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the few points where my eating habits deviate from ‘accepted medical recommendations’ (which are actually just ‘outdated medical recommendations’ such as limiting how many eggs you eat in a week to just one or two) according to the forms she had to fill out.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



Progress report and excerpt.

As I noted I probably would a little over a week ago, I’ve just wrapped up work on Chapter Fourteen: Llangelynnin of St Cybi’s Well. It’s a long chapter — twice as long as most of the chapters are — and a pivotal one, since it includes the first instance of the faith healing/psychic abilities as referenced in Communion of Dreams. Here’s a critical passage, which will resonate for those who have read CoD already, where Darnell Sidwell’s sister Megan first encounters the healing energy just as the fire-flu is becoming a pandemic:

She stepped into the small room of the well, her arms opening wide, her face lifting to the heavens. It was indeed as though she were drinking in the light he still saw there, or perhaps like she was drinking in rain as it fell. She stood thus for a long minute, perhaps two. Then slowly she knelt before the opening of the well, her hands coming together and plunging into the cold, still water. The light filling the small space seemed to swirl around, coalescing into her cupped hands as she raised them out of Celynin’s Well.

Darnell stepped inside the small roofless room, bending to help Megan stand. As she did, he looked down and saw that she had water in her hands, but not filling them. Rather, it was water as he knew it from his time in space: a slowly pulsing, shimmering sphere. It seemed to float just above the cradle made by her hands.

 

That brings me to a total of approximately 95,000 words. I still have one short transitional ‘interlude’, then three named chapters, then a brief ‘coda’, and the book will be finished. Probably another 25,000 – 30,000 words. Which will put it right at about the total length of Communion of Dreams.

What’s interesting for me is that this chapter has proven to be a pivotal one in another way: it feels now like I really am on the home stretch of this project. Just finishing this chapter has changed the whole creative energy for me. There’s still a lot of work to do, but it no longer feels … daunting.

We’ll see.

 

Jim Downey



Bad medieval book manners.

Oh, this is just completely delightful! Here’s the intro, but you definitely want to go read the whole thing:

Bad medieval book manners. Part 1

Handle with care. Those who have worked with manuscripts in libraries and archives know that the casual relationship between the reader and the printed book stops at the door and a special covenant enters into force once we approach bound parchment (ok, some paper, too, mais j’en passe). ‘Be careful with that’, ‘no flash, please’, ‘don’t open it like that’, ‘use a book-rest, don’t you see you’re hurting it’ are ululations typical of a manuscript room. Needless to say, things were not quite like that in the long Middle Ages. Those manuscripts that have made it through fire and water, deliberate destruction or noxious negligence usually tell us stories of a book culture where the reader and the book were only slowly coming into a friendly bond. Historians have been telling us about book damage arising from negligence, weakness or deliberate fault, but wouldn’t it be great to hear the story from a contemporary who’s lobbied à pleins poumons for the dignity and sacrality of books? This man was Richard de Bury (1287-1345), bishop of Durham, Lord Chancellor, Treasurer and Privy Seal and author of the ‘Philobiblon’, a work that is as fascinating as it has been neglected by modern historians. It is Richard’s manifesto for bibliophilia or the love of books. In it, books take central stage, speaking to us, often through personification, about their ordeals, rewards and achievements. It is, for me, the greatest confession of faith of a bibliophile.

And part 2 is here: Bad medieval book manners. Part 2

Go read and enjoy!

(And yes, I have seen every such type of damage in my conservation practice.)

 

Jim Downey



Having artists and writers involved in space research and planning? What will they think of next?

A good friend (and fan of Communion of Dreams), passed along an article which made me chuckle. Here’s an excerpt:

Earlier this month, the White House’s Office of Science and Technology assembled a strange gathering: scientists, artists, engineers, and policy-makers, for a workshop designed to imagine how humanity could settle the solar system.

The workshop, held in early February, was titled Homesteading in Space – Inspiring the Nation through Science Fiction, with the express purpose of imagining how manned space efforts can take us to our neighboring planets, not just for a short visit, but for longer durations.

And she added this comment with the link: “The group gathered reminds me a lot of your group from COD.

Ayup. Here’s the relevant passage from Chapter 1:

“I’ve had my expert do a preliminary search through the old NASA archives. I recalled that they had protocols for dealing with such possible situations, and I doubt that anyone else has really thought much about it since the turn of the century.

“In addition to Don’s field team, the preliminary search suggests that another component should be theoretical, a mix of disciplines so that we can get as broad a spectrum of experience and mind-set as possible. Probably we should have an expert in computer technology. A cultural anthropologist. Someone with a background in game theory and communication strategy. An artist or two. We’ll see if a more thorough survey of the NASA material has any good suggestions beyond that. I’ll get to work identifying appropriate individuals.”

And here’s a discussion the chosen artist (Duc Ng) has with the team leader in Chapter 4 about why it’s a good idea to have such non-technical people included in any such group:

“Why do you have an artist on this team?” asked Ng.

“It was a recommended protocol in some of the old NASA guidelines. Artists have a broader perceptual framework, aren’t necessarily limited by ‘logical possibilities’.”

“And what does that mean to you?” Ng leaned across the table. “That I’m just another kind of sensor you can use? Think about it. Those folks at NASA may have had something else in mind.”

Jon paused with his breakfast. “Go on.”

“How about if intuition and creative insight are the guiding principles of the culture that created the artifact? Not just a technological culture with its unique aesthetic sense, but a culture of intuitives who eventually produced sufficient technology to create this thing. A culture just the obverse of our own: largely artistic, with a secondary interest in technology.”

“With only a secondary interest in technology, how could they ever become a space-faring race?”

Ng shrugged. “Who knows how long they had been at it? Their culture may be tens of thousands of years old. Even a very modest rate of technological development could have led them into space eventually.” He paused, sighed. “Look, my point is that we can’t get stuck just looking for a technological explanation. The very reason that artifact was created, sent here or left here, may have had nothing to do with anything scientific or what we would consider logical. It may have had as much as anything to do with the passions, the dreams of the creators.”

Dreams which may take us to the stars.

 

Jim Downey

With thanks to Jane for the link and observation!




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