Cardiac Adventure Part 2: QRST

February 7, 2018


 Sunrise over Medellin Colombia


Part 2 of my cardiac adventure follows, my contribution to February as heart month. As I mentioned in part 1, some of this may be a bit airey-fairey. Bear with me. My heart attack gave me a lot more than a cardiac history and a colorful collection of new pills to pop every day. It gave me something not many people get to see: The arc of my life, and therein a path forward toward recovery in more ways than one. Why the picture above? It's the view I see every morning from my balcony here in Medellin. My new morning ritual is rising at 5:30, curling up with a cup of coffee, and simply watching the city awaken. It's more than meditation; it's an active process of passivity, if that makes sense. Blaise Pascal said 'All men's miseries derive from not being able to sit in a quiet room alone.' My quiet room is my balcony 17 floors up. In these mornings I'm alone with my thoughts, able to let my too often fevered brain slow down and process the softer, gentler messages that can only come from such quiet contemplation.


And after a brush with death a month ago, I'm given to as much of that contemplation as I can muster, my effort to avoid the unexamined life that Socrates mentioned centuries ago. I've taken advantage of the time & silence to go into my thoughts, and really discern what's important for the last scattered scraps of time I have left. Thus the title of this post, QRST. I've taken liberties with the medical acronym. My QRST stands for Quiet, Reflection, Silence, and Time. 


The human heart is a complex, hard working, intricate, and (mostly) reliable organ. It's been referred to as the seat of the soul, the organ of love, Mo Chroí, My Pulse, in Celtic, a Hungry Gorge according to William Blake.




But the human heart also centers our deepest and most profound wants, needs, yearnings, and often disappointments. It's the locus of our pleasure and pain, the vault that holds our true and often hidden selves. As Matthew Arnold writes in The Buried Life:


A longing to inquire

Into the mystery of this heart which beats

So wild, so deep in us—to know

Whence our lives come and where they go


So here's what came to me on my balcony, and I don't think it was the coffee. I understood that my personal QRST needed adjustment. I had no plumbing problem, a leaky valve, or a dripping faucet. The stent took care of those physical details. Instead, I had a case of today's biggest malady, a focus on all the negatives that surround us, our preoccupation with everyone else's leaky valves, drippy faucets, and clogged sinks. The QRST analogy much on my mind these days, here's what I came up with.


As I was laid out flat on my back in the ER three weeks ago, my heart went into V-Tach, a precursor to V-Fib, that is, full cardiac arrest. I nearly died that afternoon. Death is the only journey for which we unpack, so I started the process that day. I opened the suitcase, unzipped the hidden lining, and began sorting out the QRST of my life.



The Q is for Quiet. But it's not the Quiet we ordinarily think of, the noise-free hours between midnight and six when the trash truck starts pealing its backup bell, and the neighborhood dogs wake up in protest. Not the soothing silence before testosterone-poisoned boys extract every possible decibel from their screaming motorcycles. The Quiet I refer to is the escape we find almost impossible to shut off these days, our intracranial clang and clamor. The incessant noise inside our own heads.


I live in a city of 4 million souls, a wide, sprawling town that's spread across the Aburrá Valley, and nestled in the embrace of the Andes. Positioned as it is, Medellin is a bowl of frenetic energy most times, and the noise level reflects that. So it's difficult to achieve the Q, the inner serenity. How to turn off the barking dogs? The backup alarms and the boys lusting for every decibel? My morning balcony ritual and being mindful of every detail helps: the comforting warmth of the cup against my hands; the blanket of morning sunlight creeping eastward and mirroring off the buildings; lights appearing at windows across the way, a human story behind every one. In short, it's being outwardly attentive to the world awakening around me, and grateful for the gift of yet another day. I know I've succeeded when long minutes pass and my Q wave persists. When a motorcycle fueled by testosterone tears by and I ignore it. Not easy; but it's getting easier.


My R wave these days is for Reflection. The opposite of the heart's energetic pulsation in a way, my R wave marks a mandatory cycle of slowing down and Reflecting. For too long I've had what may be the second biggest malady of modern life, the drive to always be accomplishing something. Why is it that I always need a product of some kind in the works? Something I can hold in my hand to justify my use of oxygen, and my place in the world? As I recline on my balcony I sense that the answer may be difficult to deal with: Maybe after nearly 70 years on the planet what I have to offer isn't enough? Maybe what I've crafted after all this time still fails a test of some kind? The image of a carrot on a stick comes to mind, and I don't even like carrots all that much.


Here's the distressing part. What if I never do measure up? What if I'd died that afternoon knowing (or feeling) that I'd left something undone? Or that I'd not left anything of value? Why would I feel like that? 


Poet Laureate John Ciardi was once asked about his fears as a poet, what he was afraid of concerning his work? He said his biggest fear was that he'd left part of the poem inside his head. I think we're all obsessed with this fear, that we'll pass this way only once and leave something critical undone. After my heart attack, I understand better than ever that what I've done is sufficient, that my legacy is intact if I choose to believe it is. Here's my alternative offering, my newest project if you will. As I stared into the abyss, I saw none of the fantastical punishments or promises, the heaven and hell nonsense that I'd learned from the nuns in catholic school years ago. I didn't see either a heaven or a hell. The closest I came to such torment as hell would be knowing in my last moment that I’ve left someone unloved when to give them the love and affirmation they crave would have been so easy. If I can say I've done that, the feeling will be very gratifying. That alone is worth the Reflection.


Something else I've Reflected on is my spouse's part in all this, how connected we are, and how deeply. This isn't intended as a love letter to my wife, but I don't write enough of those, so if it comes across that way, so be it. Since my heart attack a curious thing has happened. In addition to the harsh and alarming physical messages I received from my heart that day, I heard a far softer, much more 'heartening' message as well, that I need to let go, and let her care for me the way I'd want to if she'd been the one to suffer the injury.


