Tuesday, November 23, 2010

Fate, Costochondritis, and the Desire to Write Honestly

This is going to be a blog of all over the place while in the same place, a seemingly disparate group of threads that end up swirling together in a random mix. It is today and yesterday and and a few days before that. And all of those moments combined with the beginning, which was a handful of days that happened last year.

Yesterday was spent in the sensation of drowning--me, the editor hard at work on multiple projects--flailing in repeated waves of chest tightness and bound up in the feeling of someone stepping on my ribs, all the while moving through the day trying to focus, act as if nothing was wrong and reminding myself to remember that I was alright, that it was nothing more than costochondritis ("an inflammation of a rib or the cartilage connecting a rib") and working despite and around the fact that for at least 90 percent of the time I was thinking about my heart (the situation that led to the costochondritis was inevitably unearthed by it) and falling lost in the feeling of suffocation as I resited the urge to panic.

I am writing about this because when I started this blog, I promised myself I would be honest, that I would use it as a place to openly talk about the phenomenology of my experience, and that I would say whatever I was compelled to about the experience of almost dying. Not because I think I am so important that the world needs to listen to ME, but because I was so lonely and afraid as I lay in my hospital bed in the cardiac ward after surgery. I still remember thinking a lot about how I was just one sad and scared body in one room in a hallway of seemingly endless rooms with a lot of other undoubtedly sad and scared bodies. I remember thinking that at some point, when I was OK again, that I wanted to put those feelings, that empathy, to use. (Referring to myself and the others in the ward as "bodies" is apropos, because the days after surgery, like yesterday, were defined by moments of drowning, of feeling lost in my own flesh.) I decided to write whatever came to mind because I think someone out there who has hung out in cardioworld too may find something of value here. And I also write because I think honesty is imperative in relation to the near-death experience. It is easy to move to the "let's just think happy thoughts" place, but that isn't real. And catastrophe is a part of this strange thing called living and there is not reason to write as if it isn't.

And now, back to yesterday:

Later, in the middle of the night last night, when the sudden thunder woke me up, I realized that the not-able-to-breathe day had been caused by the coming storm. The shifts in the barometric pressure and the fluctuating temperature had triggered an intense flare up of my now ever present, sometimes sleeping, but too often raging costochondritis friend who has burrowed in and set up shop around my ribs. This is one of the things that can happen after a sternectomy. It is part of the new me who still catches me off guard.

Oh, costochondritis, you fancily named, five-syllabled reminder. Thank you for inhabiting my body and giving me the opportunity to think about my almost-death as I tried instead to edit well ...

Of course, that ode is tongue and cheek as I would much rather have never encountered this new inhabitant at all. Just as I would have preferred to never run into those ripping arteries that have led me to this. To this blog. To this moment. To this night when I feel better and the stifled breathing is for a moment just a memory I choose to write about.

This weekend I encountered the unexpected vehement frustration of someone who could not believe it when I said I would take my heart attacks and surgery back. In her mind where I am now is a result of fate and something that happened to show me my purpose in life. By saying I would take it back, I suppose in her mind I was somehow scoffing at this opportunity and denying the gravity of the situation and the gift it has provided.

According to this view, I am alive because of fate. I had my heart attacks because of fate. I had a bypass all because of fate. The universe somehow got itself together to mix things up in such a way that in July of 2009 I received this fabulous event that would reveal (in part) to me my purpose. So I suppose I could have sat at home and not had surgery if it were my fate to survive anyway? Forget the scientists and the doctors, nevermind the ER staff and the nurses, skip past the anesthesiologist and the perfusionist: let's be sure to not thank them!

Yesterday, for whatever reason, conditions converged in such a way that my flare up of costochondritis was the worst it has been since I first had symptoms of it earlier this year. Usually it's achy and I feel like my breath is a little shallow. Yesterday, however,  the tight, throbbing sensation in my rib cage made me feel like I did just a few months after surgery when I was still healing. Not only was it intrusive physically, but mentally as well. The pain was a reminder, carrying me right back to those days when I was still wondering if I would live.

