Dealing with sudden heart problems
A change in health can be hard to accept, especially if it happens overnight. Lucy Trevallion hears about Jason Gutridge’s emotional journey after his sudden collapse.
It was a crisp, winter morning and Jason cycled in the sunshine past the cabbage fields on his way to work. He felt very tired, but put it down to that Monday morning feeling. He chained up his bike and walked through the factory towards his workbench, when he felt an overpowering wave of illness. He couldn’t speak but knew he needed to sit down. Just as he did, he collapsed. Luckily, his friend caught him as he fell, and called an ambulance.
It was a huge shock when Jason awoke in hospital having had a life-threatening episode of ventricular tachycardia (VT). He was very active and felt healthy. His heart had returned itself to a normal rhythm, and when another episode of VT struck, it again resolved spontaneously. “The doctors were quite surprised it did that,” he says.
Jason had scar tissue on his heart, which the doctors thought was either congenital or due to a common virus that can attack heart tissue. The scar tissue disrupted the electrical signals that control the heartbeat.
Jason was fitted with an implantable cardioverter defibrillator (ICD) to reduce his risk of another event and was discharged after two weeks. But the emotional effects lasted much longer.
Dealing with fear
On his journey to recovery, one of the first roadblocks was fear, which he describes as “an overpowering, self-protective instinct”. Both Jason and his wife, 43, had to fight the urge to keep him tucked up in bed, where he was safe.
“It’s like there’s a tarantula and you’ve got to pick it up,” he explains. “That’s how I felt about walking out the door. That spider’s dangerous; it could bite you; you could die. Psychologically, the first time I got out of bed felt just as scary. It’s a massive barrier.
“Walking down to town on my own was terrifying. I thought: ‘What if I don’t come back?’ Your loved ones are sitting at home, waiting, thinking that too. It’s a two-fold psychological issue.”
Walking to town on my own was terrifying. I thought, 'What if I don't come back?'
Dr Kelly Buttigieg, a cardiac psychologist at King’s College London, explains that it’s common after a heart event to want to withdraw to a safe place and avoid activities we previously enjoyed. “However, when we do this we remove some of the factors that can help with our recovery,” she says.
“Avoidance can actually lead to more anxiety in the long term.” Instead, she recommends a gradual increase in activity, which may help reduce this fear and increase your confidence.
Jason started by walking up and down the garden, and gradually increased it to walking along his road. “I had to take my wife with me because I didn’t have enough guts to do it on my own,” he says. “For a big burly bloke to be all vulnerable, it’s a very strange feeling. It might sound old fashioned but I was always the man of the house. That all changed because I was relying on my wife to protect me.”
Regaining identity after a heart event
A cardiac event can have a huge impact on your sense of self. Jason says that during recovery, he felt like a different person. “You feel damaged and you don’t know what level you’ll recover to,” he explains. “I felt guilty. I just wanted to get back to normality – I wasn’t bothered about climbing a mountain or cycling 30 miles – I just wanted to be me again.”
I just wanted to get back to normality - I wanted to be me again
Health issues can also affect how you and your partner relate to each other, explains Dr Buttigieg. You might feel your roles have changed to ‘patient’ and ‘carer’. It’s important not to let these roles take over.
“The carer should try to gradually return to roles that are meaningful to them, so that their activities are not wholly focused on the carer aspect of their identity,” she says.
Doing cardiac rehab at your own pace
Jason was so keen to get back to where he was – a strong, sporty man – that he pushed himself very hard during cardiac rehabilitation sessions. His exercise specialist told him to “slow down”.
“It’s important for us to take a step back and realise that in our fast-paced society we may have found that pushing ourselves in domains like our work has led to some benefits in the past, such as career progression,” says Dr Buttigieg. “However, this might be unhelpful for our physical and emotional health after a heart problem.”
It can be particularly hard for people who have perfectionistic traits, she says. One helpful technique is to be more aware of your thoughts, and reframe them. For example, a perfectionist might think: ‘I must push harder; everyone in my cardiac rehab group is doing more intense exercises than me.’ It could be more helpful to think: ‘Others in my exercise group may have different cardiac diagnoses and different experiences, so it’s not accurate to compare myself directly with them.’
Jason went back to work part-time, eight months after the incident. But he soon sought out an office job, as he was concerned about the effect of physical labour on his body.
Four years on from his episode, Jason says one of his biggest problems is still having the self-confidence to feel that he fits back into working life. He says: “I still have issues like: ‘Am I good enough? Can I keep the pace going like I used to do?’”
You can ask for one-to-one support from your cardiac psychologist if you need it
Dr Kelly Buttigieg
When he gets into this thinking pattern, Jason says he might go into “a weird place” for an hour or a day but then he says ‘no’ to himself and makes a conscious effort to stop the thoughts and be more compassionate to himself. Psychologists recognise that consciously saying ‘no’ to yourself, or visualising a stop sign, can be helpful when you get stuck in negative thinking patterns.
In this adjustment period after a heart event, symptoms such as a lack of confidence can improve through cardiac rehab. “If you’re unsure about going, ask if there’s an opportunity for you to observe a group first, to manage any nerves or misconceptions,” Dr Buttigieg says. “Or invite your loved ones to come along to a cardiac rehab session, the assessment appointment or final review. You can also ask for one-to-one support from your cardiac psychologist if you need it. The teams want to work to support you and find a way to meet your individual needs.”
Avoiding negative thinking
For Jason, an ongoing obstacle is frustration at not being able to do the things he wants to do, or doing them slower or worse than before.
This is quite typical, Dr Buttigieg says, particularly when meaningful roles – like being a parent, grandparent or friend – are affected by the heart problem.
I refuse to get bitter and angry... I’m here, I’m watching my kids grow up...that’s wonderful
“Try to understand which thoughts arise during times when you are frustrated, and how they might be unhelpful,” she says. “Some examples are: ‘I shouldn’t be this tired’ or ‘I must get back to work’. We call this ‘should-ing’ and ‘must-ing’. Try to reframe these thoughts more realistically by, for example, thinking: ‘Working half days is actually significant progress. I was on sick leave just three months ago.’”
Jason still gets frustrated, but now appreciates his level of ability and tries not to fall into negative thinking patterns. His daughters, now aged 15 and 13, both enjoy indoor climbing, which he isn’t able to do. “My pleasure now lies in seeing other people do stuff,” he says. “If you don’t twist your mind round to that way of thinking, you’re for ever going to be in a frustrated mind-set, and bitterness can creep in.
“I only asked ‘Why me?’ once, and then I felt guilty and thought: ‘Why not me?’ I refuse to get bitter and angry about what has happened to me. Now I think: ‘I’m here, I’m watching my kids grow up. If all I can do is watch them grow up, then that’s wonderful.’”
Jason's top tips for rebuilding confidence
1. Set yourself a timetable
"I would watch the TV for an hour, have breakfast, get up, sit downstairs and do some reading, get a visitor, do a walk in the afternoon, and the day passes. You have to have a routine."
2. Accept visitors
"I think visitors, as tiring as they may be - and it is extremely tiring - are very important. You get a glimpse of normal life and this gives you hope and encouragement."
3. Set realistic goals
"You might think of making a cup of tea as a menial task. But these tasks are parts of your life that you can get back."
4. Get a little independence
"Try to physically be able to do things for yourself, such as washing yourself or walking down the garden and back. This will have a huge effect on your confidence."
5. Go outside
"Even if you don't want to, force yourself to go out. The biggest thing you can do to get back to your life is to overcome the fear of going out again - and that's massive."