Friday, January 10, 2014

Now that we're home and things have settled, I really do want to tell you some stories about our trip. Since I fell off the radar, we spent 5 weeks in the UK and Ireland. We ate and drank and loved all over London, we visited the medieval church where Jeff's parents were married and we saw more than 15 shows in 5 days at the Edinburgh Fringe. We drove 1000 kilometers around Ireland and then drove some more as we toured the South of France and Italy. Our transatlantic cruise, of course, was canceled, but our insurance company did fly us home first class. There's nothing like afternoon tea at 35 000 feet. (And nothing like self-administering a needle full of anticoagulants up there, either.)

And then there's life after the trip. A return to Toronto much earlier than anticipated, subletting one apartment while renovating two others. Considering a leap back into the rat race, and then deciding to be a manny instead. And I haven't had an ounce of alcohol in four months. Yes, there are stories in all that, too.

But when I think of our trip, my memories of the places we saw and the people we met cannot be separated from the maps created by my dear friend Paul. A Technicolor blast fills my brain every time I look at them, which you should know, is often. They're are as important to me as any picture I took along the way.

Wednesday, January 8, 2014

When I was two, a drunken neighbour donned a gorilla costume, popped out from somewhere, swept me into his arms and ran around the house. I dreamt that monkey was gonna get me for years. In the 90s I sat rapt, watching night-vision footage of bombs and burning oil fields, and I thought the Gulf War was coming to get me. Several times weekly (during humid and volatile summers) I thought a twister was coming to get me. I dismantled my room, pulled posters and loose objects from their displays and tucked them into safe-keeping under my bed, or on particularly green-skied afternoons, all the way down to our basement where I buried them under couch cushions.

Bullies, cold and flu, brain aneurisms, you name it; even if I saw my dad wistfully palming a baseball glove, I worried he'd come searching for a moment of bonding. Looking back on my life, I kind of always thought something or someone was hunting me. In modern times my therapist refers to "legendary defensiveness", and I suppose it really is. Legendary, I mean. I was born and bred to feel under siege.

My heart (the physical one, tucked there behind my ribs) has always been a terrific pursuant. From a young age, I remember it beating wildly, like a coffee can full of June bugs. I remember feeling it and sometimes worrying it might explode. I was never athletic, so rarely concerned I'd be asked to push it to its limits, but it often happened when I was entirely at-rest, watching infomercials or reruns of Family Ties.

In my twenties I (reluctantly) attached its rhythm and sporadic dramatics to anxiety; eventually I learned how to breathe it into submission. Sometime before my 30th birthday I quietly celebrated my ability to quell its wild beating almost entirely. Bouts of anxiety came with garden-variety palpitations, thump-thump, of which there were many in The Year of Going Freelance. Then less as we packed our lives into streamlined cases for this journey around the world. While we were gone, so was the ruckus in my chest. It wasn't until our trip's coda that a month's worth of incessant fluttering had me anxious-squared: That's anxious about being anxious and it's a tough one to climb out from under. In London, palpitations turned into a tightness in my chest, as if someone were sitting on me. I noted to Jeff, as I do, that it felt like my organs had outgrown my body.

By the time we got to the South of France, I was having trouble sleeping. I'd wheeze and wake with a start, gasping. Our friends had joined us for two weeks and I wanted to soldier on, to enjoy our visit. And so we did. We enjoyed Cannes and Nice, Monaco and the towns of Cinque Terre. We rented a villa outside Seggiano in the heart of Tuscany before heading north for two days in Milan, then a few in Venice. While I avoided alcohol and often slipped to bed while the guys drank rosé long into the night, I did enjoy those parts, despite my growing inability to breathe.

Cinque Terre is a magical place. We stayed in La Spezia, a larger city near the strip of charming cliff-side towns, in a terrific apartment. We shopped for fresh fish in the open-air market, ate a ton of gelato, and craned our necks as we wandered through piazzas and narrow alleys. When we hopped a train toward the five towns, I was feeling the same: tight-chested, easily-winded, with a general malaise hovering just above the surface. Before long we were scaling a hill, larger than expected, between Vernazza and Corniglia. Rocky steps and steep hills; I couldn't breathe. An hour of this, slower with every crest, and I finally had it. My skin was cold, but my brain felt on-fire. I crouched, then sat, then I felt like vomiting so laid down on the ground, which smelled conspicuously of urine. Somewhere between a panic attack and cardiac arrest, things felt oddly grim. A cold sweat came over me and I remember Jeff saying something about my being grey. He held my legs up in the air and calmly told me to keep breathing. I looked up through the trees, now blurry and waving in slow motion.

Through a tunnel of muddled sounds I heard something about a nurse and a woman's face appeared inches from mine. A blonde American in her 50s sat on folded legs in the dirt, resting her hands on my chest. In just a moment or two she turned everything around; colour filled my face and I was able to breathe again. She told me my pulse was normal and then vanished. If Jeff and our friends weren't there to verify her actual existence, I think I'd question it myself.

