Maybe the MRI scan had got it wrong. Hopefully it would be something innocuous. But then again, as I constantly harangued my clients, hope is not a strategy.
The surgeon didn’t beat about the bush. He was doing me a favour squeezing me in for a TOE (a transesophageal echocardiogram) at 8am before performing a heart bypass operation on another patient.
In the pre op suite he’d explained to me the ‘good catch’ that the radiology team had done in identifying the growth at all. It was inconclusive on the scan and would require inserting an ultrasound scanner down my oesophagus and into my stomach whereupon he could get a closer look at the growth.
Of course I should have asked him what he thought the growth was. How often do we quote Tim Ferriss at Smácht that ‘A person’s success in life can usually be measured by the number of uncomfortable conversations he or she is willing to have.’ But I fudged it. Chickened out. Hoped again that it would be fine.
Only last weekend I’d been kitesurfing in the waves in Lahinch, blissfully unaware of tumours in the heart. Afterwards I’d met my wife for lunch in Ballyvaughan and loitered with relaxation over the weekend newspapers for hours. That evening we’d had dinner in Linnanes and I got to sit in my favourite seat overlooking Galway Bay and the sun setting over Connemara and The Twelve Pins.
We luxuriated over plans for the first decent holiday of our adult lives. For the first Summer in 25 years our kids were independent and we had planned to spend a full month chilling in the south of Franc from mid-June to mid-July. We’d purloined the ideal house – set on a cliff face overlooking the stunningly picturesque and historical town of Collioure.
And now, with two weeks to go I was supine on a bed in the Blackrock Clinic, answering a myriad of questions I’d answer a myriad of times over the coming months.
And then I was in theatre. A real live theatre.
As one of the nurses was helping me on to the operating table she burst out laughing.
‘Would you look at yourself. Your gown is on back to front.’
I became terrified. And for the first time in four days there it wasn’t the tumour that caused it.
‘I’m grand and warm as I am,’ I replied feebly, hoping she’d forget about it and get on with the anaesthetic. I should have known better. You don’t mess with a theatre nurse.
‘Ah, we couldn’t have you going back to the recovery room dressed like that. Put it on right now.’
Perched high upon the operating table I tried to be as inconspicuous as possible reversing that wretched surgical gown.
Once again, loud peals of laughter.
‘Would you look at yourself. Are they your jocks you have on? They’ll have to go. We may have to insert a tube up your groin.
Peripheral vision is amazing. Without turning my head I surveyed every conceivable hiding place in that theatre. There was none. It was bare, clinical, sterile. There was no place to hide. The guy who hid Shergar couldn’t have hidden a pair of knickers in that theatre. They knew it. The anaesthetist knew it. And I knew it. And we all burst out laughing. No one had ever told me that you leave a certain bit of your dignity at the door of an operating theatre.
I went to sleep marvelling at how a sense of humour and cheerfulness and humanity can pervade and thaw even the most sterile of environments.
There wasn’t much laughter upon awakening. The theatre was quiet, somber, subdued. I was wheeled back to a recovery room and told that the surgeon would talk to me around lunchtime.
The wild horses in my mind were on the rampage again. They had almost reduced the guy who preached positive thinking for a living to a cathartic, miserable, hopeless bundle of nerves.
They would have too had my wife not insisted against my wishes on joining me in the recovery suite. As I ranted and raged at her for joining me in my supreme moment of sorrow I wondered, not for the first time, why it is that we reserve our sharpest anger for those who care about us the most.
‘Now listen up, and listen well,’ she said assertively, dismissing my ire.
‘I’ve just spoken with the surgeon. You do have a growth but in all likelihood it’s benign. Your blood tests have all come back normal. And the surgeon will speak to you later this morning. He performs dozens of these operations each year. Now get a grip of yourself and stop feeling sorry for yourself.’
The amygdala, or primitive component of my brain, went berserk. ‘The unadulterated cheek of her. Here you are in the process of dying and she lectures you on feeling sorry for yourself! You tell her that this is not just a bad hair day.’
