May 21, 2023
Dear Leland and Everett,
A few days ago I received a scary medical test result. The test is called a Coronary Artery Calcium, or CAC score, and it measures the amount of calcified plaque in the arteries. Basically, unlike lipid tests, the CAC gives a direct measurement of the blockage in one’s arteries.
My doctor sent me my result and informed me that I was in the 99th percentile for my age group. Heart disease is currently the leading cause of death in America, so being in the top 1 percent of my age group, well, it scared me.
My previous doctor in Singapore was the first to propose I take the calcium test. He didn’t anticipate we’d find anything, and in fact was promoting it as a way to rule out heart disease as a concern over the next ten years. Alas: we discovered even then that I already had a rather shocking amount of plaque buildup in my arteries. We followed up with a cardiologist who confirmed that I was at no immediate risk of a heart attack, but suggested I start a “massive” dose of statins. I read about statins, and was reluctant to start them so young (I was 38 at the time); my doctor (not the cardiologist) and I decided to pursue lifestyle changes. I went on a ketogenic diet, saw a nutritionist regularly, and started an strength training regimen. I lost 50-60 pounds, and within a year weighed less than I had exiting high school (albeit presumably with less muscle). After 18 months I requested a retest, and while the plaque had progressed, I had pretty dramatically slowed down the progression. My intention at the time was to ratchet up my exercise routine, and attempt to get in outstanding physical shape.
Shortly after the second test, our family moved back to the U.S. Unfortunately, this changed everything in my life. I did not maintain my diet, my weight loss, nor my exercise routine. The four years since we moved back have been some of the most stressful of my life. In those four years, your mom and I both worked stressful jobs, we built a house, your mom’s dad passed away, and Covid lockdowns increased work stress while decreasing healthy outlets to deal with work stress. None of these are meant to be excuses; they are just what happened. Throughout I worried about what the stress might be doing to my body, and particularly my heart. I gained weight, I exercised infrequently and inconsistently, and I lost track of my diet. One of my reactions to stress is to eat: I eat more and I eat unhealthy foods.
And so, I asked my doctor if I could retake the calcium test. The result was disappointing: I have significantly more plaque than I did in my previous test. I wasn’t able to meet with my doctor for a week, and I won’t be able to see a cardiologist for a couple weeks still. In the meantime, all I could do was my own research to try to discern my level of risk. What I found wasn’t comforting. It’s a running joke these days that researching one’s own medical condition is sure to scare you, as you tend to find worst-case scenarios and assume they are at least equally weighted with more favorable outcomes. As far as I could tell, I was either at immediate risk of a deadly heart attack, or had at least truncated my life to where I had only several years left to live.
I spent the next week gripped in fear and sadness. How had this happened? Why hadn’t I gone on a statin earlier? Why hadn’t I protected my health these last few years? Why hadn’t I secured more life insurance? Why hadn’t my doctors advised me better, or tested me more?
The truth is that I was doing the best I could at the time with the tools I had. So, I truly believe, were my doctors, and everyone around me. In other words, relitigating the past wasn’t useful. Instead, I chose to muster my courage and face my fears head on.
The first question I asked myself: how is this situation a gift? I am starting to believe that everything we face in life is a gift from God, and we get to choose whether we honor and accept those gifts by addressing the challenges life gives us, or whether we reject those gifts by blaming others or running away from those challenges.
Not surprisingly, my being needed time to identify the gifts. So I moved on to an easier question: what am I so afraid of? And so I closed my eyes, took deep breaths, and started to closely observe the sensations in my body. I could feel the gripping fear in my stomach and torso. And so I asked: what is here? The results surprised me.
I used to fear orphaning you boys, or at least leaving you without a father. I know folks who lost their fathers, and it leaves a lasting wound. I didn’t want that for you. But several month ago, on a turbulent flight without you boys, I faced that fear, and ultimately came to accept that God would decide whether you boys were meant to grow up without me, and that I just needed to trust. In that moment I sensed that “today is not my day”. Ever since, if I find myself fearful of leaving you two without a father, I go back into my faith that God will decide; each time so far I have sensed that “today is not my day”. With practice, I discovered, I no longer hold the fear of orphaning the two of you tightly. To be clear, I have no desire to leave you without a father, but that fear no longer hangs over me, nor negatively affects my decision making, nor paralyzes me when in situations beyond my control (like on a plane flight).
As you know from these writings, I have also harbored in recent weeks a fear of death. And so in my meditative state I explored my fear of death. I found no resonance; exploring death didn’t exacerbate my fear or physical discomfort at all. Turns out I had, as expected, mostly addressed my fear of death, at least insofar as it held me in a constant if unconscious state of dread.
