Image: Timothy Hellum
When writer Kathleen Dore started graduate school at age 51 to work on adolescent mental health, she was following her heart. Little did she know, her heart had lessons of its own to teach.
On June 1, 2017, a day after the approval of my research proposal, I had a heart attack. I'd noticed no warning signs and didn't have risk factors: no high blood pressure; no high cholesterol; no diabetes; not overweight; never smoked; and no immediate family with cardiovascular disease so young. I had been really tired in May (which I now know can be a warning sign), but I chalked it up to a busy April. I ate healthily and had been doing cardio exercises a few times a week for 15 years. In fact, I was booked to do the Heart & Stroke's Ride for Heart in Toronto a few days later—I'd done the 50-kilometre bike ride the year before and found it easy.
But on June 1, while gently warming up on the elliptical at the gym, a sudden pain spread across my chest underneath my breasts, like a rope being pulled tight. It was worse than the worst muscle spasm I'd ever had, and it wouldn't stop. So I stopped (that was smart). I looked for help (smart again). A friend happened to walk up; he wanted to call 911. "Let's wait—it might pass," I said (not very smart). He persisted, naming other symptoms: pain in my arm? No. A cold sweat? Yes. "Call 911," he told the staff.
In an ambulance, a paramedic ran an electrocardiogram (ECG) and told me I was having an "event"—he didn't mean a garden party. He called the nearest hospital with a cardiac unit and sent them my data, gave me two chewable Aspirin and told his partner to drive.
At the hospital, I made small talk with the paramedics and nurses who stayed beside me. "Isn't it ironic that I'm supposed to do the Ride for Heart in a couple of days?" One of the paramedics said, "Don't worry, you'll be doing it next year." It was then that something shifted. I wanted to believe her—but I didn't. Looking back, I realize that doubt had arrived. And once doubt got in, the door was wide open to fear.
This is a story about living with fear and heart disease, but more than that, this is a story about living with a heart that wants to hope.
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At the hospital, things happened fast. A doctor came in and explained the procedure he'd do: an angioplasty with stent. He'd make an incision in my wrist and, while viewing live X-ray images, guide a catheter through the arterial system to the heart. Then, a wire would be threaded through the catheter and across the blockage. A thin, expandable balloon would be passed to the blockage, then inflated. The balloon would push plaque aside and stretch the artery open. Finally, a stent would be inserted to keep the artery open and the blood flowing. He listed what could go wrong, including a small risk of death. (Not me! I thought.) Moments later, my buddies the paramedics wheeled me into the procedure room. One joked, "Just think, if you were in the States, this would cost you about $125,000." I smiled. Then, he leaned close and whispered, "Good luck, Kathleen."
The mood changed in that cold, efficient space. Even when I think of it now, it's like I'm there: Five or so people in scrubs move quickly and quietly. A nurse helps me turn onto my side. A sheet goes up in front of my face, blocking my view, even of my own body. I can see only two things: a clock on the wall and a giant monitor showing shapes I can't discern. It's an image of my beating heart. "You can watch the whole procedure," a nurse says. But I can't look. The huge screen overwhelms me. Fear is palpable now, but I will myself to stay calm, stay alive. I push away thoughts of my husband, son and mother, knowing I'll lose it if I think of never seeing them again. Breathe, I tell myself.
My eyes lock on the clock. I hold my focus there while the doctor works, aiming for a tiny clot near my heart. "The culprit," he calls it. I watch the time pass, three hands ticking.
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That was Thursday morning; I was home on Saturday afternoon.
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NAVIGATING LIFE POST-HEART ATTACK
It felt like the heart attack cleaved my life in two: the before and the after, the then and the now. Life felt normal on May 31. On June 1, it felt fragile and finite. That knowledge changed me. My idea of who I was and what I was able to do was shaken. My heart felt broken, literally and symbolically.
This was grief and trauma. I recognized these states because I'd been studying how they affect adolescents. I'd never dreamed I'd experience trauma—but who does? Over the next two to three months, the remnants of trauma—the fear that I'd pushed away during the heart attack—would return repeatedly, challenging my efforts to heal and to hope.
My reaction wasn't unusual. Numerous studies have found significantly higher rates of anxiety and depression following a myocardial infarction (heart attack) than in the general population; according to one study, women in all age groups and patients aged 45 to 64 (relatively young for cardiac patients) had an even greater risk. More sobering was that following a heart attack, higher rates of anxiety and depression (disorders that often occur together in a grim two-for-one deal) are linked to higher rates of death. "There are almost two times more deaths in heart patients with depression than without," says Sherry Grace, a professor at Toronto's York University and senior scientist at the University Health Network. "There are higher morbidity rates, higher repeat procedures and higher hospitalizations, so it's nothing to take lightly."
For writer Kathleen Dore, recovering from a heart attack has provided life-changing lessons in compassion and loving kindness.
