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Most of her life, Rosie O'Donnell worried that she wouldn't live past 39, the age at which her mother, Roseann, died from breast cancer in 1973. "I thought for so long I was gonna follow in my mother's footsteps," says the comedian. While the fear lessened over time as she outlived her mom, all those dark thoughts came rushing back Aug. 15, the day after she suffered a heart attack. "I thought about what my mother must have felt, because she knew she was dying and leaving five children under 12," says O'Donnell, 50, looking out over the Hudson River from her home in Nyack, N.Y. "My two youngest are 9 and 12, and I was 10 when my mother died and I hardly remember her. I remember thinking, 'This is too soon to be done.'"

Her health crisis was the latest blow in an emotionally grueling year for the star. O'Donnell and her now-wife, Michelle Rounds, 41, had planned to spend the summer relaxing after the cancellation of her OWN network talk show, The Rosie Show, this past March. ("It wasn't working," she admits, "but I wish I could have delivered more.") But their plans took a frightening detour on May 13, when Rounds woke up with violent stomach cramps, which left her unable to keep food down for several weeks. While Rounds underwent a slew of hospital tests, O'Donnell slept on a cot by her side and numbed her fears with burgers, cheesecake and candy, and, she says, "abused sugar the way a drug addict would." In June, Rounds was diagnosed with rare desmoid tumors, growths that can spread aggressively and damage surrounding tissues and organs. By then, O'Donnell had gained 20 lbs. and reached her highest weight ever: 234 lbs.

Weeks later came her wake-up call. O'Donnell had always thought a heart attack "would feel like a Mike Tyson punch," she says. "But this was different." She first felt nauseous the afternoon of Aug. 14, while working on crafts with her son Blake. "My arms started aching and my chest hurt," she recalls. "My son said, 'Mommy, you look very white.' I knew something was wrong." That night, she slept fitfully, surrounded by bags of frozen vegetables in a failed attempt to cool off. But afraid of scaring her four kids-Parker, 17, Chelsea, 15, Blake, 12, and Vivienne, 9 (she shares custody with first wife Kelli Carpenter, with whom she split in 2007)-she did not go to the hospital, a decision she now calls "stupid." Still nauseous the next day, she finally went to her doctor, who told her she'd had a heart attack and immediately put in a stent to restore blood flow.

She was terrified, as were her kids, who asked her: "Are you gonna die, Mama?" After assuring them she would take better care of herself, O'Donnell tossed out all her junk food, "especially anything with sugar," she says. For once, it wasn't difficult to live without sweets. "Those foods almost killed me," she says. Now 12 lbs. lighter, she adds, "It took a heart attack for me to learn to take care of myself."

O'Donnell now calls the past few months "the most emotionally taxing of my adult life." She and Rounds are fighting to raise awareness of desmoid tumors, a condition so rare that only 900 cases are diagnosed in the U.S. each year. (The two will join in the Desmoid Tumor Research Foundation's Running for Answers 5K on Oct. 21 in Philadelphia.) The experience, says Rounds, who successfully underwent surgery in mid-June to remove the tumors, "made us a stronger couple."

It also forced them to alter their marriage plans. Instead of the big bash they'd planned for August, the couple wed June 9 in a quiet ceremony with only an officiant and one witness. "It felt important to do it before Michelle's surgery," says O'Donnell. "God forbid anything had gone wrong."

Now that they've survived their respective health crises, the couple are ready to celebrate in style. Next summer they are planning a big wedding bash: this time not in sickness but in far better health. "We've been through a lot, but we got it all out of the way," says O'Donnell. "And we are really due some 'happily ever after' time now!"