The City (John Updike)

His stomach began to hurt on the airplane, as the engines changed pitch to descend into this city. Carson at first blamed his pain upon the freeze-dried salted peanuts that had come in a little silver-foil packet with the whiskey sour he had let the stewardess bring him at ten o’clock that morning. He did not think of himself as much of a drinker; but the younger men in kindred gray business suits who flanked him in the three-across row of seats had both ordered drinks, and it seemed a way of keeping status with the stewardess.

Unusually for these days, she was young and pretty. So many stewardesses seemed, like Carson himself, on second careers, victims of middle-aged restlessness — the children grown, the long descent begun.

A divorced former business-school math teacher, he worked as a sales representative for a New Jersey manufacturer of microcomputers and information-processing systems. In his fifties, after decades of driving the same suburban streets from home to school and back again, he had become a connoisseur of cities-their reviving old downtowns and grassy industrial belts, their rusting railroad spurs and new glass buildings, their orange-carpeted hotels and bars imitating the interiors of English cottages. But always there was an individual accent, a style of local girl and a unique little historic district, an odd-shaped skyscraper or a museum holding a Cezanne, say, or a Winslow Homer that you could not see in any other place. Carson had never before visited the city into which he was now descending, and perhaps a nervous apprehension of the new contacts he must weld and the persuasions he must deliver formed the seed of the pain that had taken root in the center of his stomach, just above the navel.

He kept blaming the peanuts. The tempting young stewardess, with a tender boundary on her throat where the pancake makeup stopped, had given him not one but two packets in silver foil, and he had eaten both-the nuts tasting tartly of acid, the near engine of the 747 haloed by a rainbow of furious vapor in a backwash of sunlight from the east as the great plane droned west. This drone, too, had eaten into his stomach. Then there was the whiskey sour itself, and the time-squeeze of his departure, and the pressure of elbows on the armrests on both sides of him. He had arrived at the airport too late to get an aisle or a window seat. Young men now, it seemed to him, were increasingly corpulent and broad, due to the mixture of exercise and beer the culture kept pushing. Both of these specimens wore silk handkerchiefs in their breast pockets and modified bandit mustaches above their prim, pale, satisfied mouths. When you exchanged a few words with them, you heard voices that knew nothing, that were tinny like the cheapest of television sets.

Carson put away the papers on which he had been blocking in a system-computer, terminals, daisy-wheel printers, optional but irresistible color-graphics generator with appropriate interfaces — for a prospering little manufacturer of electric reducing aids, and ran a final check on what could be ailing his own system. Peanuts. Whiskey. Crowded conditions. In addition to everything else, he was tired, he realized: tired of numbers, tired of travel, of food, of competing, even of self-care — of showering and shaving in the morning and putting himself into clothes and then, sixteen hours
later, taking himself out of them. The pain slightly intensified. He pictured the pain as spherical, a hot tarry bubble that would break if only he could focus upon it the laser of the right thought.

In the taxi line; Carson felt more comfortable if he stood with a slight hunch. The cool autumn air beat through his suit upon his skin. He must look sick: he was attracting the glances of his fellow-visitors to the city. The two young men whose shoulders had squeezed him for three hours had melted into the many similar others with their attache cases and tasseled shoes. Carson gave the cabdriver not the address of the manufacturer of reducing and exercise apparatus but that of the hotel where he had a reservation. A sudden transparent wave of nausea, like a dip in the flight of the 747, had suddenly decided him. As he followed the maroon-clad bellhop down the orange-carpeted corridor, not only were the colors nauseating but the planes of wall and floor looked warped, as if the pain that would not break up were transposing him to a set of new coordinates, by the touch of someone’s finger on a terminal keyboard. He telephoned the exercise company from the room, explaining his case to an answering female and making a new appointment for tomorrow morning, just before he was scheduled to see the head accountant of another booming little firm, makers of devices that produced “white noise” to shelter city sleep.
The appointment jam bothered Carson, but remotely, for it would all be taken care of by quite another person — his recovered, risen self. The secretary he had talked to had been sympathetic, speaking in the strangely comforting accent of the region-languid in some syllables, quite clipped in others — and had recommended Maalox. In the motion pictures that had flooded Carson’s childhood with images of the ideal life, people had “sent down” for such things, but during all the travelling of his recent years, from one exiguously staffed accommodation to the next, he had never seen that this could be done; he went down himself to the hotel pharmacy. A lobby mirror shocked him with the image of a thin-limbed man in shirt sleeves, with a pot belly and a colorless mouth tugged down on one side like a dead man’s.

