by janette schafer
Consider the word corset. As a noun, it is a close-fitting undergarment designed to mold a body into a desired shape. Corsets are tightened by laces, stiffened with whalebone, enclosed around the trunk. Pieces of wire and tape hold my breastbone together, forming a corset I can’t take off. It will be several months—maybe a year—before this tight physical sensation inside of my torso will fade away.
My jaw hurt, a stabbing pain that made my head pound. I grabbed the edges of my oak desk at work to catch my breath. My heart pounded relentlessly, rattling through my chest like a proverbial runaway locomotive. The bright, overly-cheerful green walls beneath the fluorescent light of my office hurt my eyes. I closed them a moment, making a concerted effort to slow my breathing and calm down. Work stress had been getting to me, specifically the mad dash at the end of the year to make the annual sales goals for my bank. The branch was particularly busy, a steady stream of patrons walking in and out of the gray-tiled lobby. I was inundated with interruptions: fee refund requests, my signature needed for cashier’s checks, explanations for the tenth time to one of my older clients that banks no longer sell traveler’s checks. A manila file folder stuffed with corporate tax returns sat unopened on my desk. I needed to get those documents uploaded to a loan file today if I wanted to meet one more sales metric before December 31, 2018.
My vision went blank for a moment as I clutched my temples. This was the worst headache of my whole life, and again my jaw pulsated. I rested my forehead on the desk. I said aloud to myself, “Damn, I feel so tired.” For the past three and a half months, I’d been a full-time commercial banker and a full-time graduate student pursuing a Master of Fine Arts degree in Creative Writing. I turned in my last paper for the semester the night before. Winter break would give me a much-needed rest. At forty-six years old, with so much work, I was feeling every bit like a middle-aged woman. To take advantage of the fellowship I was awarded, I needed to be a full-time student. As the primary breadwinner for my family, I needed to stay a full-time banker too.
So much stress wasn’t good for me, and, as a diabetic, it elevated my blood sugar; but I thrived under pressure. Deadlines, clocks, calendars: those things motivated me to stay on task. Being busy made me feel productive and happy. As a high school student, I wrote for the yearbook, played in a concert band, sang in choir, competed in State Solo and Ensemble, and performed in community theater. In college, I was in two professional fraternities, two choirs, opera workshop, and I was the winner of a student composer award before my academic career was derailed by experimenting with drugs. During my first attempt at a bachelor’s degree, I stepped over the invisible line from partying and binge drinking to alcoholism.
I sat down with a thump in my office chair. I did not have the time for a headache like this today. I rubbed below my ear and along the edge of my jawline. I only had one hour left in the workday, and I could hold out until then. I didn’t like the prospect of failing at my business lending goal when I was so close to making it. I went to the scanner to start the upload. There would be plenty of time to rest later.
It was a long day and I slumped on the couch, ready to go to bed for the night at 7:00 p.m. The pain in my jaw wouldn’t quit. The ache throughout my head was nearly unbearable. My husband wasn’t home yet, and my housemate could tell I was exhausted. She offered to whip something together for me to eat. I gratefully accepted her offer.
“You don’t look so good anyway,” she joked.
“Funny that, I don’t feel so good.” I smiled weakly, absolutely at the end of my physical endurance for that day. I really had been pushing myself to the absolute maximum. The ding of the microwave let me know that the leftover pasta and veggies my housemate heated were ready. As I ate, I tried to practice the deep breathing exercises my therapist had given me. They didn’t seem to be helping tonight. After dinner, I tested my blood sugar. It was nearly 500, well above the danger threshold. It was particularly alarming, as I hadn’t eaten anything that fun all day. My chest was heavy like a lump of lead.
“Hey, Anne, I really don’t feel right.” Oh, how my head hurt.
“My chest feels like someone is sitting on it. I have the worst headache ever, and my sugar is ridiculous.”
“Do you want me to take you to the ER?” She looked concerned.
“Yeah. I better go in.”
When it comes to hospitals, I’m a frequent flyer. Thanks to diabetes and genetic hypertriglyceridemia, I’ve had pancreatitis more times than I could possibly remember. I could diagnose myself quicker than my doctors could. Since pancreatitis can kill a person, I always went straight to an ER if I felt the symptoms coming on. Particularly bad episodes lead to lengthy hospital stays and the joy of vomiting yellow, acrid bile. My alcohol and drug use in my twenties and thirties didn’t help my health situation either. When I was thirty-seven, a doctor at St. Clair Hospital told me I had the liver of a seventy-year-old man. How many foolish rows had I engaged in with doctors, telling them I could still have one or two when they told me I needed to stop drinking altogether? It pained and embarrassed me to remember. Even after years of sobriety, I was still physically paying the price for those past indiscretions with a scarred pancreas and an enlarged liver.
