Wednesday, August 13, 2014

Thoughts on Cardiac Depression and Robin Williams

The link between cardiac surgery and depression is a real thing and it may have played a role in Robin Williams' suicide.

I know because I suffer from Post-Traumatic Stress Disorder and I have ever since my first cardiac event.

My cardiologist told me that it was very common to suffer from these things following any cardiac surgeries. I've had several. My very first panic attack was when I had a carotid stent put in. I was made to lie on a table in the cath lab while my doctor inserted a balloon-like stent into my carotid artery. I had to remain awake on the table throughout the procedure so that they would know in an instant if I suffered from a stroke during the stenting. Consequently, I had my first major panic attack right there on that cold, metal table in that bright, antiseptically clean operating room. I wasn't allowed to move or cry or scream or pull away. I wasn't able to be medicated to calm down. I could feel the fluttering movement of the scope inside my body as it wormed its way up my neck to my carotid artery.

"Hold still," my typically jovial cardiologist told me through gritted teeth. This was not a time to ask silly questions.

I watched the computer screen above me as he performed this complicated task and then whispered and pleaded with the nurse to give me something to stop the intense fear and inevitable shaking that I knew was coming on strong. I knew that I was powerless against it. It was that feeling of standing alone in the ocean on unsteady legs and watching the rocks get sucked back by the tide, knowing that a giant wave was forming and there was no escape from it crashing down upon you. I knew the crash of a panic attack was imminent even though I'd never experienced one before.

Once you have one, you never forget how horrible it feels.

That was eight years ago. I was 32. I still have panic attacks today and will probably have them forever. It just goes with the territory. Depression is a part of the equation as well, but I've never let it swallow me whole the way others have. I've always stayed a few steps ahead of it, but that's not to say I'm immune.

My open heart surgery has left me with a long scar down my chest. It's faded throughout the years some, but it's still there. I forget about it at times, but then I'll notice someone eyeing it and my hand instinctively flutters up to my neck, creating a visual barrier. I'm not embarrassed by the scar. At first I hid it with boat neck shirts and scarves. Now I wear it like a badge of courage. It tells people what I've been through. A reminder that I'm a survivor. I survived childhood cancer. I survived having a premature child. I survived open heart surgery. And, yet, the sternotomy scar is the only thing that is a visible reminder.

Robin Williams wore his scars openly as well. You could see it in his eyes. The pain in his eyes was there even when he was making hundreds of people laugh. The joy that they felt was elusive for him. He was an outsider probably wondering why it was so easy for others to bask in the joy that he gave to them effortlessly. Why was it so hard for him to feel the same way?

My cardiologist told me that my surgery was typically an older male surgery. While heart disease is a growing problem with women (today it is the leading killer of women, more deadly than all forms of cancer), open heart surgery is typically an older male issue. He said that men would get very depressed after the surgery (Dr. Tara Narula, associate director of the cardiac care unit at Lenox Hill Hospital and a spokeswoman for the American Heart Association and American Stroke Association has said that cardiac depression affects 20-40% of all heart surgery patients) and yet no one really knows why. Consequently, my appointments after my surgeries always focused on how I was feeling: physically and emotionally. 

For the first six months after my surgery, I was in a lot of pain. It's no wonder since the surgery is a very savage one where they literally saw your breastbone open and pry your ribcage apart and then a lengthy and intricate surgery takes place while your body temperature is lowered into hypothermia and you are put on a heart and lung machine--for all intents and purposes you are the closest to being dead while still technically being alive. 

When they are finished and they have brought you back after nine to twelve hours of being practically lifeless, they sew you back up, wrap your ribcage in titanium and poke and prod you to make sure you are coming back to life in one piece. The first few days of intensive care are what typically cause the PTSD.  My doctor compared it to being a prisoner of war. You are in pain. You are not allowed to sleep normally. You don't know if it is day or night. You are being poked and prodded. You are uncomfortable and miserable and aren't aware if you are awake or asleep, up or down, inside or out. It's basically hell on earth.
And then you begin the long road to recovery. No driving. No walking for long periods of time. Always tired, always in pain, always breathless and weak. No lifting anything over five pounds. You are reduced to being a child--always having to rely on others to care for you. For men, it eats away at their egos. For women (especially with children), it's hard to be taken care of when they are typically the caretakers of the families.

But long after the immediate effects of the surgery are gone--the scars have healed, the pain is gone-- there is an unsettling feeling that can strike at any moment. I don't know if it's the realization that you have knocked on death's door and hung out at the threshold for a little while only to be turned away. Maybe it's the knowledge that life can be taken from you in an instant. Perhaps it's survivor's guilt. For me, my aunt passed away from a very painful cancer a year after my surgery. While she was going through her treatment, she'd often look to me with that helpless, expectant and terrified gaze and tell me that I was the only one who could understand what she was going through. She'd plead with me through her eyes and I could only offer her my strength and my sympathies. But in the end, that wasn't enough.

I don't know if Robin Williams felt those sudden moments of terror following his surgeries. I know that I used to wake up in the middle of the night terrified of something cracking my chest wide open, feeling helpless and unable to move, overwhelmed by pain and by fear. There's a loneliness that only those who've stayed in hospitals long term can ever fully understand. I've spend most of my life in hospitals and though I joke that it is like my second home, there is a tension that lives within those sterile walls. Perhaps it's the ghosts of the many lives lost there. Maybe it's the collective fear and sadness that remains like residue on the walls. But once those hollow emotions get inside of you--those ice-cold pinpricks of isolation and hopelessness-- it's so hard to ever completely rid yourself of them.

So, yes, I believe that Robin Williams had a lot of issues he was dealing with which ultimately led to his taking his own life and perhaps his cardiac issues did contribute to his demise. Substance abuse is something that I thankfully have never experienced. He had been very open about his abuse throughout his life and those who suffer from PTSD and depression are more susceptible to falling back into the clutches of the abuse. His life was cut short by so many demons that plagued him. Maybe a few of them crept in while his heart was wide open and defenseless. Perhaps they sat on his shoulders and whispered to him in the dark hours of the night. Or maybe they hung from his back like so many terrible addictions.

We tend to equate the saying "Carpe Diem" or "Seize The Day" with Robin Williams' character in the movie Dead Poets Society. But we should also be reminded of a similar Latin saying, "Memento Mori," which means, "Remember, you are mortal." Robin Williams was just a man with the same problems as every other man. None of us are immune to feelings of depression or inadequacy or grief. Yet, it seems so unfair that in his ability to bring immense joy and happiness to others, he ultimately failed to find it for himself. 

For someone who spent his life giving to others through laughter, ultimately it is through tears that we have learned the most important lesson he could have ever given. No one is immune to the damaging effects of depression. It is a silent killer. It creeps through every age, race and earnings bracket. It affects men and women, old and young, rich and poor. It can feel like it's contagious.  It can remain dormant for years and rear its ugly head and strike someone down when you least expect it. But it can be treated and monitored if caught in time. Awareness is the key.

Whatever the case, it is important to reach out to those in your life who are suffering from depression. It doesn't have to be someone who has gone through addiction or a major surgery, but those are the ones who should be watched a little more carefully. If you are ever feeling alone or depressed or just ready to give up, there are so many programs available to you and people who can help you through your darkest hours. If you are experiencing suicidal thoughts, please call the National Suicide Prevention Lifeline at 1-800-273-8255. 

You are not alone.