My Broken Heart

"...women are commonly excluded from research, partly due to a reluctance to account for and investigate the variability that can be introduced by women’s hormonal cycles. And research that does include women commonly fails to check for differences between men and women."

Academy of Sciences: How healthcare and research is failing women. July 2021.

“The grief that does not speak whispers the o'erfraught heart and bids it break.” Shakespeare

On a bright early morning at the end of April 2023, a couple of weeks after my 54th birthday, I suffered a rare kind of heart attack. It was a Spontaneous Coronary Artery Dissection - a SCAD. I'd never heard of SCADs before, let alone heard that they're the result of arteries weakened by hormonal changes, combined with an episode of extreme emotion or stress.

I am very lucky to be alive, and, three years on, to be suffering only minor symptoms; namely, boughts of extreme, wall-hitting fatigue and an, at times truly disconcerting, hyper-awareness of my heartbeat. Unpleasant, but live-able-with. The experience has nonetheless significantly impacted my life. A month after I was discharged from hospital, I was told by the Cardiac Rehab Team that because of the risk from extreme emotion or stress, I must take urgent steps to eliminate them. This meant if I could retire, I should. The fact that I could retire is a privilege. Nevertheless - both financially and emotionally - it was a painful call to make.  

Ultimately, I decided there was little choice but to leave my job as an academic in a university department that I loved. My contract finished on July 31st 2023.

Since the heart attack, I've read the medical research, joined one research project on SCAD and genetics at the main UK centre of expertise on SCAD at the University of Leicester and Leicester Glenfield Hospital, and another on SCAD Treatment and Rehab, at Edinburgh Napier University. I've also joined various online support forums. I've learned a great deal about what happened to me. Even now, I keep coming back to these three reflections:

a)         how easily I might have dismissed my symptoms (and why)

b)         the comparative lack of research into women’s heart attacks (and health generally),

and,

c)         the strange reality of the psycho-somatic interface.

The best way to explain why these reflections preoccupy me is to set down the story of what it was like, as an otherwise healthy middle-aged woman, to experience a heart attack out of the blue. What follows is my memory of what happened on that spring morning, written down about five months after the event, with some longer-term reflections along the way.

Here's what happened.

Thursday morning

I was alone at my flat in Chester, getting ready for a day of meetings that was to culminate in an evening lecture and formal dinner at the University at which I worked. Around 8am, realising that the day was so full, I wouldn't have time to come back to the flat to change for the evening, I decided I'd have to put my dress on now, and just cope with feeling uncomfortable and over-dressed during the day.

I hadn't slept much at all the night before. It had been an awful night.

Eighteen months previously, I’d experienced a debilitating episode of severe depression. It had been my first in nearly a decade, but, having suffered clinical depression before, I knew that I had to take it very seriously because of my vulnerability to addiction. So, I had embarked on some psychotherapy.

As I've written elsewhere, I believe in (good) therapy. I think of it as the effort to take responsibility for elements of my personality that bring me and others unnecessary pain. The self-understanding and change that I seek can’t be achieved without support. It requires challenge, witness and insight from a mind external to my own - someone who can see my biography more objectively than I can and can make, or at least suggest, the links that my conscious mind tries to hide from me. I didn't expect it to be easy, but this time it had been significantly harder than I’d been prepared for.

In the course of therapy over the previous 15 months, the consequences not only of adverse childhood and early-adult experiences, but also of intergeneration trauma, on the shaping of my personality had been, at least partially, revealed. Great chasms in my relationship with myself (to use the cringeworthy jargon) had become obvious to me, as if I'd just chewed up a giant existential disclosing tablet. The awful depression I’d initially presented with had, thankfully, somewhat receded. I’d had a couple of short but truly horrible relapses in the preceding 15 months, but, for the most part, the depression had mostly returned to familiar and manageable levels. However, I was still experiencing anxiety, sometimes bordering on panic. What I was facing about myself in therapy had made me feel exposed and fragile. Painful material from the past was emerging and it was hard work to maintain the everyday persona necessary to function while all this was going on. Profound and disturbing unconscious upheavals were lurching and pitching around somewhere deep down, while my surfaces felt like they were cracking for all the world to see. Most disconcertingly, I found myself genuinely confused about the true location in time of the source of overwhelming and irrational feelings.

In line with Carl Jung’s claim that the task of midlife is to turn inwards and integrate conscious and unconscious, my intuition was that these bizarre and intense emotional upheavals were, potentially at least, arcing long-term towards healing.

However, they were terribly painful. Enduring them, on top of the standard pressures and pains of work, post-pandemic life, and menopause, was inevitably taking a toll. Furthermore, I had recently had my therapy suddenly and unexpectedly terminated. After treating me for 15 months, the therapist had concluded that my issues were beyond the scope of their training and skills. I had trusted, opened up, and then suddenly found there was no way forward. At least not immediately. I was a walking open wound.

Having activated dormant emotions associated with a difficult past, and then having no support to hold, let alone to process, them, it was perhaps not at all surprising that I was struggling to sleep.

But that night had really been especially awful.

As I sat at the computer, hair wet from the shower dripping on the pink dress, the clattering sound of the passing trains and the bright light coming through the window were jarring. The symptoms of lack of sleep — the headache, digestive discomfort and aching limbs — were sabotaging my focus. I had the wretched anxiety that comes with the sense that the meagre physical and psychic resources available to me would not be equal to the day.

My mind and body were flooded with the anguish that had kept me awake. I wanted to write it out. To do the kind of writing no-one sees, for purging, and to investigate, to find out what, really, it is that hurts so much.

One of E.M. Forster's characters said, 'How do I know what I think until I see what I say?' For me, that holds for feeling as well as thinking, even on a good day. I don’t know my own emotions unless I can write them. The relationship between my inner life and my keyboard is wholly different to that between my inner life and my actual voice. If I try to speak about myself outside of the usual social scripts, mysterious, free-floating, inchoate fear chokes me back into silence. Writing, though, provides safety and order. It offers a second go, a third go, at descriptive accuracy and authenticity. It's speaking to no-one, so I can at last be myself, unencumbered by anxious projections onto the mind of a specific listener.

Partly through therapy, though it also feels like an instinctive truth, I’ve become more open to the idea that the struggles I face in the present are tightly bound up with the past, though in ways that are not immediately obvious. The skeins that link present and past require careful and critical unearthing. Recognising the limits of my conscious mind in that endeavour, I’m cautiously open to practices of dream interpretation, free association, and creativity as methods of exposing why current experience can feel so disproportionately intense. If I’m open enough I can sometimes discern that painful (or indeed beautiful) features of current experiences, and current dramatis personae, are lodestones for features of past experiences and characters. Sometimes I’m able to uncover convincing backstories for apparently irrational elements of my present behaviour or intense feelings. But correspondences are not always obvious, and they’re not simple either. I have to get right inside experiences and emotions – past and present – to pull at the threads. And I can only really hold on to those threads if I write them. They slip back down below consciousness again all too easily.

So, even though it's the beginning of the working day and I have a lot to do, I start to write. I focus on the contours of my nighttime anguish. I'm writing about recent, intense emotional pain, and I’m writing through it, into the past. I’m asking myself what at some deep level I know links events and experiences, spanning from my childhood and early adulthood to the present time. The feelings come, and with them tears, as is so often the case when I do this, but that’s fine, because there's no-one here. And as Paul Coehlo says, “tears are words that need to be shed.” As I write, I'm looking for what themes, emotions and events 'mean'; what my part in them tells me about who I am and what I'm afraid of. There's a pain in my chest that doesn't surprise me. It is emotional pain. Or perhaps, to use Irving Yalom's productive terminology, it's “existential pain.”

Some of the therapy I'd recently had involved developing the habit of returning mindfully to the body as a reference point for emotions. 'Where in your body do you feel that?' my therapist would ask. “In my neck.” I'd say. “In my guts.” Despite my familiarity with secular mindfulness practice of the Body Scan, I would find those questions, in the context of therapy, irritating. I felt they were wildly missing the point of what I was saying. I wanted my stories, that were taking immense effort to tell, to be engaged with on their own terms, not reduced to bodily sensations. However, aware that I don’t always know what’s best for me, I tried hard to moderate that irritation in the service of what I hoped was something I was meant to be learning. I wondered if I could learn a new language of my body. Perhaps there was a difference between feeling the stranglehold of anxiety in my throat or in my sphincter that I could learn to detect, and that being able to do so would offer me some emotional wisdom that I currently lacked? Was my difficulty in verbally articulating my feelings in the moment that they were present, and my discomfort with drawing attention to my body, mean I was somehow disconnected from it, or from embodiment itself? I thought that was possible.

