The Year of Magical Thinking (4 page)

We were married at San Juan Bautista.

On a January afternoon when the blossoms were showing in the orchards off 101.

When there were still orchards off 101.

N
o. The way you got sideswiped was by going back. The blossoms showing in the orchards off 101 was the incorrect track.

For several weeks after it happened I tried to keep myself on the correct track (the narrow track, the track on which there was no going back) by repeating to myself the last two lines of “Rose Aylmer,” Walter Savage Landor’s 1806 elegy to the memory of a daughter of Lord Aylmer’s who had died at age twenty in Calcutta. I had not thought of “Rose Aylmer” since I was an undergraduate at Berkeley, but now I could remember not only the poem but much of what had been said about it in whichever class I had heard it analyzed. “Rose Aylmer” worked, whoever was teaching this class had said, because the overblown and therefore meaningless praise for the deceased in the first four lines (“Ah, what avails the sceptred race! / Ah, what the form divine! / What every virtue, every grace! / Rose Aylmer, all were thine”) gets brought into sudden, even shocking relief by “the hard sweet wisdom” of the last two lines, which suggest that mourning has its place but also its limits: “A night of memories and sighs / I consecrate to thee.”

“‘A
night
of memories and sighs,’” I remembered the lecturer repeating. “
A night.
One night. It might be all night but he doesn’t even say
all night,
he says
a night,
not a matter of a lifetime, a matter of some hours.”

Hard sweet wisdom. Clearly, since “Rose Aylmer” had remained embedded in my memory, I believed it as an undergraduate to offer a lesson for survival.

D
ecember 30, 2003.

We had seen Quintana in the sixth-floor ICU at Beth Israel North.

Where she would remain for another twenty-four days.

Unusual dependency (is that a way of saying “marriage”? “husband and wife”? “mother and child”? “nuclear family”?) is not the only situation in which complicated or pathological grief can occur. Another, I read in the literature, is one in which the grieving process is interrupted by “circumstantial factors,” say by “a delay in the funeral,” or by “an illness or second death in the family.” I read an explanation, by Vamik D. Volkan, M.D., a professor of psychiatry at the University of Virginia in Charlottesville, of what he called “re-grief therapy,” a technique developed at the University of Virginia for the treatment of “established pathological mourners.” In such therapy, according to Dr. Volkan, a point occurs at which:

we help the patient to review the circumstances of the death—how it occurred, the patient’s reaction to the news and to viewing the body, the events of the funeral, etc. Anger usually appears at this point if the therapy is going well; it is at first diffused, then directed toward others, and finally directed toward the dead. Abreactions—what Bibring [E. Bibring, 1954, “Psychoanalysis and the Dynamic Psychotherapies,”
Journal of the American Psychoanalytic Association
2:745 ff.] calls “emotional reliving”—may then take place and demonstrate to the patient the actuality of his repressed impulses. Using our understanding of the psychodynamics involved in the patient’s need to keep the lost one alive, we can then explain and interpret the relationship that had existed between the patient and the one who died.

But from where exactly did Dr. Volkan and his team in Charlottesville derive their unique understanding of “the psychodynamics involved in the patient’s need to keep the lost one alive,” their special ability to “explain and interpret the relationship that had existed between the patient and the one who died”? Were you watching
Tenko
with me and “the lost one” in Brentwood Park, did you go to dinner with us at Morton’s? Were you with me and “the one who died” at Punchbowl in Honolulu four months before it happened? Did you gather up plumeria blossoms with us and drop them on the graves of the unknown dead from Pearl Harbor? Did you catch cold with us in the rain at the Jardin du Ranelagh in Paris a month before it happened? Did you skip the Monets with us and go to lunch at Conti? Were you with us when we left Conti and bought the thermometer, were you sitting on our bed at the Bristol when neither of us could figure how to convert the thermometer’s centigrade reading into Fahrenheit?

Were you there?

No.

You might have been useful with the thermometer but you were not there.

I don’t need to “review the circumstances of the death.” I was there.

I didn’t get “the news,” I didn’t “view” the body. I was there.

I catch myself, I stop.

I realize that I am directing irrational anger toward the entirely unknown Dr. Volkan in Charlottesville.

