The Heart Outside the Heart
Echo’s eyes glossed spiderlike, and his tongue flopped out the side of his mouth. As our Uber careened through Brooklyn traffic, I tried to hold him steady without looking at his right side. They had shaved half of my beloved dog diagonally across his back down to the skin. Thirty gunmetal staples gleamed from his armpit to his hip. Between each staple, the crust oozed raw and pink. He moaned with any lane change, any tap of the brake, any inhale or exhale I took as I balanced him on my lap.
It had only been three weeks since a fist-sized lump had appeared fully formed on his right side, transforming my fear of Echo’s eventual death into corporeal form. The vet rushed him to surgery to remove the cancerous growth, and though they’d gotten “good margins,” a term I hadn’t encountered before, they’d had to remove much more muscle than expected, which, they told me, would make for a tough recovery.
In the Uber, I cradled Echo and bit my lips to keep from crying at the sound of his whimpering. They say dogs resemble their owners, or vice versa, and I’d already begun to think of Echo’s health problems as a sick turn of this cliché. When I was diagnosed with chronic neck pain, so was he. As I struggled with lower back pain — well, he did too, the vet told me when Echo turned 11, earlier this year. Now, as he shivered and shook on the way home from the surgery, my jaw tightened: A disease had slashed him in the same place I’d been haunted by pain every day for the past 13 years.
When I was 23, an autoimmune illness almost swept me underground. My body mistook my liver for an intruder and attacked it quickly, mercilessly. The disease is called autoimmune hepatitis, and it’s beyond rare: The odds of diagnosis are .00001 percent. My skin and eyes turned radioactive yellow, my urine gunmetal gray. My stomach distended so much I looked six months’ pregnant. A touch against my right ribs felt like a sledgehammer shattering a full-length mirror. As my liver shut down, my brain swelled, creating disorientation and delirium. Within a few weeks, I went from completely healthy to hospitalized and preparing for a liver transplant.
Somehow I’d avoided the transplant, I remembered as the Uber took a turn too quickly and Echo heaved onto my left leg, screaming. At the last minute, the medicine had kicked in, convincing my immune system to stop attacking my own body. Somehow my liver had recovered to almost full capacity.
Thirteen years later, I still ingested the same immunosuppressants every day to stay alive. I hated taking the pills — not only because they reminded me of being sick, but also because they came with serious side effects, from weight gain and glaucoma to hair loss and lymphoma. Each morning, each swallow felt as if my heart were breaking for the first time. I say “heart” because who would ever think of the liver? Little did I know when I first entered the hospital that for thousands of years, people thought of the liver the way we today think of the heart. Aeschylus and Sophocles considered it the center of our emotions and passion; modern translations of the Old Testament replace the word “liver” with “heart,” so a contemporary audience can understand the sentiment. I discovered this a few years ago, and it somehow made my disease feel more palatable. When someone would say, “cross my heart” or “the heart of the matter,” I’d lightly touch my ribs on my right side, as if to pat the organ they meant to name.
Now, remembering this solace, I tried to pet Echo’s soft black fur while avoiding the cloudy plastic cone around his neck. How strange it was, I thought as I whispered “good boy” in his ear, that while my body stayed intact, my mind dismembered itself. I’d never really left the hospital. Yes, my legs carried me out of the building. I’d thought I was free. But as soon as the sun set or the TV show ended or the conversation paused, my mind took me back into those beige walls, each moment from the past splayed open. Even riding an elevator could transport me: The faint rush of blood made my head spin, and suddenly I could feel myself lying on a gurney, going up and down on the way from excruciating test to excruciating test. When I went to the doctor for checkups, I watched my ghost stumble behind me, head down and lump in our throat. Worse, once in a while I’d catch a glimpse of my ghost doing something I hadn’t remembered. The smell of past tuna sandwiches from a hallway kiosk made me want to vomit them all over again. At home, I was plagued with waking nightmares. The terror of looking in the mirror to see whether bile had emptied into my eyes, like the yolk spilling into the white of an egg. I felt damned to return to that illness over and over again, to be reminded of everything that had happened, and to feel the fear that it could happen again so clearly. How could I enjoy my time, knowing that I could — and most likely would — get sick in the future?
