When I woke with chest tightness and pain and numbness down both arms, at first I thought I had slept funny and one arm had fallen asleep. But then I realized it was both arms, which didn't make sense. And also my chest felt really tight, as though compressed with a strong, thick, solid rubber band.

These are sensations I've come to know well over the last 18 months. Carrying in the groceries, or schlepping the laundry -- almost any exertion can bring this on. It always goes away within a few minutes if I sit and breathe. But it had never happened before during the night, while I was at rest.

I picked up my phone and googled "heart attack symptoms." Shortness of breath, chest tightness, numbness or discomfort in the arms: those have been my regular companions for a while now. Breaking a sweat for no reason: find me anyone peri-menopausal who doesn't experience that sometimes?

I thought about calling an ambulance. I imagined having to wake up my twelve year old, the ride to the hospital, the hours of tests, the likelihood that the doctors would say, "It's just anxiety," or "Nothing clinical here." Maybe it's nothing, I thought. I wanted it to be nothing. I went back to sleep.

In the morning, on urging from friends, I reluctantly called my doctor, who instructed me to go to the ED. There they diagnosed an NSTEMI: non-ST-elevation myocardial infarction. Eventually an ambulance took me to Baystate: riding backwards, strapped to a gurney, watching the green hills go by.

I arrived at the Davis Heart and Vascular Center late on Friday. Procedures like cardiac catheterization don't happen on weekends. Enter electrode stickers, an Intellivue MX40 wearable monitor, a heparin drip via IV. Every two hours a phlebotomist arrived to draw more blood, charting troponin levels. 

In the subsequent days, sometimes I could maintain equanimity. I could reach my gratitude practices, maintain perspective, feel how lucky I am that we caught this quickly. Other times I couldn't help leaking tears, swallowing around a painful lump in my throat: feeling shaken, vulnerable, afraid.

I discovered that when they draw blood, I make the same pained sounds my mother made. Also, when there are IV ports on my hands, they remind me of her hands once she fell ill. That's not how she would want to be remembered. She'd be pleased that people complimented my manicure, though. 

A fabulous nurse told me amazing stories about his ancestors buried in the North Adams cemetery. An ultrasound tech asked me what I do for a living as she slathered me with conductive gel. When I told her, she asked if I could explain to her what Jews believe about the apocalypse and the End Times. 

As a pastoral caregiver I know that both laughter and tears are normal in a hospital. (Not just in a hospital; always! But emotions are heightened at times like these.) Sometimes I could lift up and let the current carry me. Sometimes I sank to the bottom and crashed into the riverbed rocks. 

On erev Shavuot I joined, via Zoom, the festival service I had planned to co-lead. I sang Hallel very quietly. I may never forget singing לֹא הַמֵּתִים יְהַלְלוּ־יָהּ וְלֹ֗א כּל־יֹרְדֵי דוּמָה ("The dead do not praise You, nor all those who go down into silence," Ps. 115:16) attached to a heparin drip and cardiac monitors.

Now I am home, learning about MINOCA (myocardial infarction with non-obstructive coronary arteries), and preparing to seek out diagnosticians who might be able to weave my strokes 15 years ago, my shortness of breath, and this heart attack into a coherent narrative with a clear action plan.

After my strokes, I saw specialist after specialist in Boston. Eventually I leaned into not-knowing, into taking Mystery as a spiritual teacher. But now that I've added a heart attack to the mix, I'm hoping anew for a grand unifying theory. For now, I remain in the not-knowing, with gratitude to be alive.

Related:

• Breathless, 2021
• Pulse, 2021
• Different Strokes, 2009
• Unexpected, 2006