He said it doesn’t look good
he said it looks bad in fact real bad.
(From: “What the Doctor Said,” by Raymond Carver; In: A New Path to the Waterfall, 1989)
They were words I never thought I’d hear: “You have heart failure.” Heart what? I couldn’t comprehend what the doctor was saying. I first heard the words as I lay in the hospital bed, under observation for three days after suddenly collapsing as I was walking the dog. When I’d regained consciousness, I was surprised to find I still had the leash in my hand, but lying face down, on the pavement, blood dripping from my chin. Disbelief accompanied me as I made my way back to the house, concerned I had a meeting to go to in a half hour and couldn’t seem to stop the bleeding. On impulse, I called my husband at his office and said, “The weirdest thing happened. I apparently fainted while walking the dog.”
His response was immediate: “Call the doctor!” But I shrugged off the need to call her. I had just had my annual physical exam two weeks earlier, and when I mentioned some brief spells of light-headedness, she was unconcerned, telling me most likely I was dehydrated. Apparently, as we found out a few days later, it wasn’t dehydration at all.
I was ready to hang up the telephone, telling my husband I’d call the doctor after my meeting when I felt faint again and mumbled “oh, oh,” as I felt my knees buckle, and the floor rushed up to meet me. I came to as I heard the telephone ringing moments later. My husband had called 9-1-1, and the EMTs were on their way. Before I knew it, I was on a stretcher, loaded into the ambulance, and transported to the Emergency department where I was subsequently put under observation for three days, monitored around the clock and tests were administered. Even then, when the cardiologist stood at my bedside and said, “You have heart failure,” I felt shock and disbelief. As cardiologist John Stone, MD, notes in his book, In the Country of Hearts (1990), “It’s easy not to think about the heart until trouble arises.” (p. 3)
The truth is that it’s not easy to accept the reality of any life threatening illness or bodily betrayal until the shock of a hearing a doctor’s diagnosis. For years, I’ve invited the cancer patients in my writing groups to write about the moment they first heard a doctor confirm they had cancer. It’s usually one of the very first writing prompts I offer in those workshops. The writing that emerges from that first exercise is always vivid, descriptive and immediate. Those seconds in which a physician delivers words that change your life in an instant can still evoke strong emotions as you recall it months or even years later.
I heard the words, “it’s cancer,” or some version of them, over eighteen years ago. I’d gone in for my annual mammogram, but it quickly became something more than routine as the technician kept returning to the room to say, “I just need to take a couple more images.” I remember it well, even though my diagnosis was not life threatening, not the sort that sends you home thinking about mortality.
But I got off easy. Ten days ago, my husband and I sat together in a surgeon’s office, and I heard the words again, only this time, the surgeon’s words were directed to my husband: “Stage 3. Kidney cancer.” Surgery in just nine days to remove one kidney and determine if the cancer has spread as, we could easily tell, he suspects.
I listened, intent on capturing all that was discussed in my notebook, turning to study my husband’s face as together, we looked at the CT scan and listened to the surgeon’s explanation. At one point, I felt the rush of emotion and forced myself to not cry, so that I could stay focused on how J. was receiving the news. I remembered Joan Didion’s words, “Life changes. Life changes in an instant.” And so it was changing, right then, in a brightly lit examination room of a surgeon’s office.
You want to forget, for things to be normal, the way they were… It’s like stepping into a swift river; the current of the ordinary grabs you, and before you know it you’re being buffeted against the rocks, on your way over the falls as you watch the shore recede. It may all be over so soon, you worry in midstream, you won’t have time to do anything at all.–(D.L., cancer patient from a Writing Through Cancer workshop exercise)
For the past several months, our focus has increasingly been on my health–my heart failure and treatment– likely the result of damage to my heart from the radiation I had eighteen years ago for that very treatable breast cancer. And my husband has always been remarkably healthy. His father, a physician, died just days before his 99th birthday, and we always assumed that J. had his father’s genes and would likely live as long or even longer. Maybe he will yet; maybe not. As John Stone wrote in a poem, “Health is whatever works/and for as long.” (From; “He Makes a House Call,” In: Music From Apartment 8,” 2004)
I thought about Stone’s definition as we made our way home through the afternoon traffic. Health and mortality were playing in my mind. “I always thought I’d be the first to go,” I said. “You know, the issues with my heart…”
“Maybe not,” he murmured.
“Well,” I quoted former comedienne, Gilda Radner, “‘It’s always something,’ isn’t it?”
“It is,” he replied, but I didn’t expect this.”
“Nor did I,” I said, adding, “But I guess we’re at the stage in life when “somethings” like this are not unusual.”
“I guess so,” he said quietly, and we continued home, negotiating the traffic in relative silence, both of us still feeling the disbelief that accompanies such diagnoses.
It was, for me, another reminder of how we have, in essence, two hearts, the literal one, pumping blood, giving life, and its “fraternal twin,” the metaphorical one, the one long considered as the “seat of emotions” (Stone, p. 5 – 7). And my metaphorical heart was aching.
I wrote… to remind myself of the beauty of life, something that’s all too easy to overlook during the crisis of illness or loss… I forgot that our lives are made up of equal parts sorrow and joy, and that it is impossible to have one without the other. This is what makes us human…I wrote to remind myself that in the darkest hour the roses still bloom, the stars still come out at night. And to remind myself that, despite everything that was happening to me, there were still choices I could make. (From the preface, Survival Lessons, 2015, by Alice Hoffman)
- Write about the moment you were first diagnosed with heart failure. Try to recall as much of the detail of that moment as you can: The moments before the diagnosis was given, the room, whether you were sitting, lying down or standing, the quality of light, the doctor’s face, the words given to you, and what you were feeling.
- John Stone said, ” It’s easy not to think about the heart until trouble arises.” Use his words to begin a story or a poem about your heart.
- How has heart failure affected your outlook on life and mortality? Explore one or both.