I will soon have a major heart surgery. It probably won’t kill me. I have known my whole life that at some ill-defined point, I would have this surgery. A few hours after I was born, the attending pediatrician heard a telltale murmur. Three leaflets of my aortic valve did not close flush. A small amount of the blood passing through the valve leaked backward and across it, returning unoxygenated blood to the body. Over the past forty-six years, the opening of the valve has narrowed, making it harder for blood to get through the valve and out to my body. With each beat of my heart, that returning trickle has become a torrent. The left ventricle now does double its intended work; it is exhausted. My aorta is exhausted, too. It is too elastic and struggles to hold its shape.
I spent much of my childhood and early adulthood vigilant for symptoms that I am now experiencing: chest pains while exercising, shortness of breath, passing out. Still, I am lucky. My disease has progressed slowly while the surgery itself has improved radically. A hundred and thirty years ago, a pioneering cardiac surgeon in a city hospital would have simply numbed me with opium or ether, then performed the surgery while I was awake but oblivious, tied down to a table, working from under my armpit. Thirty years ago, an expert cardiac surgeon at a university would have cracked open my chest, sewn a pig’s valve to my heart, and then, if I survived the recovery, done it again after three or four years. When I turned thirty in 2007, the fact of my murmur ceased to pique the curiosity of these university cardiologists. They had once tracked my defect with great interest, hoping to perform a rare and fascinating surgery on a young person. Today, a valve replacement and aortic repair are unusual for someone in his late forties, but not uncommon. I meet with my cardiologist in an auxiliary office on the main campus of the local medical foundation. The patients in the waiting room, once much younger than me, are now much older.
Come surgery day, my aortic valve will be replaced with a mechanical valve. Then, a piece of Kevlar will be wrapped around the aorta. Both the mechanical valve and the Kevlar wrap should work just fine to the end of a normally-expected long life. Neither should need to be replaced. My odds of surviving the surgery are excellent. If all goes well, the surgery will take about ten hours. I will be in the hospital for five to ten days of recovery: cardiac intensive care, then intensive care, then a general bed. Upon release, I will go home and recuperate for a few months. For the rest of my life, I will take a daily medication to prevent blood clots from forming around the new valve, and another medication to regulate my heartbeat. Of course, there is always fine-tuning to be done after a major heart surgery. It will take a while to get my strength back. But by this time next year, hopefully, I will be exercising and walking around with more vigor than I have now. A steady click-thump, click-thump will replace the loud, trolling snare of my valve sputtering open before it almost closes shut.
“Come over here,” my girlfriend said to her son the other night, as she lifted her head off my chest. She is a doctor. Her son is eleven years old. “Want to hear what a stenotic valve sounds like?”
Her son put his head on my chest, then just as quickly jumped up.
“Yuck,” he said. “I do not like the sound of that at all.”
*
The body’s capacity to adapt to what it cannot do when the heart begins to fail is remarkable. The hormone and nervous systems increase the blood pressure. They hold onto salt and water in the body. Circulation improves. But after a while, uncirculated blood starts to back up in the chambers of the heart. The weakened heart enlarges from doing the extra work of rerouting that surplus blood back out into the body, while the blood itself holds less and less oxygen because of the failing valve. As the body demands more blood, more stress is put upon the body, which in turn puts more pressure on the heart. Like an overfull balloon, the enlarged heart changes shape. The left ventricle takes over some of the work of the aorta. The less elastic aorta swells to allow still more blood to pass through, distributing less and less oxygen. The body gets tired faster, often without warning. Finally, leaks spring in all directions. The heart signals panic. Major symptoms begin.
By all accounts, in my youth, I was a bit of an odd duck, a bright, big, and reckless boy whose vigilance for symptoms made him anxious, cautious, and more than a little neurotic from a very young age. That ache in my arm while playing outside? Let’s go to the cardiologist. Dizzy-headed getting up from collisions on basepaths, or kickball thumps to the head? Call Dr. Diehl. Once, popping up from the sofa, seeing stars, I thought, Okay, this is the beginning of the end. Or had I just stood up too fast? Phone call. Visit. I was hooked up to machines and administered a battery of tests, then given a general recommendation to continue my caution while also living life to the fullest. Life was short, the cardiologist assured me. I would know when I was having real symptoms. It was always good to check in, even if I just thought I was having them.
