You Gotta Have Heart

Cigarettes

A pack of Vantage containing two cigarettes was in my coat pocket when I arrived at the hospital. It was a bitter morning in late December. The angiogram was scheduled for eleven o’clock—at least I had been told to be there at eleven o’clock—but it didn’t take place until three in the afternoon. I made a scene over this at hourly intervals, first arguing with the receptionist in the waiting room, then insisting on being admitted past the swinging double doors behind which others before me had disappeared, to confront whoever was in charge back there. I wasn’t about to be a meek cipher in the hands of the authorities, the medical bureaucracy. I would begin this journey in the right spirit.

But no matter how vehemently I railed against the injustice and lack of consideration, the angiogram didn’t take place until three o’clock.

I was in the hospital for the replacement of an aortic valve, what the surgeon afterward—while I was still unconscious—told my family was a “very nasty” valve. He had advised that I stay at the hospital after the angiogram, since the surgery would begin around six the next morning: why go home merely to get up in the middle of the night and return? This seemed sensible and I agreed. My plan was that once the angiogram was over—I understood you had to lie still for an hour or so afterward—assuming I survived, I would go out with my husband for a cup of coffee and smoke what would be my last cigarettes for quite a while. Maybe forever. Again, assuming I survived. Whenever doctors or nurses lean over my body preparing to insert something in a place not designed to be penetrated, I feel endangered. During the angiogram they would be making a hole in my groin and threading a tube straight up to my heart; it sounded like an unwieldy as well as unnatural procedure, but many before me had lived to tell the tale, and most likely I would too.

While it was in progress, though, I had my doubts. I wasn’t completely unconscious; I had enough awareness to hear the older doctor telling the younger one—a very young doctor, his bare face sticking out of the plastic shower cap was cherubic—what to do, how to guide the tube inside me, and so on. I said, “Why so much instruction? Are you actually teaching him how to do this on me?” The older doctor laughed, ha ha. “No, of course he knows how to do it.”

I didn’t want to distract them from the lesson, and so I desisted. Also, I really wasn’t up for a dialogue; I was too entranced by the drug. I’m not sure what they gave me—if I were I’d try to get a prescription—but it was something that leaves you half awake and aware, and yet everything happening to your body, as well as the people working on it, seems at a great remove. So close and yet so far. Something unnatural is happening to you, but it’s painless, and anyway “you” are not the same singular entity as before: there’s the body that belongs to you (who else?) and then there’s your dimmed consciousness, looking on from afar. A great drug, but it wears off quickly.

Instead of carrying out my plan of a cup of coffee and cigarette afterward, I found myself being led into an elevator by an orderly, brought to an upper floor, and assigned a room, a rather nice private room: a luxury floor. The room had the usual hospital paraphernalia and TV protruding from the wall like a hunter’s stuffed moose head, but it also had the mildly pleasant, expectant, scentless air of a hotel room, and that was how I intended to treat it. I began getting out of the grotesque hospital gown—white with little blue circles, not dots but donut-like circles, little O‘s. Later I discovered that this garment, whose only accommodations to the shape of the human body were enormous sleeves and a string to be tied at the neck, also came in sky blue with no circles.

I can’t help wondering if there is a reason—economy, perhaps, or mere thoughtlessness?—why these hospital gowns have to be quite so humiliatingly ugly. I know they have to be open so that the body within is fully accessible to the professionals who will handle it, but must it be ugly besides? Adding insult to injury, so to speak? Would it cost so much more to use the services of a designer, maybe not someone first-rate like Donna Karan or Ralph Lauren, that would be an extravagance, but some young person just starting out who’d be grateful for the work? It would be only a one-time thing.

I was reaching for my street clothes when a nurse came into the room. “What are you doing?” she asked, gazing at me and my husband, who sat in one of the pink plastic chairs.

“Getting dressed,” I said.

“You’re supposed to leave the gown on,” she said.

“My surgery isn’t until tomorrow morning and it’s not even six yet. We’re going out to get a cup of coffee.” Despite my pose of bravado, I knew enough not to mention the cigarettes.

She was no Sue Barton but a stern-looking nurse of the old school: stocky, short hair in a mannish cut, sharp voice, no-nonsense. “You’re not going anywhere. This is your room. You’ll stay here until they call for you.”

“I beg your pardon,” I said, tying my sneakers. “The surgery isn’t until tomorrow, as I said. The angiogram is over. There’s nothing you need me for. I’m going out. I promise I’ll return for dinner.” I added a little chuckle, to lighten the situation. I didn’t want to make this a fight over my civil rights—or rather I did, but without being pompous, as such fights are liable to be.

“You don’t understand,” she said, a bit more gently, as if indeed the rules hadn’t been explained to me properly. “You are a patient.”

~

My mother used to tell me that I had no patience. She also used to say, during my minor childhood illnesses, that I was a terrible patient, I suppose meaning fretful, demanding, and impatient. Maybe because I’ve been labeled as impatient, I’ve always disliked the homophonic connection between the noun “patient,” the sick person, and the adjective “patient,” the character trait. They come from the same Latin root for suffering or enduring, and it’s easy to see why that root branched out in the two directions and parts of speech. But that doesn’t mean that a patient necessarily is or ought to be patient: that is to say, according to the dictionary, “enduring pain, trouble, affliction, hardship, etc., with fortitude, calmness, or quiet submission.” Certainly it makes practical sense to endure one’s ailment with fortitude and calmness (not that practical sense ever played a large part in determining my attitudes). But must a patient also endure with “quiet submission” the thousand-and-one well-documented indignities of hospital life? I would think a patient’s patience is already being sufficiently tried by illness; she shouldn’t be expected to muster still more reserves of patience for those indignities. rather it’s the doctors and nurses who should be patient with the already patient patient.

~

All the same, after my husband went home and I began anticipating the events of the next morning, the fighting spirit deserted me. I was a patient. I put on the hospital gown, ate the hospital dinner, and settled into bed with a fat Henning Mankell mystery. All that was missing was a cigarette, one of the two in my coat pocket, but I didn’t dare. It was a good thing I didn’t, because the nurse entered and seemed pleased to find I had surrendered like a chastised child. She gave me a stack of papers to sign granting the hospital permission to do with me as they would, and I signed without really reading them, just a quick glance. I was in no mood to contemplate whatever I was agreeing to. Then she gave me a thick folder of information about hearts and heart surgery, complete with diagrams and charts. “This literature may be helpful to you,” she said. “It will familiarize you with your surgery, and with what goes on in the heart in general, how it functions and how to take good care of it.”

I accepted the folder politely but had no intention of spending what might be my final hours reading its contents. I was thinking, so this “literature” will tell me what goes on in the heart? As if I didn’t know! I’d spent years of my life reading about the heart. There was little I didn’t know. The Heart Is a Lonely Hunter. The Heart of the Matter. The Heart of Matter. In the Heart of the Country. In the Heart of the Heart of the Country. A Simple Heart. Near to the Wild Heart. The Mortgaged Heart. Heart of Darkness. Change of Heart. Crimes of the Heart. Habits of the Heart. “The heart has its reasons,” Pascal said.