Confused, I asked myself: if I’m not afraid of dying, and not afraid of leaving my boys without a father, then what is this fear which so totally consumes me in this moment. The answers came back immediately: “what am I going to tell my mom (your Gran)?”, and “how is this going to inconvenience (your mom)?” Unbelievably, in the face of my life ending early and dramatically, my chief concern was with how it would impact my two favorite women. There is a longer story behind this fear that I need to save for another day. For the purposes of this story, what matters was the realization that I need to address some fears I have with my mom and your mom. Namely, I need to be willing to be me, fully me, and trust that they will appreciate seeing and knowing me more fully…or that if they don’t, that I can source my love and approval from within myself, and don’t need their love and approval and permission to be me. To be clear: I will always love your mom and I will always love my mom. But I can love them without sourcing my love and approval and sense of wellbeing from them. I had already identified the need to rebalance my relationships with my mom and your mom; what became salient in this moment was the relative urgency: my body wants this to be a top priority.
When I was about 7 years old I played soccer. I was the goalie. Because I was tall, because I have good reflexes, and because I have good hand-eye coordination, I was a good goalie. But I didn’t like playing goalie. I wanted to run around and kick the ball. The goalie was confined to an area, I wanted to roam around freely. I happened to play on a good team, so the ball was generally on the other side of the field; I spent large swaths of the game with nothing to do, and found the whole thing profoundly boring.
I asked my coach to play other positions. I asked my parents to let me quit. My coach didn’t listen. My parents…well, I don’t remember the conversations with any specificity, but the sense I have almost 40 years later was that I got steamrolled.
During one game the other team had a breakaway in the box. This was a classic 1-v-1 breakaway between a striker and goalie. In these situations, the goalie is supposed to run at the striker at full speed, and then slide before the striker attempts to kick the ball and score. The goalie is to take up as much space, and as many scoring angles, as possible. I knew all of this, even then. But instead of doing what I knew to do, I ran at the striker, jumped, and spun in the air, as if I were a complete novice as a goalkeeper. My coach was outraged, and immediately pulled me from the game. My dad was furious, and lectured me the whole way home.
I had mostly forgotten that story until very recently, when it suddenly occurred to me: I didn’t feel heard, and was trying to get people’s attention. I wanted my coach to hear that I didn’t want to play goalie. I wanted my parents to hear that I wanted to quit soccer. I didn’t know how to be heard, and so I did something to get their attention. I think the reason I remembered that story recently was that it resonated, all these years later. I wasn’t feeling heard, I was feeling steamrolled, in most areas of my life. The memory of the soccer story helped me understand that, rather than do something dramatic to get attention (which is fine for a little kid who doesn’t know better), I needed to start intentionally standing up for myself, my needs, and my wants. I can’t, and don’t need to, control what others do. But if I don’t articulate my wants and needs clearly, I don’t give others the chance to hear me. I have work still to do, but I am practicing standing up for myself now.
I mentioned earlier that I was not only scared, but also saddened, by my test result. The sadness was partly just the normal grieving process: the idea of not being able to watch you boys grow up, and not being able to experience all the joy and excitement and sadness and growth that you have ahead of you, just broke my heart. But I was also saddened that my spiritual journey might be ending before it really started. I sense, for the first time in my adult life, that I am finding my path, and that I am finally finding God’s calling for me. And so it brought me great sadness to think that I might not have the opportunity to walk my path. I thought, briefly, that I had found my calling and my path too late, and that I had squandered the opportunity, at least in this life.
Therein lies the gift I mentioned earlier: I had the opportunity to sense the sadness I would feel if my life ended without me finding and walking in my path. And so when I feel tempted to bury my wants and allow myself get steamrolled by others, I can be buttressed by the sense of importance and urgency that I need to live my life, now, in honor of my calling.
I am coming to believe that our physical ailments are manifestations of emotional and spiritual struggles. And so the metaphor of a blocked heart highlights, or underscores, for me the sense that I have lived my adult life for others at the expense of my own wellbeing. I’ll share more in another post. For now the realization is that my heart, my energy center for love and joy and sadness, has been blocked as I suppressed my own wants and needs for those of others.
This chapter of the story ends on a happier note. I met with my doctor on Friday. He believes that I can still live a long and healthy life. We agreed that I should start on medication and that I should see a cardiologist for further testing. But with medication and lifestyle changes he believes I might even be able to improve my blood flow again. And so, all the more reason for me to continue making the lifestyle changes I need for me, to clear my emotional and spiritual blockages, so that I can allow love and joy and blood to flow freely through my heart again.
I love you both. And I let you be the judge of whether I made the lifestyle changes needed to live a long and healthy life, and be there with you as you grow into the gorgeous adults you have capacity to become.
I love you,
Dad
Letters to Leland 