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Here they are, the two men in my life who have stepped forward in an executioner’s line. We’ll take the shot, they’re saying, as they assume positions in twin chairs stationed in every cardiologist’s office we’ve visited since my becoming torrential. My heart’s tricuspid valve, the valve shunting blood between the right atrium and right ventricle, is island-stormy, the culprit in my ongoing ventricular arrhythmias. My heart races into abnormal, potentially lethal rhythms, the leading cause of sudden cardiac death. More accurately, I am a bomb and a squall. Despite the perilous force I’ve become, Dad and my husband, Paul, refuse to take shelter but show up with the grim, undaunted resolve of Sasquatch hunters.

They don’t cry when I cry. They stare at their clasped, furred knuckles, sometimes at the anatomical heart poster on the corkboard, or maybe the printed flyer for a cardiac support group, then at the doctor who stands throughout this morning’s appointment. He’s a cardiac structuralist, the Frank Lloyd Wright of pleasing architectural symmetry in the heart, and he’s holding a metal contraption about the size and sheen of a vaginal speculum. Turns out, it can repair mitral valves but is also being used off-label for leaky tricuspid valves. Hope for harmony. Yet I feel my tuneless heart in my throat, twin larks fluttering left and right of my windpipe. The bleating is obvious when I throw my head back to laugh, which I haven’t done since becoming torrential.

I arrived hoping to proceed with a minimally invasive catheter valve repair, but apparently I don’t qualify, because (a) it’s a repair typically done on older people not necessarily expecting to live another thirtyish years, nor wanting, needing to see their children into adulthood; and (b) the clips used to extend the flailing valve doors called “leaflets,” enabling the doors to meet and shut, are designed to bridge the equivalent width of a backyard pool, not the Colorado River.

I leave with a referral to a heart surgeon, one who performs open-heart surgery, as in: pry open sternum for most panoramic view while heart is stopped and placed on a bypass machine. I picture blood flowing circuitously through tubing, blood that seconds prior warmed my toes or fueled a random fury, as my heart fades, fades to the wan translucency of a sautéed onion.

Maybe I have it all wrong. There can’t possibly be that many twirls and turns, so much whimsy. It’s no carnival. Nor is it entirely macabre. Surgeons of all ilk play their favorite music while working. I’ve asked. A previous doc, who successfully slipped a cardiac defibrillator and its errant wires out of my chest, is a country fan. My physician brothers say there’s occasionally the doc who prefers silence. I doubt that doctor. A doc should be so experienced in overcoming chaos that slicing flesh to the din of preschoolers wouldn’t matter. I might request Florence + the Machine during surgery and hope they sing aloud to the ominous chorus of making it out alive to see the morning.

For now, we’re in a bright room with percolating blood. Let’s imagine the bypass machine mimicking the white noise purring on my nightstand. Or even Paul’s CPAP. A sound I nonetheless associate with elective, peaceful lights out. Let’s imagine the machine is not made of plastic tubing—I’ve tossed all BPA-riddled food containers—but of the goodness aglow in my green juices, liver detoxes, collagen powders, and probiotics. How religiously I labor toward health, a stonemason in this department, and yet. Let’s imagine my blood is free to escape the OR—so austere, so metallic—and it swims off to the waiting room, where Dad and Paul, and Mom (she’ll be in town with soup and worry we’ll try to swallow too), can behold a part of me, and find mesmerizing comfort akin to fixating on a saltwater fish tank. At this point, they’ll take anything. Perhaps something about my blood’s viscosity, its racing, riotous flow, will be instantly recognizable: stubbornness, anger, athleticism, the bravery they claim to witness. Let’s say when my blood returns, the sudden zap of life resembles a mash-up of camera flash and orgasm. I rise. I sing Madonna’s “Like a Virgin.”

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The three of us go to breakfast. Somehow we’re hungry. Dad imparts his unflappable optimism: “I feel like we have some direction.” Paul agrees. I stare down my pesto scramble, the eggs from a nearby free-range ranch. Happy hens. Hens snoozing in hutches with music piping through while they lay. “Lay, Lady, Lay” by Dylan, I suppose. I feel directionless, bullied by their expectant sorrow and the ambient Christmas music imploring joy and snow, of which snow is more probable, despite living in San Diego.

