HEALTHY FAMILY REACTIONS TO ILLNESS: INTERMEDIATE STAGE

Once the shock of the initial diagnosis or hospitalization has passed, families become more task oriented in their coping efforts. Now family members begin aggressively to seek specific information about the pa¬tient's condition and the anticipated course of treatment, hospitaliza¬tion, and rehabilitation. Many of these important questions have no definite medical answers, and this uncertainty increases frustration and fear among family members. This is the stage during which difficult emotions surface in families. Reactions to the tensions of the situation can begin hurting marriages during this stage, too. One of the most difficult aspects of this stage is dealing with grief.
Major illness is always equated with loss, and grieving begins immediately. This is not to imply that every cardiac family experiences the wailing-and-gnashing-of-teeth variety of mourning. Many heart patients and their families report a kind of grieving that is more like melancholia, in which they become preoccupied with thoughts about the meaning of their lives—past, present, and future.
For others, illness brings a grieving process that is similar to what happens when a loved one actually dies. Denial and shock over this illness, and the feared losses of health and of a happy and healthy future, lead to periods of despair and confusion. Next comes a period of bargaining—the grieving individual clings to the fantasy that the loss can be erased "if I can just be good enough" in following the rules of rehabilitation. Of course, the bargaining stage inevitably ends in disappointment. Neither the illness nor the need for rehabilitation goes away. Stages of anger and sadness then follow. These painful emotions must be identified and fully expressed before the grief can progress to acceptance.
In healthy families, grieving is done out loud. Family members express their feelings within earshot of one another. It is a mistake to hold back expression of feelings of grief and sadness during stressful times. Doing so only increases your pain and distances you from your family. Allowing a loved one the privilege of seeing and hearing your most private reactions is an act that demonstrates your love, respect, and trust for that person. The fears, worries, and tender feelings experienced during this stage of adjustment need to be shared within families.
A myth that works against emotional healing in dealing with heart illness is the notion that the patient might die from experiencing any strong emotion or from seeing his or her spouse show any strong feelings. Although it is wise to avoid emotional excitement during the immediate stage of recovering from illness, you should know that few heart patients die from excitement. In fact, in families that believe this myth, the heart patient might feel "dead" from the boredom of being shut out of intimate interchanges with loved ones!
The truth is that holding in emotions is much more stressful for any individual patient, and growing distant from your mate because of failure to be open is much more stressful for couples. Holding back expression of feelings in your marriage will only contribute to a growing sense of depression for each of you. Healthy couples are open with each other about their feelings—even their grief, anger, and frustrations about illness.
At this stage, couples often begin grappling with tensions that have to do with their reactions to medical treatment. By now, the patient is out of shock and is no longer sedated, probably growing frustrated and expressing aggravations over inadequate medical care to the spouse more often than to anyone else. The problem is that the spouse feels powerless to make this problem go away and may feel placed in an uncomfortable double bind: afraid that complaining to the medical personnel might alienate them; afraid that not complaining might alienate the sick spouse.
Tensions often grow in the marriage as the spouse and other family members continue to shield the patient from accurate and honest information about his or her condition. This pattern may be indirectly encouraged by the behavior of medical personnel. When a doctor or nurse takes the spouse and family aside and quietly discusses the patient's condition, the indirect message being given is, "It would be better for the patient not to hear these facts." Although shielding the patient from the truth is well-intentioned, it soon proves to be far more frustrating, frightening, and insulting to the patient than it is helpful.
The first round of what often becomes an ongoing source of marital tension in cardiac rehabilitation begins now—differences in interpretations of medical advice. That a husband and wife might interpret doctors' advice differently is certainly understandable when you consider how some of the medical advice is given. What, after all, is specifically meant by such phrases as "Use in moderation" or "Begin to exercise at your own pace" or "Use your own judgment"? Furthermore, the initial instructions for at-home rehabilitation procedures and facts about the patient's condition are given during the stress-filled period of hospitalization. This is, understandably, a time when spouse and patient are not at their best in terms of digesting new information.
We often see patients in our outpatient cardiac rehabilitation program who swear that they were given no input about diet, exercise, sex, work, and other matters upon being discharged from the hospital. The truth most often is that the information was offered but did not register in the minds of the couple, both of whom were still reeling in semishock. When husband and wife don't agree about what is and is not safe or advisable behavior, conflict between the couple is fueled. What often happens next is that the spouse begins to monitor the patient's behavior like a parent looking over the shoulder of a child. This, of course, quickly becomes tiresome for both partners and leads to direct or indirect bickering.
Such marital tensions often lead to both the heart patient and the spouse experiencing a period of depression shortly after returning home from the hospital. This homecoming depression usually lifts within four to six weeks, more or less. Healthy couples help each other through this phase by allowing each other freedom to vent feelings and by giving each other ample support and reassurance that life will go on.
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