She met her husband the first time at night, in a hospital emergency room. Maybe that’s why, she thinks, the image she has of him is layered with shadows.
Right ventricle, left ventricle, right atrium, left atrium. Early on Ross drew and labeled a diagram of the human heart for her. “My beat,” he grinned. He wanted her to see what he spent his days doing. The terms sounded like a litany. She tucked the drawing in the top drawer of her bedside table.
“I’m a heart man.” He says this on occasion, at parties where he is guaranteed an audience of people who haven’t heard the line before and who laugh appreciatively at a doctor not taking himself too seriously.
She has heard the jokes and stories so often she might expect to be irritated or bored by them, but she isn’t. She’s fond of them. The way he flourishes the same old phrases, angling for laughter and approval reveals a vulnerability, a side of his character different from his crisp, efficient professional self. When he trots out one of his jokes or stories she wants to protect him.
Hearts are his business. Ross is a cardiologist. From early morning until quitting time — sometimes late at night — he examines people’s hearts. Using a battery of arcane instruments and tests, he measures their performances and records their idiosyncrasies.
From a group of electrocardiograms — to her eyes unintelligible squiggles on red graph paper — he can differentiate between the tracings made by old hearts and the ones made by young hearts.
He tells a story about visiting a remote rural hospital. He was examining a male patient and asked for the man’s cardiogram. A flurry of activity followed and a strip of ECG paper was pressed into Ross’s hand. He read it and shook his head. “This is an older person’s ECG,” he’d said. Embarrassed, the hospital staff had admitted they had misplaced the man’s chart.
Ross always tells this story in a self-deprecating way, almost as if he’s apologizing for his skill. In fact, she knows he takes great pride in his ability to decipher information and symptoms, he enjoys figuring out what’s wrong.
The party is winding down, which is just as well. She hadn’t wanted to come, but Ross had said, “It’ll be good for you — for us,” he’d amended quickly. “We can’t stay home all the time.” She had capitulated, and here they are in this stuffy room, surrounded by people full of empty conversation.
No, she’s being unfair. Her irritation is a result of fatigue. She’s tired. So is Ross. She can see how pale he is, especially around his eyes. He’s unhappy, too. It’s there in the way he only half-listens to people, flashing them a quick grin that fades almost immediately.
Ellen takes a deep breath and watches him for a while. Then she sets down her wine glass and slips down the hallway and through the front door. She’ll walk home, it’s not far, just a few blocks. The cool night air will clear her head. She feels jumbled up after talking to so many people.
Lately it’s as if she has lost a layer of herself, as though a protective outer skin has been peeled away. She used to know exactly who she was and what she thought. She had been able to handle anyone and everyone. She dealt with them all at work — the screamers, the bullies, the whiners — none of them threw her. Whatever the problem was, it was theirs, not hers. She had been firmly encased in her own skin, separate and impenetrable.
Not any more. These days when she talks to people she often has trouble following what they’re saying because she is overwhelmed by the feelings that seem to radiate off them, like sound waves, setting up interference, so it’s hard to determine what the person really wants to communicate. One woman at the party tonight was going on about how happy she was her divorce had finally come through but all Ellen could hear was the throb of sadness in the woman’s voice, all she could see were the bruised shadows under her eyes.
It’s good to be out here, alone. The sky is a deep velvety purple, the colour of a ripe plum, barely lighter than the black shadows of trees and houses around her. The moon is a silver coin climbing above the horizon. There is the merest hint of a breeze, just enough to stir the uppermost leaves of the trees, and the smell of sun-warmed grass rises through the dark air. Across the street two teenage boys are walking in the opposite direction; their words and laughter are sudden explosions in the night’s calm.
It was on a night like this that hearts brought her and Ross together, her heart specifically.
She woke up alone in her apartment in the middle of the night with a sense that something was wrong. She lay in bed listening — had the sound of an intruder in her apartment disturbed her? She couldn’t hear anything, but gradually she became aware of a drumming in her ears. Not an external sound, but an internal one. She realized her heart was racing, thudding as if she had just finished running a race. She turned on the light and took her pulse. 140 beats a minute. It seemed high. She lay back, waiting for her heart to quiet but it didn’t. Instead, she felt a heavy weight pressing on her chest.
