Larry Zaroff, MD, PhD
Stanford University, Palo Alto, California, United States
Photography by Anthony Kai C
My clinic is far North in Acres, Montana, perversely, a small town near the Canadian border, where, in October, without permission the dark sneaks in early.
My work here, after twenty-six years as a cardiac surgeon in Los Angeles, is the way I want it, a quiet general practice with few families, maybe 4,000 folks if I count the surrounding cattle ranchers. Mostly I see the tailings of what was twenty years ago a profitable mining town and occasional passersby, refugees from the cities. Locals and visitors have tortured bodies in common: exhausted, old, three-pack-a-day smokers, residuals of the outdoor life—chasing cows and copper—looking for their real selves. The abandoned. I am of little help in treating their loneliness. I keep hoping that some day I will be asked to examine a youngster, a healthy one, who needs medical approval before going off to work in the county school about 20 miles south.
My office, on the first floor of a former clothing store, is simple, a consultation area, which is my living room and a single exam room. I keep open everyday, weekends, holidays, for lack of not much else I want to do. I don’t travel, stay around if anyone wants to drop in. By six, I was planning on locking up, going upstairs to my apartment, having a sandwich and a glass of cab, and reading the latest biography of Lincoln. As I stood to lock the door, it creaked open to frame a woman, at least six feet tall, delicately featured, red-brown hair poking out of her grey hood. Next to her was an animal, whose bulk reached to her slim waist. The creature, like his mistress, was also hooded, the cowl, shrouding the entire head, was attached to a flowing dirt-brown gown that descended sharply to the pine floor. No feet were visible.
I considered a dog, a Great Dane, weirdly outfitted. Of course, must be Halloween. Standing behind the pair in the quick twilight, adding to the strangeness, was the rising moon, half-empty, singling her out, leaving her companion in the shadows. Both arrivals remained static, not a word. I was intrigued, joined the silence. What a scene. “Trick or treat?” I inquired. A tortured smile from the woman, but no movement from her mysterious escort. “Come in please, yes, bring your whatever—it seems well behaved. How does it see, head covered?” Her voice was so blue, feathery, that I had to lean forward to hear, “He feels his way.” “Well sit down, what can I do for you, are you ill?” “Thank you doctor, my name is Geraldine, and I am well, but it is my brother.” “What is the problem, I don’t make many house calls around here.” “A house call won’t be necessary—this is my brother, Gregor.” “Does he have a bad back—why is he bent that way? What’s he hiding? Can I see him?”
“Doctor, I had better explain before you meet Gregor.” As she was speaking, a rustic noise, as if two sticks were being rubbed together, emerged from the brother, accompanied by a strong movement of a head up and down. Geraldine said, “My brother was perfectly fine, a normal thirty-six year-old who always put his family first, although he had a job that forced him to travel all over the state repairing computers. He was tall, taller than me, handsome, with blonde curly hair, never a bad word. A sweet man who adored his parents. We were, are very close, almost twins, he is six years older, but treated me as an equal, best friend. He came home last night as he always did for the weekend. He complained all through dinner to my parents and me that he no longer enjoyed his job, in fact hated the work, was not appreciated, and spent most of his time with machines not people. He felt less than human. He went to bed early, very depressed, even missing the Leno show—which he adores. The following morning he did not get out of bed to take his usual Saturday walk with our golden retriever.
Duncan, always tranquil, was frantic, standing, howling, growling, scratching at the closed door to Gregor’s bedroom. I slid the door open to find Gregor completely huddled under the blanket. I walked in and asked what the problem was. No answer but something, like a stick, poked out from the blanket. Dark green, hard looking, moving, shaking, seemed out of control. I screamed, jumped away from the bed, thinking an animal—Gregor had been eaten. Duncan yelped, reversed, out the door. Nothing else happened for a moment, then this thing, appendage, seemed to wave at me. I was too frightened, frantic to respond and stumbled out of the room, slammed the door. I didn’t know what to do, call the police, the fire department, Terminex, anyone. Then I heard a shuffling noise coming from the room, followed by a faint clicking; then the same shuffling again. As I was standing in the next room, still trying to think whom to call for help, a sheet of paper slid under Gregor’s door. The printed message, in caps, said, “I AM GREGOR—SOMETHING HAS HAPPENED TO MY SKIN. PLEASE CALL A DERMATOLOGIST.” Whatever had occurred, whatever it was, it could use a computer. I have never been so scared in my life. Click, click. In a moment another note appeared under the door: “Please come in, I won’t hurt you. I need help. I have turned into some sort of monster, an insect, a reptile, not sure what, and I have trouble speaking.”
