My father never had a high opinion of the medical profession generally.
Before dawn one day a little over a decade ago, my brother called to tell me our father had died. Just a week before, he had collapsed from a “digestive trouble,” and my mother had summoned an ambulance, but none of us thought at the time that he was in any serious danger. He was only seventy-six, and had gone along on a bird-watching expedition a couple of weeks before.
My father had never made his own welfare or mortality an issue—and his devotion to this arrangement discouraged the rest of us from disputing it. As he aged, it was also of course convenient for us grown children to have a tireless, faithful, though bad-tempered servant in the background of our adventures. Even now, in fact, though this essay is supposed to be about my father, it’s hard for me not to bring the attention straight back to me and my generation. In my defense, that is how he wanted things to be; he was stubborn in his efforts to prevent anyone from knowing what his suffering was actually like. Writing about him now is therefore an act of impiety I’d rather avoid.
But I think the story is too informative for that. My father was an extreme example of America’s freakish ideology, in which the body has been deemed not so much the honorable container of the soul but something detachable from it and combustible as fuel. Americans manifest two kinds of heroism in connection to health. On the one side is the brilliant surgeon or drug developer, implacably devoting himself to the salvation of hopeless cases. On the other side are the patients like my father who resist the system at all costs, with their loved ones and the community in mind, even if that means hiding a fatal illness for months or years and dying relatively young to avoid a high-pressure diagnosis and high-tech treatment. Either way, our ideal is to trade one life for many, whether by genius or by suffering. The question of why American health care isn’t informed by common-sense moderation and geared toward a preponderance of happy lives and dignified deaths has, among many plausible answers, one that’s rather simple: That dispensation doesn’t result from the soaring “moral leadership” we expect in this most fraught domain of social welfare. We would rather see stunts than be more or less content to be reasonably healthy and long-lived on average. We dream of the all-out sacrifice that changes everything forever.
The Body as Implement
My father, who had a long career as a biology professor, was an offspring of the rural Great Depression; he was born in southeastern Ohio in 1931. His family came out better than most—as local high-flyers, in fact: His father came to head an office of the new Farm Bureau, his mother became a schoolteacher, and his older sister hosted a regional cooking show during the early days of television. Then there was my father’s doctorate in biology from the University of Minnesota and his long career at Bowling Green State University in northwestern Ohio. He was a community leader in conservation and public health even after he and my mother retired to northwestern Pennsylvania, near the “game lands.”
But just for his family to get through the Depression entailed ruthless exploitation of the children, and the effects remained with my father all his life. He sustained a hernia at the age of six from hauling milk containers as tall as he was. The tear may not have been promptly or properly repaired, and the incident didn’t exempt him from heavy chores thereafter.
A couple of years before his death, he frightened and angered me by his sudden, uncharacteristic demand that I take his side against my mother because recent medical imaging had revealed an abnormality that might be cancer. He waved at me a film depicting a wide line within his abdomen. After I snapped, stalking off, that he should take the matter up with his doctor and not with me, he came to me and apologized: It was very likely just the old hernia anyway.
I made him promise nevertheless to follow up on the imaging, but he never did. Perhaps the hernia was the remote cause of his death. As the autopsy would eventually show, he died from esophageal cancer, a condition often brought on by chronic acid reflux. He always had reflux. And reflux can be caused, as I know from my own experience, by a hernia. But he regarded, and habituated those around him to regard, all his ailments and other physical limitations as if they were a criminal record he was quietly living down.
Apparently, the habit dated far back. He was, though muscular from all the farm work, likely too small to play high school football with any degree of safety. He played anyway and had a knee bashed; there is nobody alive who could tell me whether he had any treatment or even left the field. The bum leg didn’t stop him from enlisting at the start of the Korean War and serving in the mountain artillery, where the demands for physical strength were highest: Those soldiers had to deploy massive guns over steep terrain and haul and load hefty shells; he said only five boys out of three hundred had passed the physical test.
But in Korea, a cannon recoiled onto the knee with the football injury, rendering it a near-total loss. For the rest of his life he didn’t so much limp on it in the normal way as use it the way you would use a disposable prosthetic; but he couldn’t hide that he moved around with pain. He would not consider a knee replacement even when they were common, and his relatives received successful ones, and his medical coverage would have been more than sufficient.
