Monday, February 8, 2010

Women and Heart Disease: The Heart of a Woman

Here it is: the final chapter - of the manuscript, not of life. Life keeps changing and I keep marveling at it. My little grandsons are the light of my life, beyond all expectations and my heart health continues to improve! I recently lost about fifteen pounds (a brain change!), which wasn't really necessary but is such fun... I never thought I'd be called "skinny", and in truth I'm not (middle-age spread anyone?), but I'm taking less medication and have more energy. The other news is that you can catch me on UTube doing a video for "Go Red for Women" and on a medical segment on CBS news with Dr. Holly Phillips which aired on February 4th. It's all enjoyable and I am so glad to have venues for my goal of educating health professionals and especially women, so we not only survive but we thrive. I'll probably write from time to time, but I sure would like to know my "audience", so please sign in and "talk" to me! I hope I've reached someone out there...

Adaptation: Skillful Thriving

By now you are well on your way to physical recovery and may be examining and perhaps reworking any lifestyle patterns which are not helpful. After all, what choice is there? You could not possibly stay in one place as you read on, exploring your own life each day. If this does not ring true, try re-reading the initial phase of this book - and the other wonderful reams of pertinent material out there. If you are really stuck, do not give in to feeling sorry for yourself and do not give up. You are inherently worthy of that further effort of exploration no matter how intractable you may find yourself! Besides, we all retreat, regress or have doubts from time to time, so be patient with yourself, but do not let yourself off the hook.
Adjusting to being a "heart patient" - and I freely admit to my continued discomfort with the term, still looking around me under the pretense that there must be another person in the room to whom that reference is being made - is far from simple and can be a lengthy process. I'm no Pollyanna and in fact am known for my realism, tinged with the optimism to which I have referred. Accommodating to an unwanted situation is a heavy burden, but failure to adapt is even more cumbersome. A modicum of fear may always co-exist with the prevailing feeling that you will live a long, productive, interesting life. I have reached a "this is it" point and know that whatever the damage or difficulty, there is ample solace in that the field of cardiology has more than ever to offer us if further treatment becomes necessary.
The challenges for women are unique: we must campaign for inclusion in more thorough, longitudinal studies. We must educate ourselves to avoid unnecessary incidents based on ignorance. We cannot allow ourselves to be ignored and need to take steps toward self-advocacy leading to prevention, by speaking up and insisting upon receiving the attention and medical care to which we are entitled. Perhaps we need to get political, going to bat for our inherent right to be taken seriously. We are dying of heart attacks at a terrifying rate and yet have not been properly informed. Gender differences in communication are widely studied, but how many women, their physicians, friends and family are aware of the crucial differences, literally in our hearts? We cannot afford to wait passively for this education to take hold: it is killing us at a rate of one in three, some of us at ages far too young to die. More women die of heart attacks than of the three other major causes of death combined. We must come forward to each other and to health care professionals – ladies, it is time to roar!
For me and many, many heart patients, the alterations in lifestyle due to having CAD are actually rather minimal in the scheme of things. I have conquered the issue of not exercising and know that I will maintain the level of fitness I have achieved, along with a decent weight based on reasonable eating habits. Mood stabilization and stress management are continuously challenging. Pill-taking, including vitamin supplementation, has become completely routine and self-education is ongoing and fascinating, particularly in the areas of complementary medicine and interventional cardiology. Since I have always been avidly interested in medicine and an advocate of involvement in one's own care, reading books and articles and tuning in to the latest thoughts and opinions in the field is, happily, natural to me. It is hardly necessary and you will not suffer if you do not mimic me in this area, but certainly be involved with physicians and others who are open-minded and up-to-date. Most of the time, I am attuned to my body without being either easily alarmed or out of touch. It takes most of us a long time to reach this point and none of us can honestly boast that we have reached that place of perfection where the pendulum is ever, let alone always, at the center. When I float too far from that midpoint, I either notice and correct myself or am willing to take note based on the recognition of those around me that I am out of balance. If your desire to maintain a realistic level of health is strong, it will be evidenced through your powers of adaptation. I hope you will take pride in your accomplishments; the tasks are remarkable, may be new in certain aspects and will bring you to a point to which few people aspire and even fewer achieve.
I have the sense that as my journey continues, I will learn more and hopefully better ways to manage my illness. Not a single day goes by that does not remind me that I am a heart patient. It may be a twinge; breathlessness when I take two steps at a time up a staircase because I have allowed myself to "forget"; or simply having to chase an errant pill that falls on the floor and rolls under a counter.
Every single day grants me the opportunity to appreciate that I am here to see my daughter blossom; to absorb and attempt to return the love of my family and friends; to nurture the determination I have developed to help me to thrive. The addition to my life of my three little grandsons is inexplicably extraordinary and has called upon strength and energy I never thought possible.
Not a single day passes that does not challenge me to become more, to use my strengths to help me build weaknesses into assets; to develop my ability to convey my odyssey to anyone who may derive value from it. I am actively involved in the “Go Red for Women” campaign and hope to deliver my messages of education for women and my mantra of thriving through the American Heart Association as well.
I know how fortunate I am to have survived the heart attacks themselves and that the intermittent symptoms, both physical and psychological, pale in light of the fact that I am still here, able to share my thoughts, ideas, dreams and, yes, nightmares with the people whose lives I touch and who enhance mine. Life can be stormy at times, challenging beyond my comfort zone, but I can generally figure out how to pick up the pieces, sometimes on my own, sometimes through friends, colleagues and family. I am staunch in following my medication regimen; careful, though not a purist in my eating habits; avidly active and, maybe most important and telling, as positive as humanly possible in my attitude about what it really means to live. I falter and I am more aware than I wish to be of the physical reactions that seem to haunt all of us living with coronary artery disease. Sometimes I feel overly dependent on the most valued and valuable people in my life, but they are consistent in their caring and comprehension of the ongoing saga. I know that they each have their own crew to spill over to if I lean too heavily on them or if I give them cause for immediate concern. Two years ago I was hospitalized overnight due to a new set of emergent symptoms that turned out to be based on small vessel disease - not life-threatening and easily treated, but frightening nonetheless. A follow-up angiogram actually demonstrated improvement (additional collaterals, probably my reward for knocking myself out in rehab!) With all my experience, all of my accumulated wisdom, I was so terrified that the "cath lab" team had me practically under general anesthesia to perform this relatively simple test! Anticipatory pain is not easily avoided and falls somewhere between warranted and absurd, closer to the latter in the end. The outcome served as a reference point for future tests, which have been necessary from time to time. I may never actually watch the procedure, as I have been told others do, but hopefully I will not be so filled with dread that anxiety overtakes rationality. I urge you not to be too hard on yourself should you be in a similar situation. I could not have predicted that I would have reacted so strongly, particularly given how many incidents I had weathered, but there I was, a virtual basket case! The good news outweighed the rest, but I have not had that that level of difficulty since. At this point I have nicknamed myself “Six-stent Sue”, proudly “wearing” them and doing quite well!

So there it is. This chronology hopefully has added to your knowledge base and will serve you well in your own journey toward not merely surviving, but thriving, day to day, often with small steps, usually in a forward direction. Humor, sheer determination, positivity, fine medical care and sufficient curiosity about the future will act as the balance on the other side of the seesaw as life continues.
Thriving is a skill seldom taught, that once acquired thoroughly enhances one's life. You will struggle to find your unique ways of achieving it. You will remind yourself that you are worth it and will take responsibility for seeking out and consistently utilizing the many resources that exist and will be there to assist you. You will revel in your small accomplishments and take note of the behaviors and attitudes that thwart you, consciously replacing them with more workable ones. You will be conscientious about following the advice of people who know you well, filtering their wisdom while increasing your own. You will accept and cope with the downturns, difficulties and scares, using those moments to drive you toward your ultimate goals. You have already survived, a wonderful feat that deserves momentous appreciation. You now have the incredible opportunity to use that survival as a stepping stone toward thriving, building and living a life defined by humor, delight, purpose and joy.

Sunday, January 31, 2010

The Heart of a Woman: Women and Heart Disease

Welcome -- and welcome to a new decade! It's hard to believe that "The Heart of a Woman" was written nearly TEN years ago! There remains only one chapter you have not yet seen, and then decisions to be made: other than this blog, my work is unpublished and do I continue to blog?? Updates abound, of course... I have also been meaning to tell you that the site does not italicize, but I have: anything I consider crosses the line from journey to self-help is in italics, so use your imagination and enjoy!
By the way, look for Go Red For Women, headed by my cardiologist, MaryAnn McLaughlin. The annual luncheon is on February 26th and will be well-represented. What a cause it is! You can google it (and me) to obtain more information.

