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heart, which is the most primary organ of your survival, even though that’s not saying much, throw it away, replace it by sewing in a big chunk of somebody else entirely, then wheel you into the ICU, where you’ll wake up later feeling like you’d been kneeling in the street and a speeding car hit you right in the middle of your chest. (Despite being on enough IV morphine to lay out a small horse.) Not that I’m not glad she can. I don’t mean to sound ungrateful. Not that I won’t be really happy about it when it’s over. But right now it isn’t over. Right now I’m looking it in the eye, and I’m writing the damn truth about how I feel. I’m just trying to describe how it feels to have to reset my internal clock to suddenly gear up for more pain and struggle.
    So, that’s my huge secret about me and the heart. I have a very small pocket of mixed feelings about it showing up when it did.
    Please, whoever is going to be reading this, please, please, don’t ever tell my mother what I just wrote.
    Dear Vida,
    I’m sitting in the doctors lounge with the two surgeons who assisted me on your transplant. Talking over what we think you might want me to write. I wasn’t really sure I was clear on that, and although these two are tremendously helpful in the OR with surgery, they’re not too much help in the lounge with journaling. So I’m just going to do my best here.
    I’m guessing you don’t want to know too much about the bare medical details, things like whether or not I had to order another unit of blood sent, and how the ICU nurses were concerned about the amount of fluid in your drains, and how long we monitored that before we decided you were doing OK and we could go have a soda. That’s all in my paperwork if you care, but I’m guessing that’s not why you gave me your journal. So I’ll tell you a few more personal things, things that come more from my heart. How appropriate is that?
    I’ve known you for a long time, Vida. We go way back, don’t we? This was the third time I’d opened your thoracic cavity and watched your poor beleaguered heart doing its best to circulate your blood. The first two times, of course, being the second and third phases of your Norwood procedures. A couple of things I’ll note.
    One, every time I close up a patient’s sternum I have a little wish, or hope, or even prayer as the case may be, that this will be the last time any human will witness the beating of that heart. I’d wished that for you twice already, and I remember feeling that your poor heart has had far too much exposure and supervision in its short life. But this time I got to wish it with more conviction. When you’re doing the Phase II Norwood, that’s hard. It’s unrealistic. You know there will probably have to be a third, especially in your case. Then after the third, you just don’t know.
    But this time, maybe we really are done. I hope so.
    Secondly, I also want to say that, even though it’s not medically logical to feel this way, I felt a little guilty toward your old heart. For giving up on it. It was still living, still trying. I had to remind myself it was also failing, and would have ended your life soon. But it seemed, each time I saw it, so valiant in its efforts.
    Lastly, and this is something that both of my colleagues agree with one hundred per cent: we have looked into many thoracic cavities, and seen many different conditions. We’ve seen old hearts, loose and oversized and covered in fat deposits. We’ve seen neonatal hearts barely the size of a walnut. We’ve seen newly transplanted hearts, small and fit, beating in old bodies, looking too young and enthusiastic for their surroundings. We’ve seen single-ventricle hearts like yours, struggling to do their work against overpowering odds. But there is one thing we never get used to seeing, and that is an empty thoracic cavity, one containing no heart at all. No matter how many transplants we perform, we never really get used