A Eulogy for Harry Guise (1997)

A Eulogy for Harry Guise
August 14, 1997
St. Patrick’s Cathedral
Harrisburg

David B. Schwartz


It is with a sad heart that I walk from my home in the shadow of this cathedral to join in mourning the loss - but celebrating the life - of my colleague, friend, and mentor Harry Guise. I wish to sing the praises of a good man.

Harry and I worked together. Anyone who knew Harry even slightly knew that for him work was not a casual affair. He worked hard all of his life, and his work was helping people. I want to tell one story that tells a little about this work of his.

A few years ago our organization in government had an opportunity to hire someone for the summer to help us. When the paperwork was completed, the bureaucratic office handling hiring offered immediate approval - if we would take a person they’d like us to hire. In fact, she could start tomorrow. But Harry felt differently. We were an office to help people with disabilities, and we should hire someone with a disability for this job. So he persisted.

Harry had to persist a long time to get what he wanted, and the summer was long past and he had done a lot of additional work before he was able to hire such a person. That is how Horace came to work with us.

Horace was an older man who seemed to have never had much of a break in life. Harry took an interest in him, spent time with him, and he did good work for us. When the position ran out, he went on and moved someplace else.

A couple of years later, I was surprised to see Horace sitting in Harry’s office, visiting him. He had come back to town, and the first thing he did was to see Harry. Horace was dying, Harry told me later, and had come back to see Harry one more time. In Harry, this old disabled African-American man who no-one seemed to want had found someone who wanted him, who encouraged him, who saw something in him. So it was no surprise, actually, that he would come back to see Harry one more time.

How many Horaces were there in Harry’s long working life? How many people did he take an interest in and help them to find the blessings of work, a blessing that they would otherwise have not known, and which was so important to him? In fact, if you assembled all the people who Harry helped in this way, the crowd would fill this Cathedral, and the street beyond.

Harry, as others have said, was very self-effacing. He would never sit still for such praise as this. I used to tease him with a nickname I had for him: “Columbo,” after the Peter Falk character in the detective series. For Harry, like Columbo, combined his self-effacing nature with extraordinary perception and intelligence in service of his calling. Like Columbo, when he needed to get to the bottom of some knotty problem he would engage people in offhand conversation. If it was winter, perhaps he would even be wearing a rumpled raincoat. People would take in his comforting diminutive figure, look into his innocent face and his twinkling Irish eyes, and they would tell him everything. Then Harry, who would never miss the subtlest of inflections, would figure out from what they had unself-consciously told him just what to do to be able to get someone a job, or fifty people a job, or a hundred people a job.

I quickly learned not to do anything important without asking him. I would sit down in the big chair in his office, and run by him some new, enthusiastic idea of mine, and Harry would reveal the gaping hole right before my feet that I would disappear into if I took one more step. “How on earth do you know where all these holes are?,” I once asked him in amazement. “Oh,” he replied with a wry chuckle, “I fell in all of them.”

Sometimes, after patiently hearing out some new exciting proposed plan of mine, and being asked what he thought of it, Harry would ask, “How about if I sleep on it?” This, I came to realize, was Harry’s gentle way of saying “David, that is such an extraordinarily bad idea that I am actually worried about you, and maybe if you sleep on it you will forget about it by the morning.”

He was always saving me, and us.

In a meeting over some difficult problem, when everybody was starting to get just a little irritable, Harry would look up and say “Well, are we having fun yet?”


It is important to sing the praises of unsung heros, and Harry was such a hero. He was a hero of mine. He helped people. He was never confused about what was right. He was unwavering in his commitment to people, and untiring in his efforts. He taught me patience.

Thanks for being patient with me, Harry. And be patient for a moment, past the threshold of this world, while I sing your praises; that of a good man.

Post-Katrina in the Big Easy (2008)

The Fragility of Natural and Human Culture in New Orleans

David B. Schwartz
3/30/08

“Culture,” the social philosopher Ivan Illich once said, “is that which holds the economy at bay.” A culture says that here in this place we do things in this particular way, we live in this particular way, which we hold above the measure of money alone. It is the unique, local way in which we “face illness, suffering, and death.” Here we eat in a certain way, live in a certain way, create in a certain way. “When a culture perishes,” Margaret Mead once wrote, it is a terrible loss for the world:

Human cultures are the most distinct creations of human beings, drawing as they do not only upon the special contributions of the singularly gifted, but upon the imagination, explicit and implicit, of every man, woman, and child who live within them, and through them, and who, each generation, remodel the traditions they have received from their cultural ancestors. But although human cultures are the most distinctive creations of the human, they are also the most fragile, for they live primarily in the habituated beings of living persons. Like a dance, for which the music and choreography have never been written down, a great part of human culture is lost to humanity when the group which has carried it, devotedly, in every word or gesture, is dispersed, or destroyed, or forsakes the traditional ways for ways which are new.*




One might think of the borders of a culture as a kind of levee holding back the sea of monetary economics which drives the modern world. Standing in New Orleans’ lower ninth ward I could see where the material and cultural levees failed in hurricane Katrina, and the scraped and barren ruins left in the wake of that breach. I stood where an enormous Mississippi barge, surfing a wall of water, scoured a living neighborhood from the face of the earth, taking a big part of a musical culture with it.

I was shown around the lower 9th by my old friend Richard Waller, a conservationist and volunteer with Common Ground, a visionary and unusual community organization operating out of a tiny house stuffed with 50 college students. They were stacked in bunkbeds, using one bathroom and a garden hose for a shower. The students and the organization’s leadership were there to try to do what they could for those who had called the lower 9th home. Richard’s own focus was not in house reconstruction, but in attempting to restore the wetlands whose slow death over decades had allowed the full force of wind and storm surge to strike unmoderated from the Gulf of Mexico.

“This neighborhood,” Richard gestured, “once had the highest percentage of home ownership by African-American people in the entire United States.” If one listened to mere reports on the news, one would assume that Katrina had washed away some kind of impoverished slum. But this was far from the case. This marginal, below sea-level land was once home to a unique culture whose art has spread throughout the world. These streets gave birth to the blues. It gave birth to jazz. It held the home of the legendary jazzman Fats Domino, who had to be pried away from his beloved piano by his family as the water rose. It’s a good thing, because when the levee broke his piano submerged under fifteen feet of water. It stayed for three weeks. The few remaining houses, scattered here and there across now open lots, still retained numbers spray-painted by national guard troops showing the number of bodies to be removed. There were 1600.

Why did art flourish here? What was so rich about this soil that such creativity emerged? One thing that was unusual about this neighborhood was what they did with their small homes. And they were small – tiny, in fact, by modern American standards. Most of these modest homes did not even have air-conditioning despite its near, humid subtropical climate. While almost everyone in an American suburb strives virtually ceaselessly to pay mortgages, car loans, and increasing improvements, something which requires two incomes to support even with effort, people in the lower 9th part of the “Big Easy” took quite a different approach. With many houses handed down and paid for, often only part-time jobs – even as musicians – were needed. They chose the luxury of time over productivity. With only part-time effort required to secure an acceptable roof over their heads, they could sit on their porches, drink some beer on a hot afternoon, play music, and sing. We are told by anthropologists that “primitive” tribes, including some still existing today, spent and spend much less time securing food and shelter than people in modern societies. In the modern world, work without end is taken to an extreme. Yet right in America, in a Southern city which was home to a community of free slaves even during the civil war, a certain traditional way of living persisted even into the beginning of the 21st century. Persisted, that is, until the levee broke.

Why did the levee break? In a phrase, the war against culture and the war against nature are the same thing. Richard took me out to the edge of the wetlands bordering New Orleans. Walking through piles of rusted steel from depots supplying offshore oil derricks, we came to the indistinct boundary between land and water. “They say down here that when God was trying to decide whether to make this part of the world land or sea, he finally decided upon - neither,” Richard said. You could see where the hurricane had torn up vast swatches of wetland grass, leaving reflective pools of open water that presented no resistance to winds and storm-surges. It was this grass that Richard and his teams of student volunteers were replanting from grasses sprouted in children’s blue wading pools. It seemed an inspiring effort, against overwhelming need.

But what was of greatest importance in that wind-swept place was not what you could see, but what you couldn’t. What was not there to be seen were the endless cypress and hardwood forests that within recent memory covered the spot where we were standing, as far to the north as one could see.

The previous day Richard showed my son and I through such an intact cypress swamp. Tall cypress trees with their characteristic “knees” emerged from the ground that was neither solid nor liquid, in the way that cypresses are particularly adapted to flourish in. Around their roots, a rich and complex ecosystem flourished, too: tall grasses, wild irises in bloom, seemingly somnolent alligators, and more snakes – mostly venomous brown cottonmouths, than I had ever seen anywhere. The boggy land practically squirmed with them. Although the swamp had been hit by Katrina too, here miles of established wetland vegetation had helped to muffled the blow.

It was only as long ago as when Richard and I were in high school that the Army Corps of Engineers had carved a canal through a swamp just like this to make barge traffic from the Mississippi to the Gulf more efficient – and profitable. It was called, by it’s acronym, “Mr. Go.” This immense and destructive undertaking had never turned out to be useful – it was now being decommissioned - but one thing that it did accomplish was to let the salty water of the Gulf up into the freshwater swamp. This breaching of an invisible biological levee caused the death of the forests, and the grasses, and the ecosystem itself. When the hurricane swept through this wasteland, the man-made levees failed. When they did, the culture of the lower ninth ward went under.

While much is made about how governmental systems failed in the emergency, the failure of technology is hardly a surprise. Louisiana is, too, hardly Holland, where an efficient system sticks its technological thumb in the first trickle of a leak. Here there was a pumping station that, unmaintained, failed to start when remotely signaled. We admired the massive concrete construction of a watertight door made to swing shut over a railroad cut in case of flood. Also remotely activated, it was disabled by rusty chains and padlocks. It was like chaining shut an emergency exit. You would have to wade out there with a key to get the thing closed in a hurricane.

Cypress swamps need no activation. They just need to be there. To claim that global warming spawned a killer hurricane is just a fragment of the story. All aspects of nature manifest boundaries that define inside from outside. They may be a cell wall, or a saline differential or a cultural boundary of language, of art, of ways of living. They are all levees that hold the economy at bay, to use Illich’s terms. For it is the unlimited workings of a freemarket economy that is the sea that ultimately covers them all. It starts with the death of a wetlands, proceeds to the collapse of man-made levees, and ends with the death of a culture. Standing in the remains of the lower 9th ward, where concrete steps punctuating blank grassy fields are all that remain of a community, you can walk the lonely streets and strain to hear a single blues note.

