Matters Of The Heart: On Daily Life With A Defective Yet Vital Organ

August 26, 2018.

It’s hard to have a heart these days. Much about our society is cold and severe. It does to the heart what the artist Jeff Koons does to it in his work Hanging Heart: makes it hard and steely, all surface and impenetrable. You can see it in an image made by Emmanuel Dunand.

Hearts like this won’t get crushed, the perfect thing for a difficult and challenging world where, we are told, success demands focus and shrewd calculations.

A steel heart that is nevertheless pretty.

It often appears Koons is right about our hearts: you must hang yours, until it is dead, or leave it hung out to dry if you want to succeed in life. We all know this, don’t we? The young people I meet in the university classroom do. They know very well that it takes a steely heart to make the harsh decisions demanded by daily life in a world where every threat is also an opportunity for those with an entrepreneurial spirit. At the very least you must steel your heart, let it grow hard and impenetrable, to maximize advantage without cracking under pressure or even just growing faint from all the exertion.

When a cold and heartless society does treat matters of the heart, it makes that heart bright red and shiny, tied up in a bow for easy consumption, like you see in this image made by Hubert Fanthomme: a rendezvous with Jeff Koons’s Sacred Heart.

He is right again, unfortunately: the sacred moments of a society in which we hang our hearts look and feel very much like this. If sacred time is, as a common definition holds, time that is “wholly other” than the time of profane everyday life, if it is time “set apart” for activities that are other than those that make up the business of life, break time, as it were, then it should come as no surprise to hear that our sacred time is devoted to glamorous vacations or wild intoxications, adventurous excursions or dreamed-of dropouts in the spa—all of which are packaged, ready-made, and easily produced en masse, even when expensive.

Reflecting ourselves and our reality back to us in splendid forms, brilliantly colored and dazzling, Sacred Heart is emblematic of the feel-good aesthetic for which Koons is known. “I just try to do work that makes people feel good about themselves, their history, their potential,” he says, and who, in a society that hangs its hearts until they are cold and steel, if not stone, wouldn’t like to have a heart bright red and shiny tied up neatly in a bow, packaged and ready-made for easy consumption. “I believe that my journey has been to remove my own anxiety,” he continues. “The more anxiety you can remove, the more free you are to make that gesture… If the anxiety is removed, everything is so close, everything is available.” When anxiety is desperately avoided, matters of the heart are made easy to deal with, and having one can only be pleasurable, gleeful—fun, in short. Following your heart, we are led to believe, is the secret to a life of bliss, and the path followed straight and smooth. Hearts never seem heavy.

The world in which anxiety is desperately avoided, it bears repeating, is the hardhearted world in which you steel your heart for the business of life, life become a business to succeed or fail at. That heartless world of the Hanging Heart is the world for which the heart is never heavy, never darkened by anxiety but always bright red and shiny, the same world that makes the Sacred Heart, so shiny and easy to possess.

It is an odd world we have come to where hearts are hard enough that they never break yet are always light.

*

My own heart is heavy to bear and easily lost. That was a lesson that came crashing over me undeniably this summer, 2018. It was a difficult time for me. I am usually able to get out of bed early, before my wife and children, an ability that is especially important in the summer months when everybody, being either a teacher or a student, is at home and a few precious morning hours starting at 5:30 or earlier are the most reliable times of peace for writing and reading. This also has the advantage of freeing longer hours of the day for work on our place or time spent with family. But this summer I struggled to rise before 8:00, frequently failed at that, and then often found myself napping again before 11:00. It had always been typical for me to lie down to rest in the early afternoon, around the lunch hour or shortly thereafter, usually for twenty or thirty minutes; it can be invigorating and refreshing. Those rests became sleeps this summer, the pause that refreshes the slumber that never ends. They stretched to sixty then ninety minutes, even a full two hours, and when I woke, I rose groggy, still cloudy.

