Surgery Returns to NYU Langone Medical Center

Chang W. Lee/The New York Times

Senator Charles E. Schumer spoke at a news conference Thursday about the reopening of NYU Langone Medical Center.

NYU Langone Medical Center opened its doors to surgical patients on Thursday, almost two months after Hurricane Sandy overflowed the banks of the East River and forced the evacuation of hundreds of patients.

While the medical center had been treating many outpatients, it had farmed out surgery to other hospitals, which created scheduling problems that forced many patients to have their operations on nights and weekends, when staffing is traditionally low. Some patients and doctors had to postpone not just elective but also necessary operations for lack of space at other hospitals.

The medical center’s Tisch Hospital, its major hospital for inpatient services, between 30th and 34th Streets on First Avenue, had been closed since the hurricane knocked out power and forced the evacuation of more than 300 patients, some on sleds brought down darkened flights of stairs.

“I think it’s a little bit of a miracle on 34th Street that this happened so quickly,” Senator Charles E. Schumer of New York said Thursday.

Mr. Schumer credited the medical center’s leadership and esprit de corps, and also a tour of the damaged hospital on Nov. 9 by the administrator of the Federal Emergency Management Agency, W. Craig Fugate, whom he and others escorted through watery basement hallways.

“Every time I talk to Fugate there are a lot of questions, but one is, ‘How are you doing at NYU?’ ” the senator said.

The reopening of Tisch to surgery patients and associated services, like intensive care, some types of radiology and recovery room anesthesia, was part of a phased restoration that will continue. Besides providing an essential service, surgery is among the more lucrative of hospital services.

The hospital’s emergency department is expected to delay its reopening for about 11 months, in part to accommodate an expansion in capacity to 65,000 patient visits a year, from 43,000, said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.

In the meantime, NYU Langone is setting up an urgent care center with 31 bays and an observation unit, which will be able to treat some emergency patients. It will initially not accept ambulances, but might be able to later, Dr. Brotman said. Nearby Bellevue Hospital Center, which was also evacuated, opened its emergency department to noncritical injuries on Monday.

Labor and delivery, the cancer floor, epilepsy treatment and pediatrics and neurology beyond surgery are expected to open in mid-January, Langone officials said. While some radiology equipment, which was in the basement, has been restored, other equipment — including a Gamma Knife, a device using radiation to treat brain tumors — is not back.

The flooded basement is still being worked on, and electrical gear has temporarily been moved upstairs. Mr. Schumer, a Democrat, said that a $60 billion bill to pay for hurricane losses and recovery in New York and New Jersey was nearing a vote, and that he was optimistic it would pass in the Senate with bipartisan support. But the measure’s fate in the Republican-controlled House is far less certain.

The bill includes $1.2 billion for damage and lost revenue at NYU Langone, including some money from the National Institutes of Health to restore research projects. It would also cover Long Beach Medical Center in Nassau County, Bellevue, Coney Island Hospital and the Veterans Affairs hospital in Manhattan.

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Surgery Returns to NYU Langone Medical Center

Chang W. Lee/The New York Times

Senator Charles E. Schumer spoke at a news conference Thursday about the reopening of NYU Langone Medical Center.

NYU Langone Medical Center opened its doors to surgical patients on Thursday, almost two months after Hurricane Sandy overflowed the banks of the East River and forced the evacuation of hundreds of patients.

While the medical center had been treating many outpatients, it had farmed out surgery to other hospitals, which created scheduling problems that forced many patients to have their operations on nights and weekends, when staffing is traditionally low. Some patients and doctors had to postpone not just elective but also necessary operations for lack of space at other hospitals.

The medical center’s Tisch Hospital, its major hospital for inpatient services, between 30th and 34th Streets on First Avenue, had been closed since the hurricane knocked out power and forced the evacuation of more than 300 patients, some on sleds brought down darkened flights of stairs.

“I think it’s a little bit of a miracle on 34th Street that this happened so quickly,” Senator Charles E. Schumer of New York said Thursday.

Mr. Schumer credited the medical center’s leadership and esprit de corps, and also a tour of the damaged hospital on Nov. 9 by the administrator of the Federal Emergency Management Agency, W. Craig Fugate, whom he and others escorted through watery basement hallways.

“Every time I talk to Fugate there are a lot of questions, but one is, ‘How are you doing at NYU?’ ” the senator said.

The reopening of Tisch to surgery patients and associated services, like intensive care, some types of radiology and recovery room anesthesia, was part of a phased restoration that will continue. Besides providing an essential service, surgery is among the more lucrative of hospital services.

