Friday, April 29, 2011

Conroy's Reading Life

Our good friend Edie gave me My Reading Life by Pat Conroy when I recently entered the hospital, which was supposed to be for a more routine visit than it turned out to be. She knows I love good writing, and she thinks of me as a writer as well. It was a very thoughtful gift. Yes, I write, and I enjoy it, but to be a real writer means to forsake just about everything and dedicate yourself to the craft. It also helps to have an abundance of talent, an omniscient eye and an encyclopedic memory.

I cannot think of any great writer who is not obsessive compulsive about writing. In many ways, I wish I could roll back time and make that choice, but it would have been to the detriment of a publishing career I loved and other avocations such as the piano, studying the machinations of economic markets, politics, and a bunch of other things. Although I started Conroy's work in the hospital, I had difficulty concentrating on it or anything else after undergoing such major surgery. My recovery left me unable to do much but change channels watching awful TV which I can only describe as crap, and if that is emblematic of where American "culture" has migrated, there is no hope for our society.

Once I returned home, I picked up the book again. Conroy achingly cries out in poetic terms for an understanding as to why he writes, why he found refuge as a child in literature, first as a means of connecting with his mother (no, worshiping her) and as a means of escaping his father. I have a particular empathy for literature as a means to understand family, as I wrote in an earlier piece: "What draws me to these writers is families, or more specifically, dysfunctional families. Strong mothers or weak fathers or weak mothers and strong fathers with borderline “crazy” behavior, dark humor and the unpredictable maturation of children from those families. Of course if art mirrors life, it may be that “dysfunctional” is merely normalcy in today’s world."

It was heartbreaking, though, to read Conroy's dedication page. My Reading Life begins with: "This book is dedicated to my lost daughter, Susannah Ansley Conroy. Know this: I love you with my heart and always will. Your return to my life would be one of the happiest moments I could imagine."

So, as in my family, succeeding generations are affected by the tribulations fostered by previous generations. I naturally tried to discover more, and found his comments about the dedication page in an NPR review: Apparently he has been estranged from his daughter since divorcing her mother in 1995: "She has a perfect right not to see me. She's 28 now. But I thought this [dedication] was going to be a last cry of the heart. I would at least try to get her attention and see if I could get her to come back. It has been one of the most soul-killing things to ever happen to me." [Copyright 2011 National Public Radio]

Maybe his daughter will reconnect with her father if she has the opportunity to read this book and understand the undertow of Conroy's maturation as a man and as a writer. He covers a wide range of influences on his writing, first and foremost his mother, who became immersed in Gone With the Wind, continuously reading passages from the novel to her son, beginning when he was five years old. "I owe a personal debt to this novel that I find almost beyond reckoning. I became a novelist because of Gone with the Wind, or more precisely, my mother raised me up to be a "Southern" novelist, with a strong emphasis on the word "Southern," because Gone with the Wind set my mother's imagination ablaze when she was a young girl in Atlanta, and it was the one fire of her bruised, fragmented youth that never went out....It was the first time I knew that literature had the power to change the world."

Then there were the teachers, in particular Gene Norris's English class, and the "anti-teachers" in particular his father, Donald Conroy, the Marine who beat his family. Conroy bore much of this. "From an early age, I knew I didn't want to be anything like the man he was....I was on a lifelong search for the different kind of man. I wanted to attach my own moon of solitude to the strong attraction of a good man's gravitational pull." Gene Norris was that man and he became a lifelong friend and mentor to Conroy and introduced Conroy to a wide range of classic literature.

Then there were people in his life who could have been negative influences, the librarian, Miss Hunter, at Beaufort High School, Cliff Grabart, the proprietor of the Old New York Book Shop in Atlanta, and the cantankerous, but lover of literature, a book representative, Norman Berg, who I met on several occasions at book conventions. Conroy even went out on sales calls with Berg. That was the foundation of the publishing business then.

From each of these people Conroy took away something and bonded with them in his own way. In fact, Conroy was sponge-like in his dealings with people and the literature he read, recording everything, the eyes and ears of a writer on duty at all times. This is what separates mediocre writers from great ones.