So ... would I take my heart disaster back?

Well, what do you think? And my life, by the way, I wanted to say the other night (and actually did say to some extent) was just fine before it happened. I actually had plans and felt like I had purpose. I lived my days encountering those others and those moments that continually give life meaning and point you in the next direction. I don't know if I would have said I knew what my Purpose was with a capital P, but I don't believe there IS any such thing as a ONE grand Reason for a person's life anyway, at least not in the sense that it is written in a book by another's hand and at a distance. Instead I continue to dwell in the world of the moment to moment, day by day, one encounter then another. Because isn't there sufficient meaning and purpose there, without taking it to the next level and insisting on having my life inscribed as part of some Grand Narrative?

So no, my heart attack and surgery are not things that I will ever call good. I will never be thankful for them. I would rather they hadn't happened. They were random events that happened to me. Just like random events that happen to biological bodies all the time. No stars converged to send me a message. No fingers reached from the universe to say hey, let's give these coronary arteries a little tug. It just happened. And here I am. Thinking about my life in ways that I hadn't thought about it before from a perspective I didn't expect. But it isn't "better" or "desired" but just something that is.

And of course, it hasn't killed me, and in some ways I may have even become stronger because of all of it, but it could also be true that I have gotten through the situation by relying on strength and the love of others that I already had. "What doesn't kill you makes you stronger" isn't so cut and dry. We live and we are wounded. We live and encounter setbacks, disasters, losses, and all kinds of chaos. What doesn't kill us may not always make us stronger. Sometimes events that happen simply change us, scar us, build up our immune systems a bit, and leave us changed and permanently altered as we look around us and gather our new selves up again, while possibly always on some level missing the ones we were before.

One night, as I lie there in the hospital last summer, a code red alert sounded. I listened as nurses and doctors ran down the hall. Someone was dying. I was alive. If my "fate" was to live because I had a purpose, does that mean the dying one didn't have a purpose or get the same chance to find out what her or his purpose was, after surviving such a horrible thing? To answer yes, would mean I find myself just a bit more special, would mean I deny the random, and would mean I deny that I simply got lucky.

So, fate?


And the ache of costochondritis days making me stronger?

Not really. It's more a matter of getting used to it, taking more ibuprofen, and simply finding ways to deal, but I certainly wouldn't mind if it decided to go away.

Saturday, November 20, 2010

The Importance of Flow for the Health of Women's Hearts

Research presented earlier this week at the American Heart Association's 2010 Scientific Sessions indicated that women who report having high job strain have a 40 percent increased risk of heart disease (This includes heart attacks, arterial blockages, and the need for procedures to open blocked arteries.), compared to those with low job strain. On initially reading the headlines, part of me thought, well, of course, this is a no brainer, isn't it? After all, that thing called "work" is where we spend at least 40 hours of every week. So a stressful job is naturally going to take its toll on the heart. What really grabbed my attention though, in addition to the HIGH percentage of those with increased risk of heart disease, is the way job strain was defined:

"Job strain, a form of psychological stress, is defined as having a demanding job, but little to no decision-making authority or opportunities to use one’s creative or individual skills."

The italics are mine, and the italicized text is worth repeating. Little to no decision-making authority or opportunities to use one's creative or individual skills.

So it's not having a job that is demanding, but it's alienation from oneself and ones job that puts the strain on the heart. Reading this, I started thinking of so many different things--about women, being a woman, seeing smart women around me who aren't valued for what they have to offer, and even the ways women often don't value themselves and perhaps even settle into situations and jobs that really don't do it for them without recognizing that settling is what they're doing. Just the day before, in a conversation with a friend (yes, a woman), our discussion turned to the way one can sometimes find oneself inhabiting the space of comfortably numb (some Pink Floyd settling) compared with the psychological concept of "flow" as defined by psychologist Mihaly Csikszentmihalyi.

