Friday, May 06, 2011
Jay Neugeboren: The Two Bobbys--Fischer and Neugeboren
My brother Robert experienced his first psychotic break in 1962, and has been in and out of mental hospitals and halfway houses ever since. In 1997 I published Imagining Robert: My Brother, Madness, and Survival in which book I set Robert’s particular history as a mental patient in the context of our family history: our childhood, his life in and out of mental hospitals, and our relationship through the years. In 1999, I published Transforming Madness: New Lives for People Living with Mental Illness, where I wrote about people who had been institutionalized for mental illness—some for as much as 15 years—but who had made their way back to full, viable, and gloriously imperfect lives, and where I also told the ongoing story of Robert’s life. The essay reprinted below, which brings Robert’s story forward to recent times, was published originally in The Huffington Post on the first anniversary of Bobby Fischer’s death, January 17, 2009 (Robert and Bobby Fischer were in their high school’s chess club together), and then, somewhat revised, in Midstream (Winter, 2010).
The Two Bobbys: Fischer and Neugeboren
by Jay Neugeboren
In the spring of 1956, when my brother Robert was thirteen, I gave him a chess set for his Bar Mitzvah. Robert was an excellent chess player, and when, at 14, he entered Erasmus Hall High School as a sophomore in the fall of 1957, he joined the chess club. Bobby Fischer also entered Erasmus that fall and he too joined the chess club. By this time, at 14, he had become the youngest player ever to win the United States National Junior Championship. Yet when Robert, who would spend most of his adult life as a mental patient, would try to get Fischer to play with him, Fischer would refuse. “’With you, Neugeboren, I don’t play,’ he always said to me, Robert says. Why not? “Because,” Robert says, smiling, “he said I played crazy.” (Bobby’s sister Joan, five years older than her brother--I was five years older than Robert--had introduced Fischer to chess when he was six by buying him a chess set from the candy store over which they lived.)
In 1972, at the age of 29, in Reykjavik, Iceland, Fischer defeated Boris Spassky and became the first American-born player to become international champion. In the remaining 35 years of his life, he did not, except for a rematch with Spassky in 1992 that resulted in Fischer’s permanent exile from the United States, ever play tournament chess again. He became an itinerant madman and recluse--chess was nothing more than “mental masturbation,” he declared--and his primary antagonist when he surfaced periodically, often in rambling broadcasts from the Phillipines, became the international Jewish conspiracy.
Jews were a “filthy, lying bastard people,” hell-bent on world domination through ruses such as the Holocaust (“a money-making invention”), and the mass murder of Christian children (“their blood is used for black-magic ceremonies”). On September 11, 2001, he told a radio audience that the attacks on the World Trade Center and the Pentagon were “wonderful news.” What he wished was for the United States to be “wiped out.”
“We all started together at Erasmus, but then the three Bobbies dropped out--” Robert often says “--Bobby Fischer, Bobbi Streisand, and Bobby Neugeboren.” Fischer dropped out of Erasmus during his junior year, after he won the United States Chess Championship for the first time. Robert dropped out a few months later when our parents moved from Brooklyn to Queens, and, at the beginning of his senior year, transferred him to Forest Hills High School. Soon after, he dropped out of both Forest Hills High and our parents’ apartment, and, at 16, moved into a run-down apartment with several older men on Manhattan’s Upper West Side.
Three years later, when Fischer’s sister and mother, Regina, moved out of their Brooklyn apartment, Fischer, who had been traveling in South America and Europe, moved into the apartment and lived there by himself. His mother joined a peace march, across the United States and Europe to Moscow, and on the walk met a man she later married and with whom she settled in England. During the remaining 38 years of her life, Fischer saw her rarely, and became deeply distraught when, in 1997, he was unable to attend her funeral. Our mother left New York for Florida in 1973, and during the remaining 20 years of her life, so traumatized was she by Robert’s illness, that she saw him only twice.
Early in 1962, in the same year that Fischer moved back into his mother’s apartment, Robert, following a drug-enhanced cross-country trip to California, where he lived for six months, moved back into our parents’ apartment, became floridly psychotic, attempted to kill our father, was taken away in a straitjacket, and was incarcerated on a psychiatric ward at Elmhurst Hospital in Queens.
Both our mother and Fischer’s mother were Registered Nurses, and in both families they were the ones who put food on the table and paid the rent. Fischer’s father, Hans-Gerhardt Fischer, a German biophysicist, abandoned the family and divorced Regina when Bobby was two, after which Regina raised Bobby and his sister on her own.
Although our father did not abandon us (throughout our childhood, however, he and our mother constantly threatened divorce), he failed at every business he tried, and it was our mother who, working at various jobs, including 16-hour double-shifts as a nurse, supported the family.
Like Fischer’s mother, our mother was a crusader for a peaceful, non-violent world, and in the four small rooms of our apartment regularly went on tirades about how religion, by setting people and nations at war with one another, were “the cause of all evil in the world.”
During Bobby and Robert’s teenage years, both mothers, fearing their sons were deranged, arranged for psychiatric evaluations. Fischer’s mother took her son to the children’s psychiatric ward at Brooklyn Jewish Hospital; our mother took Robert to the Director of Adolescent Services at Brooklyn’s Kings County Hospital. Whereas the doctor at Brooklyn Jewish Hospital declared Bobby Fischer healthy, the doctor at Kings County told my mother that Robert should be hospitalized immediately, and that he would probably have to live in a mental hospital for the rest of his life.
A day or so later, Robert confided that he’d “cheated” at the interview--“I passed the admissions test!” he exclaimed proudly--by giving the psychiatrist answers he knew the psychiatrist wanted. Why? Because he wanted to find out what a mental hospital was like. Well, you might be able to get in, I said, but once you’re in, it might not be so easy to get out. Robert agreed to a second evaluation, which I arranged at Bellevue Hospital, where the Director of Adolescent Services declared him to be totally healthy.
In the fall of 1962, at about the time Robert was leaving Elmhurst Hospital for an eighteen-month stay in a psychiatric facility that specialized in treating adolescents, Fischer began living at a YMCA. He also began denouncing the Russians, accusing them (with justification) of rigging their tournaments, and railing against tournament promoters for stealing money from him. He played in fewer and fewer tournaments, began moving from apartment to apartment, living in seedy hotels, and carting around suitcases filled with vitamins and herbal remedies he believed could stave off toxins secretly being put into his food and water by Soviet agents.
