I’ve always loved hospitals. I even love the smell of them. The ammonia delicately lining the corresponding commercial catalog furniture. In my day-to-day, I’m in the upper echelon of pickiness about the textures of blankets, comforters, and sheets. But in a hospital, I’ll graciously accept the bleach-roughened utility linens, always heated to perfection. I make sure to ask for a few extras to layer, creating the illusion of a lifeless leg to wrap my own around. Then my job is simple: cuddling up and doing what I do best in hospital stays - sliding in and out of consciousness between mealtimes, awaiting my chance to call in custom modifications of the cafeteria menu. If I’m down with a cold, I don’t let friends or partners bring soup or care for me; years of stubborn independence made that an impossibility, but hospitals are a different story. Hospitals have receipts, nurses have paychecks, and that’s the kind of care I can sign on for, one with no expectations besides courtesy and a fat bill.

Despite this uncommon adoration, by age twenty-eight, the frequency at which I rolled in and out of EDs had a way of souring an otherwise cherished place. Over the span of a year, I had received revolving door treatment at over a dozen-odd Emergency Rooms. Each arrival had been the same; a long wait, rushed triage, brief assessment, blood draw, and inevitable disregard when they caught sight of my raised BAC. It felt like no number of visits would get me out of the “drunk tank” and into the patient pool. If I was lucky, they would order me a dose of Ativan before ushering me back toward the street. I was in no mood now to trudge my own weakened body across town for more of the same.

It was only June, but the sticky heat of Louisiana summer had already crept in from the gulf. Leaving the temperature-controlled shotgun during daylight hours was reserved for emergencies - like beer runs and grocery shopping. I just wanted to stay in bed, back in the ninth ward, nursing bottom-shelf vodka, attempting to dim the helplessness of my physical state. This sensation felt different than booze sick, like every organ weighed down with rocks, and lacking strength to raise a single finger in protest.

Booze sick, I knew all too well. By the tender age of nineteen I began to notice my hands trembling in the mornings. I assumed it was from anxiety or low blood sugar. What started as a minor annoyance progressively escalated. An hour after arriving to work, a catering business I had owned in San Fransisco, I’d find myself unsteadily grappling with my knife handle, mauling carrots and onions alike. The kitchen was a haphazard operation and sipping light beers through my twelve-hour shifts was the norm. Each day, as I would down my first drink, no sooner would the unsteadiness lift from my nervous limbs. The implications of this pattern became increasingly difficult to deny. Despite not being a liquor drinker, despite not being legally old enough to drink, I was officially ethanol dependent. And so began years of medical detox to ease my worsening withdrawals. These in-patient stays became my sanctuary, breaking up earnest attempts at continuous sobriety and the tedious art of feigning togetherness on the outside.

Nearly a decade later, and the mirage of togetherness was progressively diminishing. My mother’s voice screeched from the receiver as I lay incoherently sprawled across my bed, eventually succumbing to her plea that I return to a hospital. She talked me into splurging for a rideshare to the closest ED, if only to pause her incessantly dialing. I suppose that’s what I deserved after one too many blacked-out calls complaining of disabling nausea and shooting chest pains. In her defense, I tend to phone her solely with insufferable news. I’m a glutton for it. Call it bitterness, but even at twenty-eight, I desired some sort of reparations in the form of concern, making up for years lacking in parental guidance. If the last year of hospital visits didn’t come up with any answers, I held little faith I would find them now. It felt like I had just reached a new undiscovered tier of sick, a new level of tomfuckery.

I drifted in and out of the nurse triage, the waiting room, and finally pulled into the main ER. Still drunk and disoriented, booze sweat drenching my clothes - piercing me as it shook hands with the unsympathetic central air conditioning. There was a part of me that just wanted them to find something wrong with me, anything to pull me out of agitated alcohol withdrawal and swaddle me in a gurney. There existed a deep knowing that what my body was experiencing – unprecedented fatigue, seizing chest pain, strained breathing – was beyond the scope of late-stage alcoholism. No reprieve came from drunkenness, no respite found in a bottle. The only remaining move in my playbook was getting myself to the front desk. If no reason existed for admission, I earnestly questioned my ability to make it home.

The incessant sound of vitals signaled through my curtained “room”, alongside an orchestra of beds and their subsequent heartbeats. My ears darted back and forth, from each mechanical rhythm, trying to identify my own life song from the patchwork of pulses. It was difficult to think outside the rhythm of air being forced into my lungs like an unwelcome intruder. I could make out an ultrasound on my left and the doctor peering at me over the NIV mask, “This may be shocking news ma’am, but I must inform you that you’re in heart failure and experiencing cardiogenic shock. We are taking immediate steps to provide necessary medical care”. The swollen balloon of my left ventricle rhythmically mocked me on the screen above; this was not the kind of “something wrong” I was hoping for.