The Surgeon

Weeks before the operation, I meet the surgeon for the first time. He’s a young man, quite good-looking in the common way of well-bred American white males, so common I barely notice them: dark hair, squarish face, neatly shaped features. Charlie Sheen, say, or a less charismatic Tom Cruise. Courteous manners. He explains the “procedure.” I ask him what kind of valve, animal or artificial, he’ll use to replace my faulty one. I thought I’d have some say in the choice once I was apprised of the advantages and disadvantages of each, but as we sit there, I realize he is not the kind of doctor who would welcome my input; he is most definitely the decider, as George Bush used to say, and that’s okay with me because I don’t really have an opinion. He says animal.

“What kind of animal? A pig?”

“No. A horse.”

There is a pause, as I consider horses as opposed to pigs. “This may sound like a silly question,” I say, “but isn’t a horse valve a little large for me?”

He laughs. I made him laugh, quite unintentionally. There was a saying we had back in Brooklyn, that some girls think they’re hot shit because they can make a man laugh in bed, the joke being that this is pretty easy to do, within the range of almost anyone. “We don’t use the entire valve,” he says. “We make a valve from material in the horse’s heart.”

Oh. What about those horses? Is it like organ transplants—someone young and healthy is in an auto accident and their intact, barely used organs are rushed to a patient who needs them? No, I doubt it. Horses don’t get into auto accidents. Are they horses who’ve outlived their usefulness and been put out to pasture, like Black Beauty, whom I wept over in adolescence, to spend the remainder of their lives at ease, as in a nursing home? (Though people in nursing homes tend to decline and die faster than those cared for at home.) And then these horses die of natural causes but have agreed beforehand to allow their organs to be used for humanitarian purposes? I mean, of course, that their owners agreed. Perhaps their owners got paid for the heart parts; yes, surely they got paid.

Now that I’m thinking of it, sitting here facing the young, generically handsome and self-assured doctor, I actually find I prefer a horse to a pig, if I have to have some other species inside me. I don’t feel fastidious or repelled by the prospect of carrying around a part from another species; after all, we’re in this together, all creatures great and small. Nor am I a snob about animals. But I think most people would allow that horses are more attractive than pigs. As I stare at the doctor—a button on his right shirt cuff is loose and dangling, it could fall off at any minute—it occurs to me that perhaps Orthodox Jews with a faulty aortic valve would not permit a pig’s valve to be lodged inside them. If their doctor opted for a pig, they might protest and insist on a horse—no cloven foot. If no horses were available, an artificial valve would have to do. I read somewhere that Orthodox Jews, whose wives and daughters wear wigs covering their natural hair, stopped permitting wigs made of Indian hair. Indian hair is the best hair for wigs, and perhaps the best hair all around, period. There is a thriving business in selling Indian women’s hair. But Orthodox Jews worried that some of the Hinduness might remain in hair taken from Indian women and thus would violate the heads of Jewish wearers. Well, I’m not an Orthodox Jew so I needn’t concern myself with hair just now, or with the doctor’s loose button. Just pigs and horses.

Like a pubescent girl, I love horses. I even rode horses, though not well, in my teen years. My family spent the summers in a bungalow colony in the Catskills whose aggressive dullness I loathed, but its one attractive feature was the nearby hotel where you could rent horses and ride around on the dirt roads. My favorite horse was called Brownie, very gentle, and I learned to trot, to post properly, and even to canter, before I got old enough to stay home alone during the summers. In Brooklyn a few times I rented horses at a stable near Bergen Beach and rode along the ocean. I felt I was in a movie: the surf, the sand, the sky, the horse, and me on it. I rode just two or three more times as an adult, and then the equestrian part of my life was over.

But I do know horses, at least a bit, and I would like to know the provenance of the piece of horse heart about to be implanted in my own: was he or she a farm horse, a police horse, maybe a prize race horse? I enjoy the races. I’ve been to the track lots of times, both Belmont and Saratoga, with my husband and friends: could I possibly harbor a piece of a horse I’ve seen in a race, a horse I might have bet on, and won with?

“Okay,” I say. “A horse.” I try to think of suitable and intelligent questions to ask. “How do you get to the valve? I mean mine, not the horse’s.”

“We reach in,” he says, not exactly tersely, but in a tone that means he doesn’t care to elaborate.

~

We reach in. I’ve remembered those words ever since as a kind of magic formula, an Open Sesame, as it were. So ominous, so graphic, and yet so vague, enigmatic. They reach into me. Me! This man would touch my heart as no man ever had before.

The only other question I had for the surgeon was, Will I die by your knife? and it certainly wasn’t suitable to ask that. What did I expect? Of course he would say I’d be fine. He’d probably say, with a confident chuckle, that he’d done this hundreds of times, thousands. Later on I thought of many specific and important questions, but at the time, confronting him before the surgery, my mind was blank. It seemed I should know him better than one brief appointment’s worth, since he would be opening my chest and handling my heart. And yet he was a virtual stranger. It was like going to bed with someone when all you know about him is his name, if that.

“How long is the recovery period?” I asked, as I stood up to leave.

“Two weeks,” he said.
Mild, Moderate, Severe, Critical

It wasn’t as if I was undertaking this surgery under duress, as it may appear from my recalcitrance. No, strictly speaking, I chose it. I’d known about the faulty valve for several years, but at first the cardiologist, a gentle, rotund, clear-eyed youngish man, said the situation was “mild.” Unless and until it progressed through “moderate” to “severe” to “critical,” at which point it would require surgery, I should forget about it and carry on with my normal life. In that instance I was more than willing to obey the doctor without question. At this rate, “critical” would not arrive for many years, I thought, maybe so many years that I would already be dead and therefore no surgery would be necessary. I carried on. Until one day after a stress test, the cardiologist directed his steady gaze at me and said the state of the valve had passed “severe” and was near “critical.” He strongly recommended surgery. Soon.

“Are you serious?” I said, still panting from the stress test, sitting on the examination table, my legs dangling down. The idea of undergoing heart surgery had no reality for me, even though I’d seen several members of my family go through it. From my husband’s bypass operation six years ago, I knew intimately what open heart surgery entailed.

“Very serious. If you don’t do it you have a fifty-fifty chance of dying in two years.”

Aha. Something clicked in my mind as I quickly moved into rebuttal mode. “But that means I also have a fifty-fifty chance of living. So . . .” I shrugged.

“Okay then,” he said, his kindly face unchanged. I guess he’d heard every kind of response, even flippant. “Make it four years. Then your chances of dying really improve.”

Doctors, I had learned, call invasive surgery an “insult.” (My husband’s doctor referred to his heart surgery as “the second insult.” When I asked what was the first, he said, “Birth.”) Now I could see the aptness of the term. More than repelled and frightened by the prospect of surgery, I also felt insulted—in advance—especially as I recalled the array of side effects my husband, sister, and brother had experienced. But I didn’t want to die in two years, or even four. So I chose to be a patient instead.

