4

A very young-looking man in sneakers and a knit tie approaches my bedside saying, “I heard you had quite a night.”

“Who’re you?”

“Oh, sorry. I’m Dr. Baird, the resident here on Six South.” He extends his hand.

“I don’t shake. Immunosuppressed. And you’re a giant germ in a white coat.”

“I wouldn’t doubt it, heh-heh . . .” He’s looking down at the ground, chuckling, closing his eyes behind long dark lashes.

Too adorable. That’s what I’m thinking. This guy is what Jill and I would’ve called cute thirty years ago. He lifts his face into a wide white smile, glowing like a high school valedictorian—or a middle school one. There’s no hint of his needing to shave that chin anytime soon, which doesn’t stoke my confidence.

“Is Dr. Kobashigawa coming to see me?”

“He’s making rounds this morning. Should be here within the hour.”

“I’ll do the intake with him then, thanks.”

“I’d like to examine you real quick first, if that’s okay.”

“It isn’t.”

Ahem, ahem.

Jody clears her throat and shifts in her chair beside my bed—right ankle over left knee, and switch—reminding me that I’ve got an audience. “Okay, okay, sorry,” I say, sweeping my hands from side to side, shooing away my own words, resetting. “I’m not at my best right now. This is scary and freakin’ awful, you know, Doctor, um . . .” I lean forward to look at the laminated ID tag hanging from his neck. “Baird, right, Dr. Baird. I was admitted through the ER after midnight. My heart keeps slowing down.”

He gestures toward a folded sheet of paper sticking out of his coat pocket. “Yes. It’s here on the overnight monitoring report.” I’d been hooked up to a telemetry monitor—a constant EKG watched carefully by a central station on the cardiac floor. “Your heart is . . . well, it’s failing.”

“Yeah, news flash, right?” I look over at Jody for corroboration on my mild sarcasm. She’s got her chin to her chest, staring into her lap.

“I’d really like to examine you before I—”

“Wait a sec. I think it might be happening right now. I’m feeling . . . floppy. Light-headed, ugh, hard to breathe . . .” I launch into habitual self-preservation mode where I become an excellent teller of symptoms in an emergency situation so a doctor can more easily identify what’s going on in my body and, with some luck, save me from it. All eyes shift to the monitor screen beside my bed—a jagged stream of heartbeat lines in green and orange moving left to right beneath a large blue number that shows my pulse rate. The number is going down, sliding in free fall like a stone through black water, no sign of where the bottom may be: 91 . . . 83 . . . 76 . . . 65 . . . 58 . . . 49 . . .

“I don’t feel so good . . .” My hand lands on my forehead—I’m sweating.

Jody jumps to her feet, arms crossed in front of her chest. I turn my head toward her, and our eyes meet in trepidation. “Do you, uh . . . think you should maybe go get someone?” she asks the young doctor.

“Let’s just watch and wait a minute.”

Two nurses rush in, without our summoning. “Oh, you’re in here. Good,” one says to him. Central station had alerted them.

“Just giving it a few.”

I turn on my right side and gaze up at the monitor: 41 . . . 49 . . . 60 . . . 73 . . . 82 . . . “Here it comes now,” I say, and lie back down in bed. “I’m all right.” Jody remains standing, shifting nervously foot to foot. The nurses leave.

“Yup, looks like you’re back at ninety or so, which is . . . fine, ” the doctor says, back-stepping toward the door. “Maybe I’ll come later and take a listen to your heart after you’ve seen Dr. Kobashigawa.”

I say okay, and he turns to leave.

“Excuse me, excuse me, Doctor, please,” Jody calls out. “That can’t just keep happening to her, can it? Should I get the nurse if her pulse falls again?”

“Amy’s on telemetry. The station will call the floor and send someone right away if there’s trouble.”

“Oh, okay, oh, good. Thank you, Doctor. Thank you so, so much,” Jody says, all earnestness and direct eye contact.

Her solicitousness makes me uncomfortable—even though I know to expect it. Jody is always so darn kind. So careful and deliberate in what she says. And while I am just now discovering the etiquette she brings to a hospital setting, this isn’t the first time I’ve wondered at her steadfast considerateness and decorum: I’ve been with Jody amid a group of women on several occasions where a gossipy comment pulls everyone in—except her.

Did you get a load of Renee’s dress at the party last night—could it have been any farther up her crotch?

Great body, but come on, we’re not teenagers . . .

Even my teenager wouldn’t dress like that.

Well, Brett sure couldn’t keep his eyes off . . .

Andy too, and I gave him a kick.

Ha-ha-ha . . .

And then there was Jody: “Totally short, yeah, and not my taste at all. But Renee seemed to be having a fabulous time, and I’m all for happiness.” A few words from Jody can dry up the juiciest chatter—just like that. I’ve never once heard a mean syllable slip from her lips.

But then, I haven’t spent all that much time with Jody. She and her husband, Jack, live in Los Angeles and are friends of friends, really, and this connection has brought us together mostly for celebratory group gatherings and outings over the last ten years. We’ve hugged each other in good cheer, the way occasional friends do—So good to see you!—and clinked glasses around a decade of happy-birthday dinner tables. But we’ve never had a girls’ lunch just us two, and I’ve never once called her to say, I’m so sick today, I could cry. Jody is a situational friend, not a close one, and the situations have all been fun.

But now the circumstances are the opposite of fun, and I feel a burden to hold onto Jody’s high regard and show that even under great stress, I still exhibit qualities worthy of her and the girlfriends we share in common. Pressure to perform bears down on me now, just as it has in the past—a familiar tension between my strong drive to put on a good face and my desire to give myself a break while in the grip of critical illness. While I used to see this as a choice between kindness to others and kindness to myself, experience has shown me that the two are actually blended: by eking out grace in the toughest moments, I reap benefits in the form of a favorable opinion from the people around me. I must keep this reciprocity in mind while in the company of Jody, who has never seen me under the strain of medical emergency.

