by Lynne Cox
“Why are you provoking grief?” he asked.
Provoking grief? I said to myself. Was I doing that? Why was I stirring up feelings of sadness and loss? Why would I want to bring up those painful feelings? I didn’t need to relive those sad things. Why would I provoke grief when I was doing well? Being sad was a feeling I had endured for a long time. I didn’t enjoy it, but it was something I knew well. I was comfortable with the internal script that went with being sad. I didn’t know what else to expect and feel. But I was undoing my progress by provoking grief. I had a choice. I didn’t need to provoke grief. I could choose to be happy. It was a big realization for me.
The day I learned I might lose my heart, I started talking to it, and the conversation has never stopped. This helped me stay connected with what I was feeling emotionally and physically, and it helped make me aware of how my heart was responding.
Each day I told my heart that I was happy that she was still a part of me, and I was grateful for her. I told her that she was strong and powerful and that she would endure like she always had. I told my heart that I loved her, that I always wanted her with me. We still had great things we would do together, and I wanted to do them wholeheartedly.
19
SYNCHRONICITY
Ed Schlenk, the doctor from Iowa, and I spoke once in a while on the phone. He said I had experienced a lot of emotional loss and grief and might have things I needed to work through. It might help me to speak with a psychologist.
I was feeling okay but was willing to speak to a professional if that would help my recovery.
The same day, Bob Swoap e-mailed me. Bob was a clinical psychologist and psychology professor at Warren Wilson College in North Carolina. He was an acquaintance of Oliver Sacks.
Oliver was my swimming buddy and one of the world’s most famous neurologists and psychiatrists. Oliver was a professor of neurology and psychiatry at Columbia University Medical Center, a professor at the NYU School of Medicine, and a best-selling author. He wrote about his patients’ neurological afflictions with incredible insight and compassion and he focused on the magnificent adaptations they made to live their lives as fully as possible. He also wrote about his own health challenges and explained how he overcame them.
Oliver had initially put Bob Swoap in touch with me. Bob was a sports psychologist who was writing an article for Blue Ridge Outdoors magazine. He asked if he could interview me about my mind-set during my open-water swims, how I overcame uncertainties and fear, and how I kept working toward my goal when I was discouraged. He believed this information would help other people achieve their goals.
We talked on the phone for a long time. His questions were thoughtful and different because he understood the mental challenges people faced when they were working toward their goals.
The interview became uncomfortable when he asked if I was still swimming. I didn’t want to talk about not being able to swim so I told him I was busy with my new book and was only working out in the gym, but I hoped to get back into the water sometime.
He asked if I was going on a book tour soon. He said he had heard book tours could be exhausting. It was funny; he seemed to ask all the questions I didn’t want to answer. I wasn’t sure if I was going to be strong enough to go on the book tour, if my heart could handle the stress, and I was afraid of having a setback, but I didn’t want to discuss this with him either.
I said I was working on coordinating the tour with my publisher and planning to build in rests along the way so I could pace myself like I did on a long swim.
Bob said he had been a swimmer since childhood, but open-water swimming was new to him. He had recently competed in an open-water swim and was hoping to do more in the future. His coach was planning to compete in a lake swim in northern Vermont and wanted advice on cold-water conditioning and navigation. We talked about how he and his coach could train.
Bob asked if I was training for a big swim, and I thought to myself, He seems to be touching on everything that I’m dealing with. I said I was working on being healthy.
He asked if he could call back in a few days with follow-up questions. He had a positive attitude, was insightful, and was good at building rapport. I looked forward to talking with him again.
When he phoned I answered his questions and told him I thought it was synchronicity that he had contacted me the day Ed suggested I speak with a psychologist. I asked him if it would be okay to talk with him about something personal. He said he would be happy to help if he could.
I summarized what had happened with my life and heart, and explained ejection fractions.
Bob already knew all about ejection fractions. He had worked and conducted research at Duke University Medical Center as a health psychologist. Patients who were at risk for or who had had cardiac arrests worked with him to change their behaviors to reduce their chances of having heart attacks. He used cognitive-behavioral techniques to help them make changes. These included stress management, eating better, becoming more active, and developing deeper connections with friends and family.
It seemed amazing that Bob had gotten in touch with me. As a sports psychologist he understood athletes, having worked with them from the recreational to the Olympic level. And as a health psychologist, Bob understood the effects of the mind on the heart and vice versa.
“I’m not sure I heard what you said. What did you say your EF is?” Bob asked. He sounded incredulous.
“It was fifteen,” I said.
“That is low, but you said you are feeling better?”
“Yes, I’m a lot better,” I said and told him the changes I had made in my life: improving my diet, reducing my calorie intake, gradually increasing my exercise, hanging out with positive friends, praying and meditating, and trying to let go of negative thoughts, changing my internal dialogue, and being aware of things that were stressing me so I could figure out how to deal with them or get myself out of stressful situations.
Bob said I was making changes that would help me and I was doing well. He offered to talk again if I got stuck. He was reassuring, and I was glad we had talked. I felt like I was doing better with my mental focus, but I was still searching for ways to help my heart function improve.
