I randomly went home on Sunday. I woke up around 6 a.m. outside my own volition, without any alarms, and decided it would be a good idea to hop on a train and head up to L.A. I pretty much just ate something like six meals and watched cable TV with my dad. We watched a bunch of westerns.

But my mom casually mentions the fact that she notices that my dad seems to sleep a lot now during the day, and she wants to know if this is related to the fact that he has heart failure. Memories from intern year in the CCU flicker through my mind, and I think about all those poor souls with awful, awful cardiomyopathy, and dread sort of grips my chest. Like it or not, a lot of medicine is what we erroneously call gut instinct. More accurately, it is unconscious knowledge, the sort of pattern recognition capability the mind excels at, even when our consciousness fails to keep up.

My mom and I discuss the various things that have transpired over the past three months regarding my dad’s health. Apparently he really does have a left ventricular thrombus, but for some reason, his cardiologist is not treating him with low-molecular weight heparin. And the strangest thing is that my dad is not taking any sort of diuretic.

I am incredibly skeptical about the notion that he was never prescribed any Lasix. The idea that someone with an ejection fraction of 45% could escape the grasp of this drug seems absurd to me.

Then again, I know for a fact that my dad basically manages his own medications according to his own whims. He is, after all, a physician himself. So, for all I know, he probably takes Lasix whenever he feels like he’s getting bloated, or putting on weight too quickly, or whenever his legs swell up too much. He used to screw around with his long-acting nitrates and his anti-platelet medications, but stopped when he started getting chest pain too frequently for his own liking.

It is a known fact that physicians are the worst patients in the universe.

But watching my dad slumped over in the couch, snoring noisily at 1 p.m. worried me. The notion burrowed into my mind, and dug and dug, and it’s still digging, and I don’t want to take my thoughts to their logical conclusion.

Maybe it’s just his sleep apnea catching up to him, I tell my mom. And I know he stays up late watching TV. And in a short while, my dad wakes up, and he’s his normal self, quick-witted and temperamental as always. He takes me back to the train station, and I try not to think about the fact that none of us are getting any younger, and that damned stopwatch is always ticking, ticking, like an industrialized version of Poe’s tell-tale heart.

And I think about my silly desires. If I ever have kids, I want them to meet my dad. And that damned pendulum just keeps swinging and swinging, the grains of sand keep falling, and I’m not even sure I can get to that path from where I’m sitting, and maybe everything going through my brain is just futile.

I think to myself about the fact that there have only really been one or two things in my life that I’ve actually succeeded at, and I wonder if either I’m due for more, or if that’s really it, there ain’t no mo’, and it’s all down hill from here.

They say that you’re at your peak when you’re around 19. Physiologically, this makes sense. You’ll have just finished myelinating all your long tracts, and neural signals will be traveling the fastest that they ever will. Your lungs will have finally stopped developing, and your athletic ability will be at its optimal. Your long bones will have just fused and you’ll be as tall as you’ll ever be. I can still imagine what it must have felt like about a decade ago, when I thought I had everything I ever wanted.

But everything after that is a wearing and a grinding. The only thing that I’ve managed to improve, with a modicum of suffering, is the state of my brain, but at times like this, even that’s questionable. I have certainly not taken the best care of myself. But I figure I’ve got a ways to go. There are probably a lot more twists and turns to the future than even I can imagine.

And like always, all that I can really do is hope for the best, but expect the worst.