Gary Grah had a broken heart. Eighteen months ago doctors performed a triple bypass and sent him down the path to recovery. Physically, his heart was mended. Emotionally, he wasn’t the same. “When I was in the hospital, I didn’t care if anyone visited me,” said Grah, 57, an insurance agent from Crown Point, Ind. “I didn’t feel like communicating. I didn’t know how cheerful to be when I didn’t know how bad I really was.”
Postoperative depression is not uncommon, especially in instances of open-heart surgery, even in cases where the physical recovery is swift. Grah was moved out of cardiac intensive care the same day as his surgery and was able to climb a full flight of stairs in the hospital just four days later.
The science behind bypass surgery has been fine-tuned, but fixing the physical heart wins the battle, not the war.
For men, who are generally less accustomed than women in outwardly coping with their emotions, postop depression can seem more profound.
“It’s like grieving,” said Dr. Trent Orfanos, a cardiologist based at St. Anthony’s Medical Center in Crown Point and the duration can range from less than six weeks to more than six months. “It’s a matter of losing some of your independence, some of your strength and masculinity in a way, because you’re not invincible anymore. You’re mortal. You’re fragile.”
Nearly 3 of 4 bypass procedures are performed on men. Long-term survival rates are high for open-heart surgery, which has become startlingly commonplace.
“It’s amazing how many people I meet who have had this procedure,” said John McCullough, 76, an advertising consultant in Easton, Pa., himself the recipient of a triple bypass less than a year ago. “Honestly, it’s like a tonsillectomy.”
The operation is routine. Gone are the days of massive scars. Today’s incisions are literally glued shut, and scant physical evidence remains.
The sadness lingers
But in the days and weeks following the procedure, patients are susceptible to sadness. Studies have shown that patients who show signs of depression while still in the hospital are twice as likely to suffer another heart-related incident within 12 months of their surgery. In the majority of cases, however, depression presents itself as recovery progresses at home.
For some, twinges of sadness may be the physiological result of the body recovering from anesthesia and the traumas of surgery. For others, the sadness stems from an abrupt shift in roles. Men find their validation in doing. They’re action-oriented problem solvers. But when the doers suddenly aren’t allowed to do, when they’re told to stay home for weeks and not to lift anything weighing more than a pound or two, they’re stripped of much of what they believe makes them vital.
Suddenly the depended-upon become the dependent. The change comes swiftly, and there’s no time to adjust mentally.
“My dad was the oldest of five with a lot of responsibility,” said McCullough’s daughter Miye McCullough, 25, a human resources professional from Manhattan. “So he feels that he has to be responsible, and here he is, his role in the family paused.”
Paused. Precisely. For the time being, the days of doing are gone. A necessary part of the recovery process is the temporary reassignment of familial roles as men learn to accept their temporary limitations. Other members of the family need to be sure to encourage a new heart-healthy lifestyle both in word and deed, leading by example and offering empathy and praise for all the changes and challenges that are being required and met.
But despite the best of intentions, where attention is concerned, there really can be too much of a good thing. And yes, women are the worst. Nurturers by nature, women are prone to doting. And although many men may appreciate the attention at the outset, they can quickly feel as though they are being viewed as helpless.
“Men are raised in our culture to not be weak, not to show their emotions. They feel in some ways kind of defeated, that this has taken over them, that they’re not strong enough to overcome this,” said Nancy Boland, clinical supervisor and exercise physiologist for the Rush Cardiac Rehabilitation Center in Chicago.
Patients ask, ” ‘Is it OK that I get angry when people try to baby me?’ Yes, of course it is. You don’t want to be babied, but everyone’s afraid. Women see it as loving, but he sees it as babying or hovering,” Boland said.
It is a delicate dance, but families slowly find their way, and many report a newfound closeness in their relationships after surgery.
“My father was always my friend, but we’re much closer than we were before. And you’d think that’d be impossible because we’re very close,” Miye McCullough said. “He’s a more gentle person from what I’ve seen. Not that he wasn’t before. He was always gentle. He always has the right thing to say. He’s very brilliant, and he’s all of these wonderful things, but it’s made him more sensitive now.”
