But after all the tests I had during my second hospital stay, 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.”
I first read Yeats when I was a graduate student. In a seminar on the great modern writers, we read Yeats for months, everything he ever wrote, including the automatic writing that he said came to him from voices only he could hear. The teacher was dignified and ladylike in an old-fashioned way, with print dresses and white hair that looked as if she’d just come from a beauty salon, and it was unsettling to hear her discuss the more ribald passages of Joyce’s Ulysses. There were only three students in the seminar: besides me, an Indian woman who wore wonderful outfits, not saris, but trousers and long, embroidered tunics in bright colors—I would look forward to see what she had on each Tuesday and Thursday; and a woman who was married with four children and lived right in the neighborhood. She became my close friend. She continued her studies and went on to teach at Bryn Mawr and eventually to become the head of the English Department, though she did not look or dress or comport herself in any way like our original teacher. It was in this friend’s guest room that I discovered the mystery novels of Henning Mankell when I taught there years later.
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 mightily. 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. The 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 from possible death within the next couple of years. 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. And there was nothing terribly beautiful about how I looked just now. Ten pounds less does not qualify as “a terrible beauty.”
At one point I gave in to despair at my diminished self 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 flat and one-dimensional, in the same plane. I’m not ready to think in more planes than one, the most simplistic.
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 emails from my computer, which I used in bed on a special board my daughters got me that served as a desk. Deleting emails 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 the 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 their old addresses or at any addresses I was aware 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 visiting nurse and by a physical therapist. The visiting nurse took my blood pressure, asked me questions and entered data in her laptop. 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 classes, 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, that 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 as best as 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.
Before, I’d occasionally felt what I casually called depressed, but I see now that this was a misnomer: I’d been merely discontented or out of sorts, 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 very long. 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 onto 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, anxiety, depression. 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 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 that 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 plagued by uncertainty. I could easily have asked 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 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. Doctors 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 this 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 six 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 not especially ugly and hardly noticeable anyway. But when I see it in the mirror, I’m reminded that it was, for a few hours, a gateway of sorts. It is the mark of 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 when the doors opened. Some double 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. Of course; 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 in the chest in exactly the right position? Are the double doors of 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 all 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 from 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, newcomers 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 looked 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.
The last step in the dressing room was to attach the 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. A slim, dark-haired one 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. It was best to ignore it. Leave it to the professionals.
This Is Where We Came In Page 4