Personalizing the Millenium: Love, Laughter and Reality

New Year's Eve 1999: Nearly fifteen months had passed, yet I could barely make it a mere four blocks - uphill, at night, chilly head winds - to a party I attended with all three generations of my family. It was the first time in many years that we were all in the same place at year's end, and it seemed particularly fitting. We were so busy down-playing this major event with all its international hype that we almost missed it! There was the ball dropping in Times Square, throngs of people from all over the world cheering, Dick Clark, who must be three hundred years old by now, doing his annual schtick, turned up a notch for the turn of the century. I think it was three days before it finally hit me: I was so "lucky" to be alive! Why shouldn't I be celebrating wholeheartedly! I had to laugh at myself! It is so easy to forget to appreciate what is, go on about our business as though no one day matters. Because every day is precious, we should act accordingly, but do we? I was eerily aware that I still was not consistent enough in practicing what I preach and called myself up short, resolving to greet each day with enthusiasm, pride and plans, not as simple a prescription as it sounds, as we all intrinsically know.
I keep going back to the importance of social contact, a healthy, universal need. You may be the type of person who is always surrounded, or perhaps you have one special friend and a few people on the periphery of your life. Even if you are a loner or non-joiner, hopefully you are exercising or enjoying special interests with people who are like-minded. The intellectual and emotional stimulation you both give and receive while in the company of others adds to your physical and mental health. Make wise choices, of course, continuing to put yourself in the midst of positive, supportive, fun-loving folks, welcoming their thoughts and ideas and cherishing the mutual contributions to one another's lives.
My journey was no longer dramatic, the heart-related symptoms having become routine, along with pill-taking and exercising, the highlight of each week's schedule. I still marvel at my friend's prognostication that I would come to love it, but he could not have been more endearingly and enduringly correct! If you are a non-believer - or, more likely, a non-exerciser - allow me to proselytize once again, just for a bit. Not only will exercising increase your physical tolerance, it may well increase the number and strength of your collateral vessels. While exertion on the various pieces of equipment may not be thrilling at the moment, the results are astounding. Most of us leave radiantly red-faced, perspired, inspired, almost giddy. Our blood pressures and heart rates are better controlled than ever and we are intentional, purposive, intense and consistent about our program. If anyone had told me a year ago that these words would come from me, I would have laughed heartily (pun intended) and sent them on their merry way. Okay, I don't love every minute of it and when the class is small enough so that I can monopolize the treadmill for a half- hour I have to force myself to stay on it, but what an accomplishment! My friends no longer have to ask if they need to drop me off before they park the car. I can walk briskly or climb a flight of steps without becoming winded - and that is with only 70% of my heart working! If you were never in particularly good shape, you will be so surprised at the benefits of a reasonable program targeted for cardiovascular fitness. Don't look for weight loss or muscle mass, but do expect to work hard - they don't call it working out for nothing - and then you can fully expect to reap the rewards. Now, how can you resist?
The dawning of the new year provided yet another opportunity to continue on a clear, positive track. I paid particular attention to the blossoming of new friendships, choosing not to focus on my impending divorce. When you hear the voice of the optimist hesitate, it is the realism coming through, which is neither negative nor positive; it is just an indicator, a challenge of some sort, a green flag. For me, reality was based on being able to separate the provocative from the productive. You have the power to control your reactions, which are based on your unique interpretation of events. I have chosen to use that power to study life's seemingly difficult moments and then compartmentalize, carefully weeding through the emotions, coming to terms with the parts of the equation over which I may not have control. You need to neither overreact nor fall prey to the inevitably disabling inertia which is best defined as choosing not to make choices.
The issue of control, or more aptly withdrawal from the need to control, challenges me and probably always will. You will know from the reactions of people around you if you have become more "laid back", easier to be with, emotionally quieter. It will be a great feat if you were the typical Type A personality we all know but do not need to be, and it is gratifying and exciting to make the switch! Achieving this kind of growth is energizing, as opposed to the debilitating results of having to know everything, be everywhere, be everything to everyone. There is no loss here, just pure gain. I giggle at what I do not know that less than two years ago I would have been crawling through walls to uncover. We often think that there is a payoff in control, that it is empowering, but I have come to believe that it just makes us seem anxious and relentless. Think about it this way: is it logical, convenient and desirable or, in all honesty, is it intrusive, irritating and counterproductive? Bearing in mind that we repeat behaviors that work, that seem to end in a payoff, what is to be gained by the drilling and grilling and accumulation of drama generally associated with those who seek to control? Why would anyone knowingly subject him/herself to the grueling task of controlling people or situations when the alternative is to be peacefully aware and engaged, but not on the alert or on one's toes? If you need to confront your behavior in this area and modify it, you are guaranteed to feast in the payoffs.
Here are a few carefully chosen "givens":
- we all fear rejection and crave acceptance; we need approval and have difficulty fielding criticism
- fulfillment and gratification are essential ingredients in our lives
- plateaus are reached by devoting ourselves to thriving.
I am not suggesting that there is nothing you need to control and you should go through life under anesthesia! You and only you can control your reactions and your behavior. The good news is that you therefore have the power to re-shape the aspects of your life that you decide you need to address. After all, if we label surviving as a challenge, then thriving defines itself as the ultimate achievement. Another in the inevitable, remarkable series of turning points in my physical and emotional recovery surfaced when all the hoopla of the new millenium died down and I found myself wondering what was next in the saga. No longer dealing daily with the initial denial and having achieved a higher level of acceptance, I knew I had to embark on something meaningful, but what? When I first had the idea for this book, my thoughts ran the gamut from how dare I to how could I not share my story? But I was so tired: tired of being tired; tired of how hard it was to keep moving in the direction in which I believed; tired of the pill-taking, the doctors' visits, the side effects of so many medications. Logic dictated that I take a new direction. This was tantamount to an admission that I had not yet arrived, one of those situations when the good news and bad news are the same: I could take command, but only if I granted myself some leeway, gave in to the fatigue when necessary, cut myself some slack so that the continuation of what is in fact a life-long journey could be broken down into paragraphs, not unwieldy volumes. If you are one of those people who expect and demand too much from yourself, you are accustomed to tempering desire with reality. If you expect too little from yourself, then you will need to recognize that as a pattern which disables you, and redouble your efforts toward improving the quality of your life. How you do it will depend in large part on how you conquer your fears and ensuing moments of immobilization. There is nothing superficial about our journeying and it is by definition not simple. On the other hand, are you complicating it by staying on the fence, in a neutral position? Are you allowing yourself to settle for what is instead of moving forward, even in the face of some natural anxiety? Are you either over-analyzing or not thinking enough about where you are, relative to where you want to be? Again, you may benefit from keeping track of your thoughts through writing. You may want to make a list of what you have accomplished thus far and then another list of the challenges you wish to incorporate in the immediate future. You can knock yourself out of the race by being too smothering of yourself, just as you can thwart yourself by being unrealistic.
I am not a person who is constantly driven; I can lay back, pet the cat, watch mindless television, but there always comes a point that I encounter unmet social needs or am dissatisfied with staying still. Sometimes you will be able to capture a vision of yourself with that movie camera in your mind's eye and become excited by what you see, as I did when I conceived this book. Trust yourself to get started, use your resources to jump start you if that is what you need, but make friends with your thoughts, your frames of reference, your goals, plans and desires. The focus cannot remain on your illness - you will bore yourself to tears! How many times do we hear people exclaim: "I just knew it was time to move on!" Try Iyanla Vanzant’s method of rewording your messages to yourself to formulate an action plan and then kick-start yourself. Believe me when I tell you that the pride and courage you demonstrate will feed on itself and keep you highly motivated to remain on your chosen path.

Wednesday, January 13, 2010

Women and Heart Disease: The Heart of a Woman

As I post this chapter of my writings, a new year -- a new decade -- has begun. There are challenges and opportunities; there are difficulties and demands; there are, as always in my life, beginnings. Happiest New Year to All, and now please read on...