Such vigilance had real benefits. I hated my middle school football coach. I was large and strong, but soft and sensitive and absent-minded, so he decided to “turn me into a man.” This meant staying after practice late together. He would kneel down into a three-point stance in the parking lot and scream at me to hit him as hard as I could. Then harder! I wore my pads. He wore a business suit and loafers, his tie loosened. He was the youngest brother in a family construction business, he explained during breaks in the exercise, and he had once been soft, too. But look at him now! When the cardiologist at the university forbade me to return to the team after a check-up—my disease had progressed and the isometric exhaustions of tackle football now threatened to stop my malformed heart entirely—my parents were perplexed. The coach was disappointed. I was relieved. I had the tall, heavy build to play football well into my adult life, and I was helpless in the face of confident adults—teachers, coaches, priests, cardiologists—who told me they knew best. The decision was, thankfully, made for me.
I was soft, still, when I won the cross-country Team Spirit Award in high school two years running. In my last-ever race, I sprinted out to the front of the pack, slapped a tree about eight hundred yards into the course, and keeled over. My heart felt like it was going to explode. The varsity runners cheered for me to keep going as they sprinted past. At the starting line, I had bet my coach two slices of pizza and a Snapple that I would take the lead at some point. I finished the race second to last. An exchange student who got lost in the woods walked in a few minutes behind me. After the meet, Coach drove me to the pizzeria, bought me the slices and Snapple (peach), and then quietly asked what I thought would have happened had I just kept running that hard. “I would have died,” I told him, “I think?” I really had no idea. I had never in my life gone all-out physically doing anything for fear of what such abandon might do to my heart.
*
The first heart surgery was performed in 1896. Through the left side of a stabbing victim, a doctor manually sewed closed the wound. Soon, surgeries were performed live in the open chest cavity. The first valve replacement, from a cadaver, was performed in 1952. The first heart-lung machine was connected in 1953, allowing John Gibbon to stop the heart and repair its valve. A full valve replacement using the machine followed in 1960. In that time, a primitive ring-and-ball mechanical valve was replaced by a valve using a disk that tilted open and closed. A mechanical valve was developed with two leaflets, then three. In the 1970s, new anti-calcification drugs made flesh valves harvested from pigs and cows the replacement valve of choice. A cow valve was the best option for me at birth and well into my adolescence. I would get eight years out of the valve. That valve lifespan increased to twenty years by the time I was in college. Meanwhile, the artificial valves improved in quality and longevity; one mechanical valve now lasts a patient the rest of his life. Since my birth, the risk of death from the surgery has plummeted from around thirty-five percent to below ten percent.
Today, very high-risk patients—older patients, patients with complications—don’t have their chests cracked open at all. Instead, the new valve is inserted laparoscopically into the femoral artery then run through the artery up the leg and into the heart. Microscopic cameras guide the surgeon. The new valve is closed, like an umbrella, then opened into the correct place. Nearly any patient can survive this surgery: no heart-lung machine, different anesthesia. But the success rate of the surgery itself is still much lower than traditional open-heart procedures. As long-term data is accumulated, this might change. But for now, cracking open the chest is still the safest option.
The evolution of the surgery is likely to indicate laparoscopic surgery within the next ten to twenty years. Like the cow and mechanical valves before it, I would opt for this surgery if time were on my side. There are likely to be other quantum changes in heart surgery in the coming decades that will make the cutting-edge options I have now—so much better than those my parents might have chosen when I was born—seem positively primitive by comparison. That is the hope, anyway. Should I need a second valve replacement, the next surgery will likely be even easier than this one. I might even be awake for it.
*
The prospect of any heart surgery in 1977, when I was born, surely filled my mom, especially, with genuine terror. Her own mother had died a year before I was born. Her father had died when she was a teenager. Both had suffered prolonged cancers. I thought I was a very clever teenager—what I would now call an asshole—when I announced at the dinner table one Christmas that I had probably been a “save-the-marriage” baby. Mom burst into tears and left the table. Of course, my birth coincided with a profound grief. It was likely a reason for my parents to feel hopeful after a very hard time. Lucky them.