He did the ex-pat "thing" in Paris in the late 1970s. "Parisians... relish the xenophobic sport of stereotyping and love to offer an infinite variety of theories on the nature of Americans. To them, we as a people are shallow, criminally naive, reactionary, decadent, over-the-hill, uncultured, uneducable, and friendly to a fault....Whenever Parisians heard my execrable attempts at French, they would cover their ears with their hands and moan over the violation and butchery of their sweet tongue." My own visits to France taught me a similar lesson, my high school French had to be left behind and I sometimes pretended to be Canadian. But maybe the French are on to something, given my captivity by the mindless TV programming during my hospital stay.

Conroy was finishing The Lords of Discipline in Paris, staying at a hotel where he encountered a wide range of travelers, including other artists. As my son is an inveterate traveler, I was fascinated by Conroy's exquisite explanation as to what it is to be an ex-pat, meeting other people on similar journeys: "Because we were strangers who would know one another on this planet for a very short time, we could trade those essential secrets of our lives that defined us in absolute terms. Voyagers can remove the masks and those sinuous, intricate disguises we wear at home in the dangerous equilibrium of our common lives. The men and women I met at the Grand Hotel des Balcons traveled to change themselves, to trust their bright impulse with the hope they would receive the gift of the sublime, life-changing encounter somewhere on the road. There is no voyage without a spiritual, even religious impulse. Each of us had met by accident, our lives touched briefly, fragilely -- then we continued on our own private journeys, and those intense encounters left a fragrant pollen on the sills and eaves of memory."

But to this point, My Reading Life is merely a warm up for what is the main event and influence on Conroy's writing and he appropriately entitles the chapter "A Love Letter to Thomas Wolfe."
It was Gene Norris who gave him Wolfe's classic Look Homeward, Angel in 1961 as a Christmas present. "The book's impact on me was visceral that I mark the reading of Look Homeward, Angel as one of the pivotal events of my life....The beauty of the language, shaped in sentences as pretty as blue herons, brought me to my knees with pleasure....I was under the illusion that Thomas Wolfe had written his book solely because he knew that I would one day read it, that a boy in South Carolina would enter his house of art with his arms wide open, ready and waiting for everything that Thomas Wolfe could throw at him."

I felt the same awe when I read the novel in college, probably at about the same time as Conroy. Never before had I felt that way when reading fiction. The only way to describe his writing is as being concurrently prodigious and poetic, an uncommon combination. And the novel was even larger before publication and luckily for Wolfe his editor was none other than the legendary Maxwell Perkins at Scribner's who also was Ernest Hemingway's and F. Scott Fitzgerald's. Wolfe was in good company.

The publication of Look Homeward, Angel, had, at its heart, detailed autobiographical elements, the same sort of autobiographical elements in which Conroy's own The Great Santini is grounded. Wolfe's work caused an uproar in his hometown, beautiful Asheville, North Carolina. For a while he was banished from the town, but he did return later to write You Can't Go Home Again.

Conroy has made the pilgrimage to Asheville, first with his teacher, Gene Morris, to visit Wolfe's "Old Kentucky Home," the boarding house maintained by Wolfe's mother. Conroy rocked on the chairs where the boarders gathered on the porch. He toured the home which has been so lovingly restored. I wonder whether Conroy has seen the wonderful play about Wolfe's return to Asheville, Return of an Angel which we were lucky enough to experience during one of our visits to Asheville. It brought Wolfe's return to Asheville alive.

We have been to the Wolfe home in Asheville twice and came away with the same feeling of time having been stopped during those years, before Wolfe's untimely death at the age of only 37. Imagine the great works he would have written if he had lived. As Conroy says, "I think the novels of his fifties and sixties would have been masterpieces. Time itself is a shaping, transfiguring force in any writer's life. Wolfe's best novels sleep in secret on a hillside in Asheville -- beside him forever, or at least, this is what I believe." I agree, Pat, and thank you for reminding me of Wolfe's passion, an invitation to reread his work.

Conroy's concluding chapter, "Why I Write" is probably one of the best I've ever read on the subject, setting the serious writer apart from the potboilers that weigh down today's best seller lists. "Stories are the vessels I use to interpret the world to myself...Good writing is the hardest form of thinking. It involves the agony of turning profoundly difficult thoughts into lucid form, then forcing them into the tight-fitting uniform of language, making them visible and clear."