Persons under the shock of genuine affliction are not only upset mentally but are all unbalanced physically. No matter how calm and controlled they seemingly may be, no one can under such circumstances be normal. Their disturbed circulation makes them cold, their distress makes them unstrung, sleepless. Persons they normally like, they often turn from. No one should ever be forced upon those in grief, and all over-emotional people, no matter how near or dear, should be barred absolutely. Although the knowledge that their friends love them and sorrow for them is a great solace, the nearest afflicted must be protected from any one or anything which is likely to overstrain nerves already at the threatening point, and none have the right to feel hurt if they are told they can neither be of use or be received. At such a time, to some people companionship is a comfort, others shrink from their dearest friends.

T
hat passage is from Emily Post’s 1922 book of etiquette, Chapter XXIV, “Funerals,” which takes the reader from the moment of death (“As soon as death occurs, someone, the trained nurse usually, draws the blinds in the sick-room and tells a servant to draw all the blinds of the house”) through seating instructions for those who attend the funeral: “Enter the church as quietly as possible, and as there are no ushers at a funeral, seat yourself where you approximately belong. Only a very intimate friend should take a position far up on the center aisle. If you are merely an acquaintance you should sit inconspicuously in the rear somewhere, unless the funeral is very small and the church big, in which case you may sit on the end seat of the center aisle toward the back.”

This tone, one of unfailing specificity, never flags. The emphasis remains on the practical. The bereaved must be urged to “sit in a sunny room,” preferably one with an open fire. Food, but “very little food,” may be offered on a tray: tea, coffee, bouillon, a little thin toast, a poached egg. Milk, but only heated milk: “Cold milk is bad for someone who is already over-chilled.” As for further nourishment, “The cook may suggest something that appeals usually to their taste—but very little should be offered at a time, for although the stomach may be empty, the palate rejects the thought of food, and digestion is never in best order.” The mourner is prompted to practice economy as he or she accommodates the wearing of mourning: most existing garments, including leather shoes and straw hats, will “dye perfectly.” Undertaking expenses should be checked in advance. A friend should be left in charge of the house during the funeral. The friend should see that the house is aired and displaced furniture put back where it belongs and a fire lit for the homecoming of the family. “It is also well to prepare a little hot tea or broth,” Mrs. Post advised, “and it should be brought them upon their return without their being asked if they would care for it. Those who are in great distress want no food, but if it is handed to them, they will mechanically take it, and something warm to start digestion and stimulate impaired circulation is what they most need.”

There was something arresting about the matter-of-fact wisdom here, the instinctive understanding of the physiological disruptions (“changes in the endocrine, immune, autonomic nervous, and cardiovascular systems”) later catalogued by the Institute of Medicine. I am unsure what prompted me to look up Emily Post’s 1922 book of etiquette (I would guess some memory of my mother, who had given me a copy to read when we were snowbound in a four-room rented house in Colorado Springs during World War Two), but when I found it on the Internet it spoke to me directly. As I read it I remembered how cold I had been at New York Hospital on the night John died. I had thought I was cold because it was December 30 and I had come to the hospital bare-legged, in slippers, wearing only the linen skirt and sweater into which I had changed to get dinner. This was part of it, but I was also cold because nothing in my body was working as it should.

Mrs. Post would have understood that. She wrote in a world in which mourning was still recognized, allowed, not hidden from view. Philippe Ariès, in a series of lectures he delivered at Johns Hopkins in 1973 and later published as
Western Attitudes toward Death: From the Middle Ages to the Present,
noted that beginning about 1930 there had been in most Western countries and particularly in the United States a revolution in accepted attitudes toward death. “Death,” he wrote, “so omnipresent in the past that it was familiar, would be effaced, would disappear. It would become shameful and forbidden.” The English social anthropologist Geoffrey Gorer, in his 1965
Death, Grief, and Mourning,
had described this rejection of public mourning as a result of the increasing pressure of a new “ethical duty to enjoy oneself,” a novel “imperative to do nothing which might diminish the enjoyment of others.” In both England and the United States, he observed, the contemporary trend was “to treat mourning as morbid self-indulgence, and to give social admiration to the bereaved who hide their grief so fully that no one would guess anything had happened.”

