💔 COPING WITH AND ADAPTING TO HIGH-MORTALITY ILLNESSES
🤔 Jack's Story: Living with Vulnerability
Deep down in the "wishing" part of his mind, Jack thought he was immortal. 🦸♂️ Oh, he acknowledged that he'd die someday, but that day would forever be a long way off, he believed. He lived his life accordingly, even though he had almost every known major risk factor for heart disease. He was 30 pounds overweight, 🍔 ate high-cholesterol food with abandon, smoked two packs of cigarettes a day, 🚬 got little exercise, experienced a lot of anger that he had trouble expressing, 😠 and had a father who had died of a heart attack at the age of 48. 💔 Jack had felt especially invulnerable 2 years ago on his 49th birthday, almost believing that, because he had lived past his father's age of death, the grim reaper would somehow never find him. ☠️
Jack's beliefs were jolted a couple of months ago—he had a heart attack that put him in the hospital for 3 weeks, including a week in the coronary care unit. 🏥 He was stunned at first, "this can't be happening to me," he thought. Soon it sank in that it was happening to him, and he felt anger and a sense of grief and helplessness. 😢 He was not prepared for this. He tried to deny and minimize the problem, but his physical weakness made it clear to him that he is, after all, vulnerable. Although this realization was depressing to him for a while, he had always taken pride in his "fighting spirit." 🥊 A month later Jack announced, "I'm going to change my life," and he did! ✅ He gave up smoking, changed his diet, and started an exercise program. Just as important, he gradually changed his outlook on life. He now realizes how much the people in his life mean to him and how important he is to them, and he is actively working to get closer to them. 💕
📊 The Leading Causes of Death
The majority of deaths in developed countries result from three chronic diseases: 🫀 Heart disease, 🎗️ Cancer, and 🧠 Stroke. In the United States, the death rate for heart disease has declined by half since 1970, but it is still the number-one killer by far; cancer is second, and stroke is third. People know these are the leading causes of death—and for many patients and their families, being diagnosed with one of these diseases means death. 💀
AIDS emerged in 1980s as a major killer, 🦠 and public attention has focused on how it is spread, the large numbers of people infected with the virus, and the huge numbers of AIDS victims who die each year around the world. 🌍 These four high-mortality illnesses are the focus of this and next coming lectures.
Although many people deal with having high-mortality chronic illnesses in positive and constructive ways, 💪 not all do. So we will examine how patients and their families react to and cope with health problems that have a high likelihood of taking their lives. 😔 We will also see the psychosocial adjustments these people make when the illnesses are terminal. As we study these difficult circumstances, we will consider many important issues and try to provide answers to questions you may have. ❓ What is it like to live with heart disease, stroke, cancer, or AIDS? How do these illnesses affect the patient's functioning, and what treatment regimens do they entail? What special problems exist when the victim is a child? 👶 What can be done to help terminally ill people and their loved ones cope? 💙
⏳ Coping With and Adapting To High-Mortality Illness
Many healthy individuals who wonder how much longer they are likely to live look up the statistical life expectancy for people their age and gender 📊 and probably adjust that figure on the basis of the longevity of other people in their families. But estimates of a person's life expectancy are very imprecise, and this is true even for people with health conditions that seriously threaten their lives. 🎲 Public opinion aside, having a high-mortality disease—even cancer or AIDS—does not usually mean a person will die in a matter of a few weeks or months. ⏰ Many cancer patients, for instance, survive for 10 or 20 years before the disease takes their lives, and some are totally cured. 🎗️✨ Still, no one can tell for sure what the course of the disease will be, and these individuals and their families must adapt to this uncertainty. 🤷♀️
🌤️ Adapting While the Prospects Seem Good
Since none of us knows for sure what lies ahead for us, we all live with some degree of uncertainty. 🔮 But for patients with high-mortality illnesses, the uncertainty for them and their families is more real and urgent. Even though they may have good prospects for the future, either in the short run or more permanently, the diagnosis changes them. 🔄
Mortality is the main issue of concern to patients in the first few months of convalescence with a seriously life-threatening illness. ⚰️ During this time, patients often show optimistic attitudes, 😊 hope they will be cured, but begin to view their plans for the future more tentatively. 🤞 They also tend to switch from using mainly avoidance coping strategies to using active problem-focused approaches. 🎯 Jack, the man we described who had had a heart attack, showed these adjustments when he changed his lifestyle and his outlook regarding the people in his life. Lifestyle changes are typically part of the rehabilitation programs people with heart disease, stroke, cancer, and AIDS are asked to follow. 📋 Self-help and support groups that interact either in group meetings or online are available to patients with these illnesses to discuss and get advice about specific problems and stressors in their daily lives. 💻🤝
As a patient's recovery progresses, he or she is able to return more and more to a regular routine, 🏡 often gaining great satisfaction by once again being able to do simple household or self-help activities. Having activities to occupy the day is important to convalescing people, particularly those with chronic high-mortality health problems. 📅 These activities give them some respite from thinking about their conditions. 🧘 Patients often try to isolate the diseases from the rest of their lives by focusing on other things, such as preparing to do projects around the house or to return to work. 💼
Sometimes these plans and preparations can lead to problems, however, if patients overestimate what they can do. ⚠️ For example, a patient named Clay who had suffered a serious stroke described how he started making plans the glorious day he left the hospital—projects to do: Museums 🖼️ and galleries to visit, friends I had wanted to meet for lunch, go for a picnic, 🧺 go to attend a football match. ⚽ It was not until several days later that I realized I simply couldn't do them. I didn't have the mental or physical strength, and I sank into depression. 😞
Patients need to be encouraged to develop reasonable plans and to carry them out, especially with regard to going back to work or getting training to enter a new job, if necessary. 🎓 Sometimes the helplessness that chronically ill people feel and the nurturance their families give lead to a cycle of continued dependence that persists when the patients are able to begin doing things for themselves. 🔄 Gentle push by family members can help patients become more self-sufficient, thereby making them feel useful and bolstering their self-esteem. 💪✨
💭 Cognitive Adjustments in Long-Term Adaptation
In the process of adapting to high-mortality illnesses over a long period of time, some individuals make helpful cognitive adjustments. 🧠 By interviewing women who had had surgery for breast cancer a few years earlier, researchers found that these adjustments center on three themes:
- Finding meaning 🔍—patients may find meaning in their illness experiences, either by determining why the illnesses happened or by rethinking their attitudes and priorities.
