…it’s not easy to think about the heart unless trouble arises.–John Stone, MD
This past Wednesday I began another expressive writing series at Gilda’s Club, an organization founded in memory of comedian Gilda Radner to provide support and services to people living with cancer. The workshops, which I began nearly 20 years ago, inspired by the research on writing and health from psychologist James Pennebaker, is an 8 week series designed to encourage participants to write and share their stories of cancer. At each meeting, I offer writing prompts and suggestions aimed at different aspects of living with cancer. In a typical first session, such Wednesday’s, we begin with the moment of diagnosis, of becoming a cancer patient. The two different prompts I used in our initial meeting were: 1) describe the moment you first heard “you have cancer,” and 2) when you think of cancer, what are the metaphors you use to describe it?”
It was only later, after the session ended, that I thought more about the images and words they used to describe cancer–not just their metaphors, but how differently their words are than those I use to describe heart failure. What I feel for my damaged heart can only be considered as protective, even tender. Not so with my group members’ feelings about cancer. Their metaphors had no tenderness in them. For example, cancer was compared to a rotting fence, a brick, a death sentence, an evil invader, a boxer in a fight for life, a fast growing weed, even a cockroach. Not surprisingly, the most prevalent metaphor used in the cancer literature is still one of battle–a fight against the disease.
But the heart is no invader, and the use of metaphors in heart disease, transplant or failure, as researchers Biglino, Layton and associates discussed, are limited when compared to other serious illnesses like HIV/AIDS or cancer. As cardiologist Sandeep Jauhar, MD describes in his book, Heart: A History (2018), our “second” or metaphorical heart has long been associated with feelings, considered as the locus of emotions even across different cultures. While science has ultimately corrected those misassumptions, these earlier connotations continue to influence the way in which we talk about our hearts.
I turned again to The Cancer Poetry Project, two favorite volumes of poetry written by patients, caretakers and medical professionals and in some poems, found metaphors of battle, cancer as enemy, spy, shark, or an invader, among others. Metaphors are, as many have pointed out and the literature confirms, commonly used in the way we talk about cancer. But in matters of heart disease and failure, even after scouring LitMed, NYU’s Literature, Arts, Medicine Database for relevant poetry and literature, I was disappointed to find scant offerings compared to cancer. I returned to some of the books on the human heart that have recently taken up residence on my bookshelves. Again, I was struck by the paucity of metaphors to describe our life-giving organ. For example, Albert Carter III, writing in Our Human Hearts (2006) described the contemporary view of the heart, as ” a pump, and one worth caring for” p.35), while other authors referred to it as an engine.
I didn’t think much about my heart until after I was hospitalized and diagnosed with heart failure in 2008. Since then, I’ve also compared my heart to an engine, the life-giving one that one keeps all systems running. It’s a real workhorse, hard working, steady and, for at least two-thirds of my life, reliable. When I think of my “engine,” I recall my high school sweetheart’s old Model A Ford, a real jalopy by today’s standards. He nursed and tinkered with the old engine, determined to keep it running until we’d graduated and left for university. In some ways, I consider my medications, daily recording of my vitals, even the bothersome bulge of the ICD below my collarbone are the regular tinkering of my heart, my engine, designed to keep it running for as long as it can.
The tenderness I feel for my heart is expressed in the way I talk it. Yes, you read it right: I talk to my heart. In my cancer writing groups, I often prompt the members to address their cancer as if it is a character. They do, and the writing is always descriptive and strong, but more than talking to their cancer, they talk back to it, as if addressing a bully. And there is such intensity in their words that you think they just might send cancer packing–and soon.
I have never “talked back” to my heart; I feel no fury toward it. I’ve only talked to it–and with a great deal of compassion and tenderness. It happens almost unconsciously. If I am short of breath or my heart rate increases , thumping loudly against my chest after walking uphill or climbing the four flights of stairs to my daughter’s apartment, my hand reflexively moves to my chest, the place where my ICD bulges beneath the skin, and I pat it gently as a mother might soothe her crying infant and quietly say, “Slow down a little.” “It’ll be all right.”