Also in that chapter, he returns to the overarching theme of literature and family, the role of literature explaining who we are and where we came from: "I've always wanted to write a letter to the boy I once was, lost and dismayed in the plainsong of a childhood he found all but unbearable. but I soon discovered that I've been writing voluptuous hymns to that boy my whole life, because somewhere along the line -- in the midst of breakdowns, disorder, and a malignant attraction to mayhem that's a home place for the beaten child -- I fell in love with that kid." And I too fell in love, as much with Conroy's nonfiction as his novels, particularly with My Reading Life, as well as My Losing Season. Such truthfulness and beautiful writing. One can only hope his honesty will lead to a reconciliation with his daughter. It would be just.


Sunday, April 24, 2011

Natty Bumppo Economics

The recently completed $38 billion battle of brinksmanship over next year's federal budget is going to look like child's play in comparison to the upcoming showdown over the need to increase the debt ceiling. So, so much more is at stake, including the dollar's status as a reserve currency. And yet, our congressional "leaders" have declared a recess until sometime in early May, only a couple of weeks before the Treasury hits the debt ceiling. No doubt the recent move in gold and dollar weakness reflect an increasing anxiety that the United States Government could actually default. S&P has put the US on credit watch. Without Congressional action we will simply greatly increase the cost of inevitably having to borrow anyhow when Armageddon comes knocking at our fiscal door, and who will want to lend to a deadbeat government? Why would our politicians even play such a game? Is it a form of political conspiracy to bring the government to its knees?

Agreed, carrying unsustainable debt is a sure death knell as well. But debt on the balance sheet comes not only from making poor judgments and being profligate, it also comes from failing to raise revenue. Both sides of the income statement --- expenses AND revenue ---need to be examined by our absentee representatives.

It is wishful thinking, particularly as the economy has been on life support through the Federal Reserve since the 2008 financial crisis, that we can grow enough to offset the tax cuts that have been implemented since the Clinton years. US taxpayers with the highest adjusted gross income have watched their federal tax rates fall from about 30 percent in 1995 to 17 percent by 2007. No argument that we need to simplify the tax code, but tax revenues need to be higher, simple as that. We need to revisit those Clinton rates again, a graduated tax rate without the loopholes. Close as many doors as possible to the underground economy. Eviscerate tax avoidance strategies.

We also need to shore up Social Security by increasing the wage limits for SS taxes -- or how about a similar "donut hole" we give to seniors for their drug needs, taxing wages for social security to a certain limit, then no tax until another higher limit is reached, and then resume taxing for social security revenue. On the expense side of the income statement, means testing will have to be instituted and the retirement age slowly moved back.

The ideas put forth for privatizing Medicare will slowly kill the program, so desperately needed by the middle class. Cost containment measures have to take first priority. A voucher program is smoke and mirrors. Can you imagine the average senior having to make such decisions with insurance companies pulling the strings?

And Medicare being entirely turned over to the States, many of which can hardly make their own budgets balance? Disaster for the poor.

These are huge issues and I don't mean to simplify any of them, but defaulting on our debt is NOT the first step in resolving any of these problems. It will be our last.

The amazing thing about this "movement"-- if it is fair to call it that -- is some of the people who would be hurt the most just say "bring it on, let the government fail." Perhaps this notion harkens back to the idealized Natty Bumppo from James Fenimore Cooper's Leatherstocking Tales. But this is not a mythical tale of American rugged individualism and "one shot, one kill." It is about cooperation and compromise. We need our representatives to do the hard, serious work they were hired to do without all the political posturing and partisanship, and without the brinksmanship of the twelfth hour.

Thursday, April 21, 2011

Widow Maker Redux

There is a reason I've been silent so long. In fact, I am lucky to be around to resume the story I wrote last November when I described my silent encounter with the "Widow Maker" artery. The link gives the detail, but briefly I unknowingly had a 99% blockage in the infamous Widow Maker's artery, the LAD. If it were not for the fact that I regularly exercise, the problem would have gone unnoticed, and indeed my case would have resulted in another widow.

At that time, a cardiac catheterization revealed the blockage and I was given the option of less invasive three kissing stents vs. open heart surgery. Naturally, given the choice between the intrusive bypass, the possible complications, and the long recovery, I choose the path of least resistance. After all, couldn't I undergo the more invasive option if the stents didn't work?

Following that procedure, I began a cardiovascular rehab program, which consisted of 36 sessions. Once again exercise saved my life. I was on my 33rd session when I started to feel some burning sensation in my chest after about 15 minutes on the treadmill (I was doing 30 minutes at 3.8 mph). It would generally pass and I rationalized it was gas, but, here is the value of such programs (one that may become vulnerable to cuts in Medicare): the extraordinarily caring cardio nurses on duty reported it to my cardiologist who called me in for a nuclear stress test. I got through the test, so I went about my business again waiting for results the following week.

