The following version of this story was used to create this guide: Foer, Jonathan Safran. "A Primer for the Punctuation of Heart Disease." The New Yorker, 2002. Print.

Note that all parenthetical citations refer to the page number from which the quotation is taken.

The story begins with the speaker describing the use of the "silence mark" as punctuation for an absence of language in conversation. He explains its significance using the example of a conversation between him and his father in which very little is said, but there are a number of long pauses. The speaker announces that these silences usually occur when discussing his family's history of heart disease as well as their ties to the Holocaust during World War II.

The speaker then moves on to describing the following punctuation marks: the "willed silence mark," signifying an intentional silence, the "insistent question mark," denoting a rejection of the willed silence, and "unxclamation point," which represents a whisper. For each new punctuation mark that the speaker introduces, he provides an example from a conversation with someone in his family. When describing the "pedal point" (~), or a "thought that dissolves into a suggestive silence" for example, the speaker refers to a conversation with his brother in which he tells his brother not to worry about the trouble with his heart. The two each say "I know~" back and forth, without every clarifying what they mean (83). The speaker then moves on to other punctuation like the "low point," used in place of phrases like "this is terrible," and the "snowflake," to signify a unique arrangement of words never spoken before in their family history. For the snowflake, the speaker provides the example of, "I didn't die in the Holocaust, but all of my siblings did, so where does that leave me? ❄" (83).

When discussing the "corroboration mark" (☺︎), the speaker explains that it mostly applies to his father. He says that his father has suffered more heart attacks than the rest of the members of the family combined. The speaker also notes that his father credits his successful marriage to having been a "yes man" early on. His father tells the speaker that he, too, will become a yes man, and the speaker thinks that he already is one.

Next, the speaker lists a series of symbols that all serve as representations of the words "I love you." He refers to these symbols as "Barely Tolerable Substitutes" (83).

The speaker then explains the significance of the "reversible colon" (::), in which two separate ideas explain each other. He provides the example, "My eyes water when I speak about my family :: I don't like to speak about my family," along with a number of others (84). The next punctuation mark is the "backup" (←), in which "We start again at the beginning, we replay what was missed and make an effort to hear what was meant instead of what was said" (85). Finally, the speaker explains the significance of the "should-have brackets" ({}), which represent words that should have been spoken but were not. To conclude the story, the speaker presents another conversation with his father in which "I love you" and other phrases are placed in should-have brackets. The conversation also includes a number of other symbols to which readers have been introduced, along with others the speaker has not explained at all. At the very end of the story, the speaker admits that he often thinks about his family's "should-have" versions of conversations, saying, "I sew them together into a new life, leaving out everything that actually happened and was said" (85).