As for working our place, I am usually energized by it. The property is not large, about 3.25 acres, but it is also not small for someone who came here from urban Chicago and had never before ridden a lawn tractor, cleaned a gutter, or tended a garden. There is a lot to do, especially in spring and summer when all that there is to do comes on very quickly, tasks being called for in rapid succession. I can usually rise, slower than needed but still rise to the challenge until the swelter of July and August keeps me inside, but this summer I retired before the middle of May and ignored the weeds that needed to be pulled in favor of hours inside mostly sleeping or reading fiction. The vegetable garden grew grass knee-high; paths I opened two summers ago behind the old barn closed again; poison ivy returned on a hillside that past diligence had nearly eradicated. The edging having been neglected, the place was becoming shapeless again.

I was clearly losing heart. My spirits were low, and my courage was failing as I grew deaf, nonresponsive to the world in which I might have found myself had I been able to look. Lying in bed for long hours, resting, with the door shut so the children would not see me in my weakness (as if they did not already know), or else sitting in a club chair in the cool of my bedroom, looking without focus, I ignored the claim exerted on me by the yard and any thing or person calling. Dispirited, I was, as I said, losing heart.

It turns out I was right in more ways than I knew. One morning, sitting at my desk, reading and writing and enjoying the freedom of it, my heart skipped a beat, several beats or a beat several times, really. Putting my fingers to my neck to take my pulse, I found signs of the heart I was losing. I felt six normal beats then nothing, six normal beats then nothing, and so on again and again for maybe ten cycles. During those intervals of nothing, it was as if the world blinked or the filmstrip of consciousness’s stream had had a few frames snipped out, instants of blackness that change nothing but make everything tremble.

Everything remained in place, but nothing was the same. I was lightheaded, faint, and dizzy, so I went upstairs to lie down and rested until, thirty minutes later and still a little dizzy, I called the doctor for an appointment. After seeing my primary care physician the next day, then, by some blessing of good luck, my cardiologist the day after, blood work and, more significantly, an echocardiogram, we knew it was indeed my heart that was defective: an insufficiency of my aortic valve meant that a significant amount of blood was flowing back into the left ventricle of my heart with each beat, causing the muscle to work harder with each pulse to counteract what the experts call “severe regurgitation.” The weakness and fatigue, as well as the throbbing in my head and surging in my chest, were explainable by this.

I was indeed losing heart: the organ was defective and now defecting from the rest of me. In fact, it is not much of an organ if it is neither an effective means to an end nor an instrument that serves its master. My heart was defecting: it was not obeying my command that it deliver more strength, more power, more vitality; it was inefficient and not helping me produce more effects in the world I wanted to make for myself. My heart was defecting—as if it were not really mine—and the defector threatened to tear me apart.

It’s hard to have a heart.

*

We decided on aortic valve replacement surgery and soon after set a date, September 18, 2018. Perhaps then my heart could be mine again? Perhaps then the heart would be a mere organ again? That is, it seems, the operative premise of medicine in the minds of many who practice and partake of it, and it is a good one, one that I gladly endorse and one I assumed in choosing to undergo the surgery that would replace my defector, the valve I had had from birth, with one that would do my bidding and thereby let me live longer and better. They said I would be better than ever, that I might not even recognize myself with my newfound energy. Having had this defect from birth, I have after all never known what it is like to have a heart that functioned effectively as an organ. I could be whole, me all the way through myself.

These were some of the reasons we gave as we rationalized our decision. They were some of the hopes we entertained as we looked ahead in expectation of the future we imagined. But in the irrepressible background of these hopes and reasons lurked a set of questions that remained troublesome and pressing to me, metaphysically inclined as I am. Even if the hopes are realized, the expectations come to pass, and the reasons prove justified, will it be I who am better; will it be the same I who is “cured” as the one who needed help? What does “cured” mean? At what point do we say recovery is over and I am recovered? Maybe even more important, do I want the cure if it means I won’t recognize myself afterward? Yes, I do, but what does that say about who I am not the same as myself?