Beginnings: Life Changes, Life Laws and Letting Go

The sense of "here we go again" was ringing in my ears. I was hypersensitive, attuned to my body as well as my feelings, quite aware that my emotions were raw and tenuous. On one hand, I was in a honeymoon phase of living with myself and enjoying it immensely! Nothing moved unless I moved it; there was silence broken when and how I preferred it; effort was expended in the directions of my choosing. I continued to work, but no longer for the business, so the phones were quiet, the voluminous paperwork non-existent and the endless diplomatic interventions with staff and clients absent. On the other hand, this immediate change in life style was shocking, and it would not be long before I had to ask myself what was next.
Following Phil McGraw's Life Laws and intertwining them with my own philosophies, I began the first leg of this necessary journey. All ten of his laws have incredible merit and I highly recommend both of his books, "Life Strategies" and "Relationship Rescue". Your ways of handling the particular challenges you face will likely be augmented by his ideas.
Life Law #2 states that you create your own experience and are accountable for acknowledging and accepting what you have created. This does not imply that if you have had a heart attack that you have chosen it or are to blame or are a hapless victim. In fact, there are no victims, according to Dr. Phil, just "volunteers". The truth is that you are responsible for reclaiming your life, for putting yourself back on track and moving forward past the point of survival - you have won that battle - and onward. "Change" is not a dirty word; it is inevitable, meaningful, exhilarating and strengthening. I can almost hear you thinking "Easy for her to say, but I'm frightened and I don't want to face any more difficulty than has been thrust upon me ". But you have already begun anew and you have proven yourself. You have emerged victorious at least on a physical level and I believe that without a reservoir of desire to stay in this world that you might not have achieved that. Give yourself more credit and begin to realize that a beginning has crept into your life scene, and in confronting it you are astronomically increasing the possibility of thriving! If you insist upon fighting change, you are failing to acknowledge that you are accountable for your choices and the consequences of those choices. You are taking away from yourself rather than embarking on the quest to become more.
I could not remain numb because to do so would have robbed me of the payoffs of new, or at least improved behaviors, ways of being in the world that would enhance me.
Although it was tough to face, this was actually a good time for me to go through the separation. It was an opportunity to re-examine my choices and decisions, rejecting what had not worked and welcoming different strategies. We cannot allow emotional blindness to thwart us or frustration to stop us. I knew that I was foisting myself into a fearsome state but that avoiding it would keep me burdened with the tension and stress of staying in a situation that was not working. Fear and escape from pain have a seductively narcotic effect, but that anesthesia leaves you emotionally stranded, disabled from taking positive action. This is real life and you need results, not excuses. Harsh though it may seem, my goal is to help jet-propel you to where you need to go. Your job is to trust the process, immerse yourself in it, embrace it with open arms.
I was still coping with changes in medications, trial and error additions and subtractions attempted according to my doctor's wisdom. Every test, every symptom, every report had to be examined. Fatigue was limiting, fear was still hard to quash and the reactions of doubt and anguish among my closest friends and family made me so emotional. Although I was optimistic, I could not help but become impatient with the slowness of the healing process. Not knowing what to expect, what baseline would eventually be achieved was baffling. I so wanted a working crystal ball! When would I reach my maximum in terms of energy level? When would I stabilize on the medications and perhaps reach the lowest possible dosage levels? What could I reasonably expect of myself in rehab? We all pose similar, unanswerable questions and doubt creeps in even when we are determined to remain positive -- it is the reality check syndrome. Once again, the issue of control, or lack of it, enters into the picture in its many shades of gray. I consider myself to have a rather high level of self-awareness, and well I should, but I was amazed somehow that the further I was from the heart attacks, the more I was able to give over control. It was taking root more and more deeply, sometimes consciously and more often as a matter of course. To me the latter provided a modicum of proof that this was going to become permanent, not just situational. Some examples seem minute, but they were winking at me on a more regular basis: "Where would you like to go for dinner" would be met with "It's up to you" and not followed by suggestions, complaints or comment. I did not have to participate in everything but could allow others to take the ball. Life had become easier because I had made it become easier! It was not mysterious and certainly not impossible.
I had yet another opportunity in November to go to Florida with my wonderful, supportive, spirited daughter and she made all the arrangements, she drove, she navigated, she led me. I was calmer than ever, easier with myself and finding that the smallest pleasures put a silly grin on my face. Thriving was taking on so many definitions, including simply enjoying life and recognizing it. The full blown meaning (prospering, succeeding, growing or developing vigorously, flourishing), could be taken down a notch to mean feeling content more frequently. It is important to take notice of your own progress, especially when it is inherently slow. I was not entirely without responsibility for my medical condition, but once I could at least allow my doctors to guide me, I could bow out of the brunt of the work that I was not knowledgeable enough to handle. I was careful about food, exercise, rest, pill-taking, but the rest could be up to them. I had chosen them wisely and had a high level of trust and respect for their judgement. If I was too hesitant to report to MaryAnn an incident known to my support system, I could accept their nudging me and make a phone call, without resisting. One of the byproducts was a reduction in my general level of fear, the affliction of "what-if". In fact, days after our return from the trip I was scheduled for another stress test and was actually excited rather than unnerved. This time I would be strutting my stuff instead of fearing that I would fall apart! Indeed, my exercise tolerance had grown, but there were still abnormalities evident, just as on my ECG's, but nothing dire, and, most importantly, I was continuing to develop collateral vessels, "extra" blood vessels capable of taking over for blocked, plaque-filled ones that may have caused the heart attack. Hurrah for rehab!
Perspective is of such great import and, by definition, can take place only with the passage of time: Thanksgiving was coming again and the differences in the long year that had passed were actually dramatic. I was brighter and cheerier, much more energized, had greater stamina and concentration. Overall, I was involved, enlivened, peaceful and filled with optimism, quite a counterpoint to the dulled, tired, unenthusiastic participant just twelve months earlier.
My strong sense of realism was at play, too, and I knew that I would be thrust into periods of sadness and loneliness despite my inner strength. I had made a decision that was not without difficult consequences. My initial inaction was inherently emotionally costly but now I had to develop strategies that would allow me to cross this next threshold, not a simple task. Bathed in a variety of side effects from the many medications I had to ingest, ranging from the ridiculous (a puppy-cold nose) to the sublime (those wondrous vessels), I had to admit that it would be with considerable difficulty that I would move forward.
In our moments of greatest difficulty, forward motion seems so daunting. Getting real, accepting what is, holding yourself accountable for where you are - all of these notions that I hold dear - will sometimes leave you feeling overwhelmed. Life may seem so difficult to manage, as though you need to be made of steel, while feeling more like Jello. As a people-person, I can vouch for the value of being active and among those who make you feel most alive. It is a natural phenomenon to feel alone from time to time, even if you are in a rewarding relationship, working, parenting, taking advantage of avocations, participating in group activities or individual counseling and invested in attending to your own needs. There has always been some controversy regarding the differences between "alone" and "lonely". In my experience, heart patients who identify their lives as being full still speak about a specific type of loneliness/aloneness that is based on the uniqueness of the nature of the disease. You may feel a distance from your significant other, best friends, close family members who can sympathize but not empathize and an uncanny closeness to your classmates in a cardiac rehab program. When you awaken with symptoms in the middle of the night and you are alarmed - "Oh, no, is it happening again?" - your doctor, your trusted medical resource, is not likely to be present and neither are your compatriots. Your spouse may be lacking patience, certainly lacks expertise and/or may not know how to be available to you in the way you need him/her to be. These are moments when you are most likely to feel like you are in a morass and on your own (alone) and unable to use the usual resources to fill the immediate need (lonely). I made reference to the 5 AM syndrome concerning my mother, but it still happens to me some early mornings, too. If I am awakened for any reason at that hour, I have to remind myself of all the positive results of my last tests, convincing myself that no, it is not happening again, that I am receiving excellent care. My only job is to soothe myself back to sleep; anxiety breeds like little rabbits and can drive you needleessly nuts! It is essential to have a well-thought out plan of action in case serious symptoms arise, since logic so easily gets thrown out the window when anxiety slinks in. Perception, your own personal way of reacting to a situation that presents itself, is the key: I can feel a flutter and decide I'm in trouble or I can choose to process my reaction through a decidedly calmer filter. I can panic or I can summon my most forceful, diligent, rational thinking mode. I can run for the phone, get all worked up, no longer able to distinguish between fact and fear, and create a vicious cycle leading to a place I do not want to be; I can also be still, pause, listen. Just as in other aspects of our lives, we can use as life lessons the issues of the past without allowing ourselves to be controlled by them. It is not our particular life situations that shape us, but rather our reactions to them. We all have a certain way of filtering our perceptions, so the physical stimuli can be distorted or addressed calmly. You need to be aware of whether you are creating an opportunity to examine yourself, or falling apart in advance of true knowledge, even at five in the morning. How many times do you hear about someone screaming through childbirth while the woman laboring in another room is brimming over with delight and awe? Their pain thresholds may be similar but their filtering systems are likely quite different. One may be frightened of the unknown and the other more educated; there may be many elements to the equations, but one thing is certain: the screamers among us often find themselves reacting to their difficulties with less forethought, probably in large part due to their lack of ability to test their assumptions prior to exhibiting their reactions. So what does all of this mean in the scheme of things? How can our perceptions help us simplify our lives? How do we objectify reality so that we can make sense of our thoughts, actions and reactions? When we sift through Phil McGraw's ten laws of life, we begin by becoming accountable for our lives, willingly, purposefully and consistently, without blame and with true acknowledgement. When perception is clouded by past experience and negative expectations, we fall prey to limiting rather than challenging ourselves. Self-fulfilling prophecy can cut both ways: if we believe that we can get well and fight for ourselves, the outcome is nearly always positive; conversely, if we are pessimistic, refuse to accept what is, become filled with self-pity, we are apt to induce distress and exacerbate the negatives of our situation.
During a rehab session recently, an upbeat, pleasant, bright woman suddenly sat down, lowered her head and nearly passed out. Her blood pressure had soared, her face was blazing and she was dizzy and near tears. She was attended to by the nurse and doctor on staff and told to sit quietly, stop exercising and just breathe. I made my way over to her and she immediately began telling me exactly what she was reacting to. Her daughter-in-law had written a letter to her filled with complaints about the difficult issues in her marriage, demanding that Lois do something about her grown son. Lois reacted strongly and negatively to the nerve of this woman. Upon reflection, she realized that whatever the intent of the letter, it was her responsibility to own her reaction. She slipped, forgetting that this woman could not cause her to react in any particular way, and that Lois's reaction was purely driven by her own thoughts. The daughter-in-law did not make her blood pressure rise, Lois had done that to herself. The good news is that when it happens, we all can take the liberty to adjust our reactions. She nearly slipped further by chastising herself rather than using the "Aha" moment to assist her. She was proud to come out of the incident with her thoughts intact and her blood pressure back to normal. She will write a positive, simple, short letter back acknowledging that married life can be difficult and that she is certain that they will find solutions on their own. She went home feeling renewed and relieved that she does not have to solve their problems and she does not need to allow herself to be negatively affected by their issues. We can choose what to react to and how much precious energy we want to expend. We do not have to drive ourselves into a tizzy unless there is something at stake that is worthy of our attention, and then we can work through these moments in ways that are helpful, not harmful. A "heartache" can be dangerous, even life-threatening for us. We absolutely must protect ourselves from reactions that can bring about an array of symptoms that can become precursors to disaster. We are fully responsible for managing our dis-ease, which is good news! We have ample motivation to make sense of each troubling situation with simplicity and clarity. There are no guarantees, but it is tempting to tell you that if your thinking is sound, your judgement will be too, and your life will be easier, more pleasant and healthier if you learn to think before you act or react. Lois had allowed herself to become immobilized by the frustration and annoyance inherent in the situation, and it had affected her health. Her stark awareness will be a terrific reference point so that she can choose other ways of handling similar incidents if they occur.
So now I had to ask myself some questions: would seeing clients, writing diligently, going to dinner with special friends, a birthday party for Mom, the routine of seeing the dentist, going to doctors, exercising three days a week enable me to practice what I preach and live what I had not only learned, but was teaching? Questions like these served as markers for my worst moments, red alerts to remind me to empower myself. I was nearing empty and refueling was a necessity. Back to the wisdom of Iyanla Vanzant's quiet pause. Back to the trust in my abilities. Back to the life experiences that prepared me for this one. Forward, using what I call the "movie camera" in our brains. Time to reflect on reasonable, short-term goals. Time to appreciate and luxuriate in the joy of my daughter, the dearness of my mother, the specialness of my friends and family, all earned by my being who I am. Time to enjoy the holidays and the coming of a new year - the millenium, in fact! There were days that getting out of bed in the morning was a chore and sleep a refuge. There were days that dragged on slowly and days that were unproductive. There were thoughts that demonstrated a longing to know my future and conflicting ones that knew better than to take more than a day at a time. If all of this sounds familiar to you, that should not be surprising, but while it is happening it is so difficult to take it all in. Becoming entrenched in a negative mode is a prescription for trouble, limiting the ability to filter and to be open to finding new ways of coping. Rather, you need to remind yourself yet again that you have survived, so you have already come out on top! Your attitude about striving to thrive is where your power resides. You may have been knocked down by your heart attack, but what matters now is getting back up and staying there! You're not on this life journey alone, and you do not have to be totally in control, but you must take charge of managing your life. I have often joked with clients that if challenge builds character, we can readily understand why there are so many characters among us! Expect the hurdles, but don't label every situation a disaster; know that there will be pain and difficulty, but do not react in advance, daunting yourself before you have the opportunity to create an efficient, realistic plan. Become your own top-flight manager, allowing the perhaps unexpected, yet predictably present changes in your life to function as opportunities for furthering your growth. I recently asked the director of a private school for children with learning disabilities what she would like to do differently in her already remarkable school. She told me that she starts every day as though she was about to be replaced by someone else. She then becomes that new person - a new broom, as she phrased it - and she tries to be that new broom every single day, because a new broom always does a better job. She is always open to new ideas and approaches and is an incredible motivating force for both staff and students.
One of the major responsibilities of parenting is to instill in our children the ability to adapt to change, for we know that it is inevitable. We also know that beginnings are created by endings, even unwanted ones. I could not know what the future design of my life would bring, but I certainly knew that I would be the driving force. Why-me and what-if questions are debilitating and unnerving, involving a remarkably useless expenditure of energy, yet leaving us devoid of answers. I had to re-invent parts of myself, mindful of my good skills and abilities as well as my areas of lesser ones. The natural fear of the unknown is based on needing to know the answers to unanswerable questions. In terms of CAD, great advances are being made in the field, so I feel assured that within the next five years and subsequent similar blocks of time, I will benefit from gains in the treatment and management of cardiac patients. I know that closure in the relationship was critical and had to be addressed fully in order for me to move forward without having a chip on my shoulder, let alone, as my mother phrases it, “an entire lumber yard”. Determination and commitment are central in this important task. Remember, too, that behavior is purposive and self-rewarding. It is essential that you reflect on why you act the way you do so that you can choose to eliminate behaviors that limit you. You will have command only if you take note of the consequences of your actions and you will move forward by planning, not wishing, hoping or dreaming. It is a tall order, this life based on deep thought, but I assure you that having been through all you have - and I say this with true empathy - the rewards are going to be extraordinary. One of the ways that I can assess my own progress is by noticing the reduced frequency and duration of the inevitable lows. It may serve you well to keep a diary or a journal as you go along, particularly if you are experimenting with new strategies. It will keep you honest and involved and help you to integrate the new with the old. You already have a core from which you operate, based on your lifelong value system, experiences, desires, needs, expectations, successes and failures. You may need to make adjustments, admissions, acknowledgements. You may actually find that you are closer than you thought to achieving your goals, attending to the meaning of your life and becoming your own patient, realistic manager. It is magically uplifting to see yourself recognize the quality of your life plan as it takes shape. Of course, the path is bound to be bumpy. It is appropriate to demand command of your own life with conviction and boundless determination. Don't cut corners by setting your standards too low. Try to find a balance between striving for great heights and deciding it is too difficult to create a life that can be more than it is right now. Neither settle for nor create an unrealistic scenario that is bound for disaster. Success breeds more of the same and as you and the people around you notice that you are fighting for yourself and are determined to become more, you will flourish.
You may want to ask yourself specific questions, such as:
- Am I managing my financial life appropriately?
- Am I killing time or utilizing and appreciating it?
- Do I need to develop my interests or select gratifying hobbies?
- Am I remembering to see the humor in quirky situations?
If finances are problematic, you have a real battle to wage. In my family we say that money is not a problem -- lack of money is a problem! Again, utilize the knowledge and experience of those you trust or to whom you are recommended. If you neglect this issue, I can promise you that it will ferment, grow and taunt you. Solutions abound and must be sought out.
The issue of time is precious. Having come so far, gained so much, worked so hard, your time is so vast in its value. It is not about "one day down", but rather a matter of reveling in the treasure of using and delighting in every moment of every day.
Perhaps you will come to realize that you always wanted to DO IT! Pottery? Reading? Canoeing? Whatever enters your mind, if you cannot arrange to do it, then read about it, talk about, engage in any possible aspect in it, but do not drift away from it.
Humor is my favorite topic. It is health-giving, life-extending, both immediately gratifying and endlessly referential. Sometimes I feel like Dudley Moore in "Arthur", all by myself and just laughing at my own thoughts. It is a lifesaver and a true necessity, especially in tough situations. Whatever brand of humor appeals to you, whether from a book, a comedic performance, a movie, a joke, use laughter as a lifeline - trite as it may sound, every chuckle is worth a million times more than even the slightest frown.
There is every reason not to set yourself up to believe that everything will always work, just because you are designing your life with more thought. To quote Dr. Phil, “Sometimes you make the right decision and sometimes you have to make the decision right". Keep on track, but remember that the softness of the path you are designing allows for flexibility and once you have taken responsibility for struggling to mold it, then your strength lies in not rigidly clinging to what does not work. It is your life, you are the managing agent and you will be able to figure out what works best for you once you commit to the idea of honing your skills and reaching for your particular star.

