Thursday, December 10, 2009

Women and Heart Disease: The Heart of a Woman

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

Entrances and Exits: Planning, Motivation and Responsibility

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

1 comment:

  1. Cardiac arrest is life taking disease. If instant first aid is given to the patient, life of the patient can be saved. The first and foremost aid is to make the person sit down and calm. The family doctor or treating doctor should be called immediately. If possible, rush the patient to the hospital. The garment worn should be made loose so that patient can relax.