A World No Less Sublime

Reflections on the events of winter 2007.

December is a good month to attend on the wards. Patients arrive with their respiratory ailments, and students discover unfamiliar lung sounds.  In thirteen years of teaching at the University of Oklahoma, I never complained about a December assignment, but this December was testing my resolve.

Winter was raging throughout the Great Plains, and Oklahoma was reeling from the icy assault.
Roads were empty, trees were broken, and neighbor-hoods, severed from power, were dark. At OU Medical Center, however, lights were aglow, bringing the sick to refuge from the seemingly Siberian cold. The city hibernated, but life in our medical fortress prevailed.

The weather had little effect on my mood because the month was going well:  The students were sharp, the residents were hard-working, and the nurses were accommodating. When time allowed, we reveled in "ice stories," never realizing that the most provocative story would be eclipsed by an intimate tale.

It began one morning during a break in the storm. I was scrubbing my head in the shower when I noticed my right arm faltering. I felt no pain or weakness and finished bathing without incident. That day at the hospital, I felt fine and later swam and lifted weights without difficulty. But the next morning, I found myself inexplicably using both hands to shave and brush my teeth.

I arranged to see my doctor but quickly postponed the appointment when the storm resurged. Several large trees had collapsed in the yard. I spent the weekend cutting, lifting, and removing debris. My arm held up well.

The following week, however, a colleague, seeing me walk, remarked that my arm was not swinging normally. Soon, I began having trouble writing prescriptions. And then, the coup the grace: While demonstrating a simple exercise to a patient -- the "itsy, bitsy spider" climbing the wall-- I struggled to move my fingers.

I visited my doctor that afternoon. He listened patiently and through careful examination tried to solve the mystery. He asked me to tap my fingers:  My right hand was slow and awkward. He checked alternating hand movements: The result was the same. Then, a final test:  foot-tapping. I expected this to be normal because I had no trouble running.  Astonishingly, my right foot faltered.

He looked at me sympathetically and said, "Your strength is fine."  Then cautiously, as if trying to avoid notice, he said, "Your findings are extrapyramidal. They are consistent ... with ... Parkinson's."

There was silence. I gazed at my feet. After a few moments, I tried tapping again. There was no change. One thought consumed me: I am only 45 years old.

Could Dr. Parkinson have foreseen the anguish his genial name would evoke? I canceled my clinic, drove home, and spent the evening staring at a wall. Every sound was magnified—the howling wind, the ticking clock. Breathless and bewildered, I imagined a bleak future. The struggle had begun; I was locked in health care's ravenous embrace. How would it end? Did I have disability insurance? Long-term care insurance? I was desolate. A happy life had ended without eulogy.  For two days, I ate and slept little.

Then came the day of my appointment with Dr. Bharucha, a neurologist who specialized in movement disorders. I arrived early and sat in the waiting room, reflecting on the stealth of my disease. When had it arrived? Was it a year ago, when my agility at the piano first declined? Or a month later, when "decon-ditioning" led me to the gym?

A nurse called my name and led me to the examination room.  She checked my vitals, scribbled a note, and left.  I closed my eyes and rested my head against the wall.

Within minutes, Dr. Bharucha entered the room, presumably on a cat's paw.  He walked so softly that I barely noticed his arrival. He clung to his papers in one hand and to an old, black doctor's bag in the other. Placing them on a table, he turned slowly and, seeing me, smiled and gently nodded.

He was maybe in his early 50s and of medium build. His face was genteel; his eyes, though dark, were subdued. He squinted often, though the light was dim. A crescent of short, black hair marked the perimeter of his pate. He seemed comfortable in his gray wool jacket and monochrome tie. I tried to picture him in a starched, white coat, but could not: The angularity was off-putting.

He sat on a stool and rested his hands in his lap. Then he began to speak—slowly, sparingly. I could not place his accent, but it enriched the lush cadence of his voice. He asked for my story, which I gave in detail. He was motionless throughout the telling. When I finished, he stood and approached me. His movements were slow and deliberate.

During the physical, my attention veered toward his remarkably placid manner. He was so quiet. Afterward, he spoke in almost a whisper. His voice was soothing, almost hypnotic. His words, impeccably molded, seemed spaced to poetic meter. Occasionally, he would clear his throat, but with a discretion that left the lilt of his voice undisturbed.

He spoke of diet, exercise, rest, and medicine, but mainly he spoke encouragingly. Parkinson's disease was treatable. Medicine had greatly improved lives. The outlook was continually getting better. His words were anodyne; his manner, even more so. There was an irresistible timelessness about him. He was decidedly unmodern. And as he spoke -- and paused -- the gloom slowly lifted. Only serenity remained.

I left his office relieved—but why? Surely doctors are immune to the consolations of their own physicians. We do, after all, know the tricks of the trade. Are we so easily charmed by word and manner?

Driving home, I looked at the city. The storm had ended and the clean-up had begun. Mountains of debris were being removed, and power lines were being repaired. I turned on the radio and listened to the politicians trading banalities. As usual, "hope" was being dispensed as a balm for the nation's ills. I was accustomed to ignoring such talk. But not today. Hope -- even in the abstract—was tangible, measurable, sustaining.

Arriving home, I rushed to the kitchen, opened the cupboard, and like Lazarus reborn, devoured everything. Replenished, I entered the library and pulled a book of poems from the shelf. Therein I discovered Tennyson's In Memoriam A.H.H., an elegy to a lost friend. I spent the evening lost in Tennyson's grand nostalgic vision. As my eyes tired, I turned to music. An old symphonic recording not heard in years occupied the same shelf. I put it on. The pathos was wrenching, despair ending in triumph. Finally, I turned to the window and opened the blinds. The clouds had receded and the room erupted in a glorious display of iridescent light. The moment transcended time and circumstance.

What had begun in hopeful silence had ended in epiphany—in the blissful and startling realization that a phrase was no less stirring, a melody no less radiant, a sunset no less sublime because of my affliction.

I opened the book of poems again and immersed myself in the inspired oration of Tennyson's Ulysses:

Tho' much is taken, much abides; and tho' We are not now that strength which in old days
Moved earth and heaven; that which we are, we are,—
One equal temper of heroic hearts,
Made weak by time and fate, but strong in will
To strive, to seek, to find, and not to yield.

Night had arrived. I crept into bed. The room glimmered with the sparkle of icicles beneath the eaves. Yesterday had brought despair; tomorrow might bring the same. But today, we were what we were: serene and content to have savored the joys of a bounteous world, and now to slip dreamily into God's wistful embrace.