One way in which grief gets hidden is that death now occurs largely offstage. In the earlier tradition from which Mrs. Post wrote, the act of dying had not yet been professionalized. It did not typically involve hospitals. Women died in childbirth. Children died of fevers. Cancer was untreatable. At the time she undertook her book of etiquette, there would have been few American households untouched by the influenza pandemic of 1918. Death was up close, at home. The average adult was expected to deal competently, and also sensitively, with its aftermath. When someone dies, I was taught growing up in California, you bake a ham. You drop it by the house. You go to the funeral. If the family is Catholic you also go to the rosary but you do not wail or keen or in any other way demand the attention of the family. In the end Emily Post’s 1922 etiquette book turned out to be as acute in its apprehension of this other way of death, and as prescriptive in its treatment of grief, as anything else I read. I will not forget the instinctive wisdom of the friend who, every day for those first few weeks, brought me a quart container of scallion-and-ginger congee from Chinatown. Congee I could eat. Congee was all I could eat.

5.

T
here was something else I was taught growing up in California. When someone appears to have died you find out for sure by holding a hand mirror to the mouth and nose. If there is no exhaled moisture the person is dead. My mother taught me that. I forgot it the night John died.
Is he breathing,
the dispatcher had asked me.
Just come,
I had said.

December 30, 2003.

We had seen Quintana in the sixth-floor ICU at Beth Israel North.

We had noted the numbers on the respirator.

We had held her swollen hand.

We still don’t know which way this is going, one of the ICU doctors had said.

We had come home. The ICU did not reopen after evening rounds until seven so it must have been past eight.

We had discussed whether to go out for dinner or eat in.

I said I would build a fire, we could eat in.

I have no memory of what we meant to eat. I do remember throwing out whatever was on the plates and in the kitchen when I came home from New York Hospital.

You sit down to dinner and life as you know it ends.

In a heartbeat.

Or the absence of one.

During the past months I have spent a great deal of time trying first to keep track of, and, when that failed, to reconstruct, the exact sequence of events that preceded and followed what happened that night. “At a point between Thursday, December 18, 2003, and Monday, December 22, 2003,” one such reconstruction began, “Q complained of ‘feeling terrible,’ flu symptoms, thought she had strep throat.” This reconstruction, which was preceded by the names and telephone numbers of doctors to whom I spoke not only at Beth Israel but at other hospitals in New York and other cities, continued. The heart of it was this: On Monday, December 22, she went with a fever of 103 to the emergency room at Beth Israel North, which had at the time a reputation for being the least-crowded emergency room on the Upper East Side of Manhattan, and was diagnosed with the flu. She was told to stay in bed and drink liquids. No chest X-ray was taken. On December 23 and 24 her fever fluctuated between 102 and 103. She was too ill to come to dinner on Christmas Eve. She and Gerry canceled plans to spend Christmas night and a few days after with his family in Massachusetts.

On Christmas Day, a Thursday, she called in the morning and said she was having trouble breathing. Her breathing sounded shallow, labored. Gerry took her back to the emergency room at Beth Israel North, where X-rays showed a dense infiltrate of pus and bacteria in the lower lobe of her right lung. Her pulse was elevated, 150-plus. She was extremely dehydrated. Her white count was almost zero. She was given Ativan, then Demerol. Her pneumonia, Gerry was told in the emergency room, was “a 5 on a scale of 10, what we used to call ‘walking pneumonia.’” There was “nothing serious” (this may have been what I wanted to hear), but it was nonetheless decided to admit her to a sixth-floor ICU for monitoring.

By the time she reached the ICU that evening she was agitated. She was further sedated, then intubated. Her temperature was now 104-plus. One hundred percent of her oxygen was being supplied by the breathing tube; she was not at that point capable of breathing on her own. Late the next morning, Friday, December 26, it was learned that there was now pneumonia on both lungs, and that this pneumonia was, despite the massive IV administration of azithromycin, gentamicin, clindamycin, and vancomycin, growing. It was also learned—or assumed, since her blood pressure was dropping—that she was entering or had entered septic shock. Gerry was asked to allow two further invasive procedures, first the insertion of an arterial line and then the insertion of a second line that would go close to the heart to deal with the blood pressure problem. She was given neosynephrine to support her blood pressure at 90-plus over 60-plus.