As I gazed at Echo’s small patch of face resting on my leg, I remembered the decision to get him. A year after the catastrophe, I was alive but alone. I thought a dog might help. The first evening I brought him home, I held this newly existing puppy, this little fluff, against my chest and admired his miniature paws, his silky ears, his white sunflower of fur surrounding his button nose. He was so fragile, and so strong. So alive.
I planned to name him Henry. But I dreamed I was standing in a verdant field. “Echo,” I called. My new puppy came running.
This quickly became more than a dream. I’d been hoping for a lap dog, but Echo made it clear he was not going to sleep all day. On a nearby trail, we bounded through dust during the summer and greenery in the spring. The uneven terrain kept my mind busy, charting my next step among rocks and mud. When I wasn’t focusing on my footwork, I watched Echo. He hopped like a rabbit, springing his back legs forward at the same time rather than alternating his limbs like a normal four-legged animal. The white plume of his tail bounced with each step. He regularly disappeared into thick overgrowth, scrambled up boulders, and rolled in foul patches of dirt.
“That’s the butchest shih tzu I’ve ever seen!” an older man exclaimed as Echo emerged from a tangle of dried branches, his face exuberant and dirty, then took off running across a shallow stream. He scampered and galloped, occasionally glancing back to reassure himself that I was still there. His excitement about being alive was contagious. Every breath was remarkable in its existence, worth living for. Carrying Echo’s leash as he welded himself onto dogs’ faces in the park and waded into shallow water on trails, I came to think of him as my heart outside my heart — a part of me that somehow existed independently. I lived in cold fear of him dying, which, like my own death, would happen someday. It felt unbearable and true.
In the evenings, he burrowed next to me on the couch while I watched TV and admired his half-moon eyes as he slept, gently placing my palm on his belly to absorb the cadence of his breath. I’d pull his soft frame even closer to mine and stroke the white star on his forehead.
A decade later, I was still stroking his forehead, though now under direly different circumstances. The car squeaked up to our apartment building. I started to pick Echo up and get out, but he dervished in an imaginary circle, legs splayed and head swirling. “No,” I screamed. I hugged him tight, the staples biting my stomach as I pressed him to me so he wouldn’t plummet to the pavement. I punched keys in the lock. Gently, I placed him on his bed.
But psychedelic from the anesthesia and the pain meds, Echo wouldn’t rest. He spent the next few days mewling, staring into the distance, and shaking uncontrollably. At first I invoked the catalog every pet owner or new parent knows well: Do you need to eat, drink, pee, poop, vomit? Are you cold? Hot? Use your words, for God’s sake. But it was an internal chill, one that could only be warmed by both of us lying down, where he’d squat on my stomach for approximately 20 minutes and then drape himself across my belly to rest his head on my right ribs, right where it hurt me most. His signature snort would let me know he was finally comfortable.
All the while, I talked to him. Despite the fundamental language barrier, I vowed not to lie or sugarcoat the situation. I decided not to say things like everything’s going to be all right or you’re fine. Instead I recited the phrases I wanted people to say to me in a crisis: I’m sorry you’re going through this, I’m here for you, I love you and will always take care of you.
But could I? Dogs have to be in considerable pain to show it, a survival instinct to protect their standing in the pack. Usually you have to look for subtle clues, like panting or hunching. Even a few hours after surgery, unable to stand on his own, Echo had wagged his tail wildly when I walked into the room. One week after that horrible day, he still spent most hours trembling involuntarily, a feral look in his eye. The kind words and blankets and pills were not enough.
Finally the vet wrote my 17-pound dog a person-size prescription of pain meds, which was difficult to get in the middle of an opioid crisis. After retrieving the pills, I fed Echo the narcotics in a spoonful of peanut butter, then crawled into bed and held him. He quaked from his sunflower nose to the small bones in my wrists, from his staples to the top of my ribs, from his hammering heart to my stagnant liver. As his elbow jabbed into my right side, pain rippled from his body into mine. My eyes split open.
I found myself laying inert under starched white hospital sheets, my arms stippled with bruises from blood draws, and an IV line protruding from a puny vein in my hand, since the ones in my arms had collapsed hours or days before.
A tall nurse with buckteeth appeared by my bedside.
“Name?” she questioned.
“Megan Giller,” I answered.
“Birthdate?” she asked.
