The Best American Essays 2011 Read online

  My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

  On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue memorial light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

  After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes, and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

  A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was eighty-four, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors—perhaps with the exception of Fales—as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious—our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts—had been lost.

  The surgeon was forthright: without open-heart surgery, there was a fifty-fifty chance my mother would die within two years. If she survived the operation, she would probably live to be ninety. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said—a little weakness on one side?

  I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

  The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

  She spent the spring and summer arranging house repairs, thinning out my father’s bookcases, and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

  Last August, she had a heart attack and returned home under the care of hospice. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California—almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

  A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for forty-five of their sixty-one years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

  Auscultation

  Steven Church

  FROM The Pedestrian

  Chamber 1

  IN AUGUST 2007 we all waited to hear news of six miners trapped 1,500 feet underground by a massive cave-in at the Crandall Canyon coal mine in Utah, a catastrophic collapse so intense that it registered as a 3.9 magnitude earthquake on seismographs. As rescuers began the arduous three-day process of digging the men out, they also erected seismic listening devices on the surface and set off three dynamite charges, a signal to any surviving miners to make noise. Lots of noise. The electronic ears listened for the sound of hammers pounding on the rock and on roof bolts, the telltale rap-and-thump of human life. We listened and listened but never heard a thing.

  Six miners missing. Six boreholes drilled into different areas of the mine. They sent oxygen sensors, cameras, and microphones down through PVC pipe, fishing in each hole, searching every possible area for the men. Oxygen levels were misread, confused, and ultimately determined to be dangerously low. Three rescue workers trying to dig the trapped miners out were also killed when a wall of the mine “exploded,” crushing them. We never saw or heard any sign of the miners, and all six men were considered missing and presumed dead. All rescue efforts were eventually abandoned. I don’t know if there is a signal for this, another series of blasts to say goodbye, or some other ceremonial end to the search. Maybe they just switch off the drills and unplug their ears.

  The owner of the mine, Bob Murray, held a press conference and said, “Had I known that this evil mountain, this alive mountain, would do what it did, I would never have sent the miners in here. I’ll never go near that mountain again.”

  Finally a seventh hole was bored into the mountain, and through this hole they pumped thousands of gallons of mud and debris, filling all remaining cavities and sealing the tomb off permanently with the missing miners still inside.

  Researchers today at Utah State University are working to create more effective listening and noisemaking devices to help trapped miners—some of them seemingly crude and simplistic, yet still effective. One plan calls for four-by-four-inch iron plates to be placed at regular intervals in the tunnels, with sledgehammers kept nearby—the idea being that a trapped miner can find his way to a station and slam the hammer into the iron plate over and over again. Think of the noise below. Think of your ears. Geophones on the surface—the kind of sensors they use to anticipate earthquakes—would register the sound waves created by the hammer pings and create a listening grid, a kind of sound map of the mine, which they would then use to pinpoint the exact location of any miners still kicking below the rugged skin.

  Chamber 2

  Recall the ice-cold press of the metal disk against your cavity, the sting and soft burn as it warms on your clavicle, your breastbone, fingers moving metal across your naked chest, around behind, fingertips stepping down your spine, one hand on your hip, maybe your shoulder, the other sliding around your rib cage, always, always with the whispered command Breathe . . . breathe . . . good, and the eyes staring not at you but at the cold diaphragm, the metallic spot on your body, listening as if your body possesses a voice of its own and speaks in a language only others understand. The diaphragm will only broadcast its secret to the touch. It knows you. And when it touches you, it sings s
ounds of your body, noises you can barely imagine—the hypnotic pump of organs, the soft ebb and flow of blood in your veins, and the breathy whisper of lungs at work—noises that can name you normal, healthy, or not. The intimate instrument—the stethoscope—knows your body in a way your own hands and ears never can.

