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the few points where my eating habits deviate from ‘accepted medical recommendations’ (which are actually just ‘outdated medical recommendations’ such as limiting how many eggs you eat in a week to just one or two) according to the forms she had to fill out.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

 



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



Shorter of breath, and one day closer to death.*

“Well, I’d hate for you to have a heart attack,” said my doctor. She was standing against the wall in the small exam room, arms folded in a classic body language message of being skeptical about what I had just said.

* * * * * * *

I wrote this in September 2007:

And as I stood there at the sink, washing the dishes, thinking favorably on the option of having a heart attack, it sunk in that I was done. I mean, I’d been considering that a heart attack might be the best solution to my problems. Yeah, a heart attack. Hell, at 49, I’d probably survive it. It’d come as no surprise to anyone, given the kind of physiological and psychological stress I’m under. No one could blame me for no longer being a care-provider for someone with Alzheimer’s. Hey, it might even get someone to think about noticing my writing, since a tragic character (whether alive or dead) always gets more notice as an artist than does someone who has their life, and their shit, together.

That was a few months before our care-giving journey ended, and Martha Sr passed away. For those who don’t know the story, I was able to re-center, and continue with my role as a care-provider the next day. The following year was spent recovering from the stresses of that role, and getting my shit back together. Because in spite of the perspective indicated in the final sentence of the passage above, my hold on things wasn’t nearly as solid as I thought at the time.

Such is often the case. I think it’s a defense mechanism, with more than a little toxic-masculinity.

* * * * * * *

Did I say toxic-masculinity? Why yes, I did. Such as in this timely article:

Men, in short, are less likely to seek preventive care than women and more likely to put off seeing a doctor when in need of medical care. They also prefer to seek out male doctors, but they tend to underreport pain and injuries to male doctors, thereby compromising the chances of receiving optimal care. And all of this, it should be said, is particularly true among those men who prescribe to masculine ideologies.

“Masculine men tend to not go to the doctor, and when they do, they tend to pick male doctors whom they then underreport their ailments to,” Sanchez said.

* * * * * * *

We recently had a change in our financial situation, thanks to the sale of some property we owned. That, combined with the protections of the ACA which mean you can’t be as easily penalized for a pre-existing condition, made it a lot easier for me to make the decision to having something checked by my doctor.

Howso? Well, our income has never been huge. In fact, it’s always been pretty modest, though in recent years it has gotten better and become more stable. But still, if I had something turn up which required me to miss a significant period of work, or which came with a large insurance co-pay for treatment, we would have lost what progress we had made. And not having to worry about having a documented ‘serious health issue’ mess up my insurance coverage in the future is a huge relief.

In other words, I’m financially stable enough to get sick. Hell of a system, isn’t it?

* * * * * * *

“Well, I’d hate for you to have a heart attack,” said my doctor. She was standing against the wall in the small exam room, arms folded in a classic body language message of being skeptical about what I had just said.

Which was that I was reluctant to go see any medical specialist, since the way the system works it’s almost guaranteed that they would find something which needed ‘treatment’. After all, none of us are walking perfect models of health. And, as the old adage goes, never ask a barber if you need a haircut.

But I nodded my head, sitting there on the exam table.  I had my shirt back on after they had done the in-office EKG, which showed that everything at present was OK, but that there were possible indications of problems in the recent past. And the very mild symptoms I had recently were possibly indicative of a coronary arterial blockage, and it runs in my family on my father’s side. “Yeah, me too. OK, go ahead and book me for a stress test.”

She nodded, we chatted some more, and she left.

I had the stress test last Friday. Got the call with the results yesterday.

No complete blockages. But some constrictions which need to be addressed. So yeah, sometime soon I’ll be seeing a cardiologist, and we’ll discuss options from there.

It’s not good news. But it’s not horrid news. After all, this is one of the most common medical problems around the world. So we’ll see what happens.

But I’m glad that I’m lucky enough to be in a position to have it found, treated (to whatever extent possible), and not worry about it completely ruining our financial situation. And I’m also glad that I’m not quite macho enough to think that I should ignore the classic symptoms, as mild as they were.

 

Jim Downey

*Of course.

PS: if you feel the need to post a political comment related to the ACA … don’t. I’ll just delete it.



And you thought Skynet was scary …

Three billion bank accounts ended on August 29th, 2016. The survivors of the monetary collapse called it Judgment Day. They lived only to face a new nightmare: the War of the Billionaires. The cartel which controlled the money, Ca$hnet, sent several Terminators back through time. Their mission: to leverage the buyout of the remaining political system. The first Terminator had taken the form of Donald Trump, who quickly moved to consolidate power in the Republican Party. The second Terminator was known as Micheal Bloomberg, who sought disruption and control of the Democrats. By the time Terminators Gates, Zuckerberg, and Buffett showed up, the working republic which had struggled for decades was finished.

Then the Billionaires began to war among themselves …

 

Jim Downey

(With apologies to James Cameron.)
[I can’t believe I just said that.]



I hate to say ‘I told you so’, but …

Last week I wrote the following excerpt from St Cybi’s Well:

Megan came out of the bedroom, dressed, but still toweling her hair. “Done. Bathroom’s all yours. What did the BBC have to say?”

Darnell glanced over at the stereo system, then back to her. “The government is asking people to just stay home if they have any indications of illness. There’s talk of a week-long ‘bank holiday’, so people don’t go in to work or school; we’ll probably hear more about that later today. And there have been more anti-immigrant riots in London and some other places. And not just the so-called ‘Tommys’.”

“People are frightened.”

