E
ight days after arriving in Munich, the trauma team finally cleared John to leave intensive care for transfer to the hospital’s special surgical ward, where they envisioned a three-week course of specialized treatment using something called
Wundzucker.
If all went well, the treatment would be followed by plastic surgery to close the wound.
Neither of us knew the word
Wundzucker,
literally “wound sugar,” but a few days later, John noticed what looked like sandy crumbs in his sheets, as if he had been eating cookies in bed. It was only then that he realized that the white crystals the doctors had been pouring into his back twice a day were nothing more than sterilized sugar, administered after he had been bathed in a diluted chamomile extract, and his wound had been hosed out. The hosing produced pain fierce enough to require a morphine chaser.
Sugar, a treatment from Egyptian antiquity, helps heal dangerously infected wounds by killing the powerful bacteria that thrive in their depths, without causing trauma to the surrounding tissue. The practice largely fell out of favor during the 1900s, as pharmaceutical companies developed increasingly powerful antibiotics to fight infection. But in the mid-1980s, German doctors turned back to sugar when they began encountering super-powerful bacteria harbored in deep wounds that did not respond to even the most high-tech preparations. Although U.S. medical experts largely discredit the idea as quaint, European doctors who have readopted the technique say that even dirty wounds often turn free of bacteria after only several days of treatment and that the injuries tend to heal more completely and gently than with standard antibiotics.
Dry sugar crystals have an osmotic effect, drawing the liquid out of all the bacteria that lurk deep inside the wound. The removal of that liquid kills the bacteria that fuel infection. The treatment allows new flesh—the doctors call it “granulation tissue”—to grow deep inside the wound, which, in John’s case, was exactly what was needed. His wound was so large and deep that it could not just be closed; there was no flesh in the trench with which to close it. Instead it had to heal slowly, from the bottom up, and it did, over a period of weeks.
John’s doctors always worried that the infection would spread into his shattered pelvic bone, a situation they wished to avoid. Bone infections were nasty, they said, horrifically painful for the patient and tricky to heal. Although they would have liked to wait until enough new flesh formed to simply close the wound, the risk of infection was too great. They would give the granulated sugar three weeks’ time to begin producing a base of granulation tissue. Then they would call in the plastic surgeons, to finish offthe job more quickly.
On the first day of the sugar treatment, I arrived to find the surgical ward’s second-in-command already studying his new patient’s wound while changing John’s bandages. I had never actually seen the wound, and when the doctor began to say how much better it looked, and asked if I wanted to have a look, too, I naively nodded.
Clearly I had been keeping the gory details of John’s injury in some sort of psychological safe house, for when I stepped up to John’s bedside to look, I felt as if I were staring into an abyss so deep that I was afraid I would fall in. For some time I had known intellectually that John’s wound was large and had to have been made larger by the five operations in which the doctors had cut away dead flesh. But I was not at all prepared to see a horizontal trench wider than my forearm stretching from one side of his waist to the other, his spinal column looking like a white bridge over the dark red meat of his open back. It looked for all the world as if someone had taken an ice cream scoop and roughly carved a deep trench across his middle.
I am not particularly squeamish, but the wound so unnerved me that I had to turn away. The doctor noticed my distress and began talking softly, describing how much better the wound looked now, noting that the dark pink-red color was a sign of solid granulation, and pointing out that there was no longer any dead, black flesh. After he finished rebandaging the wound, we walked out of the room together into the hallway.
As soon as the heavy door to John’s room closed, the doctor apologized, saying he had assumed I’d seen the wound while John was in intensive care. Still reeling, I demanded to know if there was any hope at all of a wound that size actually healing. “Don’t worry,” he said. “ We close bigger holes than that.”
That night, when I went back to my hotel room, all the fear and panic I had been suppressing for the previous two weeks let loose. I sobbed, unable to catch my breath, for what seemed like hours before I calmed down enough to check with another expert on battlefield wounds.
