Two tomorrows arrived and faded and the chest tubes remained inside of me. The pain was overwhelming, leaving me desperate and weak, and the noise from the nurse’s station just outside my door made me too anxious to sleep so I stared out the window to the tops of the trees of Central Park. I could not see below; it looked like an expansive forest canopy and I longed to stand beneath tree branches again, swore I would be content to gaze upon the underside of a leaf just one more time. Closing my eyes, I tried to conjure the smell of spring green grass pushing up far below.
It was now day seven: two days past the day they said I would be discharged, now I would certainly miss my friend Sue’s wedding. So distant—it seemed odd now that I ever thought I would make it. In the afternoon a friendly Physician’s Assistant entered my room, grabbed the larger of the chest tube boxes that was still filling with reddish-yellow fluid, shook her head and said, ‘The chest tubes will come out today. If we leave them in any longer, you’re at risk of an infection.’
I tried to hide my excitement—they had talked of removing them every day since the operation, but this time, within an hour the PA returned and was preparing for the procedure. While she put on gloves and arranged a tray with some equipment, she asked me about Boulder and expressed envy, saying she had always wanted to move there. As we spoke, I had a flash of hope that this was the beginning of my release from the hospital, which implied I might actually make it back to Boulder, a thought I had kept distant, pushed to the periphery of possible.
‘This won’t really hurt,’ she said sitting in a chair in front of me, where I was seated on the bed. ‘It just feels funny.’
‘Hold your breath.’ Then she yanked hard on the tubes. It felt like a snake was writhing inside my chest, taking small bites of flesh on his way out, and then the PA held up the ends of the tubes before my face. They were out. Two holes below my small breasts gaped open and through them, I heard gurgling noises of my own insides. I stared at them, unnerved.
‘Okay, now breathe,’ said the PA.
I obeyed but nothing happened. I looked confused at the PA whose eyes bulged as she asked, ‘What?’
I could not breathe. I gasped. I tried again, but though I tried to move air through my lips, it hardly seemed to do anything.
‘Oh, no,’ the PA grabbed a pager frantically and said to me, ‘Keep breathing.’
I stared at the wall in front of me, fighting for breath. While the PA was on the phone, nurse Maggie rushed in and listened to my lungs with a stethoscope. Her face was long and as she stood up she placed a gentle hand on my shoulder. I was managing weak, shallow breaths, but something felt very wrong.
And on this day, Dr. A was the one to appear. His name sounded Middle-Eastern, he was dark-skinned, dark-haired, brown-eyed, tall, solid, with a shaved head, sharp metal glasses and an implacable accent. The surgeons made rounds, so a couple times per day I would open my eyes from slumber to see a cluster of white coats at the foot of my bed. They were all male and I would feel a tug of my hand, as if it wanted to lift to fix my hair, before I realized I was too tired and they didn’t care at all. The doctors intimidated me. When they entered the room they carried an air of authority that filled the space, making me see how small I was, and I shivered inside to know each one could see something, disapprove, and wave a hand that determined my fate. But no one had said much else than, ‘She’s doing well.’ I hated to think about the patients who were doing poorly and swallowed hard, even more, the pain.
Dr. A had been ignoring me for days, since the moment I first remembered seeing him. He would appear, talk to other doctors, nurses, look at my chart, look at the machines that held part of my life force, but barely graze my eyes. Once, he even turned his head to look out the window rather than meet me after I said, ‘The chest tubes hurt a lot.’ I had always felt like I was boring him, irritating him, so I tried to be quiet and complacent.
And now he stood at the foot of the bed, towering over where I crouched forward, gasping. His face was mixed with disgust and pity and I hoped the repulsion was for my condition and not myself, but I couldn’t tell yet. He listened to my chest with a stethoscope and a frown, and he ordered Mike, the x-ray tech, who entered, followed closely by Dr. V. I tried to gaze past them at the treetops, gasping in weak, ineffective breaths. Before Mike left the room after taking the x-ray, he squatted in front of me, placed a hand on my knee and looked up into my eyes. ‘Hang in there,’ he said, ‘and I’ll bring you a pair of those pants in extra small.’