When the levee broke in the lower 9th, the storm had passed. It was a bright, blue-skied day. Everyone but the meteorologists, whose accurate warnings were ignored by politicians and the news media, breathed a sign of relief. When the levee gave way, it was like the proverbial Flood.

The legendary urbanologist Jane Jacobs published a book describing how cities really worked at about the same time that the “Mr. Go” canal was dredged. Called The Death and Life of American Cities, its original title was this: Why the Planners Are Wrong. While planners like New York’s Robert Moses sat in high towers marking neighborhoods for demolition and replacement by public works, Jane Jacobs pushed her small children in a stroller through streets and parks, noticing the cultural ecology of people as carefully as Richard observes the ecology of botanical nature. In New Orleans, you can see in dramatic form why human planning always fails to equal the intelligence of the natural world, a world that encompasses cells and people alike.

When Ivan Illich first encountered the word “planning,” which emerged in the language for the first time as the canal’s dredging operations, he was puzzled at his meaning. He went to visit his old friend theologian Jacques Maritan. Did he have any idea what that word meant? As Illich told the story, Maritan sat back in his study and reflected a bit. Then he responded. “I believe,” he replied carefully, “that it is a new word for the sin of presumption.” A more common word for presumption is hubris; the sin that is inexorably followed by nemesis. It is believing, as Illich used to observe, that man can do what God cannot.

Pulling out of Common Ground’s makeshift nursery with a load of idealistic college students and sprigs of seagrass, Richard heads out for a day of wading in the mud planting single stalks of grass against an ocean. He is cheered by these students, who are flocking to New Orleans to help. He’s one of the few “greybeards” among them. He’s been through this kind of thing before. He believes that it is particularly good that they are here, because New Orleans shows them first-hand what the world that they are going to be living in will increasingly look like. New Orleans, he speculates, is merely the first American city to fall to global warming. They can get a good look at what they are going to have to deal with as adults.

Pushing a CD into the dashboard player, he punches up his favorite current song, Bob Dylan’s 1983“Blind Willie McTell.” Dylan looks out the window of his New Orleans hotel and sings homage to the man he considers the finest blues singer of them all, a man who drew upon the traditions of the Delta. Dylan’s song comes out of the pickup’s tinny speakers:

Well, God is in heaven
And we all want what's his
But power and greed and corruptible seed
Seem to be all that there is
I'm gazing out the window
Of the St. James Hotel
And I know no one can sing the blues
Like Blind Willie McTell

There’s no money in singing the blues. And there is no money in restoring wetlands. But that doesn’t stop these people. Cautioning his volunteers against alligators, snakebite, and sunburn, Richard wades out with his crew to plant the grass he has grown from seed divisions.




* Mead, Margaret, Foreword, in Zborowski and Herzog, Life is With People: The Culture of the Shtetl, New York, Schocken, 1973, p. 11.


Common Ground is a nonprofit community organization founded by Malik Rahim. It welcomes volunteers and contributions http://www.commongroundrelief.org/

On Acupuncture (1992)

A Letter to Ivan Illich on Acupuncture
1992

David B. Schwartz


A few days before Christmas, the evening before my then wife Beth was to
get on a plane for Cincinnati, she was suddenly afflicted with a severe,
unremittting, pain in her left arm. We knew what it was because she had had
it before, exactly two years ago. It was a pinched nerve in her neck. Then she
had spent six weeks on her back on painkillers, and the siege had left her with
a deadened nerve. Now it had come again, this time even more severe. And
this time there was another thing: Beth was six months pregnant. It was a
holiday weekend, and she was in agonizing pain.

When you suddenly are faced by a loved one who is an extreme and
possibly dangerous medical situation, you reach for everything to help
healing that you know. You call the obstetrician, of course, who digs up a
neurologist to meet you at the emergency room, and then you deal with the
bureaucracy of the emergency room, which is all jammed up with poor people
whose kids have the flu and who have no money to see a doctor, and you and
the neurologist have to wait to get together because you have to go through
triage to get a room. And of course when he examines Beth you have to think
to yourself that he could have talked with her and checked her reflexes in the
hall, or in a booth of the corner diner, or even in our own home. He gives her a
prescription for codeine, which you can get over the counter in other
countries and which I now know is of course is inferior to opium by
inhalation, which has been illegal ever since the Chinese built the railways. The
doctors can't do a Magnetic Resonance Image test because Beth is pregnant,
and they can't of course do surgery unless it's an emergency, since she's
pregnant. So I bring her home to lie in bed on a special pillow and suffer the
pain and see if she gets better or worse. If it gets bad enough so that she
loses bowel and bladder function, we're to call. As it turns out it gets worse,
but not worse in that way.

We started with our chiropractor, who was very helpful but who could not
affect the problem with the sensory root, then went to the neurologist, as I
described. The pain intensified and Beth started visibly sinking in color and
vitality, and started to cease eating. It got pretty scary. I called up my
mother, who drove down and immediately took over the kitchen and bought a
soup chicken. I got Beth's closest sister, who is a neurological intensive care
nurse, to get on a plane and fly up from Florida. They were on their way now.
Finally I called up my friend and master acupuncturist Bob Duggan at home
down in Maryland. Bob grasped the situation immediately in a very broad way,
and gave me some acupuncture points to start massaging. And because Beth
could not move, let alone travel two hours, he did something that was to me
just incredible; out of friendship he got in his car and he drove all the way up
here on a Sunday afternoon and treated her right in her own bed. After that
point she started to get better, and Beth's sister Joanie arrived and started
arranging ice treatments and traction and all sorts of other nursing things
and my mother made delicious meals that sparked Beth's appetite. Soon what
had been a very scary, sinking situation in which we were alone and sliding
slowly towards surgery and the potential loss of this child started to be
reversed. After a week and a half, for the first time, Beth got up, walked
downstairs gingerly in her neck brace, and joined us for dinner.
So that is what happened.


Caring and Compassion

A friend of mine named Seymour Sarason once wrote a quite wonderful book
called Caring and Compassion in Clinical Services. In it he examined the
frequent complaint about modern medicine; that doctors were increasingly
distant, technological, and lacking in real compassion. Of course he ended up
looking at what he called the "disease of professionalism," a subject that I
have learned so much about from both he and Illich. In the people involved with helping
Beth there was a great range of caring and compassion, and I think a certain
theme emerged. The obstetrician is an excellent person, somebody who would
talk to us directly at 7:50 on a Sunday morning, and who could rustle up a
neurologist, something we would have been unable to do directly. But she was
a medical specialist; all she could do ultimately was make a referral.
Dr. Shaffer, the chiropractor, was much more accessible; he lived above his
office, he answered his own phone at home, and he immediately opened up his
office and saw Beth; twice on one Sunday. He was personal and concerned.
Perhaps above all, he touched; his fingers ran up and down the surfaces of
my wife's back, bringing up a picture of the minute alignment of vertebra, of
muscles in spasm. He hammered tiny light vibrations into the resonance of
muscles and bone and nerve, attempting to change their tune, head cocked to
hear like an intuitive piano tuner. But while he worked, while he figured, his
fingers, his hands, his close presence reassured, cared, and made evident his
desire to cure Beth, this particular person in this particular distress here on
his treatment table.

The neurologist was a nice, evidently kind, but somewhat distant physician
who was not in a rush. We saw him later at his office. He sat behind a big
desk; we sat on the other side. Then Beth sat on an examining table and he
briefly checked her reflexes; yes, some further deterioration was taking
place. Neurologists, even within the medical profession, have a reputation for
being cool, emotionally isolated, "cerebral." Surely he was picturing a lot from
his verbal and brief physical examination. But the main difference from the
chiropractor was pointed out by Beth as we walked out the door of his office.
"You know," she said, compared to Dr. Shaffer, he hardly touched me."
In fact, the only kind of touch proposed was that which was scheduled for
two weeks if she did not get better; an electromyogram. Beth had had this
before; what it consisted of was sitting very quietly while the doctor drove
steel needles into the muscles of her already throbbing arm, moved and
wiggled them around, while ink lines were made on chart paper. This would tell
us with some accuracy if deterioration was taking place in the motor root. I
already had noticed that Beth did not have the strength in her left hand to
squeeze the toothpaste tube, so I knew some deterioration was taking place.
This was not very accurate, of course. But for what end accuracy in this
case? If the only treatment was referral to a neurosurgeon, and they won't
and shouldn't do surgery anyway, why do the test? It was in this instance
that your phrase "medicalized torture" came to mind.

Then, at the most desperate moment, Bob Duggan appeared. I thought it was
tremendously interesting, as I sat in the room watching Bob examine and
treat Beth, what was taking before me. For Bob was not sitting in a chair by
the bed; he was leaning over, and crawling around on the bed on either side of
her, and behind her, and scrunching up against the headboard to get to and
reach the right places; touching, testing, probing, looking in her eyes, at her
face, inserting needles, massaging points, tracing meridians. There was no
professionalistic barrier at all. He was just my friend Bob, up here to help
Beth. Flat on her back, in bed, was where she was; therefore he had to drive
all the way up here, come to her bedroom, and get onto the bed with her.
thought what the neurologist might think if I proposed that he should do the
same. He would, I am sure, be stricken with anxiety! But this is what
had to be done.

Bob was with us all of the time; as guide through this experience, as helper an
interpreter. He would call every morning to talk to Beth and see how she was
progressing. After this one treatment, things really got stirred up and begin
to move around. For the first time she got pains in her other arm. Her skin
color started to improve. Then she started to get well.

What about Joanie, Beth's sister, the nurse? She immediately came in and
kissed her and hugged her and started treating the spine aggressively with
icepacks, lovingly and firmly helping Beth to stand them because the cold
hurt at first. As the pain started to ebb slightly, she lured her through the
risk of more excruciating pain to try some hours without codeine. They got
so she could be out of pain if perfectly immobile; then the next day up to eat
breakfast, then a brief journey out of the sick room downstairs, then a rest;
now take the codeine now before it starts to hurt; now let's do traction.
Aside from her intuitive and skillful nursing gifts, the kinds of practical
things to help of which the neurologist apparently knew nothing, Joanie, like
Bob, was where Beth was; in the bed, snuggled up in my ordinary place,
drinking coffee together, watching movies on the television, talking, napping. I
could see that Joanie was not only giving her nursing care, she was coaxing
and luring Beth out of the paralysis and pain she had become encapsulated in,
back tentatively into the world of upright movement.
In asking Joanie about what she was doing, she replied that she wasn't sure
she really knew, completely; it was intuitive, it was seat-of-the-pants. "The
main thing," she said to me, "is that when you start helping someone, anyone,
they have to know that you are absolutely there for them, you are in this
with them, that even if you're not exactly sure of what to do you are not
going to retreat and go away."