The hospital’s emergency department is expected to delay its reopening for about 11 months, in part to accommodate an expansion in capacity to 65,000 patient visits a year, from 43,000, said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.

In the meantime, NYU Langone is setting up an urgent care center with 31 bays and an observation unit, which will be able to treat some emergency patients. It will initially not accept ambulances, but might be able to later, Dr. Brotman said. Nearby Bellevue Hospital Center, which was also evacuated, opened its emergency department to noncritical injuries on Monday.

Labor and delivery, the cancer floor, epilepsy treatment and pediatrics and neurology beyond surgery are expected to open in mid-January, Langone officials said. While some radiology equipment, which was in the basement, has been restored, other equipment — including a Gamma Knife, a device using radiation to treat brain tumors — is not back.

The flooded basement is still being worked on, and electrical gear has temporarily been moved upstairs. Mr. Schumer, a Democrat, said that a $60 billion bill to pay for hurricane losses and recovery in New York and New Jersey was nearing a vote, and that he was optimistic it would pass in the Senate with bipartisan support. But the measure’s fate in the Republican-controlled House is far less certain.

The bill includes $1.2 billion for damage and lost revenue at NYU Langone, including some money from the National Institutes of Health to restore research projects. It would also cover Long Beach Medical Center in Nassau County, Bellevue, Coney Island Hospital and the Veterans Affairs hospital in Manhattan.

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Leaders Meet at White House in Urgent Bid for Fiscal Deal

T.J. Kirkpatrick for The New York Times

Senator Harry Reid, the majority leader, returned to his office after a meeting with the president and congressional leaders on Friday.

WASHINGTON — President Obama and Congressional leaders met for make-or-break talks on the fiscal crisis at the White House on Friday as they struggled to find a way to head off a looming series of automatic tax hikes and spending cuts to domestic and military programs.

The president was scheduled to make a public statement at 5:45 p.m. Eastern.

After meeting for just over an hour at the White House, the four Congressional leaders — Speaker John A. Boehner; Representative Nancy Pelosi, the Democratic leader; Senator Mitch McConnell, the Republican leader; and Senator Harry Reid, the majority leader — emerged, one by one, into the chilly dusk. They avoided reporters and cameramen who were waiting and took swiftly to the S.U.V.'s to exit the White House grounds. Mr. Reid was the last to depart, and did not look up at reporters who shouted questions at him from their perch about 50 yards away.

This was the first time the group has met together in weeks to try to reach a resolution as Congress headed toward a rare New Year’s Eve session.

Upon returning to the Capitol, Ms. Pelosi told reporters that the talks were candid and constructive. Mr. McConnell entered the Capitol and headed to the Senate floor where votes were occurring and was immediately surrounded by his fellow Republicans. He spoke to them at length.

The meeting between Mr. Obama and the top lawmakers started with the president reiterating his demand for an extension of tax cuts on incomes below $250,000.

That opening offer lowered expectations on Capitol Hill that a breakthrough could be pending, but behind the scenes, talks continued, focusing on a possibly higher threshold of $400,000. Senator Max Baucus of Montana, chairman of the Senate Finance Committee, said sentiment is “jelling” around a new offer, and a source familiar with the negotiations said the president would ask Republican and Democratic leaders what proposal could win majority support in the House and Senate.

The source said that the president would use the opportunity to make the case for a proposal that he believed could pass both the House and Senate, one that included extending lower tax rates for household income of $250,000 or less and an extension of unemployment insurance for two million Americans who are about to lose their benefits. The official said that the president intended to ask the Congressional leaders for a counterproposal or to allow an up-or-down vote on his outlined plan.

The plan was in its early stages and far from being accepted. But Congressional officials say staff-level talks between the White House and the Senate Republican leader centered around a deal that would extend all the expiring Bush income tax cuts up to $400,000 in income.

Some spending cuts would pay for a provision putting off a sudden cut in payments to medical providers treating Medicare patients. The deal would also prevent an expansion of the alternative minimum tax to keep it from hitting more of the middle class. It would extend a raft of already expired business tax cuts, like the research and development credit, and would renew tax cuts for the working poor and the middle class included in the 2009 stimulus law. The estate tax would stay at current levels.

It would not stop automatic spending cuts from hitting military and domestic programs beginning on Wednesday, nor would it raise the statutory borrowing limit, which will be reached on Monday. Congressional aides said those issues would be dealt with early next year in yet another showdown.

White House officials denied that any such offer was developing and said that the president was sticking with his insistence that household income only up to $250,000 would be protected from tax increases.

