Heart Failure

The morning I met you, I locked my elbows and threw my weight against your chest. What conspired beneath the shroud of your skin was familiar: an inscrutable trigger struck your ailing heart; blood laid stagnantly in your vessels and acid built up from circulatory failure, further diminishing your heart’s contractions. An injury spirals and cascades until you’re swept away in a current only vaguely resembling the ripple that bore it. I understood this because for weeks the undertow had gripped me too, but working to keep you here that morning saved me.

Your mother wore zebra print pajamas and slept fitfully on a daybed, which she motioned for me to sit on beside her. She diligently recorded every word I said even though none of it was important because what else was there to do. She stockpiled cafeteria apples in a basket by your bed and rushed to mop up the water you spilled until I stopped her. As the days wore on, her hair became knotted and her face so furrowed with exhaustion that I barely recognized her when I walked in. I brought you a document to sign forgoing resuscitation (“Allow Natural Death”); your mother signed too, and I signed as witness to her pain.

One morning I told your mother that this was not working and we should turn off the drips, and the look on her face is one I hope I never forget because it was unmitigated devotion and devastation and strength eclipsing pain: a compilation that transcended grief. Because I imagined she was angry with you for succumbing to the addiction that lethally remodeled your heart, angrier with the institutions that damned you to it, and terrified of the expanse of nothingness she saw stretched out beyond your grave, but at that moment, she thought only of shepherding the son she never imagined burying towards compassionate death. Because the root of my pain is love betrayed, while your mother pulled from the bowels of suffering an unrelenting, enduring, self-effacing love. She turned to you: “Whatever you want.”

I kept our visits short each morning because even though I've always known that life has been better to me than I deserve, when I think of you and your mother, I know it in a way that hurts. I can’t figure out how to thank her for enduring as everything around her decays, how to tell her that the look on her face has kept me going.

This post was written by Mariam Nawas, MD.

Day 546

My phone buzzed. How was your day? I thought about the day’s events. No, stop. Too much. It was easier not to answer. I checked the refrigerator and found enough items to make cereal. Sitting down, I propped open my laptop. How was your day? I had no idea. How had it been? No part of me wanted to to contemplate, introspect, or analyze. Good, I typed. I read before sending, thought better of it, and added a smiley face. Smiley faces made it all sound better.

I basked in distraction. Social media? Thumbs up. Sports headlines? Fair game. Top thirteen things I did not know about the cast of a TV show I had never watched? Thank you, Internet. As I scrolled to thing #8, my email lit up. I closed it so that nothing could distract me from my distractions. Good, it was gone. Good riddance.

I sprawled on the couch and looked out the window. When had the leaves come back? Maybe they always grew back on Wednesdays. Or was today Thursday? All the days blended into one, and I felt seasick. It was imperative not to focus too much on details. I know who I am, and that is good enough.

That was too deep. No, that was too shallow. Cut more. Don’t cut at all. What about that bleeding? You probably should have cauterized first. Careful, I would not touch that. Come on, be more aggressive! Take your time, it’s not a race. Be more efficient; we need to move! First, do no harm. But what came second?

The phone buzzed again. Are you free? The question lingered my mind. Was I free? I did not like to think about it. Not on Wednesday/Thursday. Never mind that love was at stake. All the smiles, all the energetic chatter, all the positivity of the past fourteen hours had been spent on people I barely knew. The ones I cared most about would have to leave empty-handed. 

I turned my phone over and covered my head with a pillow. This was how the world worked: people crawling through parallel tunnels so close to each another that you could hear and smell your neighbors, wishing that one day, the tunnels would intersect and we would see each other in full light. But it's futile; cold logic dictates that parallel tunnels never meet. We will always be alone.

Bzzzzzzz. Startled, I lifted my head, saw the sweet face on the screen, and answered the phone.

I love you. Would you like to get dinner?

And with those words from her, the walls of the tunnel collapsed. The world up there was green, and she was reaching down to lend me her hand. And I knew in my heart that she had saved me, just as she had saved me on many Wednesdays (or Thursdays) before.

This post was written by Jay Shridhar, MD.


I ran along the northern edge of the city this morning through Fort Mason and the Marina Green, past the domed rotunda of the Palace of Fine Arts, threading through soggy patches of sand still drying off from weeks of rain. I landed at the northwest tip of the Presidio and paused to look back at San Francisco stationed beyond the expanse of foamy waves, drowsy in the early morning, skyline dulled against the unflagging fog.
I thought of you, wondered if you had embarked on your morning workout too. Groggy from an overnight shift, I trailed behind you early yesterday as you did laps around the ward, undaunted by the day ahead. Your fingers gripped the IV pole infusing preparatory alkaline into your veins and a knit cap gripped your scalp, a role your hair shirked cycles ago. I didn't know you, but as you proceeded on, calm and dignified, you moved me.
There is a portrait on this ward: two photos stacked in a frame. THIS is NOT the mountain I intended to climbTHIS, capitalized and underlined, leads into a murky photo of a man surrendered to his hospital bed, his face nondescript, a surgical mask shielding his nose and mouth from nosocomial germs. April 2005. Below him, a dark figure pressed against sheets of avalanche white, hunched under the weight of his backpack, braced for alpine ascent. May 2004.
History of NSCLC s/p radiation, prostate cancer s/p radical prostatectomy, and DLBCL s/p R-CHOP, found to have treatment associated AML, my sign-out read. I texted a friend: how many cancers can one person have?

I know you don’t exist for me to romanticize. Still, I wonder what mountains you were climbing when the doctor called and rerouted your entire life. What you most hope to return to once the malignant proliferation and subsequent toxic assault remits, allowing your your vitality to seep back. What is worth enduring these dark hallways for.
I know you don’t exist to remind me of my own mortality. Still, I wonder when life will swap sand and pavement for the tiles of a hospital ward. When my time would come to unlace my shoes and grip the IV pole. It seems inevitable, and I wonder if I’d ever be able to stand as valiantly as you.
I’ll run until then, because I think you would want me to.

This post was written by Mariam Nawas, MD.

Note: key details of this story have been changed to protect patient confidentiality.