Alone together for the first time ever, our essential selves are no longer diluted by the group around us; suddenly we are individuals writ large and on display. Jody is already demonstrating that her fine character remains intact, even with my pulse dropping before her eyes; intense apprehension does not fray her lovely manners—Thank you so much, Doctor, thank you! But I, on the other hand, am on edge. I was propelled through the door of the Cedars-Sinai emergency room just hours ago, superwoman Leja gripping my underarm. My desire to sustain my best self is challenged by my fading heart, and weakened by the anxiety of being far from home and far from Scott. Frightful thoughts and memories have been drawn fresh to the surface after last night’s experience, but Jody is not aware of all that has come before this, all that is flooding me now.

“I thought to myself last night on the way to the ER, I might never see Scott again,” I start in, by way of explanation. Her eyes pop. Legs cross and uncross. “I almost died in an ER with Scott twenty-five years ago.”

Jody pauses before answering, “I did not know that.”

“Yeah, makes this slow-pulse thing look like nothing because back then, before my first transplant, my heart would totally flip out. I mean completely go racing and skipping, and they’d have to defibrillate me. Shock to the chest, bang! And you know what was really strange—no one asked Scott to leave the room when it happened. He stood at the far end of my stretcher and held my toes while they shocked the hell out of me.”

Again, there’s a long pause.

“That’s . . . awful,” she says. And I know she’s got to mean it because, well, it’s Jody, and she’s kind to the core. But there’s a blankness in her tone that irritates the hell out of me. How can delivery of the word awful be so damn deadpan? Is it because of her perfect politeness? Maybe she’s making a point of not latching onto my defibrillation saga so I won’t feel awkward in the wake of blurting it out.

Does she think I’m oversharing?

But she’s got so many blanks that need filling in.

Everything I say and do in front of Jody in this hospital room is going to look pretty bad to her if I don’t hurry up and open a few windows into my past. I’m worried that, without context, she might rethink her basic impression of me as an affable woman and not be willing to take our friendship to a higher, more real level. Jody is not like our New York friends who’ve become inured to my medical dramas and have figured out their role to play in them; Jody is just now getting her first glimpse at closest range. I’d hoped that Scott and I might be able to prime her and Jack a little bit when we had dinner at their house a few days after arriving in LA, but the evening passed without either of them asking a single question about my upcoming appointments at Cedars and what my place on the heart transplant waiting list might entail. When Scott and I pulled away in our rental car, I tossed up my hands. “What’s with that?” I asked, and he said Jody and Jack probably didn’t want to pry and were waiting for me to open up the conversation. But I had a different read on it: maybe they saw that I looked just fine on the outside and figured my condition couldn’t be all that precarious—a reaction that frustrates me, but one that I have encountered enough times to shrug off.

I learned last night that I was wrong. Jody had raced from her house in Santa Monica to join Leja and me in the ER at midnight. Just thirty-five minutes after Leja’s fretful phone call woke her from a deep sleep—“I need that you come here now!”—Jody burst into my curtained cubicle. “So sorry, so sorry! It took much longer than I thought!”

“No worries, it’s great that you’re here—and I mean really great . . .” I shifted my eyes toward Leja, who’d brought her hands up in prayer position and affixed her eyeballs to the heart monitor screen above my head. “Thank you for coming, Jo.”

“Ames, I gotta tell ya, you are so welcome.” Her kind eyes sparkled above the warm Jody smile that showed a full expanse of upper and lower teeth. I immediately felt the comfort and calm of her presence.

“And just so you know, Jack wanted to come, he really did, but—”

“No need for both of you to be here.”

“Yeah, well, he took an Ambien at eleven.”

“Oh.”

“And so did I.”

“Jody! A whole Ambien, and you’re here?”

“Yup.”

Leja leaned in. “What is this Ambien?”

“A sleeping pill,” I said. “Jody, please tell me you took an Uber?”

“You know, Ames, I did not, and I will admit that to you right here at the Cedars-Sinai ER,” she said, adding an undertone of humor to her guilelessness. “There was no way was I going to wait one minute for an Uber. I just jumped in my car.”

“Nooo . . .”

“Yeah, but I’m good. I’m good!”

“You must be exhausted.”

“Nah.” She lifted her eyebrows and stared out like a doll. “I can push through it for a couple of hours. And then I’ll Uber home, for sure.”

“You do not look to me sleepy,” Leja announced, bringing her nose to Jody’s chin and inspecting upward. “Your eyes are very awake. You do the Botox, yes?”

“Leja, come on . . .” I said.

“I do not do the Botox, no,” Jody answered, “but thank you for the compliment.”

This was Jody’s first introduction to Leja. I would have to fill in some blanks in this area as well, but not just yet.

It is a good thing, then, that Leja is not here with us this morning in these tense, tight quarters. She is driving to the airport to pick up Scott, who, within twenty-four hours of his arrival in New York, had to fly back. Last night was my first emergency room visit without him by my side, and I know he’s sad and sorry for this. But I see it as a backhanded stroke of good luck, actually; I had no choice but to spare Scott this latest ordeal and its hauntings—and he will live lighter for it because, as we’ve both come to realize, heart emergencies never leave you. They stall and seep in, slip behind your mind’s curtain and wait in the wings of your consciousness, always looking for an opportunity to jump onstage—when you glimpse the light blue sweater you happened to be wearing the day the ambulance whisked you to the hospital, or the nail polish color you had on when an ER nurse said, “Get that off, honey. We need to see if oxygen’s circulating to your fingertips.” So you push that sweater far back in your closet, and you toss that bottle of nail polish and swear off all other pale pinks that may cue the frightful flash of memory. But the more skeletons you’ve got vying for your attention, the louder they rattle. And the more near-death emergencies you accumulate, the less power you have against them.

And so it was in the ER at Cedars-Sinai last night with those defibrillator pads on either side of my spine. “Just in case!” the nurse said, summoning the ghost of ER defibrillations past, when twenty-five-year-old Scott stood beside the stretcher of twenty-four-year-old me while I asked to be spared and told Scott I loved him, in between jolts of electricity to my chest.