Friday, December 25, 2009

Women and Heart Disease" The Heart of a Woman

Hi out there: Happy Holidays to you. I hope that 2010 is the best year ever for all of us!
This chapter is long and it seemed endless in the living of it! Please let me know if you have questions and/or comments!

Aspiring to Elation: Strength, Stress And Successful Striving

The summer had begun; some of my clients were away and it was the slow season for the business, allowing for more leisure at least on weekends. Just releasing my feet from shoes was my idea of freedom! I began thinking more and more about the choices I was making and committed myself to spending more time away from the relationship and the business, both of which I was allowing to cause a frightful level of stress. Reducing my work hours meant that I could make plans with friends and do the things that I found pleasurable. It sounds so simplistic and obvious, but living every day and enjoying yourself is so crucial. It is easy to kill time instead of using it; to allow the day to slide by, instead of using it to your benefit. In Hugh Prather's first book, a journal entitled "Notes to Myself", he refers to how we too often measure time by what we accomplish. He says in essence, I'm sitting here petting my cat; what more is there? If you are aware of your needs and then seek to fulfill them, you will regard your time as special and you will take responsibility for utilizing it fruitfully. You may be petting your cat, having lunch with a friend, calling a special person, or just sitting with yourself, thinking your own amusing thoughts. The concept of being alone with rather than by yourself is incredibly precious. Since we are talking about elation and eyeing the goal of thriving, we must discuss self-love and basic needs. When you are with yourself, particularly at home without distractions, you will be fully present in your life, noticing that "one" is a whole number. If you can be still, not bombarded by any "shoulds", perhaps meditative or just relaxing in your unique way, you can rely on yourself to "hear" a loving and gentle voice - your own, developed and nurtured by you, from within. Self-love is based on inner feelings developed over time, through all of your life experiences. You are where you are because of where you have been and now you must take yourself toward the zenith, to places you have not yet been. How do you do that? How do you reach that height? I had a dear friend who knew the Nike slogan long before it existed: "Do it!", he would tell me. The difference between a wish and a goal is a plan. Don't wish, promise. Don't suppose, act.
I believe that every one of us needs love, as unconditional as is humanly possible, and that we engender it when we know how to give it. We also all look for acceptance, fear rejection, and can trust and respect others according to our own level of self-respect and self-love. If you care about you, others will, too; if you find yourself difficult to be with, boring, dull, good luck finding disagreement!
Allow me a moment to “preach” what I try so hard to practice: Courage, compassion and sheer will allow us to reach out and navigate our worlds with hope and the belief that we will succeed, each of us according to our own definitions and desires. If we analyze what we are doing, heighten our self-awareness, fine tune our strategies, we really can thrive, even with all the obstacles that could cause immobilization. Fear can easily lead us to a point of paralysis or inaction; anger often obliges us to remain static, thwarting any chance of victory. Love enables us to get our needs met and self-love leads us in the direction of clarity and hope. Every day provides a chance to embrace all we have, so that even in our inevitable down moments we can call upon our inner strength to draw us closer to where we want to be. None of this is too lofty, even if difficult, but it does require wholeness, motivation and the flexibility to acquire new methods of living that will help you to operate honestly and responsively. I had to hold on to the highest vision of myself during the lowest periods, recognizing that my strengths were the tools to use to build weaknesses into assets and that sometimes my perceived weaknesses held great strength. This is a seemingly complex theory, but trust me: strong people who allow themselves to express weakness are, in effect, showing just how much strength they possess. There will be days when you find yourself in that self-pity mold, clamoring for attention, yet too distraught to start the day. The strength you will learn to use to reverse your mood will actually serve as a reminder that even in a state of supposed weakness, you can prevail. The roller coaster factor comes into play here: stress leads to illness; illness causes distress; distress causes an already full platter to overflow, which is fatiguing; fatigue leads to the potential for further illness, a lessened ability to cope and heal. I have mentioned surrendering control and it will come up again, because it was a turning point for me. Yours may come in a variety of other forms. Allow yourself to pause, perhaps even recording the changes you may feel you need to urge in yourself, creating a journal useful when you feel stuck. Use humor - your own, canned or from people around you - to remind you of the capacity you have for joy. Your closest allies are looking for ways to help you through these frustrating, puzzling, exhausting times and it will make them feel better, so use them when you find yourself slipping. All of this falls into the category of self-love and need fulfillment and will get you back into living your life, not merely existing.
The month of May had been uneventful, but for the usual and sundry complaints and annoyances, balanced by the warming weather and welcome workouts. I was nearly due for another day of Holter monitoring and was riddled with irritating side effects from medication, but fairing well, all things considered. I was amazed that a small dose of an anti-depressant enabled me to soothe myself out of any dip in my moods so that I could maintain my equilibrium. I wanted to believe that the daily medications were responsible in large part for the crying jags, difficulty getting out of bed in the morning, not wanting to bother to put on make-up. My doctors concurred that my natural joie de vivre had been compromised by the fact that several of my daily doses of wonder pills were known to induce depression, but still they encouraged me to continue the regimen. I would have to supply myself with antidotes in the form of plans, calls, writing, work, all designed to bolster my mood. My goal was to manage without the anti-depressant as soon as possible.
An uplifting moment was upon me: my brother's fiftieth birthday was nearing. I was telling a friend about the plans for his surprise party. Accustomed to hearing me sing to the background music during class, he casually suggested that I sing at the celebration! We had discussed the trauma of my difficulty in summoning my voice along with my awareness that it had deepened slightly, mainly as a consequence of menopause…
I was completely taken aback, at once surprised by the sweetness of the thought and inspired by the idea. I told no one but him that I was going to choose perhaps three songs that would reflect my and my brother’s past and that I was going to cut my fingernails and begin practicing my guitar, a closet decoration for more years than I cared to count, to accompany myself.
I immersed myself in this project, somewhat leery, nervous with anticipation, and admittedly buoyed and excited. I decided to play two of my brother's favorites from a repertoire begun in his early teens and added Whitney Houston's "The Greatest Love Of All" with lyrics meaningful to us as parents. I began spending an hour or two a day for several weeks prior to the luncheon, developing calluses on my fingers and more trust in my vocal ability. I did not announce my dubious debut/gesture to my mother, stepfather and daughter until I was confident that I would not change my mind! Once they were privy to the surprise, they pleaded with me to practice in front of them, which began with discomfort but lead to a nostalgic return to the delight of the sixties and seventies, highlighted by amateur performances and wonderful times with friends. My husband was willing to critique me, which was useful, but was not caught up in the excitement of this foray, yet another symptom of his withdrawal. I was saddened by his indifference and alert to my own, but undaunted.
With less than a week to go, I offhandedly asked my daughter if she would like to sing "The Greatest Love" with me. She has a powerful, pleasant, accurate voice and is poised and confident, but I really did not expect her to join me. I was in for a delicious surprise. She was agreeable! We practiced only a few times, considering her busy schedule, singing mainly in the car during stolen moments together and developed a Que Sera attitude. Half of the guests consisted of family, most of whom had not heard us sing together in the past and the others were friends of my brother and sister-in-law, the majority of whom we did not know. Our appearance would likely be welcomed as courageous and dear and equally unlikely to be either critically reviewed or regaled!
We arrived early enough to hide my guitar so that it would not blow my cover. At the appropriate moment, I appeared just in front of my astonished brother and reached behind me to pick up my instrument. Before I began singing he looked at me with tears in his eyes and said: "Winken, Blinken and Nod'? He is one of the sweetest, most emotional and sentimental men I have ever known, so I should not have been surprised that he would know I would sing that particular song. He had spent the better part of his early adolescence requesting it. I sang one other song with the guitar, then "Sunrise, Sunset" from "Fiddler on the Roof", with the music in the background, followed by Whitney, belted out with meaning and purpose in a duet with my daughter. It was a precious experience and a mutual gift, a moment of elation to be treasured forever.
The entire experience was palpably reassuring: I gave myself the opportunity to do what I love, with a person I love, in an environment that was supportive and unconditionally loving. It was a winning scenario of my own creation, testimony to the advice I give and a sample of what living by my own strategies could achieve. It was also more monumental than it may seem at first blush because it required me to do what we all need to do: push past the difficulties and doubts, and forge ahead - the only possible direction - toward the ultimate goal of thriving. At every step, every bend, the road becomes clearer and the bumps more manageable. When you take advantage of every opportunity, you never lose; conversely, every recognized but missed opportunity is a potential loss. I could easily have allowed my shy side to prevail and sidestep the whole thing rather than requiring myself to strive for a reachable goal. There was a purity to the scenario; I did not concern myself with anything but my sweet brother's reaction. I was not particularly nervous and reveled in the fact that this was his moment. I probably did not consciously realize yet that this shift away from myself could be replicated in regular, daily living. We get so caught up in our own generally minor travails that we do not leave enough room for the creation of the joyous moments that constitute real living. There is a self-centeredness that comes with the territory when you are in the midst of a threatening malady that, although natural, tends to be emotionally weakening. Every time you attempt to get through an afternoon or a day without thinking about your illness, you have achieved a higher degree of functioning, moving from enduring the difficulties to utilizing your energy toward resolving to re-create your world in a softer, more spirited manner. On the other hand, if your expectations are unrealistic, then you are setting yourself up for a fall. If your medical team is clearly informing you that progress will be slow, then accept that as truth. There is no sense in believing that you have total control, because you do not, and to my own amazement at the time, you do not need it. This is a mantra that I found difficult to keep in force, having been a person who thought of control as a given: if I am in control, if I am aware of everything that is happening, all that people feel, and all that “knowing” would guide me. I slowly learned that control was a headache and that surrendering it merely implied that I could trust others to handle their own lives, leaving me room to just watch, listen and learn! If anyone had portrayed me as controlling, I would have fought against the label, but in truth I was overly involved and unduly concerned about details that were best left to others! There were so many reasons for me to abandon command, actually enabling others to take over, perhaps even assisting me! Unfathomable though it seemed, it required far less effort than I could have imagined and freed me to step back and enjoy myself. I had been overworking for far too long and found such pleasure in the quiet restraint that would become habitual, relatively shortly. This representation of personal growth is meant as encouragement for anyone who takes on too much, who is overburdened by the tiresome task of navigating others' lives. None of this takes away from my professional responsibilities of guiding clients, but it has allowed me to relax and just "be". I have finally realized that the pages of the calendar are turned one day at a time, particularly in the adjustment phase of an illness, and yours are no different. Your restrictions will likely change and your risks may even diminish over time. You may not know how far to push yourself in the face of true determination.