While neither side was confident of any agreement, some top lawmakers said there was still a chance of a breakthrough that could at least avoid the most far-reaching economic effects. “I am hopeful that there will be a deal that avoids the worst parts of the fiscal cliff; namely, taxes’ going up on middle-class people,” Senator Charles E. Schumer, the No. 3 Senate Democrat, said Friday on the “Today” show on NBC. “I think there can be. And I think the odds are better than people think that they could be.”

Democrats from high-tax, high-wealth states have pressed the White House and their leaders to accept a threshold higher than the president’s $250,000, but they appear ready to accept anything that can pass.

“I have a very practical standard to apply: whatever threshold we need to avoid the fiscal cliff,” said Senator Joseph I. Lieberman, a Democrat-turned-independent from Connecticut.

Much of the legislative attention was focused on Mr. McConnell as Democrats pushed him to provide assurances that Republicans would not use procedural tactics to block any measure that the Senate might consider. House Republican leaders have already said they would be willing to consider whatever legislation the Senate could pass when the House convenes beginning Sunday afternoon. If Republicans chose to erect hurdles to any legislation, Congress might not have sufficient time to advance a measure before the deadline on Tuesday.

Mr. McConnell was well aware of the Democratic efforts to put the onus on him. “Make no mistake: the only reason Democrats have been trying to deflect attention onto me and my colleagues over the past few weeks is that they don’t have a plan of their own that could get bipartisan support,” he said on Thursday.

But he also said he was willing to review any proposal that would come from the White House and then “we’ll decide how best to proceed.”

“Hopefully there is still time for an agreement of some kind that saves the taxpayers from a wholly preventable economic crisis,” he added.

As it awaited a proposal on tax and spending issues, the Senate did make some progress on other legislation, sending the president a renewal of antiterrorism surveillance laws and advancing some relief for states and communities hit by Hurricane Sandy this year.

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U.N. Envoy Calls for Transitional Syria Government

BEIRUT, Lebanon — Lakhdar Brahimi, the international envoy on a mission to Damascus seeking an end to the escalating civil conflict in Syria, said Thursday that a transitional government with full executive authority should be established, perhaps within months, and should rule the country until elections could be held.

Mr. Brahimi did not say who would serve in such a government, and he offered no details about the role that President Bashar al-Assad would play — if any — during a transitional period. But his comments suggested that if Mr. Assad remained in the country, he would retain none of his authority.

“All the powers of government should be with this government,” Mr. Brahimi said of the proposed transitional authority.

His comments to reporters in Damascus were his most detailed since he traveled Sunday to Syria, where he met with Mr. Assad and Syrian opposition members in an effort to revive hopes of a political solution to the nearly two-year-old crisis. But even as Mr. Brahimi and other international diplomats warned Thursday of the high cost Syrians would pay if his efforts failed, there was no immediate sign of a new diplomatic formula that would be acceptable to both the government and its opponents.

“The situation is bad and worsening,” Mr. Brahimi said. “The Syrian people are suffering unbearably. We do not speak in a vacuum about theoretical things.”

Over the past month, Mr. Brahimi, as the special Syria representative from the United Nations and the Arab League, has consulted extensively with the United States and Russia in hopes of fulfilling an accord reached in Geneva this summer calling for dialogue between Syria’s government and the opposition.

As a Syrian government delegation met with Russia’s top diplomats in Moscow on Thursday, a spokesman for the Russian Foreign Ministry, Aleksandr K. Lukashevich, said no specific plan was under discussion.

Russia, a leading ally of the Assad government, has long pointed to the Geneva agreement, which calls for the creation of a transitional government and for talks between the antagonists, as the only acceptable basis for resolving the conflict. However, the agreement does not address Mr. Assad’s fate, which is a crucial problem because many in the opposition say he must step down as a precondition for talks.

In Damascus on Thursday, Mr. Brahimi also denied that he had proposed a specific plan, as many opposition members had asserted in recent days. And he said that the United States and Russia had not reached any agreement that he was pressing Mr. Assad to accept. “I wish there was a U.S.-Russia proposal for me to sell,” he said, adding: “I did not come here to sell.”

The envoy said that the Geneva framework “includes elements that are sufficient for a plan to end the crisis in the next few coming months,” mentioning a peacekeeping force to monitor a cease-fire and the establishment of a transitional government. He said that the transition “should not be allowed to lead to the collapse of the state and its institutions.”

Mr. Brahimi’s comments were met with pessimism by members of the largest opposition coalition, who have long said that any arrangement that left Mr. Assad in the country was unacceptable. They have also called for the dismantling of state institutions tied to repression by the government, especially the security and intelligence services. As insurgent groups make gains against the Syrian military, the political opposition has shown even less willingness to compromise.

