in the hall of mirrors

Flowers in the water

Hot bath with oils, flowers embedded in the solid blocks of oils... I haven't done this for very long in my life, just the past four or five years; and I've mostly thought of, explained, them as indulgences and as survival: as pleasures that help me get through the northern British winters (and springs and falls, and probably summers too).

But, while reading late Borges on immortality (much influenced by Schopenhauer); after thinking of what to read for Vanessa's memorial next week; while Twelve Monkeys, with its terrible end-of-the-world qualified by a love story, is on television; and after feeling so tired, so weak and generally unable, but more awake the past few days, I feel another meaning to them....

If it is all transient, life and breath and happiness and illness and misery etc. etc., including both the bad and the good, and none of it lasts; then every pleasure, every flower, is spring, is rebirth. Obvious, really, and something many people must find utterly banal: but this is the kind of meaning I, with my obtuse focus on some sort of permanent happiness that is always out of my own reach, would always miss.

But it is obvious: these fragments of flowers in the bath are flowers on the Ganges, are pleasure and spring and joy; and we do these things not to stave off darkness, and not to try to engage in some kind of endless pleasure, but simply because we can always, at every moment, start over – and so why not with spring, with flowers....

Missing

There are notes for two more long segments on my surgery and recovery, but I haven't had the energy to attack them yet. I hope I will finish them – not for your sake: it is entirely possible that the select company friends and strangers who read this blog are already tired of the topic – but for mine: that I can construct something of some length, made of fragments, envisioned while dazed in a hospital bed.

But right now, I'm (on the one hand) all right from the point of view of serious medical status, and (on the other) tired, groggy, queasy. Surprisingly disoriented, dizzy, out of it.

Sad dreams the past two days, about spending a great deal of energy moving into shabby, dark spaces in San Francisco, and another forgotten city: which might be seen as anxious previsions of my fading years when, not having quite overcome my career and financial errors, I am fading into the background, occupying the outward edge of livable spaces in cities that are increasingly crowded, expensive, and unable to help the new poor.

The reality, though there is much brightness and many kind thoughts in it, is perhaps creating some of this mood – I am currently missing my sister's memorial, which has, as my niece wanted it to, developed into a large, tearful/happy celebration involving relatives, neighbors, and at least two days of what seem to be pretty wonderful parties – there were a hundred and twenty expected yesterday at the house after the ceremony, on a hot day, in every room and out in the yard.

It is good to know that it's happening, and has gone so well... but it's tough that I couldn't attend, that I was in no condition to travel when it was required. All those people I remember with so much affection: and I can't help thinking there will never be a chance to see most of them again....

Ostern in Stuttgart (II)

[March 22-25, 2008]

Intensiv (Saturday/Sunday)

The two days following surgery are complex and not without their pleasures: these are the days immured in intensive care, the days of morphine. These are also the days of constant attention, many tubes and cables, an endless bleeping and ticking of machines, an excellent nurse or two, a charming young doctor; and the days when I open my computer and hear music, read e-mails, and even send out a message telling people what has happened to me. Significant: because after this the computer will be closed, as I will close down, for the better part of a week, tired, helpless, exasperated.

But first: the more highly colored experiences of intensive care. My operation took place within an hour or two of the full moon – on, of all days, Good Friday; it is Easter weekend – which, incidentally, means that far more hospital staff than usual are away from Friday through Sunday (Joyce later explains to me that Good Friday is the most important day of the year for Lutherans, and this is an assertively Lutheran hospital). However, despite the decimated ranks of doctors, nurses, and less prestigious staff, I am not badly cared for: I would say, in fact, that those who have stayed over this weekend, who have shown the workaholic dedication typical of medical personnel, are among the more skilled, the more matter-of-fact, the more educated. Indeed there seems to be a slight sense of relief on their parts, as though their more second-rate or even incompetent colleagues are away on holiday, and therefore gratifyingly absent: those who are left are happy to do all sorts of things themselves, knowing everything will therefore be done right.

A blonde nurse, perhaps in her thirties – whom I will not see again after I leave intensive care; was her name Claudia, or Charlotte? – washes me with gentle professionalism and speed; in fact everything she does is remarkably accomplished, remarkably able. Later in the week, in one of our many visiting-hour conversations, Joyce will remark on her work – she will say, in fact, remember that amazing nurse you had those first days? She really knew her stuff.

