Life lines

Authors don’t always get to choose the story they’ll tell; sometimes it chooses them. In these cases, the pen becomes a scalpel, surgically ridding the soul of a narrative metastasis that has taken over a life. Such is the case with “Sick Girl,” Amy Silverstein’s account of her struggle to survive with a defective heart, then living for 17 years with the uncertainty, responsibility, even agony of life with a donor heart.

For a law-student-cum-”sick girl,” Silverstein tells a wrenching tale, slicing down to the quick in her opening pages. She is packing her son’s things for a weekend away with his dad. “Today I create an illusion with a suitcase. . . . I will think of everything so this ten-year-old boy will be free to think of nothing: not my life expectancy, which ran out eight years ago, nor the handful of big-gun medicines I took this morning that forced me to the floor, a mommy-ball of nausea curled up on a damp bathroom rug.”

As Silverstein packs her son’s toothbrush, she contemplates suicide: “Staying alive in this body has become an obligation for me that continually raises the question of why. Why continue in a perpetual lifesaving marathon when there is no possibility of a happy, healthy end?” She intends to use her kid-free time to stop taking her immunosuppressants so her body can finally reject the heart, and she can shuffle off her mortal coil. “There will be no loving greeting for the returning football fans. There will be a death.”

Then Silverstein backtracks to her 24th year, when she develops chest pains and has random fainting spells. After an initial misdiagnosis, the New York University student learns that she has an enlarged heart, probably due to a virus. She is quickly sucked into the medical vortex and begins to fight not only for her life, but also for her still-burgeoning sense of self. “First-time patients like me were supposed to let go of their healthy selves like sand through their fingers. The loss had to be accepted right away -- with a bullet between the teeth, if necessary.” Though her body doesn’t reject the donor heart she receives the following year, her mind utterly rejects the “sick girl” identity, and she fights to preserve a sense of herself beyond her illness.

Silverstein ends up putting on a false front for years, trying to convince the world she is OK, then being angry when they don’t understand how sick she is. For a woman whose life was stalled just as it was starting, this immature response is perfectly understandable. But as a narrative thread, it quickly starts to grate. We want her to see beyond her own pain or identify other facets of it. Brief references to her savagely alcoholic mother suggest there are other issues that aren’t being addressed. Would she have been this angry and narcissistic if she hadn’t spent half her life fighting to survive? Or was the damage already done when her heart first skipped a beat?

The trouble with this kind of memoir is that there is often a disconnect between the high stakes of the story and the ability of its protagonist to translate that experience into a work of literature that will hold and transport readers. Silverstein’s prose is at best workmanlike, but her framing is masterful and the raw material is heart-stopping.