This time, I had to brave it alone. Well, not exactly alone—Leja and Jody were there too. And now that I’ve filled Jody in on my defibrillation history, I’ve also connected a jolt of meaning to the blue-and-white pads she glimpsed through the slit in my hospital gown last night. Perhaps this explains the reason for the lack of expression in her That’s awful response: Jody was so horrified, she didn’t know what to say. Perhaps once she realized the pads on my back were a symbol of dread, she lost her words. After all, the defibrillator ghost makes its icy pass through bystanders too.

We sit in silence now, our eyes checking the big blue number every few seconds.

“Dr. Lunchbox,” I say, making an effort to cut through the tension.

“What?”

“The doctor who was just here. Baird. He’s, like, eleven years old. I’m going to call him Dr. Lunchbox.”

She laughs. “Oh my gosh, that’s perfect! So young-looking! But nice, right? The guy seems really nice.”

“I’m not going to call it to his face. Don’t worry.”

“Well, that is smart,” she says, playfully.

I explain that Dr. Lunchbox is a resident, one of the young doctors on the hospital floor—maybe two or three years out of medical school—who act as liaisons to the attending physicians. “So in a complicated case like mine, Dr. Lunchbox isn’t going to be making any important decisions. That’s why he stood there just now and watched my pulse drop: he doesn’t have the authority or the experience to come up with a plan to fix it. Dr. Kobashigawa will do that, and Lunchbox will learn.”

She nods, and then nods again. “Uh-huh, I see . . .”

“You think I wasn’t nice enough to him.”

“No, I’d say you were . . . fine.”

“Look. If Dr. Lunchbox listens to my heart, he’ll be lost. No way he’s ever heard a near twenty-six-year post-transplant heartbeat before. He’d be putting on a show for me—Okay, stethoscope to chest now—lots of acting—Hmmm, yes, well. And I’d have to help him along: My cardiologist in New York says there’s a split first sound, but Dr. K hears it as a ventricular gallop. And there’s a murmur because my tricuspid’s leaking again, but don’t confuse it with a mitral valve rub, even though I’ve got a moderate to severe one of those going on too these days . . .”

She opens her mouth in amazement. “You sound like a doctor!”

“Yeah. Well, believe me, I’m not happy about it. Drives me crazy when I know more about nuances in my heart sounds than the guy listening to them, and then I have to go through the motions and pretend I value his dumb-ass input. And he’s the one who’s supposed to take care of me if everything goes haywire! I tell you, it’s scary shit to be me in the hospital.”

She leans toward the bed and puts her hand on my arm, and I feel the heat of embarrassment rush to my cheeks. The casual, surface-type relationship I share with Jody has no pretext for letting honesty fly—especially when accented with curse words. I rush to redeem myself: “Sorry, Jody. I’m all hyped up, you know? In save-my-life mode . . .”

My cell phone rings. Scott and Leja have just pulled into the hospital parking lot. I tell Jody they’ll be up here in less than five, and then rise slowly from the bed to retrieve a clean pair of black yoga pants from the closet.

Having made a rule against hospital gowns long ago, I’ve still got on the jeans and shirt I wore to the ER last night. A sick person dressed as a sick person becomes an even sicker person is how I’ve come to figure it. I’ve also noticed the medical staff perk up at the sight of street clothes on a bedridden hospital patient: even the busiest doctor can’t help but pay a little more attention when encountering the apparent display of a staunch will to normalcy and wellness. This is why I asked Leja to drop off a pair of black leggings and a few tops before heading to the airport this morning. “Do I look really sick?” I ask Jody as I head to the bathroom. “I don’t want Scott to think I’ve gone terribly downhill over the last twenty-four hours—he’ll feel bad for going back to New York.”

“No worries there, Ames. You don’t even look like you should be here.”

“Thanks, Jo,” I call out, turning on the water so I can wash any tearstains from my face.

“Jodela!” He has arrived.

“Scotty!”

I hear the squeak of chair legs against linoleum tile. Jody is up and moving toward Scott. I step out of the bathroom and find them in an elongated hug. Leja stands off to the side, glaring with suspicion.

“Hi, love,” I say, coming up behind him.

He turns and throws his arms around me. “Sweetie, I’m so sorry I wasn’t here. How are you doing this morning? Did I miss Dr. K?”

“No, he’ll be here in a few minutes. Sit beside me,” I say, climbing on the bed and leaving half the length of it for him. We fall back against the propped pillows and immediately into our natural fit with my head tucked under his chin. This is my safe place, my greatest comfort. Scott’s body—the health of it, the dependability—is an instant refuge and the source from which I have drawn strength again and again in the past. His nearness feels like hope.

I start to cry.

“I know this is hard for you,” Scott says, “but let’s wait for Dr. K.” He runs his hand along my cheek.

“We can step out . . .” Jody says, turning toward the door. Leja doesn’t budge.

“No, no. I’m just so relieved that Scott’s here,” I reply. He hugs me closer for a few quiet seconds before turning back to our guests.

“So, Jodela,” he says, “what’s new? How’s Jackie?”

“I’m happy to tell you that Jack has a breakfast meeting nearby and should be here pretty soon, I think.”

“We’re going to need more chairs,” I say. “Dad’s coming.” My seventy-nine-year-old father flew in from New York this morning as well and is likely on his way to the hospital by now. He’d volunteered to come to LA (without my mom, for now, due to her paralyzing fear of flying) and help out at the bungalow while Scott was away. “And Rabbi Borski’s stopping by too.”

“A rabbi?” Jody is surprised. She knows that neither Scott nor I have ever taken part in organized religion, let alone become active members in a Reform Jewish synagogue like she and Jack have. I explain that I reached out to the local Chabad—an Orthodox Hasidic movement.

“Chabad!” Jody gasps with disbelief.

“Strange, I know, but I talked a few times with a Chabad guy years ago. He was my friend’s rabbi, and I gotta say, he made sense to me. He said something about my life and my suffering having a larger meaning that I can’t see—like maybe I’m here on this earth to remind everyone to be darn grateful they’re not me.”

“Thanks a lot,” Scott says.

“Except for you, honey. Everyone would want to be me so they could be with you.” I mean this.

“Well, just be careful,” Jody says. “My friend had a bad experience with a Chabad rabbi. He went wacky on her, wanted money, and got heavy-handed with the proselytizing. It was a little creepy.”

