I remember that moment very clearly. I was sitting in my kitchen, staring at the wall clock. At the time, I was in the throes of a dark and debilitating depression following my heart attack, struggling with frightening daily cardiac issues that had resulted in being ordered off work on extended medical leave while my cardiologists tried to solve the mystery. I had a follow-up appointment with my doctor that morning, and at that moment, I was having a very hard time trying to decide whether or not I should wash my hair.
Normally, shower/hair-washing is just part of my regular daily routine – not something to be decided at all. But on this day, some part of me knew that this might be the third or fourth day in a row I’d gone without bothering to shower, and maybe I shouldn’t let my doctor see me like this. Wouldn’t want her to see how bad things had become for me. Wouldn’t want her to see me without my perfect pasted-on happy smile/make-up/clothes/hair.
Leslea Steffel-Dennis is a heart disease survivor who co-facilitates the WomenHeart support group in Vancouver, Washington – one of over 70 such groups in the U.S. and Canada. Like me, she is a graduate of the WomenHeart Science & Leadership Symposium For Women With Heart Disease at Mayo Clinic. Leslea wrote to me recently about this very common dilemma: should we let our doctors see reality, or our smiley-face pretending that we are “Fine, just fine” – even when we’re not fine at all?
Leslea started with the brilliant Elizabeth Banks film called “Just A Little Heart Attack” (you can also watch this 3-minute film by scrolling down this page and clicking on the right sidebar link) in which Elizabeth’s character keeps gamely smiling and insisting to her family that she is “fine, just fine” – despite clearly evident heart attack symptoms. Leslea wrote:
“What it did for me was bring up the concept of the next chapter/film – looking good for my cardiology appointment.
“Like having nails nicely polished hot red, so the Doc can’t see any symptom that would show up in my fingernails.
“Or a thick slather of foundation to hide the sick color my skin really is – and don’t forget to put some on the bruise marks from the meds.
“And when the Doc asks how you feel, it’s not the time to say ‘Well, I felt a whole lot worse when I made the appointment, but pretty good now.’
“And how about ‘I was keeping a journal of my symptoms but I forgot them at home’?”
In other words, let’s not make a fuss. It’s not that bad. Don’t whine. Don’t complain. Don’t draw attention to yourself. Smile sweetly and try to act normal.
Leslea’s list brings up the maddeningly typical tendency of women to try to minimize or dismiss their cardiac symptoms in general. Behavioural psychologists call this normalcy bias.
I’ve met women, for example, who showed up in the E.R. in mid-heart attack while apologizing for making a fuss, or self-diagnosing aloud their unusual cardiac symptoms as “it’s probably nothing” or “most likely just pulled a muscle from gardening” – or, as Elizabeth Banks says on the phone to the 911 dispatcher in her film: “Sorry to bother you…”
WOMEN! Stop doing this!
As I described in an earlier article about something doctors call “treatment-seeking delay behaviour”, a study out of Oregon Health & Science University published in The American Journal of Critical Care showed some truly disturbing results – mostly around women’s denial of symptoms and reluctance to seek emergency help even while experiencing severe heart attack symptoms.
Researchers identified six common patterns of behaviour between the time that women first know they are experiencing serious cardiac symptoms and the time when they go for help. These six patterns are called:
- knowing and going (women acknowledged something was wrong, made a decision to seek care, and acted on their decision within a relatively short time, typically 5-15 minutes)
- knowing and letting someone else take over (women told someone they had symptoms and were willing to go along with recommendations to seek immediate medical care)
- knowing and going on the patient’s own terms (women wanted to remain in control, were not willing to let others make decisions for them, and openly acknowledged that they did not like to ask others for help - these are the women who drive themselves to Emergency!)
- knowing and waiting (women decided that they needed help but delayed seeking treatment because they did not want to disturb others)
- managing an alternative hypothesis (women decided symptoms were due to indigestion or other non-cardiac causes, and were reluctant to call 911 “in case there’s nothing wrong and I’d feel like a fool” - until their severe symptoms changed or became unbearable)
- minimizing (women tried to ignore their symptoms or hoped the symptoms would go away, and did not recognize that their symptoms were heart-related)
Do any of these sound familiar to you?!
But even women in that first ‘knowing and going’ behaviour group admitted being confused about the symptoms of a heart attack. The biggest obstacle to reducing women’s treatment-seeking delays, according to the Journal of Social Science & Medicine, is in fact women’s lack of awareness in interpreting heart attack symptoms.
Speaking of heart disease awareness, Leslea says that her focus now is on reaching young (50 and under) women:
“I want to warn them of cardiac risks and possibilities, to help them become aware, and to avoid the Big One later on.”
Maybe we can enhance this awareness by not trying so hard to hide how we’re feeling – especially when we’re with the very people who are supposed to do an accurate assessment of our health: our own doctors.
Maybe we could skip the nail polish, the foundation, the stoic determination to look good on the outside in order to mask the reality inside.
Maybe the doctor’s notes in our charts will start reflecting the truth instead of the fiction we help to spread by pretending to be “Fine, just fine”.
Q: Do you dress up or dress down for your doctor’s appointments?
- The heart patient’s chronic lament: “Excuse me. I’m sorry. I don’t mean to be a bother…”
- “Knowing & Going”: act fast when heart attack symptoms hit
- Women under age 55 fare worse after heart attack than men
- “You look great!” – and other things you should never say to heart patients!”
- The new country called Heart Disease
- “I’m not depressed!” – and other ways we deny the stigma of mental illness after a heart attack
- Women heart attack survivors know their place