In the late 1980s, Ken Smith survived a heart attack. In ‘Then the heart’ (The Heart, The Border, 1990), he navigates the uncertainty, anxiety, and fear of physical pain, treatment, recovery, and subsequent return to ordinary but profoundly altered life.¹ The cardiac event is not a short, sharp experience as ‘attack’ might suggest; rather, it is part of a narrative of illness that stretches across time, place, and the geographies of the self. Smith’s vantage point at the writing of this poem takes in a genealogy of familial heart disease that invokes his difficult relationship with his father, now seen afresh through the lens of imitated pathology. Re-reading his own history, the poet sees a kind of destiny in his following in his father’s footsteps that he finds frightening rather than consoling. In this reading I consider Smith’s illness experience poem, and its rich and various deployments of metaphor in descriptions of emotion, pain, and the heart.

The poet is travelling and working, ‘over the mountains from one sea / to the other’, when he is struck by:

[…]              sudden panic, in the chest’s
left pocket a sharpness persisting into pain,
fear of more of it: of death’s knife
and a surgeon’s chainsaw to the breast,
and beyond the old fear it always was –
some moment I will die, and the universe
go on making light of itself.

The language we – as patients, writers, doctors, and caregivers – use to describe physical pain almost always takes the form of metaphors of ...