These are not unrelated to questions of importance to religion, revolving as they do around the issue of beginning again, being reborn, and being made “whole.” I should therefore know something about them, professor of religion that I am, and yet those questions and their answers signified anew and in new ways for my now very concerned questioning. This is not even to mention the one big, obvious question that shadowed the expectations that made up our days: What if it doesn’t work? What if they put me in a coma, cut me open, and can’t put me back together again?

*

My defect was congenital, a bicuspid rather than tricuspid aortic valve. This defect can also be acquired, usually in early childhood when a rheumatic fever results in scar tissue that damages one of the three leaflets composing a fully functional aortic valve. Mine was detected just before high school. Few restrictions were placed on me, and I competed in sports and other activities like most kids my age. I had to see a cardiologist annually who used imaging technologies to track the progress of my heart’s defection. These were noninvasive, in fact the same technology used to provide images of a fetus in the womb of a pregnant mother, and over the years they grew more and more sophisticated, easier to administer, and more detailed in what they gave us to see.

Many people with this defect are asymptomatic or have symptoms so mild, an unusual rush in the chest, an occasional fullness that makes you catch your breath, that they go through everyday life blissfully unaware of the defect at heart. These are the happy people—who might one day find their defect has become a total failure, heart failure, a failure of the heart whose left ventricle has enlarged through overexertion in countering the excessive regurgitation, grown stiff, and then slowly loses, irrecoverably, the strength to go on, until eventually the heart they have easily and blissfully forgotten is finally lost forever.

I am, as I said, lucky not to be one of the blissful. My defect was detected when I was in high school. My good luck meant I lived knowing this day would come, knowing that one day they would saw open my breastbone, stop my heart, cut out the old valve, and sew in a new one. Good luck.

In the meantime, until that day arrived, I lived with the background awareness that it was indeed good luck that I needed since bad luck meant the day arriving before its time. With this possibility hanging over me at every moment, good luck let me continue on. For the most part there were very few reminders of this fact. I experienced few limitations from my condition, and none of the doctors I saw placed overly inhibitive restrictions on me: I shouldn’t lift the neighbor’s car out of a ditch; I shouldn’t practice powerlifting; and I shouldn’t forget to take the pills, calcium channel blockers commonly prescribed for high blood pressure, coronary artery disease, and abnormal heart rhythms, that would defer and delay my day of reckoning by relaxing blood vessels so that my defector could pump more easily and therefore longer. Without too many real possibilities restricted from me, the reality of my heart’s defection did not impose its presence insistently and should have been easy to forget in everyday life.

And it was, for the most part. As with much of individualization and growing up, repressing and suppressing existential truths that touch intimately at the heart of who we are proved essential to living everyday life and its happiness. Neglecting these, living in their oblivion, I could be one of the happy people. After the teenager’s initial shock at hearing his future lifesaving surgery laid out before him by a gray-haired man wearing a lab coat, I went about my business absorbed in life and the happiness of living it, with only the occasional reminder of an annual visit to the cardiologist making me aware of my good luck.

Until this summer, when my birth finally caught up with me or I with it. The heartbreaking summer of staring at our clearing in the forest through my bedroom window, of listening only half-aware to the stories my son would tell of new feats on the trampoline—this heartbreak showed me the truth of my birth, vaguely sensed and dimly intuited all my life but now undeniable. I had to face it, face up to the truth of my birth. This heart has been defective ever since I was. It never worked the way I wanted it to. I have always been worried about death. I have always been inhibited in action and decision.

I have always flinched before overexertion outdoors and wanted to stay inside while the other kids played hard and sweated. I could forget that or neglect the truth of what I have been from birth and did so happily—until my heart’s defection became complete and it no longer served, did not do the work I asked it to do realizing my intentions to get here or there, to lift this or that, to be present attentively to him or her before me. Its defection was never entire, never that bad; good luck meant we caught it before then. But I now see disclosed the truth that I was never fully in command, never fully possessed of myself—that having a heart means living with this defect.

It’s hard to have a heart.

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Excerpted from From the Heart: A Memoir and a Meditation on a Vital Organ by Jeffrey L. Kosky. Copyright © 2025. Available from Columbia University Press. Used by arrangement with the Publisher. All rights reserved.