The smile had been wiped from his face, his eyes pleaded with me when he said ‘hang on’, and I could tell that today he would not be calling me the luckiest girl. Mike’s face was the greatest indication I had that something was seriously wrong. I didn’t have enough air to speak but I tried to nod.
The room was crowded with medical people talking to one another. Dr. V was checking his watch, asking, ‘when did it happen?’ I heard Dr. A explaining, as though through a thick curtain, that my right lung had completely collapsed because there was too much fluid, and that pressure from the same fluid could cause my other lung to collapse any moment. Jonathan, who had briefly left the room before the tube was pulled, entered into the chaos, immediately kneeling beside me, staring at me as if he could will me well. I watched his chest move with breath, tried to imitate it, tried to calm, while the monitors behind me showed that my heart was in distress, that there was no time for anesthesia or comfort, and that they were about to insert a tube into my already-insulted chest without painkillers. Metal instruments were delivered, the surgeons put on gowns, and a large drape was thrown over me as they had me lie back on the bed.
Mike hustled back in with the x-ray results, and the diagnosis was officially made: a complete pneumothorax. Dr. A threw a blue paper sheet over my body that fell draping my head entirely as well. ‘A—!’ Dr. V cried. ‘She’s awake.’
And Dr. A pulled back the top part of the sheet to expose my face. The confusion as he looked at me reminded me that he was not used to conscious patients. He fiddled with my gown, drawing it up to expose the side of my rib cage, but realized my right breast was exposed as well, so he pulled the gown back down and it fell, covering my side. He told me to raise my right arm over my head, which I did and he tried again, but again the gown fell. I reached across my chest with my left hand and yanked the gown away, exposing both breasts. He looked at me and I met him with a stern gaze. Lying down like that, I could barely breathe at all. Despite the urgency, human thoughts swept my mind in a flash. I saw his wife, at home, dark and accented like he was, more demure in public than most American women. She wore a headscarf and loose, western-style clothing. I understood that because I was a woman, conscious, and could look him in the eye, while my nipple stared him down as well, it seemed indecent to him. Even though that right breast had fallen down and to the right, sagging off awkwardly, disconnected from me, and tape and bandages covered most of my swollen torso. I didn’t feel like a woman. I barely felt human. And besides, I desperately needed him. He was the man who was going to save my life, and there was no modesty in that, for either of us. I knew he must be a brilliant surgeon because he was young and arrogant and at a prestigious hospital, and I needed that ego to assert itself and execute perfectionism.
They circled me: the PA, Nurse Maggie, Dr. V, Dr. A. I understood that they were the ones who might watch me die, and I saw God in their eyes, as they looked upon me with such kindness, even in that wretched body. I turned my head away from Dr. A and what he was about to do, but there was no elephant head on the ceiling in this room of the step-down unit. Someone closed the door to the hallway, my eyes floated down to the PA standing at the foot of the bed, arms crossed, frowning, watching my face, contorting her features in sympathy. I didn’t want to punish her, so as Dr. A pushed the tube deeper between the muscles, scraped a rib, and I felt a tugging and pinching deep within my chest, I clenched my jaw so tightly the pain sought another avenue and tears streamed from my eyes that felt like they might burst outwards. So I arched my head farther back and to the left—a movement I had done before celebrating a moment of ecstasy, but here I was actively trying to wrench my own head from my body. The muscles, tendons, and ligaments on my neck pulled at my chest and its fresh scars, my eyes rolled back, looking for a way out, and I felt a raspy scream pass through my lips.
As my head rolled back farther, the ceiling above me opened up, through all the floors above, to the blue sky and a giant eagle descended, gripping me in its talons, and carried me up, through the roof where I felt cool fresh air dry my wet face, soothe my soreness. I hung weightlessly below him as we gently soared towards Central Park.
‘It’s better out here, isn’t it?’ he asked.
‘Yes. Much better,’ I whispered.
‘I will take you to a treetop. I will place you there and you will look below at the trees and above at the sky.’
We were soaring above the city. ‘I want to go to that tree,’ I pointed to a branch that reached much higher than the others around it. I had watched it from my room, tall, swaying high above, reaching southeastward, bowing to the ocean.
He placed me delicately in a crook of the bow and I leaned back against the bark, smelled the scent of the green leaves. I rested for a moment before opening my eyes, as the eagle was flying away. Vultures had already begun to circle just above me. ‘Am I here to die?’ I asked its receding image.
