Cynthia Zarin's "An Enlarged Heart"

Cynthia Zarin finds meaning in patterns; the pieces collected in her recent An Enlarged Heart are retrospective exercises in patterning. Some of them are quite beautiful; others seem artificial. One piece, the title essay, which originally appeared in The New Yorker (August 18 & 23, 2003), is extraordinary. It’s about her three-year-old daughter’s battle with Kawasaki disease. A crisis memoir, it tracks the disease’s intensification, beginning with a cough, which, within a day, worsens (“That night, she wakes up every hour, coughing. The cough catches her throat, grips it, then lets go”). The next night, she begins to vomit (“She vomits again and again into the bucket, taking rasping breaths”). She’s taken to a health clinic in Provincetown. The doctor is perplexed. He prescribes Tylenol and Motrin. Her fever disappears. But next morning, she starts vomiting again (“On her back there are a few scattered red marks, as if a bird had walked along the short length of her spine”). Back at the clinic, “Her breathing is shallow, and she is whimpering.” A blood test shows nothing. “The rash on her back has spread to her stomach: small red dots just under her skin, from sternum to groin.” A massive shot of antibiotic is prescribed. Her rash worsens. By ambulance, she goes to the Provincetown hospital. The ER doctor makes a diagnosis: she has Kawasaki disease (“This disease, he says, is the primary cause of acquired, potentially fatal, coronary aneurysms in young children”). The treatment is a massive dose of intravenous immunoglobulin. She’s taken by ambulance to the Children’s Hospital in Boston. “Her hand is hot, her fingers like burning twigs. I hold on to it. I think, If this child dies, I will go mad.” The hospital’s “Kawasaki team” arrives and orders the dose. “The immunoglobulin drips into her arm. Her temperature drops, and for a few hours she responds. The fog lifts, and in those minutes we can see her, we get our child back.” But three hours later, her fever returns. The Kawasaki team prescribes a second dose. Zarin asks the doctor what happens if the fever doesn’t abate this time. “The answer is nothing. There will be nothing to do.” But the second treatment works. Her fever stays down. She recovers (“Her left aortic root may be slightly enlarged, but she’s fine”).

“An Enlarged Heart” is riveting. My coarse summary of it fails to convey Zarin’s racing thoughts and feelings, which she doesn’t shrink from nakedly expressing, even when some of them are irrational (“I think of a woman who wishes me ill, and I think, If something happens to this child, I will kill her”) and selfish (“I am ashamed of myself even as I think it that I am angry we are missing our time at the beach”). It gains immediacy from its adept use of present tense laced with flashes of hindsight (“Later, I will think, How did we know?”). It’s a re-living of the past as the present. That’s one of its most artful aspects – the way the past is grasped as the present. It’s also more linear than the other pieces in Zarin’s collection, which are written in a flickering then-and-now time-weave. But in her brilliant “An Enlarged Heart,” then becomes now. It’s an amazing piece.