Last Words

Erin Byrne

“We can’t get it to slow down,” said one of the doctors huddled outside the hospital room in which I lay, as my heart galloped right out of my chest. He recited a list of medications, adding, “We’ve given her just about everything.”

“Try a higher dose,” said another. “She’s can’t take much more.”

Another spell of tachycardia hit: quickening, ascent, the pinnacle where shades of red rotated behind my eyelids, then descent.

After a few moments respite, my heartbeat escalated even higher. This time at the apex there came a blinding white light, and my arms began to rise like Frankenstein’s off the bed.

I wasn’t trying to move them.

For two months, I’d been having tumultuous heartbeats, but on this evening in November 2021, my pulse had sped so drastically that I’d called my son Kellan to bring me to the Emergency Room.

He held my hand, a surgical mask dangling from one ear, narrating what he saw on the Emergency Room’s monitor. “Okay, Mom, it’s up to 195 … it’ll drop in a second here … going down now, it’s okay, it’s okay.”

When it subsided, I said, “You need to tell the doctors that my arms are lifting! And I’m now seeing bright white light. They need to know this, tell them.”

Kellan grimaced. “Mom … your arms aren’t moving.”

My heartbeat sped and soared, and the glare was startling and my ears were throbbing and the pressure squeezed my chest with searing pain, and I definitely felt my arms rise in zombie-like fashion. 

I realized that I might die. 

I needed to say something profound that Kellan could pass on to his brother, to our family and friends, a gem that future generations would ponder. This would be easy: As a writer, words burned unceasingly within me. They were my escape, my expression, my mission. It was time to conjure something enlightening.

I drew upon my well of wisdom and offered the drop that came up: “I love you.” 

It was all I could think of. Here sat my firstborn, yet all that came up were the same three words I’d called out every time I’d ever said goodbye to him, whispered when tucking him in at night in his youth, written on postcards, or murmured when serving him cinnamon toast in his lowest moments—when he broke his ankle playing basketball, or when his feelings were bruised.

It seemed a paltry thing to say. Kellan already knew this; it was obvious from his smile and reply that he loved me too. 

I grasped for words that would forever sizzle in the hearts of my loved ones. Perhaps something like Billie Holliday’s insight: Don’t be in such a hurry, or Coco Chanel’s example: You see, this is how you die, or a literary quote like Dickens’ Sydney Carton: It is a far, far better rest I go to than I have ever known.         

Kellan talked me through each repetition until at last the medication steadied my heart.

 “You’re going to be a good labor coach,” I said, “and such a great dad.” He and his wife, Jaimie, were expecting their first child in January. 

The heart-hammering was diagnosed as Atrial fibrillation, and an ablation was scheduled, a simple surgery which zaps the electrical impulses of the heart that cause it to misfire. I was given a prescription for Flecainide, which would stabilize the drumming when I was on the verge of passing out.

My other son, Brendan, came from Idaho the next weekend, becoming the second recipient of my further attempts to be memorable. I had made a career out of putting obscure, immeasurable concepts into words—why couldn’t I think of anything other than those three oft-uttered ones? He’d read them on sticky-notes tucked into his lunch bag, heard them murmured as I scratched his back at bedtime, and sensed them when I sat with him in a clinic after he broke his hand playing basketball. Brendan had intuited and repeated this phrase throughout his life, from Christmas mornings to after-school snack times to teary farewells when he went off to college. 

I felt inadequate. Since I’d written my first story at the age of five, an abundance of words had blossomed, day-lilies of the mind. I knew that if I went blind, I’d see them with an inner eye; if deaf, their cadence would reverberate in memory. I’d always been most myself when creating powerful paragraphs and pages, and thrilled to new or foreign terms—chantepleure (French, to sing and cry at the same time), or duende (Spanish, the dark thread that runs through our lives). 

The next month, Brendan got married on the island of Kauai. My heart fluttered during the flight, but I popped a Flecainide. Another ensured I didn’t keel over during the vows, and one more allowed me to sip champagne without my heart reeling. 