Despite Geraldine’s warning, I was stunned, terrified when she slowly slipped the cover off the creature she referred to as her brother, Gregor. This giant thing just stood quietly while I jumped away. But I could not escape the smell, an odor that did not connect with any I knew. It was slightly sweet, moist, the perfume of a dying rose in a pile of compost. I would have run out of the office if Gregor—for some inane reason I gave him the name Geraldine had used—had moved, but he stood quietly, calm. I thought of a huge reptile—I had heard of the Komodo Dragons, some reaching ten feet, but they were found only on the Indonesian islands, and Gregor had articulated antennae at least a foot long, which he waived widely, seemingly to embrace Geraldine. Six legs, scrawny like tent poles supported a five-foot body. His eyes, the size of baseballs, looked like a hundred tiny mirrors, reflecting my fear. Those eyes, no eyelids, a memory that would never leave me. It, he, was entirely dark green, almost black with a covering that resembled tree bark. His outer shell gave new meaning to insuperable barrier. For a costume it fit quite well.
Malevolence filled the room, but turned to loneliness. Gregor could not have been more alone. Not knowing what to do, I just stood stupidly quiet. Then said, “Ok, game over, take it off.” Geraldine and it shook heads in unison and then she asked if Gregor might use my computer. I thought I was certain to wake up any moment with a hangover—when did I last have a full bottle of gin? Unlikely since I drink only modest amounts of wine. Or was I dreaming? If so, why not play along? I nodded. Geraldine smiled, Gregor lowered and raised his antennae quickly, a curt “Thank you,” and waddled toward my Apple computer. He leaned his cantaloupe-sized head towards the keyboard, waving his antennae, swiveled left, sideways forty-five degrees, so that his right antenna approximated the keys. And then began to lightly touch the letters. Click, click. I was amazed at his finesse. He was typing caps. Geraldine explained that caps were easier for him to see. The words, without spelling errors, appeared: “I can understand, I can hear. I cannot speak. Doctor, is my condition known to you, is it reversible? What can be done to restore my body? Will plastic surgery help? Will medical insurance cover my cosmetic disability? Inside I am the same as I was. My appearance prevents everything. Work, friends, even family except for my sister. I can’t go out, anywhere. I am ashamed—my father threw a chair at me, lucky it missed. My mother screamed and fainted. If nothing can be done, please kill me. No law against killing a bug.” I thought the term cosmetic disability understated.
By now I wanted to wake up in the worst way. I was beyond dreams, past experience, wondered if Fred, Fred, a patient, female, had left some hallucinogen in the walnut bread she had exchanged for advice about her chronic sinus infection. Well, hell, I decided to play along until the stuff wore off. I leaned over to the same level as Gregor’s head, a mistake as his left antenna knocked off my reading glasses. Click, click. He typed “Sorry.” As any good doctor would, I took a history: “Did anything unusual happen to you the day before you changed? Did your diet alter or did you take any drugs?” Click. He typed “no.” “Well how did you sleep the night prior to your illness?” (What a euphemism) “Did you dream?” Click, click: I usually sleep very well—forgive my little joke—like a bug in a rug, but last night I was awakened at three AM—I looked at the bedside clock—by a shearing noise as if an electric hedge trimmer was in the room. And I had my usual dream, a scary saga in which I turn into a computer, an Apple desktop, and then I am discarded, replaced by a smart phone. Nothing more until I woke up with this body, this skin, unable to talk. What is going on? I am so scared.” “Gregor what is your inner life like now?” Click, click, he typed, “The same as before, but anxious, frightened.”