On Saturday, December 27, we were told that she was being given what was then still a new Eli Lilly drug, Xigris, which would continue for ninety-six hours, four days. “This costs twenty thousand dollars,” the nurse said as she changed the IV bag. I watched the fluid drip into one of the many tubes that were then keeping Quintana alive. I looked up Xigris on the Internet. One site said that the survival rate for sepsis patients treated with Xigris was 69 percent, as opposed to 56 percent for patients not treated with Xigris. Another site, a business newsletter, said that Eli Lilly’s “sleeping giant,” Xigris, was “struggling to overcome its problems in the sepsis market.” This seemed in some ways a positive prism through which to view the situation: Quintana was not the child who had been a deliriously happy bride five months before and whose chance of surviving the next day or two could now be calibrated at a point between 56 and 69 percent, she was “the sepsis market,” suggesting that there was still a consumer choice to be made. By Sunday, December 28, it had been possible to imagine that the sepsis market’s “sleeping giant” was kicking in: the pneumonia had not decreased in size, but the neosynephrine supporting her blood pressure was stopped and the blood pressure was holding, at 95 over 40. On Monday, December 29, I was told by a physician’s assistant that after his weekend absence he had come in that morning to find Quintana’s condition “encouraging.” I asked what exactly had encouraged him about her condition when he came in that morning. “She was still alive,” the physician’s assistant said.

On Tuesday, December 30, at 1:02 p.m. (according to the computer), I made these notes in anticipation of a conversation with one more specialist to whom I had placed a call:

Any effect on brain—from oxygen deficit? From high fever? From possible meningitis?

Several doctors have mentioned “not knowing if there is some underlying structure or blockage.” Are they talking about a possible malignancy?

The assumption here is that this infection is bacterial—yet no bacteria has shown up in the cultures—is there any way of knowing it’s not viral?

How does “flu” morph into whole-body infection?

The last question
—How does
“
flu
”
morph into whole-body infection?—
was added by John. By December 30 he had seemed fixed on this point. He had asked it many times in the preceding three or four days, of doctors and of physicians’ assistants and of nurses and finally, most desperately, of me, and had never received an answer he found satisfactory. Something in this seemed to defy his understanding. Something in this defied my own understanding, but I was pretending that I could manage it. Here it was:

She had been admitted to the ICU on Christmas night.

She was in a hospital, we had kept telling each other on Christmas night. She was being taken care of. She would be safe where she was.

Everything else had seemed normal.

We had a fire. She would be safe.

Five days later everything outside the sixth-floor ICU at Beth Israel North still seemed normal: this was the part neither of us (although only John admitted it) could get past, one more case of maintaining a fixed focus on the clear blue sky from which the plane fell. There were still in the living room of the apartment the presents John and I had opened on Christmas night. There were still under and on a table in Quintana’s old room the presents she had been unable to open on Christmas night because she was in the ICU. There were still on a table in the dining room the stacked plates and silver we had used on Christmas Eve. There were still on an American Express bill that came that day charges from the November trip we had made to Paris. When we left for Paris Quintana and Gerry had been planning their first Thanksgiving dinner. They had invited his mother and sister and brother-in-law. They were using their wedding china. Quintana had come by to get my mother’s ruby crystal glasses. We had called them on Thanksgiving Day from Paris. They were roasting a turkey and pureeing turnips.

“And then—gone.”

How does “flu” morph into whole-body infection?

I see the question now as the equivalent of a cry of helpless rage, another way of saying
How could this have happened when everything was normal.
In the cubicle where Quintana lay in the ICU, her fingers and face swollen with fluid, her lips cracked by fever around the breathing tube, her hair matted and soaked with sweat, the numbers on the respirator that night indicated that she was now receiving only 45 percent of her oxygen through the tube. John had kissed her swollen face. “More than one more day,” he had whispered, another part of our family shorthand. The reference was to a line from a movie, Richard Lester’s
Robin and Marian.
“I love you more than even one more day,” Audrey Hepburn as Maid Marian says to Sean Connery as Robin Hood after she has given them both the fatal potion. John had whispered this every time he left the ICU. On our way out we managed to maneuver a doctor into talking to us. We asked if the decrease in delivered oxygen meant that she was getting better.

There was a pause.

This was when the ICU doctor said it: “We’re still not sure which way this is going.”

The way this is going is up,
I remember thinking.

The ICU doctor was still talking. “She’s really very sick,” he was saying.

I recognized this as a coded way of saying that she was expected to die but I persisted:
The way this is going is up. It’s going up because it has to go up.

I believe in Cat.

