Tori Malcangio
I am Ready. I am not Ready.
I show up to a post-op appointment I don’t have.
The cardiology receptionist tells me I’m three days early; I’ve confused the time and the date, an eight for a ten, or vice versa. I have no idea. Everything lately is upside down, flipped by forces that have down-shifted my ability to give a shit. After disappearing into the administration innards, she returns minutes later to say they’ll see me anyhow. I wait in the hospital’s glassy foyer modeled after a European airport terminal, the same foyer I entered ten days ago as a woman without an internal cardiac defibrillator, ICD. A woman who could hold a cell phone within six inches of her heart or play tackle football or walk through metal detectors without setting them off. A woman without a lump under her left clavicle roughly the size and shape of a deck of cards.
The cardiology tech, an older man coming up on retirement age, explains, through a clenched set of troubled teeth, that he’s going to check my ICD, run it through its paces, as if Seabiscuit grazes above my left tit. He lays a horse-shoe shaped magnet on my lump, explaining in a pediatric lilt that some patients don’t like this. It makes them a little anxious. No sir, a lot anxious. An ICD’s job is to shock my heart back into rhythm if it slips into a dangerous ventricular arrhythmia (for which it’s notorious) too often the culprit of sudden cardiac death. I fear a shock of course, the loss of autonomy, the altered aesthetics, the why-me shtick etc., but my aversion is hardly so granular. “I hate all of it,” I tell him. “Not just this.” Not just today. For years, I’ve been avoiding this scenario. Finally, after enough convincing (you have three kids, Tori; you could die, Tori), I agreed to the ICD. The tech’s non-reaction nixes any opportunity to vent about being in my forties yet outfitted with a contraption typically inside folks with great-grandchildren and cataracts. Instead, he cozies his hands on the keyboard like my son prepping to play Fortnite. “Here we go,” he says.
My heart picks up speed, an immediate quickening, no way to stop it. The complete loss of control probably akin to passenger-in-a-plummeting-plane feeling. He nods approvingly, taps again at his keyboard. My beats return to baseline. But I don’t. This thing is as deep-state as devices get.
I feel a feeling I’m not supposed to be feeling.
I feel dangerous. Or the device inside me does. Or it’s probably that I fear things I can’t see. Cancer cells. Rapists crouched in shadow. My heart. The lump itself is obvious, but what’s underneath the thin skin remains a mystery. Conceal and carry. Like a pregnancy, or a snake digesting a mouse, or the pistol tucked against the body of savvy spy Mata Hari, exotic Dutch dancer and courtesan turned WWI German espionage artiste. For the purpose of identifying with a badass metaphor, I imagine her weapon, her divine power. I imagine her entourage of doting military lovers, so many gorgeous European men and women. I do not imagine one of the twelve revolvers used to execute her by a Parisian firing squad.
My ICD is not a weapon. So sustaining, so safe, it shares vernacular with beans and soup. In cozy medical terms, my ICD is called a “can.”
Nothing to fear.
I’m supposed to believe this. A benevolent device scientifically modulated with only good intentions. The Switzerland of devices. So they say. It’s benign, the doctor promises, simply there to watch. Three months ago, pre-implant, I asked: Can the ICD in any way hurt my heart and make my arrhythmias worse? After all, hard-wired electricity implanted inside the body is a massive deviation from natural order. The doc responded as if I were a flat-earther sipping cognac on Darwin’s divan. Silly me. To boot, the procedure itself is as complex as changing a car tire. Okay, fine. Maybe then, the danger lies in the can’s role of exposing me. I wanted to remain undercover, a spy-kind of sick.
I’m about to tell a truth I want to be a lie.
Full disclosure, since the can was implanted four months ago, I’ve gone nowhere but downhill. A heart is not supposed to feel worse if it’s only being watched. I also prefer not being watched but my heart is a classic stoic and not at all self-conscious. My heart is way more Mata Hari than me.
Looking back in the doctor’s zombie portal, I discover a message I’d sent into the medical ether a few weeks post-surgery. I can’t walk up the same hills that I walked pre-surgery without getting breathless. Other weird symptoms: restless legs, dizziness, bloodwork revealing my liver (always a gold-star liver) is starting to fail.I’ve been making excuses with the same provincial authority as the doctors: all a new normal. Par for the course. Just me plowing through an awkward courting period with my galvanic guardian and once my body adjusts to the peculiarities of this cockeyed relationship, all systems will settle. Nothing to fear.
But I fear. I fear I know more about my body than anybody else.
I make an appointment for an echocardiogram, essentially an ultrasound not of a baby’s heart, but of the heart that once beat wildly to become a mother.
