HARDHEARTED | Aparna Alankar
Breathe in, breathe out, Dhruti thought, her feet pounding the pavement as she plodded along with the rest of the runners. At this point her companions were mostly very old or visibly handicapped in some way – a woman a few miles back had been on crutches. Her lungs fought for air as she wondered which category she was closer to. A South Indian woman in her early forties on a marathon trail, years after diagnoses of hyperlipidemia and then coronary artery disease, she was no longer just physically fit, but now physically fit for her age. She felt a pang through her chest at these latter thoughts, the sharp feeling bringing her back to that colorless office in Manhattan just five years ago.
Her primary care physician had referred her to a cardiologist after she had complained of worsening chest pain and shortness of breath during her runs. At the office, she stripped off her vibrantly patterned clothes into a bland gown, and nervously settled onto the exam table. The coolness of the metal edges seeped into her skin as she listened to the cardiologist tell his medical students about the prevalence of coronary artery disease in South Asians. He had continued to show them her cardiac imaging results, describing the stenosis in her arteries and the stiffness of her left ventricle.
Here, she had asked a question.
Oh, that just means that your heart is hard, he had replied. A harder heart makes it harder to get blood to the rest of the body. The pressure can back up into your lungs, making it harder to exercise. He had handed her a script to give to her pharmacist and told her to return in a few weeks.
Dhruti rounded the corner at the 23rd-mile marker, considering the phrase. A hard heart. It had been repeated to her time and time again over the next few years after that doctor’s appointment, as she bounced from exam room to exam room, returning time and time again after failed medication trials, diets, and lifestyle modifications. The proclivity of her heart to stenose and harden seemed at odds with everything she had been raised to believe. Since she was little, she remembered her mother saying that softness, and a soft heart at that, was her birthright. Being a child born in America, she was free to do much more than just survive. Her heart could afford to be soft. And so Dhruti had fought to keep it so, despite what others would tell her. She cried too easily, she forgave too quickly, she dreamed too big, and she fell in love all the time. Others had admonished her, telling her that soft hearts do not often survive in the current world, but Dhruti had chosen to quite literally run her own path, protecting her soft heart as she navigated life in America as a first-generation child of immigrants. Along with parent’s dreams had been the inheritance of multiple health conditions, not limited to hyperlipidemia and coronary artery disease. Multiple people in her family had passed away from myocardial infarction, and she had known about her family history of heart disease long before meeting a cardiologist.
Her life had been as much about running away from something as it was about running towards something, she thought ruefully. In an attempt to escape her familial history, she had taken up running in her late teens, starting out with cross-country in high school and soon graduating to long distance running. Marathons became a yearly goal for her, and she had kept a streak going since early adulthood. The onset of chest pain and shortness of breath with running was insidious but soon unable to be ignored. She had passed through cycles of denial, fear, anger, and frustration before succumbing to the doctor’s office, feeling inexplicably defeated.
Her watch beeped, signaling another mile. Dhruti slowed to a walk, leaning against a guardrail unoccupied by spectators as she caught her breath. She closed her eyes, feeling suddenly dizzy. The white of the exam room appeared before her.
A blood pressure monitor beeped. It was a few years after her initial appointment with the cardiologist. He was looking at the monitor and frowning. He had been doing this a lot over the course of their time together. Dhruti coughed, her eyelids somewhat drooping. She had been doing this a lot, too.
We might have to escalate measures, he had said. Your chest x-rays show more lung congestion, and your hypertension is not responding to the medications.
He had pulled out his stethoscope. Dhruti had winced as the cold, hard metal of the diaphragm pressed against her chest, and then against her back. She tried not to cough again.
It is as I thought, the cardiologist had said. The S4 is more pronounced. The pressures in your lungs are getting higher. Your heart is getting harder. I would counsel you to stop running for the time being. I don’t think it’s a good idea for your heart.
Dhruti had thought of her bed back home, longing to sink deeply into its many plush pillows. Then, she thought of the feeling of wind against her face, the sunlight beating down on her as she ran along the city blocks. Nothing had made her feel as free as when she ran. It had become the only point in her life where she was not surrounded by her disease, where her shortcomings were privy only to herself and no one else. In the past few years, her family had frenzied around her as her heart health had worsened, begging her to take on less work, less stress, less hardness of life. Dhruti had refused. Mondi pilla, her father had said. Stubborn girl.
Back in the present day, the sun beating down on her once again and sweat dripping from her face to her well-beaten sneakers, she smiled at the memory. Maybe she was hard-hearted, after all.
She began down the last stretch of the race, ignoring the imminent aching in her chest and the gasping of her lungs. She had missed her yearly marathon streak for the last four years. Enough was enough. She suddenly felt light again, for the first time since before her diagnosis. The music around her soared as she neared the end of the race. Her family would be waiting at the gates. Dhruti grinned as she leaped towards the finish line, arms spread wide like an angel’s wings.
Aparna Alankar is an MD student at Rutgers Robert Wood Johnson Medical School. Alankar, who graduated from NYU in 2019 with a BA in Biology and English and American Literature, wrote and edited for Washington Square News and the Medical Dialogue Review, two student-led publications at NYU. She later created her own student-led publication, Caduceus, to provide a platform for premedical students. Alankar, who is passionate about the study of humanities and its intersections with medicine, carries this passion into medical school as a part of Arbor Vitae/The RWJMS Literary Society during her preclinical years, helping to create a distinction program in Medical Humanities.