Massachusetts General Hospital
I’ll never forget the nanosecond when my life changed forever. I fell flat on my back and instantaneously I was like a turtle some malicious child had upended. Hands kept slapping me in the face. I couldn’t tell who they belonged to. Thank goodness Nancy was at home. Otherwise I might have died. Maybe that would be for the best, I thought to myself, grateful that my mind hadn’t suffered.
Nancy heard me cry out. She came running. She saw me floundering at the foot of the stairs where I had fallen in a disastrous attempt to exercise.
It was a catastrophic moment. I was 78 years old. I had been married for 14 years to a woman who could not have made me happier. It was a second marriage. I was fond of telling my friends that I never ever suspected that the endgame would be the best game. My Jewish pessimism had told me that things always got worse—and in the blink of an eye, I discovered that God had been leading me down a garden path.
“Don’t panic! Don’t panic!” Nancy said in a panicked tone of voice. She frantically dialed 911.
In a matter of moments, I heard a siren come to a high-pitched halt outside our house. Six black-clothed, heavy-booted first responders came stampeding up the stairs. The one in charge leaned over me. His face hovered above mine like a harvest moon.
“Can you hear me?” he bellowed.
“Yes,” I said.
“Good! Don’t move a muscle,” he commanded.
He said something to his partner. She disappeared and returned with what looked like a large valise. I heard it click open; then some clanging of metal parts against one another. The next thing I knew my head was being screwed in place with something that felt like a vice. Nancy said the contraption made me look like Frankenstein’s monster.
Nancy knew the custom was to take the victim to the nearest hospital. That would be Mount Auburn or Cambridge Hospital. Neither had the kind of spinal cord injury facilities that Massachusetts General Hospital had. She called MIT Medical and asked how she could convince the driver to take me to MGH. The person on the other end of the line said, “Just keep repeating MGH over and over like a mantra.”
As it turned out, it wasn’t a problem.
“Where do you want us to take him?” the driver asked.
“MGH,” she shot back.
“Good choice,” he replied.
They placed me on a stretcher. Although I could feel my body tipping from side to side as they navigated the landing and down the stairs, my head remained absolutely fixed. It was April 26, 2014. I was surprised at how cold the outside air felt. I heard the back of an ambulance open. The stretcher slid inside. Someone got in with me. Someone else slammed the doors shut. The ambulance started to move. I listened for the siren. I couldn’t hear it. All I could hear were noises from a game someone was playing on a cell phone. I remember staring at the ceiling wondering why the lights were so bright.
Such small thoughts for so large an event. I couldn’t focus on the big picture – that is, that I might be dying and that these were my very last moments on earth, that I might never see Nancy or my children again. I concentrated on the ambulance’s suspension. The vehicle dipped and rocked at every pothole. I thought about the suspension on hearses. They were surely better than this. How odd that a vehicle carrying the living was badly sprung while a vehicle carrying the dead was not.
The ambulance coasted to a stop at the MGH emergency entrance. The rear doors flew open. The stretcher was pulled out. Its long spindly legs unfolded themselves and I was wheeled through swinging doors into the hospital proper. It had been cold in the ambulance. Now I could feel the warmth of the building. The acoustic-paneled ceiling unrolled above me.
I arrived at a brightly lit cubicle. Out of the corner of my eye I could see a doctor. I think his name was Liu. He told me he was a spinal cord injury doctor. He used the initials SCI. I didn’t know what they stood for. I couldn’t work it out. I was preoccupied with the wish that someone would put a bullet in my head. Someone broke through the pain. It was another doctor. He was asking me a question.
“If you have a heart attack,” he said, “do you want us to try to resuscitate you?”
Why is he picking now to ask such a question? I doubt I could answer it even if I were in my own home sipping a vodka martini.
“If you get pneumonia,” he pressed on, “do you want us to intubate you?”
I couldn't answer that one either. I didn't know what it meant.