Whatever was going on with me that night had nothing to do with my pancreas. But what was it? I waited in the small, sterile patient room in the ER as Cake Wars from the Food Network played on a wall-mounted television. I endured the evening’s poking and prodding. They had me on an insulin drip to bring my blood sugar back to normal. My ER doctor was a young-looking woman with round glasses and kind eyes. My past medical history caused her to be extra thorough. My housemate and husband had gone home and waited for me to call them with news. After my fourth cake war, the doctor returned.
“Well, your EKG came back normal, but with your symptoms, diabetes, and complicated medical history, I’m not sure I want to send you home yet. I kind of want you to do a stress test in the morning, so I’ll leave it up to you. Would you like to go home tonight? I’ll let you go home as long as you promise to set something up with your PCP as soon as possible. Or we can do it in the morning since you’re already here.”
“I’m already here. And I’m terrible at following up on this kind of thing.” Truthfully, I couldn’t have cared less about the stress test. It was Thursday night, I felt so tired the past several weeks, and I wanted an excuse to call off sick to work. This would give me one. My loan file was uploaded, which meant I could make my goal and have someone else execute the closing. Having a little rest would do me good. It seems so absurd now to have wanted some time off from work that badly.
Protocol: The patient exercised on a treadmill according to a Bruce Protocol.
Comments: The test was terminated due to marked EKG abnormalities. The patient exercised for 3 minutes and 41 seconds to stage II and 5 METS. The left ventricular global systolic function response to stress was abnormal...the diffuse wall motion abnormalities described above are suggestive of multivessel coronary artery disease.
The stress test did not go as planned. After a few minutes I felt like my heart was going to explode. It was beating so hard, it felt like it was behind my eyes.
“Stop!” I yelled, grabbing at my chest. An aide was prepared with some nitroglycerin. During a stress test, the techs have one minute to inject dye in the bloodstream to see how it travels through the heart. I got off the treadmill as fast as I could and laid down on the cot as they injected the dye into my IV. The warm liquid coursed through me, and the sensation made me feel like I had to pee. I looked over at the cardiologist as he concentrated on a small screen.
“Hmmm. Wow, that’s really abnormal. Look at the left side,” the cardiologist said nonchalantly to his colleague.
“What’s going on? What’s abnormal?” I asked him.
“You have some blockages. We’re going to do a heart catheterization procedure in a few minutes. We may need to put some stents in your heart.”
“You mean right now?” Damn. I started to feel a little freaked out.
I secretly wanted the weekend off from the bank to recover from the semester, but it didn’t occur to me something might actually be wrong. Immediately, I was prepped for the surgical procedure.
Conclusions: LAD with long segmental 80% stenosis leading up to a large Diag. The large diagonal has osteal 80% stenosis. Dominant RCA with Proximal 99% stenosis. Mild posterior wall hypokinesis of the left ventricle with LVEF of 60%.
Recommendations: CT Surgical Consult for CABG.
ASA Status Class 3 - Severe systemic disease.
During the catheterization, I was sedated and put into a “twilight” state. Because of my past substance abuse history, I have a high tolerance to drugs, and they lose their efficacy. In the middle of the procedure, when the surgeons threaded a hollow tube into a large blood vessel to get a closer look at the coronary arteries, I started to regain my consciousness.
“Hey, I’m awake. Am I supposed to be awake? This really hurts. This feels really weird. I don’t like this.”
“Hold still. You’re okay. Don’t get upset.” The surgeon continued with his work and I felt the foreign object snake through my body. I started to cry.
“Mrs. Schafer, are you upset?”
“Yeah. I’m scared. I don’t like this.” I tried to get control of my emotions, but fear took over and tears poured freely, pooling in my ears.
“Try to stay calm and don’t move. We’re almost done.”
I bit my lip, unable to wrap my mind around the scraping feeling inside of my chest and arm. I heard someone make a pathetic whimper. It was so uncharacteristic of me that it took a moment to realize I was the one making the sound.
“So, Mrs. Schafer, I wasn’t able to successfully complete a catheterization. You’re going to need bypass surgery. Your arteries are too blocked. We’re going to bypass three arteries.”
“What? Are you serious?” I couldn’t believe what I was hearing. Triple bypass?