I turn in surprise to my kindly friend. “Wow, Jody,” I say with a smile.

“Hold it, I take that back. Chabad can’t all be the same, right? Your rabbi could be totally different. He’s coming here to visit you and that sure shows a lot of—”

In walks Dr. Kobashigawa. “Morning, morning!”

Scott rises from the bed, and I sit up and away from the pillows. Jody gathers her bag, signals to Leja with her chin, Let’s go, and they slip out.

 

Twenty minutes later, Jack and Jody crack open the door and peek around it. “Okay if we come in?” They’ve been waiting outside for Dr. Kobashigawa to leave.

Scott motions for them to join us.

Jack walks directly to my bed and sits beside my hip. “Hi, Ames,” he says with a frown, taking my hand in his.

I’m crying.

“Can I get you something? How about some Carvel? I’ll run out right now if you want.” Jack and I share a love for soft-serve vanilla.

I laugh, snorting a little through my tears. “You silly, it’s not even eleven.” Jack grabs a tissue and dabs the corners of my eyes, while Scott and Jody talk quietly, forehead to forehead, in the corner.

Leja would not like the looks of this.

And she would not be entirely off base: there is a crossover of admiration between couples, to be sure, and it has been a constant over the years we’ve been friends. But it doesn’t rise to attraction—not sexual attraction anyway. It’s more like favoritism or harboring a soft spot for the spouse of a friend, and Scott and I happen to have it—each of us, respectively—for Jody and Jack. Almost every time we see them, Scott tells me, “I just love that Jody.” It’s her sheer good-naturedness, he says, and how she’s so straightforward and charming at the same time. “Jody’s a lot of fun, she’s casual and comfortable, not all dressed up and made up, and I don’t know why, but she makes me smile ’til my face hurts.”

“Maybe it’s because your smile is a lot like hers,” I’ve told him, “spreads across your whole face.” He seems to like it when I say that. I think Scott senses the natural fit between himself and Jody, with their deep-set eyes and brown-black hair, and the easygoing slump of their shoulders that makes them both so approachable. Everyone likes Jody the instant they meet her, and the same can be said of Scott.

“If I got swallowed by a whale and you had to pick one woman from our friend group, who would it be?” I asked him once, after a few days at the beach with Jody, Jack, and friends.

He answered immediately, “Jody. And you?”

“Jack.”

“I thought so.”

Scott and I would never know if they felt the same way about us, but it didn’t much matter. There was nothing to act on, nothing to do. Just a little sparkle to enjoy every now and then. Just a little special appreciation, and the pleasure of being appreciated specially in return.

Jack brings my hand to his lips now and kisses it. “Wanna tell me what the doctor said?”

“He says I need to have a pacemaker put in. Today. To stop my pulse from dropping. They’re going to fit me in as an emergency, maybe in an hour.”

“The doctor says she’s much worse. They’re going to keep her in the hospital until a donor heart comes through,” Scott says. “No more bungalow for Amy.”

“This is actually a good thing—getting sicker. It moves me higher on the waiting list. But I don’t want that friggin’ pacemaker in my chest. It’s crazy enough to live with someone else’s heart pumping inside me, and now it’s going to be controlled by a battery? I might as well be a robot.”

Jody and Jack think I’m being funny, but I couldn’t be more serious. Dread of needing a pacemaker has been a constant throughout my years with a racing, unruly transplanted heart. I even warned my Columbia cardiologist long ago, “Don’t you dare even suggest a pacemaker—’cause I’d give it an absolute N-O.” For me, the feeling is visceral and, I suspect, unusual among cardiac patients. I just can’t help but feel that there’s something alarming and even sickening about wedging a control device into a heart that’s already been cut from one body and moved to another.

But the full intensity of my reaction is not to be shared with Jody and Jack, not now. Boundaries may be moving fast in this hospital room, but in this moment my instinct is to pull back instead of try to explain myself. I have opened up to them more than enough already.

“Amy’s not too happy about getting a pacemaker,” Scott says.

“I don’t have a choice. Dr. Kobashigawa said he’s worried about cardiogenic shock.”

Jody and Jack freeze in place.

Jody raises her hands by her ears, as if in a stickup. “Okay, Ames, I have absolutely no idea what that is.”

“You don’t want to know,” Scott says.

“Death,” I say.

Scott shoots me a look. “That’s not likely to happen. Amy’s getting a pacemaker.”

Jody and Jack mumble how great that is, and thank God for pacemakers.

Just then my father appears in the doorway with Leja in tow. “Table for two!” he calls out.

Rabbi Borski shows up just behind them, crowding the space by the door. “Make it three!” he adds. There’s no long coat, I notice. No tall hat either. Not even a stereotypical Orthodox beard. Instead, this rabbi wears a dark blue suit and matching tie. His salt-and-pepper beard is kempt and not very religious-looking. His expression is humble and friendly.

I hug my father, do the introductions around the room, and gesture for him and the rabbi to take a seat. Scott and Leja find spots to sit at the end of my bed. Jack and Jody lean against the wall. And as if the tiny hospital room weren’t packed enough already, here comes Dr. Lunchbox.

“They’re going to take you to the cath lab for your procedure in about forty-five minutes, all right?”

I nod and turn to my father. “I’m getting a pacemaker.”

Leja jumps. “What is happened!” Scott gets up and whispers something to her that prompts instant composure, then walks over to my father and leans in for a few private words.

The room falls silent.

“Mets or Yankees?” It’s Rabbi Borski. His voice crackles with light. “I take it you’re all New Yorkers. Tell me, who’s your team?

“Mets.”

“Mets.”

“Dodgers—the Brooklyn Dodgers, that is,” my father says.

“Ah, you’re from Brooklyn. Me too,” the rabbi tells him.

“I grew up on President Street.”

“President Street! What number?”

“Fourteen sixty.”

The rabbi smiles. “My first cousin Abraham lives in that building.”

My father’s eyes cloud with nostalgia. He shakes his head. “Well, how about that. Talk about coincidence! I haven’t seen the place in sixty-five years . . .”

