Bravehearts

For people who run into cardiac trouble as young as 40, life is about living with an artificial throb.

Listening to him, you know it’s a memory stuck somewhere deep within his chest. The details, recalled from almost a decade ago, sound as precise and incisive as a surgeon’s notes: “I knew they would cut my chest with an electric saw, open my ribs and stop my heart. I would be on an artificial heart lung machine while they put arteries in… Once my heart slowly started functioning, they’d tie back my ribs with steel threads.” Saibal Das knew this, “because I had photographed an open heart surgery”. As he speaks, you get an idea of why this photojournalist’s art cuts to the core of all that he captures, whether it is the chaos of Chitpore, one of the busiest streets of his hometown Kolkata, the war-ravaged landscape of Afghanistan, or the weary visages of women circus performers.

Before anaesthesia doused his consciousness, as he was wheeled in for a quadruple bypass, Saibal had visualised the surgery. The hitch was that intimations of mortality had interrupted his assignment, photographing Chandrababu Naidu in Hyderabad. This was 2002, and Saibal Das was just 42 when he collapsed outside the then CM’s chamber. “It was like a movie,” he says, “I went to hospital in the CM’s car with a flashing red beacon and hooters blaring.”

Like Saibal, more and more men are beginning their mid-lives with balloons that aren’t celebratory. They are sterile inflatables guided in by a cardio-specialist to widen arteries. Or there are steel meshes, or stents, inserted to prop open coronaries. When blockages are severe and multiple, even blood vessels, harvested from the body, can replace the clogged ones.

The affected party includes men in their 20s, some of them engaged to fiancees whose families want to call the wedding off on account of a weak heart. Cardiologists confess that nowadays, the first appointment in the 30-40 age group is with patients who enter the clinic during or just after a full blown heart attack. When a heart ailment strikes midway through life, “it can leave them permanently battered”, says Dr Rajiv Bajaj, cardiologist at Delhi’s Batra Hospital. “The case where the guy takes it as a warning and bounces back is an exception,” he adds.

The true internal health position depends on the extent of damage to the irreplaceable heart muscle. Research shows if the damage is no more than 20 per cent, lifestyle modification can give you good years to tack on. With more than 30 per cent of the muscle damaged, the lifeline fades.

Yet, the intensity of a competitive economy forces people to stick to their grind even with weakened hearts. With sick leave carefully calibrated into packs of 30 days, who can afford a long-term patient even if your life-pump is permanently damaged and days marked?

Some days, Delhi-based designer Pranab Dutta is a man looking for God in a surgeon’s scrub to step in with a miracle stent that’ll keep his coronaries throbbing with bright red arterial blood. Other times, he heaves himself onto his Triumph motorbike and roars out on to the roads. Living a life of relentless action, he starts the day with bacon and eggs and works into the night with a cigar and brandy for company.

Dutta is locked into this dangerous lifestyle. “At 30, I was designing a book for the Escorts Heart Institute. The doctors had warned me about my heart back then,” says this 45-year-old macho man with a steel mesh in his chest. He likes to joust with fellow stentwallas: “Mine is 2.5 cm, how big is yours?” He only retreats, “When the other guy has more than one stent.”

This widespread incidence of heart insult is not because we have matchstick men in India who’re splintering. It’s because youth, even of those hanging on to it for dear life at 40, actually works against our hearts. Says Dr OP Yadava of Delhi’s National Heart Institute, “When a man at 40 and a man at 60 have an identical arterial blockage and other variables are same, the attack will be more severe, serious and damaging in case of the younger person.” Likening this to traffic, Dr Yadava explains, “If you have a highway which gets blocked suddenly, there is total chaos. Similarly, a sudden clot creates anarchy. If it builds up slowly, people find pakdandis (alternative pathways).” Nature has provided dormant blood vessels that can squeeze past a blockage. But these are effective only when the disease develops slowly. In case of an early heart attack, such pathways often don’t have time to form.