I could not believe what I was doing, having a conversation with a giant beetle or I don’t know what—who could use my Apple laptop. My intuition when faced with an unknown problem is to get more information. “I don’t know how or why you changed. I’ll need to do some research. In the meantime let us sit down. Can I get you anything, Geraldine, Gregor? Tea?” Geraldine shook her head, while Gregor typed, click, click. “Old lettuce if you happen to have any.” Some brown romaine was in the refrigerator, which I placed in a ceramic salad bowl, on the floor in front of Gregor. Years later when I reviewed what happened, the memory of that huge head eating out of my favorite bowl, the lavender one with yellow tulips on the sides, just made me queasy. I loved that bowl—it was never the same. Geraldine cried, asking what could I do: “Nothing is left of my brother but his brain and the tattoo.” Then I noticed on its shining carapace, midback, a faint red outline of an apple, split in half with a blue ax just above. “Our parents are distressed, could only yell, ‘Take it away.’ I can’t remove my brother to the zoo or place him in a circus. I still love what is left—we were so close. He acts so human, so much like Gregor, it’s just his looks.”
I admit to being an old man, 70, lonely, as old men are, the only doctor in the area, no family, no close friends, but not that lonely—yet in a moment of what must have been my drugged state or curiosity or a result of the pleading look from Geraldine—I noticed she was beautiful—I said, “leave him here until we can figure out what to do. I have a shed out back that he can stay in. Not to come out. If anyone knew he was in my back yard, I would have to leave town. Who knows what people would think? I could be accused of witchcraft or worse.” I thought of HG Wells’s book, The Island of Dr. Moreau, in which animals become part human. I said all this, certain, by the morning, whatever Fred put in her bread would be worn off.
Geraldine left, Gregor following her to the door until she turned, “Gregor, you must stay. I will see you soon.” I asked Gregor to follow me out the back door to the small shed. He hesitated then entered. I locked the door. As soon as I got back to the house, I took two 5 mg Valiums and went to bed. My last thought before the pills hit me was to remember to ask Fred what she put in my bread. Still black out when I woke up at seven, half headache, half back pain. I was reassured. Pain is real. I vaguely recalled a nightmare about a large insect at the keyboard of my computer. I made the trip to the kitchen to find a message on the answering machine from someone named Geraldine. Oops, I thought. The voice asked how was Gregor, did he get through the night, what are your plans? Now I was worried. A dream, not a dream?
I dressed in old sweats and went out back to the shed. It was locked. I never lock the shed, nothing worth locking for. Could this all be real? I went back to the kitchen, got the key, opened the door to find this very large animal who waived his antennae at me as if to say good morning. “Gregor?” The antennae bobbed up and down. He followed me to the kitchen, watched while I put the filter in the coffee flask, added some ground espresso-strong stuff, and poured hot water on top. Gregor put his paws or front legs on top of the counter, raising the left up and down, to some sort of rhythm. I got the message. I put the residual romaine in a saucer with some water. I sat in the kitchen with Gregor, surreally sharing our fantasy morning. A Dali painting. Thinking, thinking what to do.
Get more facts, ideas, of course. Carrying my coffee, I moved to the living room followed closely by Gregor. I booted up the Apple and Googled “metamorphosis.” Mostly definitions, then Ovid popped up. A master at describing change, but no human solutions. Every alteration seemed to be the result of a divine act. Short of invoking God, whom I hadn’t communicated with for 50 years, I was stuck. Then I remembered the elephant man, John Merrick, who was disfigured, by what was once thought to be neurofibromatosis, but now is called Proteus syndrome. His savior was a surgeon, Sir Frederick Treves, who took him in as a permanent resident in his hospital.