“I’m sure my cousin would be happy to give you a tour sometime!”

“Ah, now there’s a joke about that . . .” my father says, grabbing the opportunity to dig into his trove of Jewish humor. “May I share it with you, Rabbi?”

“Please do, yes.”

“So Morris is alone on a desert island for a long time. He builds a house. A library for himself. And, tzadik man that he is, he builds not just one synagogue, but two beautiful structures to God. One day a sea-wrecked sailor washes up on the island, and—”

“‘I wouldn’t be caught dead in that synagogue!’” The rabbi finishes my father’s joke.

There’s laugher and knee slapping. Everyone is swept up in the fun of a stolen punch line.

“So you’ve heard that one before, Rabbi?”

“Heard it? I delivered it to my congregation at Rosh Hashanah service this year!” He pauses, looks to the ceiling, and thinks for a few seconds. “Okay, let me tell you about this . . . There’s a church with a rodent problem, such a terrible thing, you shouldn’t know from it. You familiar with this church?”

“I don’t think so. Go on, Rabbi.”

I scan the room: there’s merriment, everyone encouraging the banter. But minute by minute, the scene is turning gruesome in my eyes: the toothy smiles all around, the popping eyes and reddened faces, the twisted sound of incongruous enjoyment. I zoom from face to face.

Don’t you see me checking my pulse rate every few seconds?

Jody’s eyes were no longer glued to the monitor along with mine: Is it that easy for others to be distracted from what’s really going on in this hospital room?

I’m about to get a pacemaker put into my dying transplanted heart, for fuck’s sake.

“Well, this church, it’s right across the street from a synagogue that also has rats, you see. The priest and the rabbi use the same pellets to get rid of these creatures, but they keep returning only to the church. So one day the priest sees the rabbi and says, ‘Do you still have rats in your synagogue?’ and the rabbi tells him no, they’re gone. ‘Can I ask you then, Rabbi, how do you get them to stay away?’ and the rabbi says, ‘I bar mitzvah them and they never come back!’”

Laugher and more laughter. The room is positively jolly.

I manage a smile, but that’s as much as I can muster.

“Why they do not come back?” Leja asks aloud.

No one seems to notice my loud exhale.

“Because after a kid is bar mitzvahed, he never goes back to temple again,” Jody explains. “That’s a great one, Rabbi!” She’s beaming at him.

My father starts in immediately, “So Sadie comes home from shopping one day and finds her husband, Sam, in a chicken suit . . .”

“‘Not on the Sabbath, Sam!’”

Another jump to the punch line.

I roll my eyes—but everyone is chuckling too heartily to notice.

My father and the rabbi continue on like this for some time, delighting the room. Finally, a nurse comes in to say, “I see you’re very popular. Some crowd in here! Amy, dear, I’ve got a gown for you.” She steps toward me and the chatter starts up again at a lower decibel. “You’re going to have to put this on for your procedure. Open to the back, please.”

I take the gown and rest it beside me. “Scotty, could you, uh . . .”

He understands.

“Hey, everyone, Amy needs to change . . .”

There’s talk of heading for a quick coffee downstairs as they file out one by one.

See you later, Amy . . .

In a bit, Ames . . .

Be right back, hon . . .

Can I get you anything?

“No.”

I sit quietly for a couple of minutes with no intention of replacing my button-down flannel shirt with the gray-blue gown just yet.

“Ames? Okay if I come in?” It’s Jack.

“Of course.”

He steps into the room and shrugs. “I didn’t go with them. Wanna take a quick walk with me in the hall?”

“Okay.” I leave the gown on the bed and slip the loop of my telemetry monitor over my shoulder like a purse. I’m leery to leave the room, but I can be a little bit brave knowing that the monitor will still be picking up every heartbeat. “Let’s go,” I say. There’s a box of yellow surgical masks mounted by the door frame. I reach for one and secure it behind my ears. “Got to wear this. Hospital germs out there.” We make a right turn and step into the wide white hallway.

Jack takes my hand.

“I need to go at grandma pace, sorry.”

“No problem, Ames. I’m just happy to be with you.”

The corners of my mouth turn up beneath the germ mask. How can I not smile at Jack’s sweetness? He let the others go for coffee without him just so we could have a walk together. We’re not going to talk about pacemakers. We’re not going to speculate about how long I might have to wait for a heart now that I’ve been hospitalized indefinitely. There won’t be any forced joke telling. Jack and I don’t have to speak at all; it’s plenty nice just carrying a feeling between us.

It’s special.

“I gotta stop, sorry.” It’s been only about twenty feet. We drop hands in front of a large window looking out over an expanse of Los Angeles. I try to catch my breath.

Jack becomes an instant tour guide, pointing here and there. “That’s Century City, and if you go straight down you’ll get to Santa Monica . . .” After a few minutes, I tell him I’m good to walk again and we head back to the room. Stepping inside the door, we see everyone is back in place, just as they’d been earlier.

Leja is glaring at Jack.

My father offers me his chair, saying, “Maybe you’d like to stay out of bed,” and I take a seat beside the rabbi. Within seconds, a young man in a Cedars-Sinai uniform comes in.

“I’ve got a stretcher outside to go to the cath lab.” He pans the room. “Uh . . . who’s the patient?” Since I’m still dressed in leggings and a plaid shirt, there’s no way to tell I’m the sick one.

Ha-ha-ha-ha . . .

I don’t join in the laughter.

“It’s me,” I say.

“I’ll be in the hall when you’re ready to go. Family and friends, you can wait in the waiting area while she’s in the cath lab.”

There’s movement around the room, everyone gathering their things.

Rabbi Borski rises to his feet. “I’d like just three minutes alone with Amy, if that’s all right.”

My father answers for the group, “Sure. See you in the hallway, honey.”

Seconds later, they’re all gone.

The heavy door thumps closed.

“Well then,” the rabbi says, and pulls out a black leather-bound book from his briefcase. “A prayer.”

 

I’m on my back, gliding beneath a track of fluorescent lights. A cath lab nurse is wheeling my stretcher through an interior hallway that leads from the holding area to the procedure room, and I haven’t got a new poem.