We are learning about catastrophe, but we are not in school.
We, my husband Paul and I, are in the heart failure doctor’s chambered room where everything is governed by cunning vigilance: an illustrated heart poster, computer apparatus, sanitizing gizmos, the biohazard box safely secured to the wall. Such hygienic precaution is unfeasible in the real world and so it rings with a folkloric vibe both villainous and redemptive. No, it reminds me of Western religion. Not surprising. My arrival in ICD-land required a convoluted act of faith—in science, in medical degrees, in expert opinions. There was no other way to save myself from myself. They said.
My echocardiogram as art. Exhibit 1. Artist: My 4rd grader
A mash up of technicolor in Crayola chalk, rendered while belly flopped on concrete, his arm outstretched to capture the full width and depth of his fourth-grade confusion. Red and blue mixing to fuming purple. Leaves and twigs and blue-bellied skinks and stupid math swirling in the vortex. Scrap paper and primary color moving helter-skelter. What is helter-skelter, he’d ask. A song and a feeling and a fate, I’d say. He’d tell me not to wash off his art, let the rain come. But it won’t rain for months.
My echocardiogram as art. Exhibit 2. Artist: Beethoven
Not so much a sonata, but an off-beat, tangled composition of fuck this and fuck that and where the fuck do I go from here? It’d be unlistenable, as alienating and sorrowful as the composer’s lackluster love life. As heartbreaking as his deafness. Though listeners might claim to feel the explosive cacophony, a messy fury, as if these terrible notes played a melody in their own hearts.
My echocardiogram as art. Exhibit 3. Artist: Van Gogh
An aura of buttercup yellow radiating from my tricuspid valve, the valve cozied between the right atria and right ventricle. Yellow because Van Gogh painted buttery auras, and not because of a splendid artistic impulse, but more likely a side-effect of his anti-seizure medication. Yellow because my heart flows in diabolical duress, like Dante’s Lethe River, The River of Forgetfulness from which souls drink to forget their past lives before reincarnation. Yellow because it’s not so much a river flowing in one direction, nor even a natural creation, nor water, but a noxious wafting gas. Like the Lethe, it can kill you, or due to its hallucinogenic properties, lead you to believe that the image on-screen couldn’t possibly be your own heart. Denial. Disbelief. Yes, hell is man-made which explains why the doctor is apologizing. So sorry. Not what he wanted. Not good. In the lower right corner it would be signed “Vincent” in cerulean.
My echocardiogram as art. Exhibit 4. Artist: Denial.
Maybe my echo was swapped for someone else’s? If it happens with newborn babies in hospitals, certainly it can happen with computer images, millions of them whizzing through the medical ether. Maybe what appears to be a wire intersecting one of my heart valves is a swizzle stick I inadvertently swallowed. Or a seamstress’s needle. Someone is trying to repair the rips and tears! But seventy percent of items sewn inside people after surgery happen to be surgical sponges. This is not a sponge. Or I have Morgellons disease and I’m seeing fibers growing inside me, soon to break through my skin and squirm like earth worms. Or this is all a galactic misread about to be cleared up by the doctor who shifts uncomfortably on the stool.
The doctor aims a pen at the grainy image on screen. He explains that one of the ICD wires, a lead (rhymes with weed), is positioned directly between the valve’s three flaps, called leaflets. Leaflets? Isn’t propaganda printed on leaflets? As a copywriter, I’ve written at least a dozen crappy leaflets to be passed out at trade show booths and fundraising galas. Yet my leaflets are vital flapping doors, the gatekeepers of circulating blood and oxygen. So much goes haywire if they misbehave, if for instance, the metal wire acts as a door-stop. My blood, oxygenated and deoxygenated mixes and stirs, flows hither and dither, neither satisfactorily forward or backward, but with the cyclonic mayhem of over-sugared preschoolers.
Turns out, I let the wolf into the hen house.
No, this: I’ve stumbled into an unauthorized alternate universe. I am an Amish woman who has escaped Lancaster County and for the first time I witness people using flashlights and driving. Dear God! The elders weren’t forthright about what truly goes on beyond my homestead. Carnage is what.
Three minutes later: I am handed a bomb the doctor has lit.
“I’m so sorry. This is not the outcome we wanted,” the doctor says again. He is no longer man, but steely robot reciting drivel from a medical text. If I held a hand to his fresh, poreless skin, I’d feel the tacky chill of fear.
I ask the air for this: Whisk me away to a writing workshop where someone is proposing a different plot. Perhaps don’t put these characters in this room? The instructor will gently suggest alternate scenarios. Maybe she’s at the vet with her dog. Maybe she’s on a date with a prick. Better yet, she’s in a job interview!
