September 12, 2016 at 4:41 pm

I just added this to the draft of my book, IN SEARCH OF OUR IDENTITY: UNDERSTANDING BEHAVIOR IN BIPOLAR, due to come out in another couple of weeks …


In May 2016, I set aside work on this book to attend to another project. In mid-July, a week or so away from returning to these pages, I experienced severe shortness of breath, chest pain, and a tingling in my upper left arm.

I called my brother, who drove me to the nearest ER. I was half-expecting to be sent home with a baby Aspirin. Three days later, a highly dedicated medical team cracked me open like a lobster and performed quadruple bypass surgery.

By rights, my heart should have stopped beating months before. It was totally blocked, and my cardiologist had images to prove it. I had been breathing on borrowed time. Had I not called my brother, had he not picked up the phone, I would not have dialed 911. I’m guessing, then, I would have been down to my last or second-to-last sunset.

In the past, I have characterized suicidal depression as a heart attack of the brain. Everything inside shuts down. Your life is hanging by a thread. Now, actually having survived both a severe cardiac crisis and a suicidal depression, I can attest that my comparison was far more accurate than I ever could have imagined. I just need to add this one observation:

Until my surgery, I simply assumed that severe medical crisis equated with high drama. With my heart about to stop beating, I figured my face should be turning purple as I fell to the floor, clutching my chest, pulling down at least one floor lamp in the process. Only then, should I call 911.

Seventeen years before, I harbored a similar misconception regarding suicidal depression. Common sense told me that I should be on a window ledge looking down, someone 20 feet below looking up and leaning into yellow crime scene tape, trying to establish a rapport through a bullhorn.

The reality – both times for me – was far different. Over a period of more than two years, right to the very end, my depression convinced me it wasn’t real. As my depression slowly claimed new territory, neuron by neuron, my mind came up with a million rationalizations. Call it a stealth condition. Even in the ER, demonstrably falling apart, I felt that I didn’t belong there, that I was unworthy of medical attention.

The heart plays similar tricks. For nearly a year, whenever I exerted myself, my breathing would become labored. Over the months, even as my condition grew more apparent, I found reasons to avoid coming to the obvious conclusion. Even the day I called my brother, I wondered whether I wasn’t being melodramatic.

My first hours in the ER seemed to confirm my hypochondria. My initial tests showed a robustly beating heart and fully oxygenated blood. To play it safe, the doctors decided to keep me overnight for further observation and testing. They lined up some routine stress tests for me the next day. Then a late blood test came in. An enzyme reaction indicated signs of my heart in distress. They would skip the stress tests and go straight to shoving a tiny camera up an artery.

Reading between the lines, I guessed the medical team would find a minor blockage, which they would rotor-rooter out. Then they would insert a supporting stent in the affected arterial region. Easy-peasy. I would be home a few hours after the procedure.

Instead, I woke up to holy fucking shit news. That evening, as I was getting out the word to those close to me, nurses and technicians prepped me for surgery to take place first thing in the morning. Talk about a stealth condition. The doctors and nurses and technicians, to a person, incidentally, congratulated me on my decision to go to the ER. My symptoms may have been subtle, they advised me, but the people who fail to get themselves to the ER are the ones they never get to hear about, the ones who don’t live to tell their stories.

So, yes, a suicidal depression is like a heart attack. But I needed to experience both to fully appreciate the quiet perversity that is their MO. How they have a way of sneaking up on you in the dark, how they can deceive you into thinking it’s all in your head, how they contrive to convince you that it will all blow over, that it’s nothing, really, that you will wake up feeling much better, until – of course – you fail to wake up.

My return to life was nothing short of a major miracle. But before I could fully celebrate, my financial and living situation entirely collapsed. Meanwhile, – and this is perfectly routine – over the next month, in a strange house, to go with the severe energy-depletion of my sternum mending and the rest of my body trying to figure out the new world order, I experienced a life-sucking major weight loss.

Oh, yes, and the type of draining depression that is part and parcel to patients recovering from heart surgery.

Welcome to a new form of death in life. At the same time, though, here I was, in deep gratitude, marveling at the miracle of my rebirth and resurrection, even while I was experiencing major obstacles with any task more complex than breathing.

But the important thing was – I was breathing. Real breaths, not labored breaths. Through the fog of my weakened condition, I began planning my life, the one that against all conceivable odds did not end months short of my sixty-seventh birthday.

As I write this, the weight is piling back on. My strength is returning. Once I am fully recovered – and this includes cataract surgery – I will be loading camping gear, a few didgeridoos, and other odds and ends into my car and taking to the road.

I’m calling it New Heart, New Start. I’m describing this new page of my life as a journey of discovery, healing, and connection. I plan on being on the road for 12 months.

I anticipate taking to the road in November. The first stage of my journey will take me out of San Diego north to Joshua Tree National Park, then east to the natural wonders of Arizona, New Mexico, and lower Utah and Colorado. This leg of the trip will be devoted to my physical and spiritual healing. The land heals. The American Southwest is very generous in this regard.

Eventually – in the spring – I will find my way to New York City to be with my daughter and her family. Then up into New England before heading west across the northern states. From there, who knows?

All along the way, I am looking to make connections – both with people I have known over the years and with a new generation of boon companions. In the course of my travels, I anticipate a gradual falling away of my outer core, and a renewed relationship with my inner one. At many points along the way, I expect to be meeting myself for the first time. Such is our search for identity. I trust I will be happy with the outcome.

This book addressed the central question of why we seem to be born different, why we feel so out of place in a world that every day seems to offer yet more convincing proof that we were meant for life on any planet but this one. The original intention of this book had been far wider. Behavior, after all, is a limitless topic. But my return from heart surgery convinced me to keep a much tighter focus. Our search for identity cuts right to the heart of all our issues.

When I saw my cardiologist a week after being discharged, he asked me if I had any questions. “Only philosophical ones,” I found myself answering. On the way home, I found myself contemplating the fact that here I was, all these years, still holding myself out to be an expert patient, the author of a bipolar expert series of books, no less. But expert patient, I began to realize, didn’t begin to tell the whole story. Yes, I still identify as an expert patient, but the process of writing this book, together with the many personal realizations coming out of my heart surgery, had the effect of turning me into a philosopher-patient.

When I returned to these pages soon after the fog lifted, I began channeling that inner philosopher. Consciously, this was not the book I set out to write. Unconsciously, this was the book I needed to write.

Thank you for reading this.