“His initiative is very late, and it is very much detached from what’s actually happening on the ground and on the battlefield,” said Ahmad Ramadan, a coalition member who is in Turkey. “We will not discuss any transitional government before Bashar al-Assad steps down.”

In Washington, a State Department spokesman, Patrick Ventrell, on Thursday praised efforts to produce a peaceful transition but ruled out any role for Mr. Assad in the process.

Frederic C. Hof, who served as a special adviser on Syria to the State Department, said in an e-mail that Mr. Brahimi’s efforts amounted to “a long shot.”

“Assad is not yet persuaded that he needs to yield power and get out,” Mr. Hof said. “There is no solution that involves him sticking around, even as a figurehead.”

Even a pact that requires Mr. Assad’s allies and Syrian opposition forces to simply agree to negotiate would be a hard sell, said Dmitri V. Trenin, the director of the Carnegie Moscow Center.

This year, he said, influential policy makers in Moscow favored a process like the one that led to the Dayton Accords to end the Bosnian war of the 1990s. “Bring them together, close the door and don’t let them out until they reach an agreement,” he said.

But Mr. Trenin said he had serious doubts that either Moscow or Washington could induce the two sides in Syria to sit down at the table. “Frankly, I see very little leverage that Russia has over Assad,” he said. “Even if the United States were prepared to lean hard on the opposition, or push them toward some kind of negotiation, I do not see the gulf states or the Turks backing that move.”

In recent weeks, said Mr. Lukashevich, the Foreign Ministry spokesman, Moscow has ratcheted up its diplomacy in an effort to “intensify dialogue, not only with the government but also with the opposition groups.”

Top Russian officials met Thursday in Moscow with Syria’s deputy foreign minister, Faisal al-Meqdad. Mr. Brahimi will meet with the Russian foreign minister, Sergey V. Lavrov, in Moscow on Saturday.

Mr. Lukashevich said Russia was open to talks with Syria’s national opposition coalition, which has been recognized by many Western governments as representing the Syrian people.

“We are not rejecting this dialogue,” he said. “On the contrary, we are holding it very vigorously with all opposition groups who are also interested in getting better insight into the Russian approach.”

“It is obviously another question when and at what level they will take place,” he said.

Kareem Fahim reported from Beirut, and Ellen Barry from Moscow. Hwaida Saad contributed reporting from Beirut, Hala Droubi from Dubai, United Arab Emirates, and Eric Schmitt from Washington.

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App Smart: Apps for the Soundtrack to Your Life - App Smart

Gone is the heyday of the vinyl record. The cassette tape is all but forgotten. Even the CD is losing its relevance; my children are amused by the idea that a little silver disc has music on it.

All of these sound storage systems are disappearing because of the rise of digital music files and the iPod. But today, the rise of wirelessly connected smartphones and tablets has brought a new way to listen to digitally stored music: streamed from a cloud-technology music service, via an app.

Pandora and Spotify are two apps that get all the attention in this digital streaming radio era, but what if you want to try a different one? There are plenty.

TuneIn Radio Pro ($1 on iOS and Android) is one of the cleverest of these apps. It’s got a very clear interface. Users will mainly focus on the app’s “browse” section, where there is a list of categories of online radio music sources, from local radio to popular “trending” stations alongside categories for talk, music or sports.

Tapping on “music,” for example, takes you to a subcategory list of types of music, and each of these then takes you to a relevant online radio station. You can also search by name for radio stations, shows, songs or artists.

When you’re listening to the radio, the app displays graphics like album covers and other data. If you wish, you can record the audio to play back later inside the app. It’s also clever enough to recommend similar music.

With a tap of an icon you can share music info over Facebook, Twitter or e-mail. I love the app’s ability to find something to listen to based on language — it’s a boon for learning a new one, and it’s great for finding global music that may be different from your usual favorites.

While the app’s “recommended” system does a pretty good job of suggesting stations to listen to based on your previous music choices, it’s not quite as handy as having it concoct a playlist of songs for you.

Rdio (free on iOS and Android) is another streaming app organized in a different way using a very different user interface. It requires a monthly fee because instead of connecting you to free online radio services, it’s simply a vast database of tracks stored by the company. This is its strength: acting like a huge iPod with an amazingly broad array of tracks.

The app tries to help with finding new music and offers you the option of seeing music in “heavy rotation,” which is a fabulous way to discover new music from an eclectic list, or a list of popular tracks or new content. The “recent activity” tab lists what Rdio users have been listening to recently. This system could let you find someone with similar tastes, and thus act as a way to finding even more great music.

