The Endangered Alphabets Project is out of the gates and running!

The exhibition of carvings is going to perform the unlikely feat of appearing in two places at once.

As of September 13th, a mini-version of the show will be on display at the annual expo of the Foundation for Endangered Languages at the University of Wales in Carmarthen, Wales, a high honor indeed.

Meanwhile, the majority of the boards will be one of the features of the Burlington Book Festival in Burlington, Vermont. They’ll be on view from September 24-October 22, and I’ll be giving a talk about them as part of the Book Festival on Saturday, September 25.

The Endangered Alphabets book is already past the proof stage and should be leaving the printers any day now. Copies will be available wherever the boards are displayed, and through this website.

What is the Endangered Alphabets project? Well, for complete details, click this link, but here’s a brief introduction.

The world has more than 6,000 languages, but in every respect that number and that variety is dwindling rapidly. Half are expected to be extinct by the end of this century.

But another and even more dramatic way in which this cultural diversity is shrinking concerns the alphabets in which those languages are written. Writing has become so dominated by a small number of global cultures that those 6,000 languages are written in fewer than 100 alphabets. Moreover, fully a third are endangered. The Latin alphabet—the ABC of the West—has gone from being the alphabet of military empire to the alphabet of economic empires and, most recently, of the Internet. On a global scale, writing is already dominated by as few as five major alphabets: Latin, Arabic, Cyrillic, Chinese and Japanese.

The Endangered Alphabets Project, which consists of an exhibition of carvings and a book, is the first-ever attempt to address this issue.

Work on the Endangered Alphabets Project has been supported by Champlain College in Burlington, Vermont, by Sterling Hardwoods, also in Burlington, and also by the many researchers, linguists, scholars and correspondents who have helped me track down these rare and vanishing scripts.

By the way: the exhibition is already booked at various venues through next spring, but my dream is for the exhibition to go on a grand World Tour, visiting every country represented in the show. Clearly, I can’t come close to affording this myself, and I doubt whether many of the peoples whose scripts are endangered can afford to fund their own leg of the world tour. The only way this is going to happen is if some major foundation, government or corporation funds it. If anyone has any suggestions who that might be, don’t be shy about suggesting them!

Manchu

Finally, I’m attacking this issue in the 21st century manner—by downloading apps onto my iPhone.

AFib Educator is made by one of the world’s largest drug companies, Sanofi-Aventis. It must have seemed a good idea to spend the time and money developing an app; after all, as the app says, AFib (the Sanofi-Aventis abbreviation) is the most common cardiac arrhythmia seen by physicians, affecting about 2.5 million Americans.

It offered an animated display that would show the difference between what the heart is doing in normal rhythm and what it’s doing during a. fib., but for some reason it would only play the “normal” animation. Not very impressive.

Its brief FAQ page starts unpromisingly with “What are the symptoms of AFib?” and confesses its own inadequacies right away: “You may not have any AFib symptoms.” I’m discovering this is, in fact, true–but it doesn’t offer any suggestions as to what someone should do if they suspect they have a. fib. but don’t know, and don’t have symptoms.

The “Who is at risk for developing AFib?” is as unhelpful as ever. It lists possible risk factors as Increasing age (duuuh: everyone’s age is constantly increasing); family history (not in my case); high blood pressure (just the opposite); coronary artery disease (nope); obesity (nope); diabetes (nope); and heart failure (only when I saw the ER and cardiologist’s bills that came in yesterday).

Another button offers to send this very limited assemblage of facts to someone else, and that’s about the extent of this app. Neither helpful nor reassuring. One and a half stars, I guess, or maybe one and a half heartbeats.

AF Guide, created by QxMD Medical Software (a thoroughly ill-chosen name, as Qx could well be pronounced “quacks”) is intended for the healthcare worker rather than the patient.

The Introduction told me a few things I didn’t know. “[T]he total number of patients hospitalized for AF is more than for all other arrhythmias combined….[T]he incidence and prevalence increases significantly with age, with 1 in 25 over the age of 60 years and nearly 1 in 10 over the age of 80 years having a diagnosis of AF.” And, not especially encouragingly, “patients with AF are at higher risk of overall mortality when compared to non-AF patients.” Okay, but is that cause or effect? Is AF a sign of increasingly deterioration of other systems?

It offers a sample ECG, which was nifty but rather limited, and a link to a much more extensive library of heartbeat patterns–but this turns out to be something of a sales gimmick, as that link takes you to a sales pitch for another, much more comprehensive $0.99 app by the same company called ECG Guide.

The Management section is a major disappointment, suggesting goals and factors to be taken into consideration, but saying nothing at all about ablation or pacemakers, about anti-arrhythmia meds, blood-thinners and beta-blockers, about cardioversion.

Continuing down the extensive menu, the Presentation section, it strikes me, could potentially provide useful fodder for the underachieving AFib Educator app. Though some of the language is maybe a bit on the techy side ”The most common symptoms are palpitations, dyspnea, fatigue, syncope and pre-syncope,” it wouldn’t take much to rewrite those in Joe A. Fib language, and the final two pieces of advice would actually be very sensible to pass on to the patient: “Define the duration and frequency of episodes,” and “Note precipitating factors and modes of termination.” Medical personnel may well not be present when all those things are going on; raise the patient’s awareness, say I, and let him or her gather good observations. And then listen to his or her report.

The Causes section is clearly moving into the realm of the medical professional, bandying about terms such as “amyloidosis” and “subarachnoid hemorrhage.” (Doesn’t that mean “bleeding under the spider”?) All in all, the causes seemed to be a lot broader, richer, and secondary to some other condition than the AFib Educator implied. In fact, it left me wondering whether the simple term “wear and tear” would apply—and if so, why. What is it that all these causes have in common, and what do those common elements do to the wiring of the heart? And for what it’s worth, I don’t think I have a single one of this encyclopedia panorama of conditions except one or both of those listed under “Idiopathic”—a term that doesn’t mean, by the way, that I’m a moron, but simply that these are causes that may not be understood and don’t fall into the other categories.

Under “Idiopathic” the app listed “Lone AF” and “Familial AF.” And these hints connect with the somewhat overlapping section “”Classification,” where I finally get my answer as to how my AF might be classified.

The three types, according to the app, are “Paroxysmal,” which affects 23% of sufferers and involves self-limiting episodes that last up to 7 days; “Persistent,” which covers 38%, lasts longer than 7 days and requires the sticky pads, the defibrillator and the electricity; and “Permanent,” which afflicts 39% of poor souls, consists of episodes that last more than a year and can’t be cardioverted. Yikes.

But then, down below these three (which conveniently total 100%), is the one that seems to be me, the outlaw, the “Lone” AF guy: “Atrial fibrillation in patients<60y without no structural heart disease or risk factors.”

Yep, I’m the one without no heart disease. I’m the zero percent, the Lone A Fib.

All in all, I prefer the AF Guide. Now all they need to do is write it out in lay terms and sell it to Sanofi-Aventis to use as AFibEducator Mark II.

But if these were really smart apps, they’d come with those little finger-clamps they put on you to track your pulse, or maybe even use the touch-sensitive iPhone screen to read your pulse as you squash the iPhone against your carotid artery. The app would read your pulse and send it wirelessly to your cardiologist. That'd be something really useful, perhaps even life-saving.

Still, these apps did have one immediate and positive effect on me. No sooner had I read that phrase "Familial AF," I heard from my sister Jennie in London:

“Hello bro, just read your email below...is this the same as heart palpitations? My heart has an irregular rhythm about 3 times a day and sometimes it's so wierd that it I feel faint. It's usually over as quickly as it started but it leaves me feeling odd. I had it particularly badly during my pregnancy but it still comes back now and again. I had loads of tests which came back inconclusive. It is not in response to alcohol or coffee etc but can sometimes be triggered by quick burst of exercise (like running up stairs). 

Should I be worried? What should I do? Is this the same as yours?”

Well, well. And my father suffered from angina pectoris—I wonder if there’s a genetic connection? I answered Jennie as best I could: “The answer is maybe, perhaps and quite possibly. You should definitely get it checked, and when you see your doctor, tell him what's happening to me.
Good luck!”


Midway through the afternoon—how is it that these huge, life-threatening things can happen and then completely slip our minds—I remembered that my sister Sally, too, had once had some trouble with her heart. I emailed her in England, and at once she read this blog and emailed back, saying we needed to talk.

As it was, we Skyped for 35 minutes, and once again I got a refresher course in how an investigation of one’s own frailties—or most kinds of vulnerability—brings its own rewards. She and I hadn’t talked in probably a year, and we had never Skyped. My brother-in-law Colin stuttered around in the background; she showed me around the extension they’re building on their house, her laptop camera taking me unevenly from room to crazily-angled room. It was eerie and wonderful to see her moving in that strobe-step fashion; it was like a sonogram of the family’s heart.

Which was, of course, the main topic of conversation. She reminded me that our father’s mother had died of a stroke, which might, after all, be the only evidence we would ever get that she might have suffered from AFib. Sally herself, like Jennie, had encountered palpitations when she was pregnant, and several times afterwards. Never had the grand mal, the insane racing heart. At the time, she sensibly recognized that the symptoms were like those of a high level of adrenaline, and was concerned not for herself but for her unborn baby, and for that reason alone went to the doctor.

“And what did your doctor say?” I asked.

“He basically patted me on the head,” she said. “This was 25 years ago, after all.”

