Two Hearts
This piece was originally published in the July 2019 edition of The Kenyon Review, and was named a "Notable" essay in Best American Essays 2020.
My heart is inflamed. It demands to be known, felt, sitting heavy in my chest, making it hard to breathe.
The pain is central, right between my breasts, and it haunts me all day, a constant grieving. It is emphatic, specific: a tightness I try to push on, my fingers on my breastbone, but cannot ease. It grips me like worry, like terror, like heartbreak.
It’s from a virus, the doctor tells me. This can happen: a virus in your throat can run its course and seemingly be vanquished, but instead, it hides out, secreting itself somewhere else in your body, looking for purchase. And there it blooms, in the lining of your heart. Pericarditis, the heart lining inflamed, fighting, aching. It feels like a heart attack, right down to the pressure on your chest and the pain sometimes running down your arm and the shortness of breath, but it is not a heart attack.
My brain doesn’t know this. My brain hears these frantic calls from my heart and sounds the alarm. The panic makes it worse; the panic makes my angry heart angrier.
The cardiologist’s office has machines that can reveal the secrets of my body. I lie on a table, on my left side, a rough gown draped over me, and a technician presses a plastic knob full of gel onto my breastbone, my breast. I hear the familiar, watery swish of the machine, and it reminds me of my first ultrasound when I was pregnant, the way I’d marveled at this tiny, fierce life inside me, the completeness of its world a mystery, the sounds of which I could only eavesdrop upon from time to time.
This time it is my own heart I am eavesdropping upon, and there it is, beating away, its own strong rhythm constant and utterly independent of my conscious direction. I feel awed and inordinately proud, the way one might feel inordinately proud of the earth, the life that grows on it, the way you might wade into the ocean and stumble upon a starfish or a crab and marvel at this secret life existing all the time without you and feeling proud somehow to be a part of it, privileged to have a glimpse of it. I feel for a moment about my heart the way I felt watching first my daughter, then my son roll over or take their first steps: good for you, look at you, look at the hard work you’re doing. I am hearing my heart do its work, and for a moment I am humbled to realize this is the work it does all the time, and that I take it for granted.
The tests reveal nothing out of the ordinary. My heart is strong, it pumps the way it should, the arteries and vessels are free of defect. What feels like a crisis is not a crisis. My brain can’t tell the difference.
—
When she talks to me, she can’t even say it. She can talk about staying up all night, about writing on scraps of paper she’s assembled into a journal. She can talk about a revelation she’s had, about a truth she’s discovered about herself, about the relief it feels to know this truth, but she can’t name it for me. She can’t tell me what it is. It’s too much.
It sounds like you’re talking about identity, I say, to help her articulate it, and she says Yes—yes, exactly. I think I know what she’s trying to tell me, but I try to mirror her approach, reflect her, come at it obliquely. We are able to talk about identity, we are able to talk about what it’s like to be fifteen, a younger sibling; we are able to talk about the self, all without talking about what we’re really talking about. My heart aches as I watch her struggle, hovering between excitement and fear, wanting to share something big with me, but also not wanting to break the spell of everything being normal.
Just sometime, when I’m not home, just go upstairs to my room, she tells me. There’s a box on my desk. You can open it. In there are scraps of paper where I scribbled my thoughts when I couldn’t stop thinking about this. You can read them, and then maybe you’ll understand what I’m trying to talk about.
I go over to her and give her a hug. I can feel her shaking, can feel her heart racing, my own inflamed heart straining in my chest, aching, sitting heavily—the weight of it all.
—
There isn’t much in the way of treatment. Rest, mostly, and massive amounts of ibuprofen, for weeks on end. Is this just what happens to me now, I ask the doctor. I get a random virus and then a few weeks later, this? This is the second time this has happened, the lining of my heart becoming inflamed by some provocateur virus. Each time I have gone to the ER thinking I’m having a heart attack.
Leaning forward makes it better; lying back makes it worse. And so even doing nothing, even resting on the couch, I am leaning forward, my elbows on my knees, as though I am rapt with attention, drawn into a conversation, leaning in to tell a secret.
—
When she was a baby, she cried one night as I was putting her older sister to bed. Oh no, Emi said, I don’t like it when he cries.
I know, I said, soothing her, me either. We both lay there in the dusk for a few moments, me waiting to hear if the cries would escalate to something requiring me to go to her, Emi waiting to see if I would leave.
Sometimes babies cry when they’re tired, I told her. You know how sometimes you cry when you get really tired? And me, too, sometimes? She nodded, her face worried, serious. Sometimes babies cry when they’re really tired, and it’s okay to let them cry a little. If he cries too much, though, I should probably go in there and help him feel better.
Yes, she said, as she hugged me. We both waited, breathing in the darkness as she continued to cry.
Oh, Mommy, Emi told me, crying a little herself, sometimes when he cries it feels like I have TWO hearts in my body.
—
I walk up the stairs to her room after she leaves for school, my heart heavy, its lining angry and straining from the cardiovascular activity, but also the heaviness of trepidation. This is the part of the story where everything changes, I think to myself. The scene where the mother finds out the truth she already suspects about her child. I watch my feet as they step up the stairs. I press my fingers to the spot on my chest where my heart hurts the most. I move the cat out of the way. I open the door to her room, like a mom in an after-school special opening the door to her kid’s room.