In 1968, when he was 25, he moved to California, where he spent his days riding busses and reading chess books, and his evenings prowling parking lots and placing white supremacist leaflets under windshield wipers. It was in California that he became infatuated with Hitler and the Third Reich, and began collecting Nazi memorabilia. Although Jewish, he joined the Worldwide Church of God, which was based in Pasadena, and which believed in baptismal immersion and the imminent coming of Christ, in following strict Sabbath proscriptions, and in Jewish dietary laws.
In 1972, he emerged from seclusion to defeat Spassky, but after this victory his whereabouts and life again faded into a self-willed obscurity.
During the years Fischer was living in California, Robert often talked of returning there--his months in California, he said, were the happiest of his life--but after living outside a mental hospital for more than a year, during which time he completed his second year at C.C.N.Y., he broke down again, and was committed to an insulin coma ward at Creedmoor Hospital in Queens, where he would reside for four-and-a-half of the next half-dozen years.
When Fischer defeated Spassky in 1972, and when, a year later, our parents moved to Florida, Robert was a patient on a locked ward at Creedmoor. Three years later--Robert was then in his first lock-up at Staten Island Psychiatric Center, where he would live, on and off, for the next two decades--our father, without ever having seen Robert again, died.
During these years, and ever since, Robert became obsessed with Jewish dietary laws, demanding of each emergency ward, hospital, and group home in which he lived that they provide him with kosher food. He often celebrated the Sabbath and Jewish holidays, and would ask me to say Kaddish with him for family members. At the same time, though without Fischer’s anti-Semitic venom, he would also regularly disavow his Jewish identity, claiming to have been born a Baptist, to have converted to Christian Science, and to have evolved into a Buddhist.
During these years, there were long stretches when Robert and I lost touch, and I would usually locate him again only when I’d receive a call from a hospital psych ward, asking if I were Robert Neugeboren’s brother. Fischer, too, disappeared for long periods of time during these years, living, for the most part outside the United States--in Budapest, the Phillipines, Switzerland, Japan. At one point, worried that secret agents might be manipulating him by sending signals through his jaw, he had all his dental fillings removed. “If somebody took a filling out and put in an electronic device, he could influence your thinking,” he explained. “I don’t want anything artificial in my head.”
By the time Robert was in his late thirties, he had lost all his teeth--they had either rotted, been pulled, or been knocked out--and had begun wearing dentures. Earlier, he had sometimes believed that alien forces were speaking to him through his fillings. And when, some time in the mid-eighties, the staff at South Beach punished him by taking away his dentures--and subsequently losing them--Robert refused to be fitted for new dentures. He has been toothless ever since.
In the decades that followed on his 1972 defeat of Spassky, Fischer often turned down lucrative offers to play chess publicly, including a $1.4 million dollar offer from the Hilton Corporation to defend his title in Las Vegas. In 1992, however, when the movie, Searching for Bobby Fischer was in production (Fischer was enraged that the producers used his name without permission), he emerged from his 20 year retirement to play a $5 million dollar rematch against Spassky on the island of Sveti Stefan in Yugoslavia.
At the time, United Nations sanctions had been imposed on Yugoslavia and its President, Slobodan Milosevic, and Americans were forbidden to do business there. Fischer denounced the ban, and the Department of the Treasury warned him that if he played chess in Yugoslavia, the penalty could be a $250,000 fine, ten years in prison, or both.
At a press conference preceding the match, Fischer took the Treasury Department letter out of his briefcase and spat on it. He also stated that he was not an anti-Semite (since he was pro-Arab, and Arabs were Semites too), and demanded that tournament officials raise the toilet in his bathroom to a level higher in the air than anyone else’s.
The Treasury Department responded by indicting him and issuing a warrant for his arrest. Fischer played the match, defeating Spassky easily, but now officially a fugitive from justice, he continued to live in exile, never again in the remaining 16 years of his life returning to the United States.
A dozen years after the second Spassky match, in July of 2004, while Fischer was attempting to board a plane scheduled to take him from Tokyo to Manila, the Japanese government accused him of trying to leave their country with an invalid passport, and imprisoned him for nine months. A year later, in 2005, he moved to Iceland, which had offered him citizenship, and he lived there until January 17, 2008, when, at the age of 64, following a long illness, he died of kidney failure.
When I called Robert and told him that Bobby Fischer had died, he said he’d already heard the news.
“I don’t believe it’s true,” he said.
He didn’t believe that Fischer had died? But it was in The New York Times this morning, I said.
“The New York Times? All the news that’s fit to spit, if you ask me,” Robert said, and repeated his belief that Fischer was still alive. “He lived on our street, you know,” he added, “at the Nostrand Avenue end, across from the candy store
--where all the Irish lived.”
We talked about how things were going for him at his home, a supervised residence for about two dozen former mental patients that was located in the Hell’s Kitchen section of New York, and just before we said good bye, he mentioned Fischer again. “I don’t think I look like him,” he whispered.
During his childhood, Robert was called Bobby, but once he entered his teen years--at about the time he joined the Erasmus chess club--he stopped using the name Bobby. When he was Bobby, and beginning when he was three years old, he was famous in our neighborhood for his singing, tap-dancing, and imitations of Eddie Cantor and Al Jolson. He performed on street corners, in candy stores and barbershops, and at family gatherings. During his teenage years, he acted in school and summer camp productions, where he usually had the lead, and where people were forever telling him he was going to be the next Danny Kaye or Fred Astaire.
Robert was also a gifted writer, publishing poems in little magazines when he was in his teens, becoming editor of the weekly newspaper at our summer camp, and of a mental hospital newspaper during his first long-term hospitalization.
In 1957, after Fischer won the United States Open Championship, The New Yorker described him has having “a mischievous, rather faunlike face,” and noted that “though school tests have shown [Fischer] to have generally superior intelligence, he does no better than average in his studies, displaying little interest in most of the subjects taught and being restless in class.”