She climbed out of bed, feeling breathless, and called a cab.
She was surprised how crowded the emergency room was at 2 a.m. on a Wednesday night. Just inside the entrance an adolescent girl sat in a wheelchair surrounded by a clutch of friends who talked in agitated whispers while the girl spoke into a cellphone. A few rows away an elderly woman sat alone holding a large plastic bag full of pill bottles. An older couple — man and wife, Ellen guessed — sat together a few seats away. Occasionally the woman patted the man’s hand. At the far end of the room a man paced and pulled at his hair.
Ellen took a chair and waited until her name was called. The nurse motioned her into a small cubicle with beige carpeting. Its walls were made of clear plexiglass. Ellen could see out to the waiting area but the plexiglass seemed to swallow noise. Compared to the waiting room, the cubicle where she now sat was quiet. It gave Ellen an odd, suspended feeling to sit in the silence, as if what was happening wasn’t really happeneing, as if she was watching it a TV program with the sound turned off, something that didn’t really involve her — she could get up and go get a snack if she wanted to, walk away from it all.
The nurse clipped what looked like a plastic clothespin to the tip of Ellen’s right index finger and wrapped a blood pressure cuff around her arm. Ellen sat listening to the beep beep of the monitor while the nurse took her name and symptoms and entered them on a computer.
Once, the nurse glanced up at the monitor and made some notes. Then she removed the clothespin, slipped a plastic bracelet around Ellen’s wrist and led her through swinging doors. She had Ellen lie on a hospital bed and pulled a curtain around the bed. The curtain rings jingled merrily as the nurse carved this little room out of the larger one. Then the nurse hooked her up to another monitor and disappeared through the curtains.
After a while a young man appeared. “I’m Dr. Richards, the resident,” he told Ellen. “I just want to ask you a few things.” She nodded. Keeping his eye on the monitor, Dr. Richards rapped out the questions briskly. No, she didn’t smoke. No, she wasn’t taking any drugs — no prescription drugs, either.
When the questions were finished he gave her a quick nod and left. The curtain flickered as he walked away. Ellen shifted on the bed. Twice while she lay there she felt the odd clutching sensation in her chest that signaled the onset of another episode. She twisted around to see the monitor, but it was out of sight.
As suddenly as he had disappeared, Dr. Richards was back, this time with someone in tow. “This is Dr. Keenan,” he said. “The cardiologist.”
Dr. Keenan asked her what the problem was. They sat there — the walls of cloth useful for keeping out what? not the sounds of other people; she caught tatters of phrases — “… musko-skeletal” drifted past, she heard the rattle of gurneys and someone’s constant cough. It felt, she told him, like a bird was trapped in her chest beating its wings, trying to get out.
He sat across from her and she watched him write on her chart. She noted his hands — his long, nicely-shaped fingers, his square palms — hands that looked strong and competent. She saw the way his black hair curled against the collar of his white shirt, felt the cool dryness of his hands as he took some blood, recognized, even in her anxious state, the flashes of humour that punctuated his comments. For some reason these reassured her.
He took her to another room and hooked her up to an ECG machine. In a minute long, narrow piece of paper with a fluttering red line spooled out of it. Then he had her walk on a treadmill, a tip-tilty device that speeded up the longer she was on it. After that he asked her to sit down and talked to her about beats per minute, workload and fibrillations.
He told her that for reasons he couldn’t identify her heart was racing. “If it were irregular there’d be something to be concerned about, but it’s regular, so I’m not worried.” He went on to say there were other tests he could order but he didn’t expect they would reveal any problems. She was young, female, there was no family history of heart disease, no sign of trauma. “All strong contraindications,” he said.
In an off-hand way he asked about her job. She explained she worked at a publishing house.
“Lots of deadlines?” he asked.
“This is the worst time of year,” she nodded. A book was coming out next week, and one the week after; there were press releases to write and send out, interviews to schedule. “You can’t see my desk at the office,” she said ruefully. “And it all had to be finished yesterday.”
It was late, the middle of the night. There was a small rectangular window lying on its side set high in the wall. Through it she could see the sky, an inky expanse. The room they were sitting in felt like an island of light in the dark. She felt comfortable and safe.
