Sometime after he'd fallen asleep he heard noises in the room and awakened to see that the curtain between the two beds had been pulled to screen off the other bed and that there were doctors and nurses at work on the other side – he could see their forms moving and could hear them whispering. When one of the nurses emerged from behind the curtain, she realized that he was awake and came over to his bed and told him softly, "Go back to sleep. You have a big day tomorrow." "What's the matter?" he asked. "Nothing," she said, "we're changing his bandages. Close your eyes and go to sleep."

He was awakened early the next morning for the operation, and there was his mother, already at the hospital and smiling at him from the foot of the bed.

"Good morning, darling. How's my brave boy?"

Looking across at the other bed, he saw that it was stripped of its bedding. Nothing could have made clearer to him what had happened than the sight of the bare mattress ticking and the uncovered pillows piled in the middle of the empty bed.

"That boy died," he said. Memorable enough that he was in the hospital that young, but even more memorable that he had registered a death. The first was the bloated body, the second was this boy. During the night, when he had awakened to see the forms moving behind the curtain, he couldn't help but think, The doctors are killing him.

"I believe he was moved, sweetheart. He had to be moved to another floor."

Just then two orderlies appeared to take him to the operating room. When he was told by one of them to use the bathroom, the first thing he did when the door was closed was to check if the hernia was gone. But the swelling had come back. There was no way out of the operation now.

His mother was allowed to walk alongside the gurney only as far as the elevator that was to take him to the operating room. There the orderlies pushed him into the elevator, and it descended until it opened onto a shockingly ugly corridor that led to an operating room where Dr. Smith was wearing a surgical gown and a white mask that changed everything about him – he might not even have been Dr. Smith. He could have been someone else entirely, someone who had not grown up the son of poor immigrants named Smulowitz, someone his father knew nothing about, someone nobody knew, someone who had just wandered into the operating room and picked up a knife. In that moment of terror when they lowered the ether mask over his face as though to smother him, he could have sworn that the surgeon, whoever he was, had whispered, "Now I'm going to turn you into a girl."

The malaise began just days after his return home from a month long vacation as happy as any he'd known since the family vacations at the Jersey Shore before the war. He'd spent August in a semi-furnished ramshackle house on an inland road on Martha's Vineyard with the woman whose constant lover he had been for two years. Until now they'd never dared to chance living together day in and day out, and the experiment had been a joyous success, a wonderful month of swimming and hiking and of easygoing sex at all times of the day. They'd swim across a bay to a ridge of dunes where they could lie out of sight and fuck in the sunshine and then rouse themselves to slip into their suits and swim back to the beach and collect clusters of mussels off the rocks to carry home for dinner in a pail full of seawater.

The only unsettling moments were at night, when they walked along the beach together. The dark sea rolling in with its momentous thud and the sky lavish with stars made Phoebe rapturous but frightened him. The profusion of stars told him unambiguously that he was doomed to die, and the thunder of the sea only yards away – and the nightmare of the blackest blackness beneath the frenzy of the water – made him want to run from the menace of oblivion to their cozy, lighted, underfurnished house. This was not the way he had experienced the vastness of the sea and the big night sky while he'd served manfully in the navy just after the Korean War – never were they the tolling bells. He could not understand where the fear was coming from and had to use all his strength to conceal it from Phoebe. Why must he mistrust his life just when he was more its master than he'd been in years? Why should he imagine himself on the edge of extinction when calm, straightforward thinking told him that there was so much more solid life to come? Yet it happened every night during their seaside walk beneath the stars. He was not flamboyant or deformed or extreme in any way, so why then, at his age, should he be haunted by thoughts of dying? He was reasonable and kindly, an amicable, moderate, industrious man, as everyone who knew him well would probably agree, except, of course, for the wife and two boys whose household he'd left and who, understandably, could not equate reasonableness and kindliness with his finally giving up on a failed marriage and looking elsewhere for the intimacy with a woman that he craved.

Most people, he believed, would have thought of him as square. As a young man, he'd thought of himself as square, so conventional and unadventurous that after art school, instead of striking out on his own to paint and to live on whatever money he could pick up at odd jobs – which was his secret ambition – he was too much the good boy, and, answering to his parents' wishes rather than his own, he married, had children, and went into advertising to make a secure living. He never thought of himself as anything more than an average human being, and one who would have given anything for his marriage to have lasted a lifetime. He had married with just that expectation. But instead marriage became his prison cell, and so, after much tortuous thinking that preoccupied him while he worked and when he should have been sleeping, he began fitfully, agonizingly, to tunnel his way out. Isn't that what an average human being would do? Isn't that what average human beings do every day? Contrary to what his wife told everyone, he hadn't hungered after the wanton freedom to do anything and everything. Far from it. He hungered for something stable all the while he detested what he had. He was not a man who wished to live two lives. He held no grudge against either the limitations or the comforts of conformity. He'd wanted merely to empty his mind of all the ugly thoughts spawned by the disgrace of prolonged marital warfare. He was not claiming to be exceptional. Only vulnerable and assailable and confused. And convinced of his right, as an average human being, to be pardoned ultimately for whatever deprivations he may have inflicted upon his innocent children in order not to live deranged half the time.

Terrifying encounters with the end? I'm thirty-four! Worry about oblivion, he told himself, when you're seventy-five! The remote future will be time enough to anguish over the ultimate catastrophe!

But no sooner did he and Phoebe return to Manhattan – where they lived in apartments some thirty blocks apart – than he mysteriously fell ill. He lost his appetite and his energy and found himself nauseated throughout the day, and he could not walk a city block without feeling weak and woozy.

The doctor could find nothing wrong with him. He had begun to see a psychoanalyst in the aftermath of his divorce, and the psychoanalyst attributed his condition to envy of a fellow art director who had just been promoted to a vice presidency in the agency.

"It makes you sick," the analyst said.

He maintained that his colleague was twelve years his senior and a generous coworker whom he only wished well, but the analyst continued to harp on "deep-seated envy" as the hidden reason for the malaise, and when circumstances proved him wrong, the analyst appeared unperturbed by his mistaken judgment.

He went to the medical doctor's office several more times in the succeeding weeks, whereas ordinarily he saw him only for a minor problem every couple of years. But he'd lost weight and the bouts of nausea were getting worse. He'd never before felt so rotten, not even after he'd left Cecilia and the two small boys and the court battle ensued over the terms of the separation and he was characterized to the court by Cecilia's attorney as "a well-known philanderer" because of the affair he was having with Phoebe, who was a new copywriter in the agency (and who was referred to in court by the plaintiff on the witness stand – aggrieved, overwrought, as though she found herself bringing charges against the Marquis de Sade – as "number thirty-seven in his parade of girlfriends," when in fact she was looking too far into the future and Phoebe was as yet number two). At least back then there'd been a recognizable cause for all the misery he felt. But this was his turning overnight from someone who was bursting with health into someone inexplicably losing his health.