“Anima,” in Paris/Atlantic, by David Chirico
Along with mementos of his professional life in the circus, which include many photographs, costumes and props, the Strong Man Archives at Hamburg University contain a generous selection of his letters from the period during which he was elected captain of his troops on the basis of being the largest among them, and though his solitary character disposed him to various acts of privacy, and his decisions seemed less based in reality than on an inner star, the men followed him with loyalty because, behind him, they felt as safe as they would have behind a brick wall: They paid little attention to the eccentricities of his hermetic character, such as fashioning small tin fish to hang among their dog tags or illuminating, as they marched, some difficult point from an unknown scripture; they ignored him as he sat apart at night absorbed in a deep concentration with his needles, and a mixture of mud and ink that he held in a plate over the fire like an offering, turning the stuff with a stick, and after removing his shirt beginning the arduous process of tattooing that eventually covered every available patch of his body with the symbols of privacy, great birds and flowers sown over a field and names that when the men saw bulged with infection they couldn’t pronounce and images they dimly recognized from their dreams and figures of such strange and startling aspect that they could only relax when he had replaced his shirt; but No matter, they thought, since apart from this activity the man seemed born with an instinct for battle; No matter, they agreed, we’ve always returned from fighting alive—with few of them sustaining little more than a flesh wound, it was safe, they concluded, to march at a breakneck pace behind a man none of them had ever known to sleep, but who instead wrote his endless letters to some distant circus woman (in the mornings tying each letter to a stone that was hurled in the general direction of water)—What the hell, the man seems fit, and he never bothers us; so they continued to wage war behind him even if it appeared that he spent more time with his letters than with the war; He wrote in an effort to recall their life, trading for sleep the dreams he dreamed constantly of her, to once again inhabit the distant carriage of memory where they had lived together—their rolling home with its florid costumes and strings of beads and the image of a sun that he wore permanently about his neck on a chain, a gift from her, remembering their wild and scandalous apartment where he loved her in the mornings, through the afternoons, into the evenings when they had to be roused by the barker, Damn fools, the children in the big top are waiting, and he also recalled their sullen home where they sat for hours without speaking as she did her endless embroidery, while he waited, with a hopeful eye, for some word to recall their love; he fled down the corridors of memory in search of anything that had been hers, her plumed hats, her gloves, forgetting the war and their bitter campaigns for the one visible only to himself, her resurrection in print, her entire body on the page with its dimensions remembered, the hook of her thumb and the width of her ankle, the knuckles that were distantly his, her hair that he could still find wound into the fabric of his clothes; he sniffed in vain at the German air in order to retrieve her scent of broken earth, finally falling to weeping and eating whole handfuls, until at dawn the men found him gorged on mud and grass and laid him to rest in his tent, which filled with the stench of grief—when he finally awoke it was with the conviction that print couldn’t return her and instead he must return to her himself: In light of this new decision, he rushed among his men in their tents in the darkness as if they were the bronze apartments of memory, shouting Up, up, everybody up in this carnival of whores, collapsing their tents one by one with the single notion that they must fight for her: Her whom he imagined to be standing at the top of the next hill, at the bottom of every trench, in the waters of the distant ocean, crying in the three o’clock darkness, It’s noon already, bastards, and he assembled them still dreaming to march them forward toward the phantoms of insomnia—they began to fight for the image of her that he imparted to them on their illusory campaigns.
“On Keeping an Academic Journal,” in Teaching English in the Two Year College, by Michael Gee
It could very well be that the unexpected minor occurrences in a classroom are the most precious educational pearls for a teacher to record and preserve.
I consider Disney’s Jiminy Cricket to be one of my academic mentors. I have found his regard for conscience and its guiding quality to be very inspirational. Let me explain. With due respect to my real life academic peers, I have of course been well advised by them over the years. There is a problem, however. When they observe me in a classroom, I have a tendency to offer selected lectures that have been successful for me through past experience. I prepare a bit too well for these observations! I appreciate and respect the feedback I receive, yet those daily classes where I find myself alone, struggling, and taking chances (the classes that need to be observed most of all) are my best educational experiences. Jiminy Cricket has been my motivator for remembering, in a journal, such classes and learning to recognize what it is that I do right and what it is that I need to do better. He has prompted me to become a very insightful and relentless evaluator of my teaching expertise and acquire an academic conscience. Having a conscience is all about ability; the ability to learn to make good decisions by recognizing the distinction from what is right and what is wrong. An academic journal is great for acquiring this ability and turning it into an introspective teaching aid. The keeping of such a journal inspires the continual evaluation of unrehearsed classes to help a teacher get down to the true heart of what personally works in a classroom.
