The first rule after any operation is to be kind to your self.

I’ve struggled to be kind to myself for much of my life. More than ever, I’m trying to learn self-compassion. I wonder if it is mere coincidence that a guy who struggles with self compassion is having heart problems.

I found this moth dying in the trail on a crisp autumn day and immediately thought of a story that Marc-André Leclerc wrote for *Alpinist* 59 (2017), titled “The Moth.” [Photo] Derek Franz

With two aortic valve replacements by age 39, my third lease on life has already begun. It’s Easter Sunday, April 17, as I write this, an appropriate time to ponder the importance of new beginnings.

I feel as though I’ve been born at least three times now: biological birth, waking up after my first open-heart surgery in 2014, and again a few weeks ago on March 30. Each birth arrives with no small amount of pain and struggle, no matter how many times I come out the other side.

My first conscious memory from the recent TAVR operation—in which doctors went up through my femoral arteries in the legs to replace my aortic heart valve—is waking up on the operating table when they were finished.

I believe I was technically under “conscious sedation”—not awake in the sense of what we usually think of as “awake,” when we can see, hear and process our surroundings. The doctors explained that I would be asleep but not sedated so deeply that I couldn’t be roused easily, unlike the sedation required for open-heart surgery. (Think of the movie Inception, where the characters drop into successively deeper levels of a dream, each one harder to escape from.)

Immediately after the surgery, I woke with a jolt from a dream while on the operating table. I recall the sight of my right leg karate kicking the air(!) and the medical staff leaning back in surprise (Whoa!) to avoid the violent limb. The errant leg fell back to the table and someone bent over my groin to examine the damage, shaking their head. They had just finished stitching the incision and I’d reopened the wound. I fell back asleep (or was re-sedated?) and the next thing I remember is waking up in the cardiac ICU.

The wound continued to bleed for hours. A kind young nurse had to hold pressure on the wound for so long that she eventually put an IV bag on it to better maintain constant pressure in hopes of stopping the bleeding. Each hour people seemed more concerned about it. I was told to avoid moving the leg or risk tearing the wound worse.

Meanwhile, my arms were leaden. I could barely move them under their own power. I had two needles jammed into each forearm like metal splinters—an arterial line and an intravenous line apiece. Muscles cramped in my hands and all the way up through the shoulders into the base of my skull. The more I lay still, the worse the cramps constricted my upper body. I tried to meditate and accept the pain, like sitting in a tub of ice water up to my ears: Breath in. Exhale. Accept this mortal sensation like a bath. It will pass… But the ice water became fire, and, restricted as I was—wanting to toss and turn to distract myself—the flames licked at my limbs like circling snakes. After a while it grew so intense it felt like being burned at the stake. Shivers and panic coursed through my twitching body as I tried to lie absolutely still.

“Would you like some Tylenol?” a nurse asked. Yes.

When that didn’t help, they asked me to rate the pain on a scale of 1 to 10, with ten being the worst. Eight. Around then I lost control of my emotions and cried out in desperation. Embarrassed by my tears, all the emotions I’d been holding back for weeks finally burst and I cried even more. You pathetic weakling, my brain chastised.

Eventually, they allowed me one dose of a stronger drug to relive the pain. “Thanks to the opioid crisis, they barely give us Tylenol after heart surgery,” I muttered to my family sitting by.

Often it seems that my most painful moments in life are a result of standing in my own way, resisting the inevitable, unwilling to take a step I need to take. Moments when I don’t realize how much I’m fighting against myself.

Ultimately a key to calming the cramps was to have my arms repositioned. A nurse had suggested moving them earlier, but every movement seemed to bring on new waves of misery. I rejected the idea, until they had to move me onto my side for a scan. I couldn’t move my arm on its own, so the technician helped reposition the limb. It hurt worse for a few seconds and then the pain subsided like ripples on calm water. The process repeated for the other arm.

I was through the rabbit hole. Again. Reborn.

Morning after the storm, Wyoming, 2019. [Photo] Derek Franz

It’s strange to consider that this operation was medically necessary for my survival, yet in so many ways the 48-hour excursion to Denver felt like a mere hiccup in the flow of daily routines, an inconvenience, like a trip to the dentist (a rather intense trip to the dentist, but routine nonetheless). Without the operation, however, I would soon be on my deathbed. How easy it would be to dismiss the memory of it and continue on as though no miracle was performed; as if this were not my third chance at life? Too easy.

I’m trying to make this third life count. I feel immense pressure to make the most of it. And in that way, I continue to grapple with my mental health. In some moments I feel like I’m a waste of life; that I don’t deserve a second aortic valve; that haven’t done enough to make the world a better place; that I haven’t truly appreciated the talents and opportunities I’ve been given in the first place. What makes me so special that I deserve to continue occupying space in an overpopulated world that is threatened by climate change, over-consumption and war? I have no children to raise. I don’t perform any critical tasks for my communities. What have I done to deserve a third shot, more rolls of the dice at the craps table?

Standing on top of Big Bend Butte near Moab after climbing a classic route with a good friend a few years ago. [Photo] Nat Gustafson

I put immense pressure on myself to not fuck up, ever since I was a small child. It seems my primary struggle is that I have a relentless self-critic sawing away at my ear for every mistake, every stumble, every failed expectation.

On one hand, anyone hoping to achieve lofty things must hold themselves to high standards, but that doesn’t always mean the answer is to grind harder, lift more weights, eat less food, sequester themselves from all pleasure and companionship, etc. Higher standards include self-compassion, which might negate parts of the achievement plan at times. Besides, achievement is secondary to being a good person, and if I can’t forgive myself, learn patience for myself, how can I offer the same to the rest of the world? How can I honor the opportunity presented by this third chapter of existence?

By learning. Practice. Patience. Gratitude for simply being alive from one moment to the next. Breathing.

Most of my days now begin by writing over and over again: “Be kind to yourself.”

Rule #1 after heart surgery: BE KIND TO YOUR SELF.

BE KIND TO YOUR SELF.

No matter what.

Why is that so hard?

Rule #1 after heart surgery: Be Kind to Yourself