‘That is up to you.’
‘We’re going to turn the suction on now,’ Dr. V said. ‘It’s going to make you cough and that will re-inflate the lung. Are you ready?’ The way he looked at me so intently, I was not sure what I was agreeing to when I nodded.
Instantly my entire body was wracked with spasm. I began a violent coughing fit, in which I gasped desperately for air. As my body thrust forward, I thought my sternum would explode and felt the muscles on my right back and surrounding the insertion site of the tube spasm and not release. By the time I was done, my gown was at my knees, my face was covered in tears, mucous, and saliva, and I was hunched over to the right side, around the tube, unable to move.
Dr. V and Dr. A stood over me looking down at me with pity and self-loathing, although they had just saved my life. Dr. V said, ‘This tube will come out in forty-eight hours.’ He paused before adding, ‘If everything goes okay.’ He looked at his phone and went to the door, while Dr. A still stood there. I craned my neck to look up at him from my contorted position. My skin was sallow, pasty gray, my eyes were sunken with black rings around them, my body clammy with sweat, my hair a matted pile on top of my head from a week of not being washed, my gown fallen to the waist, revealing emaciated arms bruised from needles, a bandage on my chest that eclipsed my breasts, the rest of my swollen torso covered in bandages, tape, and electrodes, and hunched over to the right side.
I could not straighten my torso, so I twisted my neck to look him in the face as I said, ‘You,’ I whispered in my hoarse, haggard voice.
I took a deep, labored breath and then fixed his eyes and from my slumped position commanded, ‘You will pull it out.’
He bowed his head and said, ‘Yes. Yes, I will do it.’
Then my head dropped into my hands. I was a wilted, defeated heap. His hands reached towards me as though to comfort me or perhaps pull my gown up to cover me. But then he thought better of whatever the action was intended to be and folded his hands behind his back. He stood there a moment, but decided not to say anything, and then hurriedly left the room.
Winter. Hands, even mouths, are cold. Movement is flat-footed walking like penguins over ice. Skill looks precarious, delicate, awkward. Perhaps I didn’t stand out as much as I thought.
Mostly unemployed and busy with doctors, I decided I might as well get a teeth cleaning as well, since it had been a long while. I made an appointment and, as always, mentioned that I had been diagnosed with mitral valve prolapse as a child. The receptionist informed me that the standard protocol of premedication with large doses of antibiotics was no longer considered necessary. I just needed a note from my doctor approving that.
With new insurance, I made an appointment with a primary care physician, Dr. M. He perused my medical information, wrote down the long list of doctors I was seeing, listened to my symptoms, nodded, winced, raised his eyebrows, and then asked me to hop onto the table for a brief physical exam.
He checked reflexes, had me show him where the pain was, and then pulled out his stethoscope and put it against my chest. As he leaned back, pulling the knobs out of his ears, placing them on the sides of his neck, his eyes seemed to be popping out of their sockets as if trying to leap into my field of awareness to impress something upon me, as he asked incredulously, ‘When was the last time you saw a cardiologist?’
I shrugged. ‘Never.’
He shook his head in disbelief. ‘You need to see one. Soon.’
I sighed and rolled my eyes. It seemed that doctors loved other doctors and once you started on the train, they just kept pushing you farther down it, referring, rolling you into the next inevitable step.
‘You have what we would call a very loud murmur,’ he said, before turning to type the referral into the computer. ‘And no, I am not approving you to see a dentist without premedication. Not until you see a cardiologist.’
By the time I made it to the front desk to check out they were able to set up my appointment with the cardiologist for the following week in East Boulder.
It was a Friday and I had scheduled the appointment to have exactly one hour before I needed to leave. The medical assistant put electrodes on my chest and ran an EKG and then I sat in the quiet west-facing room, looking at the mountains. I was remembering how my ex-husband would place his head on my chest, listening and tell me I had a ‘squeaky heart’. In acupuncture school everyone had noticed that my pulse was irregular, but I had heard that was normal with mitral valve prolapse. I ran up mountains. I broke the ski trail. I had ‘bionic lungs’ my backcountry friends were always telling me. I hadn’t seen doctors throughout my twenties because I was beyond healthy. This was silly.