To keep track of my impromptu successes and failures, I try to write a brief evaluation of my instructional odyssey every day. Why did this writing assignment that I excitedly spent days developing seem so boring to my students? Why did this activity work so well in this class and fail in the next? What did I say that suddenly caused me to notice student faces with especially alert expressions? What did some of my students tell me when they lingered to talk after class? What did I learn from them? What did I hope they learned from me? For a long time I trusted my memory to keep track of all of this. Yet perhaps because of age, ego, or stress, I found myself forgetting key observations. Then I listened to myself one day defending writing by telling my students that the act of putting ones observations into words could increase ones insight and lead to wonderful discoveries. I needed to take a dose of my own medicine. An academic diary was in order. Now I would not forget my observations and I would have the opportunity to discipline myself to cultivate a conscience.
At first, when particular classes would conclude, I would write notes to myself on the back of grocery store receipts that I hurriedly pulled out of my pockets. Other times I would race to my office just before another class began and wildly write observations on the back of a stray folder. Now, I spend at least ten minutes every day recording notes in a legal pad about my students, my assignments, and myself. What specifically do I write about? In a recent class a student provided me with special insight concerning a poem that I offered in Children’s Literature. I was attempting to relate an issue concerning empathy relative to a child’s maturity. During class, a young man offered a unique story about a sacrifice he made for the welfare of a stray dog. Suddenly “Anne and the Field-Mouse” by Ian Serraillier took on a depth that I had previously been unable to acquire. Last semester I had struggled with that poem and in my journal I noted that my use of yet another poem for clarification only served to distance my students further from the point I wanted to convey. This time by using this student’s observations, my next class went amazingly well. My earlier journal record of my inadequacy with this poem kept me alert to noticing any new instructional techniques. Now that I had discovered one that worked well, I wanted to guarantee that I would remember it. Another journal entry would safely preserve it. As an added bonus this would be a tangible reminder of how indebted I could be to a student; a very important reminder of a teacher’s need to both bring to class and take away from class an attitude of humility. Down the road, as a consequence of my journal, I would have notes to access to keep me real and productive. No, my students were not to dictate my planning, but they were definitely to be a constructive influence worthy of patient and respectful documentation. As a further consequence of this event in my Children’s Literature class, I revised the requirements of one of my writing assignments. I decided that their writing about poetry would need to be linked in some way to a personal, childhood story. My later students would agree that although a poetry analysis could be challenging, the inclusion of a story made their poetry writing assignment distinctly enlightening about both the poetry and very importantly themselves. Suddenly instead of getting stiff and vague papers, I was getting nicely focused, detailed, and deeply reflective papers. Since this dose of reality in their writing sparked such enthusiasm, I even made the decision to begin to develop the class into a Service Learning course.
In addition to student contributions, it is important to keep a record in your journal of the stories that you relate to help make an assignment memorable and the illustrative examples that suddenly come to you while you are lecturing that help your students make sense out of what you are saying. We all keep records of our course descriptions and handouts, but don’t forget that notes about the impromptu daily occurrences in classes are possibly the most precious educational jewels to store away. I once noted in my journal that I was actually sympathizing with a dozing, bored student in one of my College Writing I classes. Instead of shaking my head, egotistically blaming it on him and trying as quickly as possible to forget it ever happened, I wanted to preserve a record of this event to force myself to see if I could find a way to enliven my course material. I decided that I would stop writing tedious definitions on the board. By doing this I intentionally wanted to place myself in an awkwardly unprepared classroom position to see what I could come up with. As a consequence, I have notes about how one day instead of resorting to definitions, I explained some writing basics by illustrating audience, coherence, and unity in relationship to an automobile trip with my six-year-old daughter. I found myself telling my students that when they write a paper it is shared property and that they are similar to the driver of a car. Just as the driver of the car must be aware of his responsibilities to his passengers, the writer of the paper must be aware of his responsibilities to his reader. The trip in the car must have a defined destination; the paper must have a clearly stated thesis. Since I have discovered that young children demand to know everything about any car trip and that they can be brutally observant, by pretending in class to be my daughter and illustrating her mentality, I warned my students that if their papers did not have a purpose and illustrate a coherent plan, I would kick the back of their literary driver’s seat with numerous notes in the margins of their papers to remind them, as my daughter does to me with her foot against the back of an actual driver’s seat, that someone is relentlessly awake and watching their every move. I even attempted to imitate her voice and gestures! Afterwards, I was a little embarrassed! Yet, since several students told me that they were more alert to their writing responsibilities as a consequence of picturing me as a hawk-eyed, arrogant child watching them, I knew that I wanted to document, at least for a while, what I said and did in class that day so that I could repeat what recently took place next semester. Alert expressions on the faces of previously bored students told me more distinctly and more memorably than any peer that I had scored a teaching point.
