On Being a Patient

by Stephen Becker

FIRST I was a wizened man of ninety-five in Washington, D.C., wearing a brown gabardine suit and a Panama hat and sitting in a warm, humid greenhouse. To step outside, or smoke a cigar, was to die; but the inactivity galled, and fear was shameful, and I stepped outside and lit a cigar.

Then I was my own age, thirty-one, in a small town in upstate New York, and there was an epidemic, and our children were dying, and we could save them only by bringing wooden objects — furniture, crates, toys — to the schoolhouse. Snow fell. Soon there were no wooden objects to be found, and our children went on dying.

Then I was a helicopter pilot, and a space pilot (this was all in January, 1959), and the manager of a theatrical troupe stranded in St. Petersburg (not Leningrad; St. Petersburg). I was the landlord of a boardinghouse on the West Coast, and my tenants were drunken, aged Bohemians, and I left because there were toads in the swimming pool, I lay on a couch in Salzburg — in the house where Mozart died — begging two beautiful women for another cup of cocoa, because the cocoa was drugged, and I needed it, and I offered them money. In Mexico we played a game with the bartender, and a blue bead curtain hung in the doorway; you won the game by smoking your cigarette, and drinking your tequila, in a mysterious and secret fashion.

A man said. “Do you remember my name?" Back in New Bedford I signed off the whaler after a two-year voyage, but the house I lived in was gone. I was cold. I was in command of a Canadian corvette, but they had tied me to my bunk. On the islands between New York and France I sat down to a lavish dinner with many friends, and I was wearing a white gown, bloodstained, and my arms would not move, and I was freezing. A man said, “Do you remember my name?” I was the governor’s cousin, and a car was coming for me. A lady told me to stop being silly, and I swore at her, viciously. I was in a bar in Chicago with Bao Dai, and a man was saying, “Do you remember my name?”

I finally remembered his name, and eventually got to know him fairly well. He was an intern, and he had been trying to rouse me from a week of coma. All those lovely, horrifying, claustrophobic hallucinations — many more than the few mentioned here — had come within two or three days, as consciousness nudged me. Over the next week they ceased to be deep hallucinations and became a fitful delirium, punctuated by my loud insistence that I be taken back to the hospital. Yes, yes, the nurses said; and I hollered some more, because here we were in Texas, or Italy, and I had to be back in the morning for a spinal tap. Sometimes my wife was there. Sometimes no one was there, and I held long conversations with I.V. bottles. But always I was cold; and often I was tied down, pinned, locked in. I wondered why.

One morning I found out. I woke up, and was calm and lucid and full of curiosity, and they told me I was paralyzed to the neck.

That surprised me. I was too depleted for feelings of shock or tragedy, but was capable of surprise and — the word seems frivolous, but is accurate — dismay. That something was wrong, I had known three weeks before: extreme weariness, explosive puffs of pain in the legs and feet, and a slack, red-eyed face. Just after the new year one of my normally efficient systems had ceased to function, and when the failure persisted I drove myself to the hospital and had myself admitted. I was, for the first time in my adult life, a patient.

That was on a Sunday evening, and I went home ten months later.

IN THOSE days the language requirements for visiting interns were elastic, and unless you were lucky your first interview was conducted in AngloHungarian or pidgin Wendish. My own exhausted intern had been napping, and was not disposed to stretch his mind as far as English. We compromised on French, so the whole experience began for me in a surrealistic haze — the more so as my French was a lot better than his, and after a few moments I had to phrase the questions as well as the answers. When the history and symptoms were on the record I was put to bed; the intern said “Ciao,” which took us another step away from the real. I awoke weak but refreshed, ate well enough, and was punctured here and there by the laboratory people. Shortly my doctor arrived, and then an internist, for an intensive interrogation. By the third day, when my legs would barely move, we knew that my spinal cord was burning away — some sort of myelitis had attacked me, and I learned that the plural of myelitis is myelitides. Wednesday night my wife fed me, and the next voice I heard, over a week later, was saying, “Do you remember my name?”

