by Carolyn Thomas ♥ @HeartSisters
“Wow! You look great! You look just the same!”
In the early days, that was a fairly typical greeting from those who had not seen me for a while. While some might assume that this is a thoughtful and flattering comment to offer a freshly-diagnosed heart attack survivor, many times it didn’t feel that way.
Surprised? Many people, especially in the early days, weeks and months while still reeling emotionally and physically from their life-altering cardiac train wreck, tell me that they often feel like replying to such greetings with:
“I am NOT the same!”
Instead of the well-meant but oddly niggling “You look great!” – what might be more helpful to the freshly-diagnosed heart patient?
First, the urge to say something comforting and encouraging to somebody with heart disease or any other chronic and progressive illness seems like a natural, kind-hearted gesture. But my heart sisters tell me that they suspect these comments more often reflect the relieved feelings of the speaker rather than the fabulousness of our actual appearance.
Friends and family alike can feel apprehensive that we might look very sick and very different, and that this dreadful appearance will make them feel awkward or uncomfortable just being around us. What will they say? How will they react if we look or sound really bad, if we don’t look “the same”?
It’s a similar reaction observed in end-of-life care: bereaved people are often told by well-meaning friends and relatives, in particularly chirpy tones, how “Great!” they look – this after the death of somebody they love. It can be hard to know just how to respond to such an irrelevant assessment of something as trivial as your outward appearance when you are grieving. Most people simply try to be gracious, smile gamely, and say: “Thank you.”
Particularly for women (who are socialized from birth about the over-importance of looking good), it can seem natural to make a comment about how others look.
Similarly, when others see me now, walking/talking/smiling – looking and sounding pretty much like my old self – no wonder they may gush in a tremendous flood of relief:
“Wow! You look great! You look just the same!”
What these gushers may not appreciate is how long it has likely taken me on a bad day to look “the same”, how much effort and exhaustion this has meant, what I’ve gone through just to run a comb through my stringy hair or brush my teeth – and don’t get me started on taking a shower or maintaining this pasted-on little happy face in order to keep up my pleasant facade of normalcy.
Because that, above all else, is what heart patients long for: to feel normal again. Not just to look normal.
Other things to avoid saying when visiting:
- don’t start in on that endless story of your Uncle Stan and his much more interesting heart attack – heart patients simply don’t care about other people’s medical drama at this moment
- don’t try and push any life-saving miracle cures, products or supplements on us, particularly if you are selling them (this is unforgiveably tacky)
- don’t try to cheer us up if we’re having a bad day – we’re entitled to have a bad day once in a while because we’ve just had a heart attack, for Pete’s sake – and if we do confess that we are having a bad day, do not under any circumstances say: “Well, at least YOU LOOK GOOD!” – unless you want a small metal canister of nitroglycerin hurled at your head
Next time you approach a heart patient, a bereaved person grieving a loss, or those diagnosed with a chronic, progressive disease – what could you do or say instead of focusing on appearance?
One of the most helpful comments to me so far has been some variation of the simple statement:
“It’s great to see you!”
… which is probably fairly accurate, feels pretty darned good to hear, and doesn’t elicit the “If you only knew…” reply that we’re silently muttering.
Remember too that gifts of service or time are always a good idea. When I was newly home from hospital after my heart attack, I loved people who phoned and said: “I’m at the grocery store – what can I pick up for you here?”
One friend came over and planted all my summer annuals for me because she knew I was not able to do that; another called to say he was coming over to wash and vacuum my car.
Bring a heart-smart casserole, homemade soup, vegetarian chili, or (best idea ever!) a big fresh salad when you drop over. If you’re not a cook, splurge on a special magazine that you know the freshly-diagnosed heart patient likes. If you can’t afford that, bring a stack of library books selected just for her (one of my neighbours, for example, brought over a dozen gorgeous library books on flower-arranging, which she knew was a keen interest of mine – and then made a plan to return them all to the library for me when they were due in three weeks).
Keep your visits brief – just making conversation, even with people we love, can be exhausting for us, especially at the beginning of our recovery.
For an enlightening perspective on what it’s like to live with a chronic illness, visit the But You Don’t Look Sick? website to read Christine Miserandino’s powerful personal essay called ‘The Spoon Theory‘. She uses a handful of restaurant teaspoons to illustrate to a friend her limited reserves of energy (spoons) that must be carefully planned and counted out to get her through an average uneventful day. Christine’s unique Spoon Theory helps to explain what is very difficult for the healthy to understand: how utterly exhausting it can be to get through the simplest of tasks when she’s having a bad day. In Christine Miserandino’s case, her chronic diagnosis is lupus, but she could well be speaking for heart patients, too.
Though battling a shopping list of debilitating symptoms since the age of 15, Christine has consistently been told, by both well-wishers and doctors alike: “But you don’t look sick!?” as if that were some kind of compensation for being chronically ill. Worse, the words somehow imply that she can’t possibly be as ill as she claims, given her “normal” physical appearance. See also: When We Don’t Look As Sick As We Feel
It’s almost enough to make you wish some days that you wore a neck brace, a leg cast or some other visible outward sign that something’s not quite right.
Many times, not looking “sick” makes it harder to validate a medical condition that nobody else can see.
© Carolyn Thomas www.myheartsisters.org
See also:
- “But You Don’t Look Sick…“
- Stupid Phrases for People in Crisis
- ‘Healthy Privilege’ – When You Just Can’t Imagine Being Sick
- Why You Should Not Ask: “How Are You Feeling Today?”
