“Heart Open”

Fiction by Mitch L. Adler

Part Two
   One week to the day before his 45th birthday, Michael Westerman, rushing up a staircase, got winded. He closed his eyes and tried to pull himself from whatever had seized him. It gripped his back and pulled him down with the force of a tackling football player as the floor rose to meet him.
    “Listen, whenever I hear someone tells a person in a situation like this how lucky he is, I’m stunned. Wouldn’t I have been luckier to avoid the whole thing?”
    “Then at least try to consider how lucky you are not to have been born a hundred years ago when they had no idea how to fix heart valves. You’d be finished. Or what if you’d been born in a country where they don’t do the procedure?”
    “Fine, but wouldn’t I have been luckier to be born a hundred years from now when they’ll know how to fix people even better?”
    “I’m serious. If even one thing had happened differently, you’d be gone.”
    “Yeah, I get it.”
    “You can think what you want, but you’re really lucky. You’re not dead, and you’re in a place where they know how to fix whatever’s wrong. I have to go, but for now, do yourself a favor. Think about the fact that you’re alive.”
    “Aren’t most people?”
    “Are you serious? You ever check out the alumni thing they send us? Every year the back page has more names; they just had a girl who graduated this May.”
    “So, tell me how she was lucky.”
    “She was a lot luckier than Stan. Remember Stan-the-man in third grade? Remember what happened to him?”
    “Of course I remember. So who was he luckier than?”
    “You think the universe owes us anything? Maybe you feel that you’ve got a right to take up space in the world, but I can tell you that most people occasionally think about the fact that they’re lucky to have had the experience.”
    “Which experience?”
    “Any experience. A couple of breaths, hearing a sound. Mathematically, when you factor in the zillionth of a chance that this slice of the cosmos would ever come into existence, combined with the even slimmer chance that it would spring a form of life which would line up like chain links to lead to whoever’s here now, the whole thing’s infinitely less likely than the chance of things not going that way. Do you not see that?”
    “I see it.”
    “And that’s only part of the story. There are other elements, just as unlikely, that come into play. And after all the slim chances of everything happening in just the right way to set things going, you have to factor in the chances of any two people meeting. This is where almost everyone, including the people who write about it, almost always gets it wrong. There’s one part they miss. They overlook the fact that even if two people are perfect to have a certain experience together, the chances are less than one in ten-to-the-twenty-sixth against them actually existing in the same part of the world at the same time.”
    “How do you think this stuff up?”
    “By the way, this doesn’t just apply to people pairing up. It’s the same for any experience. Anything that occurs does so against odds that place it between a one-time experience and as close to nil as you can get. Me and you crossing paths in second grade? It will never happen the same way again, not to anyone, ever, because the set of variables that shaped the experience will never occur in the same way, especially since we already occupied that set.”
    “How does this come to you?”
    “What’s the difference? The point is that every day is made up of its own set of moments, each of which is new and different, and that makes every experience unique. It’s like nature gives everyone gifts that no one else can replicate. Got it?”
    On the evening prior to surgery, Dr. Pahtek Binja sat down in Michael’s room, opened a chart, and said, “O.K., ask me questions.”
    “How much time do I get?”
    “As much you need. I won’t leave until you know everything you want to know about tomorrow. It can be overwhelming, so now’s a time to ask questions.”
    “The operation. Can you explain what you’re going to do and why I need it done?  I still don’t understand how you’re so sure I need this, and how you know that my passing out the other day couldn’t have just been a one-time thing.”
    “We can be certain that your giving in to the short-of-breath sensation is not a ‘one-time-thing,’ just from the pictures we took with the echocardiogram. The valve is leaking. Remember when I gave you the stethoscope and you heard it? That’ll get worse if we don’t fix it. Right now, you’re the first one on the docket for tomorrow.”
    “So what happens when I wake up?”
    “They’ll check with you to make sure you haven’t snacked, and they’ll do another EKG, which’ll stay on so we can monitor your heart. You’ll have a line in for your IV, another for the anesthesia, and once you’re out we insert a tube along your windpipe. It’s connected to a respirator. You with me?”
    “Yes.”
    “The respirator takes over your breathing for you. We’ll insert another tube through your nose and throat and into your stomach to stop air and liquids from collecting. You’ll have a catheter inserted into your bladder to collect urine while we’re working. We use the heart-lung machine to keep your blood flowing while your heart is stopped. There’ll be a team assisting, and once you’re on the machine, we stop your heart and cool it. Then I’ll repair the valve —”
    “What about sawing me open?”
     “Yes, I have to split the sternum to get to your valve so I can fix it.”
    “How are you going to fix it?”
    “It’s leaking, so I’m going to restore the seal and reinforce it with a ring. It’s a synthetic band that stays in. Before you’re discharged you’ll get a card to put in your wallet so if there’s ever a situation where someone needs to know what you’ve got, they’ll have all the information.”
    “What if I don’t have my wallet with me and I get into an accident?”
    “You’ll be fine. The manufacturer has a Web site and a registry. Anyone can go in and pull you up on his screen, it’s not a problem.”
    “But if I’m unconscious, how will the doctor know to look online for my ring if I can’t tell them I’ve ever been operated on? “
    “Anyone who examines you will see the scar.”
    “Right.”
    “So then we start your heart again and disconnect you from the machine. The whole thing takes a few hours.”
    The doctor leaned back. He looked satisfied that his story was complete.  
    “How long does it take to recover?’
    “A few months. But afterward, you’ll feel much better than you do now. You say you’re not usually short of breath, but sometimes you are and you’re too young for that. Without this procedure, all bets would be off for how long before the leaking will flood the other valves, and then you’ll have a situation. Better to repair the valve now.”
    Dr. Binja’s hands moved in the smooth, quiet way accessible only to natural journeymen. It is a distant world that encompasses the grace of the artisan, the dancer, and the surgeon whose focus exists outside the limits of time and space, transcending borders that contain others. He worked as the distinctions between his hands and the tissue they sculpted thinned and lifted, as lines and shapes and blood and tissue embraced his movement, their strands forming a single braid, as if synchronizing themselves to a quiet, universal music.
    And so, as the surgeon was at play inside Michael’s chest, repairing and sculpting to renew the order that nature had intended, or becoming part of a new nature, four hours passed. A pause follows and a bubble forms, a strand contracts and a bubble pops, a wave pushes as a stitch breaks, and a single speck of perfection ends. A bump, a break, a tear, a spurt, and a patient’s heart stops.
    Despite the best of chances, there are no guarantees, and Michael understands this. If asked, he would have admitted to knowing he was fortunate and lucky, as he had come to understand and embrace the fact that, regardless of one’s perspective, every moment is a gift of opportunity, a complete product of nature’s generosity, and he had experienced more moments than he could ever recount.



    Mitch Adler, an SAT tutor in East Hampton, was a contributing editor at National Lampoon who won first prize in an internet-based science fiction contest and has contributed previously to The Star. He recently underwent the surgical procedure described in “Heart Open.”