My journal also has become a place to record educational stories about my classroom admonishments and confessions. I have an entry about an unexpected scolding I once gave to my writing students. “You had better watch out because when I sit down to grade a paper, I remove the staple or paper clip holding the pages of the essay together and I spread the pages out on a long table so that I can see every page at once. I can immediately trace a writer’s entire thought process by just casually moving my eyes.” A few students told me that because I had said that, they decided to proofread their papers in the same way and they saw their writing now in a much clearer context. I have also told my writing students that most teachers probably do not like to read papers any more than students like to write them and that in my case I now and then surf the internet for a brief respite while reading papers during the early morning hours when I do much of my grading. “Challenge me! Wake me up after reading a dozen boring papers in the wee hours of the morning and become my saving intellectual buddy.” Soon I was getting e-mails posted at two o’clock in the morning from motivated students enthusiastically telling me to persevere because their paper could be the next one in my stack of essays.
Plus, I also have notes about my failed attempt to engage my students in a discussion concerning atomic weapons through an article about an exhibit in the Smithsonian Institution displaying portions of the B-29 aircraft that dropped the first atomic bomb. It was nice, however, to later record in my journal a recent e-mail sent to me by a student alerting me to the upcoming display of the fully assembled aircraft. Maybe my effort was not such a failure after all!
Are all of these notes a waste of time? Certainly not for me. I prepare for my classes each semester by both evaluating my texts and carefully reading my journal. My journal contains many of the observations and remarks I didn’t plan on making or hearing in class, yet it records the instructional expertise that I rely on as significantly as any other academic planning and research I do for a successful semester. Don’t promise yourself that you will remember the daily and apparently insignificant events in your classes. They are certainly not insignificant and they deserve to be recorded. Write them down. You will be induced to become a very articulate student of your profession and do Jiminy proud!
- Serraillier, Ian. “Anne and the Field-Mouse.” The New Oxford Book of Children’s Verse. Ed. Neil Philip. New York: Oxford University Press, 1996. 218-19.
In the Room My Dad Built, in Paterson Literary Review, by Josh Lewis
My Dad’s den: an alcove of animal stinks.
To the left, a bear and deer stand guard
Against intruders. I don’t sleep well
When they peer down at me.
The same with the sea bass
Above my head. It would turn me
Into bait if it ever dislodged itself
From its hooks and nails.
To my right, a bobcat
Takes down a quail.
The quail doesn’t stand a chance
Especially how my Dad molded the scene.
My Dad works with dead or dying animals.
His skills: exquisite. He can render
Any creature lifelike. Breathe life
Into any hide or carcass. My Dad
Gave me half-life. Not complete
But enough to write these lines.
My Dad gave me breath,
But not fully. I struggle
To sleep in this chamber
My Dad has supplied for me.
This lair where I’ll live
For the next few weeks,
Alone and in contact
With my Dad’s hoof and paw prints.
His antler of thorns.
The Greatest Compliment in Five:2:One Magazine, by Joshua Lindenbaum
You’re one of the only people I don’t worry about:
he finished his statement with a sip of Scotch;
who knew—alcohol could be punctuation.
I took a sip of my beer,
digesting the compliment,
watching the suds pour into my lips.
Somebody has faith in me,
and he knows me well to boot,
a boot that’s been through tons of throughs,
through and through.
Now I know what God feels like.
Heart-speak, in Under the Sun, by Alexis Katchuk
I am waiting to come back to life. For the second time. This will require that I die. For the second time. The first time I died was on December 30, 2000, and I was twenty-three-years-old. It was in the middle of a snowstorm and my car was surrounded by four feet of snow. When I woke from a four-hour-long nap with a heart beating over 200 times per minute and lungs that didn’t want to take in air, I called 911.
