麻豆传媒

In the 1970s, when I was a young cardiologist, having a myocardial infarction was a life-changing and often career-ending event.

For some reason, the medical community believed that irreversible ischemic injury to the heart necessitated a major shift in the conduct of life. The patient was advised to do everything possible to reduce stress, since we assumed that continued stress would simply precipitate another ischemic event -- or even sudden death. Patients were told to rest at home for long periods, and to permanently "slow down" and downshift their lives into a less hectic pace. Often, this was interpreted by the patient as a precipitant for withdrawal from an ongoing career and intense professional responsibilities.

I can remember many patients whose soaring careers were cut short by the experience of a myocardial infarction. I even recall some patients wanting to keep their MI a secret, so that they could return to their professional goals, without the stigma of illness. Many feared that they would be passed up for promotions or that their illness would embolden others to challenge their leadership. The life-threatening event was uniformly regarded as making a person vulnerable.

So MIs often ended careers. Often, the subsequent psychological consequences were devastating.

But times have changed -- a lot.

Take a look at Bernie Sanders. He is 78 years old and is the longest serving independent in U.S. congressional history.

Sanders has been incredibly consistent in his advocacy for progressive principles, but for most of his career in Congress, he was ignored. He was an outlier in the political spectrum of beliefs.

But in 2016, the world suddenly caught up with what Sanders had been advocating for decades. He ran an intense campaign against an establishment candidate, and he almost succeeded in grasping the Democratic nomination for president. He spent exceptionally long hours of work, even though he was then 75 years old.

Sanders changed American politics forever. Progressivism is now a viable political philosophy. And this year, at the age of 78, he announced that he would run for president again. His campaign raised a great deal of money, and he campaigned with zeal. But during the last several months, he seemed to be losing steam. Some thought: maybe Sanders was finally getting old.

And then, two weeks ago, his world changed.

Bernie Sanders suffered a myocardial infarction. The extent of the infarction is not publicly known, and little has been revealed about the degree of left ventricular dysfunction. We do not know about the possibility of hibernating myocardium. All we know is that he received a few stents. We can only speculate about what that means with respect to his long-term prognosis.

We do know that Sanders ignored the early signs of his heart attack, a .

If you thought that this medical event would have led Sanders to terminate his campaign and allow others to lead the progressive movement, you were wrong.

One week after his heart attack, Sanders participated in an intense nationally televised debate. To most observers, he gave his best performance to date. He seemed more focused and more articulate, and perhaps, he had adopted a softer and more persuasive tone. Whatever he did, it worked.

One week later, Sanders received new endorsements from the progressive wing of the Democratic Party. He was campaigning harder than ever before. And his speeches attracted larger crowds. He and his campaign were even more committed than ever.

For all practical purposes, his heart attack that -- if he were going to make a difference in the world -- he needed to act sooner rather than later. The episode galvanized his determination to move his efforts to an even higher level than before.

I can identify with Bernie Sanders -- completely.

In October 2014, I was a department chair with a mission that was quite distinct from my career in cardiovascular research. I had just learned certain results from the PARADIGM-HF trial, which culminated a 20-year journey to identify a role for neprilysin inhibition for the treatment of heart failure.

In my zeal to publish the on the trial, the stress was incredible. And in the midst of that effort, I experienced prolonged midsternal chest pain, with the classical symptoms of myocardial infarction.

Realizing what was happening, did I immediately seek medical attention?

No. I went into a state of denial. I was visiting my daughter at her university and did not want to interrupt the visit. So for five days after the event, I did not see a cardiologist.

On the fifth day, after returning home, my ECG showed an acute anterior wall MI, with Q waves and ST segment elevations in multiple leads. The entire anterior wall hardly moved. My ejection fraction was estimated to be less than 30%. I was taken to the cath lab where I was found to have a >99% lesion in the left anterior descending artery, which was opened and supported with a single stent. I was then discharged from the hospital, but with significant left ventricular systolic dysfunction. That meant that I was destined to develop heart failure, a disease that I had studied my entire life.

What did I do? I was certainly not going to spend time bemoaning how stupid I had been in delaying my medical care. Instead, I took the most aggressive approach possible, using drug treatments for my post-infarction course, many of which I had personally helped to develop over the previous three decades. I pursued every possible path towards myocardial recovery.

One year later, my heart had recovered nearly all of its function. My ejection fraction had increased to the normal range. My ECG now reads out as normal.

What did I do with my career? Did I decide that it was time to take a break?

I was 63 years old, and I had a long list of things I wanted to do. The heart attack reminded me that I was not immortal. If I was going to accomplish the goals that were important to me, I needed to act quickly. That meant moving back to cardiology and devoting myself with greater energy than ever before.

It is now October 2019, and this month marks the fifth anniversary of my MI.

I am much busier than I have ever been. My research activities were reinvigorated and greatly expanded. I am more productive (with respect to projects and writing papers) than at any time in my life. I started a blog. I am full of ideas that I want to pursue, and there is much work that must get done. Amazingly, I am succeeding in moving all of these to fruition.

Why the incredible intensity of effort? As in the case of Bernie Sanders, in 2014, I was reminded that my time to make a difference is limited. Of course, I always knew that. We all know that. But my MI was a sharp forewarning with a simple message: If I do not act now, I will never get it done.

My academic efforts are now more focused, and I am far more determined. The result is an intriguing (and mysteriously pleasing) feeling of impatience. I am less likely than ever to wait for the "right" time for something to happen, and I am far more likely to take steps to make it happen, so that I will be around to see the fruits of my labor.

I think my writings are more compelling. My presentations seem more impactful. I travel nationally and internationally, perhaps more than I should, trying to make a difference. I am mentoring more people than ever. And I have opened up dozens of new collaborations.

I am fully committed to changing how the medical community thinks about heart failure. That has always been my personal mission for the past 40+ years. Now, it is more important for me to do so than ever before.

I am enjoying myself immensely. In every sense, I am having the time of my life.

Life is a story. We write it; we experience it; and sometimes, we take a bit of time and read what we have written. As one might expect, the final chapters of a novel are often the best parts of a book. It allows the author to tie up all the loose ends and deliver an impact that will last a long time.

In the past, a life-threatening event was viewed as the final chapter. Now it is truly an opportunity for renewal rather than remorse. It is a keen reminder that there is a great deal of work to do, and no time to waste.

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