We wondered why pregnancy should have brought on AFib in both of them (hormones? The extra weight? The fact that the mother was essentially breathing for two and creating a greater oxygen need?) but there are just too many potential culprits, and we gave up. The good news was that she hadn’t had an attack (that she had noticed, at least) for years.

“Maybe when I was walking quickly uphill,” she said, thoughtfully. “But now I work at home, so I don’t walk quickly uphill any more.”

For whatever reason, I cleave to my use-it-or-lose-it mentality, and demand the ability to walk quickly uphill, even at 57. Or cycle. With a backpack. Or, one day, make a quick break out of goal and score, shocking everyone.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.

Well, you know how it goes. Just when you think it’s safe…..

So I had the Klonopin for just 24 hours, I’d had just one good night’s sleep and there I was thinking that things were on the mend. I was taking metoprolol, a beta-blocker, to keep my heart rate down, I felt more energy than I had in ten days, and I thought, well, let’s keep trying to extend my range, let’s just cycle quietly over to the park and stand in the goal for a little while to see what happens.

It was a beautiful day; after the amount of time I’d spent indoors, I felt almost blinded by the summer light, the open field, the lake and the mountains beyond.

When I say “soccer,” I mean a regular pickup game, players of both sexes, all ages, all abilities, from probably fifteen different countries. Played in a very good spirit, on not a very good surface, so what with having a couple of conscientious defenders in front of me and the fact that it was hard to string two passes together in a row, as a goalie I wasn’t exactly pushed to my limit.

Even so, something was clearly off. After no more than five minutes my heart felt full, a little heavy. After fifteen minutes I was getting a few petit mal symptoms—not a good sign. But they kept going away, so I kept going on. Maybe forty-five minutes in, though, everything kicked up a gear. Now my heart was racing, up to maybe 150 beats per minute. So much for the metopropolol.

I sat on the grassy bank behind my goal, trying to catch my breath. The attack kept feeling as if it was about to fade out, but then kept getting a second wind, then a third, then a fiftieth. I pushed my bike uphill to the main road, stopping every few yards, then cycled home along the flat. Oddly enough, I wasn’t afraid: after you play soccer, or any sport, for long enough, any injury becomes a good injury, a sign you were in the game.

By 9 p.m. it was still going on, though in a low-key way, perhaps thanks to the beta-blocker. My pulse at the base of my neck went 1, 1-2, 1, 1-2-3, 1, 1-2, 1.

I was almost fine when I was lying down, propped on my right shoulder (watching the original La Femme Nikita), but as soon as I moved, it all started up again.

So here’s the thing about information. Not only had I been discharged out into the world without a clear diagnosis, I also had no sense of what I should do about this attack, and nobody to ask. Sure, I could make another thousand-dollar trip to the emergency room, but by now I knew that if I went there one of two things would happen: (a) I could lie around like I was doing at home, except they wouldn’t have La Femme Nikita; or (b) they could shock me. I didn’t feel like option (b) unless I had a grand mal that went on for ten or twelve hours, so I decided to stay at home—but that meant I was left to my own ignorant devices.

Around 11 p.m. I did two things. I emailed my friend Dr Omar Khan, a co-conspirator in all kinds of adventures of mine and also a guy who seems to keep checking his email until 2 a.m. I also decided to take a Klonopin and see whether the soporific effect would also calm down my heart.

By 2:45 a.m. the Klonopin hadn’t really worked: I’d dozed a little, but was still palpitating, and now my Restless Legs Syndrome had literally kicked in. Well, my family doctor had said I could take up to 2 mg of Klonopin, so I took another. Next thing I knew, it was 7 a.m., and, clutching my chest like a man who things he may have left his wallet in the restaurant, I realized my rhythm had restored itself. I felt bathed in relief. Drenched. I crawled off the couch, staggered upstairs, fell into bed and slept until past noon.

The next couple of days were dedicated to not losing faith. I walked the dog, and every time she stopped to sniff I stretched as if I were planning to run a half-marathon that weekend. I did little half-mile bike rides to pick up small quantities of groceries.

My cardiologist called to amplify what Jeremy, the EKG tech, had said about my beautiful heart. All four chambers, he said, are beating soundly with no evidence of thickening. There’s some slight leakage (he called it “regurgitation”) around my tricuspid valve and my mitral valve, but not nearly enough to cause (a) concern or (b) a. fib. Pretty much what we found last time, five years ago.

So the next step, he said, is to schedule a stress test, which would tell if I had any blocked arteries. If I didn’t, he said, then he could prescribe me anti-arrhythmia drugs, which sounded like a good idea but which apparently are under no circumstances to be used if there’s any heart damage. If I do have blocked arteries, I thought, then I guess they go in there with a balloon or a corkscrew. But I really didn’t think so. I really still put this all down to stress.

For the next week, nothing untoward happened. Each day I tried a little more activity. One day, as part of my resolution to see at least a little sunshine on every decent day this summer, I spent a couple of hours vigorously gardening, pulling impacted weeds, shoveling earth, bending and straightening over and over. No ill effects, a great sense of accomplishment. Another day I felt weird, and lay down for a serial nap that ended up lasting two hours. Determined again to see something of the glorious day, I cycled nearly a mile to Waterfront Video, the farthest I’ve ridden since the incidents began. It’s all pretty flat, but even so, on the way back I noticed things going awry. At first just the odd off-beat; then that pattern of an off-beat every seven or eight. I pulled over, having the sense that somehow the cycling was at fault. Standing or walking slowly seemed to make things no worse, at least.

After a minute or two’s rest I felt back on an even keel, and cycle on, trusting myself to go no higher than first gear. My heart fidgeted a little, but I got home okay.

On the way I realized something I’d never quite put into words before. The first erratic beat is alarming because it feels somehow larger than usual. Instead of being confined to its usual two dozen or so cubic inches, it seems suddenly to balloon up so I feel it throughout my chest, up in the base of my throat. There’s simply no ignoring it: something is wrong, something is struggling.

This general rhythmic uncertainty continued for much of the evening—not a flat-out madness but a low-grade loss of groove that meant that even getting up to move into the kitchen set me off that tentative regularity. And with it came a pallid, timorous emotional state that our friend Emily Skoler, who knows knows chronic illness and medical uncertainty better than most, calls “gray.” Lying down to try to sleep, my heart felt like a small bird in a cage knowing he’s being watched by a cat.

I had several email exchanges with Omar, who as usual was both informed and helpful. Except in one instance: because the ER docs had talked about the risk of blood clots rising appreciably if an episode of a. fib. lasts longer than 24 hours, I’d been pooh-poohing the notion of being put on blood-thinners for the rest of my life, as some a. fib. sufferers are. But when I happened to mention this to Omar over the phone, he said in a worried tone, “Oh, it only takes about two seconds for a blood clot to form.”

Another weird and unpleasant thing has started happening, possibly connected to the heart issues, possibly not: for two consecutive mornings, at around 6:50 a.m., I had terrible dreams in which things went wrong or broke down or fell apart and I was handed a bill for thousands of dollars—bills that, needless to say, I could no more afford to pay in my dreams than I can in conscious life. I woke up almost in tears.

Finally, on August 3rd I had the stress test.

Barbara drove me out to Dorset Street, a little over a mile from home, with my bike on the back of the car. She needed the car; I convinced myself I’d cycle back, as it’s pretty much all downhill. Part of me was saying “Um, this could turn out to be a terrible idea,” but I ignored myself.

The series of tests, which lasted nearly four hours, were pretty unspectacular. A nurse took a series of EKG’s, which were all normal, and notable only in that she managed to nick my chest with the razor and had to add a small circular plaster to all the electrode contacts she was sticking to my torso.

Next was an IV and some kind of isotope to help with a scanning series of images that took 17 minutes and during which I gratefully fell asleep.

Then came much waiting for Dr Fitzgerald, who was held up at the hospital—lots of cardiology needed on rounds this morning, apparently. Does the heart go wrong more often than any other major organ?

Finally he arrived, moved through his small gaggle of waiting patients, and came to find me (reading David Mitchell’s excellent novel Number9Dream) in the waiting room.

The stress test involved my walking on a treadmill that every three minutes raised itself to a steeper incline and accelerated. They wanted to see what happened to my heart when it got up around 140 beats per minute—and frankly, I was pretty curious too, especially as, if I did go into atrial fibrillation, I’d have to find another way to get home.

I needn’t have worried. Once again, as five years ago, my heart behaved like a trouper, and by the end I was up over 150 bpm, running uphill, and still it behaved itself. This was good news in more than one respect: it meant I don’t have a blocked artery, and that news in turn means I’m eligible for anti-arrhythmia meds. Maybe I’d need to take them for a month, maybe for ever. We’d have to wait and see.

But the two most interesting events happened after the stress test. First, once the treadmill was thrown into Slow Down mode, I had a series of little cooling-down spasms, right there for everyone to see, and damn peculiar they looked on the monitors. Yet after ten seconds or so the ship righted itself, and apart from a couple of brief PVC’s, all went back into Life On Earth mode. So once again it was the post-exertion phase that was the issue.

But surely the oddest part of the whole day was that I asked Fitzgerald for a copy of the read-out tape, which the nurse/tech insisted that he sign.

“It’s a medical record,” she explained to me.

“Oh, I thought he was signing it as a work of art,” I said.

I brought the printout home, cycling without the slightest problem, and later that evening I cycled over to Kinko’s and blew up one section of it by about 400%. I was going to carve it.

