When you open a non-fiction book, you’ll likely find a section called the foreword, written by somebody who is not the book’s author. It addresses a reader’s questions about the book: Why is the author of this book particularly qualified to write it? What will I gain or learn by reading this book?
The Chicago Manual of Style writing guide describes a foreword as “written by someone eminent to lend credibility to the book”.
I needed to find someone eminent (definition: famous, respected, important) to agree to write the foreword for A Woman’s Guide to Living With Heart Disease because, unlike other heart books out there written by cardiologists, my heart book was written by a heart patient with zero medical training. To many, that translates as zero credibility.
I also needed to find an eminent person who was also familiar with my Heart Sisters blog, upon which my book is based. With fingers crossed, I decided to ask the eminent and internationally known cardiologist, Dr. Martha Gulati.
She and I had been following each other on social media for a long time, but finally met in person in 2015 when she was one of the organizers of a medical conference on women’s heart disease at Mayo Clinic. Dr. Martha and Dr. Sharon Mulvagh (like me, both proud Canadians!) led by Dr. Sharonne Hayes (founder of the Mayo Women’s Heart Clinic) had contacted me to say that their conference speakers’ roster “needed more Canadian content!” They invited me to come to Mayo to speak about my own perspective as a heart patient-turned-blogger and women’s heart health advocate.
I’ve often said since then that meeting Dr. Martha in person at Mayo for the first time was like meeting one of the rock stars of cardiology! She’s been a cardiologist for over two decades, and has a unique expertise in women’s heart disease. You can find out much more about Dr. Martha’s accomplishments, cardiac research, awards, and publications here.
I was absolutely over the moon when, on February 8, 2017, her exact reply to my request was:
“Of course I will!!!! I am honoured to be asked!”
In case you don’t already have a copy of the book yet, here’s the wonderful foreword written by Dr. Martha Gulati:
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“We cannot change what we are not aware of, and once we are aware, we cannot help but change.”
“The good physician treats the disease; the great physician treats the patient who has the disease.”
Sir William Osler, 1st Baronet, MDCM, FRS, FRCP [ii]
“As a young medical student at the University of Toronto in Canada, I became acutely aware of the differences in how we treated men and women who presented with a heart attack. The symptoms of men were never doubted. If a man mentioned chest pain or chest pressure, a heart attack was always the first on the list of potential causes of what was going on, and the hospital team rushed to determine if the man was having a heart attack and take the next steps. Time was heart muscle! It was understood that this was the number-one killer of men.
“With women, I watched doctors ask more questions about the chest pain: What is going on at home, Mrs. Jones?; Are you under some stress, Ms. Smith?; What did you eat today, Ms. Black? The sense of urgency was rarely seen. Even when a woman had classic symptoms of a heart attack, rather than rushing to get an ECG or taking her straight to the cardiac cath lab, I saw doctors delay the treatment to make sure stress, anxiety, or reflux was not the cause of her symptoms. This delay, despite the fact that heart disease was also the number one killer of women.
“This behavior shocked me, because I was very aware that heart disease and strokes had taken the lives of women in my family.
“I became convinced that women’s symptoms were taken less seriously by doctors, and the emerging evidence at the time supported that conclusion. Women who had heart attacks were less likely to get guideline-recommended therapies, less likely to receive timely care, less likely to undergo any revascularization, and more likely to die than men.
“I began to think about what would happen to me, my sister, my cousins, and my girlfriends. What would happen to us if we ultimately had a heart attack? Why would we, just because we are women, be treated so differently? Suddenly I knew what my mission had to be: I was going to have to be a cardiologist who cared exclusively for women and who studied heart disease in women, if I was to be part of the change.
“I have now had the honor and privilege to care for women and their hearts for many years. And I hope I have been part of the change in caring for women. Nonetheless, we are still at the infancy of understanding women’s hearts and the impact of heart disease on the lives of women affected by this disease. It remains both of interest and of concern to me that heart disease is still underappreciated both by women and by physicians.
