The day I promised to love you forever, I’d spent my morning tending to a patient awaiting a heart transplant. His heart was failing, the left ventricle weak, baggy, sagging like the overstretched neck of a favorite old T-shirt, no longer able to contract enough to push adequate blood to organs and extremities. A colleague signed the patient out to me after his overnight shift. “Stable now, may need a balloon pump later,” he pronounced.

Intravenous lines fed chemicals into the patient’s blood: inotropes to force the heart to pump harder, vasodilators to make the work of pumping easier, diuretics to chase extra fluid out through the kidneys. The drugs created a fragile balance. The scale could tip at any moment. Then the only option left, until a new heart became available, would be a pump inserted in the left ventricle, a device to mimic heart contraction, forcing out more blood. 

I don’t remember how my patient came to be in end-stage heart failure. There are so many things that can go wrong with a heart—disease of the muscle itself is one, but also valves that leak, faulty electrical connections, holes in the walls between the chambers, occluded arteries like clogged pipes—a house that might require repair of many sorts. Despite this, you and I take our hundred thousand daily systoles for granted. 

The house metaphor kind of works, doesn’t it? So many of the common metaphors about the heart make little sense. My patient’s failing heart was enlarged, a sign of damage. But when we’re not speaking medicalese, if we say that someone has a big heart, it’s a good thing, more capacity to love. Perhaps the real meaning of the metaphor is that someone who gives a lot of love might wear their heart out, rendering the muscle large and lax, less elastic, less resilient. I hope this isn’t true. Can we measure amounts of love? Mete love out to keep from using up our hearts?

It was Aristotle who first said that the heart was the seat of the soul, of feelings, including love. Today we say that feelings are in the purview of the brain, yet when we’re happy or sad or frightened, the first sensation might be in the center of the chest—pounding, burning, breathlessness. We say “my heart is full,” “my heart leaped from my chest,” or “my heart is broken.” 

There it is, a metaphor with a medical correlate: an emotionally broken heart can translate into a physically broken one. Broken heart syndrome, otherwise known as takotsubo cardiomyopathy, a sudden temporary failure of the heart caused by severe stress. The medical explanation is that stress causes release of catecholamines, like adrenaline, which stun the heart muscle, rendering it temporarily weak. I’ve seen this once, watched the miracle of spontaneous recovery, but the permanent kind of heart failure is much more common.

The day I promised to love you forever, my patient with his permanently damaged heart lay in wait for someone else to die so that he could keep living. His wife paced the hall outside his room, teary eyes, nails bitten to the quick. When she married him, he promised to protect her. Neither one of them could have known that his heart would fail, putting hers at risk for breaking. If the heart is the origin of love, did he love her less with his damaged heart? If the heart is the seat of the soul, what does it mean to replace one heart with another? 

In anatomy lab we removed our cadaver’s sternum and ribs to expose the heart, a purple-brown blob nestled just left of center, between the pink of lungs. Cut into the great vessels, followed their paths through chambers, examined valves, their leaflets attached to the chordae tendineae, the so-called heartstrings. The contraction and relaxation of these heartstrings holds valves open or closed, a process we don’t feel. And yet, metaphorically, I felt the pull on mine the day I met you. How does that work?

Aristotle believed the heart was the most important organ in the body. This can’t be true; no organ functions independently. To my mind, though, it’s the most complicated, the most difficult to comprehend. So much it must accomplish just to keep on beating. So much it has to know. So many ways for it to break. 

Is it possible for me to love you forever? Will my heart know how or will it someday fail? 

Rosalind Kaplan has been published in several literary and medical journals, including Amarillo Bay, Annals of Internal Medicine, Another Chicago Magazine, Brandeis Magazine, Eastern Iowa Review, Green Hills Literary Lantern, HerSTRY, Ignatian Literary Magazine, Minerva Rising, Open Arts Forum, Prompted, a Philadelphia Stories Anthology, The Pulse Magazine, Signal Mountain Review, The Smart Set, Stonecoast Review, and Sweet Tree. Her memoir, Still Healing: A Doctor’s Notes on the Magic and Misery of a Life in Medicine, was selected as the winner of the Minerva Rising 2022 memoir contest and is forthcoming in fall 2023. She is a physician and also teaches narrative medicine and medical memoir writing at Thomas Jefferson University/Sidney Kimmel Medical College. Dr. Kaplan is a 2020 graduate of Lesley University’s MFA in creative nonfiction, and she has attended a number of writing workshops. She lives with her husband, two rescue dogs, and has two grown children.