“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion.” Florence Nightingale
Stephen Bloom became my patient almost ten years ago. He was an anxious fellow with high blood pressure and a less than perfect lipid profile. He also had borderline diabetes.
His previous doctor had told him he was a heart attack waiting to happen. “A walking time bomb” were the words Stephen remembered.
The doctor’s words had done little to bring about any change in Stephen’s lifestyle. When I met him, he was thirty pounds overweight with a blood pressure a good ten points over ideal, and his lipids were not quite controlled, but his biggest problem was his anxiety. He acted like every day was his last. He worried about what to eat, about which kind of physical activity was too much or too little, about side effects and about the cost of his medications.
Over the next several months we adjusted his medications and he actually lost a few pounds. I helped him figure out which foods raised his blood sugar the most and I encouraged him to make small changes in his eating patterns between each cholesterol test. But he was still on the verge of panic about his heart attack risk.
I had to work on his anxiety.
“Look at all the things you have been able to change. Your blood pressure is controlled, your weight is down, your blood sugars are normal and your cholesterol is so much better.”
I took a deep breath and added: “Right now, your biggest cardiac risk factor is your own stress and anxiety.”
He thought for a while, then seemed to relax and said “OK, that makes sense”.
I continued to see him every three months to monitor his progress, and he seemed to be more and more solid in his belief that he was doing everything he could to lower his heart attack risk. He seemed to enjoy life, and was an absolute rock when his wife, Donna, had a stroke.
Then, one day about a year ago, Stephen ended up in the emergency room with chest pain. His EKG was normal and his blood work didn’t show any sign of damage to his heart. I saw him in follow-up and ordered a nuclear stress test, which was normal.
From then on, Stephen’s anxiety was back. He often experienced chest pain when he got upset or when he couldn’t fall asleep at night, but never with physical exertion. I broached the subject of doing something more for his anxiety, but he said no, adding “I think my heart is starting to act up, it’s just not showing in the tests yet”.
All the courage he had gained and been able to maintain over the last ten years had suddenly escaped him, and he became more and more convinced that the good health he had enjoyed was sure to come to a cruel end at any moment. Unlike ten years ago, nothing I said made a difference this time.
I kept wondering, had I failed to reassure him, or was his fear and anxiety so deep, so miasmic, that he couldn’t be helped?
Shortly thereafter Stephen transferred his care to a doctor in the next town.
The other day I happened to see his sister, Gertrude. She told me Stephen was on all new medications and had to see Dr. Grimes for follow-ups at least every month because he was at such high risk for having a heart attack. Stephen never did anything without checking in with Dr. Grimes. In fact, she added, Dr. Grimes considered her brother to be “a walking time bomb”.
A Country Doctor Writes: 
