Hospital (24 page)

At age forty-nine, when Alan was sixteen, Martin Astrow became sick with Parkinson’s disease. It seemed impossible. He was a fine physical specimen.Look at the old photos of him—handsome, bare-chested in the sun, his tall, slender bride on his arm in one shot; Martin wrestling with a fish in another. Then Parkinson’s, with its terrible symptoms—the shuffling, the drooling, the muscle contractions, the gait freezing.

The son couldn’t remember his father ever complaining about the degenerative illness, the tremors and rigidity imposed on an athletic body. What might have seemed a cruel joke to someone else, a mockery of a life devoted to scientific mastery, Martin Astrow seemed to accept as biological fate. On occasion, however, there were outbursts that were at odds with his gentle nature—slapping Alan for returning a library book late, hitting him with a belt when he was mean to his brother. Ruth Astrow simply denied that these events had happened, whereas her son later attributed them to the disease. What causal links could be made between these irrational episodes, shocking at the time, and a shy boy’s attitude to authority figures, later manifested as a desire to both rebel against and please them?

Astrow recalled his father with love and a sense of frustration. He wanted to help him. One summer he worked in a Parkinson’s research lab. Though later he linked his decision to become a doctor with his father’s illness, when he entered Yale University in the fall of 1972, he declared himself a history major, not premed. He wrote for the
Yale Daily News
and studied literature. He played the clarinet. He loved theater. He was interested in politics and law. Maybe he could be a reporter. He was smart—summa cum laude, Phi Beta Kappa. He had always excelled at everything he tried, except art. The possibilities were vast.

Yet in the spring of his sophomore year, or maybe it was fall of junior year, he decided to go to medical school. He couldn’t remember when or exactly why, but he did remember where. Walking across the plaza by the Beinecke Library, he realized it was time to accept his fate. The compassionate streak that sometimes got him into trouble was his destiny after all. He wasn’t outgoing enough for politics, nor tough enough for law. He would become a doctor.

I atrogenic. Literally, “brought forth by a healer” in Greek, referring to complications or sickness resulting from misguided medical treatment. Paraphrased by George C. Scott, playing a doctor in the 1971 Paddy Chayevsky satire
The Hospital,
a movie Astrow loved:

“In short, a man comes into this hospital in perfect health,” says the doctor played by George C. Scott in disbelief, on hearing about a patient’s progress through the system. “In the space of one week, we chop out one kidney, damage another, reduce him to coma and damn near kill him.”

Did modern medicine cause more disease than it cures? Astrow didn’t really think so, but he knew that something was missing, a philosophical and spiritual dimension to taking care of patients that seemed to have become incidental. Call it healing.

At Yale School of Medicine, the students learned to draw blood on one another. At the time, his second year, Astrow had been sick, not sick enough to miss a day of school, but sick. He lost five pounds, had low-grade fevers, GI symptoms. The blood work showed he was anemic. Tests followed, and he was diagnosed with Crohn’s disease, an inflammation of the intestine. The prognosis was devastating: He could be chronically ill or need surgery. Crohn’s disease—very common among Jews—was thought to be psychosomatic, like irritable bowel, linked to worry, anxiety. Though this wasn’t accurate, the association itself was enough to provoke worry and anxiety.

The diagnosis made him angry. An iatrogenic illness. If they hadn’t drawn his blood, maybe he wouldn’t have been sick. He would have been fine. He knew that his reaction was irrational, that he was lucky, and that the doctors hadn’t caused the disease but found it. A year on sulfasalazine and the Crohn’s symptoms never reoccurred. Even so, the experience left him with an enduring skepticism about overtesting patients. He remained acutely aware of the ramifications of giving a diagnosis; the worries, frustration, and anger it could trigger; how simply articulating a disease could disrupt a life.

Ability. Affability. Availability.
Patients often don’t distinguish among these, warned an associate dean at his graduation from medical school.
Remember that.

