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Judgment, Interrogation, and How to Face Them

Carolyn Thomas of Victoria, Canada, had been out for a morning walk in 2008 when “out of the blue” the 58-year-old felt ill. Pain engulfed the center of his chest and radiated down his left arm. She was nauseous and sweaty.

The emergency room doctor did a few heart tests and then told Thomas, “You’re in the right demographic for acid reflux. Go home and see your family doctor for a prescription for antacids.

But popping antacids regularly for a few weeks did nothing for her symptoms. Thomas had burning acid reflux, lacked the energy to walk, and felt like he had a Mack truck parked on his chest.

Fearing that she was dying, Thomas returned to the emergency room. It was then that she learned that the chest and arm pain was due to a widower’s heart attack – 95% of one of her coronary arteries was blocked.

A shock to the heart

Thomas and everyone who knew her were shocked that she has severe coronary artery disease (CAD). She was fit, healthy and did not smoke. She discusses her case in her blog, Heart Sisters, on Women and Heart Disease.

“The most common question,” Thomas says, “was, ‘How could you, among all people, have a heart attack? “”

His friends seemed to want to believe that Thomas, a long distance runner for almost 20 years, had somehow caused the disease.

“The questioner needs reassurance that this bad thing will not happen to him, so he searches for answers to confirm his unrealistic belief that bad things happen to other people, not to me,” Thomas says.

But those on the other side of the interrogation, she said, may feel unfairly judged.

Heart attacks can happen to people who feel and appear healthy. Most people with coronary artery disease have one or more risk factors, such as high cholesterol or high blood pressure, and feel well. But a small number do not have any of the typical risk factors, says Deepak L. Bhatt, MD, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center in Boston.

Thomas wonders if people would prefer to believe that she had a heart attack because she smoked or was diabetic. “It could mean that my heart disease is self-inflicted,” she says.

Two years after her heart attack, Thomas discovered that she had something that increased her risk for heart disease: a history of dangerous high blood pressure (preeclampsia) during pregnancy. Early menopause and polycystic ovary syndrome are also risk factors. These things are inevitable and “certainly not self-inflicted,” Thomas says.

Thomas says that even though a classic risk factor such as obesity leads to heart disease, there is still no justification for judgmental attitudes.

“Blaming the patient is an attempt to reinforce the belief that this diagnosis could never affect me or my family,” she says.

Why heart disease doesn’t get enough love

You’ve probably heard that October is Breast Cancer Awareness Month. But Thomas says there is a shocking ignorance about heart disease, even though more women die from it in the United States than from all forms of cancer combined.

“Breast cancer is widely seen as a tragic diagnosis that attacks innocent people out of the blue,” says Thomas. But heart disease remains poorly understood.

A reader of the One Heart Sisters blog recalled a conversation between colleagues after her own heart attack:

“They were talking about breast cancer awareness. I said it was a good cause, but did they know that heart disease is actually the number 1 killer of women? And a woman said, “Yes, but you do it yourself. If you take care of yourself, you won’t have a heart problem! ‘ “

Bhatt, the doctor for Brigham and Women, is not surprised. “If patients have cancer, it’s very rare that people blame them for their disease. There is a little more blame that tends to occur with heart disease, as the typical risk factors are widely known.

Escape from the “judgment zone”

Thomas says it’s human nature for family, friends and colleagues to express their curiosity about major events. One way for her to deal with the potential of overly complicated questions is to choose her listeners carefully. People who you expect to support you can disappoint. Or you might find sympathetic ears in the most unlikely places.

Ironically, your loved ones may not be the best listeners when you need to vent, as they may be too worried for you. “These people want and need to hear from us that we are better now and that we are back to normal and that our frightening health crisis is over so they can relax,” Thomas said.

Thomas also says that you can choose who to confide in. If you are not comfortable with sharing, a generic answer is fine. For example, say, “Thank you for asking the question. I will know more about this after my follow-up appointment with a cardiologist. ”

One of the readers of Thomas’s Heart Sisters prefers to simply say, “I have more questions than answers right now.”

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