The medicine tasted chalky and gritty and gave the pain, after a moment’s hesitation, an extra edge, as of tiny sandy teeth. His hotel room also was orange-carpeted, with maroon drapes that Carson closed, after peeking out at a bare brown patch of park where amid the fallen leaves some boys were playing soccer; their shouts jarred his membranes. He turned on the television set, but it, too, jarred. Lying on one of the room’s double beds, studying the ceiling between trips to the bathroom, he let the afternoon burn down into evening and thought how misery itself becomes a kind of home. The ceiling had been plastered in overlapping loops, like the scales of a large white fish. For variation, Carson stretched himself out upon the cool bathroom floor, marvelling at the complex, thick-lipped undersides of the porcelain fixtures, and at the distant bright lozenge of foreshortened mirror. Repeated violent purgations had left undissolved the essential intruder, the hot tarry thing no longer simply spherical in shape but elongating. When vomiting began, Carson had been hopeful.

The hope faded with the light. In the room’s shadowy spaces his pain had become a companion whom his constant interrogations left unmoved; from minute to minute it did not grow perceptibly worse, nor did it leave him. He reflected that his situation was a perfect one for prayer; but he had never been religious and so could spare himself that additional torment.

The day’s light, in farewell, placed feathery gray rims upon all the curved surfaces of the room’s furniture — the table legs, the lamp bowls. Carson imagined that if only the telephone would ring his condition would be shattered. Curled on his side, he fell asleep briefly; awakening to pain, he found the room dark, with but a sallow splinter of street light at the window. The soccer players had gone. He wondered who was out there, beyond the dark, whom he could call. His ex-wife had remarried. Of his children, one, the boy, was travelling in Mexico and the other, the girl, had disowned her father. When he received her letter of repudiation, Carson had telephoned and been told, by the man she had been living with, that she had moved out and joined a
feminist commune.

He called the hotel desk and asked for advice. The emergency clinic at the city hospital was suggested, by a young male voice that, to judge from its cheerful vigour, had just come on duty. Shaking, lacing his shoes with difficulty, smiling to find himself the hero of a drama without an audience, Carson dressed and delicately took his sore body out into the air. A row of taxis waited beneath the corrosive yellow glare of a sodium-vapour streetlight. Neon advertisements and stacked cubes of fluorescent offices and red and green traffic lights flickered by-glimpses of the city that now, normally, with his day’s business done, he would be roving, looking for a restaurant, a bar, a stray conversation, a possibility of contact with one of the city’s unofficial hostesses, with her green eye-paint and her short skirt and tall boots and exposed knees. He had developed a fondness for such women, even when no deal was struck. Their brisk preliminaries tickled him, and their frank hostility.

The hospital was a surprising distance from the hotel. A vast and glowing pile with many increasingly modern additions, it waited at the end of a swerving drive through a dark park and a neighborhood of low houses. Carson expected to surrender the burden of his body utterly, but instead found himself obliged to carry it through a series of fresh efforts — forms to be filled out, proofs to be supplied of his financial fitness to be ill, a series of waits to be endured, on crowded benches and padded chairs, while his eye measured the distance to the men’s-room door and calculated the time it would take him to hobble across it, open the door to a stall, kneel, and heave away vainly at the angry visitor to his own insides.

The first doctor he at last was permitted to see seemed to Carson as young and mild and elusive as his half-forgotten, travelling son. Both had hair so blond as to seem artificial. His wife, the doctor let it be known, was giving a dinner party, for which he was already late, in another sector of the city. Nevertheless the young man politely examined him. Carson was, he confessed, something of a puzzle. His pain didn’t seem localized enough for appendicitis, which furthermore was unusual in a man his age.