He had also lost much of his hearing from the artillery fire, and late in life he admitted to having dealt with severe tinnitus for decades: “I just try to turn it off in my mind.” You could see the aftereffects of the acid reflux in his teeth: There were deep grooves in the outside surfaces, where he must have brushed the crumbling enamel ruthlessly. Severe reflux (as I myself have experienced) normally calls for extensive rebuilds of the dentition to prevent “bite collapse”; but my father never had any dental care except the filling of cavities. Did he keep his teeth rooted and functioning through sheer will? He would never have submitted to the expense and trouble of dentures.
His poor cardiovascular health in old age was so badly tended, given his still-strenuous life—he hunted, butchered and cooked game, did volunteer environmental work, made his own rope (his friends applied to my mother for coils of it after his death) and other outdoor equipment, hauled rocks, harvested apples—that crises would sneak up on us and go unaccounted for. Once I emerged from a Payless Shoes in the local mall and saw him lying on the food-court floor between paramedics. I rushed up, knelt down, and took his hand, which he withdrew. He was embarrassed, and wanted no interference as he got rid of the young men and prepared to drive home.
But it was his kidney stones in early middle age that put my father to the ultimate test. For most of a week, we would find him at dawn lying pale, stone-faced, and sweating on the living room carpet because he could neither sleep nor keep still through the night so as not to disturb my mother. But morning after morning, he would bathe and dress and go off to teach. I don’t know what finally got him to the hospital—I was a teenager at the time and wouldn’t have been told—but it’s pretty certain he knew what was wrong (he was an adjunct medical professor), and that it could debilitate or kill him. He would at length have considered either to be a willful abrogation of his many responsibilities.
He had the stones surgically removed but came down with a hospital infection. He had never had a high opinion of the medical profession generally. Now, in the hospital himself and under attack by a new strain of antibiotic-resistant bacteria, my father was overwhelmed by contempt for the whole staff, and instead of staying put while they tried one drug after another, he checked himself out and began cooking up remedies in his own lab at the university, returning to teaching at the same time. The wound was open and the pus draining, so he taped a shunt and plastic bag to his back and hid it all beneath his suit jacket. He eventually killed the bacteria somehow, but he may have damaged his digestive tract, producing even more reflux than the hernia alone could have caused.
Such behavior may sound like manipulative martyrdom. It was—sort of. He meant us children to pick up that if he was enduring all of this to keep the household whizzing toward a glorious future, his children could at least study their brains out and earn money for college, and his wife could at least eschew spending on clothes and home furnishings. But because, as a rule, the grisliest accounts of his physical states got back to us by chance—a couple of his students detected the drainage apparatus under the jacket, for example, and the news spread in the small town—I think he meant (consciously, anyway) to take on himself most of the burden, emotional and physical, in secret.
I don’t think I can ever get my mind around the burden, particularly given his habitual activities. His research—in addition to his heavy chores around home—was physically demanding: He would trek through woods and over farmland, don waders and slog around carcasses on a slaughterhouse floor in search of parasites, and trap specimens of mutant fish in Lake Erie. Toxic-waste dumpers didn’t want him near the sites, but he tended to find out so much about them that I suspect he crawled into them at night to take samples.
He traveled every chance he got, and to some difficult places, but always with concentration and results. During a conference trip to Moscow in 1968, he was assigned to spy for the CIA (as he told us many years later), and figured out from the poorly staged funeral of a heroic general that the elite part of the Soviet army was on its way to invade somewhere—and indeed it was: Czechoslovakia.
After seeing baby seals being blinded by flies on the Galápagos Islands, he invented a specialized flytrap, a wire basket hung over the water and baited with the carcasses of invasive species such as goats, through which maggots bored until they fell through the mesh and into the water and fed the fish. Since he could achieve that sort of thing with his mind, we readily cooperated in ignoring all that was wrong with his body; it was the easiest of all the goals he set for us.
Wanton Waste and Wickedness
That was how he handled his health, or how he didn’t. Then, during his final years, there was a peculiar bureaucratic circumstance at play, further discouraging him from submitting to treatment for the cancer symptoms he must have recognized from the start. For years, the federal government had refused to confirm that he had ever served in the army, thereby making him ineligible for veterans’ benefits. A building full of records had burned down; the VA was nevertheless accepting only original documents, not copies, and no other evidence of service such as photos, eyewitness accounts, medals, or newspaper clippings. (My father was decorated and promoted on the battlefield, so there was coverage in his hometown paper.) He fought furiously for benefit eligibility, with the help of his congressman.
These efforts had nothing to do with immediate financial need; the benefits were only to be backup. He had good medical coverage along with his pension, and the cheap Pennsylvania land was quite a practical choice for my parents’ home during retirement: The timber was worth several times the value of the land, and selected hardwoods could go at any time for ready money.
