December 7, 2022 / Rhys Wynn Wilkinson

The soul, simultaneously caged and liberated by heart surgery, struggles to process the life after death that follows one’s “passing” beneath the knife; desperate, it grasps at once the Reaper’s tattered cloak and the feathers of the archangel’s wing.

Count back from 100.

You don’t dream under anesthesia. While the mind lies dormant, the spirit fidgets under the approaching, frigid blades. A blood-soaked surgeon, that kind-hearted voyeur, peels back muscle and tissue layer by layer, at last uncovering the final intimacies of the body: the heart, the abode of the soul.

Lucky souls mature alongside the flesh that shelters them, ripening and rotting in perfect harmony, then leaping from the life-tree only when time steps in and the seasons change. Unfortunate souls are released into the ether with cruel, sudden finality — gunshots, long falls, poison — as though plucked from the bough by a hungry passerby.

But the tormented soul watches its home deteriorate about it as the apple maggots feast. It seeks a bird to extract the pests, but flinches at the mercenary’s deft yet incursive work. The fruit is saved, but the echo of the savior’s searching strikes will remain with the soul until it meets the ground below.

In 2019, my soul was similarly disquieted by an agile aviary assault  — that is, I had open heart surgery. When I awoke, the first thing I noticed were the tubes: IVs in my arm, a drainage tube in my chest, a catheter in my — well, you know. Painkillers and rehydration fluids in, pus and piss out. Morphine makes your mind feel like a television stuck on a static noise screen, crackly and blank, aware of the electric activity but unable to display an image.

If my analog brain had been able to string together thoughts at this time, it would have reflected on incapacity and humanity. It might have pondered: Here I am, unable to breathe/move/eat/shit on my own. A few hours ago, my heart was stopped, my ribs were cracked, and I was insensate on a table like a cadaver in a morgue. Surely this constitutes a Frankensteinian reanimation. Praise be — and call the priest — the pig is squealing though the butcher just carved it!

I needed surgery because my heart was too big. No lie: a rare birth defect caused my right atrium, one of four quadrants in the human heart, to grow engorged due to blood leakage from a malformed valve. Left untreated, my ballooning heart would have eventually become too large to function. Yet limited research meant that my prospective surgery — the cone procedure — remained on the cutting edge of medicine. When I was younger, there was little to no information on patient recovery, meaning one could only guess at its long-term effects on patient health. The procedure, first conceptualized just four years before my birth, would only be supported by conclusive patient safety data by early 2018, a mere year before I went under the knife.

Two years sooner, and I would have received a much more invasive treatment which solved the short-term problem but raised the odds of sudden arrhythmic death syndrome. Two more years without surgical intervention, and my heart may have stopped on its own. The timing was downright providential. I had cheated death, bypassed that fated instant of return to the dust of the world. Yet despite my miraculous survival, the pungent sweetness of decomposition lingers, a looming reminder haunting my nostrils.

My every moment is framed in relation to an approximation of death — my operation. Rooted in time to the hours spent in the clutches of that stern, cloaked reaper, tracing the healed scar on my chest, I yearn to return to the life “lived before,” to heal the internal scars suffered by the soul.

But from birth, I’ve been in pre-op, preparing, keenly aware of the lost innocence stolen by my at-birth diagnosis. The cosmos snatched the wine glass of my youth bearing the blissful ignorance of childhood, quaffed it, and shattered the cup on the floor. Not a shard of this holy grail may be retrieved, nevermind the potent libation which once swelled within.

Annually, doctors contemplated the question of moving forward with surgery, and annually, I arrived at the cardiologist’s office ready for the inevitable. When a date for my procedure was finally set, I devoured the Hagakure, the 18th century spiritual guide for samurai. I made it the manifesto for my healing, guzzled the sour guidance like life-saving medicine: “Rehearse your death every morning and night. Only when you constantly live as though already a corpse will you be able to fulfill your duties without fault.”

I mythologized my procedure as a noble ritual sacrifice, a tragic yet rapturous end, and all but wished for an operational “failure to rescue” — that is, surgical malpractice resulting in death. To dare to set foot in the operating room, a patient must release their grip on life and optimism and embrace their own demise, accepting the possibility of never returning from the shadowy, anesthetic valleys.

