Fleishman Is in Trouble Read online

  But I wasn’t like Archer Sylvan in other ways; I was never given the opportunity to try. Archer would sleep on tour buses with bands or camp in the desert with an actor or do ayahuasca with a politician and come to the realization that he had to divorce his wife and marry his research assistant, whom he now realized he knew twelve lives ago. He got lost for days waiting for a reclusive rock star. He spent $7,000 on stripper tips once, submitted the expense without a receipt (naturally), and was reimbursed even though no stripper ended up in the story. Once, I had to check a second bag on a flight from Europe where I was interviewing an actor and I got a pissed-off call from our managing editor and I never did it again.

  Archer had written the article version of “Decoupling” in 1979, fourteen thousand words just following a man pseudonymed Mark —editorialization in even the names—through his divorce. Even before the Internet, the story made the rounds. It was a scandal, calling out women for changing the rules on men with no warning because of their vapid women’s lib and their stupid sexual awakenings. Sexual awakenings were not supposed to extend beyond what was merely an upgrade in enjoyment for men.

  It was also an undeniably great story. It was electric and incisive. It extended its observations into audacious extrapolation in a way no one in nonfiction had really done before. It became the kind of story that was dragged out every time someone wanted to make a comparison with a piece of new reporting. “This is basically ‘Decoupling,’ ” or, “Well, it’s no ‘Decoupling.’ ” In the restaurant with Toby, my scrolling landed on a fifty-year-old woman riding a horse in a bikini who wanted Toby to know she was into nipple play, and a line from “Decoupling” occurred to me: “His misery was a fog that obscured slightly but not completely an entirely new land of opportunity. He did not realize that the land of opportunity was obscuring something even more potent.”

  I looked up from Toby’s phone. “I never understood why you married her.”

  He leaned back and began to pull on his chest hair. “I got married because I fell in love.”

  After that, we saw each other every few days. I’d drive my big, dumb SUV to the Upper West Side and wait for him at the diner next to his hospital, or I’d take the train into Penn Station, and we’d meet for diner food and rehash it all.

  Our second lunch:

  “Or maybe when we get married we have no ability to know how long forever could possibly be,” he said as he ate an egg-white omelet. “Think about all the times something feels like it lasts forever. Forever seems like the duration of high school, which is four years but that’s only because we’ve only been alive for sixteen years and so four years of that is a huge chunk of our lifetime—a quarter of it. By the time we make this decision, to hook ourselves to a person for the rest of our lives, we’re what? Twenty-five? Thirty? We’re babies. We don’t even know what we’re dealing with. How could we fathom what it would be like to be on our best behavior for that long? Or know what is funny or charming to us now but intolerable in the future? How will we know what we need? Your tastes in TV haven’t even changed yet. I loved Friends when I was young and then I loved Friends in reruns in my twenties and now if I hear the sound of the opening music I want to die.”

  “You only say that because your marriage didn’t work out,” I said, eating a blintz. “If you’d ended up happy, you’d think it was just fine.”

  “You only say that because your marriage is working out.”

  “You don’t know anything about my marriage,” I said.

  “I know that it’s continued. And even if continued marriages aren’t happy, they are still categorized as happy.”

  Our third lunch:

  “Marriage is like the board in that old Othello game,” he said as he ate a chicken breast baked dry, no added oil, please. “The board is overwhelmingly full of white discs until someone places enough black discs in enough of the right places to flip all the discs to black. Marriage starts out full of white discs. Even when there are a few black ones on the board, it’s still a white board. You get into a fight? Ultimately fine and something to laugh at in the end, because the Othello board is still white. But when it finally happens and the black discs take over—the affair, the financial impropriety, the boredom, the midlife crisis, whatever it is that ends the marriage—the board becomes black. Now you look at the marriage, even the things that were formerly characterized as good memories, as tainted and rotted from the start: That adorable argument on the honeymoon was actually foreshadowing; the battle over what to name Hannah was my way of denying her the little family she had. Even the purely good memories are now haunted by a sense that I was a fool to allow myself to think that life was good and that a kingdom of happiness was mine.” (I told him I understood his metaphor, but also that’s not how you play Othello.)

  Our fourth lunch:

  “It’s like group therapy,” he said, eating a scoop of cottage cheese, and talking about all these new people he’d dated, so many of whom had been through the same thing. “It’s like group therapy, if at the end of group therapy the therapist put your penis in her mouth.”

  Our fifth lunch:

  “It couldn’t be me,” he said as he ate four turkey slices with mustard and no bread. “There are too many of us who want the best for our children and our spouses. Sometimes you end up married to someone who didn’t realize she didn’t want to be married. I mean, look at this.”

  He swiped up a photo. A perfectly lovely woman with dimples, wearing a bathing suit and squinting in the sun. I liked to see the pictures on his phone, which included things I couldn’t imagine myself, and I liked him to give me a play-by-play so that I could ask him questions about why he said what and how long before he went to bed with someone. (I also liked to see Rachel’s text messages come in, if they happened to while I was looking at his pictures, and marvel at what a pterodactyl she could be because I could be bad but I was never quite that bad.)