I look over to Paul. The scene grows edges, dimension, all the prickly contours of a reality that can’t possibly belong to me. He sits on the orange plastic chair pushed into a corner. He’s dressed as if from here he’ll be driving to the office. This is the first of many plans we’ll be trashing. We know this already.
This is not the outcome we wanted.
I question the we. How many conversations did we have about this potential risk? Zero. How much did you, doctor, share about the known and widely documented hazards of a lead intersecting a tricuspid valve and potentially causing massive leakage. Nothing. How many checkups, post-ICD, did we do to assess this risk? Not a single one.
Last week we celebrated our 20th anniversary. Paul gave me a lightning bolt necklace, gold that won’t grey like my first one. Real gold, solid as my anger. Does the doctor notice me touching it? Does he see how it so uncannily falls down the middle of my clavicle like the wire cleaving my heart valve? The leaky valve problem was a minor issue pre-can; on the scale of leakage it was categorized as mild/moderate, but has been aggravated to torrential. That’s the language in the echocardiogram notes and it’s exactly as it sounds: a severe storm. Not a natural progression, nor a result of love, loss, or stress, but a man-made aberration potentially larger than what they sought to fix—how long has it been?—eight months ago. I’ve given birth to a catastrophe one month premature.
“I can’t say if it will return to baseline after lead removal,” the doctor says. It, meaning the heart, meaning let’s strike the victim’s name from the record. Mata Hari’s real name was Margaretha Zelle. If I change my name, can I unbecome a woman with an outcome that we did not want?
“Yes, another surgery. And a little more risky.”
I believe nothing. A little more could very well be the guarded patois for no more walking. No more laughing too hard. No more hills or highs of any kind.
“What happens if they can’t fix it?” I mean more specifically, what if after this lead revision, this explant—what shall we really call it?— what if my breath becomes harder and harder to catch and it flees from me like a defiant child, then what? It gets hit by a car?
“We don’t want to go there,” he says, condescending, cagey, not someone I’d have chosen to oversee my heart. No delicacy. No humility. He’s donned the protective armor of an amateur physician who has entered a funhouse of unknowns and is forced to stare down the terrified face of one of his youngest patients.
“We do,” I say. “We do need to go there.” I want to tell him that where we go from here, will be up to me. You directed a series of wrong turns. I’m driving now.
“We’ve discussed this before,” he says, from condescending to defensive. I know exactly what he can’t say and I resent his lack of experience, his forcing me to do his dirty work.
“Heart transplant.” I say it as if admitting to lying, cheating, stealing, when he’s the criminal in the room.
He nods. Keeps nodding. His slight smile says good girl. Such a good, good girl. My doctor, the gloating tiger trainer, is pleased that his most stubborn lioness had learned to leap through the hula-hoop.
I show up for a second surgery I wasn’t supposed to have.
Abstract
Background: Implantable cardioverter defibrillator (ICD) and permanent pacemaker (PPM) lead placement may worsen or result in tricuspid regurgitation (TR). While the association between lead placement and the incidence of TR has been established, current understanding of this problem and the havoc it subsequently wreaks on the family of patient remains incomplete. This systematic review and meta-analysis seeks to pool one family member’s emotions (whom we call “Mother”) on the night before explant surgery (not to be confused with the Night Before Christmas when all the through the house not a creature was stirring, because on this night, Sunday November 5th, all the creatures are stirring and if you were to show up on her unlit street and hold an ear to the frosted glass of her front door, you would hear a cacophony of heartbeats). We will use existing evidence of prior stress created by Mother’s heart to better understand the severity of teen daughter’s (Daughter) emerging tears as she asks, “Do you think the doctor is nervous tonight? I mean he’s in charge of your life.”
Methods: A quick mind search is performed to identify all relevant assurances that this doctor is the best, and you should have met him because his demeanor was an Epsom salt bath and a quaalude. And he wore cowboy boots. Studies somewhere confirm that men who wear cowboy boots can not only castrate steer and build fences but fix hearts. Overall, five minutes are spent selectively tailoring responses to both calm nerves and assuage Daughter’s fears, a two-for-one that Mother spends the whole night processing alongside her dog Fern, until the alarm buzzes at 4:30 am. Analysis of the night sky slowly glowing up to day-sky confirms no epiphanies, as Mother tends to think this mega-metamorphosis should. On the drive, she twists the braids Daughter wove last night as she sat in front of Daughter’s floor mirror. “I taught myself on a Barbie,” Daughter said. “I’m sorry I didn’t teach you,” Mother said. Daughter said that it was okay, but Mother wanted to flip back the pages to her ten-year-old girl and teach her anyway. Mother said that if she’d taught her, Daughter would be a messier braider. Paul merges freeway to freeway. His compassionate silence allows Mother to extract and pool conflicting emotions: terror, anger, confusion, grateful the day of exorcism has finally arrived. She finds it compelling, unfair that the doctor who put in the ICD is not the one who removes it; like the cleaner at a murder scene, this second doctor is tasked with scrubbing and erasing someone else’s terrible decisions. The surgical table is a steel cigarette surrounded by leering screens; the one directly in front of Mother spells out her name center-screen, as if it’s her directorial debut or her welcome home from a long, exotic journey.
