Communion Of Dreams


The virtuous heart.

I got an object lesson in privilege yesterday. My privilege.

I went in for my first session/assessment for cardiac rehab, following the stent procedure I had two weeks ago. The RN who did my assessment had been a cardiac surgery nurse, and knew her stuff. She also had all of my medical records pertaining to my procedure, and was completely familiar with my overall health and particularly my cardiac health (which, as I have mentioned previously, is actually really good).

We went through what is the normal procedure for such things: I got hooked up to a heart monitor, she checked my blood oxygenation, my blood pressure, my pulse. All were excellent. Then we went through my exercise and dietary habits in pretty thorough detail, discussing the few points where my eating habits deviate from ‘accepted medical recommendations’ (which are actually just ‘outdated medical recommendations’ such as limiting how many eggs you eat in a week to just one or two) according to the forms she had to fill out. All that was routine, and the same material I had been over with at least half a dozen other medical professionals in the last month.

Then we got into discussing just exactly what the condition of my heart now was, and what was recommended to help me improve it, post-procedure. She started out with the model heart on the desk, relating it to how my own chart compared, and complimented me again on the fact that I basically have no other evidence of atherosclerosis or plaque build-up anywhere in my heart other than the one problem section of my RCA that they stented. She said something to the effect of “genetics plays a role, but undoubtedly your regular walking every morning for the last decade has made a huge difference.”

“I’m lucky. I’ve been able to arrange my life so that I could take the time out to do that, for the last dozen years or so,” I said.

She nodded. “A wise choice.”

“Well, not one a lot of people can make. Most people can’t just schedule an hour for daily exercise. Like I said, I’m lucky. Very lucky. ”

“True,” she said. “But I always tell people that whether or not to exercise is a choice they make.”

I paused, considered, then nodded. We went on with the rest of the assessment.

Why did I hesitate? Because in that moment — in her statement of my ‘choice’ — lies a perfect summation of my privilege.

I’m a ‘virtuous patient’, in the eyes of most of the medical community. I’m a nice guy, who is well educated, professional. I exercise regularly, eat (relatively) healthily, don’t smoke at all, and rarely drink to excess. I maintain good social integration, and work to have a happy marriage and a good support network of friends. I even floss more than is probably average.

So, since I do all those things, in their eyes the quirk of a fault that is my kinked coronary artery isn’t really my fault. It’s just a small bit of bad luck. A small bit which can be forgiven, because I make a lot of ‘good’ choices about how I go through life.

But while I have indeed made a number of choices which can be considered to be virtuous, my privilege lies in having been able to make those choices.  Realistically, how many people who are earning minimum wage are able to plan to go walking through their neighborhood (or at the local YMCA or city activity center or mall) every morning? How many people living in a food desert have access to plenty of fresh fruit and vegetables? How many people who are actually obese (I need to lose a good 50 – 60 pounds to be at my ideal weight), would be perceived as being lazy rather than working to maintain good health? How many people have the formal education and time to stay on top of modern medical research and discussion of best practices such that they can discuss the nuances of diet and exercise and the role it plays in cardiac rehabilitation?

I could go on and on. But I’ll refrain. For those who are already concerned with such matters, it isn’t necessary. And for those who seldom or ever consider how privilege affects health, it won’t be sufficient. However, perhaps a few people — you? — will take the opportunity that my privilege has presented to realize that how we judge the choices of others comes mostly from how we perceive them as people.

 

Jim Downey

 

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And then one day you find ten years have got behind you*

Another progress report/follow up to my previous two posts.

As of Thursday, I had passed the week-long “don’t exert yourself” mandate following the cardiac stents installation. There wasn’t any worry about how my heart would do, just that I needed to let the puncture in my femoral artery heal completely.

And as I resumed my normal activities, I realized that things had, indeed, changed. Significantly. For the better.

Which was a little confusing, initially. Because as I had noted, I wasn’t feeling particularly poorly or limited prior to the procedure. In fact, as I said in my previous posts, there were no real indications that I had much of a problem. That was because overall my heart was very strong, and was perfectly capable of dealing with the blood demands of my body in almost everything I had wanted to do. It wasn’t until the very upper end of the stress echocardiogram that there was objective evidence of a possible blockage. The ultrasound imagery showed that the lower part of my heart wasn’t doing much work — the upper 2/3 of the heart did almost everything. That was because of the 95%+ blockage of the lower part of the RCA.

