The Heart of the Matter

What you miss when you're under pressure

It’s been a strange week. Last Friday as I was leading a live, online meditation, I asked everyone to sit up tall, close their eyes, and get more interested in what they were feeling rather than what they were thinking. Almost instantly, I felt something myself. “Oh wow,” I chuckled, “I just realized it hurts when I breathe.” I’ve been meditating every day since 2001, and I’m still amazed at how many things happen outside our awareness as we’re going through the day. How long had it been hurting for me to breathe? A few minutes? A few hours? When I first began meditating twenty-plus years ago, I would joke that the birds must have waited for me to settle down and quiet my mind so they could put on a show and sing their hearts out, though obviously the birds are always singing and are certainly not waiting for me (or you) to notice. It’s still like that - I sit up, close my eyes and suddenly hear the birds in the trees around my house, or the seagulls cawing by the beach, or I hear a car going by or an airplane overhead. I might hear the brakes on a truck a few blocks away, or a distant siren. Or I might notice that I’m profoundly sad, anxious, giddy, or really missing my mom. There’s such a shocking amount of information about how we feel or what we need or what’s happening in the environment around us from moment-to-moment, and some of that information can be really helpful, but if the voices in our heads are loud or there are a million things to get done in a day, we might not get the memo. When we were done meditating, I chatted with everyone for a few minutes, sent love, and signed off. I spent a little time exploring this weird feeling in my chest. It felt like pressure, not pain. The pressure was at about four if I was going to put a number on it, and I observed that it was only on the left side. Around my heart. Okay, I thought, there’s pressure around my heart, huh. Spoiler alert: I did not have a heart attack. 

Me, my kids, and a seagull that flew by at the exact right moment.

I paid attention as the day went on. The pressure continued to be there, but it wasn’t increasing. I wondered if maybe I’d strained a muscle in my chest during my yoga practice the previous day. I’d also had a physical with a new doctor at a new practice the day before, and suddenly got an email alert that I had a message from her. My blood pressure had been extremely low at the appointment. My blood pressure is always low, always about ninety over sixty, or eighty-five over fifty-five, but at the appointment the first reading was eighty-three over thirty-three. “Am I alive?” I quipped at the nurse. She didn’t laugh, in fact, she looked worried. We did the test twice more, and twice more it was low, but not as low as the first reading. She asked if I felt faint or nauseous. I said no, I felt fine. Then the doctor came in and she didn’t seem as troubled by my low blood pressure, so we moved on. She asked me a million questions about my health and my lifestyle:

Did I smoke? No, never been a smoker. 

Did I drink? Rarely. (Reader, I have the tolerance of a small radish, so drinking for me is infrequent and involves about four sips of alcohol. That’s all it takes and I’m tipsy - super cheap date.) 

Did I exercise? Yep, yoga all week, and the elliptical machine and weight training with my son three to four times a week, too. 

How about diet? Vegetarian, mostly gluten-free, lots of fruits and veggies, don’t use butter or eat much cheese, no fried food, not a big sweets person. 

I mentioned to her that a couple of years ago I had bloodwork done and my cholesterol was weirdly high - so high that my doctor at the time sent me for an ultrasound of my carotid artery and a scan of my heart. There was no plaque build-up, so he didn’t put me on any medication and said I was probably one of the 1.5 million people who are genetically predisposed to have high cholesterol, known as familial hypercholesterolemia (I feel like they could have worked a little harder on the name). I should have asked my parents at the time whether either one of them had high cholesterol, but I don’t think I did. I can’t ask them anymore, because I’ve lost them both in the last few years, which is by far the most painful thing about being in this chapter of life. You start to lose people, and not just distant relatives you never knew, but your actual parents. And if you have kids, you probably have teenage kids who have all kinds of hormones rushing through their veins, and problems that are bigger and harder to solve than a scraped knee, right at the time when you are going through all kinds of fun peri-menopausal hormonal adventures yourself. They call it the “Sandwich Generation” because you are sandwiched between aging parents who need you and teenage kids who need you. It’s not a tasty sandwich, even if you have excellent teenagers like I do.