My body is, afterall, a terrific source of grief to me.

To use the terminology that I’ve no doubt appears in my medical notes, as well as being an addict, I’m an “involuntarily childless woman” and a “rape survivor”. My body has catastrophically let me down and it has been the site of; indeed cause of; experiences that (among others) have brought me, at times, to the brink of despair.

I listen often to Nina Simone's magnificant and inspirational Ain't Got No/I Got Life. I think if a Black woman can feel that way about a body upon which unspeakable atrocities have been perpetrated throughout history, I should surely feel gratitude for mine. But I sometimes wonder if I even know my body, let alone understand or appreciate it.

In the early years of my recovery from alcohol addiction, like most people in early recovery, I struggled with very poor interoception. I couldn't interpret the internal signals that others read with ease. The craving for a primary substance screams in every cell, drowning out that more subtle, yet literally vital, somatic language. Other needs can’t make themselves heard. I didn't know I was hungry, so I often didn't eat. I became thin and frail. I also didn't know I was angry. So I internalised all my anger and raged against myself. Seventeen years on from achieving abstinent recovery, I had much healing under my belt. Yet here I was, seeking therapy for depression. Perhaps I was still living that legacy of separation from my body. So, I had persevered with the 'where in your body is this emotion?' questions, even though they made me squirm, and my grasp of their purpose was uncertain.

But now, at my desk, I'm not bringing that sanitised 'curiosity' to my bodily sensations. I’m definitely not identifying myself as the dispassionate observer of feelings that ‘visit’ me. Far from it. I'm ‘in’ them; fully ‘hooked’ and ‘fused.’ I’m keening – silently — though in my head the noise is deafening. I’m grieving losses, and spewing pain and fears directly onto the page. I'm trying to put the form of words onto my wailing. I'm right in the centre of the vortex of a profound and unbearable, yet on the surface, disproportionate, sense of having been abandoned, rejected and shamed. I’m asking myself, 'What the hell is this anguish that is coming up from the depths of my psyche and breaking my heart?' Tears drip onto my typing hands, and my chest aches like hell.

After a while, though, a harsh inner voice tells me I can’t afford to be ‘indulging’ myself like this. I've got to work. My life is truly going to unravel if I don’t. The voice is not wrong.

It was as if someone I didn’t like, and who didn’t like me, was writing my to-do list.

I’d been struggling with work motivation for a while. Something idealistic and driven had broken inside me a couple of years ago, and I couldn’t seem to retrieve it, not wholly anyway. That’s not to say work was always unsatisfying – it really wasn’t. In a few areas, I felt I was making valuable contributions. But I didn’t have the capacity for the day-to-day grind that I used to have. It was as if someone I didn’t like, and who didn’t like me, was writing my to-do list. There was no joy in tackling it and it didn’t even feel like ‘mine.’ It’s a feeling that has ebbed and waned over the last few years but it is particularly sickening just now. The problem, of course, is that if I don’t do what I’m supposed to, people I care about suffer. 

As pressure of work chokes off the healing drive that begs me to write, a stifling claustrophobia begins to squeeze at me. With effort, I minimise the document and go back to my email inbox.

I wipe a hand over my wet face and scroll, wincing at what's there that urgently needs dealing with. The pain in the middle of my chest still impacts my breathing. Part of me thinks "I'll go and get some Gaviscon in a minute," but the other part is glued miserably to my screen.

So much of any academic's inbox is filled with the kind of work that isn't true work. It's the feeding of the insatiable ouroboros of university administration. It's forms and processes. It's the placating of this or that management structure (there are many), all of which must be achieved before any real life-giving work can be undertaken. There is enough of this 'non-work work' to take all my contracted hours and more. It's running-to-stand-still work. And, much as I hate myself for it, I'm always behind. My anxiety ramps up further. Truth be told, this morning’s work anxiety is no worse than it always is, but, as is so often the case, my depleted and burnt-out mind tears ineffectively around the to-do list like a distressed dog on a chain, worrying, energetically, but entirely impotently, at whatever issues happen to present themselves as being within reach.

Finally, randomly almost, I open a student's dissertation draft. At least that's real work. She’s been waiting for feedback. I endeavour to swallow back my own self-hatred sufficiently to move myself emotionally into her world, into the way she thinks and writes. I try to see what she means, and to imagine where, in terms of meaning, she might want to go. I try to help her communicate more directly and to link her thoughts to canonical, academic ideas in such a way as to tickle second-markers and external-examiners into approval. I attempt to convert her personal reverie into the language of the academic game. Why? Because I want her to do well. Not because the language of the academic game makes all that much sense to me anymore. But at least there's purpose here, for her, and I suck gratefully on the tiny bit of oxygen it offers.

The marginal relief, however, doesn't seem to impact the pain in my chest. Focusing on any one task requires fighting off the oppressive presence of an inbox that, in that moment, seems to represent all my failures and inadequacies. And behind the inbox is the deeper wretchedness that was upon me in the night. It’s as if my left arm is held up to shield me, to take the weight of a pending but terrific emotional avalanche that would annihilate me if it were to fall, while my right-hand endeavours to do something tricky and intricate in the space I’m exerting all my strength to protect for it.  

The effort required to do one task is significantly greater than the actual demand of that single task.

And now there's pain in my left arm too. I shake it, almost surprised to discover it isn’t actually raised to protect me, but it’s at my keyboard. I drop it to my side and repeatedly clench and release my fist. It must be pins-and-needles from my intense and emotional typing moments earlier.

Focus, for god’s sake.

The verb and subject in this student’s sentence don't agree - will she know what I mean by that? Perhaps I'll just fix it for her.

Ouch, no. That’s not pins and needles. It’s actual pain.

I delete the fiddly comment box I’d started on the track-change document and change the word in her script. Not great pedagogy perhaps, but I’d rather not overwhelm her with grammatical nit-picking. It’s soul-destroying for students. Her draft is already so littered with my comment boxes that Word is not showing them all in full. My heart aches for her. What she wants to say is so personal and honest. I’m being too heavy-handed.    

‘That is my left arm, isn't it?’ I engage the conscious thinking that is required for me to distinguish between left and right. Yes, that's my left arm. It was upper-arm, but now it’s upper and lower-arm too.

I bring my arm back up to engage with the keyboard and look at it in disbelief, as if it doesn't belong to me. Then with a whoosh, the pain, in both arm and chest, intensifies.

No.

This isn't right.

It's cardiac. I know that.

I google it anyway. Don't trust myself.

Yes. It's cardiac.

Instinctively, I put my hands on the desk to push my chair backwards and dip my head down below desk level. I begin to feel significantly more nauseous. Oh God. What shall I do?

I get up from the computer, pick up my mobile from the desk in my right hand, and cradle my aching left arm close to my body with my right forearm. I go and sit on the floor in the lounge, my back against the sideboard and my knees up to reduce the need for my heart to pump blood to my legs. A picture, vaguely remembered from a First Aid manual, is in my mind. I think of myself as a line-drawing of a distressed little chap in a suit jacket and loosened tie.

I’ve called emergency services several times in my life, in some pretty harrowing circumstances, but always riddled with doubt about over-reaction. Should I ring them now? I don’t know. But I’ll look like an idiot if I am having a heart attack and don’t do anything about it. My brain parses intense fear I might die into anxiety about ‘looking like an idiot’ – a thought that contains within it deep dread of causing anyone else inconvenience through a failure to act correctly on current information.