I wish I could remember more details of this woman who so impressed Joyce; but of course my attention those first days was contingent on the various hazinesses coming over me – those are in fact the days when I stumbled most over my varying ability in German: sometimes I could answer complicated questions and orders without a pause; but at other times, when tired or suddenly awakened from half-sleep, I could barely understand a word, and was treated more like the foreigner I am.

All these feelings and sensations, in intensive care, are softened, made more magical – no, not by the morphine, but – by the snow: because intermittently over this Easter weekend, so weirdly early by any calendar, a beautiful blanket of snow will drift over the quaintly German houses seen outside my window: like a holiday card; like a beautiful cliché.

In Praise of Cole Porter

I don’t assume the Chefarzt will spend much time with me – although, to my surprise, he will visit all but one of the days following my surgery – and I assume that I will see more of the apple-cheeked, friendly young male doctor. But, in intensive care and for a day or two afterward, I instead spend time with a friendly, astoundingly talkative young woman with dark hair – a very capable doctor, but also someone with many interests, who will talk about all of them without a lot of pauses. She gossips about the Chefarzt, showing the satirical adoration I will note in the other young doctors – the man is clearly vastly respected, and largely feared, and also, privately, seen as rather irritating; she loves to show off her able and idiomatic English, which occasionally leads to slight duels between us to display our abilities in each other’s language; we rattle on, competing for each other’s attention, friendlily and enthusiastically interrupting in a macaronic English-German that shifts back and forth across the linguistic map. Although occasionally, when I’m tired, I beg to sleep for a bit, for the most part I am happy, engaged, charmed – there is no better way to be distracted from the boredom and stress of the Krankenhaus, especially in the long evening and morning hours when Joyce cannot visit.

For instance, once the young doctor hears I am a Musikprofessor, and a former singer, she says she also sings – and promises me a copy of her home-made CD of herself covering Porter and Gershwin favorites. The next day, she brings the CD, in an orange plastic case; although the computer is open, I’m not up for hearing it at that moment, and lay it aside with her permission. (It will later go into a bag of books that Joyce will bring from home; when they go back after a few days, it goes with them – I assume it is now somewhere among her papers, so I can’t tell you what the young doctor did with those wonderful, fun songs – They Can’t Take That Away From Me, You’re The Top).

When I open the computer, I discover an open network: and I receive two hundred e-mails, all at once – masses of garbage; because for some reason the past five days have seen a surge in spam, plus there are many end-of-term e-mails from the university (as usual, before going away for Easter vacation, everyone and his sister has suddenly discovered that they have many terribly important announcements to make, to the department, to the school, to the faculty, to anybody who might possibly be convinced to pay attention). I spend some rather mentally blurry time that day and the next deleting and filing e-mails, which will boil down to five or six of actual interest – all of which, however, I am too tired to manage right now.

The young doctor/singer will tell me about this network connection: she explains that the hospital has no open network, but that one of the homes across the street has a network carelessly without a password – and that, in fact, my very room in intensive care, plus the storage room next to it, are the only places in this entire large multi-winged hospital where an open network can be found. She tells me with a touch of hilarity that, if the residents of that house knew how many hospital staff went into that storage room to check their e-mails, they would faint with shock…

Alerted to the need for expediency, I send an e-mail to my family telling them what is going on, in dry and reassuring terms (especially since I won’t be online for some time, creating panic seems foolish). And I send the same e-mail to the department, to a few crucial friends – one of whom will complain about being on a mailing list – a complaint that will later make me angry, when I am feeling my most tired and helpless. Isn’t it enough that I troubled to send a message from, of all places, intensive care?...

In any case, I like this doctor, her helpfulness and intelligence, her amusing conversation; she becomes an instant friend. And she is honest and direct, doesn’t pull any punches: when I am trying to think backwards – surgery Friday, entering hospital Thursday, flight Wednesday, pain starting Tuesday – I ask her, so when did my appendix actually, probably, burst? (I am getting adept with the awkward and slightly obscene-sounding phrase ‘perforierte Blinddarm’, which I will use with great frequency in the next ten days.) Apparently, at the point when the appendix bursts, a patient often feels briefly better, the pain decreases; so perhaps it was Wednesday evening, when I ate two rolls with cheese. So, I ask her, you don’t think it could have burst on Tuesday evening?