Then it dawned on me. While I’m still alive, he wants to know how I want to die. I’m sure my questioner had his reasons. After all, if it turned out that I lived but couldn’t answer questions, then Nancy would be stuck with a vegetable. Even so I couldn’t say a lot for his timing. I have no recollection of what happened next.
I woke up the following day in an intensive care unit wearing a collar that made me look like an Ndebele tribesman, the ones with rings around their necks.
There was a young man standing in the room. He was dressed as if it were casual Friday—slacks, shirt, V-neck sweater, no identification. Nancy was in the room with us. He introduced himself as Kris Kahle.
“You’re the neurosurgeon everyone genuflects to?!” Nancy asked in a surprised tone of voice.
“How old are you?” I asked.
“Thirty-seven,” he said, smiling.
“Are you sure you’re up to this?” I asked.
Kris ignored the question. He told us my MGH team was debating whether to operate tomorrow or wait a few days in order to let things settle in to see what else might turn up. He was in favor of operating the next day, but his colleagues had convinced him to wait. So I was to go under the knife, as they say, in two days.
I spent 13 hours in the operating room. Divided into two operations weeks apart, the first lasted 9.5 hours, the second 3.5. It seems that for a very long time my spinal column had been abnormally narrowing. The ligaments connecting the cervical vertebrae in my neck were slowly turning to bone. The condition is called DISH (diffuse idiopathic skeletal hypertrophy) or Forestier’s disease, essentially a kind of degenerative arthritis. No one seems to know the exact cause. There is no cure and my condition is still ongoing. One doctor told me that the only way to insure a non-recurrence is to be sure to die before I’m 105 years old.
A normal spinal column is about 15mm in diameter. Mine was shrunk to half the diameter, about 7 or 8mm. To make matters worse, my spinal column is riddled with bone spurs. When I took the fall, the bone spurs at the top of the column hammered my cord like tiny mallets.
One doctor’s report put it this way:
Patient has diffuse idiopathic spinal hypertrophy/DISH, leading to cervical stenosis, or narrowing of the cervical spinal column. Due to this, there was no room for the cord to move. This combined with minimal shock absorption from the CSF [cerebrospinal fluid] led to a cervical spinal cord injury.
Or as Kris Kahle put it, mine was “the crappiest spinal column” he had ever seen.
The first operation involved exposing my spinal column from the base of my skull to about the middle of my shoulder blades. The surgeons shaved away as much as they could of the excess bone that had barnacled it. The laminectomy relieved pressure on my spinal cord. When they finished, they installed two rods to shore up what they had scaled down. During the operation they had thought about turning me on my back and going through my throat to expose the front of my spinal column. Then they could shave off even more detritus. They thought better of it. Thank heaven for small mercies. There is something as ghoulish as it is miraculous about surgical medicine.
The second operation, the 3.5-hour one, was the result of the first operation. A surgical infection had set in. A significant portion of the area around my incision had turned spongy. They needed to go in and cut it out. A complication ensued, the loss of cerebrospinal fluid. The surgeons discovered a tear in the membrane that separates the skull from the brain. Had this gone on undetected, my brain would have sunk inside my head, and while it would not have been fatal, it ought to be. It would cause incredible headaches. The virtuosi who were operating on me were faced with a problem. The tear was located close to a bone. This meant that it was going to be very difficult to mend it with sutures. Kris and his colleagues decided to cover the tear with muscle fiber held in place with glue. That raised yet another problem. The plastic surgeons, the ones who tidy things up after the operation, were in favor of a completely different procedure. They wanted to leave the tear un-mended and, instead, insert something called a vac sponge into the spinal column at the site of the tear.
A debate ensued. The neurosurgeons were insistent. The plastic surgeons were insistent. Chief neurosurgeon Kahle asked to be excused. He went to the nearest telephone and called every neurosurgeon in the hospital. He polled them. To a man/woman, they voted unanimously to nix the vac sponge. Kris went back into the operating room. He politely reported his findings and said that, while he respected their opinion, he had to decline the direction in which the plastic surgeons wanted to take my spine. That is what he said. I suspect this is what he was thinking: Why don’t you do your job and let me do mine?
