Reflections After An Unexpected Heart Attack

PART ONE: THE UNEXPECTED EVENT

I’ve had chest pain before. Three years ago, I visited the ER and underwent extensive testing that showed a strong heart. They gave me Xanax and Prilosec to see if one of those who help, and the Xanax worked. Chalked it up to stress. Since then, whenever I have had discomfort in my chest, Xanax and just a change of position cleared it up pretty quickly.

This time, the pain started the same way but quickly became something else. It was center mass; hard, demanding, unrelenting. I didn't feel like a vice was squeezing my chest or that an elephant was standing on me. It didn’t radiate. I just hurt, sweated profusely and turned very pale. Xanax and Tums did nothing. No position was comfortable. It took probably 30 minutes for my wife and I to decide it was time to take me in just to be sure. (No need to tell me we should have called an ambulance. We heard that one or thirty times while at the hospital).

Going in was a more confusing decision than it may seem. I am 47, and I am low on all the risk factors. (When I told my doc I didn’t have a family history, he said, “Now you do.” Clever guy.) Why would I be having a heart attack?  Six days prior, my son and I had done Crossfit’s 16.5, which was for me a 17 minute grinder of thrusters and burpees. Two days prior, I had tacked an extra session of clean and jerks onto a heavy kettlebell WOD. Thursday, the day of the attack, I had done heavy deadlifts and squats at the YMCA. I had some minor chest pain, but it went away when I sat down. It should have happened at any of those times, right? But it happened when I was playing Carcaconne with my family.  The whole drive to the hospital I fluctuated between, “No way!” and, “I wish Sheila would just blow that red light because this really hurts and might be serious.”

I found out after the surgery I had 100% blockage in left anterior descending (LAD) artery that runs down the front of the heart and supplies the front and main wall (that's a before and after picture to the right). That kind of heart attack is commonly called a Widowmaker, a little nugget of info I’m glad Sheila and I didn’t know that at the time. The doc told us later, “A lot of people don’t survive this one.” 

Why did it happen? Plaque dislodged and moved; that is the only thing that is clear. Sometimes it happens unexpectedly. Could I have done something to prevent it? Sure, in a general sense. I could have spent my whole life being healthier – but we could all do that, right? Nothing stood out. To quote my quotable doc again, sometimes it just happens. Occasionally the marathon runner keels over while the 85-year-old obese lifetime smoker does not. There are general principles that tend to ensure certain results - and then there are particular people who get different ones. I appear to be particular.

A lot of things worked in my favor. I was home and only ten minutes from the hospital, not flying to or boating in the Keys like my wife and I had been doing three weeks ago. My wife was present to observe what was happening and help me decide what to do. I got to the hospital relatively fast, probably within about forty-five minutes after the pain started. (Fun fact: the nurse asked Sheila if she wanted clergy present, and Sheila said, “He’s here already.”) From the time I got to ER until I had a stent was an hour and fifteen minutes. Because I got in so fast, blood flow started quickly enough that long-term damage to the heart muscle will likely be minimal. 

So now it’s a handful of pills every day, a very slow reentry into the ebb and flow of life, a suddenly serious study of how to fill my body with things that promote heart and artery health, and a lot of prayers of gratitude that God has allowed me more time with my wife, my boys, and my friends.  

Which brings me to the theological part of this experience.

* * * * * * * * * *

PART TWO: HEART ATTACKS AND THEOLOGY

I’m not certain what to say to others about my survival and recovery. My dad died of pancreatic cancer in his fifties; a friend, a fellow pastor, died this past year from a massive heart attack. I have officiated funerals and celebrated miraculous recoveries. The moment I say, “I am thankful that God in His sovereign mercy allowed me to live,” I am aware of the multitude of others who will respond, “Then why did God in His sovereign mercy not spare the one that I loved?” 

I’ve asked the latter question before. My dad’s death made me revisit the problem of evil – why does God allow so much brokenness and pain in the world?[1]  But life on the other side of a heart attack has brought about a newly personal question for me. Now I’m revisiting the problem of good – why does God bring life, hope and healing to the ones he does?  Specifically, me.  I’ve had two DVTs and a heart attack in the past five years. That’s not a good track record. Yet here I am. Why me and not my dad, or my friend?

My answer has been a work in progress for years, I suppose. I offer the following thoughts because I think doing theological work in this area is a good idea. This doesn't mean I'm right. I'm processing. I pray that it’s also reflective of progress in a biblical understanding of how God interacts with the world. 

God allows plenty of things to happen that are just life, and they happen because He has ordained the world to work in this way.The sun rises on the evil and good, and it rains on the just and unjust (Matthew 5:45). There are times and seasons for good and bad things.[2] We reap what we sow (Galatians 6:7). The world on this side of the Fall has thorns and thistles that are at times fatal. In all this, God is not absent. 