Imagine a water bottle. It’s a cheap water-bottle, the disposable kind found in 24-packs at Costco. The lining is pliable plastic, which you can easily squeeze and send water plunging out of its open bottleneck. That’s the chambers of your heart, assuming you’re in moderate or acceptable cardiac health. It’s lean and efficient striated muscle, churning the blood of your four-chambered casing. My heart has worked more than its fair share of nightshifts. It has danced way past its bedtime, and those muscles grew thick and immobile – like a sturdy water bottle, meant to endure dishwashers and backpacking trips. Those bottles might be durable but try squeezing a Nalgene and seeing if the water comes squirting out the top. My heart pumped at a mere 15%. I asked the technician if this was bad since it’s easy to misinterpret medical analysis. “I saw 13% once” he replied. Somehow that wasn’t very encouraging.

Dr. Google had become my nighttime reading during my stay. I learned how chronic congestive heart failure brings a slower, more painful death than a heart attack. When the distressed heart cannot pump out all the blood inside it, the blood backs up into veins and leaks through small vessels; tissues swell painfully. The heart beats faster; the patient strains in a futile attempt to get oxygen; the kidneys and liver fail. Starved of oxygen, so does the brain.

How could I resist doing blanket research on my newfound diagnosis? It didn’t feel morbid, it felt inevitable and realistic. It was my way of balancing out the shoulder angel chanting delusional messages of immortality. You are Leeba. You are the bull in the china shop, the sacrificial healer, the stubborn redhead, the one who speaks with their hands and chants with their feet. You’ve asked the big questions and read the right books. You have stared into the face of life! All my “vibrant” life experience, all my occult studies, world travels, hitch-hiking, meditation dabbling; all these small individual puzzle pieces that provided some semblance of comfort, some half-hearted illusion of substance or meaning, were all shattering before me. The “story” of who I was began melting away.

After being transferred from two other hospitals that couldn’t adequately treat the severity of my condition, I made my home in the Ochsner transplant ICU ward, which sits blocks from the Mississippi River. During my month-long stay, Hurricane Barry traversed the vast ocean in our direction, prompting the levees to lift for the first time since Katrina. Staff started sleeping in cots set up in the temporarily closed hospital café. The nurses were abuzz, gossiping about boarded up houses and coworkers stuck in surrounding flooded towns, but I was filled with a silent electricity. My speech and demeanor adopted a patience and graciousness I had never known. From the 7th floor I watched the thick paned windows shrouded with rain, looking like stained glass, deep muted blues cascading down its siding in sheets. It was overwhelmingly clear that this was my moment of surrender; to let go of fear, let go of control, let myself make the most of whatever time I had left.

Without knowledge of its inception, there had grown within me a need to find gratitude for the gravity of my situation, to put end to the constant running my life had dissolved into. From one coast to the other, from one relationship to another, to the middle of nowhere to live off the land, to the bustling streets of big cities, constantly searching for my external environment to change my insides, without doing the internal work necessary to make a different life for myself. It somehow felt like poetic symmetry that alcohol dependence, likely a factor in the progression of my heart failure, was also the inspiration for the gratitude I now felt. I had been in and out of recovery treatment programs for over a decade. I had tried meditation-based recovery, science-based recovery, twelve step, DBT, CBT, harm-reduction, the list goes on... I could never string enough dry days together to move past the tumultuousness of early recovery. I never had enough time sober for the shame to begin lifting. Guilt, shame, and insecurity couldn’t hold a candle to the urgent desire for sentient participation found in the wake of my diagnosis. If the only thing that could pull me out of my addiction cycle was getting a wake-up call this loud, then it still meant whatever time I had left would be collectively more valuable than the last decade. The fact that my diagnosis ultimately facilitated a changed relationship to alcohol, was an essential element of its silver lining.

Memory quilts weaved their way into my consciousness. Every four hours a nurse came in to check my vitals, empty my catheter, give me medication, and blow up the Swann inserted in my jugular: a thin tube which passes through the pulmonary artery, and into the right side of the heart. It was equipped with a small balloon, that inflated inside my heart chamber, measuring the resistance of it pumping against the mechanized inflation. It sounded more like a carnival clown’s balloon trick than a medical device.

All the hours in between were filled with a phantasmagoria of recollections, shifting evocations; many innocent in their weaving, but cruel and melancholy in their unearthing.  Drinking was always supposed to be something I did until I got enough love, enough validation, enough courage to live untethered from a tumbler. Every year, the more I leaned, the farther I was from standing on my own. Smoking, drinking, late nights, long shifts; these were all expected to shed days and months off my life, but I always imagined the moment my world would turn for the better, a moment which consistently existed in tomorrow.

I had dangerously high hopes for myself growing up. I was raised in a supportive, multi-generational cohousing community. I wasn’t “an accident”. I was the only child of two older and settled pseudo-hippies who spent the first few years of my life not working to prioritize all their time and attention for me. I went to interesting summer camps, I skipped grades in school, I was passionate about art and music. Despite all this, I was absolutely a feisty kid – which is the nice way of calling a kid an asshole. I was by no means any teacher’s pet, but I also was told endlessly that “I could do anything”. These are dangerous, dangerous words.