Another belief I developed is that when people suggest that you are "doing too much", a safe and fair response is "I can only be doing what I can do or I would not be doing it!" It's glib, but blends accuracy with resolve, and perception with sound judgement. Reaching ever higher implicitly demands more and more of you and the rewards are heavenly.
Toward mid-summer, I found the makings of elation in the anticipation of two sets of plans: a weekend at summer camp, visiting my friend's thirteen-year-old and another trip with my daughter.
Despite having to walk uphill in torrential rain, even stopping because I was out of breath -- regardless of being drenched -- camp was a fantastic experience, a return to the best of my youth and a powerful example of utilizing an opportunity. The familiar atmosphere brought out the best in me, the child within, the free-spirit revisited. I literally climbed up the rafters to rescue a missing parka, taught several campers to dive off the raft, drank "bug juice" at the picnic and did not want the long day to end. All day I had flashes of my wondrous summers. It was a day to shed the woes and responsibilities of adulthood and substitute the euphoria I never forgot from childhood. I had the support and concern of my friend and her lovely step-daughter and was filled with the pride that comes from such an accomplishment. The return to the purity of the happy camper was an utter delight.
The week's vacation to the South of Spain was really incredible! Again with my daughter and without my husband, it provided me the think-time necessary regarding the marriage, while thoroughly enchanting me as I soaked up the atmosphere of the country. I went home with the conviction that I could not allow the relationship to continue. After many conversations with my daughter and, mainly, with myself, and having shed a flood of tears, I knew what I had to do. The tears translated into words, sentences, reams. Anyone who has suffered the disappointment and pain of ending a relationship, particularly one you expected to last "forever", can furnish the manuscript. There was just one more complication: he was finally going back to his country for a twelve-day stint, just a day after my return. I survived the interim period silently, both before his departure and during the phone calls while he was away, determined to tell him upon his return what I hoped he already knew. Upon reflection, perhaps he had resigned himself to the possibility, but that did not make the role of initiator any easier. It was impossible not to recall what the relationship had held for so long and equally impossible not to recognize the reality of where it was now. I thought I was handling the sadness and disappointment well, but my body betrayed me. I believe in the theory that we all have a physiological weak spot and that somatic responses occur with reason. I had a client who expressed that she was so angry she wanted to kick someone, but held back, only to develop pain in her thighs and hips. Another kept telling me what a pain in the neck her adolescent was and wound up needing medical attention for the pain in hers. Many people get headaches or shoulder pain, and if you listen to their complaints, they will use phrases like "The weight of the world is on my shoulders" or "my head feels like a balloon". We who have had heart ailments have a new weak spot and for me that meant that "it made my heart ache", "my heart was pounding", "the fear gave me palpitations", were no longer expressions, but were a harsh reality. I reported more frequency and a longer list of symptoms to my doctors, required more medication, had a harder time sleeping and experienced more fatigue than usual. There are times when we expect too much of ourselves, just as there are times when we are not expecting enough. My staunch recommendation is that you face up to your needs and figure out what may help you most, perhaps including talking, writing, useful reading, punching pillows, but also making a conscious effort not to do anything harmful. Do not self-medicate, but do take care of yourself; avoid the company of people who are negative; do not become isolated if you think it may depress you; and do not lose sight of your humor or your determination. I think both philosophically and professionally that group or individual therapy can promote healing, both physical and emotional, and it can be a brief, situational intervention. The aftermath of a heart attack or any serious issue, particularly since it is not chosen, can bring out the best and the worst in people - the "beast" instead of the "best", as one client suggested. Hopefully you will learn so much through it all that you will become more than you were, or a stronger, healthier version of yourself.
So if this is supposed to be a chapter on elation, why am I including a calamity called “separation”? I was armed with the knowledge that moving through the initial phase would be a stepping stone, a catalyst, another threshold crossed toward something unpredictable but better. If you can welcome change, even while you are wincing from it, you will think, behave and react in ways that will promote growth, not disaster, even during the turmoil. From the seeming chaos of a disordered happening, you can will yourself forward. As dramatic as it appeared, the separation gave me what Iyanla calls a "comma", that pause during which to be still and expect the best even in the midst of struggle and upheaval. I needed my voice to be gentle, my surroundings calm. I literally needed to hear myself taking deep, even breaths, particularly when I had heart symptoms, but also in a concerted effort to avert them.
Elation: exhilaration, euphoria, enthusiasm, exaltation. Would it take a near miracle to reach these states? Some days it seemed that way. I would have to continue to draw from all I knew and add to my repertoire on practically a daily basis - we all do. Focusing on the positives was a stretch at times. Here I was, single, living alone for the first time since age nineteen, but for my ever-affectionate cat, but I was getting on with my newly-shaped life. Despair: desperation, despondency, discouragement, disheartenment. Opposites are powerful teachers. Shades of gray aside, I would create another system of "E's", for Excellence, not borderline failure, made from a fabric, indeed a quilt, sewn with strong and colorful thread. Elation is not constant - if it were it would be exhausting! It is momentary appreciation, sometimes trite, from a sensational sunset, a silly smile, a hilarious joke. Sometimes it is so special, from an important accomplishment, a day spent alone but not lonely, a new lesson learned in an "aha" moment. Recognizing and cherishing the power, the force involved and the results from the effort lend incredible delight.
It is unreasonable to expect elation at every turn or to expect yourself not to react to the incidents that frighten, dismay or disappoint you. The ways in which you react are the essential ingredients in the mix: are you cognizant, or in denial? Are you open and honest about what you really want? Are you living what you have learned? Are you reflecting the twinkle from a light moment or are you paying more attention to the twinges? Are you gratified by the sweetness around you or are you not noticing it? How are you treating yourself? Your sincere, carefully pondered answers to these questions will alert you to whether or not you are available, loving, giving, intentional and devoted not only to the concept but to the action involved in thriving.
I had reached the one year mark: in the opinion of the medical profession, the stents had continued to do their job! Of course we're never home free, since we are "managed", not cured. The ups and downs are inevitable and expected, unwelcome and frustrating. The tension of major change, albeit chosen, is a challenge. My husband and I sat down together and discussed our lives with a fair amount of honesty. I felt strong but sad, controlled but certainly not in control; he was tearful yet angry, upset and resistant. I was as gentle as I could be, knowing that my resignation was out of step with his and not looking to cause hurt, but definite in my belief that we had to be apart. I knew he had a place to go, not that it was my job to worry about that, but we who are natural givers cannot help ourselves! I offered to help him organize and pack his belongings, knowing that he would appreciate the gesture even though it was difficult for him to realize that he both needed and resented my assistance. That emotional discrepancy is representative of one of the keys to the demise of the marriage. Having declared myself, I felt free to make plans with friends, telling him my schedule just in terms of my availability to the business. He did not actually move out for several of the longest weeks I can remember. He had his own ideas about what we should do legally prior to separation and there were some ugly moments. There was one particularly terrible outburst that lead to my feeling a sensation best described as slight pressure mixed with a kind of closeness in my chest not unlike the earliest symptoms in the mall. This is labeled "atypical angina", more often experienced by women than men, and, as we now know, often regarded as stress-based. Since women are always told they have a great capacity for understanding and even welcoming emotions, if we go along with that sometimes male attitude of “It’s all in your head” or “It’s just stress, dear”, it could lead to our demise! Symptoms serve as an opportunity to prevent the occurrence or re-occurrence of heart-related problems. Be on the alert to another example of women's needs not being properly addressed.
In any case, I was inadvertently endangering myself by becoming hooked into his reactions. When I hear that a couple is in the process of separating, my rule of thumb is not to do precisely what I was doing! Elation/despair, elation/despair… Once again, I needed to kick myself into practicing what I preached. The teacher needed to brush up. I promised myself that I would never again be in that dire situation and would act according to what I knew. That was our last battle.
There is no way to completely avoid stress, we all know that, but there is a multitude of skills at our disposal to cope with it without falling apart. My elation came in the form of turning weakness into strength. If we see that we are making errors in judgement and respond accordingly, the results are so rewarding. As a realistic optimist, I know that there are times when nothing works, but I also firmly believe that there is usually a method that becomes a saving grace, maybe even a new addition, to a repertoire that needs to grow. Finding out what works best for you is nothing less than fantastic; implementing it appropriately may require you to draw on two of the three E's -- education and emotional support. Please do not be embarrassed by your neediness. Treasure your ability to define your needs and notice that only through self-love will you use the resources both from within and outside you to reach toward your goals. When you reach out you are coming from a position of strength, even while you are feeling weak.
I felt like so many people who have been in similar situations: I had nowhere to go but up! Being a heart patient was enough to cope with, and now I was facing a separation? It was a double whammy. I would need to gather my troops and prepare for this next life change. Little by little, package by package, the moving out began, the tangible symbol of moving on. I was no longer focusing on the heaviness of the moment and more able to concentrate on attempting to make his exit as painless as possible for both of us. Of course, I was only one half of the equation, and I had at last learned that I could not, would not and did not want to control, narrate or script this particular saga. I knew myself well enough to not be alone with him as he departed, hopeful that he would not cause any great degree of difficulty, so my wonderful brother and sister-in-law joined me for the evening. Much to my surprise, as I closed the door behind the person who was for so long the love of my life, I stood still in our entryway with my entourage in the next room, and I was dumbfounded! After literally years of frustration, disappointment and dismay, he was gone and I was going to be living alone. It was too much to absorb. I was wearing neither tears nor smiles. I felt stunned but not empty, as though I had worked hard, yet had not achieved anything award-worthy. I had no reference point from which to springboard - there was no "recipe" for this occasion. The numbness was not destined to endure but the battle toward elation would continue to be waged on a daily basis.
From endings come beginnings and, at last, I felt I had more than begun.