Results: Immediate patient emotion: partial relief. No complications. The leads slid out like a warm knife pulled through butter. The potential three-hour surgery only went an hour. No lasers needed. No bleeding. No open heart surgery. Couldn’t have gone better. But it could have. There’s no noted improvement toward a return to baseline. Right heart still severely dilated. Tricuspid valve still torrential. There was hope for small, but instant signs of improvement. The device itself has been sent to pathology, maybe to be swabbed for evidence of attempted murder. Mother can pick it up in two weeks. The can is gone. In its place, a large square bandage protecting a zipper contraption pinching skin together, asking for a repeat of its former mending. A thick black perpendicular line intersects mother’s chest; the tracing of where a knife would have cut through bone if things had gone south. Isn’t this enough? Worst-case scenario averted? Except that the lioness they sought to tame with the ICD, now feels more agitated and growly. It skips and blurts, paces and protests, speeds up only to bang against what must be the end of its chain and is jerked back inside the muscled walls of its crumbling kingdom. There is no telling who imprisons who, heart or human, only that neither can escape the other. The commonest form of anxiety post-explant: what the fuck next? The device Mother was implored to get, lest risk dying, is gone. She is sent home with a stack of stapled discharge instructions: avoid hot tubs and saunas for two weeks. Diet: low sodium and low fat.
Aftercare: For the remainder of the afternoon, lay on the couch with nine-year-old son Wyatt and watch documentaries on freediving. Who knew there were so many! These naysayers of death, dive hundreds of feet underwater, foregoing oxygen for like four minutes. Their heart rates plummet to a semi-conscious ten beats-per-minute. Their organs compress, vessels in their lungs burst, many black-out upon surfacing and require immediate resuscitation. The drama is addictive and sort of holy because they’re dead, and then they’re not. Mother notes that she was once only a marathon runner, only scraped the surface of risk. She never taunted death, not so arrogantly. At the end of one episode, a safety diver, the person who provides underwater aid to fellow free divers, dies of cardiac arrest after swimming his unconscious girlfriend to the surface.
Conclusion: Heart surgeons don’t get nervous even when a heart has been handed to them to save. If you hold an ear to the frosted glass of Mother’s front door you will hear the muted puttering’s of undetermined beginning, middle, and end. You will hear Mother’s parents say, I’m so glad it’s over. As if this is a cookbook ending. You will hear Wyatt explain his dreams of monsters coming for his mom. You will hear Paul hum the praise song he paced to while held hostage with his “visitor” nametag in the waiting room. You will hear Mother’s two teenagers making plans for the upcoming weekend that doesn’t bleed into another hospital stay, another surgery. For now. Further studies are warranted to evaluate Mother’s high (maybe unrealistic) expectations for a return to her abnormal normal.
Keywords: ICD; lead placement; tricuspid regurgitation; all the creatures were stirring; cowboy; daughter; sons; husband; the deep unknown; black-out; cookbook ending.
I see a heart surgeon who might not have a heart.
My situation is murky and fathoms deep and according to the heart surgeon on the Zoom call today, it’s also a super gray area. Brain gray? Thunderstorm? The sad griege of dead coral? We’re meeting to discuss open-heart surgery to fix the torrential valve, the final checkpoint before heart transplant becomes my last resort. I don’t qualify for a less invasive valve repair because the ICD damage is such that a tear-down is required, not just a remodel. Paul sits in the dining chair beside mine. Fern, behind me, is warm lumbar support.
The surgeon wears shipshape blue surgical gear, a head cover knotted at the nape of his neck, as if fresh off a transplant. This casualness is reassuring, a suggestion that who I get now is the same person I’d get in the operating room: assured, unruffled, slightly cybernetic.