The Dead

In the two years just before my surgery, two of my closest friends died. They both lived nearby—Glenda right around the corner for twenty years, and Rebecca about three blocks west for even longer. Glenda died of a brain tumor, or perhaps it was ovarian cancer that spread to her brain. She died in Australia, where she was born, so I didn’t see her in the last few months, only spoke to her on the phone. By the end her voice on the phone sounded like static. Rebecca died of lung cancer. I saw her a lot during that illness, except near the very end when I called to ask if I could come over and she said, “I love you, dear, but I can’t see you.” I always was touched when she called me dear. I don’t find it easy to use endearments, except with children.

I met Rebecca at Yaddo, an artists’ colony, and though I felt slightly intimidated by her—she was very shy, I later learned, and this gave her an air of aloofness—I invited her to take a walk one afternoon. Yaddo is in Saratoga Springs, where the famous horse races take place, and on our walk through a back lane we passed stables and horses meandering around a meadow, a tranquil scene. Little did I know then that thirty-two years later a piece of horse would prolong my life. After that walk we were good friends for the rest of her life.

I met Glenda because I reviewed a book of hers for Ms. Magazine. The book, full of bizarre and darkly whimsical happenings, intrigued me; I thought the person who wrote it must be equally odd and eccentric, so I went to a reading she gave in an Upper East side bookstore to check her out. I was hesitant about introducing myself—I hadn’t published any books at the time, only short pieces in magazines—but she was approachable and grateful for my review. We discovered that we were neighbors and we too became friends for decades.

I introduced Rebecca and Glenda, and we formed a kind of trio, meeting in the late afternoon in the West End Bar near Columbia University to drink and smoke and talk about our work. We had met as writers and continued that way, although as our lives became enmeshed and our children grew up we talked about everything else under the sun. We were very different but we came to understand one another perfectly because we were intuitive about reading character, the signs of character. Glenda, who was not odd or eccentric in any immediately obvious way, spoke with her Australian accent in a soft, gentle voice and had impeccable manners, and in that soft, gentle voice she said outrageous and radical things. Rebecca was older and seemed to carry the wisdom of the ages in her head, which was capped by sleek auburn hair shaped like a bowl, but she bore her burden lightly, with wit; she was from Georgia and had a pronounced southern drawl and a wry skepticism about most things, but a sentimental streak that came out in her love of cats and dogs. There was a spell when I would ride my bike down Riverside Drive first thing in the morning, and I often met Rebecca walking her dog, who she insisted had said a few words and even shed a few tears. Glenda drove a large car and I’d sometimes run into her going to move it in accordance with the parking regulations, as one must do on the Manhattan streets. She said she had learned to spot people who were about to vacate their parking spaces; she could tell who they were by their purposeful gait, and by the way they fiddled with their keys in their pockets, and she followed them.

Sometimes only two of us would get together, and I wondered about the combinations of two out of three: for instance, how the two of them sounded and spoke when I wasn’t present. The ways I spoke with each of them alone were very different; this was inevitable, given how unlike we were. We resembled three interlocking circles—I’m thinking of the old Ballantine Ale logo, the three circles standing for Ballantine’s salient qualities: purity, body, and flavor. None of us represented any of those qualities especially, but the design fit. We shared a considerable common area, yet each of us had a large private space of our own.

Anyway, they died, Glenda in 2007 and Rebecca in 2008, and I was bereft. After Glenda died, so far away, Rebecca and I felt the lack. Even though our friendship was rich on its own, we would never again know that special interlocking threesome. Then Rebecca got sick, and though we never said it aloud, we both knew I would continue with a double loss, missing the particular quality of our friendship, in which we could say anything that occurred to us and neither of us would ever be shocked, and sometimes we need not even say it—a meaningful look could convey volumes. Rebecca was unshockable and through her I learned to be the same.

The nurse woke me at 5:00 a.m. for the heart surgery and I thought: I am the last of the three, and maybe this year, the third year, 2009, will be my turn. As they wheeled me into the operating room, before the anesthetic that put me out, I had a glimpse of them in an afterlife that resembled the old West End Bar where we used to meet in the ancient booths, dark and smoky, nursing our drinks of choice: wine, bourbon, and for me, Diet Pepsi; I was never much of a drinker. They’re chatting away. I don’t know what the two of them sound like alone, without me, but I do manage to hear a few words in Glenda’s gentle, now slightly anxious voice: “Where’s Lynne? She’s never this late.” Then comes Rebecca’s deep, bourbon-soaked drawl. “She’ll turn up soon. She’s very reliable that way.”

Rehearsal

When I first came out of the operating room I was adorned with tubes, like someone who’s just come from the Mardi Gras parade in New Orleans, bedecked with colorful necklaces and bracelets: tubes in several orifices and some where there were no orifices to begin with, such as the chest. Over the next few days the tubes were removed, one by one, some with a pop and some with a slither. My tubes were removed by a young Japanese physician’s assistant named Elliot, a small, doll—like man, delicate and slim as a miniature. I became fond of Elliot: something about his easygoing, competent manner combined with his delicate appearance inspired trust. He listened to my complaints with a benevolent neutrality, and often told me not to worry. Usually it’s irritating to be told not to worry, but when Elliot said it I didn’t mind. He rarely smiled yet appeared serene, and he always explained exactly what he was about to do. With one of the tubes, a catheter, he said he would count, One, two, and then I must take a deep breath while he pulled it out, and that way it wouldn’t hurt. “One, two, breathe! Okay?” I breathed at the proper moment and it didn’t hurt. Elliot praised me as if I were a kindergartner who had just written the letter A for the first time. I was proud of myself. It was a small accomplishment, true, but in my condition, it was pride-worthy. I felt so diminished and changed after the surgery that I couldn’t take anything for granted anymore.

Pulling out the chest tube was more complicated as well as risky. It required some rehearsal. “We can’t let any air get into the pleural cavity where this tube is,” said Elliot, “so we have to practice first. You breathe, hold your breath, and I pull. Don’t release your breath until I have the tube fully out. Do you understand?”

I nodded.

“So we’ll have a little rehearsal first,” he said.

All this attention gave me a heady feeling, as if I had an important part in a play. As an adolescent I had aspired to be an actress, and even studied acting for a while at the Henry Street Playhouse. One of my teachers was William Hickey, who later played, among other roles, a Mafia capo in a popular crime movie, a comedy. My aspirations came to nothing since I had little talent and much reserve. Still, with this in my past and diminished as I felt, the thought of a rehearsal of any kind brought a bit of excitement.

Elliot implied, or I inferred, that if air got into my pleural cavity, something terrible might happen to me. Surely less adept and alert people must have had this tube removed and I’d never heard of any misfortunes resulting. And yet I felt it was a matter of life and death to do it right. “Breathe,” said Elliot. “Hold. I pull.” I held my breath while he pretended to pull. We rehearsed this two or three times.

“Okay, ready for the real thing?”

I was ready. Breathe, hold, pull. Together we did a perfect job. The final tube. I was on my own.