By this point we were nearly over the top of the last hill, and I made my way down the other side. Breathing still wasn't easy, but I managed and soon found myself enjoying a honey gelato, a skinny, gooey comb jammed in the top.

By the time we got to Venice, things had gotten worse. I couldn't sleep and the bridges had me gasping. Venice is a walking town, no cars or bicycles, no South East Asian tuktuks to make a walk to dinner easier. After struggling to sleep that first night, I sought out a tourist-friendly medical centre and meandered through the streets in the morning. The guys went to the Biennale (Venice's biannual art festival) and I began what would be a week-long adventure through the Italian medical system, deemed second best in the world.

The Red Cross Clinic in San Marco Square was completely empty except for a handsome young doctor. I sat in front of him and said I couldn't breathe. A Polish woman appeared from behind a curtain (and a near-offensive amount of blue eye shadow) and tried to decipher what I meant. I mimed constricted breathing and she led me to a table. Without many words she attached the soon-to-be-familiar electrodes of an EKG monitor, muttered something about atrial fibrillation and told me I'd need to go to the hospital "right away".

Within minutes, four burly paramedics arrived at the clinic and carried me to their waiting boat. These situations have a way of making you celebrate tiny victories, and a ride in a water-ambulance seemed a pretty novel idea. I took a couple of photos and wondered if I might die.

I spent much of the afternoon being shuttled around different parts of the hospital, through its outdoor arcades and slow-moving vintage elevators. It'd take some time, but when I finally left the hospital 7 days later, I'd discover just how beautiful a place it is.

I was calm and felt okay, spending a few hours looking around at the (mostly) old people who filled the emergency ward. Just waiting. But I'm the type who likes that; if Anthony Edwards isn't crashing my gurney through a hospital door, it means I'm not dying. Instead I'd decipher the Star Trek colour code of this particular institution; doctors in white, orderlies too. Nurses wore teal and paramedics in heavy fluorescent coats came and went, dropping another patient in this purgatory between good health and bad.

Halfway through the day they wheeled-in a real and true Befana - the folkloric Italian witch. Her C-shaped chin curved up, nearly touching her hooked nose. Surely the witch in Snow White was modeled after this very woman. Her hair was gently swept behind a tortoise band, smooth and grey. Her skin was tan and youthful, for her 80+ years, though had gone crepey and puckered at the seams. But she lacked all the mystery and terror of a witch, instead just a tiny, vibrating shell under her yellow, government-issued hospital blanket. Every so often we'd lock eyes, hers weepy, and she'd mutter something which seemed rather urgent. "Inglese, I'd say," with a universally-understood shrug.

In those early hours I met Maria Cristina Pasqualetto, my new cardiologist, a very reserved and quite-serious woman in her mid- to late-30s. She was beautiful with the long-limbed grace of Gwyneth Paltrow, she might be played by a pixie-shorn Penelope Cruz in the movie of my life. Her English was good, but lacked ease, thus vaguely discomforting in its bluntness. "Your heart has problems," she stated. I couldn't help but think, "Well, anyone who knows me knows that."

Another of my brief trips out of triage took me through a series of outdoor promenades to radiology where a CT scan would rule-out a pulmonary embolism. There was a young man there, looking three-sheets-to-the-wind on pain meds, his arm in a temporary sling. His parents sat next to him and when he was called for his x-ray, his mother, crestfallen, crumpled into her husband's shoulder. I thought about my own mom, and the jarringly-innate desire to have her there; I'm not sure what these worried Italian parents thought when the foreigner in the wheelchair began to cry along with them.

Throughout everything we made good use of Google Translate, typing back and forth with the doctors and nurses in an attempt to avoid miscommunication. When one rather steely woman said the CT showed "pleura", I shrugged. "It doesn't translate," I insisted. Her screen, one side Inglese and the other Italian, showed pleura in both boxes. I searched my brain, deep in its frontal lobe, trying to dredge old French-language lessons. Pleura. Pluie. Rain. Water. Moisture. Fluid. "Fluid on my lungs!" I shouted, to their satisfaction. And with that, they told me I'd need to stay the night.

I was admitted and, without a vacancy in Cardiology, unceremoniously dumped into General Medicine where a series of scary theories were thrown around: cardiomyopathy (a virus in the heart), coronary artery disease, a selection of previously-asymptomatic congenital issues, hyperthyroidism ... the list seemed long and not particularly comforting. Nor were the three old men dying in the corners of this room. The ward didn't even offer the dignity of curtains between its beds, only a couple of feet between me and a sometimes-conscious man who intermittently shouted "Mamma Mia!" with cartoonish bravado. Tuesdays with Paolo.