The New Yorker could have been describing Robert, who, until he ballooned up in recent years from side-effects of antipsychotic medications, had had a playfully mischievous and faunlike face. And though Robert won a New York State Regents Scholarship to college, and though he did well on annual State Regents exams, his teachers (and our parents) repeatedly complained about his poor grades, his restlessness, and the ways in which he would, with jokes and banter, delight and distract other students.
In competition, Fischer was, from his early years, known for his killer instinct--“I like the moment when I break a man’s ego,” he told Dick Cavett after his triumph over Spassky. But ruthless and mean-spirited as he could be in matches and in his anti-Semitic and anti-American rages, with friends, as long as they did not betray his whereabouts, Fischer had a reputation for being exceptionally generous and kind. In Reykjavik, when he was playing against Spassky, he left thousands of dollars under pillows for the maids who cleaned his room.
Although Robert complained ceaselessly about money--“I have no money! I have no money!” he’d cry again and again--he regularly gave money away to other mental patients, even though the giving left him broke. When I once asked why, he shrugged and gave an answer that seemed to him self-evident: “Because they’ve had very hard lives.”
But he could also be nasty, especially with those paid to care for him in mental hospitals: screaming at them, hitting them, biting them. And in the months before and after Fischer’s death--in his own sixty-fourth year--Robert’s health, like Fischer’s, began to decline precipitously, and as it did, the rage he had previously vented on hospital workers, he now poured forth on the staff and residents of his group home.
He began, also, to be hospitalized every few weeks: for heart problems, lung problems, incontinence, and--most of all--from myriad problems associated with Parkinsonian symptoms (tremors, drooling, troubles with balance and walking, lack of impulse control), which symnptoms were themselves a result of the massive amounts of antipsychotic medications he had been taking for more than four decades.
The more his physical condition deteriorated, the nastier he became: screaming at people in his residence, striking staff members, refusing to shower, refusing to clean his room, or to clean up after himself in bathrooms and communal spaces.
Until a year or so before this, he had been enjoying the best period in his adult life. Whereas he had never, in the preceding five decades--when he had been hospitalized approximately 60 times for psychotic episodes--lived outside a locked facility for even two full years, he had now been living in a group home, the Clinton Residence, on West 48th Street, for more than seven years without even a single hour of hospitalization.
Early in 2006, not long after Fischer moved to Iceland, the staff psychiatrist at Robert’s residence recommended that Robert move to Wanaque House, a block away, where he could enjoy greater independence. At Wanaque, Robert had a room of his own, cooking privileges, and less supervision.
But at Wanaque, almost from the day he arrived, he started having serious physical problems, and the more his physical health failed, the more his irritability rose. He began urinating and defecating in public spaces, and stuffing large amounts of paper towels in toilets and sinks; he became unable (or unwilling) to dress himself, wash himself, or get up or down staircases without assistance; he began using racial slurs against young black residents who, the staff feared, might retaliate.
In September of 2007, on a morning when Robert was unable to move his legs or feet, he was taken to Roosevelt-St. Luke’s Hospital, where doctors concluded that his problem was due not only to drug-induced Parkinsonism, but to anemia, which condition had probably been aggravated by a severe loss of blood brought on as a result of an anal fissure for which Robert had been hospitalized a few weeks earlier. Roosevelt-St. Luke’s transferred Robert to the Kateri Residence, a skilled nursing and rehabilitation center, for physical therapy.
At Kateri, Robert did exceptionally well for a week or so, and was calm, lucid, and in playfully good spirits. When I visited him with my two sons, Aaron and Eli, and mentioned that on the following day, I was going to City Hall with my fiancée, Kathy (she was 57, I was 69), to get our marriage license, Robert wept softly, gave me a hug, then turned to his nephews. “This is very good news, you know,” he said, “because this way, if they have children, the children won’t be bastards.”
A day or two later, the director of Wanaque called to tell me that the director of Kateri had hung up on her after accusing Wanaque of “dumping” Robert on them. When I attended a conference at Kateri later that day, Robert’s social worker said Wanaque was refusing to take Robert back, and that Kateri would, therefore, discharge him to a nursing home as soon as possible. She handed me a small brochure. “Pick out five nursing homes,” she said, “and we’ll do the paper work.”
She told me that the people at Wanaque and Fountain House were a bunch of liars and that I shouldn’t believe anything they said. She also said I should only look for nursing homes outside Manhattan.
But Robert only knew people in Manhattan, I protested.
The social worker again insisted that no facility in Manhattan would take him.
But why not? I asked.
“Because he’s schizophrenic!” she declared.
After the conference, I found Robert in a lounge, and from the calm, joking man he had been a few days before, he had regressed to the raving wild man he had been 20 or 30 years ago, during his worst times in state hospitals. He began shouting at me, ordering staff around, and soaring off into flamboyant riffs that were comprehensible only if, like me, you knew him across a lifetime and could decode his references.
A day later, the Kateri social worker telephoned to report that Robert had become so unruly that they had transferred him to an inpatient psychiatric ward at St. Luke’s hospital.
When I visited Robert the next day, he was as floridly psychotic as I’d ever seen him. Given Robert’s history of stability during the previous eight years, the chief of psychiatry was baffled, and I explained what I thought had happened: Robert had been caught in a crossfire between two institutions--one telling him he could never go back to where he was living, and to the neighborhood that had been home to him for eight years, and the other telling him he’d been dumped on them and they were shipping him out to a nursing home.
At this point, I called the director of Wanaque, who now assured me that Wanaque would take Robert back, at least until they could find a nursing home for him. I also called people I knew in the city’s mental health system. Three days later, Robert was discharged to Wanaque, and back at Wanaque, his psychotic symptoms vanished as suddenly as they had appeared.
The staff psychiatrist at Wanaque, however, was “at his wit’s end,” he confided some weeks later. The problem, he explained, was that medications used to reduce Robert’s Parkinsonian symptoms (by producing more dopamine in the brain), had the opposite effect on his psychotic symptoms (where medications were used to reduce the amount of dopamine in the brain), and finding a pharmacological balance was fine-tuning of the most difficult and treacherous sort.
