The wounded healer.

THE WOUNDED HEALER

Lost in America: A Journey With My Father

By Sherwin Nuland

Knopf, 2003. 212pp. $24.00

Readers of Sherwin Nuland's creepily powerful How We Die: Reflections on Life's Final Chapter (1994) will have noticed a number of contradictions, loose ends, and silences in that blend of vivid popular science and gripping case histories. Nuland claimed he wrote the book "to demythologize the process of dying ... not to depict it as a horror-filled sequence of painful and disgusting degradations, but to present it in its biological and clinical reality, as seen by those who are witness to it and felt by those who experience it." But in fact the only myth he systematically demolished was the genteel fantasy of "death with dignity." With what seemed like unrelenting animus, he kept reminding his audience that 80% of them were likely to die in the impersonal sterility of a hospital (quite possibly in the awful high-tech isolation of an ICU) and that exiting through the various "doors of death" (heart attack, stroke, trauma, Alzheimer's, AIDS, cancer, etc.) was often, if not usually, "painful and disgusting." Though not shy of flaunting elsewhere (e.g., in How We Live, 1997) his medical acumen and surgical gifts, Nuland ended this book with two accounts of his own well-intentioned malpractice: when he cruelly extended the lives of patients (one of them his brother Harvey) with pointless chemotherapy and other desperate procedures. The brilliant Dr. Nuland, professor of surgery at Yale and National Book Award winner, obviously had some major attitude problems.

Despite its supposed pragmatic, objective purpose, How We Die turned out to be a deeply, if murkily, personal book. Born into a family of Russian Jewish immigrants in the Bronx, Nuland dismissed his religious roots as "the load of emotional detritus I now euphemistically call my heritage." Though he gave a long, moving account of the death of his nonagenarian Bubbeh from a series of strokes, he skimmed over the death of his beloved mother from colon cancer (when he was only eleven) and said nothing at all about his father. He briefly alluded to the fact that he had been divorced and that his second wife was a Christian. And, for a final puzzle, he dedicated the book to Harvey Nuland and a man named Vittorio Ferrero, both of whom he called "my brothers." Who, one wondered, was Ferrero?

All these questions and obscurities have now been cleared up in this almost unremittingly painful memoir, where Nuland appears not as the omni-competent, formidably eloquent (How We Die is studded with apt literary quotations) master physician, but as the bleeding, battered (by deaths in the family, etc.), guilty, anxiously surviving son of an impossible father, whose journey to di goldene medina led to a lifetime of misery and heartbreak. While Nuland's career eventually assumed many of the familiar comforting contours of an American triumph (from poverty-stricken Shepsel Nudelman to much-feted Dr.-Professor Nuland), it never did, and never could, wholly emerge from beneath the decades-long shadow cast by the wretched Meyer Nudelman, the ferociously irascible garment worker, hypersensitive, undemonstrative, ignorant, speaking only Yiddish and incomprehensible broken English, a man bedeviled by fate and a mysterious debilitating disease that dragged him to his death after countless agonies, indignities, and operations. Throughout How We Die Nuland gave many broad hints that in becoming a doctor he was trying to play savior to a world racked by the diseases that swirled around him when he was growing up. In Lost in America he records the devastation wrought by those diseases and his often passive, helpless response to them.

Nuland begins in medias res with the crippling bouts of depression that lasted from his late thirties to his early forties and landed him in a mental hospital for over a year (1973-74). In the course of this crisis his wife left him and the medical staff wanted to do a lobotomy on him. Only the spirited resistance of a young resident psychiatrist--Vittorio Ferrero, who became Nuland's lifelong friend and mentor-rescued him and then brought him back from the abyss, mainly through twenty sessions of electroshock.

All this ties in with his father because, as Nuland sees it, the key to his depression was the "dark, enfeebling seduction to make myself what he [Meyer] was." What right did he have to escape the maw of debilitation and death that swallowed up his father? But escape he did, though he still has occasional afterclaps of his illness. In any event the mostly tragic memory of his father will never let go.

Meyer Nudelman's story could be crudely summarized as a non-stop run of very bad luck. Born in the Bessarabian shtetl of Novoselitz, he apparently quarreled with his family there. He came to America on his own in his late teens (1907). He later learned that everyone in Novoselitz had been machine-gunned by the Nazis. Never successful at anything he tried, he eked out a hand-to-mouth existence, often helped by cash from relatives or landsleit--which he bitterly resented. His wife's family couldn't stand him; he lost his first son to pneumonia at the age of three. His Judaism was a matter of grinding obligations, and it brought him no visible consolation. Finally, and worst of all, after what must have been a thoughtless one-time dalliance or visit to a brothel he contracted syphilis, which took almost a half-century to kill him as it inexorably wrecked his body and mind.

Nuland didn't discover the true cause of his father's staggers, shakes, kidney stones, infections, loss of bladder control, "lightning pains," moodiness, and violent outbursts until he was a first-year medical student at Yale. (Meyer himself and Harvey never learned the truth.) By then he had already endured and hated his father's weird behavior for all his conscious life. He had often done dutiful service to Meyer, had visited him constantly in the hospital and helped him year after year to negotiate the treacherous wintry streets between the 183rd St. IND subway stop and his apartment on Morris Avenue. But he had always been deeply ashamed of his father. He had fought the old man's bossiness; and on one harrowing occasion he had flatly refused to enter a movie house his father had all but crawled to because he had already seen the show. "Pliz, Sheppy," Meyer begged, "I eskink you pliz. So fah we cummink and voz fa me hodt. Pliz dun't be lak det." In a fit of gratuitous sadism, "Sheppy" wheeled around and pulled Meyer back home through the snow.