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In me, this discordant rhythm, is Hammerklavier, Beethoven’s Piano Sonata no. 29. Arguably among the most difficult piano solos to crack, its daring fifty minutes combine trills, climbing octaves, and Baroque “possessed” fugue, with various sections described as both “inexhaustible and exhausting,” “strangely unstable,” and the slow movement section, “a mausoleum of collective sorrow.” Hammerklavier is the only sonata in which Beethoven provided metronome markings, but they’re frantically too fast. Cardiologists and musicologists have studied his work, and posit he likely had a heart arrhythmia and was composing music to match his feverish internal rhythms. Notes like “heartfelt” in the margins of his work seem to confirm this theory. Furthermore, at the time of this piece’s composition, he had lost his hearing, and perhaps the jarring confusion, thundering radiance, and breathtaking sorrow listeners feel might simply be Beethoven listening closely to the last thing he could hear: the musicality of his racing heart. It’s his musical electrocardiogram. His heart guided his music and saved him from madness inevitable when an artist is denied his art.

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I am saved. I am surrounded. Suffocated sometimes, but cradled by people who want nothing more than to lift me up to the benevolent gods and beg for their best wizardry and wise potions. In moments, this sober business of lifesaving resembles amateur bartending. A shot of maybe jiggered with bitter reluctance, garnished with a soggy wedge of let’s see. All of which would feel less like hope if I were drinking alone. No dad. No husband. No mom. No kids to supplant the stress with an essential layer of levity. It’d be just me up against empirical data and lavish brunches at noon, humming “Silent Night.”

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Weeks ago, my beagle/basset Ben showed signs of neurological distress. Fine one minute and the next, uncontrollable drooling and collapsing hindquarters. On a Sunday, his condition appearing terminal, we drove to the emergency clinic. I hugged his gaunt body in the exam room, so sorry for any inattention he certainly felt during his puppy years when I was tending to crying babies and then again in his twilight years when teenagers overthrew the throne. Also, that morning he drank voraciously, so I figured kidneys, maybe liver. Quick bloodwork revealed only a slight uptick in liver enzymes, but nothing alarming. The vet said, “I also did an abdominal ultrasound, no charge, checking for obstructions. Nothing there, except his heart appeared enlarged. Looks like heart failure. I’d like to refer you to a cardiologist.”

“Fucking kidding me?” I whispered to Paul. His plump lips shocked out of repose, his silvering hair a promise to age alongside me.

“Sorry,” I told the doctor; I wasn’t doubting her expertise. “Jingle Bells” from the lobby. “Just weird, I guess. Family history.”

Is this strange coincidence, or what do you call it when a dog’s heart takes on the calamities of yours? Mirror-pain synesthesia, where pain in another being provokes pain in the spectator, a friend, a pet. Ben, as unassuming as a creature could possibly be, has been a hyper-empath all his life, trying to unburden my diseased heart.

He’s fifteen and a half, I reminded her. I said it apprehensively, guarded. Did she catch me computing the cost of canine cardiology? If Ben were younger the stakes would be vastly different. His comfort, I told her, is our priority.

We drove him home with antinausea medication and, no joke, Lasix, the same heart medication I was taking, and laid him in his fleece bed. Our two other dogs surrounded him in primitive vigil, nosing, sniffing, processing the peculiar reek of imminent death. We took pictures. We prepared.

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It happens fast, the heart surgeon’s getting straight to the point. A tall, serene man, he’s a shaman or glassblower in his off-hours. He’s sitting. It’s about a fifty-fifty split on who sits and who stands during appointments. I prefer sitting, as I can better disassociate and imagine a job interview. I can pretend to be preparing my answer to: “If you could be any animal…?” I don’t wish to be an animal; I enjoy contributing to the conscious annihilation of our planet.