“Yeah, no surprise.” Darnell nodded at the stereo again. “There was also some science reporting about VCS [Viral Cytokine Syndrome, which is the initial name for the spreading illness] itself. Looks like it is caused by a flu strain which is similar to the 1918 virus, but one which is even more virulent.”

Megan paused, her hands lowered. The towel hung limply by her side. “Didn’t that kill millions, world-wide?”

“Yeah.”

“And this looks to be worse?”

“Yeah,” Darnell repeated. “This seems to spread just as easily, but kills faster. Well, kills healthy adults faster – that cytokine storm thing, which is basically the immune system going crazy, creating high fever and complete exhaustion. Anyone who is young, or old, or otherwise has a compromised immune system, can get the flu and there’s a good chance that they’ll develop pneumonia which can kill them in a week or so without proper treatment.”

“But there are treatments for pneumonia.”

“There are. And even some things that can be done for someone with Cytokine Syndrome, if you get to them soon enough.” He sighed. “But how well do you think the health system here or anywhere will be able to handle such a fast-moving epidemic, particularly if health workers are among the most vulnerable group? Do you remember how devastating haemorrhagic fevers like Ebola have been in isolated areas, because health workers are often among the first victims of the disease? And those require direct contact with bodily fluids … this flu is airborne.”

Today, from NPR’s coverage of a new global health risk report:

Sands says the Ebola outbreak of 2014-15 was a wake-up call. It showed that the world is not prepared to deal with a rapidly spreading disease.

“The alerts were raised too slowly. Local health systems were quickly overwhelmed. The international response was slow and clumsy,” he says. “We lacked many of the medical products we needed, either therapeutic or vaccination or indeed even effective diagnostics.”

* * *

If an outbreak like the Spanish flu of 1918, which killed more than 50 million, were to happen today, the economic damage would be in the trillions of dollars. And the psychological toll could make things worse. Sands says news of a deadly, highly contagious pathogen could prompt people all over the world to panic.

“We are much more connected not just physically but by media nowadays,” he says. “Hearing about and seeing infectious disease outbreaks on TV can spread fear even more rapidly than the disease itself. That in turn can grow changes in behavior and policy which magnify the economic impact.”

*sigh*

 

Jim Downey



Writing is a process of discovery …

It’s an annual ritual. Salvaging what I can of the deer netting, pulling up the long lengths of rebar which pin the support towers in place, packing up chickenwire. While it wasn’t as good a year as it could have been, it was a better year than I thought it would be, and I hope that the next year to come will be even better yet.

* * *

This is good. Relevant excerpt:

You know what writers feel like when they’re not writing?

Guilty. Incredibly guilty.

Miserable.

They don’t need anyone to come by and kick them while they’re lying there, writhing in the seventh circle of hell, telling them, “Oh, remember those ten books and multiple short stories you wrote? Well, sorry, you stopped writing for a year so none of that counts. You’re no longer a writer.”

* * *

We live in a disposable world. Disposable electronics (when was the last time you tried to fix a tablet, laptop, or television?). Disposable water bottles. Disposable people.

Last week, I did this:

20151104_095415

20151104_110513

That is, I detached the deer netting I had put on my tomato towers, folded it up, secured it, and stowed it away to reuse next year.

This, actually, was a stupid thing to do. That’s about $20 bucks of deer netting. It took me about 90 minutes to salvage it. The amount of my time (in terms of billable hours) which went into doing that is literally 10x the value of the netting I saved. Stupid.

I don’t mention this to tout how environmental, enlightened, or noble I am. None of those things explains why I did what I did.

Well, OK, I try to be environmentally conscious. But I’m not fanatic about it.

No, I did that because in this instance it wasn’t about economics. Gardening, in purely economic terms, is fairly dumb. I don’t do it to save money. I do it to save my sanity.

* * *

By nature and profession, I save old things. It’s just part of my life. And I’m good at it.

Now, that deer netting above isn’t old, or valuable. And how does spending 90 minutes on a weekday morning fiddling around with rusty twist ties and uncooperative lightweight netting save my sanity?

Well, because it gives me time to think.

And thinking is how I spend the vast majority of my time & energy writing.

* * *

It’s an annual ritual. Salvaging what I can of the deer netting, pulling up the long lengths of rebar which pin the support towers in place, packing up chickenwire. While it wasn’t as good a year as it could have been, it was a better year than I thought it would be, and I hope that the next year to come will be even better yet.

Yeah, I’m talking about my garden. But I’m also talking about St Cybi’s Well.

I should have been finished with the book two years ago, according to my Kickstarter plan and promises. Hell, even at that point, I thought I would be done with the manuscript early in 2013.

But writing is a process of discovery. Self discovery. I knew this, but having it driven home during the last couple of years has been … sobering.

Other than periods when I’ve struggled to sort out some particular issue with the book, I haven’t suffered the writer’s block which J.H. Moncrieff discusses in her blog post linked above. But upon occasion my writing has made me feel miserable. And guilty.

Part of that is just a sense of failure because I grossly misunderstood what it was going to take to finish this book. Yeah, I’m talking about the time & energy commitment. But I’m also talking about the psychological challenge of writing a book about the onset of the end of the world we know. Thinking through the details of that takes a toll.

Recently I asked an old friend to read the book so far, and give me feedback. As I told him, I have been so deep in this thing that I had lost my bearings — I could no longer tell whether the thing was any good or not. And that was true.

But the deeper truth was that I could no longer tell whether I was any good or not as a writer.

He says it is. We’ll see if I am.

 

Jim Downey

 




Follow

Get every new post delivered to your Inbox.

Join 353 other followers