Astrow remembered. He also remembered the angry critiques of the medical system he read as a medical student, as relief from the crush of data he had to memorize. Books like
Medical Nemesis
by Ivan Illich, the former Roman Catholic priest (whose mother was Jewish) whose fierce antiestablishmentbooks and articles grabbed the imagination of baby boomers in the 1970s and then were largely rejected or forgotten.

Much later Astrow would often reread an essay called “The Patient as a Person” by Abraham Joshua Heschel, the rabbi who wrote learned, emotional treatises on Jewish law and marched with Martin Luther King Jr. Astrow especially liked one section of the essay, originally delivered as a speech at the American Medical Association in 1963: “The truth of being human is gratitude, the secret of existence is appreciation, its significance is revealed in reciprocity. Mankind will not die for lack of information; it may perish for lack of appreciation.”

Heschel gave that lecture in an era when paternalism was the accepted relationship between doctor and patient. By the time Astrow became a doctor almost twenty years later, openness prevailed, an attitude Astrow believed in and practiced. But he found that honesty could be more treacherous than deceit. Cancer forced patients and doctors into the realm of philosophy by bringing the uncertainty of existence into sharp focus.

Another lesson from Astrow’s medical-school years: His father had been taking bromocriptine, a medication used in the treatment of menstrual and fertility problems that had been found useful in controlling Parkinson’s symptoms. Martin Astrow was under the care of the leading expert on Parkinsonism at Columbia Presbyterian, who urged hospitalization when the patient began having strong dystonic reactions to the medication— causing him to flail wildly. The doctor told him to come into the hospital to have the dose readjusted. By the time Martin arrived, he had broken into a cold sweat and was in pain so severe that the admitting doctors decided not to do an EKG. He was given a private room and assigned a fourth-year medical student to look after him.

Three days later an EKG revealed that the pain attributed to a drug-reaction muscle spasm had been a major heart attack. He survived, but with severe heart-muscle damage.

As Astrow received this immediate education about the frustration and fallibility of medical science, he also began wondering about the source of character. Why was his father able to cope with his illness with such courage?

For several years Martin continued to work, until the Parkinson’s made it too difficult for him to walk. But he didn’t despair, or at least he didn’t reveal any despairing feelings he might have had (except for those occasional displays of anger). Astrow’s mother remembered Martin’s answer to the doctor they saw at Mount Sinai, a man close to his own age at the time, about sixtyfive, who looked at her husband pityingly, as he asked his patient how he passed the time.

Martin seemed surprised by the question, his wife recalled. He had been immersed in reading the works of Einstein, contemplating modern physics. “I have plenty of things to do,” he told the doctor. “I read. I watch television. I exercise.”

When he was sixty-seven years old, on Valentine’s Day, he put all the family photographs into albums and organized the bookshelves. His wife went shopping for a new television set to replace theirs, which was broken. They were going out for dinner that night to celebrate Valentine’s Day, as they always did. While at the store, Ruth heard her name being paged. It was Martin calling to say he’d fixed the television; she didn’t need to buy a new one. That evening they went to dinner at a seafood restaurant, as planned.

Maybe the fish they ate was from the ocean, Alan Astrow speculated. A heavy salt load would explain the pulmonary edema that killed his father that night.

Martin Astrow had lived to see his son become a doctor. He had celebrated Valentine’s Day with his wife. He’d arranged the bookshelves and fixed the television. He had left his house in order.

Would he have lived longer if someone had done an EKG on him that first night at Columbia Presbyterian, a decade earlier? Undoubtedly— maybe—if he had been struck by the disease just a little later, when treatment of heart disease had progressed, much of his heart muscle might have been saved. But back then? Astrow couldn’t say.

Much of Astrow’s job would be helping people live with uncertainty, even those with an optimistic prognosis. Hopefulness was less likely to be a lie now—far less than when he had begun to practice oncology. But cancer continued to be an elusive disease. Could he ever say with certainty there would be a remission, even when it was likely for certain kinds of cancer after certain kinds of treatment? Some other disease could come into play, as it did with his father. The prospect of death was always present for everyone, but cancer made the inevitable hard to ignore. The only real variable was timing.

