Rant 8 February 2003: Make hay while the sun shines

As I write this in mid-January, my father lies in a hospital bed. At the moment, he is in no danger of dying, though one could not necessarily have said the same a few days beforehand, as he lay in bed at home, clutching the phone, waiting for the moment when the chest pressure became too much to bear and he would have to muster his strength to dial 911. He says that that night, he did not know if he was going to live to see the morning, and there is no hyperbole in this statement. I try to imagine what he must have thought about during those hours. Then, as the tears press at my eyes, I decide it is probably better not to imagine.

Luckily my father is an optimist, and as he cheerfully eats his hospital dinner (“I love hospital food!” he exclaims, without a trace of irony), surrounded by dog-eared newspapers and his beloved books, absentmindedly wiggling his little feet at the ends of his fuzzy-plaid-flannel-clad legs, he says that he is going to change his life. Being immobilized by the weight of your mortality gives you plenty of time to think; not that dad ever slacked in that department. When he arrived at the hospital, the doctor took one look at the overweight, 58-year-old man with chest pains and told dad to, quote, get his affairs in order. Some days later thanks to the wonders of modern medicine, flippant predictions of my father’s incipient demise are no longer being made, but my dad is quick to realize that it’s time to face facts: he needs desperately to change his lifestyle.

I never really knew most of the extended family on my father’s side. Dad’s father, a kind and amiable man, at least when he wasn’t drinking, died when I was thirteen. He was a heavy smoker, and a drinker for many years, though he eventually quit the booze. Dad’s mom, a generally unpleasant woman who cried at Richard Nixon’s funeral and had managed to ostracize most of her family, died several years later from a stroke. As a child I recall her careful arrangement of pills in tiny ordered canisters like dolls in their houses, and the way her thin, pointy-manicured hands looked like a bouquet of spikes. I also remember that she didn’t like my mother’s food, and would bring her own white bread and margarine when she came to visit. Her decades of poor health were probably due to a lifetime of secondhand smoke exposure and the typical nutritional habits of working-class white people, along with the bitterness experienced by women of a certain generation who were clever and should have been educated professionals, but wound up spending their adult life in menial work and attempting to be good wives to abusive drunks. Most of dad’s cousins dropped dead of heart attacks. One was a firefighter, who one day at age 46 responded to a routine call about a car fire one day and keeled over at the scene. The leaves on my father’s family tree have pretty much all dropped by now, and in almost all cases, the wind that blew them away was heart disease.

So here I am, thinking about my dad in his hospital bed. Dad was always a healthy, hearty man who loved to eat and drink. Like the majority of middle-aged North Americans, he is carrying some extra pounds. Though he eats relatively well and doesn’t indulge much in the worst types of junk food, he taught night courses at the university and ate dinner there four nights a week, which meant eating fast food. He likes exercise, particularly martial arts, but for him, it’s the first thing to go when any work stress appears, which was often. This year, dad was serving as the director of the Italian program at the university, which necessitated a lot of extra administration time. The commute to his job is long and stressful, driving at least an hour each way on crowded or dangerous roads. So-so nutrition, lack of physical activity, the stresses of lifeā€¦ there were little things, here and there, piling up. Little things which aren’t a big deal in isolation, but when they appear together and stay friends for a long time, mean that one night, a man who thought he was healthy will hold a phone like a security blanket, trying to breathe, thinking that each difficult inhalation might be the last one.

I hug my dad good-bye and walk out of the hospital. I can feel the burger and fries I indulged in earlier sitting in my stomach like a reproach. My liver is quietly processing the saturated fats to protect my bloodstream from the worst of the nutritional onslaught. I try to reassure myself that an occasional burger is no big deal, and it’s not. I eat well and I exercise. But how many times have I relied on the goodwill of my body to see me through? How many times have I thought to myself, oh well, I’m young and resilient, I’ll just dump this crap into my body and not worry about it? Taking care of yourself only needs to happen when you’re old, right? “You’re female and in good shape”, says dad to me when I voice my concerns about our family history, “You’ll be fine”.

But he’s wrong: cardiovascular disease, including coronary heart disease and strokes, is the number one killer of women over 65. The foundations of heart disease, arterial obstructions and athersclerosis, a thickening of the artery walls, begin as early as childhood. My arteries aren’t going to be squeaky shiny clean for 50 years then suddenly get covered in crud one day. It’s a long, slow process that begins early. Estrogen provides a small protective effect, but I can’t count on it, nor do I want to. With my genetic background that predisposes me to heart disease in early midde age, I’m going to be in some deep shit if I’m not careful. My body may even now be silently, subtly eroding: microscopic potholes in smooth arterial roads, infinitesimal globules of arterial plaque collecting around their edges like fluttering birds at a water hole. I may indeed be fine, but I’m going to have to work damn hard to make sure I stay that way.