When I heard that voice I was in another hospital: a large institution run by the state and county jointly, with a good supply of the monstrous instruments that might become necessary, like iron lungs and wooden coffins. I had been rushed there late at night, a tube in every orifice and a gloomy anesthesiologist beside me; had been amply furnished with oxygen and liquid refreshment; and had been fussed over for seven days by teams of young doctors and special nurses. The infection had started at the base of my spinal cord and moved upward, paralyzing me progressively; there was nothing anyone could do but keep me as strong as possible. If it died before reaching my upper cervical vertebrae I might live, and that was all they could hope for. My eyes were covered with moist cotton, to prevent their drying, and one resident, with a delicacy I am still grateful for, instructed the interns to remove the cotton as soon as I showed signs of life so that I wouldn’t wake up and think I had gone blind. Meanwhile, my respiration was down to six per minute, and an iron lung stood ready.

I missed all that, of course, the drama, the tension. I might have died an easy death, unknowing, slipping from one blackness to another. Instead, my respiration went up and my pulse came down, the iron lung was wheeled away, and my wife was told that I would live. A day later I called for her, and I can remember the first sight of her, and her kiss, and myself asking, “Did I almost die?" and accepting her “Yes” as perfectly natural.

At that point I ceased to be an abstraction, and became again a patient. But you must know what I mean by the word: I was not a rich man in a private room with a light touch of gout. I was a pauper in the charity wards of a public hospital, and I was helpless. I slept away the days and nights, and drifted in and out of delirium; I could suck down baby food, but chewing exhausted me; I could talk, but only a phrase at a time. (My closest friend was permitted to see me, and stood silently, wearing a gauze mask, at the foot of the bed.

I woke up, and we looked at each other for a while because there wasn’t much to say, and finally I wheezed, “That’s . . . the last . . . time . . . I ever . . . kiss . . . your wife.”) Worst of all — and I remember this much more clearly than the rest — my arms were paralyzed; my hair, after two such weeks, was filthy, and my head itched damnably, and I was unable to scratch it.

Slowly order returned, sequence, continuity. Nurses made mysterious adjustments, and I learned that a tracheotomy had been performed, early on; a metal tube in my windpipe, like a tap in a barrel of beer, had helped me to breathe without chest muscles, and had kept me from choking on my own humors. Without a cork in the tube, speech was impossible, and my first fight with bureaucracy was for free speech in the primary sense. I won. My insistence was taken for rebellion, and therefore high spirits. (I learned later that any patient who argues with the staff is presumed to be improving or senile.) An old friend brought me a sheaf of Utamaro prints; they were tacked to the wall, and I contemplated them thankfully for two weeks, but when I left the contagious ward they were burned. Delirium lessened. Messages reached me from the world at large, reminding me that a novel of mine had been published on the day I passed out. The reviews were mixed but generally good, and it might even earn its advance. (I wish for all harried writers the equanimity with which I received this news.) I ate better, and graduated to mashed potatoes. I was laved and anointed. I flirted with nurses. I was palped and prodded, and for all I know leeched and cupped. I remember little of the daily routine, because I was not active in it: I was an object and not a participant.

I learned, finally, what was wrong with me. It was something called Landry’s Ascending Paralysis. That was the syndrome. The disease was just “some sort of myelitis" — a lesion of the spinal cord, an infection, probably viral, that started low and moved up. No one knew why or how I had contracted it. (No one knows yet. I like to think it was hard work and clean living.) The name of the disease meant nothing to me, but the prognosis was unnerving: “Anything is possible,” I could go on for years as I was, a vegetable; I could recover entirely; I could be stabilized anywhere in between. At that news, my emotions were stirred for almost the first time. I was angry and depressed, and my first reactions were ordinary: self-pity; “why me?” (there are some fifty cases a year in the United States); and “what have I done to deserve this?" (an easy question, unfortunately, for any man to answer). But in one of my wakeful and lucid moments, late at night, as alone as I will ever be, I saw how useless my questions were, because I saw what had happened to me: I was smack up against the absurd. I had read about it for years; now I was it. That did not burst upon me with the force of a blinding revelation. It simply seemed true; perfectly true; so true that I took it for my answer, and stopped my foolish riddling. After that night a good part of the fight was over, and won, with the conscious decision to do what had to be done, take my lumps, and keep my mouth shut. (That was seven years ago, and this is the first time I have written about it. I probably won’t again.)