When John McCullough speaks of the care he received from his wife and daughter, he simply says, “It was nice. It was nice to be loved.”
In many families, love equals food. Most men didn’t get to a bypass place by noshing carrots and whole-grain bread, and an abrupt change in diet can take an emotional toll.
“I’m not fat,” John McCullough said. “As we Scots say, I’m thick.” And although he has long since given up Scotch and cigarettes, there are some things he’s not willing to let go.
“Mom put him on a low-sodium, low-fat diet,” McCullough’s daughter recalled. “And she walked into the kitchen one day and he was frying bacon. She just flipped. She said, ‘You’re not supposed to be eating that.’ And he said, ‘I need to.’ “
Classifying bacon as a need might be stretching the rules a bit, but he was right: It might be unreasonable to expect anyone to give up favorite foods overnight.
“Diet is one of the huge challenges for people,” Boland said. “Healthy food choices don’t have to be sticks and twigs. Make healthy food choices, have the food taste good but still also splurge every now and then.
“It’s a habit that needs to be learned: ‘I can’t have french fries every day, or I can’t have that whole pizza versus one slice.’ It’s a behavior change that takes time,” she said.
Back to work
Just a few weeks after surgery, as recovery progresses and appetite increases, many men start feeling physically stronger, and the desire to work returns. What a patient does for a living will help dictate how soon he can return to his job.
“With physically challenging jobs, you want that time off to get better, but even the emotionally challenging jobs, like with people who work on the stock exchange, it may not be physically exerting, but the emotional whirlwind takes a toll on you physically,” Boland said.
A six-week break after surgery is the general rule, but as with most of the recovery process, common sense often is the best guide. Well-intentioned spouses and employees may try to shield patients from workplace woes, but being entirely shut out of the working loop isn’t always advisable.
“My wife told the girls in the office that I was to have no stress,” Grah said. “So I would call the office and the girls would give me an indication of how busy things were, but they wouldn’t tell me anything. When [work] is taken away from you for a period of time, you feel a sense of loss and that creates its own stress.”
Grah thinks that contact with the office actually aided his recovery. After he was allowed to check in on the goings-on, his mind was able to relax and his body could focus on the business of healing.
Other patients find they’re fearful to return to work, unsure if they’ll be able to perform adequately, or if performing adequately will jeopardize their recovery. They needn’t worry. If they’ve begun cardiac rehabilitation and received permission from their doctor to return to work, they’ll likely be able to withstand the rigors of their job.
Rehabilitation is an integral part of the healing process for bypass patients and is generally covered by most insurance providers. As physical strength increases, confidence returns and depression wanes. Patients should work out as much as is comfortable, reassured that “bypass surgery can’t be hurt with exercise,” Orfanos said.
“You’re not going to knock a graft loose. You don’t want people to be afraid to get out there and use their bodies. One of my patients, a year later, is still afraid to do some things when really, he’s better off than he was a couple of months before the operation. Then it was dangerous. Now it’s different. It’s much, much safer.”
Rehabbers also reap the added benefit of developing friendships with other bypass patients. “That camaraderie–‘We’re all in the same boat’–seems to help,” Orfanos said. “They can share war stories.”
Where to find support
If your blues aren’t fading, you might want to consider joining a support group such as Mended Hearts.
Affiliated with the American Heart Association, Mended Hearts chapters are located in 260 cities across the United States to provide support to heart patients and their families and caregivers.
Membership entitles you to a subscription to the quarterly journal Heartbeat as well as participation in your local chapter.
Annual and lifetime-individual ($17, $150) and family ($24, $210) memberships are available. For more information and to apply online, visit www.mendedhearts.org. Or contact Mended Hearts at The Mended Hearts Inc., National Office, 7272 Greenville Ave., Dallas, TX, 75231.
Call 800-242-8721, sponsored by the American Heart Association, to find your nearest Mended Hearts chapter, to request educational information about your condition and to find someone in your area who can talk to you about heart disease.
— B.K.
