by Tilda Shalof
I look at Ivan. He doesn’t entirely get it – maybe because he’s never felt this himself? He is all concern and caring, with a dash of impatience. I feel for him; it can’t be easy being around a depressed person. It’s, well, depressing. Thankfully, it doesn’t have that effect on him. Over our years together, he’s seen me through many ups and downs – upheavals that had nothing to do with weather, success or failure, work, love, or stress. I hardly understand it myself. Is depression created in the mind by destructive thought patterns? A personal weakness? A learned behaviour? A genetic inheritance, imprinted in my DNA with an identifiable marker? Produced by faulty biochemistry? A spiritual quest? A moral failure? All of the above?
Ivan reminds me of what I have to be grateful for (it’s a long list), to be more positive (I will try), and to keep moving, walking every day (I am.).
“Maybe you should see your doctor,” he says. It’s a comment that surprises me because Ivan doesn’t usually give much credence to a problem like mine, a problem that looks like if you only tried harder and exerted more effort and self-discipline, you could shake it off and pull yourself together. If only this was a garden-variety sadness I could talk myself out of, or exert will power over, I would, but I’ve come to the conclusion that I can’t. It’s beyond me; this much I now know.
15
CHANGE OF HEART
“The most important thing is for you to get started on a cardiac rehabilitation program,” Dr. Drobac says at my six-week checkup. In cardiac rehab classes, he explains, I will learn about a healthy lifestyle, how to reduce cardiac risk factors, and will have the opportunity to start exercising in a monitored, supervised environment.
Bo – rrrrringgg. Pshaw on cardiac rehab! Probably a bunch of old geezers in baggy sweatpants, attached to electrodes, strolling on treadmills. More preoccupation with my heart. I want to put my heart problem behind me, throw off patienthood, and get back to being normal and light-hearted again.
Dr. Drobac recommends a particular program that is for women only. “Women have different needs when it comes to cardiac rehabilitation.”
“Like what?”
“For one thing, women have more stress, especially if they work outside the home. They are looking after everyone else and don’t always take care of themselves.”
You got that right – it describes a lot of women I know.
Together we look at my ECG and echocardiogram results. He admires Dr. David’s beautiful handiwork and points out the significant improvements in my heart function. “You have a healthy heart now, Tilda,” he says, then sits down to work out some fateful arithmetic.
“Well, let’s see, how old are you?” He looks at the year of my birth in my chart. “You’re almost fifty, so let’s say fifty. You have a tissue valve and let’s say you get fifteen years out of it and in all likelihood you will. That takes you to sixty-five, then you can get a new valve and most likely have it inserted minimally invasive, by angiogram.” He reminds me about the single-dose blood-thinner tablet in development that simplifies anticoagulation. “It will be available by then and at that time you may opt instead for the mechanical valve, which will give you another twenty years, taking you to eighty-five or ninety. If you keep making healthy choices and take good care of yourself, you could live to a hundred.”
I like this hopeful math, but so much can happen. I’ve never taken anything for granted, much less now. He reminds me about taking antibiotics before dental work to prevent bacterial endocarditis, gives me the go-ahead to drive, discontinues the beta blocker because it is no longer needed (and agrees it may have caused the nightmares), but does want me to continue with the daily two tablets of low-dose aspirin, something he recommends for most women and men in my age group.
“How are you feeling?” He looks at me closely. “Depression is common after cardiac surgery,” he says, opening a door I refuse to enter, still clinging to the hope that I can fix myself by myself. As for the cardiac rehab classes, I turn them down, too.
[It’s time for another Public Service Announcement: Don’t do as I did, folks! A recent study has shown that patients who participate in cardiac rehabilitation cut their risk of death by 50 per cent due to changes in diet, exercise, and lifestyle.]
“What did the doctor say?” Ivan asks when I return to the waiting room.
“That my heart is working well and I should come back in six months.”
