Optimism, Denial, and Echocardiograms

echocardiogram – often referred to in the medical community as an ECHO, is a sonogram of the heart, otherwise known as a cardiac ultrasound (wikipedia).

Lonna?

Yes, the lady with the dreary white lab coat and short red hair meant me. Many people assume my name should be pronounced the exotic way.

Just so you know, it’s not exotic. It rhymes with one of my less-than-favorite fruits.

As a child, I had difficulty sucking in my stomach. My ballet teacher told me I had to stop standinglike a banana.

Hmm.

Maybe that’s why I got the nickname.

(shakes head) Now is not the time to bring up childhood torments.

Back to yesterday morning.

We have to go to the second floor, lab coat lady said (I never did find out her name).

I glanced at David. We’d spent the hour-and-a-half drive to the hospital laughing and singing and thinking, hey, this might be a date.

We’ve always had less-than-traditional dates.

This time, we were waiting to see if my decreased hemoglobin was due to a really rare side effect of Sprycel – pulmonary hypertension.

Okay, so it wasn’t a date.

For those of you non-medical people, pulmonary hypertension is high blood pressure of the vessels that connect the heart and lungs. If these vessels are hard for the heart to pump through, the heart muscle gets bigger. And tired. If unfound, or untreated, pulmonary hypertension can lead to heart failure, and all sorts of other things I didn’t really want to think about.

Truth be told, I hadn’t been thinking about any of those things for the last six weeks. Ever since we heard I was supposed to have this test, as long as I let myself think about it, I  had chest pain. If I stopped thinking about it, no pain.

Yeah, I was getting kind of messed up.

So, I stopped thinking about it. I did other things. I worked. I read. I wrote. I played with my kids. I spent lots of time with family and friends. I slept. I watched TV.

For the first couple of weeks, I was petrified of exercise. Which made me depressed, because, I really love that runner’s high.

And – as my guest post later this week will attest – exercise is important when you have a chronic illness, even a chronic cancer.

But about a month ago, I realized, whatever. I can’t wait for something bad to happen. I have to be optimistic. And in order to be optimistic, I needed to exercise.

It was a great distraction. And as time went on, I realized that I had no heart symptoms whatsoever, especially when I exercised. If I truly had pulmonary hypertension, exercise would be difficult, right?

So I started to believe nothing was wrong with me.

We like to call it optimism. I think it was more like denial.

In fact, I think a lot of what the world calls optimism is really denial.

The two are related. Both are necessary. Denial is an effective – temporary – coping mechanism. It allows us to have moments, or hours, or even days, where we take mental holidays. Not developing this discipline of not thinking about it can actually be harmful, because we can end up swallowed by grief.

But let us not confuse denial with optimism.

For denial – as a long-term strategy – is really just optimism’s shallow-and-selfish second cousin.

Most of the world runs on denial. Retail therapy, entertainment, jet-setting; all these stem back to the need for escape. The need is valid. The amount of money we spend to fill it can be endless, though, because denial never lasts longer than the thing we do to achieve it.

So many people – usually those untouched by life’s challenges – deal with difficult things by saying, that’s not going to happen to me.

When our loved ones are worried, we often tell them to disregard the source of their fear. That’s not going to happen, we say. And though we are often right, looking at the bright side doesn’t prevent the really bad thing from coming.

In fact, as long as we base our hope on the reliance that nothing bad will happen, we get pretty anxious. Because this kind of hope is dependent on something insanely unpredictable.

Yesterday morning was another lesson in that. When we got to the second floor ECHO room, I thought, hey, I recognize this place. I glanced up at the sign. I looked down the hallways. And then I remembered.

This is where my dad spent much of his last two-and-a-half years.

I saw the room where he recovered from pancreatic surgery. I saw the chair I crocheted a Canadian flag blanket in, out of sheer boredom, or maybe an attempt at denial, a thing to do when you’re twenty-one and about to get married, and hoping you get to have the normal, happy, self-absorbed engagement of most girls, giggling at the size of their rings and pouring over details of dresses, invitations, and buffets.

I had some of that, sure. But I also spent many nights at home by myself, missing my long-distance fiance, wondering when mom would come home from the hospital, and wondering if my dad would be able to walk me down the aisle.

Or if he’d be alive to see it.

Some people suggested we postpone – or even cancel – the wedding. I refused. I think Mom thought it was because I was indifferent, or cold, or that my relationship with my dad wasn’t the best. But it wasn’t any of those things.

I had to go through with the wedding. I was tired of worrying about my dad alone. I was engaged to an American, and until we were married, he couldn’t be here.

I needed David around full-time.

