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By Gabriel Brownstein •

For years, I’ve assigned Joan Didion’s essay “Why I Write” to my fiction writing workshops. For me, as a short story writer, there are two crucial sentences in the essay. Didion precedes these sentences with the Latin “Nota bene,” and she gives each sentence its own paragraph:

It tells you.

You don’t tell it.

When I assign the essay, my students usually have a simple, honest question. What, my students want to know, is that “it” that guides the fiction writer?

Pictures in her mind, Didion says. “Pictures that shimmer.” She says that she asks herself: “What is going on in these pictures in my mind?” [italics hers]. And that question, as much as anything, seems to motivate her writing—an exploration of her imagination, an imagination that she feels is not exactly a part of her.

Lots of writers talk this way. Stephen King, in On Writing, describes the plots of his novels as things unearthed from underground. Toni Morrison, too, has discussed her work as archeological. In her wonderful novel, The Mind-Body Problem, Rebecca Goldstein writes about the way mathematicians talk about equations and theorems—they talk about them not as things being cooked up in their heads, but as distant objects they are trying to see, as planets viewed through a telescope.

This has been my watchword for decades—as a writer of short stories and a teacher of creative writing—“it tells you; you don’t tell it.” See what’s going on in those pictures in your head. If you want to tell a good story, put your imagination and language in the lead and follow. Donald Barthelme calls this artistic attitude “Not-knowing.”

However, somewhere around 2016 my life changed. I was forced to stop writing fiction, and forced to reevaluate my approach. Sometime in the ending stage of a novel for which I (and my agent, so it seemed) had high hopes, my health gave out on me. My heart, which had been surgically repaired when I was a child, then repaired again in my mid-thirties, began to beat madly every night. My sinus node, the set of nerves that governs the healthy heartbeat, lost control of the heart muscle.

I have an implanted defibrillator—a device designed to protect me from irregular heartbeats—and it can deliver electrical shocks to bring my heart back into its normal beat. One night my implanted defibrillator shocked me nine times, each time firing sixty joules of electricity to my chest, a feeling like a bomb, like a brick crashing out of my ribcage.

My life stopped being my own. I underwent several procedures to try to cure me of my arrhythmias. Radio ablations, they’re called; a wire was guided up from my thigh and into my heart, where it burned the muscle in there, trying to break up the dangerous electrical circuits of my heart.

The first couple of radio ablations didn’t work. The bad heartbeats kept coming back—the top of my heart beat normally, while the bottom chambers pounded as if I was running up a hill. The bed shook with the pounding of my chest. I wasn’t sleeping anymore. Neither was my wife.

In the midst of this, I got a phone call from my agent. He wondered if I wanted to try to revise the novel one more time. I knew he was right—the book needed rewriting. But in my poor state of health, I simply couldn’t do it. I could no longer use the telescope of my fiction to investigate the imaginary planets where my characters’ marriages were in crisis. There was no longer an “It” there; “It” didn’t tell me anything. So when I got up in the morning and sat at my desk, instead of working on my novel I started writing about my heart.

As I started research, I began to see that I could tell an important story. I was born in 1966. Heart surgery is not much older than I am. I was in the first large cohort of patients who had open-heart surgery when they were kids, and open-heart surgery began with people like me—people born with heart defects.

In the 1940s, in Baltimore, Helen Taussig, a deaf, dyslexic doctor, invented the treatment of pediatric heart patients, and she did it on kids with my particular defect, which is called the tetralogy of Fallot. In the 1950s, in Minnesota, two doctors, C. Walt Lillehei and John Kirklin, began operating on children’s hearts—the first open-heart surgeries in the history of the world. In 1960, congenital heart defects were one of the leading ten causes of death in the US. But by the 1970s most of us survived. At time of writing, there are more than two and a half million Americans living with congenital heart disease.

The story of my heart defect, the tetralogy of Fallot, was big. The first person ever to describe it was one of the great geniuses of the seventeenth century: Nicolaus Steno, who proved that bones turned into fossils, who demonstrated that mammals produced eggs, and who invented geology—the study of the formation of the surface of the earth. But Steno, somehow, gave up his study of nature for the church—he became a priest, a bishop, and eventually a saint. For months, Steno was my obsession.

The first doctors to study children’s hearts were all women—including Helen Taussig and her mentor Maude Abbott. In the first half of the twentieth century, women in medicine were shunted into odd corners, and babies with heart defects were considered incurable, and somehow these dying babies and these women (called “hen-medics” by their male colleagues) found each other. Their work led to heart surgery, and we owe to these women all the wonders of life-extending cardiology.

I had a huge, complicated, ungainly story to tell, and how was I, a short story writer, going to tell it? I had trained myself to unearth the fossils of my imagination and to examine them meditatively, but here were the real fossil-bones of history, and I had never done anything like this before. My agent urged me to make the story bigger, to push it beyond my life, and to include the lives of other patients. I interviewed these remarkable people and fell in love with them—and now I had a new, greater responsibility, not just to history but to these new friends, who had lived difficult lives, and had entrusted the stories of their traumas to me.

I had lunch with my editor, and I said, “I have no idea how to order this.”

He said, “Have you tried chronological?”

Still, it was like putting together the skeleton of a dinosaur, or maybe a herd of dinosaurs. But as I talked to older doctors, cardiologists in their nineties who remembered how heart surgery began, I found guidance. Abraham Rudolph, perhaps the oldest and greatest of the pediatric cardiologists I spoke to, surprised me in an email by quoting Salman Rushdie: “Facts are hard to establish, and capable of being given many meanings. Reality is built on our prejudices, misconceptions and ignorance, as well as on our perceptiveness and knowledge.”

Rudolph was thinking about medical dogma in the 1950s, and his misgivings about repair of what are known as atrial-septal defects, holes between the top chambers of the heart. He was wondering whether those first experimental heart surgeries he had participated in, surgeries that changed the course of the history of medicine, were in fact necessary, if some of the patients might have lived on without them. An extraordinarily sensitive and reflective man, he was casting doubt on the necessity of his early work, but in doing so he was also teaching me about imagination, about the mind. Medical imagination, he seemed to suggest by quoting Rushdie, was not so, so different from literary imagination.

It tells you; you don’t tell it. That was precisely the attitude I needed to fit together all the pieces of my story. To create a palpable reality I had to acknowledge my limitations, but also to envision it—telling the truth, it turned out, was not impossible. Trying to tell the truth was an awful lot like imagining. The results weren’t so different than (Stephen King–like) unearthing a story from underground, or (Rebecca Goldstein) viewing the whole through a telescope. It came together. My life was the spine, the lives of the doctors emerged like limbs, like a head, like a torso, and the patients I interviewed were the connective tissue, holding the whole into place.

But that imagining could not be forced. I needed to reflect on the stories I was telling, and to see (to borrow Didion’s language) which pictures shimmered in my mind. Then and only then could this complicated history, this big mass of stories, sort itself out. I just had to listen to each story very carefully, and to hear how and when they wanted to be told.

 

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GABRIEL BROWNSTEIN’s new book, The Open Heart Club, is a personal history and a history of heart surgery. He’s the author of a novel and a collection of stories, and for his fiction has won a PEN/Hemingway Award and a Pushcart Prize.