Physical

An American Checkup

James McManus

Farrar, Straus and Giroux

Excerpted from Physical by James McManus. Copyright © 2006 by James McManus. Published in January, 2006 by Farrar, Straus and Giroux, LLC. All rights reserved.

THAT’S THAT

I looked away to the hills
Above the river, where the golden lights of sunset

And sunrise are one and the same, and I saw something flying
Back and forth, fluttering its wings. Then it stopped in mid-air,
It was an angel, one of the good ones, about to sing.

—MARK STRAND, Dark Harbor, XLV

I would kiss the diamondback if I knew it would get me to heaven.

—LUCINDA WILLIAMS. “Get Right with God”

The truth is, I don’t think I’m going to die. Not today, not tomorrow, not in 2067. Not me. To begin with, I’m careful and lucky enough not to get hit by a bus. An SUV maybe, or the culture of SUVs, or the cult—but no bus. I’m also immune by dint of heredity to most forms of cancer, by passport to snakebite and tropical maladies, by suburb and commuting pattern to Al Qaeda, by neck of the woods to tsunamis and hurricanes and earthquakes and floods, and by basic straight wholesome good old-fashioned solid moral American core family values (or a least a fear of needles) to overdose and sexually transmitted diseases. I’m bulletproof. At the same time, I try pretty hard never to imagine those eight hyphenated integers after my name or under my black-and-white photograph. No, not my zip code or social security number—those both have nine. Phone number? Ten. I’m talking 1951-20whatever.

Right now I’m fifty-four, a baby boomer gone mostly gray on the top and squishier than I’d like through the middle. I’m no Orson Welles or Chris Farley, no late Brando or early Belushi, but the small of my back, well, it isn’t so small anymore. Otherwise I seem to be in reasonably half-decent shape for a fellow my age. Plus I’m bulletproof, baby! So it doesn’t really matter, you see, that my father had his first heart attack at forty-six and a fatal stroke at sixty-one. Or that his father, the man for whom I was named, died of a heart attack at thirty-five, when my father was seven months old. Or that my kid brother Kevin, who was named for our father, died at forty-one of complications after a marrow transplant at Johns Hopkins, the best leukemia treatment center on the planet. A funny, Athletic, warmhearted guy who wrote features for the The Washington Post, he was in such bionic shape that it took a couple of weeks for even total renal failure to kill him, and his wife and mother and siblings got to watch every minute. “How’m I doin’?” he gasped upon briefly emerging, blind and desperate, from his final coma. “How’re the kids?” My doubles partner, an ophthalmological surgeon, developed frontal lobe dementia and doesn’t recognize his wife and children anymore, let alone me; needless to say, he no longer plays tennis or practices medicine. My caustically hilarious editor at Harper-Collins died in 2001 after a long illness. The woman who taught me how to play poker died on her ninetieth birthday. On his way in through a Wrigley turnstile in September 2004, my office mate and fellow geezer dad’s hyper, magnificent brain was drowned in its own blood by an aneurysm. In 1999 my fourth child (third daughter) made an unexpected footling breech presentation, got her neck lodged between her mother’s abdominal muscles during the C-section, and almost snapped her spine or strangled herself getting born. Two years later my son, a scorchingly talented guitarist who was named after me—me, who has less than zero musical talent—died of a drug overdose in a mental health clinic at age twenty-two. Suicide? It would not have been the first time he tried. Medication mistake by a nurse? Autopsy report inconclusive; lawsuit pending. At least two pharmaceutical companies who made antidepressants prescribed for him, Wyeth and GlaxoSmithKline, had lied about data suggesting links between their drugs and suicide in teenagers; lawsuits pending. Not that legal maneuvers or money can bring James back to us, or retroactively soothe all the pain he was in. Executing by hand the persons who manipulated the data and made the decisions to keep pushing those antidepressants wouldn’t accomplish that, either, though I’d still love to do it. In any event, I sure miss my beautiful son. I’ve read and heard people say that losing your child is the worst thing you can ever experience, and I can’t disagree. I’d also assumed it would kill me.

At this stage I realize that all these events were horrific but not that unusual, and certainly more are to come. More? All of us will surrender our health, our standing, our marbles, our self soon enough, or so I’ve been given to understand. Yet the most forceful and eloquent part of my soul still insists I will be the exception. I’m still alive, after all.

