I teach a course called What Do You Want? that’s based on a process I developed to help me create a more consistently satisfying and meaningful life. It didn’t become part of my program curriculum until I recognized that without knowing what they really want my clients can’t make effective use of the tools I teach them.

The purpose of the course is to identify what I call Big Picture Wants. There’s a psychological term for this, higher order wants, but the concept seems to be a well-kept secret. I do a lot of reading and researching in this area, and I didn’t come across a reference to higher order wants until after I started teaching the What Do You Want? course.

There’s a belief out there in the world that it’s OK—even necessary—to get your needs met, but getting what you want is optional. (Do you really need it or is it just something you want?) It may seem as if trying to get a need met or satisfied is less self-centered or narcissistic than pursuing something you want, but that isn’t the case. It’s simply more underhanded, and it actually keeps your attention focused on you.

There aren’t that many things we need from a survival standpoint: food, water, shelter, and social connections cover most of them. Nearly everything else is optional.

But, as David DiSalvo says, “We have a big brain capable of greatness,” so we’re not satisfied with merely surviving. We want more. We’re actually wired to want more. But we can go either way with that. System 1, the unconscious part of the brain that runs us most of the time, is focused on the short-term, on immediate gratification, on feeling good. System 2, the conscious part of the brain is focused on the long-term, on the bigger picture, on plans, goals, and dreams.

If we don’t know what we really want—meaning what leads to a satisfying and meaningful life as we define it—we’re likely to succumb to what feels good or what’s easiest in the moment. What we’re chasing over the long-term has to be compelling enough to keep us focused and not susceptible to immediate gratification.

I’ve never been clearer about how important this is than I am right now.

Roadwork Ahead

This past December I developed a process for reassessing and prioritizing my own Big Picture Wants for 2016. As I went through the exercises, I realized that one of them—vitality—was a keystone for the others. I want vitality for its own sake, but vitality also positively impacts every one of my other BPWs. Being aware of how important vitality is to me allows me to focus more attention on it, which has a cascade effect on the rest of them.

Armed with this awareness, I set out in January to increase my level of physical exercise and pay more attention to what I eat. And through the first six weeks of the year, I felt fantastic—full of vitality and very productive, focused, and energetic. Then came the crash.

I had an incident while I was using the treadmill one day in February that was somewhat alarming but didn’t stop me from completing my workout. I had a similar, though milder, incident the following day. But the next time I used the treadmill, everything felt normal. About a week after that, I started having chest congestion and trouble breathing. I’d been having some sinus congestion on and off, so I thought the chest congestion was related. I kept up most of my scheduled activities, but it became more and more difficult to do that. I facilitated a four-hour workshop the last Saturday in February and had to have someone else carry my materials from my car into the building.

The following Monday, a friend took me to the ER, where over the course of the day and numerous tests, it was determined that I was in heart failure as a result of undiagnosed mitral valve stenosis and atrial fibrillation and/or flutter. I was transferred to another hospital where I remained for the next seven days.

Three cardiologists are convinced I had rheumatic fever as a child, which is the usual cause of mitral valve stenosis. My general cardiologist claims it is “remarkable” I had no symptoms prior to February because the stenosis is moderately severe.

Lost and Found

This was definitely a life-changing experience, but primarily because I was quite aware I had lost—at least temporarily and possibly permanently—the thing that mattered most to me. Shortly after leaving the hospital, I resumed walking every day, but it was a slog and I wasn’t clear why. I kept up most of my activities but I tired much more easily and although I enjoyed facilitating my classes as much as ever, life was not nearly as invigorating as it had been before.

Then my general cardiologist decided that all of my EKG results indicated I had an atrial flutter, not fibrillation. He referred me to a heart rhythm specialist to be evaluated for a catheter ablation, a procedure that had the potential for eliminating the atrial flutter by destroying the parts of the heart that are causing it. The rhythm specialist explained that my heart was beating 240 times per minute, but due to a conversion (2:1) within the electrical circuit, my pulse measured 120. It was 120 when I was sleeping and 120 when I was exerting myself. It never changed, which was why I was having so much difficulty walking and why I was so tired.

The day the procedure was supposed to happen, it was discovered that my flutter is on the left side (atypical) rather than the right side, so I didn’t get the ablation. Instead they did cardioversion to shock my heart into a normal rhythm. That almost always works but it’s temporary (5 minutes, 5 weeks, 5 years…you never know). So I was put on a medication to maintain the normal rhythm.

It took a few days after this procedure for me to notice the difference. My pulse rate was back to increasing and decreasing the way it’s supposed to. Walking suddenly became much easier and much more enjoyable. Within a few more days I was back to walking at my usual pace for the usual amount of time. And I had energy. I had focus. I had enthusiasm. My vitality was back!

Having had it, lost it, and regained it confirmed its value and importance to me. It’s what I want. It’s what I really want. I now have numerous inconvenient dietary restrictions, which means I have to spend more time preparing my own meals, but if I do that I’m more likely to maintain vitality. I’ve recently been cleared for any and all forms of exercise, which I enjoy doing anyway, but if I do them regularly I’m more likely to maintain vitality. I have way too many medical appointments (11 this month) that eat up a lot of time. But being monitored is something that can help me keep on the right track and maintain vitality.

So I don’t have any internal dialogue about whether or not I’m going to do any of these things because I’m very clear what doing them gets me. I don’t do them because I’m “supposed to” or “have to.” And no will power is involved. I’m not remotely tempted to slack off because vitality is much more compelling to me than any short-term gratification. That simplifies decision-making and makes doing what I need to do easy. (I wrote this post before the major disruption, so there’s some irony in what followed. But my attitude hasn’t changed.)

That’s really the point of identifying Big Picture Wants. When you know what you really want—and you know what it takes to get it—the path ahead is clear. You don’t need to motivate yourself or talk yourself into doing those things because why wouldn’t you do them?

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At the moment, my heart is in a normal rhythm and my heart failure is “well under control.” At some point there will need to be an intervention in regard to the mitral valve, but I don’t have another appointment with the valve specialist for six months. And I’m now down from three cardiologists to two. As Dr. S said the last time I saw him, “Who needs three cardiologists? You’re not that sick.” Cue the theme from “Rocky.”