I remember telling a girl I dated in college once that I’d like to be dead by fifty. It was an egregiously stupid thing to say, the kind of low-risk rebellion a teenager from the suburbs engages in to seem dangerous and irreverent, like smoking a joint or shoplifting or wearing eyeliner (all of which I have also tried). I said it with a sly smile, which only got bigger with her protestations. “Why would you say something like that?” she asked. She seemed slightly disturbed, the response I was going for. “This world is trash,” I said. “Who the hell would want to live here for a long time?”
As was the case with a lot of the stuff I said back then, I didn’t know what I was talking about. I did believe — and still do — that the world is awful in many ways. But I knew nothing of death. I’d never had anyone close to me die. Save for a back surgery my dad had when I was ten, I’d never even visited a hospital for anything serious. The only funeral I’d attended was for a good friend of my father’s who drank himself into the grave after his wife left him. It was a Jewish service. As people surrounded the family to offer their condolences, I saw the dead man’s young son smile for a moment. I still think of that smile a couple times a year, like a childhood riddle whose answer still eludes me.
I spoke flippantly of death — and falsely longed for it to impress girls — because I really knew nothing about death. Of course I knew it happened, but it was so far away and inconceivable as to be ignored, like the outer reaches of space.
One day in August, ascending the stairs to my apartment after returning from the gym, I almost passed out. My vision went spotty and dark the way it does after looking at a camera flash, but not before I looked down to see my chest rapidly pulsating with my heartbeat. I scrambled to unlock my front door and ran to the couch to lie down. After a few minutes, the vertigo went away and my vision returned, but my heartbeat stayed fluttery and rapid. When I finally stood up and looked around, I noticed that in my haste I’d knocked over a stool and forgotten my keys in the door.
It was a hot day and I felt dehydrated. I’d spent a couple hours at the gym and I live at the top of a five-story walkup. To me, the signs pointed to a case of overexertion, so I decided to drink a lot of water and sleep it off. After going to bed at around 11, I woke at 3 A.M. with the sound of my heart pounding into the mattress and vibrating up through the pillow into my ear. I turned on a light and briefly considered going to the emergency room. I nixed that idea because then, by definition, I would be having an emergency, and I didn’t have emergencies. I had minor problems and I drank water and slept them off. Going to the emergency room would have forced me to reevaluate everything I thought I knew about myself. And so I googled to see when Mount Sinai’s Brooklyn Heights urgent care opened. I then spent the next five hours tossing and turning in bed, berating myself for all the stupid decisions I’d made with my health over the years, the garbage I ate and drank and smoked, all the while confident that death was like space, confident that I would never walk in the darkness of either.
At urgent care, a gentle nurse wearing tinted glasses and a thick gold chain over his scrubs calmly checked my blood pressure and put a cold stethoscope to my back, sending goosebumps down my arms. He dotted my torso in electrodes and administered an EKG. Before he left the room, he said, “Best of luck to you.” My stomach sank at that: “Best of luck.” It’s what someone says when they’re not sure you’re going to be O.K. A few minutes later, a physician came in and told me that I was experiencing what’s called atrial fibrillation. Though I was sitting still, my heart was beating erratically at a rate of a hundred and forty-two beats per minute. “That’s how fast it should be going if you’re running a marathon,” the doctor said. She told me she wanted to call an ambulance to take me to Mount Sinai’s cardiology center on the Upper East Side.
“I took an Uber here,” I said.
“You’re free to do what you want, “ she said, “but this is more serious than an Uber.”
I acquiesced and they wheeled me out of the building on a gurney. As I rolled past the nurses’ desks a couple of them turned to me. “Best of luck,” they said.
The ride to the hospital was one of the more surreal experiences of my life as I sat awake, lucid, blasting through New York City across the Brooklyn Bridge and down the wrong way on one-way streets with a siren blaring overhead. On the thirty-minute trip, I finished reading the last two pages of Slaughterhouse-Five, a book I’d often chastised myself for not reading sooner. Billy Pilgrim’s predicament, being “unstuck in time,” resonated deeply in that moment. In an ambulance, an E.M.T at the ready if I were to begin dying — maybe I already was dying — my mind wandered scattershot to various eras and people in my life: A cruel thing I’d said once that I might never be able to take back now. My mom singing to me. A girlfriend I’d once had. I’ve heard she works near the Brooklyn Bridge these days; maybe just then she was on the phone making dinner plans with a new boyfriend, maybe she had to pause for a few seconds to let the siren pass.