I ring 999, ask for "ambulance, please" and describe the situation to the call-handler. As I do so, I feel worse. I think I'm going to be sick on the carpet. I wonder if I'm going to faint. I lie right down on the floor, the phone to my ear. I can feel prickles of sweat on my forehead and my hand slips on the phone. I'm asked detailed questions about my behaviour in the last twenty-four hours, my medical history, and now, about my family's medical history. Were my parents alive? How did they die? I'm bewildered at the level of the conversation. It feels like this is some kind of test and I must give the right answers to qualify for help. I give a matter-of-fact account (not easy) of the deaths of my parents, and then before yet another question can come, I exclaim with a cracking voice, close to tears “look, I really, really don't feel well. I'm scared. Something’s really wrong!” “It's okay,” she says, “I've already dispatched an ambulance, but it may take 30 minutes to come.”

I think, 'Oh my god, will I still be conscious, or alive, in 30 minutes?' but I say, “Thank you so, so much.” We wind up the call, and she says, “Call back the moment anything changes.”

“I'll try,” I say weakly, wholly unable, by then, to point out the absurdity of her request.

I’m relieved to be liberated from the call. It had taken so much energy to make the decision to call, to hold the phone and respond to the questions. The world goes quiet apart from the terrific pounding of my pulse, that tells me I am not (yet?) in cardiac arrest.

I try to breathe, and to summon my ‘go to’ panic-attack visualisations — places, people, specific words — and my ‘technique.’ I cough, deliberately and dramatically, in an attempt to shock my heart into a new rhythm.

I remember answering a question from the tutor on a Mental Health First Aid course about whether the class knew the kinds of techniques used by people with panic disorder for managing attacks. I’d put my hand up and said, “I’m sure this is not a standard thing but when I’m having a panic attack, I try to cough hard. I’m sure it doesn’t really change my heart rhythm, but that’s what I stupidly imagine I’m doing.”

The tutor had responded enthusiastically. “Yes! That’s exactly what I was looking for! Brilliant! People who live with these conditions are so full of wisdom about mitigation. Rather than telling them what to do if an attack is happening, they might just need someone to prompt them about their own experiential knowledge.”

I’d felt validated in that interchange. The course had figured mental health issues as a ‘they’ problem. That had irritated me, and I’d deliberately corrected it with my personal disclosure. But the tutor had not othered me. Quite the opposite. He’d transformed my lonely and idiosyncratic ‘stupid imagining’ into a wise technique, and he’d figured me as part of an experienced community of people living with panic issues, a community to which it had, at that point, never occurred to me that I belonged.

I try it now. I cough. Hard.

The thing about all these techniques; ‘box-breathing’, ‘sober-breathing’, ‘say five things you can see, etc’, ‘tapping’, ‘visualising’, even ‘coughing’, is that they don’t help much at all. But the tiny bit they do help is worth having. I cough hard, to the point of nearly vomiting, so stop abruptly. But — gasping and sweating — I’m still here. I try to steady my breathing, humming to myself to help me do it. I think about the people I love. I bring them to mind and tell them I love them, how wonderful and glorious they are, how grateful I am for them, and if this is goodbye, how their presence in my life is infinite, so it’s only a kind of goodbye. I hope the power of my love and good wishes reaches them somehow.

I’m still here.

From my position on the floor, I realise that I will have to get up so as to buzz the paramedics into the building and open the door to the flat. Can I get up? I'll have to. If I open the window, at least I'll be able to shout to them from the floor if I have to lie down again.

I get up very slowly, my head spinning. All my experience, inner and outer, seems to have gone into slow-motion. Each step towards the window feels unlikely to advance me, but I get there, and desperation gives me the strength to yank the handle and push the window open.

The blast of air on my face combines with the relief of what I see, and everything returns to normal speed. An ambulance is parking-up outside. They’re here! Already! Thank you, thank you, thank you! Someone - a neighbour? -  is letting them in downstairs. Who is that? How embarrassing.

I don’t need to buzz them in, but I go to the door of the second-floor flat and prop it open with some difficulty. I’m shaking. I feel so weak, and the door is heavy. I don’t seem to be able to move the door-stop into place with my foot, so I bend down to move it with my left hand – while holding the door open with my right. As my head drops, the planet spins on its vertical axis. I have to crawl back up the door to a standing position, seemly against the odds.  Mission accomplished, I lean louchely against the door frame and greet two young male paramedics as they come bounding up the stairs.

I feel extremely silly in my body-hugging pink dress; a gift from a dress-wearing friend some months earlier when I thought I might have to do some TV at short notice. She and I’d had a lovely evening together, when, after feeding me a delicious home-cooked dinner, she’d invited me to try on dresses from her wardrobe for her expert assessment, with a view to me borrowing something. However, she'd decided that borrowing was out of the question. I must have this dress for keeps. It really wasn’t her colour, and I looked so 'hot' in it, she had said.

Now, leaning against the door frame, I feel as if I look like some sad, lonely, middle-aged woman, dressing up and feigning illness so as to have handsome young paramedics pay her some attention. I'm mortified.

They breeze in with an air of confident professionalism and sit me, half-lying, on the sofa, apologetically asking if I'd mind pulling the dress right up so that they can get at my chest. It sticks, and, as they stand over me, I have to shimmy. Once my sordid efforts are successful and the dress is up, bunched in my hands at my neck, they swiftly stick ECG wires on pads to my chest and down my left side. I wonder if I should offer to remove my bra as my breasts are lifted, creating a buffer between the pads and the organ beneath. I test out the line 'should I take my bra off?' in my mind. Already mortified by the dress, the wriggling, and now by the fact that I’m lying completely exposed, I reject it, preferring just to hope that their decency and my mortification will not combine to produce an inaccurate reading.

I have to assume they know what they're doing.

The wires now in place, one gives me a reassuring smile and presses a button. Paper prints out from the bottom of the machine. He tears it off and consults it.

“It's normal.”

I feel a mix of immense relief and intense embarrassment flood through my body.

It's just tiredness and indigestion. You idiot. You fucking idiot.

I apologise for time-wasting and they gallantly respond. I did the right thing.

I say, weakly, "I feel a bit better now."

One of them is crouched over me disconnecting the wires from stickers, politely leaving the strongly adhesive stickers themselves for me to remove. He replies, grinning,

“Is that because we're your saviours?”

“No!” I snap, nerve-touched. "It's because the ECG was normal.'

"Ah," he says, twinkling at me, "it's just we often get patients feeling better when we arrive."

His colleague explains that because the symptoms I'm reporting are cardiac-related, they do recommend that I go to A&E and have a couple of blood tests. "But I warn you, it would be a wait of four to six hours. Your choice, of course, but we do recommend it."

My slightly panicked-mind ranges over my appointments. But I concede, "Okay then. I'll make some calls and then I'll go to A&E."

"No, no,"' he says, "We'll take you in. But – and please don't take this the wrong way -- perhaps, you might like to get changed first?"

I blush and thank him.  I go into the bedroom. Not without some difficulty because I'm trembling and feeling pretty unwell, I change into jeans, oversized t-shirt and hoodie, and grab my work rucksack. In the ambulance, they give me an aspirin and a GTN tablet and take me to A&E, while I gush my support for their industrial action.

Hospital

When I'm triaged, my blood-pressure is on the floor.

I tell the alarmed nurse it's usually low anyway, and it’s okay. I don't think I'm going to pass-out now. Under pressure from the number of casualties in her queue, she’s pragmatically reassured, and I'm sat on a chair in a corridor. I start to make the necessary calls to postpone appointments. I'm then moved into the A&E waiting room, from where I call John, my partner. He's at home in North Wales, 70km away. I tell him I've just got to wait here and have two blood tests a couple of hours apart, but I'm fine. The ECG was normal. I've just had a funny turn and it's all a fuss about nothing.

He is not reassured.

"You MUST get someone to sit with you or at least let someone in Chester know you are there, so that they can ring me if you can't," he says.

I think the chances of me not being able to ring him are so small, they seriously don't merit me disturbing anyone else. But because he's distressed, I say I'll do as he asks. One close colleague is away at a funeral, but, reluctantly, I message a couple who I’m pretty sure are currently in Chester. I let them know I'm in A&E and that I'll update them once I've had the tests. ‘No need to come or do anything,’ I say, ‘I’m fine. This is just a FYI.’

One of them, Caroline, previous owner of the pink dress, drops everything and comes straight to A&E.