Anyway, I suspect my dad may have had a similar but much worse thing happen, because he was extremely healthy, he ran six miles a day most of my life, and even up to the last six months of his life before things took a serious turn, he was still going to the gym every day and doing “his yoga,” the stretches I’d given him to do. He was eating “health food” long before it was popular - in fact I used to hate the school lunches he packed for me when I was a kid. Pumpernickel bread that was dry and crumbly with thick, natural peanut butter, honey and bananas, fresh cut strips of green peppers in a sandwich bag, maybe raisins if I was lucky, but even those would be the golden raisins and not the darker ones I liked. He was ahead of his time and I was too little to realize these lunches were a lot healthier than the ones I packed for myself at my mom’s, where I’d find Wonder Bread, Miracle Whip and Oscar Mayer bologna in the fridge, or Kraft American “cheese” slices, yippee! My dad didn’t drink aside from the very occasional beer, and he didn’t smoke except for a pipe he liked for about ten years during my childhood. My dad died at ninety-six, but he had a pacemaker the last twenty years of his life. I remember when he got it. He called me from Raleigh where he lived. He said he’d had a cold and had been feeling dizzy. He almost passed out in his garden one day, so he drove himself to the doctor. I remember saying Dad, why did you drive yourself anywhere if you felt dizzy? But he just brushed me off and said when he got to the doctor he explained about his cold and the doctor took his blood pressure and listened to his heart and did a few other things doctors do, and asked my dad if he felt well enough to drive himself to the hospital. The doctor said it was no big deal, he just wanted to send my dad for a couple of other tests. So my dad drove himself to the hospital to find a team of doctors waiting to wheel him in for emergency pacemaker surgery. Apparently his doctor hadn’t wanted to alarm him lest he drop dead right there in the office, but my dad’s heart rate had been twenty-seven beats per minute when the doctor checked it. My dad told me this story like it was amusing, but I remember being horrified that he hadn’t called me when he got to the hospital and realized what was happening. What if you’d died on the table? I asked him. Who me? I’m healthy as a horse, he’d laughed. And I guess he was right.

Dad circa 1981.

So now I get the message from my new doctor, and I see right away that there are some exclamation points which don't seem like the sort of punctuation you want from a doctor, unless they’re saying, You’re in great health!!! Congratulations!!! That’s not what her exclamation points were about, though. My cholesterol was so high, she wanted me on medication right away, because regardless of whether it was genetic, she said my risk for stroke and heart attack were elevated because of the cholesterol!!! Of course I’m reading this message with pressure on the left side of my chest. So I went to the pharmacy and picked up the medication and started taking it right away. I don’t need exclamation points to get the message!!!! 

By the end of the day I was feeling anxious. What does a heart attack feel like, anyway? What are the precursors? When do you go to the ER for chest pressure? I really did not want to go to the hospital. My husband told me not to worry, I was super healthy, my blood pressure was really low, I was not having a heart attack, but Google was less reassuring. I spent a few hours wondering whether I was being smart and not alarmist for not going to the ER, or really dumb, like one of those people you read about later and wonder, why the hell didn’t they go to the hospital? We watched Dream Scenario which was interesting enough to get my mind off the whole thing, and I got ready for bed. When I got in bed, when I actually got horizontal, the pressure went up to about seven. That’s four to seven if you’re counting. I tried turning one way, then another but it didn’t help. I Googled again. I started crying because I was exhausted and wanted to go to sleep but really wasn’t sure if I should be going to the hospital, and really didn’t want to have a heart attack in my bed. My husband said he would do whatever I wanted to do - if I felt like I should go, we’d go, if I thought I wanted to try to sleep and see how I felt in the morning, that was fine, too. I decided to try to sleep. It didn’t go very well, but I nodded off at about 4am. In the morning, I was still alive and the pressure was still there. I still did not want to go to the ER.

I couldn’t get my new doctor to respond to my messages, so I got online to see if I could figure out a little better when you really ought to go and get checked out. Part of me still thought it might just be a strained muscle. I found a site called JustAnswer (no kickbacks or anything and I’m certainly not endorsing, just telling my story) where you can join and get a specialist on the phone. It’s $47 a month for this service, but I decided to sign up, pay the $47 and cancel right away. I entered my query about chest pain, and lo and behold they had a cardiologist available to talk to me on the phone. She was incredible. She asked me tons of questions, had me move around, and took note of the fact that the pressure got worse when I reclined and better when I sat up. She asked me if I’d been sick recently, and I have - I had what I thought was a cold over Christmas. She said she thought I might have had Covid which is surging right now, and that the pressure in my chest might be pericarditis, an inflammation of the fluid around the heart that can happen after infections, whether they’re viral or bacterial. She said she did not think I was having a heart attack, but she advised me to go to the ER so they could determine if it was pericarditis, which sometimes requires medication and bed rest. She was so calm and so smart, I felt better instantly. We headed to the ER.