There wasn’t time to memorize one and there’s no comfort in harking back to a recent recitation that brought me no good luck. I’m going to have to scrape the bottom of the mind game barrel—fast.

All right—how ’bout let’s play “What’s different here?” This is my first time in a cath lab that’s not Columbia’s, after all; what’s different here at Cedars? Not my best invention, but it will have to do. Carefully narrowed focus is the only trick I’ve got right now.

Okay, so . . .

Lining the hallway, there’s a stretch of horizontal hooks where X-ray protective clothing hangs at the ready. Some items have designs: purple swirls, camouflage, tiny dots in happy colors (These belong to the nurses, I’m thinking, they like to doll up their gear at Columbia too). Then comes the lineup of scrub sinks—deep stainless steel basins with foot-pedal controls and large hanging vats that dispense some kind of skull-and-bones hospital-grade soap with the touch of a forearm. Two doctors stand side by side chatting, their hands covered in bubbly froth.

What are the sinks doing in the hallway? At Columbia, they’re inside each procedure room.

My stretcher comes to a stop, and I’m watching the doctors rinse and re-bubble, scrub-brush their nails—rub, rub, rub—and rinse again, this time with fingers pointed down (so the germs slide away from the body and down the drain—Columbia doctors do this too).

I should remember to do a final downward rinse at the end of my hand washing . . .

The nurse hits a silver square on the wall. A pair of double doors opens to the cath lab, and she pushes me inside. It’s freezing in here.

Two large flat-screen monitors. Dozens of meter-length catheters in sterile wrap hanging inside glass-front cabinets. Steel cart with surgical implements lined up. Yup, just the same as Columbia.

The narrow procedure table is set in the center of the room.

“Can you slide yourself over, or do you need help?” the nurse asks.

“Done it a hundred times. Literally. I’m great at the stretcher-to-table switch,” I tell her, pushing up with my hands and shifting my body from one long cushioned surface to the other. But this time the simple motion sucks all the oxygen out of my lungs. This has never happened to me before.

I’m so much sicker now than I ever was at Columbia.

Mind game over.

“Give me a minute before I lie down?” I say to the nurse, hoping it will be enough time to regain my breath. She nods and turns to greet the doctor who’s just come in—a small, quick-moving man with wiry gray hair.

“I am Dr. Wayne. Hello, Mrs. Silverstein.”

“You can call me by my first name if you like. I’m Amy.”

“Hello, Mimi.”

“No, it’s Amy,” I say, and then immediately think to correct myself for fear that he might call me “Itsamy.” Dr. Wayne’s speech is choppy, perhaps due to his jittery manner.

“Today I will put in a pacemaker.”

“Yeah, I guess that’s what you gotta do.”

“I’ll give you medicine for sleep . . .”

“I’m not going to sleep.”

“Not really sleep. Just very, very relaxed. Like sleep.”

“Nope. No sedation at all. I do everything without sedation unless it’s a surgery. This isn’t a surgery, is it?”

“Not exactly surgery, but—”

“Good then. No sedation.”

The doctor whirls away from the exam table and mumbles under his breath loud enough for the nurse and me to hear: “No sedation! For a pacemaker! Sheesh . . .” He heads into the hallway to scrub up. The nurse remains behind, tending to an array of syringes and small metal utensils.

“I don’t want to give anyone a hard time,” I tell her, “but I’ve had lots of experience staying awake through hard stuff. And I don’t like being put out.”

“You wouldn’t really be out. Just relaxed. We’d be giving you some Versed . . .”

Versed! No way.

I’d like to ask her how many times she’s had Versed, because I’ve had it plenty and it’s a nasty sedative.

Instead, I press my lips closed. Check your attitude, Amy.

That’s what Scott told me just before we headed out to LA. We had a long talk one evening, mulling the challenges we knew would be coming and trying to anticipate what else we might face. “If you’re going to die,” Scott said, “and let’s be honest, you might—you need to think about how you want to act at Cedars, how you want to hold yourself in the end. With your friends—do you want to be loving, or bitter and angry? And with the doctors and nurses—do you want to earn their respect for the way you’ve lived these twenty-five transplant years, or do you want to show how you’ve been wrecked by them? It’s all about how you want to be remembered,” he said.

This was not the first time that Scott had attempted to remind me of my better nature. There had been plenty of instances through the years when frustration and fear overtook me, transforming qualities like self-advocacy, determination, and attention to detail into alienating misbehaviors. The constancy and complexity of transplant-related illnesses would crescendo from time to time, to a point where it felt unbearable—and where it would imbue me with a distorted sense of self-righteousness: Give me a break—I can’t be bothered with decorum. I’m too sick. And then I would rage against Dr. Davis’s missteps, calling him inane, or I wouldn’t pick up the phone for days when friends called to check in, or I’d yell at Scott for no reason at all and then cry and cry and cry. Then came the heavy regret: “Scotty, I’m just so, so sorry . . .” and he would close his eyes and shake his head. “You’re dealing with unbelievably scary stuff, I know. But you’ve got to find a way to stop taking it out on the people around you.” If I didn’t, he said, I would send everyone scurrying away.

I tried to do better. With each successive medical crisis, I got a little more adept at keeping my fear from spiraling into anger and spurring me to lash out. But I found that the success of my efforts was only proportional to the health challenge at hand: the more life-threatening it was, the less I was able to contain my angst. What degree of self-control, then, would I manage to exert in the face of this retransplant?

I was yet to find out. But it spooked me to notice that, in light of what awaited us in California, Scott had rephrased his usual advice about how I might carry myself in the hardest of circumstances. For the first time ever, he was framing his words in a context of finality, asking me not about how I might want to be perceived but rather remembered.

I just want to be remembered without everyone misunderstanding me.

