The Moonlight Sonata at the Mayo Clinic Page 12

Outside Rochester was a sign that advertised it as the Best Place to Live in America.

  As we drove into the town, past the small malls, the big malls, the fast-food joints, and then a neighborhood of two-story midwestern houses with wide porches, we could see two gray and glass high-rise buildings at the center of town. As we grew closer, signs with the immediately recognizable three-shield blue logo appeared and then the words Mayo Clinic.

  Thirty-five thousand people are employed by Mayo in a city of just over 100,000. The clinic itself is in these two twenty-story buildings, Gonda and Mayo. A thousand people a day pass through the doors.

  The Kahler Inn and Suites was across the street and down the block from Gonda. It was dowdy and privately owned and had a large TV in the small lobby, around which people who did not look well sat on a large lumpy couch watching CNN. We checked into a spacious plain room and went outside to find something to eat.

  Hardly anyone seems to actually live in downtown Rochester—the Mayo buildings and hotels and restaurants that serve the sick constitute almost all of it. The downscale Kahler Inn and Suites, the upscale Marriott and DoubleTree. (The Marriott had town cars with drivers waiting outside, groups of women in head scarves and men in dark expensive suits.) The streets at night seem to be populated only by patients and their families. That first evening, we were almost run over by two elderly women driving motorized sit-down scooters. Each of them had a guard that propped her chin up, as if part of her chin or neck were missing or needed support. They were driving along the sidewalk at speed and talking about whether they were going to make the light. Each of them in her right hand held a lit cigarette.

  On another block was a younger woman, chubby and dressed in a shapeless cotton dress. She too was sitting on one of the scooters, but she had a small calico cat in her lap. She smiled warmly. We smiled back. Later we would see a small group of people standing around her stroking the cat while she talked to them. The cat, I saw, was a lure.

  We learned fast that almost everyone in the hotels was going to the clinic. There was really no other reason to be there. At every restaurant, at every hotel breakfast, at the smallest transaction (buying underwear, cough drops), the clerk or waitress would say to me, “Good luck,” and we both knew what that meant. Soon Vincent and I said it, too, when we got off an elevator, to the people still inside.

  Our dinner that first night was at a café recommended by a friend of a friend, a woman who had a stage-three cancer and is alive, she said, because of Mayo. Being alive “because of Mayo” is a refrain. Another is “It took them twenty-four hours to diagnose it.” And although I don’t watch House or the other medical TV shows (I am too scared to), the shows must have added to the expectation, the answer that all of us who are patients here, seek.

  Before I fell asleep, what came to my mind was that Rochester was a cross between Lourdes and The Magic Mountain. I had heard of so many patients who had traveled miles and miles and waited for months to get here on a pilgrimage to healing. And having seen the women downtown that night, I wondered if, like Hans Castorp and other patients in Magic Mountain, there were people who were at home here or were, by a combination of illness and medical institutionalization, trapped. The whole town was Oz.

  In the morning, we had our first two appointments, and the only appointments so far on my list. I was to start at the place where the symptoms started, in ophthalmology, and they would set up the next appointments within the clinic. I had heard of the famous Mayo team system but didn’t really know much more than lore.

  I was anxious. I dressed carefully, trying to look like a real person, a professional, a person who was more than her illness, all of which disappeared as I walked into the building.

  We entered through a tunnel from our hotel, one of the many makeshift subways that connect the buildings in downtown Rochester. (The reason for them would become unmistakably apparent when we returned the following March.) We followed a young couple pushing what looked like a lump of blankets in a wheelchair. One handled the chair and the other rolled an oxygen tank alongside. As we grew closer to the glass automatic doors that opened into the Gonda Building, more and more people were walking with us: the halt and the lame and the very sick. A man on crutches. A little girl with a bald head. A man with his whole leg covered in a bandage.

  In the two-story entryway were huge “chandeliers,” or glass sculptures, made by Dale Chihuly—bursts of yellow and green that extended the length of the long bright hall. The glassmaker wanted them to be cheerful, he said, and I was glad that he had been commissioned to make these blasts of warm color for this place. Compare them to the usual lights found in most hospitals and lobbies of medical clinics—the cottage cheese ceilings, the cold, weird lighting fixtures that seem to have been manufactured for medical offices alone. These were made by an identifiable human hand.

