Saturday, February 9, 2008


Richard, my sweetie, started having frequent heart palpitations a few weeks ago. His cardiologist discovered that he has a bicuspid valve where a tricuspid valve should be. His blood was sloshing back and forth where it should have been flowing unimpeded to its next destination. His heart was working harder and growing bigger. And while I always thought of his heart as boundless and inexhaustible, in a medical sense, a big heart is not a good thing. The concern barometer is now turning in Richard's direction. The words heart medication and cardiac surgery have entered the landscape of our relationship.

I was used to being the patient. My body and its slips and slides had been the gating factor determining when Richard and I could travel, visit friends, go to a movie, and do the things "normals" do without calculation or consequence. My chronic pain had become the fulcrum on which our relationship balanced. Richard would look up at me and ask me, "How are you doing?" which was code for "Are you having any pain? Because if you are, I will know how to modulate my part in this relationship. I won't bring up heavy issues or suggest a hike. I will postpone my needs until you are feeling better."

This is how a partnership of equals devolved into an distorted triangle where pain came first, me second, and Richard a distant third. Did I enjoy the privilege pain afforded me? Yes and no. Luckily, Richard cared unconditionally and wanted to do things to make a smile appear on my strained and melancholy face. My needs ruled. But the power pain afforded me also stripped me of a sense of real competence. Weakness, vulnerability, and inability became the cornerstones of my authority. And while they offered me control in the external world, they cost me my identity as an intelligent, worldly, empathetic, capable and funny person. Not a very good deal.

And now, Richard is moving into the patient realm. He is still fully functioning, but he gets disturbing heart flutters. When this happens, we both freeze and fix our attention on his chest like hound dogs pointing at wounded prey. I need to be thoughtful, rational, and adaptable. My patient persona is of no value in this new equation.

Couples, especially long term ones, are so intertwined in practical, emotional, and magical ways. We finish each other's sentences. We phone each at the same moment. Like a ballet duo we dance through household routines without bumping into each other. I can tell by the way Richard breathes what is on his mind. He can understand what the slightest tightening of my face signifies.

Richard stayed strong and healthy while I was the sick one. Now I am doing pretty well, and he is having distressing cardiac symptoms. When I was sick, Richard discovered emotional capabilities he didn't know he had. Is it now my turn to polish my tarnished identity and become a healthy, competent adult again?

Maybe in our next phase we can learn to dance again as we did before pain, as equal partners, complementing each other, sharing the load, without illness as our mediator.


Emily said...

this was beautifully written. it perfectly expresses the strange life of a marriage that includes chronic pain.

Barbara Kivowitz said...

Thank you Emily. Chronic pain and illness do indeed move a relationship down strange paths.

Adam said...


Fyi, I had a bicuspid aortic valve and as a result needed to have heart valve replacement surgery.

It wasn't easy. For me... And, my caregivers. I battled cardiac depression, pain pill issues and some other challenges during my recovery from aortic and pulmonary heart valve replacements.

If you need any thing, let me know.

Adam Pick
Author of The Patient's Guide To Heart Valve Surgery