When I died, I was talking to a doctor in an emergency room in northeastern Pennsylvania. There was no warning, other than my skyrocketing heart rate and inability to take in enough oxygen. No white light. No voices calling me from beyond. No hearing loss. No feeling of disconnectedness as the world slowly faded away. The doctor and I were talking, and then we weren’t.
The memory of what happened during the fifty-three seconds of blackness that followed is not my own; all information I have has been given to me. I had no pulse. There was no presence of electrical activity in my heart. I was not breathing. The doctor began chest compressions. Someone placed a hard board underneath my torso, making the doctor’s chest compressions more effective. A nurse bagged me, manually filling my lungs with air. Someone injected epinephrine and atropine. Someone called for the crash cart. I’d like to think someone was praying.
Then the blackness was gone. I gasped for air, and my upper torso lifted off the board, either from the force of the doctor’s compressions or from the force of my breath. And, once again, I was alive.
At the time, I didn’t realize how lucky I was. Every year, approximately 400,000 people in the United States experience a sudden cardiac arrest while in a hospital. Only ten percent of these patients survive. This means that out of every ten such patients, only one will walk back out the hospital doors. I was that one person.
* * * * *
I saw my first cardiologist in 2001. My sudden cardiac death was written off as an unfortunate, but not uncommon, side effect of anorexia. According to the doctor, if I simply ate and stopped running for hours every day, I’d never have to visit the emergency room again, at least not for my heart. Although it took four more years–years filled with ER visits due to fainting, blacking out, and shortness of breath caused by cardiac arrhythmias–I did start eating and I did stop the obsessive over-exercise. Following the cardiologist’s logic, free of the anorexia, I should have been free of the ER.
In 2006, while living in Washington, D.C., I fainted during a heat wave and was not only taken to the ER but kept on the Cardiac Crisis Unit of that hospital for three days. Discharged to the care of a doctor who would become my second cardiologist, I was not-so-kindly informed that if I had never been anorexic, I would never have ended up in the emergency room and, unfortunately, there was nothing anyone could do. Three more fainting episodes and another ambulance trip landed me in the office of my third cardiologist. This one faulted my low blood pressure. His prescription: Drink a lot of water.
I carried multiple water bottles everywhere I went but continued to faint on a weekly basis. By the summer of 2007, having finally given up on cardiologists and emergency rooms that never gave me any answers, I decided the best way to deal with the fainting was to not deal with it at all.
I stopped going to cardiologists. I stopped going to emergency rooms. If I fainted in private, I kept silent, alerting no one, not even my apartment-mate. If I fainted in public, I assured people that nothing was wrong, that I simply must have stood up too quickly and got dizzy. I went to my general physician for my regular check-ups but never mentioned the fainting.
It was easy to believe the cardiologists who blamed the anorexia. For several years, the eating disorder had resulted in chaos–inpatient hospitalizations, partial hospitalizations, emergency room visits, doctors’ appointments, therapists’ appointments, interrupted semesters at college, incomplete coursework, and frequent fights with family and friends. I had numerous physical health problems–an overall weak immune system, anemia, a body prone to colds and viruses, and kidneys that endured multiple infections. Blaming the fainting spells on the eating disorder was a natural thing to do. I began to think that I deserved the fainting, that it was the universe’s form of punishment for having deliberately harmed my own body for so long.
* * * * *
Between my stays on the Cardiac Crisis Unit in 2006 and the spring of 2009, I fainted in five separate states and the District of Columbia. I have fainted in my own apartment, in a store, in a classroom, in a professor’s office, in the school hallway, in a hospital, in a doctor’s office, at a friend’s house, while riding the MetroRail in D.C. and while running in a park. Out of all of these public places, I find that the best place to faint is the Metro, especially if it’s during rush hour. People running to a business meeting don’t want to stop and deal with a sick person, so if you come to and assure people that you’re “Fine, just fine,” they will shrug their shoulders and step off the train. If someone feels especially generous, he might give you his seat.
In addition to proclaiming, “I’m fine, just fine!” after I faint, I am adept at not-fainting. I know how to stand when my heart suddenly skips a beat, when the world goes black, when the ringing in my ears blocks out peoples’ voices, when I can feel my body temperature suddenly spike so that sweat coats my palms and drips down the backs of my knees.