Finally, there was my mother, who works most winters caring for elderly
wealthy people in Florida. There was chicken soup, and more chicken soup,
and roast chicken, and snack trays brought to the room, and daily trips to
the grocery store to bring back mountains of stuff that I was just
confounded we could need all of, but it was as if she was going out to gather
sustenance, activity, color and smell and taste, to bring the wind of life into
the house that had formerly been so sick and still. We had a birthday party
for my mother in the midst of it all, right around Beth's bed.

Now each of these people, these healers were, it could be said, professionals.
But what an incredible range there was. What was the essential difference? I
must say, I was impressed with what seemed to be the influence of
economics. The one who was the strongest part of the economic system, the
neurologist, with his office and his instruments and network of referrals and
need to see patients in the emergency room, was the least influential of the
healers. The chiropractor, who lived above his office and who really
had a healing touch, was much more of a simple "tradesman." But the real
healing presence came from Bob and Joanie, who had no economic connection
at all. Joanie, of course, because she was Beth's sister, who Beth in turn had
once cared for and run her pig farm when she was laid up. The unexpected
event here was Bob, a friend who I had met through a friend in faraway Lee
and Manfred's and Ivan’s apartment in Oldenburg, Germany. Who would leave
the clinic, the desk, and just come. For what? I would have to ask him. For
care and compassion? Surely. But primarily from philia, because we were
friends and when I was in distress and called him he not only talked to me, but
he came.

This also reinforced something that I have been thinking about much lately;
that under the smothering and distorting layer of economics, of the
commodification of care, that here and there the caring, skilled, ethical
professional clinician can still be found to exist. They are a fragment of an
older culture of healing not yet displaced by modernism.


Which Body?

I had thought a bit about compassion and clinical professionalism before, of
course, so these events served mostly to help me notice a few finer points
about it. What was completely new to me was the evident and striking
difference in the body of my wife that each of these clinicians saw.

I began to see for the first time what my friend Ivan Illich was pointing to in
his work on the 'history of the body." And I had recently read a book by his
and my friend Barbara Duden. One phrase which kept coming back to me from
it was her realization in The Woman Beneath the Skin that in reading about
the bodies of 18th century Frenchwomen that her own experience of her
body was useless as a basis and guide. Visiting Bob Duggan’s school of
acupuncture I began to hear about this very unfamiliar acupuncture body,
which was similarly different from the allopathic medical body I had been
trained to see, and which I unreflectedly thought the body was.

Here all these acupuncturists were talking about six superficial pulses on each wrist that I had never even heard of. Of qualities of fire and of wood. They were talking
about a body I had never seen, but which was very evidently there.
In the space of a very few days, I saw three practitioners examine my wife as
I watched. I tried to follow along and picture in my mind what they were
seeing. The chiropractor, as I mentioned, followed the alignments and
movements and tensions of the body with a delicate sensing hand. It was
clear that he could feel the spine as his hand rippled along it; all of its fine
bony edges, where the nerves inserted; how the slight turn of a foot turned
up the tension in the right shoulder just so. The neurologist's body, in
contrast, seemed very abstract. He didn't need to touch it. From my own
limited training in that area, I could I think picture what he might be seeing.
There were all of these neurons, and synapses, and disks. It was a cool, clean
wiring diagram of sorts. The neurologist's icon for the body seemed to be the
computer-generated images of the MRI, showing the solid architecture of the
body, the map the neurosurgeon clipped to the back-lit screen before he
began to cut.

In the body seen by the neurologist, the fact that my wife's skin had started
to get pale and flaky at the same moment that the pain had started, or the
fact that her head was chronically congested, or what might be happening in
her emotional life when this pain erupted, were not part of his picture of the
body; they simply didn't exist. Even my wife's good obstetrician, when
questioned about the skin change, suggested she see a dermatologist if she
really wanted to pursue it. These aspects of the body were apparently part
of another specialist's picture. And all pictures in allopathic medicine seemed
to be taken at extreme magnification, like a snapshot with the wrong lens
that turns out showing only somebody's belt buckle, with their head and feet
beyond the frame.

Then there was Bob's picture of the body. Trying to follow what he was doing,
I watched him closely. It was clear that the body he was working on was
almost a completely different body that the body of the neurologist, and very
different in many ways from much of the chiropractor's. He put tiny needles
in the right arm, and made the pain in the left arm moved around. He showed
me where to press under the right armpit to reduce the pain in the left arm -
and it did! He had me massage a point near the right collarbone, and Beth
reported a warmth going down her left arm, ebbing away the pain. He saw the
fact that the pain was moving around as good, and helped I think to free the
energy up so that it could move around some more.

To Bob, the skin and the congestion were intimately connected; breathing
related to ability to heal and reduce inflammation, something that must be
opened up. He saw drinking hot things and avoiding cold as things that had
effects on the body before him. He looked at Beth's eyes; asked about her
energy level, saw the health crisis as a process with the nadir behind us, and
stirred the fires of healing. Even to the small extent I could follow the image
of the body he saw in my wife it was quite astonishing.

I began though this to see a little bit of what Illich was talking about in
examining the certainty that I had assumed to be the body. Can I say that the
body is a participatory creation? What a wonderful body the body of
traditional Chinese medicine seems to be. In the allopathic medical body,
there is no way of healing in this case but rest; no way of controlling pain but
giving the entire central nervous system a mild painkiller. In the acupuncture
body, I sit and massage points on the foot, wrist, and breastbone. When I
move the latter, my wife's breathing instantly slows down and deepens, the
tension starts to go out of her body, and the pain subsides a bit. I put my
hand on her swollen stomach. Every time I massage the breastbone, the baby
kicks.

Community

I did not consider myself to have deep roots in the community of Harrisburg
back when Beth was sick. So it really was a kind of a surprise to me to learn
what connections we actually had when we needed them so much.
Since we were unexpectedly at home for Christmas with nothing much in the
house, a friend from my office dropped by with a complete Christmas dinner
that we could eat on the bed. Jack at the pharmacy on the corner ordered
the special pills Beth needed. When I stopped by our neighborhood Greek diner
to pick up a milkshake to try to get Beth to eat something, the owner
refused to charge me for it, sending it along with get-well wishes. Since funny
movies helped distract Beth from the pain, I'd go over to the little movie
store on the next street to get her daily "movie prescription" refilled. Every
day the owners, true movie fanatics, would debate what would be the best
"classic" to send over, and inquire how she liked the last one. After a week,
they started to keep a list of ideas they had on the bulletin board behind the
counter in preparation for my evening visit.
The most moving thing, though, was Mary and David's visit. Two years ago
when we were in town alone we had a homeless mother and her three kids
over from the shelter for Christmas with us, and we became friends. We
helped them to get out and to set up, and I had thought to myself that this
Christmas they would again be celebrating it in their own home. We hadn't
seen them for a while but then Christmas night Mary and her oldest son David
rang the doorbell to come and wish us Merry Christmas and bring some gifts.
They had heard Beth was ill from a friend who runs a stand at the market.
Them reappearing was really the nicest Christmas gift of all. We had been
there for them, I guess, and they were there for us. We were there for each
other.

All of these things; the response of our friends and neighbors, my mother
and Beth's sister appearing, made me think about something that Illich said
once; that culture was ”that with which we faced illness, suffering, and death.”
I had thought that this seemed a somewhat unusual definition of culture at
the time. This experience brought home to me in a deeply personal fashion
how all we have to look to really is our culture, and that even when you think
that you are in a place where there is not much surrounding you there is
often more than you think.

Everything good that happened to us through this; Bob's trip up, the help of
family and friends and neighbors, took place within the realm of friendship, or
family, or neighborhood. And even the useful clinical help we received was
cultural first, and professional second.

A month or two later Beth was much better. In fact, she seemed completely
recovered. We had since seen a neurosurgeon, and he told us that despite the
lack of pain there was progressive motor loss, and that if she did not have
surgery after the baby is delivered (presuming there was no recurrence
before) that there was a danger of becoming significantly disabled. It was a
worrisome prospect. He seemed quite sure. He looked at the MRI (seeing,
incidentally, a different structural problem than the other physicians read
there) and there the problem was, plain as day. Perhaps, I worried, he was
correct.

Neurosurgeons are trained, and skilled, and can see something - the nerves -
much better than I could. But I, I learned, could see something that he could
not; that the body which he saw and accepted with such certainty is only one
body of many. There are many healers, and correspondingly many bodies. And
beyond the individual body, there is also the vision that includes the person,
physically, psychologically, spiritually (to use the closest available terms) as
one part of a network of others of which this body is inextricably part, such
networks themselves being part and expression of a larger culture of
meaning. Perhaps, I began to understand, culture is not only that with which
we face illness, suffering, and death, but that which defines these very
experiences. It is culture, after all, that gives us the specific bodies that we
are so certain that we have. This helped me to reflect more about why in my
own work on healing I have been so continuously drawn to the structure of
culture, rather than to the structure of nerves, whence I started twenty-five
years ago.
Our son Nate, who was three months away from his birth when Beth was sick,
is now ten years old. And Beth is fine. She seems just about as strong with
her left arm as she is with her right. Maybe a little less; I don’t know. She
carries heavy things around and doesn’t favor one arm. So I guess it remains
no problem for her.

She does have a problem every once and a while. Her back starts to knot up
in the same way that preceeded her terrible attack. Curiously, it is always at
the same time; around the winter solstice, when the days are shortest, a few
days before Christmas. She always tends to slow down, rest, and take a few
days off work. She gets some chiropractic adjustments from Dr. Shaffer,
and maybe a massage. Sometimes we used to drive down to see Bob for
an acupuncture treatment. The pinched nerve has never, so far,
come back. We felt lucky.

When Christmas comes, though, we always used to think back on what
happened that Christmas tenyears ago, when Beth didn’t have surgery after
all, and I learned so much about our bodies and about our community.


