he is not old.
He’s lean—hard-muscled—works out three times a week at a fitness center in Hopewell. He hasn’t smoked in thirty years and he eats carefully, and drinks sparingly—until two or three years ago he’d risen at 7 A.M. each morning, in all vicissitudes of weather, to run—jog—along country roads near our house for forty minutes to an hour. (While I lay in bed too exhausted in the aftermath of turbulent dreams—or, it may have been, simply too lazy—to get up and accompany him.)
How nice the nurses are, in Telemetry! At least, those we’ve met.
An older nurse named Shannon explains carefully to me, as she has explained to Ray: it’s very important that he breathe through the oxygen mask—through his nose—and not through his mouth, in order to inhale pure oxygen. When Ray does this the numerals in the monitoring gauge rise immediately.
There is the possibility—the promise—that the patient holds his own fate in his hands. In his lungs.
Once we’re alone Ray tells me that he feels “much better.” He’s sure he will be discharged from the hospital in a few days. He asks me to bring work for him in the morning—he doesn’t want to “fall behind.”
An anxiety about falling behind. An anxiety about losing control, losing one’s place, losing one’s life. Always at the periphery of our vision these icy-blue flames shimmer, beaten back by our resolute American sunniness. Yes I am in control, yes I will take care of it. Yes I am equal to it—whatever it is.
Ray clasps my hand tight. Ray’s fingers are surprisingly cool for a man said to be running a fever. How like my protective husband, at such a crucial time to wish to comfort me.
A young Indian doctor comes into the room, introduces himself with a brisk handshake—he’s an ID man—“infectious disease”—he tells us that a culture has been taken from my husband’s right lung—it’s being tested to determine the exact strain of bacteria that has infected the lung—as soon as they identify the bacteria they will be able to fight the infection more effectively.
In a warm rapid liquidy voice Dr. I_ speaks to us. Formally he addresses us as Mr. Smith, Mrs. Smith. Some of what he says I comprehend, and some of it I don’t comprehend. I am so grateful for Dr. I_’s very existence, I could kiss his hand. I think Here is a man who knows! Here is an expert.
But is the Widow-to-Be misguided? Is her faith in this stranger in a white coat who walks into her husband’s hospital room misplaced? Would there have been another, happier ending to this story, if she had transferred her husband from the provincial New Jersey medical center to a hospital in Manhattan, or Philadelphia? If she’d been less credulous? More skeptical?
As if she too has been invaded—infected—by a swarm of lethal bacteria riotously breeding not in her lungs but in that part of her brain in which rational thought is said to reside.
February 12, 2008.
To Richard Ford
At this moment, Ray is recovering from a nasty cold that morphed into pneumonia without our somehow noticing . . .
Much love to both,
Joyce
To Leigh Bienen
Ray is recovering—slowly—from a severe pneumonia that began as a bad cold . . .
Much love to both,
Joyce
February 14, 2008.
To Gloria Vanderbilt
Ray’s condition improves—worsens—improves—worsens—I have almost given up having responses to it. But the doctors say that over all he is definitely improving—it’s just that the pneumonia is so virulent, through most of one lung.
(I know little of infectious diseases, but am learning rapidly.)
Love
Joyce
February 13, 2008. The bacterial infection in Ray’s right lung has been identified: E. coli.
“E. coli! But isn’t that associated with . . .”
“Gastro-intestinal infections? Not always.”
So we learn from Dr. I_ . Again we’re astonished, naively—there is something naive about astonishment in such circumstances—for like most people we’d thought that the dread E. coli bacteria is associated exclusively with gastro-intestinal infections: sewage leaking into water supplies—fecal matter in food—insufficiently cooked food—hamburger raw at the core—contaminated lettuce, spinach—the stern admonition above sinks in restaurant restrooms Restaurant employees must wash their hands before returning to work.
But no, we were mistaken. Even as, invisibly, a colony of rapacious E. coli bacteria is struggling to prevail in Ray’s right lung with the intention of swarming into his left lung and from there into his bloodstream to claim him, their warm-breathing host, totally—as totally as a predator-beast like a lion, an alligator, would wish to devour him—so we are learning, we are being forced to learn, that many—most?—of our assumptions about medical issues are inadequate, like the notions of children.
It’s liquidy-voiced Dr. I_—or another of Dr. I_’s white-coated colleagues—(for in his scant six days in the Telemetry Unit of the Princeton Medical Center Ray will be examined or at least looked at by a considerable number of specialists as itemized by the hospital bill his widow will receive weeks later)—who explain to us that E. coli infections, far from being limited to the stomach, can also occur in the urinary tract and in the lungs. Escherichia coli are found everywhere, the doctor tells us—in the environment, in water—“In the interior of your mouth.”
Most of the time—we’re assured—our immune systems fight these invasions. But sometimes . . .
Patients with E. coli pneumonia usually present with fever, shortness of breath, increased respiratory rate, increased respiratory secretions, and “crackles” upon auscultation.
(Why do medical people say “present” in this context? Do you find it as annoying as I do? As if one “presents” symptoms in some sort of garish exhibition—Patient Ray Smith presents fever, shortness of breath, increased respiratory rate . . .)
Now the exact strain of bacteria has been identified, a more precise antibiotic is being used, mixed with IV fluids dripping into Ray’s arm. This is a relief! This is good news. Impossible not to think of the antibiotic treatment as a kind of war—warfare—as in a medieval allegory of Good and Evil: our side is “good” and the other side is “evil.” Impossible not to think of the current war—wars—our country is waging in Iraq and Afghanistan in these crude theological terms.
As Spinoza observed All creatures yearn to persist in their being.
In nature there is no “good”—no “evil.” Only just life warring against life. Life consuming life. But human life, we want to believe, is more valuable than other forms of life—certainly, such primitive life-forms as bacteria.
Exhausted from my vigil—this vigil that has hardly begun!—I slip into a kind of waking sleep at Ray’s bedside as he dozes fitfully inside the oxygen mask and in my dream there are no recognizable figures only just primitive bacterial forms, a feverish swilling and rushing, a sensation of menace, unease—those hallucinatory patterns of wriggling light obscuring vision that are said to be symptomatic of migraine, though I’ve never had migraine headaches. My mouth has gone dry, sour. My mouth feels like the interior of a stranger’s mouth and is loathsome to me. The jeering thought comes to me You must have been infected too. But you have been spared this time.
Waking I’m not sure at first where I am. The sensation of unease has followed me. And there in the