“We’re going to do the surgery Monday, and you’re going to stay here. Your widowmaker is 99% blocked, so you’re at very high risk for heart attack. We could do an emergency surgery because you are young and otherwise strong, but I prefer to have some time to prepare. You’re going to be in ICU on complete bed rest. Someone will be constantly checking on you, so if something bad happens, we’ll know immediately, and you’ll be in the right place.”
“My widowmaker? What do you mean by widowmaker? What do you mean by something bad? Am I going to be okay?”
I was terrified.
I was sure I would remember the nurses’ names. Had I known the anesthesia from the coming surgery would affect my memory in the way that it did, I would have written them down. There were two nurses I saw a lot in the three days I spent in bed waiting for the triple bypass to happen. The night nurse had red hair and freckles.
“I wish I would have brought my Kindle with me,” I told her. “But of course, I had no idea I would be here for a long stay. I wish I had something to read.”
“Usually in the ICU, my patients can’t talk to me. I’m a big reader too.”
“I’m also a writer. If I didn’t have IVs in each arm, I’d probably try and write in my journal.”
“What do you like to write?” The night nurse seemed genuinely interested. At work if I attempted to talk with my bank colleagues about writing, their eyes would glaze over.
“I write a little of everything, but poetry and plays are my favorite. I’ve had a couple plays produced.”
“That is so cool! I love going to plays and shows downtown. I’m going to be leaving in a few minutes, but when I come back tonight, I’ll let you read my favorite book. It’s called Deathless, and it’s based on a Russian fairy tale. I’ve never read a book like that before. Anyway, I’ll see you tonight.” I didn’t think she would really remember the book later, but I thought it was sweet of her to offer.
The nurse with dark, curly hair took care of me during the day. I remember that her hands were small, her voice was soft, and she had the kindest face I’d ever seen. I loved talking to her and making her laugh. At one point, she was changing the stickers on my chest for the heart monitor. She hefted one of my meaty breasts up and pulled at the adhesive beneath it.
“So, are we dating now?” I mockingly asked her. She started to giggle.
“I’m trying to work here,” she replied as she smiled.
“You know, I should probably meet your mom. I don’t usually let my dates go to second base unless I’ve met their mom.”
With that she let loose with a belly laugh and leaned over, placing her hands on her thighs. “You are too funny! You are making me neglect my other patients. I’m staying in here too long.”
“Hey, can I tell you something? I’m really scared.”
She made a little noise of concern and grabbed my hand. “I promise you everything is going to be all right.” There was something about the way she said it that made me completely believe it.
In the evening, as promised, the red-haired night nurse brought me her book. I liked the title: Deathless by Catherynne M. Valente. I hoped that I would be deathless. I devoured half the book by morning as it was pretty hard to sleep being woken up every thirty minutes.
“You can keep the book and finish it if you want to. I’m off Sunday, but if you give it to your day nurse, she’s a friend of mine and she’ll get it back to me.” I thanked her and finished the book throughout the day on Sunday in between short naps. That night, I passed it off to her friend.
“Hey, could you get this back to the redhead? It was a really good book.” I handed the paperback to my day nurse.
“You bet. Actually, I told her I wanted to borrow it, so I’m going to read it next.” This made me smile.
“I think you’ll really like it. I know I did. There’s lots of mythical creatures and fairies and such.”
“Cool, I like that sort of book.”
“I feel like I’ve had two guardian angels: one by day, and one by night.” She squeezed my hand.
“You’re sweet. We’re going to come check up on you after your surgery.” Later, she kept her word.
For some reason, I remember the title and author of the book, maybe because the title, Deathless, instilled in me some hope and gave me a word I could cling to. I would trade that memory for their names.
There was a particular moment while awaiting surgery: my loved ones were escorted out and I waited for the surgical team to arrive. Those were the loneliest minutes, alone with my fears and my mortality, thinking of every possible, terrible outcome. Everyone said, “Good luck,” even my husband, like I was headed off for a job interview or a race.
I folded my hands above my heart as I had when I was a child in Sunday school. I didn’t know that part of me still believed in the act of prayer. I thought of other prayers I’d sent up through the years as I struggled on and off with addiction and depression. Those were selfish prayers: Please, God, don’t let me get caught. Please, God, I’ll never do this again if you get me out of this. Please, God, don’t let me be pregnant or have VD; I don’t know what I did last night. Please, God, make me come down. I’m too high, and I don’t want to OD.
