MICHAEL DOWNING

It was the third week of the fall semester. I was teaching two courses, and I’d already been absent twice. I was trying to figure out how to carry my book bag.

A few months earlier, I flunked a genetic test and learned that I inherited a mutant protein from my father. He was 44 when he died. I was 45 and healthy by conventional cardiovascular measures, so the first symptom would probably be my sudden death.

I opted for an implanted defibrillator. As a bonus, I was given a staph infection. In September, I puffed up, my surface temperature soared and an emergency explant surgery (the defibrillator was contaminated) left me once again at risk of sudden death. In a few months, the doctors would stuff another device into me — which also had to be yanked out (product recall). But for the moment, I just had a hole in my chest, a catheter sticking out of my forearm and a month’s supply of syringes and antibiotics. I couldn’t use either hand for lifting.

For one week, illness trumped every topic. Even the visiting nurses started dropping hints like, How about those Red Sox? My partner, Peter, offered to sling my bag over my shoulder and get me out of the house.

I occasionally shoved myself aside to think about Binny, the sister of a friend. I met her only once, but I was bowled over by her spirit. Binny’s own adventures in medicine culminated in a heart transplant — and she became one of the first transplant survivors to bear a child. Then her second heart failed, and her only hope was another heart and everything that surgery entailed. While I was in a hospital in Boston, Binny was in a hospital in New Hampshire, choosing not to undergo another transplantation. She died.

Peter was recalibrating my injection schedule so I wouldn’t have to shoot up on campus when I said, Binny.

Peter nodded.

I said, It’s hard to say if she chose to die, or if she chose her life. Peter didn’t say anything.

I said, I know I can’t imagine what she endured, but I think I got a little taste. It’s intolerable, and yet you can tolerate it. That’s what I learned. But tolerance is a failure to respond. And if you don’t respond to most of what you feel, what makes you know you are alive?

I could not articulate exactly what I knew, but I was certain I knew it.

I drove to campus, parked and grabbed my bag. I felt a sting in my arm near the catheter. To get the book bag on . . .

To read the rest of this essay, follow this link to the New York Times.