The List

Isabel

She dreams about hearts, when he isn’t there. About one heart, actually, a seemingly average and healthy human heart, cone-shaped and hollow, embraced by a colorful network of arteries and veins. A textbook heart. The typical human heart is fist-sized, she was taught—tuck your right elbow to your side and place your right arm at a diagonal across your breastbone, and there you are, your clenched fist roughly the size, shape, and correct placement of the muscular, double-pumping organ of Valentine and black velvet torch song fame: the heart. During the average lifetime the average heart, at seventy-two lubb-dupps per minute, will beat two billion times—Think McDonald’s hamburgers sold, Al said to her once, picture two billion patties being pumped out to poison the world—and spurt on its way enough blood to fill one hundred swimming pools. Picture it like that, Al said. One hundred swimming pools of blood, circled by one hundred film executives in lounge chairs, reading screenplays, dipping their toes in from time to time. The heart’s intricate choreography, balancing nerve impulses and muscle contractions—Just picture Martha Graham’s eurythmics, he said, danced by women in red satin, picture them flowing around in sync. He was trying to help her study and being no help at all, just messing her up with his silly, pointless facts. He thinks visually, she knows, he has to get the image printed, framed. Everything’s a movie in his mind. Eidetic. That “organ of Valentine and black velvet torch song fame” is his silly picture, not her professors’, not hers. Marlene Dietrich’s face while singing “Falling in Love Again” in a throbbing voice, that’s heart, he said. Look at that quivering throat. And look how the shadow under her nose shapes a butterfly, look at the agony bleeding in her eyes. Now, you want to see heart and soul, look at Falconetti’s Joan of Arc. Look at that cinematic face, torn between spirit and flesh, shadow and light. Look.

I don’t need your pictures to appreciate the facts, the important facts, she told him. There’s no metaphor here. There’s no such thing as a soul. A heart is just an organ. A heart is just a heart.

A sigh is just a sigh, he crooned, stroking her hair, the fundamental things applyyyy—

All right, she said, throwing a textbook at him, please take your movies and hamburgers and red satin out somewhere, and let me study.

Sweetheart, you’ve been studying. You’ve been studying for eleven hours. You need to take a break. He kissed her hand, held her fingers to his lips.

I have an exam tomorrow.

You’re all clenched. You’re going to snap. And not in a good way.

I don’t snap.

You need to engage in a fun and mindless activity.

Please, she begged, tugging her hand away. She was trying so hard to focus, and here he was, with torch songs and pools of blood. Her hand was shaking. Please, Al. Go. Go do something. Don’t you have to be at your little job? Don’t you have something to do?

This, he said. This is all I have to do.

You are a waste of a human being, she announced. She’d never said that one before, and it sounded, even to her at that second, too harshly excremental and conclusive. But she was so tired.

And we didn’t break up that time, she remembers. I think he just left to buy a newspaper. Or maybe a pumpkin. It was fall, I think. We’d been together maybe six months. He probably went out to buy a pumpkin. Yes, she remembers him walking out, the familiar, punctuating slam, recalls her heart rate jumping to brisk, then rapid. And she’d felt asthmatic, a sudden, panicked dyspnea. She’d sat on the couch and tried to stay very upright, raising and dropping her shoulders and chest. She was scared she would suffocate, and that only makes it worse, the fear, that’s what keeps your bronchi in spasm when you’re not really a true asthmatic person. Which she isn’t. But then he came back with a pumpkin, and a bottle of tequila, and all the air came back into the room, the apartment, (inhale), her lungs, her blood. (Exhale, deep.) He hacked out a crude, gruesome, screaming face—It’s a Munch pumpkin, he’d said, Look—and she carved in the detail with a scalpel she’d been meaning to return to the hospital. That she’d let him make her steal, once. She let him pour her shots. She let him make her down them. She will let him, let herself, do anything at these moments, Just stay, please, so I can breathe. They’d stripped off their clothes and threw handfuls of slimy orange pumpkin guts at each other. They rubbed slick strings of it onto, into, each other. The next morning, during her exam (Cardiac Structure and Function, with Clinical and Procedural Application and Protocol, got there late, his fault), she’d felt a pumpkin seed slide out of her.

