I KNOW HEART ATTACKS, and this wasn’t a heart attack, even though a doctor back home in Austin later speculated that it was. It happened a few days before last Thanksgiving, as my wife, Phyllis, and I were walking from our hotel in Paris to the Musée d’Orsay, having just been rudely rebuffed by a cabdriver who apparently had more important things to do than drive us a mere twelve blocks. The French have a term for the growing resentment that was welling up in my chest: l’esprit de l’escalier. Roughly translated, it means discovering on your way down the stairs what you should have said or done in reply to an insult in the drawing room. It would be easy—oh, so easy—you miserable Frog mutant, to crush your windpipe with my thumb and be halfway to Marseille before they find your body. It was at that moment that I sensed that something else was wrong. I felt dizzy and exhausted. A dull ache filled my right arm. I paused to catch my breath, walked another half-block, and stopped again, on the verge of collapse. I spotted a park bench and rested for maybe twenty minutes. After that I felt better. The problem didn’t reoccur for the remainder of our vacation. But I knew that it would be back.
Coronary artery disease is an old and much-hated enemy of mine. The beast attacked me without warning in 1988 as I strolled with my Airedales along Shoal Creek’s hike-and-bike trail. Heart attacks, as I learned, are not necessarily sharp, stabbing pains: This one felt like a bear squatting on my chest. It was hard to breathe, and the pain was constant. At first I dismissed it as indigestion, but seven hours later I was flat on my back in an emergency room. Doctors subjected me to a coronary angiogram, a procedure in which a catheter is run from the groin to the heart. There it injects X-ray dye and films evidence of blockages, which are visible on a TV monitor. It showed that five arteries were clogged with plaque, the residue of more than fifty years of unrighteous living. The blockages were preventing blood from flowing from my aorta to my heart muscle, hence the pain. I had two choices, a doctor explained: Undergo quintuple-bypass surgery or die.
A few days later, while I was in the merciful recesses of anesthesia, a surgeon ripped open my chest with a power tool, pried apart my breastbone, and located the clogged arteries. Using a long section of saphenous vein that he had removed from my right leg, he attached one end of the new vessel to my aorta and the other to a coronary artery downstream from the blockage, creating a detour. Once all the grafts were in place, blood was able to flow freely for the first time in months, if not years. For the better part of an hour, my own heart was stopped, and my life was sustained by a heart-lung machine, dead time that some patients believe lowers their IQ a few points. After his own bypass, in 1991, Larry McMurtry wrote to me and explained that the dead time “opens a gap that’s nearly impossible to close—at least I can’t close it.” McMurtry stopped writing, lecturing, traveling, or visiting his three bookstores. “I couldn’t even read, not a book for two and half years,” he wrote. “I felt that I had become an outline; then I felt that someone was erasing the outline and that I was simply vanishing—evaporating.”
Recovery takes anywhere from six weeks to more than three months, and a big part of that is psychological. I became convinced that I would never write again because it was impossible to write without a cigarette, or so my history had instructed. Yet six weeks later, I forced myself to sit down and write a long letter, thanking friends for standing by me. It was a perfectly wonderful letter, if I may say so, bordering on pure poetry. I had smoked my last cigarette on the way to the ER, and now I began researching the other causes of heart disease, with the idea of writing a book. I went on a diet and lost thirty pounds, began exercising at a gym three times a week, and in 1998 published the book HeartWiseGuy. Judging from his recent win at the Academy Awards, McMurtry also got over it—as much as you can get over these things.
In fact, two years after surgery, I began experiencing blackouts, brief moments where I would slip away to somewhere dark and lifeless. The blackouts were caused by an abnormally slow heartbeat, so doctors implanted a pacemaker in my chest wall, just above the heart. After that, when my heart rate got too slow, the device sent a small electrical impulse that prompted the heart muscle to adjust its rhythm. Despite the pacemaker, however, over the next decade I developed a condition called atrial fibrillation (also known as afib), in which scrambled stimuli cause the heart to beat either too fast or too slow. In 2003 I went to see a heart rhythm expert in Austin named James Black. He changed my medications and implanted a newer, jazzier pacemaker, which doesn’t completely control the problem but at least keeps a record of how often it occurs. Lately I’ve had an irregular heartbeat more than 60 percent of the time.
A week after returning from vacation, I told Black about the episode in Paris. Another doctor I’d talked to guessed that I had had a heart attack, but Black thought otherwise. “If it had been a heart attack, you wouldn’t have felt better after resting,” he told me. “But you obviously had a spell where your heart wasn’t getting enough oxygen.” He recommended a nuclear stress test, which is like an ordinary treadmill stress test except instead of walking at increasingly fast speeds for ten to twelve minutes, you walk at a leisurely pace