We sit and chat in the waiting room for nearly three hours, during which I have the first blood test. I'm exhausted, as seems natural after a poor night's sleep and a funny turn, but otherwise I'm stable. My chest hurts, but entirely consistently with bad indigestion. I'm mortified by the inconvenience to Caroline, and to the NHS, of me being overtired and a bit silly, but her presence cheers me up. We tell each other stories of our respective recent travels, and we laugh a lot, even to mutual ‘shushing’-point, feeling our laughter might be inappropriate in such a setting.

We are both expected at the same evening event and, as time ticks on, it looks unlikely that I'll be discharged in time to go back, gather myself and get changed for it. I feel ill and very tired too, but that feels to me hardly worthy for pulling out. I wrestle with the decision, but we eventually decide that Caroline will give my apologies. She goes outside to make the call for me, and to ring John with an update. After she returns, I eventually manage to persuade her to go and get on with her day. She asks me to ring when I’m discharged, so she can come and pick me up and take me back to hers for the night. I’m uncomfortable. I really don't want to commit to being a burden. Surely, I'll be OK. I don't say so, as it would be rude, but I’d rather be on my own. I desperately need quiet time after all this excitement. But Caroline is kindly assertive. My promise not to go back to the flat alone is a condition for her leaving now. Eventually, I surrender and give it. After she goes, I get up and walk around the waiting room. My legs and back are stiff from hours of sitting. In doing so, I lose my seat to another patient and have to wander for a bit longer until another becomes available, on the opposite side of the waiting room, in a dark corner. I feel strangely, disproportionately, disconcerted by the move. As if the chair I was in before, in the light, next to Caroline, was a lucky chair that was making me well. I don’t feel so good in this new chair.

An elderly lady next to me is struggling with arthritic fingers to open a packet of sandwiches.

“Can I help?”  She passes me the packet with shaking hands, and I realise my hands are shaking too.

Half an hour or so later, I'm finally called.

*******************

I assume that I'm heading back to the bay where the first blood test had been taken. I wonder, hopefully, if they'll let me go once the blood is taken, or whether I'll still need to wait in the waiting room for the results to come through.

But, oh? No. I’m not going back to the bay.

The nurse walking me to my destination takes me instead down trolley-lined corridors, turning this way and that. I try to remember the turns so as not to get lost on my way out, but I’m soon disorientated. I’m invited to sit on a bucket chair in a bay while a bed is washed down in front of me.

Confused, I ask the nurse, "What's happening? Is it bad? Where am I?"

"You're in resus,” he says, taking my last question first. “No, not bad, as such, it's just that, well," — there's a pause — "the doctor will explain in a moment.” Then, patting the now-dressed bed, “Perhaps you'd like to pop up on here?"

He disappears, and I lie on the bed, blinking, confused. But as promised, within minutes, a doctor comes. After introducing himself he says, 'Your blood test showed a raised enzyme associated with a cardiac event, so we're going to admit you and treat you as if you're a heart attack patient. You're in resus because that's the only place in the hospital we have an available heart-monitor just now." My questions are met repeatedly with, “we’ll know more when the results of the second test come through.”

The nurse accompanying him gives me a little plastic cup full of tablets. I’m told what they are but I can’t retain the information. She takes more blood, and then links me with a mass of wires to the heart monitor. There is an absurd, but not insignificant, part of me that feels some relief that, whatever this enzyme means, I perhaps haven't, in fact, been wasting everyone's time and resources.

I call John in Wales to let him know I’m being admitted. He’s caring for his daughter’s dog, and he has no transport as I have the car here with me in Chester. He feels desperately powerless, but his daughter and her partner are on their way to him from London and will be with him shortly. Then I message Caroline and Paul. My colleague, Paul, has keys to my flat. They go together straight to the flat and get me an overnight bag, and within an hour they're with me in my bay in resus.

I do wonder how many people have colleagues close enough to be dispatched to make decisions about what might be needed or appreciated from a bathroom cabinet or underwear drawer, and for that to feel natural, on both sides. It's a precious closeness, more often reserved, in our atomised society, only for family. Later that night I notice the care with which the bag has been put together.

While Paul and Caroline are with me, another doctor comes by. He says that the second blood test has confirmed that I have indeed had a heart attack.

It's a shock.

I'm 54. I’m healthy. I don’t ‘live it up’ in any way whatsoever. I like my lifestyle, but I imagine (in fact, know) there are nuns having considerably more fun than I have! How can I have had a heart attack? I know, of course, even as I’m thinking it, this is a self-pitying and irrational ‘why me?’ reflex.

I had, in fact, been diagnosed with high cholesterol by a routine blood test about six months earlier, but I was still waiting for the GP to act on it. It had been so high the doctor had thought it was probably a lab error. I'd organised a repeat blood test, for which I’d been issued the wrong paperwork, and I’d had to return to have the test done a third time. But there'd been no news and no action. I was caught somewhere between thinking I should chase that up when I get a minute, being bored and irritated by the whole palaver, and complacently assuming the most recent test had indeed confirmed an error and the reason I hadn’t heard anything was because it was, in fact, fine.

Is that the reason I’ve had a heart attack?

I feel furious with the surgery's ineptitude, but more with my own failure to advocate for myself.

Although I’ve lived reasonably healthily for the last couple of decades (apart from stress), I wondered, too, if damage from earlier decades of drinking, smoking, and all the rest of it was now coming home to roost.

This doctor tells us that a Cardiologist will come to see me later on, for a more detailed discussion. I'm glad that Paul and Caroline are there to hear the diagnosis. It seems unreal. We digest the news. I can see they're a little shaken too, and that helps me to grasp the significance of what I've just heard. Caroline pops out to ring John with an update and we learn that he and his daughter will be with me tomorrow.

My mind then turns anxiously to work.

We go systematically through my various commitments, and for each one a solution is swiftly determined. I cringe at the weight of work that will fall on others, starting at 9.30am the next day with a two-hour class. However, their help is unconditional and absolute. I'm not to worry about anything. They will work it all out in collaboration with colleagues and our departmental heads.  

Paul, always interested in numbers, watches my monitor as, with each problem I raise and he and Caroline solve, my heart-rate and blood-pressure are positively impacted. I can't see it because it’s behind me, and I’m linked to so many wires I can’t really move, but he reports, with some astonishment, what it's doing.

Paul and Caroline eventually have to leave, because of the university event. In the quietness that follows, I ring John for a catch-up and text another couple of friends. Later, I'm sent down for a chest Xray on my bed, with a stereotypically comical porter. On the journey, I notice corridors lined with trolleys occupied with very poorly people, and I realise that were it not that I needed a heart-monitor, that's where I'd be. It makes me wonder if I'm 'very poorly' and I wonder what that might even mean. Despite the porter’s incessant joking, for which I’m exceedingly grateful, I feel bewildered.

Half an hour or so later, back in resus, a technician with an ultrasound machine on wheels comes into the bay to give me an echo-cardiogram.

I'm unexpectedly side-swiped with a flashback, to when similar ultrasound machines diagnosed the deaths of my babies after miscarriages. To say I'm used to this kind of flashback might imply I've found a way to cope with them. I haven't. They’re unpredictable and unswervable. The most unlikely stimuli can trigger them, and they are infinitely worse if I’m already feeling under-par emotionally. Even the sight of a happy, tail-wagging lamb, suckling in an early-spring field can sucker-punch me to the point of breathlessness with the thought that I will never bond with an infant like that. A woman merely saying her child takes after their father, can wrench my heart with the overwhelming pain that I wasn’t able to create life with the man I love – that our respective characteristics, good and bad, are not miraculously and uniquely comingled in another, new, precious individual. Even a plant that fails to flower, a dingey patch of daffodil leaves in the shade, or hydrangeas in the wrong soil, can hit me with the pain of identification. I have failed to flower. I have a wholly counter-intellectual sense of a being fundamental, irreversible failure as a female of my species. This visceral feeling cannot easily be articulated as it risks appearing to affirm a patriarchal pronatalism that I wholeheartedly reject. It also risks appearing self-pitying. I know the reason that I struggle to move through this catastrophic grief is because culture will not permit me to grieve, and, equally, I struggle to give myself permission. I’m oversensitive and incredibly touchy when people talk about parenthood or childlessness – especially when they universalise their experience, or if there is an edge of judgement, even of opinion.