No, she says, if it had burst on Tuesday, you’d be dead.

Listening

These two days, I’m moored once again to my computer – but uninterested in the habitual and boring practices that have hypnotized me lately (solitaire, downloads, surfing, repetitive tedium). In the afternoon I open iTunes and play music, slowly, complicatedly, trying to manage the drip in my right hand, the tubes and cables that make reaching the keyboard slightly more work than seems worthwhile: all that seems pleasant is my playlist of folk music, and I turn that on for a bit.

A heap of Peter, Paul and Mary. After ‘500 Miles’, I am struck by the opening of ‘Sorrow’, to which I’ve never paid much attention –

I am a man of constant sorrow, I've seen trouble all my days. I’m goin’ back to California, The place where I was partly raised.

All through this world I'm bound to ramble,

Through storm and wind, through sleet and rain.

I'm bound to ride that northern railroad,

Perhaps I'll take the very next train.

Your friends they say I am a stranger
You’ll never see my face no more

And, among the self-pity and exhaustion, the sight of other patients – all old and pathetic, most of whom will be here longer than I, many of whom will die here… I think too much about these lyrics, I fall into them, enveloped in a new identity.

Later, increasingly tired, finding the tangle of tubes difficult to manage, I hear before I close the computer (for what will be a number of days) a rather rattling, slightly irritating reel, from an album by one of my colleagues: something I find difficult to handle right now, but something that gets into my ear. And my brain. As we shall see….

Darker angel

Increasingly my intensive care nurse is a Krankenpfleger, a male nurse; there are usually more of them than Krankenschwestern in intensive care, under the theory that they can handle tougher tasks and more problematic patients (dubious but there you are). He has dark hair, broad cheekbones, and never smiles: a Slavic or eastern face, dramatically if grimly handsome from my low, bed-ridden angle.

When I tell Joyce about him, she teases me, assuming I am attracted to this man. I can’t seem to correct this misconception, but I try: seeing him is not really pleasant, or erotic – it is impressive, intimidating, even, in the pale blue light of intensive care at four in the morning, slightly frightening. He cares for me coolly, precisely, and with scant interest in discomforts or problems I may have: not that he is not thoroughly professional – but any empathy, any warmth, is absent, and he seems skeptical of my need for pain medications, my wishes to move into a different position, as though we are on a battlefield, with no time for such weakling’s niceties.

Not that I dislike him, either: but he is the kind of nurse who makes you think twice, or three times, about ringing the buzzer – he is to be asked only for definite and clear tasks, and for help that you can prove that you deserve.

Geräusch (Sunday/Monday)

Sunday night brought chaotic, boorish noises from the street: I assumed they were Swabian drunks – this is, after all, a city that is well off, but is located in one of the more rural parts of what was once Western Germany. Some of my expectations of Stuttgart are, in fact, derived not only from Wolf and Gustav, my primitively wild Swabian friends from the early 1990s (think brown leather pants, rarely changed, a motorcycle, and lots of pot); but also from a comic book I bought around that time – Peter Puck’s Alle lieben Rudi, which retells the obnoxiously funny adventures of a pair of hapless middle-class Stuttgarters caught in a crazed world of skinheads, hippies, neo-Nazis, yuppies, nudists, gangs, punks, and other obsessed and loony groups.

So I just assume that the noise is drunks: smashed bottles, roaring, dirty songs, late-night takeaway: an Easter Sunday, but well after all the churches have closed; a bunch of roaring boys who don’t have to work on Monday.

But on Monday, Joyce tells me news of the world: that, this Easter weekend, the most startling thing on television is China’s crackdown in Tibet. She tells me of the Dalai Lama screaming in anger, chaos, guns – I am not quite up to hearing this… but she’s right, I do care about it. Joyce thinks the noise might not have been roaring boys, but Tibetan demonstrations… and I think: well, that would change everything; and then: but how can we know?....

Cast out (Monday)

It is the dark angel, the Krankenpfleger, who, on my third night after surgery, decides well after midnight that I can be moved out of intensive care.