When playing a track, Rdio’s interface is similar to TuneInRadio Pro’s, without the “sharing” options. It’s a powerful app, but though its interface is easy on the eye, navigating through it can be confusing. There is lots of swiping up and down among the app’s different sections, and then side-to-side swipes to get to settings or your playlists. The Rdio service is also pretty expensive at $15 a month, although this does include unlimited access.

Shoutcast (free on iOS, and via WinAmp app on Android) is another “radio” style music app, with a minimalist-looking but easy to use interface. You can go with the app’s recommended radio stations, or search among stations that are grouped by category.

You can also search for a particular band or track, then click on the right radio station to listen to it. This can be an interesting experiment. For example, I found it amazing how many stations around the world were playing U2’s “I Will Follow” at the same time.

But the iOS app’s “favorites” facility, like the “recents” one, just lists radio stations, which may not help you remember the genre or track you were listening to that led you to that particular station in the first place. There’s no playlist power either.

Songza (free on iOS and Android) is a popular streaming music app akin to Rdio but with a simplified icon-driven interface similar to Shoutcast’s. As well as letting you “explore” to find music, Songza’s strength is its great “concierge” recommendation system based on mood.

For example, it groups music into such categories as “unwinding” or “a sweaty dance party.” The app then creates a playlist so you can simply leave it running. There’s a great social-sharing angle to this app, including publicly shared playlists, but though it looks wonderful and simple, with easy icons, its interface can be a little awkward to get through.

These apps will probably result in some music discovery for you; they’ve certainly led me to unfamiliar bands. But be aware when using them on the move, as they can eat up your mobile data fast.

Quick Call

Flipboard, the popular news aggregator app, is finally available in an edition that’s compatible with Android tablet devices. It’s free, and just as in the iPad version, the tablet version is optimized to make the most of the graphics on a bigger tablet screen.

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Well: Too Young to Have a Heart Attack

The foreshadowing escaped me: The night before we left for our summer vacation in Michigan, I accidentally stepped on my Kindle — which, like my heart, I cannot live without — and broke it. Reduced to reading novels on my iPhone, I made the best of it several days later, sitting in a sunroom overlooking Eight Point Lake, where my family gathers each year with friends.

The day before, proving to my teenage sons that 48 isn’t too old for fun, I had hung on for dear life as I zoomed behind a speedboat on a ski tube. The next day, I was enjoying a few moments of solitude in those blissful minutes before the sun goes down, finger-swiping to turn the page of my novel on my phone’s tiny screen, when my left arm started hurting.

You know that childhood feeling when your mother is mad at you, grabs your arm and squeezes it as she drags you away from whatever grief you’ve been causing? It felt like that, times 10, from shoulder to wrist. My chest got slightly uncomfortable, and I started sweating profusely. For the next four or five minutes, I kept to myself. I was incredibly antsy — up, down, sitting, standing, leaning, lying; my arm and I simply couldn’t get comfortable.

I instinctively knew what was happening but wasn’t ready to say it out loud, trying to reassure myself. There was no elephant on my chest; I’m too young – no one in my family has had heart trouble before age 55; I’m 50 pounds overweight but carry it well. Nevertheless, I motioned my husband up from the dock and, cradling my arm, told him something was really wrong.

He rushed to get some baby aspirin he’d seen earlier in the bathroom, which I chewed. I noticed him quietly doing a Google search for “heart attack symptoms” on his phone as family and friends gathered around us, but I was otherwise inside my head, no longer able to focus on what anyone else was doing or saying.

Our friend drove us to the E.R., where my EKG looked normal and the first nitroglycerin pill had no effect. But 10 minutes later, about the time the second and third nitro pill were making the pain dissipate, the doctor showed up with the result of my cardiac enzyme blood test. It’s supposed to be 0, but mine was much higher. And, he said, that weird somersault feeling I was having right at that moment at the base of my throat was actually tachycardia, a rapid heart rate. Before he was even done talking, an ambulance crew was waiting to take me to a bigger hospital 30 minutes away for a cardiac catheterization.

A little balloon angioplasty through the groin? I could deal with that, and maybe I could convince them to let me go back to the cottage in time for dessert. Instead, I woke up the next day, struggling to breathe, wrists strapped to the rails of a hospital bed, hearing the word “surgery.” I was extremely agitated, confused and unable to ask questions because of the breathing tube running down my throat.

This was not the summer vacation I had planned.

It turned out my “tortuous” left anterior descending artery was 95 percent clogged, and the angioplasty effort tore the inner artery wall, making a stent impossible and creating an even more critical situation. While I was still anesthetized, a surgical team was rounded up at 3 a.m. for an emergency heart bypass. In the span of a couple of hours, I went from expecting a teeny balloon in my artery and a little puncture in my groin to having open heart surgery and an eight-inch scar bisecting my chest.