My father had spent years in the South Pacific during World War II, and was assigned to an army medical unit, where he ferried the wounded and the dead from the battlefield to field hospitals. My mother had told me when I was a child that he did not like to talk about the war. His only sporadic comments about it usually erupted in response to newspaper stories quoting members of Veterans of Foreign War societies. Anybody who would join a group like that, he would say, must have spent the entire war in a cushy office on a U.S. base. His premise was that nobody who actually saw fighting would ever want anything further to do with the military. The only time he willingly discussed his five-year stint was the night he and I went to see
M*A*S*H
at a local movie house. He loved it, the first war movie he had ever seen that caught the crazed reality of war.
I dialed home and tried to describe for my father the size and depth of the trench across John’s back. I told him that the doctor had assured me that healing was possible, but that I wasn’t sure if I could believe him. My father was quiet while he searched through the wartime memories he generally kept at bay. “ I remember a guy we brought in without a calf,” he said. “His calf had basically been blown off. There was pretty much nothing there but bone. I can tell you that the meat grew back. It’s amazing what a body can do when it wants to live.”
We said good night. I hung on to his words and actually slept.
I
used to think that my family’s central dynamic may have gotten stuck on food because of the onset of my brother’s renal problems when he was two, that my parents never stopped trying to devise a diet that might make his kidneys behave. But in searching through old scrapbooks and notebooks, I found that food was at the center of things long before he got sick. I could not spell “cereal” or “carrots” when Danny took his first solid food at seven weeks, but I was interested enough to write about it on a thin piece of brown construction paper stuck into my first scrapbook. “ When my brother was 7 weeks old we gave him cirel,” I wrote. “On June 18, my baby brother aet ate carrets he took all that my mother gave him! . . . on June 21 my brother ate Squash.”
Nobody remembers if it was Danny’s pediatrician who suggested that my parents ensure that he ate a protein-rich diet, to make up for the protein spilling out into his urine, upsetting the body’s delicate balances and threatening his life. It is possible that it was something my parents did on their own. But I know that for a dozen years at least, our family’s chief work at mealtime was to get my brother to eat plenty of protein-rich foods: meat, eggs, and dairy products. Like a Greek chorus, my father, mother, and I repeatedly interrupted the chatter of all our meals with a basic line: “Eat your meaty, Danny, eat your meaty.”
How familiar and oddly comforting, then, when John got out of intensive care and found himself constantly hungry. The hospital’s surgical chief said it was the strongest sign to date that his body was beginning to heal. He also told us that a body successfully growing new flesh would demand a high-protein, high-calorie diet. The hospital would provide it; John was expected to eat it.
From that moment forward, each of John’s three daily meals arrived laden with protein-rich foods. Thick slices of cold cuts, large wedges of cheese, hard-boiled eggs, huge chunks of meat or fish, containers of yogurt or milk-rich puddings, whole-grain breads—John’s food tray would have made a cardiologist blanch. Consumption of this food was no chore for John; he was ravenous at each mealtime and ate with gusto, from the slabs of liverwurst on thick brown bread to the mounds of herring in sour cream. The granulation of new flesh in his wound was gobbling up the calories and proteins faster than even John could keep pace with, pulling extra protein wherever it could find it. No matter how much he ate, it wasn’t enough. John’s hair turned brittle in the coming weeks and thinned out dramatically, as the healing wound pulled proteins from even the hair on his head.
He was not the only one with an appetite. I had always had a fast metabolism, and the adrenaline rush from the shock of the shooting and all that followed had only made it faster. Every morning I would go down to the hotel’s breakfast buffet and eat dinner-sized portions of scrambled eggs, tiny, herb-flavored sausages known as
Nürnberger Würstchen,
a mound of German-style home fries, crunchy breakfast rolls, yogurt, and bowls of out-of-season berries flown in from someplace south of the equator. Only after I had eaten like this every morning and downed a large pot of tea did I feel physically and mentally ready to return to the hospital.
