One Step at a Time
It is common to have multiple health issues at the same time, especially with heart failure patients. Often some of the problems are physical and others are emotional. Yet they work together, for better or worse.
The poor health of these patients dictates the pace at which we can treat their various issues. In the case of Harold, the pace was very slow, but produced very pleasing results.
A Hermit No More
The first time I met Harold he was in dirty sweats with stringy white hair to his shoulders. He was quite a hermit and very socially awkward. As he shared his story, it became apparent that he was very bright and well educated. He said it was very difficult for him to come to the center because his wife had died of cancer a few years before in the same facility, and that coming to see me was the first time he had been back since his wife died. After he shared that information, he paused as a shadow crossed his face, and he said when he found out she had died he jumped three stories down in the hospital stairwell, was injured, and spent a month in a psychiatric hospital. After sharing this, he smiled, and said he was doing better now.
After obtaining his health history and doing some teaching, it was time to examine him. The first time I touched him, he startled and almost jumped off the table. He had not had any physical contact since his wife died. After the initial shock, he settled down and the exam was able to be completed.
Initially he was seen weekly, because he had been quite unstable and was very socially isolated. Baby steps were needed with Harold. As the weeks rolled into months, he began to open up more and more. His appearance improved. He began to dress in nice cotton shirts and slacks with belts; and he even got a haircut! He looked like a new man, and was actually quite handsome!
As his physical appearance improved, so did his disease self-management. He started to weigh daily to monitor his fluid balance, take his meds as prescribed, and eat a bit better. He would put up a barrier when daily walking was discussed. He told me he had been a professional bike racer, and it was hard for him to walk slowly when he was used to moving so fast on a bicycle. I talked with him about the benefits of a cardiac rehab program, thinking it would help with his social isolation and allow him to use a stationary bike. He demonstrated anxiety just talking about it, so a plan was made.
At each visit to the center, the benefits of cardiac rehab would be discussed. He began to appear more comfortable as time went on. Then one day, I said we would walk down and take a look at the cardiac rehab facility together. We made it to the door of the center, and then he told me he was too anxious to go further so we stopped. He was flushed, and nervous, in a full-fledged anxiety attack…but also a bit proud of himself for going that distance. Eventually we made it all the way in the door, and I introduced him. After that, he agreed to go. As it turned out, those sessions three times a week helped turn his life around. He excelled on the bikes and got in shape, made friends, (one of which became a serious lady friend), and really enjoyed himself. His new friends encouraged him to resume one of his former hobbies, fixing up race cars and racing. He was not able to race, but he restored a race car and was able to drive it around the track on non-racing days. He was even able to squeeze into his old race car uniform…quite a joy and surprise for him!
As his social isolation and mental health improved, his physical health did also. He stayed out of the hospital, and the frequency of his visits to the center lengthened from weekly, to twice a month, and then monthly. He needed that monthly contact emotionally (he called me his angel), and for accountability and disease monitoring. He would usually come in with his lady friend, who was delightful and fun. It was fun to see how far he had progressed from his initial visit to the center!