Judgment, Interrogation, and How to Face Them

Carolyn Thomas of Victoria, Canada, was out for a morning walk in 2008 when “out of the blue,” the 58-year-old felt sick. Pain engulfed the center of her chest and radiated down her left arm. She was nauseous and sweaty.

The emergency room doctor ran a few heart tests, then told Thomas: “You’re in the right demographic for acid reflux. Go home and see your family doctor for a prescription for antacids.”

But popping antacids regularly for a couple of weeks did nothing for her symptoms. Thomas had burning acid reflux, lacked energy to walk, and felt as if she had a Mack truck parked on her chest.

Fearing that she was dying, Thomas returned to the ER. That’s when she learned that the pain in her chest and arm pain had been a widowmaker heart attack — 95 percent of one of her coronary arteries was blocked.

A Shock to the Heart

Thomas and everyone who knew her were shocked that she had severe coronary artery disease (CAD). She was fit, healthy, and did not smoke. She discusses her case in her blog, Heart Sisters, about women and heart disease.

“The most common question,” Thomas says, “was ‘How could you, of all people, have a heart attack?!’”

Her friends seemed to want to believe that Thomas, a distance runner for almost 20 years, had somehow brought on the disease on herself.

“The questioner needs reassurance that this bad thing will not happen to them, so they seek answers to confirm their unrealistic belief that bad things happen to other people, not to me,” Thomas says.

But those on the other side of the interrogation, she says, can feel unfairly judged.

Heart attacks can happen to people who feel and look healthy. Most people with coronary artery disease have one or more risk factors, like high cholesterol or high blood pressure, and otherwise feel fine. But a small number don’t have any of the typical risk factors, says Deepak L. Bhatt, MD, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center in Boston.

Thomas wonders if people would rather believe that she had a heart attack because she smoked or had diabetes. “It might mean that my heart disease was self-inflicted,” she says.

Two years after her heart attack, Thomas discovered that she did have something that raised her chances for heart disease: a history of dangerously high blood pressure (preeclampsia) during pregnancy. Early menopause and polycystic ovary syndrome are risk factors, too. These things are unpreventable and “certainly not self-inflicted,” Thomas says.

Thomas says that even if a classic risk factor such as obesity leads to heart disease, there still is no justification for judgmental attitudes.

“Blaming the patient is an attempt to reinforce the belief that this diagnosis could never touch me or my family,” she says.

Why Heart Disease Doesn’t Get Enough Love

You’ve probably heard that October is breast cancer awareness month. But Thomas says there’s a shocking unawareness of heart disease even though more women die of it in the U.S. than from all forms of cancer combined.

“Breast cancer is widely perceived as a tragic diagnosis that attacks the innocent out of the blue,” Thomas says. But heart disease remains misunderstood.

One Heart Sisters blog reader recalled a conversation between co-workers after her own heart attack:

“They were talking about breast cancer awareness. I said it was a worthy cause, but did they know that heart disease is actually the No. 1 killer of women? And one woman replied, ‘Yes, but you bring that on yourself. If you take care of yourself, you won’t have a heart problem!’”

Bhatt, the Brigham and Women’s doctor, isn’t surprised. “If patients have cancer, it is very rare for people to blame them for their disease. There is a bit more blaming that tends to happen with heart disease because the typical risk factors are widely known.

Escape the “Judgment Zone”

Thomas says it’s human nature for family, friends, and co-workers to express curiosity about major events. One way she handles the potential for too-nosey questions is to pick her listeners carefully. People you expect would be supportive may disappoint. Or you might find sympathetic ears from the unlikeliest places.

Ironically, your loved ones may not be the best listeners when you need to vent because they may be too worried about you. “These people want and need to hear us say we’re better now and getting back to normal and that our frightening health crisis is over so they can relax,” Thomas says.

Thomas also says you can choose whom you confide in. If you’re uncomfortable sharing, a generic response is fine. For example, say, “Thanks for asking. I will know more about that after my cardiologist follow-up appointment.”

One of Thomas’s Heart Sisters readers prefers to simply say: “I have more questions than answers right now.”