If I wanted to, I could bend my knees and fall. I learned how to fall long before I learned how to stand. My doctors would prefer it if I fell. My body wants me to fall. Sometimes even I want to fall. It’s easier than planting both feet on the ground, closing my eyes, and taking slow, shallow breaths through my mouth and thinking don’t fall don’t fall don’t fall. If I flinch, if I clench a muscle, if I breathe too fast, if I breathe through my nose, or if I open my eyes before the ringing in my ears has stopped, I will fall and the world will go black.
* * * * *
I am not alone in my tendency to faint on a frequent basis; I share this proclivity with a breed of goats. When startled, Fainting Goats–also known as nervous goats, stiff-legged goats, Tennessee goats, and myotonic goats–will stiffen up and tip over with their legs sticking straight out. In about ten seconds, they will pop back up and run around as if nothing had happened.
The exact history of the fainting goat is not known. The first known fainting goats were discovered in Tennessee in the 1880s, but they were owned by an old shepherd who never told anyone where they came from. One legend is that shepherds kept a couple of fainting goats in their flock of sheep. This way, if wolves attacked, the startled goats would faint. The wolves would attack and kill the goats while the sheep escaped to safety. The International Fainting Goat Association, dedicated to preserving the breed, does not list this legend anywhere on its site, but there is a clause in its code of ethics that any member found guilty of abusing a fainting goat will have his or her membership revoked.
Technically, fainting goats don’t faint. They never lose consciousness and remain fully aware and alert the entire time they are lying on their sides. The goats have a hereditary genetic disorder called myotonia congenita. When startled, the muscle cells contract too much, causing a sudden, if temporary, paralysis. If a fainting goat is standing up when startled, it may remain standing in an immobile position. But if the goat is running or walking when startled, the sudden paralysis pitches the goat onto its side.
When I faint, I experience nothing but the blackness I encountered during my sudden cardiac death. I don’t know how long the blackness lasts until I come to and someone tells me how long I was gone. And most often they use that phrase: you were gone. Except, similar to the fainting goats, I don’t go anywhere.
So I am jealous when I hear stories of other people experiencing some level of higher consciousness while fainting. Homer and Lucretius wrote about how some illnesses, including fainting, could incite creativity. The debate over the validity of Joan of Arc’s visions has lasted almost 600 years, and some contemporary doctors have theorized that she was a victim of epilepsy or tuberculosis, both of which often induce fainting spells. The International Association for Near-Death Studies puts great stock behind the idea that the spirit leaves the physical body during an episode of fainting or during a coma, and that we have the ability to access these spiritual memories if we learn to attune ourselves to them. The Institute of Noetic Sciences applies scientific processes to study intuitive knowledge gained through experiences such as fainting, severe illnesses, prolonged comas, and near-death experiences.
I want to say that fainting ends with a spark of creative energy that results in an artistic masterpiece. I want to tell you that after my first death, I woke seeing everything through a sun-kissed lens, and that I now experience everything as a changed woman, a better woman, able to accept herself with grace, peace, and love. I want to say that I have gained some critical piece of self-knowledge that allows me to spread such inner wisdom to others. Instead, when I was brought back to life, I woke up with a confusion that has never left.
* * * * *
In the spring of 2009, during my second semester of my PhD program, the fainting episodes increased and I never had time to recover from the exhaustion that typically followed each episode. After I fainted while running in the park, my doctor’s gut feeling that told him something was wrong overruled my general wariness of cardiologists, and he sent me to my fourth cardiologist, who told me I was an interesting puzzle, but that he had no idea where the central piece of that puzzle lay. So the fourth cardiologist sent me to my fifth cardiologist, a specialist. An electrophysiologist is a cardiologist specializing in the electrical workings of the heart. This specialist was kind enough to tell me that I “shouldn’t be fainting” when I felt my heart skip a beat and told me to come back in another year for a follow-up. The fact that I was fainting didn’t seem to concern him.
My regular doctor was concerned, however, and sent me to my sixth cardiologist, another electrophysiologist, who needed only five minutes with me, my history, and my electrocardiogram (EKG) strip to know what was wrong.