Previously published as: “An Occasion to Think About Healing: A Letter to Ivan Illich.”
The Journal of Traditional Acupuncture, XIV, 2, Spring, 1992, 15-18, 49-50. Excerpted in Quintessence, 13(2), 1-2, as The Acupuncture Body.

Woodstock Sells Out (1999)

Woodstock Sells Out
Ithaca Times, August 8, 1999

David B. Schwartz


In 1969 My brother Dan and I went to Woodstock. In July, thirty years later, we went to different music festivals in upstate New York: he to the Woodstock revival in Rome, and me to the Grassroots Festival of Music and Dance in Trumansburg. What we saw this time could not have been more different.

There has been a lot written about the original Woodstock, because something extraordinary happened there. People have various opinions about what it was. I’ll give you my own opinion, forged on the scene. The sixties were a period of time in which there was great estrangement of young people from the prevailing structures of the society. The Vietnam war, the military, police, government, corporations, careers, - all were rejected as false preoccupations with money, power, and “things.”In Dustin Hoffman’s movie [ital] The Graduate, the confused young graduate is advised soberly by an “organization man” that the secret of the future was [ital] plastics. “Don’t trust anyone over thirty,” we said, and believed it. The old world of organization men was over, and a new world of peace and love were at hand.

This was hopelessly naive, of course. But there was one moment in which the possibility could be glimpsed. The hundreds of thousands of people pouring into Woodstock completely washed away any semblance of structured authority for managing people. Police, overwhelmed, were on their own in the midst of the flood. Although police were widely distrusted - even hated - in the sixties, I remember a scene of a group of kids pushing a stuck police cruiser out of the mud. Without the trappings of power, they accepted the officer as a person - and extended a hand to him. He might as well relax and enjoy the music. He wasn’t going anywhere.

In the sixties there was a popular Rousseauan belief that if people just set aside the moribund world of power and management and money, that community would take care of everything. At Woodstock, for a brief moment, this was true. Everything was free. Abandoned to the care of each other, we took care of each other. The tribal instinct of people surfaced, and community worked. I remembered standing in the rain and mud, looking out over the hillside of people, and thinking “My God, it is true. This does work! Without organizations things [ital]were better! It was a moment in time. But social history did not go forward in that way, not in that way at all. It went back to money and power and organizations as never before.

Thirty years later, the same producers, now in their early fifties and presumably wiser, held another “Woodstock.” This time they ensured that everything was securely under control and that everything made a profit. They held it on an old military base double - fenced with razor wire on the outside so nobody could sneak in without paying. They ran everybody through metal detectors. They forbade anyone to bring supplies in. You had to purchase everything at the prices demanded. This was a moneymaking enterprise. Whether high gate fees, exclusive television access to young women with their shirts off, or 8oz bottles of water for $4, it could hardly escape anyone’s mind what they were ultimately there for - they were there to be a captive audience for people to make money from. The symbolic presence of bank machines helpfully scattered throughout the grounds could not have been more pointed. Take your money out and spend it here! When the riots broke out, the looting of the bank machines could have not been more pointed either. At the original Woodstock, money was of little use. A commune, the Hog Farm, gave out free food. Thirty years later, nobody was giving anything away for free.

While my brother was at Woodstock, my friend Cosmic Bob and I went to the Grassroots festival together, as we do each year. Unlike the one in Rome, this one was so much like the feel of the original Woodstock that it was stepping into a time-warp, even if many in the festive crowd hadn’t been born yet when the original took place. People wandered freely, listened to music, shared their food and their tents, kept an eye on each other’s children. “It’s Woodstock with nose-rings,” I remarked to my friend Bob.

There are those who claim that the riots at the ‘90s Woodstock show that kids are just different nowadays. And different they are, surely. It is a far different time. But the behavior of the same kids at a festival not 100 miles away showed that this is not the point at all. The point is that if people feel that they are citizens, involved in a community-sponsored event like Grassroots, they behave like citizens. If they feel like they are just consumers, being milked like so many cows, then they just may kick over the milking stands. You just cannot manage people for your own economic benefit without running the risk of them exploding, no matter how many security police you employ or how high fences you build. Whether the American Revolution, the French Revolution, prison riots, Columbine High School, or “Moneystock,” as some dubbed it, the managed approach blows up in your face - eventually - every time.

Cosmic Bob and I stopped by a fence to chat with Tommy Mann, who runs the security detail every year for Grassroots. An old hippie, Tommy has the kind of mind that would have made him a chief of detectives in another age. Casually leaning against the fence, his long blond hair brushing against his Tee-shirt, a small radio poking out of his back pocket, Tommy chatted with us, while scanning the crowd and missing nothing. For here and there, there might be somebody who hadn’t heard the news that we all looked out for each other here. When they acted on that belief, a few of Tommy’s orange shirted volunteers would materialize and expel them through the fence. You needed just a little managed security, and Tommy and his folks provided it.

Tommy, and everyone at the Grassroots festival, know that if you try to manage things too much, that you’ll spoil the fun. Besides, what kind of a festival would that much management make? The answer is Woodstock 1999. It’s like what’s happening to the practice of medicine under HMOs - all the caring is being driven out of it. It’s not surprising, I guess, that if some people think that you can produce care through management that you can even produce a music festival in this way. Bob and Tommy and I chatted about the Woodstock festival then taking place concurrently - this was before the ending riots. It hadn’t attracted any of us. “HMO Woodstock,” Cosmic Bob called it. I guess that if an HMO produced a music festival that’s just what it would look like.

The Cafe Cure (1990)

The Cafe Cure: or, Take Two Cappuccinos and Call Me in the Morning

David B. Schwartz

Coffee is a powerful drug. I am not talking here of its well-known ability to increase alertness, keep one from nodding on one’s desk in the afternoon, drive that extra hour at night. Rather I am speaking of its less-acknowledged but no less powerful stimulant qualities: the ability to stimulate conviviality, assuage feelings of isolation and loneliness, even perhaps arm one for the personal irritations of the workday. These effects are not captured in formulaic descriptions for the chemical caffeine: C8H10N4O2. For this, chemical analysis will not suffice. To get these effects, coffee must be taken in the company of others.

Each morning in Harrisburg, the daily ritual of people part of this “drug culture,” (as the anthropologists might put it) is repeated. Tables fill up at the Alva Restaurant across from the train station, at the State and the Colonnade on Second Street, and scores of other places “where everybody knows your name.” In recent years, this ritual has blossomed in the emergence of a phenomenon which residents of Seattle or Paris or Vienna could possibly do without: the neighborhood cafe. At places like Sweet Passions on Third Street or The North Street Cafe, coffee is drunk and banter exchanged. Yet there is more going on than meets the eye. For in this casual “wasting of time” may lie a potent inoculation against some of the more pernicious diseases of modern living.

You don’t have to be a particularly astute observer to recognize that the modern world is obsessed with the feeling of stress. In fact, such stress, as well as feelings of isolation, disconnectedness, and loneliness, are virtually epidemic. An ever-escalating offering of stress-reduction programs, therapies, legal and illegal drugs, and wide-screen TVs attempt to assuage such feelings. The bottom line, however, is that they often don’t work. This is because of the simple reality that people were born and bred to be part of community, to feel they are members of a tribe, to eat and drink and celebrate and suffer together. Alone, they are as bereft as the last of the passenger pigeons, or one bee in a hive. Alone, they grow so isolated that they sicken. Many prescriptions can be offered for this sickness. Yet almost free - if not free - treatments exist for the price of a cup of coffee.

Available Without Prescription

People are suffering severely from the loss of a sense of connectedness and community. This is increasingly shown by research. While it may be surprising, for instance, to read medical studies showing that participation in a support group improves outcomes for women with breast cancer, this can only be news to a medical system that has believed the historically recent idea that disease is a phenomenon solely of cells, heredity, and chemicals. By reversing the interpretation of support groups, one might claim that the “tribal healing effect” is so powerful that it can even be observed in a hospital. Can it be that a short time in a cafe in the morning increases your resistance to disease? In fact, there is some medical evidence to indicate that this may be so, and research on this very phenomenon may verify what common-sense knows to be true.

Here in Pennsylvania, for instance, there is the well-studied “Roseto Effect.” Starting in 1961, medical researchers became transfixed by this small, Italian-immigrant town in the Poconos. In Roseto, unlike in neighboring towns, the state, and the nation, residents seemed nearly immune to one of the most common causes of death: heart attacks. People died of heart attacks at a rate half of the rest of the country. In Roseto, unlike elsewhere, there were more widowers than widows.

What could be causing this dramatically higher level of health? Researchers swarmed over the town, giving physicals, measuring cholesterol, following women into their kitchens to watch them cook. People who lived in Roseto, it turned out, smoked and drank wine freely. Well, the researchers thought, maybe it’s the olive oil - based “Mediterranean diet.” Then they found that the groaning tables of Roseto weren’t the product of olive oil - that was too expensive. In Roseto, meatballs and sausages were fried in lard. It didn’t matter. So it wasn’t about serum cholesterol, apparently. What was it about? Roseto, it turns out, was an outstandingly tight-knit community. Everybody knew everybody else. Family homes held three generations. Meals took hours. Nobody applied for welfare. Concluded long-time researchers Drs. Stewart Wolf and John G. Bruhn (the latter now Provost of Penn State’s Capitol Campus): “People are nourished by other people.”


The application of this once universally-known truth was summarized by sociologist Dr. Ray Oldenburg in his aptly-named The Great Good Place - Cafe’s, Coffee Shops, Community Centers, Beauty Parlors, General Stores, Bars, Hangouts, and How They Get You Through the Day (Paragon House, 1989.) If home is your first place, and work is your second, Oldenburg claimed, then cafes and corner taverns were a “third place.” A healthy society depends upon a balance between these three kinds of places. In Britain, everyone has their pub. In France there is still one cafe for every thirty-two adult citizens. But in America, inhabitants have increasingly tried to survive with only two: home and work. It is unlikely, Oldenburg cautions, for either a free society or an individual to survive on such a lean diet of meaningful community contact. It’s almost enough to make a person depressed.


Homespun and Professional Treatments

Depression - in fact all so-called “psychiatric” phenomena - are extraordinarily individualistic and complex. As an analytic psychotherapist, I treat people’s serious depressions, depressions which are significant, painful, and sometimes even life-threatening. For such depressions people are ill-advised to “buck up,” “slow down,” or even drink coffee. In serious depression, among other painful symptoms, all the color, verve and energy of the world can simply fade away. But a depression always tells us something about the struggle the person is in, as well as the society in which he or she lives. It is often an attempted solution to an essential problem. And it is undeniable that simply living in the modern world presents essential problems.