In fact, immediately afterwards, boating friends of ours from Connecticut, Cathy and John, visited us and over the next four days we took our small boat out to watch the moonrise over Singer Island, ran the boat up to Jupiter the next day to the funky, fun, Guanabanas Tiki Bar and Restaurant where we could tie up at their splintery old docks and enjoy a little bit of the Caribbean right here in Palm Beach County.

The following day we went to Peanut Island, our favorite destination on our boat, watching Tiger Wood's yacht, 'Privacy' (Tiger put the boat up for sale recently if you have a spare $20 million or so and can afford the crew and maintenance) glide by as Ann and company played Scrabble on the beach. We enjoyed lunch al fresco and later barbecued dinner and left as the sun slowly set.
A possible negative report on the stress test was the farthest thing from my mind, and I went about my normal activities as usual. In retrospect, our friends' visit could not have come at a better time.........the calm before the storm. Life as usual.

My follow up appointment with my cardiologist was the day after they left. Apparently, the stress test, combined with the burning symptoms when exercising, called for another catheterization and, as was explained to me, the sooner the better. The following Monday, March 28, I went into the hospital and had the catheterization expecting, at worst, Restenosis, which usually happens within 3-6 months after stent placement and I was still in that time frame from my previous procedure. I thought I would wake up to still another stent or a treatment of intra-coronary radiation (brachytherapy).

Wishful thinking. I was told my Widow Maker was now more than 90% blocked again (turned out later to be 100%) with another artery 50% and I would need dual bypass open heart surgery. There is a delightful acronym for this surgery as it is sometimes called: CABG ("cabbage"). I was to become a cabbage patient. Luckily for me, one of the gifted thoracic surgeons in the area, Dr. Arthur Katz, was available for the task, and also that I was at the Palm Beach Gardens hospital which is a leading heart hospital.

First order of business was to get as much as possible of the blood thinning Plavix out of my system before surgery. I had been on the drug since my first stent more than six years ago. However, knowing that I had such extensive blockage in the LAD (the LAD coronary artery supplies a very large part of the heart muscle) made it a judgment call of how long we could wait. The surgery was scheduled for March 31 but after a blood test, it was delayed one more day (April Fool's day). Our son flew in from Tokyo (where he had been during the earthquake, but that is another story) to be with me and my wife. His presence made all the difference to Ann who bore the brunt of seeing my struggle and trying to communicate status reports to friends and family via email and phone. My older son, Chris, could not be here but Ann kept in constant touch with him.

Dr. Katz specializes in surgery without the use of a heart lung machine (off-pump, it's called), something I was grateful for as I have heard about cognitive recovery and other issues resulting from that. But as it turned out, my operation was anything but routine. First, endotracheal intubation (the process of placing a breathing tube to protect my airway and control breathing during the administration of general anesthetic), became very difficult because of various anatomical issues unique to me. A fiberoptic bronchoscope had to be used after several unsuccessful attempts at direct larngoscopy and glidescope.

Surgery went well initially, using an internal mammary artery and another artery from my left leg, but then there was increasing difficulty controlling bleeding. I had a number of transfusions. In fact, after my sternum was wired and the chest stapled, there were further signs of internal bleeding so for the first time in recent memory, Dr. Katz had to reassemble his OR team and go back into the wound. This carries a risk of course and it is why surgery is as much an art as it is a science.

Thankfully, he was able to control the bleeding at this point, but I had been through the wringer and back again, and had to have half of my body's blood replaced. As I had so much anesthesia, my recovery was to be equally slow and for four days I had that breathing tube down my throat as I went in and out of consciousness. My throat had been lacerated and was now excessively swollen. Waiting for my throat to return to normal, mittens had to be put on my hands so I wouldn't grab the tube when I had brief borderline awareness. Ann said during those moments I was waving my arms, gesturing with my boxing glove hands and giving everyone the fish eye. No wonder.

When I finally came to, I was in intensive cardiac care, pretty much unable to move, and having been unconscious for four days, would now probably be awake for at least two days. Those nights were the most difficult, not being able to move much, trying to get into a comfortable position, forced to lie on my back. I could hear almost every precious heart beat and sometimes the creaking of my sternum which was wired together. Deep into those nights you are left with your thoughts and fears, regrets and hopes.

