2019 was supposed to be the year I rose like a phoenix from the ashes. I was coming off almost a decade of nearly continual stress as my parents’ health failed, and four years of frequent, often abrupt travel between Atascadero and Los Angeles that left me the Marriott Gold Elite member I never wanted to be. After my mother passed in June of 2018 the six months I’d allotted to wrap up her affairs and regain my emotional equilibrium had stretched to seven, but they were behind me and now – as my oldest brother had put it – was the time to grasp my new lease on life. Existence would be resplendent once again. My Nikon would emerge from its polyester purgatory in the closet. Stories would flow in rich, even profligate abundance. 

I reached out eagerly to that future and…well, what it handed me was more Humpty-Dumpty than firebird. So instead of a tale of extravagant success and unrestrained joy, this is the story of a step by step – I won’t say struggle, that’s a bit melodramatic for the year that has passed – but journey, perhaps, back to a state of wellbeing. And at least it is a story of a kind, for words the past year came harder than expected, and I’d like to be reacquainted with them again.

Anxiety, of the Free-Floating Kind

Anxiety and I have had a long and excessively intimate relationship for half a century now. Night terrors, panic attacks, dread of parties and conferences and meetings: living with it in all of its infinite variety for so many years that I’ve had the opportunity to watch it age, though definitely not like a fine wine. It’s not a thing you often talk about in polite company, I suppose, so I don’t really know how others experience it. Here, however, is mine.

When I was a child, I ran. Ran as if my body could somehow escape my terrified mind, flying out the back of my skull and onto the sidewalk where some cat could follow along and bat it into a bush for all I cared. Better off without it, I sometimes thought. My first memory of anxiety was at a Rose Parade when I was seven. My father and I were briefly separated in the crowds, and layered on top of the fear of being lost was my initial grappling with the concept of “never.” What if he never finds me? What does that mean?  I was small, jostled and ignored by everyone around me, and as I was pushed toward the street my mind raced with the fear of being trampled by horses or run over by a float. Not the trampling or running over per se, but the inexorable never of the aftermath: Never another day alive? What does that mean? 

Panic attacks in college involved insomnia. A lot of insomnia. The causes were, my family doctor said, the usual for an ambitious student: too heavy a course load, too much work, not enough sleep. I took up following baseball as a hobby, because ticking off boxes on a scorecard required a small amount of concentration and precision, Vin Scully calling Dodger games was soothing, and after game shows often ran late into the night. When baseball season ended I dove into meditation, vegetarianism, and a very strict nighttime schedule, which seemed to keep the worst of the monsters at bay.

The pattern continued in adulthood. More insomnia, with a dose of autophobia tacked on for good measure. This was particularly distressing as my life up until then had largely been defined by the time I spent alone – writing, thinking, even just listening to music in the dark – so to be so terrified of solitude that I could barely take a shower without screaming was an unpleasant wrinkle to my existence. I was still working too much, not sleeping enough, with the added pressure of a mercurial boss and demanding clients in the infamous tech startup environment of the early 90s. Both my father and father-in-law were fond of saying that I didn’t handle stress well. If they were trying to be helpful they failed, because once again all I could do was circle my tail chasing a new anxiety: Don’t handle stress? What does that mean?

Menopause wrapped my brain in cotton. For a while – until I sorted out the evolving emotional states hormonal changes seemed to have thrust on me – the world had a certain dreary patina to it. With every book I read, every movie I watched, every meal I cooked came the niggling thought, Haven’t I done this before? Is there nothing new to experience? The sole upside was that the panic attacks came cotton-wrapped too, almost as if they were happening to someone else. Their frequency even started dwindling, eventually down to nothing.

Or so I thought.

Into the Medico-Pharmaceutical Complex

My parents’ long and painful decline was, I realize in retrospect, an emotional respite on at least one vector: there were coat hooks in abundance on which to hang dismay and agitation, encouraging fewer episodes of unmoored, existential dread. But not even a week after their estate was finally closed out with the winning of a tussle over twelve thousand dollars owed by my mother’s skilled nursing facility, the panic attacks came crashing down again and nothing – not yoga breathing, not distracting myself with video games or Netflix, not my husband trying to reassure me that it would go away soon – would help.

Which is how I ended up at Urgent Care Atascadero with a blood pressure of 185 over something equally high, hyperventilating and unable to stop shaking. Atypically, the doctor arrived in the examining room almost immediately, likely because his first order of business was deciding whether to pack me off to ER. (I didn’t know the phrase “hypertensive crisis” then. I do now.) He was tall and broad, with a shaved head and a smile that – as certain literary genres put it – never reached his eyes. Even in my discomfort I couldn’t help but whimsically imagine him ending his day by slipping out of his white coat, retrieving a bass from an equipment locker and driving to Pismo Beach to stroll onstage at Mr. Rick’s dive bar. Perhaps the lead singer of a Shriekback cover band. We’re on the road and we’re gunning for the Buddha…

He had been joking with my husband about their matching hairstyles, but I realized he was now talking to me, asking about anxiety and panic attacks. “How have you managed that in the past?” he asked.