It is far from uncommon, for instance, for a person with far too much to do, who is plagued by feelings of isolation, and who is suffering in other ways, to walk past one or two convivial cafes on the way to fill a prescription for an antidepressant. Antidepressants are marvelous things, particularly for serious depressions, but one of their characteristics is that they often work even if taken alone in one’s lonely apartment. This is not true for coffee.

This is not to simplify the problem of depression and other afflictions. But, even in the many instances in which a convivial half-hour with the regulars in a cafe might produce miracles as great as Prozac, it simply seems impossible for many people to take that half-hour for themselves. Being driven has become unremarkable. Getting to the office a half-hour early to beat the rush has become quite common, even if it results in insomnia or an ulcer; coming in a half-hour late by way of the cafe is much less so. Yet despite fortitude and determination, there are many sensitive people who are unable to live in this incessantly busy, lonely, way.

The fatalities of the pressure which characterizes today’s American society reminds me of people with anexoria nervosa, “fasting girls.” Women with this extremely serious condition diet to the point that they can die. It is a peculiar form of death by malnutrition, for it is starving in the midst of plenty. Clinical work with such women reveals that they maintain a fixed idea that they are overweight, despite the evident fact that they are thin as rails, to the point that they weaken, to the point that their menses stop. It is the frightening consequence of a false idea. It is, as many observers have pointed out, a disease which only could emerge in a society obsessed by thinness, especially for women. No Eskimos ever had anexoria.

Likewise, overwork and incessant business have become so normal and accepted that people can starve themselves of the company of others. They rush past the cafe with the firm idea that they have too much work to do, that they have no time, that they must eat lunch at their desks. After a time, these people may go to their doctors for ulcers or depression or panic attacks or some other symptom that, insistent as an oil light in a car, is telling them that their bodies, minds, even souls, can simply not keep up the pace that they have set.

So, wake up. Disregard the incessant internal and social voices. Start leaving work early one night a week and go to the model train club, or the bowling alley, or take all the kids to see the Senators play baseball on City Island. Resolve that, barring emergencies, you are going to stop at the neighborhood cafe or diner at least three mornings a week to catch up on the local gossip. You may start to feel a lot better.

If you still feel driven by pressures, good professional care may be helpful. When it works, you may find yourself walking down the street, looking at the birds circling overhead, stopping in for some coffee and a glance at the morning paper with a new spring in your step, a new ease in encountering each day. But if you are not sure that you need this, try something close at hand and see if it works for you. Take two caupiccinos and call me in the morning. It might just work.

ICU Psychosis (1999)

Intensive Care Psychosis
David B. Schwartz
December 19, 1999




Driving a person into a psychosis usually takes years. Also, you usually have to start young. I am a psychotherapist; I treat people with psychoses. So I was astonished to see my mother, before me in the bed in an intensive care unit of the Cleveland Clinic recovering from abdominal surgery, in the midst of a full-fledged psychotic reaction. She hallucinated floridly, seeing people who neither I or the nurse could see; she stared fixedly at my face, describing how she could see right through my transparent jaw to my spine. She was preoccupied with something that I couldn’t make out about a hurricane. “Help! Call 911! “She yelled at me as I was outside her door speaking with the resident doctor. “These people (she meant the nurses changing her intravenous lines) are killing me!” She was delusional and sometimes panicked, but was too weak and groggy to be able to get up.

Around her, dozens of electronic instruments blinked and beeped. Monitors called out when her pulse rate went high, or low, or her breathing rate changed significantly. Four or five IV drip regulators signalled insistently when something stopped up or went wrong; these were a lower-order sort of alarm that the nurses could attend to when they had a moment to turn to something less pressing, so they often continued, ignored, for a long time. The nurses, one to each two patients, moved constantly, adjusting their charge’s physical parameters and needs. I sat by the bed, talking to my mother in a soothing, hypnotic voice, suggesting that everything was all right, that there was no hurricane here, only in her dream, and that she could rest and get better. Then she would go to sleep again, and into troubled dreams, eyelids flickering like some dog by the fireplace chasing rabbits, or maybe being chased.

The next day, when my mother was physically well enough to be transferred to the regular floor, her psychosis was still florid. But now she was stronger. She demanded her coat so she could go out for dinner. She wanted the bars on the side of her bed down; when the nurses and I said that she really had to stay in bed, she ordered me to get my toolbox and take the bars off. My ability to calm her waned. When I went out of the room for a minute she tried to crawl out between the side rails and the footboard, pulling her IV lines out in the process.

Unable to control her now myself I demanded the resident doctor on call who, with admirable patience instead of drugs, which he explained would depress her already diminished breathing ability, managed to talk her fully back into bed and reluctantly ordered body and wrist restraints until the psychosis passed. “It’s ICU psychosis, certainly, he confirmed. We see it all of the time, especially in older people.” “How long does it last?” I asked. “They have to experience a day and a night,” the nurse interjected. They have to see the sun come up and go down and come up again. Up on the ICU there is no day and no night. And it’s noisy and busy; they can’t sleep.” True to their predictions, a tumultuous day later my mother’s psychosis started to break up, leaving much residual confusion and alarm.


What Causes ICU Psychosis?

Everyone that I talked to, both doctors and nurses, instantly identified my mother’s psychotic break as an ICU psychosis. It was, in fact, apparently unremarkable to them. They see it constantly. But what was unremarkable to these clinicians was remarkable to me. What immense pressures must be operating to jar someone into a psychosis so quickly! This is almost unheard of elsewhere. At first, I assumed that this must be a toxic reaction of some kind, or a neurological event. Such things will produce a psychosis this quickly. But I was reassured by those who saw it daily that, despite the alarming symptoms, it was not toxic or neurological, and usually dissipated after a little while. Although when I first put the question to the resident doctor about its usual duration, he admitted that he did not know. It only dissipated after patients had left the ICU, he pointed out. He, himself, was always in the ICU. So he really didn’t know.

Everyone agreed, however, on the various factors that seemed to go into the potent mix which produced ICU psychosis. First, there was usually age and some fragility, together with the patient’s own pre-operative anxiety. Then there was anesthesia, which took a while to completely wear off and get out of the bloodstream, and the trauma of the surgery itself combined with post-operative pain medication. In addition to these primarily physical factors, there were others inherent to the ICU environment itself. The ICU was a self-contained, brightly-lit world in which the normal rhythm of days was suspended. Things hummed on endlessly, day or night, weekdays or Christmas. There was the busyness of the staff working tirelessly in shifts to keep the person alive, attended by the constant beeping of clusters of machines around the bed. There were dozens of unrecognizable people constantly disturbing and touching you . There were staff conversations at all hours and the checking and administration of medications 24 hours a day, making it almost impossible to sleep.

Research on ICU psychosis has attempted to weigh the various factors in the ICU experience to determine which is most influential. Perhaps it is the loss of a 24-hour circadian rhythm, some speculate, or the constant bright lights. Others have shown the importance of the sheer level of noise in an ICU, which approaches the din of a subway. Staff conversations are the most disturbing of noises, they found, and one hospital implemented programs to reduce noise in such units, with successful effects. Sheer sleep deprivation due to noise, apparently, may be the biggest factor in inducing a psychosis; in one study one-third of people who were sleep-deprived developed psychosis.

The possibility exists, however, is that it is none of these individual factors that precipitates ICU psychosis. Instead, I wonder if perhaps it is the cumulative effect of all of these disturbing factors, these necessary side effects of life-saving treatments, that together knock an old person loose from their moorings. Taken individually, all of these treatments have side effects which are manageable. When they are applied together, however, it is possible that a strange thing happens: beyond certain level, these individually healing factors combine to produce an environment of a fundamentally different nature: one that has a decent chance of saving the person’s life while driving them briefly out of their minds.

Perhaps it is in the ICU, I realized, standing there caring for my delusional and hallucinated mother, that the ultimate effect of an intensive caring environment may be seen. How paradoxical, I thought: out of such incredible, lifesaving care should come an environment that the human mind can simply not bear.


Effects on Staff.

One thing that struck me immediately about the intensive care unit was the astonishing compassion and dedication of almost everybody I met. There are many complaints these days about a lack of compassion in medical and other service environments , but this was undetectable to me here. The nursing staff and the doctors, charged to maintain life in people who were at a high risk of dying any minute - and who did die, every day, despite the most heroic of efforts, showed the seriousness and commitment one sees only in MASH units on TV - and without the lulls in the action. Residents virtually lived in the hospital. Nurses came in even if they were sick. There are few places in society in which people work with such undying commitment, with such unslacking effort, without a break. It was simply inspiring.

I tried to imagine going to work every day to take responsibility for people who were, by definition, at the very edge of death. One error, perhaps one personal trip to the bathroom, and they might die. Many of them would die anyway. In this ICU, virtually everyone was elderly, very sick, with many things wrong with them, who had just endured yet another major surgery. After one of these surgeries, they would probably die here. If there was a complication, they might be rushed back to surgery. “Here, If it can be done, it will be done,” admitted a young nurse, who talked with me during a rare pause late one night. The atmosphere of sedated agony must be intense, despite being punctuated with the relief of people who recover to go home like my mother. “I just try,” the nurse admitted startlingly to me, “not to get too attached to them.” This, I realized, was not the statement of a grizzled and uncaring old veteran; this was the confession of a dedicated nurse on her first job who was trying to avoid a nervous breakdown of her own.

ICUs are, in fact, notorious boiler-rooms for staff burnout. Nurses are so much on the edge of coping, she said, that they tend to request transfers out in waves. Everything will seem to be going along all right, and one nurse will put in for a transfer. Then transfer fever will spread through the tightly knit group of women, like a rash of suicidal attempts rippling through a college girl’s dorm. Before you know it, seven nurses are gone, the place is impossibly understaffed, and you have to start all over again to staff the place.

As with ICU psychosis, there apparently are a variety of theories to explain the high turnover. Certainly, it is “stressful,” to use the contemporary term. But I wonder if the same factors that make the ICU so difficult to bear for patients may have a similarly powerful effect upon the staff. They don’t go psychotic, of course, but apparently many people find the environment similarly impossible to bear over the long-term. There were no nurses over the age of 35 there, I noticed. The longest-tenured “veteran” nurse I met was a twenty-something woman who had been there six years.

