I’ve been trying to define the thing that’s been nagging me since my aortic dissection in the Fall of 2016, the formless thing lurking in the back of my mind. It is a constant presence, albeit non-intrusive. It doesn’t rear its head and demand to be taken seriously or paid attention to; rather, it is like (to quote myself) “an unsubstantiated rumor that nonetheless has the ring of truth.”

          And the realization I’ve come to, since essentially achieving a full and complete recovery, is that, where, in middle adulthood, from my mid-thirties on, life promised all sorts of possibilities – after all, my wife worked for the United Nations and then the World Bank and her jobs entailed so much international travel that, upon her retirement, we could not possibly have used up all of her frequent flyer miles, although we had made a pretty good dent in the balance – now, well…. I had been able, thanks to her, to travel to Nairobi, where her U.N. agency, the United Nations Environment Programme, was headquartered, to Spain, where our daughter and her Navy husband and their three children, three of our four grandchildren, were stationed for several years, to France, Italy, Switzerland, Sweden, Norway, Denmark, the Netherlands, and England and Scotland. I was able to travel several times to Hungary – my grandmother was Hungarian – and visit cousins, accompanying an elderly uncle – an expatriate Hungarian physician – for a medical conference in Budapest, and, on another occasion, by train from Budapest through what was then Yugoslavia and the Balkans to Greece.

         On all of these occasions, and our extensive domestic travel as well, there was always a sense that each new place visited held promise as the site of another possible life for us post-retirement. The things we could do, the places we could see from our new “home base” and the communities it might be possible to become a part of – this is all grist for the writer’s mill, of course, and I always returned from these trips with notebooks full of jottings, lines which might lead to a poem, descriptions of people or places in circumstances that were either out-of-the-ordinary or just the opposite – exceedingly ordinary, and how those individuals might respond in any given situation or circumstance I might create for them, and so forth.

         The morning of September 12th, 2016, we were sitting at the breakfast table of our little camp in western New York State’s Cattaraugus County. I had cleared the breakfast dishes and sat back down to discuss the route we were planning eastward along Lake Ontario’s south shore and thence up to the Thousand Islands region of New York and along the St. Lawrence River, intending then to cross into Canada and travel along the river to Montreal, and perhaps Quebec. We settled on a timetable for closing the camp up for the winter, and I stood up.

         It felt like a water-balloon bursting behind my collar bone, a gush and the immediate, horrible sensation that something had just gone terribly wrong. I sat back down.

          “Is it your heart?” my wife asked, seeing the obvious distress on my face.

         I nodded. She immediately dialed 9-1-1, and went to unlock and open the door to the drive, the only approach route to the camp an ambulance could take. It occurred to me that, if I died before they arrived, my body might well release the contents of my bladder and bowels, so I stood and quietly moved into the bathroom, where I began shedding my clothing to save the EMTs time, and sat on the commode. I really didn’t want my last moments of life to inconvenience anyone any more than they were already guaranteed to do. Once the ambulance arrived, they carried me out of the tiny bathroom and onto the gurney, carried it out the door and slid it into the ambulance as friends gathered around. Jack Jarrett, who would two years later lose his on-going battle with cancer, gave me a knit stocking cap because, “It’s cold in the hospital.” As they loaded me in the ambulance, Joanie placed the file which contained my medical history into my hands; the EMTs made sure it got to the hospital ER. My cardiologist in Delaware had told me there was evidence of an aneurysm but that it was small enough that he hadn’t thought it would be a problem if we went away for the summer. I must not have taken his precautionate “Don’t overdo it,” very seriously, climbing a heavy extension ladder to repair some screen on our front porch which had come loose, moving heavy furniture and so forth.

         At any rate, it turned out that I had suffered an aortic dissection, where – luckily for me, only the inner lining of my aorta had torn. As it continued to tear I would feel as if a Samurai had taken his katana and was slowly pulling it down through my chest, but this pain was, luckily, not constant, so I had moments of lucidity when I could carry on a brief conversation. This intermittent agony would reoccur fairly frequently as my aorta tore further and further.

         In the meantime, Joanie arranged with neighbors to shut the doors and make sure the stove and the coffee-maker had been turned off, and Jack’s wife, Vicki, drove Joanie to the hospital, actually beating the ambulance there by another route. When they wheeled me into the ER, one of the admitting doctors asked what I thought the problem was. I told him I thought the aneurysm had burst; he smiled confidently and aid, “We’re the doctors – let us make the diagnosis,” as I thrust the file of my medical history into his hands and said, “Read this!”

         They took some X-rays and suddenly all looked very concerned, and finally someone came up to me and said, “We’ve called for a helicopter to fly you to Buffalo.” Once they realized from the X-rays that I was nearly right (it hadn’t yet burst, but was likely to), they realized the situation was more than they could handle there.

         Out to the parking-lot helipad I was once again loaded and strapped in. It was actually a nice, if somewhat noisy, flight, even with the headphones they gave me to help cancel the noise. I could look out and see the Enchanted Mountains below, covered in verdant forests and the occasional farm field or pasture, and I couldn’t resist asking if the Mercy Flight heli-transport system had ever lost a chopper on of these flights, and tried to grin. “No, we haven’t,” came the answer as the medic grinned back, “And we’re not gonna start now.” I drifted in and out of consciousness with the waves of pain, but I was glad to be able to suck it up and not dissolve into emotional basket case.