When he left I had one of those marvelous epiphanies, like little mental orgasms, that unfortunately don’t last long. If they did, we might never get back to the world’s work. I was staring out the window at the Hudson river, wide, placid that day, steel gray under a wan sun, and suddenly I was seized by the glory, the miracle of being alive: I’d had that ghastly surgery and survived. It was done, I was blessed. None of the dailiness I’d fretted over before—family problems, work, dealings with banks and institutions, the construction across the street whose dumpsters’ groans and beeps woke us at seven in the morning, plus the dire state of the world—none of this mattered anymore. Compared to the wonder of life itself, those things were small and would sort themselves out. What mattered was that I would continue living. I didn’t stop to think about in what condition I would live, too fine a point just then. Simply, as Strether in Henry James’s novel The Ambassadors cries, “To live, to live!”

This feeling lasted, though not in the full intensity of its first strike, for about two and a half days. By the time I went home to start the labor of recovery, all the daily irritations came back and resumed their usual importance. And a little later on came the fear.

Recreation

Toward the end of my five-day sojourn in the hospital, when I could walk around comfortably, I looked for entertainment other than staring at the Hudson river from the pink plastic armchair in my room or reading my fat Henning Mankell mystery. I practiced going up and down stairs on the miniature wooden staircase near the nurses’ station: it led nowhere, just five steps up and five down, with a small platform on top. I made believe I was a political candidate about to deliver a campaign speech to an adoring crowd. I tried hanging out in the waiting room to feel part of the great outside, to hear conversations among civilians, not patients, conversations not about symptoms and procedures but about worldly things, sports, movies, traffic accidents, natural disasters . . .

A pretty fiftyish woman with lots of makeup and bright red hair elaborately carved into a tower—like pile asked me what I was “in for” and who was my surgeon. When I told her, she grew rhapsodic on the subject of my surgeon, a genius and savior. He had saved the lives of both her mother and her priest in conditions of extreme coronary drama. Furthermore it had been he, she claimed, who operated so successfully a few years ago on former President Bill Clinton, although owing to hospital hierarchy and public relations, the feat had to be attributed to the head of the department.

How to respond to this dubious bit of gossip? “You don’t say,” I said, using an expression from my childhood I believe I never used before.

The man next to her, whom I recognized as the husband of my new roommate—she had arrived attended by her family in the middle of the night—said, “I was in the living room and my wife was in the kitchen. I heard her calling, but to tell the truth, most of the conversation in the house is between my wife and the dog, so at first I assumed she was talking to the dog. What did that dog do now? But she kept calling so I figured I better go see. She was lying on the floor groaning. When we got her here we learned her aorta had ripped all the way down her body to her thigh.” This sounded almost as gruesome as the murders Henning Mankell had concocted in his very long book.

It was, yet again, my surgeon who had saved her life. When she was brought to my room the previous night after the surgery, her appearance was not promising. She was quite overweight in her hospital gown, covered with tubes as I had been, and her skin was almost as gray as her long disheveled hair. She coughed all through the night, deep, wracking, wet phlegmy coughs that seemed to rise from the pit of her stomach and spew upward like a geyser. At one point I rang for a nurse because the coughing alarmed me: she could die while I lay listening and then I would feel guilty for my inaction. The nurse came and murmured, “That’s what happens when you have surgery after a lifetime of smoking.”

That might have been me, I thought, given my lifetime of smoking, and I felt a moment of rare gratitude that it was not. Even though smoking wasn’t the cause of my nasty valve, by rights I suppose I should have been coughing too. The woman’s coughing reinforced the dogma that smoking has terrible effects. But it also suggested that in some cases it might not. I thought of the two cigarettes still in my coat pocket, in the closet of our hospital room. If my roommate weren’t so sick we could share them, have our last cigarette together, maybe in the bathroom with the door locked, like ten-year-olds.

The red-haired woman said, “I practically fell to my knees when I saw him after my mother came out of the recovery room. I didn’t know how to thank him.”

I hadn’t seen the surgeon since my operation (he’d seen me but I was unconscious at the time) and hadn’t given a thought to thanking him, which in retrospect feels ungrateful and ungracious. But at that point I was still thinking of him more as my assailant than my savior.

“So how did you thank him?” I asked.

“I’ll give you a tip,” she said, winking. “He likes Cabernet Sauvignon. By the case.”

After a while I left the waiting room and took an exploratory walk down the corridors. I’d been encouraged to walk and for once was glad to follow orders. I like walking, even down a hospital corridor where you peek into rooms and see people in various states of disrepair and wearing charmless cotton gowns.

After my walk I returned to my pink chair at the picture window overlooking the Hudson and resumed the Henning Mankell mystery in which so many vile murders were described. I’m not an avid reader of mysteries; the only time I read them passionately was when I was around ten or twelve and gorged myself on Agatha Christie, Erle Stanley Gardner, and Ellery Queen’s Mystery Magazine. That quickly passed. But over the last few years I began listening to books on tape while I puttered and exercised in the morning, and found mysteries ideal for this purpose. Their merits aren’t exclusively or primarily literary (although there are exceptions like P. D. James or Walter Mosley) so I needn’t be afraid of missing some splendid phrase. The plots kept me going through the tedium of the exercises.

I discovered Henning Mankell on the shelves of a friend’s guest room where I stayed every Tuesday night one spring, when I taught a course at Bryn Mawr. This friend, with whom I’d gone to graduate school years earlier, had very exacting taste. She was so learned that for a long period she was head of the English Department at Bryn Mawr, so I assumed anything I found on her shelves would be high-class stuff. I started a Henning Mankell mystery one night and got so absorbed that I asked if I could borrow it for the train ride home and return it the following week.

Henning Mankell is from Sweden, and his detective, Kurt Wallander, lives in a small, dismal Swedish town. He is depressed, like his town. He has lots of personal problems—his divorce; his relationships with his grown daughter and his aging father, an idiosyncratic painter; his insomnia; and so on—in addition to the distressing murder cases assigned to him. He is often tired, cold, rain-soaked, and at odds with his fatuous supervisor. Wallander is an instinctive detective, thorough and painstaking rather than brilliant, and he quickly grew on me.

Mankell writes in short factual sentences that one by one are not striking, but when strung together become passages of vivid and forceful prose. Prose that’s hard to stop reading. I kept the light on over my hospital bed each night, following the crimes and Wallander’s team of detectives, the hunted and the hunters. The story was more grotesque than usual in Mankell’s books, which are generally pretty grotesque. It involved a nurse seeking out and killing, in ingenious and sadistic ways, men who had abused and murdered women. Once she found them, she tied them up, placed them in sacks, starved them, and subjected them to other lengthy indignities I’ve managed to suppress. Reading about this treatment in the hospital after having my chest opened up, with people all around me whose chests had been opened up for one reason or another, felt satisfying. The world was full of atrocities, and the motives, benign or malignant, didn’t seem to matter much. What mattered to me was simply the fact of the intrusions—that one person had performed them on a fellow human.

