The writer, David Toms (from Waterford, living in Norway), has a rare congenital heart defect called transposition of the great arteries. For people with transposition the aorta and pulmonary artery are inverted, so that much of the blood running through their bodies is deoxygenated. As children this turns their skin blue at the extremities. The official medical term is ‘cyanotic heart disease’ from kuanos, the ancient Greek word for dark blue. Surgeries and medications treat the condition to some extent, but it is a lifelong illness that affects someone’s whole existence in ways big and small.
Pacemaker is Toms’s memoir of life with transposition of the great arteries. But it is much more than that because it is also written with great artistry. Instead of the usual beginning-to-end narrative the book is divided up in loosely chronologically ordered vignettes (lots of one-paragraph pages) around thematic subjects such as his teenage experiences, the awkwardness of having an unseeeable disability, the effect of illness on his romantic life, and the pleasures of walking.
The best part of the book, near the end, covers the period in early 2020 when Toms caught Covid-19 and was seriously ill. His partner, Miriam, and his mother, Maria cannot visit him in the hospital but get daily updates by phone from the staff; he prints their texts to each other.
The next few years will be full people insisting to each other that, yes, despite what you may think, in this or that book the part about Covid-19 is actually very good. Here I insist. The Covid-19 part is extremely good. The reason why it works is that Toms uses the texts between Miriam and Maria to introduce, and for the most part tell, the story. The first ones effect a significant change of tone from the pages before, as if walking across the book suddenly you fall into a drain. They also, by depriving readers of the narrator’s voice, put them in the same position as Miriam and Maria: uninformed but needing to know. When the narrative voice finally reappears, there is such a release of tension that Toms’s gains a charge of powerful feeling.
The sequence is enough to compensate for the book’s ending, which is an anti-climax. Obviously, Toms recovers – otherwise he would not have written the book – and that makes a formal problem because recovery is not the same as growth, and the drama of illness is not like a hero’s journey. The ending’s tone has too much of a ‘that’s over, back to normal’ sort of a feeling. In storyboard terms, it is less an arc than a boomerang.
In one place in his book of aphorisms Kafka wrote, “‘And then he went back to his job, as though nothing had happened.’ A sentence that strikes one as familiar from any number of old stories – though it might not have appeared in any of them.” It certainly might have appeared at the end of Pacemaker.
Probably what Toms needed to do was introduce some new element or point of view that could reach some further climax beyond the personal intensity of being hospitalised with Covid-19 (in Angels in America for example, Prior recovers from AIDS and so the play’s climax comes from one of its side-plots as well as a sweeping call-to-arms for the 1990s gay civil-rights movement).
The book is well-written throughout and not over-written. What carries the writing is less the idiosyncrasies of the prose than the way in which details become charged with meaning enough that they turn into symbols. Toms then reintroduces these symbols at moments of high impact. That said, the book’s most effective symbols are not details but mantras. The best of these is the book’s first line: ‘Every time I write about my heart, I write about walking. Every time I write about walking, I write about my heart.’ This might as well have been ‘Ōṃ.’
The writing is blunt sometimes where Toms explains himself with a short ‘sum-up’ sentence, often at the end of a paragraph, that tells the reader what they are meant to take as the point of everything that has gone before. Here is the end a paragraph in which Toms describes making a walking stick:
“It takes weeks. Patient waiting. The drying process. The removal of the bark. It is best to do in springtime when bark has not yet dried in and a stick is easily shorn. Then you must treat the wood. Resurrection is a process”.
These words have a lovely whispering sensuality; but ‘Resurrection is a process’ undermines it. ‘Abstract Noun X is Abstract Noun Y’ – nothing of what comes before entitles Toms to make this jump straight from the realm of things to that of historically passed-on notions and abstractions. The only means by which writing ever can expect to pass to the transcendent realm is through the backdoor of the immanent. It would have been better to continue describing in more detail the treatment of the wood: to let it stand for itself as its own idea, its sense smaller and larger than any of its interpretations.
Overall this is a sensitive and carefully written book worth reading. It is not an easy sort of book to write because of the temptations of false authority. In real life people who suffer for reasons beyond their control always deserve sympathy and respect. But literature is more cruel and no matter what, every narrator must work for their reader by being some combination of beautiful, interesting and manipulative.
Pacemaker is sometimes beautiful, often interesting, and always manipulative in a way that makes it a success. I do not have a heart condition, but I identified with the scenes from Toms’s childhood and teenage years, as well as the few mentions of his experience studying at university. They made me see bits of my past differently and understand them better. That was because of Toms’s skill at literary manipulation: finding in such moments things that resonate enough for readers to allow an author to tell them what to imagine.