         We landed on the roof of Buffalo General; the crew handed me off, informing the doctors of my current status, symptoms, and so forth, handing over the file which also contained my medications list. Someone called Joanie – Vicki was driving her from Olean to Buffalo and was about forty-five minutes away when her cell phone rang – and told her that they needed to operate immediately if there was any hope of saving my life. By this time nearly four hours had passed since the moment of the initial event, and it is little short of miraculous that the outer lining of my aorta hadn’t also ruptured at any moment in the process to that point, allowing me to bleed to death internally in almost an instant.

          I will be perpetually grateful to Bill and Melinda Gates, who underwrote a brand-new, state of the art vascular center at Buffalo General – and to Dr. Janerio Aldridge, who spent the better part of fourteen hours – perhaps more – hunched over my form effecting repairs.

         Massive amounts of blood were lost, I was packed in ice in order to drop my body temperature to slow my biological functions, and I was, somewhere in there, placed into an eight-day medically induced coma, during which I had some really – there’s no other way to put it – trippy dreams. Before they induced the coma, however, I drifted up out of the anesthesia enough to be aware of my son and daughter standing next to the head of whatever device I was laying upon, each in their turn weeping and pleading with me not to die. My daughter even brought a little stuffed bear, and my wife told the doctor to put it next to my face.

         I am told they grew concerned several days after the surgery when I took a turn for the worse, and the family gathered again, this time to say goodbye. While they were waiting in “the family room” in the ICU, expecting the bad news at any moment, the doctor, when he appeared, said, “We don’t understand how, but he’s turned a corner.”

         And I had, albeit I was completely unaware of any of this.

         Three weeks later I was transferred to the Specialty Select Hospital in Erie, Pennsylvania and the bear my daughter had gotten me accompanied me. At Erie they were trying to wean me from the ventilator, for when they first took me off of supplemental oxygen it felt as if I were drowning, or being smothered, and I responded in panicky fashion. I had also lost nearly sixty pounds, more than a quarter of my body weight before, not the sort of diet plan recommended by dieticians. So one of the other things they did for me at Erie was to feed me. Their chef, Tony, actually came to my room to ask what would taste good. Thanks to the wonderful staff there, I also got wheeled in a supine position into a shower by Ben and Gus, two orderlies, keeping my index finger over the hole in my throat that was shrinking but which had not yet healed over. I had to do this to prevent water from getting into my windpipe, but I also had to do it in order to force air I was exhaling over my vocal cords when I wanted to talk.

         After three weeks in Erie, Joanie arranged for a transport ambulance to bring me back to Delaware where I would begin the long process of rehab; I had not stood up once in the better part of two months, and vomited when the staff tried to help me stand the first time.

         Our return to Delaware meant my wife could sleep in our bed at home, and make the fifteen-to-twenty minute drive each morning. Once I was at the rehab center I began to jot down notes and lines of what I hoped would be poetry or the germ of a short story. I had left several poems and short stories (and two novels) unfinished when my aorta split. Each week I progressed a little bit more, eventually getting to the point where I could use a wheelchair, then crutches for short stretches. Doing each of the physiotherapy exercises I recalled my old high school cross country coach, Al Watson, shouting, “Finish strong! Finish strong!” and I would do more of the exercises than the physiotherapist asked.

         The rest of my family, in addition to my wife and kids and grandkids, came to Delaware for Thanksgiving that year, and the rehab center allowed me to attend the dinner at a restaurant where a large table had been reserved, and two of my three sisters (one of the two married with spouses) and one of my two brothers (both unmarried) were in attendance. Several family members got weepy when I was wheeled in, as my attendance had not been announced in advance.

         A week later I was able to walk out of the rehab center on a cane and come home.

         And now? The feeling is that the closer to home we stay the safer we’ll be should any sort of medical emergency arise. I feel as though the promise of the future has become a contracting set of possibilities, a shrinking world, in fact. Where in adolescence I was so short I once seriously considered becoming a jockey, once I grew tall and got picked at playground basketball games, I was never able to stuff the ball – what I’m saying is that I have always had to be aware of my limitations, such as they were, but even in adulthood, basketball aside, they were few; now they seem to be daily increasing. I am restricted from lifting weights heavier than twenty pounds (it was ten for the first two years after my follow-up open-heart surgery in 2018), which really is limiting – I used to clamber up a three-story ladder with an eighty pound bundle of shingles on my shoulder back when my neighbor and I reroofed our duplex in Washington, D.C. And travel the way we used to do it is probably finished for us as well; intercontinental airplane flights or twelve-hour drives appear to be major hurdles now rather than fairly minor, short-term inconveniences.

         So now, like some radioactive element with a very short half-life, I am aware of the scorekeeper’s clock running down. I shrug when the thought occurs to me – after all, it’s little less than miraculous that I am still here, and I came to terms with my failures and shortcomings back in 2016. The thing nagging at me – maybe nagging isn’t the best word – the thing that I’m aware of most of the time, is my own mortality. It doesn’t scare me as it once did. After all, Death holds no surprises once you’ve knocked at his door and he’s welcomed you in. He won’t be angry if I arrive a bit late.