The door slid back and a tall, energetic, young doctor walked in. ‘I’m Dr. S!’
A baby-faced boy hovered behind him and Dr. S said, ‘This is Gary. He’s a medical student. Alright if he sits in?’
‘So, you’ve had a heart murmur since you were kid?’ he asked, as they both sat down.
‘Been following up regularly with a cardiologist?’
‘Well, let’s listen.’ He leaned forward, placed his stethoscope over my heart, increased the pressure, moved the metal piece up, down, and to the side, then leaned back and asked me, ‘Okay, if he listens?’
Dr. S waved at Gary. ‘You should listen to this.’
I smiled and joked with him, ‘So, Doc, do I need a heart transplant?’ He smiled a little but didn’t laugh.
When Gary was done, Dr. S said, ‘We should get an echocardiogram.’
I shrugged. ‘Ok.’
‘Today,’ he said.
I glanced at my watch. ‘I only have half an hour.’
‘That’s okay. We’ll get you in right away.’ With that, he hopped up, slid the door open and spoke with some people. Then he returned and ushered me to the room next door. ‘This is Carrie. She’ll be doing the echo. I’ll come in to read it with you when you’re done.’
The gel on the tip of the probe was cold and it gave me goose bumps. I didn’t like the way Carrie had to press hard against my ribs and dig into the flesh of my breast. My instinct was to pull away but I took a deep breath and tried to muddle through, hoping it would be over more quickly. The machine made noises as bright patches of green, red, yellow, and blue flashed on the screen.
Carrie didn’t speak and after less than fifteen minutes she stood up and slipped out the door, while I wiped the gel off my chest and dressed. I had my shoes tied, my sweater buttoned, my scarf placed, my sunglasses perched on my head, and my shoulder bag dangling from my arm by the time Dr. S entered. He sat beside me, looked at the screen, pushed some buttons that made the screen move with flashing colors and noise.
‘Yeah, you have mitral valve prolapse,’ he said.
‘See here: the valve isn’t closing all the way.’
‘And see this blue? That’s where you have some regurgitation.’
‘Hmmm,’ I said, adjusting my scarf.
He leaned back, crossed his arms and looked at me seriously. ‘You need heart surgery,’ he said.
I was still clutching my bag as if I were about to leave. My mouth opened, no words formed, and it closed again. He said some more things that I didn’t hear and then handed me a card and said, ‘Call me this weekend if you think of any questions.’
I drove home, west towards the mountains, the sun hiding behind some gray clouds stuck to the peaks, but breaking through gloriously to light up patches of the Rocky Mountains. My mouth was pursed, my jaw was clenched, my eyes squinted behind the sunglasses, furrowing the place between my eyebrows. My right hand gripped the steering wheel while the left elbow propped on the door and absentmindedly scratched my head. I wasn’t thinking yet. I was just driving.
I called my mother that night and told her. ‘So when will it be?’ she asked.
‘Well, I have to decide first.’
And the following day, Saturday, sitting in the sunroom with Jonathan, who asked questions and I replied, ‘I still have to decide.’
‘Decide what?’ he asked.
Someone said they had to cut open my heart. I had to sit with that, feel it, imagine it, allow myself to acquiesce. By Saturday afternoon I had questions for Dr. S so I called the number, left a message and he called back right away.
‘I thought I would hear from you,’ he said.
‘I was in shock, I think.’
‘So, I’ve had a cough for a while. A dry cough. Could that be related?’
‘It could be congestive heart failure.’
‘And if I don’t get surgery?’
He sighed heavily, audibly. ‘It’ll just get worse. It won’t go away. It’ll get a lot worse.’
‘And if I wait too long to get the surgery?’
‘The heart muscle could get damaged. Irreparably.’
High dry alpine climate crushed the tulips in snow when they wanted only rain. Dandelions retreated on themselves in another spring storm that forgot to show in January. I am made of petals too—each year, fight the elements. Usually lose. Flowers on a rocky outcropping tell me that delicate things can survive a gale.