“Maybe I’m a slow bloomer,” Carson suggested, each syllable, in his agony, a soft, self-deprecatory grunt.
There ensued a further miasma of postponement, livened with the stabs of blood tests and the banter of hardened nurses. He found himself undressing in front of a locker so that he could wait with a number of other men in threadbare, backwards hospital gowns to be X-rayed. The robust technician, with his standard bandit must ache, had the cheerful auto of a weight lifter and the great ladies’ (or men’s) man. “Chin here,” he said. “Shoulder forward. Deep breath: gold it. Good boy.” Slowly Carson dressed again, though the clothes looked, item by item, so shabby as to be hardly his. One could die, he saw, in the interstices of these procedures. All around him, on the benches and in the floors, other suppliants, residents of the city and mostly black, served as models of stoic calm; he tried to imitate them, though it hurt to sit up straight and his throat ached with gagging.
The results of his tests were trickling alone through their channels. The hair-haired young doctor must be at his party by now; Carson imagined the clay of silver, the candlelight, the bare-shouldered women — a festive domestic world from which he had fallen.

Toward midnight, he was permitted to undress himself again and to get into a bed, in a kind of mergence holding area. White curtains surrounded hum, but not silence. On either side of hum, from the flanking beds, two men, apparently with much in common, moaned and crooned a kind of tuneless blues. When doctors visited them, they pleaded to get out and promised to be good henceforth. From one side, ager a while, came a sound of tidy retching, like that of a cat who who has eaten a bird bones and all; on the other side interns seemed to be cajoling a tube up through a man’s nose. Carson was comforted by these evidences that at least he had penetrated into a circle of acknowledged ruin. He was inspected at wide intervals. Another young doctor, who reminded him less of his son than of the shifty man, a legal-aid lawyer, who had lived with his daughter an whom carson suspected of inspiring an even dictating the eerily formal letter she had mailed her father, shambled in and, after some poking of carson’s abdomen, shrugged. Then a female physician, dark-harked and fortyish, came and gazed with sharp amusement down into Carson’s face. She had an accent, Slavic of some sort. She said, “You don’t protect enough?”
“Protect?” he croaked. He saw why slaved had taken to clowning.

She thrust her thumb deep into his belly, in several places. “I shouldn’t be able to do that,” she said. “You should of through the ceiling.” The idiom went strangely with her accent.
“It did hurt,” he told her.
“Not enough,” she said. She gazed sharply down into his eyes, her own eyes were in shadow. “I think we shall take more blood tests.”

Yet Carson felt she was stalling. There was a sense, from beyond the white curtains, percolating through the voices of nurses and policemen and agitated kin in this emergency room, of something impending in his case, a significant visitation. He closed his eyes from what seemed a second. When he opened them a new man was leaning above him — a tall tutorial man wearing a tweed jacket with elbow patches, a button-down shirt, and rimless glasses that seemed less attachments to his face than intensifications of a general benign aura. His hair was combed and grayed exactly right, and cut in the high-parted and close-cropped style of the Camelot years. Unlike the previous doctors, he sat on the edge of Carson’s narrow bed. His voice and touch were gentle; he explained, palpating, that some appendixes were retrocecal — that is, placed behind the large intestine, so that one could be quite inflame without the surface sensitivity and protective reflex usual with appendicitis.

Carson wondered what dinner party the doctor had been pulled from, at this post-midnight hour, in his timeless jacket and tie. Carson wished to make social amends but was in a poor position to, flat on his back and nearly naked. With a slight smile, the doctor pondered his face, as if to riddle it, and Carson stared back with pleading helpless hopefulness, mute as a dog, which can only whimper or howl. He was as weary of pain and a state of emergency as he had been, twelve hours before, of his normal life. “I’d like to operate,” the doctor said softly, as if putting forth a suggestion that Carson might reject.

“Oh yes, please,” Carson said. “When, do you think?” He was very aware that, though the debauched hour and disreputable
surroundings had become his own proper habitat, the doctor was healthy and must have a decent home, a family, a routine to return to.
“Why, right now,” was the answer, in a tone of surprise, and this doctor stood and began to take off his coat, as if to join Carson in some sudden, cheerfully concocted athletic event.