I believe in God.

“I love you more than one more day,” Quintana said three months later standing in the black dress at St. John the Divine. “As you used to say to me.”

W
e were married on the afternoon of January 30, 1964, a Thursday, at the Catholic Mission of San Juan Bautista in San Benito County, California. John wore a navy blue suit from Chipp. I wore a short white silk dress I had bought at Ransohoff’s in San Francisco on the day John Kennedy was killed. Twelve-thirty p.m. in Dallas was still morning in California. My mother and I learned what happened only when we were leaving Ransohoff’s for lunch and ran into someone from Sacramento. Since there were only thirty or forty people at San Juan Bautista on the afternoon of the wedding (John’s mother, his younger brother Stephen, his brother Nick and Nick’s wife Lenny and their four-year-old daughter, my mother and father and brother and sister-in-law and grandfather and aunt and a few cousins and family friends from Sacramento, John’s roommate from Princeton, maybe one or two others), my intention for the ceremony had been to have no entrance, no “procession,” to just stand up there and do it. “Principals emerge,” I remember Nick saying helpfully: Nick got the plan, but the organist who had materialized did not, and suddenly I found myself on my father’s arm, walking up the aisle and weeping behind my dark glasses. When the ceremony was over we drove to the lodge at Pebble Beach. There were little things to eat, champagne, a terrace that opened onto the Pacific, very simple. By way of a honeymoon we spent a few nights in a bungalow at the San Ysidro Ranch in Montecito and then, bored, fled to the Beverly Hills Hotel.

I had thought about that wedding on the day of Quintana’s wedding.

Her wedding was simple too. She wore a long white dress and a veil and expensive shoes but her hair was in a thick braid down her back, as it had been when she was a child.

We sat in the choir at St. John the Divine. Her father walked her to the altar. There at the altar was Susan, her best friend in California since age three. There at the altar was her best friend in New York. There at the altar was her cousin Hannah. There was her cousin Kelley from California, reading a part of the service. There were the children of Gerry’s stepdaughter, reading another part. There were the youngest children, small girls with leis, barefoot. There were watercress sandwiches, champagne, lemonade, peach-colored napkins to match the sorbet that came with the cake, peacocks on the lawn. She kicked off the expensive shoes and unpinned the veil. “Wasn’t that just about perfect,” she said when she called that evening. Her father and I allowed that it was. She and Gerry flew to St. Barth’s. John and I flew to Honolulu.

July 26, 2003.

Four months and 29 days before she was admitted to the ICU at Beth Israel North.

Five months and four days before her father died.

During the first week or two after he died, at night, when the protective exhaustion would hit me and I would leave the relatives and friends talking in the living room and dining room and kitchen of the apartment and walk down the corridor to the bedroom and shut the door, I would avoid looking at the reminders of our early marriage that hung on the corridor walls. In fact I did not need to look, nor could I avoid them by not looking: I knew them by heart. There was a photograph of John and me taken on a location for
The Panic in Needle Park.
It was our first picture. We went with it to the Cannes festival. It was the first time I had ever been to Europe and we were traveling first-class on Twentieth Century–Fox and I boarded the plane barefoot, it was that period, 1971. There was a photograph of John and me and Quintana at Bethesda Fountain in Central Park in 1970, John and Quintana, age four, eating ice cream bars. We were in New York all that fall working on a picture with Otto Preminger. “She’s in the office of Mr. Preminger who has no hair,” Quintana advised a pediatrician who had asked where her mother was. There was a photograph of John and me and Quintana on the deck of the house we had in Malibu in the 1970s. The photograph appeared in
People.
When I saw it I realized that Quintana had taken advantage of a break in the day’s shooting to apply, for the first time, eyeliner. There was a photograph Barry Farrell had taken of his wife, Marcia, sitting in a rattan chair in the house in Malibu and holding their then-baby daughter, Joan Didion Farrell.

Barry Farrell was now dead.

There was a photograph of Katharine Ross, taken by Conrad Hall during the Malibu period when she taught Quintana to swim by throwing a Tahitian shell in a neighbor’s pool and telling Quintana the shell would be hers if she brought it up. This was a time, the early 1970s, when Katharine and Conrad and Jean and Brian Moore and John and I traded plants and dogs and favors and recipes and would have dinner at one or another of our houses a couple of times a week.