  “How can you look at this woman and say she’s a failure?” he asked, pointing at the picture. “Sometimes it just doesn’t work out for you. Don’t think of it in such a binary way. Your marriage not working isn’t always about you. Your life not working isn’t always about you. It could just be about your life.” Which, sure.

  By then he was tan from all his walking around the city. He had been filled with the notion lately that there was so much life in him yet. He now felt young and somehow this made me feel even older. It was like I wasn’t looking, and then suddenly I was gone. I looked up again at Toby straight in the face, but he had taken his phone back and was responding to a new text.

  * * *

  —

  ST. THADDEUS HAD once been a mental hospital that was owned by the City of New York, which then sold it to Columbia University, which tried to renovate it into just a regular hospital but did a half-assed job so that as of the mid-1980s, it still looked and felt and even smelled (they couldn’t get the smell out no matter how much they tried) like an asylum. It wasn’t a public hospital, but nobody wanted to go there for surgeries—not when you could go to Lenox Hill or Mount Sinai. In 1988, a finance group bought it from Columbia, which dumped $100 million into it and turned it into a modern marvel: glass and metal and stainless steel and state-of-the-art everything and the smell finally gone. Being at the hospital was like being inside the future, but as it was imagined by science fiction films in the last part of the twentieth century, not the actual future we ended up with, where everything just turned out being smaller and flimsier than it used to be.

  An unconscious woman awaited Toby in the ER. “Karen Cooper, forty-four. Unresponsive since arrival, some delirium prior to arrival, reported by her husband. Elevated AST/ALT,” Clay said. Clay was the runt of this round of fellows. He had a slightly lazy eye, which would stray only when he’d been staring at you for a long time, as if the eye were done with the conversation and was hinting at the rest of him that it was t
ime to go. It was unclear if he knew about his blackhead situation.

  The patient, a blonde with the kind of nose job done so early in her teens that the columella nasi was dripping out from beneath the tower of the septum so that you could see the two small tabs inside the nostrils, was completely out. She wore one of those satin dresses that is either a nightgown or a very slinky evening gown, and her hair was spread out across her pillow in a very Sleeping Beauty vibe. Toby briefly wondered who did the hair thing.

  Beside her, in a chair, was a man, about Toby’s age, his hands clasped on the top of his hair. He stood up when Toby walked in and extended his hand. His name was David Cooper; he was the husband. His head was power-shaved, and he was at least six feet tall. Maybe six-one. Did it matter after six feet, though? He was tall.

  “I’m Dr. Fleishman,” Toby said. “Can you tell me what happened?”

  Karen Cooper had spent a weekend in Las Vegas with her best friend. They’d had a wild time, celebrating a friend’s something-or-other, and when she came back, she seemed woozy. This was a week ago. “She was just much clumsier than usual,” David said. She was falling over and tripping and even listing when she was just standing still. She had joked that she must still be drunk. Then, yesterday morning, she started slurring, “also more than usual,” he said, “and she was saying crazy things.”

  “Like what crazy things?” Toby asked.

  “Like out of nowhere, things that didn’t make sense, like she was going to have a carpool pick me up from work, and to make sure I told the mom driving thank you. The kids don’t even have a carpool. They have a driver. She talked about our bowling league, and I can tell you, we’ve never bowled together more than twice in twenty years.”

  “Is she on any other medications?”

  “She’s on Zoloft. She went to the doctor maybe a year ago saying she felt out of it a lot, and he said she was depressed and gave her Zoloft. Hey, does she look yellow to you?”

  She was yellow like a highlighter. “That’s jaundice,” Toby said. “That’s why I was called. I’m a liver specialist. Let’s go back to this morning for a minute, though. When did she stop responding to you?”

  “I woke up and she looked what I thought was pale but then yellowish and she was sort of dazed, so I put her in a car to take her to the ER, and the minute we got her into this bed she fell asleep, but now—” He looked over at his wife’s body. “I don’t know if she’s asleep or if she’s unconscious. They said she’s unconscious, but it looked like she was just tired and fell asleep. She wasn’t in the middle of a sentence or anything.” Now he was panicked. “Which is it? Is she unconscious? Or is she just asleep?”

  “Well, we’re going to figure that out,” Toby said. “She’s in good hands now. If you wouldn’t mind, Dr. Clifton here is going to show you our family lounge, and we’re going to examine your wife and find out what the heck is going on.”

  “I can’t stay?”

  “It’s best that we do our exam and get a handle on what might be going on, and you look like you could use a cup of coffee.”

  Clay guided him out.

  “Can anyone tell me what’s going on?” Toby asked.

  Logan was first. “It’s alcoholic cirrhosis, right? She went on a bender, and her liver is just too injured. She’s probably been a secret drinker for years.”

  “You sure?” Toby asked.

  Joanie said something but nobody could hear it.

