He had the heart attack on a street in New York City. It was on the West side, on 49th street by the Hudson river. He was aware of a moment of keen exhilaration, a feeling of utter potency, a coming-together of sky and ground in his person, and then the worst pain he had ever experienced was destroying him through his right arm and chest.

In the ambulance going to Mount Sinai hospital the kinder of the paramedics asked him if he had insurance.

I don’t think so, he said.

Ok, the paramedic said.

Is there going to be a problem? he said.

The kinder of the paramedics held the drip bag very steady and looked out of the window. The roads were bad and the ambulance rocked and jittered as it it tried to carve a path uptown along a crowded West Side Highway.

He knew why he had had the heart attack. In the moment of aftermath as he lay on the sidewalk, not even able to shriek, his left foot jerking into the road, he knew. A couple of nights earlier, his last in London before coming to see his declining father on a regular and unwelcome duty visit, he had bumped into someone he hadn’t seen in years. He hadn’t remembered especially liking this person, but both of them seemed to be smitten by an equivalent kind of nostalgia for the people they had used to be, or at least had been promising at the time to become, and they had ended up in a flat in Stoke Newington snorting cocaine with a record producer and two Latvian girls. He had never liked cocaine very much either and hadn’t taken it for a while and, two days later, struggling to stay alive on a sidewalk in New York, he was astonished at his banal thought that knowing it was cocaine that was killing him was exactly the same sort of feeling as having food poisoning, and knowing which of the lunchtime shrimps had inflicted it.

What happens if I don’t have insurance? he asked.

It’s not the end of the world, the less-kind paramedic said.

Put it this way, it’s better if you do, the nicer paramedic said.

His first hours at the hospital were a miracle-jungle of tubes and pain populated by people who walked very fast and people who didn’t walk at all. The next morning after being visited by a ferocious woman from hospital administration, he called his father’s apartment. His stepmother answered the phone, because she always did. His father was eighty-seven years old and disintegrating in an angry silence, filling the time with jigsaw puzzles and playing backgammon on his computer. In the evenings he watched boxing on tv at a peculiar angle because stenosis of his spine had curved his back until his chin now permanently rested on his chest.

I’m in a hospital, he told his stepmother.

Dad was doing no better, his stepmother informed him. Dad was suffering with his back and his memory, and his breathing of course. He wasn’t talking to her, he hadn’t been talking to her in months. Dad was looking forward to seeing him, they both were. She was doing what she could but she was sick herself and didn’t he know she was doing the best she could? And where was he? They’d been expecting him by now.

I had a heart attack, he said. And I might need a bit of help with money.

He tried to explain his circumstances and predicament but her horror at her own had made her impregnable.

She was sympathetic, of course she wasa heart attack! That’s awfulbut they were having so many expenses now, with Allie the cook and Alla the helper, Dad was in such a poor way, she hardly knew if they had any money to spare. And you know how strange he is about money? I don’t know where he keeps any of it.

Ok. Thank you, he said.

During a telephone call to London, his ex-wife told him that he did have insurance. Family travel insurance he had taken out years ago was politely renewing itself every year by direct debit out of the bank account that their divorce had emptied. This did not entirely relieve him. Worrying about how to pay the hospital bill had kept other concerns away.

He made a friend at the hospital. There was a sort of courtyard at the back of the burns unit where some of the patients and staff went to smoke. Smoking was not permitted anywhere on hospital property but a few senior doctors used the area so the practice was unofficially allowed. He had found the door to the courtyard the previous day and turned back, frail and cowardly, into the safety of the hospital. The second day he forced himself to be stronger than he wanted to be. He went into the courtyard and sat on a bench, pretending he was capable of reading a book, and met a woman there. She was pale and had tattoos and body piercings and did everything very gracefully and slow. She kept snakes in her apartment in Brooklyn and her girlfriend had been bitten by one of them.

That’s awful, he said.

She’s getting better. You have to administer the antidote within twenty minutes. I got her to the hospital in eighteen.

They sat in silence for a while after that. He broke it by suggesting that maybe it was reckless to keep dangerous animals for pets.

They’re not pets, she said.

Oh. Ok. Keeping animals then? Keeping animals and feeding them and looking after them and so forth who have no memory of you.