The Loss of Proportion

The problem of ICU psychosis arising in intensive care units, it seems to me, captures the dilemma of what happens when you make care settings steadily more intensive in response to “need.” John McKnight pointed this out in relation to social services in a community; if you keep intensifying services around a person, eventually you pass a threshold in which people are no longer connected to the world, because all of the services surrounding them have combined to create a new and artificial environment. Sitting in the intensive care unit in Cleveland I realized that this process of intensification reaches its apogee in ICUs. It is here that one can observe the logical endpoint of increasing professional services around a person to help them. It is here that you can observe both the blessings and the costs of combining helpful services past a certain threshold.

ICUs are a kind of “miracle pill” with one whopping side effect. “Caution,” ICU’s would say in bold print if they were pills listed in the Physician’s Desk Reference; “may cause psychosis.” This doesn’t change for a moment the fact that ICUs are literally life-saving pills. But if one looks at their application with a little common-sense, certain incongruities arise. Is the accepted level of side-effects inevitable? Or could it be reduced by the application of a little proportion in prescription-writing?

While other ICUs in the Cleveland Clinic held people who were recovering from injuries and/or surgeries for neurological or cardiac conditions, or who were in acute medical crises, the people in my mother’s ward were almost all both old and sick. Does that mean that they should be denied treatment? Of course not. But many of these people, according to the nurses, came back again and again, following one surgery after another at the end of life. This is what used to be called drawing near death, or, eventually, dying. There were a lot of people there, it seemed to me, who were passing out of this life in stages via the surgery and ICU. Were at least some of these people prolonging the agony of dying by extensive medical intervention, adding a psychosis to the process as well? It seemed to me entirely possible.

If you accept the idea that there are some people passing through ICUs and experiencing a psychosis who intensive care really can’t help much, then perhaps they could be spared this high-tech tool and the side-effects that come with it. Perhaps they could approach death with the palliative help of less injurious care, and die in their own, rather than hospital, beds.

For those for whom the ICU has real life-saving blessings to offer, on the other hand, could the environment be “de-intensified,” keeping at least some connection with the rhythms of the natural world? Others have suggested that ICUs don’t necessarily have to have unvarying white lights, no windows, and a screeching-subway noise level in which it is impossible to sleep. A sharp nurse on the regular hospital floor to which my mother had been transferred after the ICU did not re-connect a cardiac monitor. She noted that in their unit the staff had reached the decision that reasonable attention to one’s patients was really just as good. “Those machines tend to make you lazy,” she observed. “You don’t have to look at the patient.”

In fact, the general nursing text used in that same hospital in 1922 retained the idea of some judgement and balance in using the technology of the humble thermometer in attending to an unstable patient whose temperature needed to be closely monitored, the more so when it was one of the few technological monitoring measures available. In that handbook the authors advised nurses this way:

“The pulse and respiration in critical conditions are watched constantly, and even though the temperature is not actually taken because it might disturb the patient, a nurse is on the alert to note any increase shown by the face - flushing of the face; hot, dry skin; hot and tremulous lips; and rapid breathing.” [italics mine]

If a nurse from the wards of 1922 were to come onto an intensive care unit, along with marvelling at the wonderful new technology, might they also not see what contemporary nurses become inured to; that the beeping of a temperature monitor might disturb a patient’s life-restoring sleep as much as rolling them over to insert a thermometer might? It might take people from another time to notice that proportion had been lost. I suspect that one reason that ICUs are quite as bright and noisy as they are is simply this loss of a sense of proportion, or said more simply, the loss of common-sense about what a sick or injured person needs to recover. The technology is there, and so it gets used. The fact that all of this together precipitates a major psychotic break is simply something that one gets used to, like the fact that taking an antibiotic may give you a stomach-ache. A psychosis, however, is no stomach-ache.

Curious about what I was seeing of the culture of ICUs, I asked my cousin, Dr. Robert Schwartz, a hematologist of wide experience. He explained it to me this way:

“ICU-ers are a lot like fireman. There may be a very small self-contained fire in your house, but the firemen in their zeal to prevent further flare-ups, will usually take their axes and water hoses and systematically destroy whatever is left of your home and possessions, doing far more damage than the fire ever would have done. In a like way, in their zeal to treat, ICU-ers may forget what they’re trying to accomplish and endlessly assault a patient with procedures and drugs, even though the suffering becomes unbearable and the outlook futile.”

After 48 hours with the ICU, Bob made it a rule to go back to basics and decide whether it made good sense to go on. I had the feeling that if he were the staff physician of the patients in my mother’s particular ICU that it would not have been quite so full.


As I write this my mother is back in the Schuyler County Hospital near her home, recuperating until she is strong enough to go back to her apartment. It is a tiny hospital, perched on the hillside above her village of Watkins Glen, N.Y. Looking out her windows she can see Seneca Lake stretching off to the north, the same visa that she has seen and lived in for much of her life. She knows many of the nurses and doctors at this hospital; Watkins Glen is a small village, and you don’t meet a lot of complete strangers if you’ve lived there a long time. The food is enticing and good. Her neighbors come and visit her. Not coincidentally, the confusion consequent to her psychosis has faded completely. Last night she went to the Christmas dinner at her apartment complex, returning to the hospital to sleep.

Would my mother have experienced an ICU psychosis at Schuyler County Hospital? It’s not a fair comparison, really; they don’t do major surgery at such a little hospital. She had to travel five hours to Cleveland, to the big teaching hospital, to get that done. But I wonder; if her ICU in Cleveland had a view out of the window through which she could see hawks soar, would it have made a difference? If the dawn had broken each morning on a valley outside, the sun making its transit across the sky to cast the long shadows of sunset upon the far hills, would even an unconscious person know it somehow? If the lights had been turned down softly at night, the nurse padding silently in to look at her breathing, the alarms turned down or placed outside, might she have retained a thread to the rhythms of the world that had been already so disrupted by anxiety, anesthesia, major surgery, and medication?

I think that if you tried these things and conducted a study - modern medicine is guided by studies - that you would find that the incidence of ICU psychosis would decrease dramatically. In other words, people might be able to receive the good of hospital care without incurring so many of the injuries that such care now brings. This would surely be a good thing.

I think that the lesson of ICU psychosis is that professional care, concentrated beyond a certain point, becomes something that is not so good for you. Like a powerful medication diluted to the correct proportions, care can pull someone back from the shadows of death. But beyond a certain point, paradoxically, it begins to turn into something different, harmful, even toxic. Beyond a certain point it is not the world, even in small measure, but an environment. Beyond a certain point you may preserve your existence, but lose your mind. This phase-change that occurs with the concentration of care can be observed not only in hospitals, but in all settings where people are cared for, whether these be hospitals or human service agencies, mental retardation programs or schools. ICU Psychosis dramatizes the fact that sometimes too much of a good thing is not so good at all.

The Yuri Gagarin of NIH (2002)

The Yuri Gagarin of NIH
Roger P. Peters ( 1943 - 2001)



Though you are in your shining days
Voices among the crowd
And new friends busy with your praise,
Be not unkind or proud,
But think about old friends the most:
Time's bitter flood will rise,
Your beauty perish and be lost
For all eyes but these eyes.

-WB Yeats


“The modern hero is he who triumphs in the inner struggle.”

James Hillman



I only heard from Roger in times of great crisis. Once, after years of radio silence, he called from a curbside in L.A. He had just filed for his third divorce and was fleeing crazy in pain from his home in Colorado, driving his Volvo P1800 fast and living in his car until the worst of it subsided. “I’m getting divorced again, Schwartz,” he started abruptly. “I’m across the street from the L.A. courthouse. I just filed the papers. I’m heading North.” Then all was quiet for some more years. He buried himself in teaching, tracking coyotes, skiing, and writing books on cognitive psychology, trying to grab fame somehow with this next one. This was normal for Roger. He had been just this way back at New College in Florida in the sixties, when we had sat on a log by the bay and studied the emerging field of psychobiology together. Life for Roger was all full-throttle acceleration punctuated by cataclysmic crashes. As he crawled out of the latest wreckage, my phone would ring.

“Roger!,” I exclaimed with delight when the phone rang a few years ago. “How great to hear from you! What’s up?” Roger was at home in Durango. This time he did not get to the point right away. We talked of this and that. But then he blurted it out. “I have melanoma.”

I’d heard a little about melanoma, one of the most feared of all cancers. I remembered Doc Daneeka in Catch 22 was morbidly afraid of it. Doc Daneeka was a driven hypochondriac who was always sure that the latest of his symptoms were sign of some dreaded disease that would kill him and, at least by that route, get him out of the War. He studied up on fatal diseases. His favorites, I remember were melanoma and Ewings’s tumor. He liked the fulminating kinds best.

A fulminating disease was what Roger had, but he seemed typically matter of-fact about it. Once he rebounded from the first lightning-bolt of a cataclysm, Roger always spoke as if he were delivering a lecture to a large hall of his students; outlining his points logically, enunciating clearly with precise diction. He had had the mole even thirty-some years ago at New College; old photographs of him without a shirt showed it. It had never caused him any trouble. But a couple of years ago a physical therapist giving him a routine treatment had remarked upon it and advised him to get it checked out. It looked suspiciously like a melanoma to him. The physical therapist had been terribly right.

Melanoma, a physician friend of mine told me, is “sneaky.” I thought of it as a dry dandelion ball. You blow on it and the seeds fly in all directions. At least one seed had apparently scattered in Roger’s body. He hadn’t even bothered to tell me when he had the first mole removed. He hoped for the best. Sometimes it doesn’t spread. But another mole had appeared nearby. That was bad. His doctor had removed this one, too, but had taken the serious step of starting him on a year-long course of interferon. Interferon stimulates your immune function, makes you run a fever and hopefully “burns out” the dispersed melanoma seeds. Roger had just started as we spoke. He had taken a year’s leave from the university. Taking interferon, he said, was like having a mild intermittent flu. You gave yourself a shot, then you started feeling sick. You felt bad for a few days, and when you started to feel better you gave yourself another shot. Roger rolled with it. For the first time in his life, he was not focused obsessively upon being productive. For once he didn’t have a book deadline set for himself. He didn’t because he couldn’t.

Interferon was strange stuff, Roger reported, ever the meticulous observer. It gave you technicolor dreams. It also impaired your sexual functioning. No real matter, he quickly said. His girlfriend was on an extended job in another state. But she was to come home just when his year of interferon was over. “When Sherry gets back, Roger volunteered enthusiastically, “I’m going to get a 55-gallon drum of Guinness-flavored Astroglide!” That was Roger, fighting melanoma and laying in sexual lubricants at the same time.