  From the beginning, Mayo distinguished itself in this way: it struggled against the impersonal that is the ubiquitous nature of most medical institutions. The people who built and planned the Mayo Clinic and who, I imagined, kept working at it, were trying to combine both efficiency and humanity in every Mayo transaction. They did not always succeed at this almost insurmountable task, but not for lack of trying.

  Once we passed out from under Chihuly’s glass, we were in a larger area. In front of us was a vast room with a glasswalled atrium planted in fall colors, red and orange. In front of the atrium was a grand piano with a small polite sign that invited anyone to play as long as you thought “people would enjoy it.” No one was sitting at the piano as we walked in, but someone would play later in the week and leave me with one of my most lasting impressions of the Mayo Clinic. This lobby is two stories high. I imagined that the person who designed it hoped to counteract the feeling of being crowded.

  When we walked out of the elevator onto the seventh floor, we faced a glass case containing tribal clothes from New Zealand. In every nook and corner in the Mayo Clinic buildings was original art or collections of beautiful objects: Chinese porcelain in neurology, Steuben glass in X ray, an Asian rug with a pattern of beautiful running horses in CT scan. No pastel machine-made watercolor prints.

  The chairs in the ophthalmology waiting area were comfortable and broken up by a glassed-in optometry shop. Other waiting areas were next to large glass windows with easy chairs and couches in a living room arrangement. Part of the problem with medicine is its pervasive impersonality, the way one feels as if one’s singularity were slowly being eroded by the attitudes of the assistants, the doctors, and the surroundings. These attitudes were often based on the glass wall: they were on one side, we were on the other. But at Mayo, when I was there, the smallest transaction had a quality of both gentleness and competence, a vast, interlocking machine of efficiency communicated on human terms. To help the bad business of waiting, receptionists told me exactly where the doctors were. (He is in the lab. She is with residents.) They invited me to come to the desk “after thirty minutes of waiting.” I was never given a rude or vague reply. Patients were encouraged to ask for an earlier or different appointment if time was freed up. When I arrived at one doctor’s desk earlier than planned and told the receptionist, she said, “I will text him to tell him you are here. He is in the lab. When he replies, I’ll let you know right away.”

  Lines were avoided by the large number of people behind the desks and little buzzers like those that restaurants give you to announce your table is ready. To pass the time, jigsaw puzzles were left out on square tables (my favorite touch). Free Internet and, in some areas, free computers. Televisions were small and unobtrusive.

  Light was maximized. Glass walls, floor-to-ceiling windows, skylights, the entry atrium.

  The staff reached toward us rather than turning away. They deemphasized the wall between us by concentrating on what we had in common. More than anything, they, with few exceptions, did not lord it over the patients; someone had thought about the power that medical staff have, innately, over the vulnerable and the sick an
d had done dozens of small things to counteract it.

  Yet despite everything Mayo did, from the well-educated and friendly Minnesotans it employed to the jigsaw puzzles it provided, they were still “the staff” or “the doctors.” They were still inhabitants of well land. We were in Oz. I longed for a doctor who had had something go wrong with her eyes.

  As I sat in the waiting area, I thought about how, in my past life, I had just kept going forward, adding things to my to-do list, flying back and forth across the continent, speaking to church groups, writing, teaching, preaching, holding down a part-time job, cooking, cleaning … I thought about the people I knew who did this kind of thing well into their sixties, well into their seventies. Not many, but a few. Did I have an inner thermostat that ceased working, that could not adjust? Would it be “all downhill from here”? What if I did not “get well”?