But my father had a Depression child’s nightmare of the worst-case scenario: that instead of kiting around the world, pursuing risky, idealistic professions and raising stellar children, my brother, sister, and I would gather around to watch fluids going artificially into and out of his body, and to help drive him up the wall with the uselessness and waste of it all. My mother, if she lost the “farm” because of the medical expenses, would fall on us as an additional burden and distraction. He had told me years before that he considered such a situation abominable. His generation had already had the most lavish lifestyle in the history of the world; their selfishness was beyond belief, the wanton consumption of the future, of culture, of civilization.
The medical system for elderly patients, seen from the inside by a life scientist, presented itself as at bottom so wicked that it took on a life, a drama, independent of immediate circumstances, though the circumstance over which he had worried the most changed in a way that ought to have reassured him. Sometime before he died, he did have his veteran status certified, but he still hid away from any medical contact that would have led to a diagnosis and choices about treatment. There’s no evidence that he himself ever looked into prognoses for cancers of the digestive tract at various stages, though he had all the resources and expertise to make such research meaningful. It was just necessary, he was deeply convinced, that he die before anyone could get to him and force him to live.
A Rare Win
A bigger picture of his mood, in a national context, was apparent in the drifts of documents that I sorted through in his workspace at the “farm” (his university office had looked much the same): peer-reviewed scientific articles by himself and others; his letters to newspapers, friends, relatives, colleagues, and public officials, and the sparse replies; popular science and nonprofit and political journalism from the country’s two coasts. In many cases these documents were extant in multiple copies for dissemination, but most copies had apparently remained in his possession because of scant interest out there.
Placement in the piles offered plausible chronology, as in archeology. I saw that he would find something out through professional research, through personal observation, through reading, through an analytical melding of—on the surface—quite disparate facts in an institutional domain or in the public one; then he would get organized to inform people and equip them for concerted action.
But in retirement, he could seldom even get anyone to witness his intellectual ministrations. After trying for a while, he would put aside the latest set of documents and go on to create another, hoping that at some point people would see how much trouble the country was in, or would be in soon, and would let him help guide a rescue.
When he and my mother visited me as a grad student at Harvard soon after they both retired, he brought offprints of his most recent articles to show around. I don’t remember what these were about, but he did come up with—or improve on, if they came from other people—increasingly ingenious and pragmatic ideas as time went on, such as a new kind of biomass conversion for recycling human waste. At any rate, at Harvard he was able to track down only one biology professor who would do so much as listen and smirk for a minute or two.
But many of his communication initiatives, I saw from the mess on the floor, were “mere” amateur flailings of intelligence and decency while public life, from the 1980s, grew unashamedly cruder. Neoconservatism and neoliberalism were more irritating to him because he was himself, by instinct and avowal and many organizational commitments, a fiscal and social conservative, an NRA anticommunist nationalist Republican. He all but writhed to learn of the selfishness, shortsightedness, and betrayals of trust that were bound to break down a functional establishment. The degradation of public schooling was particularly dangerous, he believed, because people were becoming less able to tell what was being done to them, as well as what they themselves were doing. The feelings of a lawful, skillful hunter, who learned early about the reality of suffering and all its implications—“My eye saw what my hand did”—were turned into helpless torment by the direction of the country.
For instance, there was a largely one-sided correspondence with a game warden and other local authorities. A slob hunter—one of an increasing number coming for weekends from midwestern cities as hunting deteriorated from heritage craft to outdoor frat party—had killed a doe out of season, and, without her, her fawn died. The official response was that though technically and in principle something could be done, nothing was going to be done. My father could only investigate, question witnesses, and put it on record, and endure mockery as a crank for insisting that these crimes mattered; they were eternal.
But as to my father’s best-informed public-interest frustrations in relation to his willful death, there was a theme in the archive that was like a steel wire extending over decades and now cutting into me. He had come of age with the GI Bill, which funded training for tens of thousands of scientists; the Sputnik panic of the late fifties and early sixties pumped up their research funding and assured them that they were essential to the country’s future and would always be listened to. But—as he was hardly alone in realizing, though he realized it quite early—the creation science campaign that came to prominence in the seventies would weaken empiricism and lessen its influence on public policy.