“Yoga and meditation.”

He snorted. “Hippie crap.” He pulled a prescription pad from his pocket and started scribbling. Then he ripped it off and handed it to me. “Take this. If you aren’t feeling better in half an hour, go to emergency.” And he was gone.

I stared down at the piece of paper. “Lorazepam.”

“What your mother was on?” my husband asked.

I nodded. “Highly addictive.” We had discussed that at length when my mother’s doctor suggested it for curbing the worst excesses of her debilitating anxiety, decided that at ninety years old addiction probably didn’t matter all that much. I eyed the trash can. “I don’t want to take this.”

“Well,” he said, moving toward the door, “let’s get it filled and see how you feel.”

Walgreens was crowded and the pharmacy was slow and I felt better by the time we got home, so the Ativan went into a dark cupboard unopened. And although for the time being the worst of the symptoms had faded, I would have been lying if I said I felt like myself, since “myself” didn’t generally suffer from nearly nonstop premonitions of imminent doom. So, reluctantly, I pulled up Anthem’s website and went in search of a doctor who specialized in internal medicine, colloquially known as the GP for old people.

It had been years since I had a primary care physician. I’d tried a couple of times, but whenever I found one I liked tolerably well our insurance got pulled out from under us and they inevitably didn’t take the new provider. Finally I gave up. We had a couple of decent urgent care facilities nearby, and I didn’t have any chronic conditions – well, aside from the glaring psychological one – and it wasn’t as if I’d ever gone to a physician who seemed so engaged with me that I’d be relieved to have them at my hospital bedside. But…nonstop premonitions of imminent doom.

I found a local doctor with Dignity Health who was taking new patients (however put off I was by their Hello humankindess corporate motto), and though I wasn’t certain how I was going to manage the two months until his first available appointment I put it on my calendar. Then promptly had another attack that landed me in Dignity’s urgent care. The nurse practitioner was sympathetic to my desire to limit my use of lorazepam, but told me to take it anyway. In exchange, she’d get my appointment moved up. 

So two days later I was sitting in an examining room liberally decorated – aside from the usual anatomical posters on the wall – with Michael Pollan books on healthy eating. Which proved to be a godsend, because the doctor was nearly forty minutes late to the appointment, though the Ativan went some way toward preventing me from caring.

The doctor, when he finally arrived, was the polar opposite of the bald behemoth of the first urgent care. He was very young, slight of build with thick blond hair conservatively cut. His resting expression was one of concerned gravity. His eyes participated fully in it. In another century I could imagine him on horseback, traveling between rural patients in the Appalachians. He took my blood pressure, said it was high. Asked how I’d been managing my anxiety in the past.

“Yoga and meditation,” I replied again. He nodded silently. I couldn’t parse his expression. “Have you been taking the lorazepam?”

“For the past two days, yes.”

“And how is it working?”

“I feel great. Better than great. I feel amazing.” I frowned a little. “I want to stop taking it.”

For the first time, he smiled. “Good. We’ll see what we can do.” He thought for a moment. “You have high blood pressure, and show signs of orthostatic hypertension – your blood pressure spikes when you stand up. Nothing to worry about,” he added as I looked concerned, “it’s just something that happens to some people. Beta blockers are often prescribed for both, and off label for anxiety.” The faint smile came and went again. “One stop shopping.”

I grinned. “I like the sound of that.”

He left for a moment, then returned with a thick sheaf of papers. They contained a number of things I was dreading, heralding the descent into the medico-pharmaceutical complex. Orders for a baby dose of metoprolol. Orders to see a gynecologist. Orders for a mammogram and a blood test. Orders for a colon cancer screening. Orders to see a cardiologist to get fitted for a heart monitor for two weeks. “I’m 95% positive that your episodes of extreme high blood pressure are related to anxiety. But it’s better to be certain.” Recommendations for a blood pressure monitor. “I want you to start taking readings three times a week.” I must have made a face, because he said, “You’re on medication now. We need to know if it’s working.” His tone blended sympathy and gravity into an authoritative cocktail that had me meekly nodding, even as I was annoyed with myself for it.

Then there were the unexpected things. Several pages of detailed dietary suggestions. And the URL to a meditation app. “Just to help you get back into the flow of it,” he said.

That surprised me enough that I googled him when I got home. A philosophy of patient care popped up in a sidebar. Among other things it said: Although trained in the art of western medicine, I truly believe the secret to health lies in ancient and natural practices that do not require a prescription, namely, exercise, nutrition, mindfulness and spirituality.

