I was driving the back roads this morning playing The Chieftains Christmas CD, "Bells of Dublin." (Browse here to hear their fine fiddling and piping.) "The Bells of Dublin" gladdens the heart on a dreary December day; I truly look forward to hearing it each year. By the time I reached Heart Man's house, I was in an excellent mood and whistling an Irish tune.
Maybe you have this conversation with your patients; the one that begins, "As we age..." and concludes with trying to get the patient to make some sensible accommodations for having grown old and frail. Heart Man is physically frail, but his faith has never been in better health. He sees God in almost all persons and places. I suspect he makes daily, even hourly, contact with the spiritually numinous; the thin places where we come close to God. His spirit is lively and faith makes him unafraid of death. Yet, he has a hard time living with the limitations of his body.
How soon can I plan on going one last time to Europe? he asks. "Can you walk upstairs without needing oxygen?" I ask gently. Then I review the rigors of air travel. "Do you think you could do that without getting totally exhausted?" Of course the answer is no; but he did so hope to go just once more.
I have another patient, recently diagnosed with elevated triglycerides, stroke, and new hypertension, whose life and diet have suddenly, radically, changed. It was easy for Trig Lady to maintain a heart-healthy diet when it was served from Dietary three times a day, but now that she's home she wonders what to cook, because she never was much of a cook when it came to vegetables. And, what should she do with 8 pounds of bacon and sausage she has stored in the freezer?
Do I really have hypertension now, Trig Lady asks; I've always had a low blood pressure before. So should I really give up the bacon? I haven't had any for a whole week...so I shouldn't worry about eating healthy anymore. Right?
Before this begins to read like an NCLEX test question, I should tell you the most merciful answer is the swift and terrible one, couched as a question if possible. To Trig Lady I said,
"With your condition/on your diet/to lower your cholesterol, you have to limit saturated fats. That means choosing foods that give you good nutrition and less fat. Bacon has three things you don't need/want: sat fat, sodium, and nitrates. It doesn't have much food value (protein, vitamins) beyond that. What breakfast foods could you eat that have good nutrition and less fat than bacon?"
Of course, even after your pep talk the patient may not do as you direct; she may talk herself into that bacon after all. Imagine how she will go about replacing that high sat-fat with something better. Make sure she has a plan for meals and a way to get the foods you suggest. If that fails, you can always suggest to husband/daughter/friend that a freezer raid is in order.
It turns out Heart Man had only a vague understanding of how the circulatory system works, despite a history of major cardiac deficits. I learned this as I was covering normal body circulation and how cardiac deficit impairs it.
"...then the left ventricle squeezes the blood out the aorta and sends it to the whole (peripheral) body," I said, wiggling my fingers and shaking a leg to demonstrate. Seeing his wondering face, I concluded, "It really is just like the Psalmist says, we are fearfully and wonderfully made."
The patient gazed at me and then lit up with a smile. "Imagine all that!" he said. "I had no idea...to think that's how God made us. All those blood vessels. Praise the Lord!" I tell you, we were having church right there in the living room.
I found myself wishing someone could make travel possible for him, all the while knowing it was a forlorn hope. On the Prayer Team at church we learn it is our place to ask for healing in body, mind, and spirit; the rest is up to God. Whatever God chooses, I suspect Heart Man's praise will be unceasing. Let mine be, also.