Exploring the art of prose


Heart Trouble by Rex Adams

“Heart Trouble,” by Rex Adams, is the winner for Dialogue in the 2018 CRAFT Elements Contest. The story is also a finalist for Character.

“Heart Trouble,” by Rex Adams, is a portrait of ordinary people in an ordinary situation that offers something fresh, urgent even, to readers. A finalist for both Character and Dialogue, with a vivid Setting, too, this piece held our attention as a solid contender in all elements. It’s an easy story to read, in that the storytelling appears effortless, and we’re given enough without being given too much.

Adams made superior choices in the way Darla’s character moves through this narrative and interacts with the supporting characters. From the first page, where we are firmly grounded in character and place, dipped into action right on time, and treated to Darla’s engaging voice, we find that her interiority is a comfortable place. Adams effectively deploys a clothesline structure, hanging backstory and scenes from the through line of Darla’s stream of consciousness, moving us seamlessly between now- and then-time. The imagery is rich: “Harold on his back with his chest pried open and a team of surgeons bent over his heart praying to it,” and “[cloud] remnants would sheer off and roll over the Cascades, dropping no rain, only their shadows shambling across the sagebrush and dryland farms and patches of scabland.”

Ultimately Adams’s crafting of subtle, small, realistic dialogue tipped the scales on this piece for us. The dialogue here serves to build character and advance tension. You’ll read in Adams’s Author’s Note that he edits with careful attention to avoid mundanity in dialogue, to have a “chance at authenticity.” The line between mundane and authentic can be perilous to walk, but here the dialogue succeeds, teaching us about Darla and Harold and their relationship, enriching our empathy. Thank you for reading.  —CRAFT


The nurses, cafeteria workers, surgeons, Harold, they all irritated Darla. So did the old man in the room next door. He was dying, had been for days. Family kept streaming out of the elevator, stomping down the hallway and into his room, the footfalls on the tiled floor of the ICU like hammer blows against her skull.

She also felt irritated that she was stuck at the Seattle VA hospital instead of home. At home she could work on the pole barn she and Harold had started building two weeks earlier. She could weed the garden, harvest the carrots and radishes, and water the lawn that would be drying up in the coulee’s arid, hot air. It seemed everyone else’s lives continued, but not hers. Hers had paused so Harold’s heart could be rebuilt.

And then there was Marni, Darla’s daughter from her first marriage. She was due to give birth within the month. A boy. Darla’s first grandbaby. She should be with Marni, preparing for the child.

Most of all she irritated herself for being so irritated. The irritation made her feel cold and callous, not at all herself.

Harold touched her arm and gave her a feeble smile. She covered his hand with hers.

“Are you thirsty?” she asked.

He nodded. She handed him a giant plastic cup with a lid and straw. He pursed his lips around the straw and sucked iced water from it. Weakly. Her irritation surged. Why wasn’t he recovering sooner? Why couldn’t he take care of himself? Why did she have to sit here and baby him and prod him to complete his breathing exercises and make sure he didn’t push himself up with his hands and remind him to squeeze his heart-shaped pillow when he coughed?

Harold closed his eyes. She lifted her hand off his, but then his lids fluttered open and she saw him pleading, so she put her hand back and stared down at her short, stubby fingers and the age spots speckling her veiny skin.

“Goddamn, this hurts,” he said, his voice hoarse. A sutured incision peeked out of the top of his gown.

A quick image flashed through her head, one of Harold on his back with his chest pried open and a team of surgeons bent over his heart praying to it.

“I can’t imagine,” she said.

“I never felt anything like this.”

“It’ll heal.”

“I know. But goddamn, it won’t heal soon enough.”

“Do you need more meds?”

He nodded. She patted his hand and stood.

“Hurry back,” he said. He wore a white beard, typically trimmed neatly, with a bald dome bordered by white hair also kept neat. But now his beard and hair were shaggy, below his eyes the flesh ruddy. Under the ruddiness a gray had crept in.

