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A MEDITATION ON ILLNESS, AGING, AND DEATH
Everyman. By Philip Roth. 192 Pages. Houghton Mifflin 2006

Philip Roth's new short novel Everyman is a meditation on illness, aging, and death. It reads like an obituary of the deeper, uncomfortable truths of one unnamed man's life. While that may not sound like most physicians' idea of recreational reading, Everyman touches on issues that neurologists confront every day. How fully do we know the complicated people who are our patients? What is the emotional meaning of illness to different people? How well do patients and their doctors address these serious and personal subjects?

ROTH'S BACKGROUND

Philip Roth is one of America's major novelists of the last 40 years, with 27 books to his credit.

Like many of his narrators or protagonists, he was born in 1933 to lower middle class, generally observant Jewish immigrants, and grew up in New Jersey. His childhood encompassed the Depression and World War II. Building on the sacrifices and striving of two previous generations, he and his generation would appear to have attained the “American Dream.”

Though Roth focuses on the Jewish experience in America, often in hilarious detail, his underlying themes are those of 20th century America and can apply to many other immigrant groups.

PROTAGONISTS AND THEMES

As in Everyman, Roth's protagonists are ordinary men who were raised to be responsible and who see themselves as trying to do the right thing. They work hard, marry, raise children, and prosper. But fulfillment and happiness prove elusive. For example, in Portnoy's Complaint, written in 1967, the narrator remains immature, self-absorbed, and stuck in self-destructive bad habits. American Pastoral, which won a Pulitzer Prize in 1997, explores the disintegration of a comfortable family, apparently steeped in goodness and virtue, as it tries to deal with political events that shake all their conventional assumptions.

Roth's protagonists wrestle with powerful internal conflicts (framed in earlier work in Freudian terms) between their ingrained responsibility, conventional morality, and parental and societal expectations on the one hand and the id, or desire, on the other. Like the protagonist of Everyman, they may say they only “did what they did” and rationalize atrocious behavior. But there is always a price to be paid, although often not immediately obvious. Some of his characters have insight into their own motivations, but at other times their willful self-justification can be truly aggravating. On the other hand, Roth can really evoke the obsessive quality of his characters' lust in language that is both erotic and graphic.

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Dr. McCammon writes about Everyman: “As a physician and a middle-aged child of recently deceased parents, I found it impossible not to read this novel. It is all familiar, and the same issues will confront us all soon enough.”

STYLE OF STORYTELLING

For those not acquainted with Roth's oblique, non-linear style of storytelling, Everyman is a good, manageable introduction. The reader often must work to follow where the story is headed amid digressions that jump around in time, usually related to memories of childhood or various romantic adventures.

The book begins with the nameless protagonist's funeral and then proceeds to a wandering recollection of his life, where the major touchstones are illnesses and the women who were present to take care of him. His mother eased the trauma of hernia surgery at age 9, but even at that age he is aware of death.

He grows into a man who describes himself as “reasonable and kindly, an amicable, moderate, industrious man.” Yet he is also a serial adulterer whose two sons from his first marriage hate him implacably. His one daughter unaccountably adores him.

During a happy interlude at age 34, just before he develops a nearly fatal perforated appendix, he develops a fear of the night during walks along the beach and finds that “the profusion of stars told him unambiguously he was doomed to die.”

That feeling apparently passes and his recollections skip ahead, noting twenty-two years of excellent health, to the quintuple bypass, his first encounter with the systemic atherosclerosis that will be his undoing. Details of his midlife crisis and ill-advised third marriage are gradually revealed. Some descriptions of medical procedures suggest Roth's own personal experience, but the author is also a meticulous researcher, so it is hard to be sure.

OF INTEREST TO NEUROLOGISTS

The treatment of Everyman's cerebrovascular disease will both interest and disconcert neurologists. Perhaps to avoid the possibility of a stroke, which killed his mother and disabled his second wife, Everyman undergoes a first, successful carotid endarterectomy. Obstruction is mentioned, but symptoms are not. Later, at the “annual check of his carotids,” progressive stenosis of unknown severity is found, and a second endarterectomy is scheduled. There appears to have been no neurological input at any point, which is a sad commentary on the view that vascular intervention is a safe and simple way to correct a pesky plumbing problem. However, by this time, Everyman is 73 years old with a prior coronary artery bypass graft, later coronary and renal stents, a pacemaker, and an asymptomatic myocardial infarct. He might have opted to proceed with surgery, but a neurologist could have presented the risks and benefits – and might have stayed the surgeon's hand.

Some readers might complain that the story is telegraphic and the character sketchy, but what stands out is this Everyman's particular reactions to life's significant milestones. His parents die; he envies his brother's effortless good health; the pleasure of painting in retirement evaporates; and the list of medical problems lengthens. Saddest of all, he is more and more alone, having burned his bridges over the years with decisions that gave in to impulse.

“Now,” he finds, “eluding death seemed to have become the central business of his life and bodily decay his entire story.” His deepening depression is unrecognized and untreated. Contrast is provided by some affecting vignettes of friends and acquaintances, which sketch alternate ways to face the challenges of age and illness.

As a physician and a middle-aged child of recently deceased parents, I found it impossible not to read this novel. It is all familiar, and the same issues will confront us all soon enough. I also found it noteworthy that there was none of the usual tirade against the medical profession. Except for a damning story of psychoanalytic hubris, there is minimal complaint. However, given the centrality of illness in the story, Everyman's doctors are hardly present as personalities. They perform surgeries and get their patient home, but there is no real human connection. The physicians don't open the Pandora's Box of emotional issues, and the patient, typical perhaps of his generation, never mentions the dread and despair he feels as he confronts aging, impending dependence, and the progression of disease.

LITERARY ALLUSION

Roth's title refers to a medieval morality play, also entitled “Everyman,” which dates to about 1520. Both tales confront the inevitability of death, but the medieval play is surprisingly compelling and accessible. Death is sent by God as a messenger to Everyman, a representative for all mankind, as the narrator is in Roth's story, to remind him that God will call him to account and he had better mend his wicked ways. Everyman asks to “defer this matter to another day,” but to no avail. He calls for help from friends and family, who forsake him, and his worldly goods are useless. As expected, his salvation comes through repentance, but the play clearly endures because the audience identifies with Everyman's desperate struggle to evade and finally to accept his fate.

Roth's Everyman also takes a reckoning of his life, but he experiences no epiphany or transcendence. A man of his own time, he is left to face death alone, without a belief in God or any consolation. Has the world changed much over 500 years? The moral imperative to live a righteous life is just the same, Roth seems to suggest, and just as impossible a goal, particularly if you have no hope of eternal reward.

Should you read this book? If you enjoy good writing and thought-provoking ideas, then absolutely, yes. If the subject seems too gloomy, then maybe not right now. But sometime you might want to dip into Philip Roth's extensive body of work. Everyman is quite good and gives a concise taste of Roth's themes and literary style.