THOMAS LARSON

(River Teeth Volume 13.2 Spring 2012)

[Note: This 2012 publication carries some of the initial material for what became The Sanctuary of Illness: A Memoir of Heart Disease. This essay explores areas I didn't follow up on, with the book, and, thus, is quite different from the memoir.]

You Were Dying

You have to love this line from the Abbott Labs pamphlet on coronary artery disease, one of the parting gifts the charge nurse presents to you after you’ve had a heart attack: “The first symptom of heart disease is sudden death.” It’s among a flurry of statements about your condition, which, even though it’s only now materialized, you realize you’ve always had. Had you died, you would have had none of the secondary symptoms like agonizing chest pain and claustrophobic fear. But thanks to the cath lab and the cardiologists and your good fortune to be only a mile from the hospital, you didn’t die. You’re still kicking, albeit pinned between “it’s here” and “what do I do next?” One thing’s certain: you’ve been returned to your sense of wonder, now more sharply teleological than ever. The unanswerable questions start to queue. Is it possible to move before the bullet’s impact? Halfway from the bridge to the water, will your regret reverse the plunge? (Shouldn’t it be the first symptom of suicide is sudden death?) These indirections, which you haven’t had the luxury of contending with until now, initiate you into a new drama, the comedy of blood. You awake to the patient’s lot, which is to face (or not) this conundrum: as the language of treatment and recovery, of advice and afterthought, of lyric and lament claims to embody the disease, the disease, living on in you, articulates something else entirely.

Reading on, you find another of the pamphlet’s gems: “It is possible to have a heart attack”—and, I would add, die—“without experiencing any symptoms.” With that first attack five years ago, an assault thrust at me from within (the opposite of the knife my ex-wife once aimed at my gut), I drove myself—stricken, doubled-over—to Urgent Care where the cardiologist who stabilized me an hour later phrased it so: “You were dying. Did you know that?” I understood the statement, the question. I was thankful to hear him say were, which confirmed I’d made it. But did I know I was dying? In what way might I have known it? I sensed my death may have been happening, may have been approaching. And I suppose I realized I was dying. That’s why I rushed in for help. But in the moment I was dying, I didn’t know I was. The answer is no, I didn’t know that. I only knew it because the cardiologist told me I was. Ex post facto. So it doesn’t count, this (useless) adage that sudden death will kill you. It’s merely one of the disease’s more devious ironies. Despite what those “sent back: he’s not done with me yet” bestsellers say, I doubt there’s an afterdeath (the euphemism is afterlife) where you wake up and say, I just had a heart attack that killed me. I doubt there’s a heaven, or hell, or limbo in which you or I are judged or carry on. There is only what we project or predict about each of our ends.

I want neither. I want to experience my end as mindfully as I can. I admit that I’m as likely as you are to project some post-Earth Eden in which, even for a moment, I might awake to the magisterial inconsequentiality of my demise. Such mindfulness reminds me to listen again to the old Blind Willie McTell tune: “You just well to get ready, you got to die” and its refrain, You can’t tell the minute or the hour. Knowing well what you don’t know is a later, koan-like symptom of heart disease. You leave the hospital, arteries reopened, blood coursing again, with a new sensibility, whose vitality soon slips into despair—that you are more lost than alive, and this is how it’s supposed to be because your end-of-life childhood has just begun.

This is an excerpt from the 10,000-word essay published in River Teeth: A Journal of Nonfiction Narrative. Order a copy here.