I’m after maximum transparency these days. A freedom made more manifest in this exam room decorated with the same heart anatomy poster and the same two chairs for Dad and Paul. I can say whatever I want. I can say heart transplant, when the doctor asks what the very first doctor told me, before we began desperately seeking other doctors’ opinions. I can say nothing, when the doctor nods and says, Actually, I agree. I can think to myself, your eyes (blue?) are shockingly intent as if you’re already examining my leaflets, so tiny you say we won’t know if they’re damaged until you touch them. Mosquito tongues, snowflake branches, I imagine. As for your music, I’d guess Chicago and Eric Clapton.

“Getting on the transplant list can take some time. Tests, counseling to make sure you’re physically and emotionally prepared, and compliant.” The last word stings. Too close to complacency. To comatose. I’m not crying as hard as I have in previous appointments because he’s not talking about me, he’s talking to my yielding avatar. The patient. Also, he’s talking about the person who must die first. They don’t even know it yet, their terrible fate from which I might benefit. How much of this is miracle and how much is tragedy?

The doctor continues, “I had a kid who felt so good he stopped his immunosuppressants. His body rejected the heart.” He reanimates the air with transplant success stories: marathons, professional soccer, pregnancies—fully bodacious lives of which I’m skeptical. It rings of religious conversion. “Once you’re on the list, assuming you match, it can be just days or weeks for the actual transplant.”

Silence clinches the room, the sixth person. I forgot to mention the physician’s assistant akimbo near the door, funeral hunch, stripper mustache, white lab coat. The silence neither sits nor stands but fogs like smoke, like I need to drop and crawl, feel for heat on the door. I can evacuate, flee safely with my kids, dogs, husband, and parents. Probably my computer too. I will write about infernos from wherever we’re sheltering.

“How long between making the list and getting the heart?” Dad asks. His hearing aids aren’t to blame—he got swept away in a torrent of remembering a baby he hoisted from a crib every morning, a bride he walked down the aisle, his three grandkids with my hair, my keen eye for imposters. The doctor, zero annoyance, reexplains everything.

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We sit for breakfast on the patio of a white cottage-turned-restaurant. Across the street is Solana Beach Train Station where (pre-kids) Paul and I would park, cycle fifty miles north up Pacific Coast Highway, then return to run San Dieguito Lagoon behind where the three of us sit today, sipping waters, admiring the enormous girth of the patio’s oak tree. Back then, this restaurant wasn’t a restaurant—it was still a home with junk drawers and rotting produce, lived in by complicated people perhaps forcing grace at mealtimes, trying to beat whatever odds were stacked against them.

We await food ordered on the premise, again, that “fresh and local” saves lives. Paul seems to be saying, with heavy cream waterfalling into his coffee, that he’s on no diet, will never diet again. While Dad says—did say, in the hospital parking lot—and I can’t shake both the audacity and desperation I completely understand as a parent myself, “The words heart transplant once scared me. Not anymore.”

I feel neither unscared nor scared. I’m the bark sloughing off the trunk, answering to seasons beyond my control.

“I’m pissed off,” I tell Paul. Dad has gone to the bathroom. The Lumineers lilt “Ophelia” into brisk, sun-stoked air.

“I can tell.” I appreciate the validation, and love even more that he’s not going Eckhart Tolle on me with positive redirection.

“You heard the doctor chuckle when I asked again about just replacing the valve?”

The exchange was reminiscent of Little Guy asking last year if Santa was real. He was sure, backed by classmates, it was a hoax. I told him the truth. He looked off, presumably into all future Christmases I’d wrecked. “Are you sure?” he pleaded. He had no idea how badly I wanted to be unsure.

“I think you should call those people,” Paul says. The success-story people. The doctor handed over phone numbers to patients pleased with their new hearts. But like skilled salesmen, they’ve probably perfected the art of compassionate elimination, and will fail to mention the nights they lay awake second-guessing a decision to welcome a heart the body never stops trying to evict. How many transplants have failed besides the boy who bucked compliance? Just failed naturally. The body spitting out a splinter.

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My breakfast tastes perfunctory. I think that’s how to categorize the bewildering sensation of entrapment surrounded in finery. The family. The food. The freedom to move about the cabin and go wherever necessary to get this figured out. Dad continues to say, “We’ll figure this out.” I’m a Rubik’s Cube. I can’t be a daughter, wife, mother, or woman. Easier to be a puzzle. How to cope with ill children: divide and solve by layers without messing up the pieces already in place. One side at a time. One note, one song at a time. Otherwise, the entirety of a child’s beauty is a crushing portrait of the magnificent potential at risk.