Yet, on discharge, I had little idea of the emotional challenges I would face. Carolyn Thomas, who writes a blog for women with heart disease (myheartsisters.org), understands: "I'd love to see every cardiologist, nurse or hospital janitor say to every heart patient before discharge: ‘Heart patients often experience feelings of severe emotional upset, anxiety or depression following such a serious diagnosis. We know that these issues are common, treatable and usually temporary. You are not alone.' " But alone was what I felt, and though I had previously loved solitary "me" time, being alone post–heart attack brought on big fear. Rational or not, I thought I might die alone at any moment. To make matters worse, I was physically weak and occasionally had symptoms such as fatigue, nausea, lightheadedness and shortness of breath—all possible side-effects of my new medications; and panic-attack symptoms; and symptoms of a heart attack. How could I tell what was causing them? I became caught in a vicious cycle—the symptoms were real, but then I'd panic and they'd get worse, and then the panic would increase, and so on.
Looking back, I think I had two mild panic attacks; both sent me to the ER. The second happened during our much-anticipated cottage vacation more than two months after the heart attack—it was a turning point.
By then, I had passed a stress test with an encouraging "Perfect" from my cardiologist in mid-July and started a cardiac rehabilitation program that taught me how to exercise safely while recovering. I was at the gym four to five days a week. And an echocardiogram showed no permanent damage to my heart. All this meant I was very lucky and grateful, and could swim to my heart's content, so to speak. We'd enjoyed four days with friends, but then, they left and my husband returned to the city for work. Though tired from socializing, I was determined to enjoy time alone with my son. On that first day, we swam a lot and canoed. I wanted to show him how healthy I was. But I'd overdone it with five days of too much activity.
Kathleen with her 16-year-old son, Aaron Davis, and her husband, Barry Davis.
While watching a movie that evening, I suddenly felt very sick. I didn't say a word, but my son looked over immediately. "Everything OK over there?" he asked. I said I thought I was tired and would go to bed; I actually wanted to go to the hospital. I knew my extreme alertness to any flutter in my chest was hypervigilance, a response common to both cardiac patients and trauma survivors. I thought if I could just relax, I'd feel better.
The next day, I did feel a bit better, and we both enjoyed a lazy day, but as sunset approached, fear did, too, and with it came the heart attack–like anxiety symptoms. It felt irrational to think I'd die right there in front of my barely 16-year-old son, but the thought was enough to send me to the local hospital, which was only 15 minutes away. When a compassionate emergency-room doctor and nurse looked at the ECG and told me my heart was fine, I quietly cried. I was so grateful—for life and for their kindness, because they knew what was happening in my mind and didn't minimize it. I decided right there to act against anxiety. I'd had enough of this roller-coaster ride.
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LIFE LESSONS LEARNED
Back in the city, I realized being disciplined only worked for some aspects of heart health. It got me to the gym, kept me on my medications and helped me eliminate added salt, sugar and the bad fats (trans and saturated) from my diet. These steps are proven to treat and help prevent heart disease, and I had no trouble changing habits to save my life. But none of those changes made me feel better emotionally. Fear and anxiety didn't respond to discipline, but they did dissipate in the emergency room when they were acknowledged as legitimate responses. I'd learned that human kindness soothed my anxiety in seconds, and compassion eliminated my shame—shame that I was clogging up the ER with "fake" heart-attack symptoms, shame that I was frightening my son by being sick, shame for not having the "perfect" recovery, shame for having a heart attack so young in the first place, shame for just being me.
Compassion, I reasoned (and I was surprisingly logical about it), was what my heart needed. It became my own personal prescription. And I knew I'd have to learn to self-administer it.
I started by seeing a psychotherapist I hadn't been to for years. During the first meeting, after I'd shared about the heart attack, he told me in his gentle way that he'd had a heart attack 15 years ago. My jaw dropped. He said that now he rarely thinks about it but follows a healthy lifestyle and trusts his doctor to monitor his cardiac health. As we shared experiences, I felt deeply understood, and grateful to have a fellow cardiac survivor walk with me while I explored my fears. Best of all, I saw what recovery can look like. It looked healthy. That gave me hope.
I also returned to daily meditation. I watched online talks by Sharon Salzberg and Sylvia Boorstein, two American Buddhists. I tried one of Boorstein's guided meditations, and it felt right. The words resonated. The practice was elegantly simple. Settle on the breath and repeat unhurriedly: May I feel safe; may I feel content; may I feel strong; may I live with ease. The idea is you move outward from blessing yourself to someone you love, then toward people who have harmed you and toward all beings.
I'd noticed that the heart attack itself had made me feel kinder, even to strangers. I knew we shared the same ultimate fate. And although accepting that life is finite is frightening, it can also be uniting. Loving-kindness practice has deepened my feeling of love toward others and helped include myself in the circle.
"Self-compassion and loving-kindness practices are very useful in times of anxiety, fear, illness and crisis," says Dr. Ana Bodnar, a Toronto-based registered clinical psychologist who incorporates Buddhist practices into her work. "Loving kindness is seen as the antidote to fear in Buddhist psychology." I didn't know that when I adopted the practice on my own, but I do know I haven't felt true panic since that day in the ER. It feels as though my emotional and physical selves are helping each other heal. Being gentle with myself has paradoxically made my heart stronger than an exercise bike could ever do on its own.
That doesn't mean I'm not signing up for this year's Manulife Heart & Stroke Ride for Heart. I hope I'll be ready for the 50K, but if not, I'll try the 25. It's scheduled for June 3, my one-year anniversary of coming home from the hospital—a good day to celebrate the return of hope.