In addition, the nursing homes to which the staff had been making application were rejecting Robert. The logistical problem--true for thousands of others in Robert’s situation--soon became clear: group homes such as Wanaque were ill-equipped to care for elderly people with histories of mental illness who developed disabling medical problems, while nursing homes that could provide such care were ill-prepared--and/or unwilling--to accept people who had psychiatric conditions and histories.
By Thanksgiving, 2007, Robert had become the only person at Wanaque who had a (temporary) home health aide assigned to help him with the ordinary stuff of life--getting dressed and washed, cleaning his room, getting to and from meals and medical appointments. When he developed a blood clot in his left leg, the hospital saw to it that a physical therapist visited two mornings a week for a while, and, Robert’s physical health continuing to fail, he was given a wheel chair, and home health aides were assigned to him ten hours a day, seven days a week.
Although Robert continued to live in the city in which he was born and had resided his entire life, and dozens of his cousins and old friends lived in the city, in the eight years he had been out of a mental hospital, I could count on the fingers of one hand the number of visits he had had from any of them. So that just as his brilliance and fame had been less spectacular--more local--than Fischer’s, so his state of exile was less spectacular, and considerably less newsworthy.
In limbo, then, between two states of misery--Wanaque, and a place yet to be found--he continued to live in a room that was less than a hundred feet square, and contained a bed, a dresser, a chair, a small desk, and a broken TV set on a broken cabinet. Kathy and I visited often, and many visits were delightful (while waiting in the street one day to let two men who were lugging a huge TV set pass, one of the men turned to Robert. “Thanks for your patience,” he said. “Why?” Robert replied without missing a beat. “Do you think I’m a doctor?”). His memory, especially long-term, remained intact, and he delighted in reminiscing about friends and relatives, about homes and hospitals he’d lived in, about Erasmus, about California, about growing up in Brooklyn.
Bobby Fischer, he informed us at lunch one day, had moved into Wanaque and was living in a room on the floor above his. Really? I said, and when Robert insisted it was true, I told him that I still had the chess set I’d given him, and I offered to bring it. He said it was better that I keep it because everything in his room that had any value--and much that didn’t--was always being stolen from him. Then he talked about walking home with Fischer from school, and about a satchel, containing a chess set, that Fischer always carried with him.
Fischer’s death, and Robert’s friendship with him when they were boys--and the sad, uncanny parallels in their lives--had put into relief, yet again, the sorrow of Robert’s life: his early brilliance, flair, and sweetness, and how they had devolved into an ongoing misery whose pain and despair I could only imagine. And yet, it occurred to me, the mad thoughts and acts that had marked most of his adult life had served, I believed--as with Fischer--to defend against feelings and thoughts immeasurably more terrifying than the symptoms of madness he, or Fischer, exhibited.
Madness itself, in addition to being a defense, was also a kind of exile, as was, in both their lives, years without end in which these men were disconnected from almost everything--friends, relatives, places, work, passions--that had held meaning and pleasure for them when they were boys.
How had it happened? How could it be that such otherwise bright, gifted young men had descended into a darkness from which they never fully emerged? And what--in their biology or their situations--in their genes, their families, their choices, or their sheer bad luck--had brought about conditions of madness and misery that had, across lifetimes, proven refractory to amelioration or reversal?
How could it be that the sweet giggling infant I would, in our Brooklyn bedroom, lift from his crib and take into my bed, so we could snuggle and laugh together--how could it be that this child, ablaze with promise and delight once upon a time, had turned into the agitated, fearful, heavy, shapeless old man--all flab and dead weight--who, as I discovered on the evening of one of his hospitalizations, I could barely lift.
Taken to Roosevelt-St. Luke’s because of a fall that left him badly bruised and confused, Robert was, when I arrived, lying on a gurney in a dark corridor, covered in his own piss and shit, and unable to keep from screaming at me while I maneuvered him into a wheel chair so that he could continue moving his bowels. An hour or so later, after he was settled in his room, we talked in the easiest way--about Wanaque, about summer camp, about his niece and nephews--and when visiting hours were over, I kissed him good bye and he smiled at me. “I really appreciate your coming here, Jay,” he said, and he did so in a calm, natural voice, as if he were a man in whose life nothing had ever gone wrong.
In April, 2008, Robert celebrated his sixty-fifth birthday, and became eligible for a permanent home health attendant. Three months later, a nurse arrived at Wanaque to to evaluate his eligibility. When she introduced herself and put out her hand, Robert shook his head sideways. “I don’t shake hands,” he said angrily.
The nurse moved away. “You can do what you want,” I whispered to Robert, “but if you screw up this interview and you’re not approved for a home health attendant, you can count on Wanaque shipping you to a nursing home as soon as they can.”
“Okay then,” he said, and for the rest of the interview, and the physical exam, he was a model of cooperation, charm, and sanity. A few days later he was approved for a permanent home health attendant.
A month later, I told him that Kathy and I would visit with him on Labor Day.
“That’s good,” he said, “as long as we don’t have to work too hard.”
By this time, the staff psychiatrist having found a workable balance in Robert’s medications, and Robert no longer fearful he would have to spend the rest of his life in a nursing home, he was in generally good health and spirits, so that when it came time to eat dinner on Labor Day, he made his way to the dining room without a wheel chair, a walker, or even a cane.
When we were done eating, Robert reached over and, eyes moist, took my hand. “Glad you could be my guests today,” he said to me and Kathy. “It’s been a good day, don’t you think?”
And just as I had been wondering how it could be that the spirited young man I had grown up with had turned into a debilitated, lifeless old man, so I now wondered about the mystery--and miracle--of his resilience. It never ceased to amaze: that people who had had the most wretched and unenviable lives were able, as Robert was, to survive and to do more than survive: to retain an ability to be themselves in all the complexities and contradictions of their identity, history, and feelings, and to be capable still of taking ordinary pleasure in this often cruel and incomprehensible world.
