Sometime after it became clear that my best friend was going to die within the next couple of years -- I had been there the night he had his initial episode of pulmonary edema -- I began a casual conversation with him so far as any thought of something beyond this life.
His childhood Catholic faith, even nourished by a time as head altar boy, had long disappeared. Neither of us had any belief in the Biblical heaven or of any sort of anthropomorphic afterlife. I remained open to the possibility, however improbable, that there was something -- a something beyond human comprehension -- that might follow this mortal existence. A few odd occurrences that were likely wishful thinking on my part and dismissed as "cosmic serendipity" by my friend had left me open to the idea. He would have none of it and was clear in his belief that beyond this life there was nothing.
My best friend. Yes, he was that; more than fifty years earlier I sat in a classroom that was nearly full with about fifty freshman students in the Honors Chemistry course as the professor, standing behind a typically black topped laboratory desk, the chalkboard at his back, lectured on in a particularly dull performance. Finally the signal of the period's end sounded but the diminutive lecturer, seemingly oblivious to the sound, continued on. After a minute or two slowly increasing background noise in the room, the result of closing books, shuffling papers, and fidgeting students, grew loud. Still he continued as I turned to my friend sitting next to me on my left and instructed him, "Carl, tell him to shut up, would you?"
It was a facetious request but he was as impatient at that point as I. Just as he spoke the background noise without reason suddenly ceased and my friend's voice which would have otherwise been lost in the din was clearly heard.
"Shut up, you dink."
I hunched down in my seat trying to hide and at the same time stifle my laughter but my friend was unfazed as he sat straight with his arms crossed in front of his chest and a defiant expression on his face while the professor, apparently oblivious to this sound as well, continued on. At last, having made whatever point in the lecture he intended, the professor dismissed the class.
I had seen that expression on my friend's face before. Weeks earlier, sitting in an English class of a dozen students, a young lady asked my friend about the paper he had written for the assignment we all had. It was early in the first year of the advanced program when some of us were apparently trying to impress one another. With a look of serious concern she inquired, "Didn't you double footnote?"
He sat up straight, slowly crossed his arms in front of his chest, stared at her with an expression that combined annoyance with disgust, and said nothing. After a few moments she turned away, a victim of this marvelous countenance I would see many times over the next half century.
All had begun at the end of August, 1964, a week before most students arrived, when nearly forty young men -- or were we really still boys? -- moved into a wing on the seventh floor of the old dormitory, a residential hotel in an earlier time, the walls painted institutional dull and the faded charm of old fixtures still in the suites. The early week was required for an orientation to the accelerated academic program to which we thought ourselves fortunate to have been accepted. Beyond orientation, this first week allowed us to meet our classmates with whom we would presumably spend the next six years which would culminate, each of us hoped, with the awarding of an MD degree.
It was easy for Carl and me to become friends. He had traveled the furthest distance to be in Boston and spoke in the easy and friendly manner of his home in small town Ohio, so unlike many east coast classmates who were somewhat louder, somewhat more brash. The differences between us -- he was Catholic, Midwestern, and confident, I was Jewish, New Englander, and insecure -- were unimportant. We soon became friends, and had in common other things, an independent outlook, a bit of stubbornness, underlying honesty. An appreciation and joy found in intramural football and occasional beer as well.
But more than anything it was the conversation that was so much a part of our enduring and lifelong friendship, a long running exchange about life which meant about everything and so went off in various directions -- religion, politics, sports, family, work and play. As time went on, as the conversation created its own history, it never became old or dull. There were always, for me, new things to be learned, new opinions to consider, different perspectives to ponder. It was a guy's conversation, a sharing more of ideas and thoughts than feelings. There were insights and hopes, expectations, and disappointments. As the decades passed it noted the surprises, the unexpected twists and turns life takes. It was that ongoing conversation I most enjoyed, and easily, as we understood each other, being pretty simple and uncomplicated individuals.
Carl became a radiologist, comfortably happy in the dim light of his field, proud of his efficiency, good at what he did. I became an emergency physician when the specialty was in its earliest stages and had practiced it for fifteen years until age and family led me to an easier life with the regular hours of primary care.
Emergency medicine had exposed me to many episodes of pulmonary edema in which the failing heart cannot pump well enough to keep up with the returning circulation which then backs up and fills the lungs with fluid. It is an extremely uncomfortable and frightening experience for a patient; it occurs rapidly and produces the sense of drowning. Untreated it is usually fatal but the treatment is generally straightforward and most patients improve rapidly, going from a struggle for air, thrashing anxiety, and wild-eyed panic to restful smiles and thankful words.
After school had ended we followed our own paths thousands of miles apart, visiting each other every few years when opportunity allowed. Later, having become parents, we managed to twice, years apart, cross paths in the middle of the country on family motorhome trips beginning on opposite coasts. Later still and children grown I was visiting him and his wife in Salem, Oregon, the night of the pulmonary edema.
By then the party times were long passed. He had become physically disabled, wheelchair bound because of failed hips. I had been doing the travelling, the visiting, for more than a decade. In 2002 my wife and I flew from our New Hampshire home for the reunion with our dear friends. Five years later she and I spent a delightful meandering month in our micro-mini motorhome on a cross country trip with Salem the destination, another happy visit.