I could operate a TV on the wall with a remote. It is not possible to realize how bad late night TV is until I became dependent on watching it all night, unable to sleep. I thought it ironic that juxtaposed to my surgery was all the rhetoric on the news shows about shutting down the government because of the lack of a budget compromise, all the posturing and huffing and puffing by the wolves in Washington, the propaganda about "entitlements" and the inexplicable inability of rolling back some of the Bush tax cuts as one part of dealing with the growing deficit. A subject for another entry, but, this is what I listened to as I was personally benefitting from an excellent healthcare system and no doubt a very expensive one, the very one some of our politicians would like to turn over to the insurance companies.

There is no way to describe everything that had to be done to me and for me to pull through, but I had asked my son to take a picture of me in recovery, thinking I might want to post it if I survived the operation. Warning, it is not a pleasant sight, but I include this at the end of this entry. It puts a "face" on Medicare. In spite of all of the shortcomings of the program, as one of the most civilized countries in the world, such care must be available to all. And of course, throughout all of my 15 days and nights lying in that hospital bed, I was looked after by a revolving crew of highly trained nurses who literarily kept me alive changing vital fluids, making me as comfortable as possible with all the tubes and apparatus attached to me and using all their skills and experience to help me survive my arduous surgery. There is no way I could ever thank them properly enough for their dedication and professionalism.

My breathing tube was gone by the time I came to. The third chest drain was yanked out (yanked is the correct word) by Dr. Katz as he diverted my attention to a discussion of where I grew up and my familiarity with Jahn's, a favorite teenage hang-out in Richmond Hill. Strange to be talking about Jahn's "kitchen sink" some fifty years later while a chest drain is being removed. Finally my urinary catheter was removed as well.

Another complication was a sudden spike in fever when I finally got to the regular cardiac unit, so for the next two days I was tied to massive intravenous antibiotics. No one could explain this spike which disappeared as quickly as it appeared other than it being somewhat par for the course.

So now I have been home for a little over a week and thanks again to Medicare, have been closely monitored by an attentive nurse and physical therapist putting me through the paces in the house. I now have follow-up Doctor appointments and have been given the green light to return to cardio rehab next week. While bypass surgery has relatively good prognosis, the fact that I had complications, new blockages, etc., results in some anxiety. I eat a healthy diet, exercise, have always been active, but as I said in my prior entry on the Widow Maker, hereditary factors seem to preside over everything. Will my therapy and new medications offset this deficit? That is the hope.

To friends and family who might be reading this, thank you for all your heartfelt support, for me, and my wife who has been valiant through all of this. Ann was calling, emailing everyone, coming home from the hospital near exhaustion. Her last email after my second (no, actually third) operation in a week is typical of the kind of attention she gave to everyone, in spite of the late hours she returned from the hospital:

Dear Friends and Family,
It's been a day from hell. All I can say is thank goodness Jonathan was here with me, or I would have lost my mind. In short, Bob was bleeding profusely during and after the operation this morning for the double bypass. We saw him very briefly in the critical care recovery room with a million tubes coming in and out. We were home less than an hour planning to return over the next visiting period when Bob's Surgeon, Dr. Katz, called and said he was going back in again, Bob was still oozing and he was reassembling his OR team. That meant cutting his chest open over the fresh stitches, undoing the wiring on the sternum, breaking it again and taking another look.

I thought Jon and I were going to pass out. Once we started reading all the literature on this procedure and all the risks involved, we were totally freaked. When it was finally over, we saw the Dr. and spent 20 minutes discussing everything.

The good news now is that Bob is stable. No profuse bleeding, holding his own. They can't take out the breathing tube yet, however, because he is still in critical care and because he may have suffered lacerations in his throat when it was originally inserted (with great difficulty) and they're waiting for an ENT specialist to examine him.

To update, Jon and I have just returned from our third brief visit at 9:00 this evening and although we are both bleary eyed, I wanted to send this quick, and I hope reassuring, note to you. He is completely stable, but still heavily sedated and was not aware of our presence. He has a dedicated nurse with him all night who is a gem. The ENT Physician had not arrived but was expected at any minute. His heart is strong now, the lungs are clear, all his other vital signs are good and we are confident that he will make a full recovery.