Maylis de Kerangal - The Heart

She takes a deep breath of winter, eyes closed: the bluish planet is drifting through a fold in the cosmos, suspended in silence amid gaseous matter; the forest is starred with straight-lined gaps; red ants are writhing under trees in a sticky frost; the garden expands: mold and stones, grass after rain, heavy branches, palm tree claws; the lidded city incubates the masses; children in bunk beds open their eyes in total darkness; she imagines her heart — a chunk of dark-red flesh, oozing and fibrous, pipes running in all directions — this organ riddled with necrosis, this organ that is failing. She closes the window. She has to get ready.

* * *

It is nearly a year since Claire Méjan rented this one-bedroom apartment without having even seen it — the mentions in the ad of the Pitié-Salpêtrière and its second-floor location being enough to make her sign a check, then and there, for the exorbitant sum demanded by the guy at the real estate agency. It’s a small, dirty, dark place, the balcony on the third floor obscuring the view from her window like a helmet visor. But she has no choice. This is what it means to be sick, she thinks — not having a choice. Her heart has left her no choice.

It’s myocarditis. She found out about it three years ago, during a cardiology consultation at Pitié-Salpêtrière. Eight days before that, she’d stayed at home with flu, poking the crackling fire in the hearth, a blanket over her shoulders, while outside in the garden, snapdragons and foxgloves cowered in the wind. She had gone to see a doctor in Fontainebleau and told him about the fever, the aches, and the tiredness, but she had neglected to mention the short-lived palpitations, the pain in her chest, and the breathlessness she experienced during exercise, ascribing these symptoms to weariness, winter, the lack of light, a sort of general exhaustion. She left the doctor’s office with a prescription for flu medicine, and decided to stay home and work from bed. A few days later, dragging herself through the streets of Paris to see her mother, she collapsed in shock: her blood flow decreased dramatically, her skin became pale, cold and clammy. She was taken to the ER in an ambulance, sirens screaming — like she’d found herself in an American soap opera — and they resuscitated her, then began the first tests. Blood analysis confirmed the existence of an inflammation, so they examined her heart. After that, she underwent a series of exams: the electrocardiogram detected an electrical anomaly; the X-ray showed her heart to be slightly enlarged; then, finally, the ultrasound established heart failure. Claire stayed in the hospital. She was transferred to the coronary care unit, where more specific exams took place. The coronary catheterization was normal, reducing the likelihood of it being cardiac arrest, so they decided to carry out a heart biopsy: Claire received an injection in the cardiac muscle via the jugular. A few hours later, the results concluded with a hostile-sounding nine-syllable diagnosis: myocardial inflammation.

The treatment was two-pronged: the first dealt with the heart failure (the organ no longer pumping efficiently), and the second the rhythm disorder. Claire was ordered to rest — no physical strain whatsoever — and to take antiarrhythmic drugs and beta-blockers, while she was implanted with a defibrillator in order to prevent sudden death. At the same time, the viral infection was treated with powerful immunosuppressants and anti-inflammatories. But the disease persisted in its severest form: it spread into the muscle tissue, the heart grew even more distended, and every second the risk of death hung over her. The organ’s destruction was now considered irreversible: she needed a transplant. A new heart. The heart of another human implanted in the place of her own — the doctor’s gestures seemed to mime the surgical act. In the long term, this was, for her, the only solution.

* * *

She goes home that evening. Her youngest son came to fetch her from the hospital; he will be the one who drives her back there. You’re going to agree, aren’t you? he asks quietly. She nods mechanically — she feels overwhelmed. Arriving at her house on the forest’s edge — this fairy-tale house where she now lives alone, her children having all grown up — she goes straight to bed: lying on her back, staring at the ceiling, fear pins her in place, infects all her future days with no possible escape. Fear of death and fear of pain, fear of the operation, fear of the postoperative treatments, fear that the organ will be rejected and she will have to start over again, fear of a foreign body intruding in hers, fear of becoming a chimera, of no longer being herself.

* * *

She has to move. She’s taking a risk, living in that village fifty miles from Paris, a long way from any main road.

Claire feels an immediate loathing for her new apartment. Too warm, in both winter and summer; the need for lights even in the middle of the day; the noise from the street. A final airlock before the operating theater, she envisages it instead as an antechamber of death, thinking she will die here because — even though she isn’t bedridden — she feels trapped in this place: she can’t leave it without what seems a superhuman effort, climbing the stairs gives her pain, each movement making her feel as if her heart is separating from the rest of her body, slipping from its perch inside the thoracic cage and falling to pieces. This feeling turns her into a shaky, limping creature, on the verge of a breakdown. Day after day, the space seems to close in around her, limiting and reducing her gestures, restricting her movements, narrowing her entire world, as if she has a stocking or a plastic bag over her head — something fibrous that stifles her breathing — as if her feet are caught in quicksand. She grows somber. To her youngest son, who comes to see her one evening, she admits that it disturbs her, the thought of waiting for someone to die so she can have their heart: It’s a strange situation, you know, and it wears me out.

* * *

To begin with, she is reluctant to really move in. What’s the point? Live or die, she won’t be staying here long — it is temporary, no matter what. But she doesn’t let her fears show — she acts tough. Her first weeks in this apartment alter her relationship with time. It’s not that it changes speed — slowed down by paralysis, by the dread of her suspended sentence, by her debilitating circumstances — nor that it stagnates, like the blood in Claire’s lungs stagnates; no, time seems rather to disintegrate in a bleak continuity. Partly due to the unending darkness of the place, the alternation of day and night soon loses its distinction: all she does is sleep, with the excuse that she is channeling the shock of this forced move. Her two eldest children gradually come to regard Sundays as her visiting day, a fact that makes her sad without her really knowing why. Sometimes they reproach her for her lack of enthusiasm: across the road from the hospital, it could hardly be better, they say to her straight-faced. The youngest, on the other hand, turns up at any time and gives her long hugs. He is a head taller than her.

* * *

Sinister winter, cruel spring (she cannot see the greenness returning to the forest, the pure colors bursting forth again, and she misses the undergrowth: the golden stumps and the ferns, the light probing in vertical rays, the multitude of noises, the foxglove scattered in semishade behind flower beds, on secret paths), hopeless summer. She is withering away (you need some sort of structure, meals at fixed times, a daily routine, repeats everyone who comes to see her, finding her depressed, distracted, vague, even a little creepy, her blond-haired black-eyed beauty altered, corroded by anxiety and the lack of fresh air), her hair is dull, eyes glassy, breath sour, and clothes shapeless. Her two eldest children try to find someone who can look after her — a home helper who can take care of the housework, the shopping, monitor her intake of medicine. When she learns about this plan, anger brings her back to life — are they trying to hack away at the little freedom that remains to her? White-faced and bitter, she rants about being under house arrest, no longer able to bear healthy people’s opinions about sickness.