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.

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.

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.

Women and Heart Disease: The Heart of a Woman

It's difficult not knowing if anyone out there in the bloggosphere is reading this, but I'm undaunted and optimistic, so here is the next chapter:

The Journey Toward Adjustment Begins: Turmoil, Reflection and Realization

Psychological savvy did not spare me the need for catharsis. Announcing to myself that I would be okay, that I had survived, could not stop me from recounting my experiences to anyone who had the time and patience to listen. Perhaps the more dramatic sagas of our lives vary by theme, but our reactions bear much more similarity than difference. I believe that there is a high level of universality in our need to share our most vivid memories which are centered around our most heightened emotions: fear, love, anger and hope.
After her three-week stay, added to the total of two weeks during which she stayed near the hospital by remaining at my home while I was hospitalized, I was ready and able to release my mother, although not without mixed emotions on both sides. I told myself that this was a milestone and knew that she needed to resume some semblance of her own life. It is unimaginable the toll all of this had taken on her. An incredibly strong, vital, willful, logical, loving woman, her habit/defense of putting her emotions on hold was wearing thin. I knew she had been unable to sleep through the night (to this day she will tell me with pride when she has not awakened "in the five's", the third MI having occurred at about five in the morning, but it is a rare occurrence). Sometimes it is impossible to ascertain who is more important to whom; we truly like each other and have developed a warmer, closer, more enjoyable camaraderie than ever. The definition of "need" does not properly flatter our alliance, for we have a rare and treasured affinity for each other. There are days that we talk to each other several times, laughing at life, supporting each other through life's less humorous moments, discussing everything from politics to the stock market to parenting. We shop for gifts for various family members and are noted for our hilarious adventures in that momentous event: shopping for bathing suits! We're fun-loving and play off each other to the hilt; remarkably, this is being repeated between my daughter and me. I cannot possibly overstate the case for having someone available, practically on-site, at least in the initial throes of your illness. I was extraordinarily lucky to have been able to call upon the close tie with my mother, but suffered terribly that I could not rely on my husband who "should" have been available to me. I recommend not exerting precious energy by not facing your situation realistically, whatever it is. There are professionals who are ably trained to lend comfort and assistance if you do not have someone known to you at your disposal. Whatever you need to do to take care of your immediate needs, just do it! You will need to take responsibility for moving on in your life, including, but not limited to work, pursuing your interests and engaging with people with whom closeness and support can be counted on.
By now about seven weeks had passed since the final MI and I had purchased tickets two months earlier for my daughter and me for our annual foray to see the Alvin Ailey dance troupe, truly our favorite. The show was marvelous, despite the fact that it was an evening performance and I was fighting my on-going fatigue. Again I could feel like a "regular" person, enjoying life. Our seats were down so close that we could see the beads of perspiration soaring through the air like tiny sprinkler systems as the performers spun and leapt. Of course that meant that we had to climb a virtual Mt. Everest to reach the exit when the last curtain call signaled our departure! By the time we reached the zenith, even with my daughter pushing me from behind, and even at a slow pace, I was in tears. Here I was attending this fabulous show and I had to cope with being at the effect of my dis-ease. She tried to comfort me and I recalled the words of wisdom of my physician describing the importance of the passage of time, but a slow recovery was out of tune with my natural drive. This was an example of weariness impinging upon good judgement. The impact was strong because I felt weak.
I could not help but notice that anything I did that was beyond the nothingness of basically staying in bed, with the exception of adding the block or so daily walk, took a toll the next day. I made as few actual plans as possible. The trick was to be meaningfully busy but not exhaust myself into despair. That pacing continues to play an important daily role even as I progress. If I look or act tired, there is an almost accusatory response: "You're doing too much". I maintain that you cannot be foolishly risk-taking, but it is not entirely possible to know what is too much. I guess caution is necessary, but I know that there is incredible psychological merit in pushing yourself just far enough to feel the value of what you are doing, to surpass yesterday's feats and set ever-higher goals. Simply put, you cannot do what you cannot do!
Less than one week after Alvin Ailey, I was able to go food shopping, but only with the cart as an aid and just briefly. I could not carry heavy packages, although temptation and stubbornness made me try, only to be thwarted by heavy breathing and weak knees. It was becoming more difficult to figure out what to do with myself, which was actually a good sign, albeit heavily disguised. Wanting to be back in life was enormously positive. I think that if my mind had been less clouded by the chronic fatigue, my concentration would have improved and I would have known and appreciated this important piece of information. That not being the case, even a good movie could not keep my attention, so languishing in bed or on a chair provided no solace and became a perceived enemy.