Just as we need some kind of accomplishment to feel whole, we seem to need our full agency to be entire and lovable. Unless we're 'doing our part,' or 'paying our dues,' we're somehow diminished. Never mind that those who love and care for us ache for a way to show us that. Never mind that they're honored to be able to demonstrate their concern and care for us. Especially in western society, we feel that accepting help, when allowing ourselves to be vulnerable, even helpless, that reliance on others diminishes our worth. If we're not wholly capable of doing everything for ourselves we feel like 'a burden,' someone who thrives on 'entitlement,' or who feels justified in demanding paybacks for the care and feeding of others that we've done. We disdain the concept of release, the need to let go and be human, and real, and heartened by the interventions of others. It's tough to be helpless. But it can be tougher for those who love us, and who yearn to show us that. What my heart was telling me is this: Be human, and let the care and affection flood in. Its warm, soothing waters contain all the healing energy I need.


One of the most powerful and unexpected outcomes of my heart attack has been the psychological aspect of it, the emotional blow to my sense of agency, and the harsh understanding that I truly have sustained a major injury. I've felt humbled and helpless in many ways, and spent a lot of time dwelling on what happened to me. Even now, when my recovery is progressing reasonably well, I feel fragile, and breakable, and unable to relax about normal bumps and bruises. I focus on trivial things that never occurred to me before like my skin tone, and heart rhythm, and 'cap refill'. This is not time well spent. As I wrote in part 1, the feeling of helplessness, and the loss of agency has been deeply troubling.


My dear spouse, the retired nurse, aches to 'make it better,' and to get me 'back on my feet.' At first, my default with her attentions was to become angry and upset at the assumption of helplessness. Like a petulant child refusing my medicine I resisted her care, seeing in my wife's well meaning efforts instead the need to control me and direct me around, like herding sheep. This may be the most difficult part of the ordeal, seeing the care and nurturing for what it is, true love and concern for my (and our) long term stability and health. I've come to understand that looking at the big picture helps. We're all in this leaky little boat together. Those who believe they're in control, or who have full agency in their lives are misled. None of us is able to direct our own lives. We're all helpless to one degree or another, and believing we're fully in control is a dangerous and useless illusion. Only by acknowledging our humanity, and allowing others to see that, can we truly evolve into the powerful human beings we are.


My S wave represents Silence. This is not the same as Q. This Silence is the distancing I'm intending from another S, that is, Social Media. The corrosive, poisonous, negative energy found on FaceBook, Google+, Twitter, and the rest these days is killing us, I believe. Especially with the sapping power of the political climate, all who partake on a regular basis, and I count myself among them, or did, are exposing ourselves to real and long-lasting damage. I believe a future scientific analysis of health trends from this time will show a spike in such attacks and maladies as mine, that the population will trend toward less health, and more illness, partly because of the negative attraction of those sites and our interaction with them.


I don't believe in a god, as such. As I get older, I believe more and more in a universe that swarms with energy, a seething maelstrom of ions exchanging their negatives for positives and back again, impacting everything. It's not unlike the frenetic energy of this verdant valley in the Andes in which I live, on an unfathomable scale. I believe energy cannot be created or destroyed, that its value and volume have been constant since the eons of time. I also believe we have access to that energy, indeed that we're swimming in it, and that our choices about how it's used in our lives somehow projects outward, and then echoes back to us, like those swarming ions, either enhancing our existence, or corroding it. And I've come to believe that if we choose to focus on the negative poles of that energy, we attract the same back into our lives. By actively logging onto those social sites, participating in the reflected and too often vicious messages of negativity they contain, we immerse ourselves in a black, backward swirl of our own choosing. Our minds and bodies can't help but decay from that sapping power. Silencing our activity there can allow better choices, and more positive and healthy energy to flow. 


One more thing about those sites and our almost addictive attraction to them. I've come to understand that they're a distancing mechanism from people around us. That we use FaceBook, and Google+, and Twitter to shut out others while we enfold ourselves in a comforting blanket of anonymity, dismissing a need for true communication. John Paul Sartre wrote in his dark play No Exit, 'Hell is other people.' Could Sartre have foreseen the addictive power of FaceBook? I intend to Silence this power in my own life. My responses on social media will soon darken, and I believe the new light I'll attract will mean more healing energy. 



T is for Time. Since my close acquaintance with my own mortality, I've thought a lot about immortality and our quest to secure it. For me, immortality is nothing more than a measure of the love we’ve strewn across our abbreviated moment of light and laughter. Call it legacy, I suppose. A personal anecdote here. When we lived in the U.S., my wife and I became heavily involved in the LGBTQ rights movement. We were major donors to the Human Rights Campaign, (HRC). We used our energy and resources to help our LGBTQ friends secure their full slate of rights and protections, especially the right to marriage equality. Instead of sapping our energy, this work energized us, and gave us much more than we contributed. The day the U.S. Supreme Court ruled in Obergefell V Hodges in favor of marriage rights for all was one of the high points of our lives. In other words, those years of time and attention to someone else's needs was Time incredibly well spent. I proudly consider them part of my legacy. 


        With Chad Griffin, president of the HRC.                                     With good friend Jim Obergefell 


I'm happy to report that my mornings on the balcony are no longer spent awaiting another visit with my cardiologist. They're free, mostly, for contemplation and the ease of retirement I've awaited for a long time. My heart still flutters and rumbles from time to time, but it's still ticking away, still reminding me that listening to its timely message makes for a more mindful, and peaceful life. Thanks for reading. 





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