Fortunately the prefrontal cortex, or conscious part of my brain, countered by saying. ‘She’s got a point. Relax. Don’t get ahead of yourself.’
I would learn later on my journey that people who present for organ transplant and who have a stable and loving and supportive relationship have a far higher probability of surviving and thriving than those who don’t. Serious illness, like serious business, thrives and responds best to positive and caring people. The antithesis is also true. I would learn in due course that I quickly needed to lose those emotional vampires who revel in the drama of your challenge and love nothing more than to regale you with their saga of doom and gloom. Frequently these people can be scarily close to you.
There was nothing negative about the medical team. They were responsive, reliable and most importantly, caring. In addition, they revered my surgeon. They left me in no doubt that not alone was he a lovely man, but that he was an outstanding surgeon and physician and acclaimed globally.
He was still draped in all his surgical regalia when he met us. Five hours of full on open heart surgery had failed to dampen an iota of his ardour and energy.
It’s amazing the things that strike you about someone when you’re emotionally under the cosh. I was intrigued by his accent. There was a clear American twang there in that he pronounced ‘and’ as ‘end.’ He’d most probably worked in the States at some stage of his career. There was also a dollop of Dublin 4. He very likely lived near the clinic in D4. And I could have sworn there was a dollop of Kerry there.
The three components of my brain – The Chimp (Amygdala or primitive); The Champ (Frontal or Rational); and The Computer (Parietal) were engaged in open warfare. The Chimp was telling me to get the hell out of there by faking a dizzy episode. The Champ was advising me to stay calm; listen to the surgeon; and trust that everything would work out. The Computer just kept impartially feeding me information from my vast reservoir of experiences and memories.
It reminded me that one of the best business people and most positive people I’d ever known, Lorcan Fehilly, had died from cancer of the heart.
Fortunately, it also accessed some real gems of wisdom that resonated deeply with me at that moment. In particular, I can recall vividly hearing Jim Rohn speak on wisdom:
‘Don’t wish it was easier, wish you were better. Don’t wish for less problems, wish for more skills. Don’t wish for less challenges, wish for more wisdom’.
I heard Robin Sharma on the subject of fear:
‘Lean in to your fears. Go out to your edges. Because the place where your greatest limits live is also the place where your greatest growth lies.’
I also clearly heard Deepak Chopra’s wonderfully healing and comforting Indian accent talk of acceptance.
‘Today I will accept people, situations, circumstances, and events as they occur, not as how I’d like them to be.’
The surgeon drew an inverted image of a heart and proceeded to scrawl in black ink what I presumed was the tumour.
‘Its about a centimetre big and it’s moving. It’s like as if it’s on a calcified stalk and it’s surrounded by a circular head.’
I wondered if anything as sinister had ever been identified since TEO records began. In fact, I wondered if I’d survive the day.
Annie, sensing my despondency, interjected positively, and asked the hard question softly.
‘But it’s probably benign?
I shot her a filthy look. Questions like that were designed to elicit information. More information than I wanted. Or was able to handle.
I was right. The surgeon was polite and helpful in the extreme and took full opportunity to go into detail.
‘There’s a good chance it’s a myxoma. An atrial myxoma is a noncancerous tumour normally found on the upper left side of the heart.’
This was the kind of stuff I wanted to hear and I perked up considerably.
‘But it’s rare to find them on the right side. They’re normally on the left.’
That fact would traumatise me for weeks to come.
‘What you don’t want is a carcinoma.’
I knew the Chimp in my brain could produce a carcinoma in seconds so I wisely diverted that topic of conversation .
‘What do you recommend I do?
‘As the atrium is quite large the growth is unlikely to cause any blockage issues. However, there is always a risk of clotting. If it was on the left side that could cause a stroke. As yours is on the right the clot would likely occur in your lung which is not as critical.’
‘The challenge with this presentation is that extraction will necessitate full open heart surgery. That entails cutting through your chest muscles and breastbone and connecting you to a heart-lung bypass machine which enables me to work on your heart and extract the growth.’
‘The risk for me, while there, is low. But even though you’re fit and relatively young the recovery for you will be challenging.’
