UPS Store President Shares Four Lessons Learned From Surviving a "Widowmaker" Heart Attack

Sarah Casalan, president of the UPS Store Inc., vividly remembers the night two years ago when she suffered a heart attack. Initially, she dismissed the discomfort as indigestion from a hamburger she had eaten the previous evening. Despite having what she described as an "iron stomach," the feeling was unusual and intensified. She spent over an hour lying on the bathroom floor, drenched in sweat and overcome with nausea, unable to stand.

"That's when the alarm bells started ringing," Casalan recalls, "though even then, I couldn't imagine I was having a heart attack." At 47 years old, active, and generally healthy, the idea seemed improbable. The absence of chest pain further fueled her disbelief. "Why would I think I was having a heart attack without chest pain?" she questioned.

Eventually, she managed to get up and reach her mother, who was visiting at the time. Within approximately five minutes of realizing she might be experiencing a heart attack, she lost consciousness. Doctors later determined she had a complete blockage in her left ascending artery – a condition known as a "widowmaker" heart attack – which carries a mere 12% survival rate outside of a hospital for women. Subsequent medical analysis suggested the heart attack might have been triggered by an excessively inflamed heart following a prior COVID-19 infection.

The ensuing events were critical. Casalan experienced several cardiac arrests, requiring resuscitation and placement on life support for both her heart and lungs.

"My family was advised to prepare themselves and say goodbye," she recounts. Doctors informed them that her best chance of survival lay in a heart transplant, and she was added to the waiting list.

Prior to this crisis, Casalan, who has led the 5,700-store network since 2021, had shared the stage with the company's CEO and CMO at a conference, feeling "ready to take on the world." Now, she had embarked on a challenging journey to recovery, marked by numerous setbacks. Yet, she is eager to share her story, driven by a strong commitment to supporting working women, particularly mothers, and advancing health equity.

"It's a great extension of two things I'm deeply passionate about," explains Casalan, now 49 and a board chair with the American Heart Association of Chicago. "How do we show women how they can be successful in the workplace and successful mothers? Successful single mothers? You have to be a healthy mother to do all those things."

From her near-death experience, Casalan derived several invaluable lessons concerning leadership, parenting, and navigating setbacks.

Lesson 1: Have Faith in Medicine

Casalan remained on life support for many days, facing initial complications. She developed a blood clot that severely restricted blood flow to her leg and foot, necessitating extensive surgery to save her limb. Her hospital stay extended beyond two weeks.

"I was discharged with a life vest," she explains, referring to an external defibrillator designed to mitigate the heightened risk of cardiac arrest. She also enrolled in cardiac rehabilitation. "The plan was, if I could survive the first 90 days, maybe we could avoid the transplant. And I'm here today to tell you that I have my own little heart."

Casalan has regained the vast majority of her heart function. "My message is: Science matters. Medication matters." During a recent doctor's appointment, she was told, "Listen, you can do all the lifestyle things, all the interventions, but the medication and the science are what got you here."

Lesson 2: Listen to Your Body

Through advancements in genomic risk analysis, Casalan discovered she possesses a 70% higher-than-average risk of cardiovascular disease. Knowing this earlier might have altered her lifestyle choices.

"I lived in New York City for 15 years. I worked in the fashion industry. I was single. I lived an extraordinary, full, and interesting life, fueled by caffeine, bagels, M&Ms, and Diet Coke," she admits. She recalls a mindset of "being all in on everything and everyone, everywhere, and not having to take care of myself." This was further compounded by the considerable stress of a "highly contentious divorce."

Her experience taught her a crucial lesson: "If you don't listen to your body, it will speak for you eventually...My invincible persona was re-educated."

Lesson 3: Good Leaders Are Vulnerable and Know How to Handle Setbacks

Casalan's return to work presented significant learning opportunities. "To build confidence and understanding within my team, I had to be completely honest about everything—including my limitations. That was incredibly difficult." However, she believes this honesty fostered "openness within the team to discuss the realities we were all managing and how we could support each other."

The most significant shift in her leadership style stemmed from confronting further setbacks during her recovery. A stress test revealed a 70% blockage in another artery, her left main artery, requiring immediate robotic-assisted bypass surgery.

"That was tough," she confesses. "I'd anticipated setbacks...but that wasn't what I expected, for my healing to be derailed."

In her previous "indestructible" phase, she tended to "run through all obstacles," believing, "there's no constraint we can't eliminate. We put our minds to it, and we can do it." The second blocked artery altered her perspective.

"Now, I view setbacks as sometimes being far beyond our control and influence," she explains. She's more inclined to explore various options, recognizing the need for potential pivots in approach. "It's opened up more creative conversations," she notes. "Instead of just giving up or pushing on, we take time to consider what the setback means and how to respond. Allowing that time and grace has made a significant difference."

Lesson 4: It Really Does Take a Village

The night of her heart attack, when Casalan lost consciousness and was taken away by paramedics, her two sons—both on the autism spectrum—were awake and witnessed the event. "They saw the paramedics take me away, and it's still a significant memory for them," she says.

However, they were immediately surrounded by a strong support system. "I'm incredibly fortunate. I come from a line of strong women," she remarks, referring to her sisters who came from the East Coast (one staying for eight weeks) and her mother, who remained for a year. She also credits her "extraordinary nanny."

Despite the gravity of the situation, she prioritized her children's well-being. "The most important thing was that they were surrounded by love, safety, and optimism. We didn't discuss the severity of what happened until I was better." They've since processed the event, including a visit to a local fire and rescue open house where they thanked the paramedics personally, providing a sense of closure.

Now, Casalan openly discusses her near-death experience, particularly with her younger son, who coincidentally underwent corrective heart surgery at 10 months old. They sometimes "compare scars" and recently participated in an American Heart Association event together.

Her sons have even found humor in the situation. "They're funny," she shares. "They'll say, 'Well, Mom, you know you only live once! Except you.'" Her experience highlights the importance of family, friends, and community support in navigating difficult times. The "village" played a crucial role in her recovery and her children's emotional well-being.