by Joanne Wilkinson, MD

I have a stress test nearly every year. I do this because my mother dropped dead of a heart attack when she was thirty-six, and now I am thirty-five.

They stick EKG leads on me, and for weeks I have blotchy red circles on my skin where it’s reacted to the adhesive. I run on the treadmill. Sometimes the cardiologist scans my heart and arteries with ultrasound; other times, he injects me with a radioactive marker. Sometimes he looks at me as though I’m wasting his time. Sometimes he frowns and looks concerned when he hears about my family history.

I always pass the test.

Why did my mother have a heart attack? I don’t have satisfying answers for this. Was her cholesterol high? I don’t know. They didn’t check young women’s cholesterol in the 1970s; they just gave them Valium for the tightness in their chests and told them not to worry. Was it because she had uncontrolled hypertension? Because she didn’t exercise? Because she was doomed?

Am I doomed?

Last night I had dinner at an extravagant restaurant in New Orleans.

I’d never been to New Orleans before, and part of me was delighted by the experience: holding hands with my husband as we walked through the French Quarter on our first weekend away together in almost a year; sitting back in the restaurant and letting a tuxedoed waiter fuss over me with a breadcrumb scraper.

But the other part of me cut every morsel of steak and looked at it as an evil invader cloaked in creamy, atherosclerotic sauce. The other part of me woke up this morning and raced to the hotel’s gym, certain that the vague discomfort in my stomach as I bobbed on the StairMaster was due not to overeating but to incipient angina. The other part of me has coronaries on the brain.

I feel a lot of different things about food. Just before coming to New Orleans, I was struck by a bout of rotavirus, kneeling on the bathroom floor for hours, collapsing on my futon tachycardic and lightheaded. For three full days I lived on nothing but Gatorade; when we finally arrived in New Orleans, we ordered spinach tortellini from room service. As the first fragrant bite permeated the mucus membranes of my mouth, I felt I’d come back to life.

On the other hand, my pants were fetchingly baggy during those few days that I was ill. Once, I had an acute gallbladder attack. For two weeks I could eat nothing but crackers, and I lost fourteen pounds. Sometimes I think if I could have lasted just a little longer before surgery, I could have made it to twenty.

I love food. In college, I became an athlete. I still row and lift weights most days. Every morning, I leave the gym feeling cleansed, with that pleasantly wobbly feeling in my legs, the good kind of ache. When dinnertime rolls around, I love the sensory experience of a bowl of chili, pasta and vegetables, grilled chicken. My husband is a good cook, and I let him feed me. When I was growing up with my father, we ate out most nights and ordered pizza the rest. He was not the kind of person who relished the act of cooking and eating a meal. Food was fuel, nothing more. Now, I taste not only rosemary and garlic but also the balm of my husband’s love and good will warming me, radiating outward from my stomach.

On the other hand, I’m terrible about feeding myself. For years, I felt that the whole idea of sitting down to eat was self-indulgent, not something I deserved. A cookie grabbed on the run between patients was what I should get, not a meal. I often forget to pack lunch, forget to eat lunch or dinner when I’m working. I look up from my desk at odd times of the day, starved, and realize the cafeteria is closed and that I’ll have to buy a granola bar from the vending machine.

Sometimes I look at every piece of food I put in my mouth and think, “Well, this is it–this is the one that will put me over the edge.” When I die, they’ll say, “It was that last creme brulee in New Orleans. What was she thinking?”

Sometimes, even though I love food, I wish that I could subsist on fat-free protein shakes three times a day. No more real food, no more decisions. No more living.

And other times, because I am home with a sore throat and feeling sorry for myself and haven’t had a mommy to take care of me since practically forever, I ask my husband to make macaroni and cheese for me, and he does, and I eat it and feel loved.

I don’t know the answer. I don’t know if the slow accumulation of eating out and desserts over the years will kill me, or if so, when. I don’t know if I’m actually allowed to be nourished, to eat good food, to let my husband take care of me in a way I barely remember. I don’t know if I will live to be ninety eating Whitman’s chocolates, like my grandmother. These thoughts are always with me, and sometimes I wish I could lay them down.

This morning, after the gym, I walked down to the riverfront with my husband and ordered beignets. We were in New Orleans, so I had some. They were delicious.

We sat in a little corner breakfast shop, on vacation together, the sun warming our backs. We talked about our lives, our plans, about how nice vacation is. The breeze blew in from the water and lifted my hair. I licked my finger to pick up the last bit of powdered sugar from my plate.

Then we walked away, into the day.

Joanne Wilkinson is an assistant professor of family medicine at the Boston University School of Medicine.
This piece was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission.

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