Initially, my thought was to give the carving to Fitzgerald as a present for him to mount on his wall, or his office door, or something, in which case he’d want a single complete healthy sinous beat, I expected. But then I thought it might look more interesting with two consecutive beats. When I got to Kinko’s and looked more closely at the printout, I realized I had a choice of all kinds of highly defective beats, as this section of tape was from my brief post-stress arrhythmia. For me, though, the bottom line showed the most promise: for about five inches it showed the frantic two-stroke beating of the high-speed arrhythmia, then it showed my heart restoring its native pulse and falling into that familiar peaks-and-valleys design probably used in cardiology ads everywhere.

Blowing up images on a Kinko’s copier is an inexact science, and what I ended up with was not exactly the final, healthy sequence I intended. It was, in fact, something much more interesting: it was the four transitional beats as my heart was getting back in the saddle, so to speak, and as such even a lay eye like mine could see the jagged tracing starting to smooth out and take on its graceful undulation.

This, I realized, was my signature—my cardiac signature. Probably everyone’s heart is slightly different, and beats slightly differently. This carving was a strange, even slightly morbid kind of self-portrait.

But it was also a story. Those four measures, to think in musical terms, tell the story of that mysterious electrical force buried deep in the tissues of my heart and its successful struggle to overcome whatever agency of chaos and old night had temporarily thrown it for a loop—or, to be more exact, a series of croquet hoops. This was the story of strength renewed and hope restored. It was, in effect, the Human Comedy—the journey undertaken by the naïve everyman into parts unfamiliar and unknown, the journey that ends with everything returning to normal. And for the cardiologist, a job well done.

I really love the stormy ripple and curl in the maple behind/underneath the EKG line. The standard medium is, of course, graph paper, which makes sense of you want to quantify the event. But artistically that implies that the EKG line exists within the possibility of a Platonic or Euclidean perfection: the grid gives our heart something to match up to, or against.

And the truth is, it can’t. Hearts can be healthy but they can’t be perfect, and they can’t all achieve the same peaks and valleys that imply ideal functioning. We each have our cardiac quirks and idiosyncrasies, just as we each have our own array of freckles, of bruises and small scars, of the archaeology of major surgeries.

The stormy background of the maple wood suggests that this line is only one of many, many rhythms and dynamics that make up our lives, and our lives within the world as a whole. All I’ve done, as an artist, is pull out one of those rhythms, those currents, those threads of constant and complex change.

A chronic illness is a strange companion: the more deeply ingrained it gets into your body, your life and your psyche, the more it becomes a condition of existence, a normality rather than an abnormality.

For me, the chronic condition that was underlying much—who knows how much?—of these cardiac events was the fact that all my life I’ve been a terrible sleeper. Over the years this has got generally worse: my natural sleep-cycle is 90 minutes on the dot, so every night I wake up every 90 minutes. Sometimes I go back to sleep, sometimes not.

The worst part, though, is the actual trying to fall asleep. Unless I’m getting fairly strenuous physical exercise, the act of trying to sleep is a drama of frustration. For about ten minutes I’ll start to drift off, but the slightest distraction—a noise, an itch, a recollection of something I need to remember to do—pulls me back into alertness, and from then on it may be hours before I can let go. Come to think of it, the night of my first attack, July 13^th, I had gone to bed before 11 p.m. but once again had failed to make it across the border, and by midnight, when the a. fib. started, I was awake and despairing.

In fact, come to think of it some more, pretty much the previous four months had been even worse, in terms of insomnia, than usual. Twice, quite recently, I had not managed to get to sleep until around 5 a.m., and on top of everything else, my Restless Legs Syndrome symptoms had come back from wherever RLS goes on vacation. Far from being restful, nighttime had become the time of twitching, frustration, loneliness, and too many trips to the refrigerator in search of comfort foods.

My two night-time attacks of atrial fibrillation, of course, had made things still worse: Monday night I was up literally all night, and Wednesday night, after getting back from the hospital I didn’t get to sleep until maybe 4 a.m. My RLS was getting worse than ever, and to cap it all, various households of students in our neighborhood kept setting off fireworks until 3 a.m.

The attacks had also badly shaken me in other ways, too. My friend and former NPR producer, Bob Malesky, wrote to me later, putting this grim nighttime scenario into words that sounded awfully familiar. For nearly two months after his own heart attack, he said, “I no longer trusted my heart. Every little palpitation, twitch or odd rhythm in my chest suddenly portended an oncoming heart attack. It was hardest at night, when I lay down to go to sleep. I’d feel every beat and wonder if the heart might quit on me during the night. Needless to say, I wasn’t sleeping well.” Every moment, he said, was clouded with “the fear that my heart was going to betray me.”

Yet somehow this piece of the puzzle, too familiar to be visible, had not occurred to me. By now we were on to July 22nd. I was taking metoprolol, a beta-blocker, to keep my heart rate and blood pressure down, and I couldn’t tell whether it had the effect of suppressing my energy and spirits altogether, or whether my general sense of having turned into a crabbed and shuffling old man was depressing me. Determined to get out of the house and have at least the minimum of exercise,  I cycled half a mile across town (to meet a student) and back, and immediately after I put the bike away in the garage the fluttering started–again, not during exercise but afterwards.

Was I doomed to a life without any exercise at all? My God, I’d kill myself. And why did this disturbance, like my father’s angina, strike after exercise rather than during?

It settled back down, but on my way out to see my family doctor, Dennis Plante, at 4:30 p.m. I was exhausted, confused and scared.

He read the blood tests that he and John Fitzgerald, the cardiologist, had ordered. They had all come back normal: liver normal, prostate normal, cholesterol a little high but better than a year ago, kidneys normal. A beautiful heart, beautiful blood.

But it says a great deal about his skill as a diagnostician that we talked the subject into a slightly broader realm, and finally we tackled the triple issue of my inability to sleep, my RLS and my anxiety. He listened to it all—I’m fairly sure he was hoping to get out of the office by 5 p.m. but stuck it out until 5:30, bless him—and decided to tackle all three head on with a substantial prescription of Klonopin.

Klonopin is essentially a variant of the lorazepam I’ve taken occasionally, originally for fear of flying, but it’s a much heftier dose. The point, he said, is that we may not know what causes a. fib. but one thing we know for sure is that it’s exacerbated by tiredness. Likewise, we may not know what causes RLS but one thing we know for sure is that it’s exacerbated by tiredness. Let’s try guaranteeing a good night’s sleep and see what happens. Reboot not just the heart but the whole corpus.

Let’s spell this out more clearly: this one prescription had three values: (a) increase sleep and thus decrease a contributory cause of a. fib.; (b) decrease anxiety and thus help sleep; (c) suppress RLS symptoms. The complete trifecta.

Dennis Plante’s plan worked like a well-designed potato peeler. Took 1 mg around 10 p.m. and immediately fell asleep for almost an hour. Was woken up by loud noises that turned out to be skatebarders doing tricks on the road in front of our house. Asked them politely to move down the road; they agreed politely. Fell asleep again around midnight and slept pretty much straight through until 8. Can’t remember the last time I slept so well. Un-frigging-precedented.

The Klonopin didn’t make me feel drugged and dopey, thank God. The following day I felt a little sleepy at times but not nearly so wrung out as I had done for the past–um, well, for pretty much all of the recent past. Cycled to campus and back, and to the coop and back, with only one tiny flutter. My heart felt—well, sound. (Sometimes it feels uneasy even when it’s ticking normally.) My senses of humor and imagination were back. The a.fib. might not be cured, but my spirits were much less daunted and cowed than before. Aware of the (somewhat distant) danger of addiction, I decided I was gonna give the Klonopin another shot that night, and then maybe try sleeping undrugged for a night.

One last thing. Talking to Dennis Plante, I told him that one of the aspects of the whole cardioversion–in case you’ve forgotten the jargon, that was the bloody great electric shock they gave me to bump my heart back into rhythm–experience that struck me as the most remarkable was the titration of the sedative. A dose of somethingthat is strong enough to knock you out so hard you don’t feel all those volts, yet last only four or five minutes? That’s pretty impressive anaesthesia.

He nodded, but branched off in an unexpected direction.

“Plus it induces a certain amount of amnesia,” he said, no longer looking at me but away into the distance. “If you’re going to be shocked that hard, we don’t want you to remember it.”

Once again I had the frisson of knowing something terrible had been kept from me, even though I had been through the heart of that supposedly routine darkness.

Of course, I was hoping that my visit to the cardiologist the day after next would not only answer my questions (Why had this all started up again? What was causing the individual attacks? Why had the one on Monday night seemed so different to the one two days later? Would I have to keep getting shocked? Would I have to have a pacemaker? Would I have to have that terrifying-sounding operation in which the surgeon burns away part of the heart?) but even go so far as to tell me that nothing had really happened, and that I would play soccer until I was a thousand.

Of course, nothing of the kind happened. Total number of questions answered definitively: zero.

The cardiologist, Dr John Fitzgerald, took a good listen to my heart and his tech stuck more of the EKG electrodes on my formerly hairy chest, which was now starting to resemble the patchy hide of an extremely unhealthy donkey. At that particular moment, my heart was beating away with a quiet confidence I personally didn’t share. This, I realized, was the problem with having an intermittent condition (like asthma, or headaches, or a weird noise emitting from the transmission at any time exceptwhen the car was in the shop: they couldn’t tell me much until things started going wrong again.