And so it went, year after year. Nuland had his share of life-threatening experiences: from sticking his father's watch chain into an electrical outlet, from diphtheria and an ingested fishbone. Apart from that, however, he went from strength to strength, culminating in his being chosen as one of the two chief surgical residents at Yale Medical School. But, for all his intelligence and charm, Nuland failed to appreciate either the depths of his father's travail or the fact that nakhes over his younger son's achievements was about the only good thing in his nightmarish life. (In a miracle of perfect timing Nuland brought the news of his coup at Yale to his father on what proved to be Meyer's deathbed in Montefiore Hospital.)

The secret, then, that readers of How We Die never could have guessed was the complex layers of what Nuland almost mockingly called "my heritage." That legacy, it develops, included fluency in Yiddish and much deeper attachment to Jewish ways than one might have imagined in the man who described himself as a "confirmed skeptic." Nuland now tells us that he kept kosher until his senior year in medical school, that even then he continued to don his tallit and read the Shabbes service in his dorm room. He and his brother did, to be sure, change their names (just as he was finishing high school), in an archetypal desire to flee both their embarrassing past and anti-Semitic bias. But now in his own old age, "on every Rosh Hashanah and Yom Kippur morning" Nuland continues to remind his children of

    "the dread, awe-inspiring prayer (the Untaneh Tokef) that is about
    to be recited on that solemn day of divine judgment and atonement
    for sin. I do it as a kind of memorial to my father, because he
    would invariably poke me in the side at that dramatic point in the
    service, to be sure that I was aware of its towering significance in
    the life of every Jew."

Lest that sound like Fiddler on the Roof sentimentalism, it has to be noted that Nuland also compares the solemn prayer to "the song of the Lorelei, trying to lure me back to the destructive reefs of obsessional thinking, guilt, and depression." But at the same time he insists that, "Formalized religion, formalized prayer, formalized observance--they are all part of the heritage of my family, and I cherish the sustenance they give me. More than cherish--I need it." Sustenance? Cherish? Need? Go figure. Is this the same man who wrote in How We Die, "Nothing would please me more than proof of His [God's] existence, and of a blissful afterlife, too. Unfortunately, I see no evidence for it in the near-death experience"? Or anywhere else, he might have added.

The explanation is, of course, a simple one. Nuland was, and continues to be, forever bound to everything his father stood for, including, however tenuously, Judaism:

    As a child in the synagogue on Yom Kippur, I would stand alongside
    my father in tremulous awe as we intoned the ancient formula before
    the heavenly decision is made as to who shall be at peace and who
    shall be tormented. But penitence, prayer and good deeds can avert
    the security of the decree. The Hebrew word translated in the
    prayerbook as "penitence" is tschuvah, whose literal meaning is
    "return." I have owed Meyer Nudelman recompense for the ravages
    inflicted on his years, and for my inability to perceive his
    unhappiness. It is by returning to memory and to my father that I
    have sought to comprehend my own severe decree against myself, the
    guilt and sickness whose ravages are not to be forgotten. My quest
    has been to perceive what he really was.

So there can be no tidy conclusion here, no--the inevitable psychobabble cliche--closure. Nuland is too honest and too faithful to his father's and his own unredeemed experience for that. And honesty is a crucial element in Nuland's riveting narrative. He stops at nothing: he admits that he never took his father seriously, that starting in his sophomore year in high school year in high school he wanted Meyer to die; that for years his father lived in the same apartment with his wife's mother and sister Rose, but never spoke to them or looked them in the eye; that Meyer was in many ways an awful husband to Vitsche: joyless, domineering, emotionally tongue-tied (aside from passing on his syphilis to her); that as a young boy Shep was bothered by the stench, first of the menstrual pads soaked in Vitsche's infected blood, but then for years on end of the rags that Meyer wore beneath his trousers to stanch his incontinent bladder. Everything at 2314 Morris Avenue may not have been awful (Meyer managed to say to Vitsche--and his son managed to hear him say it--when X-ray treatments made her hair fall out and she asked, "How can you still care for me?" "It was not for your hair that I fell in love with you"), but the texture and tenor of the lives recorded here are almost unremittingly grim.

Still, bleakness, however truthful, hardly guarantees a great story. What puts Lost in America in the same class as Edmund Gosse's Father and Son (1907) and Philip Roth's Patrimony (1991) is the astonishing detail and (mostly frustrated) tenderness of his memory. In How We Die Nuland claimed to have an eidetic memory; and his ability here to reconstruct snippets of conversation, vanished scenes and topography from his boyhood (e.g., parts of the Bronx that have long since been urban-renewed out of existence) seems to back that claim up. Yet when he comes up against blank spots (who was that terrifying wild drunk who came pounding on the apartment door in the middle of one night when his father was away?), he leaves them blank--as unknowable as Meyer's life in Novoselitz.

The picture that emerges is heartbreaking: of unfulfilled energies (beautiful Aunt Rose, slaving away forever at a sewing machine), of innocent mistakes (Harvey never recovering from the excessive bed rest and massive overfeeding he was subjected to after contracting rheumatic fever), of lives crushed by circumstance (Nuland's dead brother Maischl, by all accounts a marvelous child). Now happily married to a Gentile (In How We Die Nuland talks positively about "Sarah's tradition" and quotes St. Paul's encomium to love from 1 Corinthians) and lionized by Gentiles, Nuland still can't forget the jeers and raw hatred the faced the day in the late 1930's when he walked through an Irish neighborhood with his father and other Jews from his congregation en route to perform the ritual of Tashlich at Pugsley's Creek.

Americans, especially believers, like to think that, as in "Amazing Grace," the lost will be found and the wounded will be healed. The beauty of Nuland's book is the way, at once passionate and sober, it presents the commonplace tragedy of the irrecoverably lost and the incurably wounded.