitudes, impressing upon me the deep contradiction of the medical establishment. Even though he helped people, King was paid a higher salary than I would ever have in my life to perform what was at its root the highest and most poisonous act of compassionless being. The illusion of compassion was present in the kind of healing that, once in a while, occurred. But, yes, this healing was an illusion because it didn’t touch the spiritual and psychological energy of the patient, who no matter the “result,” would be forever damaged by the objectification of his body, as well as his and the doctor’s role in the prolongation of a health-care system that caused sorrow and despair. And this sorrow and despair was the right of the privileged few—those citizens who could afford to see physicians like King or, rather, those citizens who had medical insurance through their work: the employed and moneyed.

My scar, which now pulsated and moved like the deepest and most eternal of rivers under my and King’s gaze, now flowed into the towers, from which the burn victims fled. I wondered how many of them could afford insurance. Would the government take care of them? Would the government take care of the working poor?

King didn’t respond to my statement. Instead, he turned his back on me and addressed Kay, ordering her to bring an EKG machine into the room. As King gave this order, his hand moved up to my chest, where it felt the endless, deafening pounding: the arrhythmic splutter of a heartbeat that was in overdrive, working extra time to keep me breathing, no matter how slight that breathing was.

Nodding his head, King turned abruptly to the door and turned off the lights. Just after he did so, he told me to try and get some rest.

But I couldn’t rest. I felt my mind slipping into a murky region of black clouds and a rain that wouldn’t come—a sticky hemisphere that I’d never escape. The landscape of my days—all my days, right up until this point—was dotted with quicksand, which wasn’t just a threat or something avoidable; rather, it was the inevitable transformative terrain, all the misery and heartache in the world that would form the compass of my life.

The quicksand illumination came at no cost, just as the depths of my life were always available, always transparently obvious. But I, high on a wave of academic success and arrogant as only the young and untested can be, didn’t foresee the inevitable crash. I didn’t bother to notice the millions of people that formed a mass—a herd—outside the walls that I’d constructed to isolate my wife and myself from what was really going on. My empathy for the mothers and fathers who’d died in the towers could have been false; that is, if they’d died and my sickness hadn’t forced me to contend with my own suffering and my own damaged body. But I still saw a glimmer of hope as I opened my eyes and saw a slim and thin bar of light, where the door to my room didn’t quite meet the floor. Nurses, doctors, and their staff bustled outside, and I wanted to join the flow of their everyday lives. My reading of Joyce somehow contributed to this flow. Perhaps the EKG, with its paper and cords, could save me from the quicksand of my life. Perhaps this machine would provide the answer.

When Kay and King returned to the room and applied the sticky pads to my chest and other parts of my body where I’d never thought they’d go, their eyes widened so much that I could see the glare of the EKG illuminating them with a light that I somehow knew was unholy. Like conspirators in a Shakespeare tragedy or henchmen in a Scorsese film, they dissembled, muttering to each other in a code that I couldn’t understand. They both left the room, and when they returned, King passed me a thick brown folder that contained all the records and notes that had accumulated since my first visit more than a month before.

He’d later semi-apologize: “I’m sorry that I didn’t catch this sooner.”

Today, he said, “You’re lucky the EKG lit up—you’re very lucky it lit up at all, Paul.”

It was the first, but not the last time, that he’d addressed me by my first name—and his pronunciation of my name, oddly enough, echoed through my head in the same ambiguous tonality that Nana’s had, a decade earlier, when she’d crowned me a “good driver.”

King instructed me to drop off the records in Dr. Royce’s office on my way out of the clinic and to make an appointment for the next day. Dr. Royce was a cardiologist, and until I saw him, I was to take as many diuretics as possible to drain my body of as much fluid as I could. With a little luck, King expounded, I might be able to sleep that night.