His heart trouble, it had been her fault. She’d worked him too hard setting poles for the new barn. The day had been hot. The six-by-six poles were pressure treated and heavy. She had not wanted to hire anyone for the work, so it was Harold and Darla, with their old tractor, tipping the fourteen foot six-by-sixes into the holes with the loader bucket, bracing them, squaring them to a dry line strung between batter boards. Harold had been slow, whining about the heat, dragging his feet through the dust.

He’d snapped at her every time she wanted to adjust a pole. “Jesus,” he’d said. “It’s off an eighth-inch. Are we really moving this post?”

And they did, and then it was off a quarter-inch the other way. And so they moved it again, too far. And then it was out of plumb. Once they plumbed and braced it, it was off a half-inch. They did each pole this way, nine total. They didn’t get to the tenth pole. After the ninth, Harold complained about his arm hurting and rubbed his chest. He sat down on a berm of soil and took off his cap, setting it next to him. The color he’d turned, gray and pale, scared her. She had been certain he was going to die.

She walked out and past the old man’s door. There had to be twenty people scattered around the room, some seated, some standing. In the middle was the old man, his hospital bed slightly elevated, with a blanket covering his legs. His eyes were closed and his head tipped back. His face looked the same gray shade Harold had turned. Apparently the old man still lived, although it didn’t look like much of a life.

Darla stopped at the station and told one of the nurses that Harold needed something for pain. She didn’t follow the nurse back to Harold’s side. Instead she hit the button on the wall and the large steel doors swung open. She walked out of the ICU and down the long, cold corridor to the elevators. Her footfalls echoed off the walls. She rode the elevator to the ground floor, made her way through the lobby, past volunteers and old vets in wheelchairs. A group of soldiers in uniform handed out cookies from behind a booth. She took one and nodded at the soldier who gave it to her, and then she stepped out into the cool, damp air.

She stood in front of the hospital’s sliding doors and breathed in deeply. She could taste the air. It was different than at home. The air at home was so dry it felt like it would crack your lungs and lips. In Seattle the moist air made her skin feel softer than it had in a very long time. The dampness was a relief after sitting in the hospital for so many hours, so many days. Their F250 sat down there in the parking lot. She could walk down to it and get in and drive out of the city, taking I-90 up over Snoqualmie Pass, out of the trees, away from the people, into the dry country.

She almost started walking toward the truck thinking about it. But instead she sat on a bench and ate the cookie and watched vehicles prowl the paved lot searching for a parking space. A man and woman dressed in WAZZU crimson and gray walked up the slope toward the tarmac in front of the hospital, causing the lonesome feeling for home to peak again. To her left, across the street, a golf course lay emerald between groves of trees. Over the golf course soft, white clouds drifted, and beyond them the sky was a deeper blue than on the east side. Closer to the ocean she guessed. All those clouds and they would stack up against the mountains and never make it to the coulee, not many anyway. Maybe a few remnants that would sheer off and roll over the Cascades, dropping no rain, only their shadows shambling across the sagebrush and dryland farms and patches of scabland.

The irritability that Darla had felt in the hospital dissipated. Guilt replaced it. She hadn’t told Harold that she was leaving. He would be scared. He was so gentle, although he pretended not to be at times, talking gruffly and puffing his chest out. She loved his prickly gentleness. But now in her sixties she sometimes mistook his kindness for weakness. He was so different from her first husband. Greg still had the same petrified face and petrified attitude at sixty-two that he’d had at forty-two.

She brushed the crumbs from her lap and pushed herself up off the bench. She thought maybe she should lose some weight. She had always been a tad overweight, but her body didn’t carry it as well anymore. Dull pain gnawed at her knees, back, and feet.

Poor Harold. She needed to get back to him. He’d be in a panic if she didn’t.

She made her way back through the lobby and stopped at a coffee stand, paid two dollars for a cup of black coffee, and then made her way to the elevator and up to the ICU.

She glanced into the old man’s room as she passed. A man she assumed was her age stood next to the bed with his hand on the old man’s chest. At first she thought he was probably the old man’s brother, but then realized he was more likely his son.

