Dad's Heart, My Life

The Enemy Within

I have grown over time to consider the human heart -- or, more accurately, the specific fist-sized, 12-ounce-or-so, four-chambered, spider-webbed organ pulsing within me -- as a living, breathing entity quite apart from the rest of me. It has a personality, a life of its own. I can stand at a remove from my own self and look upon it. When I do, I see both a loyal friend and a distrusted enemy. It doesn't just beat in my chest -- lub-dub, lub-dub. It talks to me, LUB-dub, LUB-dub, continually reminding me of its presence, asking -- no, demanding -- that I attend to it. I listen and answer. You bet I do. Years ago I made my deal with this devil: I keep you in shape, you don't attack me. We have been in long conversation ever since.

As for Dad, I have no idea. He never talked to me about any of this. About his father. About his first heart attack in 1963. About how it affected him, changed him, scared him.

I asked Mom if she could explain what Dad was like after his first heart attack. She didn't answer immediately. Instead, she tapped on her chest and looked past me, trying to find the correct words.

"He was," she finally said, and then she stopped talking but kept tapping. "He wasn't introspective," she continued. "He wasn't withdrawn." She was still tapping. "He was inner-directed after that first heart attack." That confirmed what I had long suspected -- that Dad was different after that first heart attack.

A coronary infarction kills heart muscle. Myocardium dies and does not come back. Dad didn't come back, either. I see that now. He could stew, no doubt about it. Mom talks of Dad spending a lot of time in the basement in the first year or so after his heart attack, sitting by himself, drinking a couple of beers, just . . . sitting. Not reading, which he loved to do, not watching TV.

"He was depressed," Noreen said upon hearing this, making a quick and likely correct diagnosis. We know that now. Many people who have had a heart attack confront the symptoms of depression. Of course they do. For some, the depression itself can become its own risk factor.

Dad's Legacy

In his office at the Princeton Longevity Center, David Fein, a specialist in preventive medicine, turned my attention to the computer screen and its digital slides, in shades of black and gray. Then suddenly, there it was, a line of white, a bony old man's finger clutching at my heart. The blockage was in about 20 percent of my left anterior descending artery. There was about the same in my right coronary artery. My risk of having a heart attack in the next 12 months: 10 percent or more, according to the data. Left untreated, the risk would only compound, the doctor said, making a heart attack a near certainty.

When I left the center I was worried that I would never set foot inside a gym again, never get on the rowing machine, lift weights, anything. What was the point? I had failed. I was utterly devastated. It wasn't just that I had heart disease. No, what stung (the way I saw it) was the fact that I had become that part of Dad I had worked so hard never to be.

It was Noreen who dragged me through that first weekend, mainly by saying almost nothing. "You're still here, Steve," she said. To her it was that straightforward.

Fein had said as much. "There is basically no end to the ways that having kept yourself fit has improved your situation," he said. I'd lowered my insulin levels, improved my blood lipids, built collateral arteries in my heart around any blockages, to name just a few. The list, he said, was endless. I would probably already have had a heart attack by now -- at best. More likely, I probably wouldn't be alive to be getting this news. I was even paying forward, banking reserves on any heart attack that I might someday have. "The odds that you'll do well if you ever do have a heart attack are very high," he said -- the most left-handed compliment I have ever heard.

He talked of death. "It can be difficult to accept one's mortality," he said. But I didn't think then, and I don't think now, that this was about death. I faced my mortality on Sept. 30, 1969. The night I watched Dad die I watched me die, too.

My life began the night his ended. Learn from me, he said.

And so I did. I have become who I am because of him. I can't imagine my life without all that running and rowing and biking and all the rest. Day after day. It's who I am, because of him.

And I am alive.

Steve McKee is the author of "My Father's Heart: A Son's Journey" (Da Capo Lifelong), from which this article is adapted. Comments:health@washpost.com.