Saturday Palpitations

Heart impulses represented in the cardiac cycle.

It was early Saturday morning, I was making my plans for the day, crossing-off a few items that seemed unreasonable with others that had been accomplished. As I moved toward the kitchen, a voice from the living room bellowed “the coffee is ready”  turning my head I could see bright rays of sunshine making a visible path through the open front door.  My morning greeting followed with “did you have breakfast?” she answered, “yes” so I grabbed a cup of yogurt, found a banana in the fruit basket and sat down with cinnamon coffee in my favorite cup. 

She came to the table, pulled up a chair up close and said with half-hearted laughter, “I keep having these fluttering feelings” and I asked,  “what have you been up to this morning?” She said, “well, I ate cereal for breakfast, took my medication then I rode my bike to the bank.  Now I’m getting ready to go grocery shopping, choir rehearsal and then to get my hair done, but I keep feeling these flutters.”  Her schedule made me uncomfortable, she had other unmentioned responsibilities like caring for my grandmother and cooking dinner but I wasn’t ready to stir up an argument. My response, “well, it’s been a busy morning so why don’t you go back to the sofa and rest for awhile”  from the other room we talked about a co-worker who’d died suddenly a few days ago. She took pause to admit her feelings of anguish.

My summertime stay made for an opportunity to talk about anxiety, stress and triggers. Learning to listen attentively and offering the power of presence to her narrative, I began to see her rage with the world of injustice, her strength to overcome, but more clearly, a shield entrapping her emotions as described in Paul Lawrence Dunbar’s poem “We Wear The Mask.”

“What Shapes Health?” a series of webinars held by Robert Wood Johnson Foundation with leading national experts presenting their research on the relationship between stress and health.  My talks with mom don’t afford the opportunity for statistics and analysis, but the current evidence does compel my passion to carry on with our dialogue.  She’s interested the simple facts. In response to the New York City Health Department’s no trans-fat public awareness campaign, her question “What’s the big deal?”  As I grinned through a a medical student biochemistry lesson on lipid metabolism she became irritated and puzzled. I made more progress when I went told story about french fries and  the hidden calories in partially-hydrogenated oils leading to weight gain, rising cholesterol levels, which may increase the risk of heart disease.  She got it, began reading food labels more carefully and switched out the oils in the pantry with healthier choices. Yet, our conversation about the relationship between stress and health continues to be challenging as her perceptions are not mine. I'm asking the upstream policy questions about the conditions in our lives that can help alleviate stress and make for healthier living. Mom's web of healthy choices are obvious from the breakfast table to the bike path, but there's also chronic stress embedded in tough daily decisions and the quest for life balance.

By late Saturday evening, I was sitting in front of the computer with the banter of young people outside my front bedroom window and a hint of barbeque in the air keeping me alert enough to move through the night’s reading.  I heard rushing foots steps coming down the stairs, she knocked on my door.  In a shaky voice she said “What did you tell me to do about these palpitations?”  My alarm-filled response, “have these continued from early this morning?” She nodded, exclaiming “I’m too uncomfortable to lie down or sleep like this.”  My response, “you have to go the hospital” reaching for the phone I dialed 911. She lamented that she didn’t think her situation was that serious. I did. She urged me to take her blood pressure.  I did not.

The prevalence of heart disease among black women is twice as high as for others.

The ambulance came in less than ten minutes. Her pulse was rapid, blood pressure was abnormally high and the portable heart monitor gave a picture of irregularities. She was rushed to the hospital while I stayed behind with my grandmother who was now awake, upset by the ordeal and demanding answers by asking the same few questions repeatedly. “Why did they have to take your mother to the hospital?  What’s wrong with her heart? How did that happen? She’s too young to have heart trouble? They took your mother to the hospital? For what?”  It was a long night. 

After an hour in the emergency room, mom was admitted to the hospital.  Her pulse, blood pressure and rhythms returned to normal with medication.  Further test results, proved puzzling to the doctors, but she was released from the hospital after a few days with instructions to follow up with her primary care physician and with a referral to see a cardiologist.

That summer, I also finished my first reading of our cardiovascular physiology packet with a more profound interest in the advances of science and medicine as well as the research related to health disparities.

Cross-posted at www.KevinMD.com