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Dad has been paying for meals, for pretty much everything orbiting the nucleus of what’s beyond purchase. He bought Little Guy an RC car. They took it to an indoor track, Little Guy returning charged by his brush with speed and motors. This time, Paul and I say we’ll pay for what we agree is the best breakfast so far. More meals to be had. More doctors to wager opinions we will choose either to accept or dismiss. Swipe left, or is it right? Being a cardiac patient looks a lot like the dating life of my single girlfriends. Who do you want to slice you open, steal your heart?

The server places the check on the table with three shortbread cookies. Cute. Sweet Jesus, they’re hearts! I’m not as mystified by the shape as they are.

“Take the signs,” I think Paul commands. Dad seconds the thought: serendipitous.

“Well, Ben is still alive,” I say. “Hearts aren’t failing everywhere.”

If the cookies really are symbolic, what’s the parable? Is it a glowering portent of the people who lived in this cottage? Were they pushed out by developers, and therefore resentful of us diners, exploiters, and was this the wrong place from which to launch next steps? Or is it merely a vanilla gesture with a primitive moral: hearts will appear randomly in my life as lore, as reminders to love.

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Ben is fine, until he’s not. This is a love story; they all end abruptly. And broken. Off-beat. Racing. Life and hearts both. We live. We learn but not enough. Days after Ben’s passing, I learn the human heart recently broke the record for farthest distance traveled for a transplant. It flew from Juneau, Alaska, to Boston: 2,506 miles. Time is the enemy in the transplant world, and a four-to-six-hour window of transport is preferable, not the seven-plus hours this heart spent in transit. But a new sophisticated cooling system, monitored by a doctor on her phone app, successfully kept the organ at the optimal four to eight degrees Celsius. Anything higher or lower, and risk of tissue damage increases. Damage. Only death gives us permission to stop fighting it.

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Three weeks to the day of the last vet visit, after eating his breakfast, Ben slowly melts to the hardwood floor. Little Guy has a baseball game in ten minutes, his last of the season. This is when you feel a heart racing time, a ticktock deep within I might know better than you. I beg Ben to wait, as I often do with my heart. Driving, dinner with the kids, client meetings: please do not make a scene and take me down. Or, at least, as I fall, loop a sonata in my head.

I lay Ben on his bed. I press an ear to his thundering ribs, and hear the kids’ wailing, their questions about ends I have no business answering. His panting. I flip his ears inside out—the pearly white of a heart on bypass. My heart. His heart. I do think it’s wild how we all hide fist-sized workhorses. I whisper to him the countless ways he’s made our lives more livable; somehow I know I’ll return to find his flank flat as a summer lake.

I kneel at his bed, willing him to rise. Another breath. Beethoven also inked “breathless” in the margins of his sonatas. Through music, he revealed his body. Because as we share hearts, we will one day share breathlessness. Ben is impossibly still, a stillness so absolute it must be parody. Right? Tell me something different, is what I’m asking for. Show me what I want to see. Play me music I want to feel. Tell me the lies I need to hear.

 

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TORI MALCANGIO received a journalism degree from Arizona State University and an MFA from Bennington College. Her fiction has appeared in The Missouri Review, Conjunctions, Best Small Fictions 2021, Glimmer Train, The Cincinnati Review, McSweeney’s, American Literary Review, The Chattahoochee Review, Mississippi Review, Tampa Review, Cream City Review, ZYZZYVA, River Styx, AGNI Online, Passages North, and more. Tori is the winner of the 2023 Missouri Review Jeffrey E. Smith Editors’ Fiction Prize, the William Van Dyke Short Story Prize, the American Literary Review Short Fiction Award, the Waasnode Fiction Prize, The Cincinnati Review Robert and Adele Schiff Award, and the Lascaux Prize in Short Fiction. “Racing” is an excerpt from her memoir in progress, My Heart Is a Bomb.

 

Featured image by dxiane, courtesy of Unsplash.