The hospital is becoming busy again: after the holiday weekend (I assume the usual accidents, chaos, and probably those drunken lads – how many heads with beer-bottle-glass in them?), and several days of relative quiet, more beds are suddenly needed in intensive care. So, somewhere between two and three a.m., when I have settled to a peaceful if plugged-in night – sleepless as always here, but at least dazed into quiet and immobility – there is a chaotic rush of connections and disconnections, packing up and straightening and changing; and I am moved…

But normal rooms are not, at this time of night, available. I am shifted into what I think is a surgical room, or a surgical recovery room – I don’t quite understand the hasty explanations in the dead of night, none of which come from the Krankenpfleger anyway (he is not given to explaining things). This new room has a strange design: four bays, with beds, but no tables or stands; a large dividing wall in the center of the room, with an open transom over its entire length; a few small watercolors, some high-tech lights. But clearly not a room designed for patients, at least not patients who are anywhere near to consciousness.

My neighbor – or possibly neighbors – whom I cannot see as he is (they are?) on the other side of the dividing wall – has a machine helping him breathe. The air is strange and dry; the machine breathes constantly, in and out, a rhythmically changing white noise punctuated by occasional wheezes and coughs that fixes my attention unbearably. Sleep is out of the question: although this is the darkest room I’ve been in for days (no bleeping machines – in fact, my five tubes and cables have been reduced to three; and over the coming days I will look forward to the disconnection of each in turn), there are still unfamiliar, distracting, low-level lights. And that machine. And the parched air.

A kind of purgatory….

Umgezogen (Tuesday)

The next morning, I am moved again, to the hall where I will spend the next week. I will start to get familiar with a new run of nurses and doctors; to become accustomed to the disciplined pattern of the day; and will gradually, slowly, improve.

I am not unhappy; though not as dazed with comfort as on the two days of morphine, my drip (along with masses of saline and three bottles a day of various antibiotics) includes frequent Schmerzmittel, pain medication.

So when I am finally settled, I am pleased: with the clean, quiet, well-designed room, whose furnishings are distinctly more modern than in my pre-surgery room, and more comfortable than the purgatorial surgical recovery room; with the fact that I am alone, the other bed empty; with the relative quiet and peace of a hospital room that is not in intensive care. Too tired to read, to touch the computer, and it is hard to stay awake through Joyce’s visits: but I do not anticipate problems.

And so I am unprepared for the misery, the panic, the disorientation of the next two days….

Ostern in Stuttgart (I)

[March 19-23, 2008]

Winterschnee (Wednesday)

Snow is forecast, although it is Easter weekend (admittedly a very early Easter, tribute to the peculiarly arcane calculations the Church goes through to establish the date – look it up some time, the formula is nothing short of bizarre); and here it is – rich, heavy snow, very wet, but falling beautifully in the small park outside my room.

This hotel room is tiny but outrageously efficient: this is, in fact, a Germany that I’ve always liked a great deal – well-made, well-designed, excellent heating and lighting, wonderful bread, a vast range of Schinken und Käse at the deli next door. Perhaps I like it so much, not only because everything is so dependable, so neat, so functional, but because this is the Germany I first saw in 1993 – my first trip to Europe, the eight or nine months I spent in Kiel and Darmstadt. Like those small cities, Stuttgart was bombed flat in the war; so everything is post-war design, what Joyce has called ‘very seventies’; but Stuttgart does this kind of thing distinctly better than Kiel or Darmstadt, as it is both small and quite wealthy, because of the local Mercedes/Daimler-Benz money. I remember the city tram lines, which had a charming toylike quality – I wonder if they’ll still look that way to me….

Nachtschmerzen

Rather horribly, the night before my flight today, my digestion became acutely painful, endlessly, miserably so; I slept very little, and was a wan, frustrated ghost by the time I took a taxi to the airport. Impossible to change my flight, of course, impossible to handle being on the plane, impossible to handle the unreasonably bad planning at Schiphol where, as I’d been warned, transfers have become outrageously slow and difficult: a weird contrast to the rationalist pleasantness of the architecture of the new airport, which is purely rational urban Dutch, as though the entire place were a Helvetica font.

My dear friend Joyce, whom I am visiting here in Stuttgart, is in so many ways a blessing, and is happy to spend time helping me try to feel better: some Heilpraktiker tea, some pills at the Apotheke, a couple of Brötchen at the delicatessen by my hotel. I can do no work today, although the whole point in this trip is to put together this book that should have been finished ten years ago: but she is forgiving about that, and when we have done what we can to generate some symptomatic cures she takes me back to the hotel, we sneak various teas and a hot-water kettle into my room, and I sleep all evening.