Ivan thinks this is wonderful news and of course it is, but he expects me to act like my old happy self so I fake it with a big smile. Maybe if I give him the “right” answers, too, like I did with the automated telephone questions, he’ll leave me alone. The moment we get home, I am wiped out and head straight for the recliner.
For the next few days I keep company with my chubby brides, pageant-bound tots and their obnoxious stage mothers, and the glamorous L.A. tattoo artist and her bad-ass entourage. Today on Dr. Phil, three sisters natter at one another about the distribution of their aunt’s will. “It’s a choice,” Dr. Phil says to them. “You can choose to put energy into feeling bad, into perpetuating all of this anger and negativity. Or you can stop it right now, in this very moment.”
Maybe that’s my problem. I have to stop the negativity – but how?
As the day wears on, stopping the negativity becomes even harder. I am sitting in my office, staring at my books, when I begin to feel my hearting thumping. It’s pounding. I take my pulse. Eighty at rest. Too high. Something is wrong. The worst possibilities crowd my mind. I take my pulse again. Eighty-four now. I pick up the phone and call Dr. Morse, who opens up an appointment for me right away.
“It looks – and sounds – like you’re having an anxiety attack,” she says the minute I walk in but examines me thoroughly to rule out any cardiac problems. We chat briefly and she asks me how I’m feeling, but all I tell her is “fine.” Calm and reassuring, she advises me to come back tomorrow, but after seeing her, I feel better. When I get home, I call to cancel the appointment.
“I try to see what the bride sees,” says a TV-wedding consultant. “I had a bride who chose a strapless dress with a sweetheart neckline and mermaid skirt and it looked beautiful on her at the first fitting, but now she says, ‘It’s too much dress. It makes my head look tiny.’ She wanted it taken in all over. I didn’t agree, but I supported her decision because my job is to see things as she does. I am there to help the bride get what she wants, to help her have her perfect wedding and feel beautiful on her special day.”
Now that’s what I would call “bride-centred care”! Nurses have the exact same challenge – to see the patient’s perspective. Only then can we offer what is needed, not what we think is needed. Problem is, I can’t offer that same empathy to myself right now.
I flip to another channel, where a perky self-help guru advises, “Hug yourself. Smile, even when you don’t feel like it. Make a list of things that cheer you up.”
I try out these things, but they feel artificial and contrived. Even Max senses the ruse. “What’s wrong, Mom?” After school he comes over to sit beside me on the couch.
“Nothing,” I say, but I can’t fool him.
He tries to cajole me, picking up his old riff. “It looks like someone got up on the wrong side of Oprah’s couch.”
Determined to get a reaction, he tries again. “It looks like someone got up on the wrong side of the bestseller list!”
“Still working on your routine?” I ask with a weary half-smile. “It’s funny, sweetheart,” I say but can’t manage a genuine laugh or smile.
“Tough crowd,” he mutters as he goes up to his room.
–
Today I was reminded of the grandiose pledge I made to myself before my surgery to one day work toward better health care for all. But on the radio I heard a patient tell about how having to wait too long for radiation and chemotherapy caused her cancer to spread. She was forced to go to the United States for treatment there and feels the Canadian health care system has let her down. I can’t im
agine the terror of not being able to get life – saving treatment. I can’t bear the thought of people not receiving the health care they need. It has never happened to me or any patient in my care, but the problem of inadequate resources and access to health care is real for some. But too often, the public evaluates the entire health care system on the basis of their singular experience, on how well their own needs were met. When patients say, “This is a good hospital,” they mean, they got better here, the doctor had good bedside manner, the nurses were nice, and they didn’t have to wait too long to be seen. How can we get beyond caring exclusively about our personal needs and move toward a consideration of what’s best for the kind of society we want to live in? Besides, why can’t everyone have great health care?
