by Liza Lichtenfeld

All the metaphors failed her when she went searching for the heart sounds in the middle of the night. A patient had an elephant sitting on his chest. The arm had pins and needles. The pain sliced through the back. The lady felt like she was running a marathon standing still. The old man had butterflies, a flood of monarchs, flitting their wings against his ribs, beating him up. Gretchen stumbled through and tried to open her ears and fumbled around for that thing. It was a muscle. It was a pump. It was an organic bit with a life of its own, the bloodstream like estuaries, like highways, like a fiber-optic network, like electricity, like conveyor belts, like the wheels on a bus. It did not work. She dipped her head forward and sidled the earpiece into her ears and blew on the end of it. One hand slid the end of the stethoscope down through the neck of the gown, the other reached for the wrist and felt around for a rhythm. I’m sorry that my hands are cold, I run cold. Cold hands, warm heart, maybe.

Hospital feet are kept in prisons and sometimes the drummers in the feet hide. Gretchen had to peel the compression stockings down to see if blood flowed still, to measure the rapids, the height of the tide. There are islands in the North Sea that are just large enough for one little house. They are little islands that are nothing more than pebbles when seen from above in a plane and when the tide rises, it rises quickly and she wonders, she wondered, where will all the water go? Because it wasn’t just the water from the North Sea. It was the water from the Atlantic and the Gulf of Mexico and maybe even Lake Michigan. If she were Homer, she would have thought that there was an edge or an end, but she wasn’t, and she knew they were connected, like everything, so she looked at the necks and the feet as she had been taught. The tide must be measured from the neck up and the legs down.

She had a mind of her own, the patient remarked, when Gretchen asked about the framed photo of the dog. She looked at the dog but thought of the heart—it had one too, and the kidneys and the brain—all of them had minds of their own. Well, of course the brain had one. How obvious; the brain had a brain of its own, duh. Gretchen’s right palm moved over her left chest and she tapped with two fingers. One, two. One, two. She had done this to another heart in the operating room once, reminded it to get going already. It was an open heart swap, the old man trading in or trading up for a better piece of meat, a sturdy grip that could keep him going—nobody discussed the story of the newer version, the hand-imported variety, flown in from not so far away. They just popped the old one out and popped the new one in and then connected all the tubes. Then the surgeon told Gretchen to place her fingers over the top of the right atrium, to the side of the superior vena cava, where the sinoatrial node lived. He told her to tap. Not a jazz tap but a drum-line tap; one two, one two. She tapped it and the heart followed, thump, thump, on its own automation, of its own determination, casting an electrical web out and pulling it in with each thump. Gretchen tapped her chest once more. For this she loved the heart. She loved that thing that loved to love.

A musical ear was a gift, she’d been told. Gretchen maneuvered the stethoscope beneath the gown and pressed the thing firmly against flesh. Again she closed her eyes and tried to untangle the shadows of the beats in her ears. But before she could describe the dimensions of the heart’s dim corners, it happened. The patient felt fine. Then the patient felt pain. Then she held her chest. Gretchen opened her eyes. There was a march, steady and true, something kicking about in the chest—she heard that. She looked at the patient, who was still talking to her, and knew that she was not dead. The machine said that something was closing in though, mountains upon foothills in the ST segment of the EKG, or maybe it was that a wall had been built and the signal was cut. Gretchen imagined an electrical pole falling in a rainstorm.

The head doctor came. The medicine was given. The heart stopped marching steadily. It did high kicks instead and then flutter kicks and then spun into break-dancing moves that were wasted on everybody. Gretchen stood back and then stood forward. The room filled to the brim. She wanted to tap the woman’s chest with her fingers but there were too many people. She looked for the drummers in the feet and in the arms and then she did as she was told and pressed her palms with nearly straight elbows into the body, over and over and over again. She had to press hard because she had to will the heart; it no longer would go of its own volition. She had to try to squish it, just enough to inch the blood forward. The ribs felt like wishbones when they cracked. Nobody remembered to make a wish with the first crack. Gretchen remembered with the fourth and fifth. It didn’t matter though.

When the room emptied, the doctor talked, the husband cried, and Gretchen tapped her chest with two fingers.

Liza Lichtenfeld calls herself “a wannabe writer and a gonnabe doctor.” In her final year of UNC-Chapel Hill Medical School, doing clinical work in Asheville, North Carolina, she is in constant triage mode. Though she thinks of herself as “a Chicago kid at heart,” she is grateful to call Asheville home.

About Heart—Both snapshot and sensory rumination, this is a story from the heart about the heart. It offers a swift slice of the magic, disappointment, and inevitable wishful thinking that live side by side in medicine.