When heart patients meet the Black Swan

by Carolyn Thomas  @HeartSisters

blackswan_johngouldI have a little ritual as soon as I board the ferry from my island home for the one hour and 40 minute sailing  over to the mainland: I make a stop at the magazine rack of the B.C. Ferries gift shop. It has something to do with both the beautifully tactile feel of a new magazine and its clear association in my brain with almost every ferry ride I’ve ever taken through our west coast Gulf Islands.

That, and a pack of Mentos . . .

During last week’s sailing to Vancouver, we had barely settled into our front row seats in the forward lounge with the Mentos and a copy of Psychology Today in hand before I was riveted by editor Kaja Perina‘s third page commentary. She writes about something called the Black Swan, a reference to a 17th century philosophical thought experiment.  

Although the PT article by Brooke Lea Foster that Perina is introducing in her opening editorial focuses on famous Black Swan events like plane crashes and shark attacks, a Black Swan event is any that’s considered rare, unpredictable, and has significant repercussions.

This definition immediately – and not surprisingly – reminded me of how a number of us heart patients define our cardiac events:

  • rare (for us, at any rate!)
  • unpredictable (never saw this coming)
  • significant repercussions (both physical and psychosocial)

As Perina writes in her refreshingly insightful editorial, we often spuriously rationalize these occurrences in hindsight:

“One need not be the victim of a headline-grabbing disaster to feel the power of the Black Swan.

“In the course of a lifetime, many people will confront a serious medical diagnosis that was, one second prior, not even a word or phrase in their vocabulary. 

“Of course, such moments are not truly “rare”, but they feel like a one-in-a-million punch to the individuals staring them down.”

The former editor-in-chief of Wired magazine, Chris Anderson, once observed that our brains are wired for narrative, not statistical uncertainty.  That rings true for those of us diagnosed with a chronic and progressive illness like heart disease.  He wrote, for example:

“We tell ourselves simple stories to explain complex thing we don’t – and, most importantly, can’t – know. Trying to extract generalizable stories to explain unpredictable events may be emotionally satisfying, but it’s practically useless.”

Similarly, before you experience a heart attack, you may have clear beliefs, as I did, about what kind of people have them (most likely: not you!). And after you survive a heart attack, you will, I predict, make every effort to try to make sense of your unpredictable event through generalizable stories.

In her Psychology Today article, Foster revisits people who have survived traumatic events. Survivors, she explains, no matter the particular trauma or the wreckage it leaves behind, must cope with the same emotional reality: the unthinkable did happen – to them.

“Some say they think of their lives in two parts – who they were before the event, and who they became after.”

“The unimaginable has the ability to warp or sharpen statistical reasoning, but more important, to tap reserves of empathy, often creating a sudden kinship with strangers who struggle with the same twist of fate.

“Whatever the probability, such events don’t gently usher in enlightenment and perspective taking. They shove you, naked, onto an advanced ski slope.”

Illustration: John Gould, The Birds of Australia, London 1840-1869


NOTE FROM CAROLYN:   I wrote much more about becoming a patient in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press (and use the code HTWN to save 20% off the list price when you order).

See also:

Why hearing the diagnosis hurts worse than the heart attack

How we adapt after a heart attack may depend on what we believe this diagnosis means

Which one’s right? Eight ways that patients and families can view heart disease

Six personality coping patterns that influence how you handle heart disease

Denial and its deadly role in surviving a heart attack

Surviving the crisis: the first stage of heart attack recovery

The new country called heart disease


Q:  How have you experienced your own Black Swan event?



21 thoughts on “When heart patients meet the Black Swan

  1. While still groggy after an angiogram, I was told by the doctor who did it that I have cardiomyopathy. He then left the room, and left me with the poor nurses, who had to answer my questions – but it’s not life threatening, is it? – having never heard this word before in my life.

    So glad that I found your website – it’s excellent.

    Liked by 1 person

      1. Thanks for your response, Carolyn. I had kind of been prepared for heart news, as my father had a heart attack at an early age (he is still around 30 years later), but NOT this news.

        I really appreciate your website, as I am trying to keep my heart strong in all ways – I do not need any complications besides cardiomyopathy.

        I found one article on your website about cardiomyopathy. Thank you for that. Do you know about any other good reliable sources for this?

        I am not finding it easy to find good information on it. And a lot of what is out there is very scary. All my cardiologist does is prescribe meds – which I know is the way it is treated (until more is needed). I am investigating supplements and exercising regularly – NOT suggested by cardiologist! (this is also in BC Canada).

        Liked by 1 person

  2. Carolyn, I always find your articles so interesting and relevant to what’s happening in my life.

    This latest article rings so true to me. Life has been divided by “life before” and “life after”. Nothing is the same anymore. Everything about my life; my family, my career, and even my marriage is different now. Hopefully all for the better!

    Liked by 1 person

  3. 2 black swans for me, neither of which I saw coming at all: diabetes diagnosis 13 years ago, & arthritis 3 years ago. Both have caused major changes. Funnily, I have always expected a heart attack, since my family has a strong history, and my mother had her first at age 42 – But I haven’t had a heart attack yet! I’m 65, and waiting for it…..

    Liked by 1 person

    1. Hello Ellen – that’s the thing about Black Swan events: we don’t see them coming, we don’t wait for them, we don’t even think about them. Best of luck to you – maybe you’ve already had your lifetime quota of Black Swans so far…


  4. My experience with the Black Swan has continued on for 2 years and counting. Just when you think all is fine, the fear is back with yet another diagnosis. It never ends and I will cope the best I can. God bless all who are feeling like the “rare and special” case.

    Liked by 1 person

  5. Carolyn you really nailed it!

    My experience started out thinking about my heart attacks…but it unearthed another powerful event… the suicide of my father in law… and all the trauma to our family. Was a black swan for sure.

    Liked by 1 person

  6. What to say except: AMEN! We are all terminal, aren’t we? And we don’t need an ‘event’ to tell us that! So why not start living healthy right now?

    And you help with that Carolyn, reminding us every day that despite all the research, the medical care (good or bad) and the advice pundits, it’s still ALL in the palm of our very own hand!

    Liked by 1 person

  7. I have a friend that had a heart attack about 2 years ago. With job, family (divorce, death of family members, problems with kids) The stress caused another attack and he is going for more heart surgery on Tuesday. This article made me see things in a new light. Everyone is waiting on the “BIG ONE”, the chemical attack, the next bombing, the next terrorist attack.
    God knows we fear too, But we are used to it, We live daily with the fear of “the attack” that lives within our own bodies.

    I like Tim McGraw’s song Live Like You Are Dying:

    Make a difference while you are here. Life: there is no way to get out of it alive, but we sure can make a difference while we are here, find your purpose and do it (it brings strength to your soul and to your heart). and if you feel it necessary, go 2.7 seconds on a bull named fu man shu 😉 Take pictures!

    Liked by 1 person

    1. Thanks so much, Rachel. I love that Tim McGraw song, too! One of the women in my heart health presentation audience on Tuesday asked: “How can we tell if we are at risk for having heart disease?” and my answer was something like Tim’s song: “Just assume that you are already at extreme risk and start living healthy now – because you just never know!”


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