“Additionally, it remains a ‘secret disease’ for many women; unlike breast cancer, heart disease is rarely discussed, despite the enormity of the disease and its impact on women. The perception that a woman is to be blamed for a heart attack is one of many reasons women are often silent after a heart attack, despite the fact that many risk factors for heart disease overlap with risk factors for breast cancer. It still is often thought of as a man’s disease despite all the marketing, education, and public awareness campaigns driven toward educating women about their risk of the greatest killer.
“We continue to see gender gaps in the treatment and management of heart disease and stroke, with persistently worse outcomes and higher mortality in women, particularly younger women, compared to men. We continue to have gender gaps in the enrollment of women in cardiovascular trials. Only recently was it mandated that cellular research and animal studies include both sexes, where again, the female sex has often been excluded.
“So there is much more work to do in both helping women understand that they are at risk for heart disease, as well as improving the education of physicians in order to close this gender gap in heart disease outcomes. And further, we need to continue to advocate for more research to be done on women and their hearts so we can become better at preventing and treating heart disease in women.
“A Woman’s Guide to Living with Heart Disease is an excellent book that will not only benefit any woman living with heart disease, but also physicians and other health professionals caring for women. It gives a unique perspective on heart disease that has really not been heard until now–the patient’s perspective.
“Carolyn Thomas is a woman who lives with heart disease. As a result of her personal experience, she has become the voice of many patients in the world through her blog, her writings, her public speaking, and now through this book.
“As a woman who experienced a heart attack, was misdiagnosed, and deals with everything that living with heart disease entails, Carolyn uses humor wrapped in practicality and common sense to help women navigate their disease and all the overwhelming emotions that come with this diagnosis. Additionally, she has provided useful information for health care teams to appreciate what patients need and expect from their practitioners.
“To paraphrase the above quote from Osler, the great physician will treat not just the disease but the patient. As a physician, I feel that that is also the message Carolyn sends to us. And it is an important one for the health care team to remember.
“I have had the pleasure of knowing Carolyn, first through her writings and then eventually in person. Our bond was threefold: our mutual love of the heart, our desire to make sure (she as a laywoman, I as a doctor) that medical information was fully and accurately translated to patients living with heart disease and–last but not least–our love for our homeland, Canada.
“I am so grateful to have her as someone I send my patients to connect with on the internet. Her thoughtful comments on her experiences, combined with her interviews of others and her reflections on research, have made her the voice of the heart patient. Hers is the voice I hear when I look at my patient and realize that everything I said was not absorbed because my patient is still recoiling from the diagnosis I handed her. She is the person whispering in my ear, asking me to remember to introduce everyone in the room. She (and her blog) are the reasons I insisted that the gowns in my women’s heart center open in the front and are warm and cozy.
“Carolyn has given a voice to the female heart patient in a way that few others have been able to. I am grateful that she decided to write this book, because I believe it will improve the dialogue between heart patients and their physicians. She empowers women to improve their health, their life, and their ability to communicate with their doctors effectively. She also validates what many patients feel but have not been able to express.
“This book will allow women living with heart disease to know they are not alone and, I hope, will help them find their own voices.”
Martha Gulati, MD, MS, FACC, FAHA
Editor-in-Chief, CardioSmart, American College of Cardiology; author of the best-selling book, “Saving Women’s Hearts”; Division Chief of Cardiology for the University of Arizona College of Medicine-Phoenix; Professor of Medicine and Physician Executive Director for the Banner-University Medicine Cardiovascular Institute in Phoenix.
1. S. Sandberg, Lean In: Women, Work, and the Will to Lead, New York: Knopf, 2013.
2. Brainy Quote: https://www.brainyquote.com/quotes/quotes/w/williamosl386616.html
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Q: Are you as inspired as I was by reading Dr. Martha Gulati’s words?
How to save 20% off the cover price by ordering my book directly from Johns Hopkins University Press using the code HTWN