Mindfulness and spirituality? I was certainly more interested in the former than the latter but still…Maybe I had stumbled onto the perfect physician for me.

I saw him again when the myriad test results came back. (This time he was 30 minutes late. No longer on the Ativan, I was a little annoyed, but told myself that taking his time with patients wasn’t necessarily a bad thing. I almost believed it.) There were no particular surprises in the standard tests. Inevitably, cholesterol was moderately high, vitamin D moderately low. He prescribed twenty minutes of sun exposure a day and a supplement for the latter, the dose so modest that it was difficult to find among all the supercharged vitamins sold at local stores. He once again suggested dietary changes for the former, a move to a more “plant-based” diet. He said it tentatively, a little anxiously even. I assured him that I had been a vegetarian before and didn’t anticipate any trouble shifting back in that direction.

The results of the heart monitor were, as he put it, “inconclusive.” There had been one “possible” episode of arrhythmia in the entire two weeks. “Likely nothing to worry about, but the metropolol should smooth that out too, so I’d like you to keep taking that indefinitely.”

Indefinitely. That word made me sigh a little. It had come for me: the time to start taking a medication I would probably be on for the rest of my life. Ah well, it did make me feel better – more “smoothed out,” as the doctor said. The anxiety had receded. I could exercise fairly strenuously without my heart pounding in my ears, and get up in the middle of the night without feeling like I was about to have a stroke. Just be grateful for that.

Habits, and the Changing Of

And now the hard work began: lifestyle changes. The doctor hadn’t said specifically to lose weight, but I wanted to. He hadn’t told me to exercise more, but I wanted to do that too. At fifty-seven years old I had started to grow comfortable with the idea of being uncomfortable, unresisting to creeping feelings of unattractiveness.

When my line in the sand on pant sizes was swept away by weight gain, I sighed and blamed it on menopause and metabolism changes. And again the next time. I replaced them with unflattering jeans I didn’t like because at least they didn’t cut into my expanding waist. When an impossibly young optician put me in glasses frames that she said were “age appropriate” and a good size for progressives, I sighed and said okay even though I kind of hated them. When my ankles started hurting first thing in the morning I sighed and chalked it up to joints beginning to wear out, hobbling unhappily around the house for half an hour before they warmed up. When indigestion became a semi-regular companion I sighed and blamed it on genetics – after all, my mother had suffered from that as she grew older too.

Maybe, I frowned at myself in the mirror after the second appointment, maybe I’m too young to be thinking like that.

First up was exercise. I have never particularly liked physical activity. My fondest memories of summer were building a sheet fort on the screened porch as soon as school let out, and crawling into it with stacks of books and carrots, notepaper and pens. If I’d had my way I wouldn’t have emerged until September: pale and weak-limbed maybe, but stuffed full of wondrous adventures of the mind. When I did exercise, it was doing things I enjoyed: tennis, tai chi – or when I was older, yoga and weight training. But never, ever, anything remotely resembling cardio, anything more strenuous than walking the dog. (I had one ill-fated flirtation with the Couch to 5K running app. My husband still uses it. I…do not.)

That wasn’t going to cut it anymore. But I have also never particularly enjoyed crowds of people, so I wasn’t going to sign up for a gym. (And anyway, I knew what the odds were that I’d exercise if I had to go somewhere to do it – there’s a reason that our weight rack is in the bedroom.) Casting my net on Amazon, I found a few Weight Watchers DVDs from the early 2000s. The multi-tiered workouts featured a young woman who once upon a time would have been called “pleasingly plump,” an archetypal middle-aged soccer mom, and a woman who looked like – and in fact was – a dancer. The “pick the one you look sort of like and do those moves” approach was appealing. 

Even more appealing was the fact that the programs were fifteen minutes long. That let me mix in weight training, or yoga, or sometimes nothing else at all. Because while my “sheet fort” might be my own entire house now, I still prefer adventures of the mind.

Then there was that shift to a “plant-based” diet. The Internet is a cacophony of advice when it comes to eating – so much so that USA Today’s 2020 ranking of best diets contains a whopping 35 entries (which, by the time you get to the end of it where Whole30, Keto and something called the Dukan diet lie, has largely abandoned the notion of “best” and entered the realm of “distinctly unhealthy” or “virtually impossible to follow”). But since my goals were first and foremost medical – trying to lower both blood pressure and cholesterol – I retreated to my preferred online source for all things therapeutic, the Mayo Clinic (whose meal plans were criticized by USA Today primarily for being rather expensive).