My attitude regarding the surgery was not the conventional, expected, or sensible one, that’s for sure. It was more childish than adult. I knew that, and yet I clung to my resistance. It felt satisfying, far more so than quiet submission. Weeks after my release, when I met acquaintances or neighbors on the street and told them why they hadn’t seen me around, some people responded by saying, Isn’t it wonderful, the miracles they can perform these days! Aren’t you lucky!, and the like. I wanted to punch them. In some obscure nook of my brain I recognized the truth in their words, but I wouldn’t acknowledge that nook. There are times I still don’t. It wasn’t so much their actual words that disturbed me, but the gross ignorance behind them, ignorance of anything other than pure survival. Ignorance of what the newspapers call collateral damage. When listening to news reports of our current wars, I always find the collateral damage aspect the most intriguing. I wish reporters would examine that damage further—who are these unintended victims whose lives end for no reason other than someone’s faulty aim, or being in the wrong place at the wrong time? Why shouldn’t their photos, with small intimate bios, appear on the back pages of The New York Times, as did those of the victims of the September 11 attacks?

Collateral damage as a result of surgery is quite different, of course. The patient is far from dead. Rather, the patient’s entire body is analogous to the nation under siege, and regrettably, individual parts of the body unrelated to the main arena of attack are made to suffer.

The Hippocratic oath enjoins doctors to do no harm. But my surgery did harm: not only the sawing and hammering open of my chest and all that went with it, but the onslaught of fear—called “depression” by the professionals—that took me by surprise a couple of months later, and that allegedly strikes thirty to forty percent of heart surgery patients. So technically the doctors violated the oath. But of course they must, in order to do their work. Every painful treatment could be considered a violation of the oath. On the other hand, if my faulty valve caused my death within a couple of years (as the sweet-faced cardiologist predicted), and if doctors had a remedy that could have averted that and yet they withheld it, that too would be doing harm. Arguably even more harm. You can’t win: harm is done either way. Again, it’s a matter of motives and results, means and ends, a slippery subject. Maybe the problem is with the oath itself. Nevertheless, no one would consider rescinding it, because who knows what doctors might do, left to their own devices.

“You Will Swallow the Tube”

Less than two weeks after the surgery, I find myself being prepared, in an extremely small room crowded with medical equipment, for a TEE, a Transesophageal Echocardiogram: a tube with a tiny camera at the end goes down the esophagus and behind the heart in order to see if there has been any stroke activity back there, any pieces—”grunge matter,” one doctor called them—broken off during surgery that have traveled to the brain. The TEE, one of several tests for stroke, is happening because a few days earlier, barely back home after my bonding with the anonymous horse, I looked down at the strips of tape bisecting my chest—some strips halfway off, some hanging longer than others, an ungainly tangle of tape—and asked why they were there. I never keep myself in such a messy state. My husband immediately suspected, especially after a few more weird remarks, that something had gone wrong in my brain. Next stop, the emergency room of our local hospital, not the hospital where my “nasty valve” had been replaced.

I had either had a stroke or a TIA, a transient ischemic attack, or mini-stroke. A TIA is better because it lasts only a short while and leaves no permanent neurological deficits. In my case, by the time we got to the ER I had recovered and might have been better off going home.

The days that followed were filled with tests or waiting for tests: they never took place exactly when scheduled. Some of the tests were very simple, such as the neurologist asking me to touch my nose then touch his finger, or to walk a straight line down the hospital corridor. Some were elaborate and involved sophisticated machinery, such as the TEE or the previous day’s MRI. I tried to do well, as I had always tried on tests in school, even when there was nothing much I could do. Except during the MRI: there were moments when the technician said, “Don’t swallow now,” and perversely, those were the moments when I felt the greatest need to swallow, and did. The heart has its reasons.

Some people can tolerate being slid into a tube like a roast going into the oven, followed by the sensation of being buried alive to the sound of jackhammers, and some can’t. I assumed I’d be in the latter group, yelling to be freed. I was offered a sedative beforehand, but it came with a paper to sign that said one possible result of the drug was death, so I chose to pass it up. As it happened, I surprised myself: I didn’t mind the MRI too much. My daughter was in the room with me, and the technician, Pedro, arranged a small mirror at the end of the long tube so that I could see her and not feel totally cut off from the world of the living. This was kind of him, but he couldn’t get the mirror in exactly the right position, so that I only saw a segment of her face, oddly angled, as in a Picasso painting.

After the MRI we had to wait a long time for an orderly to wheel me back to my room; it was the week of New Year’s, so the hospital was understaffed. I was more than willing to walk but that wasn’t permitted. I was starving and the candy machine in the hall didn’t work. We asked Pedro if he had anything around to eat. He said apologetically that all he had was a few pretzels. He gave us an enormous plastic jar with a red top and a few pretzels way down at the bottom. We reached in, our arms in the jar practically up to our elbows. They were great pretzels—I can taste them to this day.

~

The preparation for the TEE is being done by a nurse with minimal English. One of the innumerable things I learned during my two five-day stays in different hospitals, one for the surgery and one for the TIA, is that the caretakers of hospital patients are nearly all immigrants. Why is this? Are immigrants particularly good at hospital care, or is it the only job they can get? We certainly should not complain about immigration because without it many of us might be dead or neglected. Not only nurses and attendants, but doctors as well (though not my all-American surgeon).

As with the angiogram, the preparation for the TEE takes a very long time, longer in fact than the test itself, and involves, among other things, the nurse spraying some foul-tasting stuff into my throat to numb it. She apologizes profusely for the taste, which I find puzzling: with a tube about to travel all the way down your esophagus to photograph the back of your heart, who gives a damn about a bad taste?

After a while the doctors arrive, a man and woman, both very young, the man wearing a yarmulke. They barely acknowledge me lying on their table, no more than one would greet a sausage (kosher, in his case) brought in on a plate for breakfast, in fact maybe less, and they talk to each other in low tones. Maybe they’re talking about me, but then again they might equally be talking about football scores or last night’s blind date or problems with their aging parents. The nurse continues to explain the procedure to me, so thoroughly that I could probably perform one myself in a pinch. Definitely a case of too much information, especially as there’s a partial anesthetic so I won’t be fully awake or aware in any case. She must be obeying a new law of full disclosure.

The key part of the explanation regards the tube. While the young doctors continue their murmuring, the nurse holds up her second finger and says, “We use a tube like this, about this size, to go down your esophagus with a little camera at the end.” It is amazing where they can put cameras nowadays, but I reserve that line of thinking for later. I’m interested in this tube.

“You will swallow the tube,” she says.

“You must be kidding.” I don’t actually say it, though.

Noting my consternation, the nurse says with a smile, “Are you good at swallowing big things, big pieces of steak or chunks of banana?”

“No!” It happens that I’m very bad at that sort of thing. Even large vitamins are uncomfortable to swallow. As the child of civilized parents, I was taught to chew. Moreover, ever since a teenager in our building almost choked to death on a melted cheese and sausage roll, I’m afraid of choking. Her father, seeing her turning blue, tried the Heimlich maneuver and when that didn’t work, he flipped her upside down and held her feet and shook her until the gob popped out of her throat.