He explains how surgery can potentially exacerbate my now struggling heart. A new valve asks a lazy heart that since the ICD has been pumping blood in any old direction to suddenly pump it correctly, in one direction, not backwards into the liver. My heart is a ramen-slurping pothead about to get kicked off his parents’ couch to go find a job. It might protest.
“Can you tell me why you’re so opposed to transplant?” he says. I try to mentally reroute the popping veins on my hands. Paul might not be breathing.
Did I hear him correctly? Do I tell him I feel opposition rattle my core like burrowing creatures can feel a future earthquake? Or did he mean to say, I completely understand your hesitation? Is he as grievously insecure as most of us and his question is actually: Why do you not trust me? This might be about whole-body surrender, where he’s too frequently the conductor and the conduit. I think this is also about the strengths of his body vs. the weaknesses in mine. Don’t I know that his educated body can save mine!
Maybe I should repeat the question as liars do to buy extra time. But he’s the liar. Or am I lying to myself? Do I not want my heart fixed? Am I in thrall to my wounds?
Through the Zoom lens, I attempt the cordial body language of someone not assaulted by apathy. I scrub and filter his inquiry, prepare to respond with solicitous bullshit. I must tread lightly. If I spare no candor, and point out his lapse in humanity, certainly he’ll recall the rub in the operating room while my heart is stopped and my five liters of blood percolate on bypass.
First, I cite my devout loathing of pharmaceuticals and the whole pill-popping creed predicated on the fantasy that humans are entitled to an everlasting pain-free, happy-rich existence. Which brings me to my apex fear, “I don’t want to be dependent on prescription drugs for the rest of my life. I’m not okay with just a passing-grade quality of life.” He pushes up the headscarf, nodding as if to pacify a child who has just shared that monsters live under her bed. Later in the visit notes, my improperly articulated fears will be cheapened to: patient opposed to transplant because of medications.
I am dodging questions I should not be dodging.
Wyatt and I explore our neighborhood at dusk. He’s on his hand-me-down bike and I’m walking. Unprotected. If my heart blows, I don’t have the ICD to save me. But the ICD almost killed me. Is this irony, a shitty consequence of medical arrogance, or just the most harsh reminder that doctors are imperfect humans like the rest of us who occasionally make enormous human mistakes? The blushed clouds to the west are whipped into a celestial meringue. Beauty, I heed your warning: just a few degrees of digression and you boom into thunderheads. My neck thuds following a mild incline in the sidewalk. Wyatt pulls ahead, skids to a stop, and turns to face me. I feel him assessing me, my heavy breathing and geriatric stoop. All three kids are doing this lately. Side-eyeing me. My little spies.
“You’re forty nine?” he says when I finally catch up. I nod. I worry he’s doing complicated mortality math; the kind of calculating if I’ve lived enough years to die satisfied. “You think you’ll get older, Mom?”
“I do.” I don’t. I do. I don’t. I do. I oscillate daily, hourly, between knowing and not knowing; certainty of any kind rings with naïveté or gloom. If heart valve surgery isn’t successful, my name will likely be added to the heart transplant list. Yet, I understand the hardline concessions one makes on quality of life with a transplant, and have decided it’s not for me, the former athlete, the tiger trainer of her own fierce body. How do I carry on as a lessor version of me?
“Watch,” he says, “I taught myself how to do this.” He pedals ahead, hands off the handlebars, wobbling into the brisk headwind, screaming, “I think you’ll get old too.”
His heart is not the heart he was born with.
Weeks ago, the cybernetic surgeon gave me a list of heart transplant patients. He evangelized post-transplant triumphs of marathon running and pregnancies and life blooming not wilting. I need to have a definitive answer to transplant if say, I come out of surgery worse and lay in bed on life support. I know my answer, but Paul says that he and the kids need a different one. Try again. He hopes my obstinance will bend to the idea that life, however skewed, just life itself, just breathing, should be good enough.
I was nervous even texting him, but tonight is the real deal: a meeting between two total strangers with contrary points of view: heart transplant recipient and heart-transplant skeptic. I spot Mike immediately. He’s sitting on a concrete bench outside the pub where we agreed to meet. I wave to him, he stands. We hug. I think we hug. Or I may have offered my hand remembering the life-long immune issues.
Mike has fair, freckled skin, a thick auburn beard (same color as Fern) and a serene kindness I sense isn’t transplant residue, but has long been a character trait, one that buoyed him through leukemia at eighteen and a subsequent heart transplant at thirty-two-years-old, six years ago. The chemotherapy destroyed his heart. Another case of medicine’s duplicity, a topic we’ll cover later on, him with more restraint than me.
We sit on the patio. Appetizers arrive, the delicate foodstuffs of encounters not to be complicated by big food. Conversation begins to flow immediately.