WHEN the risk of contagion was gone we took a long step: I was moved to a ward full of people, and the special care ended. I was one of thirty then, cardiacs and auto accidents, cirrhosis and diabetes, strokes and fractures. It was a new world, and I was in it for what would doubtless be a long time. (Everyone was cheerful and optimistic in my presence; unintended irony, because after that solitary night I was beyond optimism or pessimism.) As soon as I could move my index finger — a sign that I might recover — I had to decide whether to join this world of strangers, or to remain aloof. The choice was not as simple as it may seem. Not since the war had I faced a long stay with a random crew of men. (A compulsory stay, and with my own countrymen. I had lived in Chinese dormitories and small French towns, but there was a romance to that kind of mingling, and the exits were never barred.) This new world was not brave; it was a world of rock ‘n’ roll (everyone seemed to have a small radio, and they all blared at once; for months I could name the top ten, and hated all ten of them), warriors’ reminiscences, batting averages, drinkers’ boasts, comic books, amatory exaggerations, Abbott and Costello, and racial, social, and religious pride and prejudice.

As the paralysis retreated, the unease advanced. Now, thank God, I could scratch my head. Soon I could touch my first three fingers with the thumb of the same hand; one triumphant morning I could join thumb and little finger. One day I actually sneezed, which is a work of serious proportions; my chest heaved and swelled, air whistled in, the convulsion came; and what emerged was an infinitesimal, barely audible sniff, the catarrhal whisper of a rheumy hamster. A few days later the therapist placed an object in my hand, and I identified it by feel as a roll of adhesive tape. Then, a giant stride: I distinguished a nickel from a dime. My bed was raised; I could sit up and look around without fainting. But I had no desire for company. The music drove me wild; the sounds of television were even more inane than the pictures. I made a comb case by threading a leather lace through holes. It was much admired. I drew a tree in crayon, and was pronounced talented. As soon as I could turn pages — a delicate and complex operation — I read. I could feed myself, and ate solid food. I began to put names to the faces and voices around me, to nod, to say hello. I enjoyed visits from the doctors, and learned phrases like clonic spasm and paresthesia; when the visiting specialists came on rounds, trailing interns like fat hens with innumerable chicks, I liked overhearing their consultations and arguments. But I was like a student misfit hanging around the faculty club. My wife came every day; I clung to her, and to my books and my occupational therapy (always called, regardless of its nature, “basket-weaving”). In short, I was an uncertain intellectual snob. I was afraid of people.

Coffee and cigars brought me around. Hospital coffee is by definition terrible, weak and somehow salty, and one day a nurse brought me a jar of instant coffee with my breakfast. Someone at the other end of the ward had sent it along, and it transpired that he was the X-ray technician who had worked me over weeks before, at the first hospital. A week later a heart attack had brought him here; he was recovering well, possibly because here his wife was a dietitian (she too was very kind to me; we were a club within a club). I got myself cranked up and waved in thanks, an exuberant, abandoned three-inch wave. People looked at me and laughed. I grinned. Every morning Chris sent me coffee, and with every wave of thanks I was integrated a bit further. And then one evening a fellow named Nate dropped by to chat. He was in his late thirties, a diabetic who died within the year; his eyes were going bad and he squinted, and when I first saw him I thought he looked like a surly barfly, a hater. He was not. He was a soft-spoken and gentle man (a foundling, he told me) who spent his days doing small favors for the bedridden. As we talked, he lit a cigar. It was a White Owl and not an Upmann, but the smoke he blew my way was the most savory I can remember. He offered to blow smoke at me after dinner every day, and I accepted with thanks. He was liked, and brought other men with him, and soon I was no longer a snob and no longer afraid.

The fear was strange; I like people and am gregarious enough normally. I think now that it was a projection of physical fears. When you are immobile, and have no sensation below the waist, any traveling object is a threat; any bump or sharp contact may do vast damage that you will not even feel. For a while I hated needles. Every morning a girl pricked me for blood; twice a week larger amounts were drawn from a vein in my arm. When internal infection set in, injections were the answer. For certain examinations the anesthetic was given by needle. Needles everywhere. And visitors bumping against the bed, and nurses dropping things on my dead legs. But fear gave way finally to acceptance; I ceased to care about the needles, and I made friends. For the first weeks I may have been in a deeper and less obvious shock than simple physical shock, and perhaps that enabled me to assimilate the bad news without horror; and maybe I was afraid to come out of it, afraid of stimulation from needles or people, clinging to a defensive narcosis through the worst days.

