Sue Fallon

Women and Heart Disease: The Heart of a Woman

2010-02-08T20:49:00.000-08:00

Here it is: the final chapter - of the manuscript, not of life. Life keeps changing and I keep marveling at it. My little grandsons are the light of my life, beyond all expectations and my heart health continues to improve! I recently lost about fifteen pounds (a brain change!), which wasn't really necessary but is such fun... I never thought I'd be called "skinny", and in truth I'm not (middle-age spread anyone?), but I'm taking less medication and have more energy. The other news is that you can catch me on UTube doing a video for "Go Red for Women" and on a medical segment on CBS news with Dr. Holly Phillips which aired on February 4th. It's all enjoyable and I am so glad to have venues for my goal of educating health professionals and especially women, so we not only survive but we thrive. I'll probably write from time to time, but I sure would like to know my "audience", so please sign in and "talk" to me! I hope I've reached someone out there...

Adaptation: Skillful Thriving

By now you are well on your way to physical recovery and may be examining and perhaps reworking any lifestyle patterns which are not helpful. After all, what choice is there? You could not possibly stay in one place as you read on, exploring your own life each day. If this does not ring true, try re-reading the initial phase of this book - and the other wonderful reams of pertinent material out there. If you are really stuck, do not give in to feeling sorry for yourself and do not give up. You are inherently worthy of that further effort of exploration no matter how intractable you may find yourself! Besides, we all retreat, regress or have doubts from time to time, so be patient with yourself, but do not let yourself off the hook.
Adjusting to being a "heart patient" - and I freely admit to my continued discomfort with the term, still looking around me under the pretense that there must be another person in the room to whom that reference is being made - is far from simple and can be a lengthy process. I'm no Pollyanna and in fact am known for my realism, tinged with the optimism to which I have referred. Accommodating to an unwanted situation is a heavy burden, but failure to adapt is even more cumbersome. A modicum of fear may always co-exist with the prevailing feeling that you will live a long, productive, interesting life. I have reached a "this is it" point and know that whatever the damage or difficulty, there is ample solace in that the field of cardiology has more than ever to offer us if further treatment becomes necessary.
The challenges for women are unique: we must campaign for inclusion in more thorough, longitudinal studies. We must educate ourselves to avoid unnecessary incidents based on ignorance. We cannot allow ourselves to be ignored and need to take steps toward self-advocacy leading to prevention, by speaking up and insisting upon receiving the attention and medical care to which we are entitled. Perhaps we need to get political, going to bat for our inherent right to be taken seriously. We are dying of heart attacks at a terrifying rate and yet have not been properly informed. Gender differences in communication are widely studied, but how many women, their physicians, friends and family are aware of the crucial differences, literally in our hearts? We cannot afford to wait passively for this education to take hold: it is killing us at a rate of one in three, some of us at ages far too young to die. More women die of heart attacks than of the three other major causes of death combined. We must come forward to each other and to health care professionals – ladies, it is time to roar!
For me and many, many heart patients, the alterations in lifestyle due to having CAD are actually rather minimal in the scheme of things. I have conquered the issue of not exercising and know that I will maintain the level of fitness I have achieved, along with a decent weight based on reasonable eating habits. Mood stabilization and stress management are continuously challenging. Pill-taking, including vitamin supplementation, has become completely routine and self-education is ongoing and fascinating, particularly in the areas of complementary medicine and interventional cardiology. Since I have always been avidly interested in medicine and an advocate of involvement in one's own care, reading books and articles and tuning in to the latest thoughts and opinions in the field is, happily, natural to me. It is hardly necessary and you will not suffer if you do not mimic me in this area, but certainly be involved with physicians and others who are open-minded and up-to-date. Most of the time, I am attuned to my body without being either easily alarmed or out of touch. It takes most of us a long time to reach this point and none of us can honestly boast that we have reached that place of perfection where the pendulum is ever, let alone always, at the center. When I float too far from that midpoint, I either notice and correct myself or am willing to take note based on the recognition of those around me that I am out of balance. If your desire to maintain a realistic level of health is strong, it will be evidenced through your powers of adaptation. I hope you will take pride in your accomplishments; the tasks are remarkable, may be new in certain aspects and will bring you to a point to which few people aspire and even fewer achieve.
I have the sense that as my journey continues, I will learn more and hopefully better ways to manage my illness. Not a single day goes by that does not remind me that I am a heart patient. It may be a twinge; breathlessness when I take two steps at a time up a staircase because I have allowed myself to "forget"; or simply having to chase an errant pill that falls on the floor and rolls under a counter.
Every single day grants me the opportunity to appreciate that I am here to see my daughter blossom; to absorb and attempt to return the love of my family and friends; to nurture the determination I have developed to help me to thrive. The addition to my life of my three little grandsons is inexplicably extraordinary and has called upon strength and energy I never thought possible.
Not a single day passes that does not challenge me to become more, to use my strengths to help me build weaknesses into assets; to develop my ability to convey my odyssey to anyone who may derive value from it. I am actively involved in the “Go Red for Women” campaign and hope to deliver my messages of education for women and my mantra of thriving through the American Heart Association as well.
I know how fortunate I am to have survived the heart attacks themselves and that the intermittent symptoms, both physical and psychological, pale in light of the fact that I am still here, able to share my thoughts, ideas, dreams and, yes, nightmares with the people whose lives I touch and who enhance mine. Life can be stormy at times, challenging beyond my comfort zone, but I can generally figure out how to pick up the pieces, sometimes on my own, sometimes through friends, colleagues and family. I am staunch in following my medication regimen; careful, though not a purist in my eating habits; avidly active and, maybe most important and telling, as positive as humanly possible in my attitude about what it really means to live. I falter and I am more aware than I wish to be of the physical reactions that seem to haunt all of us living with coronary artery disease. Sometimes I feel overly dependent on the most valued and valuable people in my life, but they are consistent in their caring and comprehension of the ongoing saga. I know that they each have their own crew to spill over to if I lean too heavily on them or if I give them cause for immediate concern. Two years ago I was hospitalized overnight due to a new set of emergent symptoms that turned out to be based on small vessel disease - not life-threatening and easily treated, but frightening nonetheless. A follow-up angiogram actually demonstrated improvement (additional collaterals, probably my reward for knocking myself out in rehab!) With all my experience, all of my accumulated wisdom, I was so terrified that the "cath lab" team had me practically under general anesthesia to perform this relatively simple test! Anticipatory pain is not easily avoided and falls somewhere between warranted and absurd, closer to the latter in the end. The outcome served as a reference point for future tests, which have been necessary from time to time. I may never actually watch the procedure, as I have been told others do, but hopefully I will not be so filled with dread that anxiety overtakes rationality. I urge you not to be too hard on yourself should you be in a similar situation. I could not have predicted that I would have reacted so strongly, particularly given how many incidents I had weathered, but there I was, a virtual basket case! The good news outweighed the rest, but I have not had that that level of difficulty since. At this point I have nicknamed myself “Six-stent Sue”, proudly “wearing” them and doing quite well!

So there it is. This chronology hopefully has added to your knowledge base and will serve you well in your own journey toward not merely surviving, but thriving, day to day, often with small steps, usually in a forward direction. Humor, sheer determination, positivity, fine medical care and sufficient curiosity about the future will act as the balance on the other side of the seesaw as life continues.
Thriving is a skill seldom taught, that once acquired thoroughly enhances one's life. You will struggle to find your unique ways of achieving it. You will remind yourself that you are worth it and will take responsibility for seeking out and consistently utilizing the many resources that exist and will be there to assist you. You will revel in your small accomplishments and take note of the behaviors and attitudes that thwart you, consciously replacing them with more workable ones. You will be conscientious about following the advice of people who know you well, filtering their wisdom while increasing your own. You will accept and cope with the downturns, difficulties and scares, using those moments to drive you toward your ultimate goals. You have already survived, a wonderful feat that deserves momentous appreciation. You now have the incredible opportunity to use that survival as a stepping stone toward thriving, building and living a life defined by humor, delight, purpose and joy.

The Heart of a Woman: Women and Heart Disease

2010-01-31T16:22:00.000-08:00

Welcome -- and welcome to a new decade! It's hard to believe that "The Heart of a Woman" was written nearly TEN years ago! There remains only one chapter you have not yet seen, and then decisions to be made: other than this blog, my work is unpublished and do I continue to blog?? Updates abound, of course... I have also been meaning to tell you that the site does not italicize, but I have: anything I consider crosses the line from journey to self-help is in italics, so use your imagination and enjoy!
By the way, look for Go Red For Women, headed by my cardiologist, MaryAnn McLaughlin. The annual luncheon is on February 26th and will be well-represented. What a cause it is! You can google it (and me) to obtain more information.

Personalizing the Millenium: Love, Laughter and Reality

New Year's Eve 1999: Nearly fifteen months had passed, yet I could barely make it a mere four blocks - uphill, at night, chilly head winds - to a party I attended with all three generations of my family. It was the first time in many years that we were all in the same place at year's end, and it seemed particularly fitting. We were so busy down-playing this major event with all its international hype that we almost missed it! There was the ball dropping in Times Square, throngs of people from all over the world cheering, Dick Clark, who must be three hundred years old by now, doing his annual schtick, turned up a notch for the turn of the century. I think it was three days before it finally hit me: I was so "lucky" to be alive! Why shouldn't I be celebrating wholeheartedly! I had to laugh at myself! It is so easy to forget to appreciate what is, go on about our business as though no one day matters. Because every day is precious, we should act accordingly, but do we? I was eerily aware that I still was not consistent enough in practicing what I preach and called myself up short, resolving to greet each day with enthusiasm, pride and plans, not as simple a prescription as it sounds, as we all intrinsically know.
I keep going back to the importance of social contact, a healthy, universal need. You may be the type of person who is always surrounded, or perhaps you have one special friend and a few people on the periphery of your life. Even if you are a loner or non-joiner, hopefully you are exercising or enjoying special interests with people who are like-minded. The intellectual and emotional stimulation you both give and receive while in the company of others adds to your physical and mental health. Make wise choices, of course, continuing to put yourself in the midst of positive, supportive, fun-loving folks, welcoming their thoughts and ideas and cherishing the mutual contributions to one another's lives.
My journey was no longer dramatic, the heart-related symptoms having become routine, along with pill-taking and exercising, the highlight of each week's schedule. I still marvel at my friend's prognostication that I would come to love it, but he could not have been more endearingly and enduringly correct! If you are a non-believer - or, more likely, a non-exerciser - allow me to proselytize once again, just for a bit. Not only will exercising increase your physical tolerance, it may well increase the number and strength of your collateral vessels. While exertion on the various pieces of equipment may not be thrilling at the moment, the results are astounding. Most of us leave radiantly red-faced, perspired, inspired, almost giddy. Our blood pressures and heart rates are better controlled than ever and we are intentional, purposive, intense and consistent about our program. If anyone had told me a year ago that these words would come from me, I would have laughed heartily (pun intended) and sent them on their merry way. Okay, I don't love every minute of it and when the class is small enough so that I can monopolize the treadmill for a half- hour I have to force myself to stay on it, but what an accomplishment! My friends no longer have to ask if they need to drop me off before they park the car. I can walk briskly or climb a flight of steps without becoming winded - and that is with only 70% of my heart working! If you were never in particularly good shape, you will be so surprised at the benefits of a reasonable program targeted for cardiovascular fitness. Don't look for weight loss or muscle mass, but do expect to work hard - they don't call it working out for nothing - and then you can fully expect to reap the rewards. Now, how can you resist?
The dawning of the new year provided yet another opportunity to continue on a clear, positive track. I paid particular attention to the blossoming of new friendships, choosing not to focus on my impending divorce. When you hear the voice of the optimist hesitate, it is the realism coming through, which is neither negative nor positive; it is just an indicator, a challenge of some sort, a green flag. For me, reality was based on being able to separate the provocative from the productive. You have the power to control your reactions, which are based on your unique interpretation of events. I have chosen to use that power to study life's seemingly difficult moments and then compartmentalize, carefully weeding through the emotions, coming to terms with the parts of the equation over which I may not have control. You need to neither overreact nor fall prey to the inevitably disabling inertia which is best defined as choosing not to make choices.
The issue of control, or more aptly withdrawal from the need to control, challenges me and probably always will. You will know from the reactions of people around you if you have become more "laid back", easier to be with, emotionally quieter. It will be a great feat if you were the typical Type A personality we all know but do not need to be, and it is gratifying and exciting to make the switch! Achieving this kind of growth is energizing, as opposed to the debilitating results of having to know everything, be everywhere, be everything to everyone. There is no loss here, just pure gain. I giggle at what I do not know that less than two years ago I would have been crawling through walls to uncover. We often think that there is a payoff in control, that it is empowering, but I have come to believe that it just makes us seem anxious and relentless. Think about it this way: is it logical, convenient and desirable or, in all honesty, is it intrusive, irritating and counterproductive? Bearing in mind that we repeat behaviors that work, that seem to end in a payoff, what is to be gained by the drilling and grilling and accumulation of drama generally associated with those who seek to control? Why would anyone knowingly subject him/herself to the grueling task of controlling people or situations when the alternative is to be peacefully aware and engaged, but not on the alert or on one's toes? If you need to confront your behavior in this area and modify it, you are guaranteed to feast in the payoffs.
Here are a few carefully chosen "givens":
- we all fear rejection and crave acceptance; we need approval and have difficulty fielding criticism
- fulfillment and gratification are essential ingredients in our lives
- plateaus are reached by devoting ourselves to thriving.
I am not suggesting that there is nothing you need to control and you should go through life under anesthesia! You and only you can control your reactions and your behavior. The good news is that you therefore have the power to re-shape the aspects of your life that you decide you need to address. After all, if we label surviving as a challenge, then thriving defines itself as the ultimate achievement. Another in the inevitable, remarkable series of turning points in my physical and emotional recovery surfaced when all the hoopla of the new millenium died down and I found myself wondering what was next in the saga. No longer dealing daily with the initial denial and having achieved a higher level of acceptance, I knew I had to embark on something meaningful, but what? When I first had the idea for this book, my thoughts ran the gamut from how dare I to how could I not share my story? But I was so tired: tired of being tired; tired of how hard it was to keep moving in the direction in which I believed; tired of the pill-taking, the doctors' visits, the side effects of so many medications. Logic dictated that I take a new direction. This was tantamount to an admission that I had not yet arrived, one of those situations when the good news and bad news are the same: I could take command, but only if I granted myself some leeway, gave in to the fatigue when necessary, cut myself some slack so that the continuation of what is in fact a life-long journey could be broken down into paragraphs, not unwieldy volumes. If you are one of those people who expect and demand too much from yourself, you are accustomed to tempering desire with reality. If you expect too little from yourself, then you will need to recognize that as a pattern which disables you, and redouble your efforts toward improving the quality of your life. How you do it will depend in large part on how you conquer your fears and ensuing moments of immobilization. There is nothing superficial about our journeying and it is by definition not simple. On the other hand, are you complicating it by staying on the fence, in a neutral position? Are you allowing yourself to settle for what is instead of moving forward, even in the face of some natural anxiety? Are you either over-analyzing or not thinking enough about where you are, relative to where you want to be? Again, you may benefit from keeping track of your thoughts through writing. You may want to make a list of what you have accomplished thus far and then another list of the challenges you wish to incorporate in the immediate future. You can knock yourself out of the race by being too smothering of yourself, just as you can thwart yourself by being unrealistic.
I am not a person who is constantly driven; I can lay back, pet the cat, watch mindless television, but there always comes a point that I encounter unmet social needs or am dissatisfied with staying still. Sometimes you will be able to capture a vision of yourself with that movie camera in your mind's eye and become excited by what you see, as I did when I conceived this book. Trust yourself to get started, use your resources to jump start you if that is what you need, but make friends with your thoughts, your frames of reference, your goals, plans and desires. The focus cannot remain on your illness - you will bore yourself to tears! How many times do we hear people exclaim: "I just knew it was time to move on!" Try Iyanla Vanzant’s method of rewording your messages to yourself to formulate an action plan and then kick-start yourself. Believe me when I tell you that the pride and courage you demonstrate will feed on itself and keep you highly motivated to remain on your chosen path.

Women and Heart Disease: The Heart of a Woman

2010-01-13T17:26:00.000-08:00

As I post this chapter of my writings, a new year -- a new decade -- has begun. There are challenges and opportunities; there are difficulties and demands; there are, as always in my life, beginnings. Happiest New Year to All, and now please read on...