I’d recently heard someone say that an acquaintance of theirs was ‘wracked with grief’ about their childlessness, as if being ‘wracked’ with it was going a bit far. For days afterwards, merely as a result of being accidentally exposed to someone’s random opinion about someone I didn’t know, I’d felt the tentacles of serious depression squeezing at my heart. If it had been an opinion about anything else, I’d have been able to challenge or ignore it. But experiences like this can darken my inner landscape so easily, and choke me into silence. I have found very few spaces in which this grief can speak. Even spaces that it would be reasonable to expect would be safe are often, unfortunately, not.

Depression and disenfranchised grief are not my only struggles related to this loss. I know I have unresolved trauma too, because I have flashbacks and visions. Recently, in the heat of an intensely painful conversation about something else entirely, there was a discarded dummy on the pavement where my interlocutor and I were walking. I nearly trod on it. Privately intensifying the challenge of what was already a profoundly distressing conversation, my feelings instantly constellated, as they always do when this happens (discarded dummies are surprisingly common) around the wholly irrational, yet unbearably painful two-word thought and image,

'Dead baby.’

I thought I would faint, but I just gasped. But then, overloaded with pain, I shut down and completely lost my voice, failing to hold my end up in a high-stakes conversation that I desperately needed not to mess up.

And here, even in this hospital environment, with its intense focus on my current health emergency and nearly thirteen years on from my miscarriages - the probe, the gel, the monitor with its green lines on a black background, the motion of movement on my body, and the silence as an expert looks intently for information and systematically measures things on the screen – I’m back in the moments I learned of their deaths, and the tears for my dead children come instantly.

I surreptitiously wipe them away and look at the monitor. Despite the intense pain in my chest, I see my heart pumping, wriggling even; moving, kicking; seeming, to me at least, fully alive.

The technician won't be drawn on details, but shrugs in a mildly positive way. A doctor will have to look at it.  

As I lay in resus there is occasionally a great deal of action. A trolley zooms by with a nurse bouncing up and down on a man's chest. He survives. I hear the doctor explaining to his shocked family who arrive a few minutes later that he died for a few minutes but has been resuscitated. They cannot process it, and I detect the ways they’re completely failing to hear what they’re being told.

A bad head injury comes in. I hear the handover. The patient suffers with alcohol dependence. He'd had a period of a month's sobriety but then heard that the funding for his treatment that was due to begin in a few weeks’ time, had been cut. He'd relapsed, fallen, and cut his head. The pain in my chest intensifies sharply with my identification with him, and with my anger at the funding cut and its implications for him — for so many — for the wholly avoidable misery of it all, for individuals and for their families. I think of his 'month'. White-knuckling, waiting for his treatment. Hanging on. Holding his head above the waves while the storms of addiction threaten to engulf him in every wretched moment. The sight, in the distance, of the lifeboat of treatment to encourage him to keep swimming despite his exhaustion. Then the deadly news that, suddenly, the lifeboat’s not coming. There is no lifeboat. Of course he despaired and got sucked under. Who wouldn’t?

My heart was also affected by the respectful way the two nurses spoke about his case; despite the fact they probably weren't aware they were being overheard. I'm accustomed to embattled NHS workers speaking dismissively, or even scathingly, about people who struggle with addiction. I get it. Their lives are made infinitely harder by people who appear to do stupid things. These two were respectful. I was put in mind of my brother, Dave, who, before he died at 48 from pancreatic cancer four years ago, was an A&E matron in charge of a very high-tech resus unit, much larger and fancier than this one. He would have spoken with respect, too. I missed him so much. Selfishly, I wanted to ask him what was wrong with me and what I should do. I wanted his big, strong, practical larger-than-lifeness here, bossing the situation. I wanted him cracking jokes, taking the piss, bear-hugging me and smelling of washing powder.

I could feel the effect of all these emotions as they expressed themselves, physically, in my chest.

Apart from these moments of intense action, things are eerily quiet in resus, aside from the incessant bleeping of my machines. In another quiet moment, I overhear snatches of the 8pm handover about me.

"Yeah - nice lady - totally compliant.  Her first ‘trop’ was elevated - and then her second trop was above 2000."

"Wow – okay."

"Yeah, right. She's awaiting transfer to Broadgreen.”

I’d heard the term ‘troponin’ from the doctor who first admitted me to resus - so I use my phone to google what a troponin score of more than 2000 means. I immediately wish I hadn't. It’s considered high if it’s above 30.

Soon after this, another friend and former colleague, David, arrives to sit with me. I’m pleased to see him, despite my introversion and ambivalence about socialising. This ambivalence is captured perfectly for me in Bob Dylan’s line, “Sign on the window says, ‘lonely’. Sign on the door says, ‘no company allowed’.” A few people seem to have managed to climb in through my window when all the while I’m applying my shoulder to the door. David is one.

We're told that a Cardiologist will be coming by to see me shortly. This feels important. Ever practical, David suggests that he opens a note on his phone to record the questions I want to ask, and he prompts me to consider ones that don't immediately occur to me. I feel relief as my solitary bewilderment gives way to partnered organisation and purpose.

Half an hour later, the Cardiologist arrives, and his professional and highly-specialist aura sparkles the air in resus. I try to sit up straighter in the bed. John often observes that my unnecessarily deferential attitude to professionals is one of the few signals that betray my otherwise mostly hidden working-class background.

David follows our conversation, recording all the answers on the phone note, gently prompting me when I forget things we’d discussed earlier. I'm told that as soon as a bed is available, I will be transferred by ambulance to the heart hospital in Liverpool, where I will be given an angiogram. That procedure, and all my medication is explained to me. David’s intervention means I now have a grasp of the different effects of all the tablets and a note of what they are. I ask about the implication of my scary troponin score, and the Cardiologist says it only means I have definitely had a heart attack. It has no other implication. I ask whether a very long mountain hike that I’d been on two days earlier could have contributed, and he says that exercise can indeed induce heart attacks, but they happen during the exercise or very soon after. Not two days later. He asks me about alcohol and smoking, and I explain my history. He congratulates me on being in recovery.

I often wonder if there has been new training on this – as these days NHS workers almost always make a point of responding with hearty, scripted congratulations. It wasn’t always the case. Sixteen years ago, a Consultant Gastroenterologist had told me that, surely, I could have the occasional drink now? Wasn’t total abstinence a bit extreme? Wouldn’t I even have a beer at a barbeque? I found this extraordinary, especially as I was being treated for chronic gastric issues that were, according to him, almost certainly the consequence of excessive alcohol consumption. I realised that even intelligent and highly qualified people, if they don’t have first-hand experience of addiction, can really struggle to imagine what it’s actually like. They don’t grasp the difference between excessive use and addiction. Their ignorance is a form of solipsism. They assume that because they can moderate, everyone can, really.

If my recovery had not been secure in that moment, his words as an authority figure could have been, quite literally, fatal. They certainly deeply unsettled me, because they lined up with an internal voice (the voice of my addiction) that thoroughly agreed with him and was begging me to kick-back and enjoy the drink I deserved. It took me a very long time to stabilise mentally, to properly identify the voices in my head, and to securely trust that my own knowledge of my condition might be superior to a trained and qualified doctor’s. It was one of a few times that I’ve come dangerously close to relapse.  

Back in the present moment, the Cardiologist explains that it is possible that my past addiction could have brought about a weakness that paved the way for this cardiac event, but it would be hard to say, and not really worth thinking about. I notice gratefully that he is passing up an opportunity, that I expect some would take, to punish me for past behaviour. I mention my high cholesterol. He confirms that blood tests show my cholesterol is very high and he says that certainly could be a factor, but again, we won't know what caused the heart attack until we have the angiogram results.

After David and I have digested all this news, shared it on the phone with John, and the evening has worn on a little, I press David to go home. But he stays. He asks me what I need.

“How can I help you relax?”

Tears prick the backs of my eyes in response to his care.

