The Gift

Donald J. D’Amico, MD

he normal aortic valve is the size of a silver dollar when open, and yours is less than a pencil. It could close completely any day.”

I had been diagnosed twenty-eight years earlier with an asymptomatic congenital abnormality of my aortic valve. My valve had only two cusps whereas the normal valve has three cusps. The turbulence that occurs with a bicuspid valve causes it to progressively calcify in the great majority of patients; this accumulation of calcium gradually reduces the valve’s size when open and its ability to function properly, a condition known as aortic stenosis. Given that patients with aortic stenosis are at risk of fainting spells, bouts of weakness, or even sudden death due to restriction or cessation of blood circulation, I had been told that I should receive an echocardiogram every two years to follow my condition.

I was completely asymptomatic, busy, athletic, and—perhaps sadly predictable—a physician, so I ignored this important recommendation for almost three decades, relegating it to a footnote in my otherwise quite fortunate medical history. However, during the chaotic activity of my life in our medical center during the COVID pandemic, I began having episodes of tachycardia, and after toying with dehydration and possible COVID-related effects as excuses, I finally got around to my ridiculously delayed monitoring echo in 2024. To everyone’s surprise given my relatively minimal symptoms, I was found to have extremely severe aortic stenosis, and for a variety of reasons, an open-heart aortic valve replacement was recommended, to which I immediately agreed.

Confronting such a formidable surgery, like encountering a grizzly bear on a casual hike, has a way of rapidly, i.e., convulsively, rearranging one’s priorities. I decided at once to be quite transparent about my situation with my family, friends, faculty, and colleagues, and this mobilized a tremendous amount of support. Indeed, I had extraordinary, I would say, unequalled advantages going into my surgery: I am a surgeon married to a surgeon; I have had a visible leadership role in our medical center for over seventeen years and was confident of its superb reputation and its passion for safety; I knew my surgeon as both a world expert in aortic procedures and as a friend; and dozens of highly skilled physicians and medical center leaders made themselves available to me for whatever I might need.

While I knew from my general medical knowledge that my odds for a successful outcome were excellent, my experience as a surgeon has taught me that complications and unexpected problems can always occur even with the most favorable candidates for a given operation. In fact, surgeons have something of a superstitious anxiety when taking a “straightforward case” to the operating room as disasters in this group seem to occur with distressing frequency; I have certainly had my share of experiences with this unfortunate scenario in my own practice. The list of rare but serious complications of an open aortic valve replacement includes not only fatality but other debilitating events such as stroke, myocardial infarction, arrhythmia, pulmonary embolism, and others. As a result, despite my advantages as a patient, for the first time in my life, I felt the full force of confrontation with my mortality.

At first, I found that my attitude alternated between fear and poignant sadness. These feelings were soon tinged with overtones of guilt and shame in the face of many unfinished plans and revolving dreams. There were so many things I had been planning to do! Suddenly, my comfortably vague timelines had shrunk and hardened into a few weeks. Gurdjieff had cautioned us that “tomorrow” is a disease and a pervasive one:

Thanks to the disease ‘tomorrow,’ the three-brained beings there, particularly the contemporary ones, almost always put off till ‘later’ everything that needs to be done at the moment, being convinced that ‘later’ they will do better and more.[1]

My impression of my scattered self in those early days after the severity of my condition was known led to an undeniable self-diagnosis of tomorrow syndrome. Indeed, without any warning, I suddenly had two diseases. Fortunately, this anxious state and its grip would not persist as I readied myself for surgery.

Given the certainty and essentiality of death in the human condition, it is woven deeply into religions and spiritual traditions by beliefs, prayers and meditations, services, customs, music, and visual art. Several specific practices emphasize the extraordinary value in keeping one’s mortality actively in mind. The Trappist monks’ greeting “Memento Mori” (Remember: you are dying), mutually offered as they pass in the monastery, is perhaps the most famous. Gurdjieff highlighted a practice of death awareness several times in his writings—and undoubtedly on many occasions in his meetings:

One of the aphorisms on the walls of the study house in the Prieuré: “One of the best means for arousing the wish to work on yourself is to realize that you may die at any moment. But first you must learn how to keep it in mind.”[2]

The sole means now for the saving of the beings of the planet Earth would be … that every one of these unfortunates during the process of existence should constantly sense and be cognizant of the inevitability of his own death as well as the death of everyone upon whom his eyes or attention rests.[3]