By turning a medical decision into a democratic one, Kris managed not only to go the way he wanted to, but to do so in a way that relieved the plastic surgeons of responsibility for the decision. But then he was a very unusual surgeon.
The first time I met Kris, he quickly disposed of what happened to me and went on to talk about literature. He told me that while he was getting a doctorate in genetics at Yale, he read all of Marcel Proust. He wanted to know what I thought of Remembrance of Things Past. I told him that there were three great works of literature that everyone should read. The first was Don Quixote; the second was War and Peace; the third was Things Past. Then I told him that the greater the work of art, the easier it is to state its theme. The theme of Don Quixote is “to enjoy life to the fullest, you have to be crazy.” The theme of War and Peace is “one cannot control events.”
“And the theme,” he interrupted me, “of Things Past is ‘ life is memory.’”
It was our discussion of literature rather than any medical credentials that made me have complete confidence in him.
I spent most of my days at Mass General in a drugged stupor. On one occasion when Nancy came to visit, I was slumped in a wheelchair with my mouth open and my tongue lolling to one side. She told me I looked as if I had had a stroke.
“What have you done to my husband?” she cried.
The nurse had only that morning been assigned to my case. She had no idea what Nancy was talking about.
Just then the hospital’s director of physical medicine and rehabilitation, Ron Hirschberg, walked in. He looked at the nurse and asked, “What’s happened to Jay?”
Then he leaned over me, and shaking my shoulder, he shouted, “Jay, are you in there?”
Apparently I jerked my head up, opened my eyes for a moment, and gurgled. Ron punched his cell phone and called the medication doctor on duty. “There’s got to be another way to deal with pain,” he implored.
The doctor canceled all narcotic orders. The pain worsened, but at least I didn’t look like death warmed over.
While I was at MGH, I was for all intents and purposes paralyzed. I couldn’t feed myself and for a time I could not eat. I had to be force-fed with a tube that went up into my nose and down into my esophagus. My bladder wasn’t working. I had to be catheterized every six hours. As for my bowels, well, my bed was my toilet. I had to be rolled over onto my side to be cleaned up.
When Christina, one of my physical therapists, came to help me move my arms, she had to lift them up off the bed. I couldn’t overcome the force of gravity. When one arm was a foot off the bed, she would gently move it back and forth encouraging me to take over as much of the effort as I could. Once, while she was floating my arm in this fashion, she stared at me expectantly. Apparently, my eyes had taken on the look that said I was about to speak. Instead, I started singing.
Row, row, row your boat
Gently down the stream.
Merrily, merrily, merrily, merrily,
Life is but a dream.
It made her laugh. That was the first time I had sung anything since my accident. I remember being surprised. My voice was thin and reedy, but I was on key.
There is a portrait of me, a photograph taken by the husband of a friend. His name is Carlos. In it I am wearing a checkered green sport jacket, a lavender shirt and a bow tie. I’m holding a trombone to my lips. Even though I’m actually playing the horn, my eyes and my mouth are crinkled into a smile. The photograph was propped up against the wall in the ICU unit. Nancy had put it there to show my caregivers who I used to be and to remind me of the same.
I had been on the faculty of MIT from 1977 to 1985 as Head of the Department of Linguistics and Philosophy. After that I was associate provost for educational policy and programs. As a professional linguist, I published close to a hundred articles and co-wrote or edited a half-dozen books. I was and continue to be editor-in-chief of Linguistic Inquiry, a major theoretical journal in the field, and a monograph series associated with the journal.
I was also a jazz musician. I played in the New Liberty Jazz Band, a Dixieland band that performed in parades on a 1941 Ford fire truck that had been lovingly restored by the cornet and banjo players. There were other bands including the Aardvark Jazz Orchestra, the oldest continuous jazz ensemble in the country. The orchestra was 41 years old when I had my accident. I was supposed to play a concert at MIT the night of the day I fell. I didn’t think that I would ever get back to it. My arms were useless. There was no movement in my legs or my feet. I couldn’t even wiggle a toe. I’d lost 25% of my lung capacity. But then I did sing Row, Row, Row Your Boat on key.
