The year after the insertion of the renal stent, he had surgery for another major obstruction, this one in his left carotid artery, one of the two main arteries that stretch from the aorta to the base of the skull and supply blood to the brain and that if left obstructed could cause a disabling stroke or even sudden death. The incision was made in the neck, then the artery feeding the brain was clamped shut to stop the blood flowing through it. Then it was slit open and the plaque that was causing the blockage scraped out and removed. It would have been a help not to have to face this delicate an operation alone, but Nancy was swamped by her job and the demands of caring for the children without a mate, and as yet he'd met no one at Starfish Beach whom he could ask for assistance. Nor did he want to disrupt his brother's hectic schedule to tell him about the surgery and cause him to be concerned, especially as he would be out of the hospital the following morning, providing there were no complications. This wasn't the peritonitis crisis or the quintuple bypass surgery – from a medical point of view it was nothing extraordinary, or so he was led to believe by the agreeable surgeon, who assured him that a carotid endarterectomy was a common vascular surgical procedure and he would be back at his easel within a day or two.
So he drove off alone in the early morning to the hospital and waited in a glassed-in anteroom on the surgical floor along with another ten or twelve men in hospital gowns scheduled for the first round of operations that day. The room would probably be full like this until as late as four in the afternoon. Most of the patients would come out the other end, and, too, over the course of the weeks, a few might not; nonetheless, they passed the time reading the morning papers, and when the name of one of them was called and he got up to leave for the operating room, he gave his sections of the paper to whoever requested them. You would have thought from the calm in the room that they were going off to get their hair cut, rather than, say, to get the artery leading to the brain sliced open.
At one point, the man to his side, having handed him that day's sports section, quietly began talking to him. He was probably only in his late forties or early fifties, but his skin was pasty and his voice was not strong or assured. "First my mother died," he said, "six months later my father died, eight months after that my only sister died, a year later my marriage broke down and my wife took everything I had. And that's when I began to imagine someone coming to me and saying, 'Now we're going to cut off your right arm as well. Do you think you can take that?' And so they cut off my right arm. Then later they come around and they say, 'Now we're going to cut off your left arm.' Then, when that's done, they come back one day and they say, 'Do you want to quit now? Is that enough? Or should we go ahead and start in on your legs?' And all the time I was thinking, When, when do I quit? When do I turn on the gas and put my head in the oven? When is enough enough? That was how I lived with my grief for ten years. It took ten years. And now the grief is finally over and this shit starts up." When his turn came, the fellow beside him reached over to take the sports section back, and he was shepherded to the operating room by a nurse. Inside, half a dozen people were moving about in the glare of the lights making preparations for his surgery. He could not locate the surgeon among diem. It would have reassured him to see the surgeon's friendly face, but either the doctor hadn't entered the operating room yet or he was off in some corner where he couldn't quite be seen. Several of the younger doctors were already wearing surgical masks, and the look of them made him think of terrorists. One of them asked whether he wanted a general or a local anesthetic, the way a waiter might have asked if he preferred red or white wine. He was confused – why should the decision about anesthesia be made this late? "I don't know. Which is better?" he said. "For us, the local. We can monitor the brain function better if the patient is conscious." "You're telling me that's safer? Is that what you're saying? Then I'll do it."
It was a mistake, a barely endurable mistake, because the operation lasted two hours and his head was claustrophobically draped with a cloth and the cutting and scraping took place so close to his ear, he could hear every move their instruments made as though he were inside an echo chamber. But there was nothing to be done. No fight to put up. You take it and endure it. Just give yourself over to it for as long as it lasts.
He slept well that night, by the next day felt fine, and at noon, after he lied and said a friend was waiting downstairs to pick him up, he was released and went out to the parking lot and cautiously drove himself home. When he got to the condo and sat down in his studio to look at the canvas he could soon resume painting, he burst into tears, just as his father had after he'd got home from his near-fatal bout of peritonitis.
But now, instead of ending, it continued; now not a year went by when he wasn't hospitalized. The son of long-lived parents, the brother of a man six years his senior who was seemingly as fit as he'd been when he'd carried the ball for Thomas Jefferson High, he was still only in his sixties when his health began giving way and his body seemed threatened all the time. He'd married three times, had mistresses and children and an interesting job where he'd been a success, but now eluding death seemed to have become the central business of his life and bodily decay his entire story.
The year after he had carotid artery surgery he had an angiogram in which the doctor discovered that he'd had a silent heart attack on the posterior wall because of an obstructed graft. The news stunned him, though fortunately Nancy had come down by train to accompany him to the hospital and her reassurance helped restore his equanimity. The doctor then went on to perform an angioplasty, and inserted a stent in his left anterior descending artery, after ballooning the artery open where new deposits of plaque had formed. From the table he could watch the catheter being wiggled up into the coronary artery – he was under the lightest sedation and able to follow the whole procedure on the monitor as though his body were somebody else's. A year later he had another angioplasty and another stent installed in one of the grafts, which had begun to narrow. The following year he had to have three stents installed at one go – to repair arterial obstructions whose location, as the doctor told him afterward, made the procedure no picnic to perform.
As always, to keep his mind elsewhere he summoned up his father's store and the names of the nine brands of watches and seven brands of clocks for which his father was an authorized distributor; his father didn't make much money selling watches and clocks, but he loaded up on them because they were a steady item and brought window-shoppers in from the street. What he did with these seed memories during each of his angioplasties was this: he would tune out the badinage the doctors and nurses invariably exchanged while setting up, tune out the rock music pumped into the chilly, sterile room where he lay strapped to the operating table amid all the intimidating machinery designed to keep cardiac patients alive, and from the moment they got to work anesthetizing his groin and puncturing the skin for the insertion of the arterial catheter, he would distract himself by reciting under his breath the lists he'd first alphabetized as a small boy helping at the store after school – "Benrus, Bulova, Croton, Elgin, Hamilton, Helbros, Ovistone, Waltham, Wittnauer" – focusing all the while on the distinctive look of the numerals on the dial of the watch as he intoned its brand name, sweeping from one through twelve and back again. Then he'd start on the clocks – "General Electric, Ingersoll, McClintock, New Haven, Seth Thomas, Telechron, Westclox" – remembering how the wind clocks ticked and the electric clocks hummed until finally he heard the doctor announce that the procedure was over and that everything had gone well. The doctor's assistant, after applying pressure to the wound, placed a sandbag on the groin to prevent bleeding, and with the weight resting there, he had to lie motionless in his hospital bed for the next six hours. His not being able to move was the worst of it, strangely – because of the thousands of involuntary thoughts that suffused the slow-moving time – but the following morning, if all had gone well overnight, he was brought a tray of inedible breakfast to look at and a sheaf of post-angioplasty instructions to follow and by eleven A.M. he would have been discharged. On three separate occasions he'd arrived at home and was hurriedly undressing for a much-needed shower when he'd found a couple of the EKG electrode pads still stuck to him, because the nurse helping to discharge him had forgotten to peel them from his chest and throw them in the garbage. One morning he looked down in the shower to find that no one had bothered to remove the IV feeding needle, a gadget they called a heplock, from his black-and-blue forearm, and so he had to dress and drive over to his internist's office in Spring Lake to have the heplock taken out before it became a source of infection.