One fine day, in an effort to return to my "old" self, I willingly made the effort to take my mother for her monthly doctor's visit, and then to my friend's salon for a haircut for her and a much-needed manicure for my weak nails. All told, including a substantial amount of driving, it was about a four-hour day, one of my longest outings to date. I was beaming, deserving of an award, dead tired, ultimately physically miserable. I needed to figure out ways of buoying myself, lecturing myself into believing that this was just the beginning. "Those who can't do, teach", I heard my clever inner voice utter. It was difficult to know whether I was being hard on myself or not pushing hard enough; was I demanding too much, too soon and not being stoically patient? There were no clear answers yet. I had read Nietzsche in college and remembered an apt point: "What does not kill me makes me stronger". I was beginning to smirk at myself: no one wanted me to suffer from overexertion, but my mind was leap years ahead of my body and I felt like I was at a virtual standstill. It is so important to take regular backward glances so that the small steps forward are noticed with relish. My four-hour day was actually laudatory.
Now it was time to schedule another doctor's visit, and I was armed with my rather long list, but when I called for the appointment, the office announced that the doctor was no longer accepting my medical insurance and had been off the plan for nearly a year! This was a stunning revelation, since his name was in the most recently sent book of providers and I had seen him twice. The office suggested that I notify the powers that be and find out what to do. That saga does not bear lengthy discussion. Suffice it to say that they permitted me to see him one last time, promising to pay for the three visits, but with no apologies. I spoke with the doctor, who furnished me with the names of trusted colleagues, which I presented to my daughter and her friend from medical school, who was doing a cardiology rotation at the hospital with which I had decided to affiliate. It is supremely important to gather your resources and make a well thought out decision, for this person will be pivotal in your treatment, attitude and, potentially, degree and type of recovery. I settled on a female physician, young, considered brilliant, warm, honest, respectful and completely up to date in the field.
Within literally seconds of meeting her, I knew I had made the best possible choice. MaryAnn McLaughlin was a delightful person, in addition to being thorough, kind and a wonderful listener. She has been selected to take over many of the patients of the renowned Dr. Valentin Fuster, since he had just been elected president of the American Heart Association. What an honor, and so deserved.
Thanksgiving was three days away, so she was filled with good wishes and encouragement. Although the third "insult" to my heart had caused the most damage, I would ultimately be able to live my life relatively similarly to before, with drugs, the continuation of a proper diet, reduced stress and appropriate coping skills and the addition of a structured exercise program. She addressed her medical concerns and suggested certain changes in medication and was open minded regarding vitamin supplementation. Finally, a dream realized with no nightmarish element.
Nothing comes easily with our strange health care system: the insurance company often takes months to pay the doctors, but it was only a week before I heard that Dr. McLaughlin was not on the plan either! They had lost all of her files and it would be at least six months before her eligibility would be determined. This absurdity was beyond my endurance, so I set out to address the issue, time consuming but ultimately gratifying. They "allowed" me six visits with her, more to be authorized if she played the system from her end. The secretary and I developed a love/hate relationship - I pushed her, helped her, bothered her, pleaded with her - and the daunting task reached completion with the doctor being added to the plan and me continuing to be under her competent care. Do pick your issues, since frustration does not enhance healing - but oh, success is so sweet!
The Thanksgiving weekend with extended family at my parents' home in what we call "the country" brought comments like "Oh, you look so great!" I guess people expected me to look dreadful, and those who had seen me in the first few weeks would not have been proven wrong, but by now my color had returned and I was a fantastic faker. Why, I could spend upwards of an hour, maybe two, enjoying my little cousins, judiciously nibbling at an array of foods not suggested for ingestion, smiling at other people's stories. I carefully kept from revealing that my eyes were propped up with invisible toothpicks and my head was reeling from the effort of just being there. I look to laugh, find humor just about anywhere, adore kids, but all I wanted was slumber! There was a surreal quality to the day, a mismatch among thoughts, feelings and actions.
Meanwhile, there were post-Thanksgiving sales at the Outlet Center ten minutes from my family's house, a command performance requiring my presence. I was called upon to muster both energy and enthusiasm, both of which resided in my mind, but not body. I dragged myself around, feeling at once delicate and amused, jubilant and foolish. I slept well that night.
By the end of the weekend, I was ready to go home and face a week that consisted of such mundane chores as bringing my car to the shop and going for my monthly blood work. Added to that was my husband's annual check-up with his internist who is also a cardiologist. He could see that my accompanying his patient was not easy. Equally evident was the tension between us, building by the day, but not stopping me from being in attendance.
