November 9th

The nurse came through the door differently.

It was 10:15 on Thursday evening, November 7th. The ward had settled into its overnight rhythm—the particular quiet of a hospital after the last shift change, monitors steady, the corridor outside moving slowly. The day had been ordinary by the standards of that room: a walk outside, pork rinds sourced by Niles from Jungle Jim’s, the ongoing project of getting a screen protector onto a new phone with hands that weren’t quite steady enough.

Then Sam came in with a phone, and the way she was moving told you something before she handed it over.

Amy, the transplant coordinator, was on the line. They had accepted a potential donor heart. The process still had steps, but if everything held, surgery could happen as soon as tomorrow.

I texted Niles at 10:15pm: Transplant coordinator just called—they have accepted a potential donor heart. They still need to run through their process, but if all goes well they may do the surgery tomorrow.

Then: I am totally stoked and totally freaked.

He understood immediately.

The Competition

Joe and Parker—the transplant NPs who had been managing my care for weeks—were already home. They heard the news and, by their own later admission, made a run for it. They wanted to be the ones to tell me. Amy beat them to the phone. Sam, who had delivered the handset, was barely containing herself; I had her read before the call connected.

When Joe and Parker told me afterward, laughing, that they’d tried and failed, I understood something about that unit that I already knew but that bears saying plainly: these were not people performing care. They had a genuine stake in what happened to me. Delivering news like this—a potential match, after weeks of watching a patient wait—was a highlight. They competed for the moment because the moment mattered to them. When it happens for one of their patients, the whole unit feels it. That’s not in any job description. That’s something else entirely.

The Long Night

The text blast went out.

Eric: OH MAN THAT IS GREAT NEWS.

Sherrill: I’m so excited!!!

My mother, called directly after Teresa, moving immediately into logistics mode.

Eric closed with: One minute, one hour, one day at a time. Tomorrow will be the biggest day of your life. You got this.

What followed was the longest short night I can remember. I told Niles I felt terrified, anxious, and Zen—all of it simultaneously, none of it contradicting the rest. I told my nurse the same thing. Sherrill pushed back on the terrified part, and she had a point worth addressing directly: I was not afraid. Not that night, not at any point during this process. I want to be clear about that, because there is a moment coming—in the recovery ICU, the morning after this surgery—where I will experience the most extreme, abject terror of my entire life. But it will not be mine. It will be drug-induced, a side effect of the epinephrine drip, a chemical state with nothing to do with my actual psychology. My own fear response, through all of this, was simply absent. I cannot fully explain it. I have stopped trying.

What I was experiencing that night was not fear. It was the intensity of a moment you have been moving toward for months, arriving without warning on an otherwise ordinary Thursday evening. The runway I had been watching shorten for weeks had finally ended. I was at the edge. And the next step was off it.

I did not sleep much.

November 8^th—The Information Arrives in Layers

By 7am I was already texting. No updates yet. Docs at 6, nurses at 7, transplant team meeting around the same time. Blood thinner not yet stopped—they want eight to twelve hours off therapeutic levels before surgery, which means mid-afternoon at the earliest if things moved today.

8:00am: a nurse popped through. The donor had been declared without brain activity. The initial read was that it was not a high-risk heart. The offer had been accepted, though they could still decline after further review.

9:28am: they stopped the blood thinner.

That is when it became procedurally real. Not the call the night before, not the morning update—the moment the argatroban stopped is the moment the body of clinical machinery began orienting toward a specific outcome. Mom had arrived forty-five minutes earlier. Teresa joined by FaceTime for the conversation with the transplant NP. No set OR time yet. Could be this evening. Could be tomorrow.

I told Niles: Man, am I an internal mess right now.

The High-Risk Conversation

At 11:29am the picture clarified.

Dowling had been through. The information that had arrived in pieces through the morning now had its full shape: technically, this was a high-risk heart. The donor had a history of recreational drug use. There was no evidence of disease transmission—no hepatitis, no HIV, nothing clinically concerning. Dowling had reviewed it thoroughly, from every angle he knew to look.

He asked if I trusted him.

I said of course I did.

He said: take the heart.

He had looked at it up, down, and all around. He was convinced it was the right heart for me. It was my decision—but if he were me, he would move forward.

The nurses said the same, a few of them separately, in the way people do when they want you to hear something from more than one direction. High-risk designation covers a wide range. This was not what people picture when they hear those words. The designation is clinical and specific, and within it there is enormous variation. Plenty of perfectly viable donor organs carry that label for exactly this reason.

For my own part, I already knew. I could see the end of the runway—not shortening anymore, but arrived at. I accepted.

Dowling told me it was the smart choice.

Eric’s response, five minutes after I sent the update: I’m gonna get a new heart because I got high. Afroman. It was exactly the right note.

Psalm 51:12

Rabbi Buchwald had sent it a few days earlier. On the morning of November 8th, I forwarded it to several people:

לֵב טָהוֹר בְּרָא לִי אֱלֹהִים וְרוּחַ נָכוֹן חַדֵּשׁ בְּקִרְבִּיו Create for me a pure heart, O God; and a steadfast spirit renew within me. — Psalms 51:12

I did not add commentary. None was needed.

