A Message From The Heart

While reading the Sunday New York Times yesterday, I came upon an article that make me sit up, take  notice....and remember.

It was an opinion piece by Martha Weinman Lear, author of the books "Heartsounds" and "Echoes of Heartsounds". Her books had been about her late husband's series of heart attacks before the final one that took his life. This article was about her own heart attack.

Like many women, she did not have the classic chest-clutching pain. Instead, she felt suddenly ill with a fluttering in the chest, chills, vomiting and diarrhea. She called her doctor immediately.

It was the diarrhea that threw him off and made him decide that she had "a stomach bug."

But still he scheduled her for an EKG the next morning. What that test revealed was that she had had a heart attack. Not a mild one nor a massive one. But a substantial one. She was admitted to the hospital immediately.

Lear was lucky -- lucky that the heart attack was not massive, lucky that she had a physician willing to run a cardiac test. In the not so distant past, research on women's cardiac problems was scant and the fact that women often exhibit quite different symptoms was not recognized until quite recently. Traditionally, men showing symptoms of a heart attack have been treated appropriately and aggressively while women reporting the same symptoms have often received a psychiatric diagnosis.

Lear reported that this gender bias in diagnosis only began to change in 2001 after a study from the U.S. Institute of Medicine confirmed significant gender bias in all areas of medical research. Still, she says, women make up only 24 percent of participants in heart-related studies. But there is hope. She reported that only a few days ago, the National Institutes of Health announced that it will give grants totaling $10.1 million for scientists to include more women in clinical trials.

So there is progress. Now we need to get past lack of information and outright denial on a personal level.

And I know a lot about that, reliving my own as the memories came back.

It was a bright late August Saturday in 2003. I woke up feeling good and ready for a busy day. I had cancelled my Saturday patients at my private psychotherapy practice that day because of a schedule conflict with one of my other two jobs -- this one the admissions representative job for Northwestern University. I was due at a picnic at a lovely park in Santa Monica -- about 40 miles from my home -- honoring the entering freshman from the Southern California area. Several alums would also be attending to give information and encouragement to the enrolling students and their parents. And I was to host the event and furnish the food -- heaping platters of deli sandwiches I would pick up locally and transport to the park.

But before hitting the deli, I decided to go to my private practice office to finish up some paperwork. There was plenty of time. I sat down at my desk, pulled out an insurance company file and started writing. Suddenly, I went from feeling fine to feeling terrible.

It happened in an instant. I felt dizzy, a fluttering in my chest and broke out in a cold sweat. I fell to the floor and passed out. When I came to, I felt extreme nausea and overwhelming fatigue. I crawled on my hands and knees to the adjacent private bathroom in my office and, for the next half hour, alternated between bouts of vomiting and diarrhea.

Then most of the symptoms passed except the weakness and fatigue. I crawled from the bathroom to the couch and lay there considering my options. Going to the emergency room was not among them. In my tunnel vision, all I could think about was the picnic. I had to go. I had to get the food there. It was my job. People were depending on me. It never occurred to me to call one of the alums and ask him to come up to Santa Clarita and pick up the pre-paid for food at the deli and to send my regrets. My only options, as I lay there considering them, were to do it all myself or ask my husband Bob for help. I realized, at last, that I couldn't, shouldn't, drive. I picked up the phone and called Bob.

When he arrived, looking concerned, I minimized my symptoms. "It was probably a touch of food poisoning or something," I said, ignoring the fact that he and I had eaten the same dinner the night before and the same breakfast that morning and he had no symptoms whatsoever. "I'll be fine. I just need you to do the driving this morning."

So we picked up the sandwiches and transported them to the park. Steve, then head of the alum volunteer group, looked at me closely as he took the sandwich platters from Bob. "Are you okay?" he asked, putting a hand on my arm. I was still feeling so weak and fatigued, I could barely stand.

"I'm a little under the weather today," I said, averting my face lest he see the extent of my distress. "Could you please host this event today? Do you mind? I think I need to go home."

"Of course," Steve said, putting an arm around me. "I wish you had called me before. I would have taken a swing up your way to pick up the food so you wouldn't have to come all this way. I'll handle this. You take care of yourself."

But I didn't. Slumped in the front seat on our drive back home, I got a call on my cell phone from a friend who happened to be a doctor. I told him about my symptoms and he started yelling "Why aren't you in the emergency room??? Go to the emergency room NOW!!!" I nodded and hug up.  Bob looked at me curiously.

"What was that all about?"

I sighed. "Oh, Larry...you know, he's so excitable. He thinks I should go to the emergency room."

"If he thinks so, you should. The Kaiser hospital is two off-ramps away. Let's stop by there and just be sure this isn't anything serious."

I shrugged. "They'll just tell me I have the flu or food poisoning and I'd feel silly. Let's just go home. I want to sleep this off."

So I did. And I was lucky: I woke up. Feeling better.

But Larry had called every emergency room in the area to see if I was there. He was frantic over my lack of interest in getting tested and treated. He fumed at me for a long time. But it took me three years to go for a cardiac exam because, well, I was so busy. I didn't get those cardiac tests until 2006 when I was entering a medically supervised weight loss program at UCLA Medical Center. It was then that my cardiac problems became real to me and that I knew the terrible risk I had taken three years before when my fatigue and denial had kept me from seeking immediate help.

My subsequent reading about the differing symptoms for women's heart attacks, most recently Martha Weinman Lear's New York Times article, has been instructive and alarming and has made me want to spread the word.

If you have any of the following symptoms, particularly in combination, seek medical help immediately: sudden neck, shoulder or back pain, chills, cold sweat, nausea, vomiting, diarrhea, pressure in the chest area.

Please don't do what I did.

My tunnel vision about work obligations, my habitual busyness, my skewed priorities and my denial that anything serious was wrong could have killed me on that sunny Saturday eleven years ago.

I'm profoundly grateful to have lived to tell this cautionary tale.