The baby of the family, I was adored, and also taught to keenly know my body, accept my limits, and avoid strenuous activity, which I mostly followed. I’m pretty sure the reason I never tried hard drugs was because I feared what they would do to my valve. Ditto weight lifting, skydiving, polar plunges, and once, after a day-long hike to the middle of nowhere, jumping thirty or so feet into a lake (would the shock of the fall stop my heart? the cold water?). Instead, I was inclined to take meta-risks, risks that warranted a lot of psychological exertion but no physical caution: dares, racing off to the Peace Corps, writing poetry, having three kids in four years. “Time is short” is my mother’s theory of my every tattoo, piercing, haircut, extravagant gesture, and marriage, as well as the one time I invested a few hundred dollars in Krispy Kreme donuts stock. I denied it each time, all except the stock buy. In my defense, Krispy Kreme was indicted for investor fraud the next year. They still make great donuts.
It was important as a teenager to take prophylaxis antibiotics before every dental cleaning. Any resulting bacteria in my mouth could weaken the valve in a matter of weeks and kill me. Sore throats and fevers required medicines, too, to prevent local infections from spreading to the valve. Other cautions were emphatically more elective in nature. At the first sign of a head cold, I still quaff handfuls of fizzy vitamins, droppers of essential oils, and exotic herbal remedies. I am vigilant about sleep, obsessive in my need to regulate it. I take an SSRI to mitigate anxiety and depression. I go to the urgent care at the first sign of illness, however it may or may not connect to my heart. In my twenties, I had sinus surgery and foot surgery (not great) to correct chronic imperfections. In the time I had left, if I couldn’t fix my heart, why endure a bad sniffer or stunted toes? Then, as now, I believed that if I could predict what would happen next, then I would prevent any minor threat from becoming a major one. Did my strategy work? Hard to say. It’s impossible to prove a negative.
Of course, the science of medicine makes mistakes, too. In my thirties, cardiologists stopped prescribing antibiotics for dental work. The risk of infection was overblown. Rest no longer equates longevity. Cardiologists now encourage long-distance running as a way to both extend the life of the heart, and also, to minimize and relieve the symptoms of heart disease. Last year, my doctor told me it was fine to lift weights. At my age, with my disease progressed to its final stage, the benefits outweighed the risks. “Gain weight, lose weight,” the cardiologist shrugged. “The valve will decide on its own how it wants to deteriorate.”
*
When I visit the cardiologist for a quarterly check-in, a machine, then a camera, and then finally an echogram measure my valve’s narrowing and leakage. My grumbling heartbeat is amplified first to a glitchy shushing on the big screen, and then a precise whine. The gel on my skin is bracing. The hair on my chest, shaved. Sometimes, I fall asleep during the procedure, at least until the technician’s wand rakes across my sternum and startles me awake. She presses as deep as she can under my ribcage to get the best picture, and so, a better measurement of stasis or decline. After the procedure, the technician punches numbers and pictures into the final report, which indicates either stasis or progression, expressed succinctly as two numbers. The mean transvascular gradient is derived from the Bernoulli equation and traces the valve’s Doppler spectrum. The peak velocity gradient examines the relationship between systemic arterial hemodynamics and peak-to-peak (deltaP(PtoP)), peak deltaP and mean deltaP, also using Doppler echocardiography. In short, I have no idea how either number is calculated or what it means. I do know that both numbers have value. Four or higher is bad for the mean transvascular gradient. Sixty-five or higher is bad for the peak velocity gradient.
Often, during the procedure, I make a game of controlling a number I do understand: my heart rate. Sixty-two. Fifty-eight. Fifty-one. Prone, covered in wires and suction cups, I can lower my heartbeat, and that feeling of control tethers me to a concrete world of literal and vivid experiences that I can verify (unlike the gradients) according to my senses. Briefly, my vigilance accords me power over my heart. Of course, the power doesn’t last. As the technician removes the wires and suction cups, my heart rate regresses to a pedestrian mean. The machine goes into sleep mode. It ceases to communicate anything of value to anyone. It is done with me, for now.
