Poems followed by part of a memoir, by Daniel Sundahl

THE MAN WHO BALANCED A TEA CUP ON HIS HEAD and other FUGITIVE PIECES

-LXXIV-

HEART’S NEEDLE

        “A person often feels the pain below the left nipple…usually lasts only for a short time….”

        —from Medical News Today

It’s an odd smothering feeling in the center of one’s chest as if someone is pressing down on the breast bone or if more extreme as if someone is sitting on one’s chest. And there’s a lack of ease complicated by anxiety which is like hypertension.  So, he said, that doctor, my internist, my  coronary calcium scan showed a high score. It was a test that cost me $99.00 which is, I suppose, cheap if it’s life-saving, that is.

So, I’ve got some clogging in my heart’s arteries, he said, which bears watching, carefully, I guess, more so as I approach age 73….

Likely no more hiking trips on the Appalachian Trail, he said. It wouldn’t make common sense. “No,” I said, “I shall be off for another likely toward the end of March.”

But I’m not sure the whole thing is accurate.  Becky the dog and I run about four miles almost every day.  Jog actually.  But even so, heart rate up and then quickly down. Breathing is good. So….

What’s odd, though, is  how I have become more aware of the subtle nature of the heart and tendencies toward  hypertension, that anxiety again. I guess the two go hand-in-hand and I find myself at times and in certain situations rubbing the palms of my hands across the tops of my thighs, my breathing more tight. I suspect it’s environmental. A word I enjoy, “environ-mental.” 

But why?

Well, I live these days “environ-mentally” with two women, my wife Ellen Frances and her 98-year-old mother whose dementia incrementally increases. Her hearing is slight and her eyesight is equally slight. She also has heart disease having lost about 40% from the back portion to the bottom of her heart. Her mind is there but firing in unusual ways and she has taken to “shaming” me. “You have to remember that you come from a very poor background and the whole of your life has been an attempt to get over that background.” As an example. But if language is a measure of thought, I wonder from whence came that thought and how long has this lady been harboring that thought or is it the dementia?

Did I mention she took a right-handed swipe at me the other day but I danced back, floating like a butterfly and did not swipe back to knock that old woman on her keister—tempted though. So I walk around on broken light bulbs and egg shells scattered on the floor...

But I’ve come to understand, from research, that it’s common for such a person suffering from dementia to “like” one person and then “dislike” another person. Me? I’m the latter and so live with these demented outbreaks which when inserted into a 44-year plus marriage does challenge the notion of loyalty. My wife, of necessity, must care for her mother while on occasion heading to the liquor cabinet for a “nip.” 

If “heart disease” can be physical and meta-physical I know the source of my own discomfort since the floors of my home are littered with eggshells and broken light bulbs upon which I walk with extreme care. One never knows, for example, what might fly out of that demented closet.

Think of it this way: 

My mother-in-law is convinced that there’s a woman in an apron living in her closet. On another day, though, there are four children.  On another day, well, a little black boy is sitting on the floor in the hallway. Yesterday, a clear bright day, blue skies, calm, in her mind a tornado was approaching and no amount of reasoning could bring her mind back to reality. So, I gathered some pillows, and to secure her safety, into the downstairs powder room bathroom with her little dog for an hour or so until, as I told her, we had received an “all clear.” It satisfied her, for a time….

A man by the name of “Ernest,” by the way, seems to follow me around the kitchen. Some people have been unloading lumber in the living room and there’s a man on a horse living in the garage. 

Dementia…

That’s hyperbole about the egg shells and broken light bulbs, of course, because if that were the case I would surely sweep that floor. People say that it’s a blessing to “be” caregivers and it is even if tedious and uncomfortable. Or so I suppose. Perhaps I’ll study this a bit more and add another chapter to this here memoir. In the meantime, though, I’ll live with her comment that I just “don’t understand women.” Which is not as odd as it sounds, and is likely true.

I need, though, to give some thought to this, this business of heart disease which is, of course, physical but then in a life spent searching for metaphors, here’s another, and a good one at that….

Heart disease that is or rather “dis-ease”  which is closer to the metaphor I’m searching for.

The doctor, who will soon prescribe anti-anxiety medicines, and who is explaining all of this stuff to me, had a visual aid, a three dimensional heart with puzzle like pieces that he could take apart and put together to show me. It was a bit like revisiting that shop class from years ago where the teacher had a good-sized  wooden six cylinder car engine which he had taken apart and then placed all the pieces on six or seven large metal tables and then bid us all to put the thing back together again. By doing so learning all the parts.

And thus with this wooden model of the heart, this engine, this pump, this anatomical thing which is hardly sensory but must be fun for little scientists as was that wooden six cylinder car engine model fine for prospective car mechanics although surely outdated now.  “Yup, running a little ragged and that clicking noise you hear means you need your valves ground….”

Is the doctor telling me I need my valves “to be” ground? And by doing so they “seat” better? Curious the analogy, and “to be.”

Valves and heart valves;  here’s where blood from the lungs comes in, the pulmonary veins, into the left atrium and then, well, they meet your heart, right there between your two lungs, one right and one left, resting sort of on the top of this muscle called the diaphragm.  All of this inside stuff is called the thorax.