- Ten Helpful Things To Say To A Sick Friend
- What Not to Say When Visiting the Sick
Heart Sisters 
After my heart attack my boss called me at the hospital and mimicked Redd Foxx doing his Fred Sanford fake heart attack i.e ., “It’s the big one, Elizabeth! I’;m comin’ t’ join ya, honey!” Sigh….
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Hello Todd – that kind of “hilarity” is only funny to those who have never actually experienced a heart attack… 😦
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Being told “You look great!” when you are ill and in constant pain can be experienced as an accusation that you are exaggerating about your condition or pretending to be ill, or – especially if you are female – you are not physically ill at all.
‘Charitably’ your tormentors may be concluding that you are ‘depressed’, and so they persist in the cruel, dispiriting Cheer Up admonitions. It is all especially hurtful when these people assume the mantle of being your friends. And it is near-impossible to remonstrate with their hypocritical nonsense because you are then interpreted as ungrateful/ill-mannered/rude.
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So true, Margaret. Thus is reality for those living with an invisible illness.
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You look great = one of those mindless forms of greeting that are meaningless, like saying: ‘hey how’s it going?’ or
“Hello, you look great!”
“So do you! How ARE you?”
“Great, just great!”
“That’s really great!”
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Ha! Thanks Elma – it was really great hearing from you!
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Boy, this article hits the nail right on the head. How often have I too felt like saying IF YOU ONLY KNEW to those “gushy” comments. I’m not a heart patient but have health issues that are mostly “invisible” to the average person. I’ve learned to master saying FINE THANKS at all times, it’s just too exhausting to deal with otherwise.
I love your website and have just subscribed today to receive your email updates. THANKYOU for this, you do an awesome job here and not just for heart patients.
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Thanks so much, Click Chick – and also for the reminder that readers can subscribe free to be notified about new posts here. Shameless promotion: just click on the Follow Heart Sisters tab on upper right sidebar! 🙂
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“….don’t start in on that endless story of your Uncle Stan and his much more interesting heart attack – heart patients simply don’t care about other people’s medical histories at this moment….”
Oh, oh. I wish I’d read this article a week ago. I just came back from a weekend visiting an old friend who’s recently had open heart surgery, spent every day fussing over how good she looked and telling her all about my relatives and their cardiac stories (lots of heart disease history in my family). Now I’m thinking that she must have been happy when I finally shut up and flew home!
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This post should be required reading for all med students as well as our family members.
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I agree 100%. Sometimes I feel like I must have looked awful before my heart attack and it miraculously make me “look great”.
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I completely agree. This also reinforces our society’s obsession with women’s outward appearance and the unspoken expectation that looking good at all times is THE most important thing for women, even for those suffering debilitating symptoms. Who doesn’t like a good makeover show on TV, right? We all love those “after” photos better than the “before” – the implication is: we better all look like “after” shots in real life. Thanks for your very astute observations here.
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As a bereaved person who has recently lost my dear twin sister, I can vouch for how common it is for people to comment on MY APPEARANCE when they now see me in public since the funeral. At first, I felt so stunned by these comments – of all things to say! who cares how I LOOK at a time like this?!?! – that I honestly didn’t even know how to reply.
Thanks for helping to explain where this is coming from, people’s fears and awkwardness around difficult scenarios like grief or illness. I too used to think that saying something positive and flattering and cheerful like “You look GREAT!!!” would somehow cheer a person up or distract them from their unpleasant reality. Instead, it can come across as shallow and superficial and NOT APPROPRIATE. Unless you have ben through something like this yourself, it is so hard for others to really understand why these comments are not helpful.
I will remember to use your suggested comments instead. Very helpful – EVERYBODY should be aware of this useful information. Thankyou.
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I feel so surprised at this. Never would I have believed that by complimenting somebody on their appearance that I was somehow saying something wrong. Who doesn’t feel cheered up by a pleasant flattery?
Are those with chronic illnesses that hyper-sensitive then? I’m afraid to say anything for fear of offending now!
Your alternative suggestions, however, are useful and I shall remember them for future use.
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Yes, I am hyper-sensitive, and who wouldn’t be when you are told you have heart failure at 46 and could have sudden cardiac arrest at any time. Your world is turned upside down.
You are trying to live one day at a time, and miss your old life. You hate relying on other people when you used to be so independent.
Just because I look good doesn’t mean I feel good.
Just be there for your heart friends. I keep waiting for someone to say why are YOU parking in the handicapped spot so I can show them my scar from the pacemaker.
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I can certainly relate to this “But you don’t look sick…” article. I was in to see a psychiatrist a couple of years ago and later saw his note to my family doctor: “Healthy young woman, somewhat distracted…”
When I saw him, I was battling a new diagnosis of rheumatoid arthritis, lost employment, hypothyroidism, depression, through-the-roof stress, flashbacks from post traumatic stress disorder, nights racked with pain – yet was not taken seriously because none of it showed! As the article suggests, crutches or a full-body cast at least say: “Handle with care”.
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I accessed my medical records and found that just prior to my cardiac arrest at 28 and following my brother’s death of a heart attack (age 24) the doctor had said that I was a healthy young woman who appeared to be overly worried about the possibility of heart issues in my family. Humph. Well I showed him SDER.
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Oh my gosh, are you ME? Your words and feelings are the same. Thank you for wonderful posts. Lois Trader
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