Posted by Eric Obenauf at 9:11 AM 0 comments Labels: Jay Neugeboren, You Are My Heart
Friday, May 6, 2011
Wednesday, May 4, 2011
Jay Neugeboren: Perfect Health But for the Quintuple Bypass
Wednesday, May 04, 2011
Jay Neugeboren: Perfect Health, But For The Quintuple Bypass
A dozen years ago I had emergency quintuple bypass surgery that saved my life. But the surgery would never have taken place, and I wouldn’t be here, if a life-long friend of mine—Rich Helfant, a cardiologist—had not listened to me tell my story. I also told the story in a book, Open Heart: A Patient’s Story of Life-Saving Medicine and Life-Giving Friendship, published by Houghton Mifflin in 2003. The article reprinted here appeared on the Op-Ed page of The New York Times, April 2, 2004.
Perfect Health, But For The Quintuple Bypass
By Jay Neugeboren
Two surprising medical studies -- one questioning the value of so-called good cholesterol and another finding that extremely low levels of cholesterol may reduce the risk and severity of a heart attack -- have put the debate over coronary disease back on the front pages. And while any new scientific knowledge is of course a good thing, I worry that our continued focus on medical testing and prescription drugs as the primary ways of preventing heart disease will distract us from a more important element in treating illness: the well-trained doctor who knows his patient.
Consider my experience. Five years ago, at the age of 60 and without any conventional risk factors or symptoms, I received a diagnosis of coronary artery blockage -- over the phone, from a cardiologist 3,000 miles away -- and underwent emergency quintuple bypass surgery.
Two doctors had examined me in the previous months (I had been experiencing some shortness of breath and a burning sensation between my shoulder blades), but they failed to discern my problem. This may have been somewhat understandable. For the previous 25 years I had swum a mile a day and regularly played tennis and basketball. I had never been a smoker. My cholesterol and blood pressure levels were normal. And, at 5 feet 7 inches tall and 150 pounds, I was perhaps five pounds heavier than I was in high school.
One of the doctors performed an electrocardiogram and an echocardiogram and diagnosed a viral infection of my heart muscle. Fortunately, I had also been talking frequently to a childhood friend who was the former chief of cardiology at Cedars-Sinai Medical Center in Los Angeles. When I told him that my cardiologist thought the problem was viral, he replied, ''It's not viral -- I want you in the hospital as soon as possible!''
Within a few days I was admitted to Yale-New Haven Hospital, where an angiogram revealed that two of my three major coronary arteries were 100 percent blocked, with the third 90 percent occluded. In a six-and-a-half-hour emergency operation, my life was saved.
Since then, I have been thinking: as miraculous as the technology is that saved my life, if not for the clinical judgment of an old friend who took the time to consider my entire case, all the medications and machines in the world would have been useless.
In cardiology, I've learned, getting the diagnosis right is no simple matter. If you add up all the commonly known risk factors -- smoking, high cholesterol, high blood pressure, obesity, lack of exercise, genetics -- they account for only about half of heart disease cases. Moreover, according to the American Heart Association, 50 percent of men and 63 percent of women who die suddenly from heart disease have no previously known symptoms.
Although baby boomers tend to obsess about cholesterol scores the way we used to obsess about SAT scores, such figures are often meaningless or misleading. Add to this the fact that the way doctors are now taught, and the way the health care system is now run, have undermined the traditional doctor-patient relationship. Not only do doctors have less and less time to meet with us, but, given the vagaries of health insurance, the doctor we see one time may not be the same doctor we see the next time, and so we often remain strangers to one another.
It is also not comforting that a study in 1997 of 453 residents in internal medicine and family practice revealed that they failed to identify the distinctive sounds of common heart abnormalities with a stethoscope 80 percent of the time. True, using a stethoscope, listening to the patient and taking a careful history may not be the only ways to accurately diagnose heart disease. But in the words of Dr. Bernard Lown, inventor of the defibrillator, listening to the patient and taking a careful history remains ''the most effective, quickest and least costly way to get to the bottom of most medical problems.''
My old friend the cardiologist has similar concerns. ''The diagnostic acumen of the physician at the bedside, on the phone or in the office, has been severely compromised,'' he told me. ''Because the mind-set has become, 'Well, the tests will tell me anyway, so I don't have to spend a lot of time listening.' ''
This, I suspect, was the mind-set I ran into. I was seemingly healthy, two doctors who examined me failed to discover the gravity of my condition, and I nearly died.
So, while it is surely important to pay attention to cholesterol research and advances in technology, it might do at least as much good if hospitals and insurers would simply give doctors the time to know and hear us. The dictum of the great physician William Osler -- listen to the patient and the patient will give you the diagnosis -- still holds true.
P.S. My friend Rich Helfant’s line to me was, “It’s not viral, goddamnit! I want you in the hospital as soon as possible!” The NY Times cut the word “goddamnit.”
Posted by Eric Obenauf at 7:36 PM 0 comments Labels: Jay Neugeboren, You Are My Heart
Jay Neugeboren: Perfect Health, But For The Quintuple Bypass
A dozen years ago I had emergency quintuple bypass surgery that saved my life. But the surgery would never have taken place, and I wouldn’t be here, if a life-long friend of mine—Rich Helfant, a cardiologist—had not listened to me tell my story. I also told the story in a book, Open Heart: A Patient’s Story of Life-Saving Medicine and Life-Giving Friendship, published by Houghton Mifflin in 2003. The article reprinted here appeared on the Op-Ed page of The New York Times, April 2, 2004.
Perfect Health, But For The Quintuple Bypass
By Jay Neugeboren
Two surprising medical studies -- one questioning the value of so-called good cholesterol and another finding that extremely low levels of cholesterol may reduce the risk and severity of a heart attack -- have put the debate over coronary disease back on the front pages. And while any new scientific knowledge is of course a good thing, I worry that our continued focus on medical testing and prescription drugs as the primary ways of preventing heart disease will distract us from a more important element in treating illness: the well-trained doctor who knows his patient.
Consider my experience. Five years ago, at the age of 60 and without any conventional risk factors or symptoms, I received a diagnosis of coronary artery blockage -- over the phone, from a cardiologist 3,000 miles away -- and underwent emergency quintuple bypass surgery.
Two doctors had examined me in the previous months (I had been experiencing some shortness of breath and a burning sensation between my shoulder blades), but they failed to discern my problem. This may have been somewhat understandable. For the previous 25 years I had swum a mile a day and regularly played tennis and basketball. I had never been a smoker. My cholesterol and blood pressure levels were normal. And, at 5 feet 7 inches tall and 150 pounds, I was perhaps five pounds heavier than I was in high school.