Each year, roughly nine million echocardiograms are performed on patients in the United States. Each echocardiogram checks the structure of the heart and surrounding blood vessels, analyzing how blood flows through them, then evaluating the pumping chambers of the heart. The same technology is used, less precisely, to perform ultrasounds on expectant mothers. When I saw my oldest son for the first time on the sonogram screen, I recognized with a certain delight the squiggles, cones, and triangles that rendered him a fetus, moving in time and space, his patient heart healthily pumping blood in all the right directions and colors. “It’s a boy,” the obstetrician said to us, drawing the mouse cursor across the fuzzy white blob on the screen. “But of course, you probably saw that.”
*
I have not yet told my three sons that I will have this surgery. The mediator who helped to navigate my ex-wife and I through our divorce recommends treating the surgery like a simple trip to the hospital. Dad will go to the hospital. Then he’ll come home. Then he’ll rest. The less they worry, the better. I have not told my ex-wife about the surgery either. Of course, she already knows about my diagnosis. For ten years, she watched closely enough the general terror of my going to the cardiologist, and then returning home, chastened and exasperated, self-absorbed she would probably say, waiting for yet another round of tests. I imagine that she feels long done with such anticipation. Certainly, she has already put her time in.
I will lean on friends and family, heavily, for support and help. Apparently, I can hire a surgery doula (they exist) to guide me through the surgery: arrival and departure and preparation, keeping track of medications and notes, arranging professional care, talking through what to expect while I’m expecting . . . to what? Die? Recuperate? Angst? I like the idea of hiring someone who does this kind of work for a living, to whom I might outsource the worry that I will anticipate the wrong things, and forget the important things, and screw up everything else. Who I might ask to remind me, for example, that more than 182,000 people have a valve replacement surgery in the United States every year and nearly all of them survive, and very few of whom hire a surgery doula.
A couple of older friends have had valve replacements, and have been more than willing to share their experience and talk through the hard parts. By their consensus, having the breathing tube pulled out of the chest is the worst part, followed closely by the coil of electrodes attached to the heart being detached and pulled through the open chest cavity. Apparently, you feel the wires pulled from the heart and through the chest, snaking each vein and ventricle they pass. Post-surgical pain is minimal at first. The brain is flooded with narcotics. Nerve blocks stent the immediate surgical area. One friend warns that I will feel the pressure of my sternum held together with wire and struggling to open back up ever more as it heals, a kind of weight that does not lessen, that feels, he says, like not quite being able to breathe deeply enough, or balancing a barbell on the center of one’s chest. I have winnowed all my worrying down to these three parts of the process: breathing tube, coil, chest wired shut. It is easier to fixate on how my body will feel, for example, than it is to wonder whether my sons will forgive me for becoming so weak in front of them, or for dying, or for emerging semi-intact, changed, dependent, different from the father they knew before the surgery in some way that makes us less close, or makes them feel more alone, all possibilities consistent with the experiences that friends have had of the surgery, and their friends and family who had it, too. Absent being able to tell my boys exactly what will happen after the surgery, I tend to agree with the mediator’s advice. Less is more.
*
“We want to use the natural hardware for as long as possible,” the cardiologist explained last winter when I asked whether we could just schedule the surgery and get it over with. I was sick of waiting. I felt reckless to just finally move things along.
“There is always,” she said, “a risk to major surgery.”
Some of the risks are obvious: infection, internal bleeding, and death. Staph and fungal infections increasingly common in hospitals. COVID.
Other risks are elusive and less distinct. In the middle of the surgery, after the sternum is cut and spread apart but before the valve is cut out and replaced, my heart will be bypassed and I will be placed on a heart-lung machine. The heart-lung machine will circulate blood through my body while my heart does not, mimicking the action of the heart, while the heart itself is stopped by cold water poured into my now open chest cavity. The heart must be stopped before it can be operated on. Only then can the star of the show, my failing valve, be given its curtain call, and then replaced with pieces of metal, and finally, sewn to the nearby heart tissue.
