Stephen A. Karol
From CCAR Journal: A Reform Jewish Quarterly, Winter 1997
Reprinted with Permission
``This 44 year old... patient of mine since 1983 is known to have hyper-cholesterolemia treated with Pravachol 20 mg. per day. He has a positive family history for hypertension. He has a stressful occupation but otherwise has no risk factors for heart disease. The patient has had some vague chest discomfort. This occasionally happens in the winter. It has gone on since 1993. It is not related to exertion, excitement or emotion...''
That's me the physician wrote about on January 22, 1995. It was the day I had my heart attack. I'm now forty-five years old. I have a great wife and a super daughter. We live in a wonderful new house with friendly neighbors in a town outside Boston the beauty of which captivates us. I was one month into a two-month sabbatical, to be followed by a congregational trip to Israel that I had planned for more than a year ... I gave up smoking a pipe eight years ago. The only liquor I ever have is a sip of Shabbat wine. I was riding my bike. I was taking swimming lessons. A week before, my wife and daughter and I had been to Cleveland for my nephew's Bar Mitzvah service in which I had the privilege of reading Torah and blessing him. The next day, I was scheduled to go to Brandeis University to sit in on a class that I would eventually be teaching as a ``visiting scholar'' in the Hornstein Program for Jewish Communal Service. And waiting for me when I was to return from my time off was a long-term contract with my congregation in the expanded building we dedicated back in October.
``At 9:10 p.m. the patient had substernal chest pain. At 9:30 p.m. I received a call from his wife stating that the EMTs were at his house and that he was on the floor of the bathroom. He had not passed out, but he was having severe pain and looked awful ... When I arrived (at the hospital), the patient had six of ten chest pain. He was hypertensive with a heart rate in the fifties ... His electrocardiogram shows acute ST segment elevation inferiorly and anteriorly, consistent with an infero-anterior myocardial infarction.''
I'll never forget that night, the pain increasing as I sat at the computer while I was printing up a chapter from a book I had started to write. It was the proverbial ``elephant sitting on your chest'' feeling, and I thought a little Advil and lying down would take care of it. Fortunately for me, I have a low threshold of pain. Once the EMTs got me up off the floor and started to wheel me out of the house, I said ``I'm sorry'' to my wife. My daughter, who had been awakened by all the noise, was standing in the living room with our neighbor who came over to help out. She was crying, as you could imagine, and she handed me one of her stuffed animals. ``Take this with you, Daddy, and it will make you feel better,'' she said. ``I'll be back,'' I replied.
From Sunday through Thursday I was in the hospital, dealing with the fact that I, who was too young and too busy to have a heart attack, had had a heart attack. I wondered if it was caused by the funeral I did that Sunday --- the one for former members of the congregation whose son had committed suicide. Do the funeral in the afternoon, have the heart attack at night. It made sense. I was to discover later that it took more than that for my heart to fail. On Thursday afternoon, I tried walking with my wife outside my room, with a monitor attached to me. The nurse saw something she didn't like, and they made an immediate decision to ship me into Boston for a cardiac catheterization.
From the friendly local hospital I was transported to the big city hospital. The waiting for the cath procedure the next day was maddening. Afterward, the cardiologist told me I'd had an LAD dissection. The left anterior descending artery of my heart had been dissected by a piece of plaque that had come loose. It was, he said, a one in 10,000 chance ... My luck, I thought. With those odds, I should play the lottery ... Finally, they let me go home on Tuesday night.
My movements were pretty much restricted --- no walking, lifting, climbing, driving. There was a great burden placed on both my wife and daughter to take care of me. I was allowed one trip down the stairs in the morning and one up the stairs at night. Our living room became ``the solarium,'' and I was glad that it was nice and sunny. By Saturday I felt pretty good, but ... by dinner time had worked myself into a real snit featuring chest pains. Our neighbor was good enough to drive my wife and me to the hospital, where they diagnosed me as having a panic attack, settled me down and released me the next day. At that point, my wife decided to call her mother and ask her to come and help out.
