A Story – My Life as a Gout Man

 Not so long ago, when I was in my mid-thirties and employed in Manhattan, I had an after-work ritual. Two or three nights a week, before boarding a train at Grand Central to my house in the exurbs, I'd stop at Jimmy's Corner, a boxing bar, for a martini and a beer. The bartender, Mike, had studied with the novelist John Gardner and had good stories on tap. Next, I'd sneak into Grand Central Oyster Bar for a dozen briny Cotuits or Malapeques. When I got home, my wife was invariably working on recipes for her first cookbook, which was about steak. I was eating large.

Gin, beer, oysters, steak: These are a few of my favorite things, the four horsemen of the four essential food groups—spicy, crispy, salty, and fatty. But together they're a toxic culinary brew for someone genetically predisposed as I am—though, poignantly, I did not know it at the time—to the physical and moral blight known as gout. What's gout? Medically, it's easy to describe: It's a form of inflammatory arthritis. When your blood has elevated uric-acid levels, caused by diet or genetics, that acid will form crystals that make a beeline for your joints, usually your big toe, as if they were ninja throwing stars. Once lodged in the most unpleasant manner possible, they settle in for a long and demented siege.

What's not easy to describe is the pain gout inflicts. I remember my first attack as if it were just fifteen minutes ago rather than fifteen years. It was 3:00 a.m. (Gout usually slips in like a thief in the night.) I'd gone to sleep after a version of the dining ritual detailed above. I awoke, to paraphrase the first sentence of Thomas Pynchon's Gravity's Rainbow, to a screaming coming across my sky. The big toe on my right foot was cherry-red and as swollen as a clown's nose. It felt as if someone had taken a flat nail and driven it, like a Vulcan, through the toe's midpoint. If a small puff of wind blew over this toe or a sheet so much as grazed it, it was as if a gang of droogs had commandeered Hannibal's elephants and had them each step on that nail, one at a time. I woke small children and large pets with my howls. I whimpered like a baby.

Many men—gout afflicts mostly men, though women are not immune to its ravages—have tried to describe the pain of gout. Nathaniel Hawthorne likened it to being thumbscrewed, except on yonder toe. The writer William Golding (Lord of the Flies) said it felt like something “out of Charles Addams,” the New Yorker cartoonist who satirized sinister things. My favorite writing on gout's exquisite torments is from the novelist and gourmand Jim Harrison, who equated it to being shot in the toe by someone using a silencer. It's the kind of agony, he wrote, “where you limp toward the bathroom calling out for pets that died in your youth.”

The funny thing about gout is it's not that uncommon. And skinny people can get it, too. More than 8 million people in the United States suffer from gout. There's some solace to be had in the fact that so many geniuses have felt its pinch, from Galileo and da Vinci to Karl Marx, Thomas Jefferson, Mark Twain, Joseph Conrad, and Henry James. Benjamin Franklin wrote a dialogue with his gout, during which all he could sometimes utter was “Eh! Oh! Eh!” When New York Times op-ed columnist Frank Bruni was the paper's restaurant critic, he described his battle with the disease. This might be the place to add that some scientists believe the Tyrannosaurus-rex specimen known as Sue had gout. I feel for you, Sue.

It takes a certain amount of courage to out oneself as a member of what my friend the novelist Geoff Nicholson has called “the gout community.” Gout is, by reputation, something that afflicts fatties and rich men, Tories and Republicans, country-club buffoons in double-wide khakis. (Dick Cheney: gout man.) It has been called “the disease of kings and the king of diseases.” It's a throwback, seemingly belonging to the Middle Ages, if not Tolkien's Middle-earth. In his Devil's Dictionary, Ambrose Bierce defined gout as “a physician's name for the rheumatism of a rich patient.” These are some of the perspectives on gout, at any rate. People rarely feel sorry for you when you have it; instead, they stifle chuckles. Surely you've brought this on yourself.

Reader, I did bring it on myself. In part, I have my father to thank for this joker in the pack of my genetic burden; he's a sufferer, too. But I'm a big eater and have never been possessed of either an El Greco thinness or a strong impulse to exercise. The list of foods that gout experts advise you to avoid, because they're high in the purines that can raise uric-acid levels, sounds like my idea of a perfect week of dinners: anchovies, trout, bacon, veal, asparagus, kidneys, lentils, haddock, goose, scallops, brains, pheasant, crab, duck, eel, tongue, oysters, tripe, and alcohol of most forms. Deep down, I'm more of an on-the-edge eater (offal, crustaceans, bivalves) than a steak man, and gout, as did Mao, punishes the curious. When my attacks occurred, about every nine months or so and always at the worst possible moment, I knew I was guilty of a foodie version of what the writer Eve Babitz has termed “squalid overboogie.”

These days, my gout is more or less gone. I've been attack-free for three years. For this, I can thank a wonder pill, allopurinol, which I take daily. I put off going on allopurinol for a long time. For one thing, you should always think hard about going on any daily medication. For another, I feared that the glories of allopurinol would prevent me from making lifestyle changes I surely needed to make anyway. But when I take it, at least I am no longer stumbling into grimy walk-in medical clinics at midnight, begging doctors with tattooed knuckles for cortisone shots.

Gout had one last horror in store for me. When I first began to take allopurinol, I neglected to note the warning that the drug can bring darkness before dawn, meaning it often makes gout worse before things get better. A few days after starting the pills, I had a nuclear-level attack. I wept. I rent my sheets and garments. I Googled self-amputation techniques. I cursed fate and oysters. My wife took to sleeping in the attic. I'd recently had a conversation with my teenage daughter, Harriet, who'd been reading Bossypants, Tina Fey's memoir. In one anecdote, Fey talks about a male boss of hers who frequently peed in jars because he was too lazy to walk to the bathroom. He kept the jars around his office. “Is this something men do?” Harriet asked me. I shook my head. “I've never peed in a jar,” I said. “I don't know of any men, with the exception of truck drivers, who pee in jars.” During my final gout attack, the worst of my life, I peed in jars. Snapple bottles—Diet Cranberry, my favorite—to be exact. Over the four days that I couldn't hobble from bed, these bottles gathered in a humiliating little cluster next to my nightstand, like votive candles of the especially damned. To this day, my children, those awesome but cruel little fuckers, love to razz me about them.

“There are times when only a sick man knows how warm and bright the rest of the world is,” Aravind Adiga writes in his excellent new novel, Selection Day. For this lesson, gout, my nemesis, I thank you.

This article originally appeared in the April '17 issue.


On – 22 Mar, 2017 By Dwight Garner