The heart-lung machine is a real study in contradictions. Of course, I need to use the machine in order to have the surgery that will prevent an otherwise premature death. But a wide range of scary potential after-effects characterize the post-operative patient who has spent time on the heart-lung machine. Blood clots, bleeding after surgery, surgical injury to the phrenic nerve (the diaphragm), acute kidney injury, decreased lung and/or heart function. Also, what is generally referred to as cognitive bias modification: memory loss (short and long term), general fogginess (short and long term), a feeling of having lost a sharpness of intellect (short and long term), an expansion of feeling generally (long term), a diminishment of one’s capacity for feeling (long term). Depression, anxiety, and suicidal ideation (short and long term) are all par for the course. These risks are decreased with shorter times on the pump and increased with longer pump times, though most patients experience some degree of at least one of the symptoms.
Other symptoms are indicative of having been connected to a heart-lung machine, though a causal relationship between the machine and the symptoms have never been clearly established. As patients increasingly opt for surgeries that require a long period of time under anesthesia—joint repairs and replacements, transplants—the new thinking among doctors and surgeons is that the drugs themselves might alter the brain and/or otherwise increase a patient’s susceptibility to negative repercussions. Put simply, the inorganic circulation of blood may just not be very good for the body. The body would prefer that the heart do that work.
Of course, no one really knows whether post-operative changes are secular or sacred in nature. Some argue that the very practice of surgery is itself a violation of the natural order, one that excises a penalty for doing the thing that nature will not. In other words, extending a life, altered, may not be the same thing as restoring a life. Or perhaps the restoration is itself the miracle. When the Little Prince peers up at the heavens, he confides, “And now here is my secret, a very simple secret: It is only with the heart that one can see rightly; what is essential is invisible to the eye.” Is such a change of heart (pun intended) the tax one pays for having a death-defying surgery at all? In certain myths, travel back from the after-world, the afterlife, the place of death—the literal stopping of the heart, then restarting it—requires paying a toll to those who do not return to the world of the living. That toll is sometimes collected right away: Charon’s obol, six mon to cross the Sanzu River, Moonlight Graham’s first at-bat, after which he walks as an old man back into the corn past right field, doffing his spectral cap to the spectral players on the diamond.
Other times, the toll comes well after the fact, a kind of EZ-Pass approach to traveling the heart-lung machine’s superhighway to a repaired valve, a Kevlar’d aorta, and a reasonable life expectancy. Patients with valve replacements report diminished strength earlier in life than their intact counterparts. They grow foggy and confused after the surgery, and do not always restore entirely their mental and physical faculties, a phenomenon, common among all surgeries, known as “pumphead,” named of course for the heart-lung machine—those anecdotal effects suspected to be caused by its inorganic pumping of blood throughout the body. Such patients live as long as their intact fellow travelers of life, though sometimes with less vitality. Cognitive decline—a diagnostic reality hard for the patient himself to recognize, though usually pretty straightforwardly seen by his loved ones—is the major symptom of “pumphead.”
*
The great irony of my impending diminishment is that I have not felt this physically healthy in years, perhaps ever. When my diagnosis was confirmed as “severe,” I hired a trainer. I told myself that I wanted to be in the best shape possible to survive my surgery, but really, the decision was entirely vain: I wanted to look good, once, because I might never have the chance to do so again. Under the trainer’s watchful eye I ate a strict diet and worked out daily. I still do. Over the course of a year and a half, I lost seventy pounds, packed on some muscle, and lessened my body-mass index from obese to overweight to normal. Now, I wear slim-cut shirts. Veins pop (the proper lifter’s term) on my arms and legs. I no longer sweat when I eat (my favorite joke from the Simpsons: when Marge praises Homer after he stops drinking beer and loses weight, “ . . . and best of all, you don’t sweat when you eat!”). I feel generally pretty great.