Although he kind of breezed past it, there was one thing that told me just how serious Roger’s situation really was. “The doctor,” he said, after outlining in detail the next stage of his medical campaign, “says that if it comes back a third time, I’ve got about six weeks.”

I hung up my telephone and called our old friend Hart. “If we want to see Roger, we should see him soon,” I said pointedly. “Despite his optimism, I don’t think he has long. “Let’s go to Durango.” Hart agreed at once.

“But let’s not just fly,” I suggested. Let’s arrive in the proper style on motorcycles, just like the old days.” Hart was enthusiastic. We bought plane tickets, and not many weeks after met in the main concourse of the Albuquerque airport. “So how bad do you really think it is?” Hart asked, now that we could talk in person. “Roger sounded pretty upbeat on the phone.” “Roger’s always upbeat,” I countered. I’ve done a little reading on melanoma. Do you know what one oncologist said?” I asked.
“What?”
“Melanoma,” I paused,” “gives cancer a bad name.”

An hour later we were at Pedro’s motorcycle rental shop, cranking over two overlarge bikes for the trip up to Durango. Motorcycles had changed since Hart, Peters, and I had been riding buddies in Sarasota in the sixties. You used to have to stand on the crank in sturdy boots and kick the engines over. Now you just pressed a starter switch. But they roared just as loud as ever and went immensely faster. We flew out of town on old route 66, catching the old twisty main route up to Santa Fe. We leaned through the curves in the desert hills, stopping in Santa Fe, then climbing the mountains into Colorado, soaking our stiff motorcycle butts in the Pagosa hot springs. Pausing overnight, we rode the remainder of the route into Durango the following day, following Roger’s directions to his driveway.

Stopping at the bottom, we rode side-by-side up the sandy road to his house in a valley overlooking the overhanging mountains, rattling the windows with our straight-pipe exhausts. As we leaned the hot bikes over on their kickstands and pulled off our helmets a frail, back-braced, but broadly grinning Roger came out of his house to greet us. “Schwartz!,” he exclaimed, hugging me. “Hart!” “You came! And on these beasts!” He walked around them admiringly.

A mutual friend later told us that Roger had said that when we arrived it was like a whole part of his youth had come riding up his driveway. I was pleased. This was the effect that I was looking for.


Basic Natural Roger Peters.

Roger made his dramatic appearance on the New College scene in a memorable Basic Natural Science lecture on the mating ritual of the cricket. It was 1966. All one hundred of we first-year students were sitting on folding chairs in the teak-lined music room of the old Charles Ringling mansion in which we had heard so many intellectually challenging but academically wooden lectures. It was sometimes hard to keep one’s mind on the speaker as just yards away Sarasota Bay sparkled under the brilliant Florida sun, dolphins swimming along the breakwater in pursuit of jumping fish. And sitting just a few seats down from you was the entrancing and intelligent young woman with whom you had watched the sun come up sitting on that very breakwater. Having passed the night deep in conversation, you wondered if the pleasures of last night might lead to even more thrilling ones in the coming evening. Looking up from her notes, she gave you a warm glance. Yes, it was hard to concentrate on a monotonous academic monotone.

Then this little intense guy - he couldn’t be more than 5’2, shorter than his younger brother John a year or two ahead of me in school - took the lecture platform. I knew that he was a math tutor, although the catalog listed him as having a degree from Chicago in political science. But here he was lecturing on animal behavior. Well, at New College, the lines weren’t drawn rigidly. He was an incredibly dynamic, energetic speaker. He talked about the new emerging field of psychobiology, and the way that the study of animal behavior could tell you a great deal about the foundations of human experience itself. Sex, for instance. I glanced over at the young woman to my left. To dramatize, he laid out the invariable“hard-wired” fourteen steps of the mating dance of some kind of cricket. But instead of just delivering them from the podium, he danced them out.

‘First, the male cricket approaches the female cricket and waves one antenna,” he instructed, crouching down in a cricket-imitative stance, hands pointing out from the top of his head as antennae. Fixing a fetching woman in a sundress and sandals in the front row in a libidinous gaze, he suggestively wiggled one antenna at her. She colored, and the audience roared. “The female then signals back,” he intoned, leaping as if he were a cricket himself to the far side of the platform, spinning about and wiggling an antenna in the direction from which he had come. More giggles. Meticulously and dramatically, he laid out all fourteen ritualized exchanges of cricket foreplay.

“The purpose of the instructor, a great Michigan professor named Marian Kinget once pronounced, “is to dramatize certain insights.” The cricket lecture, remembered fondly by friends who were there with me in that room thirty-five years ago, conveyed an insight that piqued curiosities on my part that have driven a lifetime of study. Back then I couldn’t know with what power Roger would come into my life. “Who was that masked man?” I questioned a classmate after the lecture. “That class, my friend, was Basic Natural Roger Peters. And that’s the guy himself.”


Sitting on the Log.

By a year later Roger and I had become fast friends. We both loved motorcycles, we both loved adventure, and we both had become completely absorbed in the emerging field of psychobiology that I had first heard of via the crickets. Back when the field was small, we could do the heady thing that is so rare in modern scientific fields - we could read every article that came out. Then we’d talk about them.

One spring, Roger signed up to teach only one tutorial, and I signed up to take it. That administratively took care of his teaching and my course requirements for the trimester. We developed a rhythm. Starting early in the mornings, we would read the literature. Then, after lunch, we would meet on our tutorial log in a little clearing by the bay. Roger would fish under the log and fish out our mason jar, we’d roll a joint, and talk. “What about this new holographic theory of memory in Pribram’s Scientific American article?” I’d ask. “Is this incredible, or what?” And we’d talk animatedly about Pribram’s experiments and his new theory, which promised to replace the old localized idea about memory storage. We’d connect it with other things that we had read and thought about, about the behavior of people around us, and even society, in the midst of sixties turmoil. Everything was fodder for our conversation. This conversation continued between us, despite long interludes, for the rest of his life. These are things I speak of to no-one, anymore.

In doing psychoanalytic psychotherapy, which has become my profession in later life, I have learned the truth of the dynamic formulation of intrapsychic conflict. You conceive a wish, and against this experience a fear. The wish draws one forward, and the fear pulls back. In describing this, Freud captured a basic quality of the experience of living. I have come to see that the nature of the conflictual struggle in a life is determined in part by the intensity and energy of what analysts term libido, and which I think of as soul-force. In some people the energy of the soul seems very weak; in such people the intensity of the struggle is weak also. Desire is weak, and fear strong. When resistance to moving forward arises, it is not so hard to distract and subdue the resulting anxiety: some television, a few beers, maybe a little shopping makes it possible to continue what one is doing without too much discomfort. With others, however, the soul-force is massive, and the fear also. Here one sees a great and even illuminating struggle, with massive suffering. One may see a life-course characterized by stratospheric flying interspersed by cataclysmic crashes.

I remember hearing a story about the great composer Stravinsky. He had written a piece for violin which a great violinist in an orchestra had struggled with hopelessly. Finally throwing down his violin in disgust, the violinist shouted to Stravinsky, at the podium, that the piece “unplayable.” “Yes,”Stravinsky replied. “What I am looking for is the sound of someone attempting to play it.”

This was like Roger’s life - riveting music punctuated by broken strings, jumping up and down on the violin like a frustrated Daffy Duck, followed by great heights of musicianship. As often as Roger proclaimed another “peak experience,” he was alternatively dusting himself off of broken glass, broken telephones (he once put one that had brought news that displeased him through a small hole in his kitchen wall, followed by the kitchen chairs.) When he married his second wife, a very nice woman who struggled with depression as much as Roger struggled with more animated crashes, we referred to them as a couple as “R & B:” not for Roger and Bonnie, as they thought, but for “Rhythm and Blues.” Roger was all Rhythm.

This was the story of Roger’s life. Back in college, one of those sudden torrential downpours started when Roger realized that he had left his car windows open. Rocketing out of the door of the science lab without looking to the left or right he stepped right in front of one of the maintenance crew’s pickups, which caught him square on the bumper like the sweet spot on a baseball bat, whacking him in a low, sickening arc into the sandspurs alongside the road. When I dashed over to pick him up, he groggily pulled himself up on my arm, waved off any offers of medical attention, and insisted that I drive him not to the hospital but to a friend’s house, where he staggered in and collapsed on the couch, regaining consciousness later that evening to go stiffly about his remaining business.

On another occasion, running in late to teach a class he neglected to see that the glass door to the room was closed until he was on the other side of it, covered with glass and dripping blood on the carpet. Girls screamed as he started to ready his lecture notes regardless, and he was forced to retreat, staggering into my girlfriend’s room to be cleaned up and bandaged. As his motorcycle riding buddy, it seemed to me that he was saved from vehicular disaster only by his lightning-sharp reflexes.

Roger’s appetite for walking the razor’s edge reached its highest form in relationships with women. The complexities of a relationship with one woman seemingly not enough, Roger often arranged relationships with two women at a time, constantly calculating their respective travel paths so as to avoid encountering one when he was with the other. Once, walking down Main Street in Sarasota with his girlfriend Marci, he suddenly spotted his wife walking toward them, who had suffered a breakdown and was presumedly in the psychiatric ward. Marci felt a sudden push in her back and found herself propelled through the open door of a shop, as Roger ran forward to see his wife and redirect her away from the scene. Marci had to find her own way home. Later, of course, he was deeply and sincerely apologetic to her - as he always was after such near-misses and disasters. Supplicating angry women was a regular necessity of Roger’s early romantic life.

This diminished as Roger grew older, but never disappeared. In his early fifties, he wrote a letter to a sometime girlfriend when he realized that he owed a letter to another. Hitting the “find/change” command on his MacIntosh, he printed personalized but identical versions to both: every “Kristy” became a “Jordan.” He sent both out. A few weeks later he received replies from each of them, who were friends. Both Kristy and Jordan sent him copies of the same reply, word-for word. They had just had lunch together.


Despite the many “crashes” he experienced, Roger was like the legendary motorcycle-jumper Evel Kenevil: always rolling out of some flaming crash to jump to his feet, arms held up to show the crowd he was OK. A few ribs taped, and he’d be back off the ramp, whether that was tracking wolves by light plane and snowshoe in Northern Minnesota, working out a new theory of how human intelligence evolved from the cognitive mapping necessary to track prey, passing Robert Redford’s sport’s car on his bicycle down a precipitous mountain road, high and outside, teaching his classes, writing another book, getting married again. “Our relationship has deteriorated to the point,” he wrote me in the midst of one marriage, “that we communicate exclusively through slammed doors.” Yet he would always try again. How can you not love someone like that?