Her parents had been dead so long she’d nearly forgotten that people her age still had parents on earth. That was the right way, for children to lose their parents. She thought suddenly of Cory. Darla and Greg’s second born. She’d lost him nearly two decades ago, on the highway north of Coulee City, at Million Dollar Mile. She’d let him ride with his cousins in the back of a pickup her seventeen-year old nephew was driving. This entire stay at the Seattle VA she’d kept Cory from her thoughts, had been proud of herself for not letting the hospital and all the illness and suffering drag her back to Million Dollar Mile. She didn’t intend to go back there yet, so she pushed her dead son out of her mind.

When Darla walked into Harold’s room she felt relieved to see him dozing with his heart pillow in his lap and his mouth open. He really did look terrible with his beard and hair untrimmed. Not that she looked much better. She hadn’t bothered looking in a mirror in some time, and truthfully she’d never really given a damn how she looked. Her hair was a ratty mess and always had been. Some time in her early twenties she’d quit fighting it and let it be its wild self. But Harold, he’d always been so neat and trimmed. He looked ten years older with stubble around his throat.

She sat down in the chair next to him and opened the book she had been reading. Before she’d read to the bottom of the page she felt his hand on her arm. She looked over. He stared at her. The oxygen tube draped over his ears and the tiny air nozzles poked into his nostrils.

“Where did you go?” he said.

She held up her expensive cup of coffee and said, “Downstairs.”

“You didn’t tell me.”

“I know. I’m sorry. It just seemed a good time to get out.”

“I wish you’d let me know.”

“You’re right. I’m sorry. I will next time.”


“Okay. Go back to sleep.”

“Those drugs make me drowsy. Terribly drowsy. So drowsy I fear I won’t wake up.”

“You’ll wake up. You better. We have to finish the barn.”

“I’m sorry,” he said.

“Don’t be. Go back to sleep.”


He tightened his grip on her arm. She patted his hand. His eyes still stared at her, watery and dull from all the medication and pain. She couldn’t image how it must feel, to have all that cartilage sawn open and all that bone stretched apart. She shuddered thinking about it. Harold’s blinks grew longer until they weren’t blinks anymore and his bottom lip hung down. A lump crept up into her throat and she felt she might cry, staring at Harold the way he was, thinking about how close she came to losing him, all because she had to get that barn built and not spend too much money doing it. But then her sadness was whisked away by the thought of the poles, still not set in concrete, propped up by two-by-sixes and the tenth pole still on the ground, all of them drying and twisting in the sun.

Darla stood lathering shaving cream around Harold’s throat when the old man next door died. She knew he had passed by the way his visitors filtered out of the room. She paused, holding out her lathered hands, to watch them. They walked out with heads tipped forward, shuffling slowly to the elevators, shuffling as mourners.

The son emerged last. He was tall and slender, something she had not noticed while he leaned over his dying father, dressed in slacks and a short-sleeve button-up shirt. He walked down the hallway, following the path of his kin, dabbing under his glasses with a handkerchief. A child watching a parent die. As it should be, she thought again, and then she went back to work on Harold’s neck, the soapy scent of the shaving cream replacing the ICU’s sterile, medicinal odor.

Darla had been reading in the chair under the television, thinking Harold was asleep. But then his head shot forward and darted back and forth. His hand reached out and grabbed the bed railing.

“Jesus, Darla, I’m seeing things that happened twenty-five years ago, but I’m right here and I know they aren’t happening.”

She didn’t know if the drugs or the pain caused Harold to hallucinate. She moved from the chair under the television to the one next to his bed. He stared at her with bugged eyes, the white hair around his bald dome standing out like a shock had shot through him.

“I’m still in the house behind our church and I’m still married to Maryanne, and I can’t get away from her. You aren’t anywhere, Darla. You aren’t anywhere.”

And Cory is still alive, Darla thought.

“Well, you aren’t there,” she said.

“I know it, but I don’t know it all at the same time.”

“You’re okay, Harold. I’m here. I’m not leaving you with that mean old woman.”

“Oh, please don’t.” He reached out and Darla took his hand. He squeezed and she could tell he squeezed as hard as he could, but his strength wasn’t much and it didn’t hurt at all. It just reminded her of how far they had to go before her husband was well again.