20
HEART CELLS
“There’s something that we’ve been missing,” Joe the fireman said.
For two months he had been trying to figure out why I had become ill. He thought it was caused by something more than the stress of life. Had my daily routine changed?
I didn’t think so.
He asked me the last time I’d done a long-distance cold-water swim.
It had been five years.
He asked me the last time I had consistently trained in the ocean.
It had been more than two years.
That was what we had been missing. My heart had been acclimated to cold, and I had suddenly stopped swimming in cold water. The cold stimulus had been removed and that had affected me negatively. He thought I needed to get back into the cold to get well.
He made sense to me. I remembered when, after my first English Channel swim, my dad phoned me in Dover and asked me how I was feeling. I was tired and elated. At age fifteen I had become the youngest and fastest person to swim the English Channel, but my neck and shoulders were sore from lifting my head too many times to see the French coast. I also had intense muscle cramps in my calves when I went to bed, and the muscles between my ribs ached. He explained that the intercostal muscles, the muscles between my ribs, were used to support my breathing. I had worked and breathed hard for almost ten hours and I had stressed the muscles. The cramps in my legs could have been caused by muscle fatigue or dehydration or an electrolyte imbalance. I needed to rehydrate and eat bananas and oranges to rebalance my electrolytes. Most important, I needed to detrain, which would help take the soreness out of my body, allow me to stretch and relax, and allow my body to adjust to a lighter workout.
Detraining was a concept that I had not heard of. My dad e
xplained that I had trained hard for years to swim the English Channel. It would be too much of a shock to my body and mind to suddenly stop working out. I had to detrain—gradually reduce my time in the water. That morning I needed to swim in Dover Harbor for two hours, the next day I would swim for at least an hour and a half, and when I arrived home I planned to continue tapering my workouts. Then I could take time off, but my body was accustomed to being active, so I needed to continue walking, lifting weights, and doing calisthenics and other activities.
If I detrained, my body would have a chance to acclimate to the reduced workload. Hearts and bodies do not adapt well to sudden changes.
My dad also explained that I had worked hard and long to achieve a big goal and it would be a big psychological letdown if I just stopped swimming. He said I needed to give my mind a chance to adjust too.
After I swam the English Channel, the last thing I wanted to do was to go for a swim the following morning. I wanted to relax and enjoy the success with my mom and friends. But my dad knew things about the mind and body.
Joe knew a lot about training too and I agreed that I needed to get back in cold water—but I couldn’t swim.
He laughed and said I didn’t have to go swimming to be in cold water. I needed to reintroduce my heart cells to the cold. He suggested that I hold a cold wet dish towel for at least five minutes each day and measure the water temperature, my blood pressure, and my heart rate both before and after.
He said that it might sound like a strange thing to do, but he thought it would help.
It didn’t sound strange to me. It sounded like a fantastic idea. Joe didn’t know about all the experiments Dr. Keatinge had conducted on me at the University of London. He didn’t know that my response to the cold was dramatic, and that it was different from other test subjects’. But I had not been training in the cold and so I had lost my acclimatization.
“Joe, could I reacclimatize faster if I put my hand in cold water?” I asked. I was excited about testing his idea.
“You need to reintroduce your heart to the cold gradually. You need to give yourself time. Don’t sabotage yourself,” he warned.
“What do you mean?” I asked.
“People try to do too much too soon, and they get hurt. That causes a setback and slows down their healing process. You need to build back gradually. Be smart. Start by holding the cold wet towel.”
I was excited to test Joe’s idea. I measured my blood pressure. It was 111/73 and my heart rate was 58 beats per minute. I submerged a dish towel in 57 degree Fahrenheit water (13.9 degrees centigrade), squeezed out the excess, and held the towel over the sink.
It was good to be in touch with the cool water again. It felt like I was holding on to a piece of home. I smiled and relaxed. When five minutes had passed, I set the cloth down and measured my blood pressure. It was 113/62 and my heart rate had increased to 97 beats per minute.
My heart rate had significantly increased after I held on to the cold cloth. It could have been because I had an irregular heartbeat, but when I sequentially measured my heart rate, I didn’t see this much difference. When I walked into the ocean, my heart rate and breathing increased until my body adjusted to the cold water. When I started swimming my heart rate and breathing slowed down. My response to the cold towel was the same as my response to walking into the cold ocean. It was exciting.
21
MOVED
The day after Valentine’s Day my friends helped me pack my things and loaded them into their cars. I followed them out of the neighborhood and felt sad and happy—sad for the home and friends I was leaving and happy for my new home and the friends I would make. I remembered an encouraging line from Tennyson: The shell must break before the bird can fly.
It was time to fly.
Raylene, Jay, and Emmy carried boxes and plastic bags up the fourteen steps to my new home. The place was perfect, but I was concerned. I had to climb the steps slowly so I wouldn’t overstress my heart. What would happen if my health suddenly declined and I couldn’t climb the steps? I wanted to believe that I would recover.