She isn’t the heart in the dream; she’s the propelled blood. She’s venous blood, a textbook royal blue, deoxygenated and exhausted, flowing into the right atrium from the superior vena cava. The heart welcoming her home, a regular rhythm and rate, no pericardial friction, no murmur, rubs, or gallops. All is well, on track. A contraction, steady, the dependable dupp of those lubb-dupps, escorts her through the tricuspid valve with a lovely systolic swoosh. Homeostatic. But the contractions accelerate then, eighty, eighty-five, ninety beats per minute; she’s suddenly racing now to the pulmonary circuit, through the lungs, where she picks up fresh oxygen and turns the pretty bright red that oxygenated blood should be. So everything is still fine, she should be happy, content. But then, again, an increasing pressure, a new sense of urgency and stress, what is that? It’s the beating heart, that’s all, pushing her along. But still speeding, going too fast. The contractions go unregulated now, arrhythmic. The beats are unhealthy, violent. She’s pounded and driven along by something muscular and enraged, she has nowhere to rush or escape to but forward, into a dark, wet, airless maze of veins. Racing blindly, back into the left atrium, have to feed that heart—violent contraction, angry atrial systole—flooding into the left ventricle, its striated walls of myocardium pounding at her, as thick and raw and shiny-fat as Angus steaks. A cruel shove into the aorta, and you’d think she’d feel victorious now, it’s over, a good job done, but there’s no applause, no award, no chance to relax, there’s still the pressure behind her, still building, erratic, becoming a boil. And it begins all over again, her panicked hunt-and-chase from aorta to artery to capillary to vein, trying to deliver oxygen and carry away the waste products of cell metabolism but only building to her own sense of craze, of doom, everything out of control, a mad whirl, out of sync, turning to pure hot salt, and the only escape, she suddenly knows, will be outracing it, outcrueling it, she feels herself pound, she’s boiling livid and strong, she’ll explode right through this cruel and ugly trap of a heart. And then she’s awake, clutching empty sheets and choking for air, her own pulse at a mad, burning, lonely race.

She made the mistake, once, of telling him about the dream. One of the times they’d broken up, but were being friends.

Fantastic Voyage, he said. Fun movie. I don’t think I have it. Let’s rent it sometime.

How many times have you seen it? she asked, chewing a fingernail.

Friends rent movies together, he insisted.

Not until I’m done with finals, she said firmly.

Look at you. He laughed.

What?

Dreaming about hearts. You think you think in black and white, that you’re all reason and intellect, but you’re not. You’re all primal color. You’re all blood.

Oh, right.

You’re on a voyage, you’re driven, but you’re terrified of taking a wrong turn. Of getting caught up in some dark and wild ride.

You’re being very obvious, she said.

But we can learn from our dreams, he continued, in a mock-professor voice. I think you want to go a little unstable and simmery sometimes. Go snap. In the good way. You just need that kind of pumping up.

No, I don’t.

You have the potential to be a wonderfully whimsical, imaginative, paradoxical person when your rational, anxious evil twin shuts up. Your dreaming gives you away. Can’t you see that?

I did learn from that dream, thank you, she told him. It’s very effective to nap or sleep after studying, your subconscious goes to work on the material and it aids retention. I use my REM cycles to organize data in my brain. That’s the beauty of sleep. It can be very productive. I scored a 99.9 on my cardiac exam.

She watches him sleep, sometimes. She doesn’t think he’s really dreaming when he dreams, either. He’s just watching what flickers by, passively, as if the insides of his eyelids are twin projection screens. He’s even too lazy to use sleep. His closed eyes, without his glasses, look so vulnerable, naked.

Van would understand the heart dreams, she thought but didn’t say. Al would just make some snide comment about Van being a neurotic neurologist, about his reducing the ecstatic poetry of dreams to a series of electrical stimuli. Which, really, is all they are.

And then Al was talking about what starts the cardiac contractions in the first place, how no one even knows how that really works. What gets the heart beating, really? What keeps it pumping? And what destroys that force, in the end, what compels it to let go, what’s the final, extinguishing thing? And he was using words like magic and enigma, so then they wound up arguing over electrical stimuli, anyway.

Don’t, she’d said. Please don’t start talking about the Divine Spark, or the Mysteries of the Universe, or that sort of thing.

You hate that it’s unanswerable, don’t you? he said, laughing. You hate having to circle none of the above on the exam.

You just like easy answers, she told him. Answers that let you off the hook.

Isabel, he said. He shook his head at her. He has long curly hair, thick and firmly rooted in his scalp, the custardy blond of plasma or pericardial fat.