Flow, a positive psychology concept, is basically a mental state of being in which a person in an activity is fully immersed in a feeling of complete, energized focus, full involvement, and success in the process of the activity. Importantly, flow is a delicate balance, an in-between space where the challenge is neither too much or too little. Too much challenge can disrupt flow (when one is involved in an activity that is completely overwhelming, such as being tasked with writing an article about the evolution of bird wings without a background in ornithology). Similarly, a lack of challenge also makes achieving this state of flow unlikely (say being tasked with proofreading articles about the evolution of bird wings when one has written five books on ornithology). In both instances, getting lost in the moment, becoming one with the activity, falling into it to the point that the boundary between you and the task begins to collapse, isn't likely. Not that being challenged too much or too little are bad things in and of themselves, but when these non-flow states are the norm and not the exception, it's another story altogether.

This idea isn't new to me, generally. I can think of times in my life when spending most of my days unchallenged began to spill over and leak into all other areas of my life, but the idea that this could be bad for my heart, adds another dimension to the topic.

Getting back to the conversation with my friend and my thoughts about smart women in unchallenging, not-nearly-enough jobs, with all economic considerations aside (yes, these days, it's simply good to have a job and a regular paycheck), I worry about that invisible line that one crosses when not-enough is pushed aside and replaced by that sense of numbness, of being comfortably numb, of no longer even knowing what one wants. It is the spillover effect of not having flow. Say I am bored, but comfortable for 40 hours of week; the job is familiar, I know what to do, everything about the work environment is "safe," if I stay in this situation long enough do I eventually risk losing a sense of who I am? Even in my off hours? I think of times in my life when I am challenged and invigorated and my days are filled with hour after hour of "the flow zone" and what I notice is that my life itself becomes more expansive, more energized, more alive. In every way. I work hard, but I am not drained. I work hard, but I am motivated. To do more, to reach more, to open more, to keep going. It is the opposite of dwindling. If I haven't quite made my point, think of those long weekends or even weeks where you decide not to do too much except watch a marathon of some fabulous TV series. You spend three or four days watching three seasons worth of Dexter, for instance. Hell, it's a good time. You really do enjoy it, but how do you feel at the end of it? Bleary, a bit sluggish, perhaps even brain dead? Compare with a day spent with friends in good conversation. The words bounce and gleam and sentences burst to overflowing. The world shimmers in that way it does when you see parts of it in a new light. You eventually part ways with your friends only because you have too--because the bar or coffee shop is closing or you realize day has turned into night, but you go home and you still have more to say. You fall asleep still thinking of the conversation. You wake the next morning and you are compelled to write about it, even.  A follow up email, a blog, a journal entry ...

That's the difference between non-flow and flow.

So flow is good for a woman's heart. I think about the women I know. The women I have known who sell themselves short. Ultimately, it could be bad for their heart, especially if they accept job conditions that aren't enough.

One of the unexpected directions the reported outcomes of this heart study led me is back to my early graduate school self. There I was, in my second year of my PhD program. One day I asked a friend if I took up too much space in our seminar. Not physically, but I was worried about being a giant class conversation hog. Did I talk so much that others didn't get the chance to speak? Was I rude? Did I blurt out my ideas and run roughshod over others? No, my friend said. In fact, he pointed out to me that I was quite the opposite, that every time I had something to say, I would apologize before saying it.

Imagine. I was worried about taking up too much space when in reality I was in the habit of dismissing my ideas before uttering them. "This is probably a dumb idea, but ..." You know the game.

This was an eye-opener. At first I didn't believe him. So I started listening to myself. And sure enough, there I was; apologizing for my ideas. Then I started listening to all the other students. What I noticed was that almost without fail the other women in the room were doing the same thing. SMART, INSIGHTFUL women, all working on their PhDs in philosophy were apologizing for their thoughts. The men in the room weren't apologizing at all.

