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HEART DISEASE: FORUM (FINDING THE PATH OF HEALING)
Mary is a fifty-three-year-old single mother of two teenagers whom she had raised alone since early childhood. Mary had recently become more involved with a new boyfriend. There is a strong family history of heart disease on Mary’s father’s side; she, however, was a nonsmoker, had exercised regularly and had always been well, before she suffered a small heart attack.
Mary was discharged from the hospital without overt complaints, but in the next few weeks she began to experience mild chest tightness and shortness of breath when she was active, which she was almost immediately upon returning home. Activities included her previous exercise routine, work and sex. She was surprised, disappointed and frightened by not being able to “get over it.”
Mary was increasingly perplexed that her physical symptoms could not be “solved.” She continued trying to go back to work, but kept having a tightness in her chest and shortness of breath climbing stairs at work, and even during meetings. Eventually, she called her cardiologist, complaining, “I’m not getting better and I cannot go on like this.” She underwent an exercise test, which showed that her heart muscle was getting insufficient blood supply; and a subsequent angiogram revealed that the blood vessel that had been temporarily blocked, causing her original heart attack, was now quite narrow and almost fully blocked. Angioplasty was recommended and, despite apprehensions and the difficulty of losing further time from her work, she underwent the procedure successfully and was left with moderate heart scarring but no further shortness of breath or chest tightness. She was told to monitor this carefully, and she was placed on drug therapy to lower cholesterol and blood pressure, which she found somewhat of a nuisance. She was also started on an exercise program but was counseled to not overdo physical activities initially, advice which “was against the grain” for somebody who likes to live life at full speed.
In this forum, one year after her heart attack, we invited Mary, her boyfriend and her eighteen-year-old son to discuss this phase of her recovery.
Mary: I’m still confused as to what exactly led to me feeling that I had hit a brick wall after my heart attack. Was it only that my heart was not good, or did I bring it on myself by getting into activities too soon?
Dr Dorian: Your symptoms were not directly caused by overdoing it. Rather, your first heart attack was incomplete, and left you at risk for another one. The activity that you tried to do, however, did bring on your chest tightness and shortness of breath, which were signals from your body that your heart was getting insufficient blood and, in turn, meant that you needed further testing and treatment. Although rushing back to your previous life is usually not dangerous, what happened to you highlights the fact that the return to activity needs to be measured, and done in close cooperation with your physician.
Mary: When I think back, it was an unsettled time for me. Strange to say, but once I had been discharged, I just shut my heart out of my mind. I was more concerned that my boyfriend would leave me than anything else.
Boyfriend: Well, I hope you have been reassured about that. I was surprised that you could even think that I would somehow just abandon you.
Mary: It’s easy to look back and say that now, but I didn’t know what was going to happen next, especially after my life was so rudely interrupted by my heart. Before that, I had thought I could control everything. After the heart attack, things seemed beyond my control. It was such a relief to know that you were there for me.
Son: You haven’t mentioned my sister or me yet. That was a scary time for us too. You weren’t well, my dad’s been out of the picture for so long now, and we were left to fend for ourselves.
Mary: Yes, those were difficult times for the family.
Son: When you came home the first time, we weren’t sure how to handle you, but after only a few days you got busy again.
Mary: You know, I’ve always solved things that way; only this time, I got a rude shock.
Boyfriend: Yes, you found you couldn’t do those things you had always done with ease.
Mary: It was a shock when I kept trying and I just couldn’t…
Son: Now, Mom, don’t get upset.
Mary: Well, I just seemed to hit a brick wall.
Boyfriend: That was when she started to feel down. I had never seen her like that before. You were always such a happy person? so full of energy.
Dr Baker: Yes, Mary, you illustrate well the link between not being able to do something and low mood. When there is the feeling of incapacity, of not feeling capable, which was always so important to you, then instead of feeling on top of the world, the world felt on top of you.
Dr Dorian: Let me jump in here. I can see why you became depressed when you couldn’t go back to work or resume your physical activity. However, I think originally this came about because you wanted to deny the fact that you had heart disease. Although dwelling too much on one’s heart may not be a good thing, pretending the heart is perfect when it isn’t is also not healthy. Many of my patients with a strong family history pretend to ignore (and are sometimes successful at it!) the fact that deep down they are afraid that the same thing that happened to their family members will happen to them. This can result in not seeking or pursuing medical care, and especially not taking medications that are offered or prescribed.
Mary: Well, I can now certainly agree with that. For all those years I didn’t want to look at the fact of my family history and I didn’t pay much attention to what the doctors told me.
Boyfriend: You mean they found something wrong with you?
Mary: At my regular health checkups I was told that my cholesterol was on the high side. Also, my blood pressure was slightly elevated, but I never pursued any treatment for this.
Son: Mom also never wanted to talk about what had happened with her family…
Mary: I didn’t tell you that my father, his brother and my uncle all had heart attacks in their fifties, and my brother has already had bypass surgery.
Son: And that’s why, when she had her first attack, my sister and I were very upset.
Mary: I feel now as if I neglected the two of you.
Dr Baker: It looks like you neglected yourself.
Son: Mom, you were the one who was ill.
Boyfriend: You know, when you first came home from the hospital, you tried to pretend that everything was completely normal, although, of course, I knew it wasn’t true. You have always pretended you were invincible, but this time I think you knew that you were in a desperate fight that you thought you could not win. It took you some time to allow me to help you, since I think you felt that this showed that you were weak in some way. I am glad you were eventually able to reach out to me and to your children, who were happy to help you.
Dr Dorian: We find that patients who “bottle up” all of their fears and emotions seem to have more trouble coping than do those who can express their fears and their feelings. In addition, facing up to your fears and recognizing the need for treatment will make it easier for you to follow through with recommendations for medications, tests, and so on, all of which involve a certain amount of nuisance, hassle and possibly discomfort.
Mary: You know, in a sense I think the angioplasty saved my life That, and that frank discussion I had with my doctor, which made me realize that I was really overdoing things and I needed to slow down and pace myself much better, because things have gone quite smoothly since then.
Dr Dorian: Again, I must point out that “overdoing things” is emotionally unhealthy. However, excessive physical activity is rarely dangerous and simply increases the chance that you develop symptoms such as shortness of breath or chest discomfort. All heart patients have to learn to live within their limitations.
Dr Baker: I gather there have been a number of changes in the family over this time.
Son: Mom was always Supermom until the heart attack. Then, she didn’t want us to look after her. But when she found she couldn’t do what she wanted to do and she was getting short of breath, she just slowed down; she couldn’t help it until she had that procedure.
Dr Baker: What has happened since then?
Son: Mom’s different now.
Mary: Also, my healing has turned me around. I’m more open with myself. I don’t shut out my problems and I have started to learn to accept help from others. I try to be open with others. I am paying more attention to my children than before. I suppose the family has grown up.
Boyfriend: It has changed as well.
Mary: He means that he is also a part of it.
Boyfriend: I know that it will take time for me to be fully accepted.
Son: We talked about it and I’ve told him that we do like him, and we know he’s good for Mom.
Dr Baker: A balance is achieved by the end of recuperation, not only in the body and in the mind, but in the family system as well.
Mary: I reckon we are on the way to getting there. Now, I feel more confident, and there is more harmony in the family.
*21/214/2*