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

by Carolyn Thomas    @HeartSisters           .  

When Edward Davies was with the British Medical Journal, he attended the Lown Institute conference in Boston, where he was reminded of some unlikely wisdom from boxer Mike Tyson. In the run up to a big fight, he explained, Iron Mike was being bombarded with media questions about how he intended to deal with his powerful challenger. Did he have a strategy?  What was his plan? 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 living 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 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.”

NOTE FROM CAROLYN:  I wrote much more about adjusting to life with a chronic illness in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 30% off the list price).

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

See also:

“To just be a person, and not a patient anymore”

Looking for meaning in a meaningless diagnosis

Why hearing the diagnosis can hurt worse than the heart attack

News flash: care improves when doctors consider the whole person

Healthy Privilege’ – when you just can’t imagine being sick

Why don’t patients take their meds as prescribed?

The new country called Heart Disease


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

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

  1. No matter how much you try to prepare for it, even when it’s inevitable, the moment one lists for transplant can feel quite a bit like that too. At a certain point with my lung disease, I knew at some point it was inevitable, yet when it became reality it certainly hit harder than I anticipated.

    I like this analogy quite a bit. I’ve often compared life with my rare diseases as being similar to this, like an ongoing boxing match. Yet I think we both, in spite of getting punched in the mouth, still hang in & defend ourselves as much as possible through learning all we can on how best to deal with these types of situations.

    As usual, love your candor & blog Carolyn. You’re a powerful ally for others in similar situations. Keep it up.

    Liked by 1 person

    1. Thanks for your kind words, Nikki. And for reminding all of us that we can never truly prepare for a traumatic medical event, even when we see it coming! Interesting also that you’ve been comparing your own experience with an “ongoing boxing match”. Just keep on rolling with the punches…

      Liked by 1 person

  2. 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.

    Liked by 2 people

    1. 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…


  3. 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.

    Liked by 1 person

      1. 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”.

        Liked by 1 person

        1. 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.


          1. 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!

            Liked by 1 person

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