IN THE streets outside any hospital are signs requesting quiet; but no room on earth is as consistently noisy as a hospital ward. Bustle is constant. My basic routine was unvarying: wake up, wash, breakfast, Chris’s coffee, rest, therapy, lunch, rest, therapy, rest, supper, Nate’s cigar, free time, sleep. But the variety of event superimposed upon that routine was limitless. Doctors sweeping onto the ward, interns being solemn, nurses gossiping. Visitors lost. A crew of plumbers trotting in like the Marx Brothers. Gray Ladies and social workers and veterans advisers. The old patient’s son and his lawyer, trying to make changes in the will. Admissions and discharges. The flower ladies: every week an orange-juice can full of lilies of the valley. Accidents: broken glass, silvery liquids, slippery floors. Bedpan jokes. The cloudy octogenarian, hairless and senile, who wanders the wards without pants. The specialist, brisk and imposing in street clothes. Sometimes the specialist was for me, a neurologist; he would poke and tap and stick me with pins and smile encouragingly. Once I lost my cork in the middle of the night and woke with a raging thirst but unable to holler for water. I fell in love with two or three nurses and was assured that it happened often. Once I woke up in London, which was odd only because I had never been in London and was supposed to be finished with hallucinations. A liver case had a nightmare and woke us all with endless, agonized, quavering shrieks. A nursing student gave me a dry shampoo. A Greek pilot with a bad heart gave me a book about Athens; it was in Greek but the photographs were pretty. The doctor in charge of physical medicine and rehabilitation decided I was ready for serious work. The nurses accused me of malingering. We were all very busy, and my emotions were working again. By then I had learned to be cheerful and polite except under extreme provocation, like being given someone else’s medicine, but I had also learned to be angry. There were moments of bitterness, despair, hilarity; but my basic emotional state for the next nine months was simple: I was sore as hell.

Not that I lacked the calming and ennobling influence of spiritual advisers. There are many sorts in a hospital. I liked best the much-maligned Gray Ladies. They come by to ask how you are, and whether you want a book or some supplementary basket-weaving, and they chat briefly and go on, and there is no nonsense to them, no backslapping, no inspirational inanities. Then the social workers are fairly good. Their job is to keep your family together, and eating, and they take you away from your own troubles. The man from the Veterans Administration is always welcome because he is showing you either how to save some money or how to get some. When you are a free lance of any kind, dead broke, with three kids and no medical insurance, and no benevolent company to keep you on the payroll, and no “sick leave,” and no stocks and bonds or sellable furniture, and no income whatever for what looks like a long time to come, these considerations become important. Worry is unhealthy, and retards convalescence. (I was very lucky here. Many sensible friends sent my wife small sums immediately, without even asking. Simon and Schuster, then my publishers, sent a handsome check — as a gift, mind you, and not an advance. So did the National Cartoonists Society, with whom I was then working on a book. And a small group of ruthless poker players I had been supporting for years established a kitty in my children’s name.)

But man cannot live by bread alone, much as he may want to. I suppose every public hospital has its chaplains, and God knows I had mine. (We even had a choir. A group of ladies came around once a month with a portable clavier, or calliope, or harmonium, a gleaming percolator, and sang the great old songs like “The Lost Chord.”) I had, to begin with, a crew of earnestly religious nurses, some evangelistic, and probably the battle between Lucifer and the Lord was joined when the first nurse said to me, “God works in mysterious ways his wonders to perform.” My answer was doubtless a grunt, but at that moment the metaphysical me (a very little fellow; I am one of these hommes moyens sensuels) took up a classic stance: chin tucked into left shoulder, left jab on the way, right hand protecting head and ready to hook. My troubles had only begun.