* * * * *
Blood flows. The heart beats. Even if you measure life by the electrical activity of the brain, if the heart stops pumping blood through the body, the body will quickly die, making the brain irrelevant.
The THUMP-thump you hear through a stethoscope is the sound of the forceful upper chambers of your heart beating, followed quickly by the less powerful sound of the lower chambers beating. The heart must beat in this order: atriums (upper chambers) followed by the ventricles (lower chambers). When this happens, the blood follows a predictable cycle: blood from the body is dumped into the right atrium via two large veins and is then forced into the right ventricle by an atrial contraction (the first of the two thumps). A ventricular contraction (the second of the two thumps) pushes the blood into the pulmonary artery and then the lungs to drop off the carbon dioxide and pick up oxygen before heading back to the heart, into the left atrium. Another atrial contraction forces the blood into the left ventricle, and another ventricular contraction sends the blood back out through the aorta to the rest of the body.
I no longer take this reliable cycle for granted, because–for me–it is no longer reliable. The “weird heart beats” when my heart “skips a beat” have a scientific name: premature ventricular contractions (PVCs). These PVCs act as a roadblock to the route my blood takes through my body. A PVC occurs when the ventricles beat too soon, not allowing the atriums to also beat. All the blood is pumped out of the ventricles, but because the atriums never had a chance to beat, the blood pools there in the upper chambers. A single PVC is harmless, experienced by almost every person almost every day, and most go unnoticed. The heart goes back to its metronomic rhythm, and the blood that had pooled in the upper chambers of the heart is allowed to continue on its journey. No harm done.
Unless the single premature ventricular contraction turns into three or four. Then there’s a problem. The ventricles keep beating, but because blood is pooling in the atriums, never reaching the ventricles, no blood reaches my lungs. No blood reaches my muscles. No blood reaches my organs. This alone is enough to deprive my body of enough oxygen that I can no longer remain conscious, and I faint. I can’t get back up and run around full of energy because my body is doing damage control. My heart rate goes up, pumping the blood faster, getting much needed oxygen out the length of my limbs, all of which are trembling and weak. I breathe slightly faster than normal, taking in more oxygen. My body craves the homeostasis it had just moments before.
On the health scare continuum ranging from completely harmless to imminent death, fainting from three consecutive PVCs would be given the status of “relatively harmless.” Maybe your electrolytes are slightly low and your heart is working overtime that day and is tired; maybe you’re in a high-anxiety situation and your skyrocketing heart rate temporarily disrupts the heart’s electrical signals; maybe you’re ill and your entire body is over-fatigued; maybe it was just an anomaly.
Or maybe you have an extremely rare genetic form of progressive, irreversible, and untreatable cardiomyopathy where multiple PVCs can lead to dangerous arrhythmias such as ventricular tachycardia, ventricular fibrillation, and, of course, sudden cardiac death.
Arrhythmogenic Right Ventricular Dysplasia (ARVD) is a very unemotional way of saying that the muscles of my right ventricle (the lower chamber on the right side of my heart, the side responsible for pumping blood to the lungs) are dying and there is not a damn thing anyone can do to slow the progression of muscle death, let alone stop it. I can do my best to prevent arrhythmias by keeping my heart rate under 120 beats per minute, but a small, circular piece of metal is what stands between me and my next death.
Several times a day, the fingers of my right hand reach up and trace a two-and-a-half inch horizontal scar underneath my left collarbone. After that, I gently palpate the edges of a raised square with rounded off corners directly underneath the scar. This noticeable bump is from a chunk of metal that is 2.93 inches high and 2.43 inches wide. Leading from this piece of metal is a wire, threaded through a vein and anchored in the muscular walls of my right ventricle. An Implantable Cardioverter Defibrillator, or an ICD, is similar to a pacemaker, although a pacemaker is always working, continually sending out small pulses of electricity to keep the heart beating in a steady rhythm. An ICD is an extra strong pacemaker on standby, ready to send a large electrical pulse to the heart when the electrical signals from the natural pacemaker cells of the heart cause the muscles of the heart to contract out of sync with one another. Once the muscles of the heart begin contracting out of control, the heart has immense trouble correcting itself. The ICD interrupts the faulty electrical signals with a jolt of electricity, giving the heart a chance to revert to its normal rhythm.