That night, after Jeff left,  I was completely alone and, for the first time, acutely aware of my situation. A cloud of words I couldn't understand filled the air and my body had gone rogue. I'd spent the year traveling the world, seeing so many of the things I'd read about in our complete collection of encyclopedia. We'd organized and strategized nearly every hour of the 225 days that came before this one, and it was plainly obvious that level of control was gone. And so from the moment I stepped into the Red Cross clinic that morning, I saw the lesson here: I must trust these people and do what they say. And so I laid quietly, careful not to stir my heart.

The next week was a series of tests and efforts to rule-out that list of maybes. It was a horrifying angiogram and several echocardiograms and daily blood tests. Daily shift-changes brought varying degrees of English proficiency as nurses marched in and out of the private room Jeff had lobbied for upon my move to Cardiology. My favourite was a sturdy woman in her 50s with coarse red hair.  She couldn't string an an English sentence together, but when she plunged a needle full of blood thinners into my abdomen, she knew how it stung. While many would simply stick-and-run, she'd sympathetically wince, squeeze my hand and stay with me for those thirty-or-so seconds of pain. No words between us, just a shared moment of critical importance.

Sebastião, my favourite orderly and a brick shithouse of black hair and big white teeth, took Jeff aside on that first day to offer comfort (and gay-friendliness), "I see the sentimentality between you and have told the others. You'll be free to come and go whenever you like." And so he spent long days with me, watching shows and idly flipping through magazines. From this moment on, staff stopped asking Jeff to leave the room for blood pressure tests and they shared their latest findings with the both of us. I'll remember Sebastião forever for that simple gesture.

But Jeff would leave at night, and I'd lay in my bed listening to the beeping sounds at the nurses' station, wondering if it was my heart causing the commotion. I coaxed myself to sleep, feeling confident that my redheaded nurse would take good care of me.

They were sure of one thing: My heart, at this point, was working at about half its normal capacity. Persistent atrial fibrillation (ongoing for five weeks, since those days in cheery London town) had caused me to go into heart failure. This very-common arrhythmia, on its own, can't kill you, but when left to fester so long causes your heart to weaken and your blood to thicken, your risk of stroke swiftly rising. And so with meds to manage my heart rate, some to control its rhythm, anticoagulants and time, I would be back to normal. Dr. Maria Cristina Pasqualetto (you simply must say her whole name) warned in her matter-of-fact way: "Medicine. Rest. No whisky, no wine, no birra." She said we must go home, no more gallivanting around. And with that, Eat Gay Love would come to a bizarre halt.

And, whether I like it or not, life is different now. I can't tell if it's because we took this trip, or because of how it ended, or because of the things we saw along the way. I knew it would take time to digest the year we've had, but even more-so now. Life is different. I know that with my whole heart.


(The halls and arcades of Venice's Ospedale civile SS. Giovanni e Paolo.)


1) Atrial fibrillation is the most-common heart arrhythmia on the planet; millions have it. Most experience it in waves, lasting only a few minutes. Throughout my life I have been very aware of "palpitations" - a cute word for an arrhythmia - but it has never persisted for five weeks straight. When I'm off medication chances are I will experience AF regularly throughout the rest of my life. The key is to listen and beware of persistence.

2) Some heart issues are caused by "plumbing" and others are "electrical". Arrhythmias are the latter and often have very little to do with the condition of one's heart, their diet, or their fitness. Lots of tests proved that my heart, under normal circumstances, is entirely normal and healthy. In this particular situation, the arrhythmia was allowed to persist so long that it caused other problems. Heart attacks are a plumbing issue. Atrial fibrillation is not related to heart attack. I was never at risk of a heart attack and my heart is structurally sound.

3) In atrial fibrillation, the electrical signals that maintain the rhythm of the heart are out of sync. Often the upper chambers (the atria) of the heart will beat (vibrate, really, like a hummingbird) between 400 and 600 times per minute. The lower chambers cannot keep up, try as they may, which results in an arrhythmia. In a case of persistent fibrillation, the heart can exhaust itself and result in heart failure. (Of course, normal heart rates are between 60 and 80 per minute.)

4) Atrial fibrillation (especially persistent) disrupts efficient blood flow through the heart, and therefore the rest of the body. When your heart is working inefficiently, it has an impact on all organs, vital and otherwise. Getting the heart back into normal rhythm is critical. During disorganized beating, blood can collect between the upper and lower chambers, resulting in a stroke. People with AF are 5 times more likely to suffer one. After five persistent weeks in this condition, I was at particularly high risk, hence the very high amounts of anticoagulants (blood thinners) upon my arrival at the ER and throughout my stay.

5) In ridiculously simple terms, blood enters the heart, pumps, and then exits the heart. Yours should expel at least 55% (but not more than 70 or 80%) of the blood it takes on in order to feed the other vital organs. Mine was working at 28%: half its required function for good health. This means other vital organs weren't receiving enough blood, circulation was bad, and everything was just grinding to a halt. This is known as congestive heart failure.

5) I'm currently on a medication to control the electrical rhythm of my heart, one to lower the overall heart rate, and Aspirin to thin the blood. My heart is very close to the magic 55%.