At Mount Sinai, they attempted to slow my heart rate with an IV drip of a beta blocker. When that didn’t work, my heart began to race even more. There is a comedic cruelty in trying to steady your pulse as doctors and nurses swarm you, stabbing you with needles and asking if you smoke crack. After a couple hours, they told me they were going to try a cardioversion, a procedure in which they stop your heart momentarily and then shock it back into rhythm. “Turn it off and turn it back on?” I asked. “Like an old laptop?” “Kind of,” said the nurse, offering a weak smile. As she pulled shut the curtain to my bed she said, “Good luck.”
The doctors said that sometimes a cardioversion can result in “complications.” For instance, a cardioversion might dislodge a blood clot hiding in your heart and lead to a stroke, which in turn can kill you. I figured I should let some people know if there was a greater-than-usual chance I could die soon, and so I called my mom. I’d avoided calling before so as to not worry her, I said. “Don’t shut me out of your life and tell me you’re doing me a favor,” she said. Next I texted my friend to tell her that I was in the hospital and I dearly appreciated her friendship. After that, I cried silently for a couple minutes.
The last thing I remember before the cardioversion was the anesthesiologist saying, “This is only going to take a second, but you do not want to be awake to feel it.” When I came to, my heart was back to a normal rhythm and there was an electrode burn on my sternum about the size and shape of a deck of cards. It lingered for weeks, scabbing over and itching and reminding me of the time they powered me down.
They sent me home that day with blood thinners and a beta blocker, which I took daily for three weeks, shaving and walking carefully lest I cut myself and “bleed to death all over the freakin’ place,” according to one doctor. I started drinking a lot of juice and eating more foods rich in omega-3 fatty acids. And then, two months after the first attack, as I exited my favorite smoothie shop on my way into work, it happened again. I took a big sip of my Protein Buzz and gasped as I felt my heart quake and fall into an erratic staccato rhythm, like a jazz drum solo. I went to work and waited to see if things would calm on their own. When they didn’t, I hailed a cab to see my cardiologist, who prescribed an anti-arrhythmic pill. An hour later I was back to normal. Today I keep a troika of beta blockers, blood thinners, and antiarrhythmics lined up neatly on top of my dresser, sentinels in the fight against my own heart.
My cardiologist tells me atrial fibrillation isn’t life threatening: It’s common, and that I could live a happy and healthy life for several decades with little management other than exercise, healthy eating, and taking medication as necessary. He tells me I should take steps to “chill out,” so I’ve signed up for therapy and piano lessons. (When they fall on the same day, I walk into my counselor’s office with “Row, Row, Row Your Boat” stuck in my head.)
I accept most of the doctor’s opinions at face value, but the heart isn’t a gallbladder or even a limb. The heart is foundational. The heart is a linchpin for life, and mine is jittery. Flying home for Thanksgiving last month, I felt myself become nauseated when I got to the part in The Year of Magical Thinking when Joan Didion described her late husband’s health issues:
His cardiac rhythm had been slipping with increasing frequency into atrial fibrillation. A normal sinus rhythm could be restored by cardioversion, an outpatient procedure in which he was given general anesthesia for a few minutes while his heart was electrically shocked, but a change in physical status as slight as catching a cold or taking a long plane flight could again disrupt the rhythm.
John Dunne’s last cardioversion took place in April 2003. Nine months later he’d be dead of a heart attack so sudden he couldn’t lift his arms to catch himself before falling and smashing his face into the dinner table.
These days I’m less glib about death, despite the general and sustained ugliness of so many things. Plane flights scare me more than they used to, and I drive slower, with visions of shattered glass and scorched metal easing my foot off the gas pedal. Perhaps that’s just because I’m older now, not a nineteen-year-old who can’t see past Thursday. Perhaps it’s because a lonely ambulance ride will do that to a person. I’ve always been aware that the potential for tragedy surrounds each of us constantly, but nowadays that tragedy seems just an inch closer to me than it was before. I’ve come to think about my heart the way others think about god, an all-powerful force I can’t see that could wipe me out on a whim. I will catch people looking at me on the subway, staring quizzically as I stuff my hand up my shirt to clutch my chest and see if anything’s amiss. I stand stock-still to better feel the beats. I think to myself, Best of luck.
Photo by Marcin Krzyżanowski
Save Yourself is the Awl’s farewell to 2015.