My wife had filled out the admitting forms at the second hospital, and when she came to religion she conscientiously wrote NONE. I could not have done that myself; it is impossible for a Jew to avoid the word “Jewish” without a sense of betrayal, or at least a tedious explanation. But my wife and I are a very usual sort of casual and permissive unbeliever, and she was protecting me from sinister possibilities: that I would come out of the coma nose-to-nose with a stout, cheerful, disputatious reform rabbi from Princeton, who would beam upon me and inform me in cultured accents that God had chosen to spare me for the time; or that I would die in the repellent odor of suburban sanctity, without even a chance to fight back. (She had a more serious and immediate reason: a friend of ours had regained consciousness in the first hospital just as I was passing out, to find herself being given the last rites. A week later she was fine, but still quivering with horror.) My wife was right, but the results were bizarre: being, on paper at least, a lost soul, I was claimed by everybody, and suffered triple visitations.

Of them all I preferred the Roman Catholic priest. He was rotund and bespectacled, vaguely European, and evoked nicotine stains and fiascos of cheap wine. He would come to my bed, shake hands (always), and stand for a moment nodding, as if the NONE at the foot of my bed were no more than he had expected in this vale of pagan tribulations. “How are you today?” I was well; still working at it. “Good,” he would say. “Keep it up. You may go all the way.” With luck, I would say. Then he would smile, because we both knew he wanted to add “and with help from above,” and was refraining only to show me that his sympathy was human as well as professional. “Do you need anything?” No; but thanks. Then a wave, perhaps a sketchy blessing, and he was gone. A good man.

The Episcopal priest was also a good man, but very different: lean and gray, an amateur of the arts, a medical theorist, doubtless a member of book clubs. When he heard that I was a writer he was suffused by a pinkish ecstasy. From then on his visits were cultural events. I dreaded them; but he was a busy man, and kept them short. Finally at home, and even respected, in daily arguments about Jack Dempsey and Joe Louis, Pie Traynor and Pinky Higgins, Jack Daniel’s and Old Cirrhosis,

I resented interruptions from Sinclair Lewis and Somerset Maugham, from Millet and Millais and Millay and Malotte — interruptions that sent my new friends wheelchairing off in mild terror. But these visits, too, were welcome, sometimes funny and always a test of my good nature, my moral fiber, my grace under pressure.

I saw the rabbi only once, and I was rude; perhaps it was the rudeness that we reserve to cousins and never indulge with strangers. At the time I was on a tilt-table. Bedridden patients, like rising politicians, must be brought to uprightness gradually. They are strapped to tilt-tables and raised toward the vertical until they pass out, which defines the limits. I had worked up to about 70 degrees, and daily spent a pleasant quarter of an hour at that angle, wrapped like a mummy and bound to the table, looking out over my ward like the figurehead of a garbage scow. It was hard work. It required neck muscles to keep the head from lolling, and concentration to keep the breathing steady. I was straining to make a success of this when the rabbi came along, and the first thing I knew I was in an old-fashioned disputation: a roaring discussion of omniscience, omnipotence, oceanic feeling, intercession, and so forth. It may have been simply the frustration of having to argue with my hands tethered, or it may have been that if there was a God I had good reason to be vexed with him. but I found myself informing the rabbi warmly that I was not interested in reform pieties, Sabbath hootenannies, or Rachel and Leah in wedgies; on the other hand, if he represented the old angry bearded Jehovah, I was at his service. He left soon after, and later I was ashamed. He was a young man, but he had probably spent twenty years ridding himself of the old anthropomorphic orthodoxy, and he had left his study to spend a day in Bedlam, and I had taken advantage of his good nature and rude health, and been a boor. He never came back, and I wish he had.

But I hope I may be forgiven; and then the anger was good for me. Getting well is a bitterly hard job. Recalcitrant nerves and muscles depress the spirit, and the work requires every shred of will; the possibility of a short, bedridden life hovers like a nightmare; moral despair and physical exhaustion battle for the soul. Under these conditions a good nurse is worth more than rubies, and a religious caterpillar more hurtful than boils.

Unctuosity and inspirational twaddle can be vicious, and applied pity can be maddening. And the theological dice are always loaded: if you recover, then God is good; if not, then God works in mysterious ways his wonders to perform. It is Job, and theodicy, all over again, but no one will ever argue it on that level. What you get is metaphysical molasses. A blasted man should be spared such sticky nonsense.