She arrived on Monday night late ... My wife went to work the next morning, and when she returned, I convinced her to take me to the emergency room. My heart didn't bother me but my stomach hurt like never before, my left arm was weak and I was worried that I was going to have another heart attack. What I had instead that day in the hospital was a revelation. In the bed next to me was a seventy-five-year -old man who had been found lying on his apartment floor twenty hours after he had collapsed. Across from me was a young victim of spouse abuse who had taken an overdose of pills. Next to her was a man my age who had suffered a heart attack and was ranting and raving about how no one was taking care of him well enough and fast enough. I decided then and there that I was in pain, but that it could have been worse, and that I intended to get better.
After that, my doctor put me in a two-week ``quarantine'' --- no phone calls, except from doctors and family; no car rides, except for appointments and a couple of meals out. He presented to me a new concept, especially for a rabbi: ``Think of yourself first.'' By February 16, I was in the cardiac rehab and stress management program at the hospital. On February 20, I was driven to Brandeis by a congregant and toddled my way to the classroom to teach my first session in the Hornstein Program. The next day, the day of departure for the Israel trip, my wife and daughter and I went out to dinner to take our minds off the fact that we weren't going. On February 23, I took and passed a thallium stress test and on the 27th, taught again at Brandeis. On March 5, Samantha, Mary, and I welcomed everyone from the Israel trip back to the temple and were glad we did. The following morning, as required by my cardiologist, I began seeing a psychologist once a week. And as I had planned originally, I made my first public appearance in three months at the temple at our Purim carnival. I started work the next day, with a different schedule, a different outlook, and a different definition of what and who comes first and what is normal. How different was it? I taught the third of my four sessions at Brandeis in the morning, came home for lunch, took a nap, and worked at the temple for three hours in the afternoon.
``You're too young to have a heart attack!'' I've heard that statement over and over and over again since that night ... But I have learned that there is more to heart disease than meets the eye. I may not have looked like a heart attack candidate, but I fit the profile. There was more to me and what was going on inside me than anyone knew ... This heart attack was the result of the way in which I deal with stress and disappointment and anger. It now has to be the way I used to deal with stress and disappointment and anger.
There are probably very few people who have seen me explode in anger at someone, verbally abuse another person, or confront someone publicly and have it out with them. To lose control of my emotions was a defeat. To express my emotions was a weakness. To keep my cool was a victory, even it if meant that inside me it hurt. All along, I ignored an important statement from Leviticus: ``Reprove your neighbor, but incur no guilt because of him.'' Whenever I have interpreted that for others, I have said that it means that you should sit down and talk with someone when you have a problem. The guilt you incur is when you don't make the effort to talk or when you yell first instead of trying to talk reasonably.
I learned during my recovery period that I have not fully practiced what I preached. When I told the officers at the end of my sixth year here that I could no longer handles the overwhelming responsibilities of being rabbi, Bar/Bat Mitzvah tutor, and school principal, one of them asked me: ``Why didn't you tell us before how much this was hurting you?''
Why didn't I tell ... I know it will get done right if I do it. It's called ``Type A behavior'' --- striving for perfection, expecting everyone else to do the same, being upset when they don't, and either letting them know it angrily or keeping it cooped up inside. I call it ``imploding'' instead of exploding...
My negative feelings revolved around not living up to commitments. I made commitments to people, I helped them, I taught them, I performed life-cycle events for them, I cared about them- and they did not respond as I had hoped. Bar and Bat Mitzvah students who did not go on to Pre-Confirmation and Confirmation, violating the very meaning of their ceremony; couples for whom I did baby namings who told me they would join the temple and did not; men and women who studied and became Jews-by-choice under my sponsorship, who were officially welcomed into our community on the bimah, and have yet to be involved at all; members of the congregation who resigned without warning, or who resigned and then exploded about this or that which could have been resolved if we had sat down and discussed it. I took, and I think, still take each one personally, although much less so now than before. I am a rabbi committed to the survival and continuity of the Jewish people, and I don't believe that money issues or personal slights or empty-nest syndrome should stand in the way of that. It is the act of breaking off the commitment to which I have reacted. But I made the problem worse by the way I reacted. And because of my heart attack, I was faced with the challenge of abandoning my passionate feelings about Judaism, or retaining them and toning down my reactions, or retaining them and telling people exactly how I feel about their actions.