Beginnings: Life Changes, Life Laws and Letting Go

The sense of "here we go again" was ringing in my ears. I was hypersensitive, attuned to my body as well as my feelings, quite aware that my emotions were raw and tenuous. On one hand, I was in a honeymoon phase of living with myself and enjoying it immensely! Nothing moved unless I moved it; there was silence broken when and how I preferred it; effort was expended in the directions of my choosing. I continued to work, but no longer for the business, so the phones were quiet, the voluminous paperwork non-existent and the endless diplomatic interventions with staff and clients absent. On the other hand, this immediate change in life style was shocking, and it would not be long before I had to ask myself what was next.
Following Phil McGraw's Life Laws and intertwining them with my own philosophies, I began the first leg of this necessary journey. All ten of his laws have incredible merit and I highly recommend both of his books, "Life Strategies" and "Relationship Rescue". Your ways of handling the particular challenges you face will likely be augmented by his ideas.
Life Law #2 states that you create your own experience and are accountable for acknowledging and accepting what you have created. This does not imply that if you have had a heart attack that you have chosen it or are to blame or are a hapless victim. In fact, there are no victims, according to Dr. Phil, just "volunteers". The truth is that you are responsible for reclaiming your life, for putting yourself back on track and moving forward past the point of survival - you have won that battle - and onward. "Change" is not a dirty word; it is inevitable, meaningful, exhilarating and strengthening. I can almost hear you thinking "Easy for her to say, but I'm frightened and I don't want to face any more difficulty than has been thrust upon me ". But you have already begun anew and you have proven yourself. You have emerged victorious at least on a physical level and I believe that without a reservoir of desire to stay in this world that you might not have achieved that. Give yourself more credit and begin to realize that a beginning has crept into your life scene, and in confronting it you are astronomically increasing the possibility of thriving! If you insist upon fighting change, you are failing to acknowledge that you are accountable for your choices and the consequences of those choices. You are taking away from yourself rather than embarking on the quest to become more.
I could not remain numb because to do so would have robbed me of the payoffs of new, or at least improved behaviors, ways of being in the world that would enhance me.
Although it was tough to face, this was actually a good time for me to go through the separation. It was an opportunity to re-examine my choices and decisions, rejecting what had not worked and welcoming different strategies. We cannot allow emotional blindness to thwart us or frustration to stop us. I knew that I was foisting myself into a fearsome state but that avoiding it would keep me burdened with the tension and stress of staying in a situation that was not working. Fear and escape from pain have a seductively narcotic effect, but that anesthesia leaves you emotionally stranded, disabled from taking positive action. This is real life and you need results, not excuses. Harsh though it may seem, my goal is to help jet-propel you to where you need to go. Your job is to trust the process, immerse yourself in it, embrace it with open arms.
I was still coping with changes in medications, trial and error additions and subtractions attempted according to my doctor's wisdom. Every test, every symptom, every report had to be examined. Fatigue was limiting, fear was still hard to quash and the reactions of doubt and anguish among my closest friends and family made me so emotional. Although I was optimistic, I could not help but become impatient with the slowness of the healing process. Not knowing what to expect, what baseline would eventually be achieved was baffling. I so wanted a working crystal ball! When would I reach my maximum in terms of energy level? When would I stabilize on the medications and perhaps reach the lowest possible dosage levels? What could I reasonably expect of myself in rehab? We all pose similar, unanswerable questions and doubt creeps in even when we are determined to remain positive -- it is the reality check syndrome. Once again, the issue of control, or lack of it, enters into the picture in its many shades of gray. I consider myself to have a rather high level of self-awareness, and well I should, but I was amazed somehow that the further I was from the heart attacks, the more I was able to give over control. It was taking root more and more deeply, sometimes consciously and more often as a matter of course. To me the latter provided a modicum of proof that this was going to become permanent, not just situational. Some examples seem minute, but they were winking at me on a more regular basis: "Where would you like to go for dinner" would be met with "It's up to you" and not followed by suggestions, complaints or comment. I did not have to participate in everything but could allow others to take the ball. Life had become easier because I had made it become easier! It was not mysterious and certainly not impossible.
I had yet another opportunity in November to go to Florida with my wonderful, supportive, spirited daughter and she made all the arrangements, she drove, she navigated, she led me. I was calmer than ever, easier with myself and finding that the smallest pleasures put a silly grin on my face. Thriving was taking on so many definitions, including simply enjoying life and recognizing it. The full blown meaning (prospering, succeeding, growing or developing vigorously, flourishing), could be taken down a notch to mean feeling content more frequently. It is important to take notice of your own progress, especially when it is inherently slow. I was not entirely without responsibility for my medical condition, but once I could at least allow my doctors to guide me, I could bow out of the brunt of the work that I was not knowledgeable enough to handle. I was careful about food, exercise, rest, pill-taking, but the rest could be up to them. I had chosen them wisely and had a high level of trust and respect for their judgement. If I was too hesitant to report to MaryAnn an incident known to my support system, I could accept their nudging me and make a phone call, without resisting. One of the byproducts was a reduction in my general level of fear, the affliction of "what-if". In fact, days after our return from the trip I was scheduled for another stress test and was actually excited rather than unnerved. This time I would be strutting my stuff instead of fearing that I would fall apart! Indeed, my exercise tolerance had grown, but there were still abnormalities evident, just as on my ECG's, but nothing dire, and, most importantly, I was continuing to develop collateral vessels, "extra" blood vessels capable of taking over for blocked, plaque-filled ones that may have caused the heart attack. Hurrah for rehab!
Perspective is of such great import and, by definition, can take place only with the passage of time: Thanksgiving was coming again and the differences in the long year that had passed were actually dramatic. I was brighter and cheerier, much more energized, had greater stamina and concentration. Overall, I was involved, enlivened, peaceful and filled with optimism, quite a counterpoint to the dulled, tired, unenthusiastic participant just twelve months earlier.
My strong sense of realism was at play, too, and I knew that I would be thrust into periods of sadness and loneliness despite my inner strength. I had made a decision that was not without difficult consequences. My initial inaction was inherently emotionally costly but now I had to develop strategies that would allow me to cross this next threshold, not a simple task. Bathed in a variety of side effects from the many medications I had to ingest, ranging from the ridiculous (a puppy-cold nose) to the sublime (those wondrous vessels), I had to admit that it would be with considerable difficulty that I would move forward.
In our moments of greatest difficulty, forward motion seems so daunting. Getting real, accepting what is, holding yourself accountable for where you are - all of these notions that I hold dear - will sometimes leave you feeling overwhelmed. Life may seem so difficult to manage, as though you need to be made of steel, while feeling more like Jello. As a people-person, I can vouch for the value of being active and among those who make you feel most alive. It is a natural phenomenon to feel alone from time to time, even if you are in a rewarding relationship, working, parenting, taking advantage of avocations, participating in group activities or individual counseling and invested in attending to your own needs. There has always been some controversy regarding the differences between "alone" and "lonely". In my experience, heart patients who identify their lives as being full still speak about a specific type of loneliness/aloneness that is based on the uniqueness of the nature of the disease. You may feel a distance from your significant other, best friends, close family members who can sympathize but not empathize and an uncanny closeness to your classmates in a cardiac rehab program. When you awaken with symptoms in the middle of the night and you are alarmed - "Oh, no, is it happening again?" - your doctor, your trusted medical resource, is not likely to be present and neither are your compatriots. Your spouse may be lacking patience, certainly lacks expertise and/or may not know how to be available to you in the way you need him/her to be. These are moments when you are most likely to feel like you are in a morass and on your own (alone) and unable to use the usual resources to fill the immediate need (lonely). I made reference to the 5 AM syndrome concerning my mother, but it still happens to me some early mornings, too. If I am awakened for any reason at that hour, I have to remind myself of all the positive results of my last tests, convincing myself that no, it is not happening again, that I am receiving excellent care. My only job is to soothe myself back to sleep; anxiety breeds like little rabbits and can drive you needleessly nuts! It is essential to have a well-thought out plan of action in case serious symptoms arise, since logic so easily gets thrown out the window when anxiety slinks in. Perception, your own personal way of reacting to a situation that presents itself, is the key: I can feel a flutter and decide I'm in trouble or I can choose to process my reaction through a decidedly calmer filter. I can panic or I can summon my most forceful, diligent, rational thinking mode. I can run for the phone, get all worked up, no longer able to distinguish between fact and fear, and create a vicious cycle leading to a place I do not want to be; I can also be still, pause, listen. Just as in other aspects of our lives, we can use as life lessons the issues of the past without allowing ourselves to be controlled by them. It is not our particular life situations that shape us, but rather our reactions to them. We all have a certain way of filtering our perceptions, so the physical stimuli can be distorted or addressed calmly. You need to be aware of whether you are creating an opportunity to examine yourself, or falling apart in advance of true knowledge, even at five in the morning. How many times do you hear about someone screaming through childbirth while the woman laboring in another room is brimming over with delight and awe? Their pain thresholds may be similar but their filtering systems are likely quite different. One may be frightened of the unknown and the other more educated; there may be many elements to the equations, but one thing is certain: the screamers among us often find themselves reacting to their difficulties with less forethought, probably in large part due to their lack of ability to test their assumptions prior to exhibiting their reactions. So what does all of this mean in the scheme of things? How can our perceptions help us simplify our lives? How do we objectify reality so that we can make sense of our thoughts, actions and reactions? When we sift through Phil McGraw's ten laws of life, we begin by becoming accountable for our lives, willingly, purposefully and consistently, without blame and with true acknowledgement. When perception is clouded by past experience and negative expectations, we fall prey to limiting rather than challenging ourselves. Self-fulfilling prophecy can cut both ways: if we believe that we can get well and fight for ourselves, the outcome is nearly always positive; conversely, if we are pessimistic, refuse to accept what is, become filled with self-pity, we are apt to induce distress and exacerbate the negatives of our situation.
During a rehab session recently, an upbeat, pleasant, bright woman suddenly sat down, lowered her head and nearly passed out. Her blood pressure had soared, her face was blazing and she was dizzy and near tears. She was attended to by the nurse and doctor on staff and told to sit quietly, stop exercising and just breathe. I made my way over to her and she immediately began telling me exactly what she was reacting to. Her daughter-in-law had written a letter to her filled with complaints about the difficult issues in her marriage, demanding that Lois do something about her grown son. Lois reacted strongly and negatively to the nerve of this woman. Upon reflection, she realized that whatever the intent of the letter, it was her responsibility to own her reaction. She slipped, forgetting that this woman could not cause her to react in any particular way, and that Lois's reaction was purely driven by her own thoughts. The daughter-in-law did not make her blood pressure rise, Lois had done that to herself. The good news is that when it happens, we all can take the liberty to adjust our reactions. She nearly slipped further by chastising herself rather than using the "Aha" moment to assist her. She was proud to come out of the incident with her thoughts intact and her blood pressure back to normal. She will write a positive, simple, short letter back acknowledging that married life can be difficult and that she is certain that they will find solutions on their own. She went home feeling renewed and relieved that she does not have to solve their problems and she does not need to allow herself to be negatively affected by their issues. We can choose what to react to and how much precious energy we want to expend. We do not have to drive ourselves into a tizzy unless there is something at stake that is worthy of our attention, and then we can work through these moments in ways that are helpful, not harmful. A "heartache" can be dangerous, even life-threatening for us. We absolutely must protect ourselves from reactions that can bring about an array of symptoms that can become precursors to disaster. We are fully responsible for managing our dis-ease, which is good news! We have ample motivation to make sense of each troubling situation with simplicity and clarity. There are no guarantees, but it is tempting to tell you that if your thinking is sound, your judgement will be too, and your life will be easier, more pleasant and healthier if you learn to think before you act or react. Lois had allowed herself to become immobilized by the frustration and annoyance inherent in the situation, and it had affected her health. Her stark awareness will be a terrific reference point so that she can choose other ways of handling similar incidents if they occur.
So now I had to ask myself some questions: would seeing clients, writing diligently, going to dinner with special friends, a birthday party for Mom, the routine of seeing the dentist, going to doctors, exercising three days a week enable me to practice what I preach and live what I had not only learned, but was teaching? Questions like these served as markers for my worst moments, red alerts to remind me to empower myself. I was nearing empty and refueling was a necessity. Back to the wisdom of Iyanla Vanzant's quiet pause. Back to the trust in my abilities. Back to the life experiences that prepared me for this one. Forward, using what I call the "movie camera" in our brains. Time to reflect on reasonable, short-term goals. Time to appreciate and luxuriate in the joy of my daughter, the dearness of my mother, the specialness of my friends and family, all earned by my being who I am. Time to enjoy the holidays and the coming of a new year - the millenium, in fact! There were days that getting out of bed in the morning was a chore and sleep a refuge. There were days that dragged on slowly and days that were unproductive. There were thoughts that demonstrated a longing to know my future and conflicting ones that knew better than to take more than a day at a time. If all of this sounds familiar to you, that should not be surprising, but while it is happening it is so difficult to take it all in. Becoming entrenched in a negative mode is a prescription for trouble, limiting the ability to filter and to be open to finding new ways of coping. Rather, you need to remind yourself yet again that you have survived, so you have already come out on top! Your attitude about striving to thrive is where your power resides. You may have been knocked down by your heart attack, but what matters now is getting back up and staying there! You're not on this life journey alone, and you do not have to be totally in control, but you must take charge of managing your life. I have often joked with clients that if challenge builds character, we can readily understand why there are so many characters among us! Expect the hurdles, but don't label every situation a disaster; know that there will be pain and difficulty, but do not react in advance, daunting yourself before you have the opportunity to create an efficient, realistic plan. Become your own top-flight manager, allowing the perhaps unexpected, yet predictably present changes in your life to function as opportunities for furthering your growth. I recently asked the director of a private school for children with learning disabilities what she would like to do differently in her already remarkable school. She told me that she starts every day as though she was about to be replaced by someone else. She then becomes that new person - a new broom, as she phrased it - and she tries to be that new broom every single day, because a new broom always does a better job. She is always open to new ideas and approaches and is an incredible motivating force for both staff and students.
One of the major responsibilities of parenting is to instill in our children the ability to adapt to change, for we know that it is inevitable. We also know that beginnings are created by endings, even unwanted ones. I could not know what the future design of my life would bring, but I certainly knew that I would be the driving force. Why-me and what-if questions are debilitating and unnerving, involving a remarkably useless expenditure of energy, yet leaving us devoid of answers. I had to re-invent parts of myself, mindful of my good skills and abilities as well as my areas of lesser ones. The natural fear of the unknown is based on needing to know the answers to unanswerable questions. In terms of CAD, great advances are being made in the field, so I feel assured that within the next five years and subsequent similar blocks of time, I will benefit from gains in the treatment and management of cardiac patients. I know that closure in the relationship was critical and had to be addressed fully in order for me to move forward without having a chip on my shoulder, let alone, as my mother phrases it, “an entire lumber yard”. Determination and commitment are central in this important task. Remember, too, that behavior is purposive and self-rewarding. It is essential that you reflect on why you act the way you do so that you can choose to eliminate behaviors that limit you. You will have command only if you take note of the consequences of your actions and you will move forward by planning, not wishing, hoping or dreaming. It is a tall order, this life based on deep thought, but I assure you that having been through all you have - and I say this with true empathy - the rewards are going to be extraordinary. One of the ways that I can assess my own progress is by noticing the reduced frequency and duration of the inevitable lows. It may serve you well to keep a diary or a journal as you go along, particularly if you are experimenting with new strategies. It will keep you honest and involved and help you to integrate the new with the old. You already have a core from which you operate, based on your lifelong value system, experiences, desires, needs, expectations, successes and failures. You may need to make adjustments, admissions, acknowledgements. You may actually find that you are closer than you thought to achieving your goals, attending to the meaning of your life and becoming your own patient, realistic manager. It is magically uplifting to see yourself recognize the quality of your life plan as it takes shape. Of course, the path is bound to be bumpy. It is appropriate to demand command of your own life with conviction and boundless determination. Don't cut corners by setting your standards too low. Try to find a balance between striving for great heights and deciding it is too difficult to create a life that can be more than it is right now. Neither settle for nor create an unrealistic scenario that is bound for disaster. Success breeds more of the same and as you and the people around you notice that you are fighting for yourself and are determined to become more, you will flourish.
You may want to ask yourself specific questions, such as:
- Am I managing my financial life appropriately?
- Am I killing time or utilizing and appreciating it?
- Do I need to develop my interests or select gratifying hobbies?
- Am I remembering to see the humor in quirky situations?
If finances are problematic, you have a real battle to wage. In my family we say that money is not a problem -- lack of money is a problem! Again, utilize the knowledge and experience of those you trust or to whom you are recommended. If you neglect this issue, I can promise you that it will ferment, grow and taunt you. Solutions abound and must be sought out.
The issue of time is precious. Having come so far, gained so much, worked so hard, your time is so vast in its value. It is not about "one day down", but rather a matter of reveling in the treasure of using and delighting in every moment of every day.
Perhaps you will come to realize that you always wanted to DO IT! Pottery? Reading? Canoeing? Whatever enters your mind, if you cannot arrange to do it, then read about it, talk about, engage in any possible aspect in it, but do not drift away from it.
Humor is my favorite topic. It is health-giving, life-extending, both immediately gratifying and endlessly referential. Sometimes I feel like Dudley Moore in "Arthur", all by myself and just laughing at my own thoughts. It is a lifesaver and a true necessity, especially in tough situations. Whatever brand of humor appeals to you, whether from a book, a comedic performance, a movie, a joke, use laughter as a lifeline - trite as it may sound, every chuckle is worth a million times more than even the slightest frown.
There is every reason not to set yourself up to believe that everything will always work, just because you are designing your life with more thought. To quote Dr. Phil, “Sometimes you make the right decision and sometimes you have to make the decision right". Keep on track, but remember that the softness of the path you are designing allows for flexibility and once you have taken responsibility for struggling to mold it, then your strength lies in not rigidly clinging to what does not work. It is your life, you are the managing agent and you will be able to figure out what works best for you once you commit to the idea of honing your skills and reaching for your particular star.

Women and Heart Disease" The Heart of a Woman

2009-12-25T18:42:00.000-08:00

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

2009-12-10T12:12:00.000-08:00

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.

Women and Heart Disease: The Heart of a Woman

2009-11-19T17:24:00.000-08:00

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

A New Era Dawns: Friendship, Frustration and Forward Movement

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

Women and Heart Disease: The Heart of a Woman

2009-11-08T20:16:00.000-08:00

It's difficult not knowing if anyone out there in the bloggosphere is reading this, but I'm undaunted and optimistic, so here is the next chapter:

The Journey Toward Adjustment Begins: Turmoil, Reflection and Realization

Psychological savvy did not spare me the need for catharsis. Announcing to myself that I would be okay, that I had survived, could not stop me from recounting my experiences to anyone who had the time and patience to listen. Perhaps the more dramatic sagas of our lives vary by theme, but our reactions bear much more similarity than difference. I believe that there is a high level of universality in our need to share our most vivid memories which are centered around our most heightened emotions: fear, love, anger and hope.
After her three-week stay, added to the total of two weeks during which she stayed near the hospital by remaining at my home while I was hospitalized, I was ready and able to release my mother, although not without mixed emotions on both sides. I told myself that this was a milestone and knew that she needed to resume some semblance of her own life. It is unimaginable the toll all of this had taken on her. An incredibly strong, vital, willful, logical, loving woman, her habit/defense of putting her emotions on hold was wearing thin. I knew she had been unable to sleep through the night (to this day she will tell me with pride when she has not awakened "in the five's", the third MI having occurred at about five in the morning, but it is a rare occurrence). Sometimes it is impossible to ascertain who is more important to whom; we truly like each other and have developed a warmer, closer, more enjoyable camaraderie than ever. The definition of "need" does not properly flatter our alliance, for we have a rare and treasured affinity for each other. There are days that we talk to each other several times, laughing at life, supporting each other through life's less humorous moments, discussing everything from politics to the stock market to parenting. We shop for gifts for various family members and are noted for our hilarious adventures in that momentous event: shopping for bathing suits! We're fun-loving and play off each other to the hilt; remarkably, this is being repeated between my daughter and me. I cannot possibly overstate the case for having someone available, practically on-site, at least in the initial throes of your illness. I was extraordinarily lucky to have been able to call upon the close tie with my mother, but suffered terribly that I could not rely on my husband who "should" have been available to me. I recommend not exerting precious energy by not facing your situation realistically, whatever it is. There are professionals who are ably trained to lend comfort and assistance if you do not have someone known to you at your disposal. Whatever you need to do to take care of your immediate needs, just do it! You will need to take responsibility for moving on in your life, including, but not limited to work, pursuing your interests and engaging with people with whom closeness and support can be counted on.
By now about seven weeks had passed since the final MI and I had purchased tickets two months earlier for my daughter and me for our annual foray to see the Alvin Ailey dance troupe, truly our favorite. The show was marvelous, despite the fact that it was an evening performance and I was fighting my on-going fatigue. Again I could feel like a "regular" person, enjoying life. Our seats were down so close that we could see the beads of perspiration soaring through the air like tiny sprinkler systems as the performers spun and leapt. Of course that meant that we had to climb a virtual Mt. Everest to reach the exit when the last curtain call signaled our departure! By the time we reached the zenith, even with my daughter pushing me from behind, and even at a slow pace, I was in tears. Here I was attending this fabulous show and I had to cope with being at the effect of my dis-ease. She tried to comfort me and I recalled the words of wisdom of my physician describing the importance of the passage of time, but a slow recovery was out of tune with my natural drive. This was an example of weariness impinging upon good judgement. The impact was strong because I felt weak.
I could not help but notice that anything I did that was beyond the nothingness of basically staying in bed, with the exception of adding the block or so daily walk, took a toll the next day. I made as few actual plans as possible. The trick was to be meaningfully busy but not exhaust myself into despair. That pacing continues to play an important daily role even as I progress. If I look or act tired, there is an almost accusatory response: "You're doing too much". I maintain that you cannot be foolishly risk-taking, but it is not entirely possible to know what is too much. I guess caution is necessary, but I know that there is incredible psychological merit in pushing yourself just far enough to feel the value of what you are doing, to surpass yesterday's feats and set ever-higher goals. Simply put, you cannot do what you cannot do!
Less than one week after Alvin Ailey, I was able to go food shopping, but only with the cart as an aid and just briefly. I could not carry heavy packages, although temptation and stubbornness made me try, only to be thwarted by heavy breathing and weak knees. It was becoming more difficult to figure out what to do with myself, which was actually a good sign, albeit heavily disguised. Wanting to be back in life was enormously positive. I think that if my mind had been less clouded by the chronic fatigue, my concentration would have improved and I would have known and appreciated this important piece of information. That not being the case, even a good movie could not keep my attention, so languishing in bed or on a chair provided no solace and became a perceived enemy.
One fine day, in an effort to return to my "old" self, I willingly made the effort to take my mother for her monthly doctor's visit, and then to my friend's salon for a haircut for her and a much-needed manicure for my weak nails. All told, including a substantial amount of driving, it was about a four-hour day, one of my longest outings to date. I was beaming, deserving of an award, dead tired, ultimately physically miserable. I needed to figure out ways of buoying myself, lecturing myself into believing that this was just the beginning. "Those who can't do, teach", I heard my clever inner voice utter. It was difficult to know whether I was being hard on myself or not pushing hard enough; was I demanding too much, too soon and not being stoically patient? There were no clear answers yet. I had read Nietzsche in college and remembered an apt point: "What does not kill me makes me stronger". I was beginning to smirk at myself: no one wanted me to suffer from overexertion, but my mind was leap years ahead of my body and I felt like I was at a virtual standstill. It is so important to take regular backward glances so that the small steps forward are noticed with relish. My four-hour day was actually laudatory.
Now it was time to schedule another doctor's visit, and I was armed with my rather long list, but when I called for the appointment, the office announced that the doctor was no longer accepting my medical insurance and had been off the plan for nearly a year! This was a stunning revelation, since his name was in the most recently sent book of providers and I had seen him twice. The office suggested that I notify the powers that be and find out what to do. That saga does not bear lengthy discussion. Suffice it to say that they permitted me to see him one last time, promising to pay for the three visits, but with no apologies. I spoke with the doctor, who furnished me with the names of trusted colleagues, which I presented to my daughter and her friend from medical school, who was doing a cardiology rotation at the hospital with which I had decided to affiliate. It is supremely important to gather your resources and make a well thought out decision, for this person will be pivotal in your treatment, attitude and, potentially, degree and type of recovery. I settled on a female physician, young, considered brilliant, warm, honest, respectful and completely up to date in the field.
Within literally seconds of meeting her, I knew I had made the best possible choice. MaryAnn McLaughlin was a delightful person, in addition to being thorough, kind and a wonderful listener. She has been selected to take over many of the patients of the renowned Dr. Valentin Fuster, since he had just been elected president of the American Heart Association. What an honor, and so deserved.
Thanksgiving was three days away, so she was filled with good wishes and encouragement. Although the third "insult" to my heart had caused the most damage, I would ultimately be able to live my life relatively similarly to before, with drugs, the continuation of a proper diet, reduced stress and appropriate coping skills and the addition of a structured exercise program. She addressed her medical concerns and suggested certain changes in medication and was open minded regarding vitamin supplementation. Finally, a dream realized with no nightmarish element.
Nothing comes easily with our strange health care system: the insurance company often takes months to pay the doctors, but it was only a week before I heard that Dr. McLaughlin was not on the plan either! They had lost all of her files and it would be at least six months before her eligibility would be determined. This absurdity was beyond my endurance, so I set out to address the issue, time consuming but ultimately gratifying. They "allowed" me six visits with her, more to be authorized if she played the system from her end. The secretary and I developed a love/hate relationship - I pushed her, helped her, bothered her, pleaded with her - and the daunting task reached completion with the doctor being added to the plan and me continuing to be under her competent care. Do pick your issues, since frustration does not enhance healing - but oh, success is so sweet!
The Thanksgiving weekend with extended family at my parents' home in what we call "the country" brought comments like "Oh, you look so great!" I guess people expected me to look dreadful, and those who had seen me in the first few weeks would not have been proven wrong, but by now my color had returned and I was a fantastic faker. Why, I could spend upwards of an hour, maybe two, enjoying my little cousins, judiciously nibbling at an array of foods not suggested for ingestion, smiling at other people's stories. I carefully kept from revealing that my eyes were propped up with invisible toothpicks and my head was reeling from the effort of just being there. I look to laugh, find humor just about anywhere, adore kids, but all I wanted was slumber! There was a surreal quality to the day, a mismatch among thoughts, feelings and actions.
Meanwhile, there were post-Thanksgiving sales at the Outlet Center ten minutes from my family's house, a command performance requiring my presence. I was called upon to muster both energy and enthusiasm, both of which resided in my mind, but not body. I dragged myself around, feeling at once delicate and amused, jubilant and foolish. I slept well that night.
By the end of the weekend, I was ready to go home and face a week that consisted of such mundane chores as bringing my car to the shop and going for my monthly blood work. Added to that was my husband's annual check-up with his internist who is also a cardiologist. He could see that my accompanying his patient was not easy. Equally evident was the tension between us, building by the day, but not stopping me from being in attendance.
Later that week, I had to go for a minimally invasive test to determine whether what appeared to be an old ovarian cyst was significant. Again I became tearful on the table, unable to answer questions without more emotion than made logical sense. Again I found myself explaining what had happened to me just two months previously. Again I was told how great I look, how young I seemed, what a shame that I had to go through even this test. I was repelled by my self-pity and hypersensitivity but pleased to be the recipient of the warm words of wisdom and kindness of the physician.
There is something disingenuous about feeling one way and looking another. There was nothing intentional about this dichotomy, just genetic good luck. For months it was a theme song. I would yank myself through each day, progressing in baby steps, wanting to tell people that I understood their reaction but it was causing an unpleasant one of my own. It was almost a throwback to adolescence when no matter what your parents told you about your beauty, you saw only the blemish on the end of your nose. At first I assumed that it was placation, not able to comprehend the veracity in the face of the mismatched equation, but even my honest and direct mother had to agree that the way I looked did not betray the reality. It was probably close to a year before I became accustomed to the chant, but on bad days I wanted to snarl and tell people I did not care how I looked, that the way I felt was the salient issue and that was still far from acceptable.
If my initial recovery was deemed typical, then it would be up to me to attempt to maximize it through careful experimentation. I accepted a part-time return to my responsibilities in the business, still relying heavily on our office manager, but willing to answer the phones, take reservations, deal with the moment-to-moment rigors of this "24/7" business. As I recall, I worked just a couple of hours a day, but it took the edge off my husband's responsibility so that he could drive knowing that his trusted helpmate was available and I was also able to continue to see my clients, my real priority.
I don't think a week had gone by before I became painfully, personally aware of the effect of stress on physical ailments. Between our marriage, which I had by this time named an "emotional divorce", and my reaction to the level of stress he brought to our difficult business-of-immediacy, I grew worse. I was tired, irritable, disappointed, more aware of the nuisance of the side effects of the myriad medications I was taking and just plain miserable. Startled by the extent of my reactions, I had to begin to retreat from the business, electing to instead use my mental energy to see my clients. Most of them came in the evening, so pacing myself to be totally alert at the end of each day was tough in itself, but a quarter of a century of experience and gratification made it as rewarding, stimulating and challenging as ever. Admittedly, the realization that I was in an impossible marital situation was just devastating. The downward spiral was reminiscent of the common, dizzying “ether dream” I had at age seven during a tonsillectomy. I felt as if I had too little control over my own healing and nearly none in the matters between us. He had refused outside help and was convinced that it was my problem, since he saw couples all the time who were in much worse shape than we, so according to his system of logic, we were really fine. When tenacity turns to relentlessness and desperation, acceptance is absent. There was no way I could reach him, but now I was beginning to accept that as fact. Now I had to tackle the issues of my heart on two levels, the emotional and the physical. Weariness is an enemy of good judgement, limiting one's ability to defend, assess, critique, decide. If the proverbial genie had arrived, my wish would have been to transform the marriage into a livable, loveable, daily delight. Usually, I was beyond feeling sorry for myself and was ready to take on the physical challenge, but the sense of being alone even when he was present was choking me. With all of this brewing, we had made plans to visit friends that weekend. It was early December, the weather was cooperative, their grounds lovely and inviting and their company refreshing. I was close to both of them and adored their kids. Confident in their discretion, I had discussions with each of them during the course of the day concerning the problems about which I had complained prior to the MI's. Like my mother, daughter and other friends, their wish was for maintaining stability, believing that it would lead me closer to the fullest possible recovery. I had a hard time helping them understand that our staying together was hampering me from improving, abetting the continuation of high levels of stress, one of the immediate causes of the attacks. I began feeling troubled and like a troublemaker, a complainer and a victim, heartless and heartbroken. By the time we left, I had spent no time with my husband and was not able to talk to him during the fifty minute trip home. I was crying silently, tears streaking down my cheeks, into my neck. I was too depleted to tell him what was wrong and too drained to allow myself to think, so I just allowed it to happen. I turned my face toward the window, and he never even knew.
My first stress test was upcoming within days after the perversely strenuous visit. This was not just the walk-on-the-treadmill variety, but an involved, three-to-four hour study involving intravenous radioactive dyes and "pictures" of the working heart. My daughter was a graduate of the hospital's medical school and was well-liked and highly regarded, so between that and the presence of her friend who was still working with my cardiologist, the team treated me like royalty! I had a cheering squad while I struggled on the treadmill and company during the waiting periods. I appreciated it, although I had no idea that this was not the norm! Herculean as it was, any unpleasantness was more than compensated for by their presence.
There was a dual purpose for the test: assessing baseline damage and clearing me to begin Cardiac Rehabilitation. The latter was at once terrifying and thrilling. Me? Exercise? Three times a week? It was a foreign language, but I was fascinated and had been told that the benefits could be "amazing". Good word - works well juxtaposed to my presence. I always joked that my driving leg was in the best shape of any part of my body and that if answering the door for my clients or the phone for business were considered exercises, then I was in fabulous shape. Never one for structured programs, I believed that treadmills and stationary bikes should be prettier, since they nearly always became decorations or closet substitutes. It would be interesting to meet my comrades, I was drawn to that, but the idea of voluntarily bouncing around on equipment -- at a rodeo, maybe!
During the week following the stress test, I had intentionally made several sets of plans, testing my endurance and filling my need to enjoy my life. I took a friend's precious eight-year-old to see "The Nutcracker", which she enjoyed thoroughly, mainly from her perch on my lap. On the way in to the building, it was almost humorous to keep her in view as she mounted the steps two at a time and went up and down three times before I could stagger to the top. I was undaunted, reveling in how adorable she was and how blind she was to my effort. Kids do not need lessons; they know intrinsically, enviably how to live in the moment.
I also committed myself twice to taking care of my friend's twelve-year-old after school, another venue with the reward of concentrating on something other than palpitations, extra beats, momentary chest pain, sleepiness.
Next on the agenda was a truly momentous occasion: lunch with my parents and a first cousin whom I had not seen in forty years. I remember being twelve or so to his seventeen and having such a crush on him. He was an even more handsome version of Ricky Nelson, ever-popular teen heart throb, and sweet, with an endearing smile. We had little contact beyond those years, and I was away at summer camp when he was married. For about a million and a half reasons, it was not until his wife found us via the Internet that this rendezvous occurred. He and his wife knew about the heart attacks from our phone conversations, but the face-to-face meeting brought the usual comments around how good I looked. Better than in my teens? In any event, sharing thoughts about relatives long since gone and using broad strokes to fill in the decades was precious. For me it was a brief visit, since I had clients to see, but we promised to get together soon, or at least in less than four decades.
Two days later, just a week before Christmas, I went to the cardiology department for the stress test results and yet another ECG and exam. My ejection fraction percentage had changed very little, a slight disappointment, but all in all, I was rehab-ready and would meet the staff at the end of that long week and then begin the program one week later. Would this be the beginning of palpable improvement, the missing link in my regime, the new wave, the holiday gift that would make me last a lifetime?

2009-10-29T14:08:00.000-07:00

Welcome back... or, for first-timers, please read from the bottom up!
"Home to Stay" continues, with more experiences and more possibilities to thrive...

You will notice that I consistently extol the virtues of having a network of supportive people around you. I am aware that not everyone has such a "team", in which case the time has come to join a support group, whether social or therapeutic, or perhaps begin with a counselor, psychologist or other professional with whom you can share your innermost feelings and fears. No one should have to endure this saga alone. With all my natural strength, positive attitudes, knowledge and training, I needed every moment of advice and solace I sought and still do. Please be neither embarrassed by nor avoidant of the level or types of need fulfillment you are experiencing. As a survivor seeking ways of thriving, you are entitled to whatever services your community has to offer.
The next ten-day period would be most eventful: I would see my internist, who was the Executive Director of Mount Sinai's Women's Health Center, with whom I had a wonderful relationship; don a holter monitor which would record every heart beat for a full twenty-four hours; and return to the cardiologist for yet more news.
The visit to my internist, with whom I had only spoken since heart attack numbers one and two, began with greeting each other with a long hug. I was armed as was my custom with a three-by-five card filled with questions, an excellent shortcut and the best way I know of to insure that no matter what time constraints the doctor may have, he or she has to respect your completing that list. It also helps you to focus without relying on your memory, so that you avoid returning home and only then realizing what you forgot to mention. She had been genuinely taken aback by the news and was filled with endearing well wishes. She agreed to serve as the nucleus of my growing army of physicians and supporters, all test results to be sent to her office and any modifications duly noted on my chart. I advocate establishing this system as a simplifier, a sort of centralized catalogue of information. There was nothing to be added at this time but she did reassure me that the healing would continue and there was a chance that some of the scarring would resolve, enabling my heart to work more efficiently. She is also a hematologist and would handle monitoring the effect of the blood thinners, pivotal to preventing further incidents. She went so far as to imply that I would soon have even more at my disposal than I knew in the arsenal of treatment. I needed the details of that alluring hypothesis to wait until I was ready to avail myself of whatever she had in mind. It is not helpful to have a carrot held so far from your reach that the effect is actually negative. I was dumfounded by my ability to not know every conceivable detail. All I wanted was the magic wand response that every patient not-so-secretly hopes for, and I am a slow healer, so time was both on my side and a tease. I longed to hear sentiments like "this will not affect your life span", "you can expect to return to life as usual shortly", "you have been through the worst of it already". I knew rationally that these would be nothing more than absurdly scripted phrases, too empty to serve their purpose.
I think the most gratifying question-and-answer session I have had to date took place with her that day:
"I want to be able to ignore all these little twinges and peculiarities instead of being on red alert so frequently".
"Go ahead and do just that!", she replied. Music to my ears, but with symphonic complexity and not to be taken too literally…
The holter monitor records every heartbeat for twenty-four hours: the results were dismaying. During one, half-hour period between two and two-thirty in the morning, while sound asleep, I had had fifty-two extra beats. There were other "hot spots", too, but this was most alarming. For now it meant taking a slightly higher dose of one of the prescriptions, but was not described as foreboding. According to the cardiologist, with whom I felt comfortable and secure, I was on the right track. A full month finally had passed, but we would not know how well the stents were working for another five. It would be difficult to wait that long to hear some good news, but "positivity" was an ally.
I was walking every day, though never alone, once venturing by car with my husband to a nearby pretty park with a pond to fulfill my one-block hike. I also decided not to wait any longer to return to work, since I have a home office. I called some of my clients and scheduled a few sessions, which was a good distraction and served its purpose - and assuaged some of the growing guilt of "abandoning" them. On balance, it was more difficult than I could have imagined, beckoning me to concentrate intensely, but well worth the result of returning me to the familiar role of giver. If your situation is similar, and your doctor concurs, I would return to a reasonable work schedule as soon as possible. It can have an enlivening effect.
Still plagued by any strange sensation or irregular heart beat, particularly at night when reactions are heightened, I was frequently panic stricken, wondering if number four was lurking in my midst. There was one moment that I had a stabbing pain I tried desperately to ignore, but the gig was up when my friend called serendipitously, just to check in, and basically ordered me to report to the cardiologist, even though it was Saturday night. What with malpractice suits skulking in the foreground of most physicians' minds, I was afraid I would be told to come to the emergency room, not exactly my favorite destination. Instead, the head of the department happened to be on call and had no qualms about telling me that signs of recovery and healing take many forms, not all pleasant, but this did not seem ominous to her. If she could express such confidence, it made sense to accept it. Lesson learned: make the call! In this case, it was self-protective, non-alarmist and positive.
Someone had forgotten that ribbon you're supposed to break through at the finish line, but no matter; this was my first solo trek, and, bottom line, I had arrived!
Avid about regular mammography and breast sonography, I had added that to an already long day. In general, a somewhat unpleasant, but no-big-deal event - there's that word again - it elicited my vulnerability, particularly in light of the soreness on the side of my chest which could have been mimicking cysts or... I found myself in tears while lying on the table being examined by a physician I had met just once. I explained the circumstances of the past month that led to my hyper-emotional response and she was sympathetic. I felt like a little kid at the pediatrician's office, immersed in self-pity and probably baseless fear, Pavlovian perhaps, and therefore unavoidable. The mere thought of receiving more news to process was paralyzing. Of course, I was fine, just a little unnecessary squeamishness, a perceived lapse in coping suitably. I was groping for strength and was hardly proud to be such an obvious wreck, explicable but still unsettling, another reminder of the arduous struggle that actually had just begun. It is so important to remind yourself that it is human and expected that you will have moments that tap into your natural apprehension and cause you to react, sometimes even over-react. I wish I had recognized and befriended it as acceptable and permissible, allowing me to be more intentional and logical about not over-scheduling my day. It was probably a mistake to have gone for the test alone, but I had not properly judged my own need, a common error. My physical healing would be inexorably linked to my level of psychological acceptance and the fight would be arduous. Seizing the immense opportunity for learning from living this apparent nightmare had to be absolutely primary. My surviving had been only the beginning: the gates leading to the ultimate goal of thriving were coming into view. The unraveling of my marriage was unfortunate but not unusual. It also served as an opportunity to change my life, to head in directions I may never have thought possible, to become more self-reliant. In so doing, self-love and hope ultimately replace anger and fear.

The Heart of a Woman: Women and Heart Disease

2009-10-22T16:33:00.000-07:00

Last night was, indeed, an "event": The 2nd Annual Go Red for Women meeting, attended by about 90 people, from a variety of companies, families, backgrounds, with heart disease prevention being the common ground. I was the only "patient" in the group, invited by my cardiologist who chairs the committee. It is a division of the American Heart Association (AHA) and is funded by Macy's, Merck and others. The educational information, mainly specific to women, was spoken about at the podium and viewed on screen in the form of a TV show hosted by Hoda Kotb on Channel 4. The show had aired on a Saturday night, but was not well-publicized. It concisely presented the range of signs and symptoms women present with and used actual womens' "stories" which focused on making good choices that can lead to treatment and prevention of heart disease and related health issues. The statistics are alarming: not only is heart disease the most frequent cause of death of women in America (one every minute), but because knowledge is power, we must be informed! So, here is a portion of the next chapter in my saga, with some - I hope - helpful points on coping with this dis-ease and not only surviving, but THRIVING!

Home to Stay: Merging Encouragement, Caution and Patience

My mother was still my constant companion, providing food, sweetness, solace, conversation and encouragement. It is common to experience a certain degree of insecurity outside the protective hospital environment and I was not immune to that feeling. Not surprisingly, mixed emotions abounded: I was thrilled to have been sprung but could not keep myself from the inevitable "what ifs". Among the many physical effects were palpitations and "extra" heart beats, odd sensations which are insistent and obvious but not dangerous in the absence of angina (chest pain, which I have learned comes in many varieties). In addition, I developed a condition known as costochondritis, an inflammation of bone and cartilage causing constant soreness in the area of the heart near the uppermost ribs, difficult to ameliorate even with strong pain meds, which should have resolved within a month but was to last for several. Turning onto my left side would serve as an unwelcome reminder of past occurrences, alternately causing a peculiar fluttering sensation or pain significant enough to cause apprehensiveness. Short of sleeping with the telephone in my hand, I had no idea what I should be doing, particularly at night. Other than my ever-increasing impatience, I was not faring badly and I just knew that the sooner I could be cleared to do something simple but meaningful, like driving, the sooner I would begin to return to my pre-MI, optimistic state. Although not completely realistic, these urges are potentially commendable. Welcome them if they come, but with a general sense of caution. If you are in the reverse situation, afraid to move around, especially without the "border patrol" provided by the hospital milieu, question first the distinct possibility that you are truly not ready for much activity. Respect the way you feel physically and then try to find a balance between your emotional needs and your body's ability to cooperate.
On the first morning, I was reluctant to overdo anything, but by that evening I was emotionally ready to start small, with the previously simple, daily chores like bed-making. I awoke the next morning excited that I had an activity to start the day! Can you imagine such excitement over bed-making? However, I was stunned that it left me breathing as heavily as if I had just simultaneously moved two pianos! Off to a rough start and admonished by both mother and husband, I would not promise to cease and desist but would compromise by resting between sides. How lame! So what could I do? For one thing, I could not wait to take an actual shower. When I acted on it, I had another rude awakening: I could not hold my arms up long enough to wash my hair and had to do it in small bursts, skipping the conditioner. How dismaying not to be capable of such a routine task, and how typical. I found it impossible to separate what I should be able to do from what I could realistically expect to do. Questions surfaced such as just when would my stamina begin to increase? What would become my norm? I found it useful to write down my questions and frustrations in almost journal form, for later presentation to my doctors or just as an exercise to look back on over time. Progress would come, but neither quickly nor evenly, as is so characteristic in recovery.
The next rude awakening came when a Celine Dion concert was scheduled on television that night. I love music and have a penchant for singing, so I had something to look forward to that would be guaranteed to lift my spirits. I was alone in the bedroom when a favorite song began, but when I attempted to join in, I found that I could not complete even a phrase without a breath and could not hold the long notes. Tears welled in my eyes as I put forth my best effort, but I was unable to really sing. I went into the kitchen where my husband was sitting and reading the paper, and collapsed onto his lap, bawling like a baby. I needed comfort desperately, but he was not able to understand the depths of my despair, a preview of coming attractions of what was left of our once-sweet relationship. I felt stifled, hopeless, damaged. This was probably among my lowest points to date: it was sinking in that this was real and was happening to me. I was a "heart patient". The diagnosis of CAD (Coronary Artery Disease) on the chart bearing my name really applied. Acceptance is both an achievement and a hardship, as you may already know. There was still a level of comprehension I had yet to reach. Maybe I never will be total, and perhaps it is not necessary.
My first doctor's appointment was scheduled for a few days later, but with the same gentleman who had caused the hemorrhage, so I was, logically, ambivalent about seeing him. He knew the case well, so I deferred to his knowledge of my case over my lack of basic trust. In the meanwhile, I experimented prior to the visit so that I could report both my achievements and misgivings. There were moments when I was certain that I could drive at least locally, but with both sides of my groin still healing, that would have to wait. In the apartment, every move I made seemed to negatively affect me. Just being out of bed too long induced the need for a nap. I was struggling with bouts of rapid heart beats (palpitations) and extra beats, strong and out of nowhere, usually momentary but frightening. I was not sure what to pay attention to and report and what to dismiss. It is a gross generalization, I know, but I do think that this is common among all of us in this and similar situations. I felt far too ignorant - and a part of me still wanted to keep it that way!
Within those three days - not my usual three hours - prior to the appointment, all of the unpacking from the vacation not taken was done and organization had returned. My mildly compulsive side was delighted!
Stir crazy, I announced that it was time to make a brief foray into the outside world. Despite thinking I may have been pushing my luck and with a baffling but intriguing yellowish-green light from the doctor, assisted by Mom's understanding and appreciation of my need and urged on by my own feeling of being nominally ready, or at least not foolhardy, off we went! Breathless anticipation prevailed!
We were out for about an hour - drugstore, cleaners, small stores for small steps - and I was nothing less than thrilled. I was also astoundingly exhausted and then took my longest nap to date. It had taken a toll but had bolstered me beautifully.
To this day, I continue to be confounded by the concept of "doing too much". I probably define it poorly, definitely resist it with stubborn fervor and frequently exceed the normative boundaries regularly. For example, I have been "caught" more than once walking backwards on the treadmill in the rehabilitation program I will talk about soon. What the staff considers dangerous I see as different, interesting and good exercise for yet another set of muscles to which I have never been introduced. I'm a psychotherapist, not a physiologist, and I had no concept of how many underserved muscles I own! I don't have the nerve to prescribe my pushing the envelope to anyone else, but it is part of my personality and, well, I have not fallen yet!
The doctor's visit was meant to reassure me, including a walk completely around the hospital corridor with the doctor. I could barely keep up with him, proof of his poor judgement, I felt, and this was supposed to have boosted my confidence? The way I felt afterwards just served to frustrate and annoy me. He instructed me to begin walking half a block a day for a week, doubling my mileage the second week. I was practically embarrassed at this low-level beginning but excited that I had reached the point where I could "exercise". His sample "run" with me was not exactly inspiring, but from nothing to something, plus my own efforts just within stores, there was palpable progress. Small steps …
I hear both complaints and accolades involving physicians from my comrades-in-arms all the time. True to form, I was rapidly running out of patience and rightfully lacking basic trust in this individual, so I devoted some time to finding an alternative. I suppose it would have been easier to just stay with him, and I did have a hard time calling the office to have my records transferred, but I knew that it is essential to put your own needs first. I tried to be casual and positive when speaking to the staff, not wanting to seem overly critical and aware that I wanted not to instill any resistance from them. Admittedly suffering from Oprah's "disease to please", this self-ish-ness is not natural for me but it was time for another round of self-advocacy. I wondered how many people still revere their physicians based on the lore of old and are too reticent to facilitate a necessary change. The process is not easy for those of us who, by dint of current circumstances, feel weak and needy, confused and concerned, but I hope you will listen to that inner voice most of us possess and take care of your self. Let the doctor's inner circle take care of him/her!
From the many recommendations I sifted through, I chose one doctor from my insurance company's network who was greatly respected and set up an appointment for the following week.
Time passed in slow motion, another universal feature of recuperation. Although battling with a combination of resistance and faith, I was taking an array of prescriptions including two different heart medicines, a cholesterol lowering drug, another to prevent clotting, plus one to keep my long-standing thyroid problem in check and had to re-adapt my hormone replacement therapy (HRT) to the new regimen. Recently - or, more to the point, finally - studies are being conducted, revealing that HRT has benefits for women with heart disease. I had consulted with an internist who specialized in clinical nutrition and endocrinology who suggested a list of vitamins and supplements he felt were cardiac protective and then added in a reasonably palatable protein drink. I thought it would be difficult to keep track of just the scripts: when I realized I was taking upwards of twenty-five pills a day, I decided to become more active in assessing whether or not all this was necessary. The battle had only begun, but I was hopeful that there would come a time when changes and deletions could be made. The good news is that within a few months I was able to adjust the dosing schedule so that I only had to take the array of pills and capsules twice a day. I extol the virtues of simplicity and endorse the concept of thinking through your specific situation - with the help of medical personnel - to arrive at methods of easing your own path toward healing. Compliance is essential and your level of participation and understanding in your own care is an excellent route to acceptance.
I became more receptive to learning about the mechanism of the heart just in time for my introduction to the next physician invited into my life. I brought three extra sets of ears with me (mother, stepfather, husband), a highly recommended strategy, and became the recipient of more information than I bargained for! The results of the echocardiogram, basically a revealing sonogram of the workings of the heart, demonstrated exactly what I feared. My ejection fraction had not changed, the ventricular wall motion was almost non-existent and the area of permanent damage covered 30% of the front of the heart. I suppose I would be a better role model if I said "my" heart, but the reality is that I was still not able to fully personalize news like this. No good news, no apparent improvement, but it had, after all, only been three weeks since the last episode, although I would have sworn in court that at least twice that had passed! I learned that it would take six weeks before the first real hints of potential recovery of the heart itself begin to reveal themselves. Patience is one of the tests of inner strength during this trying time. Generally, keeping busy would be the logical way to help time seem to pass more quickly, but when you are essentially exhausted, have difficulty concentrating and are frequently living in a state of fear and fatigue, time can practically stand still. The distractions of your most loquacious fan club members work best!

Women and Heart Disease" The Heart of a Woman

2009-10-17T08:48:00.000-07:00

Chapter 6 of the saga is long, but if I have anyone's attention, hopefully you won't mind. In re-reading it, and somewhat re-living it, my hope is that someone out there will note something that hits close to home. I so long for my words, thoughts, feelings and experiences to be of use to women, families, friends, so please read on...

The Next Shock: Fear, Weakness And The Beginning Of Hope

Once again, I had no way of knowing what was in store for us all.
On only the second of those two slow motion days following the much-awaited and applauded release from the hospital, I awoke at five in the morning, unable to go back to sleep and feeling just plain peculiar. Within a few minutes, I began to feel cold, sweaty and weaker by far than I had been. Imitating the hospital protocol, I took a sleeping pill, an avoidance mechanism but a necessary evil given the situation. Perhaps sleep would provide the solace we all seek when we cannot seem to get a handle on our emotions.
No more than five minutes later, a pain began, this time in my back, at about the level of my shoulder blade, different from and substantially more severe than the second attack. I had heard that the pain of an MI could occur in the back only, but it was still surprising, to put it mildly; it was only my immediate history and experience that could have signaled that this was not muscle strain or merely the result of sleeping in a bad position. Again, lack of information particularly for women could have caused a delay in seeking medical attention. For me, denial was impossible; I knew that this would be a command performance. I did what most women probably would have done: awakened my husband and dressed in loose, comfortable clothing, anticipating being driven to the hospital. Next, I visited the bathroom to run a brush through my hair, perhaps adding lipstick so that I would not appear too pale. When I looked in the mirror, my eyes bulged and I gasped at my appearance: I was actually whiter than a sheet, an expression I had never before taken literally and a shocking state. My reflection was barely recognizable. The feelings elicited from what may not sound calamitous to anyone who cannot empathize were beyond dramatic and were frightfully disturbing.
I managed to wake my mother to mobilize her, and her first, half-awake response was to ask me what time it was. The digital clock read 5:17; it would be years before she stopped awakening at that very time every morning. Like insomniacs who are advised not to glance at the clock when they awaken during the night, I wished I had not implanted that seed.
In the midst of this harrowing occurrence, my incredibly organized mother actually spotted my discharge papers and had the wherewithal to bring them along. Cognizant that we would not be driving anywhere, and having begun to learn that not being in control had its advantages, I simply dropped onto the bed and we called EMS (the amazing Emergency Medical Service). My husband was too upset to give the operator our address with any clarity, so I had to summon the energy to take over this seemingly simple task. The pain was beyond the usual scale of one to ten, so when more than seven minutes went by, we called again and were told that the ambulance's engine had failed. They were giving the call to an ALS team - the Advanced Life Support service we should have asked for in the first place. We were all understandably distraught, but this time they arrived quickly and they were wonderful. I had had only one ambulance adventure prior to this, following an automobile accident in which I suffered rather minor injuries, but major anxiety. I was fine until I was placed into the rear of the car and asked my name and then my date of birth. I gave my name and then drew a complete blank on my birthday. It is unpredictable what panic causes, so this time I was determined to remain calm, even in the face of escalating pain and, once again, great concern for Mom and husband. The two professionals worked on me quickly but calmly, attaching me to an ECG unit, deftly starting an IV line, giving me aspirin, asking pertinent questions. I was not 100% there, partly because I had intentionally detached myself and partly due to my condition. The subject of lack of control kept re-surfacing. Of all things, my most vivid memory consists of being wheeled down the hallway of my apartment building, leaning back in a wheelchair with my head resting on the soft, reliable, warm ample belly of one of the paramedics! The comfort I felt from that moment will always stay with me. I kept my eyes closed for most of the time I was being loaded into the ambulance, vaguely aware of voices around me. I had a degree of confidence in my rescuers that allowed me to maintain myself all the way to the hospital. It was a revelation once again that I could actually benefit by not being in control, still a new experience for me that was beginning to take root with less resistance and more aptitude.
A note of uncanny irony: about six months after the ambulance ride, I found myself obsessed with the sights and sounds of emergency vehicles. I could not shake it, so I just let it flow for about a week or so. Having worked with clients who were prone to anxiety attacks, I knew the importance of allowing the experience to wash over me. I stopped fighting it and hoped that it would somehow turn out not to be a stumbling block but rather a precursor to the next level of my emotional recovery. The next week, my mother and daughter and I had scheduled lunch together and as we were leaving the restaurant, two uniformed paramedics arrived to pick up their outgoing order. It was my mother who recognized them; it took me a while, having remembered only two salient points of information: that one was tall and thin and the other much shorter with that sweet belly, and the other the sound of their voices, confident, firm, dear, encouraging. She was right and they remembered that early morning call and were pleased to see me looking healthy, particularly in comparison to our first meeting. I never again had the dramatic emergency vehicle reaction. I had learned another lesson: it is potentially more effective to stand back from ourselves, looking in from the outside, remaining open and observing the messages that come in so many differing forms. Perhaps it was all in the realm of "meant to be"; perhaps I needed to see them again to thank them and reach the kind of closure for which particularly women search.
My husband followed behind the ambulance, our car practically inside theirs, while I was monitored by the paramedic. I felt like I was drifting, searching ambivalently for lucidity, but preferring to give myself over to his expertise. In the face of utter helplessness and lack of options, I was putting into practice the life lesson that was in its infancy. I only vaguely recall the shift from car to ER cubicle and the pain was intractable. The first three doses of morphine did not touch it. I knew that terror could worsen the situation, so I began concentrating on the Lamaze style breathing I learned as preparation for childbirth decades prior. I used whatever mental energy I could summon to help my body control the pain. I had no idea that my mother was right there next to me in the ambulance, listening attentively to the EMT's (Emergency Medical Technician’s) report to the hospital, block by block. I was determined to relax physically and draw from the modicum of strength I could muster to take myself away from any negativity that could hamper my chances of survival. I could not take responsibility for any more than that - it was both the most and the least that I could do. Modern medicine would have to provide the rest.
If my recollections are correct, I believe that the second trip to the cath lab (short for catheterization laboratory, where the angiography team works) came quickly. This time, my daughter did not have to witness the emergency: she had gone to Florida with a close friend for a much-needed vacation, at my insistence, despite her trepidation, but it was to be interrupted that very day, stirring with familiarity the unnecessary but not unexpected feelings of guilt and helplessness.
Now I was in for the same procedure, balloon angioplasty but with two more stents added, same essential vessel, same problem. What had happened that caused this even more damaging crisis? Apparently, though not yet medically proven, the vessel had been nicked and the original stent not placed far enough into the area of blockage to hold it open. True to their job description, platelets had surrounded the area of the wound and clotted over the entry point, re-occluding the narrowed artery, not unheard of, but not common either, after performing this sophisticated yet imperfect medical maneuver.
While we waited for the room and crew to be readied, I found myself drifting again, hearing the concerned voices around me, and, for the first time, wondering if I could endure this. I found myself thinking that it might be too difficult, that it would be easier to just let go, that the degree of pain was a sign that I might not recover this time. Warm tears flowed down my pale cheeks; an indescribable level of fatigue enveloped me. It was analogous to a meditative state, but with the added feature of deep despair. I was in such pain and had a sense that I could not be saved from the sinking ship that was my unreliable body. No lifeboats, no ability to talk myself through, no energy to fight back. Then an odd sense of calm and peace began to take root: might it be a viable alternative to just keep my eyes closed and stop working so hard? I had read that people who are dying - or choose to die - experience an astounding level of relief from pain, feelings, thoughts. Was I going to succumb this time? Did I have a say in my own destiny? This whole episode probably spanned only a minute at most when suddenly thoughts of my daughter filled my mind. Where was my will, my strength? How could I just give in, give up? How selfish was I that I could allow myself to even think this way? I had to fight, kick myself out of submission and evoke the family tradition: it was time for operation bootstraps! I recall making a conscious decision to beat the odds, whatever they were. I was not going to opt out, not in this age of cardiac miracles, not with everyone who needed me and whom I loved standing by. This was a turning point that buoyed me in spite of what was happening to and around me. I think that it was both humbling and completely lacking in humility, a kind of ambivalent thinking that helped rational thought win over the possibility of disaster.
I was in and out of the lab fairly quickly this time, but in miserable shape physically and emotionally. There was one mishap: after an angiogram, when the method the interventional cardiology team does not use a "plug" to stop the bleeding from the groin, it is necessary for the patient to remain prone for six to eight hours to avoid the possibility of hemorrhage from the insertion site of the catheter. I was reminded not to try to change from that position by the nurses and watched closely to insure that I cooperated. I had no interest in moving at all, so my compliance was a given. However, my assigned cardiologist approached the stretcher soon after the procedure, accompanied by a resident. Anyone who has been in a teaching hospital will know that these visits are common, expected and important to the training of the house staff. Unfortunately, my doctor then sat me up (I was not a willing or able participant), and began listening to my “unusual” heart sounds, instructing the resident to do the same. I recall his quizzing the resident, checking to see if he had heard "all three sounds". Apparently this was medically instructive, but within a few moments of his walking away, I suddenly felt wet. I alerted the nurses, who found me bleeding profusely from my groin and began the arduous process of stopping the flow. The second procedure had been performed using the right side of my groin, since the left had been "plugged" the week before. They do not dare to plug the second side just in case they need access if anything goes wrong, so there was nothing in place but gauze and a sandbag weight to stop the hemorrhage. It took about thirty minutes or so of direct pressure to stop the bleeding and was not only horrifying, but also painful. The nurses were appalled. The fallout included blood loss that nearly necessitated a transfusion; weakness; and rapid heartbeat (tachycardia), yet another risk to my vulnerable heart. I was totally aware of what had happened, as was one particular nurse who had exclaimed: "He sat her up!" This was in the category of “egregious medical error”, that moment in time when a rewind button would be such a convenience! Too exhausted from the ordeal to express my anger and dismay, I suffered through the immediate aftermath quietly, but made a bold, italicized mental note for future reference. Of course, it is not always possible to have a guard/rescuer standing by, but had that person been in place, I would not have had to suffer so unnecessarily.
Meanwhile, back in the CCU, foggy, despairing, humorless, both dreading and anxious for my daughter's return from Florida, my mind was whirling: what would happen next? What condition would she have to see me in when she arrived? I felt panicky, pathetic, self-pitying and shaken, with an even higher level of fear than that of the initial week. No amount of support, no words of hope could take hold. I did not dare to think that this time all would be well; having three stents somehow provided even less reassurance. Logically, if one failed, maybe this was not the way to go. With no long term research to rely on, I could not be convinced that I was in the clear. In all of these reactions there is a common thread: nagging worry shares the stage with concern for loved ones, but we cannot expect to rescue ourselves let alone anyone else from the choke hold of such epic “events”.
Astonished by the level of weakness to which my body had been reduced, and in the face of ever-growing disturbance about the care I was receiving, I was inconsolable. I was unable to summon my humor, with complex, diverse, unwelcome emotions just at the surface. What timing: my wonderful daughter had just arrived and was trying valiantly to be at once positive, professional, caring, pro-active, loving and comforting. We were both immersed in a massive cover up of our natural feeling of agonizing fear. It was a self-centered time for me and I was simply too exhausted to lift anyone else's spirits. Everyone shared my desperation; as would be expected, optimism was a commodity in great demand but small supply.
Could we dare to relax, risking the thought that all would be well in the hallowed halls of modern medicine? I was aware of a growing anger based on helplessness and fear of the unknown, both justified and provocative. The enormous strength of these feelings was completely overwhelming. Placation was hardly useful, but the only tool that seemed available. During the day, I usually had someone special with me, but the nights were intensely difficult. When I should have been sleeping, all I could do was ruminate about what had happened to me and what might recur. Locked in denial, darkness and solitude taunted me, threatening to interrupt my clumsy attempts to keep the curtain down on my intrusive thoughts of catastrophe. Just when I needed to soothe myself and could not, a male nurse appeared. He had the willingness and kindness to talk to me, reassure me, lure me into a calmer state, but I still had to rely on rather large doses of medication to induce even brief sleep. It is crucial to ask for help during these moments and I had waited too long. His presence did help to break the profound sadness permeating my unchosen world; it was pervading my thoughts in the silent room. I was losing myself in the uncertainty of my own future. I suppose we all have a right to feel sorry for ourselves, but for me the greatest suffering continued to emanate from the pain all of this was inflicting on my family and close friends. It amazes me that my best friend "Logic" and I seemed to have parted ways. There was little my intellect could provide. Actually, when I did try to think my way through the most awkward moments, I found I was convincing myself that I was indeed dealing with the unknown and that even in the best and most knowledgeable hands, I was on medically dangerous turf. This mental process was hardly my grandest achievement, slanted as it was in a negative direction. When reality hits, intellect ducks out of the way and the irrationality of emotion steps in. It would not remove itself from my midst, its honesty and insistence overpowering me. Operation bootstraps? I lacked even a thin thread, insufficient to rouse me into rationality. Even that one sweet nurse was more of a distraction than a confidence booster. The fact was that no one could possibly know what would happen during those CCU days and no one could look into the future and make any promises. A working crystal ball was on my wish list; "time will tell" was unacceptable; patience was worn already and I was only a matter of days into the journey.
Each little step after the first two days following catheterization number two was supposedly monumental. I could move to a chair unassisted, brush my teeth, but most of the simplest activities were unfathomably tiring, reminders of my "condition". I was unable to wash my own hair and showering was impossible, since removing the monitor was forbidden. I could hear my closest friends’ homilies: "Don't become the disease", "One moment at a time", "Don't set up scenarios - go with it and be positive". There was nothing wrong with anything that was said, but simple truths uttered into a deaf person's ears just do not penetrate. What was happening to this positive thinking individual who doled out advice in the worst of situations to such a vast array of people? Why was I not able to begin to "heal myself"? How could I allow this helplessness to continue and have no command over it? How could I accept it, even temporarily?
I believe that my questions echo those of so many heart patients. I was taught to fight the battles of my life, not fold up under pressure. I could not afford to lose this one. I always had my network of supporters, good listeners, kind, loving, caring, patient, but this new deal was going to be for forever? I rejected that concept out of hand.
One couple with whom I had been close but circumstantially had not seen in months came to visit. She rubbed my feet - Debbie was a dancer who for some reason thought they were terrific, although I was no dancer, unless you happened to have seen me at six in "Glow Little Glow Worm"! She was looking at me warmly, but with that same fear in her eyes that I now recognized in everyone around me. No one can save us when all thoughts are based on prevailing, ominous threats. By the time they left, I was too exhausted to hold my head up but too stubborn to allow sleep to intervene. Maybe if I stayed awake, I could reacquaint myself with my more natural, familiar ways of thinking. It did help to have certain people with me and it was therefore hard to let them go, yet almost harder to see the pain in their faces. Visitors are so important, especially when carefully selected, as is your right and responsibility. Saying "no" can be difficult but is essential. Surrounding yourself with positive, caring, pleasant people adds to your ability to filter your most frightening feelings and shore up your temporarily limited energy.
At some point in time, an adorable, kind young woman who worked in my friend's salon came to manicure my nails. What a treat! These are the moments when life's little treasures peek out of the corner of your mind that you barely know exists, and make you grin. Dawn was pleasant, conversational, professional and she brought me lovely flowers! I learned later that she despised hospitals and was terrified at the thought of coming to an intensive care unit. She never let on and I will be forever appreciative of her.
Every day gave way to those long, terrible nights and every morning tried my faltering patience. The inner pressure to drag myself out of bed made me feel torn: was I trying too hard, possibly causing a setback? What was too much and what would be just right? There are no answers, so why in the world would you expect yourself to know them? There is no course you can master, no wise tutor to guide you. You will probably find yourself trying to muster the strength to act-as-if, as I wanted to for my daughter's benefit. Interestingly, I had not sung the ever-popular "why me" tune, maybe because I had not yet accepted that I was really there. This may seem peculiar if you have not had similar experiences, but there was a fine line on the map leading to truth that I just would not cross. Yes, that was me in the CCU, but I could hear the moans of other patients and knew that someone had actually died the day before and that could never have anything to do with me. It reminded me of the out-of-body experiences I had read about. You see, I was not in the right place; I was too healthy and did not belong. I clung to that notion throughout the five-day stint, pleading to be transferred to telemetry, or, better yet, sent back home. My family members discussed my transfer, too, but to another hospital, not to the comfort of home. On the one hand, I was frightened of what had apparently happened to me - again - and on the other I refused to comprehend that I was the subject of such ludicrous discussion! Never had I been so blind and it was not self-protection or even ignorance. I have come to believe that these reactions are quite universal. In the face of the omnipresent weakness, the only thing that belied my denial was the constant beeping of the monitors, the IV lines and the medication I was being fed. All this for me? Then I would spend a moment watching the monitor and would see concretely that it really was my heart rate that was high and my pressure irregular. My husband's gaze was fixed on the numbers. My mother was no longer benumbed, but was sometimes protective to the point of trying to keep others away, urging me to sleep. (Over time, one by one, they made me privy to the unpleasant details I had carefully avoided.)
I cannot tell you that I was ever irritated by what I would previously have termed such an obvious lack of inclusion, since I wasn’t really there... I was not doing much of a job of processing even the spotty information at my disposal. Without such irreplaceable advocates in our midst, I suspect that the outcome of our illnesses would be statistically different.
My daughter was in continuous pursuit of better medical care, the phone at the nurses' station her lifeline. It was not unusual for someone to come to her announcing that Doctor So-and-So was returning Kim's call. She was exactly what we all need: pro-active, authoritative, knowledgeable, feisty and sweet, and remarkably helpful. Plagued by the fear of losing me, she propelled herself to be at her best, but she was not made of stone. She allowed her feelings of sadness, concern and fear to rise to the surface when she was alone with my husband, who did try to soothe her, and particularly with one of my closest friends, who was strong for her and encouraged her to express herself freely, no holds barred. My own attempts at reassurance probably felt empty to her. I still knew too little and she was acquiring greater knowledge by the hour.
I suppose I should have felt secure, between the state-of-the-art equipment and my retinue of supporters, but I felt awful physically, weakened and useless and was trying to will myself not to slip into the depths of depression prowling the corridors of my shadowy mind. Depression can cause heart attacks and is also common in the aftermath. The general medical thinking is that recognizing the onset beforehand can be preventative and that treatment, if indicated afterward, should be taken seriously. Medication and/or group, family or individual psychotherapy should be considered, preferably before the depression gains a foothold. My knowledge would not provide immunity, especially months later. I, too, would eventually have to acknowledge my own need. I would also have to dispense at least temporarily with control, replacing it with hope, trust, respect and belief in the people around me. What a phenomenal opportunity for growth…
At this point, the decision to transfer me to telemetry implied imminent release from the hospital, sustaining me and allowing me the freedom to interact with staff and even fellow patients, entrée into a more "normal" world. I still could barely traverse the hallway, but with encouragement and pacing, my endurance increased, if nominally. My impatience grew almost absurdly, but provided good motivation and sheltered me from the depression that I sensed threatened to overtake me. My husband remained a regular visitor but rarely stayed for long periods. My mother was in the room literally from morning to night, which I hope was even more helpful to her than for me, not easily assessed even now. Seldom is anything all one way, totally consistent or without a down side. While the presence of a trusted ally adds security, it can be overwhelming to never be alone. I distinctly remember wishing that I could awaken alone, without fear, even while fully aware that her presence was essential and exceedingly advantageous.
On the morning of my release two days later, a resident was given the chore of discharging me, having prepared a long list of instructions, including my medication schedule. It's ironic that I was comfortable being administered myriad pills four times a day with no responsibility for remembering which was which or when I took each one, another feature of my recently acquired gift of voluntarily, consciously relinquishing control. Now I was eerily disquieted by the thought of having to know what to do on my own. I guess I could not fail to notice how fuzzy I was, so I outlined what I thought would serve as a simplified dosing schedule and asked the resident to refine it and write it up for me. He seemed annoyed by the task, but I was insistent that it was a necessity, particularly in light of my resistance, qualms and fear of becoming confused and therefore risking unintentional non-compliance. He got it. This was another of those times when self-advocacy was so useful.
I had reached the last lap: they had called for a wheelchair to bring me down the long corridor, into the elevator and to our car. I still had the plastic needle in my hand from the IV, although I had repeatedly asked the nurse to remove it, but now she was on a break. Her fill-in finally arrived while I was completing my packing - it's amazing how much junk accumulates - and within no time I was bandaided and ready – or so I thought. So where was the wheelchair? After nearly twenty more minutes, a nurse offered to walk me downstairs! I felt absolutely courageous, but by the time I reached my waiting husband, I was near tears from the ensuing fatigue. I felt like a failure, unable to make my way to the finish line without needing to drop into the car as if I had just attempted a mini-marathon. You may wonder why I would use a word like "failure" in light of my "success", defined as survival and ultimate liberation from the hospital. It is unimaginably simple to "fail" to recognize your own tortoise-like progress. It is based equally on lack of experience, of ignorance, not to know what expectations are realistic and which are not, so you whine that you are so tired and then feel disappointed in yourself for forgetting that you are alive! The concept of failure is destructive, sapping energy needed to climb the long hill to the summit of recovery. It is reasonable to feel lost, uncertain, concerned, impatient; yet it is counterproductive to decide you have failed when you have barely had enough time to absorb that survival is in large part your personal success.
About four minutes into the eight minute trip home, I realized that my hand hurt. I lifted the bandaid, and there was the little plastic catheter, still in the vein! I told my husband not to be alarmed, it was not heart-related, but I did need him to pull over. I retrieved a tissue from the glove compartment, quickly pulled the catheter out of my hand and initiated direct pressure to stop the rather profuse bleeding. Blood thinners work, that’s for sure, but so does basic first aid. I was actually accustomed to these snafus by now (situation normal, all fouled up - it's a military term!), so I was almost matter-of-fact about it. I did call the floor and speak to the supervisor, who supposedly was committed to reprimanding the overworked, forgetful nurse.
When we reached home, I was thrilled that no one was around to witness my return. I was weak-kneed, inexpressibly tired and could not wait to get into bed! Was acceptance just around the corner? Of course not…

The Heart of a Woman

2009-10-03T20:16:00.000-07:00

The days pass by at an astonishing rate, but I'm back with Chapter 5 and appreciative of my readers' interest!

An Unbearably Brief Homecoming: The Emotional Strain

After nearly a full week, which felt like an eternity and was about two days longer than the average stay even for an open heart surgery patient, I was released from captivity. I still had some fluid in my lungs, was not responsive enough to the anti-coagulants most patients receive, and was barely able to walk the length of the corridor, so my eligibility for discharge was questionable.
My mother arranged to stay with me at home, partly because I needed her help and partly to assuage her own fears. If you think you are "lucky" enough to be surrounded by people who truly love you, note Deepak Choprah's definition of "luck": "Opportunity meeting preparation". We generally have no way of knowing when we may need the help I received, but the relationships I had formed, particularly with my family, were opportune preparations.
My own fears were fermenting exponentially, defenses colliding with harsh realities. With my husband back at work most of the time and just "passing by" during the course of the day, Mom's assistance was invaluable, but I was beginning to long for independence, privacy, freedom. It would feel like eons until I could take on these featured roles, and I was already impatient for signs of recovery, while uncannily exhausted and weak. Even the walk from the bedroom to the kitchen was a trek. I assumed that I would improve steadily, but had been duly warned that it would be a protracted process, a long haul.
Another uncanny, yet typical response was that I did not want to be in tune with my body, but did not dare to ignore it - not again. Every time I felt a twinge, not only in my chest but in my arms, hands, back, the inevitable fear returned. Not again, please, not again. The anxiety I felt was typical and recognizable, but somehow we tend to think that we are unique in our reactions. I had always felt the need to be in control in most situations, never knowing that I could potentially not have that control over my very existence. After a lifetime of believing that I could count on control to pave the way to normalcy, learning to give it over was unnatural for me. I would soon discover that rescinding control would become a positive attribute in this unfolding series of experiences, one that will bear further discussion as we move along together.
Eating was a surprising challenge, a necessity, but not pleasurable, since digestion was problematic and often brought what felt like chest pain. The passage of time has provided me with an inner audio taped message: "Yep, there it is again; it's sharp, but will pass, recognize it but don't fear it". It is a simple, useful device that I recommend, since it wards off any sustained, negative thought.
Regardless of how weak I was, I, like so many people, wanted to reduce the level of difficulty I was causing my entourage. For instance, in my quest to protect my mother from every tingle or ache, notwithstanding the precious energy it involved, I often repressed the urge to groan, grimace or remark. Even the minimal exertion of speaking brought difficulty breathing, but I did not want her to know just how hard a time I was having.
Then there was my limited attention span for even the most banal television programs, which left me with no distracting activities. I had no ability to concentrate enough to read even a brief news article and I sensed that I could reach my wit's end quite prematurely. The level of exhaustion was staggering, yet I did not want to sleep. I wanted to be out of bed, to do the unpacking my husband and mother had begun, to reclaim my apartment having been away for a week.
I moved around the room slowly, an apparition compared to my usual speediness. I assumed that if I behaved "as if" normalcy was nearby, it would resurface. I could not help but notice that I barely had the patience to pet our two cats, who of course wanted to sit on my vulnerable chest. I felt unrecognizable to myself and unable to imagine waiting out the recuperative period. Brain fuzzy and body uncooperative, I struggled to sift through the miscellany in the suitcases, opting to put away clothes rather than cosmetics and the usual array of overseas needs - travel iron, converter, that electric element for boiling water (all necessities for Eastern Europe). The task was daunting, borderline ridiculous, involving a climb up to remote closet shelves, with Mom in the background issuing warnings but fully understanding my need to forge ahead.
If this was the post-"MI" (myocardial infarction, synonymous with heart attack) norm, it had better be short-lived. I felt like curling up in a ball and sleeping through this phase, again anathema to my personality. This thing was not going to claim me, I was not going to don a lapel reading "Poor me, I've had a problem". I had an urge to get into the car and go shopping, do errands, return to life before the "incidents". Totally unrealistic, positive yet absurd, premature but comprehensible, I would have to wait it out. If you find yourself nodding your head, you must find familiarity in these sentiments. We all seem to follow a similar course toward recovery, including our amazement at just how difficult it is to tolerate taking mere baby steps.
Just remembering which medications to take when was tough. It was as though my memory, even my intelligence had been affected. Indeed, this was true. Fatigue alone can reduce verbal folks to the level of feeling like blithering idiots! Finding words becomes a weird treasure hunt. Concentration dips to such a low level that conversation is minimized. Communication was my raison d'etre, so when I could not complete a sentence without taking a previously unnecessary breath, I was, so to speak, deflated. My emotions were frayed and I was on the verge of becoming depressed. I was astonished that all of this was happening and did not cope well with having no reserve of energy. I was not interested in learning about ejection fractions, scar tissue, poor wall motion - the medical jargonese left me cold, serving only to heighten my concern. Attempts to comfort me were basically useless and as I lay in bed, which is where I spent the vast majority of my time, I used what little energy I had trying to convince myself that improvement would arrive.
Bear in mind that all of this occurred during a one and a half day period! I had developed an intense distaste for the process in a total of nine days! I had so much to learn...

Women and Heart Disease: The Heart of a Woman

2009-09-24T12:22:00.000-07:00

More of the saga... I guess you know that they post from most to least current, so read backwards, please!

All of these central figures in my life were essential. If you happen not to have the good fortune to have available to you a similar support network, seek out a willing nurse, colleague or friend to advocate for you and to help you feel safe. The difference it will make in your recovery is enormous, even if you have some misgivings, discomfort or shyness about it. Through the support you will receive, you will notice a decrease in fear and anxiety and an increase in relaxation and, most imperatively, hope.
When I was finally wheeled into the procedure room, nearly twelve interminable hours later, anxiety had turned to sheer terror. All the denial, all the thoughts of not belonging in the hospital had disappeared. Taking their place were immense worry, mixed with hope, tinged with only a modicum of belief in the power to meet this challenge and emerge victorious - even with my assemblage of comrades just outside the door.
The room was so large, foreboding, cold and the narrow operating table so hard and uncomfortable. The lab team was involved in casual conversation while bustling around the room, preparing trays of instruments, which I found inappropriate, implying aloofness. They seemed to have no idea that I was shivering with cold, uncomfortable, totally terrified and not particularly confident; they were busy chatting. I realized that for them this was routine, just another "angio". It amazed me that they were completely uninvolved with me, as though I was neither awake nor aware. I announced my state of being quite clearly and I guess they took my anxiety seriously, because my husband was allowed to come in to help me exercise calm and encourage trust, but to little avail. None of these feelings were unusual, just new to me.
What I did not know was that when my husband left the lab, he rejoined my daughter, mother and stepfather in an adjacent room where they watched an "instant replay" of my angiogram on a screen. They then had the ominous task of participating in making a decision about what course to take. Next, the interventionalist appeared with an announcement: "We have a problem". Since the blockage in the LAD was 100%, there was some question as to whether or not I could be helped by balloon angioplasty. He was not certain that he could open the artery and not confident that he could then properly place the little metal stent, a metal-like "gate" meant to keep the newly-unclogged vessel patent, or open. There was a distinct possibility that I ultimately would have to be taken on an emergency basis directly to the operating room for open heart surgery. I don't know that I could have rallied if called upon to assist in making such a monumental decision, but I was surely not available for consultation so he had to have the family reach consensus.
It was my daughter who was in the unenviable position of calling literally around the country to every doctor she respected, asking them to seek the opinions of their trusted colleagues in cardiology. This complete stranger who held my life in his hands agreed to attempt angioplasty coupled with stent placement, although he had expressed qualms about its likelihood of success. Stents are still relatively new in the field, having been introduced in 1995. No long-term studies were yet available, but this technical wizard's willingness to attempt the procedure could save me from bypass surgery, a rather unappealing alternative. There were no promises, but the decision had been made. I could have awakened in the “cabbage patch”, my affectionate (?) nickname for the unit bypass patients are taken to after coronary artery bypass grafts (CABG).
He succeeded, or so it seemed, and when I emerged from the lab, I remember receiving diligent care from the staff of after-care nurses. I was not particularly coherent, which frankly was my preference, and everyone was teasing me unmercifully when, after the procedure was complete, I was still asking for more medication, in a voice already slurred by narcotics! Once again, but totally out of character, I wanted not to be present; I who had spent my life trying to crawl ever-closer to the television set to witness any medically or surgically-related show, opted out of my own case. I have since spoken to many people who actually watched the monitor as first-hand witnesses to their own procedure. I needed to avoid that level of lucidity no matter how much medication it would take! Oddly, it was months before I was able to watch similar topics on television. Not only would I immediately change the channel, but my heart rate would climb and I would be on the verge of tears. My experience at the time felt so unique, but I know now that all of my thoughts and actions bore great similarity to those of us who have endured similar physical happenings.
When my family and friend were permitted to come around the curtain to see me, I remember most vividly their vociferous complaints. My somewhat relieved cheering squad had been basically sequestered in a room that was Antarctic, even compared to the post-op ante room in which I was shivering! Naturally, I would rather have been turning blue in the waiting room or boiling at the Equator than continuing to lie on the gurney, but I tried to express my condolences, quipping about my own "comfort" level, particularly to my frozen, exhausted, overwhelmed daughter. My humor intact, at least to the degree my consciousness allowed, I promised sweaters all around and was ready for the next phase. I would have gone anywhere to achieve an exit from the lab. I could not have known then one of the many things I now know: they were searching for a way out, too.
So, I was returned to the CCU, still not fully in command of my faculties, but presumably out of danger.
There followed about two days on the unit, involving a strange and unfamiliar level of incapacitation coupled with a feeling of being trapped, literally tethered to equipment, unable to venture even to the doorway. I had convinced myself that I did not feel sick enough to warrant intensive care, but admittedly and inescapably, I was not completely stable. The blood thinners were not working well enough and my heart rate was uneven. Since the weekend had arrived, my physician care was almost non-existent. If you have ever been in this disquieting situation, you know that there are many possible reactions, all of which are natural. The one that surfaces keeps hidden from view all the scenarios we elect not to expose. For example, in one of my more obnoxious moments, I instructed an uninformed on-call cardiologist to go back and read my chart before he re-entered my room! Although insulted and somehow seemingly anxious for my approval, he had no knowledge of my condition and no ability to answer any of the questions that were beginning to plague me. By this point, my daughter was furious and talking about the possibility of transferring me to another hospital. Patience was wearing thin, concerns were rising, tempers flaring, and I was not exactly making friends with the frustrated staff. My complaints were neither baseless nor sugar-coated, but they belied my desire to gain some degree of mastery or at least minimal control over what I was just barely beginning to comprhend was my condition.
I am actually not sure at what point my brother and sister (in-law, in life) were notified, but I do remember feeling so happy to see them and so beautifully close. There was a blur of visitors during those first several days, but most outstanding in my memory was my sweet, frightened brother, for whom this would engender, not surprisingly, a wake-up call. He would lose a little weight, exercise more diligently, adjust his lifestyle to protect himself. This actually did not come easily, since he at first announced that he was not the recipient of our father's genetic flaws. I remember telling him that as far as I knew there was no sperm and egg discussion regarding transfer of specific genes. He seemed to have inherited many positive features from our mother's side, but was not magically immune to the rest. His wife, my wonderful friend/ sister, was totally supportive and avidly in favor of his wise decision to change some of his potentially dangerous habits. They were both endearing, tearful, genuinely loving and concerned and we were to become closer to one another than ever. My mother felt a tinge of guilt from the first visit, but was easily forgiven!
Once I returned to telemetry, I had more freedom and there were visits, cards, flowers, gifts and phone calls from people who were important to me and some from those who were more peripheral. The common thread was that each person had concluded that they had better take this seriously in their own lives. What had happened to me seemed so unlikely that the general thinking was "if it could happen to Sue"… There was some solace in hoping that I could help transmit such an important, potentially life-saving message to as large a circle of people as possible.
Once back on the floor and able to begin to wash myself and even venture out into the hallway, I began to feel more human, even daring! It's funny how definitions twist: I dared to pull the IV pole without assistance and walked a few steps beyond the permitted parameters! Now that was me: a rule-breaker, downright mischievous!
I had survived and now would concentrate all my efforts on getting stronger. No one knew how dauntingly slow the process seemed to me already. Assembling the patience for a long journey was not my natural bent and wreaked havoc on my do-it-now personality. I also knew that I would have to summon up the courage to educate myself on a topic I did not want to utter in any sentence containing or referring to my name.
That education was foist upon me unexpectedly when I was brought to the X-ray department by wheelchair for chest films ("small complication" of fluid in my lungs and potential pneumonia). I was left alone in a hallway, waiting for my turn, my complete chart on my lap. It was my only reading material! Never one to do nothing, I began the perusal. My review: heavy, melodramatic, polysyllabic and unbearable. But there it was: “worsening of pulmonary vascular redistribution”; “diagnosis: CAD” (Coronary Artery Disease); “left ventricular wall function severely impaired”; “ejection fraction 30%” (60-80% is the norm, and is a determinant of the heart's ability to pump out blood returned to it by the venous system); “30% scarring” (necrotic, or dead, heart muscle). On and on I read, plunging myself into an abyss, really wondering if there was enough of a medical armament to pull me through.
On one particular hallway hike, I encountered the aforementioned insensitive clod who viewed me through his gender-myopic, emotionally lacking lens. I might not have bothered to pursue the closure I desired, but when he spotted me he eyed me with contempt, mighty far from the repentance I thought appropriate, so I made my move. It was calculated to be therapeutic, my natural style, but clear and no-nonsense in delivery. I ended up lambasting the poor creature because he had the gall to come back at me when I began my contributory little sermon. Initially, I let him know that I felt his manner left me feeling upset and peeved and was not constructive. I added that his training needed to include compassion, not condescension and that I did not think he was intentionally negative. When he came back at me with a fierceness belying his immaturity, I told him that he had been medically incorrect, as he well knew by then, but that his approach to me as a human being was even more reckless than his poor medical assessment. He remained belligerent, unwilling and/or unable to listen, so I suggested that his chief resident should be told the details of both this and our first encounter. He announced that he had an unblemished record and I should feel free to do whatever I wanted, never admitting even the slightest guilt. He continued to provoke me to the point of my allowing him to make my heart beat faster and my blood pressure soar, so I retreated to my room. By then, an audience of nurses and ancillary staff were sprouting antennae and making high signs. He was next victimized by my mother, who bounded toward him, intent on lambasting him further for the harm he caused her cub when he blurted "I saved her life!" Responding to his absurd level of arrogance, and never at a loss for words, she read him chapter and verse, standing too close to him to provide for the escape he would undoubtably like to have made. The crux of her message was that he may think he is wonderful, but she believed him to be an incompetent moron and an insensitive boob. She received the equivalent of a standing ovation, mimed applause included, from his co-workers who had been enduring his nonsense for months. It was a healthy release for her and a deserved bruising for him.
By day four, I was more interested in the activities of daily living (ADL, in the vernacular): brushing my teeth, using lipstick, eating, if minimally, but the level of fatigue was dismaying. I was definitely in a state of basic denial and was disturbingly ignorant about my disease. A life-long fascination with medicine, natural curiosity and the drive toward acquisition of knowledge were non-existent. I was asking almost no questions and absorbing little information. I had no interest in becoming a "heart patient" to the point that when the cardiology team would come to examine me and use terms like "coronary artery disease", I would feign looking around the room to see to whom they were referring. My baseline acceptance was about .1 on a scale of 1- 10. I never again dared to look at my chart, didn't ask what my blood pressure readings were, made funny comments as a defense, doing a great ostrich imitation, even without the sand.
I was not particularly trusting of the hospital or the doctors, none of whom were known to any of us or recommended by professionals we knew. I had acquired enough information to comprehend that I not been "repaired" through conventional bypass, so I dreaded the possibility that the stent would fail. I cried often, but was urged to quell these natural reactions so that I would not strain my heart. What a concept! How is that even possible? Talk about a "broken" heart; I was racked with fear, loaded with potentially dangerous medications that were not yet accomplishing their purpose and felt little control over my situation. My husband was trying to be present and positive but was obviously tired of the whole scene. Everyone was on overload from the ever-growing list of small disasters that had taken place - like the light bulb that broke overhead and landed on my bed, which was never properly attended to until my mother's intervention. Of course, these minor episodes provide our dismayed visitors with a safe venue for their feelings of fear and helplessness: it is a relief to react to a broken bulb rather than cope with a clogged artery!
My transfer back to telemetry just days before had been welcome, but I needed to go home, another expected reaction, familiar to all of us who have tolerated hospital stays.

Women and Heart Disease: The Heart of a Woman

2009-09-15T15:00:00.000-07:00

It has been about a week since my last blog: as is so often the case, the good news and the bad news are the same... I just spent a few days in the hospital and had the usual diagnostic tests -- stress test (pharmacologic - ugh!) and my tenth angiogram. Yikes! Although I have had odd and disquieting symptoms for two weeks, MY VESSELS LOOKED BETTER THAN EVER! I have actually improved over time (just passed the eleven-year mark), establishing some blood flow in the area where there was a 30% deficit. Amazing! And off to cardiac rehab again... another adventure?! I'll let you know. On to The Heart of a Woman, in mid-chapter 3 of the manuscript...

By later in the evening of my admission, everyone went home and I tried to rest. I really did not know what to do with myself, still rejecting the notion that I was precisely where I belonged. I just felt too well to be in a hospital. I had a history of sleeping poorly and occasionally had availed myself of mild pills when deemed essential. I requested one at about two in the morning, and finally lapsed into sleep. Sleep was a welcome relief from the conflicting thoughts that plague any patient embroiled in such unsettling, confusing and dismaying array of thoughts. I was fortunate to have had sufficient experience to know to ask for this artificial relief and would urge others to similarly avail themselves.

Who Ordered a Sequel?: The Importance of a Support System

In actuality, the pain that brought me to the ER was never documented as a heart attack because not enough time passed between the first test and the next shock: I awoke less than two hours later, despite the strength of the medication. I had developed incredibly severe pain in my chest and down my arm, much more the expected signs we are supposed to identify but most typical in men: unmistakably, indubitably, undeniably I was in the midst of a serious heart attack, despite whatever observation I was supposed to have been given. If ever there is a time that one wishes for reverie and instead is hit full in the face with harsh reality, this is that moment.
I was taken to the CCU - Coronary Care Unit - but it did not seem like much was being done for me during this drama. I was given morphine and I can't remember how long it was before the pain began to subside. I had called my house where both my husband and daughter were on the alert, and they arrived quickly. I remember being sponge-bathed early in the morning, but not understanding why, guessing that it was a relaxation tool or perhaps just bath-time on the unit, but I accepted it as a kind, soothing gesture. What I did not know was that my family was waiting for the cardiac catheterization lab to open so that I could be taken in for an angiogram, a video-displayed, radiographic visualization of my heart vessels. I remember lying on a gurney waiting to be taken into the lab. My family members were overwhelmingly sweet and supportive, but their faces reflected such strain and fear. Through the haze of sedation, I was unable to comprehend thoroughly what was happening, to them or to me. I only found out recently that the wait was far from brief, spanning nearly twelve hours.
It is astounding to note that this physical fuzziness is so common. Part of it is intentionally induced by the caregivers, but there is often an ever-present force commanding the patient to withdraw from his or her unwanted, starring role in this grade B, cinema verite, autobiographical film.
My bright, precious, mature, loving, frightened daughter, was about to be called upon to rally and make decisions about my treatment, all the while aware that I could die. Our uniquely close relationship was and is so important to both of us. The mutual love we have always had for each other, born of real affection coupled with her need for me and my intense, maternal feeling for her, was responsible for her incredibly agonizing fear. I found it unbearable to the point of tears, yet I was in too vulnerable a position to help her, perhaps for the first time in her life. This was our first role-reversal.
My mother was immersed in maintaining her stoic veneer, trying to carry herself through an experience that still remains indescribable. We are mutual lifelines, anchors for each other, best friends, and now she had to hold herself together in the face of this life-threatening scenario with me as cause, not resource person. She was gentle and loving, holding my hand, touching my face, but I could feel the apprehension right through her tender touch.
Of course her stoicism belied her real feelings and paved the way to a peculiar side effect: she became unable to take in the information offered by the team, her granddaughter, her son-in-law. This insightful, intelligent, curious woman had turned off to the point that she became "stupid" - her word. No amount of repetition broke through the wall of protection, not for several least days.
Other signs of her distress revealed themselves on several occasions. Families often argue their way through turmoil, with tragedy eliciting both the worst and the best in them. There were times when she was responsible for unwittingly alienating some important visitors, including my brother. Apparently she felt that he was lecturing me, out of his own fear, no doubt, but rather than checking with me, she tried to have him pull away. There is little the patient can do in these family situations without encountering the double-edged sword of hurting one person while protecting another. There was another incident two days later involving my friend's twelve-year-old son who was bouncing on my bed and playing with the controls. She decided that he was causing me damage, despite my telling her that I was happy for the distraction he provided. My friend and source of strength, clarity and wisdom, with whom the saga had actually begun three days previously, witnessed the episode, her role uncertain, her feelings deep. Days later my daughter told me that she was the recipient of this special friend's total support. It was neither the first nor the last time that she would be called upon to capably play this crucial role. Even though my husband tried to comfort my daughter, he was frightened, unaccustomed to hospital protocol, trying to keep his composure. What a complex cast of characters and such love, good intentions and emotional effort.

The Heart of a Woman

2009-09-07T15:15:00.000-07:00

This is the central portion of Chapter 3 and speaks for itself, if you have been reading all along. It speaks loudly, with a ring of truth and might help anyone who is in denial in the midst of a terrifying situation. Perhaps it should be entitled: "It's Not Just a Toe, You Know"! Read on... please...

I still did not believe that I had had a heart attack, so there practically seemed to be no point in my being admitted in the first place. No one would advocate this level of denial, but most people have met with it, particularly when dire predictions surface. In any case, within about two hours, my daughter arrived, trying not to look grim with concern in front of me, and I let my annoyance be more demonstrable than any threat at hand. But she had graduated from Mount Sinai Medical School in New York, and was in an arduous four-year residency program in obstetrics and gynecology and just plain knew too much! I would never be able to quell her fears or take away her anticipatory pain. To this day, despite reassurance from top medical people, she feels palpably worried that she could lose me. Tears flow as I write. I understand those fears, having experienced them with numerous scares involving my own mother, with whom I am extremely close. In an effort to fool her and pull her from shock, terror and dismay, I summoned what I thought looked like a real smile, designed to hide my own fear; I feigned an energy that did not exist. Of course I didn’t know that my pallor and quietude were giving away my little secret! I could not bear her natural reactions and so sought to save both of us by not expressing my real feelings. When a cherished family member is disturbed, it may be natural to extend comfort toward him/her, but this is one time that it is perfectly acceptable to put yourself first. The family's energy is operating at full speed in your direction and you need to allow yourself to derive all you can from them to enhance your own recovery. I call this self-ish-ness - the capacity and necessity of taking care of the self, separate from the kind of selfishness that intentionally avoids noticing the needs of others. This is your time and the more self-love you possess the more able you will be to absorb the loving thoughts and gestures of your family and friends. They will cherish the opportunity, for it will limit their feelings of helplessness and increase their ability to provide for your needs during your on-going struggle. My adult daughter's only concern was for me and she would rely on her friends and mine and our family in the interim. All of this was anathema to me in the moment, but inescapably true.
I have no idea how long it was before I was brought to a bed on the telemetry floor, where every patient wears a device that monitors the heart, transmitting information in the form of ECG waves onto a computer screen at the nurses' station. Time loses meaning as all effort is utilized to comprehend or at least begin to absorb your new situation. I was settled in, a new IV in place, under observation, surrounded by mother, daughter, husband and too many thoughts to fit into even the largest tome. This was serious business after all.
By nightfall - this had begun at 1:30 in the afternoon - I had at last accepted that I was not going anywhere. The trip to visit Romania, my husband's native land, had been cancelled. I felt terrible for him, although for the first time in my life I had mysteriously not been looking forward to leaving. He had habitually quipped to everyone we knew that I needed ten minutes to prepare for a vacation: five minutes to jump up and down and five more to pack! Not this time. I was unnaturally unenthusiastic. Even in the midst of our denial, we are more knowing at times like this than we give ourselves credit for, and yet I heard myself seriously suggesting that he try to re-book the trip, postponing it for a few days. I was the only one who thought that this was reality-based, others’ prognostications leaving me annoyed. I was already doing just fine, thank you, and gave no credence to the assumption that hospitalization was even necessary, let alone that it would be protracted. I had not yet become "a patient" and wanted to reach consensus on the likelihood of the test results confirming that I was not in any danger. We would remain packed and all would be well.
I could not have been more mistaken, but this reaction is predominant among sane folks who have not yet resigned themselves to reality, which I believe applies to most of us who are in the throes of such confounding situations.
Part of the standard regimen on telemetry involved having a nitroglycerin patch adhered to my upper chest, designed to reverse or control possible blood vessel constriction, but it induced a severe headache, the most commonly experienced side effect. I complained to an intern who proclaimed that it was "all in my head", that I was "just another hysterical woman" and should calm down because I probably had nothing wrong with me anyway. Well, I knew where the literal pain was, but objected vehemently to the vacuous, accusatory, condescending attitude he conveyed. I wanted to call his supervising physician - and his mother! - to express my consternation, but settled for Tylenol finally administered by a nurse. This was not to be my last encounter with the tall, young, misguided neophyte. Whether because it is easier not to deal with (in)human beings like him or just not a worthy exercise, the idea of summoning the nerve to contend with him, although at a later point, had merit.

Women and Heart Disease: The Heart of a Woman

2009-09-02T18:14:00.000-07:00

Here is more of the manuscript... it's strong, but hopefully useful, particularly for women, whose voices are still not loud enough!

Chapter III. The First "Event": Coping With The Initial Reality
My friend's initial response to my desperate call was "You're kidding!", reflecting both her fear and disbelief, but she knew by my voice that there was no question that I was in trouble. She left her job and reached me so quickly that I thought the phone was still attached to her hand when I somehow managed to open the door for her. We arrived in the triage area of a local hospital at breakneck speed. Initially, I was told by the nurse that I was probably fine ("Just indigestion, dear"), and the pain did finally abate. It was a surprisingly strong pain, so focused on the left side of my chest that I could describe it by simply placing three fingers on the very spot from which it emanated. There was no "elephant" and absolutely no other symptoms to report. Parenthetically, I have a family member who recently complained of pain in her right arm and shoulder, and, based on my experiences, sought help and was diagnosed with blockage in a small branch of her LAD. Lesson learned.
My speedy friend owned a hair salon and was literally in the middle of a haircut, so she left me in the presumably competent hands of the staff. I sat on a hard chair, in the midst of the usual variety of ER patients, crying quietly, feeling terribly alone, weak, scared and absolutely ignored. By the time I was actually seen by a physician, anger had taken the place of pain and fear, based in large part on the frustrating, seemingly interminable wait. If I did need care, and I had not yet admitted to that, I certainly was not getting it! Characteristic of emergency rooms and of the mindset that affects even female caregivers, no one seemed to feel that I was a true emergency. I longed for them to be correct, but it was their responsibility to notice that I existed! Never allow yourself to be overlooked and always have someone with you who can provide advocacy for you. My friend had to leave and I was initially too demoralized to assert myself. We are often taught, especially as women, to smile sweetly, wait our turn, consider others. We are labeled aggressive when we attempt to fend for ourselves and admonished for calling attention to our needs. In a medical setting, it is critical to bypass this prevalent attitude (pun intended) to make certain that we receive the best possible care.
Having some knowledge of cardiac enzyme tests, electrocardiograms (ECG's) and other tools of the trade, I announced that I wanted an ECG as a "rule out" device so that I could meet my husband as planned at the airport. My mother and stepfather were picking me up at home and I saw no need to alarm them. Whatever happened, it was over and I wanted out of there, yet another universal theme. No one wants to sit in an ER, particularly alone. Despite my adamant pleas, even in light of their limited attention, I was not going to escape admission.
I relented and gave permission for my husband and parents to be called, but decided to wait to alert my daughter, a physician only two months into her first job. By the time the first contingent arrived, I was a proverbial basket case, at once alone, frightened, filled with disbelief and frustration. I still was not entirely convinced that I belonged where I was. This is a poignant example of insistent denial, improperly paired with the fear that this might well be a major problem. For me, the worst part was knowing that my pain was being dealt to the people who loved me the most. I was told by them then and since that this notion is "ridiculous", but not to me. I was accustomed to being the caregiver, the strong, able one, certainly not the patient, let alone the one who was disrupting the lives of others. For anyone who has encountered these feelings, I can offer a note of consolation: listen to the significant people around you; they are more than likely telling you the truth. Your suffering is affecting them, but they are not holding you responsible. You are not at fault, not for the situation or for their responses. Allow them to dote on you, sit with you, encourage and nourish you, for it is deserved and essential. There will come a time when you will be available to comfort them, but the tables cannot to be turned just yet.
Every patient has valid complaints, often minor, sometimes quite important. Here is one of the most irritating of the many incidents that unfolded in the ER that afternoon: an EMT (emergency medical technician) trainee search for intravenous (IV) access in the most difficult vein in the arm. He finally managed to insert the line, but his inexperience caused my arm to ache, turn into a veritable rainbow about the circumference of a good-sized peach and definitely rendered me much angrier than before. We all have a true need for competent, sensitive care in a situation like this, and I instead felt like a mauled kitten. I did not, nor could I have expected to know that there is a vessel affectionately called the "intern" vein, a comparative breeze to enter! Stoicism is not a friend: if you want to avoid this unnecessary assault, speak up, insist that the IV team or a more experienced staff person be called in. There is no reason to increase your stress level - I urge you not to take on a "good-guy" role. This is not the time to engage in such niceties. Of course, in the scheme of things, this incident became unimportant, but it set the stage for creating a veritable handbook for coping with a string of similar nonsensical moments to come.

"The Heart of a Woman" Continues

2009-08-30T12:58:00.000-07:00

As promised, here is more of the saga ... Some of this is on Mt. Sinai's website for both the hospital and the American Heart Association. They work tirelessly to provide information on women and heart disease, hoping for a growing audience. Now that I have figuried out the blogspot system, I hope to make a contribution, too. Thanks for your responses...

The Elusive Symptoms: Knowledge is Power

The saga had probably begun at least two months before the more obvious signs to come.
I was with a friend at a shopping mall, and just didn't feel right. I felt pressure in my chest and a sense of discomfort best described as what many women call “a dark cloud hanging over me”, typically appearing during a battle with a significant other, a spouse in my case. We had insurmountable problems and I was coming to realize that the marriage could not possibly survive. To my friend, it seemed that I was describing the symptoms typical of anxiety or panic attacks, totally believable but totally out of character. The only “somatic”, or physical, reaction I ever connected to stress was that vice grip on the back of one's neck that turns into a whopping stress headache. I could only guess that I was not handling the combination of my practice, our business and the problems in our relationship well and that this was to be my newest reaction. But I had no pain down my arm, no sweating, no dizziness, just a peculiar and fleeting feeling in my upper chest. I had no idea that the warning signs, and, more importantly, the symptoms of an actual heart attack could be so varied, as we are at last learning they are especially in women. It can be a terrible, even life-threatening mistake to self-diagnose. Neither is it about blaming the victim for not knowing better. Physicians themselves have encountered similar experiences, even with their vast knowledge bases, and how often do we hear that someone left the doctor's office with a seemingly clean bill of health, only to die of a massive coronary practically on the office steps? We do not want to feel vulnerable, helpless, on the brink. According to the theory of Alfred Adler, we instinctively strive for "superiority", not over others, but for ourselves, in a kind of self-competition to improve. Predictability and trust in your own body are rattled through disease, so questioning and knowledge become powerful and necessary. You may be puzzled, frustrated, exhausted, but whatever has happened to you that you surely did not plan offers you a chance to survive. Do not allow yourself to be seduced into self-pity or inaction; for example, learn to wink at yourself when you realize that fatigue has never been defined the way it is now, one of my unrecognized symptoms! Bad news can signal many things, including the possibility of becoming more of who we can be, but first, the initial alarm needs to be heard resoundingly. In re-examining the way you are living your life, you may choose to make changes or you may come to realize that your current strategies will not let you down, despite your difficulty. I had to remind myself to consciously and conscientiously apply what I knew: again the less reliable than usual voice in my head was advising me to maximize what works and eliminate what does not. Don't rely on "wishes", have a plan; be in collusion with yourself to prepare for the best outcome possible, using knowledge, thoughtfulness, pride of accomplishment. Thank yourself in advance for your cooperation, as in a business letter requesting something you need. I had been given the gift of survival; now it would be up to me whether or not I could reach the pinnacle, the point of glory achieved by some, that of thriving.
That feeling of diffuse pressure across my chest recurred about two weeks later, same friend, same mall, but this time coupled with what I would later be able to describe as difficulty breathing comfortably. We concurred once again that I was just more unhappy than I could admit, accounting for why the fallout was way beyond just a sore neck. This conclusion was based more on ignorance than on denial, since the symptom seemed easy to pass off using the psychology with which I was familiar and had long espoused. Several weeks later, while playing tennis three days before my husband and I were due to leave for vacation, I had a pain that was completely foreign. It was strong, located on the left side of my chest, but disappeared quickly. When it recurred, I decided not to simply ignore it. Streams of memories about my father's sudden death filled my mind, and I sat down. Again, it resolved immediately, but left me feeling vulnerable and wondering how much significance it represented. When I returned to the court the next day and it recurred, I found my way to the bench next to my friend, and told her what had happened, with tears welling up in my eyes. She was concerned, even though it once again abated quickly, but neither of us could believe that it was heart-related. No-more-tennis-today was my self-prescribed resolution, but while walking the half-block from my car after tennis, carrying heavy packages, the pain returned. This time it was not nearly as brief: it lasted about a minute and left me more than nominally frightened. Now there was the whisper of an inner voice telling me to get past this, cut out the coddling. How many people react this way out of self-protection, actually causing the reverse result?
On the following day, I was completing preparations to leave for vacation which involved transferring cat litter from a large to a smaller vessel to ease the path for my cat sitter. Suddenly, the pinpoint pain just at the center of my hear hit anew. This time it was considerably more forceful, but stubbornness prevailed and I tried to finish the task. Within a minute or two, I knew that something was really wrong; the pain was not disappearing, but instead growing in intensity. I dropped onto my bed and grabbed for the phone to call the same friend who had been with me on each of the tennis days, announcing with as much composure as I could muster that I thought I was having a heart attack - no denial in this moment, just plain terror.
I wish I had known that for many women, symptoms vary both in kind and in intensity, often masked by our own desire not to give in to the early, seemingly small signs. We prefer to march on and we have been kept ignorant, too.
Until recently, the studies and their conclusions involved only men, so we have been in the dark. I duly noted my symptoms, but they were not recognizable to me as heart-related, singly or as a package. I suppose that if I could have known or even suspected that I had a clogged artery during that first moment of pain on the tennis court and marched myself to a cardiologist, I might have averted the "myocardial infarctions" or MI's (medical-ease for heart attacks) and subsequent permanent damage. My age and history might have prompted a responsible physician to order tests that could have altered the course of my "disease".
I later learned that the type of myocardial infarction that I had, permanently felled most people and was referred to as “the widow maker”, again referring to men. Remarkably, I had not succumbed, but I had lost 30% of the heart muscle and was in for a long, arduous battle to regain enough energy to remain active and feel more or less healthy.
Once there is more data out there, which we have finally begun to demand, it can be expected that women will be more likely to act upon the information elicited by our bodies. My entire history spanned a mere three days, plus two incidents easily ascribed to the problems I was facing. I lacked both the medical wisdom and the ability to accept that anything major was brewing. I have learned since that this reaction is typical of many strong, independent, intelligent people. Denial and resistance, although natural, do not promote acceptance and often inhibit reality-seeking through education.
Soon after the string of MI’s, waiting in my cardiologist's office, I noticed a chart that notes the "3 E's" of rehabilitation: education, exercise and emotional support. Blinders, self-deception and ignorance create a lack of mobilization, paralysis and an inability to take control. Crisis provides choices. You must be willing to take responsibility for yourself, even if it means knowing on whom to rely during times when you may lack clarity of thought and be too weak to be decisive. All of this presumes that you have a life plan, filled with realistic goals and incorporating others who enhance your life. If this is not quite true, you have a multitude of useful, necessary, life-giving tasks to learn and put into practice. Maya Angelou's eloquent simplicity sums up the stages of eventual growth beautifully: "When you know better, you do better". Do not fight against your own evolution. The more you know, the more you grow.

Women and Heart Disease: my journal -- and yours??

2009-08-27T10:29:00.000-07:00

This is the essence of Chapter One... horrifying, instructive, shocking... do read on...

How Could This Be Happening?: The Initiation

I sat quivering nervously, impatiently on a cold chair in a corner of the emergency room, alone, ignored, alternating between fear and fury. I couldn't have had a heart attack - or had I?
Like so many people with undiscovered, potentially disastrous diseases, I seemed to be the picture of health. I had lost about ten pounds and kept it off, not achieving perfection, but removing a likely threat, considering my history. I had been diagnosed several years earlier with labile hypertension and the accompanying annoyance of fluid retention, both hereditary. My father had a fatal heart attack in his early forties, when I was nineteen, my brother merely fifteen. He had duplicated his own mother's history.
For me, medication was successful in stabilizing my blood pressure, my cholesterol levels were only slightly elevated and I was under the care of a competent physician. My attitude was positive - I have labeled myself an "optimistic realist" - and although neither a purist nor a structured exercise person, I was fast-moving, active and avid in my belief that my rich emotional life would be a benefit to my health. So it was rather a stunning irony when, in September of 1998, at the relatively young age of 52, I had three heart attacks, all within a one-week period. The first episode brought me to the emergency room, but I was determined that the team would establish that the pain had been caused by some peculiar gastric upset, rather than anything heart-related. I was adamant that I was due to leave for vacation in just two hours and wanted medical clarification quickly so that my family would not have to be diverted to the frightening E.R. (Emergency Room) Didn't they understand that I was on my way to the airport for a long-anticipated vacation and that this could not be happening? I would learn later that this degree of denial typifies the earliest phase of the discovery of unwanted news.
I was admitted, against my desire but at the insistence of the E.R. attending physician, and then had a full-blown heart attack in the middle of the night right there in my hospital bed! Exactly one week later, having been home for only one and a half days, a repeat performance, necessitating an ambulance crew to return me to the hospital for yet another week's stay. Concisely explained, complete blockage of the most crucial vessel, the left anterior descending artery (LAD) had recurred.
But I was so different! Shouldn't my emotional health, self-awareness and lifestyle compensate for heredity? After all, if communication had been considered within the realm of athletic prowess, I might have been considered a star! In theory, I could hear my own voice saying for decades… don't hold things in, be in touch with your feelings, welcome new ideas, use humor as a survival feature, relentlessly pursue the teaching - and learning - involved in the acquisition of strategies of living leading to greater joy and understanding among people. With this philosophy of life in place, this could not really be happening. Ah, but in practice - and I was a novice in this area - there was no offer of immunity, no trade-off forthcoming as a reward for conscientious effort and even good health! The nodding heads of everyone who has suffered the cruel indignity of having to admit to illness will serve as recognition of my plight.
There was another piece of the puzzle that I had not factored into the equation: I had finally, sadly, frustratingly realized that my twelve-year marriage was in dire trouble and I was terribly unhappy, disappointed and hurt. We both tried to comprehend each of our needs in the hope of assisting the relationship. We were in the midst of building a business together and the rigors of that and his ever-growing inner tension and personal turmoil brought unbearable stress to both of us. I held fast to the notion that I could manage, that I would wait out his crisis, but our differences became difficulties and the stress turned to distress and certainly must have exacerbated what I did not even know was brewing. Our tenacity and drive proved inadequate and the disappointment and strain were immeasurable. We cannot discount this level of stress and the disarming role it plays on our bodies. No doubt he was as unhappy as I was, daunted by my health issues and not altogether pleased with my new-found friendships in cardiac rehab - and what he interpreted as separateness from him.
So many of us either have momentary lapses or have yet to learn that self-love, wholeness, must be present so that when a relationship ceases to exist, we can rely on our positive self-regard and continue to flourish without that alliance. In the presence of catastrophe, it is essential that this concept be strong and ever-present. It granted me sufficient motivation to sustain me even as my body seemed to conspire against me, but it was hard work.

Women and Heart -- my journey -- and yours??

2009-08-27T10:27:00.000-07:00

The first blog got lost somewhere in cyberspace, so here is is:

I'm a first-time blogger, hoping to reach a vast audience of women, in particular, but, of course, not only. My subject: heart disease! I know, I know, it doesn't sound like fun, but my personal journey, lessons learned and boundless challenges may help save lives. Yikes -- that sounds cocky - so NOT me! I am a psychotherapist and my on-going story of self-healing is rather unusual: I had three heart attacks, two of them major, all in one week in 1998, and I'm still here, still learning, still the eternal realistic optimist! I want to write about my experiences and share some of my own thoughts, feelings and coping strategies with as wide an audience as possible, so I'll write as often as I can and perhaps you will read, enjoy, respond... this is quite exciting!!

2009-08-24T17:03:00.000-07:00

Blog #2: I teased you yesterday about writing often... here it comes: right out of the pages of my journey, written but unpublished (so far)... The Heart of a Woman - the introduction. I hope you will want more and more, since I am one of those total givers!
Soon after I wrote my manuscript, my cardiologist called and asked me to do an interview with her for Eyewitness news on Channel 7 in New York. It was a piece focusing on women's risks for and frequency of heart attacks and possible preventive measures. For too many years, the "Church of Modern Medicine", in the vernacular of the remarkable Dr. Robert Mendelsohn, has addressed heart problems in studies and in the media with regard to men; yet is a leading killer of women, whose symptoms often are quite different from those of men. We need more information, education, research and discussion to send the signal to the majority (women now comprise 53% of the population). Needless to say, I was flattered and enthusiastic that my rather remarkable doctor chose me from among her many patients, telling me she thought I would be "perfect" for the piece!
I was oddly calm, probably because of having done a fair amount of guest speaking over the years in my own field and likely due to our mutually comfortable relationship.
Expertise comes in so many forms: when I conduct workshops for parents on enhancing discipline and communication skills, invariably I am initially regarded as "the expert". Quick to dispel such an unwieldy notion, I give over that title to the parents, who will always know their children in ways that I could not. After thirty-five years as a psychotherapist specializing in counseling families and couples, and children and adolescents with learning disabilities, I have a profound sense of appreciation of the myriad coping mechanisms necessary just for daily survival. Little did I know that direct experience, literally with my own heart, would increase my wisdom many-fold and bring me to new levels in my own school-for-living.
I was a "school psychologist" type of kid by the age of ten, known for my words of wisdom, doled out to my peers who could not have been any less lost than I. Somehow, though, I had an inborn knack for sensing the needs of others, even without benefit of true wisdom that indeed comes only in combination with experience and perspective. Coupled with a need to express myself to others, it would serve me well in many aspects of my adult life and allow me to touch the lives of many people. It was not surprising when that ten-year-old became a psychotherapist, known as a "hands-on" educator, a no-nonsense person, an encouraging source of information and a guide/mirror, gently but firmly urging people toward improving the quality of their lives.
My role on Eyewitness news was not as therapist, but as patient: I was thrust into this role of "heart patient" after the experience of my own massive, totally unexpected heart attacks. Having to "heal myself" has proven to be a difficult task, requiring the acquisition of even more inner strength and skills than I could have imagined. The roller coaster ride has provided ample opportunity to learn and grow.
The blocked vessel responsible for my attacks is of the type that generally causes immediate death; why, then, did I survive not one, not two, but three such attacks, all in one week? My mother says that it is and was predicated on my role as the center of the Oreo cookie, sandwiched between and loved by her and my daughter, precious sentiment, filled with truth and so typical of my amazingly wise, articulate Mom.
I embarked on writing about this journey because of my true desire to communicate with anyone who might learn from my experiences. Writing has always felt like an unanswered "calling", a way of reaching an audience beyond my inner circle, through which I could share my thoughts, feelings and knowledge. My reactions to the most recent experiences in my life represent the culmination of more than half a century of thinking and learning that have propelled me to utilize my passion for writing to bring compassion, comfort and energy to patients, families and friends of heart patients, especially and most pointedly female patients.
The lessons I have learned, ever unfolding, need to be shared, because that it happened bears at least equal attention to the results of it having happened. I consistently hear that there is not enough attention given to the emotional reactions of heart patients in the aftermath of such utterly terrifying "events" - an irritating term and new pet peeve. An "event" is a planned, enjoyable, memorable evening at the theater or a party, or perhaps a news story warranting attention. A heart attack is an assault, a shock, a disaster, stunning, terrifying and unwanted, not an event. The euphemism is used by insurance companies as well as physicians, as in "No, we will not allow you to continue your cardiac rehabilitation classes, since you have failed to have another 'event' ". If that's “failure”, it would change all definitions of the word!
Oprah Winfrey is a perfect example of a well respected lay person who genuinely and fervently believes that we are all here for a purpose. The realizations and changes, challenges and transformations provoked by the past several years have compelled me to write this book and have given me a sense of purpose and a concrete reason for my survival. Since my aim is not only to survive but to thrive, I hope these writings will serve as a catalyst for everyone out there. Near tragedy can become a starting point propelling us toward honest self-reflection, willing us out of pain, grief, fear or disease. Dr. Phil McGraw teaches us that if your conscious strategy for living needs revision, this is the time to get on with life, leaving demons and denial behind. I would add that the “three C’s – conscience, conscientiousness and consciousness serve us all. (My attempt and desire for this book to assist others will be most glaring in the use of italics!)
Some of the details of the earlier stages of my disease are blurred, not because of the time lapse, but due to the amounts and types of drugs used to quell the pain and sedate me during the most horrifying initial moments and hours. The clarity of my feelings remains permanently etched in my brain: I was not sure that I would survive, and, for just a fleeting moment, not sure that I could work hard enough to achieve survival. The essence of that moment and the inevitable freefall of emotions, most poignantly the depression that followed months later, may be familiar to the many people who have lived through similar experiences. I am fortunate in that I have a small, strong, wonderful support system and the willingness, ability and need to allow them to positively affect me. Some of what I have learned came from new friends/compatriots at the Cardiac Care Center where I attended supervised exercise classes for one hour, three days a week, four more than three years. I will introduce you to several of these people as we go along. They have become important to me and I will forever be in their debt for their contribution to my life. It is unimaginable to me that anyone could ride this storm alone. If this writing helps any of those people, I will forever feel rewarded by having made that kind of contribution to them. I hope that my awakenings will inspire you as you reach toward clarity, courage and the passion to thrive.
Next: more of the same, with a hopeful flair here and there to keep you interested and peak your curiousity. Thanks.......