The Preparation

OR time confirmed at 9pm: 7:45am Saturday.

What followed was the business of a man getting ready for the most significant thing that had ever happened to him, expressed entirely in logistics. Electronics consolidated into a bag for Niles to manage. Oura ring protected. The wound site from the cath that had been bleeding all day finally got a stitch around 11pm—hurt like hell, took time to come down from. The sleep playlist arranged in advance: the ambient music that had carried me through the worst nights of the wait, queued to be playing when I came out of surgery. The idea was that it would be there before I was.

Sam sat with me.

The mechanics of intubation and extubation had been what I was most anxious about—not the surgery itself, not the outcome, but the specific physical experience of waking up with a tube in place and not knowing quite what it would be like or how I would handle it. Sam walked through it with me, step by step: what to expect, what the sequence would be, what they would do if it went badly. She told me that if I couldn’t manage it they would simply put me back under and try again. That helped more than I expected.

She had been the one to suggest washing my hair in the sink. She had been the steady presence through the quiet hours of the night shift for weeks. This was the last night she would be doing that for me. Neither of us said so directly.

Niles confirmed for 6am.

Lights out.

5am. A bath. The prep. The particular clarity of early morning after a night of incomplete sleep, when the mind has given up trying to process and simply moves forward.

Niles arrived at 5:45am—early, which is Niles. Mom and my niece Heather arrived shortly after. They settled into the waiting room. Teresa and the kids were there by then as well. Before I went down, they allowed Mom and Niles back first. We visited for a few minutes—not long, not much said that needed saying. They stepped out and Teresa and the kids came in briefly to wish me luck, then left the hospital. Mom, Heather, and Niles went to the surgical waiting room. Lisa arrived later with my aunt—Mom’s sister—and my brother Jarrett made it just in time as well. They all waited together.

At some point before 7am they came for me—earlier than the scheduled 7:45, which I took as a good sign. These things move when they’re ready to move.

What passed through my mind on the way to the OR was not fear. I was not afraid—not of the surgery, not of what came after, not of the possibility that it did not work. I had been offered chances to exit this story and had declined each of them. The course was set. I had chosen it, consistently, over months, in small decisions and large ones, every time an alternative had presented itself.

I was not afraid. I was ready.

The surgery was scheduled for four hours. The procedure itself ran closer to two—these were surgeons who knew exactly what they were doing and moved accordingly. The overall process, including everything that follows the surgical portion before they close, ran longer. But by any measure, it went fast. It went well.

When it was done, Dr. Dowling went to the waiting room and told them it had gone well and they would be able to see me soon. They moved back upstairs to the regular waiting room and eventually were allowed back to the room. I was still unconscious—tube down my throat, respirator running, a row of IV machines doing their various jobs. Mom remembers standing there looking at me. Not alarming, Dowling had told them—this is what the immediate post-operative period looks like. But there I was: proof that it had happened, proof that I was still on the other side of it.

The Gap

The surgery went by the book.

I was not there for it. Someone else’s heart was removed from a cooler and placed in my chest. The diseased one was taken out. Lines were run, the chest was sealed. The machine that had been doing the heart’s work handed that work back–and presumably, no one left any screwdrivers behind.

This is what I know of it. The rest happened without me.

Waking Up

I came to later that evening.

I was fully aware of what had happened. My mind began working its way up and down my body—methodical, calm, the way I approach most things. There was no panic. I am not the type. I raised my hand and wiggled my fingers in a small wave, knowing a nurse would be nearby. Sam had told me someone would be there when I came out—not her, as she worked in a different section of the ward, not the recovery ICU—but someone. And sure enough, there was.

I could feel the tube, though just barely. The nurse was there immediately—calm, efficient, already moving. She looked at me and smiled.

Hello there.

She called for her counterpart, who arrived quickly. The second nurse leaned in:

Jim, what say we get that tube out of you?

I gave a thumbs up. To be honest, I barely knew the tube was in me in the first place. They sat me up, gave me the instructions, counted—one, two, three—and out. I coughed once, drew in a breath.

That was it. Nothing at all compared to what I had been so anxious about.

They gave me a sip of water. Then the quick version of how things had gone. They had me sitting up, and before long I drifted back to sleep.

But not before I felt it.

The Impella was gone. The pacemaker was gone. I could sense their absence the way you feel the removal of a weight you had stopped noticing you were carrying. And beneath that absence was something else—the new heart, moving blood with a force and consistency I had not felt in years. Possibly longer than I could accurately say. I had not known, until that moment, how far gone I had been. The contrast was immediate and unmistakable.

This is what a heart is supposed to feel like.

The next morning, sitting in the chair beside my bed, I dictated a text to Niles, my nurse helping me manage it:

OK, this is kind of wonky, but I am up and about and sitting in my chair. I can’t really settle the eyes so I am using the dictation. My nurse is helping me get it together. But I am doing well. That is about the best I can say at the moment.

That was enough.

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