Too many bad decisions. Too many opportunities lost in the chase for the next high. Coke is hard on the heart, but not as hard as regret. In a whisper I said, “I know I’ve prayed in the past to fall asleep and not wake up. I’m pretty sure I didn’t mean it.”
* * *
I dreamed that I was drowning. Seaweed held my ankles, looped around them like nooses. My mouth and nose were full of water. I tried to reach through the surface, but my arms were tethered. I struggled towards the air above the waves.
My eyes snapped open and the first noise I heard was my gurgle for oxygen. Something gagged me. I jerked my left arm, frantically reaching for whatever was lodged in my throat. My fingers scraped on something plastic,just beyond my grasp.
“She’s trying to pull out her breathing tube. We need to tighten those restraints.”
The straps on my arms were pulled tighter, restricting my movement. I tried to talk to whomever was holding me down, but could make no sound. Memory flooded back to my consciousness and momentarily, I felt less disturbed. Yes, I had surgery and now I’m awake.
I found out later that my oxygen levels dipped low and weren’t coming back up again as fast as they should have. The breathing tube was the worst part of anything, the way it held my throat open and tripped my gag reflex. I thrashed, unable to communicate and ask for Garth, my husband, to be with me.
Eventually I noticed my husband was there, sitting beside me, and it calmed me down. I grabbed his hand and would not let go. It was December 17, his fiftieth birthday.
“The patient has pneumothorax: we need a pigtail drainage.” I wanted to ask what that meant but couldn’t. I found out later that pneumothorax was medical speak for a collapsed lung. I slipped in and out of dreams where I was drowning.
In order to perform open-heart surgery, the skin and muscle are cut clean through, the breastbone bisected with an electric saw. The heart is hooked up to external tubes that keep the blood moving while the arteries are given new assignments while a vein from the leg is relocated. Clamps hold the ribs and chest wall open, giving the surgeons room to work. The heart is stopped, turned on its side. My most tender organ would be caressed by a man who does not love me.
The word bypass means to provide an alternate route, to create a connection to allow flow where it once was blocked. My heart was a river that had been rerouted.
It is not the surgery that hurts, but all the things that come after. Tubes dangled from my chest like chunky costume jewelry. When the tubes came out, it felt as though some part of my insides had been threaded through my torso and then removed.
I buzzed the nurse’s station because I needed to have a bowel movement. A young man who looked to be about fourteen years old situated me on the plastic portable bedside commode.
“Just press your call button whenever you’re finished using the toilet and I’ll help get you back into bed.”
I was constipated from the pain medicine but was able to produce a small bowel movement. I grabbed the roll of toilet paper on my table and wadded up a ball of it in my palm. I tried to wipe myself and found I was unable to reach behind me. The severed muscles were not yet healed. My torso felt tightly bound, suffocated in an ill-fitting undergarment. I grabbed the call box and asked for a patient care tech to help me clean myself. In my mind I thought, Please be a female, please be a female. The same red-haired man young enough to be my son arrived. He reminded me of Richie Cunningham from Happy Days. Great, this won’t be awkward at all, I thought sardonically.
“Hey, I need some help, um, cleaning things up. I just had a bowel movement.” I held out my wad of toilet paper to him. He blanched for a moment then quickly regained his composure as he took the toilet paper from me.
“Okay, I’ll just need you to bend over, and we can get you all taken care of.” I stood up from the commode, bent over, and grabbed the railing on the hospital bed to steady myself. This was the first time since I’d been an infant or toddler that someone else had to wipe my ass.
“What an ungraceful moment.” He didn’t reply. “At least your day won’t get any worse than this. Wiping shit from a middle-aged woman’s ass: it’s only going to go uphill from here.” This elicited a laugh. We were both ready for this little moment of fresh hell to be over.
So much of receiving patient care was intimate and awkward. I felt repeatedly as if I were a young woman baring her breasts for the first time to the unrelenting gaze of a lover. I couldn’t bear the terrible familiarity when the tape was removed from the surgical site. My surgeon came to inspect my incision, bringing several cardiac residents in tow. Their five heads hovered around a wound I could not bring myself to look at.
The worst things about recovery were the ones I hadn’t expected. I got a small blue football-shaped pillow with arm loops. They told me to hug it to my chest whenever I needed to cough or sneeze. Coughing was a wretched experience: my torso was shaken like a small child by an angry out-of-control parent.The pillow disbursed some of the energy, but never enough.
Sneezing was worse than coughing. Sneezes came on quick and sometimes in rapid succession, rendering the pillow useless. By the time I could grab it, the event was over, but I hugged it anyway for comfort. Afterwards, I’d felt like I’d been punched in the sternum by a prizefighter.