  Chamber 3

  Some heart doctors train their ears on classical music—Mozart and Bach and Chopin—learning to discern the individual instruments: to hear baritone from trombone, trumpet from sax, and the tum-tum of kettle over bongo or bass. They learn to listen for the flaws and failings of the heart, to recognize the music of machinelike muscle efficiency, and to understand when a noise is a bad noise. They depend on the stethoscope for more than diagnoses. They need it to be whole. Nothing promises doctor like a stethoscope draped around an exposed neck or curled over a pressed, collared shirt, perhaps tucked neatly into the pocket of a white lab coat, or clutched firmly in hand, authoritatively like a craftsman’s hammer, a plumber’s seat wrench, or a surgeon’s scalpel—the only tool for a specific job. You are familiar with the flexible latex tubing, the chrome-plated ear tubes, the hard metal diaphragm—cold, round, smooth as pearl, reflective as a mirror. The stethoscope immediately identifies a doctor—an icon of care and pain management, a reliquary of body knowledge, someone you trust with your life. Think of the things you’ve allowed another person to do and say to you, mainly because he wore the uniform of doctor and carried a stethoscope. We don’t check resumés or credentials, don’t ask for service reviews or certificates. We expect and accept the object. Even if it’s never used (but it’s always used), its appearance conjures a sense memory of that repeated sweet burn when pressed to your flesh. Regardless of physical context or attire (say at a crowded beach, in a subway, or on a mountain trail), the stethoscope speaks. It says, “I am a doctor,” and in so doing it grants rights and responsibilities, obligations and expectations. It tells us you will do no harm. It tells us you know what you are talking about. Every child’s doctor play-set comes with a plastic stethoscope, because you can’t dress up as a doctor without one.

  As object, it functions as both necessary and sufficient condition of “doctorness.” But this identity and image—of the doctor as listener, as diviner of significant sounds through a stethoscope, the magician of auscultation—is a relatively new one, just over 150 years old. The French doctor René Laennec is credited by many for inventing the first stethoscope, or at least for introducing the diagnostic practice of auscultation. In a paper published in 1819, he says:

  I was consulted by a young woman with symptoms of a diseased heart . . . percussion was of little avail on account . . . of fatness. The application of the ear . . . inadmissible by the age and sex of the patient. I recollected a fact in acoustics . . . the augmented sound conveyed through solid bodies . . . I rolled a quire of paper into a cylinder and applied one end to the heart and one end to the ear . . . and thereby perceived the action of the heart . . . more clear and distinct. I have been enabled to discover new signs of the diseases of the lungs, heart and pleura.

  It wasn’t until the 1851 invention by Arthur Leared, and the refinement in 1852 by George Cammann, of the binaural stethoscope—a simple but incredibly significant instrument—that the practice of refined auscultation began to develop and doctors could listen in stereo to the sounds of the body. Before that it was a crude monaural amplifying horn, Laennec’s ear trumpet, which offered little more than a distant thump against the rib cage. Without binaural stethoscope technology, auscultation was more like listening for trees falling in a distant forest or miners tapping faintly in a deep pit. But doctors still pressed ears to chest cavities and listened for the pings, trying to read the heart’s noises and tremors. L. A. Conner (1866–1950), the founder of the American Heart Association, is said to have carried a silk handkerchief to place on the wall of the chest for ear auscultation.

  For one hundred years cardiologists relied on Cammann’s binaural scope to detect the slightest abnormality, arrhythmia, skip, hop, hammer, block, or stutter. Nineteen fifty-two and 1964 saw further refinements of the traditional binaural stethoscope, with many cardiologists believing that the now all-but-obsolete Rapport-Sprague was the finest auscultation device ever made or used, allowing them unprecedented clarity and consistency.

  Current research is focused on developing a reliable electronic amplified stethoscope, which is not actually a listening device but a noise translator that generates a reproduction of the heartbeat, bullying the human ear out of its place as the direct register of the heart.

  I first heard the whoosh-whoosh of my daughter’s heart as reproduction, as an electronic transmission through a fetal heart monitor strapped to my wife’s belly—an electronic stethoscope. The sound is less a thump than a slosh. More valve and flap than muscled push. But it is still a treasured sound. For most of our prenatal visits, medical intervention extended only as far as placement of the fetal heart monitor. The first thing we did—doctor and parents—was listen. All together. We awaited the news of life. And anyone who’s been in this place understands the simple comfort of that sound, the reassurance of that noise—or, more directly, the doctor’s recognition that this is normal noise.