One of the doctors performed an electrocardiogram and an echocardiogram and diagnosed a viral infection of my heart muscle. Fortunately, I had also been talking frequently to a childhood friend who was the former chief of cardiology at Cedars-Sinai Medical Center in Los Angeles. When I told him that my cardiologist thought the problem was viral, he replied, ''It's not viral -- I want you in the hospital as soon as possible!''
Within a few days I was admitted to Yale-New Haven Hospital, where an angiogram revealed that two of my three major coronary arteries were 100 percent blocked, with the third 90 percent occluded. In a six-and-a-half-hour emergency operation, my life was saved.
Since then, I have been thinking: as miraculous as the technology is that saved my life, if not for the clinical judgment of an old friend who took the time to consider my entire case, all the medications and machines in the world would have been useless.
In cardiology, I've learned, getting the diagnosis right is no simple matter. If you add up all the commonly known risk factors -- smoking, high cholesterol, high blood pressure, obesity, lack of exercise, genetics -- they account for only about half of heart disease cases. Moreover, according to the American Heart Association, 50 percent of men and 63 percent of women who die suddenly from heart disease have no previously known symptoms.
Although baby boomers tend to obsess about cholesterol scores the way we used to obsess about SAT scores, such figures are often meaningless or misleading. Add to this the fact that the way doctors are now taught, and the way the health care system is now run, have undermined the traditional doctor-patient relationship. Not only do doctors have less and less time to meet with us, but, given the vagaries of health insurance, the doctor we see one time may not be the same doctor we see the next time, and so we often remain strangers to one another.
It is also not comforting that a study in 1997 of 453 residents in internal medicine and family practice revealed that they failed to identify the distinctive sounds of common heart abnormalities with a stethoscope 80 percent of the time. True, using a stethoscope, listening to the patient and taking a careful history may not be the only ways to accurately diagnose heart disease. But in the words of Dr. Bernard Lown, inventor of the defibrillator, listening to the patient and taking a careful history remains ''the most effective, quickest and least costly way to get to the bottom of most medical problems.''
My old friend the cardiologist has similar concerns. ''The diagnostic acumen of the physician at the bedside, on the phone or in the office, has been severely compromised,'' he told me. ''Because the mind-set has become, 'Well, the tests will tell me anyway, so I don't have to spend a lot of time listening.' ''
This, I suspect, was the mind-set I ran into. I was seemingly healthy, two doctors who examined me failed to discover the gravity of my condition, and I nearly died.
So, while it is surely important to pay attention to cholesterol research and advances in technology, it might do at least as much good if hospitals and insurers would simply give doctors the time to know and hear us. The dictum of the great physician William Osler -- listen to the patient and the patient will give you the diagnosis -- still holds true.
P.S. My friend Rich Helfant’s line to me was, “It’s not viral, goddamnit! I want you in the hospital as soon as possible!” The NY Times cut the word “goddamnit.”
Posted by Eric Obenauf at 7:36 PM 0 comments Labels: Jay Neugeboren, You Are My Heart
Tuesday, May 3, 2011
Jay Neugeboren: Hitler's Doctor is Living in the Bronx
Tuesday, May 03, 2011
Jay Neugeboren: Hitler's Doctor is Living in the Bronx
In 2008 Two Dollar Radio published my novel, 1940. It was my first published novel in more than 20 years (though during those years I had not, as writer, been idle: I’d published three non-fiction books, two collections of stories, one young adult historical novel, and had had a screenplay produced). But I had begun my writing life as a novelist — had, in fact, written 5 unpublished novels by the age of 23 before I ever wrote my first short story — and it was sheer joy for me to return to a form that, as reader and writer, had been my first love. “Hitler’s Doctor is Living in the Bronx” tells, in part, how 1940 came to be. It was originally published in The Huffington Post on July 21, 2008.
Hitler’s Doctor is Living in the Bronx:
How 1940 Came to Be
by Jay Neugeboren.
Ten years ago, while reading Ron Rosenbaum’s Explaining Hitler, I came across a fact that was, to me, a revelation: Hitler’s doctor, it seemed--a man named Eduard Bloch--was Jewish, and had lived in the Bronx all through World War Two. So grateful was Hitler to his childhood physician that in 1940 he intervened to provide Dr. Bloch and his family with visas that enabled them to escape Austria and the Holocaust.
Rosenbaum devoted only a half dozen pages to Bloch, but what I read took up residence in a small room of my mind, and I tried to find out more. Other than some basic facts of Bloch’s life, however, these derived largely from articles Dr. Bloch wrote for Scribner’s (“My Patient, Hitler”), and from U. S. intelligence agency (O.S.S.) interviews, the man himself remained a mystery. And so I began conceiving a story in which I conjured up what such a man--one who’d not only known Hitler intimately, but had been the unique beneficiary of his generosity--might have been like.
At the same time, I’d been doing research for a novel about a woman, Elisabeth Rofman, who was a medical illustrator at Johns Hopkins Hospital, and whose fictional incarnation was inspired by the obstetrician who had delivered my youngest child--a woman who had started out as a medical illustrator. “But while I sketched,” she’d once told me, “I kept watching all these doctors perform operations, and thinking: This isn’t so hard. I can probably do what they’re doing.” And so, in mid-life--during World War Two--she’d entered medical school and had become a doctor.
Then, one day, while an artist was showing me how, by dipping dry sable brushes into carbon dust, medical illustrators achieved their effects, I suddenly realized that Elisabeth and Dr. Bloch were part of the same story--that they were going to meet, and that they might even, against all predictability, fall in love. And so my novel began: while visiting her father in the Bronx, Elisabeth calls on Dr. Bloch, bringing regards to this newly arrived exile from a nephew, who (due to Hitler’s largesse to the Bloch family) is practicing medicine in Washington, D. C.. And thus did 1940 begin to breathe, and come to life . . . .