Of course, feeling is not data. The last echocardiogram showed a clear progression of my disease to the final, worst category: severe congenital aortic regurgitation and stenosis. Severe: the valve will soon stop working. Congenital: I was born with it. Aortic: the heart. Stenosis: narrowing of the valve. Regurgitation: the backflow through the defective valve after every beat. My heart skips beats on a regular basis. It performs atrial fibrillation: fast, terrifying flutters that my phone suggests are signs I should see a doctor. (Yes, even the Apple Watch knows that my ticker is mostly tocks). My heart still calls the shots, but in the way that an old basketball coach sits on his folding chair, arms crossed, nodding off a little when the game is in hand, springing to life to call out a play or missed assignment as the team loses its shape. Expert at what it does. Nodding off again.
*
In a recent Netflix documentary, Arnold Schwarzenegger tells the story of waking after his valve replacement surgery and being told by the surgeon that the surgery had failed. Arnold needed to have the surgery again, right away. The anesthesiologist would wait until the very last minute to knock him out, to minimize the risk of death. The complete procedure, both surgeries, took thirty-two hours in total. Arnold has since had the valve replaced three times. He is 77. Throughout the documentary, he chain smokes cigars. Vitality is a performance, he admits, but given all the options, why not project strength and invulnerability?
My dad smoked cigars for years after he stopped smoking cigarettes. In his early sixties he had what he still calls a “heart incident,” and now has a defibrillator and a pacemaker installed under the skin of his chest. He no longer smokes. He eats well, exercises, travels, periodically yells at the television. “Something is going to kill me,” he likes to joke, touching the outline bump of machine on his chest, “but my heart is not going to stop.”
“The best way out is always through,” is variously misattributed to Churchill, Mother Teresa, John Lennon, Amelia Earhart, Lincoln, the movie The Swamp Thing, even Taylor Swift. The quote originates in a Robert Frost poem, “A Servant of Servants.” In the poem, a farmer apologizes for taking so long to visit a stranger camping on her land. The farmer is very chatty. She explains that she prefers rest to medicine. She would rather stay home than return to the asylum. She would like to live on all of the land, even though she rarely ventures beyond the nearby lake where she washes her dishes. As the poem ends, she is eager for her visitor to stay and listen. To not leave? The poem is variously interpreted to mean the narrator is unwell, lonely, isolated, neglected by her husband, alienated from the modern world. I like to think the poem offers still another reading. The narrator needs to believe she knows something that the camper does not, that she has power over him for the things she has endured in the place where he is only passing through. Leave this place, she is trying to tell him, but first, come see my home. See the heart of the land before you choose your way out of it.
*
Days when I don’t have the boys, I take long hikes around the neighborhood, along the Bay, through a nearby open-space preserve that is all uphill one way, then all downhill back. I should be grading, writing, teaching, thinking about important things, checking my will, rechecking the health directive. But what I want, more than anything, is to feel vigorous before I enter the hospital. When I’m most down on myself, I call that impulse “vanity.” Soon enough, such vigor will all be undone, even reversed. Other times, though, I give myself an easy out: simple biology. The organism of my body wants longevity above all else. Yes, I have no sense of that extended time. I never have. Still, it feels like a trick, to tell myself that today is not the day for the surgery, and if I string enough todays together, tomorrow might not be the day either. Again: the pattern will end. The repetition of healthful days will remit to the steady, quiet pulse of machines keeping the lungs moving inside of a body that is not awake, checking the pressure in the veins, the various components of the blood, measuring the rate of a heart that has asked for help so long it, too, is now quiet, no longer murmuring its irregularity, the windsock valve soon to be replaced with hardware, a mechanical click I will hear through the chest long after I’ve returned home, for the rest of my life, a very simple click-click, in fact, as the valve efficiently moves blood to exactly where it needs to go. When I’m proud of myself, I call that repetition “resilience.” I knock on wood and say a prayer: Let this be the worst thing my body endures for the rest of my life, and let that life be long and healthy!
