As the seasons change and we inch closer to Halloween, I have found myself reading the works of the great gothic writer Edgar Allan Poe, and am captivated by “The Tell-Tale Heart.” His story is about a man who does his best to convince the police, himself, and the reader that he didn’t just commit an unspeakable act of killing — even though he admits as much to the reader in the first paragraph.
While I hope this post doesn’t veer too far into dark and spooky terrain, I cannot stop thinking about Poe’s prose. The story hinges on Poe’s use of an unreliable narrator, a literary device, typically a character in a story that the reader cannot trust upfront because there is something uncertain, questionable, or untrue about the character’s actions. It’s also possible that the narrator has done something bad or deceptive and is trying to convince the reader otherwise.
Sometimes I think about pulmonary hypertension as the unreliable narrator of my life with this rare lung and heart disease. Prior to the hospitalization that would lead to my diagnosis, PH was certainly deceptive and did not announce itself in a straightforward manner — I didn’t even know it existed. It presented itself as severe asthma and doctors treated it as such.
Echocardiogram after echocardiogram, followed by a stress test (and another echocardiogram) would show regular heart response, if slightly elevated beating but no indication of elevated arterial pressures. Despite being prescribed in-home oxygen, PH did not enter my treatment plan’s lexicon even as my ability to walk the four blocks from the Metro station to my office continued to decline.
Poe writes of the narrator watching the old man in his bed: “he was still sitting up in the bed listening; just as I have done, night after night, hearkening to the death watches in the wall.” These death watches are described as beetles that folklore suggested live in old houses, their noises foreshadowing a death among the inhabitants.
This part of the story took me back to my episodes of what was then considered high-altitude pulmonary edema, and if I didn’t sit up right in the middle of the night, leaning over, the fluid in my lungs would create the sensation of drowning. I felt very much like the old man waiting for whatever near-death fate awaited me.
Poe’s narrator eventually follows through on his gruesome intent, taking the old man’s beating heart and burying it beneath the floorboards. It would be the ever-increasing “beating of his hideous heart” that ultimately seals the narrator’s fate as he cannot continue to bear witness to his own actions as the police remain in the house.
I am often preoccupied by the beating of my own heart. For as long as I can remember it always beat a little faster than normal, but not so quickly a cadence that it rang any PH alarms. Yet, I can’t help but think about the beating of my heart the night before I checked into the hospital. I was acutely aware of its sound, as though it was pulsating outside my body, growing louder like Poe’s “tell-tale heart” and slowly failing me while I was none the wiser. A night of sweating and pounding chest pains was enough to get me to check into urgent care the next morning. Nearly a week later, I would learn the truth of my unreliable narrator and the beating of my heart would never feel or sound the same again.
I see many parallels between a rare, progressive chronic illness with no cure and an unreliable narrator that might not always deliver on what the reader expects. I recall being thrown off by the different accounts of life expectancy, being told that I could leave the hospital but there was a very real possibility I could be back again, not to mention the uncertainty that can come with the high costs of prescription drugs to treat PH.
With good days and bad days, this disease also looks different in each patient. Its progression takes us all on our own journeys, and I am doing my best to maintain my own sense of reliability in my narrative.
An unreliable narrator like PH can be scary, unsettling, and often makes me feel alone at times. While this uncertainty can breed fear, I do everything to make sure it is not the overarching character trait moving my plot forward. A little hope and some optimism can go a long way to quiet those deathwatch beetles rattling in the background.
I am excited about planning my next trip to Baltimore to visit the Edgar Allan Poe House, explore more of his literary works, and continue this PHight with my own unreliable narrator. Happy Halloween!
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Note: Pulmonary Hypertension News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Hypertension News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to pulmonary hypertension.