  My first appointments were with Dr. Leavitt, a neuro-ophthalmologist, and Dr. Herman, a specialist in uveitis. My vision was tested, my eyes were dilated. The fact that the afflicted eye did not contract properly when a flashlight was shone into it was duly noted. Not noted was the look of alarm on the technician’s face, and her repeated motions with the flashlight, her calling in another technician to confirm it. Then we were shown into a comfortable examining room paneled in blond wood rather than painted white, with an examining chair next to a wide desk built into the wall. Dr. Leavitt, a small, upright woman dressed in a gray silk suit, walked in, introduced herself, and examined my eyes.

  Dr. Leavitt said the nerve looked “quiet.” It looked “white,” as optic nerves look when they have been “assaulted.” I should have another brain MRI.

  In the early afternoon we saw Dr. Leavitt’s colleague, Dr. Herman, a specialist in uveitis and glaucoma, with a mild midwestern face. He wore a tweed jacket and large scuffed shoes. His office too was faced in warm blond wood. Cabinets lined the walls. Mayo was working against the impersonal, right down to the jigsaw puzzles. Right down to Dr. Herman’s scuffed shoes.

  He asked if he might look at my eyes. He told me they were “very quiet.”

  “Someone said I had blepharitis,” I said to him.

  “Not now,” he said from behind the scope.

  “What are these pockets at the corners of my eyes?” I asked.

  “Not to put too fine a word on it,” he said, “they are fat. As the tissue thins, fat deposits.”

  “Could I have low-intensive glaucoma?” I asked, hesitant. I asked because one of Dr. Burks’s patients who had similar symptoms to mine had discovered after six months and the wrong ophthalmologist that she had low-intensive glaucoma and was going blind.

  “No,” he said. “The nerve would look different. Cupped.” He made a cupping motion with his hands.

  He sat back in his chair. He said quietly, “You may not find the cause of this.”

  I wanted to scream at him, That is why I came here. I believed that if I just tried hard enough, I would find the answer, especially here, at the Mayo Clinic. I would know.

  But instead I said, “Of course.” And was reminded of what Raymond Carver said automatically as he was leaving the office of the doctor who had told him he had stage-four lung cancer: “Thank you.”

  Toward the end of the appointment, Vincent said—it was so quiet I might have missed it—“Why can’t we do the MRI today?”

  When I heard him say we, I felt that I had been holding a heavy and unwieldy package for a year and, with one word, he took it.

  Dr. Leavitt was my team captain. She had the authority to order tests and set me up with other doctors. They handed me a sheet the next morning. I was to see a rheumatoid specialist, a neurologist on two separate days, and then Dr. Leavitt again. I was to have the brain MRI and a blood test and a “twenty-four-hour urine test.”

  I was given a new Mayo number to replace the temporary number I had been given earlier, and it was bar-coded onto appointment sheets.

  The lab area was in a “subway” floor, below the lobby. When I came out of the elevator, sheets in hand, I hesitated for a second—right or left? A man in a blue coat with a little Mayo pin appeared at my left hand and asked politely and without condescension, did I need or want direction? “Blood lab?” I said. “Right down that hall.” He pointed to my right. “Straightaway.” When I got there, I found ten receptionists and two people in line. Within five minutes I was in a pleasant room with a young woman who told me she would take my blood and arrange for the urine test. She asked me, as every single person who assisted me had asked, my birth date. Behind me was a miniature conveyor belt. The blood draw was painless; she placed my blood on the conveyor belt, where it rattled out of sight. Then she handed me a jug—labeled with my name and Mayo number—and told me that for the next twenty-four hours I was to pour all my urine into it. To test for heavy metals, she said. “All of it?” I said, alarmed. “All of it,” she said, and smiled. “I’ll give you a plastic bag to hold the urine jug,” she said. I thought of the plan Vincent and I had to hike that afternoon. This will be interesting, I thought. She asked me when was the last time I ate fish of any kind (walleye, the night before), and she asked for the exact size. “Please don’t eat any fish for the next twenty-four hours,” she said. She looked at the clock and wrote down nine-fifteen a.m. “Tomorrow,” she said, “you’ll finish at nine-fifteen a.m.”

  “Precisely,” I said.

  “Precisely,” she laughed.

