A Yale surgeon's old pain

Special to The Times

"My father's power and the weakness that nurtured it have accompanied me all the days of my life," reflects Sherwin Nuland in the foreword to his poignant and heartfelt memoir, "Lost in America." Now in his 70s, a clinical professor of surgery at the Yale School of Medicine, Nuland is the author of several critically acclaimed books on medical subjects, including one that won the 1994 National Book Award: "How We Die: Reflections on Life's Final Chapter."

As an epigraph to the closing chapter of his new book, Nuland quotes a passage from Charles Dickens' "Great Expectations": "It is a most miserable thing to feel ashamed of home. There may be a black ingratitude in the thing and the punishment may be retributive and well-deserved, but that it is a miserable thing, I can testify." For the painful story that unfolds here is fraught with the contending emotions of guilt and shame: the shame that Nuland felt as a young man at being the son of a sickly, bad-tempered, unhappy, unsuccessful immigrant father barely able to speak English and the guilt that he felt over being ashamed of his father and treating him unkindly -- a guilt that continued to plague him long after his father's death.

Indeed, Nuland begins, not with his boyhood in the Bronx of the 1930s and 1940s but with a brief, though harrowing, account of the depression that he suffered in the late 1960s and early 1970s, which became so severe that he had to be admitted to a mental hospital: "I was ... completely disabled by pathological preoccupations and fears. Obsession with coincidences, fixations on recurrent numbers, feelings of worthlessness and physical or sexual inadequacy; religious anxieties of guilt and concerns about God's will.... Rational thinking was driven out by a ferocity of fear that consumed all energy and pride."

Neither medication nor psychotherapy seemed to help: Baffled senior psychiatrists were talking about a lobotomy. Only the stalwart intervention of a young psychiatrist prevented Nuland from suffering that fate and, instead, a series of shock treatments finally helped restore him to mental health, perhaps, he speculates, by having somehow burned away the obsessional circuits he'd been forming in his brain.

But the memory of his father, who died in 1958 shortly after his 28-year-old son won the coveted position of chief surgical resident at Yale, continued to haunt him more than 40 years later. "Lost in America" is, among much else, a son's attempt to come to terms with a father who evoked a bewildering mixture of conflicting emotions in him.

Aware of the tricks that memory can play and increasingly conscious of the gaps in knowledge that cannot be restored, Nuland proceeds to tell the story of growing up in a Yiddish-speaking household where none of the adults -- his father, his mother, his maternal grandmother and aunt -- was able to read or write English. In some respects, it is a tale with universal resonance about a bright young American-born boy, eager to enter the wider world, torn between love for his immigrant family and embarrassment over their greenhorn ways: the story of a son who strives to achieve what his father could not.

But it is also an atypical story about a father who, Nuland can't help feeling, was sui generis. The sense of embarrassment that plagued young Nuland was not just the usual awkwardness felt by many children of immigrant parents but a more powerful blend of fear, anger, pity, love and revulsion that he felt about his father -- as distinct from his equally foreign mother, grandmother and aunt. "Momma was the totality of all I knew to be good, and I was certain that she lived only to be my mother."

Nuland's Bubbeh (Yiddish for grandma) was "a gentle, adoring old lady who stroked my face and looked into my eyes as if she saw her entire world renewed somewhere in their depth." Momma's unmarried sister Rose, who also lived with them, was a plump, brisk, attractive woman who had turned down all of her many immigrant suitors, none of whom measured up to her standards.

Nuland's father, who emigrated on his own from Bessarabia (now part of Moldova) in 1907, was a sickly, sad, frustrated, disappointed man, "lost in America." Too naive and gullible to make a go of the candy store he once tried to operate, he never managed to get beyond his low-paying job as a garment worker. Worst of all, from the viewpoint of his two children, Harvey and Sherwin, was his propensity for unpredictable outbursts of rage. The least little incident or minor mishap could trigger a torrent of furious invective. At other times, he was an awkward parent: "He would try to express his affection by stroking my cheek, but the inadvertent clumsiness of the gesture would make me pull back in a sudden defensive movement, and he would become offended and angry. At such moments, his glance hardened with his temper."

Even as a child, Nuland sensed that his father's frightening anger was the result of feelings of weakness and impotence. Not only was he unworldly, unsuccessful and disappointed, but, as Nuland later came to realize, he also suffered increasingly from a physical ailment that made it difficult for him to walk steadily or control his bladder. His and the family's lives became sadder still when Nuland's beloved Momma died when Nuland was just 11.

Like many a child of an embarrassing parent, Nuland was anxious to distance himself from his father. On a few occasions, recounted here in painfully honest detail, he came close to being downright pitiless and cruel. Almost anyone who has been a child will recognize the emotions that attend such moments: the irritation leading up to hurtful action and the remorse that attends one's later recollections of it.

Writing, as George Orwell observed, is sometimes motivated by a desire to seek revenge for childhood injuries. Such autobiographical forays may also be acts of forgiveness and expiation. Nuland's unsparing, deeply felt and searching attempt to remember and understand his personal and familial past is no "Daddy Dearest" but an illuminating journey into some of the darker areas of the father-son relationship.

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