We can fix the problems: improve efficiency, ensure access, contain costs, reduce overcrowding in ERS, and improve wait times. New and expanded roles for nurses and other health care professionals could meet more peoples’ needs. More nurses – especially in the community and in people’s homes – would reduce costly hospital stays. Nursing isn’t the way to solve the problems, but it would go a long way toward a solution. Overall, we have a good thing happening here, but sometimes it feels like I’m the only one who thinks that way.
But even I would have had difficulty navigating the system if I didn’t know it as well as I do or didn’t have a family doctor to guide me through it. I would not have been able to interpret information and would have been even more anxious about the hospital and the tests I had to undergo. Important details might have been missed. Maybe patients need someone like a wedding consultant to plan their hospital “event” – someone to listen to your concerns, field questions, quell jitters, make referrals, coordinate appointments, keep you on track. Being a patient is a big job to tackle all by yourself.
Thinking about the problems of health care have put me into deeper gloom and doom. Why don’t more nurses stand up to protect and speak out for Medicare in this country? Nurses are so close to the reality of peoples’ lives and know the effects of poverty and inequity on health. We should be the loudest advocates of all for quality health care for everyone.
I sit, mired in my thoughts, fretting over the health of the health care system. The kids are busy, getting ready for hockey practice.
“What’s wrong, Mom?” Max asks, coming over to check on me before they leave.
“I’m worried about the health care system.”
He pats my back. “Don’t worry, bubbelah, the health care system can take care of itself without you for a while.”
The next day I go back to see Dr. Morse, who suggests I take an antidepressant.
We all have our own mythologies, the stories we tell ourselves to get through hard times. My story is that I should be strong enough to overcome depression with my own willpower and determination, that relying on drugs is the easy way out. Yet, I have never passed a similar judgment on a patient. I have great sympathy – even affinity – for patients with mental illness. It’s just another example of the perplexing dichotomy between how I care for my patients and how I care for myself.
“Why not take meds?” a friend says. “Everyone’s on them these days. The stock market is a disaster. There’s a financial crisis. It’s enough to make anyone depressed.”
That reasoning I don’t get. Antidepressants are for depression, not life’s challenges. For me, the only thing I ever found depressing was depression. Sure, stress and real problems can lead to depression, but that’s not my situation. Are medications the only way to way to feel better? All I know is that I can’t fix this by myself.
I’m listening to a cryptic telephone message from Janet: “Meet us at the farm. Be there or be square.”
What farm? Where? Why a farm, of all places?
“No questions,” Janet goes on, anticipating my thoughts. She only gives me directions and the admonishment, “Just show up.”
Janet, Jasna, Stephanie, Kate, and Edna are waiting for me, greeting me at the entrance to Pine Farms with its rolling hills, trees in autumn colours, a pick-your-own apple orchard, and a country kitchen serving homemade soups and pies. They present me with a huge bouquet of flowers and I accept it with a deep bow, like I’d just performed a recital at Carnegie Hall. How women excel at making moments special.
“Lots more people wanted to come,” says Janet, “but I said no. Too many cooks spoil the brew.”
“There you go again,” Stephanie says with a chuckle, “messing with these classic sayings.”
“It’s too many cooks spoil the broth,” I correct Janet.
“Maybe your people made broth – chicken soup,” she says with a flounce, her bright blue eyes twinkling. “Mine made brew. My grandfather had a booming business during Prohibition. He cooked hootch on a homemade still.”
I try to laugh but can’t pull it off. I hope they can’t tell I’m not in my usual good spirits and don’t enjoy the silly banter as I usually do.
Before we leave, Janet pulls me aside. “What’s wrong? You’re not yourself.”
Of course I tell her.
“Take the meds,” she urges me. “Why the hell not? Do whatever it takes to feel better. What’s your problem? You wouldn’t treat a patient like this. Depression requires treatment as much as a bone fracture or a thyroid condition. You wouldn’t neglect those conditions. Why the double standard?”
And so, because I adore her as a friend and respect her as a professional – and in my heart, I know she’s right – I take Janet’s advice.
