The ER doctor tells me if I leave the emergency room without getting a transfusion I am at risk for a heart attack or stroke at any second. In fact, he says, they would like to admit me to the hospital and give me a transfusion. The red cell count for a man my age, 53, should be from 40 to 49; mine is 21.5. The iron saturation level for one my age should be from 20 to 50; mine is 3. Not good. Not safe. Just to top things off, an EKG reveals my heart has a blocked left bundle branch. I have a strange notion that if this kills me, I will have died from something in nature, a branch! They tell me the heart’s two bundle branches, left and right, are essentially your heart’s pacemaker. When one is blocked, it may be something you just live with and monitor if you are asymptomatic. It may also be a sign of underlying heart disease.

I am terrified. I want to go home and wrap my mind around what I am hearing. I think maybe the EKG was mistaken and someone will run in and say, Sorry there, Mr. Kahrmann, my bad, wrong EKG, you have the heart of a warrior. But this, of course, doesn’t happen. So, despite all the information about my rather precarious medical condition and the suggested admission, I say no, I can’t be admitted to the hospital.

“Why not?” they ask.

“I have two dogs,” I say, realizing the absurdity of my words the second the escape my mouth. But I swear couldn’t stop there release. I am helpless.

They say, “Don’t you have anyone to take care of the dogs?”

I say, “No, I live in the country. But I can come back tomorrow for the transfusion.”

They say, “If you leave, you’ll have to sign out AMA (against medical advice).”

I say, “Okay, I’ll do that.”

Then, a wonderful ER doctor sits down and says, “Mr. Kahrmann, you are in really rough shape. You’re in real danger if you leave here without at least letting us give you some blood.”

The words you are really in rough shape get past the fog of fear that has me nearly frozen inside and reach me.

“Okay,” I say. I extend my hand to his. We shake hands.

I am blessed to have an extraordinary nurse named Charles Jordon. He is direct, incredibly knowledgeable, compassionate, kind and, in a way, best of all, an extraordinary communicator.

Standing facing each other after the ER doctor has left, I say, “You’d think after my life, getting shot in the head and all, there’d be no it can’t happen to me syndrome left in me. I should fucking know better.”

Charles looks at me, smiles gently and says, “You’ve never been through this though.”

I nod. He has, in one sentence, given me a kind of permission to go ahead and be frightened. He says, smiling, “Well, what do you think? You want to launch into panic right away or hold off for five minutes?”

We laugh. I say, “Fuck it, I’ll hold off.”

I stay until nearly 11 p.m. that night and get two units of blood. I even summon up the courage to tell them the reason I’m in such shape is I had bleeding hemorrhoids and was too embarrassed to tell anyone and tried to take care of them myself with over the counter meds and the misguided belief that they have to stop bleeding some day. Like when you run out of blood, I now realize.

In the ER, fresh blood running into me, I remember the last time in 1984 when I was shot and how unearthly it all seemed. I think this makes sense because in a way death is about as unearthly as it gets.

I arrive home late that night. Glad to be alive, joyous at the sight of my two dogs, McKenzie, my lovely and loyal German Shepherd and Milo, my wonderful mutt, though I never call him a mutt to his face. He has too much character and too much class for that. I am home and think of my father long gone and know that were my end to come I would be with him and in that moment all possibilities are acceptable.

The next day I schedule follow-up appointments with doctors and the day after I give a presentation at the 25th Annual Conference of the Brain Injury Association of NY. During the presentation I tell them my ER story.

After all, embarrassment can kill. It almost killed me.