Did I ever expect this? Not really. I’d read enough to know that heart disease is the No. 1 killer of women, that our heart attack symptoms often are radically different from men’s (just ask Rosie O’Donnell, whose heart attack symptoms the same week as mine seemed more like the flu), and that a third of cardiovascular-disease deaths happen to people younger than 65. But this stuff doesn’t happen to us, right?

Not only did it happen to me; it happened to me twice. I was lucky enough to arrange a flight home on a small plane — larger planes have pressure issues, and the doctors wouldn’t let us drive — but 30 minutes into the flight, my left arm started hurting and I started sweating, not to mention crying at the thought of going through this all over again.

We made an emergency landing. Later, after five hours of tests and discussion, a doctor told me it was stress-induced angina: the symptoms of a heart attack without the life-threatening blockage. He wanted me to stay overnight for observation, but finally agreed to let me continue my trip home.

I’d been relatively pain-free in the hospital, but once I was home, the agony of my titanium-twist-tied sternum was startling. I’ve had to take everything — shifting positions, showering, even breathing — slowly. I’m more aware of my heartbeat, which can be a little freaky. And while I won’t be running marathons any time soon, it’s heartening to hear from friends that I look “terrific,” nothing like a person who had a heart attack five months ago.

I’ve learned many things throughout all of this. Among them, that doctors now try to use a mammary artery, from the chest, for the bypass instead of grafting one from the leg because the mammary bypasses tend to last longer. And it’s likely that a lot of my previous complaints over the past few years — extreme fatigue, lack of endurance, poor circulation, jaw pain (not T.M.J., after all), and so many other vague symptoms — were due to this growing accumulation of plaque in my artery, not perimenopause. Even though I’m far from healed yet, I feel amazingly more alert and less muddled than I did before the surgery, and many of those other symptoms suddenly disappeared.

I also quickly learned I have more friends than I realized, as people brought dinners and well wishes for weeks on end (not to mention commiseration about trying to read a book on an iPhone, a heart-attack-inducing event if ever there was one). However, I’m still coming to terms with the idea of a heart-healthy diet here in Wisconsin, the land of aged and artisan cheeses.

Perhaps most important, I’ve learned to relinquish some control. Even if your doctor says you don’t need help walking up the stairs, let your husband or children escort you anyway. When you’ve been this close to death, the recovery is as much theirs as yours.

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Well: Too Young to Have a Heart Attack

The foreshadowing escaped me: The night before we left for our summer vacation in Michigan, I accidentally stepped on my Kindle — which, like my heart, I cannot live without — and broke it. Reduced to reading novels on my iPhone, I made the best of it several days later, sitting in a sunroom overlooking Eight Point Lake, where my family gathers each year with friends.

The day before, proving to my teenage sons that 48 isn’t too old for fun, I had hung on for dear life as I zoomed behind a speedboat on a ski tube. The next day, I was enjoying a few moments of solitude in those blissful minutes before the sun goes down, finger-swiping to turn the page of my novel on my phone’s tiny screen, when my left arm started hurting.

You know that childhood feeling when your mother is mad at you, grabs your arm and squeezes it as she drags you away from whatever grief you’ve been causing? It felt like that, times 10, from shoulder to wrist. My chest got slightly uncomfortable, and I started sweating profusely. For the next four or five minutes, I kept to myself. I was incredibly antsy — up, down, sitting, standing, leaning, lying; my arm and I simply couldn’t get comfortable.

I instinctively knew what was happening but wasn’t ready to say it out loud, trying to reassure myself. There was no elephant on my chest; I’m too young – no one in my family has had heart trouble before age 55; I’m 50 pounds overweight but carry it well. Nevertheless, I motioned my husband up from the dock and, cradling my arm, told him something was really wrong.

He rushed to get some baby aspirin he’d seen earlier in the bathroom, which I chewed. I noticed him quietly doing a Google search for “heart attack symptoms” on his phone as family and friends gathered around us, but I was otherwise inside my head, no longer able to focus on what anyone else was doing or saying.

Our friend drove us to the E.R., where my EKG looked normal and the first nitroglycerin pill had no effect. But 10 minutes later, about the time the second and third nitro pill were making the pain dissipate, the doctor showed up with the result of my cardiac enzyme blood test. It’s supposed to be 0, but mine was much higher. And, he said, that weird somersault feeling I was having right at that moment at the base of my throat was actually tachycardia, a rapid heart rate. Before he was even done talking, an ambulance crew was waiting to take me to a bigger hospital 30 minutes away for a cardiac catheterization.