But I’m not really better, and from around midnight that becomes all too clear: tonight, I am still in pain – and, increasingly obviously, real and serious pain. For months I’ve been assuming that my digestive problems were a kind of irritable bowel syndrome, something that requires managing my diet and avoiding coffee (why, in that burst of writing I did before I left, did I drink coffee three days in a row? – such foolishness); but of course last night and tonight I can’t help thinking: is this a different, a worse, problem than that? If I had an X-ray now, would it perhaps show some kind of awful dark shadow on my left side, where the colon is – where the pain is constant now?

Madness. Somewhere between the trivial pleasantries of Stuttgart, the valiant attempt to banish the ancient demons of not finishing this book, Joyce’s kindness, and my long reading of a novel by Nicholas Mosley – a book whose dark, thoughtful confusion is making perhaps too much sense to me right now – I can’t really find my balance. And I need to find it, because I’m not at home, because that damned book must get finished – and because, maybe, I really, really need to go to a doctor: and brace myself for something real – something non-trivial.

Mosley (Thursday)

And how strange: because of the pain, sleep is impossible; instead I have read this dense, wonderful novel – Nicholas Mosley’s Hopeful Monsters – five and a half hundred pages, entirely between getting on the flight at 10 am yesterday and 6 am today.

It would be so wonderful to sleep: but if I can’t sleep, at least this novel was the best of distractions. The density and darkness of so much of it – the tangled politics, ideas, and increasingly demented behaviors of 1920s and 1930s Germany and England, seen through the eyes very intelligent young people who are at a loss to understand what’s going on… and a happy-ish ending, which brings me great peace, something I could use right now.

Of course, now I have only one other book left to read, a professional and depressing one on the cultural theory of AIDS… I hope the local Buchladen has books in English.

But I think, more importantly, that I need to call Joyce as soon as I think she’s awake, and go see a doctor.

Krankenhäuser (Thursday)

Joyce responds quickly and practically to the situation – she really is a marvel – calling around to see what the best choice of hospitals would be, then telling me to dress and stand outside (I can’t button my pants, but hold them up inside my long coat) while she drives over to get me. The first hospital is a mistake, we are misled by confusing signs and two different hospitals with similar names; but we finally reach the correct one and take a gleaming elevator up to Internal Medicine. Many questions, many explanations, about insurance, citizenship, pain, age, date of birth, previous conditions; Joyce calls me, repeatedly, Herr Doktor Professor, and mentions to me later in an undertone that that ought to get me better attention. It’s like when I was living in Hong Kong: I used my titles like social weapons, and they worked – but I’m out of practice doing that, Brits tend to be somewhat ashamed of professional titles and avoid using them. Joyce points out that, on the top of the check-in sheet that is now the beginning of my medical chart here, it says clearly: Professor….

A charming, businesslike young woman doctor examines me, takes blood, enters me into the hospital: but what is wrong? They don’t seem to know….

Joyce comes with me up to my room, which I share with a very old man (it seems that almost all the other patients are in their seventies or eighties – Joyce says, well, Germany has a negative birth rate). He is not exactly charming – slurping food and moaning occasionally – but his wife and daughter are very pleasant, and I settle down, expectant that someone will now take care of me, and I can stop worrying.

In ernst (Friday)

I am not happy.

Friday morning, and although they are kind to me they have done nothing definite yet, and I am definitely not well – Bauch bloated, Magenschmerzen, Fieber. I point these things out to the nurse, in no uncertain terms; there is some bustling around, and I am taken in a wheelchair down several elevators, across and around several halls in different colors, almost entirely across the hospital to the surgical wing – to be seen, as though I was led through tunnels to consult with a sort of master wizard, by the Chefarzt (senior doctor, far senior to the ones I’ve had contact with so far). He is a big, hearty, country man; in the next few days, when he is out of the room, the younger doctors will tell me he’s known as a sort of Landarzt (country doctor), bluff and strong-willed. He examines me, then turns to me and says: I’m not sure what’s wrong, but we’re going to operate – now – so good-night, because you’re going to have general anesthesia.