“I know you’d like a definitive answer,” he said, “but all I can tell you is that everything seems to be ticking along just fine. If you can reduce the pressure you’re under at work, that’s the place to start. I’m sending you home, but if the symptoms persist, come back.” He stood. She understood the examination was over.
A little more than a week later she was doing what he had suggested, lowering the pressure. It was a Sunday morning and she had strolled over to the town’s only magazine shop for an espresso and a gossip magazine.
The town was small enough that their meeting, although not inevitable, was not unlikely. With two magazines tucked under her arm, she stepped back to scan the offerings on the lowest shelf, and stepped firmly on someone’s foot. She turned and found herself apologizing to Dr. Keenan. With his white hospital coat replaced by jeans and a sweatshirt she was surprised by how young he looked,. “Sorry,” she said.
“How’s the heart?” he asked, smiling back.
Their courtship went smoothly. Ross was goofy and funny, in private he was more engaged and playful than the calm, slightly distant man she had met in the emergency room.
After they were married she would watch him surreptitiously while he read the morning paper. She wondered if people fell in love because their hearts beat in synch, day and night, through the months and years, two hearts moving to the same rhythm. Maybe people fell out of love when they lost that shared tempo. Could you get it back if that happened?
Ross looked up from what he was reading and caught her speculative gaze. “What?” he asked.
She smiled, shook her head, brushed his question away. “Nothing,” she said. “Work.”
Initially she was interested in his work. The language he used when he discussed it was dense and arcane: tachycardia, bradycardia, ischemia, infarct — words that sounded exotic and vaguely threatening. “Semi-lunar valve,” he said once over the phone, and she pictured a ghostly light flickering on and off in someone’s chest. He mentioned atrial complexes; the words conjured up the image of an invasive knotted plant sending choking tendrils into the dark cavities of a person’s body.
Gradually, though, she withdrew and stopped asking questions. She didn’t want to know too much about the physical workings of the heart, didn’t want to know everything that could go wrong with it. She didn’t want to know just how contingent and unlikely her own good health was. The more she knew about the heart, the more capacious and baffling it became.
She had an ultrasound of her heart once. Lying on the table as the technician ran the probe over her chest she saw, projected on a television-sized screen, the image of her heart beating. For some reason, it unnerved her, the way it contracted and expanded tirelessly with no apparent thought or effort on her part. If it wasn’t up to her to keep it beating, how would she be able to start it up again if it ever stopped?
After a while she began to wonder how Ross did it, examined hearts day in and out — weakened hearts, damaged hearts, malformed hearts. How did he carry on so blithely? Didn’t he look at these hearts and know that one day his own heart might stutter and fall out of rhythm or suffer the same damage his patients’ had? Did he imagine his heart was immune to the wear and tear of time? It seemed to her he lacked a sense skepticism or doubt that most other people had. She asked herself if he suffered from a failure of imagination.
The more she knew, the more she wondered how you guarded against illness and time. Were there any defenses against the unexpected and irrevocable?
They had been married about a year when Ellen became pregnant. It was a strange state. Before this, time had seemed to move in a straight line from the past through the present to the future, punctuated by events, one incident always leading to another. Now time was like a river that had overflowed its banks. Day flowed into day; changes that she had no control over reshaped her body and her life. She floated languidly above the invisible currents that coursed beneath the surface. So that, when something changed, when the child inside slowed its movements, she felt like she was waking from a dream.
She sat in a white room, her eyes dazzled by the brightness as they were sometimes stung when she stepped from darkness into light.
Ross sat beside her. Across from them, behind a large, shiny desk, sat a doctor, a specialist her obstetrician had referred her to. The specialist was an older man with a vaguely European accent who reminded her of nothing so much as a handsome rabbit.
He spoke quietly and she had the impression his comments were directed to Ross, not her. “… we’ll have to wait,” he was saying. “It’s too early for a conclusive diagnosis.” The rabbit doctor flashed her what she was sure he thought was a reassuring smile. “We’ll just keep a close eye on the situation and see how it develops.”
He stood; she and Ross stood. They all shook hands across the shiny desk. There was a convivial atmosphere that couldn’t mask the sense of dread that welled up inside her.
She and Ross left the office. Ross walked beside her, talking and talking, “… so it may be something fairly minor, a virus, or an infection that might respond to antibiotics.” He went on and on. She could barely hear him, she was so intent on trying to sense what was happening to the child inside her.
