My path to becoming both a doctor and a writer began one fall afternoon in 1963.  JFK was President and the world seemed like a very youthful, modern place.  I had just turned 15 years old.    Despite living in what seemed to be a golden time,  I had two major fears:  I was afraid of nuclear war for one.  Everyone was in those days…the years of bomb shelters and air raid drills.   My second fear was the worry that something might happen to my parents.  My parents were 45 and 50 years old, and despite the fact that they both smoked, they seemed incredibly healthy.  But a number of events had conspired to make me nervous.  My closest cousin had lost her mother at a young age.  Soon after that, my Grandmother died of a heart attack.  And most recently, a friend of mine had returned from the movies to find that her father had suffered a cardiac arrest while on the living room couch. While most adolescents have a feeling of immortality, I no longer believed that either I or my family was invincible.

On the particular day in question, my parents, my sister and I were eating a  lunch of hamburgers and French fries at our tiny kitchen table.  I remember that my father stopped in the middle of helping himself to the ketchup.  He got a strange look on his face.  My mother sensed something was wrong immediately and asked what was going on.  My father didn’t know.  He had a strange pressure in his chest though.  Not a pain really, he said.  Just a tight feeling.  But within moments he began to sweat and said he was going upstairs to lie down.  This was odd indeed.  My father was known for bounding around, taking the stairs in our house two at a time.  We had never seen him taken ill suddenly.  My mother threw a few reassuring words our way and followed him upstairs. Within a few minutes, my mother was on the phone to our family doctor and then was hurrying out the door with my father leaning on her arm.  “Dr. Shapiro thinks that Daddy may be having a heart attack.” Was all she said.  “I am taking him to the hospital.  I’ll call you when I know what’s going on.” 

My sister and I were left at home.  We weren’t old enough to drive yet so we sat around waiting for the phone to ring.  We were terrified.  All I could think about was the night that my Grandmother had gone to the hospital with her own heart attack.  At three that morning, the phone had rung.  My mother had answered and I had heard her crying.  My grandmother had not survived the night.  From this I learned that a heart attack was a frightening, unpredictable, dangerous thing.

But my father was lucky.  Dr. Shapiro decided that he had suffered only a minor heart attack.   This sounded ok until my sister and I finally got to the hospital.  We found my father in an oxygen tent, a contraption that looked like a plastic bag with a zipper that sat around his head and shoulders.  The distorted view through the plastic, the distance it put between us and the uncertainty on my father’s face started a fresh wave of worry.   My mother told us that he would need to be in the hospital for a couple of weeks.  This was how things were done in the 60s.  A heart attack meant complete rest.  There was no such thing as cardiac rehab, surgical fixes, or fancy medicine.  

For days, I camped out in my father’s hospital room, coming right after school and staying until visiting hours were done.  My homework suffered because it was tough to concentrate. But at least I wasn’t worried about English class.  Although I was taking a college prep class, the school had assigned it to a teacher who had never worked with college bound students.  Her assignments tended to be boring and easy.    One evening, shortly after the heart attack, I sat in my father’s hospital room anxious and unable to think.  I was supposed to be writing an essay entitled, “Why We Study English” and it was due the next day. I opened my notebook, dashed off two pages that were pretty trite and called it quits.  It was the best I could muster at the time.  The gist of my essay was that language was important and knowing how to use it was important too.  We underestimated what we could accomplish by communicating, I wrote.  To make this point, I quoted the proverb: the pen is mightier than the sword.