This daunting task is, fortunately, facilitated by the hospital environment. The professionalism and respect of the nurses comes across as somber, as though they are mingling with one who has been damned. Every room I entered, I wondered how many had entered before me, how many had exited, how many souls before mine had been traumatized or dispersed in this cursed tomb, their bodies deformed and their homes destroyed.

Protocol stripped me of my day clothes, bathed me in the chemical burn of sanitizing wipes and the relentless flood of harsh fluorescent lighting. Every facet of civility crumbles as a hierarchy emerges between human and corpse-potential, human and corpse-to-be. In this sacred space, it seems, no part of the offering is off-limits. The coarse, sterile pajamas I received had no underwear. “Do I leave mine on?” A chuckle. “Of course not.” Imagination alone may contemplate to which plains and valleys begloved hands roamed as the young, ailing earth-body sprawled lifeless, lacerated, tranquil, still.

And who are these people in whose care I left my life? The surgeon, whom I met days before my procedure, wrote in his final report that he had a “lengthy discussion with [me] regarding [my] diagnosis and prognosis…and the risks involved.” I understood my situation and gave consent to the surgery, but all permission to operate is coercion under the threat of fatal consequences for refusal.

The patient cries internally, I know nothing of you, sir, though you will soon know all of me: every inch, every fold, every cell. I have been disrobed of my last shreds of humanity to sit before you today. My flesh is clean; my mind is sound; I am prepared to be ravaged. My intellect does not grasp your terms, your descriptions, my state; do what you will with the body I’ve brought. Externally, they merely cry.

If given the chance to write a letter to my soul, my brain might seize the opportunity by making a request:

Dear heart-dwelling mustard seed, my tether to the pulse of the universe, the beneficiary of my fulfilling labor: Our distance gladdens me. Our transactional relationship relies on my almsgiving alone. I run your bath with sights and sounds, and you are purified in the suds of experience. I’ve no need in my memory for the details of that heart-stopping day when our roles were inverted, you alert and I oblivious. Shared recollection will only harm my sanity and your freedom. I shall diligently continue my work, bringing you beyond this grave point, sending sweet senses to cleanse your sores and scars. I am your gentle, eternal protector; may my gifts bring you further from the trauma you have received.

And if my soul ever read this, it would give a dejected sigh, fold the letter into a tight square, and drop it in the waste bin.

Three weeks after my surgery I boarded a plane to fly across the country to San Francisco for a tech conference. The teacher chaperone handled my bags and asked how I was feeling. Like I miss being on morphine, I thought. “Better,” I fibbed. In a monotone, gray meeting room 2,000 miles from my home in Texas, I listened to some CEO speak about the future. About horizons. About youth being the key to tomorrow and the utopic force of development and progress. My sternum popped, and I could only imagine that the sun had already dropped out of frame.

Upon returning to Austin I was met by a seven-figure hospital bill which, although decisively downsized due to insurance, vanquished a savings account regardless. American healthcare would deem fit that a different boy with my heart but without my coverage should perish, serendipitous timing and medical expertise be damned.

I dare not disparage my fortune. Yet, my existence painfully circumambulates a moment of physical death; every moment before and after is lived in relation to it.  When I proclaim that I am alive, I speak of the trauma of a heart sliced and a soul exposed, a death lived and incessantly remembered. I can’t tell whether the life I lead was intended by providence, or invented through science — and if it’s the latter, I question whether I was destined to stay dead. I’m not sure which answer I’d prefer yet; I’m not sure I ever will.

I imagine that death is similar to unconsciousness under anesthesia. Looking at the bill, I remark that a funeral would have been cheaper. After all, I’d done everything besides the burial. ■

By: Rhys Wynn Wilkinson

Photographer: Peyton Sims

Models: Morgan Cheng & Nico Grayson

Stylists: Audrey Dahlkemper

HMUA: Lily Rosenstein

View the full spread as it appeared in Issue No. 19 here.
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