Thursday, December 10, 2009

Women and Heart Disease: The Heart of a Woman

Still no one listed as a "follower"... how despairing... I hope you will sign in and keep me motivated; mostly, though, I hope someone out there is in the process of THRIVING!!!

Entrances and Exits: Planning, Motivation and Responsibility

The unmonitored phase of Cardiac Rehabilitation is labeled "Phase IV" and mine happened to be a mixed class, some on monitors, others not. After a twelve-week absence, seemingly an eternity, I returned for session one of round two. I was warmly greeted by the few familiar faces still participating, and was thrilled to be there again. I had remained in contact with a few of my cohorts, forming close relationships with two or three, but I had missed being with them in the context of the program. Of the nucleus of those who have remained, one, who had been coming consistently for four years, was my most frequent partner. We had a wonderful relationship and were totally comfortable with each other. A successful attorney only about two years my senior, we had an uncanny bond and truly cared about each other. We often mobilized and motivated each other, except on those rare occasions when neither of us was in the mood – that was trouble! I knew when he was having a hard day and how to listen and console him; he noticed when I was off or struggling with hypoglycemia or fatigue. In fact, he “told” on me when he believed I was not being forthcoming with the nurses when it was clear to him that I needed glucose, the immediate cure for a dip in normal blood sugar levels! Our conversations ranged from lessons on baseball to the merits of psychological savvy; from the stock market to our favorite restaurants; from our kids to our careers. We were mutually supportive and genuinely appreciative of each other.
And then there was Arthur, the eldest in the class, whose lovely wife, Bobbie, always accompanied him to class. He and I rowed together and he never missed an opportunity to tease me by telling me with a glint in his eye that he hated me because he couldn't do what I could. I explained to him that given our "slight" age difference, he was proportionately doing what I was and that he was my role model! He was strong and sturdy and when I asked him one day when he was stalling between exercises if he was finished, he exclaimed "I've been finished for twenty years"! I countered by telling him he'd be finished in twenty years and that served as our byline every time he loitered instead of doing his routine. He was a delightfully impish, appreciative man, direct and yet a flatterer, and I think our relationship was singular. Several of us encouraged him to keep coming beyond Phase I, and he capitulated with the confession that it was due to the company, not the equipment. Bobbie and I were in cahoots to make certain that we would "win" so that he would.
When I began attending the class, I was not only the youngest in the group but one of only two women. At some point, about 35-40% of us were female, all of whom had had either an MI or a valve repair. Many were professionals who valued the program enough to leave work early three afternoons a week and the majority of us are in our fifties, young by cardiological standards. The men varied from their fifties to their mid-eighties -- Arthur and I no longer held our former position of youngest and oldest of the crew -- and many had numerous physical problems.
During the second session, I boosted both the speed and the grade of the treadmill, but became winded and uncomfortable and had to stop. My heart rate had risen to an unacceptable level, despite the medications that were supposed to suppress it. I had to deal with being out of shape, again if not still, and the setback was potentially ominous. Serendipitously, I had an appointment with Dr. McLaughlin the very next day. By now we had developed a real affinity for one another, and her concern led me back to the lab the next day for an echocardiogram that would either allay our fears or give us answers and direction. I wanted to guard against the ill effects of the natural trepidation I felt, and congratulated myself for holding on until the next afternoon. The patience factor in any long-term recovery is bound to re-surface. I greeted it as a challenge, with rehab representing the opportunity to continue the climb toward my desire to thrive.
The results were the same as the previous scan, another example of good news and bad news being the same: no improvement but no difficulties either. Unmonitored re-entry and the incremental improvement would continue and I knew I was in no imminent physical danger.
I had made plans to go away with my daughter again, this time for ten days and had no qualms about it, particularly since I could continue my workout schedule, with her in attendance, at my Aunt and Uncle's condo in Florida. They would not be using it and our aim was to relax and enjoy ourselves, dining out, swimming, reading, enlivened by each other's company. I had admitted by now that the beginning-of-the-end had begun long before: the "emotional divorce" from my husband had taken hold. We were both present, but the loving feelings remained absent from my side, despite an incessant, daunting and unhealthy inner battle. Time away from him, once inconceivable, now was imperative. It was hard to know what his actual thoughts were, but he was resentful that we only spoke once each day, implying that I was not sorry to be away from him. I still felt unprepared to announce myself, even in the midst of terrible - and useless - arguments about the possible demise of the relationship. As always, he took no responsibility for his part in my slipping away from him. I could no longer ignore the brightly lit sign on the exit door. As wonderful as it had been to spend "quality" time with my daughter, a set of ominous feelings had begun to emerge during the trip. They were extraordinarily intense, overwhelming and sometimes dangerously visceral. I found my emotions were so close to the surface that I had to fight to hold back tears even during a lovely meal or a restful afternoon in the pool.
I reneged on the promise to myself not to burden my daughter with my marital difficulties, although she knew the gist of the situation. By the time we boarded the plane for our return, I could not hide any longer. I sobbed, effortfully trying to explain the degree of our problems, while she fought with both me and herself, not wanting this to be happening to any of us. She did not want to believe that we could not put ourselves back on track but was also keenly aware of the medical risk that all of this outpouring of emotion and deepening grief could cause.
Upon our return, I began having difficulty maintaining concentration during client sessions and lost interest in talking on the phone, reading, shopping. My appetite diminished and eating became a chore. Sleeping, although physically and psychologically essential, became perversely troublesome and had to be more frequently drug-induced. It took me weeks to realize that I was clinically depressed and still longer before I would address this self-diagnosis with my physician. Preeminent feelings of failure plagued me, but I had no choice but to "admit" that I had to take action.
On a beautiful, serene day in May, I went for a scheduled check-up, and tearfully confessed that I was deeply troubled. I knew that it was caused in part by the side effects of several of the medications I had been taking, and that the deterioration of the marriage was a last straw. I was at last more than acquainted with the role played by my having CAD. Incomprehensible was my confounding inability to handle the situation on my own, using all of the mechanisms that had worked so well before my heart disease emerged. Both despite and ironically because of my closeness to several key people in my daily life, Dr. MaryAnn was the first person to whom I confessed the depth of the depression.
It would have been irresponsible not to tell my doctor that I was having thoughts about the difficulty of living as compared to the ease of dying. Devastating sadness coupled with hopelessness, to some degree without rationality, overtook me. It was the problems I wanted to disappear, not myself, but I had a few moments of not being in touch even to that degree. At its worst, I was even convinced that my daughter would be fine without me, completely unthinkable prior to this new low. I was not able to speak without crying and simply did not care to bother doing the "work" of living. Of course I had felt "down" before, but I was just so unbelievably tired, so useless, so troubled; I was dependent, weak, worrying everyone; I was working so hard and achieving so little. All the determination drained from me and I was left with no more desire to fight, no belief that I would ever return to my previous self. It may sound like this was representative of a carefully thought out plan; oddly, it actually represented a group of thoughts, frequent but fleeting, filled with pathos and self-pity, in search of permanent relief. It was not entirely dissimilar to the thought I had in the aftermath of the second angioplasty. Many heart patients, and others with significant illnesses and injuries, experience these kinds of lows and the vast majority of us bounce back. In the interim, it is shocking, often not reflective of our typical selves and extremely menacing. It must be reported to someone who can help. No one should allow him/herself to be tormented beyond the first realization that such thoughts are present. For me, ever the helpmate, rescuer, agent of cure, it could not have been more difficult to unburden myself. However, as blind as I may have wished to be and as tough as it was to remove the blindfold, help was one brief conversation away. By the time I went to see MaryAnn, I was prepared to suggest what would become a brief course of a specific anti-depressant medication, chosen based on ample research the day before my appointment! It was a defense mechanism that typified my thinking and was designed to bravely demonstrate my wisdom and resourcefulness. I had already decided that it would be our little secret, kept even from my daughter, convinced that it would harm her to know that I had this perceived, perverse weakness. I was too emotionally drained to grasp that I had been hinting to her and that my depression was far from well hidden, particularly from her.
In my work, I had often come out against clients taking drugs for depression. I always believed that the symptom itself could and often did serve as an adaptive tool useful in the process of problem solving, but personal experience has revealed that medication has its special place. Within several days, my morale began to improve and, just as I had seen in my clients, I was more reachable and more accessible to the assistance of the people around me. I do not think I would have actually done myself in, but the thoughts themselves were incredibly disturbing and were indubitably hampering my recovery. I have developed greater respect for drug intervention and now possess total empathy, not just sympathy, in regard to the physiologic/neurologic mechanism of depression and its effect on daily living. Although difficult to think and write about, this insight is high on my ever-growing list of lessons learned and appreciated.
I was fortunate that I had a mother, a daughter, a step-father, a friend who were consistently encouraging and giving, reminding me of where I had been just months earlier and telling me sweetly and convincingly that I was important to them and to many others. I could neither give up nor give in to this transient state or to the difficulties at home. I allowed them to bolster me when I needed it and could not summon the strength from within. The memories of the depths of despair are vividly engrained; they have a place in my mind that is somehow sacred. From despair has come hope; from hopelessness has emerged optimism; from pain has sprung strength; from fear has come the ability to accept love and comfort; from anger has come understanding. No matter how difficult it may be, it is essential to seek out and absorb any support, backing, advice and solace offered to you. If you had been independent, you owe it to yourself to become forward-looking and know that your independence will return. If you had been pessimistic, you will need help in working toward positive thinking. If you had had difficulty communicating your emotions, you may need to consider joining a support group or beginning counseling. In short, continue to do what works and use this opportunity to build your list of assets. When you hear an alarm go off, whether it signals the beginning of the day or constitutes a wake-up call literally from the heart, pay attention: it may well represent an opportunity, a challenge with the potential to invigorate you and lift you to new levels of being. Just when you begin to conclude that life will never be the same, you may find that there are advantages to certain kinds of change.
For me, the bottom line was that I had to re-create my life while taking responsibility for having created it. I had to acknowledge that I was accountable for being in a difficult relationship and take charge of my life, re-claim it. It was initially a months-long struggle, but as my attitudes improved, it became simply the continuation of a life-in-progress, work that is essentially the same for all of us. We need to lay out a careful, detailed, realistic plan to live our lives with optimism and courage, ferreting out the behaviors that truly reward us and resisting old habits that have stopped us from thriving. In the business world, we quickly understand that an action plan and the action it takes to carry it out are the means to success. In living, particularly in tough times, this methodology is crucial. Hesitation, inertia, giving in to the fear of the unknown, all keep you from designing a gratifying life. Every day provides you with the opportunity to break away from habitual behaviors that thwart you in your attempts to thrive. Each time you give away your power by not trying something new, you fail to reward yourself. Remind yourself that you have already fought and won the battle to survive, no doubt despite debilitating and frightening episodes. Now your job is to use your natural anxiety to move forward. In some ways, you will be meeting certain aspects of yourself for the first time! You have “hired” yourself to handle a high echelon job and, in Dr. Phil's vocabulary, have appointed yourself “the manager”. You deserve the position - just ask everyone who loves you to validate this concept - and despite your lack of experience in some facets of the job, you are the commander. You may be angry and resentful that you are in this situation and if you choose to hold dear to these emotions, then you have chosen to be powerless, hopeless, uninvolved and miserable. If you see the wonder and the opportunity as exciting, even if sometimes mystifying, you will seek the rewards that await you. If you are reading this book, then your intention is to propel yourself into a newly-formed life and if you continue on that tack, you are creating a beautiful entrance into a life of which you will be proud and through which you will thrive.
The return to rehab was my next wonderful moment, since it meant contact with my soulmates and the opportunity to muster the physical and emotional strength and energy begun four months earlier.
Structured, supervised exercise is irreplaceable, leaving no room for excuses and offering potentially ample security. Particularly for those of us who have been lax in this area, but also successful for crest fallen mavens, it is to your advantage to seek out a program and stay with it until you know for certain that you can replace the special environment with a safe, specific, consistent alternative. There were several people in my class who had been coming for three or four years, all of whom were fairing well and who looked forward to each session, as much for the mandated workout as for the immense social value. We all pushed ourselves on certain days, particularly after a break for vacation or holidays, and even after just a weekend. My closest cohort and I decided that when we reached our thirty-year anniversary at the center, we should have quite a party! Ample reason for celebration: we'll be in our mid-eighties, just like Arthur!
When I was red-faced and had struggled through every activity, I felt exhilarated more than tired, with no signs of depression, no tormenting thoughts. I was and to some degree still am amazed at my own reactions, having fully expected the reverse situation to prevail. Every time I better my own record I feel ablaze with the enthusiasm of a champion!
Particularly in light of my disappointment at home, joining in the camaraderie of our group was extraordinary. Having lunch or dinner with a friend or just spending an extra moment in the dressing room before or after class brought such sweetness into my life. I missed, even longed for, the delight my husband and I had for most of our years together. I was feeling a tad needy, generally lacking confidence in myself on a physical level, often finding myself alone in the evenings wondering if this twinge or that ache had meaning and whether or not I could conscientiously take control in an emergency. These are not idle thoughts, neither then nor now, but in time it is possible to differentiate between fear and the actual need for medical attention. In my experience, the fear-based episodes were generally characterized by emotional markers, like feeling angry that I had these problems or hearing a self-pitying choir reciting that ever-popular tune "oh-poor-me-how-could-this-be-happening". I advocate grabbing for the phone during moment number one of this party (?) to speak with someone upbeat and positive. Wallowing in misery, natural or not, is counterproductive. So what do you do when you feel like your world is caving in, no one can really help you, and you start having morbid thoughts like what if your life span will be shortened by your disease? My initial reaction was to protect the people who cared most by sparing them, so I avoided saying what I felt and donned a stoic veneer. This saga has taught me that accepting your weakness takes incredible strength. If that seems incongruous, I suspect it will not as you move along in your recovery. Playing an unscripted role as yourself, in an autobiography you would not even want to read, comes with a mandate: this is the "now", it will change and evolve and I will regain control both from within and with the help of others. Willingly, if slowly, awkwardly and then progressively more adeptly, you will recognize the real, physical, expected weakness accompanied by some level of demoralization. All of this implies that you are utilizing tremendous strength. It is a paradox stemming from the platitudes many of us heard while growing up: "Oh, you'll be fine; you're so strong"; "Nothing gets you down; you always come through"; "You're just having a moment of weakness; you'll summon your strength soon". If you are at all unclear or avoidant about why it is so important to surround yourself with folks who can empathize, a cardiac rehab program or social and/or therapy group will provide the antidote to these seemingly empty bromides. Welcome with open arms those who can just sit with you, nod in affirmation when you express yourself, encourage you without being trite. These are your finest affiliations, bound to make a profound difference in everyday life.
Topic for a doctoral dissertation: videotape rehab sessions and then count the number of head-nods during conversations! If you look at your most important, most pleasant and rewarding ties, most will be based on a meeting-of-the-minds where little or no preface is necessary and reference points abound, an apt description of our class!
In the early stages of an illness, it is common to feel fragile, uncertain and insecure. Particularly if you defined yourself by the antithesis of these adjectives, confusion will reign. Your physical weakness will vary but is real; your emotional weakness is equally real but often mingled with more free-flowing boundaries and new parameters.
Since we varied by age and degree of recuperation, each class member's program was completely individualized. There was no competition among us, but we did notice new members' precariousness as we were aspiring to raise our own levels. Sometimes one of us would experiment by remaining longer on a piece of equipment and were cheered on by the others. I watched a particularly avid classmate with a degree of envy and then realized that s/he may be a preview of coming attractions for me. You may recall that I was not exactly the Poster Person for power or prowess in the gym, but it was gratifying to note the incremental improvement on my chart. I was beginning to translate progress in class into a new language I could "speak" outside that room. No matter how fatigued I may have been when class began, I always left feeling better about myself and my body, more solid and trusting. Phase IV was moving me further and faster along the continuum of recovery. I was able to assess that the entrance into rehab could be coupled with the exit from my marriage, with duress but not danger and that forward movement would result.