What will I tell the boys when I sit down to write the obligatory “deliver in case of death” letter to each of them? I can hardly imagine starting such a letter, much less taking the writing of it seriously. How to even begin? “Dear Son”? Well, when have I ever addressed any of my boys as “Son”? Such imagining instantly devolves into mockery at the level of self-regard required to write such a letter. Perhaps I will take myself more seriously when I sit down to write. For now, I am decidedly jovial and silly around my boys. I am reluctant to change anything externally; maybe just unwilling to let the surgery take that from me, too. A gravely ill man lapsing into stentorian tones, suddenly solemn for the obvious fact of his vulnerability, eager to speak grave truths, might play well on the stage and screen, or on the page, but I’m absolutely allergic to such posturing in real life. It feels insecure and inauthentic. Certainly, not how I’d like the boys to remember me.
Still, they deserve some final artifact of their father, even if the odds they’ll ever be handed the letter are slim. So to hell with artifacts. I hope that one day they will pick an artifact for themselves, entirely separate of my hopes and desires for them: a poster, a watch, my college ring, the 1985 World Series pennant hanging next to my dresser, the houseplants, furniture, even the house itself. Our memories. The sound of my voice. That time we went to the lakefill at my university and sat on the big stones, looking out at the water. It was June, right after the divorce. Muggy, but blessedly overcast. We walked by the lake, then over to the Shakespeare Garden, around both parts of the campus, before finally ending up at Al’s Deli, ordering the best sandwiches in the world. We’ve gone back to that spot three times since, nearly a ritual. Maybe, if I die, they’ll walk that path, or find their own version of it. I would love that.
Last June, in Hawaii, we stayed for four nights at a five-star resort I definitely could not afford. It was the kind of gesture I thought, well, down the road they’ll remember their strong dad throwing them in the pool, and the surf lessons, and the poke bowls we wolfed down next to the coral reef. Among the millions of photos I’ve taken of my boys is a selfie of the three of us at sunset, wearing cheesy matching polo shirts I bought at Target, pink flamingos on even brighter pink rayon. Our faces are sun-kissed. We are all smiling. That night, we all sat in the hot tub, then watched a movie on my laptop in the hotel room. It was magical. Maybe they’ll choose that memory, too.
*
When I hike, I do mental math, multiplying by twos up into the millions, then dividing back down again until I reach one. An error either way means starting over. Since middle school, this silly practice has been my favorite form of distraction, nearly a prayer, concentrating hard on mental math while ignoring the distance remaining, the steepness of the path, the sun. Sometimes, I count the number of days until the boys come to my house again. I tune in to baseball games on my phone. My beloved Royals give up three and four runs an inning all summer, and finish with the third-worst record of their franchise history, just eight years after they win their second World Series.
At the end of the steepest hill there is a fence. It takes about 5,100 steps to get there, a third of my daily count. A hay company hangs trespassing signs there to warn of the electric fence. Along the fence are two lengths of trail that circle to either side of the hill, back toward the trailhead and parking lot. In that moment of choosing which way to go, I hope for everything: more time, more trail, more days with my boys. That the heart doctor, seeing my improved fitness, will discover some healing in the heart, and recommend the surgery be delayed another three to six months, so that I can rewind the countdown clock again. Why, she might even cancel the surgery entirely. I am a miracle patient, cured by what, prayer? Divine intervention by way of fitness, Saint John the Divine of the Personal Trainer? She’ll tell me that I was never sick at all, at least not sick enough to undergo a major surgery, and all the random juju attendant to its planning, execution (that word!), success, and recovery, is just fodder for my continuing neuroses, psychoses, drama. In grief, this stage is called “bargaining.” It is either the first or the second step. I have lived forty-six years, I tell myself often, and I have never gotten past the second step, and how freaking sad is that?
The hospital is scheduling into late November. With any luck, I will have the surgery after Thanksgiving, recover over Christmas, and teach my first classes of the winter term online. In the meantime, there are so many appointments to schedule: the surgeon, the anesthesiologist, the cardiac care team. Maybe a doula, maybe not. The cardiologist had not heard of heart surgery doulas. I was welcome to handle my cares, he explained, however I thought best. But there was a great staff in the department, ready to answer questions whenever or however I decided to ask them. An FAQ on the subject, too, that patients generally found very helpful and straightforward. These were all things we could discuss at the next appointment too. I was one of seventeen patients she would see that day. As I walked out through the waiting room, a man with an oxygen tent was reading the new issue of Reader’s Digest.