The melanoma had reappeared, despite the year on interferon. It was a reversal surely signifying his imminent death. I spoke with him by phone. “Yeah, I was really bummed out for a day,” Roger admitted. “But now I’m seeing if I can qualify for a Phase I trial at NIH.” As a researcher, Roger knew better than I that a phase I trial is the stage of experimentation in which they try to find out merely if last-resort patients can survive the treatment. No matter: Roger didn’t dwell; he was always ready to try the next thing.


I woke up last night from a dream in which my doctor had biopsied my intestines and told me that I had a fatal malignancy, from which I would soon die. My doctor did, in fact, recently tell me that he has detected some abnormality with my liver. It is probably not a cause of significant alarm, but I am scheduled to see a liver specialist in Philadelphia. Maybe she will do a biopsy with a long hollow needle through the abdomen - that is how they do it, I know. So the dream may tell me that I am more worried about this than I realize. Or it is even possible that the dream tells me that I am in fact fatally ill - dreams do tell such things sometimes. What the dream makes me think most of is Roger - how for four years he must have had such dreams, only to wake up always to find that it was true.

“Look,” Roger said in Durango when I asked him about what was thinking about death, while he pumped his daily massive dose of antibiotics into an IV line taped to his arm, “either I live or I don’t. If I live another month, I get to go deliver a paper at the APA conference in Hawaii and visit Richard Waller up in his rainforest. If I live until fall, I get to go back to teaching my favorite course and go hunting. If I die, I don’t think I’ll have any experience at all, so it won’t be unpleasant.” When he got finished with the IV, we went out to walk and look up at the mountains he loved, in the bright Durango sky he had warmed to years ago when he had moved there. He was, as always, ecstatic at the view. “Up there is where I hunt elk,” he indicated, pointing his finger along the high ridgeline. “Maybe again.”


Yuri Gagarin

Roger and I had both been in elementary school at the birth of the space age, when Soviet cosmonaut Yuri Gagarin had ridden the first rocket into space carrying a man - at least, the first one we know of. Gagarin, a prime physical specimen, had walked into his capsule. After he hit earth at the end of the experience he was too weak to walk alone. Roger checking into the National Institutes of Health was like Yuri Gagarin climbing into his space capsule.. Checking in, he seemed a man in perfect health: we took energetic walks about the grounds and talked animatedly. I drove regularly down to Bethesda from my home in Harrisburg, this was the longest that Roger and I had been able to spend together since college, and we made the most of every minute. Roger was happy about feeling good again after recovering from almost dying last year. He was his old self again. It was only the results of medical tests that revealed him a sick man; a candidate for the last-resort of all last resort treatments, an experimental stem-cell transplant.

Always the observant scientist, Roger immediately grasped the theoretical problem. Cancer cells are always floating in the body, he reminded me. Why, then, do some cancer cells take hold? Obviously it must be some failure of the immune system. So the idea was to transplant his brother’s functioning immune system into him, replacing his compromised one. To get the transplant material, his younger brother John came to Bethesda and donated blood. Taking it into the advanced labs at NIH, technicians centrifuged out all of the new, embryonic stem cells from which new white cells, macrophages, could grow, and put them aside. Then they set out to kill Roger’s existing immune system to get it out of the way.

So-called immune systems are hardy. That’s why you remain alive. Killing one involves injecting toxic agents so powerful that they destroy the bone marrow itself. With no immunity, ordinarily you would die. You would die, that is, unless you were in the world’s most advanced research hospital, with skilled nurses working constantly to keep you alive. From a seemingly healthy man, Roger retreated into a man curled up in his hospital bed, burning up with raging fevers over 105 degrees, retching constantly, lost in agony. Agony, I recall, was the term technically denoting the last stages of dying, when one was literally “in one’s agony.” But this agony was one that wasn’t allowed to proceed to death. In a brief period of lucidity, Roger quipped that his IV pole was so hung with antibiotic bags that “it looks like a Christmas tree.” Nurses, doctors and lab technicians worked to identify the specific bacteria that were trying to wipe him out. He ended brief phone calls by a hurried need to hang up as he was overcome with wrenching dry heaves.

Looking back on that terrible period, once he was able to speak once again, Roger told me that the suffering had become so all-consuming that at a certain point he lost the sense of “I” from which one experiences suffering from. He was just all pain, spinning lost in a dark void. I have read that this is the ultimate state that torturers aim to create in their victims. The phrase of my old friend Ivan Illich came to mind: medicalized torture.

When he came out of this, and stopped shaking, there finally came the signal day: they wheeled Roger up to the lab to have brother John’s stem cells dripped into his veins. I downloaded a microphotograph of a microphage engulfing a cancer cell for him to past on he wall by his bed and use as a focus for visualization exercises. Roger was going to leave no effort undone in the quest to survive where no-one had survived before. “You, Roger,” I proclaimed one day, are the Yuri Gagarin of NIH. You volunteered to be shot off into a place where nobody has been, to advance human knowledge. One day there is going to be a bust of you downstairs in the lobby.” Three months later, another college friend and I held him under each shoulder to help him to climb the three steps to her house, where we tucked him into her bed. It reminded me of that old joke: “The operation was a success, but the patient died.” Roger himself never thought of regret; he only set himself to the next goal, whether it was taking the correct complex schedule of medications, walking a few more feet the next day, or working a few hours on his latest book manuscript.


Road Trip

Roger was subsequently hospitalized for short periods for fevers, and, six months after he had arrived in Bethesda, was ready to be discharged from this last hospitalization to go home to Durango. He had tickets on a 6:10 AM flight. We arranged for me to show up at his room at 4:00 AM the morning of his departure. He was going to take a cab to save me the trouble, but this was hardly the way to celebrate such an event, I told him. “It’s just another road trip!” I admonished him. “I’ll be here.”

When I appeared at 4:00 AM, having caught a few hours rest on a friend’s couch on Capitol Hill, Roger had his duffel packed and was ready to go. I pulled the car up to the silent entrance, and we set off. Before us, the lights of the sleeping city arrayed themselves: the lights of the Capitol dome, of the Washington Monument, the highways along the Potomac. Early flights lowered themselves on the flight path toward National Airport above us, following the river to the runways. Roger was excited.

As we drove, we remembered road trips together of so long ago: driving in my Corvair Spider convertible across the middle of Florida, taking turns shuttling a friend’s Bultaco Metralla to West Palm Beach, where we all spent a memorable week aboard a sailboat called the Volante that Waller and Hazelhoff were crewing. We recalled road trips before daybreak on our motorcycles down the old Tamiami Trail from Sarasota to Sanibel Island, arriving over the causeway as the sun came up over the mainland behind us.

As we spoke of his medical “space shot.” Roger was characteristically optimistic. The previous afternoon, as we went down for his final blood tests before discharge, Roger pulled the Nurse aside. “Can you do a HIV test while you are at it?” he asked her. “Having an AIDS-free test printout is a good thing to have in your pocket on a date,” he offered me, by way of explanation. Was this the very definition of optimism, I wondered to myself, or of denial? Perhaps it is not so simple to say.

As we drove to the airport, we spoke also about deep changes that Roger had experienced within himself during this humbling experience of serious illness. Roger had not been especially given to such deep conversations about feeling, but during his illness this had changed. We had had many deep conversations about both of our struggles during his last year - conversations that were as much solace to me as they were to him. Isn’t this what friendship is, after all? We had our troubles - him especially - but we were not all alone.

In our conversations, Roger told me something that he had never expressed clearly. During most of his life, he confessed, he had felt driven mercilessly to produce. Friends always came second to this compulsion. This, of course, I knew. But I didn’t realize how deep it had gone. I knew that Roger always was writing a book against some deadline, preparing a class, organizing a new program - and before that getting his PhD, getting into graduate school - the series of stiles along his personal track had been endless. I had written a song about him - and me too, I guess - a long time ago. It was called the “PhD Blues,” and started:

When I was a little boy
In the wheatfields green
I asked my mother
What would become of me?
She said “Hey - listen up, my son,
You know full well,
You must get your PhD
Or roast eternally in hell.”

There was always that feeling about Roger, as if he were trying to produce enough, somehow, to be loved. Roger confessed that for all his years on the faculty in Durango he would come home each night and have a stiff drink to calm the desperate feelings of not having accomplished enough that day. Yet, as is so often paradoxically true, love was all around him. It was his illness, he told me, that finally caused him to see this. It was only when he could not produce in any way, but could only be cared for, that he came to see that he didn’t have to produce anything in order to be loved by his friends. His friends surrounded him - at home, in Durango, they took turns sitting with him, bringing him food, taking him to doctors, taking simple pleasure in his company. When he came East, his Colorado friends handed him off to the group of which I was a part. For this, Roger had to produce nothing - no books, no articles, no lectures.

Back in the spring on Hart’s and my motorcycle trip, Roger had taken us over to see his ex-wife Rita, who he had not seen himself for some time. Like most exes, they usually confined their talk to their now-grown daughter. But today Roger mentioned how he had been in the hospital there last spring, in intensive care. He was in terrible pain and it was expected that he might die. For a long time he was heavily medicated and unconscious. “I know,” Bonnie replied quietly. “I was there.” “You were?” Roger asked, turning to her in astonishment. “Every day, Roger,” she said softly, touching him softly. Sitting on the front steps, Roger started to cry.

When the final recurrence of the melanoma came, there were no other hospitals to go to, even in Bethesda. His brother John flew in from California with Roger’s daughter Eden. His close friends came to be with him. I talked with Roger by phone. He was characteristically doing “real good.” John was more sober. It would not be long now.

In the end and in this place Roger, who had struggled and worked all of his life unsuccessfully to find love and caring, found himself in the center of a warm and loving family. It was nothing he had to work for. There, dying in his home in Rockies, surrounded by those who loved him, he was curiously but obviously happy. At the end, when the cancer spread to his brain, the magnificent mind that had shone so brilliantly all his life began to misfire on a few cylinders, as he would have put it could he still describe such things. Finally, John told me, he lost his ability to speak. “How are you, Roger?” John asked him. Roger flashed him a grin and raised his hands from the bedsheets: Two Thumbs Up. Then he died.