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?