Fitzgerald ordered a more comprehensive EKG accompanied by an ultrasound. In return, I asked him about ablation: was it really as routine as Weimersheimer had made it sound? (After all, cardioversion was simultaneously as routine as he had made it sound and yet really, really not.) I imagined the chest being opened, a stainless-steel or chrome spreader opening the ribs, and the surgeon leaning over me holding something that looked suspiciously like a soldering iron.

But no: the surgeons go in through the thigh, Fitzgerald explained, pushing thin, flexible wires up through major blood canals until they reached various key points of the heart. (I was inwardly boggling, imagining someone in scrubs pushing a piece of well-cooked spaghetti in through my thigh while squinting intently at a map of my vascular system that looked like a more complicated diagram of the London Underground.) Having miraculously persuaded these wires to these critical points, the surgical team (also called electrocardiologists or electrophysiologists) can first take readings to plot the electrical circuitry of the heart, and then send a high-frequency radio signal to burn out a particular nest of nerves that was misfiring, burning it to scar tissue. So many parts of this procedure defied belief I couldn’t bring myself to think about it.

In the meantime, I was facing the even less answerable question of how to live my life while waiting for all the big cardiology questions to be answered–and on this issue, nobody in the medical profession had been able to give me any advice that was any more fine-tuned than Weimersheimer’s cheerful reassurance that if things went wrong again, I could always come back to the ER and they could shock me back into shape.

How much activity could I do? Was a certain amount of exercise a good thing? I had an appointment to meet a student across town and cycled there, all downhill, and though nothing untoward happened, my heart felt as if it was laboring. On the way back I pushed my bike up the uphill stretches and rode it only on the (mainly) flat, but even so by the time I got home it was skipping and hopping every few beats, though it settled itself down, thank God. I named this kind of event (borrowing epilepsy terminology) a petit mal, or minor event: something was wrong, but it wasn’t disabling and it seemed self-correcting. The attacks I’d had on Monday and Wednesday nights were the grand mal, the real deal.

If I had to come up with one defining difference between the two, it would be the racing heart. I’ve now heard from at least a couple dozen people who suffer from a. fib., and it has astonished me how many of them have put up with it for weeks, months or even years. Yet if I think of the petit mal and imagine that low-level skipping and jumping, I can imagine not noticing it. A couple times recently, even in my ultra-heightened state of awareness, I’ve not been sure if I’m on pulse or not. But the grand mal, the heart beating at 150 or even 180 times a minute, threatening to burst up through your throat–some of the a. fib. sufferers I’ve been corresponding with or talking to have never had that.

The ultrasound, which was set up for Saturday morning, was something I’d had before (see A Barrel of Monkeys) and had found utterly fascinating. Once again the tech (whose name was Jeremy) had me lie down, then wired my threadbare chest to his computer, made with the gel and began moving his wand around to see the ghostly sketch of my working heart from various angles.

By inclination and training he was an artist; his day job simply involved making pictures for doctors. As we talked, he moved the ultrasound wand a little like a joystick, his eyes on the screen, and when he got exactly the angle and the image he wanted, he took the mouse with his other hand and plotted a number of salient points on the screen, converting the pulsing sketch to data.

“You have a beautiful heart,” he said, examining his monitor closely.

Under the circumstances, this was both a compliment and a relief, and I told him so.

He’s seen all kinds of hearts, he said, many of which were not beautiful.

Genetic issues, I asked, or damage?

Damage, he said. Oddly enough, congenital defects, which normally seem both ugly and frightening, are rarely the worst of our troubles. It’s amazing how our bodies adapt, he said. No, the main problems are all self-inflicted: smoking, bad diet, bad lifestyle.

Every so often he punched a key that made the computer broadcast the sound the heart was making, or perhaps more accurately a digital facsimile of the sound. I was struck by how it sounded almost like a chuckle: cheerful, optimistic, just going on with its business.

To some people, he said, it sounds like a washing machine, turning the water and the laundry in the drum back and forth, back and forth. “You should hear the mitral valve,” he said. “We’ll get to it in a minute. People say it sounds like a dog barking.” But to me it sounded like a deejay rubbing the vinyl on the turntable with his fingertips, wacka-wacka, wacka-wacka.

I told him how stunned I’d been by the mitral valve, when I had first seen it on the ultrasound.

Yeah, he agreed. We think we invented plumbing and electricity, but it’s all there in the heart, in far greater complexity than we can even fathom.

Imagine an engineer being asked to design something as supple and perfectly-fitting as the mitral valve, I suggested, and then saying, “Oh, yes–and make it work perfectly, without stopping, for 85 years.”

Jeremy nodded. “We’ve tried, and we *know* we can’t do that.”

I left with yet more mixed messages. No heart murmur, no valve leakage, no signs of heart disease–but, at the same time, no understanding of what was causing my condition, what might help it, and how the heck I should live my life until we found some of those answers.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.

By the following day, Wednesday, my don’t-care view of a. fib. had been replaced by a cringing wariness. I walked around carefully, as if my heart were made of glass, and I was carrying it on a velvet cushion of my breathing. I felt whipped. The procedure had jangled my entire system, as I knew it would—any operation, no matter how minor, takes anywhere from a week to a month to recover from, and don’t let anyone tell you otherwise—but this particular event had left me shuffling around like an old man in bedroom slippers. Life in the household went on around me. I once knew a bunch of ageing rockers who decided to name their band Old And In The Way, and I knew just what that phrase meant.

Even walking up and down stairs took a certain deliberateness, as if I were carrying a loaded tea-tray in my chest—but once again it wasn’t when I was active that things went wrong. It was when I tried to be inactive.

The event started out around 10 p.m. like a no-account threat, a slight uncertainty. My heart stuttered, but then beat fine for half-a-dozen beats or so, then stuttered again, then picked up its rhythm once more. I walked into the bathroom, which seemed to throw things off balance a little more, and took a bath, which seemed to settle everything down completely. It wasn’t until I tried to lie down in bed that everything got out of control. For the first time I felt the familiar invasion, the abrupt manic whacking in my chest. I sat back in an armchair and laid my right palm over my heart, as if this would somehow offer it sympathy and encouragement, and slowed my breathing to cathedral calm. And for a while that worked.

Over the next twenty minutes, though, the tension and the stakes rose. By 11:30 I felt as though I were in a medieval morality play in which the stage represents Everyman’s soul, which in turn is the battlefield on which the forces of chaos strike at the forces of order, trying to overthrow them and establish violence and despair.

My heart beat normally for four or five beats, sometimes as many as thirty, but then a kind of invasion took place: my arms felt as if they needed to flail or twitch, and this current converged on my heart, which abruptly went into spasm, beating hard and fast, feeling less as if it were beating and more as if it were being beaten. These were heartbeats that had nothing to do with circulation of blood: they were a kind of war drum, or a great gate being battered. My chest and throat constricted, and that sense of squeeze rose into my ears, which grew hot, and my head. I felt dizzy, and head a soundless buzzing. And yet this most extreme symptom was the sign that everything was passing, because the energy, like a tiny, vicious whirlwind, seemed to rise out of the top of my head, leaving silence and calm behind, and when I recovered and looked around—well, inside—the attack was over, and my heart was like a mild sea breaking at the foot of the castle walls.

During the attacks, I felt so besieged I couldn’t speak, and had to give Barbara instructions in sign language. As soon as it had passed, though, I had the absurd sense that I was talking as casually as a Noel Coward character, sitting in a drawing-room armchair, wearing a dressing-gown and mildly waving a cigarette-holder to make his points.

After about an hour and a half, I quit trying to fight this battle on my own. I got Barbara to drive me to the hospital again.

It was like Homecoming Weekend. I was delighted to see the action-figure silhouette of Dr. Peter Weimersheimer, who greeted me like the artistic director of a summer-stock theater company greeting one of his New York actors, back for another season on the rural boards.

Once again I was on the bed, wired to the monitor, IV in my arm. Yet Weimersheimer seemed curiously reluctant to describe what was going on as atrial fibrillation. Like me, he felt that this curious two-phase see-saw that was going on was different from the out-and-out madness of two nights previously. “There’s something called atrial flutter,” he said, but on the discharge sheet he would ultimately write simply “Palpitations.”

As usual, I was trying to deal with the weirdness and anxiety of the situation by studying it, and myself. The most peculiar aspect of the night’s upheaval was that it reminded me more than anything else of Restless Leg Syndrome.

RLS, as it is abbreviated, is a mysterious neuromuscular disorder. Nobody knows what causes it, though in my case there may be a genetic component, as my mother had RLS, too. It’s one of the strangest and most infuriating of sensations: a kind of energy or impulse appears in (usually) one leg, making you feel as if you need to twitch or kick it. (I heard a Tourette’s Syndrome sufferer describe exactly the same build-up that, no matter how hard you try to relax or to fight it, forced him to burst out in a kind of verbal twitch.) It can go on for hours, and most frustratingly—and most like my a. fib. symptoms—it typically starts just when you’re trying to relax. I’ve had it since I was 19, though often it has vanished for years at a time, and at its worst it would keep me up virtually all night until, utterly exhausted, I felt like crying in frustration.

Whatever this particular cardiac event was all about, it seemed to behave much like RLS—only instead of creeping into the nerves and muscles of my thighs or calves, it crept into my left shoulder and pectoral muscle. The first sign that my calm phase was about to end, in fact, was that my pec/shoulder area started to feel that build-up of electrical charge, which then seemed to dive down and sideways, sending my heart into its manic phase. It was as if I had Restless Heart Syndrome.