“Seven three nineteen eighty-three,” I answered.
“Change into this,” she said.
She gave me a sleeping pill and told me I couldn’t have any water to drink because of the next day’s procedure. My heart beeped on the monitor, and the blood pressure cuff squeezed me out of sleep every 10 minutes. I wasn’t sure which nightmares were real and which conjured by the eerie glow of the IV, my arm a tree trunk bruised and hacked into submission. I woke wildly when the nurses entered the room every hour or so to change the numbers on the whiteboard by my bed, give me a fresh IV bag, or perform one of a dozen tasks they repeated incessantly. I hadn’t drunk much water during the day, and over the course of the night, my throat shriveled into a piece of packaged seaweed, disintegrating into smaller and smaller black strands every time I asked the nurses for a sip, just a sip.
Then light peeped through the slats of the tiny window in my room. The heavy door swung open. The bucktoothed nurse reappeared. She was going to give me a plasma transfusion, she said, which would help coagulation. Coagulation of what, I wanted to ask. She attached the plasma bag to my IV.
“It’ll be a little cold, Melissa,” she said.
I searched myself for my name, found nothing. I obeyed as horror itself froze its way through the needle into my vein, then up my arm and into my chest and heart, icy and grasping at any hope I had left.
Now a force field moved nearer and lifted the left side of my sheets. A pair of hands grabbed the right side.
“One, two, three, lift,” the voice said as my body was propelled onto a gurney. The wheels squeaked down a hallway into a white room.
Then there was a tingle. I could feel it in my neck. I could feel the red scorpions, and I said to myself, “There are red scorpions racing in my veins.” I knew that I was thinking more clearly than I had been the past few days, because I was not floating somewhere to the left of my body but was right here inside it, where I could feel the tingle and the red scorpions getting nearer. The red scorpions were getting stronger as they scuttled lower and lower down my body, and the tingle was like a tingle and like a needle, not like a natural vein. Now there was only one scorpion pinching me with my flesh in his claws, gyrating from the claws, churning my blood with his legs and pointing his stinger. As he ran, he skittered madly through my vein. Undaunted and uncontrollable, I could tell it was going to hurt. Undaunted and uncontrollable, it was going yogurt. Undies haunted and incontinent, I could tell it was going to hurt. Un-daughtered and inconsolable, idiot going hunting. One aunt and one troll of an eye, could lit was groin toe yurt.
After that it was muted, and there was no tingle. But it was only muted because it was not loud, and it was not quiet. I was back in my hospital bed, and it was noon. A small woman with a large nose came into the room.
“We have your results,” she said, handing me my chart. At the top, in large Helvetica letterhead, it read, “One Love Animal Hospital,” and below it, “Positive surgery: 1.5cm margins achieved.”
“Does that mean we will live?” I asked, my voice hoarse from speaking inside my head.
But she had left. Only a trace of perfume proved she’d been there.
I shifted onto my right side, the sheets crinkling. The red scorpions bit my middle, a tide swirling the venom in circles. My eyes found Echo perched on me, jabbing his elbow into that damn spot on my right side that would never heal.
“Hello,” his lips seemed to say, and his eyelids blinked like hands clapping.
He had been inert for days but now appeared awake and alert. He scuttled to the edge of the bed with one ear up, listening to the sound of children’s voices singing “Let It Go” from Frozen as they walked down the sidewalk by our house.
“Want to go outside?” I asked.
His tail shot up like a flag.
I put on some pants, and we toddled into the neighborhood, walking slowly at first. Then it was as if muscle memory took over, and he was hot on the trail of something fragrant, trying to run down the sidewalk like a pup.
He stopped to sniff at something I didn’t care to investigate further, and I gazed up at the trees and the sky.
Is this all there is? I wondered.
Then I was summoned back into myself to see his white tail like a flag, waving in the wind.
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About the Author
Megan Giller is the author of Bean-to-Bar Chocolate: America’s Craft Chocolate Revolution and a recent graduate of the New School’s creative writing MFA program. She writes for Slate, Narratively, and Texas Monthly, among others, and her writing for Engadget won honorable mention at the Society for Feature Journalism’s 2020 Excellence in Features Awards. Megan is currently working on a memoir that weaves her story with those of other female artists who live with chronic illness.