She thinks he said Isabel, just like that, making a sentence of it the way he does, then drank coffee. It was last winter, six months ago, and they were in Dupar’s, where he knows all the waitresses by name, drinking coffee, eating pancakes. They’d broken up; she’d reorganized the closets as she always did, and plucked her own clothing free of blond spirillum hairs, boxed up his videos, washed his smell and skin dust from the sheets, raised and dropped her shoulders and chest and worked at taking good, deep breaths, gloated to Van. They’d been broken up for nine days, and were being friends who hated each other.

I can’t stand this, she said, chewing her thumbnail.

He took her hand, kissed her little finger. Sweet, he said. Then he bit until the finger pad went white and strained. It hurt, but she said nothing. It was some kind of victory, that he still cared enough to want to cause her pain.

Myocardium like steaks, he said, teeth clenched on her. That’s a nice visual. You should think that way more often. Really. He released her finger from his teeth, but she left it there, pressed to his lips. So he’d be quiet. His mouth against her hand was sticky with maple syrup.

They went home and made love, and then he stayed, and then they were back together again. It always happens that way.

She’d given up going to UC San Francisco just after that. For him, so she wouldn’t have to leave him. Gave up rank, for him. Her last irrational act ever, she swore, she swears. Not that UCLA was slumming, she knew that. She would never be that out of her mind. Five years of surgical residency, then a cardiac fellowship for another three years, and she’ll be exactly where she’s always planned. But UC San Francisco ranks higher, according to the U.S. News & World Report report, second in the country to Harvard, and she had given that up. She actually begged Dr. Sayles to let her change, to support her staying on at UCLA—and this was after Dr. Sayles had recommended her for San Francisco. Sayles had agreed, with that awful “your early, obvious potential” speech, then threatened that if Isabel was ever late, unprepared, unfocused like she’d been during the last year, she was out. Dr. Sayles terrifies her. She’s exceptionally impressive. She is exactly who Isabel wants to be someday, omniscient and glacially calm.

Her parents were happy that she was staying, of course, although she didn’t tell them it was because of him. She didn’t even tell him it was because of him.

And after all that, they broke up anyway, again. And got back together. And, and, around and around, and always back to where they started. No, that isn’t quite true. Each time they push or get pushed further, a little more bursts out from each of them. And then a little more is drained or burned away. What a waste.

This last time, she was sure they could make the breakup work. They’d agreed, when Isabel finished school in June, before she began her residency at UCLA Med Center. It was time. It was just a form of a relationship they had stumbled into, that’s all, not a real one. And it has never quite worked, has it? It’s too chaotic. Stressful. Disruptive. And it has run its course. There is no future in it. Let’s acknowledge this. Al said, Sure, okay. He’d shrugged. As usual. He was very rational, calm. Champagne for Isabel, because he wasn’t good with it, and some fancy vintage scotch for him, and dark chocolate cherries filled with Grand Marnier, wishing each other well, toasting each other with Isabel’s nice crystal goblets, a dispassionate space between them, very civilized. No huge fight to trigger it, no drama necessary, nothing hurtful or raw, just a mature acknowledgment of the inevitable end. The perfect time to break up, they agreed. Toast after toast. Or, she thought they’d agreed. She felt so decided, so clear.

But the next morning, a Friday, the alarm goes off as usual, five A.M., with a blare of Buddy Holly, Isabel pounds snooze, and there, in silence, they are. Still a they. They are together, still, oblivious, entwined. She’s lying on the raft of him, that safe safe place that’s like floating on the most solid of ground, each of his breaths lifting her up, letting her rise then gently descend. He has his arms around her, her face is pressed to his chest, and his very smell is an oxygen. She feels his hand slide into her hair, another press then move down her spine, his mouth on her neck. Wait, she says, she leaves the bedroom to pee, staggering, too much alcohol lingering in her blood, and there on the bathroom mirror, a Post-it:
TO DO:

• 1. Reorganize closet (buy wood hangers/cedar things)
• 2. Wash linens—buy nonchlorine bleach
• 3. Put photos away
• 4. Call Van—gloat, dinner?

And she thinks, Oh, no, that’s right. No.

She splashes cool water on her face, gulps from the faucet. The poison, have to dilute it, have to flush it from my cells.