But before I even deal with the prospect of swallowing a tube the diameter of the nurse’s finger, I am appalled that she addresses me in the future tense, employed as the imperative. The future tense in this context is worse than the imperative itself, which would be, at the proper moment, “swallow the tube!” If she were very polite, she might add “please.” “You will swallow the tube” is a prediction. How dare she predict what I can or will do? Well, I have to be culturally sensitive, even at this stressful moment; she’s obviously not expert in the nuances of English tenses. Still, she could do better. There are plenty of preferable locutions she might have used. She might even have said, “Please try to swallow the tube. But if you can’t, we can use an anesthetic to get it down.”

She never mentioned that option, but I learned later from my brother, who had the same procedure, that with anesthesia they can get the tube down the throats of reluctant swallowers. I should have known. If they can take out your heart for a few hours, then put it back in with a little piece of horse stitched on, getting a tube down your throat must be child’s play. Anyhow, I have no memory of swallowing the tube. It must have gone down one way or another, because I remember very clearly its coming out. The sound. I felt and heard the tube emerge from the back of my throat with a soft pop, like a cork deftly extracted from a bottle of wine.

Besides the choking incident with the failed Heimlich maneuver and the upside-down caper, the other thing on my mind is a terrific movie from Colombia I’d seen not too long ago, called Maria Full of Grace. A young girl, very beautiful, pregnant, and in desperate need of money, agrees to work as a drug mule and fly to the United states with sixty-two pellets of cocaine in her stomach. Each pellet is 4.2 centimeters long and 1.4 centimeters wide. Naturally you can’t just swallow them, one-two-three. You have to learn how, rehearse, and one of the most harrowing scenes in the movie is when Maria is being trained to swallow objects of that size. A man gives her enormous black olives to practice on, and at first she chokes and gags. But she’s desperate, so eventually she learns to swallow the olives whole. Before her flight she swallows all sixty-two pellets. We see her do a few and infer the rest. Later she has to gather them when they come out the other end—this is not shown but left to the viewer’s imagination. However distasteful, it can’t be as bad as swallowing them, I suppose.

~

Throughout the preparation the two murmuring doctors kept fussing over some equipment on a table. I wanted them to acknowledge my presence as a sentient being, so I said, “Do you actually do these procedures all day long?”

“Yes,” the woman answered, barely looking up.

It was on the tip of my tongue to say something about the Nazi doctors; more than the tip, the words were nearly on my lips. After all, I thought, there’s a certain superficial similarity: Nazi doctors also performed sadistic procedures all day long, though without anesthesia. Of course the crucial difference is that their goal was not to heal but to destroy. That difference is pretty crucial, no doubt about it. Enormously, infinitely crucial. But setting aside the goal, the activity itself seemed not so different. I don’t mean to compare myself to the victims, merely to note again the conundrum of similar actions with widely different motives—as in the contradictions of acting on the Hippocratic oath.

But then I remembered the yarmulke. I didn’t want to offend this obviously Jewish doctor, an observant Jew. Strange as it seems, there I was, awaiting his instruments, at his mercy, and I didn’t want to offend him. Not that I feared his retaliation—I gave him more credit than that. But because a remark like that would be in extremely poor taste, especially to a Jew. I was proud of my self-control. After the procedure was over, I told my husband and daughter, who were waiting outside, the little joke that I’d discreetly restrained, about the Nazi doctors. They were not amused. My husband said a remark like that would be in bad taste to any doctor, Jew or not didn’t matter. I should keep such outrageous comparisons to myself. Had I not been lying exhausted on a gurney, he would have told me to develop some perspective, to see things in their proper proportions. He often tells me that when I’m in good health, and of course he has a point.

All the medical people were pleased at the results of the procedure, which showed that I hadn’t had a stroke; no little pieces of grunge matter had detached and swum to my brain. This was very good news to me too. But my happiness was diluted by the imperative mood of the nurse’s order—You will swallow the tube—which kept echoing in my ears. I suppose I’m oversensitive about language, and everything else.

In between all these tests I would walk down the very long hall, south to north—it covered two city blocks—until I reached the big picture window at the north end. This hospital was very near my home, only a block and a half away. I’d brought my children to the ER for the calamities of childhood—falling off a bike and losing a piece of finger, getting a shard of glass in the foot—so it was familiar, and as I reached the north windows at the end of the corridor, I realized I could see my apartment very clearly, its southern side: living room, study, dining room, and bedroom windows. I longed for wings, so I could fly through the window and across to the comfort of my apartment. So near and so unattainable.

After a while I found my thoughts turning to leeches. In many movies set in the nineteenth century, and in the many Victorian novels I read in college and afterward, there are scenes of people being treated with leeches that suck their blood. The patients lie on their stomachs and the leeches are applied to their backs. I was always sickened by the shiny black bloodsuckers that gorged themselves on bad blood. Watching them in films or picturing them while reading, I would shift and shrug in my chair, feeling tiny tentacles scraping at my back. I felt so sorry for the patients being treated in this way, and so superior, too: look how ignorant people were then, they didn’t have any better treatments, they didn’t know the leeches were useless. (Although I believe I read somewhere recently that leeches do have some salutary effects.)

In the end, though, I changed my mind. Enough of modern technology! Bring on the leeches!

Yeats and the Fear

Back at home, I gradually became aware of what I could and couldn’t do. I grasped what I was now, I and my bit of horse. In a word, less: less in body and spirit—meaning muscle and mind—less in will and desire and capacity. How long this recovery would take I had no idea, and I had no idea whether I would ever retrieve the “more” I’d once had, or been. Maybe like AA veterans, I would be “in recovery” for the rest of my life.

How changed I was: my constant thought. Some lines from the Yeats poem, “Easter, 1916,” kept going through my mind. “All changed, changed utterly: / A terrible beauty is born.”

Those lines were hyperbolically inappropriate for my situation: the poem is a memorial to the Irish rebels executed after their unsuccessful Easter uprising in 1916. Yeats names them at the end, a kind of incantation: “our part / To murmur name upon name, / As a mother names her child / When sleep at last has come / On limbs that had run wild.” It’s a frustrated, broken-hearted poem, its rhymes and three-beat lines almost like a child’s verse in contrast to its content. “All changed, changed utterly.”

Yes, I thought, changed utterly. Weaker, shakier, shrunken (I’d lost ten pounds, something I’d wanted to achieve for a long time, and now they were gone effortlessly), diminished in every way. But once again I was exaggerating. What Yeats means by “changed” is not weaker or thinner but dead. “A terrible beauty” must refer to the beauty of the men’s sacrifice for their ideals, for liberty, if one sees things that way. That sentiment is often invoked in wartime, but I find it hard to accept. However, within the poem, I could accept it.

I was not dead for a noble cause. In fact, according to the cardiologist, I had been saved. I tended to forget this, or maybe I’d never really believed it, since I hadn’t had any pain or severe symptoms. I was, I am, insufficiently grateful. I’m well aware of that. On the contrary, I was willfully, ignorantly resentful.

At one point I gave in to despair and moaned to a friend, “What did they do to me?” She was a tough sort who was discriminating with her sympathies. “What did they do to you?” she echoed curtly. “They saved your life. Have a little perspective.” That again! I like those painters of the Middle Ages, before the Renaissance artists began rendering perspective from the human standpoint. Earlier, everything was one-dimensional, on the same plane.