I pass him the book of essays I'm currently reading, open at the point of a folded page-corner. Caroline had retrieved the volume for me from my bedside-table in the flat. It’s Hidden Cargoes by my friend and former PhD supervisor, Dr Chris Arthur. I settle down into the bed, and David reads one of Chris’s essays to me. It’s a piece about the letters of alphabets and how — remarkably — they combine to facilitate human communication. Moments of anxiety grip me, as the essay is long. It’s late, gone 10, and David has a family. He can’t stay here reading to me like I’m a child! I feel like I’ve inadvertently trapped him. But the grip of anxiety is progressively loosened by the insistent joy of Chris’s meditation on the miracle of communication, and by my intuitive sense that, no, it’s okay — for some reason, David really is fully here, simply to read to me. In partnership with Chris, whose poetic timbre is so familiar and so very comforting to me, David’s reassuring voice creates a bubble of calm and safety amongst the bleeping machines. I'm eventually able to fully receive the kindness, and ultimately, to let go enough to fall asleep, with David still sitting in the chair beside me.

Stress and love

I later learned about the level of risk I faced of a further heart attack in those early hours and days, and the vital role of stress reduction in protection against the particular type of heart attack to which I’m inherently vulnerable. Stress reduction is an elusive mechanism. It's not entirely volitional, despite what some modern self-help culture claims. The causes and conditions of stress are both contextual and individual, and the interplay is complex. Having colleagues take your work is of course stress-relieving, but it's also stress-inducing; especially if you have empathy about other people's workloads and anxiety about the idiosyncratic (to put it mildly) state of your notes! Having colleagues protect you from stress by shutting off the informal communication channel normally mediated by conversational emails, WhatsApps, interchanges on corridors and at coffee, leaves you wondering what the hell is going on, about how much trouble you’ve caused, and what they’re all thinking. Stress floats around the difficult interface of autonomy and reliance.

The self-help world is full of unnuanced, and therefore ultimately unhelpful, bogus panaceas. The injunction to ‘take “me time”’ - a phrase that always sounds to me like an ugly celebration of the atomised individual – ignores that we live together within an economy of responsibility. My “me time” impacts you, and yours impacts me. Because my ‘me time’ impacts you, it’s not likely to make me feel infinitely, nor even hugely, better; not unless I am totally oblivious to the fibres of connection binding me to my communities.  However, taking “me time” is often presented, in our inescapable frame of late capitalism, as the highest of virtues. Some historians thought we might escape that frame as a result of the pandemic, but signs don’t look so positive now. On a macro scale, the system simply won’t look after us, so we have to look after ourselves. That we have to take “me time”, is to my mind, a tragedy; a symptom of all that’s wrong. Yet it has to be framed as a virtue for the whole dismal cycle to keep turning.

I experienced significant stress from the sudden and dramatic removal of my agentic autonomy, and from anxiety about the impact on others of my indisposition. But the dominant positive memory of the days and weeks following the heart-attack, was not so much the relief at finally having some “me time”, but the extraordinary feeling of being cared-for so tenderly and unconditionally by those and other friends who stepped-in in different ways.

I’ve often been told I’m too emotional. I've learned recently, through therapy, about the aetiology of my difficulty in 'regulating' my emotions. I'm not very keen on that term, ‘regulating’, because it makes emotions seem like some unwanted by-products of an inefficiently performing machine – a boiler perhaps. But I do concede I suffer with strong emotions. I’ve spent much of my life trying to drown them in alcohol because I couldn’t handle them. Now I have to live with them unmedicated.

A concept adjacent to the psychotherapeutic notion of ‘regulation’ is ‘co-regulation’. Again, I shudder at the mechanistic language, but I can’t deny that the intimate and loving presence of those friends in my first twelve hours in hospital made such a difference to me. Their presence somehow enabled me to be present to what was happening to me. It helped to orientate me in the world. It enabled me to navigate entirely new emotional territory, in which my own anxious mind could have threatened my life. Their presence quite literally calmed me down. I only learned later just how instrumental that had been in preserving my life in those early hours.

A social media quote meme, no doubt reproduced to induce in readers a virtuous aspiration to give to others, was, a few weeks later, to reduce me to tears of recognition and gratitude, as someone who had truly received.  

“What do we live for, if it is not to make life less difficult for each other?” George Eliot.

Angiogram

Two days later, when a bed was finally available, I was transferred by ambulance to Liverpool Heart and Chest Hospital at Broadgreen, where I had an angiogram.

The angiogram was, for me, as traumatic as the heart attack itself. It’s an invasive procedure in which a wire is passed through the wrist into the artery up the arm and across the chest to the heart. Because I was on a massive dose of anti-platelet medication, my recovery was not straightforward. My blood pressure would not stabilise, and I bled copiously from the wound on my wrist for several days.

However, the angiogram was essential for getting a proper diagnosis and for determining a treatment plan.  On the ward, prior to the procedure, John, his daughter Ceri, and I are told that the wire, which sprays dye into the arteries to identify blockages, could also deliver a stent, then and there, while I’m on the table. However, it’s possible that there could be several blocked arteries, or that the angiogram will show that the damage sustained by my heart during the attack is extensive, and in either of those cases they may decide that a heart-bypass is necessary. Because this would likely involve open heart surgery, they would not do it there and then, but take me back to the ward for a conversation about it first.

Fully informed, I’m wheeled in a chair into NASA headquarters - or is it CERN? An extraordinary room called a Cath Lab, full of revolving panels and huge monitor screens. I’m greeted by at least half-a-dozen white-coated boffins, some with clip-boards, who take it in turns to tell me their name and role.

I’m immobilised by straps on table and the procedure begins. I’m given a local anaesthetic in my wrist and the wire is passed up through my artery. It’s a profoundly disconcerting sensation, and I can feel an unnatural fluttering in my already traumatised chest as it arrives. I’m warned each time dye is to be pumped into my system. When it comes, my whole body tingles alarmingly. For the next twenty minutes I’m periodically asked by a disembodied voice to move my head to the left or back to centre, or to hold my breath, while machines whizz around close to my face. I feel like I’ve been abducted by a UFO and am being probed. The boffins call out to each other in their alien code – with letters, numbers and medical terms. The word ‘dissection’ is repeated several times.

‘Does that mean ‘cut’?’ I wonder, as I hold my breath again as instructed. ‘Perhaps it means I need surgery.’

Finally, the ordeal is over, and my wrist is encased in a plastic air-filled tourniquet so tight it feels like it will crush my bones to dust.  I’m told that the good news is that despite my high cholesterol and my addiction history, I don’t have any more heart disease than would be expected in a healthy woman my age. But the bad news is that I have suffered a Spontaneous Coronary Artery Dissection, a SCAD. In other words, my coronary artery has sustained a tear, and the blood that has exited the inner wall of the artery through the tear has pooled and crushed the artery, causing the same effect as a more traditional arterial blockage. The blood thinning medication has released the blockage and the tear should heal by itself in time without any surgical intervention. However, I have weakened arteries, and this means I will need to make lifestyle changes to avoid a recurrence. These changes will be explained to me in more detail over the coming days and weeks.

Spontaneous Coronary Artery Dissection

Back on the ward, John and Ceri have been waiting anxiously for my return. My head is thumping with pain and I feel toxic, traumatised and ill, but also so relieved that I (we) don’t have to face any surgery. My diagnosis could have been so much worse, given the high troponin score. I’m overwhelmed with gratitude for my care, and for the incredible expertise that has fed into getting me to this point – not just that of the white-coats I just met, but all the researchers, clinicians, technicians, engineers, funders and policy-makers, who have advanced research in cardiac care globally. 

In due course, the ward manager comes to explain the SCAD in more detail. He spends a long time with us, answers an awful lot of questions, and does what he can to make me feel more physically comfortable. He explains that I’ll need an absolute minimum of three months off work, but encourages me not to look any further forward than that at this point. I must focus on my immediate needs to stay safe (there is a very high risk of recurrence), to stabilise on the medication, and to recover from the invasive procedure of the angiogram. 

He explains that my high cholesterol is incidental, because there is little evidence of furring or hardening of my arteries. It will need to be dealt with as it is very high, and probably caused by stress, but it is not the cause of my heart attack.  He shows us a diagram of a SCAD and explains that they are a rare type of heart attack that happen mainly to women who’ve just given birth or to women in the menopause. They are associated with a weakening of the arteries brought on by hormonal upheavals (though not a great deal is known about the specifics of this) and the tear is created by an episode of extreme emotion, stress or exercise. I explain I’d been on a long walk two days earlier but had been told by the Cardiologist that the walk was too far antecedent to have been a cause. He agrees that holds for SCADs too, and he asks me again what exactly was happening at the time the pain came upon me.