The truth of the matter is that I had no idea how dire my condition was. Nancy, who had kept copious notes, told me later about the operations in great detail. She told me how my caregivers did not expect a 78-year-old man to survive the bacterial onslaught I suffered after the first operation.
But most of all she told me about the pain that I was constantly battling. It was her account of the pain that surprised me the most. I could remember being wheeled into the emergency room at MGH. I could remember being wheeled into an operating room twice. I could remember talking to Kris Kahle, my surgeon, about what he had done. But I couldn’t for the life of me recall the pain.
While I was a patient in MGH, I toggled back and forth between an ICU and a regular ward depending on the state of my various infections. In fact, I spent 23 of my 33 days in intensive care. No matter where I was, a team of doctors would file into my room and ask me three questions: what is my name, where am I, and what is today’s date? They always brought to mind Gauguin’s famous painting at Boston’s Museum of Fine Arts:
D'où Venons Nous
‘Where do we come from?’
Que Sommes Nous
‘What are we?
Où Allons Nous
‘Where are we going?
There was a good reason behind what I wrongly took to be their foolish consistency. If I answered any of these questions inappropriately, that could well be an indication that an air bubble had formed at the top of my skull, preventing me from thinking clearly. This was a dangerous thing. The bubble could press into my brain and cause irreparable damage. Twice they were prompted to order an MRI to see if an air bubble had indeed formed.
The first time they called for a portable MRI. This was a much smaller machine than those huge round tunnel affairs that the patient is slipped into and out of on a moving belt. This one came on a cart. It had three movable square plates that fit snugly around the top and sides of the head. I assumed they were photographic plate holders. They would have to be in just the right position. That, of course, required a highly skilled technician.
I was wheeled into a bare room and waited for the highly skilled technician. He came in with his cart and proceeded to box my head with the holders. For some reason he couldn’t get it right. Unfortunately, he was dead set on getting it right. So much so that he forgot there was a human being inside the head. I don’t recall the pain. But I do recall what happened next. From the corner of the room a nurse cried out, “Can’t you see you are hurting him? For God’s sake, stop it!”
It was as if he suddenly realized that I was not a mannequin in a training session. He stopped. I was wheeled to the regular MRI room, transferred from the gurney onto the belt that protruded from the MRI tube and drawn into the machine like a fly into a frog’s mouth. The process was over in a few minutes and there was not even an echo of pain. Odd that I could remember the absence of pain but not its presence.
The second time they were worried about an air bubble, they again called for a portable MRI. I was wheeled into the same bare room. When I expressed concern because of what happened last time, I was told that the technician was the best MGH had to offer. The door opened. The technician came in. It was the same guy. This time he got it right. Apparently the nurse’s intervention had made an impression. The event passed uneventfully.
My post-operative days at MGH were spent coming in and out of oxycodone, Valium, and morphine IV drip dreams. My memory of those days consists of snippets, as if the continuum of my life were a filmstrip and someone using scissors had cut out random pictures and pinned them to a corkboard. One was of a nurse saying that she was going home to help her son study The Odyssey.
“Tell him the Odyssey is a frame story,” I said, momentarily lucid. “It’s framed by Telemachus’ sailing out to find his father and then sailing back. The Odyssey happens in between.”
Perhaps it was the literary reference that brought me out of it.
Then I fell back into the place where most of my utterances were non-sequiturs. During one five-minute period Nancy made a list:
“It’s computationally complex.”
“Never know when they are coming or going.”
“Thank you, Peter. I could never have made it home without you.”
“My friend is a doctor.”
“Don’t sell the stock. That man can’t be trusted.”
Nancy thought that if I ever got out of this, I would find these interesting. None made sense to me except the very last one—”Don’t sell the stock.”