I was discharged on Christmas day. I was relieved to finally be able to wash my hair. I hadn’t thought to bring the pillow into the shower though, and I had a coughing fit. This prompted me to call 9-1-1, certain I had broken one of my ribs. The young men in the ambulance tried to make me feel better with their own stories about how they’d suffered that same injury. The distraction was welcome.
An x-ray revealed an air pocket in my lungs. An apologetic nurse informed me the only thing to help that was time. Some fentanyl later, I was sent back home.
Five days after my discharge, I felt a terrible discomfort in my chest that woke me from sleep. I was drenched in sweat. I stumbled to the bathroom and pulled off my soaked nightgown. My incision was hot and pus leaked from the bright red line. I remembered reading something about that in my discharge papers. I called the surgeon’s office and told them I thought the wound was infected. They told me to come in right away.
Unable to drive, my roommate drove me in but warned me she had to go to work. I told her I would take a Lyft home. I sat in the lobby waiting for the surgeon to arrive. A resident escorted me back to an exam room. She helped me take off my sweatshirt, now wet with a yellow mucus as well as a clear, sticky fluid.
“Do you feel all right?” she asked.
“No, I feel pretty bad right now. Am I going to be all right? Is this bad?” My voice trembled as I spoke. I was afraid of being cut back open. She looked carefully over my wound.
“Yes, the infection seems to be superficial and likely doesn’t go very deep. I know it hurts.” She patted my shoulder gently after assisting with the hospital gown. “Leave it open in the front,” she said. “He’s going to need to check that out when he gets here.”
The surgeon arrived, impatient and irritated as if I’d interrupted something very important.
“This shouldn’t have gotten infected,” he said with what sounded like thinly veiled contempt. “But you are obese and diabetic and a woman, so that makes you more likely to experience complications. I don’t think you are cleaning your wound effectively. This rarely happens to my patients, less than one percent of them. Are you sure you’re using good hygiene?”
“I’m taking care of my wound. I’m doing exactly as the instructions say.” I felt appalled and embarrassed. I’d been scolded like an errant schoolgirl. My pre-surgery self would have told him to fuck off. My post-surgery self was an unsure, weakened shadow of me. My cardiologist had been kind, albeit aloof. The surgeon, however, was an arrogant jerk.
“You need to be more vigorous with your wound cleansing. This doesn’t happen with my surgeries.” With that he reached over and prodded at my incision again. He then grabbed a little piece of scabbed over skin. I flinched as he pulled it off.
After open-heart surgery, my sternum was first taped closed and then bound with strong wire. The tape and wire were left behind in my body to be absorbed by the new bone. Dr. Levenson, my new cardiologist, explained this to me in language I could understand. I described that I felt as though I was being held together by metal rods I couldn’t see, that I’d been corseted in a garment of whalebone.
History of Present Illness:
Janette Schafer is a 46-year-old female patient who presents to the Heart and Vascular at UPMC Shadyside for follow-up of coronary artery disease. I met her in the hospital in the setting of unstable angina. She has a history of known familial hypertriglyceridemia. She was a smoker and she did quit smoking. She was a drinker and recreational drug user but has been sober for some time. She gained significant weight over time but was able to lose about 80 pounds. She had progressive chest pain for about 2-3 weeks and felt it was just related to anxiety. She has felt no major chest pain since her open-heart surgery, just a sensation that she’s feeling a corset across her chest.
Nothing is closer to me now than the knowledge and inconvenience of mortality. Life is fragile, x-rays are factual, and hearts are easily extinguished. Corsets were created to shape and support the body like compassionate nurses or asshole surgeons.
Corset, as a verb, means to regulate strictly or constrict. Attention must be paid now to diet and exercise, which were an afterthought before. There will be less indulgence and more broccoli. Other things in my existence will be corseted, pulled towards life. The knowledge that a bypass surgery lasts for around ten years is daunting; I will have to go through this again. I am not sure of the shape or strain of things to come, but I will embrace every curve of it.
Janette Schafer is a freelance writer, nature photographer, part-time rock singer, and full-time banker living in Pittsburgh, Pennsylvania. Her writing and photographs have appeared in numerous journals, newspapers, magazines, and websites. She was chief editor of The Dreamers Anthology, released by Beautiful Cadaver Project Pittsburgh. She is a graduate student in Creative Writing at Chatham University. Her forthcoming poetry collection Something Here Will Grow will be published by Main Street Rag in 2020.
— william hayward