It occurred to me that just as future psychiatrists and psychotherapists must undergo analysis or therapy not only to know themselves, as Socrates advised, but to see how it feels from the patient’s point of view, future heart surgeons, too, should undergo the procedures they will be performing. Maybe all of the resident surgeons in all of the disciplines, come to think of it: throat, lungs, liver, brain, intestines, whatever.

~

During my first couple of weeks at home I wasn’t up to much activity, but I was determined not to sit idle. I deleted dozens of old e-mails from my computer, which I used in bed on a special board my daughters got me, that served as a desk. Deleting e-mails was so dull that I couldn’t do it for more than twenty minutes at a time. I recopied our address book into a fresh, empty one. The entries of the people who’d moved many times, including one of our children, are now much neater, without all the crossing out and squeezing in of new information. In the new book I omitted the people who had died. Most of them I’d already crossed out in the old book, but there were a few I hadn’t had the heart to cross out, people I still felt close to: crossing out their names meant I accepted their deaths. Or was even indirectly complicit in them. I hadn’t crossed out Rebecca or Glenda. But I omitted them from the new book. Writing them in felt too creepy: they were no longer at any addresses I could conceive of.

I was much visited. Visits from family and friends were pleasant, though they wore me out after about half an hour. I was visited a couple of times a week by a nurse and by a physical therapist. The nurse took my blood pressure, asked me questions, and entered data in her computer. The physical therapist taught me exercises to get my muscles moving again. The exercises were absurdly simple, moving a leg or an arm a few inches in one direction or another. That I, with my years of modern dance, ballet, and African dance, my daily half hour of stretches, my workouts at the gym on machines that resembled the torture instruments I’d seen in a museum of the Spanish Inquisition in Toledo (Spain not Ohio)—that I should have to practice these infantile exercises (and find them difficult!) was mortifying.

When I told the cardiologist how tired I got when I did any exercise, he said I must push myself, to get back my stamina. Push yourself, he said firmly. If you get tired, sit down for a few minutes, have a glass of water, then get up and start again. Don’t push yourself, said the physical therapist. Take it easy and never do too much. If you get tired or short of breath or your heart pounds, stop at once.

Some days I pushed and some days I didn’t, but either way, those exercises and visits from the various professionals with their blood pressure kits signified that I was still a patient, even though I was in my own home and wearing my own clothes rather than the ugly white dotted gown. You are a patient, the nurse had said on the very first day. Her words had cast a spell, transformed me into a patient like a princess into a hag. What special charm could turn me back into an ordinary human being?

~

“Transformed utterly: / A terrible beauty is born.” The poetry reflected my shock. This event had never been in my life plan; I’d been told my heart was strong. I was peripherally aware of aging, but I took for granted that my strength would carry me through indefinitely. Now that belief was destroyed.

If only a terrible beauty had been born from my surgery, but that was not to be. About two months after the operation, I was overtaken by waves of fear. Not quite tsunamis, but pretty big. They swept through my body; my heart with its new valve pounded, my joints and skin felt tense, my hands trembled so that my signature looked palsied, and I had the ominous sense that something bad was about to happen. These weren’t ordinary anxiety attacks, which I’d never had, and which I’ve been told last a finite time, maybe twenty minutes. My spells were less intense, but could continue for an entire day. They were the inner ambience in which I spent my days.

I was back at work and trying the best I could to resume the activities of my presurgical life. But now, with the fear, certain of those activities became impossible: I couldn’t be with people, for one thing. The company of my fellow human beings took more composure than I could muster. Supermarkets were chaotic and bewildering. Subways were out of the question.

The anxiety that gripped and baffled me, I learned, was a common repercussion of heart surgery. I never expected it. None of the doctors had mentioned it, not that that matters much. I would still have had the surgery, and I doubt that anticipating massive anxiety would have made it any easier to bear.

Before, I’d occasionally felt what I casually called “depressed,” but I see now that that was a misnomer: I’d been merely unhappy or out of sorts or discontented, nothing that required medical attention. These new feelings were something else. Unimagined. As if I’d been colonized by aliens bringing unknown viruses and symptoms. In fact the anesthetic I’d been under for five or six hours was an alien substance that would take quite some time to dissipate. Besides the anesthetic and the emotional trauma, there’d been that mysterious heart-lung machine that for several hours substituted for my real heart. No one seems to know exactly what effect that could have on postsurgical depression, or on anything else for that matter.

I began each morning by looking forward to the evening, when the anxiety would ebb. Then I would carry my pillow and quilt to the living room couch and settle in with the three remotes to watch movies. I blessed Netflix. I read War and Peace: I wanted something that was sure to be good and would last a very long time. I’d read it when I was around nineteen or twenty, but had forgotten most of it except that Natasha first loves Andrei and after he dies she loves Pierre. Surely there was more to it than that! War and Peace offered the uncanny comfort of rereading: some parts feel utterly unknown, and then as we go along, gradually a sense of familiarity begins to unfurl and blossom. We know and don’t know at the same time. There’s the thrill of stepping into fresh territory, or rather territory we’ve visited before but which has renewed itself especially for our return visit.

I tried to explain to the doctors that I wasn’t so much depressed as anxious. They said it was the same thing. I didn’t see their logic but was in no condition to argue. (“Agitated depression,” a doctor friend told me when I mentioned it. That little phrase made more sense.) I was again at the doctors’ mercy: no longer a slab of meat in their hands but a vat of chemicals gone awry, to be treated with more chemicals, controlled substances that would counteract the uncontrolled chemicals within. They said it could last six months or more, but it would definitely go away someday. I couldn’t imagine that. I couldn’t remember how I used to be. Luckily I was able to walk to the drugstore to pick up the prescriptions, but waiting in line made me want to jump out of my skin.

I tried hard to think of what I was really afraid of. Everything, nothing. Everything unexpected that might happen in the next moment. Nothing I could name with certainty. I was afraid of fainting, of collapsing in the shower or while walking down the street. I was afraid of facing my work. I was afraid of idleness. I was afraid when I was tired—and I was tired a lot of the time—but when I took naps I was afraid I’d never manage to get up. I was afraid of life and afraid of death. But that’s all there is—what other state could I retreat to?

When I pushed my questions further, I realized I was afraid of what had already been done to my body, even though the surgery was over and I was no longer in pain. What exactly went on in the operating room while I was unconscious? That was the experience missing from my memory, making my mind unbalanced and plaguing me with uncertainty. I could easily have asked the doctors or looked it up, but I preferred my lurid imaginings.

Lurid Imaginings

Forty or fifty years ago doctors didn’t tell patients very much about their conditions, even when they were terminal. Doctors did not explain which procedures they’d resolved upon and why, or what symptoms or side effects might ensue. But over time patients began to assert their right to know, and so by now things have come full circle. They tell you everything. The scientific part, that is. My cardiologist, that kindly, balding, unflappable man, told me all about how aortic valves work, how mine was not working properly—he even pointed this out on a computer rendition of my heart in action—and how the new valve would perform better. I’ve forgotten the details, as I always forgot science lessons right after the exams, but for a while I understood how blood is pumped through the body, and why I was finding it harder to climb subway stairs and walk up hills. I had thought that was a symptom of aging and smoking, but no: it was my nasty valve reneging on its duty.