We don’t own stock, but I realized immediately where it had come from. The last time I ever saw my father alive, he was in an ICU in George Washington University Hospital in Washington DC. That was in 1972. I had to return to Massachusetts. I didn’t think he was about to die. Just before I left, he said to me, “Don’t let your mother take paper on the house.” Those were the very last words he ever said to me. In my drug-induced stupor, I had become my father and Nancy had become me. What an insane potpourri the brain can turn into.
I recall one last snippet. Every evening around 10 or 11 PM someone would come into my room to clean it. This meant emptying containers of trash collected during the day when the patient could not, among other things, take care of his bodily needs. The person who came into my room was a short, stocky woman with decidedly Aztec features and the solidity of a fireplug.
“¿Hablas español?” I asked.
“Sí, señor,” she answered.
“¿Podemos hablar español?” I asked and then by way of explanation, “Me gustaría practicarlo.”
From then on whenever she came in and I was awake, we would say a few words to one another in Spanish. She explained to me that she would like to get a job as a translator somewhere. I mentioned this to the troop of doctors who came into my room each morning. I doubt it helped.
One night she came to my room to collect that day’s debris. We exchanged a few words in Spanish. She was about to leave when a thought struck her. She turned to me and said that she was a practitioner of Reiki, a laying-on-of-hands therapy developed in Japan in 1922 by Mikao Usui, a Japanese Buddhist. She said it was a healing therapy. She offered me a session. She said she would not touch me.
She came within a few feet of my bedside and proceeded to limn a series of figures in the air. Sometimes she would seem to be writing in the palm of her hand and sometimes on an invisible slate hanging in front of her eyes. In the dim light of my room with a sack at her feet she was like a troll come to wrap me and spirit me away. I fell asleep. When I woke up, of course she was gone. In fact, I never saw her again. I wonder if I ever saw her.
After the first operation, a team of doctors streamed into my room every morning. They included members of the neurosurgical team, the plastic surgery team, and various and sundry hospital residents, students, and fellows. They would wake me from my sleep to determine how well I was doing or not doing. It was comforting to see them all there gazing down at me intent on my well-being.
Not all my visitors were so welcome. One day a doctor I didn’t know came into the room, introduced himself and, without preamble, told me that while the operation was a success, I would never walk again.
“Fuck you,” I said to myself. To him, I said, “I’m sorry to hear that.”
“I know it isn’t what you want to hear,” he said in a consoling way. “But it’s best to be realistic in situations like yours.”
I never understood why he felt the need to be “realistic.” Perhaps it was his way of defending himself from becoming too close to a patient. I learned later that the nurse on duty had overheard the conversation and had given him hell when he left the room. Much later in my hospital stay, he exchanged his severe demeanor for one with an engaging smile. I wonder if the nurse’s dressing down had changed him. I wonder if that’s how doctors are socialized on the job.
I left MGH 33 days after I had arrived. I had contracted three serious bacterial infections: a cerebrospinal fluid infection as a result of the operation, a urinary tract infection as a result of constant catheterization, and finally C. diff, an intestinal infection that is the bugaboo of hospitals because it spreads so easily. The first two were treated at MGH. The last one, C. diff, didn’t present itself until after I left.
Kris Kahle gave me a copy of Samuel Beckett’s essay on Proust as a goodbye present. I was wheeled on a gurney to the hospital’s loading dock and transferred to an ambulance that was waiting to take me to a six-week stay at Spaulding Rehabilitation Hospital in Charlestown.
“Aren’t you the driver who brought me here a month ago?” I was astounded at the coincidence.
I won’t ever forget the face that hung over me like a harvest moon yelling, “Don’t move a muscle.”
“How are you doing?” he asked.
“Pretty well, considering,” I said. “These guys saved my life.”
“No, they didn’t,” he objected. “We did.”
“When I saw you lying on the floor,” he explained, “I could tell you had suffered a spinal cord injury. If we hadn’t put your head in a vise, you wouldn’t be here now.”
He was right, of course. Had my head and spine not been frozen in place, those potholes in route to MGH would have chopped my spine into coleslaw. It takes a village. In retrospect it strikes me as odd that the villagers who saved my life—the surgeons and the first responders, the nurses and the therapists—have never met one another.