April 7th, 2023
In late 2018, I was diagnosed with coronary disease. That December I had five stents put into my heart, a procedure known as angioplasty. The following summer, one of the stents collapsed, and had to be replaced. That is called restenting.
At the time, I was writing a book about my father’s final years, and about mortality. It made sense to add my health into the narrative mix, if only toward the end. I compared the stents to five very small, very muscled miners keeping the roof of a mineral seam they were working on from collapsing onto them. Not a bad image, I thought. Whimsical.
The truth was, I’d been expecting to live with a weakened heart for a decade at least, courtesy of restenting. I also intended to publish a book that would meditate on aging, frailty, friendship and death without needing any further updates on my ownmedical status.
By fall, 2022, Just Once, No More was edited and ready to go. The story had now been told, including who died and who lived. The book’s subtitle – “On Fathers, Sons, and Who We Are Until We Are No Longer” – hinted at a stark existential frame. But the desired tone was, I hoped, philosophical and curious, infused with wonder about the ecstatic world.
The opening sentence, for instance, held no foreboding. “My father once met a bear in the bush,” I began. “He was following a path at dusk, ten miles in from the road, a Winchester 44-40 cradled in his arms.” Okay, perhaps a little apprehension there.
Even so, unruly, unpredictable life, with its zero promises for the future, had been transformed into tidy and assured art, every sentence locked in for eternity. Like most authors on the eve of being published, I was pleased – at the book finally being closed, at having survived the writing experience.
That feeling didn’t make it to the publication date. After three years of medical stability, my heart was back to not getting the blood it needed. By early February of this year, it had been confirmed that the arteries were beyond being restented. Those muscled miners lay buried under rubble, never to rise again.
One week later I had a triple bypass, my sternum split and my heart exposed for repair. On the day of the operation, and for a couple of days following, I couldn’t remember a word of the book I’d spent the better part of four years on. Nor could I summon a single whimsical thing to say about coronary disease.
Life had pushed back against art, demonstrating who was in charge.
Starting in the hospital, I did slowly begin to remember the contents of Just Once, No More. In fact, the book took on a fresh and fast pulse, as though excited and agitated by a new development. All of a sudden I was feeling the words on the page with the same intensity I was feeling the beating of my repaired heart.
Things that I had confessed to, mused and meditated on, worried aloud about, over the course of those four years had come real, seemingly overnight. I may have written about the importance of form in my writing, the extent to which how I told a story reflected the ways my body, as much as my mind, functioned, but I hadn’t meant it so literally.
A document I brought home from the hospital warned of a long and tough recovery. “You may feel tired, irritable, anxious, depressed or simply not quite yourself for a few weeks,” it predicted. “Don’t be worried if you express your moods and feelings more than before.” In the aftermath of the surgery, one should expect “emotional ups and downs.”
The warnings were helpful. My biggest up and down came from having to distinguish actual pain from jumbled memories of pain. A bypass is a startling bodily intrusion. There is no language to describe the procedure, known informally as “cracking the chest,” that isn’t violent: Surgeons must “cut through the sternum” and then “spread the ribs.”
Scarcely less intrusive is what happens next. In order to replace the arteries, doctors stop the heart temporarily and hook up a machine called a heart-lung bypass in order to pump blood and oxygen around the body.
The operation, in other words, is heart stopping. That is a cliché of pop song and poetry especially, one of hundreds associated with the celebrated muscle. But once again, while I may have riffed on heart metaphors in Just Once, No More, I was finding no poetry or song. Only that cracked-open chest, and a nine-inch incision running down the middle, vivid as a runway lit up after dark.
And although a cataclysmic experience, I had no actual memories of the bypass. The absence of conscious recall triggered its own anxiety. My mind sent outdated signals about pain, warning of further angina and a potential heart attack. This faulty diagnosis – the discomfort was from the chest wound – was understandable.
I am guessing my mind will eventually source select memories of what happened. For the moment, the confusion has brought on anxiety and irritability – if not, as far I can tell, depression.
What has left me a little depressed is a growing understanding of how inadequately I gave witness in the book to illness, in particular the vulnerability it engenders in the afflicted. During his decline my father spent about nine months total in hospital. While I wrote accounts of his various stays, including his final hours, and tried honouring how difficult they must have been, I did so as someone who’d never spent a night in a hospital bed.
Now, after that single stay of less than two weeks, I see a little more clearly, and compassionately, what he saw, and endured, and struggled with. As well, what feelings he may have carried to the grave, even if he rarely spoke aloud of his suffering. From witness to participant is a short journey across easily travelled terrain.
Since the operation, friends and family have been posing the same handful of questions. The first and most obvious – how am I feeling? The second – has the experience changed me, perhaps for good?
The first question is easier to answer. With certain friends, I use a Zen story. A rider and horse gallop down a road. A bystander, stepping aside to avoid being knocked over, asks where they are going in such a hurry. The rider replies: “How should I know? Ask the horse.”
The query to me is likely about bodily well-being, not psychological. My answer, I notice, tilts toward the effects on my mind.
The second question is trickier. As the subtitle suggests, I return to the notion of “who we are” again and again in Just Once, No More. “Essence is essence but the self never quite settles,” I write in a chapter about losing a friend to leukemia. “Not with so much happening, should we be lucky enough to live a good long while.”
Later, I wonder who exactly I have been while working on the manuscript. Not quite the same person as before I wrote it, I conclude. And, given the “insecurities of self and the inexorable passage of time,” I likely won’t be quite the same person afterward.
I spent several prebypass years reflecting on the unstable self, on how our lives are composed of shifting understandings of who we are, who we’ve been, and who – and where – we might end up. I wanted to explore how, in effect, to introspect, to track the wobbly phenomenology of identity, to suggest how best to not end up incarcerated by unhelpful, and often illusory, definitions of these fluid states of being.
Is it strange to say that my book is now “talking” more to my body and mind about these preoccupations than when I was actually writing it? Like so much else about these past few months, I find that notion unsettling, if also very interesting. Life and art clearly do echo each other, sometimes softly, sometimes loud.
Charles Foran 