In August of 1991, author Larry McMurtry struck a Holstein cow while driving on a rural road near his Texas panhandle ranch. The cow walked away from the accident and the Lincoln town car was slightly damaged, but the event marked the inception of a lengthy healthcare crisis for McMurtry.
The next morning McMurtry was “feeling under the weather” with a nagging cough. He stopped into a clinic and was surprised at the diagnosis — his doctor informed him he was having a heart attack.
After a brief stay in a local hospital, McMurtry returned home, finished a novel, and, in December, 1991, had a quadruple-bypass at Baltimore’s Johns Hopkins.
The procedure went well. McMurtry eventually went to Tucson to recover at the home of his friend, Diana Ossana. He was 55 years old, virtually pain free. Prospects for full recovery were in the offing.
Two months later, McMurtry’s situation changed dramatically. He was waking up in the night with panic attacks. He no longer could read for pleasure. In the depths of depression, McMurtry spent most of his time staring at the Catalina Mountains. He seldom left the house for the next two and a half years.
Luckily for McMurtry, Ossana provided the impetus he needed. She suggested the two work on a screenplay — which turned into a novel and then another novel. The clouds began to disperse, but the experience profoundly changed McMurtry.
The Pulitzer Prize winner evocatively described the experience to The New York Times: “I faded out of my life. Suddenly I found myself becoming an outline, and then what was written within that outline vanished.”
In Walter Benjamin at the Dairy Queen, he offered more detail. McMurtry described the heart-lung machine, without which bypass surgery would not be possible, as a spooky weapon that keeps your body alive during the process, but does not guard the essence of your persona. “Where did that go during the five hours or so when the heart-lung machine was taking care of your basic biological functions,” he asked. “While the operation is happening, you are neither really alive nor truly dead.”
After the surgery, McMurtry became convinced that his personality died in the operating room. “I didn’t feel like my old self at all, and had no idea where the old self had gone,” he wrote. “I felt spectral — the personality that had been mine…was simply no longer there — or if there, it was fragmented, it was dust particles swirling around, only occasionally and briefly cohering. I mourned its loss…you get to live, perhaps as long as you want to, only not as yourself, never as yourself.”
Few can articulate the experience as eloquently, but McMurtry’s post-cardiovascular reaction is not uncommon. Dr. Ray Ziegelstein, Vice Dean of Education at Johns Hopkins University School of Medicine notes the frequent incidence of depression after heart attacks — he says it will occur in at least twenty percent of cases. Others put the number at 30 percent or higher.
Understanding the complex relationship between depression and cardiovascular disease is akin to comprehending the Enigma Code. Medical researchers have been unscrambling the interwoven elements for years and new information is continually emerging.
To be clear, depression is not just a case of the blues. It is a negative emotional state characterized by extreme sadness, irritability, and despondency — it can be accompanied by disturbed sleep, social withdrawal, and lack of energy. Depression significantly impacts one’s capacity to function effectively or comfortably.
With advances in research, the scientific community has now definitely established depression and heart issues are on a two-way street: not only can depression follow a heart attack, but it can also increase the likelihood of having one.
Depression has become recognized as a heart attack risk factor, much like hypertension, diabetes, cigarette smoking, and alcohol abuse. Thirty-three percent of those suffering a heart attack are clinically depressed.
Studies have also found that depression is the strongest predictor of death in the first ten years following a heart disease diagnosis. It substantially increases the risk of a heart attack: the worse the depression, the greater the risk.
Heidi May, Ph.D., an expert in these areas, said, “Patients with coronary disease need to be continuously screened for depression. If found to be depressed, they need to receive adequate treatment and continued follow-up.”
It is important for science to fully explore the relationship between depression and cardiovascular disease. Every forty seconds in America someone has a heart attack. Unfortunately, that heart attack—which is sometimes deadly–can be the first symptom of cardiac issues.
In McMurtry’s case, he was able to recover sufficiently to complete a number of works, including the screenplay Brokeback Mountain, for which he won an Academy Award. Earlier this spring, nearly thirty years after his heart attack, he passed away at the age of 84.