One night nearly a year ago, I felt a faint tightening in the right side of my chest. I could have sworn it was a muscle cramp. It made sense; I’d just been released from the hospital the previous day after two weeks in bed, waiting for surgery to remove a mass on my heart, which miraculously resolved itself on the morning of the scheduled operation.
“Should we call a doctor?” my wife, Sara, asked when I told her about the pain. The previous evening, she had made a celebratory dinner at home, and she, my sister (who’d flown from the United States to Jerusalem, where we’ve lived for the past four years) and I held hands, cried a little and gave thanks. We had been through something hard, and now it was over.
“I’m pretty sure it’s just a muscle cramp,” I assured her, because that’s what it felt like: at the end of each breath, a tightening of the muscles in the right side of my chest. It was the holiday season, and I had spent the afternoon walking around Jerusalem with my sister, on a mission to find Hanukkah presents for my niece and nephew. By the time we returned home, my whole body was tired and sore. I knew I was overdoing it, but I didn’t care. The way things were supposed to have played out, I should have been in Day 4 of a seven-week recovery. I’d just survived multiple strokes and a heart tumor; a little overexertion, I was certain, was not going to kill me.
In the interview to approve my release, my surgeon had said there were no restrictions on my activity level, including sex, which he told us to pursue “Viz ensuziasm!” They had already kept me under observation for three days following the canceled surgery. The strand that had been hanging off my mitral valve, periodically breaking off and giving me strokes, had degraded into a smooth, non-threatening second skin on my heart. The final degradation had occurred by way of a stroke an hour before the scheduled surgery. It had been my surgeon’s game-time decision to perform another ultrasound before cracking my chest open. I’d emerged from general anesthesia with nothing more than a headache and a sore throat.
By the time the taxi dropped us off at the emergency room at 6 a.m. the morning after the dinner, I could barely breathe. Each attempt at inhalation brought pain. As I stumbled past the security gate, lightheaded and panicky, a young guard called after me to stop. But before I could respond, the cab door flew open and the driver leapt out, waving his arms at the guard and shouting, “Let him go! Can’t you see? This man is very sick!”
In the ER, a nurse told me to lie down and explain what had brought me to this point. But my upper body was a convulsed knot of pain, and between that and the creeping delirium, I could not string together a coherent sentence. She set me up with an oxygen tank and some Percocet, and took my vitals. Sara asked her to contact my surgeon right away.
Another doctor came by and assessed that since the pain was in the right side of my chest and my signs were all normal, it was not a heart thing, and I was not in immediate danger. Which, as I should have learned by now, meant exactly the opposite. The first sign: A nurse informed us that my surgeon was on vacation.
As anyone who’s ever binged on “House M.D.” knows, when a patient is cured and released by the first commercial break, he almost certainly will be rushed back in an ambulance, hovering capriciously between life and death just ahead of the second. Now that I thought about it, this was so obviously where things had been heading all along. How could I have been so stupid as to think I’d been spared?
The mass on my heart, it was being revealed, was just the first bloom of a sickness that had been quietly taking root throughout my body. Even the cab driver could see it: I was a sick, sick man.
Two orderlies came to wheel me out for a CT scan of my chest. Sara started sobbing. My sister, who had arrived with sandwiches, put an arm around her, and the sobbing grew into a bona fide wail. Stall curtains slinked open, people turned toward the commotion. A nurse gently but firmly urged Sara to step outside.
Soon after she returned, a distinguished-looking doctor, trailed by a small retinue of residents, threw open the curtain at the foot of my bed and abruptly began explaining the CT results in terms that were unintelligible to any of us on account of his extremely thick French-accented English.
He begrudgingly slowed his speech enough for us to gather that while the radiologist had not yet laid eyes on the CT, his own reading was . . . pneumonia. We collectively exhaled. Pneumonia was something we’d heard of. It was discrete and finite and treatable.
Having proclaimed his diagnosis, he promptly closed my curtain and moved on to the next stall. With his white beard and wide girth, we decided to call him Santa. We were Jewish, sure, and so was he, but it was the holiday season, and he had delivered relatively good news.
Twenty minutes later, Santa was back. The radiologist had read the CT, he informed us, and actually it was not pneumonia. It was a pulmonary embolism. I looked at Sara, who had gone pale. Without apologizing for his premature misdiagnosis or addressing the severity of what I was facing, he explained that this meant a blood clot had broken off from somewhere in my body and attached itself to my lung. As he again closed the curtain without bidding us adieu, I thought, “Merry Christmas.” Indeed, things had taken a turn.
The imperative to “live every day as if it’s your last” has become an increasingly silly and self-defeating thing to strive for. (For confirmation, just do an Instagram search including the term “#YOLO.”) Truly conducting yourself as if today were your last day alive requires more than bad judgment and a camera phone. What it requires is a sustained act of memory — and not just memory of the past, but memory of the future.
During my rabbinical studies, I learned about this seemingly paradoxical mode of consciousness, which the 18th-century rebbe Nahman of Brazlav described as “remembering the world to come.” This injunction refers not only to the urgency and clarity of purpose that come with considering our lives from the perspective of eternity but also to the potential worlds of connection and resonance still to unfold in this one, if we choose to embrace them.
The more common state, “Forgetting,” Nahman describes as a form of “heart death” rooted in hidden patches of inner sadness and typified by the illusory craving of things we don’t really want (#YOLO!). Its chronic effects were captured poignantly in a recent blog post by an Australian palliative-care nurse, who compiled the five most common regrets she has heard from her dying patients: I wish I’d had the courage to live a life true to myself, not the life others expected of me; I wish I hadn’t worked so hard; I wish I’d had the courage to express my feelings; I wish I had stayed in touch with my friends; I wish that I had let myself be happier. The post went viral.
The most direct route to remembering, Nahman concludes, is keeping an awareness of death close at hand. A rabbi I know who counts himself as one of Nahman’s disciples once told me that in the basement of his old yeshiva in Brooklyn lay a plain wooden casket. Sometimes students would go down to the basement, get into the casket, close the lid and spend some time considering their lives.
When I first heard the story, I thought it was depressing, morbid, ascetic — a way for scared people to terrorize themselves into religious submission. But now I think maybe the casket was for them what the hospital was for me: a time to remember themselves, and things of ultimate importance. Granted, fixating on death can drive a person to all kinds of self-defeating distraction. But meditating on mortality has a way of bringing life into clearer focus — of banishing distraction.
Five days in Internal Medicine cured me of my desire ever to return to the hospital. My first night, I was put on blood thinners, and for the next three or four days experienced the worst pain of my life. By the time the pain broke and I was weaned off the oxygen, my surgeon had returned and ordered a quick series of tests, but the ultimate result was mainly to clarify how much was unknown about what had led to my current state.
He referred me to a hematologist, and the ensuing months have been an extended series of blood tests punctuated by periodic imaging to make sure my mitral valve remains mass-free. So far, the tests do seem to indicate a slight tendency toward “hypercoagulative state,” or clotting in my blood. As far as my surgeon is concerned, I’m Hematology’s problem now. When I recently asked him for his gut instinct about the origin or makeup of the mass on my heart, he answered flatly, without hesitation, that he didn’t know, and we probably never will.
Meanwhile, I remain on blood thinners and have to schedule a heart scan every six months to make sure the valve remains clear. Assuming it does, the scans will become a yearly event, and life will go back to normal once and for all. Cue the commercial break.
Buckholtz, co-author of “Are You Not a Man of God?: Devotion, Betrayal and Social Criticism in Jewish Tradition,” blogs at badrabbi.tumblr.com.