Before he tells me who his donor was, I know. I Googled Mike Cohen; he’s a legend in the transplant community. Thirty-two-year-old James Mazzuchelli, a U.S. Navy flight surgeon, was killed during a training flight at nearby Camp Pendleton. Before he was old enough to drive a car, James told his parents he wanted to be an organ donor.
One year post-transplant, Mike pedaled his purple road bike over two-thousand miles from UCSD where the transplant was performed to James’s burial site in Florida. At Jacksonville National Cemetery Mike dismounted his bike and walked toward the grave where James’s parents stood in full sun. They’d never met in person, but when he finally hugged them he said he felt he’d know them his entire life. He unzipped his jersey. They took turns pressing a stethoscope to Mike’s chest to hear their son’s heart beating.
Under the warm glow of patio heaters, our food picked through, he tells me he never liked pizza, hated it until he got James’s heart. Turned out, James loved pizza. That was the only thing they did not have in common; from heart size to antibodies to age, they were an improbable one-hundred percent match.
I ask Mike how often he’s aware of his new heart. “Not a day goes by that I don’t think about him. I never feel like I’m making a decision just for myself.”
He says, “James keeps me going. I want his parents to know that all the adventure that lived in their son, is alive in me. I’m guarding his heart with everything I’ve got.”
I realize as we’re leaving and making plans to keep in touch, which we do, I realize I have more questions. I realize I may have been too in awe, and awe being a formidable hallucinogenic, I lost touch with the fears I wanted him to alleviate. Maybe he did. Maybe all it took to get me seeing a transplant in new light was, “My old heart was like a two. James’s heart is a ten.”
I lie in a bed I do not think is a bed.
It’s a launchpad. I feel the warming idle of engines, plumes of steam breathing into the atmosphere, a collective tremor rippling out to my parents and Paul waiting their turn to see me off. Will I fly? How long will I be in orbit? The dark side of the moon. No side of the moon is actually dark; dark in this sense implies “unknown.” It’s certainly not dark in the cardiac surgical room I’m about to enter either, but nothing could be more alien.
Everyone eventually makes it behind the tawny curtains to sit with me in the pre-op bay. A nurse in cahoots with our dodging the one-person-rule, slips in an extra chair. Dad and mom and my visiting brother Kevin (an anesthesiologist and professional keeper-of-peace) and Paul come in and out. Wyatt is the constant galactic sun around which we all spin, and he remains in the bed with me, his side rail clicked into place by the same accomplice nurse. Each peeks in first, announces themselves, smiles, approaches, takes my hand or squeezes an exposed foot, assuring me with their upbeat auras that they’re scared as hell. Their tired faces—I want to apologize for dragging them here. It’s bullshit that my life is upending theirs, that if you asked each of them what they’re thinking, my name would dominate. We’re thinking, if Tori’s heart doesn’t make it through, please give her the heart of Greek goddess Artemis, protector of women. Minutes after her own birth, she helped deliver her twin. Years later, offended by the aggressive gaze of a hunter, she turned him into a mangy stag. That heart, how do we get her that warrior heart?
I need to embrace #grateful in this moment, the 21st century antidote to distress. To a heart about to be disembodied and go on bypass. I am grateful for Wyatt’s toes grazing mine. Grateful that we’ve watched enough death-defying documentaries for him to equate risk with reward. Grateful that Kevin knows my anesthesiologist (the serendipity!) Grateful that I still have enough faith in the medical system to trust this new surgeon (not the cybernetic). I am grateful that he parts the curtain just as I begin to flood with realization of today’s truth: I won’t know if I don’t wake up. I’m grateful for his warm hello and Italian elan, as if we will be breaking biscotti in Venice’s Caffè Florian. I am grateful for not taking the sedative Versed offered to me before entering the surgical suite. The nurse can’t imagine why in hell I’d want a clear head. Are you sure? I’m sure. I like to see where I’ll be sleeping. What I mean is: You can’t know more than me. What I mean is: Mata Hari refused a blindfold at her execution. She wore high heels and a fur-lined coat. She blew a kiss to her executioners and said, “I am ready.”
I wake up to a reality that is not a ten.
It’s not a number. It’s a perpendicular sternal incision the length of my forearm and knit together like a renaissance-festival corset, and soon it’ll turn the purple of fairytale sunsets, of romance-novel prose. It’s a hospital room big enough for the three kids. Wyatt is still here and my teenage daughter and son arrived today. Just the three of us. My dad is at the gym attempting to parlay the frightening deterioration I’ve caught him eyeing in these long, moaning halls. Paul, I don’t know where Paul is, perhaps avoiding the inevitable rifts when all three offspring convene in the same space. My mom is trying to escape the trauma pressure cooker, and, I hope, is reading historical fiction in the Los Angeles sunshine.