A little balloon angioplasty through the groin? I could deal with that, and maybe I could convince them to let me go back to the cottage in time for dessert. Instead, I woke up the next day, struggling to breathe, wrists strapped to the rails of a hospital bed, hearing the word “surgery.” I was extremely agitated, confused and unable to ask questions because of the breathing tube running down my throat.

This was not the summer vacation I had planned.

It turned out my “tortuous” left anterior descending artery was 95 percent clogged, and the angioplasty effort tore the inner artery wall, making a stent impossible and creating an even more critical situation. While I was still anesthetized, a surgical team was rounded up at 3 a.m. for an emergency heart bypass. In the span of a couple of hours, I went from expecting a teeny balloon in my artery and a little puncture in my groin to having open heart surgery and an eight-inch scar bisecting my chest.

Did I ever expect this? Not really. I’d read enough to know that heart disease is the No. 1 killer of women, that our heart attack symptoms often are radically different from men’s (just ask Rosie O’Donnell, whose heart attack symptoms the same week as mine seemed more like the flu), and that a third of cardiovascular-disease deaths happen to people younger than 65. But this stuff doesn’t happen to us, right?

Not only did it happen to me; it happened to me twice. I was lucky enough to arrange a flight home on a small plane — larger planes have pressure issues, and the doctors wouldn’t let us drive — but 30 minutes into the flight, my left arm started hurting and I started sweating, not to mention crying at the thought of going through this all over again.

We made an emergency landing. Later, after five hours of tests and discussion, a doctor told me it was stress-induced angina: the symptoms of a heart attack without the life-threatening blockage. He wanted me to stay overnight for observation, but finally agreed to let me continue my trip home.

I’d been relatively pain-free in the hospital, but once I was home, the agony of my titanium-twist-tied sternum was startling. I’ve had to take everything — shifting positions, showering, even breathing — slowly. I’m more aware of my heartbeat, which can be a little freaky. And while I won’t be running marathons any time soon, it’s heartening to hear from friends that I look “terrific,” nothing like a person who had a heart attack five months ago.

I’ve learned many things throughout all of this. Among them, that doctors now try to use a mammary artery, from the chest, for the bypass instead of grafting one from the leg because the mammary bypasses tend to last longer. And it’s likely that a lot of my previous complaints over the past few years — extreme fatigue, lack of endurance, poor circulation, jaw pain (not T.M.J., after all), and so many other vague symptoms — were due to this growing accumulation of plaque in my artery, not perimenopause. Even though I’m far from healed yet, I feel amazingly more alert and less muddled than I did before the surgery, and many of those other symptoms suddenly disappeared.

I also quickly learned I have more friends than I realized, as people brought dinners and well wishes for weeks on end (not to mention commiseration about trying to read a book on an iPhone, a heart-attack-inducing event if ever there was one). However, I’m still coming to terms with the idea of a heart-healthy diet here in Wisconsin, the land of aged and artisan cheeses.

Perhaps most important, I’ve learned to relinquish some control. Even if your doctor says you don’t need help walking up the stairs, let your husband or children escort you anyway. When you’ve been this close to death, the recovery is as much theirs as yours.

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Shinzo Abe Selected as Japan’s Prime Minister

TOKYO — Parliament formally elected Shinzo Abe as prime minister on Wednesday, ending a three-year break from decades of near-constant rule by his conservative Liberal Democratic Party.

The victory puts Mr. Abe, 58, a former prime minister and an outspoken nationalist, at Japan’s helm as it faces the growing burden of its aging population, years of industrial decline and the challenge of an increasingly assertive China. The change in prime ministers is the seventh in six years, a high turnover that is itself a sign of the nation’s inability to escape its long economic funk.

Mr. Abe won the support of 328 members of the 480-seat lower house, a total that included votes from the Liberal Democrats’ coalition partner, a small Buddhist party.

Mr. Abe’s pro-business party won a landslide victory over the left-leaning Democratic Party in lower-house elections on Dec. 16. Earlier on Wednesday, Prime Minister Yoshihiko Noda and his cabinet resigned to make way for the new leader.

Despite Mr. Abe’s vows to strengthen control of a chain of islands in the East China Sea that both Japan and China claim, he has played down any confrontations between Tokyo and its Asian neighbors since the elections, instead focusing his agenda on lifting Japan’s economy out of recession before the upper-house elections next summer.

Mr. Abe has vowed to encourage growth quickly by offering 10 trillion yen, or about $120 billion, in public works and other emergency stimulus spending. He has also promised to force the central bank to move more aggressively to combat deflation and to weaken the value of the yen, actions that would offer relief to beleaguered export industries by making Japanese products cheaper abroad.

