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It had always seemed to me that Proust, because he was an invalid, with his asthma, his emphysema, his cardiac insufficiency, and his host of psychosomatic ailments, was trying to stop time, hold onto it, and preserve it in the amber of his prose, but now I suspect that quite the contrary interpretation, which is also possible, is rather more likely - that he was delighting in what he realized is an all but unimaginable richness and was celebrating these moments the best way he could, sharing them with his readers who are a writer's alternative selves. One's readers are immortal, as are the Greek gods but, like the gods, they have no sense of urgency to their existence or, say, of consequence, for nothing can be, for them, a matter of life and death. The gods do not know the limitations under which we are obliged to improvise our lives that, however brief, are punctuated by certain once-and-for-all choices we make and then realize are irrevocable.

Overture, a novel
by David R. Slavitt
219 pages
print & digital

It would be comforting if I could persuade myself to believe this and therefore understand Proust's achievement as more celebratory than nostalgic, but even for such an idea to occur to me is a novelty, which enables me to speculate as to whether this week of uncertainty may not have some instructive value. My first instinct is to turn away in disgust from the sentimentality of the assumption that the purpose of life's tribulations is to make us wise. The ravages of war, famine, pestilence, and flood are not units in some divine lesson plan, and it would be lunacy to suppose that the victims of catastrophe are likely thereby to have been enlightened. Still, at some primitive level, we suppose that medicine must be disagreeable to be effective, and then, defying the rules of logic, we infer that, conversely, whatever is sufficiently nasty must have some compensating benefit.

I do not have to go so far to allow that there can be instances where, under stress, resources we did not know we possessed may reveal themselves. But no sane person would invite distress in order to make that discovery. I should rather have continued to misconstrue Proust - if that was what I was doing - than by these drastic means correct my view of his novel. The only other compensation I can think of - which I could also have done without - is the onset, however tentative, of stoic indifference. I realize that I cannot do anything to affect the outcome of this procedure and find myself learning, from day to day, the cold comforts of fatalism. The nurse or the doctor will relay to me the determination of the pathologist, a reprieve or a condemnation and, as I have come to see during the past few days, I have no way of influencing the outcome. I try not to allow my fear to become an expectation, for it is useless to anticipate bad news, but similarly, I endeavor not to let my hopes become a jinx. Meanwhile, a part of me understands perfectly well that the decision has already been made and that these doctors are simply reporting to me what my body has announced to them as a fait accompli. Whatever they tell me ought not be surprising, for mortality is the universal condition, known from the beginning, and even if we deny or somehow forget, there will come sooner or later some reminder. Proust, sickly as he was for so much of his life, needed no such prompting. Drawing his breath with difficulty, battling asthma and then emphysema, he could not have beguiled himself by that obliviousness or denial to which most of us resort most of the time. Or to put it more strongly, one might say that, in the name of truth and authenticity, he would not have done so even if his body had permitted it. Depressing, perhaps? Just as likely, it was steadying, sobering, and, as those who go in for a kind of mysticism might put it, centering. Édouard Brissaud, one of Proust's doctors, recommended to his patient that he should keep sleeping pills on his beside table but without touching them. The valuable thing was to know that they were there and to feel that, should an emergency arise, they were available. (It was advice Proust not only took for himself but recommended to his friend, Louis de Robert.)

Brissaud, a student of the great Jean Martin Charcot's, was an interesting fellow, a friend and colleague of Adrien Proust, Marcel's father, who was also a professor of medicine. It was Adrien Proust who wrote the introduction to Brissaud's Traité de médecine, which defined asthma as a "neurosis characterized by attacks of spasmodic dyspnoea." Brissaud believed refreshingly that patients are often better judges of the remedies than their doctors because they know by experience what is good or bad for them.

