Monday, January 16, 2006

Review: Physical by James McManus

A gambler visits the Mayo Clinic to assess his odds, McManus' exam serves as rumination on health care

Review by Edward Nawotka

James McManus understands long odds. A semi-professional poker player who wrote about his fifth-place finish in the 2000 World Series of Poker in his previous book, "Positively Fifth Street," he knows "each drag off a spliff or a cigarette, each mouthful of garlic mashed potatoes or Billecart-Salmon brut rosé deducts x minutes, y seconds" off his life. All of which limits his chances of seeing any of his three daughters, two of them preteens, "speak as valedictorian of her law school class, get married, score her first goal."

At age 52, McManus finally fully realized that with his family history of heart attacks, including a grandfather who died of a coronary at age 35, the deck was stacked against him. That sudden and sobering realization propelled him to the Mayo Clinic in Rochester, Minn., for a full-body "executive" checkup, an experience he documents in his new memoir, "Physical."

The good doctors put him through a battery of tests, from dermatological and eye exams to blood and urine analysis. They gave him a "chest CT without biopsy," immunized him against hepatitis and counseled him to lose weight. In his own words, McManus was "bled, scraped, shaved, freeze-dried, stressed, scanned, and sanded, all by the best in the business." Throughout, McManus puts up a macho front. He fantasizes about "a two-mistress session" of S&M with his nurses and wants to "bump fists" with his gastroenterologist after the doc expertly lassos and removes a tiny polyp from McManus' colon. He even doesn't balk at the bill, $8,484.25. (It was covered by Harper's magazine as an expense for an article he wrote.)

Medically speaking, McManus is fortunate. His full-time job as professor at the School of the Art Institute of Chicago means he's not one of the 45 million Americans without medical insurance. Plus, his body is more or less OK, too: His only major health concern is his cholesterol, which runs "moderately high." As one might expect, his doctors advised him to stop indulging in his predinner martinis and post-dinner Parliament Lights and to exercise.

Early in the book, McManus establishes his skepticism of the medical establishment -- and for good reason. His younger brother died at age 41 from complications of a bone marrow transplant at Johns Hopkins. And his son committed suicide at age 22, possibly as a result of symptoms of depression exacerbated by the antidepressants he was taking. As a result of his suspicion, McManus does his research, and along the way treats us edifying disquisitions on everything from the history of smoking and obesity to toilets and vasectomies.

Being a novelist, as well as a gambler and a journalist, McManus seasons his text with literary and historical allusions. All the while, he highlights factoids that bear repeating. I'm sure you already know that insurance companies spend a whopping 31 cents of every dollar on paperwork instead of medical care, but it's no less startling the 15th time you've heard it.

McManus' greatest health concern is his eldest daughter, Bridget, 30, who suffers from diabetes. In discussing her affliction, he makes a strong argument in support of embryonic stem cell research, which might help her and, according to White House statistics, "approximately 128 million Americans." He castigates the Bush administration for having a "schizoid" position that curtails 99.8 percent of stem cell research and lionizes the South Korean government for supporting groundbreaking research.

In particular, McManus looks to the work of scientist Hwang Woo-Suk, who in 2004 claimed to have cloned a human embryo and extracted stem cells from it. Regrettably, in December, the same scientist disclosed that his claim was faked, which will no doubt crush the author.

When he's not being a nagging polemicist, McManus is generous with praise where he feels praise is due. In particular, the Mayo Clinic comes out looking like a paragon of good sense and medical idealism. He explains that the not-for-profit institution offers general health care to much of southeastern Minnesota in addition to serving high-end clients. In general, the doctors he encounters also impress him. When an especially skilled eye surgeon saves his daughter's eye after she's stabbed by an errant magic wand at a children's birthday party, he considers that it might be appropriate for his wife to thank the doctor by sleeping with him. Could there be a greater tribute from such a macho guy? Probably not.

The majority of us find medical matters an intimidating mystery. McManus' grab bag of personal anecdote, medical history and polemic offers an entertaining and often insightful look at one man's experience with the health care system. If there's any message to take away from McManus' book, it's to enjoy your good health so long as you still have it. Once you lose it, getting it back is an all-consuming task.

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