Mind you, I do understand the basic biological facts, and I do not believe in the soul. I was raised Roman Catholic, of course, but have spent the last forty years as secular humanist. Folks like me get branded unbelievers, atheists, heretics, educrats, ethical relativists, Jews, Brights, effete blue-state feminists, eggheaded patched-tweed-and-rimless-bifocals-wearing faggots, French, and much worse; more affectionate terms include freethinker, agnostic, lapsed Catholic, progressive, existentialist, reader of novels, queer, beatnik, and honorary Jew. I’m not sure which label fits best, but I do have a great deal of faith that our bodies—our brainwaves and actions, commerce and science and art, words and children—are pretty much all there is to us. Religion evolved to help us cope with poverty, imprisonment, fear of death, and other bad things, and that’s fine. But is some white-bearded guy named Jehovah or Olodumare, God or Allah, really out there? In here? On a throne up in heaven, above and to the left of Cloud 9? Or is he perpetually verging a gazillionth of a nanometer beyond the periphery of a cosmos expanding at 299,792,458 meters per second, frantically tap dancing along the edge of this most naked of all singularities? Was his word, his final solution, on eros, ethics, weaponry, territorial boundaries, contraception, evolution, and somatic cell nuclear transfer inked onto crinkly multilingual papyrus manuscripts a millennium or two ago? My answer to all these is, “Please.” I also have faith that there ain’t no infernal conflagration after death (unless you want to count the forging of my cremains), no purgatorial scorching of my incorporeal person-hood, no seventy-two black-eyed virgins or eighteen choirs of nineteen-year-old lingerie- modeling Brazilo-Scandinavian cherubim waiting on me up in paradise. Nor will I be reincarnated as a wild but eventually Triple Crown-winning black stallion; a granite-jawed southpaw with a 101 mph cutter I can paint the black of the plate with; or the twenty-third century’s Abraham Lincoln, let alone its most potent singer-songwriter-guitarist. even my hero Dante Alighieri’s sizzling twelve-year-old girlfriend, Beatrice Portinari, won’t really be spinning around no Empyrean in perfect equilibrium with Him. (Sorry D.) Because once my blipping EEG line goes flat, it’s going to be all she wrote. In the meantime, my life will be sweet in a number of aspects, a boot in the testicles other times. Sooner or later a Hummer will squash me like Wile E. Coyote. Either that or my heart and maybe another vital organ or two will break down and I’ll suffer, piss and moan not a little, then purchase the farm. I’ve already made the down payment.

As far as the suffering goes—how soon it starts, how long it drags out—I used to be confident that what’s called Western medicine was riding full speed, or almost that fast, to the rescue. I knew Western medicine consisted of millions of creative, altrusitic, expensively educated women and men, many working in laboratories and hospitals and clinics well to the east and south, but sometimes the term made me picture a single Asian cowgirl in snowy white lab coat and Stetson, bandolier of specimen vials jangling against her modest cleavage as she clutches in one hand the reins of a galloping stallion, in the other a glass pipette delicate enough to boink a healthy cell in to the place of a sick one. In another daydream, she wields a titanium lasso delicate enough to snare a 15 mm polyp three and a half feet up my rectum, her motto tattooed in racy arabesque just below either her navel or the base of her spine: Time to cowgirl up, take your medicine.

Not that I expected Western medicine to let me live forever—just an extra decade or so, with a little more spring in my step. What I really really wanted, daydreams aside, was for people like my daughter Bridget, who has suffered from juvenile diabetes for twenty-two years, to get a fair shot at their biblical threescore and ten. But in August 2001, as Mohamed Atta and Osama bin Laden and Khalid Sheikh Mohammed finalized their plans, our Bible-totin’ president, squinting out from his sun-blasted spread down in Crawford, took it upon himself to forbid further use of embryonic stem cells in the effort to cure diabetes, Parkinson’s, cancer, Ms, and a dozen other vicious diseases. Pretending to spilt the difference between ultraconservative Christians and the rest of us, the president’s “compromise” effectively amounted to a ban on embryonic stem cell research. He said that “more than sixty genetically diverse stem cell lines already exist” and that the NIH would be permitted to fund research on these existing lines only. Less than a dozen of them would ever be made available to scientists, most of them genetically limited to people who tend to use in vitro clinics—the white, the infertile, the wealthy. Not that there’s anything innately wrong with these categories, but researches will need thousands of lines, perhaps even one for every patient, to provide genetic matches for the entire population.

Bush claimed to have given biomedical research “a great deal of thought, prayer, and considerable reflection,” but in one fell swoop he’d dammed the flow of a decade of medical research robustly encouraged by President Clinton and host of Nobel laureates and teaching hospitals. He had stripped my infinitely resourceful cow-girl of her most promising protocol, forcing her to ride sidesaddle on a stubborn Texas mule better equipped to trudge across deserts and oil fields than gallop off into the future. And I couldn’t allow that to stand. If this pious, votemongering embarrassment didn’t change his position real soon, I might have to do something rash.