‘The option is that we do a PET Scan and monitor the activity and the growth of the tumour over a period of time.’
It was still two days premature. But what a 53rd birthday present!
There was no need for an alarm clock the next morning.
The four pints in Linnanes had succeeded in giving me a sleeping reprieve until 3am. Awakening came – instantly, suddenly, violently.
For some weird reason I recalled the concluding stanza of Yeats poem ‘The Fisherman’.
‘A man who does not exist,
A man who is but a dream;
And cried, “Before I am old
I shall have written him one
Poem maybe as cold
And passionate as the dawn.’
I only ever vaguely understood the references in that poem, but even as a youngish child the words, and imagery and pathos had always moved me. If they’d moved me in the past, they turbocharged me now. This was no dream. It existed. And it was as cold and passionate as the dawn.
I was terrified. There was only one thing for it. The Ultimate Worry Formula. I’d learned it from my late Father-in-Law who’d developed it for extreme military challenges. I had adapted the process for business scenarios and it had worked swimmingly there helping hundreds of people and organisations practically and systematically solve their problems and worries. The question was, would it work for me?
Pat had been of the first UN Generals to successfully bring troops in and out safely from the Congo. For twenty years, over pints on Friday evenings, I had been privileged to listen to his stories and anecdotes and humanity.
Sitting up in bed I induced a state I adapted from the teachings of Napoleon Hill and Maxwell Maltz called the ‘Theatre of Your Mind.’ I imagined in vivid sensory detail sitting in the pub with Pat and asking him how I could best cope with my current dilemma.
‘The first thing to remember in a crisis Padraic is to remain calm. It’s not sufficient just to remember to do so however, you have to programme it repeatedly deep down into your psyche. The human mind is skittish by nature and requires training. We spend years training soldiers to demand calmness of themselves in a crisis. It should be required training in every school and university in the world.’
‘Command your mind to be calm. Affirm to yourself over and over that you are calm. Your mind is massively receptive to suggestion. It is programmable.’
‘Secondly, there’s nearly always something you can do to improve on the situation irrespective of how bad things are.’ He loved relating the story of the beleaguered General who managed to send a message to Teddy Roosevelt complaining that he was hemmed in by the enemy on all sides and what could he do. Roosevelt’s words were pithy and punchy.
‘Do what you can, with what you have, right now.’
‘Thirdly, you write down what you’re worried about. Unemotionally, factually, objectively. It’s futile doing this exercise in your head. You’ll be sabotaged at every turn by your internal chatterbox. From time immemorial, at least as far back as when prehistoric man wrote on cave walls, the wise people have known the value of clarity. When you write your worries down you clarify their nature; their cause; and their power. In the army, we always maintained that a problem well defined was a problem half solved. You will be astounded at the amount of problems and worries that yield and succumb to this exercise alone. Therefore, should you ever awaken in the middle of the night, and are unable to sleep, simply sit up in bed, or get up altogether and write down your worries and fears.’
‘Fourthly, get the facts, and refuse absolutely to worry about the outcome until you have all the facts. It always surprises me in civilian life what critical decisions are made with insufficient or erroneous facts and information.’
‘Fifth, be prepared to accept the worst if necessary. This is not necessarily a negative response. On the contrary, when we accept the worst we frequently unleash great power. Reinhold Niebuhr bestowed on us one of the greatest prayers of all time with the words:
‘God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.’
In times of stress and anxiety, constantly repeat to yourself those words – ‘Serenity,’ ‘Courage,’ and ‘Wisdom.’ Words have a deeply soothing impact on the mind.
‘Sixth, improve on the worst.’ I later adapted this step to include two steps. What can I do about this situation? What will I do?
‘Finally Padraic, and this is most important. When you’ve applied all the steps of the formula, ‘Let go and trust.’
‘There’s a power and intelligence far greater than you surging through you and around you every second of every minute of every hour of your life. You can’t explain it but it exists. How else would the universe function with such miraculous ease? And this power exists to serve you. All you need do is acknowledge it, use it, trust it.’