The measures are intended to revive the economy ahead of the elections in June, to give Mr. Abe’s party a better chance of winning the upper house and, with it, control of Parliament. Mr. Abe will have to hurry to retain the support of Japan’s weary voters, who have shown themselves quick to turn against leaders who fail to deliver on promises of change.

Immediately after the vote on Wednesday, Mr. Abe began appointing a cabinet filled with relatively young and unknown faces. While many of these appointees are Mr. Abe’s friends, the fresh lineup is also apparently intended to emphasize that the party has changed since it was driven from power three years ago.

Among the few veterans in the cabinet is Taro Aso, 72, a former prime minister, who was appointed finance minister. The post of foreign minister went to Fumio Kishida, 55, a former minister in charge of Okinawan affairs. He is expected to try to smooth ties with the United States that have been frayed by a dispute over an American air base on Okinawa.

Mr. Abe will face other early challenges, like bridging a rift within his party over whether Japan should join a new regional free-trade agreement led by the United States. The pact, called the Trans-Pacific Partnership, is supported by business leaders but opposed by farmers, two groups that are among the staunchest supporters of the Liberal Democrats.

Another challenge will be responding to China’s stepped-up efforts to assert its claims to the disputed islands, which Japan calls the Senkaku and China calls the Diaoyu. Chinese ships and, more recently, aircraft now make almost daily incursions into Japanese-controlled waters and airspace near the islands, with no signs of letting up.

Mr. Abe has been vague about whether he will shift his energies to his long-held desire to rewrite Japan’s antiwar Constitution to allow for a full-fledged military.

Mr. Abe and other conservatives say such a step is needed for Japan to stand up for itself in light of China’s growing strength, and to share more of the regional security burden with the United States. However, the move could also be seen as provocative by China and South Korea, two victims of Japan’s World War II-era militaristic policies.

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Gadgetwise Blog: In Speaker Dock, a Minimalist Home for the iPhone 5

Capitalizing on the sudden need for iPhone 5 docking stations, Harman has released the JBL OnBeat Micro speaker dock that features the must-have Apple Lightning connector.

The $100 JBL OnBeat Micro is a redesigned version of its predecessor, the On Stage Micro. It still comes with an AC power adapter, which charges devices while they are docked, but the remote control was dropped.

The speaker dock is intended to be portable as well. It weighs less than a pound and is compact enough to fit in a purse or backpack. But it needs four AAA batteries to provide only five hours of playback, which isn’t much. It’s probably better just to leave it plugged in.

The test unit that was sent to me for review did not include instructions, not that any were needed. It has only two buttons: power and volume. Pretty simple, right? You don’t have to synch, download or fiddle with anything.

I was able to dock my iPhone 5 without removing its case, but thicker cases might not fit, because the Lightning connector is nestled flush in the bottom of the recessed dock. The dock is too small to house the iPad, full or Mini, but a USB port and a 3.5mm audio input in the back can accommodate most devices.

For a small speaker, the JBL OnBeat Micro produces surprisingly good sound, which filled my living room, tiny as it is. Even at high volumes, I didn’t notice any distortion.

The JBL OnBeat Micro doesn’t have all the bells and whistles of its rivals. There is no Bluetooth capability, rechargeable battery, alarm clock, AM/FM radio or speakerphone. But it is one of the few on the market with a Lightning connector, which raises its profile considerably.

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Q & A: Should Older Adults Be Vaccinated Against Chickenpox?

Q. Should a 65-year-old who has never had chickenpox be vaccinated against it?

A. In someone who has never had chickenpox, the vaccine would protect against a disease that is far more serious in adults than it is in children, said Dr. Mark S. Lachs, director of geriatrics for the NewYork-Presbyterian Healthcare System and professor of medicine at Weill Cornell Medical College.

After childhood chickenpox, the varicella virus is never eliminated from the body but lies dormant in nerve roots. Decades later, it may reactivate along the nerve pathway and cause the very painful rash called shingles, and later, in many cases, a persistent pain called postherpetic neuralgia, or PHN.

Therefore, for most people over 60, the Centers for Disease Control and Prevention recommends the shingles vaccine. It safely reduces (but does not eliminate) the risk of both shingles and PHN in those who have had chickenpox, Dr. Lachs said.

In someone who never had chickenpox, he said, the concern is not shingles but adult chickenpox, which has “fatality rates 25 times higher than in children.”

Such a person should instead be vaccinated against a primary infection with the varicella virus, Dr. Lachs said. The vaccine differs in strength from the one for shingles and is given in two injections, a month apart.

C. CLAIBORNE RAY

Readers may submit questions by mail to Question, Science Times, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.

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