Here’s my theory: few health crises in life are as traumatic as surviving a cardiac event. I developed this theory while I was busy having my own heart attack in the spring of 2008.
For starters, cardiac symptoms often come out of the blue (in fact, almost two-thirds of women who die of coronary heart disease have no previous symptoms.(1) Having a heart attack can feel so unimaginably terrifying that almost all of us try desperately to dismiss or deny cardiac symptoms. And according to a report published in Global Heart, the journal of the World Heart Federation, women are twice as likely to die within one year even if they do survive a heart attack compared to our male counterparts.(2)
So if – and each of these is still, sadly, a great big fat IF for too many women – we survive the actual cardiac event, and if we are near a hospital that’s able to provide an experienced team of cardiologists/cardiovascular surgeons/cardiac nurses, and if we are correctly diagnosed, and if we receive timely and appropriate treatment, and if the resulting damage to our oxygen-deprived heart muscle is not too severe, we get to finally go home, safe and sound.
And that’s where the real trauma starts.
Trauma fallout starts later on at home because so often, we are plunged immediately into a profoundly surreal state during the earliest days in hospital, post-cardiac event. A true yet weirdly hilarious example of this state is Jodi Jackson’s account of her Post-Heart Attack Stun).
But reality has a nasty way of eventually intruding into even the most dogged refusal to come to terms with it.
So once the freshly-diagnosed heart patient returns to the regular routine of home life, she starts thinking about what the heck has just happened to her body and to her life.
One of my readers – a double whammy winner in the Sweepstakes of Awful Diagnoses (first breast cancer and then, five years later, cardiovascular disease) – once wrote to me about how her heart attack differed significantly from her cancer experience. For example:
“With cancer, the enemy was something foreign that had somehow invaded my body. A tumour should not be there, and all medical effort is intensely focused on getting rid of this evil intruder.
“But with heart disease, the threat comes from my own heart, part of me! I can’t get rid of that!“
Hence the surprisingly common reaction among many survivors that our hearts have somehow betrayed us. Some of my friends living with other chronic illnesses have lobbed similar accusations against their bowels, pancreas, lungs, joints and other assorted body parts that simply do not work like the owner’s manual promised.
No wonder the late physician, author and Yale professor Dr. Sherwin Nuland described a heart attack like this (note how he, too, used the word “betray” here):
“So commonly do coronary arteries betray the heart whose muscle they are meant to sustain that their treachery is the cause of at least half of North American deaths.
“When a coronary artery suddenly occludes, a period of acute oxygen deprivation ensues. If this period is long and severe enough that the stunned and bloodless heart muscle cells cannot recover, the pain of angina is replaced by infarction.
“Each time a person recovers from a heart attack of any size, he/she has lost a little more muscle to the increasing area of scar tissue.”
Now there’s a cheerful sentiment for you, right? Something we have taken for granted all our lives (that our hearts would continue to beat regularly and pump blood like they are supposed to do) has suddenly turned on us. Which means we can’t trust it anymore.
And in some cases, we can develop a type of coronary disease that is not caused by a blocked artery. One diagnosis in particular – tricky to come by since almost all cardiac diagnostic testing for decades has been designed and researched on (white, middle-aged) men who have large blockages in their coronary arteries – is called Coronary Microvascular Disorder (MVD) or Small Vessel Disease – which I was diagnosed with about nine months after surviving what doctors used to call the widowmaker heart attack in 2008. Two cardiac diagnoses for the price of one. . .
Unlike cancer patients who fear the external danger that has invaded their bodies, heart patients fear the danger that lives within.
This also helps to explain why each little cramp, bubble or twinge that follows a cardiac event can feel every bit as alarming as the first symptoms that forced us to seek urgent care.
As Australian cardiac psychologist (and himself a heart attack survivor) Len Gould likes to say:
“Before a heart attack, every chest pain is just indigestion. But after a heart attack, every chest pain is another heart attack!”
Heart patients soon learn that they’ve just drawn the short straw in determining the future risk of another cardiac event, because one of the biggest risk factors for having a major cardiac event is having already had one.
Another cardiac psychologist, Dr. Wayne Sotile, in his excellent book Thriving With Heart Disease, reassures us that feeling terrified every day is “normal”:
“Moving very slowly, bouts of depression, weeping, social withdrawal or obsessive anxiety about dying – these are all normal during the early stages of heart disease.”
I don’t care how “normal” it may be, trust me when I tell you that “obsessive anxiety about dying” is a relentlessly exhausting way to live – and all because the body’s most important organ has stopped doing what we trust it to do.
That exhaustion is what ultimately led me to a “Eureka!” moment of patienthood, inspired by Heather Fox.
Heather is a wise and wonderful therapist (and a former colleague at the Victoria Hospice and Palliative Care Society) who visited me at my home several times in those early weeks and months post-heart attack. One day, she brought me a gift: a guided meditation CD, one that helped me visualize oxygenated blood cells coursing happily through my newly revascularized coronary arteries.
Instead of letting me continue to blame my errant organ for screwing up its job, the CD’s message also invited me to change how I thought about and talked to my heart, just as Heather taught me:
Instead of resenting my heart for letting me down, I was now to express gratitude:
“I thank my brave little heart for helping me survive what many do not.”
That single message has stuck with me every day since then. Well, almost every day . . . Some days, let’s face it, it’s harder to remember that important message than others.
Instead of blame, mistrust, anger and resentment – which had daily filled my soul during those early “Why me?” days – I learned to place my hand over my chest several times a day and offer this gentle whisper:
It’s not a perfect organ, but given what it’s been through on my behalf, my amazing and heroic heart deserves at least that.
.=This essay was also reposted on Disruptive Women in Health Care, and an excerpt from this post is also included in Chapter 10 of my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017) You can ask for this book 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 (Use their code HTWN to save 20% off the list price when you order).
(1) Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.
(2) Kavita Sharma, Martha Gulati. Coronary Artery Disease in Women: A 2013 Update. Global Heart. 2013. ISSN 2211-8160
Q: What has helped you make peace with your diagnosis – whatever it may be?