Perhaps Carson merely imagined the surgeon’s gesture. Perhaps he merely thought Bliss, or really sighed the word aloud. Things moved rapidly. The shifty legal-aid lookalike returned, more comradely now that Carson had received a promotion in status, and asked him to turn on one side, and thrust a needle into his buttock. Then a biracial pair of orderlies coaxed his body from the bed to a long trolley on soft swift wheels; the white curtains were barrelled through; faces, lights, steel door Iintels streamed by. Carson floated, feet first, into a room that he recognized, from having seen its blazing counterpart so often dramatized on films, as an operating room. A masked and youthful population was already there, making chatter, having a party. “There are so many of you!” Carson exclaimed; he was immensely happy. His pain had already ceased. He was transferred from the trolley to a very narrow, high, padded table. His arms were spread out on wooden extensions and strapped tight to them. His wrists were pricked. Swollen rubber was pressed to his face as if to test the fit. He tried to say, to reassure the masked crew that he was not frightened and to impress them with what a “good guy” he was, that somebody should cancel his appointments for tomorrow.

At a point and place in the fog as it fitfully lifted, the surgeon himself appeared, no longer in a tweed jacket but
in a lime-green hospital garment, and now jubilant, bending close. He held up the crooked little finger of one hand before Carson’s eyes, which could not focus. “Fat as that,” he called through a kind of wind.

“What size should it have been?” Carson asked, knowing they were discussing his appendix.
“No thicker than a pencil,” came the answer, tugged by the bright tides of contagious relief.
“But when did you sleep?” Carson asked, and was not answered, having overstepped.

Earlier, he had found himself in an underground room that had many stalactites. His name was being shouted by a big gruff youth, “Hey Bob come on Bob wake up give us a little smile that’s the boy Bob.” There were others besides him stretched out in this catacomb, whose ceiling was festooned with drooping transparent tubes; these were the stalactites. Within an arm’s length of him, another man was lying as motionless as a limestone knight carved on a tomb.

Carson realized that he had been squeezed through a tunnel — the arm straps, the swollen rubber — and had come out the other side. (‘Hey, Bob, come on, give us a smile. Thaaat’s it.” He had a tremendous need to urinate; liquid was being dripped into his arm.

Later, after the windy, glittering exchange with the surgeon, Carson awoke in an ordinary hospital room. In a bed next to him, a man with a short man’s sour, pinched profile was lying and smoking and staring up at a television set. Though the picture twitched, no noise seemed to be coming from the box. “Hi,” Carson said, feeling shy and wary, as if in his sleep he had been married to this man.

“Hi,” the other said, without taking his eyes from the television set and exhaling smoke with a loudness, simultaneously complacent and fed up, that had been one of Carson’s former wife’s most irritating mannerisms.

When Carson awoke again, it was twilight, and he was in yet another room, a private room, alone, with a sore abdomen and a clearer head. A quarter-moon leaned small and cold in the sky above the glowing square windows of another wing of the hospital, and his position in the world and the universe seemed clear enough. His convalescence had begun.

In the five days that followed, he often wondered why he was so happy. Ever since childhood, after several of his classmates had been whisked away to hospitals and returned to school with proud scars on their lower abdomens, Carson had been afraid of appendicitis. At last, in his sixth decade, the long-dreaded had occurred, and he had comported himself, he felt, with passable courage and calm.
His scar was not the little lateral slit his classmates had shown him but a rather gory central incision from navel down; he had been opened up wide, it was explained to him, on the premise that at his age his malady might have been anything from ulcers to cancer. The depth of the gulf that he had, unconscious, floated above thrilled him. There had been, too, a certain unthinkable intimacy. His bowels had been “handled,” the surgeon gently reminded him, in explaining a phase of his recuperation. Carson tried to picture the handling: clamps and white rubber gloves and something glistening and heavy and purplish that was his. His appendix had indeed been retrocecal — one of a mere ten percent so located. It had even begun, microscopic investigation revealed, to rupture. All of this retrospective clarification, reducing to cool facts the burning, undiscourageable demon he had carried, vindicated Carson. For the sick feel as shamed as the sinful, as fallen.

The surgeon, with his Ivy League bearing, receded from that moment of extreme closeness when he had bent above Carson’s agony and decided to handle his bowels. He dropped by in the course of his rounds only for brief tutorial sessions about eating and walking and going to the bathroom — all things that needed to be learned again. Others came forward. The slightly amused dark Slavic woman returned, to change his dressing, yanking the tapes with a, he felt, unnecessary sharpness. “You were too brave,” she admonished him, blaming him for the night when she had wanted to inflict more blood tests upon him. The shambling young doctor of that same night also returned, no longer in the slightest resembling the lawyer whom Carson’s daughter had spurned in favor of her own sex, and then the very blond one; there materialized a host of specialists in one department of Carson’s anatomy or another, so that he felt huge, like Gulliver pegged down in Lilliput for inspection. All of them paid their calls so casually and pleasantly — just dropping by, as it were — that Carson was amazed, months later, to find each visit listed by date and hour on the sheets of hospital services billed to him in extensive dot-matrix printout — an old Centronics 739 printer, from the look of it.
Hospital life itself, the details of it, made him happy. The taut white bed had hand controls that lifted and bent the mattress in a number of comforting ways.