“Isabel?” Al calls from the bedroom. “Hey. Isabel. Hey.”

She hurries back, wiping her mouth. “You’ve got to leave.”

He squints at her, blinks. “What?”

“You’ve got to go. We broke up last night.”

“Oh.” He yawns. “That. I was humoring you.”

She throws a faded sweatshirt at him, a sneaker. “Don’t talk about it. I don’t want a debate. Just leave. Please.”

“I’m going back to sleep.”

“Then I’ll leave.”

“You’ll come back.”

“We broke up.”

“It didn’t take.”

“Go back to Griff’s,” she pleads. “I mean it, I’m serious. Or go to Julie’s. That’s how serious I am.”

“Isabel,” he says. He sits up, fumbles for his glasses, and puts them on. “Sweetheart. We’re not splitting up. Stop it.”

“Yes, we are. This time, we are.” She yanks a drawer open, scoops armfuls of his stuff. Water, I need a big glass of water, I need to rehydrate, get my electrolytes back in line.

“Have you gone to the box store? Have you filled out a change-of-address for me?”

“No.”

“If you were serious you would’ve organized it better. Let me go back to sleep. I have to be at work in”—he squints at the clock—“shit, five and a half hours. Just let it be.”

“No.”

“Relax. It’s destiny. It’s fate.”

“No. No, don’t doom me that way. I can’t stand that.” The clock radio bursts into mocking song again, Buddy singing about leaving something, the day. “Oh God, now I’m going to be late.” She drops his clothes to the floor. Buddy goes on about crying, lying.

Al hits snooze. “Just come back to bed. Stop making it all so dire. Just come lie here with me and be doomed for another three minutes. Three minutes won’t make any difference.”

“No.”

“I won’t tell anyone.”

“Look at this. Look.” She throws an empty champagne bottle at him—Oh God, did I drink a whole bottle myself?—and he ducks away from its plunge into the pillow near his head.

“Christ, Isabel!”

“Do you see? Do you see what you make me do?”

“You know what? You have a biochemical problem,” he says. “You should see Van about that.”

“If my equilibrium’s out of whack, it’s from spending almost two years with you. It’s like there’s this thing in my system from you, it’s destructive, it’s like a toxin—”

“I’m a toxin?”

“Al, please. Help me. I can’t break us up alone.”

“Don’t underestimate yourself.”

“We’ve wasted enough time.”

He flops back on the bed and glares at the ceiling. He pokes his fingers behind his glasses, and rubs his eyes. “You don’t waste anything, Isabel. You mean me. That’s what you always mean. I am a waste of a human being. A toxic waste, apparently.”

She says nothing. She’s still sorry about that one, but there’s no point, now, in apologizing. It’s over.

“Well, you know, you’re a waste of time for me, too, sweetheart. You always have been.” He gets up, and whips straight a crumpled pair of jeans. His right nipple looks swollen, and she remembers gripping it with her teeth. “And seeing as how my time is essentially worthless, that ranks you pretty fucking low.” He picks up a T-shirt, sniffs at it, puts it on.

“Don’t get nasty.”

“Hey, I’m not nasty. I’m fed up. I’m finally fucking fed up with you.” He rips the pillowcases from their pillows.

“Uh-uh,” she says. “Those are Egyptian cotton, my mother bought me those. Those are mine.”

He looks at her with his I-want-to-strangle-you look, and stuffs his clothes into the pillowcases. The alarm goes off, it’s still the day, the day Buddy will die. Al grabs the clock radio and hurls it against the bedroom wall. It smashes: black plastic casing, wires, tiny bits of glass.

“Hey!” she says.

“Yeah, that was yours, too,” he says. “Sorry I’m so destructive.” He grabs the empty bottle of scotch from the floor, peers inside, tosses it on the bed. “Just UPS my stuff.”

She closes her eyes. The apartment door slams behind him. Again. As always. She thinks of the aortic valve, slamming shut. She feels shaky and she takes deep breaths, and they work, good, and hurries to remember that it’s a semilunar valve, an exit valve. Following contraction of the left ventricle, good, the aortic valve closes to prevent the flow of blood back from the aorta into the left ventricle. Yes, it’s fine, everything is on track. It’s the beauty of the system, it’s the perfect system. It can’t go backward. Unless a valve malfunctions.

No, this time, it’s over and done. She’s still breathing. She isn’t doomed to anything. This time, it’ll take.