My arms and legs are still paralyzed, and I can only hope that this is from anesthesia. Apparently the operation did not kill me, but there is not yet enough time or information to assess how I feel about that. I can’t breathe, and my vision is distorted by tears.
Before the operation, a nurse advised me that when I woke up I would be intubated and unable to speak. She emphasized that the first thing I should do upon gaining consciousness was to move my hands and feet and lift my head, implying that I should be able to do these things.
I cannot do these things. While choking on the breathing tube, I have barely enough energy to try lifting my hands and feet . . . to no avail. Forget lifting, how about just a wiggle? Nothing. Raising my head is like lifting a bowling ball with a pinky finger.
“Nurse? Nurse? He’s choking.”
We’re in Jerusalem, where we’ve lived for the past four years, so the Russian nurse answers in Hebrew: “Tell him he just needs to relax!”
One conundrum baked into human experience is the problem of interpretation: We don’t know how to comprehend things that happen to us as they are happening. We might speculate about pros and cons, but we have no idea how the consequences will unfold, and these speculations are projections of our assumptions about how the world works. We squeeze the chaotic unfolding of our life stories into familiar narratives.
For me, this is part of the appeal of religion and part of the reason I spent eight years studying to be a rabbi. It provides a narrative of hidden possibility to challenge my default scenario, with its inspiring strains of fatalism, self-judgment and worst-case scenarios. Between these competing mythologies, I remain agnostic, but I root for hope.
And yet! When I arrived in the ER in November and was told that I had a tumor on my heart and an infarction on my brain and that more strokes were probably on the way, it was hard to find a positive interpretation. For a mostly healthy 40-year-old, facing the prospect of open-heart surgery seemed terrifying and bad. Theologically, I do not believe in a punishing God. Still, my insides trembled with the intuition that I was being, at least, harshly tested, that I had brought the test on myself and that there was a very real chance of failure. In other moments, my inner nihilist muscled in: This happens to people. They get sick for no reason; they have strokes and get paralyzed and die. Why should you be different?
My surgeon was unflinching in explaining the situation. Aside from the general risks of such a major operation so soon after even one stroke, much less the six I’d had in the past two months, surgery increased the chance of re-triggering them, possibly with greater intensity. Even if the surgery achieved its objective, I might end up paralyzed or impaired. My surgeon did not use the word “death.” Instead, he said it was his obligation to inform me that “there’s always a chance with any surgery that you’re not gonna make it.”
Treating death or severe impairment as realistic possibilities, I started to see my life through the lens that in three days it could be over. This was terrifying and, it turned out, kind of great. I did not know why any of this was happening. It could not be tied to any lifestyle patterns. Did I smoke too much? Yes. Could I stand to lose more than a few pounds? Yes. But neither of these things was likely to have played any role in the formation of what doctors said was a tumor on my heart, and my surgeon, a tumor specialist, definitively discouraged me from looking for reasons. Tumors are inscrutable.
I’d been zapped, singled out by a finger in the sky. Why? There was some imbalance in my heart and in my heart-brain connection. Where else was there imbalance inside me? What was happening may not have been my fault, but my impulse was to look inward. Repent. Take inventory. Shed.
After being admitted to the hospital, I found myself crying constantly. I cried when I thought about ceasing to move through life with Sara. I thought about what her life would be like if I died in the OR. I cried about not seeing my nieces and nephews grow up.
I was also crying about other things.
In the Bible, there is something called “orlat ha-lev,” literally “foreskin of the heart,” which Jewish tradition understands as a metaphor for disconnection and numbness, a barrier to giving and receiving the compassion that is the nature of God, the fabric of the universe, naturally available to every conscious human. One remedy, proposed by Nahman of Bratzlav, an 18th-century Hasidic rebbe, is to connect more fully to the present moment, and in the days before surgery, as my mind reeled off my greatest-hits moments of paralysis, dissociation and shame, at times I felt I was crying out every feeling I had ever suppressed.
I started to see my surgery — the snipping of an obstruction so that my heart could be revealed and re-sensitized — as a covenant of rebirth. What began as a terrifying and inscrutable (but undoubtedly well-deserved!) punishment had become a vehicle for teaching me how intensely I wanted not only to live, but to live differently.
Change suddenly seemed possible. Every night, I lay in bed, covered my face with a pillow and screamed that I did not want to die. Yet I already was discovering new sources of compassion, for myself and others. I talked to my parents about the distance that had grown between us. I stayed up late reminiscing with friends. I told my siblings things I had never revealed to anyone.
