Thomas Larson didn’t want to leave in the middle of the writing class he was teaching. His heart had other ideas.

Christ, Not Now. It’s March, I’m at home in San Diego and getting ready to teach my Monday evening class. It’s strange: in the hour prior, I’m hot, sweaty. Constipated. Confused. Breathless, having just lumbered up the stairs to Suzanna’s and my bedroom. The second story — how many times have I done that? I tell myself it’s work, it’s stress, nothing else. I’m out of shape, easily winded. Indeed, for months, I’ve been trudging on the treadmill, a lot slower than usual. But I’m not sick. I’m older. What age? I have to remember. Fifty-six. Driving to class, I’m heating up, rolling down the window for a breeze. At class, I’m no better. I give my flock a writing assignment, which I check, moving from student to student. Ten minutes pass this way. Then I excuse myself — a quick bathroom stint, I think, should dispel this acidic burn in my throat. I lean into the toilet, try to vomit. Nothing. I crap, blow-it-out like bird shit. That’s got it. I rush back to class, wondering what’s happening? I don’t know. I do know I don’t want to suffer in the way I’m suffering right now. How will I make it through the next three hours? I’ve never left in the middle of a class, and only twice in 15 years have I canceled — the day my mother died and the day one of my twin sons left home, leaving a cryptic note that terrified Suzanna and me. I rationalize it — tonight’s lesson needs completing. It’s amateurish to postpone the work. Maybe I can do ten minutes on each essay we’ve read and let them go. From my notes, I outline on the board the writing strategies in each piece. And here it gets strange. The taste of reflux soils my mouth. I feel as though I’ve just plunged off a cliff and halted midair. Afloat, I sense there is no future: however many years are telescoped into these few minutes. Years into minutes. A spiral appears, widens, pinwheels, and sucks me in. I recall how I’ve told students it’s a copout to say, “It felt like an eternity” or “Time dragged on” or “Hours rushed by.” Clichés, I’ve called them. How do you capture trauma, intensity, in words? There’s no other side to this thought. I discuss one essay in two minutes, the next in a minute, the next, in 30 seconds. My words are boggy, slow. Then I hear myself speak — as though I’ve been called on — “I’m afraid I’m not feeling well. I have to leave.” In my bag, I stuff books and papers. My hands sweat. My legs quake. “For next week,” I say — and stop. Everyone is looking at me. “I have to leave.” I’m running.

Clothes Off. A nurse takes me to an emergency-room bay. “Symptoms?” she asks. “I think I’m having a heart attack,” I say again. She tells me to get undressed. I’m sitting on the bed, and begin taking my clothes off — peeling, that’s the word. They’ve been stuck on me like a soiled diaper for half an hour. My body is leaking its insides. It’s not the soul coming out, wet and furious. It’s my skin, like packaging, trying to strip itself of the invader. These goddamn clothes nag because they curtain my fat, a lifelong source of shame. For several years I’ve gained weight (again) — in the 1980s, a runner, I was svelte; in the 1990s, I got so sedentary and lazy teaching full-time I put the pounds back on; now, in the 2000s, a full-time writer/journalist, and I procrastinate getting back in shape, my belly jellying, a midlife bulge pushing me to 220. I hate the weight. I hate unbuttoning the faded pink travel shirt I’ve worn for years. I hate unclasping the stretchy waistband pants, size 40, all this so pungent, so whiny — I don’t want to see the tumescence over my too-tight underwear: how often I hide behind a T-shirt prior to sex with Suzanna (What sex? It’s been months). Why don’t I stop worrying? “Stay here,” the nurse says, “I’m coming right back.” As if I’m going anywhere.

Where is the drug to curb or redirect this avalanche?

Where are my saviors?

I put on the gown. To hell with the ties. I get back on the long plastic mat.

An orderly enters, wires me up to the ECG machine, prints out a graph-paper page on which I espy its Himalayan-like peaks and valleys. He hustles out. He returns. With a well-groomed pro, the Doc, in crisply tailored whites, who tells me what I’ve known now for an hour: “You’re right, Mr. Larson. You’re having a heart attack.”