The more experience he acquired, the larger the questions loomed.

Where did goodness come from?

Was it possible to be truthful and kind?

Could you be kind and command respect?

Those were the things Ruth and Martin Astrow’s son thought about.

Jill Nathanson grew up without religion. Her mother was a classical musician, a pianist. Her brother Roy Nathanson became a saxophonist of some renown. Jill painted. Art was the family’s theology.

Autumn 1988: She was in her middle thirties, living in her studio on the Lower East Side, pregentrification, cooking on a hot plate, when she picked up a book called
Major Trends in Jewish Mysticism,
written by the Kabbalist scholar Gershom Scholem. She didn’t know how the book had wound up on her bookshelf. Someone may have given it to her, or maybe she’d bought it, thinking it was cool—she couldn’t remember. For years she had been trying to understand unknowable things, like the depth of suffering that led her mother to commit suicide. Attempting to make an inchoate universe more comprehensible, Nathanson had scaled down her work, from big splashy paintings to smaller pieces that made her feel better, closer to finding hopefulness in the mystery of strange, shifting colors.

Things still felt dicey. While her art comforted her, the art world seemed cynical and shallow. Her life devoted to creating art hadn’t created an orderly existence. She sought redemption in color but found she wanted more.

One day she picked up Scholem on her shelf, hoping to find an answer in the intricacies of Jewish mysticism. But to her devoutly secular eyes, the words on the page seemed just as tangled—and perhaps even more incomprehensible—than earthly existence or the depths of blue.

No help.

Not long afterward Marshall Meyer entered the picture—literally, she saw him on television—and changed her life. Meyer was a rabbi, born in Brooklyn, raised in Connecticut, who had spent years in Argentina. He became a vocal adversary of the military government that had imprisoned or killed thousands of people, known as
los desaparecidos,
“those who have disappeared.” He tried to save lives of the persecuted and visited hundreds of them in jail, including a well-known journalist, Jacobo Timerman, who later dedicated his record of torture and humiliation,
Prisoner Without a Name, Cell Without a Number,
to Meyer. In 1985 the dynamic rabbi was asked to take over B’nai Jeshuran, a Conservative synagogue on the Upper West Side of Manhattan that had shrunk to eighty families. In short order he revitalized the congregation, eventually drawing thousands of people with his message that life could have meaning, urging social responsibility across religions and borders.

Suddenly Nathanson found coordinates for her sense of urgency: the book on her shelf and the rabbi on her television. It was time for action. She went to B’nai Jeshuran one Saturday morning but stood frozen outside when she realized she had a pocketbook with her and remembered vaguely that you weren’t supposed to carry money on the Sabbath. She returned a week later and still was uncertain about how to enter. This time she saw something on a flyer that might offer a possible antidote to her ignorance. She decided to return yet again on Wednesday night, for a course called Introduction to Judaism.

That night she walked in, only to find that the class was, as she said, “extremely boring.” So much for karma. She sneaked out and was standing in the hall, about to leave, when someone beckoned her into another room. She obeyed. As she sat down, an imposing figure strode in. He was the rabbi she had seen on television, even more impressive in life, who actually fit the description “a bear of a man.” He began his lecture on Rabbi Abraham Joshua Heschel. Nathanson was again mesmerized by Meyer. This was no theoretical lecture. Meyer had been Heschel’s secretary and translator, his successor in a quest to translate learning and theory into justice and decency.

Despite the power of his rhetoric, she couldn’t stop herself from glancing around, from evaluating the aesthetics of her surroundings. “I was a decorative painter at the time—for money—and the room was very dingy. It had these crummy walls,” she said. “I found myself in an ugly room with the world’s worst sponge-painting job.” She also noticed her fellow classmates— a few elderly couples and eight youngish men who were so incredibly square-lookingthat she couldn’t believe she was sitting in this dreary room with such conventional characters. But when they began to talk, she was bowled over. “The class was fabulous, just amazing,” she said. Though her intent hadn’t been to meet a guy—at least not her acknowledged intent—suddenly she saw a roomful of very interesting, possibly single men.