Reflections

A long line from below the neck to the base of the sternum. One where the old pacemaker sat, another where the Impella went in. Marks below the rib cage from the drains, a thin trace at the base of the neck from the thyroid, faint catheterization marks on both wrists.

There’s a clause in the contract of being alive that everyone carries and almost nobody reads. The arrangement is temporary. It will end. The terms are non-negotiable and the timeline is undisclosed. You signed it the moment you arrived, without reading it.

There’s a moment when the psychological weight of a transplant lands fully. For some it’s the listing, for others the wait, or the table, or the long recovery after. For me it came before any of that—the moment I said yes.

Almost every transplant candidate thinks it and almost none of them say it out loud: someone has to die for me to live. It arrives before the testing, before the waitlist, before surgery is anything but an idea. The first crisis is usually moral.

When something happens that I can’t explain, I don’t explain it. I hold it intact, exactly as it arrived, and refuse to file it under a category that would make it smaller and easier to carry. That practice is the only thing that makes the rest of this account trustworthy.

The Egyptians pulled the brain out through the nose with a hook and threw it away. It was packing material. The heart they left exactly where it was, because the heart was where the person lived. They weren’t eccentric in this, and they weren’t alone.

There’s a moment in the recovery arc when you realize the person you’ve been looking for was there the whole time. Not rebuilt. Not reconstructed from parts. Retrieved—the way you find something you misplaced and recognize it instantly.

The voice went in late September 2024, somewhere in the middle of the AFib cascade that brought everything to a head. The assumption at the time was acid damage—the kind of thing that heals on its own in a week or two. There is a version of this story where it’s a footnote.

The heart was beating, the surgery was done, and by every external measure the crisis had passed. What the discharge packet doesn’t cover is that the emotional accounting hasn’t started yet—and that the prednisone exposure began weeks before the transplant did.

The number 55 had been hanging there for years. Not a premonition—a calculation, the kind that runs quietly in the background when you know your body well enough and have been paying attention long enough to see where the line goes. When things fell apart after that birthday, it didn’t surprise me.