At lunchtime I would return to the hotel café and eat the daily special—soup, main course, salad, dessert—before I could even think about heading back to the hospital. I would stay with John till after his supper, then eat yet another large meal before falling asleep. No matter how much I ate during those weeks in Munich, my clothes let me know that I was losing weight. My entire body felt stuck in overdrive. Each night I would fall asleep exhausted, but would often awaken with a start just a couple of hours later. I would be breathing hard and in a sweat, as if I had been chased by demons during my sleep. In Munich I never remembered my dreams, but I awoke knowing they had been bad.
John’s appetite and protein-rich diet worked as the doctors had hoped, and by the end of January, they were ready to try a pair of operations to finally close up his back. Both went nearly according to plan. The hospital’s top cosmetic surgeon basically butterflied John’s buttocks, cutting flaps that he could then open out over the wound to patch what remained of the trench. Two weeks later, when I finally saw the wound for the second time, it looked as if a very neat, careful madman had carved his way around it. But to me it was beautiful: the gaping trench and open view of John’s spine miraculously gone, replaced by a couple of feet of delicately traced seams. No Frankenstein cross-stitches, just a subcutaneous blind stitch that left neat, clean lines. My nightmares paused.
8
Birthday Cake
U
ntil I went away to college, my parents, my brother, and I ate virtually every Sunday lunch of my life with a dozen or more of my mother’s relatives in my grandparents’ tiny apartment. Except for those first moments of silence when everyone dug into the steaming plates before them, Comparato, Romano, Tozzi, Delia, Fucci, and Gabriel never stopped talking, kidding, joking, telling stories, swapping news, or listening to the latest tales of wacky customers at Gabriel’s Meat Market. We ate a ritual menu: Jennie’s
pasta al ragù
, and then meatballs, sausage, chicken, pork, and braciole, thin slices of herbed, rolled beef, all of which had flavored her thick Neapolitan sauce. A mixed salad, “good for the digestion,” always followed the meat.
The only variable dish was dessert, usually one of Jennie’s homemade American specialties: fresh blueberry, apple, cherry, or pumpkin pie, depending on the season; Boston cream or lemon meringue pies on occasion; pineapple crush cake (made with zwieback, eggs, condensed milk, pineapple, and whipped cream); or, on birthdays, my favorite, Auntie’s chocolate cake, a moist, sour-milk, two-layer concoction spread thickly with Jennie’s soft, white frosting and covered in grated coconut. As a child I loved to watch the vinegar—Heinz’s white, not my grandfather’s red—start to sour the warm milk. If I stared long enough I could see the milk begin to thicken and coagulate from the chemical reaction with the vinegar. When the cake was pulled from the oven, leaving moist, dark crumbs on the toothpick tester, I loved the sight of it sitting on a cake plate in the center of any of the tables from my childhood, whether it was my birthday or somebody else’s.
Jennie and Tony, Great-Uncle Pete, Great-Aunt Philly, Deedee, Auntie and Uncle, Cousin Jo, Cousin Al, my mother: all are gone today, along with all the other great-aunts and great-uncles, and nearly all the second and third cousins who used to join us on special occasions. My grandparents’ generation produced few children, my parents’ generation even fewer. Aside from me, the only ones left from that great crowd of family that used to celebrate Sundays and birthdays together are my father and brother, and Auntie’s son, my lone first cousin, Paul.
I never lost the recipe for Auntie’s birthday cake, no matter how many times I have moved. The recipe, stained with melted chocolate and vanilla, travels with me to each new country, each new kitchen. I make Auntie’s cake at least once a year. A single bite of that cake still conjures up the days when all the characters of my childhood used to sit around Jennie’s kitchen table on Whitney Avenue celebrating the joy of birth, when I was little, when my parents were young, when my grandparents were still only in their sixties. It keeps those Sunday dinners alive in my memory, keeps alive my family dead.
B
efore John was discharged from the hospital in Munich, a gray-haired orderly named Werner walked into John’s room, read his medical chart, and pointedly asked him when he was born. When John responded, Werner—who had acquired a certain wisdom about traumatic wounds while working aboard a hospital ship off the coast of Vietnam—shook his head to disagree. “You’ve got a new birthday now,” he said gently, referring to the date of John’s shooting. “December twenty-third, nineteen eighty-nine. It’s a new birthday for your new life.”