Jay Neugeboren: Hitler's Doctor is Living in the Bronx
In 2008 Two Dollar Radio published my novel, 1940. It was my first published novel in more than 20 years (though during those years I had not, as writer, been idle: I’d published three non-fiction books, two collections of stories, one young adult historical novel, and had had a screenplay produced). But I had begun my writing life as a novelist — had, in fact, written 5 unpublished novels by the age of 23 before I ever wrote my first short story — and it was sheer joy for me to return to a form that, as reader and writer, had been my first love. “Hitler’s Doctor is Living in the Bronx” tells, in part, how 1940 came to be. It was originally published in The Huffington Post on July 21, 2008.
Hitler’s Doctor is Living in the Bronx:
How 1940 Came to Be
by Jay Neugeboren.
Ten years ago, while reading Ron Rosenbaum’s Explaining Hitler, I came across a fact that was, to me, a revelation: Hitler’s doctor, it seemed--a man named Eduard Bloch--was Jewish, and had lived in the Bronx all through World War Two. So grateful was Hitler to his childhood physician that in 1940 he intervened to provide Dr. Bloch and his family with visas that enabled them to escape Austria and the Holocaust.
Rosenbaum devoted only a half dozen pages to Bloch, but what I read took up residence in a small room of my mind, and I tried to find out more. Other than some basic facts of Bloch’s life, however, these derived largely from articles Dr. Bloch wrote for Scribner’s (“My Patient, Hitler”), and from U. S. intelligence agency (O.S.S.) interviews, the man himself remained a mystery. And so I began conceiving a story in which I conjured up what such a man--one who’d not only known Hitler intimately, but had been the unique beneficiary of his generosity--might have been like.
At the same time, I’d been doing research for a novel about a woman, Elisabeth Rofman, who was a medical illustrator at Johns Hopkins Hospital, and whose fictional incarnation was inspired by the obstetrician who had delivered my youngest child--a woman who had started out as a medical illustrator. “But while I sketched,” she’d once told me, “I kept watching all these doctors perform operations, and thinking: This isn’t so hard. I can probably do what they’re doing.” And so, in mid-life--during World War Two--she’d entered medical school and had become a doctor.
Then, one day, while an artist was showing me how, by dipping dry sable brushes into carbon dust, medical illustrators achieved their effects, I suddenly realized that Elisabeth and Dr. Bloch were part of the same story--that they were going to meet, and that they might even, against all predictability, fall in love. And so my novel began: while visiting her father in the Bronx, Elisabeth calls on Dr. Bloch, bringing regards to this newly arrived exile from a nephew, who (due to Hitler’s largesse to the Bloch family) is practicing medicine in Washington, D. C.. And thus did 1940 begin to breathe, and come to life . . . .
Monday, May 2, 2011
Jay Neugeboren: Fiction vs Non-fiction
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Monday, May 02, 2011
Jay Neugeboren: Fiction vs Non-Fiction
'Fiction vs. Nonfiction: the power of a well-made story' appeared in the May 5, 2006 issue of Commonweal. It began as a belated response, not so much to James Frey and his book, but to the hullabaloo/circus surrounding it, and the inanity of so much of the public dialogue. The title was not mine, for, as my brief remarks indicate, I don't see fiction and nonfiction as being at war with one another. They are--like the short story and the novel--simply different ways of telling stories. The assumptions we bring to a story, however, do depend upon what a writer (or publisher) calls that story--fiction, nonfiction, memoir--and thus, how, in the privacy of our reading experience, we relate the story, via memory and imagination, to what we take to be the actual world and actual events and people in it.
by Jay Neugeboren.
In the spring of 1965, my literary agent called to tell me that Harper's magazine wanted to publish a short story I'd written. The story, "Luther," told of a New York City teacher's longtime friendship with a black student who, while serving time in jail, becomes a Black Muslim. There was one problem, however, my agent said. Harper's assumed the story was derived from my experiences as a New York City teacher, and the editors wanted to run it as nonfiction.
"But I made it all up!" I protested.
The next day my agent called to tell me that since the story was not "true," Harper's had decided not to run it.
I was reminded of this when I read, in the media hullabaloo concerning James Frey's A Million Little Pieces, that Frey had originally submitted his work as fiction, but that when there were no takers, he decided to call it a memoir.
The question, then: Why, in such instances, are publishers and the public more willing to embrace a story when told that it is "true"--that it actually happened--than when told that it is, on the same subject and with the same narrative line (or even, the same words!), a work of fiction? Why this curious belief that nonfiction, because it is "true," may not only be stranger than fiction, but that it is, ipso facto, stronger?
'Twas not ever thus. In the early part of the twentieth century, large-circulation magazines such as the Saturday Evening Post, Collier's, Scribner's, Smart Set, and the American Mercury routinely ran a half-dozen or more short stories (along with novellas and serial installments of novels) in each issue, and only one or two nonfiction articles. This began to change in the early 1930s: fiction started to slip, nonfiction to rise, coinciding with H. L. Mencken's heralding of "the sociological article as the important form of literary interpretation of American mores." In our own time, influenced in part by the advent of the New Journalism and the "nonfiction novel" (see Tom Wolfe, Truman Capote), only one large-circulation magazine, the New Yorker, continues to run fiction in each issue.
The element of voyeurism can explain some of this: the frisson of seeing into the lives of the rich and famous, the glamorous and the unsavory, whether the person be Donald Trump or O.J. Simpson, Paris Hilton or Hillary Clinton. When we read of the private lives of Humbert Humbert, Emma Bovary, Anna Karenina, or Gregor Samsa, it would seem to be peeking less into their bedrooms (though we do that) than into their psyches, while simultaneously journeying into the imaginative and emotional recesses of our own hearts, fears, and desires.
There is this too: that James Frey's life, like the lives of those who have written confessional memoirs (Kathryn Harrison, Brooke Shields), becomes a public commodity. What was it like to be a drug addict? To have sex with your father? To suffer from a mental illness? We can talk with those who tell us the "true" stories of their lives; neither we nor Oprah can ever talk with Emma Bovary or Gregor Samsa.
We are often told that writers "should write what they know." True enough. Yet we come to know things in various ways, and not solely by experiencing them. (One thing I discovered during several decades of college teaching, for example, was that young men and women often write better about love--and sex--before they experience it than after.) "Desire is creation," says a character in Willa Cather's The Song of the Lark, and this speaks to what often inspires the writing of fiction (and the living of any interesting life), for it suggests that what may be most interesting about us lies not in what happens to us, but in what we dream might happen to us.