What intrigues me more than the biology, though, is how the surgery is carried out. The mechanical part. For instance, I have a pale pink line about seven inches long going down the center of my chest, starting about two inches below my collarbone: the scar. I don’t mind the scar on aesthetic grounds and I’d never dream of trying to hide it: it’s hardly noticeable anyway, and not especially ugly. But when I see it in the mirror I’m reminded that it was, for a few hours, a gateway of sorts, a double door opening to the secret lodging of my heart. “We reach in.” Welcome to my inner life, I could have said, had I been conscious at the time. Some doors open automatically and majestically, but not these. How exactly did they open?

That’s just one question I might have asked the surgeon when we met, had my mind not gone blank. Now I’m teeming with questions. How do you open someone’s chest, that is, create the vertical slit that allows for the double doors? It must be with a plain old hammer and saw, right? The surgeon or one of his helpers must draw a line down the center of the chest, maybe with a pencil or a Bic pen, but they can’t use the hammer right away. They must have to saw along the line first. Once they’ve sawed and sawed, scored the chest, as it were, then the surgeon can raise the hammer high and bring it down on the sternum like Paul Bunyan swinging his mighty axe. What does it sound like? Splitting wood? Or the kind of jagged rough sounds you hear from the back of old-style butcher shops?

So the vertical line is broken, and maybe a few ribs and other parts too. The double doors are forced open to reveal the precious, beating, pumping heart in its bloody chamber.

“We reach in.”

Somehow they disable the heart and keep the body alive by means of the heart-lung machine. I wouldn’t know how to begin asking about this machine. Is it attached to the heart? How? And also to the lungs? How big is it? Is the heart actually removed from the body? Does “reach in” mean reach in to extract the heart, or reach in to work on it? And if they do remove it, where do they put it for the hour or two or three that they’re working? (I hope they’re wearing gloves, by the way. Nowadays even supermarket clerks wear gloves.) Is it on a table? In a special dish or bowl? How far is it from my body where it usually resides? Does it feel anything— abandoned, say? What if someone is clumsy and the heart slips out of the bowl and slides along the floor? They run to rescue it. It sounds like a children’s book: catch Timmy’s heart before it rolls down the hill. Is the little valve of horse sewn on with a needle and thread or attached some other way? Staples, Velcro? How do they get the heart back into the chest in exactly the right position? Is my chest open the whole time, the unaccustomed air wafting over my innards? Couldn’t I catch a cold, so exposed?

~

I can’t remember any of this, but I believe it happened, or something very like it. It still exists, on the dark side of memory. Memory has its dark side, unseen, like the dark side of the moon. Whatever is done to the body cannot be obliterated, only turned away and hidden.

Rehab

Among the mounds of printed material the hospital sent home with me was a progressive schedule of walking. You start out with two blocks a day and gradually increase until you’re up to a mile a day. It was a very cold winter; I would bundle up to stroll along the park opposite our apartment. In the past I used to shiver in the cold, but no longer. It must have been the bit of horse, speeding my blood on its way faster than it had flowed in years. At first my husband or a friend walked with me, but soon I walked alone. I forced myself, even when the anxiety was enveloping and I feared I might collapse along the way and never make it home. In my worst fantasies, I was picked up from the snowy ground and sent back to the hospital to start all over again. When I arrived home safely from my walks, it was with great relief, as if I had survived a perilous journey, an expedition to the North Pole.

In the midst of my “agitated depression” I began an eight-week program of cardiac rehab three mornings a week at yet another hospital. There I found some half-dozen patients disporting themselves in a small gym in the basement, with the usual treadmills, stationary bikes, and weight machines. The patients changed from week to week; some graduated, others arrived. The women talked in the dressing room as women tend to do. (Maybe men do too, I don’t know.) Undressing together seems to promote emotional and spiritual intimacy. One woman who appeared to be older than I but was actually younger said she cried a lot of the time. A much younger woman said she was so wretched with her husband that she had to figure out a way to leave him. “Don’t make major decisions when you’re so depressed,” the other woman and I both advised. Just as years ago, my friends and I would remind each other not to make any decisions when we had our periods.

Before we left the dressing room, we had to attach intricate color-coded patches and wires to our chests so the nurse at a computer could keep track of our heart rates, and for all I know, our thoughts and feelings too. The program was meticulously organized: each day we were given a personally tailored schedule of which machines to use, for how long, and at what rate of speed. The physical therapists were so kind and efficient as to seem supernatural. One of them actually resembled Wonder Woman.

Every so often a patient would report chest pains or dizziness and would promptly be led to a wheelchair. Often that patient was sent to the emergency room, and as he or she was wheeled out, the rest of us, looking on, kept pacing on our treadmills or hoisting our weights. This felt heartless, but what could we do? It could be any of us in that wheelchair. The best thing was to ignore it. Leave it to the professionals.

The program worked well: the more I exercised, the stronger I got. This didn’t help the fear, though. That would take a long time to simmer down, if ever. Beneath the fear was the sense of waiting, which outlasted the fear. Waiting for something, though I never figured out what. Maybe for the return of my former self. My former strength, endurance, fortitude, courage.

As the weeks passed, I began to feel changes. This time I wasn’t changed utterly, only in small ways. I could walk up a hill or up the subway steps without growing short of breath. I could be with a friend for the duration of a brief walk. After a while I could go to a restaurant or a movie without feeling so restless that I had to flee. I became interested in the news again, the wars and natural disasters. It was even conceivable that with patience I would stop being a patient and repossess the “more” I had once been. Yes, I might soon be restored to life, a real life, and this real life would last longer than it would have without the surgery. And as I tentatively began to feel inhabited by this “real life”—going out to a movie, talking to people in a caf, caring about my work, enjoying family get-togethers-it was very like rereading War and Peace after a long hiatus: stepping into territory that was familiar and fresh at the same time, territory that was being renewed precisely by my own return.

It was still hard to admit that the surgery had been a good thing. Now that it was over I didn’t want to think about it, good or bad. What I did think about was the horse, whom I imagined grazing in a green meadow under a blue sky. Before he gave up his heart valve, of course. I wanted to know: is it possible that horses are killed expressly for their valves, as in the illegal trafficking of human organs? On that day when I first met the surgeon, did he call a stable and order a horse’s valve? I wouldn’t want to have been the cause of any horse’s death. Be that as it may, I am the beneficiary, and I feel grateful to the horse who pumps my blood so effectively.

I never did smoke those two cigarettes. When I got home from the hospital I put the almost empty pack of Vantage in the bottom drawer of my night table, next to an unopened carton. They’re still there now, almost eight months later. Even though I probably won’t smoke anymore (though you never know, I might regain my old nonchalance), I feel those two are owed to me.