Fear and anxiety after heart surgery - Richard's story
When Dr Richard Gale underwent emergency heart surgery, he wasn’t prepared for the stress, fear and nightmares that followed. He tells Molly Bennett how he sought help.
Dr Richard Gale is a former GP who has worked with cardiac patients, but that did little to prepare him emotionally when he had emergency heart surgery last year. “It was like the rug had been pulled out from under me,” he says. “I’d gone from being a well person to feeling like the future was all gone.”
But with the help of a clinical psychologist, cardiac rehabilitation and his fellow patients, he has slowly forged a path to recovery – and now wants to help others in his situation.
Richard, 54, has a family history of raised cholesterol and coronary heart disease (CHD); his father, uncle and grandfather all died after suffering heart attacks. He had also lived with asthma for many years. However, in February 2013 he found he was increasingly short of breath. “I put it down to the fact that it was winter; maybe I’d picked up a cold; I’m putting on weight... I always knew heart disease was a possibility due to my family history, but I thought it would happen when I was older,” he says. “I made excuses, but it got worse and worse.”
A trip to the asthma nurse found that his blood pressure was elevated despite his anti-hypertension medication. She changed his asthma inhaler, but the shortness of breath worsened.
He also started experiencing backache and a feeling like someone was squeezing his right shoulder from behind. He suspected it was angina, but thinking that it was typically felt in the chest, decided not to say anything. “My wife Lorraine, who’s also a GP, said I should see the doctor, but I felt like a fool,” he says. “When you’re in the medical profession, you don’t want to make an idiot of yourself. I’m a doctor, I should know better.”
I wish everyone, before their operation, could chat to someone who’s been through it
He eventually went to see his GP in July following a family holiday in Sri Lanka, having felt breathless after swimming just a few strokes. “I felt slightly embarrassed, but I told my doctor I suspected I had angina and would like to see a cardiologist,” he says.
He had an angiogram later that month and was stunned by the results: the right coronary artery was narrowed by 90 per cent and two of the arteries on the left side of the heart were narrowed by 75 per cent. “I thought they’d find a minor problem, put a stent in and I’d be home in a couple of days,” says Richard. “But they admitted me and put me on a nitrate drip.”
After the operation
He had a coronary artery bypass graft (CABG) three days later. The operation went smoothly, but he was unprepared for the anxiety he felt afterwards. “You think things like, ‘Will I be able to drive? What if I do too much work around the house – will I get chest pain and go back to hospital?’ You don’t trust anything.”
Richard isn’t the only person to experience feelings like these after major surgery. A 2012 study found that more than half of former intensive-care patients suffered from clinical levels of post-traumatic stress disorder (PTSD), depression or anxiety symptoms.
For Richard, these symptoms manifested themselves in vivid nightmares: he was a doctor on a ward and couldn’t find his patients or their blood test results, so couldn’t save them. Or he’d arrange to meet his wife and kids, but they wouldn’t be there, and he’d be alone. “I regularly woke feeling panicky and sweaty,” he says. “During the day, I found that I was jumpy and would startle at loud noises and felt on edge a lot of the time. I recognised these symptoms as being similar to those in patients I have seen with post-traumatic stress disorder.”
He emphasises that the treatment he had was “amazing”, but says that he wasn’t offered any emotional support: “It’s very physical: they are focused on measuring your blood pressure, your pulse, your urine output – no one asks how you feel.”
He found himself talking to other patients on his ward – he still talks on the phone to one of them weekly – but says many of the people he met seemed to dismiss the emotional side of their recovery. Richard believes Britain’s ‘stiff upper lip’ culture is partly responsible for this. He recalls being a junior doctor in a private hospital and seeing his patients, many of whom were wealthy executives, struggling with their emotions after heart surgery. “They would be crying and not know why,” he says. “They’d say, ‘I make million-dollar decisions every day. Why can I not deal with this?’ And I would say, ‘You’ve been through a major trauma. This is a normal reaction.’
When to seek professional help
Experiencing psychological upheaval after a cardiac procedure is much more common than you’d think. Just talking about it with others can do wonders to help. If you answer yes to any of these questions, it may be worth contacting your GP for assessment and possible treatment. You can use a more detailed tool on the NHS website.
During the past month:
- Have you often been bothered by feeling down, depressed or hopeless?
- Have you often been bothered by having little interest or pleasure in doing things?
- Have you often felt unable to stop worrying or felt you were worrying too much?
- Have you often felt nervous, anxious or unable to relax?
Seeking professional help
He heard the same message from his NHS clinical psychologist, whom he saw for three months. He’d been referred after speaking about his feelings of anxiety at a routine follow-up appointment with a cardiac nurse. Richard believes many people shy away from talking to a professional, but it was just what he needed – not least because the psychologist had himself had open heart surgery for a valve problem. “He said to me, ‘You have lost faith in your body, because your body has let you down big time. You nearly died, and you’ve got to learn to trust your body again.’ That was a big psychological barrier for me.”
It’s very important that you don’t just heal up on the physical side
Another key part of Richard’s recovery was cardiac rehabilitation. It gave him a chance to connect with other heart patients, and talk about his fears, particularly in relation to going back to work. He also kept a diary recording his physical progress. Despite all this hard work, he had a relapse six months after his bypass.
Ironically, he was on holiday again, this time in South Africa, when he began feeling short of breath. After he returned to the UK, Richard had an ECG and then an angiogram – one of his grafts had blocked. “It’s rare so soon after,” says Richard. “But they put a stent in and I’ve been well ever since.”
Richard has decided not to return to work as a GP, but is considering doing some medical legal work, or perhaps something completely different – he’s currently studying to be a master of wine. He’s also had time to reflect on his experience and how it could have been improved.
“I wish everyone, before their operation, could chat to someone who’s been through it, who could explain that it’s going to be scary, you’re going to be in pain, but it will get better,” he says. “It’s very important that you don’t just heal up on the physical side. The psychological side is equally important.”
Learn more about heart bypass and what it involves
Read more about coping with depression and anxiety when you have a heart condition
Support from the BHF
If you are experiencing stress or feeling isolated after a cardiac procedure, the BHF can help. Watch Graham’s story of coping with anxiety and depression.
Find out if there’s a BHF Heart Support Group in your area. Call our Heart Helpline or visit our ‘Heart Support Groups’ page.