Nabokov's Cardiology, by Dr. J. D. Quin, The Nabokovian 26 (Spring 1991)
On retrospective study of Nabokov's novels a high prevalence of cardiac pathology has been noted. A representative series of four patients are described with clinical information derived from the texts. Current management of the medical conditions detailed is discussed along with an explanation for the high frequency of their occurrence.
Case One
S.K., a young writer prone to suffering from headaches, neuralgia, insomnia and toothache, gave a history of "pain in my chest and arm" (89). This is typical of angina pectoris. Angina arises when the blood supply to the heart muscle is compromised, most often by the process of atherosclerosis or "hardening of the coronary arteries." Unchecked this can lead on to a myocardial infarction (M.I.) or "heart attack." Angina would be an unusual diagnosis in such a young man, as it usually occurs in middle age. A family history of elevated blood lipid concentrations (e.g. cholesterol) might be expected. Such individuals are at higher risk of an inherited lipid disorder which would predispose them at a young age to the development of coronary artery disease due to atherosclerosis. S.K.'s mother, Virginia K, had a cardiac history and died from heart failure described by his brother as "Lehmann's disease," a rare form of angina (89). In fact this Condition does not exist and is a "Lehm" joke [for the layman—CN]. It may be no more of a joke, however, than the clinically accepted label for a poorly understood variant of angina known as "Syndrome X" where the coronary arteries appear normal. S.K. was then reviewed in Berlin by a physician who "discussed coronary arteries and blood supply and sinuses of Salva (sic]," the latter probably a reference to the sinus of Valsalva which is part of the venous draining of the heart. At the early age of 30 he appears to have suffered a "heart attack" (115), although whether this was a myocardial infarction remains in doubt. Further consultations with a Dr. Oates (106) and a Dr. Starov (185) occurred. His brother once stated, "I would get all the heart specialists in the world to have him saved” (202). His fate remains unclear.
Case Two
A fifty-year-old male of mid-European origin, H.H. initially presented in his early twenties complaining of "dizziness and tachycardia" (27). His other past medical history included long-standing dyspepsia (sometimes relieved by milk and radishes), haemorrhoids and prostatism in later life. A period of psychiatric in-patient stay was also noted. During his subsequent stay in America he described an episode where he developed "a quite monstrous pain in my chest" which was promptly associated with vomiting. This episode was almost certainly his first M.I. He then states that he managed to drive the next day, a
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fact that in later years "no doctor believed" (240). And no wonder: today the management of an M.I. implies a 48-hour stay in a coronary care unit, treatment with "clot-busting" thrombolytic agents, and constant monitoring of the cardiac rhythm. He later gave a history of an incident post-M.I. where his "pulse was 40 one minute and 100 the next" (271). Today this story would lead the clinician to perform 24-hour ambulatory cardiac monitoring, as it is highly suggestive of the "sick sinus syndrome." This is a condition where the sino-atrial node (the heart's natural pacemaker) is faulty, often as a result of earlier damage due to ischaemic heart disease. Normal cardiac rhythm is easily restored by the insertion of a pacemaker. Sadly this was not to be for H.H. who died of a probable further coronary thrombosis on 16 November 1952 (5).
Case Three
An elderly Russian professor, T.P., teaching at an American campus, developed sweating and palpitations on leaving a bus (20-21). Electrocardiograms had already "outlined fabulous mountain ranges" (20). Perhaps of significance was his treatment as a child by a Dr. Belochkin (22); rheumatic fever would have to be considered as a diagnosis here as it is well known to cause long-term cardiac valvular sequelae and indeed is common in young children. T.P. later developed "a certain extremely unpleasant and frightening cardiac sensation" which was "not a pain or palpitation but rather an awful feeling of sinking and melting into one's physical surroundings" (131). Once again a 24-hour cardiac monitor would be helpful here to exclude transient dysrhythmias. Radiological examination was thought to show "a shadow behind the heart" (126). Today this would be more fully evaluated by
computerised tomography (CT) scanning and if a pulmonary cause was suspected then one would go on to perform bronchoscopy.
Case Four
The poet J.S. suffered from syncopal episodes from an early age (38). He suffered from asthma as a child and had a family history of cardiac disease, his father dying from a "bad heart" (35). The sudden nature of these episodes does not favor an epileptiform collapse but is more suggestive of a Stokes-Adams attack. During these, cardiac rhythm is disturbed and may cease transiently. Recovery is swift. Again 24-hour monitoring is useful in diagnosis and once again a permanent pacemaker is often curative. In 1958 he survived a myocardial infarction. However, sadly, shortly after this event he was murdered.
Discussion
These four cases represent only a fraction of the cardiac pathology detailed in V.N.'s novels and short stories. His clinical descriptions are accurate and beg the question, why were his characters thus afflicted? V.N. himself suffered from recurrent chest pains, which he described as "neuralgia" (Selected Letters 99). He too was once told that he had "a shadow behind the heart” (Field, Nabokov: His Life in Part 251). As a student at Cambridge he suffered from palpitations and changed from smoking Turkish cigarettes to a pipe (Boyd, Vladimir Nabokov: The Russian Years 181). In 1948 he had a bronchoscopy which involved swallowing "a vulcanised rubber tube," an experience which he described as "controlled panic" (Field 253-54). He wrote, "I have often noticed that after I had bestowed in the characters of my novels some treasured item of my past, it would pine away in the artificial world where I had so abruptly placed it" (Speak, Memory 95). Perhaps it was the case that the less treasured torments of his recurrent neuralgia and chest pains were bestowed on his characters detailed above in the hope that these too might pine away from his own existence.
—Dr. J.D. Quin, Stirling Royal Infirmary, Livilands, England