I’m Sorry. Is it then that the nurse asks the mandatory questions: my name, my address, my date of birth, my cardiac history (do I say, father, brother, both dead of heart attacks, or the less volatile heart disease?), my symptoms (I’m dizzy, I’m hot, my chest aches.) Have you ever had angina before, a sudden name for the pain that keeps washing through me? Does she lean over next and smirk a tad wickedly and say, “Please try and relax,” and I laugh? Does it happen a minute later that she rifles a medical bag for aspirin and a sublingual nitroglycerin tablet, and asks, almost like an afterthought, who to phone, and I say, Suzanna? While I wait, harried and calmed by the theatrical flurry, the pinging machines, the seismic readouts, you appear, curtain-parting and padding your way up to the bed where I lie and where on your face I see two women, you who are unafraid to approach me, indeed, desire my trouble, and you who are shocked to come any closer.

To both of you I say, “I’m sorry.”

“Don’t be,” you reply.

“But I am.”

“What for?”

Good question. I’m sorry that this dread wants you, as well as me, to bear it.

Don’t Drive Yourself. But I did. My last act of volition. Isn’t that why I’m alive and being helped? I got here lickety-split. For which I think I should receive some credit. Ah, we’re dialoguing. I’m out of danger. Indeed, I’m purring and holding onto Suzanna who smiles at the busy, fraught nurse—Suzanna, a psychotherapist, whom I’ve been with for 17 years (our home offices adjoin), who is beside me, which means I will make it. I love her for magically appearing: our eyes (hers, herb-garden hazel; mine, sky blue) lock and promise we’ll work the shock out — and what it means for us — later. She and the nurse are iterating how “right” it was I came in. Though I “could have called an ambulance, you know.” But I was just a mile away, I say. I don’t mention that I knew where the emergency room was because six weeks earlier I had rushed to this hospital, Scripps Green, a half-mile from the beach at La Jolla, when I was half-panicked, a chunk of silicone that I had buried in my ear canal for silence while sleeping was stuck. I’d had underwater hearing and couldn’t think straight. The shock of the $350 bill came later, but the good doc tweezered the greasy lump out, then told me never to do such a dumb thing again. I also don’t say that an hour earlier while hustling to my car I thought to drive home, a jet-fast three miles to get Suzanna and, with her, figure out what was wrong. This nurse would have admonished, “Had you done that, you probably wouldn’t be alive.”

These assessments keep interrupting what I want to be conscious of — blood draw; blood-pressure cuff; wristband; electronic chart; new faces, uniforms; dog-eyed gaze — and I sink back into myself where I need not participate, though I’m grateful they’re reviving me, a rare spiritual tilt for me, primed as I am, as we all are, to put this moment off until the one day, this day, when mortality shuts our putting it off up.

What For. The nurse, vigilant at my worry, says, “You’re getting emergency angioplasty very soon. Can you hold on?” I can. Suzanna kisses me, and I’m being rolled down the loud, slick hallways to the catheterization lab. (During my condition’s onset, others snap-to with procedure; suddenly I’m their ward, agented, the gawk-dumb observer, my illness gathered round by far more people than I thought possible.) The wheeler asks about my pain, one to ten. “An eight,” I say. But I also want to say I’m relieved, edging on giddy, to be alive and laid low, like a badly wounded soldier, pulled from combat and on a flight home, he believes, to recover. At least he won’t be by himself if he dies. You’re right, Mr. Larson. You’re having a heart attack. I’m surprised the attack is longer, not shorter. It’s a nether-land I’m feet-dragging my way through now that the E.R. gang has stabilized me with a blood thinner, a clot buster, a diagnosis. I have time to stomach its yaw and gauge its slice, lifted onto the altar of having a heart attack and not yet having had one.