I know this doesn’t speak to the self-reflection Scott hoped for. But right now, this is what comes to mind as I contemplate how I might explain to this nurse my aversion to Versed. I know my stance is unusual; when patients hear that they’re getting a drug to help them relax before an invasive procedure, they see no reason to object. But long, hard-earned experience has taught me this: Versed messes with your mind. It’s a powerful, tricky sedative that makes you think you’ve slept through the procedure when actually you were awake the whole time. Versed is, simply, a forgetting drug, but its powers of erasure are imperfect. Somewhere in your mind (and certainly in your body) there is a flicker of awareness that something happened to you (for instance, you might have been screaming in pain throughout the procedure), but you can’t quite get at it, so an anxious ambiguity scratches at you and festers. There is a cost to not being able to access and process our own pain and suffering—some might call this post-traumatic stress. I’ve experienced it myself, and this is why I’ve come to insist on keeping things where I can see and process them—without Versed.

I share my thinking with the nurse.

She walks from the tray to my stretcher and lowers her voice. “I agree with you. And too much Versed isn’t good for your brain cells either.” She taps her head. “But Amy, I’ve never seen a patient do a pacemaker implantation without sedation. It’s going to be rough.”

“I hope you’re wrong. But thank you.”

Dr. Wayne stomps back in and comes to a stop by my left shoulder. “I’m going to have to give you a lot. Of lidocaine. Because you said no sedation. Sheesh.”

“Fine with me.” I don’t mind multiple lidocaine shots. I’ve accumulated three or four hundred of them for localized numbing in all the biopsies and angiograms I’ve had. From experience, I know that if the doctor gives the first shot slowly—alternating a bit of needle with a bit of lidocaine—subsequent injections will become quickly pain free.

BANG!

Dr. Wayne slams the first shot into the left side of my collarbone.

“Ow!”

“That hurt you,” he says.

“My gosh, yes. Ow. In New York, the doctor gives a little bit of lidocaine at a time so . . .”

“I said you would need a lot of shots. Because of no sedation.”

BANG!

This one feels like it has vengeance behind it. I clench my teeth, determined not to give in.

BANG and BANG—two more in rapid succession.

That’s it.

“Ow! Ow! Oh my God! I can’t take it!” I’m weeping now, and I can’t believe I’m crumbling this way. I don’t cry from pain. What pierces my armor this time is the frightening vulnerability I feel at the gruff hands of a masked stranger in a cath lab far from the one I’ve known for twenty-six years. Reciting poetry couldn’t possibly combat what is looming over my body at this moment. A nurse’s tender glance would bring me no ease. The reassuring touch points I’ve come to rely on give way to stabs of surprise—each one of them another fiery agony. I have never known cath lab procedures to be scenes of horror, but I feel myself here in the grip of a ghoul.

“It’s too much for you. Right?” Dr. Wayne glares.

“No, I’m strong as hell. I’ve been on a hundred cath lab tables. It’s you! You’ve got terrible hands—has anyone ever told you that? You suck at this! Just give me the damn Versed.” Oh, I’ve really let loose now. I sure don’t want to be remembered like this, but I’ve lost all control.

“Oh, now you want it? I have to call anesthesia. It will take, I don’t know, an hour. For them to get here. Because you said no sedation!”

I pause, taking a few seconds to muster a conversational tone. “You need an anesthesiologist to administer Versed? In my experience, the nurse just puts it in my IV—at least that’s how they do it in New Y—”

“In New York! In New York!” He galumphs away from the exam table, waving his hands over his head. The nurse follows, and I’m alone.

I’ve never been left alone in a cath lab before.

Does this mean I’m on my own for the next hour? Isn’t someone coming back?

No.

They’ve left me lying flat with the slightest pancake of a pillow under my head. Within a minute, I know, I’m not going to be able to breathe.

What will I do? I’m going to have to sit up to catch my breath.

But that will ruin the layers of sterile draping they’ve laid across my body so carefully; they’ll be madder at me than they already are. I’ve got to stay put until the anesthesiologist arrives—one hour.

That’s sixty minutes. Three thousand six hundred seconds . . .

I start counting.

One, two, three . . .

Soon my head feels fuzzy. My eyes close against my will. I lose count. I think my pulse must be dropping, but I can’t place a fingertip on my wrist to check it because the nurse secured my arms tight against my sides before wrapping me in sheeting . . .

And I can’t turn my head far enough to see the blue number on the monitor . . .

And I can’t sit up . . .

And I can’t breathe . . .

And I’m alone—in this room, in this terror, in a body that is speeding toward its end.

Serious illness reveals the infinite depth of solitude. I settled into its bottomlessness years ago, and yet the panic of isolation overtakes me still.

And there’s Scott and Jody, Jack and my father and Leja—all of them sitting together in the waiting room right now without any idea that I’m barely holding on in here. How am I going to explain to them—that the doctor was rough, that he plunged needles into me like tranquilizer darts into a grizzly bear. That I lay flat on the exam table in need of an oxygen mask, but no one was there to help.

I could have died. No, really, listen to me—it was beyond what I could handle in there!

They won’t feel the weight of it. They’ll find a way to lighten whatever I say to them. We bar mitzvah the rats and they never come back! Ha-ha-ha-ha!

Stop that cackling! I can’t stand the damn gaiety!

I’ve lost count again—eighty-uh-two . . . eighty-nine?

I’m confused. Woozy.

The double doors open and someone rushes in.

My eyelids flutter.

I feel my mouth fall open.

Within seconds, the green-clad people descend, ghoulish in their masks and puffy caps, gloves and X-ray shields. There are here to slice into my skin, slide their control wires into my heart. One of them pulls back the sheeting from my left shoulder, where scattered injection punctures still ooze blood onto my naked breast.

The Versed sweeps through my IV . . .

Where are my clothes?

What happened to my voice?

Why can’t I remember?

 

I open my eyes to a familiar hospital room. Scott is the first to notice.

He sits on the bed and puts his hand to my cheek. “Hi, honey.”

I stare past him, unfocused. Lingering Versed makes it easy for me not to respond.

“She’s awake!” Leja shouts.

Shoes shuffle across the floor. I sense bodies gathering at the left side of my bed.

“Amy, honey. I’m right here.”

Scott again.

I don’t move my eyes. I don’t speak.

He smooths my hair. “You’re back in bed now. Everyone’s with you. The procedure is all done.”

All done? What happened to me in that room? . . . Will it ever be done?