That means beginning now, today, as I am about to shuffle of the edge of my twenties. Today, by coincidence, I see a clinical study that shows that even children and teenagers whose nutrition is poor are showing evidence of high cholesterol and atherosclerosis. In other words, your youth does not protect you.

Several days after dad’s first incident, by coincidence I call him in the hospital just as he is having a full fledged heart attack. “Hi dad, how are you doing?” I ask. “Not so good,” he replies. He sounds awful, the worst I’ve ever heard him sound. “Chest pains are back,” he croaked, “Gotta go. Daddy loves you, sweetie!” Click. I sit with the phone, madly trying to employ all the denial mechanisms I possess to keep from freaking out.

Seconds after he hangs up he is being wheeled down to the ICU to have a hospital SWAT team execute a commando raid on his circulatory system.

Later when we speak he says he didn’t want to worry me. My dad is such a trooper. If he were bleeding out his eyeballs he would pretend he was fine so as not to upset his daughters. “I didn’t think about God or anything,” he explains later, “No religious thoughts at all. The whole time, I just thought about my family.”

The day after dad’s near death experience, a team of cardiologists stuff a stent into his obstreperous artery, even as he begins to have a second heart attack on the table. Ha, eat hot medical technology, you clogged fucker. The artery they clean out was almost completely obstructed, full of arterial plaque and coagulated blood, like the debris of a beaver dam.

I speak to my father again once he recovers from the surgery enough to be coherent. Dad says he feels like he’s been reborn. Knowing his interest in near death experiences I ask if he had seen the white tunnel during his heart attack. “No,” he said, “Unfortunately I was conscious for the whole thing. I’d rather suck a bullet than do that again.” On this day, he can actually breathe, and he’s thrilled.

Dad’s recovery is going to be very slow and take a long time. But he will be okay, I think, if he re-evaluates his lifestyle and changes his priorities. I think I will do the same.

Update on Dad, December 2003: Dad had to have a second stent put in after another bout of chest pains in the early spring. All told, he probably spent about four months in and out of hospital. He carries around a bagful of pills. But he has lost weight and while he moves more slowly, he tells me that his cardiac rehabilitation program is going swell. Every time we go out to a restaurant, he chooses his meal carefully. With his characteristic meticulousness he examines the menu to see which entree has the most vegetables and the least fat. I hope to have Dad around for a good long time, and I’m happy he got a second chance!

Update on Dad, February 2009. Six years later. In fall 2007, dad had double bypass surgery to repair a defective valve. This was pretty scary shit, and he nearly died in the process. Now he has a bitchin’ scar, just like Krusty the Klown. And he feels a lot better now that oxygen is going where it should go. He’s even hitting the gym and doing some strength training! Every February that rolls around makes me more grateful that he’s been granted one more year. This year he’s 65. Way to kick mortality in the balls, dad!

More on coronary heart disease: Medline Plus

Sanchez, A., Barth, J., Zhang, L. “Diet and its Relation to Early
Atherosclerosis in Teenagers”. Supplement to Journal of the
American College of Cardiology
. February 2000. Vol. 35. Issue 2, Suppl. A.
This study revealed that most adolescents (over 80 percent) between the ages
of 13 and 18 exceeded dietary recommendations for total fat and saturated
fat intake. Forty-nine percent exceeded the recommended cholesterol intake.
More than one-third (37 percent) had elevated total cholesterol levels and
29 percent had elevated LDL cholesterol levels. A major finding was that
those with high cholesterol intake were more likely to show early signs of
atherosclerosis in their arteries. The authors concluded, “These data
support the assumption that diet is important in the etiology of
atherosclerosis in its beginning stages in teenagers, as it is with
atherosclerosis in the adult.”

Freedman, D., Dietz, W., Sathanur, R., Berenson, G. “The Relation of
Overweight Children and Adolescents: The Bogalusa Heart Study.” Pediatrics.
June 6, 1999. Vol. 103. No. 6. 1175-1181.
The Bogalusa heart study reinforces the importance of a healthy weight in
relation to heart disease risk. The results indicated that children aged 5
to 17 who were overweight were 2.4 times more likely to have elevated
cholesterol levels. Of those children who were overweight (a total of 813),
more than half (58 percent) had at least one risk factor for heart disease.
According to government statistics, approximately 25 percent of children
between the ages of 6 and 19 are overweight, which may place an alarming
number of children and adolescents at an increased risk for heart disease.