Scars

Sometimes I look at myself in the mirror after a shower, drying off, and I see them.

A long scar runs from just below my neck to the base of my sternum. There’s one in the upper left of my chest where my old pacemaker used to be, another on the right where the Impella went in. Below the rib cage, more mark where the drains sat. At the base of my neck, a thin line traces where they removed my thyroid. On my wrists, faint marks from catheterizations that nicked an artery on the way up into the left side of my heart.

I recently went to the dermatologist. He biopsied two sites, then went back to one and took a significant amount of tissue to make sure a pre-melanoma didn’t become melanoma.

Another scar.

Then there are the ones no one sees. Months of being poked and prodded. Swan-Ganz catheters in my neck, left side and right. PICC lines. IVs—so many IVs that the count stopped mattering somewhere in the first month.

The mirror has become something of a reminder in its own right. Washing my hands, catching my reflection—it’s become the place the scars announce themselves whether I’m looking for them or not. For years, I wore my shirts unbuttoned two or three buttons down. Now I button almost to the top. Any other way, the newest scar shows.

There’s history in that habit. I had a grade school teacher, Mrs. Lutz, who once pulled me in front of the class—I was young, and stiff in the particular way that only a young boy trying too hard to be proper can be. Every button on my shirt was done up to the collar, though I never wore a tie. She reached over and undid that top button herself, told me I needed to relax a little, and to leave it that way. I did. From that day forward I never buttoned the top button again unless a tie required it, and over the years that loosened further—two or three buttons left open, a habit that held for fifty years. Post-transplant, I’ve reversed it without quite deciding to. The habit she gave me is quietly undone by a scar.

I was scratching my arm not long ago and absentmindedly reached along the back of it, to where that new dermatology scar sits. My fingers found it before my mind caught up to what it was doing. And in that small, unplanned gesture, something settled into place: I am a collection of scars.

That’s not the same thing as wanting them seen. I’ve made my peace with what the scars mean and I still button the shirt higher. Both things are true at once. Accepting what a scar records doesn’t require putting it on display, and I don’t think it needs to.

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What the Body Keeps Score Of

The physical ones are easy to catalog. I can point to each and tell you what it cost and what it bought. The sternum scar bought me a heart that works. The thyroid scar cost me a gland—one that wasn’t going to cooperate with the medications keeping the new heart alive—but that cost is what made the new heart possible. Even the dermatology scar has a transaction behind it—the price of immunosuppression is a body more vulnerable to what the sun and the years leave behind, and staying ahead of that means letting a dermatologist go back in for more tissue than either of us wanted to take.

But a scar is a peculiar kind of evidence. It records the wound, but it also records what happened afterward. An incision that never closes doesn’t become a scar. Neither does a wound the body doesn’t survive. A scar is what remains when healing has done everything it can do without pretending the injury never happened.

I’ve stopped expecting to get back to who I was before any of this. Healing isn’t restoration, whatever the word suggests. Tissue closes differently than it started. It comes back stronger in some ways, less flexible in others. The original architecture doesn’t return. Something new occupies the place where the wound used to be, and it isn’t the same as what was there before.

The psychological scars don’t offer the same clean accounting, but they follow the same rule. There’s just fifty years of living behind me, and living—if you’ve done enough of it—leaves a wake: mistakes made, relationships damaged, things broken that could not always be put back together. Some I’ve repaired. Some I’ve tried to repair and couldn’t, because repair takes two people willing to do the work, and that willingness isn’t always mine to give. People who’ve passed on that I’ll never see again, and time with them I didn’t spend when I had the chance to.

Those scars didn’t begin with the transplant. By the time I walked into that hospital, I had already been collecting them for half a century. Some were left by things that happened to me. Some I earned through my own choices. Some came from choices I didn’t make soon enough—words left unsaid, time I assumed would still be there later. They weren’t visible and they weren’t dormant either. They’d been shaping the person making every decision that followed, including, I suspect, the speed and certainty with which I said yes when the choice was finally put in front of me: not whether to keep living, but whether I’d do it with someone else’s heart.

I’d carried all of it the way most people carry that kind of history—filed away, managed, kept below a certain waterline, but never actually inert. Then the transplant happened, and something about the combination of trauma and the medications that keep my body from rejecting a stranger’s heart hit that dam directly. It didn’t crack. It didn’t flex. It was demolished.

The transplant didn’t give me scars. It gave me a new set of them, and made the old ones harder to ignore.

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The Current

For the better part of two years since, I’ve been dealing with the fallout of that break. It’s most intense in the quiet moments—sitting alone, nothing but my own thoughts for company. The memories arrive without an invitation and without sorting themselves into good and bad first. You mourn the opportunities you missed in the same breath you find yourself grateful for the ones you didn’t. And somewhere in the middle of all of it, the same question keeps surfacing:

Why am I still even here?

I don’t have a tidy answer to that. What I have is this: at some point, I stopped fighting the current and let it carry me. I don’t pretend to know what’s on the other side of that decision. I don’t know the plan, if there is one, or who authored it, or how. I’m not a religious man and surviving has not suddenly made me one. But I’ve come to believe there’s something more—I have no better way of describing it than that, whatever it may be. I’m still here because there’s something left for me to do.

I don’t think that means I was spared for a reason, exactly. I can’t know that, and I’m suspicious of anyone who claims they can. What I think is simpler: I’m here, and being here is its own kind of obligation. Not because someone planned it that way. Because it happened, and I’m the one left standing in the middle of it.

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The Work of Repair

Part of that something is teshuvah—the work of turning back and making right what can still be made right. The word means return—not just to the right path, but to something essential in one’s self. I’ve spent a great deal of time on it over these two years, particularly focused on my relationships with others. Some have mended; some haven’t, and won’t, no matter how much of the work is mine to do. I’ve learned to hold both outcomes without pretending they’re the same, and without pretending the ones that didn’t mend are an indictment or a verdict on the effort. Some ravines don’t bridge, however carefully you build.

Others have. I’ve eased pain I once caused and, in a few cases, watched something that had broken down years ago come back into shape. It isn’t finished. It doesn’t finish. That’s not a discouraging thing to say—it’s just accurate. The work continues because the living continues, and every new day is one more chance to get a piece of it right.

The rest of the something is the writing. I’m taking what I’ve spent decades experiencing—the spiritual questions, the trauma, the technical knowledge built across a career, the physical world I’m only now getting back out into—and turning it into something someone else can use. Many Lamps, One Flame takes the philosophy. One More Beat takes the trauma. At Ground Level takes the career knowledge. Rogue Wayfarer takes wherever I go next. Four outlets, one instinct underneath all of them: don’t let any of it go to waste.

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Still Compiling

A close friend asked me recently whether the trauma of a heart transplant fades the way the trauma of childbirth is said to—background noise eventually, the way it must for women who go on to have more children. I told her I couldn’t know that firsthand, but I didn’t think it was quite the same. The details do fade for me—the sharp edges soften, the sequence blurs, the anxiety recedes into something closer to a fact than a feeling. But I believe the scars last forever.

The dermatologist’s scar is the newest one on my body, and I know now it won’t be the last. There will be more of those—physical and otherwise. More heartbreak to work through. More memories to make, some of which I’ll get right and some of which I won’t.

Compiling scars,
Finding love,
Fielding sorrow,
Gathering joy,
Healing what can be healed,
Making peace with what cannot.

There’s more to come.
I intend to be here for it.