What the Dying Heart Says

Toomey, John

Primary Category: Literature / Fiction

Genre: Short Story

Annotated by:
Miksanek, Tony
  • Date of entry: Feb-18-2015
  • Last revised: Feb-16-2015


The nameless narrator has been hospitalized for months. A terrible accident while driving his Jeep. He survived, more or less. The other occupants of the vehicle - his wife and two children - did not. He watched them die. A traumatic brain injury and locked-in syndrome have left him unable to communicate. Although his body is useless, he assures us that he is completely lucid and resentfully aware of his circumstances. He desperately wants to die and admits, "I am already dead with grief" (p. 245).

The medical team caring for him won't call it quits. The narrator's brother, Tommy, informs them that his sibling would not wish to be kept alive in his current condition. But Professor Carson, the attending physician, insists that treatment will continue because the patient is not dead. Only one doctor, a compassionate Croatian female intern, comes forward as an ally of the narrator. She wonders out loud, "What man would want to live? Now?" (p. 242).

Even as the narrator's physicians prepare him for a brain-computer interface, he voicelessly implores Tommy to "convince these bastards to let me go" (p. 244) - to no avail, of course. Dying of a broken heart and helplessly being kept alive despite a shattered one, the narrator is doomed to a survival he does not want and to remembering the gruesome loss of his family that he cannot escape.


This little story poses some big questions. Is there a "duty of mercy" inherent in the care of patients who are in vegetative states or locked-in syndromes? How do we define "survival" - complete (physical, psychological, spiritual), partial, or ill-advised? Are grief and profound loss kinds of chronic illness?

The medical professionals here are sketchy. The interns are described as novices who are arrogant and dogmatic. The Croatian woman is an exception primarily for her "precocious empathy." Professor-physician Carson is a formidale presence who seems unmoved by the patient's plight and Tommy's intervention. He believes that "the human capacity for hope is virtually bullet-proof" (p. 241).

This short story packs quite a punch of pathos and ethical quandary. Given its brevity and unique perspective, it would make good reading for medical students and residents rotating through ICU, neurology, and trauma services. It would also work well as a companion piece to The Diving Bell and the Butterfly and the story, Vegetative States.

Primary Source

Best European Fiction 2015 (pp 240-245)


Dalkey Archive Press

Place Published

Champaign, Illinois



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