A Matter of the Heart

by Pavlo Matyusha

As you approach the age of forty, your heart and body may seem to be heading in different directions. To reconcile this, you have a choice: start exercising and take medication, visit your general practitioner or a cardiologist, or even consider a pacemaker. While the latter may be the most unpleasant option, it is ultimately the smartest one. Psychologically, it is easier to address this issue in your sixties rather than in your thirties. When faced with life-changing decisions, you can either take action or do nothing and hope the situation resolves on its own. However, it is better to address problems sooner rather than later, as time has a way of settling all things.

In Ukraine, we are currently faced with choices that may seem new but are, at their core, timeless. As I laid in a hospital room with three other men, I was reminded of this truth. One of my fellow patients was a forty-year-old man who had recently been drafted into the army. Despite his weight and preexisting heart issues, he did not want to shirk his duty to defend Ukraine from the greatest evil of the twenty-first century. Seven years ago, he was brought to the central cardiology clinic in Kyiv where his heart was shocked back into sinus rhythm. Four years later, the procedure was repeated. However, during basic training at the firing range, his heart failed and he was placed on a medical commission to be discharged. He ended up in the hospital, constantly being monitored and waiting for a psychologist's opinion that would grant him a one-way ticket back home. 

The other was a twenty-three-year-old man who was wounded during heavy shelling. He drove a float-bridge carrier and had previously worked as an ambulance driver. He was dealing with hypertension, as the thought of returning to the frontlines caused his blood pressure and heart rate to spike. After being wounded in his left arm–the one that had been sticking out the truck window when the shelling started–he was taken to a field hospital where he saw other soldiers with their intestines spilling out and bones piercing their skin. Due to his injury, he spent a month in the surgery department until his arm was functional again, and then received a one-month leave which he spent in his hometown of Lviv with his wife and seven-month-old daughter. However, as the days ticked by and his leave came to an end, he became terrified at the thought of returning to the hell of constant shelling and being separated from his family again. It felt like a vicious circle, as his heart beat faster and faster. Ironically, we would both be fine if someone could add up our beats and divide them by two - 60 or even 80 for each of us.

The moment of making a life-altering choice often depends on the depth of one's knowledge. As the lights dimmed in the hospital, the young truck driver admitted to me that if he had known in advance what he would see and experience in the war, he likely would not have gone to the conscription office back in March. This raises the question: Where is the limit of value-based, knowledgeable choices? And are less informed choices also less ethical?  Unfortunately, I did not have the chance to delve further into these thoughts, as the next day they moved him to a psychiatric wing. Later that day, he stopped by our room in a hurry as he had forgotten his ID and other important documents on the window sill. He told us that he would be moved to the capital later that evening for a final medical examination.

The new patient lying on the bed next to me was a study in stoic resilience. Despite having suffered a heart attack, he seemed to have adopted an air of elegant indifference. In 2015, he had been drafted into the army as an artilleryman, and had been shell-shocked multiple times, spending weeks in various hospitals. In 2018, he left the army to start working as a carpenter in Germany. He smoked and regaled me with stories of how he had been attacked by someone with a knife in 2005, a wound that had come dangerously close to his heart, penetrating his lung and filling it with blood. But he had refused to participate in the criminal case, knowing the attacker personally and even going so far as to visit him in the hospital. To him, it was all just a part of life's adventures. He hoped to live at least ten more years, despite being forty-one years-old.  I couldn't help but be drawn to his sense of dark humor, his flimsy optimism, and the fact that his name was Oleg, the same as the young driver who had been a patient before him. It made me wonder if they should put a plate above that bed simply reading "Oleg." It was a small detail, but it spoke to the larger truth that we are all just passing through this world, trying to make the most of the time we have.     

In the halls of military establishments, my fellow soldiers and I were taught the intricacies of psychological warfare in order to command effectively and maintain morale. One crucial aspect of this is securing the support of the civilian population. However, this leads us to consider the darker side of human nature: manipulation. In today's world, manipulation is so pervasive that it can be difficult to distinguish between what is real and what is not. We are forced to acknowledge that our perceptions of reality are fundamentally biased, shaped by the various strata of society we belong to: enemies, eyewitnesses, politicians, propagandists, bloggers, social media commentators, and so on. Our choices are determined by the reality we choose to inhabit.  

The irony of war is that it lays bare the fragility of democracy and the illusion of free choice. As a soldier, I have come to realize that during times of war, logic must supersede emotions. Democracy must always be logical, especially in a war manipulated by propaganda. Critical thinking is essential in such circumstances, serving as both a checkpoint and a powerful weapon. My experiences have taught me that irrational and poorly explained actions lead us away from the truth and from democracy itself. Propaganda thrives on emotions, while democracy demands logic. But how do we define ourselves in this world of manipulation and blurred realities? Through our choices, even if they have been shaped by generations before us. War, in all its tragedy, uncovers the fundamental truths about humanity. And yet, we still have a choice. We can choose to be rational and logical, even in the face of propaganda and manipulation, and strive for a more just and democratic society.

In the bustling surgery block, where I had an appointment with a renowned cardiac surgeon, I was met with a sea of wounded servicemen. Armless and legless soldiers, waiting in silence by the elevator on the ground floor. And then, with a sudden jolt of energy, a soldier in a wheelchair started rolling up to them. The group of five shouted at him, urging him to move faster. Together, with just two complete legs and four complete arms between them, they made their way into the elevator. 

As I walked past them and into the inner courtyard, I came across a young wife pushing her husband in a wheelchair. Both of his legs had been lost in battle. Even in the bitter cold of winter, the man was dressed in a sleeveless vest over a tshirt, his empty right sleeve a grim reminder of the sacrifices he had made. He smoked with his only remaining limb, his left hand, and other legless men looked at him with a mix of pity and admiration. I couldn’t help but wonder, did he or his family expect this outcome when he joined the armed forces? What would they have done had they known the true cost of his service?

Making the right choice for your health during times of war is no simple task. It’s an unexpected challenge, much like the sudden sound of shelling. It can force you to reconsider your previous decision to fight for your country, and it’s often accompanied by fear. It’s the fear of what’s yet to come coupled with the longing to take a step back and ponder your life choices.  

Well, life choices are not an easy game: they impact your heart, your life, and your country. 

But as Marcus Aurelius once said, all our decisions, urges, desires, aversions lie within us. No external force can touch them. I like this way of thinking. It means that our choices ultimately belong to us. As you take a walk, reflecting on your own choices, you can’t help but notice a man in a crowded city street outside the hospital, excitedly telling his friend about his transfer to the very regiment you’re waiting to join. It’s a reminder that your heart will be healthy enough to make the choice you know is right, and that you will not lose this battle for anything in the world.