Two years after that I began to visit yearly, flying to Portland and driving on to Salem. By then he was newly diagnosed with heart failure. Heart failure -- why? There are a number of possible causes but he showed little interest in further evaluation or investigation. He accepted, he chose, minimal care. My advice, my encouragement, my pleading to look further, to go further was politely ignored. He seemed comfortable from the cardiac standpoint, more distressed by his hips.
During a night in May, 2012, I was asleep in the Salem guestroom when his wife rushed in to ask me to look at my friend who had awakened acutely short of breath. In a moment it was clear he was, as he himself had thought, in pulmonary edema. There he was, struggling for air, wild eyed, panicked. I was helpless, without equipment or medicines, unable to treat a life threatening condition in my best friend, a condition I had treated successfully many times. The best I could do was to get him upright, to encourage him to breathe deeply, and to reassure him while we waited for the arrival of the EMTs I had instructed his wife to call.
An hour later he was sitting comfortably in bed in the ER, feeling well, having responded to standard treatment. We spoke for a bit, I promised to return later in the day to watch a basketball game with him, and left him with his wife. My visit was extended for a few days while he remained hospitalized, no longer able to deny his heart condition or to avoid the necessary and long evaded evaluation.
Disease of the heart muscle, myocardiopathy, progressive and essentially untreatable was the diagnosis. I returned home with the hope I would see him again and the expectation of no more than a year or two, at best, of life for my friend.
For more than a dozen years our conversation had been in part continued by means of email. He had been more the listener -- or the reader -- faithfully, perhaps at times dutifully, reading my sendings which at times were long meandering thoughts, ponderings, and reminiscences. He might reply in some detail or briefly with such as, "That's really interesting" or, "You're an idiot!" In a certain way my emails had been like keeping a journal that recorded thoughts and ideas as well as prompting more than superficial contemplation. I thought that upon my best friend's death I would miss our exchanges most of all.
A few months after that visit my wife and I traveled west to Salem to visit him and her. We happily found him remarkably well and had a pleasant time. I resumed my annual visits the following spring, still happy to see him, still anticipating his death.
Health complication followed complication. The powerful diuretics required to eliminate the fluid his heart could not pump destroyed his kidneys; he required thrice weekly hemodialysis. He was in the ICU a number of times for gastrointestinal bleeding, gall bladder surgery, cardiac tamponade, and worsened heart failure. He was within hours of death several times but always survived. The year or two of life I had expected turned to three and then four.
Our email exchanges continued, my long musings continued while his responses became shorter and shorter, finally, when they occurred at all, a single sentence. In response to one in which among other topics I concluded that our particular friendship had been a special one he replied with a thanks for having been such a great friend for so long. Short, to the point, the way we liked it.
When I visited in May, 2016, four years after I had been helpless to deal with the pulmonary edema and well after the period for which I had predicted his death I found him again in the ICU. Our ongoing conversation was nearly over. Discussions of any existence beyond this one had concluded the year before with his belief unchanged; my suggestion that even if wishful thinking it was somehow possible that our paths would cross in some future unknowable and unimaginable fashion had been rejected. He died at the end of October and so did not learn who had prevailed in the Presidential election, one of the few subjects about which he could still become energized.
There was no funeral. His wife instead planned a memorial gathering for family and friends at their home for early December. My wife and I arranged to fly from east coast to west to Portland and then an hour drive to Salem. As the plane began its descent the pilot announced freezing rain had closed the airport and we would divert to Seattle. It became clear soon enough after landing that we would not be able to fly that day from there to Portland and so rented a car to instead drive.
The storm that had closed the Portland airport was moving north along the coast and we began to experience blizzard-like conditions. "That's okay, we're New Englanders and used to this," we told each other but the many cars and trucks that slid off of the road soon muted our confidence. The drive was long and slow. Finally, well after midnight we arrived at our Salem hotel.
At the memorial we embraced his widow, our grieving friend. I told many stories about my friend to his younger brother who had travelled from Wisconsin, and a few to his younger sisters. Standing by one of several poster boards adorned with various photographs from my friend's life was a sweet young lady, a Physician's Assistant who had often attended my friend and who had learned just a day earlier of his death. She pointed to various pictures and I explained them, often with a brief story. Her eyes filled with tears. "He talked about you all the time."
The following morning the weather was as it had been in the days since the snowstorm; typical Pacific Northwest -- overcast, rare snatches of sun, intermittent rain. A dreary end to a difficult visit. We had begun our drive north to Portland's airport, anxious to return home, I lost in thoughts about my buddy and concerned as to our widowed friend's future. Across the highway in a large field there appeared a full and seemingly perfect rainbow. We admired the beautiful spectacle as we continued, leaving Salem. The rainbow seemed to touch down in a far end of the field just up the road. Instead of the rainbow's landing place continuously moving further away as normally happens when driving, we had instead the sense of getting closer and closer.
Suddenly, the rainbow's end touched the car, the full spectrum of colors dazzling, flashing brilliantly, a sparkling dance on the windshield, the road obscured. This lasted just seconds and then disappeared, the rainbow itself completely gone. We were silent for a few moments, then looked at each other and asked, "What just happened?"
Originally appeared in Ocotillo Review.
Article © Harvey Silverman. All rights reserved.
Published on 2018-03-19
Image(s) © Lillian Queen and Sand Pilarski. All rights reserved.