More to the point, and infinitely more invigorating, was my transfer, at the end of the second month, to another ward. Here lived three groups: permanently bedridden charges of the state, terminal cases, and patients in physical medicine and rehabilitation. From this ward we went home or to the grave.

Rapid changes kept me busy. My lung capacity was now normal, and the tracheotomy tube was removed. I was to sleep on my stomach hereafter, mainly because of a bedsore, or sacral decubitus, which is the polite name for a hole in my lower back the size of a lime (the flesh, deprived of circulation and therefore nourishment, and under the constant pressure of my inert body, had simply disintegrated). Best of all, I was to be placed in a wheelchair for several minutes every day. (They forgot to strap me in the first time; I fainted and fell out. Scandal. Investigations.) Furthermore, my therapy was to be accelerated. No more nickels and dimes, and no more basket-weaving, but hard work with progressively heavier weights. The social problem had ceased to exist, by the way. I came onto the new ward as a veteran, and observed with delight only two radios and one television set. For a day or two I was exhilarated.

What happened next is what I will remember when the rest is forgotten. I was wrestled onto the tilt-table and wheeled down to the gym. I proceeded like a tourist through new and exotic corridors and elevators, past pipes and valves and vending machines. In the gym I was flipped over, still happy, and tilted up, and placed before a pair of wooden handles attached to pulleys. It seemed to me that the whole hospital was there watching. At the end of each cable was a weight of one half pound. My Herculean task was to grasp the handles and raise the weights.

I grasped, and pulled, and strained until I thought my bones would crack. Nothing happened. My therapist spoke soothing words, and helped by tugging at the cables herself, and with her strength the cables went up and down, up and down, up and down. Then we quit for the day, in gloomy silence, and on the way upstairs I burst into tears for the first, and as it turned out only, time. It was a violent and immitigable oppression of spirits; nothing in my life before or since compares with it. That was a unique moment of absolute and brutal disappointment; of utter and helpless despair; of a finality like that of death. I had made the mistake of hoping.

Six weeks later I was raising a thirty-pound weight twenty times with either hand.

THE next seven or eight months were anticlimax. I was a professional patient. When a new nurse woke me too early I bawled her out. I wore an intern’s jacket in place of the degrading patient’s gown. (Hospital dress as status symbol, from the director on down, is worth a study.) I could go from bed to chair and back without help, using a small overhead trapeze. I had one great stroke of luck: the doctor in immediate charge of me was a polio victim, and lived in a wheelchair, and was tough. He hounded me and harried me; he also played chess with me and made off with his share of the fancy edibles my friends kept sending me. He worked me hard, but the example was more important than the whip. At the very worst, I would live as he lived; and he was doing his job and living his life. There was no nonsense to him. He offered no pity and needed none.

I took to supervising my own care, which was not a bad idea. I recommend minor meddling and ready asperity. Patients are damaged, and occasionally killed, in hospitals (which is — obviously, I hope — not to condemn doctors and nurses). Twice I refused medicines, knowing they were not for me; twice I made mechanical adjustments neglected by the night nurse without which serious harm, and possibly death, would have resulted. More and more (outside the gym) I took charge of my own routine. I ate what I wanted, and rejected out of hand the beef lung prescribed. I napped when I wanted to. With permission, if not approval, I took a cigar after supper. (Havanas, in those days. The first one, after three months without, tasted like straw, but they rapidly became my prime solace. Later a friend brought me Burmese cigarettes, each a simple brown leaf rolled small; I was accused of retreating into marijuana, and refused either to explain or to give them up, enjoying the small scandal.) I became the senior patient on the ward, and was consulted by frightened newcomers. I grew a bristly mustache, and my children, who had not seen me for months, failed to recognize me. I wheeled myself to the movies on Wednesday nights; they were all bad, but they were a distraction. I remember explaining to a nurse why a man with a bleeding ulcer should not have aspirin; such pomposities were, I am sorry to report, good for me. I even got back to work, with a tape recorder; I lay mouthing mysteries into a microphone while my fellow patients kept a respectful distance, and my wife bore home little reels of tape and typed up the day’s ragged prose.