Okey doke…

The heart wonderfully placed and safely inside the rib cage, that also a good word, cage, with normal beats per minute of a little more than 60 to be on the safe side but less safe if over a 100, resting beats that is. I am less than 60, and closer to the mid-50s, an athlete’s heart, you see.

So, we’re hanging out in this examining room and the doctor is pretty happy with his visual aids and talking about blood flow or for that matter of fact reduced blood flow. It’s what’s going on, that pulling all that blood in and then pushing it back out which means the heart has a job which he called systemic flow through veins and arteries which have names, like superior vena cava and inferior vena cava over to the left lung and over to the right lung and then back to the heart and then out and about and all of this daily, hours and minutes, for years, pumping, throbbing, pushing and pulling. It’s work!

Latin again and for the moment sitting there on the examining table I am grateful for having learned, vena, vein, cava, hollow, and thus hollow vein, but I keep such to myself in fear of showing off or offering  the Latin and then the Greek translation. Or ictus cordus, I might say, the palpable beat of the heart. 

What does it mean to say that you believe something in your heart of hearts?

But then how about those coronary blood vessels which serve the heart itself? 

I once saw a chalice in a church sitting on the altar, both very modern and free-formed. The chalice itself was blood-red glass, and seated in gold tendrils that looked like tree branches but then the way the glass was shaped, well, heart- shaped but not a valentine heart but semi-globular form if you get my drift. The Bishop’s cup I learned.

I remember thinking “grail,” that holy thing, that search for the thing, Joseph of Arimathea beneath Christ’s cross entrusted with the Holy Grail, that cup from the Last Supper and in later literature imprisoned by the Jews but then released by Jesus and thus the first witness to the Resurrection, old Joseph about whom there are good stories. Well, maybe so, and maybe he did vamoose to England to look over those tin mines, met a few of the local Druids, and maybe he did give Galahad a vision of the Grail and maybe old Galahad did see Joseph standing and dressed as a bishop.

William Blake got a pretty good poem about this business and, well, perhaps those “feet” did walk on those shores.  There are some deep layers here if one speculates on Joseph and Jesus traveling beyond the boundaries of Palestine to spend time with those Druids which may be fascinating but also may be myth.

But I digress….

The news today, close to home, a former student two years older than me, with heart disease.  Cold back in Michigan and he out shoveling the snow. And then inside where it’s warm and a rest on the couch. After a bit his wife comes in and notes he’s not breathing. She anxiously starts an attempt to resuscitate, pausing only to dial 911 but when the paramedics do arrive it’s obvious he's gone, the heart no longer able, no longer capable, the strain, the dis-ease, the failure, no more pushing, no more pulling, no more shoveling.

There was this older man in my home town. I can see in my mind’s eye the home he shared with his wife. I remember walking the sidewalk past his home on my way to summer baseball practice. He was lying on the grass by the side of his home, his wife kneeling next to him, keening. Dropping bat and glove I hurried over, turning him on his back, raised his chin and thought to clear his mouth and then began pushing rhythmically on his chest while telling his wife to breath for him, covering his mouth with hers….

But he, too, was gone….

Stuff we learn in Boy Scouts, first aid, a merit badge.

So, he was gone and though still young I came intimately to know some stuff about death, and did not like it, did not like to lose, and could only lean across his body to hold his wife who was still keening and crying “No, no, no, no…” as if the word itself could negate his death.

Heart attack, his death tugging at her “heart” strings, and mine.

Some statistics are worth a moment of thought, since facts are, well, facts dear to those actuaries. Some seven hundred eighty seven thousand plus die of heart disease each year which means it’s the leading cause of death or over thirty percent of the total annual deaths in this country which means about 2156 per day or about 90 per hour which is well, merely a fact. There’s a government bureaucracy in charge of such, the Center for Disease Control, even to the point of calculating this: every thirty-four seconds someone has a heart disease “event” which then means that on average about 2550 people have such an event over the course of one day which suggests a small percentage survive. And all of this before the age of 75 which has something to say about  my own life expectancy. 

Oh well, c’est la vie.

Here’s something a bit more personal: my college room-mate, Bill, lithe and energetic and living in Montana prepping for an elk hunt.  He’s not feeling all that well and off to his doctor, actually his brother, and quadruple by-pass, chest cracked wide open, veins “stripped” from the insides of his thighs, stitched into place. There are diagrams showing how it’s done but not to be tried at home. But then, an odd recovery if that’s the right word: he’s become terribly withdrawn, post-traumatic stress stuff, or so he tells me. He lines the meds up each solitary day.

And what an interesting way to configure time:  punch the button on my Breitling watch and count off the seconds and announce to one and all standing near by, “Another one bites the dust.”

Should I spend time on this, then, I remember asking that doctor? You know, keep time, and every thirty-four seconds remark that I was not one of those 2550 suffering an “event” and maybe biting the dust this day? His look from his little doctor chair was oblique.