There are times I wonder if I might have been responsible for my heart’s failure. Besides the radiation therapy to my left breast twenty years ago, my heart and soul have been through a lot of stressful wear and tear–a series of difficult and extremely emotional events that occurred from my 20s through my 50s, all involving unexpected and significant losses, sorrow and tragedy–events I have described as truly “heartbreaking.” Little did I know how apt the adjective was at the time. As Dr. Sandeep Janhar said, “Even if the heart is not the seat of emotions, it is highly responsive to them…a record of our emotional life is written on our hearts…The biological heart is extraordinarily sensitive to our emotional system–to the metaphorical heart…” p. 23). Perhaps it’s little wonder that I sometimes feel as if I could have somehow prevented my heart failure, whether that is realistic or not. And again, my hand moves to my chest, and I whisper, “I’m sorry,” to my battered and weary heart.
Just as heart failure does, cancer brings us face to face with the prospect of early mortality. Fear, in those first stressful months after a diagnosis, is a constant companion. And yet, in cancer, unlike heart failure, there is hope. With the continuing medical advances in cancer treatment, many patients now enjoy long periods of remission, some even declared “cancer-free.”
Heart failure, by comparison, doesn’t come with that kind of hope, save for those who undergo heart transplants. I’m not a transplant candidate, but it took me a long time to accept that heart failure was a progressive condition. When I finally read the statistics, faced the facts and the gradual decline in my heart’s functioning, I was dogged by a persistent shadow of fear and depression for months. Finally, I turned to what I have always done in times of upheaval: I began to write, attempting to unpack and understand the underlying fears and emotions by making them visible on the page. It helped, although I still don’t find it easy to do.
I now think of myself as living well with heart failure. Thanks to my cardiologist and the medical team at the Peter Munk Cardiac Center, new medications, their iphone app “Medley,” which I use to record and report my vitals each day, I don’t fear heart failure in the ways I once did. Instead, I focus on the here and now. I cheer my heart on as my blood pressure and heart rate remain at a consistent level, motivating me to continue living a heart healthy lifestyle. I try to live as fully and presently as I can.
In fact, my heart health regimen has given new meaning to the flyrics of a favorite old Johnny Cash song. Cash apparently wanted to write a song that said “I’m going to be true not only to those who believe in me and depend on me, but to myself and to God — a song that might give courage to others as well as myself.” (From Johnny Cash, Man in Black, 1975, pp. 87-88). His song has inspired many people from all walks of life over the years. For me, the song serves as a kind of promise to my heart, one I frequently sing aloud (much to the consternation of my husband).
I keep a close watch on this heart of mine
I keep my eyes wide open all the time
I keep the ends out for the tie that binds
Because you’re mine, I walk the line…
(From: “I Walk the Line,” written by Rodney Crowell and Johnny Cash, 1956)
Well, I’m walking the line all right. I’ve learned to say “no” when I need to conserve energy; I act on my cardiologist’s advice, get a good night’s sleep, record my vitals, and take my medications twice daily as prescribed. I have more routine in my life now than I once did, but it’s probably healthier. I begin my day with quiet, a routine of writing and a regimen of Pilates stretches. I eat a heart healthy diet, walk as much as I can, occasionally swim, and practice simple meditation when worry or stress creeps up on me. I am intent on doing all I can to keep this heart of mine, this engine of life, going for as long as possible. My heart seems to agree. After all, we are in this together.
- When you think of your heart, what images or descriptors come to mind? What metaphors do you use, consciously or unconsciously, to describe your heart?
- Consider John Stone’s observation that it’s difficult to think about the heart until it’s in trouble. Before heart failure, did you think much about your heart? If so, in what ways? After heart failure, what changed in your feelings or thoughts about your heart.
- If you “talked” to your heart, what would you say to it?