They say it takes a few weeks for these pills to kick in, but on the way home I fill the prescription, take one, and within hours I feel an effect. A shift. My spirits have lifted. By the next day, I can smile, move my body with ease. Life is back into perspective; it’s manageable. My old confidence is back.
Robyn hears it immediately on the phone. “You sound better, Til. It’s you again.”
“When are you coming back to work?” the nurses had asked me at lunch and for the first time since my surgery, I can see myself returning to the hospital, being a nurse again. Is it friendship, family, meds, or simply “tincture of time” that has healed me?
I even hunt down the Cardiac Patient Handbook that I’d left under a pile of unread newspapers and take another look:
“Some patients find their sex drive is low during the recovery period after cardiac surgery,”
That’s rich. How about nonexistent? I thought upon reading that when I came home from the hospital, but now, ten weeks later … I feel differently. I read on: “If you are able to climb two flights of stairs without fatigue or shortness of breath, you may resume sexual intercourse … the best positions are on your side or with the person who has had surgery on the bottom …” Mmm … Sounds doable. I look at Ivan and think it over.
At dinner, we eat leftover chicken soup. Max watches me with interest, an idea in his eyes. “What would happen,” he asks, pointing his fork at my chest, “if I were to open up that incision of yours and pop a matzah ball in there?”
For some reason, I find this hysterically funny. We all do. Is it the goofy joke, the medication, or life itself pulling me back in? I don’t know, but what fun it is to laugh again!
16
SPINNING WHEEL … GOT TO GO ’ROUND
By mid-November my blue funk is completely gone. The spring is back in my step. Energy and joy have returned. I’m a player, back in the game.
First thing, I reach out to friends I’ve been avoiding or to whom I was rude or unfriendly. Instantly forgiving, they welcome me back and we plan lunches and get-togethers. Next, I reconnect online, ploughing through my backlogged inbox, getting in touch with colleagues, even enjoying silly email jokes sent to me, like “Surprising Animal Sex Facts” with such arcane tidbits as “a snail’s genitals are located in its head,” “a pig’s orgasm lasts thirty minutes” and “the swan is the only bird with a penis.” (That’s “some pig!” – the phrase woven into the spider’s web to describe Wilbur in Charlotte’
s Web – comes to mind.) I have arisen from the couch and turned off the TV, though occasionally I still indulge my guilty pleasure of the glamorous L.A. tattoo artist, Kat Von D., who has taught me how body art can tell a story, commemorate an event, or express a belief. This may be obvious to anyone who has a tattoo, but it’s helped me to grasp the meaning of mine. My scar tracks my journey from feeling wounded to being healed. This cracked, broken place has made me stronger. I won’t be covering it. I’ll wear open necklines – my big reveal. I’m going to rock this scar!
I’ve rejoined the local gym for physical workouts and the synagogue for spiritual ones. I’ve passed the major milestones – off all painkillers, made it through my first sneeze, have resumed driving, and now into vigorous exercise.
“Why not start out slow?” Ivan asks when I tell him about my new spinning classes where the teacher pushes us to our limit.
Ivan – always a model of balance and common sense! But gentle aerobics or restorative yoga is not what my body craves. It needs to stride, run, stomp, jump, climb, push, kick, dance, hurl, heave, and roar, because now I can!
He shakes his head wearily. “Does the phrase everything in moderation mean anything to you?” Having lived with me so many years, he knows the answer.
When the cardiac rehab centre calls to tell me there’s an opening in the upcoming class, I turn it down, but only because I have devised my own rehab program.
At the gym I have found the teacher and class for me. It’s cycling on a stationary bicycle to pumped-up, high-voltage music – everything from rock, pop, classical, country, techno, to disco. Zooming from head-banging Metallica to bubblegum “Build Me Up, Buttercup” to Amy Winehouse’s “Rehab,” Steve switches to “You Lift Me Up …” and Josh Groban’s soaring tenor voice pours over our sweaty, panting bodies.