I twitched around in this fashion until around 1 a.m., and then began noticing something else that seemed odd. The phases seemed to be polarizing. The manic phase was, if anything, more manic—at its peak I felt hot and dizzy and on the verge of passing out—but the calm phase lasted longer and longer. In the end, it was as if the existential battle was won by the forces of order if only because the forces of chaos had retreated, perhaps to regroup and mount another attack another day, perhaps to go and try to win someone else’s soul.

I left sometime before 2 a.m. Weimersheimer gave me one metropopol, a beta-blocker that would slow my heart (though not do anything specifically about the arrhythmia) and another one to carry home and take in the morning. He also left phone messages for my internist and the cardiologist I had seen five years previously, Dr. John Fitzgerald, who would make time to see me later that same day.

They were clearly serious about this chaotic cardiac event, whatever it was. Time to ramp up the gear and find out what the heck was going on.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.

For the next five years, my heart behaved itself. I played soccer, climbed a couple of mountains, rode my bike, and all the time my heart beat faster or slower as need demanded. It didn’t particularly worry me that we never knew what had gone wrong that first time. It never occurred to me that I knew nothing at all about what makes a heart go faster or slower, or what makes it beat at all. Ironically, as an essayist I looked into my heart all the time, but only in the introspective sense. I even turned down an offer to develop my experiences and reflections on my cardiac adventure into a book. Sorry, I said. Nothing happening any more. And that’s pretty much how and where the story picks up again, just a few weeks ago.

Shock Treatment

It was a Monday night in late July, over the summer break. For once I had actually had something approximating to a vacation, a week on Nantucket, cycling every day, reading books, playing guitar. Felt as fit as I had done any time in the past five years.

Two weeks later, around midnight, unable to get to sleep and lying on the couch, the old barrel-of-monkeys feeling returned, swiftly, without warning. My heart was thumping hard and fast at the base of my throat, then stopping, then thumping hard and fast again.

It was a shock—in fact, it was exactly the kind of shock that happens when I’m on a long overnight flight, and relax enough to be drifting off to sleep, and then something terrifying happens: maybe the plane bumps slightly, maybe it’s my own anxiety creating the fall, but I feel as if I start falling, shoot out a hand and catch myself. Sometimes the feeling forces its way into a dream, and I start falling backwards off a tree branch and just manage to grab hold…. It almost doesn’t matter. It’s the aftermath that matters, that horrible sense that some kind of catastrophe was just averted, and now I’m awake and sweating, and my heart is hammering in my ears.

This time there was no plane, or maybe I myself was the plane I was falling out of; and this time the shock was so great that my heart was spastic. In those five years I’d forgotten how disturbing, how wrong it feels to lose one’s rhythm. I’d almost forgotten my heart was even there.

Once again I went through everything I’d tried the first time. Holding my breath in. Holding my breath out. Reading. Taking a bath. Nothing worked. If I lay down my heart felt ten times its normal size, bashing around my chest and up into my gullet. If I stood up I felt light-headed. Sometimes I’d get three or four normal beats in a row—a dozen would have felt like a miracle—but then a beat would get lost altogether, or ten double-time beats would charge in, and the illusion that things were settling down was trampled to death.

This went on all night. Midnight until around 7 a.m. By then there was no longer any way to deny it: I had to go to the emergency room. I tiptoed into the room where Barbara was sleeping, woke her and asked her to give me a ride. She would need the car during the morning—better she drop me off than I just drive myself, light-headed and all.

At 7:30 a.m. on a Tuesday morning, the place was almost empty, and I was admitted at once. Over to a bed, shirt off, gown on, electrodes sticking to the hair on my chest, the monitor beeping on and off all the time, either because my heart was going crazy or because the electrodes couldn’t get a good contact. Some shaving. As before, an IV and diltiazem to slow the racing pulse. A nurse, a tech, and a doctor with the ultra-fit buzz-cut build of an action figure but a confident and calming manner.

So the monitoring began. Barbara decided to stay.  My heart slowed, but beat as erratically as ever.

Another patient was admitted and shown to the bed next to mine. Either some extraordinary and eerie coincidences are guiding me or else there’s far more a. fib. around than I thought, because just like five years ago, the patient in the bed next to me also suffered from a.fib.

Just as was the case last time, it was a middle-aged man, blue-collar background, whose symptoms were considerably worse than mine. This time the guy had been suffering from several years, and was on both beta-blockers and blood-thinners. Even so, he’d come into the hospital because he’d had a series of attacks that had been going on for three days. Three days!

Hs presence also reminded me that there’s always someone else who is worse off than I am—and as if to underline that, I overheard someone at the nurse’s station call, “Can someone sit with the patient in bed 37? Suffering from suicidal ideation.”

This strange, half-tense, half-drowsy state persisted for two hours. The action-figure doctor,who in civilian life was called Peter Weimersheimer, started saying things like “Well, if there’s no change, we’ll just convert you.”

I recognized a euphemism when I heard one: this was the defibrillator, the paddles, the galvanic twitch of the body on the gurney. It wasn’t until he brought the subject up for the third time that he used the phrase “shock you,” and I appreciated his efforts to keep panic at bay.

By about 10 a.m. it was clear nothing was going to change in the ER, and nothing was to be gained by going home. “Let’s do it,” I said.

They were going to give me a quick-acting sedative through my IV, Weimersheimer said, and also some painkiller. I assumed the painkiller was so I wouldn’t feel too bruised and beaten up when it was all over, but he gave a different reason. Even though I wouldn’t know or feel a thing during the cardioversion, he told me, fumbling for his words a little as if all this New Age stuff still sounded a little strange to him, he felt as though patients with a little painkiller in them seem to react…um…less during the procedure, seemed to tolerate it better. Even in my dopey state, I realized that this was a hint: while it was true that everything about the cardioversion was routine and effective, he was saying, it was also violent and alarming, at least to those who were conscious and watching.

“You don’t have to stick around,” I told Barbara, suspecting that the whole episode might be as distressing for her as it was for me—but she insisted, and pulled out her iPhone.

“I’m going to film it,” she said.

This struck me as a potentially terrible idea, but my job right now was to let the world drift away. The nurse fiddled with my IV, and I began to feel distinctly mellow. I closed my eyes, then vaguely opened them, then closed them again.

“How are you feeling?”  the nurse asked.

“Very relaxed,” I slurred. Mentally, I rolled over and cocked an ear to my own chest. My heart was quiet. Quiet, as in pulsing regularly and gently, its voice faded back into the general background noises of my body. I was blurrily delighted. The sedative must have quietened it back into normality.

“Hey, it worked!” I said cheerily, if still a little fuzzily.

“Yes, it did,” Weimersheimer said, and seemed to withdraw along with his retinue until only the nurse and Barbara were left.

“How are you feeling?” Barbara asked again–and something about the way she asked made me realize that something had happened to make her ask that question in that tone. It took me a while, but I finally got it: the cardioversion had taken place without my having the slightest knowledge of it, all over in less than five minutes, and the only way I could tell was that the right side of my upper chest, between my collar-bone and my nipple, felt as though someone had punched it.

I got dressed, feeling a little odd, was given a summing-up sheet that said my diagnosis was atrial fibrillation, and we went home.

By now it was almost noon. I lay around the house, feeling benign but oddly incurious. Now that it was over, this attack, this procedure I’d dreaded, what had I learned? When anything as strange and new and threatening as this is over, what you’ve mostly learned is that it’s over. I didn’t want to follow up with the cardiologist or my family doctor. I didn’t want to watch the video Barbara shot with her phone. What I clung to instead was that it was over and had, in fact, been fixed in five minutes using a procedure that I didn’t even know had happened. How easy! How swift! For most of Tuesday the cardioversion had the qualities of a magic spell: the demon had been killed, and could be killed at will whenever necessary. All I felt, at first, was the wonderfully mellow after-effects of the morphine and the conclusion that I didn’t have to think about atrial fibrillation any more.

That tranquility lasted until late afternoon. By then, odd signs were surfacing. My right pectoral area felt bruised, as if it had been punched. I’d forgotten that morphine makes you constipated. Some of the skin cells on my chest had been ripped off along with the defibrillator pad, and that area smarted, then stung, then felt so raw I had to ice it in order to get to sleep. And by then my back and knees were aching something fierce. It was as if all my innards had been violently shaken—as, of course, they had. The science had lost its magic: I wasn’t so keen on going through all this again, after all.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.

First, the background. We go back five years.

A Barrel of Monkeys

By five o’clock the pick-up game of soccer was just getting good. Two dozen of us had straggled down to Oakledge Park around 3:30, as usual, and after ninety minutes several people had had enough, so as the sun began to sink over Lake Champlain, spaces were starting to open up. For a forward–and at 52 I play as a forward because, dammit, I want to score a few goals to replay over and over in my mind’s eye once I’m forced into retirement–there was finally room to run, to attack the goal, to play passes that knifed through the heart of the defense.

I had been longing for the game even more than usual, because the previous week–well, the previous three weeks, really–had been stressful beyond belief. In mid-August I had been appointed director of the writing program at the college where I teach. After twenty-seven years in the United States, I finally had a full-time job with benefits–but it came with two catches.

The first was that, as an indentured member of the academic fringe, I’d never had to know anything about credits or electives or pre-requisites or course numberings–I was free to just go in and teach like a man possessed. Now I had to learn everything about running a program with ten instructors and two dozen courses, and I had to learn it in a week and a half, while writing six syllabi and getting ready to teach two courses I’d never taught before.