People say that, she said in a generous way that managed to imply that even though his opinion was stupid, it wasn’t entirely his fault that he had it.

They don’t have a big enough brain for memory, he said.

That’s what people say but it’s just not true. My python. Edgar. I was given him when he was a baby and he used to sleep on the end of my bed all curled-up. And now he’s got bigger you know what?

What?

In the night you know what he does? He stretches himself out and lies right next to me. I call him my shy husband.

That’s very beautiful, he said.

I think so, she said. My name’s Jenna.

His father and stepmother came in to see him after he had been moved out of the intensive care unit. His father was in a wheelchair and was nervous and confused. He misunderstood the situation. He decided that he was the patient and that his son had come to the hospital to visit him, and he complained about the food and the nurses and told his son to bring in a Chinese takeaway next time he came. His stepmother cut the visit short.

It’s upsetting him, she said. You can see that. I wanted to bring you in some fruit or something but we’re not strong enough for that. Here. You can get something with this.

She put a hundred dollar bill on his night table, slipping it beneath the water jug and camouflaging it with a box of tissues.

Thank you, he said.

He told Jenna about the visit, and about his previous conversation with his stepmother.

That’s horrible, she said. What are you going to do with the money?

I gave it to one of the night nurses. She’s from the Dominican Republic.

But this thing about not giving you money for the hospital. How can you refuse your child money when he’s sick?

I’m not her child. She’s my stepmother.

You know what I mean. It’s not right.

I don’t know. She’s old and he’s old and they’re both falling apart and they hate each other. The only thing they’ve got to protect them is money. She was trying to protect herself.

Were you always so forgiving?

I don’t know. Probably not.

It’s because of your heart attack, she said. A near-death experience changes a person.

Maybe so, he said.

You see? Now you know why I prefer snakes.

How’s your girlfriend?

She’s coming along. She’ll be out soon.

And the snake?

Edgar? He’s great. I can show you a picture if you like.

She showed him a photograph stored on her cellphone. He couldn’t make it out very well beyond it being of something long and brownish lying on a mattress. There was a lot of jewellery around the edges of the frame, silver brooches and chains.

Still your husband?

I guess. But Layla says when she gets out of hospital he has to go back into his box at night. She says she doesn’t want him sleeping with us. She doesn’t get it.

He liked Jenna very much. In an unspoken way they had a date to meet every afternoon. He was usually there first and he would sit with his book and wait for her to come. He found himself ignobly hoping that her girlfriend would take a turn for the worse.

And then, on his last afternoon, she didn’t come. He sat in the courtyard, on the wooden bench that had a brass plaque declaring it to have been donated by Friends of Mount Sinai in honour of someone called Sadie Fisher (1923-2007), and tried to read his book. There was the usual crowd of women in wheelchairs and fat men pretending to be funny and Latino delivery boys and doctors in green surgical gowns defiantly smoking. He felt very sad. He thought they had made a connection and he was disappointed to have been proved wrong. He assumed that Layla had been released from hospital and had gone back to Brooklyn but he thought that if the positions had been reversed he would have come by at least once, to say goodbye; and probably more than that. He had expected an evening or more in Brooklyn with Jenna and her girlfriend and their snakes.

A delivery boy stepped on his foot as he went past and in the moment that he and the delivery boy met eyes, as the delivery boy waited, with an indifferent hostility, for his reaction, he knew that his capacity for forgiveness wasn’t a sign of weakness, and nor was it do with nearly dying. He associated the image of Jen and her shy husband with this change, a shaking-up of values.

I’m going to improve my diet, he told the delivery boy. And I’m going to take up swimming and see my children more. I’m going to be a better person.

Good for you, man, the delivery boy said.

And then he inhaled the sweetness of nicotine and wondered if he would ever be strong enough or stupid enough to take up smoking again.

A girl came to stand in front of him. She wore glasses and dowdy old maid clothes and other than her pallor there was nothing to connect her to Jenna. Nonetheless, he felt her as instantly known.

Hello, he said.

Hi, she said.

Are you Layla?

Yeah.

He offered her the seat beside him. He attempted some charm that found no answering place in her. She was very solemn.

How’s Jenna? he said.

She brought her legs tight together and lowered her head and clenched her fists in her lap and it took him a moment or so to realise that she was crying.