First the big change, then the big transition

3quotes-Change-is-external--by Carolyn Thomas    @HeartSisters  

I can’t even remember reading the book when I bought it, hot off the press, back in 1991. It was during the busy pre-Kindle heyday of my career in corporate public relations. In those days, I traveled a lot for work, so on any given day I carried a business book or two in my briefcase to read on the plane. (Remember briefcases? Do people still carry briefcases?)

This particular book is called Managing Transitions by William Bridges, the “preeminent authority on change and managing change”. 

While sorting out old books recently to donate to charity, I cracked open this book to the section called How to Deal with Non-Stop Change. Bill Bridges was writing specifically about dealing with change in the workplace, but his message also made a lot of sense to me as a patient who has seen plenty of changes in my life due to a misdiagnosed heart attack  in 2008. The reality is that there is no workplace change – layoff, getting fired, restructuring, corporate merger, you name it – that could possibly compare to the profoundly significant changes that so many of us go through when we are diagnosed with a serious medical condition.   .       .

From the first symptoms signaling the changes that are about to happen to the diagnosis, treatment and recuperation, we stagger relentlessly towards what is sometimes called the “new normal”. But we don’t want the new normal. We want the old life back, thank you very much.

The reality, however, can hit hard, and it doesn’t follow easy timelines.

As Bridges explains in his book:

“Change can happen so frequently that one change isn’t complete before another change happens. It isn’t the changes that do you in, it’s the transitions between the changes.

“Change is situational. Transition is the psychological process that people go through to come to terms with the new situation. So change is external, transition is internal.”

Bridges lists the most common phases we go through during these transitions:

Three Stages of Transitions:

1. The Ending

“Situational change hinges on the new thing, but psychological transition depends on letting go of the old reality and the old identity you had before the changes took place. The first step in transition starts with an ending – paradoxical, but true. Think of some of the big changes in your own life so far: a promotion at work, the birth of your first child, the move to a new home. Good changes, all of them; but as transitions, each one started with an ending. A loss. Letting go of something.”

This stage felt very familiar to me.  Immediately after my own heart attack, my focus during the early days and weeks and months was on grieving the loss of my former life, the loss of my own self. It seemed to me that life as I knew it was over. I longed to be just a person again and not a “patient”.

Reassurances by well-meaning family and friends about how “lucky” I was to have survived what many do not did not convince me. In the business world, Bridges cites comparable examples – like the company that builds a beautiful new headquarters building, but fails to foresee that employees might experience the relocation as a loss.

It’s important to understand and acknowledge that early sense of loss. But not everything during transition is an ending, warns Bridges.

A great deal of your life is going to continue. Even in the most radical transitions, he says, it is a piece of your life – NOT the whole – that is coming to an end.

He recommends that this is a good time to take stock of the continuities in your life, and to write them on a list:

“Think about how to protect or restore these things, the parts of your life that are not threatened by your current losses. Rethink how you’re currently spending your time. Those continuities may not be getting the share they deserve. You may choose to get in touch with a person or a group you’ve lost touch with. You may need to set clearer boundaries on your obligations to others, and create space to take care of your obligations to yourself.

2. The Neutral Zone

“The second step in a transition is understanding what comes after the letting go: the neutral zone. This is the no-man’s-land between the old reality and the new. It’s the limbo between the old sense of identity and the new. It’s a time when the old way is gone, yet the new still doesn’t feel comfortable.

“When you moved to your first home, or got the promotion, or had the baby, the change probably happened pretty fast. But that’s just the external situational change. Inwardly, the psychological transition happened much more slowly, because you probably struggled for a time in a state that was neither the old nor the new. It was a kind of emotional wilderness, a time when it wasn’t clear who you were or what was real.

“It’s important to understand this neutral zone. If you don’t expect it and understand why it’s there, you’re likely to try to rush through it and to be discouraged when you cannot do so. You may mistakenly conclude that the confusion you feel is a sign there’s something wrong.”

This was definitely me.

I was utterly desperate to feel “normal” again during a time when nothing about life felt normal anymore. After finally getting medical clearance for a return-to-work trial (half days only to start), I was thrilled to be back to the office and what I hoped would mean getting my old life back again. But by the end of that first week back, I could tell – and worse, my colleagues could tell – that something was very wrong. I could barely function, had ongoing distressing symptoms, and in the hair-on-fire deadline-driven world of public relations, I knew I was in big trouble. My impatient rush to return to “normal” did not go well.

As Bridges wrote eloquently about this phase:

“The neutral zone is the winter in which the old growth returns to the soil as decayed matter, while the next year’s growth begins to stir in the roots underground. It is the night during which we are disengaged from yesterday’s concerns and prepared for tomorrow’s. It is the chaos in which the old form of things dissolves and from which the new form emerges. It is the seedbed of new beginnings.”

3. The New Beginning

“Beginnings reactivate some of the old anxieties that were originally triggered by the ending. Beginnings establish once and for all that an ending is real.”