“I can’t see your scar,” my daughter says. I suppose she wants to assess how wildly different my body is from hers and therefore safely removed from whatever got me.
“Not a scar yet. Still a wound,” my oldest corrects. He’s come dressed in his finest faded t-shirt and torn, paint-splattered Carhartts. He doesn’t paint. My daughter dons the uniform of the recently scandalous: a teeny tube top and man-sized sweatpants.
Wyatt is blowing up blue latex gloves, bopping and batting at them, knotting a festival’s worth to the rails of my bed. It’s an anxious, frenetic energy the other two can’t tolerate even under normal circumstances.
“Can you stop that, idiot?”
“What are you, retarded?”
I correct their insults with an injured gentleness I think scares them more than yelling would have. My daughter gently sits on the foot of my bed, strokes my socked foot. My older son trust-falls into the reclining chair that is my upright respite for a few hours every day. They want to know why it’s so depressing in here. If I’m sleeping. Does it hurt, what they cannot see, does it feel as bad as they imagine? No, not really, just uncomfortable. Tightness. Restriction. A sensation of major disassembly and repair that I can only explain as a shattered vase glued back together. No painkillers, just Tylenol. “Not because I’m trying to be tough, but it really isn’t a level of discomfort that needs narcs.”
“You are tough,” Wyatt interjects. His brother and sister roll their eyes. His earnest, fourth-grade adoration of me, I suspect, might be something they miss in themselves. “Well, she is.”
“Well she is,” the oldest parrots.
“Shut up, asshole.”
“Oh, big boy words from the eight-year-old.”
“I’m nine now, idiot.”
“Enough you guys. I cannot believe—” I’m addressing my oldest who is executing his strange new hair ritual; a fluff-into-his-eyes gesture that is one-hundred-percent contrary to the concept of tidying one’s appearance. “—I’m disciplining right now.”
“Figured you missed it,” the oldest says. A sweet, wounded laugh, caught between sensitive son and dissonant boy-adult.
“Just shut up, both of you.” My daughter, a suddenly sophisticated creature, pulls her smooth legs onto the bed, moves in tighter as if to guard me, an ailing cub, against the circling hyenas.
I host a guest in my body that was never cordially invited.
My anesthesiologist pays me a visit. Anesthesiologists are typically the first and last people seen during the pre-surgery hour. Rarely is there follow-up. But this physician has become an instant friend by virtue of her connection to Kevin. Everyone loves Kevin.
“Hey guys,” she says. Late day and still in scrubs, her cheer suggests she’s one of a select few who love what they do. The kids and Paul are in the room. My parents are likely out hunting and gathering for me; whatever they sense I might need now or in the near future, they seek and procure in this grimy metropolis.
The doctor asks how I’m feeling. Good, I guess. A little queasy, but alive. I’m cautious with reportage; don’t dare set the bar too high. The universe might read it as antagonistic: There she is gloating in good health; let’s strike her down again.
Paul asks if she saw the new valve, like working, after the surgeon had sewn it in.
“Oh yeah. You guys want to see it?”
She’s pulls up my inter-op images on the computer, effectively the live echocardiogram performed during the seven-hour surgery. Grainy cryptic, as shadowed in suspense as a pregnancy sonogram, she drags her forefinger over the screen, outlining the contours of my heart.
“There it is. The new pig valve.” She says it like: miracle! Like, look at my art project!
The new valve shuts completely. The leaflets meet in the middle, a diplomatic shaking of hands, the closing of iron gates in a pretentious neighborhood. The blood flows as it should, no more river in reverse snubbing the laws of nature. Can I stare at this tiny wonder? Or will any attention spook it, like the kids sneaking up on a seagull only to send it flying off?
“Can we hear it?” Paul asks. My damaged valve sounded sloppy, someone slurping spaghetti through a toilet paper roll. But this is a snap-shut, snap-shut, a sound filled with the earnest determination of a new-hire trying to make a good impression.
Paul wants to know if the surgeon had to stop my heart to sew it in. No, he didn’t, she says. Only the most experienced surgeons can operate on a beating heart.
My God, we say. Paul and I, a chorus of relief. We look at each other as if to acknowledge a joint triumph, the same astonished, exhausted faces we’d swapped at countless marathon finish lines. We did it, but how exactly?
“He didn’t remove the old valve, but sewed in the new valve over it,” she explains. A blended family situation: two distinctly different entities shouldering the burden.