I couldn’t lift or carry much, and my friends wouldn’t let me carry anything. They asked me to direct them and let them know where I wanted them to put my things.
Kathleen Fessenden and Lorraine Afzali, longtime friends, arrived, and they organized my clothes in the closet, my books in the bookcase, and my mementos on some shelves.
In less than three hours they had moved me in.
When I left my old home, I took my clothes and bed and not much else, and my friends knew that I would need many things in my home. Cindy Palin and Sandy Field unpacked a week’s worth of food and put it in the refrigerator and the pantry. I ordered some pizza. More friends arrived. We opened some bottles of wine and used my new wineglasses to toast my new home, health, and good friends. All I thought was how lucky I am to be loved and have great friends.
22
APRIL 5—ELATED
On April 5, I was scheduled to have a follow-up echocardiogram. Laura King asked if she could accompany me. She wanted to discuss the test results with Dr. Rawal. She didn’t want to have us wait a month for the test results. If Dr. Rawal wasn’t in the office for the test, she would talk with her friends, Dr. Isaac Eisenstein and Dr. William Madrid, and ask them to take a look at the echocardiogram.
Laura was determined to hear the results.
I didn’t understand why the echocardiogram was that important.
We drove over together and she phoned the office manager to make sure that a doctor would be in the office to read the echo. The office manager said the test was scheduled during lunchtime and she wasn’t sure if a doctor would be in to read it.
Laura said we would wait for one.
Laura sat in the waiting area while I went into the exam room. But a few minutes later, she tried to convince the tech to let her watch him do the echo.
He said it was against policy and told me that in the fifteen years he had worked as an echocardiogram tech, he had never had anyone try to convince him to let them come in to observe the exam. He said that she must be a close friend.
I said she was, and I heard her voice in the hallway.
The door opened and a tall, strong, middle-aged man with brown eyes, brown hair, and a big smile walked into the room. He said his name was Dr. Madrid. He was a good friend of Laura’s. She wanted him to take a look at the echocardiogram. Would I be okay if he did?
“That would be great,” I said.
He looked at the screen.
“It looks like her ejection fraction is forty-five!” he exclaimed. “She may be back in normal sinus rhythm!”
He instructed the echocardiogram tech, “When you finish, ask Judy to do an electrocardiogram, an EKG!” He sounded excited.
He left to see another patient, but he stopped to give Laura the results.
“That’s excellent news!” she said.
Judy led me into the EKG room, ran the test, and handed the EKG paper to Dr. Madrid.
He put his hand on my shoulder while he looked at the EKG. He said my ejection fraction was fifty. My heart wasn’t back in normal sinus rhythm, but it was moving in the right direction. I asked him what he meant.
He said my heart was mechanically functioning in a way that was close to normal sinus rhythm. He was so excited.
“Look, your heart rate was one hundred fifty-seven beats per minute and it was in arrhythmia when you were here in December. Look at it now four months later. It’s down to seventy-four beats per minute!”
Dr. Rawal entered the hallway and looked as if he wondered what all the commotion was about. The women at the front desk were smiling, his partner was smiling. Dr. Madrid told him to take a look at the echocardiogram and the EKG.
Dr. Rawal put his arm around my shoulder. He was beaming.
“This is great news!” he said.
It was the first time I had seen him so excited and happy.
“You can start exercising mor
e. You can increase your intensity. You need to start swimming again, but make sure to swim with a buddy.”
I was thrilled. I was a lot better and I could swim again.
He said I would need to continue taking the heart medications, but I had made a fantastic improvement.
I was excited about being able to swim in the ocean, but I knew I wasn’t ready. I needed to gradually get my body used to the cold water. And I was scared. Before I was sick, I was lifting twenty-pound free weights in every workout; now I could only lift five pounds. I had lost so much muscle strength, and my arms were flabby where my muscles had been. And I had lost endurance. I wondered if I could swim fifty meters and I was afraid. I knew this was contrary to what Dr. Rawal was telling me. He had said it was okay for me to swim, but my body wasn’t as strong as it had once been, and I was on medications that were helping my heart function normally, but I didn’t know how they would affect me when I swam in cold water. The medications helped my heart to relax and pump more efficiently, but they caused my blood vessels to dilate. I was concerned. I had trained for years to constrict my blood vessels when I swam in cold water so I could keep my core temperature normal. By dilating my blood vessels with the medication, I would lose body heat to the water. I didn’t know if I would be able to keep my core temperature normal, and if I couldn’t, I wondered how much stress that would place on my heart. I didn’t know how my body would respond to the cold. I didn’t know if Dr. Rawal would understand this because I knew my body was different. It had allowed me to do extraordinary swims.
On the drive home, Laura was grinning. She said there was something she hadn’t told me because she didn’t want me to worry. She said this had been a big day for me. The results of the echo had been important. If my heart hadn’t shown an improvement, I would have needed a pacemaker and defibrillator, and I would have been put on the heart transplant list.
She hadn’t wanted to wait for the results because she couldn’t wait that long. She and Charlie thought I was getting better, but they were nervous about the results of the echo.
