“Everybody has plans ‘til they get punched in the mouth.”

11 Jan

by Carolyn Thomas    @HeartSisters

When Edward Davies of the British Medical Journal attended the recent Lown Institute conference in Boston, he was reminded of some unlikely wisdom from boxer Mike Tyson. In the run up to a big fight, Iron Mike was being bombarded with media questions about how he intended to deal with his latest challenger. Did he have a strategy in place to cope with their plans? The boxer’s response was simple:

“Everybody has plans ‘til they get punched in the mouth.”

In boxing terms, as Davies wrote in the BMJ, this is completely literal sound advice, but as a figurative metaphor for life, it’s not bad, either:

“Listening to a patient panel here at the Lown Institute conference, I was reminded that this is a worldview that doctors might do well to remember.”

Most patients diagnosed with a life-altering diagnosis can readily identify with what that metaphorical punch in the mouth feels like. 

And no matter how competent, how smart, how resourceful we may think we are before a catastrophic health crisis strikes, many of us may suddenly feel incompetent, ignorant and helpless when thrust inexplicably into the stress of such formidable reality.  This may feel like being momentarily powerless for some, and like a sucker punch that knocks the wind right out of us for others.

What many patients learn pretty darned early on in the trajectory of a  serious condition like heart disease is that we’re actually dealing with two separate issues:

  1. the impact of the diagnosis on the body
  2. the fears and worries that accompany such a diagnosis

It’s these accompanying psychosocial issues that most physicians seem unable or unwilling to fully appreciate. As cardiologist and founder of the Mayo Women’s Heart Clinic Dr. Sharonne Hayes once explained:

“Cardiologists may not be comfortable with ‘touchy-feely’ stuff. They want to treat lipids and chest pain. And most are not trained to cope with mental health issues.”

So what can often happen is that instead of looking at the whole person sitting across from them, doctors may focus on the specific organ or body part that needs attention.

The BMJ’s Davies described the Lown conference patient panel findings from a patient’s perspective:

“Until the second they meet the doctor, patients were an individual with a unique history and plans.

“What happens when they encounter the health system is not simply that they suddenly become ‘vulnerable’ people.

“It’s that they get punched in the face and their plans change.”

We know that patients suffering from depression, anxiety, or stress that so often accompany physical illness can have difficulty remembering things, concentrating, and making decisions. And here’s how these problems can further worsen a prognosis:

  • decrease motivation to complete treatment, change unhealthy practices or start healthy ones
  • decrease ability to cope with the demands of a rigorous treatment process
  • directly interfere with the working of the body’s immune system and other functions

In 2007, the Institute for Medicine issued a report on psychosocial stress in cancer patients.* I think the report’s message also applies beautifully to heart patients – and in fact, to all people facing a punch in the mouth like any on the following list of emotional stressors:

  • the physical pain and exhaustion of disease and treatment
  • not understanding about the disease, treatment options, and how to manage your illness and overall health
  • not having family members or other people who can provide emotional support and practical day-to-day help such as performing household chores
  • not having transportation to medical appointments or other health services
  • financial problems, ranging from concerns about health insurance to payments for treatments, or problems paying household bills during and after treatment
  • concern for how family members and loved ones are coping
  • the challenges of changing behaviours to minimize impact of the disease (smoking, exercise, etc.)

As I wrote in Living With The Burden Of Treatment, Dr. Victor Montori and his Mayo Clinic-based team of researchers have introduced the unique concept called Minimally Disruptive Medicine to help address these overwhelming realities for those living with serious illness – and particularly for those with multiple chronic illness diagnoses.

Dr. Montori describes a patient’s burden of treatment like this:

“One of the key aspects of minimally disruptive medicine is the need to become aware of the burden that our treatments cause on people’s lives. We know very little about it, but our international team is working toward clarity in this area.

“We think of the patient as having the capacity to do the work, and being exposed to a workload. We consider the workload involved in being a patient - and at the same time, in being human, being a parent, a spouse, a worker, a teacher, a coach.  But all of these roles compete for the same capacity.”

Minimally Disruptive Medicine also acknowledges what some physicians may not: this overwhelming burden of treatment that so many patients live with on a daily basis can become a burden that simply exceeds a patient’s capacity to cope, and may not in fact even guarantee getting better at all.

Meanwhile, as Edward Davies of the BMJ summed up his impressions of that patient panel at the Lown Institute conference:

“For physicians, it means this: many of the patients you see are not ‘vulnerable people.’ They do not need childcare. It is just that your sudden presence in their lives has punched them in the mouth.

“The answer is not to pull them out of the boxing ring and take over, it’s to get in their corner with a bucket and sponge – and come up with a new plan, together.”

.

Q: Has a serious health issue ever felt like a ‘punch in the mouth’?

See also:

.

