Friday, December 25, 2009

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.

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