Ann Patchett Tells Everything She Knows About Love After learning that her boyfriend of 11 years has a potentially fatal heart condition, the author wonders—is it possible that anxiety ends at the moment when we no longer have time for it?

Karl decided to go to the Mayo Clinic to have a physical. He’d never done anything like that before. In fact, like many doctors, he never got physicals. If he made an appointment to see one of his medical partners, he’d wind up never going, and if he did go, they would just sit around and talk.

“Is everything all right?” I asked.

He told me he was fine. He’d only be gone one night, and no, he didn’t want me to go with him.

It was the beginning of March. I drove him to the airport early in the morning. He didn’t call until that night.

“Well,” he said. “I failed a test.”

I was standing in front of my living room window, staring out at the pitch-black dark. “What test?”

There had been an abnormal treadmill test, and then an echocardiogram that showed his heart beating at half its normal function. The left ventricular ejection fraction was at 25 percent. Normal was 55 percent. They had scheduled an arteriogram for the morning.

“I’m coming up,” I said.

“Don’t come up,” he said. “We’ll know more after the test. Anyway, there’s supposed to be a blizzard.”

I was pacing a circle through my house: living room, kitchen, dining room, living room, kitchen, dining room, while my dog followed behind. Neither Karl nor I was alarmist by nature, but I was feeling decidedly alarmed. I was at the airport first thing the next morning.

“The plane might get to Minneapolis,” the ticket agent told me. “Might. Or they could close the airport, and you’ll get rerouted. But even if you make it that far, there’s no way you’ll get a connecting flight to Rochester. It’s a whiteout.”

I said I’d give it a try.

All these years I had thought to be afraid of only one potential ending: By not marrying Karl, we could never get divorced. By not marrying him, he would never be lost to me. Now I could see the failure of my imagination. I had accounted only for the loss I knew enough to fear.

The flight to Minneapolis was delayed indefinitely. “The way things are looking up there, we don’t know when we’ll be able to go,” the agent announced, but then two minutes later she said, “Let’s go right now.”

Clearly, this was a plane full of Minnesotans going home, not Nashvillians heading north. Everyone trudged on board without blinking, and we flew away. “Lotta snow up there,” the pilot said.

In Minneapolis, the situation had grown worse. There were maybe 20 of us waiting for a small commuter plane to Rochester while we watched the snow beat into the windows. Rochester was having its worst blizzard in ten years. I looked at my watch. Arteriogram time.

The pilot came and stood behind the ticket counter. “It’s bad up there,” he said. We stared back at him, buried in our coats and hats and scarves. “What do you say? Give it a try?” We stood up together, all of us one unit. We wanted to try.

Of course you know the plane did not go down in the blizzard—this is a true story, and I am here to tell it. But it occurred to me for the entire 50 minutes of the flight that my being killed while trying to get to Karl, who was sick, would place a burden of irony on the rest of his life. I was in a single seat, and in the single seat behind me was a father who was loudly threatening his two sons across the aisle. The two sons, who were maybe 10 and 12, were beating each other, smacking and pinching and screaming like a couple of wolverines. Between the father and the sons, it was the worst behavior I have ever seen on a plane.Then, suddenly, all three of them stopped. That’s how bad the flight was. We were pitching sideways through the snow, plummeting, climbing, and in the same instant they each put their hands in their laps and did not make another sound.

How the pilot saw the runway, I will never know. We were in the air and then we were skidding to a stop and the passengers clapped and cried. “We’re here,” the pilot said. “Last one in. The airport’s closed.”

I made it to Karl’s hospital room about 30 seconds before they wheeled him in. “See?” he said to the nurse. His voice was bleary from anesthetic. “Didn’t I tell you she’d be here?” He took my hand. “They said, No, she can’t make it. They said everything’s closed. And I said, You don’t know Ann.” And then he drifted off to sleep.

Explain doubt to me, because at that moment I ceased to understand it. In return I will tell you everything I know about love.

They found no blockage in the heart, no arteriosclerosis. It was a parvovirus. He had a cardiomyopathy. The cardiologist explained to me that nearly half of the muscle tissue in Karl’s heart was dead. They would put him on a beta blocker called Coreg for the rest of his life. If his ejection fraction, the volume of the blood the heart was able to pump, fell much lower—say, to 20 percent—he would be eligible for a place on the heart transplant list.

I asked the doctor if there was any chance that the situation could improve with time.

“Heart muscle tissue doesn’t regenerate,” he said.

Two days and many tests later, we were in the airport in Rochester for a flight back to Nashville. The snow had stopped and was now plowed into towering banks. Karl and I stood together at the window, his arm around my shoulder, looking out across the field of white. “I guess when we get home, we should get married,” I said.

Karl nodded. “I think so.”

“I’ll put my house on the market.”

“Good,” he said.

And that was it. After 11 years of discussion, there was nothing more to say. “Every relationship you will ever have is going to end,” my mother had told me. If Karl needed my help, if there were decisions that needed to be made in a hospital, I could do nothing as his girlfriend. He needed a wife.

Whatever had been wrong with Karl’s health before, the Coreg made worse. He had trouble catching his breath, he had a hard time going up the stairs, he wasn’t to lift anything. Literally, he was gray.