- Gaining a sense of control 🎮—some individuals gain a sense of control over their illnesses such as by engaging in activities that reduce their risk of their conditions getting worse or increase their knowledge about their care.
- Restoring self-esteem 💎—some patients restore their self-esteem, often by comparing themselves with less fortunate people. For example, a married woman compared herself with others who may be dating and having to tell the man about the cancer. 💑
These cognitive adjustments seem to promote adaptation and probably help patients achieve or, in some cases, exceed their previous levels of psychosocial functioning. ⬆️ But many individuals, perhaps one-half, do not achieve these adjustments. 📉
Living with any high-mortality disease can be quite stressful, 😰 but each disease creates a pattern of stresses that is unique. We turn now to considering how people adapt to living with specific high-mortality health problems, starting with stroke. 🧠
🧠 STROKE
📖 What is Stroke?
Stroke is a condition in which damage occurs in some area of the brain when the blood supply to that area is disrupted, depriving it of oxygen. 🚫💨 Stroke is a leading cause of death worldwide; 🌍 in the United States each year, 600,000 new or recurrent strokes occur and claim about 60,000 lives. ⚰️
⚠️ Symptoms of Stroke
Individuals who experience any of the following warning signs of a stroke should see a physician immediately: 🚨
- Sudden weakness or numbness of the face, arm, or leg 😵 (typically on one side of the body).
- Sudden dimness or loss of vision 👁️ (usually in only one eye).
- Loss of speech, or trouble talking or understanding speech. 🗣️❌
- Sudden, unexplained, severe headache. 🤯
- Unexplained dizziness, unsteadiness or sudden fall, 😵💫 especially if this occurs with any of the above symptoms.
🔬 Causes, Effects and Rehabilitation of Stroke
The disruption in blood supply that causes strokes occurs in two ways:
- Infarction 🩸🚫—In some cases, damage results from an infarction when the blood supply in a cerebral artery is sharply reduced or cut off, either when a blood clot (a thrombus) forms or a piece of plaque (an embolus) becomes lodged in that area of the artery.
- Hemorrhage 💥—In other cases, damage results from a hemorrhage, in which a blood vessel ruptures and bleeds into the brain.
A stroke caused by a hemorrhage generally occurs rapidly and causes the person to lose consciousness; 😵 most of the damage it produces happens in a few minutes. In contrast, a stroke caused by an infarction tends to occur more slowly and the person is less likely to lose consciousness. ⏰ Strokes from hemorrhages occur much less frequently but are much more likely to cause extensive damage and death than those from infarctions. ☠️
📊 Age, Gender and Sociocultural Risk Factors for Stroke
The incidence of stroke is very low prior to the middle-age years 👶 and increases sharply after 55 years of age, 👴 doubling in each successive decade. Men are more likely than women to develop a stroke and die from it. ♂️ We can see a role of sociocultural factors in death rate data for different ethnic groups in the United States: among both men and women, death rates from stroke are about twice as high for blacks ⬛ as for whites and Asian, Hispanic, and Native Americans.
Part of the reason for age, sex, and sociocultural differences in the risk of stroke lies in biological and lifestyle variations. 🧬🏃 For example, high blood pressure is a risk factor for stroke 🩺 and the prevalence rates for hypertension increase with age and is higher in males than females and in black than white Americans.
😔 Psychosocial Aspects of Stroke
Recovery from a severe stroke is a long and arduous process. ⏳💪 Stroke patients who continue to deny their current or possible future limitations often retard their progress in rehabilitation. 🚫 When a stroke produces physical or cognitive deficits, the emotional adjustments can be very difficult. Stroke patients are very prone to depression. 😞 At this point, the more severe their condition, the stronger the depression they develop.
Although stroke usually afflicts individuals who are beyond retirement age, 👴👵 many of its victims are employed when the illness occurs and suffer impairments that prevent them from returning to work. 💼❌ Some stroke victims who do not return to work are old enough to retire early with pensions, but others must leave the work force under less favorable circumstances, which can be financially and emotionally difficult. 💸😰
The impairments produced by stroke have important social effects on patients and their families, 👨👩👧👦 particularly when the patients are severely paralyzed or have aphasia. Most of the families do not adjust well to the changing role relationships, and marital harmony often declines. 💔 In addition, social contacts and leisure activities with friends also drop off for both the stroke patient and his or her spouse. 🚶♂️❌ The more severe the remaining deficits after rehabilitation, the more likely patients are to experience psychosocial problems. 😔