“I was just working.”

“Were you particularly stressed?”

“She’s always stressed,” says John.

“No more than usual,” I say, “but work has been particularly stressful for one reason or another since the pandemic when there was a redundancy drama, and things are tough in our sector generally. As a consequence, I’ve struggled a bit with my mental health.”

“Right. You will need to address that,” he says.

I feel just a little ‘told off’, like I would have done had he told me to lay-off the chips.

My own words “I was just working”, “no more than usual” and “I’ve struggled a bit with my mental health” ring in my ears as superficial, even inauthentic – but the ward feels strangely like a seminar room. Everyone is looking at me, and I can’t say more. My imaginary left arm moves up into its familiar place to hold the avalanche back.

“Good mental health is crucial,” he adds.

Not for the first time I’m left with a sense that good mental health is so often perceived as simple, and entirely contextless.  Do the right things. Take “me time.” Don’t get upset. Be positive. Put your troubles on a leaf and let it float down the river. I’m not saying popular mental health wisdom is illegitimate, but I often wonder if it is really aimed at people who have never experienced abuse, rape, violence, poverty; criminal, structural or epistemic injustice; addiction, devastating loss, chronic self-hatred, exploitation, bullying, shaming, intergenerational trauma or serious mental or physical illness. It always seems to be aimed at people who’ve been able to trust their care-givers; and people who’ve never perpetrated anything that catastrophically hurt another. It’s aimed at the general stresses and sadnesses experienced by people whose lives are built on a bedrock of reasonable stability, whose family members have never been incarcerated or murdered and whose loved-ones have died in the right order and after a good innings.    

My experience of mental health discourses is that the gears are grinding all the time. Our systems and modalities obscure as well as disclose. Our culture of openness about mental health is a positive development for sure, but openness can become an ossified script in which to hide. It can also become a justification for intrusiveness, or a stick with which at best, to judge each other, at worst to beat. We all instruct each other to take care of our mental health and even presume that we know how to do that, yet we rarely know each other’s hidden agonies, or any more than superficial, or carefully curated, elements of personal stories. We all tell each other what to do as if there were no hidden, unconscious elements of our experience, as if we all relate to each other and to the world wholly rationally.  And we tell each other what to do as if we lived in a perfect world, or outside of a system organised around competition and greed, and as if there weren’t powerful normativities restricting the oxygen supply to anyone who fails to conform within the myriad socially-constructed games we play.  

“Yes – don’t worry.” I say, “I’ll work harder to prioritise my mental health.”

SCAD and gender

SCADs are under-researched compared with other heart attacks because they happen primarily (though not exclusively) to women. They are not atherosclerosis-related (i.e the result of hardening or furring of arteries) but caused by the effect of stress, distress or emotion on arteries that are weakened by hormonal fluctuations.

As a woman who has undergone years of invasive hormonal fertility treatment, whose miscarriages may have been caused by autoimmune dysfunction (also associated with weakened arteries), and as a woman who is menopausal and who struggles with her emotions; I'm in a vulnerable population. I had never heard of a SCAD and neither has anyone else I know, including women who are educated and informed about the menopause. I've never seen SCAD listed as a co-morbidity with menopause. The First Aid training that I have received has tended to depict the classic, dramatic, chest-clenching male cardiac arrest. Like many in the population I associated a heart attack with cardiac arrest, and while I know some women have heart attacks, I associate them, generally, with men. Research has shown how this cultural assumption, along with several other gendered factors, have contributed to a much slower attrition rate for cardiac fatalities in women than in men.  

My heart attack was frightening, no question, but what frightens me more is how close I was to dismissing it.  Dread of 'making a fuss' is not entirely gender specific, but as Pragya Agarwal brilliantly demonstrates in Hysterical: Exploding the Myth of Gendered Emotions (2022), there is no doubt that the social expectations assigned to my gender feed that dread.  When the ECG taken in the flat by the paramedics came back normal, I’d been embarrassed. I felt the fuss I’d made was bordering on unforgivable in this era of healthcare resource scarcity. The paramedics were also fairly convinced that nothing was wrong with me. I remember the tone in which the recommendation to go to A&E was put to me. ‘Have to warn you, it’s a four to six hour wait – your choice.’ I could so easily have decided I was ok. I was just being silly. I was just tired. I didn’t want to make a fuss. It was a knife-edge decision. And a decision that was made in the context of being low-level shamed. I was, momentarily, made to feel that I was just a silly woman having a funny turn. “People often feel better when we arrive.”  

Don’t get me wrong. I am so very grateful to those paramedics. I would love to meet them to say thank you. Ironically, though I denied it in the moment, they did feel like my saviours. But they, like all of us, participate in a culture that, as Elinor Cleghorn’s 2021 volume Unwell Women: A Journey Through Medicine And Myth in a Man-Made World shows so clearly, makes women’s diagnoses more socially complex than men’s. We are significantly more likely to minimise and to attempt to cope, than to ask for the help that we need.

As it turns out, the GTN tablet the paramedics gave me in the ambulance probably saved my life. I now carry an SOS card, published by the specialist SCAD unit in Leicester, that includes the line highlighted in red,

“ECG may look normal – check troponin for cardiac trauma.”   

The psychosomatic interface

A friend who came by to take me out for a very slow walk a couple of weeks after my discharge from hospital greeted me at my front door with a hug and said,

 “Oh my god, Wend! Your heart actually broke.”  

I guess it did?

On one level I find it difficult to accept that phrases like ‘you can’t keep working like that, you’ll make yourself ill’ are literally true. I don’t know why I find it difficult – it’s not like I’m some Cartesian dualist who thinks there are two discrete unrelated substances – matter and spirit. Perhaps it’s my aforementioned allergy to some popular self-help that is the problem. These wellness traditions often presuppose the identification psyche and soma, encapsulated here in the words of wellness guru Christiane Northrup MD that circulate in the memesphere,

“True health is only possible when we understand the unity of our minds, emotions, spirits, and physical bodies.”

Northrup is not a random example. She’s known for her anti-vaxx rhetoric. So many of the authors and influencers who speak in these terms have turned out to be misogynists, predators, bullies, conspiracy theorists, or white supremacists. Even those who appear genuine nonetheless seem to be engaged in the project of getting rich off the modern neuroses that the dubious worldviews peddled in their pages and posts actually feed. I often find the books which populate ‘mind-body-spirit’ sections of bookshops mildly repellent. I try to keep my social media feed free of attractive people in high-end yoga gear who talk about manifesting and life goals, because of my sense that they are part of the problem, not part of the solution.

That said, I endeavour to remain discriminating yet curious about specific practices and teachings. It would be arrogant for me, with my limited knowledge and perspective, to reject them out of hand. Mindfulness and the present moment? Yes, I find it a helpful discipline and I fully accept the need for training and practice. I’m cautiously open to the various ancient worldviews from which mindfulness comes, but I also worry about its ethical neutrality especially when it comes in ‘wellness’ or worse, ‘corporate’ packaging.  

Polyvagal theory? I’ve no idea. Some of it definitely feels like it resonates with my personal experience, but I notice that I don’t always like the politics, or the celebrity, of some of the influencers who espouse it.

Law of attraction and manifesting? Really not keen. I’m open to the idea that a positive outlook is more within my control than it can sometimes feel, and the deliberate and disciplined practice of consciously adopting one will inevitably put me more in touch with the abundance that is already in my life. However, so much manifesting thought goes far beyond that. You don’t have to be undergoing fertility treatment to encounter this pervasive discourse, but if you are, you literally cannot escape it. Back in those days I had Christians tell me I should put more faith into my praying and Buddhists tell me I should be chanting and trusting the universe more. I paid NLP practitioners to tell me I should be visualising, and I had plenty of people of all kinds tell me I should just be positive, keep hoping and you’ll see. I’ve been bruised, confused and invalidated by it all. I’ve also seen others catastrophically hurt by that kind of thinking around the terminal illnesses of loved-ones, believing tragedy was caused by their personal failure to pray hard enough.