* * * * *
In Christian mythology, Adam and Eve’s Fall from Grace possesses a truth for all believers: If you deviate from the rules that keep you safe, there will be consequences. Adam and Eve’s fall into blackness is a metaphorical one, however; they are cast from the bliss and light of God’s presence and thrown into the dark and evil wilderness of the world, forever seeking reconnection with God.
To avoid the literal blackness, I follow the rules.
I wake up in the morning wondering if this will be the day my ICD fires, if I will be lucky enough to have it shock me out of an arrhythmia or if I will be shocked out of cardiac arrest and back into life. I take a daily medication that may help keep my heart beating regularly. Assessing the effectiveness of medications is difficult when the arrhythmia is caused by irregular spurts of muscle death rather than a stable underlying condition. We do know that anytime my heart rate exceeds 120 beats per minute, I am at risk for going into ventricular tachycardia, so my exercise now consists of slow walks where I keep my heart rate between 100 and 110 beats per minute. My running shoes are now walking shoes, my Swedish racing goggles and Lycra swim caps have been given away, and my bicycle chain and gears have rusted together into an immovable, flaky mass of metal. I rarely indulge in alcohol, which has been known to trigger arrhythmias. Red wine is worse than white wine, which is worse than beer. Although I still carry a mug full of coffee to all my classes, after my first cup of the day, it is filled with decaf.
* * * * *
I know what having a jolt of electricity course through my body feels like. During the surgery to implant the defibrillator, the doctor had to induce ventricular tachycardia–an arrhythmia on the imminent death end of the continuum of health risks–in order to see if the ICD would pick up the arrhythmia and respond appropriately. When the ICD fired, I came out of the anesthesia and felt my shoulders and the back of my ribcage fall back onto the hospital bed.
And then I was back asleep. After this first shock, the doctor realized the lead wire of the ICD had been placed in a “dead zone”–an area on the lining of the ventricle wall that conducts little to no electricity. He re-placed the lead wire in a healthier segment of muscle, induced another episode of ventricular tachycardia to test the ICD, was satisfied with the resulting shock, and closed my incision. When I woke up in post-op, my back, ribcage, and shoulders ached with that exhaustion and pain that follow a multi-day high fever. The nurses quickly injected a pain reliever into my IV and began a course of high dose antibiotics through a PIC line, and once again I was asleep.
* * * * *
Most of the time, I am thankful I survived back in 2000. Most of the time I take comfort in knowing what is wrong with my heart and knowing what triggers my arrhythmias because now I can take measures to prevent them. But there are times when the general exhaustion from having a heart that doesn’t pump quite enough blood with quite enough oxygen in it is too much. There are times when the promise of sleep almost overpowers the promise of life. I cannot help but wonder: What if my first death had continued uninterrupted? What if those fifty-three seconds of blackness were just the beginning? What if the next time I die is the last time I die?
In survivor circles, it is sacrilege to question life. After all, I am that lucky one out of ten who lived. I should be filled with gratefulness and an awareness of the preciousness and fragility of life. And I am. But I am also angry and bitter and sad and scared. The cardiac diagnosis explained a great deal, but I lost a great deal in the process. Not drinking alcohol and limiting caffeine intake are minor inconveniences. I can no longer call myself an athlete, however, an identity I had owned since I was five years old, and I will always limit my activities so that my heart rate doesn’t get too high. I will always take medication, and I will always have a chunk of metal in my chest with a wire leading into my heart. The muscle cells in my heart will continue to die and be replaced by fat cells, distorting the size and shape of my heart. Things will not get better. Things will only ever get worse.
There is no predictability in this illness. I may be looking at a heart transplant; I may not be. This maybe-transplant could happen in several years or it could happen in twenty. Heart transplants are not an abnormality in survivors of ARVD, and my doctor has acknowledged that two typically benign structural abnormalities in my heart put me in the “more likely to have a heart transplant” camp. There is a hole in the wall separating my two atria, allowing oxygenated blood to mix with unoxygenated blood, a potentially fatal mixture. My tricuspid valve–the valve connecting the upper and lower chambers of the right side of my heart–does not fully close, allowing blood to flow back from the ventricle to the atrium, a process known as tricuspid regurgitation. Because the shape and size of my heart will continue to change, my tricuspid valve will continue to be pulled open, increasing the amount of blood flowing back into my atrium. A valve replacement might prevent the maybe-transplant, or it might not.