  “What’s that?” Toby asked. Clay slipped back into the room and looked between their faces to see what he’d missed.

  “It couldn’t not be,” Joanie said. She said it dreamily, almost to herself, her pen pressed softly to her lips. How Joanie loved this stuff. How her love for the diagnostic quest always superseded the usual worries in these moments—of appearances, of ego, of failure, of reputation. Clay wanted to get through the material and stop sweating so much. Logan wanted to show off and make his eight P.M. tennis game. Joanie wanted to understand and worship the miracle of this stuff. She wanted to be amazed.

  Joanie stood against the wall. Her hair was a kind of sepia—straw tinged with red at a certain angle. She wore little-girl clothes: knee socks and parochial school–style skirts and cardigans, which, in its thrift store way, stopped just before it became appealing to Toby. She blinked slowly behind her glasses when she was trying to figure something out; she mouthed words silently, concernedly, when she was trying to remember something.

  “What did he say exactly?” Toby asked them. He walked over to Karen Cooper and leaned down to listen to her heart. He opened her eyes.

  “He said she was clumsy and she was slurring—both signs of neurological events,” Clay said. “Her liver is failing.”

  Toby straightened up and looked at them. “What did our friend Sir William Osler say?”

  “ ‘Listen to your patient. He is telling you his diagnosis,’ ” Logan said.

  “So what is Mrs. Cooper telling us?”

  Clay looked at Karen Cooper. “The patient is unresponsive, Dr. Fleishman.”

  Toby inhaled slowly, and spoke on the exhale. “Her husband said what? Her behavior prior to becoming unresponsive said what?”

  “That she was clumsy and slurring, which all fits into—”

  “Yes, Clay, no one is arguing that she’s not having neurological symptoms. No one is suggesting she’s responsive. What did he say exactly, though? He said she was clumsier than usual. What this means is that something’s been going on longer than just the last week. Does she have kids?”

  Clay checked her chart. “Twin ten-year-old boys.”

  “Okay,” Toby said. “So that means her blood was clean at least when she delivered, which she probably did—” He lifted her blanket down a few inches from her waist, and pulled her nightgown up a little. “Yes, C-section. Okay, that means if she’d had a clotting problem back then, she would have known it.”

  “Right,” Joanie said. “So it developed more recently than ten years ago.”

  “Let’s find out from her internist if she has a history of elevated AST/ALT.” He looked at her chart. “She’s on Zoloft, as of a year ago. Guys, a woman comes in complaining about anything, she gets sent away with a script for antidepressants. He probably missed the signs of this while he could have helped, before neurological problems set in. Insurance won’t pay you for more than fifteen minutes of your time, but you still have to listen. You have to fill in blanks. You have to ask questions. Now, open her eyes.”

  Joanie lifted Karen’s eyelids. She looked up, surprised and thrilled. “Wilson’s!” Clay and Logan followed her, each of them taking a moment to look into her eyes. Joanie looked at Toby like she’d just seen the stars for the first time.

  Toby went over to look. Wilson’s disease was the body’s inability to process copper through the liver. The copper acted as a toxin in the brain. The easiest and most visible sign of it was a copper-colored ring surrounding the irises.

  “Right,” Toby said. “So, Logan, go get her internist on the phone.” Toby took his exam gloves off. “See, guys? Listen to the patient. Always listen. Even if the patient can’t talk, most of the time it’s all right there in front of you.”

  * * *

  —

  HE DID HIS ROUNDS. He touched base with a pediatric hepatologist whose teen patient had graduated to Toby’s care. He consulted in the ER with a college kid who had gotten hepatitis C from a shitty tattoo parlor. He saw a woman his own age with liver cancer.

  He gave a sonogram to an MTA worker whom he had diagnosed with hemochromatosis a year ago. Now the man’s liver was a little scarred, but it was better. It was regenerating. It was almost new again. Toby pushed the wand over and around the man’s liver. He loved this part; every sonogram, every biopsy, was always like the first time. You couldn’t believe what the liver was capable of. This never got old for Toby, not sin
ce the first time he saw it in medical school, in a textbook of time-lapse pictures of a healing liver. Livers behaved in some erratic ways, sure, all the organs do. But the liver was unique in the way that it healed. It was full of forgiveness. It understood that you needed a few chances before you got your life right. And it wouldn’t just forgive you; it would practically forget. It would allow you to start over in a way that he could not imagine was true in any other avenue of life. We should all be like the liver, he thought. We should all regenerate like this when we’re injured. On the darkest days of his marriage, Toby attended to his hospital business, and out of the corner of his eyes was always the liver, whispering to him that one day, there would be not much sign of all of this damage. He would regenerate, too.

  Toby felt a hand on his shoulder from behind. It was Joanie. Her hand was warm and thin and womanly through his lab coat. He turned. In his ear, she whispered that Karen Cooper had been moved to a private room. He stood up. The whispering was strange; it was too close. The hand on his shoulder, too. It all felt oddly post-coital. When she pulled her hand away, he still felt it there.