Thursday, November 19, 2009

Women and Heart Disease: The Heart of a Woman

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

A New Era Dawns: Friendship, Frustration and Forward Movement

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

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