A television set had been mounted high on the wall opposite him and was obedient to a panel of buttons that nestled in his palm like an innocent, ethereal gun. Effortlessly he flicked his way back and forth among morning news shows, midmorning quiz shows, noon updates, and afternoon soap operas and talk shows and reruns of classics such as Carol Burnett and Hogan’s Heroes. At night, when the visitors left the halls and the hospital settled in upon itself, the television set became an even warmer and more ingratiating companion, with its dancing colors and fluctuant radiance. His first evening in this precious room, while he was still groggy from anesthesia, Carson had watched a tiny white figure hit, as if taking a sudden great stitch, a high-arching home run into the second deck of Yankee Stadium; the penetration of the ball seemed delicious, and to be happening deep within the tiers of himself. He pressed the off button on the little control, used another button to adjust the tilt of his bed, and fell asleep as simply as an infant.

Normally, he liked lots of cover; here, a light blanket was enough. Normally, he could never sleep on his back; here, of necessity, he could sleep no other way, his body slightly turned to ease the vertical ache in his abdomen, his left arm at his side receiving all night long the nurturing liquids of the l.V. tube. Lights always burned; voices always murmured in the hall; this world no more rested than the parental world beyond the sides of a crib.

In the depths of the same night when the home run was struck, a touch on his upper right arm woke Carson. He opened his eyes and there, in the quadrant of space where the rectangle of television had been, a queenly smooth black face smiled down upon him. She was a nurse taking his blood pressure; she had not switched on the overhead light in his room and so the oval of her face was illumined only indirectly, from afar, as had been the pieces of furniture in his hotel room. Without looking at the luminous dial of his wristwatch on the bedside table, he knew this was one of those abysmal hours when despair visits men, when insomniacs writhe in an ocean of silence, when the jobless and the bankrupt want to scream in order to break their circular calculations, when spurned lovers roll from an amorous dream onto empty sheets, and soldiers abruptly awake to the metallic taste of coming battle. In this hour of final privacy she had awakened him with her touch. No more than a thin blanket covered his body in the warm, dim room. I forgive you, her presence said. She pumped up a balloon around his arm, relaxed it, pumped it up again. She put into Carson’s mouth one of those rocket-shaped instruments of textured plastic that have come to replace glass thermometers, and while waiting for his temperature to register in electronic numbers on a gadget at her waist she hummed a little tune, as if humorously to disavow her beauty, that beauty which women have now come to regard as an enemy, a burden and cause for harassment. Carson thought of his daughter.

Although many nurses administered to him — as he gained strength he managed to make small talk with them even at four in the morning — this particular one, her perfectly black and symmetrical face outlined like an eclipsed sun with its corona, never came again.

“Walk,” the surgeon urged Carson. “Get up and walk as soon as you can. Get that body moving. It turns out it wasn’t the disease used to kill a lot of people in hospitals, it was lying in bed and letting the lungs fill up with fluid.” Walking meant, at first, pushing the spindly, rattling I.V. pole along with him. There was a certain jaunty knack to it — easing the wheels over the raised metal sills here and there in the linoleum corridor, placing the left hand at the balance point he thought of as the pole’s waist, swinging “her” out of the way of another patient promenading with his own gangling chrome partner. From observing other patients Carson learned the trick of removing the LV. bag and threading it through his bathrobe sleeve and rehanging it, so he could close his bathrobe neatly.

His first steps, in the moss-green sponge slippers the hospital provided, were timid and brittle, but as the days passed the length of his walks increased: to the end of the corridor, where the windows of a waiting room overlooked the distant center of the city; around the corner, past a rarely open snack bar, and into an area of children’s diseases; still farther, to an elevator bank and a carpeted lounge where pregnant women and young husbands drank Tab and held hands. The attendants at various desks in the halls came to know him, and to nod as he passed, with his lengthening stride and more erect posture. His handling of the IV pole became so expert as to feel debonair.