Left alone with a novel--with a world where privacy and possibility reign--to have a novel's characters and story mingle with our own stories, is to create a mix that may be more complex than that which results from reading about what has actually taken place. For when we do the latter, our engagement with the work is largely and necessarily conscious, and deliberate.
When a story is invented, it has the potential to move beyond ordinary reality, beyond its individual characters and their tales, thereby giving us entry to a world that may be unsettling and revelatory precisely because it speaks to elements of our lives that remain ultimately mysterious. I've sometimes said about my own works of fiction that (as with "Luther") I hope readers will find them at least as real as if they had never happened.
While the preeminence of fiction may be on the decline, the power of a well-told invented story remains: a world of let's pretend, though child-like in its origin, is anything but childlike in mature works (think: Proust, Nabokov, Munro, Trevor, Saramago, Chekhov, Kafka). Perhaps, then, we sometimes prefer that our stories correspond directly to that world we read about in the newspaper and see on TV, because this is more comforting than considering the possibility that what we or others imagine may be at least as real as the world we can see, touch, hear, smell, and feel, may yet, in ways beyond predictability and beyond our control, prove true.
Posted by Eric Obenauf at 9:48 AM 0 comments
Monday, May 02, 2011
Jay Neugeboren: Fiction vs Non-Fiction
'Fiction vs. Nonfiction: the power of a well-made story' appeared in the May 5, 2006 issue of Commonweal. It began as a belated response, not so much to James Frey and his book, but to the hullabaloo/circus surrounding it, and the inanity of so much of the public dialogue. The title was not mine, for, as my brief remarks indicate, I don't see fiction and nonfiction as being at war with one another. They are--like the short story and the novel--simply different ways of telling stories. The assumptions we bring to a story, however, do depend upon what a writer (or publisher) calls that story--fiction, nonfiction, memoir--and thus, how, in the privacy of our reading experience, we relate the story, via memory and imagination, to what we take to be the actual world and actual events and people in it.
by Jay Neugeboren.
In the spring of 1965, my literary agent called to tell me that Harper's magazine wanted to publish a short story I'd written. The story, "Luther," told of a New York City teacher's longtime friendship with a black student who, while serving time in jail, becomes a Black Muslim. There was one problem, however, my agent said. Harper's assumed the story was derived from my experiences as a New York City teacher, and the editors wanted to run it as nonfiction.
"But I made it all up!" I protested.
The next day my agent called to tell me that since the story was not "true," Harper's had decided not to run it.
I was reminded of this when I read, in the media hullabaloo concerning James Frey's A Million Little Pieces, that Frey had originally submitted his work as fiction, but that when there were no takers, he decided to call it a memoir.
The question, then: Why, in such instances, are publishers and the public more willing to embrace a story when told that it is "true"--that it actually happened--than when told that it is, on the same subject and with the same narrative line (or even, the same words!), a work of fiction? Why this curious belief that nonfiction, because it is "true," may not only be stranger than fiction, but that it is, ipso facto, stronger?
'Twas not ever thus. In the early part of the twentieth century, large-circulation magazines such as the Saturday Evening Post, Collier's, Scribner's, Smart Set, and the American Mercury routinely ran a half-dozen or more short stories (along with novellas and serial installments of novels) in each issue, and only one or two nonfiction articles. This began to change in the early 1930s: fiction started to slip, nonfiction to rise, coinciding with H. L. Mencken's heralding of "the sociological article as the important form of literary interpretation of American mores." In our own time, influenced in part by the advent of the New Journalism and the "nonfiction novel" (see Tom Wolfe, Truman Capote), only one large-circulation magazine, the New Yorker, continues to run fiction in each issue.
The element of voyeurism can explain some of this: the frisson of seeing into the lives of the rich and famous, the glamorous and the unsavory, whether the person be Donald Trump or O.J. Simpson, Paris Hilton or Hillary Clinton. When we read of the private lives of Humbert Humbert, Emma Bovary, Anna Karenina, or Gregor Samsa, it would seem to be peeking less into their bedrooms (though we do that) than into their psyches, while simultaneously journeying into the imaginative and emotional recesses of our own hearts, fears, and desires.
There is this too: that James Frey's life, like the lives of those who have written confessional memoirs (Kathryn Harrison, Brooke Shields), becomes a public commodity. What was it like to be a drug addict? To have sex with your father? To suffer from a mental illness? We can talk with those who tell us the "true" stories of their lives; neither we nor Oprah can ever talk with Emma Bovary or Gregor Samsa.
We are often told that writers "should write what they know." True enough. Yet we come to know things in various ways, and not solely by experiencing them. (One thing I discovered during several decades of college teaching, for example, was that young men and women often write better about love--and sex--before they experience it than after.) "Desire is creation," says a character in Willa Cather's The Song of the Lark, and this speaks to what often inspires the writing of fiction (and the living of any interesting life), for it suggests that what may be most interesting about us lies not in what happens to us, but in what we dream might happen to us.
Left alone with a novel--with a world where privacy and possibility reign--to have a novel's characters and story mingle with our own stories, is to create a mix that may be more complex than that which results from reading about what has actually taken place. For when we do the latter, our engagement with the work is largely and necessarily conscious, and deliberate.
When a story is invented, it has the potential to move beyond ordinary reality, beyond its individual characters and their tales, thereby giving us entry to a world that may be unsettling and revelatory precisely because it speaks to elements of our lives that remain ultimately mysterious. I've sometimes said about my own works of fiction that (as with "Luther") I hope readers will find them at least as real as if they had never happened.
While the preeminence of fiction may be on the decline, the power of a well-told invented story remains: a world of let's pretend, though child-like in its origin, is anything but childlike in mature works (think: Proust, Nabokov, Munro, Trevor, Saramago, Chekhov, Kafka). Perhaps, then, we sometimes prefer that our stories correspond directly to that world we read about in the newspaper and see on TV, because this is more comforting than considering the possibility that what we or others imagine may be at least as real as the world we can see, touch, hear, smell, and feel, may yet, in ways beyond predictability and beyond our control, prove true.
Posted by Eric Obenauf at 9:48 AM 0 comments
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