The other catch was that I been hired for only a year, during which time the college would carry out a national search and make a permanent appointment. As the human resources officer started to walk me through my benefits package I began to see how much I had been paying out of pocket all these years, how marginal my freelance life had been. The prospect of having these benefits for only a year, and then being thrown back out on the side of the road, was ghastly. It was clear what I had to do: I had to be not only the best program director the college had ever seen, I had to be the best program director they could imagine.

No pressure, eh? I worked all day, every day until ten at night. Most of the time I felt as if my stomach was being gnawed from within by a large rodent. My chest was as rigid as a barrel, the ribs like horizontal staves. My mind was so occupied elsewhere, though, I barely noticed; and when I did, I took half a dozen deep breaths before hurrying on to the next job I didn’t know how to do. I couldn’t wait to get some fresh air and exercise.

Someone on my team played a through pass and I took off after it, but was fractionally too late: the big Russian guy playing sweeper stepped up and hoofed the ball away upfield. As I pulled up, I felt dizzy, and realized my heart was racing. I stood still for a moment, shook it off and got back into the game.

Another quick sprint, and it happened again. I slowed down and waited for it to pass. It wasn’t the first time my heart had done strange things–a sudden, extra off-beat thump, then a sickening pause, then back to business as usual–but when I’d asked a doctor about it he had listened to my heart, told me that I was perfectly healthy, dismissed it as a normal occurrence and said I should stop being such a wuss.

This time normal service was not restored. My heart was apparently playing a game of its own. Six beats in quick succession, then one of those sickening pauses, then four, then six more, then apparently none at all. I went over to the sidelines and sat down.

Whatever was going on with my heart had the odd effect of breaking up my sense of the continuity of the day, or the coherence of everything around me, into oddly-shaped fragments. It felt as if things in general, not just my heartbeats, were happening in short, stuttering rushes. I cadged some water–tried to catch my breath. People asked me what was wrong–I tried to tell them, at the same time shaking my head at the oddness of it all–someone said I should call it quits for the day–I said yes, probably I should–pulled my things together and got up, a little uncertainly–made my way over to my car. My body, too, had lost its unconsidered balance, and walking had become an act of concentration and will: it felt as if I were walking on stilts.

I didn’t think I was having a heart attack. Here and there I had somehow picked up bits and pieces about heart attacks and tucked the information away without telling anyone, even myself, what I knew. Heart attacks were painful—they felt like cramp—the muscles contracted hard—the pain sometimes went through the left shoulder, or down the left arm. As potentially life-saving information went, it wasn’t much, but it was just enough to keep panic at bay, panic being, in my view, the worst attack of all.

I drove home slowly. My car’s engine was running smoothly, for once, but my own was racing, braking, racing, braking.

It was strange to have lost my sense of rhythm, something I had taken for granted so deeply that I didn’t know I had one. There must be some kind of synchronization, in the normal state of things, between heartbeat and breathing and pretty much all physical activities. I once saw a film of red blood corpuscles moving through a capillary. Instead of flowing steadily, like a river, they shunted forward en masse, kicked by the cardiac pump, then stopped, then shunted forward again. And with that shunting motion, everything around them shook slightly. The heart was not only booting the blood around the body, it was booting the body as well, giving the whole system that reassurance that as was well, was working at the right pace for the circumstances. They say that the fetus hears the thump and whoosh of its mother’s pulse: maybe this is the deepest of the truths we know, this sense that the cardiac rhythm is running through us, that everything is sychronized and working as it should.

There’s something profound about this pervasive rhythm, something universal. That week, a study in the journal Heart showed that music with “a slow or meditative tempo” tends to slow the pulse of those who are listening to it–especially musicians, as it happens. Other research has shown that music can alleviate stress, improve athletic performance, improve movement in neurologically impaired patients with stroke or Parkinson’s disease, and even boost milk production in cattle. The rhythm of music, then, spoke to another rhythm so essential that it seemed to underwrite virtually every bodily activity. Who knew how it would affect me if that rhythm was now fragmented and lost?

When I got home I did what we English do in times of trouble: I took a bath.

I lay in the hot water and tried to relax, but it didn’t work. Instead, the bath left me alone with the strange sensations in my chest.  They felt, I decided, like a barrel of monkeys. The heartbeats leaped and scurried around at whim, sometimes apparently at the base of my throat, sometimes pounding at my ribs or my sides.

I let a long breath out and let my body weight fall, and the unruly contents of my chest began to sink too. For a second, in the luxurious relaxation of the outbreath, it felt as if one of two things was about to happen. One was that my heart would settle back into its old rhythm as if life were no more than a pile of bedlinen, and all I ever had to do was relax into it. The other was that I was dying, and by letting my breath go I had let go whatever strange unconscious commands I habitually send to my heart. It would sink into silence like a shell falling through the darkness of the sea, and I would die, but that would be okay, because even dying involved recovering, in a way, from this unnatural and disturbing series of broken rhythms.

Neither happened. After an instant of warmth and calm, my heart gave a deep kick right through to my back, and burst into a reckless stampede of activity. Whatever was going on, there was clearly going to be no easy answer. The monkeys shrieked and chattered and threw things. I got back out of the bath, shaken and uneasy. All the bath had done was to demonstrate with unpleasant clarity how deeply this disturbance ran. We speak loosely of the heart as the core of our being, but it’s usually just a romantic figure of speech. For the first time I thought of my heart as something utterly central to my psyche as well as my physiology. It had run amok, and because of that everything about me was amok. We think of the heart’s rhythm as internal, but it has everything to do with how we understand the world outside us. It is, then, a wave that encompasses everything, outer and inner.

Barbara, my wife, had made dinner, but every time I stood up, I felt dizzy again, and the effort of walking to the table tired me. My appetite had vanished. It was strange: all this activity inside me, yet in general I felt sluggish and distant from myself.

By eight p.m. the monkeys had shown no sign of settling down. I called my doctor.

“I would go to the emergency room, if I were you,” he said quietly but clearly. “I would go right now.”

*         *         *

“Cardiac arrythmia,” I told the admitting nurse, feeling slightly giddy–not just from lack of oxygen, but giddy with importance: for once I was turning up at an emergency room with symptoms so dramatic that there was no way I could be told to take a seat and then be ignored for two hours.

Sure enough, she sat me down at once and took my blood pressure. Her eyebrows shot up, she beckoned an orderly and sent him for a wheelchair. It turned out that my blood pressure was 84/60. If it had been much lower, I’d have been in danger of passing out.

The technician laid me on a table, stuck electrodes all over my hairy chest and turned on a heart monitor. He stared at the screen, which had been turned, perhaps prudently, so I couldn’t see it, but I could imagine what it showed: instead of the familiar parallel green lines with the up-and-down jags at regular intervals it must look like scribble. And even thinking “scribble,” it struck me that handwriting, too, conveys a sense of rhythm, and that my own handwriting, in the days before this strange attack, had been even less legible and orderly than usual.

Still no pain, just that odd sense that my insides were off balance. I kept taking deep breaths, as if this would reboot the system, and sure enough as I held my breath my heart would pause, like an old friend trying to fall into step with his buddy; but as soon as I let the breath go my heart raced as though it had fallen terribly behind with its work, and needed to catch up at all costs. Another six or seven quick beats, then a hesitation like an elevator stopping, then another quick tattoo of beats.

An hour went by. Time seemed to have become lumpy and inconsistent because of my own erratic metronome. The hospital bed, too, seemed uneven and uncomfortable. I fidgeted.

With nothing else to do, my mind wandered. My father died young, at 52, from lymph cancer following some heart trouble. For years I had been aware of 52 as a shadow, a threat. Most days I was sure I’d live past 52 because I was so much fitter than he had been–exercised more, weighed less, had never smoked, ate a healthier diet—but all the same it was a landmark I wanted to pass, to leave well behind. Now, getting increasingly uncomfortable on the hospital bed, I added up years and tracked back and forth across a mental calendar. If my heart had been capable of sinking, it would have sunk: I was the same age, to the week and perhaps even to the day, that he was when he died.

Eventually a doctor came in, studied the monitor readings, took my blood pressure again, and told me that the technical term for the barrel of monkey was atrial fibrillation—A fib in medical shorthand.

The heart, he said, is made up of four main chambers. The two lower ones, which are larger and stronger, are called ventricles. They do the hard work, pumping the blood out around the body. The two upper chambers are holding tanks: blood flows into them after its journey around the circulatory system, they fill up, a valve opens and they contract, each pouring the blood into the ventricle below it. The valve then shuts, the ventricle contracts, and the blood is on its way again. Each upper chamber is called an atrium, plural atria, adjective atrial.

Under normal circumstances, he said, all this activity is coordinated by electrical impulses in a small patch of tissue called the sino-atrial node, or SA node. (I couldn’t grasp this. Heart tissue acts as a kind of fleshy electrical circuitry? But he was moving on.) In some people, though, something causes these impulses to go haywire. The ventricles keep on doing their steady job (which is just as well, or things would go wrong very quickly for the heart’s owner) but the atria fibrillate–that is, they develop arrhythmic patterns of their own. “They’re basically just fluttering,” he said.

