The Free Press -- Independent News Media

Sat Nov 22 2008

Columns

Alexander Cockburn

No surprise: "Suprise parties" can kill
February 17, 2005

Years ago, my friend Edward Said's wife, Mariam, asked if I would make available my apartment in New York, where I lived at that time, as the site for a surprise 40th birthday for Edward Said. I dislike surprise parties, but, of course, I agreed. The evening arrived; guests assembled on my sitting room on the 11th floor of 333 Central Park West. The dining room table groaned under Middle Eastern delicacies. Then came the word from the front door. Edward and Mariam had arrived! They were ascending in the elevator. Now we could all hear Edward's furious bellow: "But I don't want to go to dinner with ******* Alex!" They entered at last, and the shout went up from 70 throats, "Happy Birthday!" He reeled back in surprise, staggered and, for a moment, I thought he was going to keel over with a heart attack. Of course he didn't, and after a few minutes looking somewhat dazed at the greetings of friends he hadn't seen for 20 years, he had a great time.

But that moment when Edward reeled back has stayed with me down the years, confirming my general view that surprise birthdays are a pernicious institution, often sadistic in basic intent. What could be more pleasant than a well-planned, entirely disclosed birthday party, with the central figure allowed every opportunity to vet the guest list, plan the impromptu toast, dictate the scope of food, drink and music? What more barbarous than the sudden scream of "Surprise!" and the unpleasing visages from the past looming into view, not to mention the wrong cocktails?

Now the scientific evidence is in. Surprise parties can kill. To put the matter in scientific terms: Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome.

Or, in the words of the press release from Johns Hopkins: Researchers at Johns Hopkins have discovered that sudden emotional stress can also result in severe but reversible heart muscle weakness that mimics a classic heart attack. Patients with this condition, called stress cardiomyopathy, but known colloquially as "broken heart" syndrome, are often misdiagnosed with a massive heart attack when, indeed, they have suffered from a days-long surge in adrenalin (epinephrine) and other stress hormones that temporarily "stun" the heart.

"Our study should help physicians distinguish between stress cardiomyopathy and heart attacks," says study lead author and cardiologist Ilan Wittstein, M.D., an assistant professor at The Johns Hopkins University School of Medicine and its Heart Institute. "And it should also reassure patients that they have not had permanent heart damage."

In the Hopkins study, published in The New England Journal of Medicine online Feb. 10, the research team found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of catecholamines (notably adrenalin and noradrenalin, also called epinephrine and norepinephrine) into the bloodstream, along with their breakdown products and small proteins produced by an excited nervous system. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a typical heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.

Upon closer examination, though, the researchers determined that cases of stress cardiomyopathy were clinically very different from a typical heart attack.

"After observing several cases of 'broken heart' syndrome at Hopkins hospitals -- most of them in middle-aged or elderly women -- we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening," says Wittstein. "These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease."

One of the earlier patients, Dr Wittstein told the New York Times, was a 60-year-old woman whose family had given a surprise birthday party for her. "Seventy people jumped out from the dark and screamed, 'Surprise!' and literally three hours later, she was in the intensive care unit."

Of course, many rituals in our society have a furtive homicidal intent, most notably those fraught sessions known as family reunions. Grandpa and Grandma drive to the event, get mildly looped, head for home and are wiped out on the interstate by a semi when Grandpa pulls out of the rest stop. Father keels over when he opens the front door to see a plump-faced man vaguely resembling the daughter who left home all those years ago saying in a slightly high voice, "Hi, Dad."

So please, no surprises.

Alexander Cockburn is coeditor with Jeffrey St. Clair of the muckraking newsletter CounterPunch. He is also co-author of the new book "Dime's Worth of Difference: Beyond the Lesser of Two Evils," available through www.counterpunch.com. To find out more about Alexander Cockburn and read features by other columnists and cartoonists, visit the Creators Syndicate Web page at www.creators.com. COPYRIGHT 2005 CREATORS SYNDICATE, INC.

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