I watched my parents at the hospital. At first glance, many thought it was my mom who brought my dad back to earth. The truth was, they balanced each other out. Even flirting with death, Dad was able to bring Mom back to the place where she was okay, where she laughed, where, for a moment, she didn’t worry.

That’s what my husband does for me.

It’s why I call him ‘Captain Optimistic.’

A friend of ours suggested yesterday that we get him a cape to match the title. But – without betraying his secrets, for this blog is really about me, and not him – sometimes I’d have to borrow that cape. Because sometimes, I’m the optimistic one.

Yesterday morning, though, I think both of us were nervous.

Because, if we’ve learned anything the past ten years, it’s that we can’t say, that’s never going to happen to me. Sometimes, the worst happens.

But that doesn’t mean it’s not going to be okay.

Ten minutes into my echocardiogram, the tech asked me if I was nervous. I admitted, yeah, I guess I was. 

Just relax, she told me. Nothing’s going to happen to you. Nothing’s going to happen to you.

I almost laughed. Things have happened to me, lady. And if you keep yelling at me to relax, something might happen to you, soon.

I took a deep breath. She snapped at me again. Don’t breathe like that. I can’t see your heart properly when you take a deep breath.

You told me to relax, I said. Deep breathing is how I relax.

Well, you can’t do that. She repositioned me, so I was half on my left side, my right shoulder leaned back to the stretcher, not allowed to breathe, and supposed to relax. You’re tachycardic; you’ve got to relax.

I glanced at the screen. 93 bpm. Pshaw, I thought. Not too bad considering I just ran up some stairs to get here.

The problem was, apparently I’m too tall and skinny for this test.

Yeah, it didn’t sound like a compliment at the time.

But the tech said when you’re tall and skinny, there’s not enough room between the ribs to find your heart, and when you deep breathe, the ultrasound loses contact altogether.

I guess most people who need echo’s have barrel chests and hearts that are easy to find.

I’m sorry, I’m too healthy to have this test?

She did laugh at that. It reminded me of the pathologist who did my bone marrow biopsy in January 2009. I’m not used to doing these on young people, he’d said. My back was to him, but David saw sweat pouring down his face as he drilled into my hip bone. In between grunts and twists of the bone drill, the doctor had asked, Do you, uh, happen to work out, or something? 

David and I grinned.

I’m sorry? I offered.

The pathologist – I don’t remember his name – and his student who’d asked if he could do the procedure (I promptly said, no, not this time, thanks), both laughed at that.

I snapped out of my reverie and looked up at the stern, short-haired, thich-European-accented ECHO tech.

Okay, I told myself. I’ve got to relax, and I can’t do what I usually do to do that.

I think the tech thought I was nervous about the test itself. I wasn’t. I was nervous about what the test would say. I wondered how it would change my life. I wondered what would happen next. I wondered if what this test said would dwindle the years I had left with my little girls.

I’d wondered all those things during my biopsy too. And it had confirmed the worst.

But, three years later, I was still here.

And the last few years have been arguably some of the best of my life.

So in the dark little room two hundred feet from the place my dad had heard, no need for chemo, we got it all, only eighteen months before he died,  I felt David reach over and touch my ankle. He smiled. And I realized, it doesn’t matter what this test says. Even if it shows the worst, I’m still going to be okay.

The worst and the best are not necessarily mutually exclusive.

Optimism isn’t believing only the best will happen. It’s hoping for the best in the middle of, or even because of, the worst.

Alright, I said. I’m okay now.

The test continued. I imagined I was on the white sand shores of Sugar Beach in Maui. I heard the roar of the ocean, I felt the pleasant heat of the sun, I smelled the incredible coconut-and-honey island smell.

Half an hour later, I opened my eyes and replaced the painfully blue hospital gown for my own clothes. I took the deep breath I’d been avoiding during the procedure.

The report will take five business days, ‘Relax’ lady said (I should have called her Frankie).

I nodded. Will they call us? Or is this one of those ‘no news is good news’ things?

Her eyes flitted to the ultrasound screen. Her jaw clenched, then relaxed.

There’s no pulmonary hypertension, she said.

I glanced at David. He had a toothy, I told you so, look on his face.

Liar, I dared back. You were just as scared as I was. 

Last month, I was given a list by four different doctors of four major things that could be wrong with me: pituitary adenoma, pulmonary hypertension, cervical cancer, and uterine fibroids.

It’s neither of the first two.

And I have to say, with the good news of the first two, I feel a rebellious hope.

It’s not denial. I’m too experienced for that anymore.

But, as I feel the fetters of pessimism slip away, one thought at a time, I think – maybe – this thing that’s gaining momentum inside me – it’s something like optimism.

The worst could happen, but it’ll be okay. I’ll be okay.

(deep breath)

Two down, two to go.