I’m the back-flat center of attention, fluorescent lights above me, film frames, clicking by, Ishmael adrift in Queequeg’s coffin. The novel’s ending reads, “I was he whom the Fates ordained.” And then, “The unharming sharks, they glided by as if with padlocks on their mouths; the savage sea-hawks sailed with sheathed beaks.” The orphan, abandoned and saved.

The smell of disinfectant and Ajax, the funhouse sound of wheels rubbering the floor, the creaky squeak of the bed’s aluminum bars like wind-swayed chains — is it then that I look up, pausing at an electronic door and a passkey pinging it open, and regard again in Suzanna’s frightened look the two women she carries — my tongue, she tells me later, curled out and onto my thin-lipped pucker with some talky intent: in that moment I recognize her double-sourced ache. First, for her grandson born three years ago with a chromosomal defect (lissencephaly) so severe that they fear he will not develop beyond infancy. Second, for her son, the boy’s father, now 42, who, just after the boy arrived, was found to have tumors on his throat and spine, little black flags of cancer. On a bookshelf, Suzanna has posted their photos above a candle and incense base. There I have seen her pause — communing with the heaviness, the helplessness her grief begets.

And now she reaches down to palm my forehead, the heart patient who needs (I’m sorry) son and grandson to move over so he — so I — receive the anxiety and sorrow she renders them.

Unclogged. The cardiologist tells me to watch a monitor as he performs the angioplasty. (His card, which I consult later, reads “interventionist,” a title reminiscent of a medical exorcist or a latter-day shaman.) I’m shaking like I’m freezing. I am freezing and frightened. “Don’t worry,” he says. “We’ve done this a thousand times.” But, I think, not on me. Above my chest he glides the fluoroscope, a Cyclopean eye, projecting real-time images of my arteries. He clicks it on and there, on a screen, is my turbulence, X-rayed within. (All this high-tech jargon, I cobble together weeks after.) He says, “I need you to pay attention. Hold your breath when I say so, okay?” Okay. He tells me he’s puncturing my groin for the catheter. Punct, and for a few hard moments I feel a hose inched in. He says that’s done, and now the dye’s coming. On the screen, my arteries darken and animate. “See them?” Yes, I do. Floating in some gray, groundless landscape, they are pulsing. They jump and jerk. Puppets on sticks. The broad, flat scope above me rotates, tilts, turns, pulls back, repositions, and hastens in close, robotic motion with spasmodic intent. I can’t quite tell whether the image is gyrating, the cath line is wriggling, or the electrical voltage is causing it to shake. (Later, I download a YouTube angioplasty video that shows such quaking is actually the excited beating of a human heart. The flush of rescue.) “Hold your breath . . . and release.” This is like vivisection: live surgery. I see a squirming strand, like a car being chased, tracked by a night-vision camera, prodding its way through the artery’s narrow passageway. “See the balloon?” Yes. It’s an inflatable little barge, a cowcatcher sweeping away the debris. The balloon unplugs the artery. “Here comes the stent,” he says. “Now hold your breath . . . and . . . and . . . release.” I follow another tunneling in but already I’m feeling something other than breath release itself. Something like the light and the whoosh when a wrecking ball barrels open a building. That’s my artery widened. That’s my blood getting through. That’s me, oxygenating. My body sighs; it need not work so damn hard. “Got it,” the interventionist says. Meaning, he’s placed the stent. (A stent is a pencil-lead-thin expandable wire mesh, made of a chromium alloy thirty-three millimeters long, three millimeters wide. Wedged in there for good.) “Two more to go.” Two more? Holy shit! But it doesn’t matter. He — we’ve — done this a thousand times, and now, include me. I feel revived. I’m back, on track and train. I know I’m back since I turn to see mortality’s depot, its eternity of benches, its ticket-taker asleep. Where I was disembarked. And from which I am yanked back onboard. “Got number two,” he says. And I can hear the train whistle woo-woo, feel the wheels wobble, see the view blur.

This is an excerpt from The Sanctuary of Illness: A Memoir of Heart Disease by longtime Reader contributor Thomas Larson.