  A baby’s heartbeat is the first sensory experience a father has with his child, often the first moment that a father begins to think of the fetus as a child. A baby: body and brain and lungs and drumming heart. An identity: the first hint of possibility filtered through an electronic translator, reproduced from a tiny speaker. Nothing promises person like these first heart sounds. Nothing says It begins like the wish-wish-wish noise of the stubborn pump—and I say this with both knowledge and ignorance of the ethical implications for some.

  Perhaps because of facts, stats, opinions, and ideas—or perhaps because I had no other way to feel my wife’s pregnancy—fatherhood was mostly an abstraction. I never really began to feel like a baby’s father until I heard the thumping inside, that telltale tapping. Or perhaps my son was not a son, my daughter not a daughter, at least in part, until their first heart noises registered in my ear—a formation of identity that wasn’t even possible when my grandfather was born, in 1906, or my father, in 1945, and was still only a rough science when I was born, in 1971. But I know that in many ways I did not identify myself as a father until I heard my child’s heart, and that I couldn’t have heard this without the aid of a stethoscope. Most of us identify a doctor by the stethoscope, that intimate disk. But it also identifies parent and child. All three fledgling identities intertwine in that examination room, hopelessly dependent on the curl and twisting turns of simple listening technology, the only tool for the vital job of reading and feeling the rhythmic thumps of the heart, that tap-tap-tap signal of life we cannot see and I can in no other way sense.

  Chamber 4

  The year is 2002, and nine coal miners are trapped in the Quecreek Mine in Pennsylvania by rising water released after a drilling machine punches through a wall into an underground spring. The nine men—a father and son among the crew—retreat to the highest spot in the mine and rope themselves together. They listen for the signal from the surface—three small explosions—but don’t hear anything. They start pounding on the roof bolts with their hammers, hoping to make some noise the surface can recognize. They pound and pound, but background noise on the surface interferes, and the seismic listening devices can’t hear them. The men write notes to family members, seal them in a metal lunch box, and wait to die. As rescuers work frantically to pull water from the mine with massive diesel-powered pumps, they also drill down from the surface to pump oxygen into the cave where the rescuers hope the men have retreated. If the miners are alive, they can only be in one place, all of them protected by a small womb of air against the rising flood. The miners continue pounding on the roof bolts, but they get no response. The miners’ families gather on the surface, huddled in a tent around the drill operator—because perhaps he is more than an operator and more than muscle: he’s more like the
human side of the machine, the listening side, the man with the touch, who watches the spin of metal, waiting. When the drill finally reaches the lightless room, 240 feet down, and punches like an amnio needle into the pocket, the drill operator shuts off the machine, quiets the crowd, and listens. I wonder what it was that he listened for. How faint? How rhythmic? He listens, his hands on the machine, until he finally hears or feels the rhythmic noise of the trapped men hammering at the steel—the sole musical evidence of survival. Above them, on the outside, the expectant wives and mothers rejoice. They hug the man at the drill and slap each other on the back and think of how they can’t wait to see and touch and smell their babies again.

  After the Ice

  Paul Crenshaw

  FROM Southern Humanities Review

  WHEN I WAS SEVENTEEN an ice storm moved through my hometown in Arkansas and coated the roads and trees with a thin layer of ice. I remember the ice only because later that morning I would receive a phone call that my nephew Keith was in the hospital. There were few details, just that he was hurt in some way and it looked serious, and driving there, the day was so bright it hurt the muscles behind my eyes. Ice covered the fields where cows searched for grass, their breath fanning the air before them. On top of telephone poles hawks sat waiting, sharp eyes scanning the fields for movement. The few drivers on the road drove slowly, fearing the ice, though by that time it was melting, and small streams ran across the road, the water turned brown and dirty from the salt and cinders the county road crews had dumped the night before.