It wasn’t clear what had caused this epsiode of mine; it wasn’t clear what caused atrial fibrillation in general. He gave me a list of possible contributing factors: high blood pressure, hardening of the coronary arteries, recent heart surgery, chronic lung disease, heart failure, cardiomyopathy (a disease of heart muscle that causes heart failure), some miscellaneous congenital defect, a pulmonary embolism (that is, a blood clot in the lungs), a hyperactive thyroid, pericarditis (an inflammation of the outside lining of the heart–uncommon), excessive use of alcohol, caffeine or cocaine. “Do you use cocaine?” he asked, peering at me for signs of decadence.

No coke—in fact, none of these sounded likely. It wasn’t at all clear what had caused this attack. It also wasn’t clear what would happen next. Now that I had had this episode, he said, the chances were that I would have more–worse attacks, more often. One possibility for treatment, he said, was that I might have a new and somewhat experimental procedure called oblation.

“Oblation?” I repeated, spelling it out, thinking of the General Oblation Board in Philip Pullman’s His Dark Materials. He nodded. This was bizarre, I thought. In religious terms, oblation is an act of offering something–praise, worship, thanks, one’s heart–to a deity. If I underwent this procedure I would literally be placing my heart on the altar of medical science.

Later, when I went to WebMD, I found that the operation is actually spelled “ablation,” but it was no less terrifying than, say, laying oneself on an altar and opening one’s shirt for the knife.

“There are two types of surgery that can be used to treat…atrial fibrillation,” WebMD announed, referring to atrial fibrillation by its chatty medical name of A. fib. “These procedures are often combined with other surgical therapies such as bypass surgery, valve repair, or valve replacement.”

Wait a moment. Isn’t that what they call open-heart surgery?

WebMD suggested two possible procedures for A. fib. One was the Maze procedure. “The surgeon makes small cuts in the heart to interrupt the conduction of abnormal impulses and to direct normal sinus impulses to travel to the atrioventricular node (AV node) as they normally should. When the heart heals, scar tissue forms and the abnormal electrical impulses are blocked from traveling through the heart.”

The other procedure was called surgical ablation. “The surgeon creates controlled lesions on the heart and ultimately scar tissue to block the abnormal electrical impulses from being conducted through the heart and promote the normal conduction of impulses through the proper pathway. This procedure involves a single incision into the left atrium. One of three energy sources may be used to create the scars: radiofrequency, microwave or cryothermy (cold temperature)…..”

I couldn’t read any more. I expected to have a myocardial infarction on the spot.

*         *         *

For right now, the doctor ordered me an IV drip and a medication called diltiazem, which would at least slow down my stampeding heart. After that, they’d just have to see what happened. With luck, my heart would return to its normal activity, called sinus rhythm–not after the cavities in one’s nasal passages, but after the up-and-down sine wave that appears on the cardiac monitor.

If the fibrillation continued, he said, they’d probably have to give me blood thinners. If my heart kept on beating erratically, blood would mill aimlessly around the atria rather than being regularly discharged. Some of it might pool at the walls, like sticks circulating in small pools at the bank of a river, and form clots. One of the clots  might break loose, wander around my bloodstream, lodge in my brain and cause a stroke.

“Now, that’s not going to happen in the next few days,” he went on, but his tone and look were a clear warning.

While I waited for the diltiazem to take effect, someone was admitted to the next bay, invisible on the other side of the curtain. Half-listening to him talking, his voice shaky and dejected, with his doctor I realized with a shock that this guy, too, had been admitted for atrial fibrillations–yet his had apparently been coming back for months, even years.

“I’ve had ablations, but it always seems to come back. It’s a pain in the ass.”

For over an hour I heard him muttering and complaining, and it felt like a message from the future. At some point he, too, must have had his first attack, probably a playful, odd episode like mine. Maybe he was scared; maybe he thought nothing of it. But it had come back again and again, and now the cutting-edge science was no longer working, and he had been reduced to this fidgeting shadow of himself, unable to tell even when his heart was working properly and when it wasn’t, perpetually a stranger to himself and his natural rhythms.

*         *         *

The electrodes kept coming unstuck, the monitor kept issuing its alarms, and eventually a nurse appeared from my neighbor’s cubicle, turned it off, and asked me what I was in for. I told her about the fibrillation. She was professional, brisk, dryly humorous about the whole thing.

“They didn’t shock you?” she asked, in mild surprise.

“Shock me?” I thought I knew what was coming, but I had to put it off as long as possible. “You mean by showing me the bill?”

But the joke was on me. She chuckled and went on, “No, they sedate you and try to shock your heart back into its normal rhythm.”

I had run out of jokes. On the one hand this whole episode was not high drama: I was just lying around listening to the monitor and reading, of all things, a magazine dedicated to the ukulele. But now, it seemed, some frightening scripts were awfully close–the paddles on their wires, the shout of “Clear!” the body twitching helplessly on the gurney. My image of the barrel of monkeys was starting to seem absurdly naive.

For whatever reason, they decided against the electricity. A technician tugged the electrodes off my chest, each one tearing out a dozen long hairs. It was the only pain I felt all evening.

I got home around midnight. The racing, exhausted feeling had ebbed, but I still felt like a disconnected mechanism, a box of cogs that didn’t fit. Lying down was the opposite of relaxation: bed, like the bath, made it only more apparent how wrong things had become. I went upstairs and slumped on the couch.

The sounds of the puppy barking woke me up. The girls were coming upstairs to let her out, and I opened an eye. Maddy was looking to see if I was awake. “Hi, Daddy,” she said, climbed over the back of the coach and curled up with me. I ran an internal check and found that a calm had settled in my barrel. No, not even a barrel: my chest had returned to its normal size and flexibility. I barely noticed my heart: it was unobtrusively doing what it was supposed to do, a good servant, a unified set of forces. I didn’t need to lose any more chest hair to know that I was back in sinus rhythm. The sun was already above the hillcrest, filling the valley with light.

Even so, my sense of myself had been shaken in ways I hadn’t known existed. I found myself joking about the whole episode, but at the same time I felt as if I were walking with my head cocked over and one ear turned toward my heart. I noticed that every so often–a few times a day, maybe–my heart produced the slightest irregularity, not the barrel of monkeys but a single cardiac hiccup, then back to business as usual. When I felt a sneeze coming on, I had the sudden sense that as I sneezed, my heart would burst. A few days later I felt a muscle twitch in my thigh and wondered if this was a different kind of fibrillation, a sign of a more general series of faults in my wiring.

*         *         *

The day after my attack, by a strange coincidence, NPR broadcast an interview with Jae Sinnett, a jazz drummer and composer who had suffered heart palpitations after a prolonged bout of food poisoning. Being a drummer, he said, he was in tune with rhythm in general, even his own body’s rhythms, so he knew something was wrong, and checked himself into hospital. He ended up composing a piece based on the experience, a track called “Palpitations.” The beat shifts back and forth between 7/8 and 6/8, he said, and the chorus is in 5/8.

I listened to it, and it was certainly interesting, but it wasn’t like fibrillation. To score my heart would have taken every meter in the book, it would have included only one beat in a measure full of rests that were anything but rests. It would have included dotted notes and random syncopations. It was anything but musical. If a jazz band had played it, the nightclub patrons would have stumbled on the dance floor, turning in bewilderment and unease. Anyone eating would have felt queasy; anyone drinking would have stared at his glass in shock and dismay, would have sworn off the stuff there and then.

*         *         *

At soccer the following Sunday I began to discover just how common it is to have a faulty heart. Two of the guys lacing up their cleats next to me told me they had prolapsed microvalves, a condition that, bizarrely, is apparently not serious in itself, but it can mean that a visit to the dentist, of all things, can be fatal. One friend, in a subtle blend of compassion and one-upmanship, told me that he had had a bout of atrial fibrillation that went on for months. He stood up and began stretching his hamstrings. “I had to wear a heart monitor,” he said, patting his chest as if showing off a medal.

Later I read that Senator Bill Bradley developed A. fib. for no apparent reason and twice had shock treatment, technically called cardioversion. George Bush Senior developed A. fib. as a result of thyroid disease. Vice-President Dick Cheney had had a defibrillator installed because of erratic heart rhythms. Half a million Americans each year are diagnosed with atrial fibrillation. It is the most common form of heart trouble–yet there’s no clear understanding of what causes it, and no cure.

I was damned if I was going to let one evening in the ER stop me playing soccer. At first I took it very carefully, hanging back in defence, stretching, trotting on the spot, listening to my own vital signs. Someone had said that dehydration was a potential factor–all of a sudden, everyone was a heart expert–so I kept taking swigs of tepid water tasting of blue plastic. After a week with no exercise I wasn’t at peak fitness, but I didn’t seem to be about to collapse. I made a few experimental runs upfield with no ill effects, and after an hour was playing striker in my usual ambitious, clumsy way, sliding to try to reach a cross, diving for headers. We played for more than two hours, longer than usual, before people were looking for an excuse to call it a day.

“Play to the next goal?” someone called out.

“How about playing to the next cardiac episode?” I called back.

*         *         *

The heart is a perfect organ for jokes. A heart attack is so sudden it has the effect of a punch line. A Jewish friend, not knowing what had happened to me, sent me a joke:

Six retired Floridians were playing poker in the condo clubhouse when Meyerwitz loses $500 on a single hand, clutches his chest, and drops dead at the table. Showing respect for their fallen comrade, the other five continue playing standing up.

Finklestein looks around and asks, “So, who’s gonna tell his wife?”

They cut the cards. Goldberg picks the two of clubs and has to carry the news. They tell him to be discreet, be gentle, don’t make a bad situation any worse.