I remember  that doctor told me that the heart has an electrical system responsible for the heart’s beating, contracting, which he said is similar to my own home’s electrical wiring, my home, my heart, the tissues in the heart’s walls like the wiring in my home’s walls. My heart /my home contracting beating, one big electrical circulatory system. Should I give my home a “life check,” reduce the strain, turn off the lights more often, forbid my mother-in-law from watching “Judge Judy” marathons?  Buy a Generac, a back-up generator?

I remember telling him that when just a lad I was heading out to hunt pheasants. one day.  A pigeon flew out of the barn’s cupola and sped my way, me thinking, wing shot. I brought the gun up and just at that moment that pigeon just seized up and dropped from the sky deader than a smelt, Jack.

“You need,” he said, “to see a cardiologist.”

And so I did, Doctor Larry, who has been in the business a long time. His aide was a cheerful sort fixing me with small electrode patches to her machine and then  switching the thing on to watch the lines on a chart, me thinking “lie detector.” An EKG, though,  which Doctor Larry said visualizes the electrical activity of my “ticker.” I immediately liked him.

All appeared normal, no thickening of the heart muscle, nothing abnormal.

He asked if I would like a stress test and I said I had one about six or so years ago  but would happily do it again. We scheduled the test and I came back about two weeks later. 

I had on good light-weight running shoes, jogging pants, and such. Her name was Maria and she hooked me up to another machine which was also a EKG device with a roll of paper, ten sticky patches, electrodes. She got a base line going and then the doctor came in and asked how high I would like to go and I said I would like to try to beat the machine. He said, “No one has ever beaten the machine.”

Which was a treadmill. And so it began with my heart-beat baseline, oxygen saturation and such, blood pressure.

A fast walk, it was, and then a gradual increase in the incline, an increase in speed and a nice jogging along. Maria and the doctor watched the paper roll out, more stress, breathing increasing, my heart being pushed.

“Any chest pain?: he asked. “No, and no palpitations and breathing good, no shortness of breath.”

I went on with no dizziness and no lightheadedness, until I reached the level of difficulty the doctor wished.  I asked for a bit more.  Nothing on the monitor said that the test should be stopped. About five minutes later we quit. Dr. Larry saying that enough is enough. He threw me comfy towel.

Back on the examining table I went and we waited for a small amount of time, the two of them watching and timing as my heart rate went down and then down some more but at a good and even pace.

Good news, then: he said, “Go hiking; use common sense.” Maria said, “You did really well.” I had impure thoughts which happens at times with Norwegians. Well, maybe a bit more but it’s just window shopping.

And so I don’t know. 

I’m cleared for more good hiking trips;  I run my three miles every morning and do so diligently.  It remains with me, though, this heart “dis-ease” which may or my not be fictional, me thinking now and again about that pigeon.  I was told that a good analogy is akin to the parabola a baseball makes with imminent death the end of that parabola like smacking against the outfield wall, Boston, say. But I wonder if the behavior isn’t more capricious, fickle.  I haven’t read Updike’s Rabbit at Rest in years and worry a bit about re-reading the book because everything that happened to that character made him a less confident man, fragile and brittle.

Over time…

What I know of my own Norwegian grandfather’s life ended with his own heart disease;  I know he fell into a kind of sorrow in time and less capable of his farm work. I know he told his family and friends he would likely not be with them much longer and one-by-one he went about apologizing and to be sure that they thought well of him and would remember him as a good man. His last Christmas. 

There was a certain kind of flow to this time in his life that made him spiritually calm, Norwegian Lutheran that he was. I’ve talked about him before and so you might recall that story. His own farm acreage was divided by a country road with two or three acres housing a country Lutheran church with high steeple and a surrounding cemetery with no fences marking the border line with those good farm fields, a kind of seamlessness. He picked out his spot that fall  after harvest time,  which was then like the end of his own life’s parabola, from Norway to Iowa to Southern Minnesota and one of the very last of the Pioneers into the cemetery.

I know from my grandmother and her daughter, my aunt, that he slowed his work that summer and into the fall. When he went about his chores but with a good neighbor’s help. He often spent much of his time by a window that faced south across the countryside and his fields but with that small church also in view. His hands were often folded and I like to think he became more spare as he became more spiritual, yearning, old and aging there on the midwestern southern Minnesota prairie that heart of America.

He had a smallish heart attack in mid-summer and was hospitalized for a bit. My father was with him a good part of what time he could spare. Grandfather insisted on driving home from the hospital. I imagine the two of them riding along in that old black car quietly and restrained, my father in his work clothes,  my grandfather in a white shirt under his laundered overalls, polished brogans. I know they would have driven by the church and then about quarter of a mile north turned west for the last short drive past part of his husbanded 640 acre farm-stead, and then up the lane to that home-place. A nice word that, all well-tended, good barns and a good herd of holstein milk cows….

I know that grandfather stopped the car, slipped the gear shift into neutral, and set the brake and then slumped over. My father then leaned over and turned off the ignition key.

It was the kind of thing only a father could do for a father and a narrative I can trace forward in time to the heart’s needle in  my own life . . .

in winter,
into a world with plowed fields,
snow drifts along the fence lines,
into a matrix of images
and needles to the heart still to come
in history….