In January, my first grandchild, Kaeden, was born, a healthy eight-pound boy, whose eyes sparked with curiosity. I’d hold him in the crook of my arm, examining his rose-colored lips, his minuscule fingernails, yearning for certainty that life after the ablation would be long, that I’d hear his first words, attend his graduations, perhaps his wedding if he married, and maybe even hold his child one day.

A few weeks ahead of my surgery, I went in for a routine CAT scan. Several minutes after arriving home, I received a phone call from the Congenital Defect Cardiology Department, requesting to see me.

I made the appointment, hung up and logged into my online chart, where I found a string of words: Anomalous Origin of Right Coronary Artery from the Left Sinus of Valsalva and Coursing Between the Aorta and Pulmonary Artery.

It was easily Googled: “Birth defect. Very rare, .026% – .25%.” “Associated with sudden cardiac death.” “Death in infancy.” “May present with ischemia or arrhythmias or syncope.” “Autopsy results have shown …” 

I read the case of a teenaged athlete whose heart had slowly been failing until he passed out on a basketball court. He was saved by surgery, but a thirty-seven-year-old mother of two was not so lucky. She collapsed in a train station, pulseless.

I became mesmerized by studies of pediatric patients who suffered chest pain, weakness, and dizziness, some of whom required open heart surgery. I remembered when Kellan had had ear tubes inserted at age two, and Brendan’s tonsils had been removed at seven— their small hands trembling in mine as the anesthesia was administered, and frantic eyes as they’d been taken in for the procedures. 

I was haunted by thoughts of boys riding bikes which capsized, wheels spinning, girls who never awoke after a night of fairy dreams, an infant who experienced sudden death due to aggravated heart failure. 

I thought of Kaeden, who gripped my finger as he gazed up at me.

At the appointment, two doctors addressed me.

“You were born with this defect.” said one doctor. “It’s serious, but you’ve lived with it this long.”

My coronary artery had created its own opening and extended itself to drop all the way down between the aortic and pulmonary arteries.

“It’s important that you understand you can die from this at any moment if that artery gets squeezed” added the other doctor. “We checked the video of the echocardiogram you were given in the hospital during the tachycardia. Your heart rate was above 200 for much of that night, and as you can see here, your coronary artery was briefly smashed between the aortic and pulmonary arteries.”

There on the screen was a rebel bucatini-shaped tube that dropped down between two pulsating arteries. It was indeed being crushed.

The blinding white and rising arms. No grand ascension, no word from the beyond, just a light and the illusion of moving limbs.  

Another appointment was made for a scan to gauge the resilience of my heart and a final warning issued: “Do not take anymore Flecainide, it could kill you.”

I recalled popping it like candy in Kauai.

The scan showed a heart able to withstand high levels of stress, so the ablation was now set for May. The day before, I sat down with paper and pen. The outlook was positive, but this rogue artery raised the risk, and I didn’t want to die on the operating table without those coveted last words in print. After my earlier loss of eloquence, now was the time to provide the wisdom to ensure that my sons lived happy, fulfilling lives.

I jotted down many enlightening phrases that read as clichés the moment after I wrote them. For six decades, my floodgates had never once been blocked. I longed to float on waves, ride on tides, and tumble on word-tsunamis, but no new paragraphs disturbed my sleep in the usual way, phosphorescing in the grainy dark from my pen into a bedside notebook. Words were accessible while working on my novel or essays, but for this all I could come up with were the usual reminders for Kellan to show his feelings, for Brendan to share his, and the same well-worn phrase. I fanned the two envelopes out on my desk in a pretty display and hoped for the best. 

After the surgery, the cardiologist said, “You did well, but you still have something called the P2 Heart Sound, which is a concern, but not too serious.” I tuned out the details—something about a valve closing that created a kind of extra beat. “We need to continue to monitor this.  If you have symptoms, you would either collapse or have to have open-heart surgery.” 