“Discreet?” Goldberg protests. “I’m the most discreet person you’ll ever meet. Discretion is my middle name. Leave it to me.”

Goldberg goes over to the Meyerwitz apartment and knocks on the door. The wife answers through the door and asks what he wants. Goldberg declares, “Your husband just lost $500 in a poker game and is afraid to come home.”

“Tell him to drop dead!” yells the wife.

“I’ll go tell him,” says Goldberg.

Boom-boom.

Yet the heart was turning out not to be like that–healthy one moment and sayonara the next–at all. Judging by the stories I was now hearing from all sides, hearts everywhere were fluttering, twitching, missing beats, softening, hardening, silting up, their valves leaking or not closing properly or slamming shut so hard they swung through their seals like a swinging door in a restaurant kitchen.

And even the ultimate punch line, the drop-dead heart attack, had lost its punch. Another email came in, this time from guitarist/historian Dick Stewart in New Mexico. He’d had a heart attack and triple-bypass surgery but was now back in circulation, so to speak, feeling mostly stupid for having smoked for fifty years, and also feeling a bit depressed, which he had been warned was the modern-day outcome of the event that for most of history had left you like the proverbial doornail.

The heart had lost its fabled carthorse strength, that tireless labor that lasted a lifetime–but it had also lost some of its sudden-death fragility. It just kept going, abused and ignored, doing its job as best it could. It was the most human of organs.

*         *         *

Dr John Fitzgerald, my cardiologist, turned out to have dark hair and a beard going grey, an ample belly from which a soft but deep voice rumbled, an attentive and courteous manner, sly humor. He repeated the definitions that were now familiar, sunlight falling through the slatted blinds of his suburban office, a world away from the emergency room.

“We want to check the echocardiogram,” he said, “to see if  there is a leaky mitral valve that might be predisposing you to having this.

“The natural history of this, over the years, is that it may not occur again for a long time. It may never occur again. Sometimes it comes back, and then it comes back more frequently, and then it becomes the dominant or established rhythm.

“We do have various ways of dealing with it. There are medications available that may prevent it from recurring, and more recently there has become available a type of surgery that modifies the conduction capacity of the heart by creating little tiny burns in the side of the heart with a special radio-frequency catheter.”

“Is that ablation?” I asked nervously.

He nodded. “That may help to prevent recurrences. That’s usually something that is reserved for people who are resistant to medication–or resistant to taking medication.” He chuckled ruefully. “It’s not something that we generally offer to somebody after their first go-round of this stuff, but if it seems to become more of a problem, it’s certainly a consideration. It’s a bit on the cutting edge. It’s a bit experimental. But there’s a couple of doctors at the Fletcher Allen who seem to be doing pretty well with it. They may be able to help us out if it should be necessary.

“The Holy Grail of cardiology is atrial fibrillation,” he said, and laughed. “If I could invent a cure for atrial fibrillation I would probably be the richest man alive and the best-regarded among cardiologists.” He chuckled heartily at the thought.

*         *         *

He sent me off to get an echocardiogram, an ultrasound of the heart. The technician had me take my shirt off and lie down, affixed three sticky contacts to my chest, squeezed lubricant onto the business end of a short white electronic wand attached to a computer set-up, placed the wand firmly on my chest in the hollow just to the left of my sternum, and looked expectantly at the two monitors.

I had seen ultrasounds before in the months before both my daughters were born, had watched that mysterious treasure hunt through perplexing sooty shapes that suddenly reveals a hand, or a foot, and then a whole pale being tumbles into view, curled as if asleep or deep in thought.

This picture was quite different. At first the strange mouth-like shape opening and closing in the darkness looked like an undersea creature of some kind, perhaps a large, hyperactive sea cucumber. But as the technician moved the lubricated wand here and there on my chest and the image became more defined, it was clear that what we were seeing was something that had never existed in the visible world, exposed to air or water.

I’d never thought about it before, but living creatures clearly have well-sculpted, purpose-built external surfaces, sometimes hard for protection, sometimes streamlined for efficient movement. The surfaces that we present to each other, and to our surroundings, have a kind of sleekness about them.

What appeared on the monitor clearly didn’t need to bother itself with externals. It had committed itself to being fleshy–that is, packed to swelling-point with life and purpose.

The cartoon heart has a simple outline, a steady shape. The thing on the monitor couldn’t wait around for definition, like a Victorian businessman too impatient to sit for his silhouette. It was working away, every cell, every syllable clenching and unclenching–not like a fist, which tends to close and open with a single sense of purpose, unified by the rigidity of bone, but in a much more complex and subtle way. The heart is a muscle, we are taught in school, but this was more like many muscles, an amazing collaboration of muscles, working not only together but in several different directions, and working, what’s more, at amazing speed. I was lying down, not particularly anxious, and my pulse was maybe 63 or 64, yet this consortium of rubbery-but-intelligent tissues was galloping along. The average heart beats some three billion times, yet the heart is the only muscle that unless damaged or diseased does not weaken with age. It seemed impossible to believe that one organ could do so much, so quickly, for so long. It seemed impossible to believe that it could do so with me barely noticing it.

Yet that was just the start of the voyage. The technician moved his mouse, tapped some keys, drew some lines on the screen to measure the thickness of this, the size of that, moved the contacts to different places on my chest, moved his wand down below my ribs and up to my throat, and finally settled on a view that looked vaguely like a large nose, seen from below and looking up into the nostrils, but which I knew must be a full-profile internal shot of my heart.

The twin dark caves were the ventricles, the larger, lower chambers that contracted regularly, pumping the invisible blood so forcefully it made the journey around my vascular system, a network so long that if it were extended it could be wrapped two and a half times around the Earth.

The smaller chambers, only partially in view, were the atria, currently behaving themselves and playing their part in this astonishing coordinated dance of muscle.

In the middle of the screen, though, was something else, something that moved more rapidly than anything else in this cardiac gallop. The wall dividing the left chamber from the right ran roughly up and down the screen, and two-thirds of the way down this whitish divider a strange flapping was taking place. Two absurdly small wings–chicken wings, I thought–were beating up and down in that sinuous, unified motion that birds’ wings obey, only with an even greater range of motion up and down. These, I realized with a shock, were the reason for the echocardiogram. These were the tricuspid (right) valve and the mitral (left) valve, and they were two of the most astonishing things I had ever seen.

If I had ever thought about heart valves before, I had probably thought of the valves in a car’s engine, opening and closing like little metal lids. Rigid, in other words, and tough because they were rigid. These winglets seemed far too pliable to work as valves, so flimsy they bent up and down wildly in the current of blood, yet strong enough that when the ventricle squeezed its dark chamber, they sealed shut, and the blood shot out through the aorta or the pulmonary artery instead of back up into the atrium.

And my own valves, no matter how flimsy or frenzied, seemed to be functioning just fine: the technician hit some keys and the computer, having used its measurements to calculate the amount of blood flow, suddenly superimposed flashing patches of vivid color–blue and red, with spots of white–on the heart’s dark and active chambers. This was the machine’s artistic impression of the activity of my invisible blood. Blue and red, the technician told me, were good; they indicated blood being pumped in the usual and healthy manner. The white blips were signs of leakage, of tiny amounts of blood being forced through the valve back into the atrium.

“Insignificant amounts,” he said, his eyes fixed on one screen, then the other. A heart murmur, but an almost inaudible one.

Looking at those wing-like valves beating impossibly quickly, it was easy to think of the heart as a miracle–and in fact proponents of Intelligent Design have a great deal to say about the heart. But the chambered heart developed, astonishingly, from a basic squeezable tube found in simple life-forms such as worms. It developed, moreover, when the first creatures left the ocean and became terrestrial. In short, the heart, as much as the lungs, is a land organ. And for all its astonishing complexities, when looked at closely it shows every sign of being riddled with mistakes, bad ideas and evolutionary dead ends. In one not uncommon congenital condition called Tetralogy of Fallot, the unborn child’s heart develops with the aorta attached in the wrong place. Variety is a human condition. The heart is a work in progress.

Above all, I had a new understanding of rhythm. If I had thought of the heart before, I had thought of it as a pump in the industrial sense, a fleshy device with a single purpose: to keep beating. Now it seemed to me that the atrioventricular node, as much as the brain, was constantly making decisions, taking into account who knows how many sets of incoming, often contradictory, information, adapting and adjusting from one beat to the next, as alert and supple as—well, a conductor, I suppose, listening to a hundred players but knowing the score, knowing too that life involves constant variety, flirting at every beat with chaos but denying it steadfastly in a thousand different ways.

What we think of as calm is in fact rhythmic; the steady pulsing of light, sound, magnetism and electricity. The deep beating of the ocean. The dance along the artery, the circulation of the lymph, wrote Eliot, are figured in the drift of stars. Diurnal, circadian, menstrual, annual. The heart manages a consolidation of all these rhythms.

The technician ripped the contacts off my chest two at a time and handed me a paper towel to wipe off the lubricant. A minute later I was out of that strange room, the room in which I had seen into—well, the heart of things. I was back into the world I was used to, a world of upright chairs and level tables, rectangular walls and floors.

It felt as if I had returned to a world designed by a more primitive geometry, rigid and simplistic, where everything was well-lit and clearly defined, a world without the slightest inkling of what rhythm meant, or of what life was capable of, especially when life itself was at stake.

And that was it, for the time being. Tomorrow I’ll tell you how this particular demon has returned.

Yes, it’s true. Here I am demonstrating the latest iPhone app–as the world’s most expensive bottleneck.