Only the complete realization by man of the inevitability of his own death can destroy those factors, implanted thanks to our abnormal life, of the expression of different aspects of our egoism, this cause of all evil in our common life. Only such a realization can bring to birth again in man those formerly present, divine proofs of genuine impulses—faith, love and hope.[4]

Personal experience confirms that acknowledging the value of visualizing one’s death is easily done in theory; putting it into practice is quite another story. Primordial components such as our reflexes and hormones are central to our makeup and are greatly strengthened by years of participation in every possible experience. When we are challenged in some way, a lightning-fast combination of thoughts, feelings, and physical actions urges us to clutch at life, flee danger, and avoid pain. With such iron-clad organic responses, it seems reasonable that we would also have an aversion to giving our death much thought, and common wisdom suggests the thoughts we do attempt are unsettling and quickly dropped. Yet if there is a hidden power in confronting such a primordial barrier, where could the energy to face it be found? Could approaching the vision of my demise openly and bravely become a pinnacle exercise of another of Gurdjieff’s Prieuré aphorisms: “Like what ‘it’ does not like”?[5]

I am confident that there are dedicated adepts in many spiritual traditions who have developed a sincere relationship to mortality from focused and wisely guided search, but that was not my experience. A strong shock was needed, and even the word “needed” is inaccurate because, like most shocks, it was utterly unexpected. Indeed, the new currents that facing death could open, and the need it could fill, were found only in the experience of being taken to that view by force. In quiet moments I discovered I wasn’t completely unprepared. As noted above, I was aware of the importance Gurdjieff placed on an active confrontation with one’s own death and the death of everyone in our view. I had visited, first as a snickering young tourist and much later for a second more respectful look, the Capuchin Crypt in Rome with its graceful though macabre wall and ceiling patterns fashioned out of the clavicles, vertebrae, thigh bones, and indeed every skeletal part of scores of deceased monks. Reflecting on what I saw, I asked why were these eminently holy monks placing their bones in elegant but disturbing traceries on these walls for us to view? I had also been fortunate to visit the meditative caves near the Great Lavra monastery in Mount Athos and accompany a young monk who was about to begin his life as a hermit in a cave. This small rocky cleft had newly become available with the death of its former occupant. I recall trying to absorb an impression of him in this barren setting, praying almost unceasingly in front of a simple icon of the Virgin lit by a candle, having only some rag like clothes and bedding, and with his rope basket that would sustain him until his dust and bones joined those of his predecessors in the cave. Though I am not drawn to asceticism, I was deeply warmed by the palpable fire of his devotion to his prayers.

* * *

In this period after my diagnosis, I found myself energized to experience again the loss of my father at age eleven (the deepest wound of my childhood); the much later death of my mother who sustained our family by love, selfless effort, and personal deprivation; and recently the passing of my beloved older brother who had been my best friend and father-substitute for a lifetime. In truth, I can’t fully recall and certainly cannot account for all the elements that participated in the inner reception of my new shock, but I found a wish to move closer to my fears and impressions, to try to make the best of my possibly limited time.

A wish to embrace, to see, to live my experience—the worried contact with fearful family and loved ones, my concerns for saddling family with the stress of untangling our finances and innumerable mundane affairs, my fears of leaving struggling family members and friends in the lurch without my watchful support, the irrevocable loss of future experiences like weddings, grandchildren, and all the rest—this wish appeared with a clarity that was increasingly deepened and welcomed.

This surprising new posture brought about several actions in my outer and inner life. I was able to relaxedly organize my documents and finances and calmly share details with my wife and oldest son. I placed my massive collection of family and nature photographs (I am an avid photographer) in crisply delineated files on my computer and handed backup drives to my family, and I recall smiling with the knowledge that the great majority would become trash, as other family members’ photographs had for me. I divided my patients among my colleagues and reflected with gratitude on the fulfillment my patients provided by trusting me with their care. I practiced my learned-late-in-life Italian and engaged my lifelong love of languages which has always seemed to be an essential part of my nature. I tried to visit or call my closest friends and arranged family dinners and get-togethers, including a wonderful weekend with everyone just before my surgery; it proved to be notably festive and not gloomy.