An hour later he had another episode. She had moved back to the chair under the television. She sat reading when Harold began to fuss. She continued to read, hoping he would calm down.

But he didn’t. Instead he called out, “Rotten bitch! Dirty, rotten, sorry bitch!” He shook back and forth as though strapped to the bed trying to escape his bonds.

Darla put her bookmark in the book and closed it. She rose and went to her husband’s side. The fear in his eyes was real.

“Oh Darla,” he said, shaking his head. “She won’t stay gone. I looked over there where you were sitting and she was there instead. Staring at me. And she had that look she always had. Jesus, I thought you were gone and she’d come back.”

“It’s all right. I’m not leaving you. I’m here and she’s off torturing some other old guy right now. I’m here, so relax.”

“I can’t.”

“You can.”

“I can’t, I can’t, I can’t!” Hysteria was setting in.

She grabbed the spirometer and handed it to him. “Try your exercises.”

“No way. I’m not, you dirty rotten bitch.”

“If I didn’t believe you were truly hallucinating I’d punch you in the chest right now.”

“Oh, Darla, I’m sorry. It’s just that she keeps popping back in. It’s you, then it’s her. I don’t know how to make it stop.”

She prodded him with the spirometer. “Do this. It’ll help. Come on.”

He puckered his lips and put the mouthpiece in his mouth and exhaled. The yellow plunger shimmied but didn’t rise.

“Don’t exhale. Inhale,” she said.

He did. The plunger fluttered and rose and then fell, well short of the mark where the plunger was supposed to reach.

“Do it again.”

“I don’t want to.”

“I don’t care. Do it.”

He did it again, but still didn’t reach the mark.

“One more, and put some effort into it this time.”

He did as told and the plunger fell short once more, but the breathing exercises calmed him and soon he drifted off to sleep.

Darla attempted to lose herself in the book, but it was useless. She had done so well pushing out Cory and the accident, but as she read the words blurred and she was back on the highway at Million Dollar Mile, holding eleven-year old Cory’s head in her lap, her thighs sticky with his blood, the hot blacktop burning her bare knees, fingers kneading his scalp, searching for the source of the blood. Her fingers found it, the open gash, but what they also felt was the softness, the sponginess of his shattered skull.

She lowered his head from her lap and slid her arms under him, the rough blacktop abrading the backs of her hands, her wrists, her forearms. She ignored the pain and lifted his limp body from the highway.

Darla shut the book and leaned forward. She closed her eyes and exhaled. Another memory flooded back. Cory, age four. She stood in the doorway of his bedroom, looking at the small child sleeping, draped over the edge of the bed, his head thrown back, an arm flung out. His body barely clinging to the mattress, ready to slip off and fall to the floor. She went to him, ran her arms under him, felt his limp, sleeping body and a shiver ran through her, but then he contracted, his little body suddenly alive, and he muttered groggily. She laid him back in the warm depression where he had been sleeping when the night began. He rolled to his side and pulled his knees to his chest. She leaned over him and kissed his cheek and smelled his breath that had already gone sour from sleep.

Seven years later, she carried him up the highway toward the pickup that he’d fallen from, his eighty pounds dead weight. Waiting for it to tense, for the muscles to fire. Knowing they wouldn’t. Knowing that the shiver that had run through her before would run through her forever.

Harold stared at her so intently, without blinking, that she thought maybe he had died. But then he blinked.

“I got to shit,” he said.

She stood quickly and went to his bed. She pressed the call button. A young nurse stepped into the room immediately. A very pregnant woman. Darla thought of Marni.

“I got to shit,” Harold said to the nurse.

“Stop talking that way,” Darla said.

“Really, I got to shit. Right now.”

The nurse smiled at Darla. “Don’t worry, I’ve heard worse.”

The nurse pressed the call button and another nurse came in, an older woman, ruddy-faced and built like Darla, short and squat.

They helped Harold from his bed. He trembled while using the IV stand as support. All the blood drained from his face. The nurses steadied him.

“How you doing?” the pregnant nurse asked.

“I got to shit.”

“Almost there.”

