A Walking Time Bomb

“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”.

2 Responses to “A Walking Time Bomb”


  1. 1 Ms. Lynette September 17, 2010 at 9:40 pm

    This makes me so sad. Having lived through heart attack with my father, now 14 years ago; colon cancer with my mother, 5 year survivor in a few months; traumatic brain injury with my brother-in-law 2 years ago and then bacterial meningitis with him 8 months ago and my own auto-immune arthritis for 10 years . . I believe I am an honest and true testament that it is not what can (and does) and happen, it how you live with and through it. Our doctors have to be a part of that attitude.

  2. 2 English Pensioner September 19, 2010 at 6:25 pm

    The problem with worry is all the people who tell you to stop worrying! Last year I went through a length period of being unable to sleep, and was becoming more concerned and worried. I now understand how sleep deprivation could be used as a torture!
    My doctor told me that he’d seen the problem before in patients of my age and he had a theory that it could be because we no longer had anything to worry about. This could well be true in my case, no work worries, my wife is now very fit after major heart surgery some years ago, and my daughter has got through a difficult pregnancy and I now have a fine grandson.
    However, when I went to see my doctor for some more sleeping tablets he was away, and his partner suggested that I try out a glass of red wine about an hour before bed whilst sitting in a comfortable chair with some quiet music playing. It worked! No more pills, although I occasionally substitute a good Scotch for the wine!

    Continue blogging, I enjoy a viewpoint from across the Atlantic. But please don’t tell a patient to stop worrying without telling him how!


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