‘When you’ve made your decision or intention, release it to this Higher Power, and trust it absolutely, even when things don’t appear to be going the way you’d planned them. Very often the outcome that materialises will be preferable to the one you intended. This is what the seers and wise people called ‘faith.’ Faith is believing without seeing.’
Pat used the formula in his own life many times.
Once, as a retired general, he’d been caught in a vicious fire in the MGM Hotel in Las Vegas. As other guests panicked and threw themselves from the windows Pat calmly coached the occupants on his floor to ‘be calm.’ He explained to them that panic and calmness were both choices. He then outlined certain facts about their present situation. Sure, there was a fire, and a serious fire. As of yet however, there were no visible flames; the fire services were at the scene in profusion; and the structure of the rooms was built of the finest fireproof materials. In addition, he made them aware of the fact that most mortalities in fires arise from smoke inhalation rather than burning. Collectively, they made the decision to remain in their rooms as opposed to randomly running down the smoke filled fire escapes or worse still, jumping to an inevitable death. Crucially, they began to wet duvets and sheets in the baths and line the doors and windows to prevent smoke inhalation. And, they trusted in a Higher Power.
After one hour they were rescued by the fire services, who provided them with oxygen masks and escorted them in ‘blind darkness’ down several stories of fire escapes.
Like Pat in the MGM Hotel, I too was on fire. There may yet be no visible flames but there was certainly smoke. The issue was, how could I get through the weekend without cracking up?
The answer seemed to be ‘The Ultimate Worry Formula.’
At 4:25 am on Saturday May 31st I sat up in bed and tackled the first step in the formula – Be Calm. How can you conceivably be calm when you’re mind is like a paddock of wild horses on a stampede?
Fortunately I had a strategy for calmness. For twenty five years I’ve meditated reasonably consistently. I first learned TM – Transcendental Meditation – and then graduated to a hybrid of yoga postures and breathing. For the past decade I’ve cheated. I use a binaural recording that induces deep alpha and theta brain activity for an hour most mornings.
I meditated now. And it did calm me.
At 5.30 am I did a ‘Teddy Roosevelt.’ I asked myself what ‘I could do, with what I had, right now.’
The answer was to get out of bed, stop moping and feeling sorry for myself and systematically tackle ‘The Ultimate Worry Formula.’
I opened the iPad and wrote down in bold font.
WHAT AM I WORRIED ABOUT?
I’m worried I’m going to die soon and in great suffering and I’m scared out of my wits.
WHAT ARE THE FACTS?
Negative. Irrefutable evidence of a growth in my heart.
Positive. Good Angiogram. Perfect Head MRI. Normal blood tests.
WHAT’S THE WORST THAT CAN HAPPEN?
I’ll die soon, in agony.
CAN I ACCEPT THAT?
With great difficulty. But if I have to, I have to. We all will go sometime.
WHAT CAN I DO ABOUT IT?
WHAT WILL I DO ABOUT IT?
I can’t say I was jumping around the garden having completing the exercise but it had provided more clarity, more focus and at least, there was a semblance of a plan there.
Although still only 6 am, I slipped on my skins and my runners and I jogged out gingerly along the Flaggy Shore. It was as if Heaney had written PostScript solely for me.
‘And some time make the time to drive out west
Into County Clare, along the Flaggy Shore, ………
You are neither here nor there,
A hurry through which known and strange things pass
As big soft buffetings come at the car sideways
And catch the heart off guard and blow it open.
The dawn didn’t appear quite as cold.
Upcoming Smácht Workshop
I’m due out of hospital late next week and still plan on having a Smácht Workshop on the afternoon of November 14th in Galway. It will be an intensive session with many new motivational and business strategies that I have acquired over my protracted absence from the boards. It’s an ideal opportunity to finish 2014 strong by reviewing your current goals; setting new ones; committing to an accountability system; and learning some dynamic new ways to increase sales. As I plan to deliver the session from our offices in the Granary Suites, places are limited. In order to ensure you get to share in this high value event please email me at firstname.lastname@example.org