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2-5-2003 - 4:33 p.m.
Denial It ain�t just a river in Egypt Even with an advanced degree that should give me some insight into the mysteries of the human mind, I am still humbled in the presence of unrelenting denial. It�s a more powerful force than gravity or lust I�m going to change this story just a bit to protect patient confidentiality, but you�ll get the point. I have this client who has been coming to me since last summer for weight control, let�s call him Bob. Bob�s a portly gent of around 45, 300+ pounds on a 6ft frame. I like him; he�s funny, smart and has a heart of gold. He also has bad knees, emphysema, coronary artery disease, hypertension, sleep apnea and diabetes, all related to his weight. About 2 years ago, Bob had to have stents placed in his coronary arteries to keep the blood flowing to his heart. Stent placement is the step right before quadruple by-pass surgery. Bob was sternly warned to lose weight and quit smoking, or else! That�s where I came in. He seemed to feel that a gay therapist would be more motivating. Sometime around the beginning of October last year, I notice that Bob was breathing hard and wheezing from the exertion of just coming up the 4 porch stairs to our office. Nurse Justin makes a comment about the labored breathing and Bob says that his cardiologist wants to do another cardiac catheterization to make sure the stents are still open and functioning. �Ok, When?� asks nosy Nurse Justin. Bob hadn�t scheduled the procedure just yet. We talk about the World Series. Bob shows up every week for his appointments through out the rest of the fall, losing 3 pounds one week, gaining 4 the next. What the heck, you can�t lose weigh during the holidays. He brings me home baked cookies. He hasn�t scheduled his testing because: he�s busy at work, Thanksgiving, getting ready for Christmas, cleaning up after Christmas, his birthday, brother coming in from out of town (for one whole day) Whatever Bob is an intelligent man but he honestly believes these excuses are valid. I begin calling him Princess Bob, da Queen of Denial. He laughs, he thinks I am kidding. I�m not. He vows to schedule the procedure �after the holidays.� New Year's Eve? MLK Day? GroundHog's day. There's always SOME holiday coming. January 2, I am all over his ass, because that�s my job. Bob tells a long, involved story about his cardiologist moving to a new hospital while his pulmonologist is staying at the old hospital. There are insurance complications. To Bob, this is good as a get out of jail free card. I�m not buying it and tell him so. He�s sweating in a cool office, wheezing like a steam calliope and looks like shit. January 28th, Bob has finally scheduled an appt with the cardiologist and then only because they wouldn�t renew his medications without seeing him. His weight and blood pressure is up. A quick echocardiogram shows a place on his heart that isn�t moving...as in permanent damage. The doctor insists that Bob have the procedure and sugests that very afternoon. But Bob is a busy man with places to go, people to see. Who is going to feed the cat? He agrees to do it in a week, which was Monday, two days ago. Bob tells me he is pissed because the doctor wants him to check into the hospital the night before. He doesn't feel it is necessary. The Procedure: Hell, Yes, the stents were occluded. Hell Yes, Bob has had a silent heart attack AND he�s got kidney damage from the relentless hypertension. Then while Bob is peacefully resting in the Cardiac intensive care unit after the procedure, he manages to have ANOTHER heart attack, all the while convincing himself and several nurses that �it�s just indigestion. �Bring me some Maalox, honey�. The mind boggles.
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