But it was too late. Darla saw it through the slit at the back of his gown before the odor filled the room. It oozed down the inside of his thigh and onto the floor. A gummy brown. And then the smell. A putrid odor, feces from way deep in the bowels where sickness dwelt.

Harold muttered, “Goddamn it.”

The nurses were aware, but they seemed unworried. “It’s all right, Harold,” the older one said. “We’ll get you cleaned up. Come on now, you’re doing great.”

He shuddered then and Darla knew he was crying. She felt his shame, felt shamed by him, felt shame for herself for not acting soon enough.

She let the nurses clean him, even though she knew he’d be even more embarrassed. At least he hadn’t messed the bed. They simply had to mop his mess off of the tile floor and wash it from his old skin. After, she stood in his room looking out the window. She could see a roof below, the green city beyond. Low clouds, but also sunshine. Trees everywhere. Houses and apartment buildings among them. The room suddenly felt so tight, so claustrophobic she had to get out.

As soon as Harold fell asleep she walked out into the hallway. She approached the old man’s room and looked in. He was still in the center of the room, on the slightly inclined bed, his head tipped back, mouth opened as if screaming. Opened as if an invisible hand had curled its fingers over his bottom teeth and pulled down as hard as possible. He was now uncovered, no blanket, no white sheet, just his hospital gown. The irritability leapt back into her. This time it was focused squarely on whoever’s job it was to remove the old man.

Christ, someone should at least cover him. He deserved a little dignity. She walked into the room, her sneakers making soft padding sounds on the hard floor. She stopped next to the bed and peered down at his silently screaming face. All his blood had gone cold, his skin turned concrete gray. His eyes clamped shut. She leaned in and stared. How old was he, she wondered. He looked a hundred, no, a thousand years old. Didn’t matter now. He wasn’t getting any older. Already with the gray on him, making him seem mummified. His bones pressed against skin thin as a fly’s wing. Thin enough she could see what his skull would look like if the flesh were allowed to rot off. She leaned in more and turned her head, placing her ear inches from his gaping mouth. Maybe he still lived. Maybe that is why they hadn’t covered him. But there was no air, not even an escape of gasses. Just a corpse. A corpse gone cold and silent.

She didn’t hear the man come in behind her. She only heard the words, “Excuse me.”

She jumped a little, startled. She turned. It was the tall son.

“Sorry,” she said. “No one covered him. I thought I’d do it.”

“I forgot my phone,” he said, nodding his head toward the windowsill where a phone set.

“I can’t believe they didn’t cover him,” she said.

“I don’t think he notices.”

“Are you his son?”


“Oh. I figured you were his son.”

“No. Just a nephew.” The man shrugged his shoulders and stared at his dead uncle. He spoke again, more to himself than to Darla it seemed, “His son wouldn’t come.”

“His son didn’t come to say goodbye?” Darla asked.

The man looked from the body to Darla. “Nope.”

“How sad.”

“Yes. Grudges.” He looked once more at the body and took a deep breath. “But I don’t know what all the old man did. Maybe something awful.”

“Maybe.” She looked at the corpse. Frail, already decomposing. She couldn’t imagine something so fragile hurting anyone. “I had a son,” she said.

“Had?” He looked at her again. “I’m sorry.”

“It’s okay. He’s been gone a long time now.” Maybe that’s good, she thought. Maybe I would have hurt him like this old man hurt his son.

The man crossed the room to the window and picked up his phone.

“How’d we ever get by without these things?” He stopped next to Darla and stared down at his uncle once more. “He was always kind to me. But who knows what went on between them.” Without looking at Darla he asked, “Do you have more children?”

“Yes, a daughter. She’s about to have a son. Within the month.”

“A grandchild. That’s wonderful. I have three.”

“I’ll cover him.”

“No,” the man said. “I’ll tell the nurses. They can cover him. I’m not sure where he goes from here.” He paused, “Why are you here? In this hospital?”

“My husband had some heart trouble. A few more days and we can go home.”

“Good,” he said, and paused. “I need to go. You should too.”