A few days before the operation, I ventured from my ward to the mall at the hospital’s entrance. Walking around, listening to music, observing people: familiar activities, but something was different. The commentary that usually accompanies such strolls, briefly attaching to each person I pass — the judgments, revulsions and attractions — were gone. It’s hard to describe what took their place other than just . . . seeing them and the low rumble of heartbreaking elation that accompanied that simple fleeting act.
I was the second surgery of the morning, but the day was a purgatory of waiting. The guy whose job it was to shave my chest showed up two hours late. Then, to my surprise, he told me to take off all my clothes and proceeded to shave my entire body.
At some point after that, I got restless and decided to do a little stretching; when I stood up from touching my right cheek to my left shin, I felt a head rush.
Except I knew it wasn’t really a head rush. The dizziness was accompanied by too many extraneous sensations — for example, when I looked toward the ceiling, my sight was fractured into cubistic fractals and a painful flood of light that provoked a sharp nausea.
I sat on the edge of the bed, massaging my temples, closing and opening my eyes, hoping this might right my brain, fix my vision and restore reality to the way I was used to seeing it. My thought was to hold off mentioning it until it passed, because to mention it would be to acknowledge that it was happening, and I did not want it to be happening. It seemed like a bad thing to be happening.
“Call a doctor,” I finally said to Sara. “I’m having a thing.”
I’d had another stroke.
By the day of my surgery, I had gone from seeing these strange masses as inscrutable punishment to seeing them as a gift. Instead of feeling I’d been zapped by a mysterious vehicle of karmic judgment, I was grateful that I had something that could be fixed with a routine surgical procedure. Interpretation reversed: This was not about confronting death, but facing life. Thank God for the masses, thank God for the strokes, thank God for the open-heart surgery.
But nothing makes you question a positive interpretation of open-heart surgery like having a stroke an hour before you’re supposed to go under. My surgeon had informed me about the danger of major surgery anywhere in the temporal vicinity of a stroke, even delaying this operation several days to get more distance from the one I had had 10 days earlier. Would they even be able to operate now?
Maybe I was being punished after all; maybe this was a test I wouldn’t pass.
Yet, an hour after the stroke I transferred my baby-smooth body onto a gurney and was rolled down the hall, accompanied by Sara to a waiting room for pre- and post-op patients. My surgeon passed by, all business. I called out to him that I’d had another stroke. Without breaking stride, he said something about a scan.
Then it was just me and Sara. She tried to be strong; I tried to reassure her. It helped that I was filled with irrational confidence — bolstered by pre-surgical Valium but founded on the hopeful sense that I had faced this test with the utmost seriousness, I had emptied myself spiritually, I had done the work.
What happened next was the worst part of everything.
“Please come back to me!” Sara erupted, sobbing, and collapsed onto my chest.
“I’ll be right back,” I said. “I promise.”
I knew this was not within my power.
As they wheeled me into the OR, a hand placed on my face a mask that blew sweet cool air into my nostrils. Nurses swaddled my arms. A voice told me to count backward starting from 100. But I did something else. I said the Shema. A proclamation of faith in the unity of existence, it’s supposed to be the last thing you say before you die. I wasn’t trying to be morbid; I was preparing for rebirth.
But also, you know, just in case.
“Honey, you’re whole. You’re intact.”
She did not mean anything I thought she meant. She did not mean the surgery had been successful, that a line of staples was now holding my chest together. She did not mean I’d had a massive stroke on the operating table but at least I was alive. What she explained was that before opening my chest, the surgeon had done another ultrasound of my heart. It showed that of the eight-millimeter mass on my mitral valve, six millimeters had broken off and disappeared, most likely causing the stroke I’d had an hour earlier. This was the dangerous part of the mass, the part that threatened to break off into my arteries and end up in my brain and give me more strokes. Instead, most of it had apparently dissolved into my bloodstream. All that was left was a flat mass, smooth against the tissue of the valve, barely detectable and posing no danger to me. He called other surgeons to look at the scan, and they confirmed his interpretation. Surgery canceled. The worst-case scenario had happened, and I was fine. At least for the moment.
Buckholtz is the co-author, with Tova Hartman, of the forthcoming book “Are You Not a Man of God?: Devotion, Betrayal and Social Criticism in Jewish Tradition.” He blogs at badrabbi.tumblr.com.