Later that week, I had to go for a minimally invasive test to determine whether what appeared to be an old ovarian cyst was significant. Again I became tearful on the table, unable to answer questions without more emotion than made logical sense. Again I found myself explaining what had happened to me just two months previously. Again I was told how great I look, how young I seemed, what a shame that I had to go through even this test. I was repelled by my self-pity and hypersensitivity but pleased to be the recipient of the warm words of wisdom and kindness of the physician.
There is something disingenuous about feeling one way and looking another. There was nothing intentional about this dichotomy, just genetic good luck. For months it was a theme song. I would yank myself through each day, progressing in baby steps, wanting to tell people that I understood their reaction but it was causing an unpleasant one of my own. It was almost a throwback to adolescence when no matter what your parents told you about your beauty, you saw only the blemish on the end of your nose. At first I assumed that it was placation, not able to comprehend the veracity in the face of the mismatched equation, but even my honest and direct mother had to agree that the way I looked did not betray the reality. It was probably close to a year before I became accustomed to the chant, but on bad days I wanted to snarl and tell people I did not care how I looked, that the way I felt was the salient issue and that was still far from acceptable.
If my initial recovery was deemed typical, then it would be up to me to attempt to maximize it through careful experimentation. I accepted a part-time return to my responsibilities in the business, still relying heavily on our office manager, but willing to answer the phones, take reservations, deal with the moment-to-moment rigors of this "24/7" business. As I recall, I worked just a couple of hours a day, but it took the edge off my husband's responsibility so that he could drive knowing that his trusted helpmate was available and I was also able to continue to see my clients, my real priority.
I don't think a week had gone by before I became painfully, personally aware of the effect of stress on physical ailments. Between our marriage, which I had by this time named an "emotional divorce", and my reaction to the level of stress he brought to our difficult business-of-immediacy, I grew worse. I was tired, irritable, disappointed, more aware of the nuisance of the side effects of the myriad medications I was taking and just plain miserable. Startled by the extent of my reactions, I had to begin to retreat from the business, electing to instead use my mental energy to see my clients. Most of them came in the evening, so pacing myself to be totally alert at the end of each day was tough in itself, but a quarter of a century of experience and gratification made it as rewarding, stimulating and challenging as ever. Admittedly, the realization that I was in an impossible marital situation was just devastating. The downward spiral was reminiscent of the common, dizzying “ether dream” I had at age seven during a tonsillectomy. I felt as if I had too little control over my own healing and nearly none in the matters between us. He had refused outside help and was convinced that it was my problem, since he saw couples all the time who were in much worse shape than we, so according to his system of logic, we were really fine. When tenacity turns to relentlessness and desperation, acceptance is absent. There was no way I could reach him, but now I was beginning to accept that as fact. Now I had to tackle the issues of my heart on two levels, the emotional and the physical. Weariness is an enemy of good judgement, limiting one's ability to defend, assess, critique, decide. If the proverbial genie had arrived, my wish would have been to transform the marriage into a livable, loveable, daily delight. Usually, I was beyond feeling sorry for myself and was ready to take on the physical challenge, but the sense of being alone even when he was present was choking me. With all of this brewing, we had made plans to visit friends that weekend. It was early December, the weather was cooperative, their grounds lovely and inviting and their company refreshing. I was close to both of them and adored their kids. Confident in their discretion, I had discussions with each of them during the course of the day concerning the problems about which I had complained prior to the MI's. Like my mother, daughter and other friends, their wish was for maintaining stability, believing that it would lead me closer to the fullest possible recovery. I had a hard time helping them understand that our staying together was hampering me from improving, abetting the continuation of high levels of stress, one of the immediate causes of the attacks. I began feeling troubled and like a troublemaker, a complainer and a victim, heartless and heartbroken. By the time we left, I had spent no time with my husband and was not able to talk to him during the fifty minute trip home. I was crying silently, tears streaking down my cheeks, into my neck. I was too depleted to tell him what was wrong and too drained to allow myself to think, so I just allowed it to happen. I turned my face toward the window, and he never even knew.
My first stress test was upcoming within days after the perversely strenuous visit. This was not just the walk-on-the-treadmill variety, but an involved, three-to-four hour study involving intravenous radioactive dyes and "pictures" of the working heart. My daughter was a graduate of the hospital's medical school and was well-liked and highly regarded, so between that and the presence of her friend who was still working with my cardiologist, the team treated me like royalty! I had a cheering squad while I struggled on the treadmill and company during the waiting periods. I appreciated it, although I had no idea that this was not the norm! Herculean as it was, any unpleasantness was more than compensated for by their presence.