I am taken into a room where a young man and woman bustle about, arranging me on a specially designed bed that has blue plastic gel supports for the feet and head – very high-tech, very well-made, very German – and prepare the anesthesia. They joke, I joke – I’m actually relieved that something is being done. And perhaps a bit relieved to being made unconscious.

But, of course, also a bit anxious….

Afterwards

It was a burst appendix: full surgery, eight-inch incision down the middle of my belly – later in the week I will read that when an appendectomy is done before the appendix bursts, it is done with a small incision, a camera, and two or three days in the hospital. Or when they already know it’s a burst appendix, the incision isn’t much bigger – but because they were going in blind, they did a great big exploratory incision. Ah well, I wasn’t so lucky: I will be here for at least ten days or so. I also read that it’s not their fault – although so many people have appendicitis, symptoms vary so confusingly that thirty per cent of appendectomies are misdiagnoses….

But, thank God, I am no longer in pain… morphine… intensive care. Feeling much better. Actually quite comfortable, rather happy. Morphine…. There are five connections to me – catheter, a tube down my nose into my stomach to carry away bile, a drip in my arm with saline, Schmerzmittel – morphine… – and antibiotics, whatever. Intensive care is fairly strange, constantly busy but at a low hum. Many machines, blinking lights, a sense of constant watchfulness. Intensive Care has not only Krankenschwestern – nurses – but also the supposedly stronger Krankenpflegern – male nurses: gender divisions are unsubtle in German hospitals. The lights are never turned off, the lights are never bright. Morphine…. there is a little tube attached to one finger, checking my pulse. Joyce says that the battery of screens behind me has all sorts of moving numbers – she tries to figure out what they mean – she can see what must be pulse and temperature, the rest are mysteries.

I am not uncomfortable. Morphine….

Nadel (Saturday)

A catastrophe: but not for me – because of me. The Chefarzt – I am gradually absorbing the information that he isn’t merely head doctor for a division or something, he is literally the chief surgeon for this entire large hospital – stuck himself with a needle during my surgery.

The dreaded needlestick injury: infection with HIV, with HCV, through accidental blood contact with a patient… one hears so much about it, it’s even been a long-term semi-tragic subplot in ER, House, and other television hospital dramas. It’s quite different when it happens during your own operation – now I feel, well, like a threat, like an unconscionable danger to others: as though those old Republican plans to put us all into quarantine in Utah were not such a bad idea….

I learn, also, that the Chefarzt is a month and a half away from retirement. He is widely feared, and as widely respected – the younger doctors (especially the meticulous young Turkish one who is slightly pompous, slightly grandiose, when he is alone in my room giving me instructions) often look panic-stricken when he is in the room, as though they’re about to pee their pants.

This is all upsetting. A plump, red-cheeked young doctor, sort of a young German teddy bear, asks me for information on my HIV viral load, my doctors, everything – I give it all to him, fax numbers, whatever I can. I am anxious, and say so: at one point I tell the Chefarzt himself, I’m very, very sorry – he simply raises his hand and says: this is not your fault, this is our job and our responsibility, don’t worry about it. And it is clear that he means it.

Of course, one must imagine: this bluff, strong man, retiring in six weeks – a moment of clumsiness in surgery: is one reason for his retirement that he no longer feels quite sure of his hands? How awful, then, that they should betray him in a moment, that they might betray his own health, his own immune system….

That day, a fax is received from England with my most recent test results; everyone is reassured that my HIV viral load is undetectable (as it has been for several years); I’d told them this, but of course doctors are always happier with information that comes in directly and officially from their own kind. Just to make sure, they send my blood to Heidelberg for testing… the next day the results are back (speedy service for a Chefarzt), and there is indeed no detectable virus.

So the Chefarzt is happy, he won’t have to do any kind of prophylaxis. Of course my HCV viral load is not low at all – but there’s no prophylaxis for that, and in any case HCV infection is exasperatingly mysterious. He seems unworried – and more than that: he seems pleased with me, that I made such a fuss about it – and this will have some very positive repercussions: because although I have not paid for a single room, I notice in the ensuing days, the ten days I will still be kept here, that I am practically always alone in a nice room.

The advantages of being a Herr Doktor Professor: and a favorite of the Chief’s….