heart

This summer, on the first Friday of July, just before my birthday, I suffered a Spontaneous Coronary Artery Dissection (“SCAD”). This is a rare thing and it is as awful as it sounds - an artery in my heart tore, and the torn flap caused a blockage, which caused a heart attack. My heart is perfectly healthy in the normal ways and I have no risk factors for the usual kind of heart attack. My cholesterol is fine and I’ve always had low-ish blood pressure. I have no family history of this sort of thing. This is hard to write about, perhaps because it was such a huge thing for me and I’m still close enough that I don’t see it all that clearly, or perhaps because heart attacks are a little boring, technical and dull. Or because I don’t want this to be a story that belongs to me.

In the summers, we work at a summer camp so our kids can attend, and I had just walked up from our camper where we stay into the camp main office. The always-chill camp nurse, Jenn, was standing outside of the office, and I said “hmm. I feel really weird.” She told me to go inside and sit down for a second. I had a seat, and my chest suddenly felt like a band was squeezing tightly all around me, and the tops of my shoulders hurt and felt hot. It felt like I had put on a tiny, terrible sports bra, and the pain would not ease up no matter how I moved my body. I kept saying “I’m so sorry, y’all - I just need to calm myself down!” and then I laid myself right down on the gross dirty rug in the camp office. I’d never do this in my right mind - that floor is foul, and laying on it is very public and ridiculous. Stephen was not on campus, so my camp friend Heather rushed me to the hospital where things at first looked fine. Heather is wonderful and bossy - this is always handy at a camp, but never so much as when she raced me through traffic, windows down, hollering at cars to move out of our way.

I’d been to this ER as a camp medical wife so many times - campers w sprains, rashes, bug bites. We’d wait for an eternity in the small lobby trying hard not to watch the news on the big TVs. This time, as soon as I came in, I was rushed back to a room. Every test came back normal at first - EKG, CT, blood pressure and pulse, all normal. After about thirty minutes of chest pain and some anxiety and pain meds in the IV, I started to feel better.

There’s a cardiac marker in the blood called troponin, and they drew my blood to check for it, as it indicates heart damage. I was assured that this was super unlikely, and that as soon as it was checked twice, I’d be heading home. My first troponin was normal. We waited an hour for the second, and started getting our stuff together to go home. Stephen was working his telemed job and had been chatting in the chair in the ER, and I was shaking my head at myself and feeling ashamed that I’d taken up everyone’s time, particularly as it was opening day for the new camp session. When the poor teen-aged PA came in to tell me that my second troponin levels had skyrocketed, and that I had, in fact, suffered a heart attack, I nearly jumped off of the table. I put my hand out and told him “no, wait - shh! Stop talking! Stop talking for a minute!” My silly, drama-queen visit to the ER had turned into a life-changing event. I hope that I won’t, but I think I’ll remember that moment for the rest of my life. I remember the way the PA leaned on the wall, his long-sleeved tee under his blue scrubs, his blue eyes.

My heart attack happened out of the blue with no warnings (“spontaneous”) and I want to remind you that you must go to the hospital if you have sudden chest pains, shortness of breath, or other strange symptoms. No one made fun of me or told me I was ridiculous even when we suspected heartburn and panic attack. I was intensely tired the day before and thought perhaps I was catching a camp virus, but I had no other red flags. My chest pains, once the heart attack began, were really intense and I wasn’t easily able to ignore them. If they happen to you or to anyone around you, don’t brush it off - go to the ER. I was embarrassed and thought I was absolutely the silliest person ever, and I’m so glad that others around me didn’t discount my pain and moved quickly to get me help. I’m so glad the ER initiated a heart attack protocol even as it looked to be very unlikely, which saved my heart from further damage. I’m still not super clear on how heart attacks work, but if you ignore them, even if you feel better, bad things can happen.

After the troponin level came back high, the air in the room changed and things began to feel quite serious. I was transferred by ambulance (no lights - I asked but they said no) to a bigger hospital in a bigger town for care on the cardiac unit. I had loads of tests and a heart cath, where they went in through an artery in my arm to look at my heart. The heart cath was fascinating, something sort of Pixar-ish or like a video game (is this from the drugs perhaps?), with huge screens overhead on which I could see the veins of the heart and the small dead bit at the end of my Obtuse Marginal Artery. I was somewhat of a spectacle during my stay in the cardiac unit, as this is so rare that many of the hospital staff hadn’t seen it before and wanted to have a look and tell me how lucky I am to be alive. While I’m glad I’m alive, I don’t feel particularly lucky, because I think that having a rare heart condition is not at all good luck, and that even if my survival odds are high, they feel much lower to me now than they felt in June. I stayed in the Asheville hospital for several days, talking nonsense in my drugged state to Stephen and my dearest childhood friend, Sam, who came to stay with me as I was far from family and slept in a horrible hospital chair to give Stephen a break.

