PITFALLS OF FAMILY LIFE

When a heart patient is not coping well with illness, the signs are usually obvious. Depression, failure to comply with medical recommendations, persistent irritability and worry, all send clear messages to everyone in the family that poor adjustment is in progress. The signs that a family is coping poorly are not always obvious, however. The web of family problems within which a heart patient sometimes gets caught is often deathly silent. I have worked with many families in which the heart patient is coping quite well but is worried constantly about the inner struggles of the spouse or the children. Remember, families always react as teams. Tension floating around within a family may erupt in symptoms at any spot in the family. This might translate into troubling reactions by individual family members or into tension within certain family relationships.
Grief is time limited; depression is not. When a person is depressed, feelings of sadness may never lift for any length of time. Depressed people feel stuck in repetitive thoughts and feelings that are frightening and painful. These often include thoughts of death or suicide. Guilt, anxiety, or anger may fill every moment for a depressed person. Constant worry and distress may lead to sleep problems, physical aches and pains, mood changes, or preoccupation with thoughts of death or suicide. Unlike grief, depression is not relieved by talking with others. For some people, depression leads to complete emotional and physical shutdown: no more tears come; ability to function is severely compromised; concentration and ability to think become fuzzy; interest in life and ability to experience pleasure seem lost forever. Erin was a soft-spoken woman who kept her emotional reactions private. In the months following her bypass surgery, she remained pleasant in her dealings with friends and extended family. But Erin and her husband were seethingly angry over their frustrated efforts to get what they considered reasonable medical care. This was this couple's arena of quiet—and risky—rebellion against illness.
With the support and encouragement of her husband, Erin repeatedly changed cardiologists. She pitted doctors against each other, telling one half-truths about the advice she had been given by another, she stalked out of waiting rooms never to return if she was kept waiting more than twenty minutes beyond her scheduled appointment time. All this was done to the applause of her spouse. As a result of this behavior, Erin and her husband were left quietly enraged and without any consistent medical care. No one knew of their rage. It was their secret way of distracting themselves from their pain.
It is important to help children cope with a parent's illness. Begin by talking with them about how you are reacting to your own fears and frustrations. Letting them see your struggle will help them feel more normal and will model for them how to express their own struggles more openly. Ask if they have questions about what is happening or what will happen now that your family is coping with illness. If they have no questions, give them information anyway. They may listen more than they let you know. Give them information that is appropriate to their age and that conveys hope and confidence that your family will endure this chapter of your life. It is okay to admit that you don't know all the answers, especially to hard questions like "Is Daddy going to die from this heart attack?"
As your rehabilitation progresses, talk openly and frequently about cardiac rehabilitation being a family affair. Regularly hold family meetings during which you encourage open discussion of your reactions to this illness or to one another. You need to be the role models, demonstrating that talking openly is beneficial to the whole family. Ask the children questions: How are they reacting to the new foods everyone is eating and to the changes that have occurred in your exercise and stress management habits? Encourage everyone to express concerns about one another. Find out what you need from one another to help make the coming week more comfortable. And be sure to point out what you have noticed and appreciated about one another during the past week.
It is especially important to let all children know that they had nothing to do with the parent's illness. Children are self-centered in their insecurities, and they need explicit reassurance that their behavior did not cause the illness. Further, let them know that you—both parents—will help them and each other to cope. Reassure your children that you do not need them to take care of you.
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