I’m going to cut to the chase here. I had an EKG, bloodwork, a chest X-ray and a cat scan with contrast (which is super weird because you can feel the dye in your veins and it feels hot). All my tests came back great. I was definitely not having a heart attack, hurray. The doctor concurred with the cardiologist on the phone. He said he thought it was mild pericarditis, that I could take ibuprofen for the inflammation, and it would resolve on its own. He cleared me to teach my 90-minute yoga class the next day, and to resume all normal activities. He also thought I’d probably had Covid, which means the whole house had Covid because we’d all been sick. Either that or some other kind of upper respiratory infection. Thankfully it happened over Christmas when we were hunkered down at home, so at least we didn’t go out and spread it everywhere. And happily my heart is really healthy. And now I have medication to lower the cholesterol so I won’t end up with emergency pacemaker surgery like my dear old dad. As I write this, the pressure in my chest is gone.

The thing is, while I was in the hospital figuring this out, I was in a room behind a curtain hooked up to machines. I don’t know why the inside of ERs and ICUs all have to look this way, but they are colorless - everything is this pale, sickly, washed-out yellow you don’t really see anywhere else, and after a while everyone there takes on the same colorless tint. It brought me back to the month in the ICU with my mom and I suddenly understood why I had not wanted to come to the ER. All those beeping machines, no sense of time, fluorescent lights, incessant beeping and alarms going off. That month in the ICU with her is still alive inside me. It was almost two years to the day since I’d gone through that with her, and being there last Saturday brought it all back to the surface. I felt vulnerable in a way that isn’t comfortable. I really, really wanted to leave, I was totally focused on how fast we could go home. I was so worried they were going to admit me, and so relieved when they said all was well. That is not the place any of us want to end up - that colorless, beeping, timeless ICU. All I could think is how much I don’t want to leave my kids. Or my husband, or anyone. I love it here on earth, as incoherent a mess as we’re making of it. I have so much life left that I want to live, and so many things I’m still working on. I’m not nearly done - in fact, aside from the vulnerability of being right smack in the middle years, I kind of love this time in my life more than any other. Losing my parents was brutal, losing my mother broke my heart, and the grief I felt the year after she died was unlike anything I’ve known, but it softened me. I feel like I understand impermanence in a more meaningful way. I have a deeper relationship with suffering and loss and as much as it has hurt, it’s also shown me things you probably can’t understand any other way, even if you wish you didn’t understand.

This is the only photo with my mom at the end that I can bear to share.

The truth is we’re all vulnerable, we just don’t like to think about it. You can do everything “right” and still end up with high cholesterol. Some things are outside of our control. Strike that, most things are outside of our control. We were just watching The Old Man and the Pool, Mike Birbiglia’s latest show, and he was talking about how a woman was just walking along minding her business and got hit in the head by a coconut and died. Bad things happen to good people every second of the day, and even if you’re lucky enough to live to ninety-six like my dad, you’re not going to live forever. None of us are. And that is something I try to remember, in a way that propels me to do the things I want and need to do each day. The things that light me up, or feel pressing or compelling, the things that make the people around me feel loved and understood. I really try not to take a day for granted, or an afternoon or a minute. It freaks me out sometimes, feeling like I could die, like it’s not outside the realm of possibility, and I think it’s just statistically true that the older you get, the more real that becomes. But I love being 52. I feel inspired these days and more myself than I’ve ever been, and also mostly unencumbered by fear of what anyone else thinks. I guess I’ve used up all my fucks or something and it’s so freeing. It makes me want to travel and have conversations with the people I love and learn as much as I can and write my heart out and give my kids and my husband and my friends and the people who show up to spend time with me everything I’ve got. I don’t want to leave anything unsaid or undone or unexplored. I don’t feel invisible or irrelevant or any of the other things people tell you you’re going to feel as a woman over 50. I feel a little bit ecstatic about life and I treasure it more, so when I feel something weird inside my own body, you can bet I’m going to check it out thoroughly. I’m glad I realized why I was resistant about going to the hospital. It’s hard to be back in that netherworld where you’re neither living nor dying, I didn’t even want to visit for a few hours. It made my heart hurt, but the time there also assured me that my heart is strong and time is always short and the birds are always singing. Make sure you don’t miss it.

If you’d like to meet me in real time to talk about how to be more present from moment-to-moment, how to face grief and impermanence head-on, and how to understand yourself a little more deeply when resistance arises, I’ll be here 1/12/24 at 11:15am PST or you can wait for the Come As You Are podcast version. And if you’d like to meet me in Portugal in June it’s going to be incredible, and I’d love that so much.