The gambler

IN “Positively Fifth Street,” one of the most compelling literary books on poker ever written, James McManus observed that “God may play dice with the universe ... but serious gamblers ... prefer no limit Texas hold ‘em.” McManus is a serious gambler, and in his new book, “Physical: An American Checkup,” he proves that he is no less serious about God’s roll of the dice, particularly when the roll’s outcome might involve McManus himself, or his children, or his country. “Physical” is ostensibly a memoir about McManus’ very thorough examination at the Mayo Clinic, but that is only the starting point of what is not a single, integrated work but a powerful collection of essays.

Securely employed, middle class, happily in love with his second wife, McManus, in his early 50s, finds himself unable or unwilling to contemplate his eventual death (“Plus I’m bulletproof, baby!”). This even though his father had his first heart attack at 46, his grandfather died of a heart attack at 35, his brother died of leukemia at 41, and his oldest daughter is struggling with diabetes. Furthermore, his son -- severely depressed and possibly suffering from side effects of the very drugs that were supposed to help him -- committed suicide at 21. McManus nonetheless maintains his belief in Western medicine: “Not that I expected Western medicine to let me live forever -- just an extra decade or so, with a little more spring in my step.”

When McManus mentions a recent less-than-bulletproof medical episode involving diverticulitis to his editor at Harper’s magazine, the editor suggests that McManus get a complete “executive physical” at the Mayo Clinic, then write about it. It’s a prospect at which McManus is not exactly thrilled: “Accepting this plummy assignment would more or less guarantee I’d be told things I did not want to hear.”

In the minds of many Americans, the Mayo Clinic is the Supreme Court of medicine, a place to get a final and absolute ruling. It’s also, in imagination and in reality, gigantic. “At more than fifteen million square feet, the clinic is almost three times the size of the Mall of America, the Gopher State’s less useful mecca,” he writes.

McManus, who loves his wine and his occasional cigarette, arrives there with a history of ignoring follow-up medical advice and treatments. He also arrives with the ability to reel off his medical statistics, in part because he’s been on statins that have lowered his cholesterol. The statistics aren’t quite so scary now: “However far I make it past 35 without dying.... I believe will be pretty much due to these pale orange pills shaped like shields. Long live those who invented them!”

McManus’ attitude creates one of the underlying tensions in this book. He’s as willing to toast the makers of Zocor as he is to make toast of the drug makers whose medications his son was taking before his suicide, and who McManus believes may have falsified the data involving suicidal tendencies as one of the medications’ side effects. Lawsuits are attractive, the author writes in the book’s opening essay, “not that legal maneuvers or money can bring James back to us, or retroactively soothe all the pain he was in. Executing by hand the person or persons who manipulated the data and made the decisions to keep pushing those antidepressants wouldn’t accomplish that, either, though I’d still love to do it.”

An executive physical at the Mayo Clinic is typically $3,000 to $4,000, with $250 of that fee circulating back into the general budget to help cover Medicare patients. The executives get a “streamlined yet comprehensive exam,” and the clinic gets some assistance in treating the un- or underinsured. Everybody ends up happy, right?

Well, not everybody. McManus is keenly aware that even there -- especially there -- at the Mayo Clinic, the Bush administration’s policy on stem-cell research is impeding the efforts of the medical community. Along with the memory of his son, there is the story of McManus’ daughter, who has struggled with diabetes her entire life. As McManus sees it, stem-cell research could find an answer for her: Scientists are on the verge of “an age of honest-to-God magic bullets trained at humankind’s vicious diseases.” And, for him, the Bush administration is hiding the weapon for political reasons.

“Could such dumb-assedness have anything to do with the fact that our president says confusingly, ‘On the issue of evolution, the verdict is still out on how God created the earth.’? Not that the president is a dyed-in-the-wool holy roller himself -- much worse, he’s a cold-blooded opportunist.

“If we ... recognize that the administration’s main goals are radical corporate welfare and even deeper tax cuts for the extravagantly wealthy, we are talking about a policy that extends the ill health of hundreds of millions of people in order to reward a few thousand lavish contributors to the Republican ticket.... “

As McManus makes his way through the efficient labyrinth that is the Mayo Clinic, we’re treated to the spectacle of McManus being McManus: He imagines the female clinicians conducting his stress test as dominatrixes; after being told to regulate his diet, McManus asks the doctor what he eats; and McManus gets another doctor to admit that he drinks wine as often as McManus does. After one doctor describes the author as “young and healthy,” McManus comments: “I wanted to hug him but managed to restrain myself, in no small part due to the freshness of our proctologic encounter.”

Back home in Chicago after his physical, McManus gets a phone call -- one of his younger daughters, while playing at a birthday party, has suffered a serious eye injury. Her cornea is lacerated in two places. McManus and his wife rush her from one doctor to another, and within a few hours they’re able to get her to the doctor who wrote the book on this particular type of eye injury. The doctor saves their daughter’s eye. McManus is extremely grateful, and so is his wife -- so much so, in fact, that McManus begins to wonder if his wife has repaid this medical stud with sexual favors. McManus’ wife, probably as amused by him as some of us are, doesn’t go out of her way to calm his hyperactive imagination.

For all his playfulness, McManus is not bluffing when it comes to the subject of stem-cell research. In an essay on the progress of stem-cell research in South Korea, McManus chronicles the work of Dr. Hwang Woo-suk and others. Hwang was a national hero in South Korea, in part because of his success “in cloning human embryos and extracting stem cells from them,” and in part because the government of South Korea has been more forward thinking than the government of George W. Bush. This section is painful to read, since in it we see a father’s desperate search for hope for his daughter’s illness and a desperate plea for leadership on this front from his country’s leader. Sadly, neither appears to be forthcoming. After McManus finished his book, Hwang quit in disgrace when it was revealed that much of his research had been falsified. And the Bush administration continues to stubbornly stay its course.

The doctors’ prescription? McManus needs to quit smoking, drink less, eat less and exercise more. I’m not giving anything away. This book doesn’t have the forward momentum or the fairy-tale ending of “Positively Fifth Street,” but like Thomas Lynch’s “The Undertaking,” it is a lively examination of mortality. *