For a decade and a half I’ve tapped myself three times before leaving the house. One tap to locate the phone, another tap for my keys, and a third tap for the money clip that holds my relevant plastic and identification.
But for the last three months there has been a fourth tap. It doesn’t belong with the other three. If you were given a grid of four pictures and asked to circle which did not belong, every single one of you would circle my fourth tap.
The fourth tap reminds me that I am sick. The fourth tape reminds me I am safe. There are times I panic when that fourth tap comes up empty, only to realize I was carrying the goods, but their small vessel couldn’t be felt by numbed fingers. It’s a little bottle, tiny really, and it holds several dozen chalky white pills.
My fourth tap finds my bottle of nitroglycerin.
My fourth tap exists because I have heart disease. My fourth tap is here because three years after my coronary artery bypass graft surgery, I had a setback and my heart started failing. My fourth tap reminds me that at any moment of any day I could be gone.
“I want you to carry these with you for the near future,” my nurse practitioner told me. “You have chest pains, you take one. You feel you need to take a second one, call 911, then take the second one, and I’ll meet you at the hospital.”
I can hear her say those words to me every time I slide that little bottle into my pocket. I hope I never have to take them, but the odds are not in my favor.
After having three arteries blocked a few months after my 40th birthday and with subsequent open heart surgery that fixed two of those arteries, I committed to changing my ways.
I used to drink every night, I quit cold turkey. I loved cigars in a Mark Twain way, I quit those, colder turkey. I gave up meat and transitioned to a whole food vegan diet, and am still eating that way, tofu turkey. I took up trailing running and lost 50 pounds. I was doing everything that everyone told me I should be doing.
Then in November of this past year I felt something in my chest. A slight tugging near my heart that made me nervous enough to go see my cardiologist. I never saw my doctor, after answering a few questions, combined with my history I was sent straight to the emergency department. I failed a nuclear stress test a week later and was sent for a cardiac catheterization that yielded a mixed review. The good news was the bypasses were clear, but according to my nurse, when you have what I have, it’s never just good news. The bad news was that there were two new blockages forming, and the really bad news was that my heart function was dangerously low.
Medical folks use something called an ejection fraction (EF) which measures how well your ventricles, usually the left, are pumping blood to your body with each heartbeat. A low EF is a sign of heart failure. After my heart surgery three years ago my EF hovered around 50%. That is on the low side (normal is between 55% and 70%) but considering what my heart had just gone through it was encouraging. Three years later, despite my best efforts my EF had fallen to 36%, and that was when my nurse practitioner got nervous (her words) and called me late one Friday night and reiterated her nitroglycerin instructions.
This is where knowing the difference between a heart attack and cardiac arrest comes in handy. I had already experienced what a heart attack is like, several times in fact, and while they are no walk in the park I managed to avoid cardiac arrest, so far. An EF of 35% or less puts people at a much larger risk for cardiac arrest, and cardiac arrest is the difference between meeting your medical team in a waiting room versus the morgue.
And just because my heart was behaving like a grumpy old man that didn’t mean it couldn’t learn some new tricks. You last breath is just that, the end, but until then it seems to me that the next first step is to breathe.
When my wife and I were living in the neonatal intensive care unit with our little guy, I asked a friend of mine, one that was living through his son’s own medical nightmare, what he did when things seemed out of control.
“Breathe deeply Kev, count back from 100, if you lose your place, start again.”
My heart got a bit lost last year, and it was time to take a deep breath and start again, because in the absence of hope there is only darkness. The heart needs the light that gets in through the cracks and shines strong on our backs.
As we head into Spring my hope is we can all move forward and arrive in the space that best suits our minds, bodies, and of course, our hearts. It seems like a perfect time to start again.