I know I’m not special or unique that my family fell apart. When I moved with my mom into the city, away from the community, there were many reasons my adolescent self grabbed onto alcohol and never let go. I wanted to be accepted among my older peers, I wanted to access a fearlessness I couldn’t muster alone. It made me feel warm and confident and whole (until it didn’t). But somewhere in the back of my head, the words of my childhood always shook within me – promising a way out after the appropriate amount of havoc and mayhem. It was my invisible parachute, which would catch me if I strayed too far. The ripcord wasn’t pulled when I dropped out of school at fifteen or stumbled my way through abusive relationships. It wasn’t pulled when alcohol became the only consistent element in my life, or when it started making me sick. As my diagnosis sunk in, I realized there was no rip cord. There was no parachute. It took falling so low that the ground was imminent for me to take my life into my own hands.

There are many hours to memory sift when you’re stationary in a hospital bed. Shifting to age twenty-one, finally legally old enough to drink, I experienced my first delirium tremens hallucination, or “DTs”. Several days after my last drink – when the vomiting had quieted - came the onset of realistic auditory hallucinations. These spiraled into sleeplessness and eventually curtailed into vivid visuals with involved storylines. An entire book could be written on the plots and characters of my few episodes, but each would culminate in a singular, shared ending: I would be forced to accept some imagined delivery of imminent death, while simultaneously becoming something more beautiful than I was in life. Instead of donating my body to science, these delusions required me to donate my body to art. Several days into my first episode, while strapped in a hospital bed next to my anxiously seated father, visions of ornate walrus men danced through the room, singing as they sliced up my body parts. I could viscerally feel their cuts as they folded my dangling flesh, twisting each julienned sliver, making shapes like origami. In another occurrence – after nearly a week of sleepless psychosis - delicate moths filled my apartment, taking turns weaving silk thread through my person in beautiful patterns, with a final knot stitched around an essential bloodline. The moth started eating away at the silk as I lay there, feeling the sensation of thread moving in and out of my skin. The voices told me I had an hour until it would hit my carotid artery, causing me to bleed out. I turned on a favorite album, left a voice mail message for an important mentor figure in my life, and lay there calmly accepting my fate.

How do death-dealing hallucinations compare to a lucid terminal diagnosis? It still felt like my existence was being bargained over, with intent to transform it into something more beautiful. There was a great relief in brushing so closely against my own mortality that I could taste it. The urgency I felt within that reception delivered an enthusiasm for life, the likes of which I had never known. For the first time in memory, I had nothing to hide, and nothing to spur dishonesty. There was grief there too, there’s no denying that. I mourned all the time I had lost half-awake, but in place of fear was an invigorating freedom. Sweet apathy enveloped me – the force behind an unapologetic glance – not because I’d given up on life, but for all the small things, all the bullshit, all the insecurities that diminish.

Author Glennon Doyle writes in Untamed, “Woman have to almost die before we give ourselves permission to live how we want”. Facing my own mortality was the most life-affirming experience I could imagine. Doctors told me I wouldn’t survive the year without a heart transplant, and I’d be significantly delayed for eligibility because of my drinking history. With this in mind, I soaked up and drank in every moment with presence and cognitive awareness I could only conceptualize previously.

I spent the next year learning how to die. I returned to my hometown in the Pacific Northwest, fit with a bulky defibrillator vest and mobile IV pump to boot. In between seemingly endless Doctor visits, I directed my attention toward restoring tattered familial relationships and witnessed the transformation of my interpersonal bonds. I went to a healer armed with sharpened amethyst, used to cut invisible lifelines. I did a past life regression as I prepared to leave this one. I don’t know what I expected from these interventions, but I was apt to try anything.

My favorite activity during this time was taking long bus rides across town, equipped with oversized headphones set to high volume. I would shamelessly blast hip-hop and top 100, lip-synching as I swung along the overhead hand grips – tickled by the thought of living long enough to withstand hearing loss! Something about being in motion would quiet my customary internal chatter.

The months continued to stack. My transplant evaluation process was put on pause, talks of LVAD surgery slowed, and I began to handle medications without initial complications. By winter of that first year my heart had shown enough promise to receive an ICD and mitral valve repair, in quick succession. I took a part-time job and started dating again. Life returned to something less predictably finite.

I can’t say where this story begins or ends. As months turn into years, every memory leading up to diagnosis is recalled more and more like a dream. The revelations of early sobriety and seemingly terminal diagnosis become increasingly less palpable. I can feel the magic power of thoughtful presence slipping from me when I get caught in petty arguments or curse at traffic, but I earnestly try to hold onto the wisdom bestowed in the acute moments of my illness. Whether it’s glimpsed through the eyes of a loved one, or the experience of your own fragility, it’s within these frightening reminders of human vulnerability that we’re forced to evaluate our engagement. We find the only thing more glorious than a birth is a resurrection.

Leeba Laviolette (she/they) is a Nursing student and Hyperbaric Technician in Portland, Oregon. Their experience with heart failure ultimately drew them to the healthcare field, with intent to pursue a career in Hospice and Palliative Care.