Ouch. That was me, too. By the time I slowly emerged from the neutral zone, I felt exhausted, yet finally ready to face my own denial. I could begin to slowly accept that, yes, this cardiac event had really happened to me, that some parts of life were indeed going to be different, and that the “new normal” phrase I used to hate was actually describing my life, especially now that I had a new diagnosis of coronary microvascular disease. I had to essentially relearn how to function each day.

What Bridges recommends when entering a new beginning after a big change is to reinforce a visual picture of what the future might look like, at least in our imagination, and how it will feel to be a participant in it someday soon.

“This picture in people’s heads is the reality they live in, and one of the losses that takes place during the ending phase of a transition is that the old picture – the mental image of how and why things are the way they are – falls apart.

“But it’s the new picture that can bring people out of the neutral zone with a sense of identity and new meaning.

“It’s important not to expect this picture to have its effect prematurely i.e. before the ending and letting go of the past is done. The picture can’t make the transition happen.”

Again, I could  sure relate to this. It’s also why my time in a supervised cardiac rehabilitation program was so valuable. While in class, I could not only begin to picture a future where I could exercise safely, feel better, and even watch myself improve week by week, but I could start making plans to continue long after my rehab program ended.

Bridges reminds us that, no matter who is experiencing change and its accompanying transitions, there is an ending, then a neutral zone, and only then a new beginning.

NOTE FROM CAROLYN:I wrote much more about change and transitions while adjusting to life after a cardiac event in Chapter 9 of my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press).

You can save 30% off the book’s cover price if you order it directly from Johns Hopkins University Press (use their code HTWN). Or ask for it at your local library, your favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon.


Q: How have you managed those transitions after a big change in your own health?

See also:

Why We Keep Telling – and Re-Telling – Our Heart Attack Story

Three Types of Heart Happiness Defined

Even Heart Patients Can Learn to be Optimists

Do you Fear Change? Then Don’t Have a Heart Attack

The New Country called Heart Disease

Six Ways NOT to Motivate Patients to Change

7 thoughts on “First the big change, then the big transition

  1. Loved this, Carolyn! Will share it with my heart sisters, but hoping they already are recipients of your blog – and your book– as I refer to you all the time!

    Keep up your amazing work – you are saving lives! 😘❤️

    Liked by 1 person

    1. Hi again Annie! Lovely to hear from you! Hope you’ve been having a nice summer and staying cool.

      PS. Last month, I was thrilled when my wonderful editor Debby Bors from Johns Hopkins University Press came all the way from the east coast to the west coast for a few days so we could meet in person for the first time! We had a great visit; she told me that my book is on the Top 5 list of all best-selling JHUPress books! 🙂 I really appreciate you sharing what I write about here (and in my book!) ❤️


  2. Thanks, Carolyn! Change has always been especially hard for me. I used to tell my employer if she knew on Friday that we would be doing something differently on Monday to please give me a heads-up on Friday so I could get used to the idea!

    With my illness I had been struggling with symptoms for so long the diagnosis was almost a relief, though my ongoing physical limitations are still not easy.

    The change that’s giving me the most trouble now is simple aging. I had always been the one to throw myself into new places and new experiences, with the idea if things didn’t work out I could always do something different! That there was always plenty of time.

    Now I’m truly struggling with knowing that simply isn’t the case. Once again I’m having trouble letting go. Such a hard thing to ask of a control freak like me! I appreciate this post because it gives me a framework for coping and planning and looking ahead.

    It gives me hope that there still is a future and that I can figure out how I want to live it!

    Liked by 1 person

    1. Hello, Pat – for a self-described control freak who feels most comfortable knowing exactly what is coming down the pike, no wonder you’ve been feeling overwhelmed lately. I think there’s also some grieving involved as we come to grips with the person we used to be when we were young – and today’s person! Good thing aging happens little by little, year by year, body part by body part so we can gradually adapt to each change… 😉

      By the way, last year I wrote about that odd sense of relief you mention that some people feel when they’re finally diagnosed – even hearing a very serious diagnosis. It’s remarkably common.


  3. Thank you so much for this article Carolyn! It rings so true to me! You brought tears to my eyes! I will have to reread it when I feel less emotional. After 4 years I am still in the first stage of transition I believe! I keep looking and longing for that perfect pill, activity or whatever that will bring my old life and energy back. Letting go is the hardest! Will have to reflect on this.

    Really appreciate and look forward to your Sunday blog! Thank you again.

    Liked by 1 person

    1. I appreciate your comment, Jacqueline. Four years is a long time to still be in ‘The Ending’ stage of transition. I think the most interesting part of that stage is the focus on “continuities”, those ongoing parts of life that are not affected by the loss, and that this is a piece of your life – NOT the whole – that’s affected by loss. For me, that was a powerful way to look at this stage. I hope it works to help you with ‘letting go’. Best of luck to you…


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