His curiosity about the city revived. What he saw from the window of his own room was merely the wall of another wing of the hospital, with gift plants on the windowsills and here and there thoughtful bathrobed figures gazing outward toward the wall of which his own bathrobed figure was a part. From the windows of the waiting room, the heart of the city with its clump of brown and blue skyscrapers and ribbonlike swirls of highway seemed often to be in sunlight, while clouds shadowed the hospital grounds and parking lots and the snarl of taxis around the entrance. Carson was unable to spot the hotel where he had stayed, or the industrial district where he had hoped to sell his systems, or the art museum that contained, he remembered reading, some exemplary Renoirs and a priceless Hieronymus Bosch. He could see at the base of the blue-brown mass of far buildings a suspension bridge, and imagined the dirty river it must cross, and the eighteenth-century fort that had been built here to hold the river against the Indians, and the
nineteenth-century barge traffic that had fed the settlement and then its industries, which attracted immigrants, who thrust the grid of city streets deep into the surrounding farmland.

This was still a region of farmland; thick, slow, patient, pious voices drawled and twanged around Carson as he stood there gazing outward and eavesdropping. Laconic, semi-religious phrases of resignation fell into place amid the standardized furnitnre and slippered feet and pieces of jigsaw puzzles half assembled on card tables here. Fat women in styleless print dresses and low-heeled shoes had been called in from their kitchens, and in from the fields men with crosshatched necks and hands that had the lumpy, rounded look of used tools.
Illness and injury are great democrats, and had achieved a colorful cross section. Carson came to know by sight a lean man with cigar-dark skin and taut

Oriental features; his glossy shaved head had been split by a Y-shaped gash now held together by stitches. He sat in a luxurious light-brown, almost golden robe, his wounded head propped by a hand heavy with rings, in the room with the pregnant women and the silver elevator doors. When Carson nodded once in cautious greeting, this apparition said loudly, “Hey, man,” as if they shared a surprising secret. Through the open doorways of the rooms along the corridors, Carson glimpsed prodigies — men with beaks of white bandage and plastic tubing, like those drinking birds many fads ago; old ladies shrivelling to nothing in a forest of flowers and giant facetious get-well cards; and an immensely plump mocha colored woman wearing silk pantaloons and a scarlet Hindu dot in the center of her forehead. She entertained streams of visitors — wispy, dusky men and great-eyed children. Like Carson, she was an honorary member of the city, and she would acknowledge his passing with a languid lifting of her fat fingers, tapered as decidedly as the incense cones on her night table.

The third day, he was put on solid food and disconnected from the intravenous tubing. With his faithful IV pole removed from the room, he was free to use both arms and to climb stairs. His surgeon at his lost appearance (dressed in lumberjack shirt and chinos, merrily about to “take off,” for it had become the weekend) had urged stair climbing upon his patient as the best possible exercise. There was, at the end of the corridor in the other direction from the waiting room from whose windows the heart of the city could be viewed an exit giving on a cement-and-steel staircase almost never used. Here, down four flights to the basement, then up six to the locked rooftop door, and back down two to his own floor, Carson obediently trod in his bathrobe and his by now disintegrating green sponge slippers.

His happiness was purest out here, in this deserted and echoing sector, where he was invisible and anonymous. In his room, the telephone had begun to ring. The head of his company back in New Jersey called repeatedly, at first to commiserate and then to engineer a way in which Carson’s missed appointments could be patched without the expense of an additional trip. So Carson, sitting up on his adoptable mattress, placed calls to the appropriate personnel and gave an enfeebled version of his pitch; the white-noise company expressed interest in digital color-graphics imaging, and Carson moiled them his firm’s shiny brochure on its newest system (resolutions to 640 pixels per line, 65,536 simultaneous colors, image memory up to 256K bytes). The secretary from the other company, who had sounded sympathetic on the phone five days ago, showed up in person; she turned out to be comely in a coarse way, with bleached, frizzed hair, the remnant of a swimming-pool tan, and active legs she kept crossing and recrossing as she described her own divorce — the money, the children, the return to work after years of being a pampered suburbanite. “I could be one again, let me tell you. These women singing the joys of being in the work force, they can have it.” This woman smoked a great deal, exhaling noisily and crushing each cerise-stained butt into a jar lid she had brought in her pocketbook. Carson had planned his afternoon in careful half-hour blocks — the staircase, thrice up and down; a visit to the waiting room, where he had begun to work on one of the jigsaw puzzles; a visit to his bathroom if his handled bowels were willing; finally, a luxurious immersion in last month’s Byte and the late innings of this Saturday’s playoff game. His visitor crushed these plans along with her many cigarettes. Then his own ex-wife telephoned, kittenish the way she had become, remarried yet with something plaintive still shining through and with a note of mockery in her voice, as if his descending into a strange city with a bursting appendix was another piece of willful folly, like his leaving her and his ceasing to teach mathematics at the business school — all those tedious spread sheets. His son called collect from Mexico on Sunday, sounding ominously close at hand, and spacy, as long awkward silences between father and son ate up the dollars. His daughter never called, which seemed considerate and loving of her. She and Carson knew there was no disguising our essential solitude.