* Institute for Medicine’s report called Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs October 2007

10 Responses to ““Everybody has plans ‘til they get punched in the mouth.””

  1. HibernationNow January 14, 2014 at 2:26 pm #

    I wouldn’t say Chronic Pain is like being punched in the mouth, it’s more like being run over by a car, daily, but I understand totally.

    It is relentless though, we don’t get a break. However, I know I should move and exercise more and that’s hard to do. Also this East Coast weather is horrible. I do love to walk so I’m hoping for less snow and more rain (?) as crazy as it sounds. I’ve been begging my husband to try to look for a Computer Job on the West Coast, so far no luck but if you hear of anything…..

    Love, Peachy keen Jr.

    Like

    • Carolyn Thomas January 14, 2014 at 2:32 pm #

      Like being run over by a car – which then reverses and runs over you a few more times. You’re so right – it’s a vicious circle: the worse we feel, the less we feel like doing precisely what might make us feel better! I’ve been known (did I mention it rains A LOT here on the West Coast?) to just go up and down the stairs, over and over, inside our 4-story apartment building on the nastiest days. Not the most scenic of routes, but it works!! ;-) Thanks, Laurie…

      Like

  2. CuriositytotheMax January 12, 2014 at 3:16 am #

    Love the quote. It feels like a punch to my psyche, soma and soul. Luckily only my soma went down for the count.

    Great post . . . . as usual.

    Like

    • Carolyn Thomas January 12, 2014 at 6:33 am #

      Well, as long as your psyche and soul are still okay . . . Thanks, Judy-Judith!

      Like

  3. Marilee Allerdings January 11, 2014 at 7:04 am #

    Great post, Carolyn! I think most people who have been diagnosed with a serious illness can relate to the “punch in the mouth.”

    I remember referring to it as being “run over by a semi”. Compassionate collaboration should be available for everyone.

    Like

    • Carolyn Thomas January 11, 2014 at 7:14 am #

      Thanks Marilee. Sometimes I think I’ve been both punched in the mouth AND run over by a semi. Very descriptive analogy.

      Like

      • Barbara Keddy January 11, 2014 at 2:49 pm #

        Thanks once again Carolyn for such a helpful blog.

        As I approach the one year anniversary of my heart attack, stent and diagnosis next Sunday, my anxiety level is very high. I find I am reliving the ‘event’ more frequently, rather than being joyful I survived the year. I still feel the wheels of the semi on my psyche.

        My family doctor knows I have always experienced great anxiety, so he probably thinks I am experiencing anxiety rather than heart symptoms. I don’t see a cardiologist as it was felt (not by me!) the family physician could take care of me, and I am left with this great burden of not only feeling run over by a semi but no one to tell me how I am doing.

        The uncertainty of living with fear, anxiety and depression that accompanies heart disease is NOT addressed by health professionals, at least not in my experience. It is the most challenging of all the issues, I believe.

        However, I have ordered a lemon chiffon cheesecake from a local bakery and I will blow out one candle. Maybe I will be able to force a smile and the cloud will dissipate for awhile. But the semi’s tire tracks are still on my chest. :-(

        I know I should stop whining as there are so many before me who did not survive the year, but somehow that doesn’t ease the burden. But, I will close with saying to my little heart: “Happy heart-iversary and thanks for holding up”.

        Like

        • Carolyn Thomas January 11, 2014 at 5:03 pm #

          Happy heart-iversary in advance, Barbara! I think the one-year milestone is the kind of anniversary that doesn’t mean party hats and balloons, but more like personal reflection on what the heck hit you out of the blue one year ago. No wonder you are reliving that event. I’m hopeful that you’ll also plan some forward-looking adventures in the year ahead (maybe a trip to the West Coast so we can finally meet in person?!) to balance out that rear view mirror. I am so pleased with your lemon chiffon cheesecake choice – just the thing to make you happy to be alive with each gorgeous morsel. Enjoy it – you have earned it.

          Like

          • Helen Holshouser January 18, 2014 at 2:58 pm #

            Oh Carolyn, I am so happy that this blogger recommended your blog to me!

            I feel like I have found a site where I belong! It just so happens I just wrote a blog post yesterday about my being taken out of my life as I knew it, by heart disease!

            Being punched in the mouth is a great analogy! (But Barbara Keddy, I am a survivor of two heart attacks, and disabling coronary artery disease for almost 15 years now! Neither my docs nor I dreamed I’d live this long!)

            I do have pneumonia right now, and with the heart disease, I am always afraid this will be “the end”, but life goes on… I finally quit living like I had a sword hanging over my head! Now I live differently, but happily.

            I look forward to following you!
            Helen

            Like

            • Carolyn Thomas January 18, 2014 at 3:16 pm #

              Welcome Helen! (What took you so long?!) So glad you found your way here – and thanks to This Time – This Space for showing you the signpost. Please take good care of yourself during this bout of pneumonia.

              Like

What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 2,935 other followers

%d bloggers like this: