Listen up, ladies: 16 things I’ve been meaning to tell you

by Carolyn Thomas

I always ask women in my Heart-Smart Women presentation audiences what they imagine I would have done had it been my daughter Larissa suffering the same heart attack symptoms that I’d been doing my best to ignore while on that cross-country flight from Ottawa.

Would I have patted her nicely on the head and urged her to just hang in there for nine more hours?  No, my heart sisters, you can rest assured that I would have been screaming blue murder to get immediate help for her.  Yes, even if it meant turning the damned airplane around during this medical emergency.

I was lucky. I managed to survive a heart attack that night on that plane – despite my very foolish determination to “not make a fuss”.  Ever since, I’ve been trying my best to bonk women on the head with reminders to put themselves first on their priority lists, and to be their own best health advocates. But this is an uphill battle that is being waged throughout all levels of women’s health care. Apparently, not even surviving a cardiac crisis is enough to convince some women that they need to start carving out “me-time” every day for the sake of their physical and mental health.  

For example, women make up only 20% of all heart patients entering structured cardiac rehabilitation programs following a cardiac event, despite the fact that we experience half of all cardiac events. First of all, men are twice as likely as women to even be referred to cardiac rehabilitation in the first place – so we really need to demand an explanation from all physicians for this shocking gender gap.

But even women who are referred often end up as cardiac rehab dropouts. And if they do eventually complete the full 3-4 month program, their attendance throughout tends to be sporadic compared to male participants. (See also: Why Aren’t Women Showing up for Cardiac Rehab?)

Dr. Chris Blanchard, a health psychologist at Dalhousie University in Halifax, has researched this phenomenon to figure out why women are up to 30% more likely to quit these life-saving cardiac rehab programs than men are.

There may be a number of reasons for our no-show tendencies, but Dr. Blanchard also blames women’s tendency to put themselves low on their own priority lists:

“They are caretakers for other people, and they undersell themselves. That’s the biggest gender discrepancy I’ve seen.

“This is extremely dangerous because research shows that 30 minutes of physical activity a day leads to a 20% increase in a heart patient’s survival.  So if we know that female heart patients are doing less physical activity, then we know that they’re potentially placing themselves at increased risk for death. That’s a huge impact.”

Here are some more “bonks on the head” if you, too, need a reminder that you are worth being the most important person in your precious life – whether or not you have heart disease:

  • Make your own needs a priority.  What you need and want matters.  If you don’t value yourself, look out for yourself, and stick up for yourself, you are choosing to sabotage yourself.  Remember, it IS possible to take care of your own needs while simultaneously caring for those around you.  And once your needs are met, you will likely be far more capable of helping those who need you most.  See also: Are you a priority in your own life?
  • Create your own happiness.   If you are waiting for something or someone else to make you happy, you’re missing out.  Smile because you can. Choose happiness.  Just for today, try being happy with who you are right now, and what you can do right now. Let your positivity inspire your journey into tomorrow.  Think you can’t be truly happy anymore because you’re a poor little heart patient now?  You are wrong. If you look for happiness – even within the limited opportunities you may have – you will find it.  If you don’t, you won’t.  See also: Three Types of Heart Happiness Defined

  • Notice and live in the present.  Right now is a miracle.  Right now is the only moment guaranteed to you.  Right now is your life.  So stop thinking about how things might be in the future, or how great they would be if only you didn’t have heart disease or _____ (fill in the blank).   Stop dwelling on what happened in the past – such as your heart attack.  Learn to be in the ‘here and now’ and experience life as it’s happening now, however that looks.  Appreciate mother nature for the exquisite beauty that it holds, starting today.  See also: Should Heart Patients make a Bucket List?
  • Start taking full accountability for your own lifeWhat is, is (as the Buddhists like to say). Own your choices and reality, and be willing to take the necessary steps to improve upon them. You are the only one who can directly control the outcomes of your life, and more importantly, how you respond to them.  Stop saying “Yes” to others all the time. And this won’t always be easy.  People with heart disease may face a stack of obstacles in front of them.  But take accountability for your situation. Choosing not to is choosing a lifetime of victimhood. See also:  Learning to live with heart disease: the fourth stage of heart attack recovery
  • Actively nurture your most important relationships.   Bring real, honest joy into your life and the lives of those you care about. This can start by simply telling them how much they mean to you on a regular basis.  You can’t be everything to everyone, but you can mean quite a lot to a few precious people.  Decide who these people are in your life and treat them like royalty.  Start saying “No thanks!” to invitations from  all the rest. You don’t need to explain why. Remember: NO” is a complete sentence. Spend the very limited hours you have left on this earth with the people you truly enjoy, who love and appreciate you, and who encourage you to improve in healthy and meaningful ways.  They are the ones who make you feel more alive, make you laugh, and not only embrace who you are now, but also embody who you want to be, unconditionally. Remember, you don’t need a certain number of friends, just a number of friends you can be certain of.   See also: Resilience: it’s hard to feel like a victim when you’re laughing
  • Be more polite to yourself.   If you had a friend who spoke to you in the same way that you sometimes talk to yourself, how long would you allow that person to be your friend?  Heart attack survivors often beat themselves up mercilessly over what they should or should not have done in the past that may have led to their cardiac event, or what they’re doing or not doing now to follow a new heart-healthy lifestyle.  Try being  as kind to yourself now as you would if a dear friend were in the same boat.  See also: “God punishes bad children!” – or, why you have heart disease
  • Look for the silver lining in tough situations.   When things are hard, and you feel down, take a few deep breaths and look for the small glimmers of hope.  Remind yourself that you can and will get through these hard times surrounding your diagnosis.  And remain conscious of your blessings and small victories – all the things in your life that are right.  Focus on what you have, not on what you haven’t.  And remember, as the Buddhists tell us, that all life is impermanent – both the bad times and the good. See also:  When you’re having a terrible, horrible, no good, very bad day
  • Stop whining to your friends.  It isn’t problems like heart disease that define you, but how you react to these problems. Venting about a traumatic cardiac diagnosis is perfectly normal – especially at the beginning. But choose your listeners carefully, because very very soon, others around you will tire of hearing you go on and on, and – worse! – you will begin to anchor your negative focus on this “why me?” victim perspective. As Dr. David Burns writes in his landmark book, Feeling Good: The New Mood Therapy:  “The negative thoughts that flood your mind are what may keep you feeling lethargic. And if you don’t recognize the emotional prison in which you are trapped, this situation can go on for weeks, months, or even years.”  Make an appointment to visit your pastor, a peer counselor, a therapist or other health professional to talk out your fears, concerns and worries with a trained listener.  Some problems will go away by themselves, but others more serious may require some type of helpful intervention.  Do what you can, when you can, and acknowledge what you’ve done.  It’s about taking baby steps in the right direction, inch by inch.  See also: Get Over Yourself: how to stop boring others with your heart attack story
  • Forgive yourself and others.   We’ve all been hurt by our own decisions and by others.  And while the pain of these experiences is normal, sometimes the pain lingers for too long.  We relive the pain over and over, and have a hard time letting go, picking away at a scab that just can’t heal because we won’t allow it.  Forgiveness is the remedy – and this applies to forgiving yourself, too.  It doesn’t mean you’re erasing the past, or forgetting what happened.  It means you’re letting go of the resentment and pain and blame and guilt, and instead choosing to learn from the incident and move on with your life.  See also:  Are You Too Hard on Yourself?
  • Be attentive to your stress level.   Slow down.  Breathe.  Give yourself permission to pause, regroup and then move forward.  Even when you’re at your busiest, a brief recess can rejuvenate your mind, body and spirit. These short breaks can help you regain your sanity and reflect on what you’re doing so you can be sure it’s in line with what’s most important to you right now. Chronic low-grade stress releases stress hormones like cortisol and adrenaline – very damaging to those delicate endothelial cells lining your coronary arteries.  Amazingly, the world will indeed continue to spin on its axis even if you are not fretting about it. See also: Is Everyday Stress Gnawing at your Arteries?
  • Start noticing the beauty of small moments.   Instead of waiting for those big things to happen – relationships, kids, a big promotion, winning the lottery, miracle cardiac cures – look to the small things that happen each day.  Little moments like enjoying that first cup of coffee in the quiet of early morning, or going for a walk in the fresh air with only the company of your favourite dog. Noticing these small pleasures on a daily basis makes a big difference to your heart health and to the quality of your day-to-day life. See also: The Days are Long, but the Years are Short: being present is good for your heart and your life
  • Accept things when they are less than perfect.   Remember, ‘perfect’ is the enemy of ‘good’.  One of the biggest challenges for heart attack survivors is learning to accept things as they are now.  Sometimes it’s better to accept and appreciate the world as it is, and people as they are, and YOU as you are right now, rather than to trying to make everything and everyone conform to some impossible ideal, or idealizing the perfect life you used to have, pre-cardiac event. Lighten up. No, you shouldn’t accept a life of mediocrity, but learn to love and value things when they are less than perfect. See also: 40 Profound Life Lessons a heart attack can teach you
  • Be more open about how you feel.  If you’re hurting, give yourself the necessary space and time to hurt, but be open about it.  Be true to yourself.  Say what you need to say.  Do what you know in your heart is right. Listen to your own inner voice.  Don’t apologize for how you feel or for what you need now.  Mayo Clinic cardiologist estimate that up to 65% of heart patients experience clinical depression, yet fewer than 10% are appropriately diagnosed.  Talk to those closest to you.  Tell them the truth about how you feel.  And please seek professional help when you need to – you’d do that if your leg were broken, so do it when your heart is broken, too. See also:  The Heart Patient’s Chronic Lament: “Excuse me. I’m sorry. I don’t mean to be a bother…”
  • Concentrate on the things you can control.   You can’t change everything, but you can always change something.  Wasting your time, talent and emotional energy by stewing over things that are beyond your control is a recipe for frustration, misery and despair.  Invest your energy in the things you can control, and decide what you can do about them.   See also: Do You Think Too Much? How ruminating hurts your heart
  • Focus on the possibility of positive outcomes.    Your mind must believe it CAN do something before it is capable of actually doing it.  Listen to your own self-talk; try to replace negative thoughts with positive ones.  Regardless of how bleak your health situation may seem right now, focus on what you can do, and then take the next positive step forward to DO IT. Everyone’s life has positive and negative aspects – don’t play the ‘heart patient card’ to avoid doing something you know will be good for your heart and your overall health.   See also:  How optimism can be good for women’s hearts
  • Start noticing how wealthy you are right now.    Henry David Thoreau once said: “Wealth is the ability to fully experience life.”  Even when times are very hard for those living with heart disease, it’s important to keep things in perspective.  You didn’t go to sleep hungry last night.  You didn’t have to sleep outside.  You had a choice of what clothes to wear this morning.  You have access to clean drinking water.  You’re reading this on a computer screen. You have access to the internet. You know how to read and write.  Some might say you are already incredibly wealthy; remember to be grateful for all the things you do have.   See also: Three things that make you happy – and three things that won’t

NOTE FROM CAROLYN: I wrote more about sharing – and not sharing – details of a serious health crisis in my book A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press).  You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).


♥   Still need more bonks on the head?  Read these Heart Sisters posts:

Scope creep: when NO means maybe, and maybe means YES

Cardiac Research: Where Did All the Women Go?

Women Heart Attack Survivors Know Their Place

Knowing and Going: Act Fast When Heart Attack Symptoms Hit

‘Time Equals Muscle’ During Women’s Heart Attacks

Women Fatally Unaware of Heart Attack Symptoms

Why We Keep Telling – and Re-Telling – Our Heart Attack Story

In Praise of Solitude After a Heart Attack

Could Goodism and Self-Sacrifice Be Linked to Women’s Heart Disease?

16 thoughts on “Listen up, ladies: 16 things I’ve been meaning to tell you

  1. Carolyn: I couldn’t agree with you more. I had quad bypass surgery in 2013 and still attend a cardiac rehab program weekly. It’s unbelievable to me the number of men and women who don’t take their recovery seriously and participate in physical rehab programs and related dietary and emotional support.

    Liked by 1 person

  2. Dear Carolyn,
    Your post inspired me to send a link to 4 dear friends & give them “homework” for our next date night. I requested they read the post & report which of the 16 things they are doing and which ones they are not. The menu of the evening is now “heart healthy” & you can be sure there will be lots of heart healthy wine being served!

    Seriously Carolyn, I look at my dear friends (all in their late 40’s and early 50’s) & their risk for heart disease is terrifying! I hope to be able to complete the assessment for each one of them or at least encourage them to go on-line & complete in private. Thanks for a thought provoking and motivating post.

    As the nurse in the group I am trying to lead by example & have successfully made some much needed changes in my life. Keep up the amazing work.


    1. Wow! I love your idea, Paula. Should make for an evening of lively discussion. Would likely work best, however, if each one does her own “assessment” (’cause nobody likes a list of their shortcomings handed to them!) Your heart healthy menu suggestion sounds perfect for Heart Month! Good job!


  3. Carolyn, I’m fortunate not to have had a heart attack (just an A-fibber who’s had three ablations), but I really get a lot from reading your posts. Especially this one. It’s a reminder to appreciate what we can still accomplish. I’m not sure I’ll ever be able to forgive dismissive healthcare professionals, however. Any suggestions?


    1. Hi Campy – I’ve had both the most wonderful AND the most dismissive health care professionals, all at the same hospital – including the E.R. doc who misdiagnosed me with acid reflux in mid-heart attack and sent me home. It’s not so much that I’ve “forgiven” him as much as I’ve just decided to move on and focus on what I am able to control these days. I could stay justifiably pissed off at this guy forever – but that would not be good for my heart, right?


  4. After my heart attack, there were times that I joked about sounding like a two-year-old who’s just learned a new word: NO!

    It seemed like every time I turned around, I was having to take a firm stand and say “No,” and finally put my own needs first.

    Almost three years later, though, I find my self-discipline slipping and I need the reminder that NO is not a bad thing to say. Especially as someone born in the Southern United States–we Southern women are raised to be polite, to not talk back to our elders, to call people “Ma’am” and “Sir,” and one of the unspoken messages of that kind of upbringing is that it’s not polite to say “No.”

    Well, it’s not exactly polite to fall face-first into the bowl of potato salad at the church pot-luck, either, so NO it is.


  5. Thank you Carolyn for these 16 things. I need a bonk on the head to remind myself to take care of myself first. This is a great blog. You always provide thoughtful and intelligent information. Thank you,


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