There was a dual purpose for the test: assessing baseline damage and clearing me to begin Cardiac Rehabilitation. The latter was at once terrifying and thrilling. Me? Exercise? Three times a week? It was a foreign language, but I was fascinated and had been told that the benefits could be "amazing". Good word - works well juxtaposed to my presence. I always joked that my driving leg was in the best shape of any part of my body and that if answering the door for my clients or the phone for business were considered exercises, then I was in fabulous shape. Never one for structured programs, I believed that treadmills and stationary bikes should be prettier, since they nearly always became decorations or closet substitutes. It would be interesting to meet my comrades, I was drawn to that, but the idea of voluntarily bouncing around on equipment -- at a rodeo, maybe!
During the week following the stress test, I had intentionally made several sets of plans, testing my endurance and filling my need to enjoy my life. I took a friend's precious eight-year-old to see "The Nutcracker", which she enjoyed thoroughly, mainly from her perch on my lap. On the way in to the building, it was almost humorous to keep her in view as she mounted the steps two at a time and went up and down three times before I could stagger to the top. I was undaunted, reveling in how adorable she was and how blind she was to my effort. Kids do not need lessons; they know intrinsically, enviably how to live in the moment.
I also committed myself twice to taking care of my friend's twelve-year-old after school, another venue with the reward of concentrating on something other than palpitations, extra beats, momentary chest pain, sleepiness.
Next on the agenda was a truly momentous occasion: lunch with my parents and a first cousin whom I had not seen in forty years. I remember being twelve or so to his seventeen and having such a crush on him. He was an even more handsome version of Ricky Nelson, ever-popular teen heart throb, and sweet, with an endearing smile. We had little contact beyond those years, and I was away at summer camp when he was married. For about a million and a half reasons, it was not until his wife found us via the Internet that this rendezvous occurred. He and his wife knew about the heart attacks from our phone conversations, but the face-to-face meeting brought the usual comments around how good I looked. Better than in my teens? In any event, sharing thoughts about relatives long since gone and using broad strokes to fill in the decades was precious. For me it was a brief visit, since I had clients to see, but we promised to get together soon, or at least in less than four decades.
Two days later, just a week before Christmas, I went to the cardiology department for the stress test results and yet another ECG and exam. My ejection fraction percentage had changed very little, a slight disappointment, but all in all, I was rehab-ready and would meet the staff at the end of that long week and then begin the program one week later. Would this be the beginning of palpable improvement, the missing link in my regime, the new wave, the holiday gift that would make me last a lifetime?

Welcome back... or, for first-timers, please read from the bottom up!
"Home to Stay" continues, with more experiences and more possibilities to thrive...

You will notice that I consistently extol the virtues of having a network of supportive people around you. I am aware that not everyone has such a "team", in which case the time has come to join a support group, whether social or therapeutic, or perhaps begin with a counselor, psychologist or other professional with whom you can share your innermost feelings and fears. No one should have to endure this saga alone. With all my natural strength, positive attitudes, knowledge and training, I needed every moment of advice and solace I sought and still do. Please be neither embarrassed by nor avoidant of the level or types of need fulfillment you are experiencing. As a survivor seeking ways of thriving, you are entitled to whatever services your community has to offer.
The next ten-day period would be most eventful: I would see my internist, who was the Executive Director of Mount Sinai's Women's Health Center, with whom I had a wonderful relationship; don a holter monitor which would record every heart beat for a full twenty-four hours; and return to the cardiologist for yet more news.
The visit to my internist, with whom I had only spoken since heart attack numbers one and two, began with greeting each other with a long hug. I was armed as was my custom with a three-by-five card filled with questions, an excellent shortcut and the best way I know of to insure that no matter what time constraints the doctor may have, he or she has to respect your completing that list. It also helps you to focus without relying on your memory, so that you avoid returning home and only then realizing what you forgot to mention. She had been genuinely taken aback by the news and was filled with endearing well wishes. She agreed to serve as the nucleus of my growing army of physicians and supporters, all test results to be sent to her office and any modifications duly noted on my chart. I advocate establishing this system as a simplifier, a sort of centralized catalogue of information. There was nothing to be added at this time but she did reassure me that the healing would continue and there was a chance that some of the scarring would resolve, enabling my heart to work more efficiently. She is also a hematologist and would handle monitoring the effect of the blood thinners, pivotal to preventing further incidents. She went so far as to imply that I would soon have even more at my disposal than I knew in the arsenal of treatment. I needed the details of that alluring hypothesis to wait until I was ready to avail myself of whatever she had in mind. It is not helpful to have a carrot held so far from your reach that the effect is actually negative. I was dumfounded by my ability to not know every conceivable detail. All I wanted was the magic wand response that every patient not-so-secretly hopes for, and I am a slow healer, so time was both on my side and a tease. I longed to hear sentiments like "this will not affect your life span", "you can expect to return to life as usual shortly", "you have been through the worst of it already". I knew rationally that these would be nothing more than absurdly scripted phrases, too empty to serve their purpose.