Mostly, I’m deeply sceptical about the normative frame of individualist and competitive thriving that drives the discourses in which these teachings so often circulate, and about the delusion that there are ‘fixes’ for the human condition.

Perhaps I’m scared that if I say emotions actually broke my heart, I could be wandering into philosophical territory that feels to me like entering a scary hall of mirrors where there’s only chimera, forms that look cunningly real and meaningful (and glamorous) but with nothing of substance animating them.    

Because of my experience of alcohol addiction, and, more specifically, of recovery, I do know, first hand, that there’s a causal relationship between emotions and health. There’s no doubt that my emotions could send me back to a drink, and if I drink, I will, (in the unlikely event I manage to avoid suicide), quickly lose my physical health. The two things are related, but there are steps between one and the other. People living with depression may struggle to sleep, eat or move, so their health suffers. People with anxiety disorders marinate in adrenaline and cortisol, with terrible long-term health consequences. Those suffering with poor physical health as a result of depression and anxiety are likely to experience more difficulty managing their depression and anxiety. A vicious cycle.  We know that life-expectancy decreases and the prevalence of diseases of despair (addiction and suicidality) increases where there is socio-economic deprivation and oppression. Of course there is a relationship between experience, emotions and health. But taken to their logical conclusions, ideas like Northrup’s, that psyche and soma are a unity, result in a dangerous belief that you can believe or think yourself well.  

The Covid pandemic and anti-vaxx culture brought its salience into sharp relief, but the discussion about the relationship between psyche and soma is of course not new. The various familiar iterations of contemporary self-help of the kind encountered at mind-body-spirit festivals all over the English-speaking world is only one set. In the late 1800s the Church of Christ, Scientist preached the idealist belief that physical illness was the result of sin or poor theology and prayer was the healing treatment. The threads of these beliefs, even though they differ in emphasis or conceptual frame, are found deeply rooted as much in charismatic pentecostalism and evangelicalism as in the myriad traditions influenced by the New Thought movement. Perhaps Mary Baker Eddy would have told me that my heart only appeared to break, but it did so because of my sinful ignorance of the reality that there is only one substance; namely, Spirit.

My friend who told me my heart had actually broken was not alone. I noticed that lots of people had opinions about what had happened to me. Many immediately jumped to the conclusion that work stress had broken it, but how they framed that depended on their vantage point on my life.

Colleagues in the trade union pointed to the shattering effects of a badly handled redundancy process, an increased sense of alienation amongst lecturing staff born of anxiety about dubious management values and the wider political threat against the humanities, as well as to the immediate impacts of shrinking workforce, threats to departmental identity, over-work and precarity. Colleagues outside the union (and some inside) pointed to the seemingly endless pressure of industrial action while the union itself engaged in destructive internal debates and manoeuvring, making it so hard to maintain a spirit of solidarity.

Colleagues in the addiction recovery world talked about the impacts of secondary stigma on pro-recovery activists in HE. Although we’d recently made gains in that area, they’d taken years and we’d faced much resistance. Things had only changed locally when I’d made the decision to become open about my own experience, a decision that came at significant personal cost in terms of relationships in recovery communities that prioritise anonymity over visibility.

People in the Religious Education world pointed to falling numbers and bad faith, alt-right influenced arguments about curriculum developments, which I’d tried, with colleagues, to fight.  

I’d recently become involved in academic work in spiritual abuse – through a wonderful network of sociologists, psychologists, anthropologists and religious studies academics genuinely committed to making a difference. I’m used to carrying the burden of my personal addiction history into my academic work while coping with the neoliberal university that demands academics build their careers regardless of the compromise of values that involves. Not saying it’s easy, but I’ve developed some of the requisite muscles. But this endeavour, similarly personal, was requiring a whole new set. I suspect I wasn’t growing those muscles quickly enough to match the pace of my need to cope with the academic and quasi-academic conversations I found myself in. 

There’s no doubt I was tired from work. Burnt-out, even.

However, despite how personal work is for me and some of the challenges of recent years, if my heart “broke”, I think it broke for reasons much deeper than work.

In some ways, though perhaps this is easy to say, I think capitalism and the patriarchy broke it. Male violence (physical and sexual) and poverty shaped my early life, the legacy of which, despite the generous and healing love I’ve since received, includes tendencies to anxiety and fawning. Patriarchal pronatalism shaped my mid-life, leaving me feeling alienated, fragmented and unfulfilled, even as I rage against myself for buying into it. Today as I write, as if to prove my point about how deeply culturally embedded and toxic pronatalism is, that renowned archetype of the patriarchy, Elon Musk, has tweeted that ‘having children is saving the world.’

In the months before the heart attack, I’d faced a couple of bereavements in quick succession. They were both, in very different ways, ‘complicated'. One in particular represented to me my own inadequacies and deep sense of shame. I had been unable to attend a funeral of someone who died too young, because of an estrangement for which I was responsible. Deaths and endings annihilate the opportunity for healing, so it was not only sad, but twistingly painful. The harm I'd perpetrated in the last years of my drinking came back with such a force, and the afflicted mental states of those dark times had to be re-felt. Other people's suffering (much worse than mine) became vivid to me.

So many of our grand narratives, those of religion, of self-help, even of psychotherapy would claim that ultimately all is redeemable, but those narratives seem too grand sometimes. As if they float above the gritty, petty, needy, selfish, terrifying reality of embodied, finite, life. I had been able to find little comfort anywhere.

On the morning of my heart attack, I was in some kind of oneirophrenic touch not only with my own sense of shame and failure and loss, but also with the ways I’ve been actively hurt, used, abandoned, judged, rejected and shamed. Of course, my life is about so much more than those experiences, and there are rich veins of love, healing, community, thriving and empowerment pulsing in my vascular system too. I would not be able to function let alone to contribute if that weren’t the case.  

But just in that one awful moment — with my arteries already weakened by the cost of female embodiment— all the trauma of my life, and indeed of generations before me, had been hauled up from the deep and was quite near to the surface of my consciousness. I was trying to hold it all, at that point, alone. The ensuing horror and grief had been so strong that it had forced a convergence of psyche and soma strong enough to cause a tear.  

*********

A month on from my discharge from hospital we had an appointment with the Cardiac Rehab Team. We were told that, unless we were struggling financially to the point that we were searching down the back of the sofa for a quid for the electricity meter, I should retire. Because of the underlying weakness of my arteries, any kind of stress could potentially be fatal.

When we finally got home, John and I argued. His relief at the clear directive to keep me safe was misaligned with my bitter grief about it's impact. I burst out of the house and went for a walk. I wanted to pound the hills in fury, but I knew I had to be careful. I couldn’t exercise and I had to ‘avoid’ emotions. Reeling, I lay down in a field, not far from the house, underneath my favourite oak tree. I tried to regulate my heartbeat, but I was angry and scared. I felt my life was contracting. My work was everything to me. Contextual hyperbole of course, but nonetheless that’s how it felt in that moment.  Who would I be? What was I going to DO all day? Stroll through the fucking fields?

The words of Mary Oliver’s poem ‘The Summer Day’, like several of her poems, are etched in my brain. I don’t have to look them up.

She talks about strolling through fields like it’s a good thing.

 ‘Tell me, what else should I have done?’ she asks.

‘Doesn’t everything die at last, and too soon?’

As Oliver's words constellated in my mind, I couldn’t help but bury my face in the ground and cry in pain for the deaths that had torn people, and children, away too soon, and for all that will remain unexplained, unhealed and unredeemed. I cried too for the loss of my career, for my identity as an academic. It too had died. Way too soon. That’s how it felt.   

Eventually, I lay exhausted and spent. Limp in the grass.

But all around me everything was irresistibly alive. After a while I turned over and opened my eyes. I saw the dancing of buttercups and sorrel, and I heard a chaffinch singing in the oak tree. As I lay still in the impossibly bright sunlight, gazing up at the cloudless sky, I could feel disembodied love, the same love that bubbled underneath the argument we'd just had, as if it was floating round the hills, over the style and into the field.

‘And this, too, will die. And too soon,’ I thought. A tear of anticipatory grief fell tickling into my ear.

But the love kept breathing through the bobbing grasses. Blowing over my face. Holding me up through the earth underneath me, until it eventually lifted me, staggering, to my feet again.