 A couple of days passed.  I went to class by day and continued my hospital vigil at night. At the end of English period, I was summoned by my teacher and asked to stay after class. My teacher took me aside.  “Where did you hear the phrase, the pen is mightier than the sword?”  She asked.  She seemed belligerent.  I couldn’t answer.  It was simply a proverb I knew. I thought everyone did.  (By the way, the derivation is incredibly obscure.  According to Wikipedia: “The pen is mightier than the sword" is an adage coined by English author Edward Bulwer-Lytton; in 1839 for his play Richelieu; Or the Conspiracy.)   When I could not produce a source for this quote, my teacher went on to tell me that this proved that I must have plagiarized my entire essay.  In fact, she claimed to have the source for the original essay and said that she could produce it.  (This would have been a neat trick since the entire paper had been concocted in under 20 minutes in my father’s hospital room!!!) If I didn’t immediately fess up to my crime, she went on, I would face severe consequences. To say that I was dumbfounded is quite an understatement.  I fairly sputtered.  I explained about writing the essay on the fly while my father sat under the oxygen tent. She refused to believe me and also refused to produce the essay she claimed to have.  Instead, I was sent directly to the school disciplinarian, a fearsome presence in our high school and was threatened with several months of detention.  The whole matter became an escalating horror that lasted for weeks.  This incident taught me about the power of false accusation, particularly when you are in a subordinate position to the accuser.  In the end, the principal, my mother, and a whole cadre of my ex-teachers became involved.   It was all hushed up, but the teacher was never disciplined and the incident remained an unresolved blot on my high school experience. For me, the incident is inextricably bound up with the story of my father’s heart attack. While the whole mess was awful and unfair, but it became suddenly less important when, in the same English class that November, a classmate burst through the door with the news that John F. Kennedy had just been assassinated in Dallas.

After my father came home from the hospital, my mother decided to do whatever she could to make him well.  For her, that included a complete revamping of his lifestyle.  Although there was less known about the prevention of coronary disease then, my mother was savvy enough to figure out an effective plan.  Gone were the cigarettes, and gone were the fried and fatty foods.  Prior to his MI, my father had hated fish and refused to eat it.  Now my mother became insistent, and fish appeared on our menu.  So did chicken, which was a huge departure for my red-meat-eating Dad.  Then there was the exercise.  My mother got my father walking 2 miles a day, a habit he continued well into his 80s. 

My mother’s plan changed and prolonged my father’s life for sure, but he remained affected by his coronary artery disease. Today, thanks to her, he is 96 but he still needed a coronary bypass operation and several stents to go this distance. Once a disease process is established, it is easier to control than to eradicate.  Ironically, I am watching an example of this principle break on CNN as I write this.  Bill Clinton has just been admitted to the hospital to have stents placed in his coronaries.  He needs these despite having had earlier bypass surgery.  The message here is that medicine and surgeries can only get us so far.  We are best off…by far….if we prevent heart disease from ever getting started.  And that is quite possible.  Blocked arteries are not inevitable.  In fact, coronary artery disease is a condition that was largely unheard of until we started eating the modern diet and stopped using our bodies to do physical work. 

Prior to my father’s heart attack, I thought the world was fair.  After my father’s illness and my plagiarism experience, I found out that fairness was not guaranteed.  But through my mother’s interventions with my father, I learned that there was hope.  You could do something to help yourself, to change the odds. I became interested in medicine and in finding ways, as my mother had, to prolong life through disease prevention. Rather than being discouraged from writing, the false accusation emboldened me to use writing to get a bigger voice. So I suppose you might say that these two experiences converged and started me on the path that led to this very moment.  Here I am, writing to people all over the world about heart disease.

So what can we do about coronary disease? First and foremost, we should try to prevent it from happening in the first place. Heart attacks occur when the small vessels that feed our heart become inflamed, damaged, and blocked.  To avoid this, we should keep our waistlines trim (fat around the middle secretes chemicals that start off inflammation in our vessels and promote coronary blockage). We should eat a diet that does not resemble the standard American diet.  Mediterranean is good.   Ancient may be even better.  If our cholesterol numbers are high, we shouldn’t fear taking medicine.  Cholesterol lowering drugs are among the safest and they also decrease vessel inflammation.  We should do everything we can to avoid damage to our precious arteries.  Damage comes from sugar that is too high (above 100 when you’ve fasted overnight), from blood pressure that is too high (in the 120s or below is best) and from blood fats (cholesterol and triglycerides) that are too high.  We should make physical activity a priority.  Our heart is a muscle, and like all muscles it benefits from a work out.

Please join me in thinking about ways that you can treat your heart better.  Find ways to encourage the same changes in those you love.   And share the word.   Thanks Mom, for figuring this out 47 years ago.  And thanks, Daddy for following the program.