In people like me who are otherwise heart healthy with no plaque in the arteries, a SCAD is usually caused by a weakness in the artery walls. Though no one is really certain as studies are small and limited, intense or long-term stress, heavy lifting or exercise, hormones, and having had many pregnancies seem to put one at heightened risk. Most likely, those of us with SCAD have many weak arteries in our bodies, making us prone to recurrent heart attacks, dissections, aneurysms, and, as the studies say, “sudden cardiac death”. As this condition is rare, we aren’t sure what this could like for me long-term, but the prognosis does seem more good than bad overall. I take more pills now than your grandma, but I’m getting used to them and hope they’ll prove protective. I take blood thinners and blood pressure medication to keep things easy on my weak arteries. This makes me super bruised up and lazy and tired, but also, alive. I have some life-long lifting, exercise, and medication restrictions and, worst of all, I can’t ride roller coasters, which makes me sad and angry. I’m told to keep my stress levels quite low so as not to irritate my heart, so I don’t want to get too worked up about the roller coasters. I guess I’ll eat a lot of soft pretzels at Disney while everyone else has all the fun.

It’s fine.

I'm told to expect about a year of more intense recovery and that this sort of thing frequently does recur, but in some people, it’s a one time misery. I certainly have less bandwidth now than I did before, even three months out, so send me all your best BBC recommendations and books to read. I need to reduce my stress, which means I will be limiting murder mysteries, so think more Hallmark. I think I may also start wearing “heart attack survivor” tees to burger joints while I sip huge milkshakes, and make lots of jokes about heart attacks that I’m too tired to have come up with just yet. Send suggested jokes.

Right after this happened, I was so tired (“serious as a heart attack” has taken on new meaning) that I couldn’t think much, but as I start to regain some energy, I’m wondering a lot about this whole system wherein we are blithely born not knowing at all that one day we will have our last birthday. How strange and unwelcome! I’m not sure why this should shift my perspective on mortality so dramatically - it was always true that life is short; I have had losses enough to know this perhaps even more than most. Why am I wasting so much time? (See above request for Hallmark tv shows.) I have been firmly propelled into middle age - I am not, not now, full of dreams for the future (a trip to Greece! New shows to play!) but rather I feel I’ve reached the top of the hill and begin to slowly walk down. My gratefulness to be alive mixes poorly with my low energy levels - I want very much to seize the day, but I have to save all my energy for afternoon carpool, and there’s nothing left over for seizing stuff.

My anti-anxiety medicine is doing wonders, as the first three months have been intensely frightening. When I visited my sister in New Orleans, she had to call off of work to escort me on a tour of the city's ERs, because I felt horrible and couldn’t figure why. Poor Stephen has accompanied me on long walks at all hours of the night and day and helped me through panic attacks, which I’d never experienced before. I tried some meditations specifically for panic attacks in these moments and found that several started with “you are ok. You are not having a heart attack” and I really cannot tell the symptoms of panic from the symptoms of heart attack - they overlap entirely. Numb arms, squeezing chest, shortness of breath, who can tell? I’ve spent several nights pacing the ER parking lot, wondering if I ought to go in. Because chest pain is common after SCAD, I slept one particularly awful night in the ER car lot. My heart feels like a nefarious jack-in-the box. I couldn’t drive for a while, but now that I can, I’m nervous in cars and nervous in stores, and I know where to find the defibrillator at church and at Target, and my mind races everywhere I go, trying to make a plan for if I collapse or start to have pain. This has changed so much for us. I wonder if I’ll be able to travel again, to dance at weddings (I have to monitor my heart rate and keep it low), to wake up and not think of myself as about to fall over the edge. I’m always wondering when I’ll have another SCAD or a different kind of dissection, and how I’ll know what’s happening, how I’ll survive it, how the kids will manage. I cannot imagine how I might do this twice.

Things are getting a little better each day, though. I don’t feel like my old self again yet, but it feels possible now that I will. I know that what left isn’t what will return, and that normal will be new and different, and me, too. I’ll close this with a depressing and dark poem I wrote in the early days - I do feel a small bit better about it all now. Not to worry.

Prayers, good wishes, and good vibes for no recurrence most welcome. It was a terrible time and I’d rather not do it again. The kids are doing quite well and have been very sweet about everything. They were happily occupied at camp when this happened, and I think that helped them process things more easily. And I have a fail proof line to use with them now when they groan about putting laundry away or when they fail to pick up their enormously heavy backpacks. “Do you really want me to pick that up for you? I’ve had a heart attack.”

Dark Sad Heart Attack Poem Sorry

How many people die of a heart attack

How many women die each day

Rates age 43 heart attack survival

Heart attack + roller coasters can I ride

Mortality after SCAD recurrence age 43

Hair falling out after heart attack normal

Last Friday morning at 11

I sat down in the office chair

And had a heart attack.

It feels important for me to tell you

That I had done everything right

That my blood pressure was perfect

That my cholesterol was perfect

That my veins were not full of sludge

That I am not fat

That I don’t eat fast food

That I never drink soda

That it isn’t my fault.

I held my hands linked over my chest

like an old woman on a soap opera

Like a tv-person having a heart attack.

I said “I think I’m just panicking.

I need to sit down.

I’m so sorry.

I need to calm myself down.”

A small, wavy hair artery

died at the end of its thread

Because my vasculature is weak

All throughout my body

and I never knew it.

Brain, kidneys, carotid, heart.

Any one could fizzle out or explode now

At any time

Spontaneously.

For the first time

I see myself as glass.

I am so lucky, everyone says.