• He was present in the Creation that he infused with a particular kind of order and natural law (Genesis 1; Hebrews 11:3; Colossians 1:6. 
• He is present in a world that ‘groans’ as the earth and the people on it await an ultimate redemption from the broken state in which that law currently unfolds (Romans 8:22-23). 
• He will be the One who ultimately restores all things to their rightful state (see Acts 3:21, which is probably fleshed out in Romans 8:20-21, Romans 11: 25-26, and 1 Corinthians 15: 25-26).

God created a universe to run in accordance with His design. We might not understand everything about that design or why it unfolds the way it does, but that’s how it is. These laws make the universe understandable. It’s why science works. However, there’s another crucial part to the story. Because the world is in a corrupted state, decay and disease have become a part of this once perfect process. Even corrupted spiritual powers can bring about physical disease (Luke 13:11). This systemic brokenness explains why some hearts fail and others don’t, or why genetics predispose us to cancer or longevity. It’s the way the world – God’s world that He created and sustains  – now works (Hebrews 1). Even Jesus references this. Luke records Jesus’ response to a crowd wondering why some  particularly bad events had happened.

Now there were some present at that time who told Jesus about the Galileans whose blood Pilate had mixed with their sacrifices. Jesus answered, “Do you think that these Galileans were worse sinners than all the other Galileans because they suffered this way? I tell you, no! But unless you repent, you too will all perish. Or those eighteen who died when the tower in Siloam fell on them—do you think they were more guilty than all the others living in Jerusalem? I tell you, no! But unless you repent, you too will all perish.” (Luke 13:1-5)

In other words, there was not some supernatural quid pro quo going on in those events. They happened because the world is spiritually and physically broken. And at minimum, God clearly allows this by restraining His actions that could have stopped those events. No matter how the details play out, a sovereign God allows His system to unfold in accordance with a purpose and design that includes its current brokenness. 

So why did I have a heart attack? One possibility is that it’s just a result of genetic and lifestyle thorns or destructively spiritual thistles. Why did I survive when other do not? It might simply be part of God’s rain that nourishes some and sweeps others away. Job puts it most succinctly in the Bible: “The Lord gives and the Lord takes away.” Indeed. And as long as I am still alive, I will bless his name.

However, I also believe God acts in the world. I firmly believe miracles happen, but they are miracles because they are not part of the ordinary flow of life.[3] They are the extraordinary moments when God chooses times, people and places in which to intervene for reasons that are often (usually?) beyond our ability to comprehend. But they don't always happen. Jesus refused to heal everyone around him (Mark 6); Paul was never relieved of his “thorn in the flesh”; and he left Trophimus sick in Miletus (2 Timithy 4:20) and counseled Timothy to drink wine for his frequent stomach problems (1 Timothy 5:23). So while the Bible[4] and history are full of miraculous events[5], they aren’t certain, and they certainly aren’t predictable. 

It’s not always clear why God says ‘yes’ or ‘no’ to a prayer for life, safety or health. We have some grasp of how physical ‘laws’ create cause and effect scenarios in the physical world; how little we know of the deeper laws governing the richly layered depths of reality in which the physical world is merely one part. Perhaps in eternity all will be made clear. On this side of heaven, we see supernatural reality as if through a muddied window (1 Corinthians 13:12). That’s why we get this kind of advice on prayer from James: 

Some of you say, “Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.” Listen carefully: you do not even know what will happen tomorrow.  Even the rabbis told you this. Have you forgotten the uncertainty of life? You are a mist that appears for a little while and then vanishes.  You must remember our dependence on God. Instead of making these great plans as if you have everything under control by your own power, you ought to say what you have been taught: “If it is the Lord’s will, we will live and do this or that.”  (James 4:13-16)

And if we are going to acknowledge that God acts in the world, it’s going to be complex. God gives and takes away (Job 1:21). God brings blessing and calamity (Isaiah 45:7). He gives sight and makes blind (Exodus 4:11). Amos asked after a disaster, "If a calamity occurs in a city has not the LORD done it?" (Amos 3:6)  If we are going to accept that God acts in the world - and if we are going to take the Bible seriously - God acts in the world in ways we won't always like.

This may be an odd parallel, but many of our popular stories highlights the peril of believing we can “play God” and change things in a way that we think must be for the greater good.  The largely forgettable movie The Butterfly Effect reminded me of the folly of thinking that I would somehow have the wisdom to know what to change to make the world a better a place. I was sobered by the scene in Bruce Almighty when Bruce clicks “yes to all” in answer to prayers – and chaos ensues.   When Stephen King’s characters in 11/22/63 go back in time to make the world a better place (and ultimately to stop JFK’s assassination), they screw up not just individual lives but the world itself. As one character explains, “Changes are never for the better. No matter how good your intentions are.” 