I even honored a wish that bubbled up out of nowhere to delay my surgery a couple of weeks to see the total solar eclipse in Dallas. I had seen my first in Prince Edward Island in 1970 during spring break in college and have never been able to shake my fascination with the extraordinary celestial display, feared in ancient times as the end of the world. For those who have never seen one, I must sadly explain that even a 99% partial is nothing like a total. When totality arrives, the sky goes dark, the wind changes, the birds stop flying, and horses whinny; in this dark sky, a magnificent corona of delicate lights appears around the darkened sun, and its previously invisible light illuminates the world with an all-encompassing gold-grey glow. My surgeon agreed to accommodate this brief postponement, and I flew to Dallas for that single day despite a dismal weather forecast; joyously, I was rewarded by a Red Sea-like parting of the clouds for a magnificent view in the critical few minutes.

With inner reflection came a call to meditate more frequently and to begin a re-read of Beelzebub’s Tales that I had long considered but put off for several years. Inexplicably to some, I discovered a re-energized wish to study the “technical” ideas and diagrams in the Work, ideas that to my experience can be an aid to opening one’s horizons. With all these efforts, I did not feel as though I was frantically grasping at urgent salvation like some sort of desperation pass in football; rather it was my considered reflection that these were simply the best things I could do with my remaining time.

On the morning of my surgery, while being wheeled in an upright chair to the operating room across hospital corridors and people well known to me, I tried to remain with my breathing as quietly and attentively as possible while I practiced a meditation known as the “I Am.” A few more greetings in the operating room itself, and then the anesthetics took me away. After the preliminary maneuvers to place various lines, monitoring devices, and creating an opening in my chest bone to expose my heart, my body temperature was lowered to 90 degrees and, for 81 minutes, my heart was stopped while the surgical team brought their magic to my core.

I recall opening my eyes in recovery and hearing my wife and oldest son exclaim “He’s awake!” I will embarrass myself with what happened next: after some quick kisses, I apologized to everyone that I wished to say a few words in Italian. This had been my prearranged plan to see if I was still able to think clearly, for if I could find my second language then I was probably mentally intact. (There has probably never been a language student who has felt such deep joy in correctly using the subjunctive!) In his memoir Gurdjieff: A Master in Life, Tcheslaw Tchekhovitch recounts a scene in which Gurdjieff, bedridden and minimally responsive for two months after an automobile accident, suddenly gestured for paper, scissors, and a pencil and began making animal cutouts and adding long columns of numbers. The clearly identifiable cow and horse he created, and the correct sums he calculated, were greeted with astonished and jubilant exclamations by the onlookers, e.g., “‘It’s a cow,’ we all say in the same breath.” [6] This activity continued as Gurdjieff reaffirmed his vital presence. In most respectful comparison, I think I understand something of his experience.

The operation was a success, and my recovery was remarkably pain-free, swift, and strong. This uncomplicated recuperation presented some unanticipated new inner opportunities and challenges. The encouragement to stand in front of the face of death has predictably changed as occurs, in my experience, with all deeply meaningful experiences offered to us, and I cherish, with the lightest touch of which I am capable, what has been deposited. My post-surgical state feels more like a beginning rather than a resumption, and for this reason, I am reluctant to harden my still unfolding impressions by committing them to paper.

Life, with all its joys, details, hopes, disappointments, and even its magnetic deceptions, progressively reasserts its energies; I welcome this with joyous though cautious relief. It is beyond glorious to be well and active again, but there are other inner things that are also important to me; their importance has been strengthened, and I do not wish to lose them in illusions of tomorrow and immortality. Like the sun on my face as I look across the landscape, life’s brightness and warmth are qualities I am by nature most reluctant to lose. Yet I have seen the eclipse and know it; a fearful approach of darkness that reveals a magnificent light, a momentary movement from concealment to discovery, a celestial event that illuminates the view with the rarest shade of sunlight and invites me to participate with gratitude and wonder. □

Donald J. D’Amico, MD, is Professor and Chair of Ophthalmology at Weill Cornell Medical College/New York - Presbyterian Hospital. He supervises physicians-in-training at all levels. Dr. D’Amico is a distinguished surgeon and lecturer and the recipient of many honors. He was the inaugural editor-in-chief of the Journal of VitreoRetinal Diseases and is a past president of the Retina Society and Club Jules Gonin. He began his participation in Gurdjieff Foundation groups in Chicago with Christopher Fremantle and has been a member of groups in Boston, Miami, and New York.