A subtle and sensible man, his modesty is what first strikes us, or ought to, even allowing for the helplessness of medicine back in those days. Before antibiotics and replacement-part surgery, doctors could do relatively little to change the outcome of a disease, which would either get better or worse, or perhaps stay the same, depending entirely on its virulence and the age and strength of the patient. The resources of medicine are much more impressive these days, although the mortality rate maintains itself at a hundred percent. Still, one need not be a cynic to imagine how, with few resources, the Parisian physician of those days might well have tried to compensate by pretending to a wisdom and power that he might offer the patient and use to his advantage. If the sufferer believed the doctor could help him, there was a therapeutic effect in the encounter itself. On the other hand, candor ought never to be entirely abandoned, and for some chronic ailments like asthma - or, indeed, the eczema I used to have - there is a kind of empirical expertise patients develop over time that a physician would be foolish not to call upon. Brissaud was not so self absorbed - or insecure - that he could not take advantage of the experience of those in his care. A large man with a big gut, he enjoyed the pleasures of the table but was not at all pompous. In 1899, he became professor of medical history at the Salpetriere and, in 1900, professor of internal medicine, but he was known there for his informality and he not only amused his students with word play and jokes but even gave up the top hat, which was the symbol in those days of professorial authority. "Hypothesis," he once said, "is an honest euphemism for ignorance - the sort of ignorance that knows itself."

The congeniality of that prescription of his for the sleeping pills - to be kept on the bedside table but not actually ingested - would have appealed to Proust, whom I imagine not only as amused but as taking an intellectual pleasure in its delicacy and refinement. I am also pleased to learn that other people have relied on this stratagem, for it was what my mother used to do to ward off panic attacks. She carried a small pill box - I have no idea what medicine it actually contained - with which she could fend off those episodes of shortness of breath and tachycardia that would sometimes threaten her, not by taking the medicine but merely by fingering the small brass box with its onyx lid, which I still have and which still works, or, I could even say, works better than ever, for now it carries the association that it was my mother's, which is inherently soothing.

How else can one account for the enormous effort Proust put forth in writing his novel except as evidence of a great desire to understand and to be understood? And how much more important is it for one's doctor to be responsive and receptive to one's complicated inner workings, not only physical but spiritual. In Within A Budding Grove, Proust writes of a Dr. Cottard, and Bergotte warns the young Marcel that "People like you must have suitable doctors, I would almost go so far as to say treatment and medicines specially adapted to themselves. Cottard will bore you, and that alone will prevent his treatment from having any effect. Besides, the proper course of treatment cannot possibly be the same for you as for any Tom, Dick or Harry. Nine tenths of the ills from which intelligent people suffer spring from their intellect. They need at least a doctor who understands that disease. How do you expect Cottard to be able to treat you?" And then, a moment later, Bergotte says, "I should recommend you, instead . . . to consult Dr. du Boulbon, who is an extremely intelligent man." Proust's model for du Boulbon was Édouard Brissaud.

It is du Boulbon who attends Marcel's grandmother when she is dying. In The Guermantes Way, Proust describes their first encounter: "Instead of sounding her chest, he gazed at her with his wonderful eyes in which there was perhaps the illusion that he was making a profound scrutiny of his patient, or the desire to give her that illusion, which seemed spontaneous but must have become mechanical, or not to let her see that he was thinking of something quite different, or to establish his authority over her . . ."

What du Boulbon tells Marcel's grandmother speaks to me with particular vividness. "You have," he says, "what I have had occasion to call 'mental albumin.' We have all of us had, when we have not been very well, little albuminous phases which our doctor has done his best to prolong by calling our attention to them. For one disorder that doctors cure with medicaments (as I am assured that they do occasionally succeed in doing) they produce a dozen others in healthy subjects by inoculating them with that pathogenic agent a thousand times more virulent than all the microbes in the world, the idea that one is ill." That idea is what has been looming over me, obnubilating my daytime skies and tainting my nights. If it is true that a hundred percent of centenarians have cancerous cells in their prostate, all that can be said of me now is what used to be said when I was a boy, that I am in some ways precocious, a quality for which I was in those days generally praised and rewarded. In fairness, I have the feeling that I should be able to collect on some of those rewards now, when I need them. At the least, I ought to have a doctor like Brissaud, who prescribes medicines I am not necessarily to ingest but only keep on my nightstand. This would be altogether delightful, not only a compliment to my intellect and refinement but also casually dismissive of the disease itself - if, indeed, I have a disease.

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