I think the most gratifying question-and-answer session I have had to date took place with her that day:
"I want to be able to ignore all these little twinges and peculiarities instead of being on red alert so frequently".
"Go ahead and do just that!", she replied. Music to my ears, but with symphonic complexity and not to be taken too literally…
The holter monitor records every heartbeat for twenty-four hours: the results were dismaying. During one, half-hour period between two and two-thirty in the morning, while sound asleep, I had had fifty-two extra beats. There were other "hot spots", too, but this was most alarming. For now it meant taking a slightly higher dose of one of the prescriptions, but was not described as foreboding. According to the cardiologist, with whom I felt comfortable and secure, I was on the right track. A full month finally had passed, but we would not know how well the stents were working for another five. It would be difficult to wait that long to hear some good news, but "positivity" was an ally.
I was walking every day, though never alone, once venturing by car with my husband to a nearby pretty park with a pond to fulfill my one-block hike. I also decided not to wait any longer to return to work, since I have a home office. I called some of my clients and scheduled a few sessions, which was a good distraction and served its purpose - and assuaged some of the growing guilt of "abandoning" them. On balance, it was more difficult than I could have imagined, beckoning me to concentrate intensely, but well worth the result of returning me to the familiar role of giver. If your situation is similar, and your doctor concurs, I would return to a reasonable work schedule as soon as possible. It can have an enlivening effect.
Still plagued by any strange sensation or irregular heart beat, particularly at night when reactions are heightened, I was frequently panic stricken, wondering if number four was lurking in my midst. There was one moment that I had a stabbing pain I tried desperately to ignore, but the gig was up when my friend called serendipitously, just to check in, and basically ordered me to report to the cardiologist, even though it was Saturday night. What with malpractice suits skulking in the foreground of most physicians' minds, I was afraid I would be told to come to the emergency room, not exactly my favorite destination. Instead, the head of the department happened to be on call and had no qualms about telling me that signs of recovery and healing take many forms, not all pleasant, but this did not seem ominous to her. If she could express such confidence, it made sense to accept it. Lesson learned: make the call! In this case, it was self-protective, non-alarmist and positive.
Someone had forgotten that ribbon you're supposed to break through at the finish line, but no matter; this was my first solo trek, and, bottom line, I had arrived!
Avid about regular mammography and breast sonography, I had added that to an already long day. In general, a somewhat unpleasant, but no-big-deal event - there's that word again - it elicited my vulnerability, particularly in light of the soreness on the side of my chest which could have been mimicking cysts or... I found myself in tears while lying on the table being examined by a physician I had met just once. I explained the circumstances of the past month that led to my hyper-emotional response and she was sympathetic. I felt like a little kid at the pediatrician's office, immersed in self-pity and probably baseless fear, Pavlovian perhaps, and therefore unavoidable. The mere thought of receiving more news to process was paralyzing. Of course, I was fine, just a little unnecessary squeamishness, a perceived lapse in coping suitably. I was groping for strength and was hardly proud to be such an obvious wreck, explicable but still unsettling, another reminder of the arduous struggle that actually had just begun. It is so important to remind yourself that it is human and expected that you will have moments that tap into your natural apprehension and cause you to react, sometimes even over-react. I wish I had recognized and befriended it as acceptable and permissible, allowing me to be more intentional and logical about not over-scheduling my day. It was probably a mistake to have gone for the test alone, but I had not properly judged my own need, a common error. My physical healing would be inexorably linked to my level of psychological acceptance and the fight would be arduous. Seizing the immense opportunity for learning from living this apparent nightmare had to be absolutely primary. My surviving had been only the beginning: the gates leading to the ultimate goal of thriving were coming into view. The unraveling of my marriage was unfortunate but not unusual. It also served as an opportunity to change my life, to head in directions I may never have thought possible, to become more self-reliant. In so doing, self-love and hope ultimately replace anger and fear.