Things began to make sense. This diagnosis took so much of what my experience had been of late and threw it under a heading that explained it all. Since the car accident I had been looking progressively worse. By March, when I met Dr. S, my skin had become pasty gray and my eyes were sunken with dark circles around them. I was thin, and thinning. And breathing had been difficult. I had noticed it on the periphery, but so focused on recovery from brain injury, I had pushed it aside and chalked it up to recovery from the car accident. When I would walk up the stairs to our second-floor apartment it always felt labored and difficult and I was winded by the end. But I was less active than I had been my entire adult life, so I imagined this is what it was like to be out of shape, a novelty for me.
The ‘aha’ illumination moment came when I reflected back on November, when Richard had taught the pranayama workshop. I remembered how much I had hated it. How any restriction and modification of the breath had made my chest feel heavy and I would gasp for air and cough. Everyone else had seemed so placid. Now I understood. The left side of my heart was failing to pump blood through my body, which meant that my lungs were full of blood that had nowhere to go. I was drowning in my own body.
And there was a cough that had been developing over the past two years. At first I had only noticed it at altitude, but in the past six months it had been more persistent. Busy with recovery, I had figured it was something irritating but benign, like post nasal drip. Now my friends teased me—with little humor—‘Thirty-three-year-old woman dies of post-nasal drip.’
The waiting began. It had not taken long to find the right surgeon. I needed mitral valve surgery and the options were replacement with a mechanical valve, replacement with a pig valve, or repair. A mechanical valve would mean spending the rest of my life on blood thinners, which—among other things—would complicate the idea of one day getting pregnant. A pig valve replacement only lasted about ten years, so at my age that seemed futile. Valve repair was complicated and there were two places in the country that had expert mitral valve repair surgeons. One of them was in New York, just a couple of hours from where my parents lived, simplifying the decision. I sent my records to New York and scheduled for the first opening they had: May, Friday the 13th, six-and-a-half weeks to wait.
The timing of my diagnosis turned out to be fortuitous. I quickly crossed a threshold into rapid deterioration. Dr. S had said it was important to stay as active as I could for as long as possible, so I walked. West on Portland, down the alley to 4th Street and up to the Sanitas trails. But I couldn’t hike all the way to the top of Mt. Sanitas—had not been able to since the car accident. Instead, I focused on making a loop with the Dakota Ridge trail. I noticed how my chest heaved with every breath, how my heart thumped erratically, unable to keep a beat. And the cough: suddenly everything was so serious.
One day—two weeks after I had met Dr. S and four weeks before operating day—I was on the trail, slower now. It was early morning mid-week and there was not much traffic. I stopped under a tree to catch my breath. Leaning against the tree, a gust of cool breeze lifted the hair off my forehead. I opened my eyes to see tree branches swaying where the air had been perfectly still before. I was standing between two aspen trees, whose young, small leaves dangled and danced, looking like hundreds of hearts. It was my last time on the trail.
Climbing the stairs to the apartment induced spasmodic coughing fits. By the top of the stairs my heart was racing and I had to sit down a long while to let it calm. All breathing came with a scratchy feeling in the chest and my chest felt tight. No matter how hard I tried I felt like I couldn’t actually take a deep breath, and I had stabbing chest and upper back pain every day now, sometimes so sharp I gasped in surprise.
And because I could not venture far then, the birds brought spring to me. In the sunroom, a south-facing wall of windows for a room large enough only for the sofa, I sat and waited patiently for what appeared. From warmer places the birds flew to the tree in the yard, lighted on the branches and sang to me, a full chorus in the cottonwood. Sometimes my eyes were open to see them chirping from budding branches. Other days my eyes stayed closed, as the ship threatened to lurch starboard and aft, so I only listened. Spring would have to take me with it into brighter spaces.
Soon I could no longer walk more than a couple of blocks from the house, and trying to hold a conversation with friends who came to visit placed too much demand on my lungs, leaving me to devolve into an ugly coughing fit that turned their faces to grimaces as they begged me not to speak anymore. Jonathan decided to fly me early to New York, fearing I might not be well enough for the trip soon.
One of my final mornings in Boulder, I was at the yoga studio practicing at the back of the room under the heater, and as I turned my head in a twist I saw, against the wall, among the props, a box that said disarticulated skeleton with skull. I stopped mid-pose and stared, wondering if that would soon be me.