I eventually cured myself of this self-deprecating behavior by allowing myself to say "This is a dumb idea, but ..." but ONLY in my head. So this habit started making itself noticeable to me. Every time I caught myself about to say it, I would say it silently, then share my thought. This had the two-fold effect of making me see how often I was demeaning myself and the effect of making me speak out more confidently (no one could see what was going on inside). Eventually, I realized that I wasn't saying anything dumb at all and that my ideas were just as important and valid and even as interesting as my cohorts'. But I never stopped noticing other women caught in this cycle of self-flagellation.

I thought of this when I read about this 40 percent increase in heart disease risk caused by job strain, because I worry that women may sell themselves short, saying yes to staying in jobs that don't allow them to flourish.

Again, I am not for a minute trying to dismiss the nuts and bolts of having a job or the difficulty of finding new jobs, if the one you are in isn't enough for you. What I am trying to get at is the importance of not losing sight of yourself, of remembering who you are and everything you have to offer, and strategizing to find ways of offering it, if indeed you are in a job situation that is sucking you dry because you aren't given the space to grow. How to get enough water for your roots is the question.

Because, it turns out that water for your roots is good for your heart. Imagine your heart in flow. Burgeoning, blossoming, reaching out, unfolding, giving to the world. To yourself. To you, the insightful woman you are, to others.  If you can't find it in your 40-hour-a-week life, but you have to stay in that job for now, then look for that flow elsewhere. Start today. Without hesitation. Feed your heart in your non-work hours and watch as you fall into the abundance of flow. Once again, it's a mind body thing. The corporeal/non-corporeal loop, one becoming the other, yet another time again.

Saturday, November 6, 2010

Some Random Thoughts about Bodies and Words

Trying to get myself out into the "philosophical world" again, I have been formulating ideas for conference paper proposals (on the subjects of embodiment, illness, writing ...) over the past couple of weeks. Putting the heart into language is difficult, even if, ironically, the call to put my heart into language has been incessant for me since the weeks soon after my surgery. Or maybe it's not that it is difficult, exactly, but when I really start to ask the question: How DO I write about this? immediately revealed is that strange slippery space where language and body meet.

Depending on what your definition of language is, words may simply, transparently, point to the object being written; words may actually shape the written object; or words may both shape the object written and be shaped by the object written, and thereby disrupt the subject-object dichotomy altogether. As far as what I think language is and does, I fall into the third camp: Words shape flesh as they write flesh and are at the same time shaped by that very flesh. Our language is an echo of our socially located biological from.

If I unravel this thought and follow it all the way to where it leads, for me, this means my way of writing about my heart attacks and heart surgery, will be shaped by the events themselves. "But, of course," you might say, "this isn't any real epiphany." Yes, of course. But, what I mean here is more than a superficial sense of having a new topic to write about, but that there is an actual way of writing that will be an outcome of what happened. A language that feels like the pulse of the events themselves. This is where the difficulty comes in: as soon as I start to think about it, I wonder what such a language will look like. And again I think about that slippery space between language and the body. Because, even given everything I have just written, there is always for me that sense that a bit of what I am trying to write slips past the words I write. Is the reverse true, I wonder: when writing about my heart, do the words I write also slip past my heart just a bit to evoke something beyond it, even at the same time it doesn't completely capture the heart?

These are some of the random thoughts I am playing around with this early Saturday afternoon. I have more questions than I do answers, but I am a lover of "the question" so that is ok with me, and I think its more honest anyway. I admit I am uncomfortable with anyone who approaches me (and yes, this has happened) to tell me with certainty that they know what my heart attack and survival "means." As if there is meaning to be found in any intrinsic sense in the events themselves. Really, what happened is just something that happened to me as a biological being. And I am with Christopher Hitchens: instead of asking "Why me?" it's more like "Why NOT me?" Bad things happen all the time; it's easy (and seductive) to think you won't be included in that. But not honest. This doesn't mean I haven't "Made Meaning" of the events or learned a lot about myself in the process, but simply that the heart attacks themselves had no Meaning with a capital m. I like it better this way: as it give me more room to negotiate this "after."