Karl’s illness gave us an enormous get-out-of-jail-free card where a wedding was concerned. We told our families that we were going to get married but that there would be no party. No invitations, no dress, no lists or rentals or presents, which blessedly meant no thank-you notes. My stepsister Marcie listed my house, and four hours later it had sold. I moved what I owned using four boxes. I filled them up, drove to Karl’s, unpacked them, drove home again, filled them up, drove back, unpacked them. I looked around Karl’s house now as a resident instead of a regular weekend guest. For the first time, I noticed how much empty space there was, empty closets, entire empty rooms. “It’s like you never actually moved in,” I said, though he had been there for nearly ten years.

“I didn’t want to do too much before you got here,” he said.

We asked a friend of ours, a Catholic priest who ran a homeless shelter, if he would marry us. He said he didn’t marry people.

“Perfect,” I said. “Just swing by the house and sign the papers, or I can bring them to you.”

We got the marriage license, which in the state of Tennessee is good for a month, and then one day our friend called and said he was going to a Kentucky Derby party in our neighborhood. He could come by. He sat in the living room with us for a few minutes and said some nice things about love, drank a glass of cranberry juice, signed his name, and went off to his party.

Is it possible that anxiety ends at the moment when we no longer have time for it? I had waited to marry Karl until I thought he was going to die. At night, we’d lie in bed in the dark holding hands.

“I’m such an idiot,” I said. “We should have done this a long time ago.”

“It’s exactly the right time,” Karl said.

Two things about marriage surprised me. The first was that I discovered Karl had been holding out on me. He actually loved me more than he had led me to believe. This is not to say he hadn’t loved me for the past 11 years, he had, but there was a portion of himself he kept to himself, thinking that if I wouldn’t marry him then chances were, at some point, I would go. It was like finding another wing in a house you had happily lived in for years. It was simply a bigger love than I had imagined. The second thing that marriage changed was that it opened up an enormous amount of free time. We no longer had to have the conversation about why we weren’t married, neither with each other nor with the world of people who constantly inquired. I’d had no idea how much time we’d spent on this topic until it was abruptly removed from the lineup.

Other than that? We were pretty much the same.

He had stopped taking the Coreg.

“You’re supposed to take it for the rest of your life,” I said, feeling a wave of panic building far, far from the shore, a wave that by the time it was fully realized would be big enough to crush the city we lived in.

Karl shrugged. “I really didn’t like it.”

“You probably wouldn’t like dialysis either, but that doesn’t mean you can stop.”

“Well,” he said, “I stopped the Coreg.” Frantic, I went to talk with one of the cardiologists in Karl’s practice, who backed up Karl like a brother-in-arms. “I never thought Mayo was right,” he said.

Mayo wasn’t right? Was that even one of the options? Karl was supposed to go back to Rochester for a follow-up appointment, but he never seemed to get around to it. Finally, after a great deal of begging and foot-stamping on my part, he agreed to have another treadmill test and echocardiogram in Nashville. The results were normal. Ejection fraction normal. Heart normal. “Everything’s fine,” he told me. Dinner is on the table. The phone call is for you. Everything is normal.

I blinked. “We have three absolute truths,” I said, holding up three fingers for visual reference. “Absolute truth number one: Half of the muscle tissue in your heart is dead. Absolute truth number two: Heart muscle tissue does not regenerate. Absolute truth number three: There is no dead muscle tissue in your heart.”

“Correct,” my husband said.

“But it can’t be correct.” I wasn’t the doctor, but this did not strike me as complicated. “One of those three things can’t be true, and I want to know which one it is because if it’s the third one, that’s a problem.”

“It’s not a problem,” he said. “Everything’s fine.”

We continued to have some version of this conversation for a long time, and it never came out differently. As far as Karl was concerned, the news was good, and he didn’t care why.

Karl’s complexion pinked up. He had no problem going up and down the stairs. He started carrying his own luggage again. “Why do you think you finally changed your mind and decided we should get married?” he asked me one day.

I looked at him. “I thought you were going to die,” I said.

“You married me because you thought I was going to die? It wasn’t because you loved me?”

“Of course I loved you. I’ve always loved you. But you asked me why I married you.”

In fact, even as Karl’s health continued to mysteriously improve, I still found myself lying awake at night, worrying that he was going to die. Stay like this, I would think to myself as I watched him sleep. Stay here, in this exact moment. I tortured myself over what awful thing might happen in the future instead of being wholly present and thankful for this moment. I realized that by not marrying Karl, by never allowing myself to be in the position to divorce him or to be divorced by him, I thought I had tricked fate. But in the wake of this commitment, I was flooded with thoughts of what I wouldn’t be able to control.

I wish I could say that we came to a point where the matter of Karl’s heart condition was properly resolved, but really, it never was. I once told the story to a doctor who explained that if the parvovirus was still active when the tests had been done, the heart could have been stunned, rendering the muscle tissue temporarily paralyzed rather than dead. Another doctor, a cardiologist I sat next to at a post–bar mitzvah luncheon, told me that it sounded to him like Karl wanted to get married and had run out of ways to ask me.

“He didn’t fake it,” I said. “I went to Minnesota. I saw the films.”

“I didn’t say he faked it,” the doctor told me. “But the heart wants what it wants.”