But what has become clear to me in the last few days, as I upped my exercise activity significantly, is that having 2/3 of my heart handle all the work of the whole heart meant that it was working harder all the time, if only just to push enough blood into the lower heart muscle to keep it alive and healthy. And now it no longer needs to do that.

The result is I feel a lot more energetic, and less tired at the end of the day. I feel, already, like I am ten years younger. I suspect that as the virtuous cycle continues to build on itself, that even that situation will improve. Exercising (walking every morning, doing yardwork for 60-90 minutes several times a week) takes less effort, and is more productive — which will help me lose weight and strengthen the muscles in the rest of my body. I recover from those exercise sessions faster, and can get more accomplished overall.

While I didn’t realize it while it was happening, I had been increasingly constrained and drained of energy. That constraint is now largely gone. Amazing what a couple of inches of steel mesh tubing can do in the right place.

 

Jim Downey

*Again, of course.



Everyday miracles.

This is a follow-up to my previous post.

I just sent the following message to my primary care doctor:

Dr M,

I wanted to take a moment and thank you. Your recommendation that I take an echo stress test likely saved my life.

You’ll probably get the cardiac cath results from Dr W, but it may not include an observation he made when he first examined me: that had I come to his practice for a routine exam, presenting the same symptoms I told you, he probably would not have suspected such a serious condition. But the echo stress test clearly demonstrated that there was a major problem. And that the cath procedure showed just how bad it was: 95-99% blockage in the lower part of my RCA.

The seriousness of that condition was masked by my overall/otherwise heart strength. But it could have *very* easily resulted in a serious M.I. or even death. Had you not picked up on the subtle indications we discussed, and taken the prudent step of recommending the echo stress test, my true heart condition may not have been discovered until it was far too late.

So, thank you. Your intelligence, education, and experience probably have added decades to my life.

Why am I sharing this?

Because I got extremely lucky. And I want others to benefit from that luck, and my experience, if possible.

As it turns out, the overall condition of my heart is remarkably good. The strength and efficiency of that muscle is at the very top range for normal healthy people, or at the lower end you’d find in a serious athlete. Furthermore, there are no other indications of atherosclerosis or plaque build-up.

However, due to either a genetic or developmental defect, the lower part of my RCA is badly kinked/convoluted, creating a situation where eddies in the blood circulation form, and allowing what plaque I do have in my system to accumulate, like a sandbar will develop as a result of a bend in a river. In my case, that accumulation had progressed to the point where just the slightest additional clump of plaque could have closed off the artery completely, allowing a part of my heart to die. That’s a classic heart attack, folks.

But the strength of my heart overall was such that it almost completely masked the condition of my RCA. It wasn’t until I was up to about 90% of my heart rate maximum while taking the stress test that indications of the problem surfaced. And even then, just how bad the situation was wasn’t fully known until the cath procedure was done. But when the cardiologist went in and directly observed the condition of my coronary arteries, he saw the problem. And with about 90 minutes of hard work, corrected it with a couple of long cardiac stents.

That was just three days ago. I actually left the hospital the next morning, and have been playing catch-up on things since then.

Think about that: for 90 minutes, a team of medical professionals were playing roto-rooter with the inside of a major artery of my heart. I was completely awake and unsedated through the whole thing. The next day I left the hospital, walking on my own without difficulty. This morning I got in my usual morning walk of a mile. For about another week I have to take it a little easy, to let the puncture site in my femoral artery completely heal, and for the next year I need to take blood thinners, but otherwise I don’t need extraordinary care.

That’s pretty miraculous, in my opinion. One of the everyday miracles which surround us, and which we seldom give due consideration. Stuff that not too long ago would have been considered science fiction.

Anyway, here’s my advice, though you’ve heard it before: pay attention to your body. Don’t succumb to toxic masculinity. Or, if you’re a woman, to the illusion that you’re immune. If you think that something is going on, get it checked out. A little embarrassment at being wrong beats dying.

 

Jim Downey