Thursday, November 19, 2009

Women and Heart Disease: The Heart of a Woman

This next chapter combines my zany sense of humor with a twist involving the dissolution of my once loving marriage. Come along for the ride...

A New Era Dawns: Friendship, Frustration and Forward Movement

Act I/Scene I at the Cardiac Health Center: I think I'm in the wrong gym class! Remember in Junior High when changing classes every forty-five minutes for the first time was an inevitable mess? There you were in math, but knew no one because it was eighth graders and you were in seventh and you were red-faced and wanted to melt through the floor and magically re-appear in the right room. Well, here I was, a relatively young looking fifty-three amongst a class filled mainly with septugenarian men! Okay, one seventy-something woman arrived a few weeks later and then two more men who were closer to my age.
What a nerve I had to react the way I did, but there was something startlingly unreal happening, just in those first moments. And then reality stung me quickly when the class actually began: many of them were the role models and I was the out-of-shape poster woman. Rehab was a great equalizer.
My sister-in-law keenly objects to the term "rehab", urging me to say that I'm going "to the gym". I understand her discomfort that I would sound like an addict, along with her desire for the use of a term that does not imply that there is anything "wrong" with me, but if you have ever seen a cardiac rehabilitation program in action, it's no gym, despite the similarity of equipment! The majority of the participants are hooked up to a monitor and are really struggling. Those of us who had completed the initial thirty-six or so sessions were no longer monitored by the staff, but we either wore a device that measures your heart rate or took our pulses manually about nine times during the hour. If the local Bally's required these steps, they would be empty.
Donning the Phase I monitor is a nuisance, and I am a natural rule breaker, often finding irritating challenges humorous, so it was natural for me to have instigated things like finding new ways of wearing the unit that seemed to defy gravity, except when the thing slipped down my leg. It frustrated a certain competent, but rigid staff person to have to figure out whether I was actually wearing the gadget, but if I could make him smile I was content, if not downright mischievous! Phase IV sans monitor would give me a sense of freedom which I would be certain to abuse, just like the devilish little girl I was at summer camp.
In any case, despite a high turnover rate - most people did not continue beyond the first phase - there was always a nucleus of us who had become fast friends. The nurses and the exercise physiologist seemed genuinely interested in helping me to “get with the program”, despite my groaning in pain – and that was just during the warm-up! On the few occasions in my distant past that I had attended aerobics classes, I had generally become the class clown, a ploy to mask my clumsiness and maintain some degree of humility. This was no joke: it was life-saving, life-giving, serious business. Our blood pressure was taken upon entering and before leaving and twice while exercising during Phase I. It was regimented, individualized and the monitor was identical to the one utilized on the telemetry floor of the hospital – not a welcome reminder. The team was vigilant, keeping track of our tracings, heart rate and experiential reactions during the course of each five-minute foray.
Within fifteen minutes and one treadmill marathon (five minutes) of my arrival, while walking around the room, before the start of the next seemingly sadistic exercise, one of the younger, more vital of my classmates approached. He assured me without reservation that I would come to like being there and would look forward to it immensely. I was giggling, and he seemed to appreciate my jovial reaction, but he would not let me refute his pearls of wisdom no matter what I said about past experiences. By the end of that first session, I looked around the room at the seven varieties of monstrous equipment and knew that "mats", the cool-down phase, would forever be my favorite activity and the water cooler would be my favorite machine! The finale, stretching in sitting and prone positions and then breathing, followed by waiting for the ECG strips to be cut and pasted into our charts, requiring us to lay perfectly still, was the end-of-class reward, lacking (fat free) milk and (low fat) cookies, and I was actually euphoric. At last, a competent performance!
Two days later, I returned to the scene of the crime, comfortably dressed in shorts, a tee shirt, and sneakers that needed to be improved upon in terms of comfort. I had a place to go, something new in my life and some mighty sore muscles. I still felt out of place, more like a mascot than a member, ogled by some of the men who seemed simultaneously uncomfortable and just a little flirtatious. Illness levels the playing field and I had the same "three R's" they had for being there: Right, Reason and Responsibility. I first began using this motto when I conducted parenting workshops, teaching, counseling and encouraging parents toward effectiveness in helping their children to grow. In this instance, our right to be there was inherent; our reason pointed to the common ground of having had heart problems; and our responsibility to heal ourselves, maximizing our heart health and overall well-being was monumental. There was an equality that transcended age, life experience, gender and I was a neophyte destined to learn perhaps the most valuable lessons of my life. I was also on my way to building special, loving, lasting relationships that would prove vital to improving both my physical and mental health.
The program may not have been a joke, but for me it was fertile field for humor. The dressing room is a particularly humorous place: picture a new member trying to figure out how to apply the leads for the cardiac monitor. There is a confusing drawing on the wall, with left and right reversed, which is hardly useful and there are four wires in four colors that snap to adhesive pads and then to four specific places on the chest. Then there is a battery to insert into the unit itself and a pouch that hangs around your neck and ties around your waist. The complications, twists and turns of this little gizmo are screamingly funny. I have seen women screech because they are fastening the little snaps after applying the sticky pads, necessitating the exertion of enough pressure to cause pain. The battle of tangled wires and frustrated patients is riotous! Ever the short cut taker, I discovered all sorts of tricks, including applying the pads after snapping the leads in place, based just on logic. Then I discovered better ways of hiding the monitor than a pants leg to avoid having it bulge beneath my shirt and yank at my neck -- I'll leave that one to your imagination...
The New Year came and went uneventfully, despite my customary romanticism. My husband was actually working that evening, which in years past would have been a wrench. Not this year: I was not feeling as dispirited as I had been even a week before, attributable to the start of rehab more than anything else. I did not need to start the year with him and had, in fact, begun it without him. Enthusiastic about finally being able to contribute more proactively to my own recovery, I was beginning to retreat from him and he sensed it. The sadness was overwhelming and the disappointment and frustration came in swells. At least I had established a pleasant routine and was beginning to create new friendships with people who needed no preface in order to comprehend one another's innumerable, collective, common tales. I could not replicate this scenario in other aspects of my life.
Attending rehab was like going to camp, which was the highlight of my life every summer from age seven until marriage, by which time I had become the youngest administrator and the first female at the camp to hold the position of assistant unit head! Similarly, at the center I was myself: relaxed, funny, outgoing, introspective, appreciative, hard-working and motivated to improve. My classmates were welcoming, helpful and found my reactions quite amusing. Certain pieces of equipment were torture devices and I was incredibly out of shape, but I looked to them like I was too young, healthy and fit to be there. Meanwhile, I was struggling to maintain my composure and humor through the exhaustion of each motion and the natural, inherent fear of the unknown: could I hurt myself in the process of helping myself? Would I come to enjoy it or face it with dread? Within a few sessions, I found I was surprisingly delighted to be there, keenly aware of the value of the program and I felt so lucky to have encountered some obviously wonderful people. I was hopeful that if I worked really hard, with thought, help and tremendous effort, I would derive the full benefit of consistent exercise, as proposed if not promised by the medical community, and I would make it fun whenever plausible.
On line to have our blood pressure taken at the start of session #4, I found myself engaged in a most peculiar conversation, having spent a mere three hours of my life with this person: I had spent the morning having my first proctosigmoidoscopy (spelling it is enough - if you do not know what it is, consider yourself happily ignorant, although possibly medically neglected), and began discussing it with my new “partner”, a seemingly personal conversation to be having with a new friend! He had begun his program just weeks before I did and had had a mild heart attack and angioplasty twelve years earlier, followed by another MI two months before mine, requiring quadruple bypass surgery. He was in incredible shape, energetic, muscular and had had a proctosig-blah-blah-blah two days before mine! Misery loves company and the raucous banter made the hour fly by. I was brightened by the very presence of my new allies. How wonderful it was not to have to explain the everyday thoughts of dread; the aches, exhaustion and persistent weakness; the perception that we were so vulnerable. He and I were usually partners and have remained close friends, despite his leaving the program after Phase I. I have to believe that meeting my rehab-mates was one of the reasons for my survival; doubtless, these remarkable meetings are another in a series of keys to being able to thrive.
Just as my confidence was building, my daughter's vacation week was upon us. We made a momentous decision: she and I would venture to Puerto Rico together, just the two of us. My husband acted as if this was terrific news particularly because of the safety factor built in by my traveling with a physician, but in actuality he was jealous, envious and resentful. His disingenuous attitude was becoming prevalent and indeed this plan did represent a serious departure from our norm. Until my first hospital stay, we had spent only one or two nights apart in nearly twelve years of being together. We had visited the island together the year before and had had a reasonably good time, but I knew that she and I would really enjoy ourselves. I was flattered and delighted and totally excited, a return to my usual reaction to life's joy.
I had no idea how much stamina I would have or how much my variety of symptoms might hamper us. As it turned out, I faired better than at home, even though I had to be pushed up hills and needed to slow what had been our usual pace. My energy increased, my ability to sleep improved and my mood was stable, even happy. Prior to the trip, I had been working too many hours at my various duties in our business and the stress was already taking a physical toll. Surely vacation is idyllic, but the diminution of my symptoms was almost stupefying. Absent from the constant difficulties caused by my home life and away from the madness of his reactions to the inevitable business glitches, I felt practically healthy. Bit by bit, I was admitting to myself that I had to take better care of myself. In my daughter's presence, the clarity of that thought was particularly poignant.
About a week after our return, a classmate invited me to attend an American Ballet Theater benefit. I did not think twice and told my husband how pleased I was to be meeting people with whom I had such easy rapport. My evolution was underway and he had no control over it, only the foreboding recognition that I was slipping away from him. The pattern was becoming clearer and more frequent: he was no longer central to me and he had no idea how to pull me back to him. Indeed, it was too late.