I also took to reading my own chart, which was strictly forbidden. The belief seems to be that if a patient is exposed to an accurate account of his troubles he will fall into an immediate decline, possibly even dying of chagrin. But the chart accompanies him everywhere, and it is impossible to keep a determined busybody from hiding in a corner now and then with the forbidden volume. I was pleased to learn that twice my savage outbursts (on the order of “called Dr. W — a murderous quack”) had been considered quotable, and that two doctors had concurred in deeming me “intelligent.” I also learned that I had spoken French and Chinese while coming out of the coma. Why such absorbing gossip should be kept from the patient I do not know.

But my life was mainly exercise. The memories of these later months are few now, like those of a man of fifty who tells you of his wild times in high school and college, and then says that he has been with IBM ever since. For two and a half hours every morning, and for two and a half hours every afternoon, I stretched and strained, grunted and groaned, the star performer among ten to twenty paralytics, aphasics, and fractures; a veteran trouper, a senior outfielder, the Sandow of the charity wards, the Grover Whelan of the therapy room. My arms and shoulders became stronger than ever, and my legs began to respond, and finally I was permitted to spend weekends at home.

Which proved difficult. Removed from the womblike security of the hospital, I was frightened again. Anything might happen, a fall, a fracture, a fever; and there I was with no doctors, no nurses, no therapists, no orderlies. No Gray Ladies. Not even a rabbi. The first two or three weekends at home were exhilarating and nerve-racking at once, but the nervousness passed, and was replaced by a ferocious desire to get out of that hospital for good. I was fitted for braces, and taught to use crutches. I was even taught how to fall. Over the summer my world expanded again, and the ward began to seem very small; I wanted to be a little frog again in my old cosmopolitan pond. The state of my health became less important; aside from the clearly defined disability I had become quite strong, and I had been — the realization was sudden and forceful — too long confined. By August I was a rebel, a prisoner reminding himself that his first duty was to escape.

I learned later that the doctors had been waiting for my rebellion, and were pleased. Cleverly I managed excursions, wandering unsupervised through the wards, or outside the gym in the summer sun; but I was more supervised than I knew. They wanted to send me home; but there were unresolved problems of internal medicine, and there was the bedsore. They knew I was ready for the world, but were not sure that I could live with the uncertainties of recovery. There were mechanical aids and medications that I might need for months, or even years, and prognosis was, as it had always been, impossible. For eight months I had known that today, this moment, might define my condition for the rest of my life; but also that I might go on recovering indefinitely. To release me in that uncertainty was to risk neurosis — depression, withdrawal, bitterness, despair. But to keep me was to risk a surly resentment, a permanent low-level claustrophobia. The doctors were weighing those dangers before I was even aware of them.

They let me go in October, after a last annoyance: they insisted on a final internal examination during the last week, and the examination resulted, as always, in a couple of days of fever, and they hesitated to discharge a feverish patient. I stormed my way through that one, and persuaded them to sign the papers; and on a quiet Friday evening I said my good-byes, wheeled myself to the car, and went home without looking back. I never did recover fully, and had two major operations in the next couple of years, and my way of life was drastically altered. But at least I was no longer a patient; I was a cripple. (Even hardened hospital personnel dislike that word, and search for euphemisms; but it is a decent and accurate word.) The difference is, I suppose, that a patient has no real independence; his life is defined and regulated by other people. A cripple’s life is defined and regulated to some extent by his disability, but after that he’s on his own. I still can’t walk without a cane, and I need hand controls to drive, but last year I swam a shallow river full of piranha and rays from Brazil to British Guiana, and for one idiotic moment in midstream I wished that all those doctors and nurses were watching, lined up on the far bank with their stethoscopes and thermometers and long faces.

There is no moral. You decide in the first month or two whether you want to live or die, and once the decision is made you are nothing special. If you decide to die no one can stop you. If you decide to live you must decide simultaneously not to ask favors and not to ask “why me?; you must reject pity and singularity with equal and absolute indifference. I suppose I learned that much, and more about getting on with my fellowman. Otherwise it was not that I learned; it was simply that I knew better and more surely what I had known uncertainly before. That we are promised nothing. That one man’s hangnail is another man’s broken neck. That the great trick is not to keep hope alive, but to keep going without it in a random universe.

That nature never rejoices, and never mourns.