These storytellers seem to understand something embedded Scripture as well. Why not consider that God decrees or causes not only things we find wonderful and good, but also things we find hard, confusing or distasteful? Perhaps both kinds of situations can be for the good of the world, and they will both ultimately reveal His wisdom and love when we can one day fully understand [6]. I don't mean this has to apply to every situation in every moment all the time (for example, James 1:13 makes clear that God does not make people sin). However, the Bible itself reveals a God who acts in ways appear to us as calamitous. And as both Isaiah and Amos ask, "Has not God done it?"

It's hard for me to see the good in my early death, frankly. My heart breaks as I think of my family in particular. However, if I am to be faithful to what I believe to be true, I have good reason to believe that, because God is who He claims, some events – even painful ones - will inevitably unfold in a way that is good in ways that are currently beyond my ability to comprehend.[7]  

* * * * * * * * * *

So what words do I use to describe God’s presence during this time of my life? Do I say he allowed my heart attack but caused my healing?  Am I not just as biblically justified to say he allowed or caused them both? (God did, after all, cause Zachariah's affliction in Luke 1).

Sitting where I am now, it strikes me as presumptuous to assign God roles or reasons. God is either sovereign, merciful and loving (and all of His other attributes) all the time or God is not. If I accept that these things are true all the time, I cannot waver simply because of my emotional response to what God allows or causes. A God of mercy is the sovereign ruler of the world, and under His watch my life was spared and my father's was not. Whatever internal dissonance I have because of this is a reflection on my ability to truly understand God’s mercy and love, not God’s ability to show it. I assume part of the glory of heaven will be that we will be granted the ability to see how God has infused history, even in the darkest of times, with mercy, grace and justice in ways that had remained beyond our ability to grasp. Perhaps the inability to ever do so is part of the suffering of Hell.

So here’s what I do, and I pray it is correct: I thank God from the bottom of my heart that I have been granted more time, and I will continue to pray for health and life for myself and others. After all, life and death are not in the hands of Satan; they are in the hands of God. Through either His permission or decree, He has allowed all of us reading this more life – and through His permission or decree, He can take it away tomorrow.  Either way, I remain confident that His steadfast love endure forever, and that one day I will understand how His constant presence and continuous mercy have been at work in this beautiful, broken world.

---

[1] Learning To Jump Again: A Memoir of Grief and Hope. Available at amazon.com

[2] “For everything that happens in life—there is a season, a right time for everything under heaven: A time to be born, a time to die; a time to plant, a time to collect the harvest; A time to kill, a time to heal; a time to tear down, a time to build up; A time to cry, a time to laugh; a time to mourn, a time to dance; A time to scatter stones, a time to pile them up; a time for a warm embrace, a time for keeping your distance; A time to search, a time to give up as lost; a time to keep, a time to throw out; A time to tear apart, a time to bind together; a time to be quiet, a time to speak up; A time to love, a time to hate; a time to go to war, a time to make peace.” (Ecclesiastes 3:1-8, The Voice)

[3] Cue C.S. Lewis from his fantastic book on Miracles: "It is therefore inaccurate to define a miracle as something that breaks the laws of Nature. It doesn't…The divine art of miracle is not an art of suspending the pattern. ... the miracle and the previous history of Nature may be interlocked after all but not in the way the Naturalists expected: rather in a much more roundabout fashion. The great complex event called Nature, and the new particular event introduced into it by the miracle, are related by their common origin in God, and doubtless, if we knew enough, most intricately related in his purpose and design, so that a Nature which had had a different history, and therefore been a different Nature, would have been invaded by different miracles or by none at all. In that way the miracles and the previous course of Nature are as well interlocked as any other two realities, but you must go back as far as their common Creator to find the interlocking. You will not find it within Nature. ... The rightful demand that all reality should be consistent and systematic does not therefore exclude miracles: but it has a very valuable contribution to make to our conception of them. It reminds us that miracles, if they occur, must, like all events, be revelations of that total harmony of all that exists. Nothing arbitrary, nothing simply "stuck on" and left unreconciled with the texture of total reality, can be admitted. By definition, miracles must of course interrupt the usual course of Nature; but if they are real they must, in the very act of so doing, assert all the more the unity and self-consistency of total reality at some deeper level. ... In calling them miracles we do not mean that they are contradictions or outrages; we mean that, left to her [Nature] own resources, she could never produce them…In other words, there are rules behind the rules, and a unity which is deeper than uniformity. ... I do not say that the normalities of Nature are unreal. ... But to think that a disturbance of them would constitute a breach of the living rule and organic unity whereby God, from his own point of view, works, is a mistake." 

[4] Miracles: The Credibility of the New Testament Accounts (2 Volume Set).  Craig Keener

[5] In Defense of Miracles: A Comprehensive Case for God's Action in History. R. Douglas Geivett and Gary R. Habermas 

[6] The movie Signs captured this idea pretty well too. 

[7] Check out this list from Joni Eareckson Tada summarized at “36 Purposes of God in Our Suffering.” http://counselingoneanother.com/2012/03/20/36-purposes-of-god-in-our-suffering/