The powerful material interests behind the change could have exercised no one more than my father, a toxicology researcher focused on the Rust Belt and Appalachia when the environmental movement yielded, in the eighties, to political reaction and an orgy of chemical dumping. Nobody believes me when I tell them this, but they can check the public record: The Pennsylvania legislature actually deemed a roster of heavy metals and other poisonous industrial waste “beneficial,” allowing a mix of these to be spread on the ground with no liner, and with no mechanisms to monitor runoff or seepage into drinking water. Such a freeform dump was planned for my parents’ district of Pennsylvania, and my father—as his papers showed—fought it with rhetorical ferocity and legal cunning. He ended up with a rare win. The company planning the dump withdrew the plans and was heard from no more.
But again and again, his professional and activist helplessness must have converged with personal horror and disgust. The usual frontline disease from toxic waste exposure in a community is childhood leukemia, generated when the immune system of the weakest bodies breaks down.
My father heard from poor and working-class women how their children shrieked as the chemotherapy needle probed minute after minute for a vanished vein; or how they died; or how they survived, but with so much brain damage that they couldn’t advance from grade to grade in school. Few others were listening to these tragedies; it was out of fashion to connect powerful decisions to pitiful torment and loss. Increasingly, you would hear from the EPA itself, in so many words, that any precautions or interventions that cost any business interests anything were out of the question. For money, anything was permitted.
To this day, in fact, I confirm my father’s deduction that greed triumphs over health in this country, wringing bodies for profit, tormenting them endlessly when they are at the end of their strength. When (for example) is the “war on cancer” ever promoted with any reference to prevention, to cancer’s myriad environmental triggers, as opposed to new treatments (which happen to have increasingly beggaring costs) and spa-like clinics promising all the special attention you deserve for the new hope and new life those out-of-touch bozos at the previous facility denied you—as if boob jobs were being touted?
My father’s version of having enough of it all was to hold his own cancerous body back from the system. It was still just a tool to exploit, just an object, but hewould decide whom it benefited, and how. Hewould write on it what meaning it had.
Hover and Observe
I saved one copy of each of the most important documents, though I couldn’t picture who would ever retrieve them, or for what purpose. The rest—bushel after bushel—I took out to the yard and burned in an old aluminum trashcan.
At his memorial service in the Methodist church my father had attended with my mother, I read a psalm about physical life vanishing, the grass burned into evanescence, and I promised the congregation that I would soon be able to read the Bible in Hebrew. (At the time, I was about to start as a visiting scholar at Yale Divinity School.) It was at my father’s insistence, I related, that I always looked ahead and high up; he would never admit that anything worth learning was too hard for me to learn.
I went to a second memorial service at the University of Pennsylvania Medical School, where his body had gone to be dissected in anatomy class. The service was for all the relatives the cadavers had left behind. The young medical students on the stage told of their reverence for their cadavers and their appreciation of the families who surrendered them. Truth to tell, my father had made the choice himself and suspected that my mother would not go through with the donation; he privately appointed me enforcer, a grim job I didn’t end up having to do, because she didn’t resist the due transfer of the body to the school before I even got home.
Several students at the medical-school service sang inspirational solos in fine voices. I was ashamed; I didn’t really want this elaborate thanks; I was certain my father wouldn’t have wanted it. I knew that without cadavers there is no proper study of anatomy; recourse to synthetic models can’t be satisfactory in instilling a sense that patients are human beings, living tissue, and that they all die. Shortly after the service, I signed up to donate my body for dissection too.
When a cadaver is dissected until it can’t be dissected any more, it is reduced to ashes and sent back to the bereaved in a small, tasteful container. My family gathered again, this time to scatter the ashes on a favorite hummock of my father’s in the woods; not a place where he used to hunt, because it was too near the house and the road, but just one where he liked to hover and observe nature. Members of the family offered verbal tributes, and I sang in Hebrew from the psalm with the refrain “His steadfast mercy endures forever.”
In the secular as in the religious realm, when someone gives his life for yours, it yields a binding narrowness of feeling. Without a special effort to loosen the bonds, all you grasp—maybe all you are meant ever to grasp—is that he did it. You don’t soon or easily wonder, “Why didn’t he ask? How could he assume that was what I wanted?” or “Where have we come to, that he found he had to do that?”
But if, as a scholar, I know anything, it’s that the holocaust or “entirely burned” sacrifice is very rare; in a range of cultures, it is all but forbidden, because it is a patent waste. Sacrifices are consumed; they are an occasion for the whole community to feast. As I, in any event, sit in front of my computer and try to convey what I know about the world, I am eating my father’s body. I am keeping the feast.