Well, I had no institution to house Gregor. I then tried “monsters,” “fictional characters.” Shelley’s Frankenstein came up. Shelly’s imaginary creature and Merrick had in common a good nature, kind, and empathetic. They were both destroyed by the way people treated them. Both shamed by their appearance. Merrick became withdrawn, saved from destitution by the kindly surgeon who kept him in the hospital in a private room away from all other patients. The creature in Shelly’s novel turned angry, vengeful, became a murderer. Would Gregor become vicious? One snap of those jaws. I then remembered the stories of men changing into wolves, lycanthropy. But transformation, man to animal, was beyond science, past my belief. But, But. Yet I was now fully awake, felt fine—any drug must be out of my system. And there was this thing looking up at me, seemingly sad-antennae drooping. I had better discuss the bitter alternatives with him and Geraldine. I called her to arrange a meeting for that afternoon, meanwhile asking Gregor to wait in the shed for fear some patient might see him. Then I would have two abnormals to deal with.
Geraldine arrived at one without her cloak, wearing a dark blue jacket and a matching cap. Her pants were black, shoes-boots. I noticed that she wore no make-up, not attempting to hide the large bags under her eyes. She was agitated, asking immediately, “What shall we do, what shall happen to my dear brother—he is human under that shell.” I felt helpless. I had been in similar situations with families begging me to do something for their elderly grandparents who were totally demented, did not recognize them, had no bowel and bladder control. I had also seen patients with terminal cancers, in terrible pain. Families asked, often not directly, if I could hasten their death. Well, that approach seemed immoral, impossible with a creature who could use a computer rationally, whose beautiful sister was sitting next to me. The problem, after all was simple. Gregor had a cosmetic disability—he did not look like everyone else. If his disability had been physical, in a wheel chair or on crutches, or even had he a mental problem, say autism, he would be more likely to be accepted into society, cared for by family, able to work. But what could I do for someone who was totally human, intelligent, could express his emotions but looked so different?
What could be done? I had no explanation nor any solution for Gregor’s atavism. I explored the alternatives with Geraldine while Gregor simply stared, listened. I said we could keep him in hiding, hoping he could, by some miracle, return to normal or we could ask the zoo or a circus to care for him.”
That statement was a mistake. Gregor rose up, ground his jaws together, shook his antennae wildly, then went to the computer. Click, click. He typed, “No never zoo or a circus, I would rather die. I am human.” “I am sorry, I agree, you are of human parents, you are intelligent, have feelings, you understand your situation. Gregor what do you suggest?” He typed, “What about magic, perhaps an exorcism? I thought, not in any textbook of medicine, but why not, what could be weirder than man into bug? Perhaps an equally bizarre solution. There was Tomay, an elderly priest who saw me for gastritis last year. He lived in the next town at a small retirement home for elderly clergy. We became friendly, often meeting at the one restaurant in town for dinner and a chess game, which he always won. I accused him of using divine powers to outwit me. “Gregor, Geraldine, I will call Father Tomay; he would know if exorcism is possible. What’s to lose?”
Two intermediaries, the caretaker and the cook, later, I got Dan Tomay on the phone, who said on hearing my voice, “Ready for another beating?” I answered, “Father this is serious, urgent. I need you to come to my place as soon as possible. I can’t explain over the phone, but it involves a human in a great crisis, which I cannot solve, but you may be able to help.” “I am intrigued, atheistic medical science asking for the Lord’s aid—how about tomorrow around midday?”
The following day Tomay arrived driving his open jeep. I went to the door, surprised again how fit and well he looked for an eighty-year-old. He was dressed as always in fatigued blue jeans, a red and pink checked lumberman’s shirt, and his New York Yankee’s baseball cap. Dan was short, solid, long silver hair that had not seen a comb. He did not look prepared for a crisis. I reviewed what happened while Tomay listened without interruption. When I finished, he said, I assume you are not drunk, or getting me disoriented before a chess match. I always thought you would do anything to win. What do you have in mind?” “Father, I was thinking of an exorcism.” “Well God always has a purpose. Bring Gregor in so I can figure out what it is. Always need cause, origin, before any exorcism.”