Pointing to our predispositions, Dr Kushagra Katariya, CEO and chief cardiothoracic surgeon, Artemis Health Institute, Gurgaon, says: “In the west, arteriosclerosis usually occurs in the sixth decade. Here, our bad genetic makeup, smoking and drinking results in earlier onset.”

Young women are shielded by protective hormones until menopause. Within ten years of this, the gender ratio becomes equal. But diagnosis remains unequal. Medical literature shows that a woman’s cardiac symptoms are often dismissed as acidity. That’s why over the last four years, there have been separate international symposiums about the treatment bias against women.

Sandeep Vij, currently CEO of DDB Mudra Group, an advertising agency, was lucky to be male. He was taken seriously. Yet, even he was undiagnosed initially. In July 2005, when he felt pain in his chest and arm, “My ECG was normal.” He went back two weeks later for a treadmill test, and the doctor stopped the machine midway. Sandeep had a 95 per cent block in his main artery. Looking back, this 48-year-old stented braveheart says, “Honestly, it’s the best disease anyone could have. My heart muscle wasn’t damaged. I’ve fixed my lifestyle and I’m good.”

Sandeep makes it sound easy. It’s not. Neema Row’s spouse had a heart attack when he was 39 in 2001. For the last eight years, he’s endured karela juice, lauki juice, flax seeds which he hates, oats which he detests, and a mid-morning diabetes drink made of ragi that he gulps with a grimace. “Our teenaged daughter wants to eat without restrictions, so on weekends we let go,” says Neema. Yet, pouring oil into a pan is an existential crisis—“It’s always measured in a teaspoon.”

This May, in what is an annual ritual between his busy photo-schedule, Saibal called his cardiac surgeon in Hyderabad to announce, “Doctor Dharmarakshak, I am still alive because of you.” That’s a one-off. Saibal, who wasn’t a pill-popper, says, “Sometimes I just stop taking medicines—they remind me I’m sick, permanently.” He’s not fussing. Dr Anil Dhall, senior cardiologist at Delhi’s Dr Max Devki Devi Heart & Vascular Institute, reels off the heavy handful of pills to be popped daily: “Anti-platelets, statins, beta blockers, ace inhibitors, B12 and folic acid.”

Patients also find themselves emotionally marooned. Says Arpita Anand, a consulting psychologist, formerly with Escorts Heart Institute, “Families are not forthcoming, they push the patient into therapy. Once the distress memory fades, patients slip back into their usual lifestyle.”

In a revenue-ruled age, even bypasses take profitable shortcuts. Dr Yadava says the ideal bypass is done on a beating heart with as many arterial replacements as “humanly possible”. An arterial bypass, though superior, is more complex and time consuming. To avoid this, most institutes use one artery and supplement it with veins. Since the left heart pressure is ten times more than the right, veins can’t withstand this force.

Oblivious to this, Saibal says, “I’ve only lost two lives, one to the attack and another in a train accident—I have seven more.” Pranab can’t head off the coming heart event, “I’m eating and living insanely, the only good thing is I that I am painting again and playing golf.” He has reassured himself with a cashless public insurance card that has a higher cover. But, warns Dr Bajaj, “Opening a narrowing with a stent does not reduce risk of a heart attack or death.” Adds Dr Katariya, “Bypass grafts do not stay open forever. We do not know about stent longevity. You have to subject yourself to rigorous surveillance and limit your lifestyle.”

The state has already made it clear you’re on your own. The year’s Union budgetary allocation for health is a piffling 0.9 per cent, to be spent mostly on polio, Aids, TB and malaria. “Why have we not heard of heart attack eradication, if we have polio eradication?” asks Dr Yadava. He says, “No one, including the Government of India, is practising preventive cardiology.”

That’s why Dr Bajaj is emphatic. “Eat food from farms, not factories. Cook in your kitchen using natural cold pressed oils like olive or mustard, not artificial ones that go through multiple harsh processes before packaging. And stop smoking.”

Meanwhile, advertisers scare people into buying that one brand of edible oil that will save them from heart disease. But wiser men, who read more than watch, know the only option is to listen to the demands of their inner thumper.

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