Almost as an act of revenge, he made plans to visit his friend in Canada for a weekend, without me. I had practically no reaction, protesting only benignly that I would like to have spent some time with his friend's son, to whom I was closer in age and basic similarity than the father. I was actually relieved that he would not be home for a couple of days, even though it meant that I would have to take full responsibility for the business. He asked me frequently when we would take our next vacation together, presumably to his country, but I had been told that it would be medically dangerous for me to travel to a third world country where medical care could be poor. As it was, my doctor had made the ingenious suggestion that I carry a list of my medications and most recent ECG with me to Puerto Rico and on vacations in general. In reality, I no longer had a desire to spend time alone with him. How sad this was; we had taken numerous trips both abroad and to the Caribbean and traveled well together for so many years. The change in me was overwhelming for him and although I saw an enhanced version of myself, he was deeply troubled by my evolution, even if he could not communicate it. He could not understand it and therefore could neither foster it nor incorporate it in ways that I still thought might have drawn us back together in a healthier alliance.
If this was to be the dawn of a new era, what meaning could I give it? Was I ready to take stock, even though it inevitably would mark an ending? I had always espoused that endings were signals of beginnings, that obstacles were merely challenges opening the door to opportunities. I needed to become more conscious and intentional in my thinking in order to maximize the potential of this unsolicited milestone. I had survived, but was not thriving to the degree I desired, not yet; I was bogged down by my physical limitations and falling short emotionally. If this was a wake-up call, the alarm was muted.
Many of us turn inward, hoping that self-reflection will assist us. I began thinking about who I was when my husband and I first met and what had drawn us together. He was the Service Director at the dealership where I purchased the first car I actually chose - not a hand-me-down or an affordable third choice - a full-price, light blue Honda, guaranteed, but misrepresented by the avid salesperson. By the end of the first eight months, the body was the same but practically every internal part had been replaced! I was astonished that this man extended himself so, never charging me for anything, always coming through, accommodating to my schedule and expressing his scorn for the salesperson's dishonesty. He was flirtatious now and then, commenting that the next time I needed a car I should come to him first, almost winking at the idea. He was extremely attractive, tall and slender, beautifully dressed and had a thick accent and an adorable, confident air. The car was stolen just months after the repairs were completed, so I took his advice and found my way back to him to shop for another car. Our first "date" was a sunrise-to-sunset expedition to an auto auction and was one of the most wonderful days ever. He was affectionate, sweet, appreciative and we bought a car. We had known each other for a year, but now were instant mates, reveling in the moment and anticipating more to come!
His accent was part of his charm, although he could not have been labeled articulate in the usual sense. He was at my apartment one day trying to improve upon the condition of the brass legs of the dining room table and asked me if I had "a sponge of tiny wires". Brillo was not a familiar term for someone who had arrived in the country a mere four years prior, having taken English for a year back in high school! His creativity, struggle to achieve clarity and genuine desire to please were wondrous. His temperament was even, his humor delightful, his intelligence a pleasure. He was endlessly romantic, buying flowers, telling me he wished he could take me for a ride on his "miracle rug" - close enough to a magic carpet for me!
I thoroughly enjoyed being the recipient of all this love and I doted on him, even rising early in the morning to make him breakfast, monumental since I have never been a morning person. I shopped for him, even buying him shoes, since I loved it and he did not. He was so easy to dress, always looking handsome, his smile adorning his wardrobe warmly.
The growth I mentioned earlier that was based in part on his making me feel loved was not destined to enhance our relationship. The more independence I gained, the more disquieted he became and the more I realized that my feeling loved was actually linked to my self-love quotient, not dependent upon his reactions to me, the more powerful the revelation became.
We had incredibly difficult problems related to his family during most of our time together, living from one near disaster to the next. Being a natural rescuer and possessing a fund of knowledge, a huge reserve of patience and know-how helpful to each situation, I flowed through all of it.
Paradoxically, my ability to cope with each predicament quite successfully armed me with a greater sense of self than ever. Simultaneously, the bottom was dropping out of the auto service industry, and he knew that he needed to abandon the sinking ship. Before he escaped to America, he had been a captain in the army and had been in charge of a four hundred person team by the time he was twenty-eight. He then became an internationally award-winning documentary filmmaker. By this time, he felt he could take command of a business of his own with great success. There were large pieces of reality missing: no seed money, no experience in this country and no collateral. Barring a miracle, he was stymied but positive and decided to go where his contacts were: Romania. We dabbled in international business for the next two years, using his contacts there but with no real backing. Our natural complementarity, coupled with my desire to participate, proved weaker forces than we needed.
I started to notice signs of what many label "male midlife crisis", changes in him that I hoped were momentary, but they were certainly not without cause. His life was falling apart personally, financially and professionally and therefore emotionally. Instead of allowing me to help him, he resisted, eventually losing his humor and even-temperedness. If not fleeting, these two basic areas of change could doom the marriage. Most frustrating was that I could not get through to him. He was unable or unwilling to listen to anything I said about him or us. What an untenable position for a therapist with a long history of reaching people with an assortment of difficulties, spanning many cultures, age groups and degrees of intellect! I was astonished that he could simply pull away, denying everything that was so crystal clear to me and to everyone close to us, especially with so much at stake. I needed to accept that my growth was continuous, which I consider to be natural, and his was circumstantially static. But was it just too soon in my recovery for me to let go? I had thwarted my own ending, with tremendous help, and was having difficulty allowing myself to face the inevitable end of our marriage, even though I knew I was in danger physically and emotionally based upon the undue duress.
There seemed to be no escape. I could not throw myself into my work since my energy was sorely lacking, which kept me from creating more of a life of my own, with the exception of enjoying the budding relationships within the exercise program, the brightest light in the saga that marks my road to recovery. I took the regime seriously, working hard to better my own performance. Much to my shock and amusement, my classmate was right on the mark: I did look forward to being there, admittedly and not surprisingly as much for the socializing as the workout, and I was beginning to recognize my own progress. The exercise physiologist had me increase the levels of difficulty on some of the equipment, signaling some advancement and I was less daunted and more gratified with each session. But the other edge of the sword was defined by my not being available to my husband in the ways he needed.
Two dates were marked on my calendar: a long overdue paint job and the last monitored exercise class. I dealt with the paint job almost single-handedly, with my husband working long hours and unavailable to assist at home. Moving furniture was impossible for the most part, since it caused my heart rate to soar, so as reluctant and he seemed in the face of my "inadequacy", he was forced to assist at least with the heavy work.
I would need a different kind of help with the insurance company. Despite beginning the process of appealing to them to extend their coverage for monitored exercise weeks before the end of the first phase, I would have to be on hiatus until they made their determination. Unfortunately, after a battle lasting almost four months, one month longer than I had been utilizing the program, I lost, despite my doctor's recommendations and a "positive" (problematic) stress test. They were not mandated to pay for more than the first round of treatment, unless I had had another event. It was infuriating, but the cure was to simply sign up as an unmonitored patient, which I did immediately, despite the mild trepidations of my cardiologist. It was also an anniversary of sorts. I had passed the six-month mark, presumably a sign that the stents were doing their job. Absent another attack, even with the many symptoms still present, I could probably assume that I had escaped the need for open heart surgery - an escape from the dreaded "cabbage patch", my nickname for the “landing area” after the procedure known in medical parlance as Coronary Artery Bypass Grafts.
The absence of the exercise program had wreaked havoc. The lack of structure alone was frustrating and basically irreplaceable. I knew that I had to keep the struggle at home from causing any type of regression. Filled with concern, but not disciplined or confident enough to even walk on my own with regularity, and with a rigorous work schedule in the business, I was more than annoyed that I had been denied access to rehab. That sense of helplessness, such bitter medicine, kept returning. The "what-ifs" we all torture ourselves with were haunting: what if this forced break caused a reversal of my hard-earned progress; what if I started to have a recurrence of symptoms; what if psychologically I could not muster the strength and self-discipline to exercise on my own; what if I did, and caused another episode and further heart damage. All my training, all my ability to assist other people in their own strivings seemed elusive when I tried to apply the knowledge to myself. It is so easy to feel lost, alone, frightened, dumbfounded; sometimes re-grouping is key and requires one backwards step, the enabler toward getting in touch with the optimism and good sense you have mirrored for yourself so often. Finding your way back to what works through your own clarity of thought or with reminders from your network, whether family, friends, support groups, professionals or some combination of all four is an essential ingredient throughout the long process toward improved mental and physical well-being. For me it began to return by almost forcing myself to "exercise" patience. Internal conversation and use of my closest supporters helped to carry me through.
It is true, sometimes painfully, that we are all ultimately alone. Lying in bed, often next to my sleeping husband who by then was a part of the problem, left me searching for solutions on my own. There was an occasional late night phone call, a necessary admission that I could not count on just myself and needed a "booster shot", that sometimes acted as an opportunity to hear my own thoughts. I recall having some chest pain and general malaise at about one o'clock one morning on a Saturday and calling a cardiologist who was an acquaintance as well as a client in the business. I was unable to hold back tears as I apologetically described the symptoms. He was kind and renewed my confidence by reminding me that healing is always uneven and that I was more than likely just fine. I implied from the conversation that he also meant that emotional healing was just as uneven as the physical. By the time we hung up, I was left with a modicum of guilt for disturbing him so late into the night, but both the pain and fear had subsided. The trick is to learn enough about your particular reactions so that you do not panic, but do develop a knack for knowing when to pick up that phone. I am still resistant to calling my doctor particularly when a symptom passes quickly; but when I am with someone who cares about me and I fail to hide a twinge, or, worse, when I have a difficult day of "just not feeling right", I have been "insisted" into making a call. I continue to have occasional scares and sometimes still need my carefully selected cardiologist to be available to assuage those fears or make recommendations. The comfort I receive overshadows the dread and adds to my growing knowledge base so that each subsequent episode will be less likely to drive me to the point of usually needless alarm.