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.