Guide to: The Mental Battle
Earlier this week, I spent eight days in hospital waiting for a possible diagnosis of heart disease. The hardest part was not the day of multiple scans and tests, resulting in a (minor) surgery. It was the days beforehand dealing with doubts, uncertainty and dark thoughts of what was to come.
Like others who’ve gone through a health scare, I’ve been able to gain better clarity on my goals, increase my mental toughness, show empathy for others going through difficult times, and make the conscious choice to live a higher quality life.
Here I’d like to share some of the tools and sources of inspiration which were useful for me along my week long “holiday” at Cardiology West Ward Level 3.
Hope for the best, prepare for the worst
First impressions upon entering the Cardiology ward were of optimism and a slight sense of surrealism in an entirely different world. These thoughts quickly changed from day to day, ranging from “will this affect my mental health” to “will my life expectancy change” to “how will I deal with this at work”? The overactive mind will race to process all scenarios, absorb all the information possible and create action plans. This can be emotionally draining and taxing on the mind. As the registrar recommended early on, “cross one bridge at a time” to avoid the speculation game.
It became immediately apparent that recognising and accepting your thoughts via mindfulness became incredibly useful. A calm place to focus the mind, in a still setting, to complete ten deep breaths. By observing your physical state, and then your thoughts and feelings, you are able to capture what is important and what is not. Are your thoughts positive and mind clear, or should you be kinder to yourself and take it easy? Sticky thoughts, even relatively inconsequential ones such as “should I speak to my neighbouring patients” tells you to follow your instincts. Given the possible diagnosis of a shortened life span, deciding to take action and introduce myself to the lovely grandmother in the adjacent bed resulted in some welcome surprises.
Despite the mindfulness breathing practices, the mind does still resort to the worst case scenario. I found this life hacker article only later on, to stay positive for as long as possible before bracing for the final news. We will later describe a set of philosophies or guidelines to manage the battle between light and dark (or action vs inaction). However it was first useful to find a level of comfort in times of uncertainty and stress.
You need something light
Just as pushing hard all the time is not recommended in sports, continually digging into questions on existentialism is not healthy either. Distractions for the mind became an important part of taking it easy and letting yourself relax. They also became invaluable to share with friends and colleagues who visited during my stay.
In terms of light material, a sense of relief came from:
- Listening to music such as Northlane’s cover of “Let it happen”
- Watching Formula 1 races or Nico Rosberg’s Beyond Victory series
- Choosing to watch Game of Thrones instead of working
- Sansa Stark trying Goat Yoga
- Guilty pleasures like watching BTS music videos or reality TV
- Walking around the West Ward to make myself a cup of tea
Productive habits were to continue studying, contribute to ideas at work via email, and commence writing.
Accepting help from others
Common questions a doctor asks when you have an illness in hospital are:
- Where do you live?
- Who do you live with?
- Do you have any family here?
These practical life questions lead any patient toward the realisation that your partner, family and loved ones are everything. They support you when you cannot take care of yourself. Who else will drive you home, pick up your kindle, or bring your undies for you? My sister was guiding me from the beginning, making me more comfortable with earplugs and eye masks in hospital, helping me process the medical implications of my results, and telling me to be kinder to myself. It was my wife who was truly instrumental in being able to support me and we are far closer because of it. Even as doctors were telling us I had one of three major heart conditions, she remained optimistic and hopeful throughout the entire process. I was stunned by her strength in character and intuition during these difficult times. Spoiler alert: my wife was right, and the doctors were leading me astray with the potential diagnosis of Hypertrophic cardiomyopathy, ARVD or Brugada.
A similar take from the nurses was, “have you had many visitors today?” The social contact from friends, colleagues and those around you can make a noticeable difference. One morning when I was not in a particularly good place (weighed by real questions of illness and disability), the nurses came around with a bright and chatty “Good morning, how are you today?” This can easily shake you out of any morbid stupor you find yourself in. And it comes to the next realisation that whatever happens, life goes on. You can recover from a heart attack or receive a diagnosis of two more years left to live, yet there is still fun and joy to be had.
A note of caution. Not everyone around you, even your oldest friends or family, will always do or say things in your best interest. Despite this, I implore those going through tough times to accept help as it may come from unexpected sources, even by sharing stories with the nurses, other patients, friends or colleagues. In retrospect, these moments were truly the shining highlights of the entire journey. The lovely lady with twelve grandchildren gave some strong advice to “go with the flow”, “just do what the doctors tell you to do” and to remember whatever you have, it is treatable.
One tip for anyone entering or working within the medical field, is to not lose sight of what motivated you to become a doctor, nurse or researcher. I quickly saw how ambitious registrars were concerned about fast results, malignant diagnoses and cheap treatments at the expense of the patient’s physical or mental health. By forgetting to care, you can easily lose the respect of your patients, regardless of how esteemed you’ve become.
The mental battle
A key balance here is between mental fortitude and having a sense of empathy for yourself. Following the tenants of tough love, it is up to you to decide whether you need a call to action to stop moping around, or need to rest and take it easy. It was no coincidence the reason I found myself in hospital in the first place was pushing too hard on a run with poor hydration, while recovering from a cold, after a focused day at work (and an abnormal ECG laying beneath the surface). There is no doubt that putting in strong efforts can get results. However this was a reality check that applying additional pressure can worsen performance (or in my case cause a complete collapse), for those who are already pushing at their limits.
Having given credit to the benefits of a lighthearted and optimistic approach, we must also acknowledge that creating an action plan and having answers can itself reduce worry and fear. Knowing how to make the worst situation look good is a useful coping mechanism to relieve pressure (Nico Rosberg). In my case, the ARVD diagnosis would mean a progressive heart disease that replaces healthy heart tissue with weaker fibrofatty tissue. Likely no more running, alcohol or camping. A shortened lifespan, possible requirement for a heart transplant and potential impact on future children. You may imagine this was difficult to grapple with all at once.
The key coping tactics were:
- Self kindness and hope. A paraphrase of Jordan Peterson’s lecture, if life is full of suffering, then the only thing you can do is to seek to do the highest good you can.
- Re-framing. When one door closes (running and exercise), another door opens (writing and pursuit of the creative arts).
- Humour. “Watch out ladies, I’ve got a pacemaker at 30!”
- Self toughness. “Stop moping about and do something productive instead.”
- Courage. The mental image of striding forward during a run.
- Anger. “Are you going to tell me what I can and cannot do?” from Gattaca.
- Understanding the utility of depression. To suppress irrational and rash self-destructive behaviours (to run an ultra marathon straight out of hospital).
- Understanding the utility of sadness. To instil a sense of clarity or beauty and reinvigorate your dreams.
- Understanding the utility of the pain arising from mistakes. To forge strong memories and represent the signposts of learning. My mistake was trying to control (lower) my heart rate in a room full of doctors and nurses during the Brugada challenge, when I should have simply let go.
- Simply making a list of enjoyable things to do when out of the hospital.
After bracing for the worst, there was only minor relief when the doctors said the cardiac MRI, stress echo and Brugada challenge were clear. After all of that, I’m a mystery case.
There are many positive lessons to extract out of the experience. Since leaving, I’ve discovered new restaurants, given a handwritten note of special mentions to the nurses and doctors, and decided to improve my quality of life by spending time with those who I care about most. I hope others can learn from this too.
Do you agree or disagree with these coping mechanisms? What is society’s role in helping the disadvantaged or disabled? How would you react? Thinking through these can improve your resilience and self awareness. I suggest you try it.