I can plan for my future, and I can work toward my dreams, but I cannot do so with any certainty that I’ll see them come true. I read the literature that tells me that the advances in medical technology allow people with Arrhythmogenic Right Ventricular Dysplasia to live longer, more active lives, with fewer heart transplants. But I’m part of the one and only online support group for this illness, and during a recent two-month period, two of our active members underwent heart transplants, another one was in the hospital waiting for the next available heart, and a fourth had just been placed on the recipient list. This is the knowledge that haunts me.
With an illness such as ARVD, it would be easy to fold beneath that knowledge, to wait around for death. To wake up each morning wondering if this is the day that my heart will stop and I will need to be shocked back into life. Or if my defibrillator will fail to bring me back to life. I could stay at home, adopt twenty cats, and become an expert on soap operas and game shows. I could order my groceries online and pick out all my books on Amazon.com, giving up my weekly trips to the local book store.
Having a device implanted in my chest capable of shocking my heart makes it hard not to wonder when that device is going to fire. However, I refuse to live my life in a reclining chair on standby, waiting for death. My heart is dying. There is nothing I can do to stop this. There is nothing my doctor can do to stop this.
I have made accommodations for my heart. But if I have learned one thing from this journey, it is that life constantly asks us to adapt to the changes around and within us. Similar to a tree, if we allow ourselves to harden and become stiff, we will eventually snap when the weather rages around us. Rather, we must learn to be supple and pliant, bending with the breeze while remaining rooted deep within the earth.
I am a professor at an area college, and I teach and tutor students and work on my own writing, knowing that my work may be interrupted at any time because of a shock from my ICD. I no longer run, but go for slow walks in the evening. Rather than getting high from the rush of endorphins pulsing through my system, I am learning to savor the beauty of the leaves and the feeling of the breeze on my skin. I still read and knit and write letters and go on road trips and visit my family. I still meet my friends at our favorite coffee shop, where the baristas know I always order decaf.
From “The Permanence of Masks,” in Fourth Genre, by Christopher Origer
It is over twenty-five years ago, while I am living in North Carolina, and I am far from the boundaries of a town I cannot avoid passing through. It’s April and the sky is probably brilliant. The day is full of promise: I’m thinking of home, my thoughts unclouded, heading north on leave from the Marines. I’ve been driving west on Route 70 from Newbern for too long—memory seems to suspend time, making all these drives long and tedious. Once I hit bare country, I become lulled by the steady tick of tires along the flat plain landscape of tobacco fields. On either side of the road, etched against the horizon, is the lumpiness of orange earth that’s just been plowed or planted, or perhaps there is already the broad green leaf of tobacco plants—memory is clever in the way it veils the truth, and I seem to recall several trips along this same route during those years. I know from a map spread out on the front seat I’m somewhere near the junction I will take to head into Virginia, through Maryland, Pennsylvania, and eventually New York. Somewhere near Selma, perhaps. I’m eager to make good time on the trip; I want to be home before midnight. Since the last town, I’ve been looking for some landmark that will tell me exactly where I am. A shape ahead looms out of the fields, and as I continue driving, I recognize the rectangular silhouettes of signs. As I get closer I see it is just one sign, an enormous billboard, jutting out straight from the field surrounding it. In the years that will eventually bury this moment, I will forget the name of the town I have been in before I arrive here; I will forget the month—I say April but it could also be May. The tobacco in broad leaf seems to make it later in the year, an impossibility. I will even forget which car I am driving. The red Cougar that breaks down one day a few weeks after the handshake warranty expires? The jeep that strands me in that inexplicably sudden Pennsylvania blizzard? In this way, memory masquerades as reliable witness, producing shiny things I swear are there, yet when I go to grasp these strands of evidence, he vanishes, and with him, any traces of proof. His expert testimony I call upon has suddenly gone out to the alley for a smoke, not apologizing for his sudden lapses, his predictable absences. There are gaps to the story, yet I can never forget the main details of the sign, nor the feeling it produces in my gut. Imagine three white horses reared back on their hind legs. The horses face south. A rider sits firmly on each saddle, grasping the reins. Each rider wears a costume, but remember this is spring and many months have passed since Halloween. There is a pointed white hood, which conceals any face, leaving a slit for the eyes only. Each wears a loose gown of white fabric. Perhaps there is a red cross on each costume—I cannot be sure. If there is, it is not the kind of cross that signals relief from suffering….