  As I left the clinic that day, I saw other people with the same plastic bag, and we silently saluted each other—united in twenty-four-hour urine. I carried the plastic bag and the jug with me into restaurants and bathrooms. In the middle of the night, I poured carefully. I balanced the bag with its jug inside in the backseat of the car on the floor. The next day, as I walked back toward a large wooden box, like an oversize crate, with urine drop-off in large letters on it, I saw a set of four interesting watercolors on the wall. I stopped to look at them, circles and squares, bright blue, orange, and yellow. They were Ellsworth Kellys.

  I dropped off my urine jug, visited the Kellys again, and then saw, to my right, a frosted sliding-glass door and a sign that read Center for the Spirit. The door slid open as I approached it (everything at Mayo is geared to wheelchairs). Inside was a wall of wood with slots in it. A stack of blank sheets with pens and pencils on a shelf below it. Folded papers were stuck in the slots. A Wailing Wall at Mayo. Inside that room, quiet. It seemed to have been soundproofed. I wrote a friend’s name on a sheet of paper, a man who was having surgery for blocked liver ducts that day, and stuck it into one of the slots. I walked farther into the room and discovered that behind a glass partition was a small carpet printed with a labyrinth—that walking meditation path found on Cyprus and at Chartres and set in stones in Ireland.

  I put my foot on the carpet and started to walk. The striking thing about labyrinths is that they are designed so the walker can’t guess where in relation to the center she is. All I could do was stay where I was. The men and women who created labyrinths knew how to place the walker in the formidable present: you can do no planning in a labyrinth, you have no horizon, no way to know where you will be next.

  Task: to be where I am. I was in and under the Mayo Clinic. I was buried but alive. The first thing I felt was a wash of gratitude, for all the people here at Mayo, for those who worked so hard to make it a place where the patients did not have to cope with rude receptionists, clogged medical records, and unexplained waits and could just face the things that we all were facing—what was written on the slips of paper stuck in the wall.

  Then I remembered something a woman said to me when giving me a massage a few years ago, before my nerve was inflamed, when I was working at great speed. She was working on my right shoulder, and she gently said, “More going out than coming in.”

  I stood there on the labyrinth and thought about how I had been “spending” my life. I had been using up what savings I had as fast as I could by overworking, overextending, over, over. And now I
was in debt. And the interest was pretty high, as bad as any bank’s.

  And I was outside the walls of the church, outside of “Christianity,” in exile, in Oz. I thought about the others who had climbed over the walls of that institution, who had strayed. The ones who had said, “I can’t do this anymore.” We know of the big ones: Galileo, Emerson, Luther. But what about the others, the ones who one day just drifted away?

  It was so much about words, I thought, as I walked on a pattern designed by persons hundreds of years ago, some of whom were members of the Catholic Church. I knew so many people by now for whom the words of the church either meant nothing or were antithetical to their experience, yet they said not a word about it. Heretics may not be tied to a stake anymore, but in any tribe our ears are tuned to the opinions of others: I voiced some doubts about the creed at a talk several years ago, and a woman stood up and walked out of the room. I thought of those for whom the words of the church were not enough, not large enough to contain their experience of the sacred. God in the rocks, in the sea, in the branches of trees. This, whispered in the hall.

  As I arrived at the center of the labyrinth, a word flew straight into my mind. It was the word Vincent had said.

  We.

  I felt the same sensation I had felt when he said it, the shifting of a weight that I had not known I was carrying.

  I pictured again the blind man in Bethsaida. He sat beside the road begging, alone. More than alone, defiled. Jesus “took him by the hand” and “led him.” I had thought of this as Jesus “helping him out,” or “healing” him, the holy man looking after the poor beggar. But just then I felt, rather than saw, that that was not what happened that day. Instead, this blind man felt someone take his hand and walk with him. He felt someone put his hand over his eyes. He understood that someone had joined him in his suffering. Someone had said, “We.”

  As I left, I saw another small room with a dome-shaped skylight (where was the light coming from? we were under a twenty-story building) and realized it was meant to be a tiny mosque. Outside was a pair of shoes, and inside, a small man sat on a bench holding the Koran in one hand while checking his BlackBerry with the other.