I returned to the house with Gregor creeping behind me. He barely moved, seemed smaller. I thought we had better do something, his health had deteriorated, he had eaten little, drank less. He struggled to move. I had to admire Tomay’s calm. When Gregor entered, Tomay just nodded to me and then to him. He approached Gregor, asked how he was feeling within, inside that shell. Gregor went to the Apple, click click, typed, “I am lost. I am a believer, a good Catholic; what could I have done to deserve this grotesque punishment, my body taken away, but my mind intact to think every moment about what has happened to me? Why this ugly physique, why not a butterfly? Father, believe me, I am innocent.” “Son, I do believe you, but God sometimes has strange purposes.” Sam, Geraldine leave us for a few minutes—I want to hear Gregor’s confession.
Gregor turned to the computer and typed, “I have not sinned—except perhaps referring once, just once, in anger to my Apple computer as more powerful than God, when it refused to follow my commands. Please forgive me.” “My son you are forgiven, surely you did not deserve this transformation. Satan is perverse; he has turned you into an insect, perhaps a warning to others of his powers. I will attempt to remove him and bring back your human body.”
Dan asked us to reenter the room and then turned to me and said, “We are not all psychotic, or hysteric—we, including Gregor are rational. I have performed several exorcisms for strange thoughts, irrational talk, extraordinary behavior, but I have never seen anything, anyone like Gregor. I will return early evening just after the sun sets. Please prepare six large candles to surround your exam table. That is where I will attempt the exorcism.”
Early evening, as the sky switched colors from blue to black, Dan returned dressed in a white vestment with a purple stole around his neck. The lights in the exam room were extinguished, the candles lit as Gregor lay, back on the exam table, six legs faintly twitching. He looked uncomfortable. Dan started the ceremony by explaining to Gregor that he was only a simple priest with no special powers except through God. I have fasted and prayed all day asking for God’s help to rid you of Satan. As we watched, Dan placed his right hand on Gregor’s head between the two antennae, which became motionless, bending to the sides in supplication, allowing more room for Dan’s hand. Dan then leaned over, his head almost touching Gregor’s chest and made the sign of the cross over his heart. How did he know the location of an insect’s heart? The first of many questions without answers. Immediately after, he removed the stole and gently wrapped it around Gregor’s head, avoiding the antennae and finally winding it around the neck, whispering, “Do not fear Satan, he soon will be gone.” Kneeling in front of the exam table, Dan asked God, Jesus, and the Archangels, Michael, Gabriel, Raphael, Uriel, Selaphiel, Jegudiel, and Barachiel to rid their brother of evil, dispatch Satan. When Dan attempted to stand, looking his eighty years, unsteady, anemic, his whole body shaking, I helped him to his feet as he turned to Gregor, who lay without movement, no sign of life.
“Gregor, good son, now wait, rest, pray. We shall know if God has listened. Morning he will rise and you with him. We will leave you with God’s will and return at sunrise.”
Dan spent the night in the spare room and Geraldine, refusing to leave, reclined on the couch. None of us slept. At seven we met to enter the exam room. Gregor was not where we left him. In the alcove where I typed my notes, Gregor lay under the Apple. He was much smaller, antennae silent, tucked along his body, his legs folded in, the body compacted, prepared, as if for recycling. Dan seeing the residual, empty, said “The end of suffering. Who of us has been more human than Gregor? Not I. The way we look does not make us a man or a woman, the image of God. After all youth, beauty, wealth, power disappear. Helen disappears. We all show our skeletons, our travel lines, as we age. Gregor was always human.”
LARRY ZAROFF, MD, PhD has had five careers following his residency and two years in the U.S. Army Surgical Research Unit. He focused for 29 years on cardiac surgery, including a stint as director of the cardiac surgical research laboratory at Harvard. There his work centered on the development of the demand pacemaker. He spent the next 10 years concentrating on climbing and did a first ascent of Chulu West, a 22,000-foot peak on the Nepal-Tibet border. His third life has been at Stanford, where he received a PhD in 2000, and where he teaches courses in medical humanities. His fourth career has been as a writer for the New York Times science section. Until recently, he worked one day a week as a volunteer family doctor. He has received awards as the outstanding faculty advisor for the Human Biology program and in 2006 was honored as Stanford’s Teacher of the Year. He also serves on the editorial board of Hektoen International.