I just went off on a tangent that I didn't expect. This is one of the things I love about writing. Just start: pen to page or fingers to keyboard and if you let the words takeover you will just end up .... where? You don't know; and that's the gorgeousness of it!

As far as what I have come up with for those conference paper proposals, I had the thought this week (and included it in a proposal)  that, for me, writing about the experience of almost dying is a meditation that begins on the surface of my flesh. One place it begins is on the six-inch scar that runs between my breasts that is at once an end and a beginning, a line of demarcation designating a before and after. I start with the scar because it is the jarring echo of unscarred flesh; to notice it means I remember a time when it wasn't there. This meditation also begins on the surface of my heart, which, as I have written about in a previous blog, I have seen resting bare, vulnerable, and exposed to the world in a photograph my surgeon took during my operation. The picture of my heart is a memory though (as all photographs are). It is a heart that is no longer, a moment before any slice has been made. But it is also a memory that doesn't feel like mine; in the picture, my heart is a stranger to me, not least because my surrounding body is invisible. The bare, silent heart, the beating of which has been temporarily stopped, is anonymous, disembodied, stripped of gender, skin color, and identity. And yet, this organ without a body is the one that must live for me to be.

Writing about my heart—as a woman, a philosopher, a painter—is something I have been compelled to do. Obviously, it's been another way to process what happened to me. Psychoanalytically I could say that I have been conducting my own little fort-da. Gathering my heart and shaping it again, gathering another time and reshaping it again. I suppose I have been fort-da dancing since I first woke up unable to walk but a few steps across the hospital room. Painting, naturally, has been another way of processing, often (through the weeks of the Watersketch Prospectus) providing a window that reveals a glimpse of what I am feeling that words alone don't.

When last summer happened, I had the experience of being betrayed—by my body, my heart—I found myself caught in an ambiguous, yet all-too-familiar dichotomy (and a very Cartesian one to boot): on the one hand, I felt myself to be drowning in the pain of “mere” and overwhelming, crumpling-into-itself flesh, while on the other, I felt myself to be profoundly disconnected from that very flesh. My damaged heart called to me as a stranger, and I wanted to turn away. Turning from the stranger was impossible, however, because it was a voice that was my own. In the haze of an unexpected after, my stranger demanded gestures—in words and paint—that listened to it and took it seriously, even if I wanted to look the other way.

I consider the line of my scar and the image of my heart as surfaces that unfold to become metaphors of the Möbius strip as offered by Elizabeth Grosz (who borrows the metaphor from Jacques Lacan.) Expressions of my stranger—in words and paint—become gestural loops, continuous motions informed by damaged/healing flesh that reach out into the world to return back to my body to reach out to the world again. My near death experience and my newly strange/estranged heart prompted me and continue to prompt me to revisit Hélène Cixous' call for women to write their bodies. Wounded, my body demanded a tactile language, and in those first months after surgery it became apparent to me once again that expressive articulations always begin in the flesh. My scar and the image of my heart had simply thrown into high relief the often terrifying strangeness of the biological interior that already was.

And just as my scar intrudes on my skin to remind me of the teeming heart-world beneath, I consider my 'scar of intrusion' as a metaphor for the place where biology and language meet, one oozing out onto the other, continually feeding the fleshly loop of embodied language.
All of this takes me back to the question: what does a this language I am after "sound" and "read" like? To throw another kink in the mix, is it a language of only words, or do I need a language that includes words and image in conversation with each other: not set up so one eludcidates the other, but to continually feed a continuous dance of evocation?