Significant changes

     I was talking with a patient recently who suffered an MI about four months ago.  He has some permanent damage, but maintains an ejection fraction of about 40%.  A comment he made has stuck with me.  He told me that he's eating well, is exercising and has lost some weight, and he has quit smoking.  Then he said that he feels he isn't doing any of these things for pleasure, but is simply following directions so he didn't die and leave his wife alone.  He keeps expecting to have another attack at any time.  He had lost the joy for living that he used to feel. 
     Sometimes when a patient survives a heart attack, we have an expectation that they will appreciate everything in their life even more than they did prior to the MI, and we may convey that expectation without being aware of it.  But we need to be careful to listen to what they are telling us.  I spoke with him at length, and he is going to join a support group and speak to his primary physician about these feelings.  I was able to relate that my father experienced some of those same feelings after he had a heart attack, too, and worked through them.  My father is now very happy and active.  If, however, I had not had the experience with my father, I would have been surprised about how this patient was feeling.  It isn't so surprising, though, if we consider that he experienced a life-altering event and that the significant change won't be easy to get used to.
     So the next time a patient doesn't respond the way you expected, look again and see if you can figure things out from the patient's perspective, not the nurse's.               Take care of yourselves.   Barbara