It suggested a two-pronged approach: eliminating foods that contributed to high blood pressure and cholesterol, and adding in foods that appeared to actively lower them. Examining what we’d been eating with a more critical eye, I could definitely see room for improvement. We’d already made some changes in the months before the doctor’s verdict, some voluntary and some the vagaries of fate. It had dawned on us that splitting a bag of chips even just on weekend days was probably not the healthiest afternoon snack. Then one of our favorite shops in SLO, Fromagerie Sophie, closed (to save the couple’s marriage, the farewell email said). That serendipitously deprived us of their monthly cheese club, which had always leaned toward triple creme brie and blue, and served four people more readily than two. 

Now I took a cleaver to the rest of our culinary habits, separating the wheat from the chaff. Charcuterie, bacon and brie were out. Kale, beans and feta were in. Beef would become a rare visitor, likely only during barbecue season, as would less lean pork cuts and chicken thighs. The fish recommendations actually worked in our favor: to maximize consumption of omega-3s, the Mayo Clinic prioritized the fatty fish such as salmon, herring and tuna that I love over leaner whitefish like cod or haddock, which I don’t.

Historically a breakfast skipper during the week, I started packing little mason jars with granola (homemade to control the sugar), non-fat yogurt and fruit to start off the day:  tiny bundles of theoretically cholesterol-lowering powerhouses. I ate before I left the house so I wouldn’t be tempted by donuts or little quiches while I was out running errands. Weekend snacks began to have more variety: herring and sour cream, artichoke hummus with pita chips (homemade to control the oil and salt), crab dip.

I felt pleased with my research, the results, and the two prongs. Then my husband welded on a third prong, and suddenly the changes bore more resemblance to a stabbing pitchfork. The first time he pulled soup rather than pasta bowls out of the cupboard for dinner, and filled that only a little over halfway with stew, I stared at it disconsolately. It couldn’t possibly be enough food. 

But in fact, it was. Turning the critical eye to that, we realized that our older cookbooks had very different notions of portions than newer ones. A pound of pasta for four servings was not uncommon in Cook’s Illustrated books from the early 2000s, where more recent books suggest twelve or even eight ounces, bulking up the dish with more vegetables. Contemporary recipes specify meat portions of four ounces rather than the previous six to eight ounces. In older cookbooks, cream was abundant and substitutions were gravely pronounced the ruination of a meal. Newer ones give a collective shrug and say, “Eh, most of the time low-fat milk is just fine unless you’re baking. Throw in some flour if you need to thicken a broth.”

And of course we are both on the far side of fifty with the beginnings of the metabolic slowdown that implies, and less active than we used to be, so all those calories aren’t justified any more. I tell myself that there’s a difference between discipline and deprivation, and most of the time I really believe it’s more than a matter of semantics. Habits die hard, but they can be killed off, though for me that involves keeping an eye on changes I can sustain and avoiding extremes that I know I’ll fail at.

A Picture and a Thousand Words

A few months into this process, I took a selfie with my dog Guinness after returning from a morning walk. It was the first one in years that I didn’t just immediately delete. Slightly leaner lines were part of it – I’ve now lost eighteen pounds, a pound every week or two at what feels like a sustainable pace. And though the smile felt a little bit forced, it was less forced than they have been the past few years. 

The reasons for that are simple enough, I think. I just feel…better. No digestive upsets since we changed our diet and started eating less. No aching ankles in the morning – and if there are some aches and pains elsewhere now, they feel like the product of muscles being used rather than neglected. The triad of weights, yoga and cardio has made each type of exercise easier to do in turn, and I’m stronger overall. 

And all of that motivated me to make other changes – perhaps more superficial, but still important to me. I replaced the baggy pants with slim fit jeans with a little stretch, started dabbling in casual shirts that weren’t men’s size extra large. When the optician directed me toward the usual “subdued” frames I pointed at a black-rimmed pair with slightly larger lenses. She looked bemused when I said if I were going to wear glasses I wanted them to be intentional and thoughtful – intellectual, even – but didn’t put up much of a fight. So now, sometimes I see my reflection and for the first time in years don’t just reflexively hate it.

When I was younger I took wellbeing for granted. Nowadays carelessness – overeating, overworking, overbalancing and then falling – comes at a steeper cost than it did before. But I’m learning that it’s important not to give ground before you have to. I still believe in cultivating grace in the face of inevitable decline. But I’m starting to believe a little less in capitulation.

A benefit I didn’t expect of caring for an older generation – either intimately as with my parents or tangentially for elderly friends – was seeing how they handled it all. The infirmity, the loss of acquaintances and family. The line between admirable resilience and stubborn unwillingness to accept limitations that blurred as steadily as their latest eyeglass prescription.

I’m not old enough to have to deal with any of that yet. But I am in the early stages of navigating the difference between chronic injury and self-induced weakness, between health issues I can ignore and ones that are likely to land me in the hospital someday. And I’m grateful for what clarity my elders have given me.