But she didn’t leave immediately. Instead she stood next to the dead man wondering if he had asked for his son in the end. If he regretted whatever he’d done to the child to make him not want to say his goodbyes. Perhaps, like Harold, he had hallucinated, and the boy was there with him, and only he could see. Maybe he felt the boy hold his hand. Maybe he thought, like Darla had, that the tall slender man had been his son and when he died he died thinking his son stood next to him.

She walked outside. A spattering of rain had wetted the pavement since the last time she’d been out. A slew of people stood around an ashtray, smoking. She thought of Marni, thought of calling her. Asking how the baby was doing. They were heading into the final weeks. She thought of Cory, of the accident. She looked out over the damp, shining city. She wanted the dull gray-green of rock and sage and the dust of home. She wanted Harold well. She wasn’t ready for tragedy. There had been a two-decade respite. In that time she had grown strong, she thought, but this stay in the hospital, Harold’s weak state and the sight of the dead man made her realize she was not strong. Didn’t want to be strong. She wanted no more tragedy. No more.

Darla returned upstairs and sat next to Harold where he slept, his sutured chest rising and falling slowly. She put her hand over his incision, but didn’t touch it. She was afraid to hurt him. All the irritation was gone. Now she just felt scared and sad. She imagined his heart healing itself, the cells and fibers twining together. Please make me go before this man does, she prayed. Please don’t make me endure any more loss.

He opened his eyes, partially anyway. She could tell he was heavily sedated. But awake. No longer hallucinating.

“I’m sorry,” he said.

“For what?”

“For shitting myself.”

“No need. I know you wouldn’t shit yourself on purpose. You only have to apologize if you die on me.”

“But you got Marni and the new baby.”

“But I need you. Along with them. I need you.”

She moved her hand to the metal rail of the bed. He placed his hand over hers and closed his eyes. Soon he was asleep again, and his chest rose and fell, slipping into rhythm with the hiss of oxygen and the beeping of the machines monitoring his life.


REX ADAMS grew up on a farm and ranch outside of Coulee City, Washington. He makes his living in the construction industry. His stories have appeared in Sky Island Journal, Confrontation, the Writers in the Attic: Song anthology, BULL: Men’s Fiction, and elsewhere. His fiction recently received nominations for Best of the Net and the Pushcart Prize. He lives near Marsing, Idaho with his wife and two young daughters.

Author’s Note

Every now and again I get lucky and a story just falls out of my head onto the page. Sure, there is work to do after the initial draft, but the structure, characters, dialogue, setting—these elements remain the same.

“Heart Trouble” is not one of those stories. It took me nearly a decade to complete, and what remains looks nothing like it did when I started. I told the story from different points of view and in a variety of settings. I abandoned Darla and Harold many times, frustrated and certain I couldn’t work the necessities out.

But Darla wouldn’t abandon me. During much of this period I worked on the road, away from my family. I’d be crashed out in a single-wide trailer in North Dakota, or chasing a paving train down the highway in the middle of the night, and Darla would show up, demanding my attention.

I went back to work. I found Darla and Harold in the VA Hospital in Seattle. The story suddenly felt true, so I continued on. “Heart Trouble” was a mess. It blew up to over fifty pages. I cut, revised, cut some more. I threw in a suicide scene, which was a heavy-handed attempt at squeezing out a tear, so I cut again. The title changed a number of times. Once in a while I’d give Darla and Harold a break, but I knew I’d return to them, that I would finish their story.

This decade of work taught me that I can’t always dictate a story’s direction. Sometimes I have to turn the characters loose and just pound away at the keys, knowing that much of what I’m putting down will get trashed. This is particularly true with dialogue. When I let the characters talk freely, without interruptions from me, the dialogue has a chance at authenticity. I always end up with an excessive amount of needless banter, but hopefully I’ll have enough skill and insight to whittle away until I find the good stuff.


REX ADAMS grew up on a farm and ranch outside of Coulee City, Washington. He makes his living in the construction industry. His stories have appeared in Sky Island Journal, Confrontation, the Writers in the Attic: Song anthology, BULL: Men’s Fiction, and elsewhere. His fiction recently received nominations for Best of the Net and the Pushcart Prize. He lives near Marsing, Idaho with his wife and two young daughters.