By then I knew that it wasn’t the kind of collapse after which I would rise up. But if it happened in an instant, there would be no chance to articulate anything significant.  I wondered if I should dispense my brilliance in bits, but my inner thesaurus had emptied. 

I considered pointing to a famous death-quote that would sum up all I’d tried to teach my sons throughout the years. Cleopatra could remind them of acceptance: So here it is; Queen Elizabeth I might highlight simple values: All my possessions for a moment of time; or Édith Piaf spur them to live with passion: I can die now; I’ve lived twice.

But to use another’s words would be admitting defeat, and what kind of writer’s legacy would that be?

Brendan and Izzy’s daughter, Isla was born the next month, a strawberry-blond round-headed infant who so resembled Brendan as a baby that recollections wafted through me when I held her. 

I found the most astonishing feature of being a grandmother to be the way scenes of my own sons’ infancy and childhood would unravel in my mind when their offspring would give a specific look or gesture: Kellan’s smirk on Kaeden’s lips, Brendan’s look of fierce concentration in Isla’s eyes. My connection with each child was deep even before they spoke any words at all.

I felt the presence of past generations as Kaeden played my father’s old bongo drums, worn from decades of tapping out jazz beats. He’d been a pianist and drummer, and his favorite song had been Dave Brubeck’s “Take Five,” which introduced a new rhythm in 5/4 time, adding an extra beat to a typical 4/4 measure. I played it for Kaeden and showed him a black-and-white photo of my dad playing drums back in the day, his jaw set, crew cut clean, tilting his head. Kaeden metronomed his at exactly the same angle.

It has been three years since I’ve had any sustained heart symptoms. Workouts register no chest pain or pressure. I’m still here, still breathing. I sing, I cry. 

Kaeden now asks questions unceasingly, and has recently awakened during the night afraid of the dark. Isla shakes her hips dancing to “Take Five” in a way her grandfather would have enjoyed. 

Time with these children has a different quality to me, because I know it’s not possible that I’ll be around for many decades of their futures. Sometimes I envision Kaeden graduating from high school and wonder if I’ll get to see him stride across the stage in his cap and gown. I hope that Isla will travel to foreign lands when she’s older, but don’t know if I’ll still be alive to hear tales of her adventures. I can’t imagine missing the looks on their faces when their first child is born, or hearing them tell me about their career plans, or hugging them when they’re fully grown.

 As my heart ticks away, I know that every day people of all ages die—of causes like cancer or stoke or heart disease, or are swept away by rogue waves, struck by vehicles, murdered by guns. This is the darkest thread. But rare is the person who knows when he or she will die, and I am no different, really, from anyone else on earth. 

The patients whose stories I’ve read live in my mind, along with countless imagined others, reminding me of their destiny and mine. I often think of those who died, and know that their parting words—the final phrase a teenager shouted jokingly to his friend, or the ultimate question a five-year-old asked his dad, or what that mother would have said to her kids at breakfast that day—would not have been predetermined.

Some nights I lie awake in the dark, blue and black patterns kaleidoscoping behind closed eyes, my heart beating as if Dave Brubeck himself had composed its rhythm, and I am suffused with gratitude for having glimpsed that what truly matters in my life is beyond words.

I no longer seek the perfectly presented last statement. I’m more occupied with Isla’s games of peek-a-boo and Kaeden’s imaginary castles. I watch my children navigate parenthood with kindness and love, and there’s nothing, absolutely nothing, I need to tell them that they don’t already know.

Erin Byrne is the author of Wings: Gifts of Art, Life, and Travel in France, editor of Vignettes & Postcards from Paris and Vignettes & Postcards from Morocco, and writer of The Storykeeper film. Her writing has appeared in The Columbia Journal, The Best Travel Writing anthologies, Hidden Compass, and many other publications. Awards for her work include a Lowell Thomas Award from the Society of American Travel Writers Foundation, four Grand Prize Solas Awards for Travel Story of the Year, three Next Generation Indie Book Awards, and an Accolade Award for film. Erin is currently completing her first novel, The Darkest of Paris Nights. www.erinbyrnewriter.com