Beneath vacant eyes, I’m trembling—terror is still coursing through me. But as I start to get my bearings, I realize that I’m also boiling mad.

“It’s the anesthesia.” My father’s voice.

No, it isn’t.

“Let me try.” Jack takes Scott’s place beside me on the bed. “Ames, it’s Jack. Say something to me. Just say, Hi, Jack. I’d like that, Ames. Ames?” He looks up at Scott, “She’s not right. Should we tell someone?”

Scott picks up my hand. “Limp,” he says. “She’s not responding at all.” Panic begins to rise in his voice. “Let’s get a doctor in here. Hey, Jody?”

“Yeah?” I hear her voice from over by the door. This silence I’m perpetuating, it’s stirring everyone up in a punishing way. Terrifying them second by second. Causing pain and fear where there needn’t be any. But I don’t know if I’m actually capable of responding at this moment. I’m not even sure I’m alive. The separation I feel from my own body is so severe, so alarming—the thought crosses my mind: Am I in shock?

Whatever I’m in, it’s an altered state, the likes of which I’ve never experienced; for the first time in my adult life, I’ve lost the desire to wrangle words and express myself. My mind is doing somersaults. Thoughts are tumbling like Ping-Pong balls in a bingo cage; each one bears a piece of vital information right there on the surface, but I can’t possibly call it out. The whirl of clack-clacking has to stop—only then can I reach into the jumble, make sense of what I pull from it, and speak aloud to those who are asking to hear my voice.

“I’ll find the resident,” Jody says. I hear the door close behind her.

Jack tries again, louder this time, “Ames! Ames! Please, just one word.”

“Squeeze my hand!” Scott calls out.

My mind goes soft again.

He lets go, and my arm collapses beside me.

“Doctor’s on his way,” Jody says. Her voice grabs my conscience. This isn’t the good impression I wanted to make on her today, but I can’t bring myself to respond. The lingering effects of Versed won’t shake.

Soon there’s a stethoscope against my chest. A penlight in my eyes. It’s Dr. Lunchbox. He addresses the room: “I don’t know what’s going on with her exactly. I’ll give Dr. Kobashigawa a call. He’ll want to order a brain scan . . .”

I’m still working myself out of a stupor, finally gathering the effort to respond. “No scan,” I manage to mumble.

“Amy!” Scott squeaks with emotion.

“Yeah, I’m here.” Even I can hear the shrug in my voice—it’s sort of like, Okay, you got me.

Scott’s eyes narrow with incredulity. “Did you just . . .” He pauses with his mouth open. “Were you able to . . . but you didn’t?”

I don’t answer.

“Why would you do that? Didn’t you see how worried we were? And you just kept pretending that you couldn’t speak!”

“I wasn’t pretending.”

I was traumatized, I want to say. I’m in shock. But I don’t.

The doctor slinks out. Jack steps back from the bed. I lift my gaze and focus for the first time on Jody, who’s pacing back and forth in short strides over by the door, her arms folded tight against her chest. She pivots to face me and our eyes meet.

I wince.

What she must think of me now . . .

I had hoped Jody and I might have days and weeks to ease into a closer friendship, that my time in LA would mean we’d get to know each other on a deeper, more meaningful level. I worry that I’ve gone and set things back for us; Jody probably thinks I’ve acted cruelly today—or that I’m crazy.

But I lost my words, don’t you see? I never lose my words . . .

What happened in the cath lab—it’s not the same as the medical trauma that I’ve become used to over these transplant years, the kind you can tamp down or maneuver around pretty well, even though it sticks with you. No, this experience today—being disempowered in such a terrifying way—it doesn’t just stick. It breaks you.

A pacemaker inside me. Versed in my veins.

Needle-stab splotches spreading black and blue across my chest.

Empty cath lab.

Gasping, gasping . . .

I can’t find a way to wrestle these horrors to the ground. There’s no stomping them out. My mind gives way to the spinning bingo cage again, little white balls encoded with memories of medical chaos—whirling, blurring. But this time, I can’t bring myself to reach into the bin and grab hold of a few, name them and reframe them as I have in the past to control the terror they carry. In this moment, the thought of even the smallest effort for self-preservation is exhausting. I can’t help but sink now; I’ve been paddling too hard and for too long.

The cost of survival is decimating me, right here, right now.

I turn my head away from Jody and find Leja on my right with her palms over her eyes, weeping. It was just one day ago that we laughed together in the garden, sharing what I’d learned about hummingbirds (my spirit animals, as she’s since come to call them), whose portents we hoped would connect my fate with an unbounded energy—soaring, zooming, persevering. But what I didn’t share with Leja were the words in the essay that drew the closest and truest parallel between these birds and me. These poor little birds would be beaten down and broken by their very existence:

The price of their ambition is a life closer to death; they suffer more heart attacks and aneurysms and ruptures than any other living creature. It’s expensive to fly. You burn out. You fry the machine. You melt the engine.

Brian Doyle, “Joyas Volardores”

*  *  *

He told me that God has a book. And in this book he keeps a list of people who are going to die soon.

I know almost nothing about Judaism, so I don’t exactly buy it.

“What we need to do is get you off that list,” he said.

“How?”

“Oh, but there is a way.”

We would use my Hebrew name. Seems the secular name I carried with me into the hospital was on that bad list in God’s book. But my Hebrew name, “Well, that, you see, is not.”

I didn’t have a Hebrew name to give him.

“So we will choose one now,” Rabbi Borski said. “What name would you like?”

I told him I knew of a Chabad woman named Ahuva.

“Means ‘loving.’ That’s very nice for you, yes, and let us add to it the name Leiba. Means ‘heart.’” He pronounced the final T sound with such emphasis that I felt it sharp in my chest. “Ahuva Leiba—a loving hearT.”

There it was again—that T.

The prayer was short; the rabbi recited lines in Hebrew and I repeated them back to him.

“That’s it?”

“That’s it.”

We walked into the hallway together and I climbed onto the stretcher. As I rolled toward the cath lab, the echo of his voice followed me down the long hallway. “Good-bye for now, Ahuva Leiba. You will live long. You will get your hearT.”