I don't believe that God caused my heart attack in order to warn me that I had better ``shape up or ship out.'' But I do believe that God has given me the faith and the ability and the strength to draw my own conclusions, to make conscious decisions, and to take care of myself and make me better able to take care of others. So, I went through the process of changing and relearning. For the next few months, I was in a cardiac rehab exercise program ... in a seminar on stress management ... joined a health club. My members no longer found me sitting at my desk and working at my computer and talking on the phone and munching on a sandwich, all at the same time. I was somewhere else in the building or out of the building, just eating. I became much more careful about what I ate and learned to think before I got angry and to express my dissatisfaction or doubts rather than bottling them up.
A colleague who had experience a heart attack a few years ago recommended that I read the book Reversing Heart Disease by Dr. Dean Ornish. Aside from his wonderful medical and nutritional advice, there is a great quote which really resonates with me, and is a good midrash besides: ``In the Old Testament, Moses loses his temper and strikes a rock; as a result, God tells Moses that he can't enter Israel. I see the story as a metaphor, that is, when we are consumed by anger (hit the rock), it keeps us from entering our natural state of inner peace (Israel). It's not simply that God punishes us; we limit ourselves. And we can make different choices.'' I learned during my sabbatical that I can make different choices, and that if I do, I and others will benefit from it in the long run. Occasionally, I slip up. But I have learned how to compensate for it. The ``old me'' would have gotten angry at myself. The ``new me'' has a better sense of humor, a better sense of perspective. I realize I am not always going to be as good as I should be.
The lessons I have learned from my heart attack in the last year and a half have already helped me in my recovery ... They are lessons I have ended up teaching my congregants, and when they are followed, life proceeds along very nicely:
- We shouldn't try to do everything ourselves ... Have enough faith in others to delegate.
- All of us would do well to schedule a time each day for exercise and relaxation in order to reduce stress and enjoy life.
- It is a good idea to take a true day off each week, even if it means doing activities instead of pure rest.
- We can set reasonable timetables and deadlines for ourselves and others. It helps to tell others that we need their work done before the eleventh hour.
- We can set standards for ourselves, but shouldn't beat ourselves up for not meeting them every single time.
- It is worth the effort to find the good in a bad situation. A big mistake is not necessarily the end of the world.
- If there occurs what we perceive to be a problem, we must deal with it immediately before it grows and festers.
- If we let a problem grow and fester, we are better off when we talk to someone who will let us vent about it, and then try to solve the problem once we have calmed down.
- If we fight for an issue and lose, if someone does or says something that we don't like, it is wrong to demonize the people.
- Just as we might think carefully about putting certain foods into our body, we also need to think before getting angry. ``Is this worth getting angry about?''
- If some situation or person causes us to get disappointed or angry, it is advisable to find out why it happened and what can be done to prevent it from happening again.
- If someone breaks a commitment, we can call them on it without exploding at them.
- If we are angry or disappointed about someone or something, we must try to get past it, because we need the energy to live the rest of our lives.
- We should not spend a disproportionate amount of time trying to please those who criticize us constantly or who will never be happy with what we or anyone else may do. Better to save our time and energy for those whom we can truly help.
- I have found it helpful to pray and meditate, on my own, in the quiet of a dark room ... when I am in need of strength, when I feel the stress coming on, when I need to remind myself that I am not in this life alone.
- We need to be aware of the signals our bodies send us, to take the time to take care of them because they will let us know when we don't. The time we devote to that will benefit not just us but also the people we love and the people with whom we work.
Hillel said: ``The reticent do not learn and the hot-tempered do not teach.'' ... He knew that life lived at the extremes of our emotions renders us less effective and less healthy than we could be ... One of the greatest lessons I have learned from my heart attack is that I can be in control. With the help of God, with the love of my family, with the support of my friends and colleagues, with the understanding of my congregants, with the skill of my physicians and therapists, I have come a long way. But how I live is up to me, and I never knew it.
Stephen A. Karol is rabbi of Congregation Sha'aray Shalom, Hingham, MA.