John Updike - Rabbit At Rest

"Harry." Janice has been telling him something. "What did I just say?"

"I have no idea." Irritably he adds, "Why bother to talk to me when you've got Charlie back advising you, to say the least?"

She flares a little; her lips pinch in and her face comes forward. "Advising me is all he's doing and he's doing that because you asked him to. Because he loves you."

She wouldn't have spoken this way before going to Florida and those women's groups, of "love" as something that is all over the map, like oil drips from speeding automobiles. She is trying to stir him, he dimly recognizes, back into life, into the fray. He tries to play along. "Me?"

"Yes, you, Harry Angstrom."

"Why would he, for Chrissake?"

"I have no idea," Janice says. "I've never understood what men see in each other." She tries a joke. "Maybe he's gone gay in his old age."

"He's never married," Harry admits. "You think he'd be interested in coming back to work for Springer Motors?"

She is gathering up her things – a black leather pocketbook packed like a bomb, the old-fashioned round kind people used to throw and not the flattened Semtex that terrorists smuggle into suitcases in airplanes, and her real-estate textbook and photocopied sample documents stapled together, for her class tonight, and a new spring coat she's got herself, a kind of jonquil-yellow gabardine with a broad belt and wide shoulders. She looks girlish, fluffyhaired, putting it on. "I asked him," she says, "and he says absolutely not. He says he's into these partnerships with his cousins, rental properties in the north end of the city and over toward the old fairgrounds, and a rug-cleaning business his nephew started up with another boy and they needed backers, and Charlie says that's enough for him, he couldn't stand to go back into a salaried job and all that withholding tax and the aggravation of being expected somewhere like at the lot every day. He likes his freedom."

"We all do," sighs Rabbit. "Hey, Janice. I was thinking just the other day we ought to get the wall-to-wall carpets in our house cleaned. No fault of yours, but they're filthy, honey."

Dr. Breit comes in Sunday morning and tells him, "Harold, you're looking A-1. Ray does beautiful work. They say around the OR, `He could tickle a tapeworm under the chin with that catheter."' Breit looks up through his furry eyelashes for the expected laugh, doesn't get it, and perches on the edge of the bed for extra intimacy. "I've been reviewing our own films plus the stuff the jerks down at Deleon Community finally got around to sending us. Your lumen in the LAD has gone up from fifteen per cent of normal to sixty. But I can't say I'm crazy about your RCA, the right coronary artery; it shows I'd put it at about eightyper-cent blockage, which is fine and dandy as long as the welldeveloped collateral is supplying the right ventricle from the circumflex. But a lesion is developing at the bifurcation of the circumflex and the LAD, and a lesion at a bifurcation is tougher to treat with angioplasty. Same thing – I assume you're interested in this – if the lesion is too long, or in a hyperkinetic AV groove, or in a situation where in the middle of the procedure you might get stranded without enough collateral circulation. In those kinds of cases, it can get hairy."

His legs are a little short for sitting on the bed comfortably; he bounces his ham a little closer to Harry's legs, and Harry feels the blood inside his supine body sway. Breit smiles and his voice grows confidential, like when he was murmuring over Dr. Raymond's shoulders. "The fact is, Harold, PTCA is a pretty Mickey Mouse treatment, and what I want you to seriously consider as you lie here these few days, even though as I say this procedure appears to have produced good results for the time being, is, now that you've tested the waters, going ahead with a CABG. Not right away. We're talking four, six months down the road before we go in again. We'd bypass both the RCA and the CFX, and the LAD depending on the restenosis, and you'll be a new man, with damn close to a brand-new heart. While we're in there we might want to look at that leaky aortic valve and think about a pacemaker. Frankly, we may have had a little postoperative MI; your electrocardiogram shows some new Q waves and there's been an elevation of the CPK isoenzyme, with positive MB bands."

"You mean," Harry says, not totally snowed, "I've been having a heart attack just lying here?"

Dr. Breit shrugs daintily. All his gestures have a daintiness that goes with his milky-pink skin. His voice is a bit squeaky, piped through his blistered-looking lips. He says, "PTCA is an invasive procedure, nobody said it wasn't. A little trauma is to be expected. Your heart shows myocardial scarring from way back. All a heart attack is is some heart muscle dying. A little can die without your noticing. It happens to all of us, just as everybody over a certain age has some emphysema. It's called the aging process and there's no escaping it. Not in this life."

Harry wonders about the next life, but decides not to ask. He doubts that Breit knows more than The National Enquirer. "You're telling me I've come into this hospital for I don't know how many thousands of dollars for a Mickey Mouse operation?"

"Rome wasn't built in a day, Harold, and your heart isn't going to be rebuilt in a week. Angioplasty does some good, at least for a while, in about eighty per cent of the cases. But bypass is up to around ninety-nine per cent initial success. Look. It's the difference between scrubbing out your toilet bowl with a long brush and actually replacing the pipes. There are places you can't reach with a brush, and deposits that have become chemically bonded. A man your age, in generally good health, shouldn't be thinking twice about it. You owe it not only to yourself but to your wife and son. And those cunning little grandchildren I've heard about."

The faster Breit talks, the more constricted Harry's chest feels. He gets out, "Let me see if I understand it. They rip veins out of your legs and sew them to your heart like jug handles?"

A frown clouds the young doctor's face. He is overrunning the allotted time for his visit, Rabbit supposes. With visible patience he licks his sore-looking lips and explains, "They take a superficial vein from your leg and in some cases the mammary chest artery, because arteries hold up better under arterial pressure than veins. But you don't have to worry about any of that. You're not the surgeon, it's our bailiwick. This operation is done tens of thousands of times in the United States every year – believe me, Harold, it's a piece of cake."

"You'd do it here?"

Breit's eyes behind his flesh-colored glasses are strange furry slits, with puffy pink lids. "The facilities don't exist yet in this physical plant," he admits. "You'd have to go to Philadelphia, I doubt we could slot you into Lancaster, they're booked solid for months."

"Then it can't be such a very little deal, if you need all these facilities." Since childhood, Rabbit has had a prejudice against Philadelphia. Dirtiest city in the world: they live on poisoned water. And Lancaster is worse – Amish farmers, overwork their animals to death, inbred so much half are humpbacks and dwarfs. He saw them in the movie Witness being very quaint, Kelly McGillis wiping her bare tits with a sponge and everybody chipping in to build that barn, but it didn't fool him. "Maybe Florida would be the place," he offers Dr . Breit. Florida always seems unreal to him when he's up here and having the operation there might be the same as not having it at all.

Dr. Breit's sore-looking mouth gets stern; his upper lip has sweat on it. Why is he selling this so hard? Does he have a monthly quota, like state cops with speeding tickets? "I haven't been that impressed by our dealings with Deleon," he says. "But you think about it, Harold. If I were in your shoes, it's what I'd have done – without any hesitation. You're just toying with your life otherwise."