He found that after an hour in his room and bed he became homesick for the stairs. At first, all the flights had seemed identical, but by now he had discovered subtle differences among them — old evidence of spilled paint on one set of treads, a set of numbers chalked by a workman on the wall of one landing, water stains and cracks affecting one stretch of rough yellow plaster and not another. At the bottom, there were plastic trash cans and a red door heavily marked with warnings to push the crash bar only in case of emergency. At the top, a plain steel door, without handle or window, denied penetration. The doors at the landings in between each gave on a strange outdoor space, a kind of platform hung outside the door’ leading into the hospital proper; pre-poured cement grids prevented leaping or falling or a clear outlook but admitted cool fresh air and allowed a fractional view of the city below.

The neighborhood here was flat and plain — quarter-acre lot tract houses built lung enough ago for the bloom of newness to have wilted and for dilapidation to be setting in. The hospital wall, extending beyond the projecting staircase, blocked all but a slice of downward vision containing some threadbare front yards, one of them with a tricycle on its side and another with a painted statue of the Virgin; and walls of pastel siding in need of repainting, and stretches of low-pitched composition-shingled roof-a shabby, sort of small-town vista to Carson’s eyes, but here well within the city limits. He never saw a person walking on the broad sidewalks, and few cars moved along the street even at homecoming hour. Nearest and most vivid, a heap of worn planking and rusting scaffold pipes and a dumpster coated with white dust and loaded with plaster and lathing testified to a new phase of construction as the hospital continued to expand. Young men sometimes came and added to the rubbish, or loudly threw the planking around. These efforts seemed unorganized, and ceased on the weekend. The drab housing and assembled rubble that he saw through the grid of the cement barrier, which permitted no broader view, nevertheless seemed to Carson brilliantly real, moist and deep-toned and full. Life, this was life. This was the world. When — still unable to climb stairs, the IV pole at his side — he had first come to this landing, just shoving open the door had been an effort. The raw outdoor air had raked through his still-drugged system like a sweeping rough kiss, early-fall air mixing summer and winter, football and baseball, stiff with chill yet damp and not quite purged of growth. Once, he heard the distant agitation of a lawnmower. Until the morning when he was released, he would come here even in the dark and lean his forehead against the cement and breathe, trying to take again into himself the miracle of the world, reprogramming himself, as it were, to live — the air cold on his bare ankles, his breath a visible vapor, his bowels resettling around the ache of their healing.

The taxi took him straight to the airport; Carson saw nothing of the city but the silhouettes beside the highway and the highway’s scarred center strip. For an instant after takeoff, a kind of map spread itself underneath him, and then was gone. Yet afterwards, thinking back upon the farm voices, the distant skyscrapers, the night visits of the nurses, the doctors with their unseen, unsullied homes, the dozens of faces risen to the surface of his pain, he seemed to have come to know the city intimately; it was like, on other of his trips, a woman who, encountered in a bar and paid at the end, turns ceremony inside out, and bestows herself without small talk.

Discussion Questions:

Carson frequently refers to making conversation or masking his emotions in order to comfort the medical team. What is the physician’s role in comforting the patient?

When Carson was told he would be having immediate surgery, he stated that he was treated “more comradely now that Carson received a promotion in status.” Triaging patient care is an important part of providing medical care, how can we acknowledge the patient although we may be pressed with more medically urgent cases?

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