There is the box on her desk, just as she’d said. Do I really want to do this, I ask myself. She invited me to do this, but is it necessary? I open the lid, see the scraps of paper, folded-up notes to herself, torn-off homework assignments she’d written on the back of, thoughts overflowing from her brain onto the paper during class, after school, late at night. I see words in her handwriting, terms I recognize but didn’t know that she knew. Confessions. Truth.
Well, that’s it, I think. That’s what I thought.
I close the box.
—
She’s worried about what her dad will say. Emi accepts the news with the nonchalance of a cool college student with only one heart in her body—oh, okay, whatever—but her dad will not be as indifferent. I see her eyes widen as she talks through the scenarios with me, feel her muscles tense as she leans against me while we figure out a script. I let her sit with her head in my lap, my fingers stroking her curls, curls that we will no longer be cutting short, curls she plans to let cascade to her shoulders, and adjust myself so that I can lean forward slightly to ease the burden on my heart.
When it finally happens, their conversation goes better than either of us expect from what she tells me afterward. I am cautiously optimistic, but I know there will be a phone call later, an argument, an accusation. I must harden my heart.
—
This is happening because he idealizes you too much, he idolizes you. This is happening because you are too much of a feminist. This is happening because his school has a literal gay agenda; it is too encouraging, too welcoming; he’s living in a bubble and he doesn’t even realize it. This is happening because we let him eat too much tofu. All that soy, all that estrogen. He’s not a girl. He’s just confused. He doesn’t know what it means to be a girl. Or a woman. Or a man.
But I tell him: he knows what it’s like to be himself. We don’t. We can only hear what he tells us, read the scraps of his journal. He is in the world now, far, so far, from that oceanic beating heartbeat on the ultrasound; but we are still merely eavesdropping on his heart, hearing only what we are allowed with our limited access, our crude understanding, the faulty technology of our own interpretations.
I say: This is happening during the best year of his life. This is happening in the context of the best grades he’s ever had, at a time when he has good friends and solid relationships. This is happening at a time when he is the happiest.
This is not a crisis for him. It’s a crisis for you.
—
My heart sends messages of pain and inflammation that my brain interprets as: help, do something, this hurts, you’re going to die.
My brain thinks this is a crisis. It’s not a crisis.
-
I arrive at the ER via ambulance. Urgent Care had insisted I be transported; I had shown up there, at my doctor’s urging, in anaphylaxis, and they were hesitant to give me a shot of epinephrine because of the pericarditis, and were worried about a possible adverse reaction to anything else they might give me in its stead. And so I was loaded into an ambulance, everything hasty and frantic, and deposited at the ER, where I laid on a stretcher in a hallway while bored-seeming people in scrubs avoided my gaze as they passed by, decidedly uninterested in me.
My allergic reaction is puzzling. For one, it’s to an antibiotic I’ve taken my entire life without incident. And for another, it’s the latest in a string of dangerous reactions to various medication. I’m put in a room, given Benadryl—no epinephrine, no steroid injection—and am left to wait it out. I lie there, waiting, a tingling in my throat, on my tongue: my tongue swelling, my lips swelling, my heart hurting, the stabbing feeling in the center of my chest swelling up again, growing more urgent.
Eventually, a resident comes in and announces that none of my symptoms make sense.
I am aware of this, I say.
She rolls her chair closer to me and says, And yet. The allergic reactions to literally dozens of medicines in the last two years? The recurring pericarditis? It might be related. It might actually be part of some larger systemic thing. Maybe some autoimmune thing.
What she’s saying is: After all this time, this might just be me. My own body fighting itself. My own body, unable to recognize its own heart.
—
She always worried about growing up. How many nighttime conversations did I have with her, lying in bed, staring at the ceiling, soothing her anxieties about becoming a teenager, graduating high school, getting into college, finding a job? She was maybe seven when she started worrying about this, asking me what she would do if she couldn’t find work, could she live in the basement, what would happen to her. These talks continued into early puberty but always seemed to be focused on external markers of adulthood and success in the world, not her body, physically growing her farther away from the safety of childhood.
Is this about not wanting to be a boy? I ask her after she knows I’d read her journal scraps, after she was able to talk about it, Or is it about not wanting to be a man?
—
My heart hurts. Does it change the pain to know that it may be my own defenses causing it?
—
She is not ready to be in the world as a girl, not yet. But at home I am allowed to eavesdrop on her transformation. She wears dresses, soft and soothing on her skin in a way she has been longing to feel. She tosses her hair out of her eyes, her curls now beginning to become long and unruly. She wears a bra, stretchy and smooth and light as air. These things ground her. These things soothe. These things allow her to breathe.
I watch her from inside the fortresses of my own confused defenses, my body aching, my heart straining in my chest, acting like a stranger to my body. Have I merely been fighting myself all this time? Has she?
But I know that my fight is not hers. And that maybe this is not what it’s like for her at all. Maybe it’s not her body fighting itself, like mine, but rather a thing inside her ripening, a knowledge slowly unfurling, so that finally it is her own heart she recognizes.