I cry. I didn’t expect to feel anything toward a valve, but I do. I feel maternal. I want to nuzzle it, feed it, teach it how to hold a spoon and sign please and thank you. It appears sentient on screen, a winged creature laboring on my behalf. These fluttering slivers of flesh once performed the same feat inside a pig, allowing it to root and wallow and now it’s inside me, revived and acclimating to my humanness. I vow to never again, never, eat the kids’ bacon scraps.
“Do you see that?” the doctor asks the kids. We pause the revelry to stare at sausage-shaped objects moving in no discernable pattern. Earthworms? An amoebic infestation? Maybe we celebrated too soon. Story of my life. “Those are the surgeon’s fingers on your mom’s heart.”
“Hands?” one of them confirms.
The kids’ faces, I want to freeze them here. Is it the sweet awe of watching fireworks or the shock of seeing inside your mom while losing sight of her, the her who was never supposed to reveal herself to you in this way, so remote, so delicate, so not the her who sops up vomit and expresses the dogs’ anal glands and screams don’t use my bathroom and if you leave the goddamned doors open again—?
The room swells in unasked questions. I suspect Wyatt wants to know if the surgeon washed his hands with soap. The other two are probably wondering what it would feel like to run their own fingertips over a beating heart. Wet velvet. A live hatchling pulled from an oil spill. I want to know how I’m alive right now while watching a black-and-white film about my near-death. How is possible to travel between two contra-consciousnesses and arrive back at the correct depot? I surge with similar wonder for migrating birds and my iCloud storage, but this is uncharted WTF territory. In the cannon of magnificent moments, even childbirth has been outdone.
I say better but I mean heartbroken.
My cardiomyopathy is not cured, was only hastened by those itty leads intersecting the valve. Nothing to fear. Except maybe a premature expiration date. Smiling executioners.
My new valve has a body-life of about seven years. I imagine it turning flaccid, then threadbare, its snap-shut declining to the half-assed state of a door wedged open with a sock. I bet the pig whose valve I have wasn’t even seven when she died. Unfair that I get to use it longer than her. Was she killed humanely in a private, soundproofed paddock so no other pigs could see or hear or anticipate their own end? Did she squeal and protest in terror, as these wise creatures do, on her way to slaughter? I want to believe no. I want to believe she simply uttered, “I am ready.”
Meantime, maybe nothing will change and my heart will continue to cruise janky and defective, but as is. Or B-side: my right side balloons into a three-fisted superheart. It’ll be so cartoony swollen, it’ll qualify for “Yo’ Momma” jokes. Yo’ heart so fat, it’s got its own zip code. So big, I’ll become a black hole, a siphon universe wherein I get pulled into my own heart and go to die there. Not because of my heart, but with it. With compassion. With mercy for grand human error.
“What if you don’t pick me up?” Wyatt asks one day. We’re driving to baseball practice. A gob of dill-pickle sunflower seeds bulges his cheek. My chest scar is at the months-later phase of vaginal pink and bone-tender.
“Of course, I’ll be there.” He stares out at the blur that I suppose is more blurred because of me. I finger the white elastic bracelet he fashioned from a face mask at the hospital. After tying one on my wrist, he tied one on his. We’re twins, he announced. True. We’re both unsure how this year will unfold: smoothly or in recurring scenarios of health scares and fixes? Dear universe, grant me omniscience. Help me help him believe that mothers with bad hearts are mothers who still show up.
“When will you get me?”
I tell him one hour. I tell him that I’m actually staying in the parking lot because I’m a weird mom who writes in her car. What I want to tell him is how erratic our hours and years truly are; they expand and contract with fickle indifference. A heave-ho, inhale-exhale dynamic we’re only allowed to admire and resent from a helpless distance. Everything is fingers on hearts: one part supernatural, one part providence, one part ruin, one part holy shit. Every day, my love, we feel our way through a four-chambered wonder.
Tori Malcangio received a journalism degree from Arizona State University and an MFA from Bennington College. Her prose has appeared in Missouri Review, Conjunctions, Best Short Fictions 2021, Glimmer Train, Cincinnati Review, McSweeney’s, and more. She is the winner of the 2023 Missouri Review Jeffrey E. Smith Editors’ Fiction Prize, William Van Dyke Fiction Prize, American Literary Review Fiction Prize, the Waasnode Fiction Prize, the Cincinnati Review Fiction Prize, and the Lascaux Review Short Fiction Prize. “I am Ready. I am not Ready” is an excerpt from her memoir-in-progress, MY HEART IS A BOMB.