He talked about the baby all the way home. He continued to talk about it that night until bedtime, and the next morning at breakfast. She tuned him out; his voice became a vague irritation droning in the background.
Her pregnancy continued, but the prognosis didn’t improve. There was something wrong with her baby.
At first she was treated with the automatic cheerfulness the medical profession adopts towards those it suspects are worrying needlessly. When that changed, when the doctors she saw no longer tried to soothe her or lift her spirits, she understood hope was fading.
One day her pregnancy ended. She went into labour; she knew immediately what it was, this deep, inevitable clenching and unclenching, and the baby was born.
They — the nurses, the doctors, the crowd of anonymous faces around her — rushed her baby away from her. A girl, she gathered from a hushed exchange she could barely make sense of, born dead, whisked away from her almost noiselessly in a dry rush of whispering voices.
“I need to see her,” Ellen said.
“No, no,” they told her, solicitous, calming. “You don’t want to.”
She ignored them. “I have to see her,” she said, unyielding. There was, she knew, an acknowledgement she must make.
They brought the baby to her. She looked at the small body that bore no obvious blemish, at the tiny perfect fingers and toes, at the eyes closed as if in sleep. She reached out and touched her daughter’s cheek. It was still warm. Then she turned away.
Later, after she had been moved into her hospital room, Ross came and sat by the bed. He seemed dazed and lost. His words tumbled out in a rush. “They’re not sure what caused it,” he said. “It may have happened in the first trimester. They’re sure it wasn’t a virus. They say the chances of it occurring again are remote…” He continued, worrying at the subject interminably.
Ellen understood that this incessant talk gave him something like comfort, but she wished he would stop. Finally a nurse came to pull the curtain around her bed. She suggested Ellen might be tired. Ross focused on her as if he was waking up, as if he was surprised to see her there. “Oh,” he said. “Oh, yes. Of course.” He stood, kissed her, and left. Ellen tried not to think of him returning to their dark, empty house and lying down to sleep on their bed, alone.
Released from hospital, she was sent home to rest. At first life continued as usual. What happened had happened, she told herself; it was not to be understood, it was just to be endured.
Suddenly, a week later, grief assaulted her, slammed against her like a wall of water. The depth of it, the breadth of it, were staggering. It seeped into everything; it was in the landscape around her, the air she breathed, the food she ate. It sank into her skin and permeated her bones.
She was out shopping one morning when she ran into a woman she knew. She tried to meet the woman’s pleasantries with the right responses. Struggling against overwhelming numbness, Ellen tried to put words together, to build sentences, to bridge the space she saw gaping between herself and this other person. The effort was enormous; sweat beaded her forehead, it trickled down her back. Yet even as they talked, she couldn’t care, couldn’t care what her friend had to say. None of it mattered, all of it was trivial.
“My heart is breaking,” she told herself. This is the name she gave to her pain. “How can I go on?”
But she did. Lying in bed at night with Ross sleeping beside her she listened to the blood pounding in her ears hour after hour. It amazed her how, despite everything, her lungs kept emptying and filling, her heart continued to count out the passing moments.
She is at her own front door. Around her the night is soft and cool. Her key creaks in the lock. She goes inside without turning on the light and kicks off her shoes. Then she makes her way upstairs to the bedroom at the end of the hall. Her bare feet make no sound on the carpeted floor.
She sits on the side of the bed. She wishes Ross could cure the ache that has settled in her chest, but instead they seem to be two strangers stumbling through an unnamed place, where words like hope and happiness have no currency.
She opens the drawer of her night table and takes out the drawing he made three years ago. She smoothes the square of paper open, runs the tip of her finger over the lines he drew and reads the words printed there.
“A map of the human heart,” she recalls him saying, full of youthful confidence.
She assumed he knew the terrain he mapped. Now she knows neither of them did. She is stumbling through a landscape, unmapped and uninhabited, that she can only dimly make out, a place she knows she will never wholly understand.
She hears the front door open and close downstairs. “Ellen?” His voice sounds tentative. It rises to her through the gathering darkness, a wisp of smoke. After a moment’s silence he calls again. “Ellen?”
Melanie Dugan
1998