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Tuesday, April 18, 2006
Dumaguing: Love makes all the difference!
By Dr. Vic Dumaguing
To your health
COUPLES take up the challenges of cardiac disease differently but all have a broad array of caring practices to ameliorate the stress both partners experience.
Cardiac disease, with its often-unexpected onset, has a major impact on both partners of a couple, the patient as well as the spouse. Although it has been shown that marital functioning, couples coping, and social support influence the well-being of patients and partners, little is known about how couples live and support each other after the onset of cardiac disease. This qualitative study aimed to explore the couples' experiences and to detect patterns and practices among couples to deal with this illness.
In-depth-interviews were conducted with 24 couples in Switzerland. The data comprised three interviews per couple and participant observation. All interviews were transcribed verbatim and analyzed with phenomenological methods.
The patients mean age was 60.9 years (20 or 83 percent male), and the partners mean age 57.8 years (22 or 92 percent female), respectively. Twenty-two patients suffered from CAD, two from valve failure. The procedures were catheter in 13 patients (54 percent), operation in nine (38 percent), and no procedure in two patients (eight percent).
The findings revealed that all couples experience a brush with death, feel very vulnerable and live with a sense of insecurity for long time. The experience of becoming ill calls for change in both partners' lives. Three different patterns of dealing with this call have been identified.
First, some couples experience the illness as having a positive effect on their relationship because it allowed them to detect new meanings in life and to reconnect with the partner in new ways. Second, some couples deal with the call by trying to control their lives and by developing new rituals to enhance the connection with the partner. Third, some couples describe that they missed the chances to change. They feel disenchanted about each other and return to previously established behaviors.
Despite different patterns and the struggle of some couples to respond to required role changes to the point of jeopardizing the relationship, caring practices, which show love and support for each other, are deployed and ameliorate the demands of the illness. Practices concerning three domains were described; a) detecting and managing illness, b) bearing witness to suffering of either partner, and c) modulating the mood and climate in the relationship.
First, the partners help to detect the illness because they observe a decrease in strength and stamina, organize support and work the health care system on behalf of the patient. After discharge, reorganizing daily life is of major concern for the couples such as managing medication regimen and integrating lifestyle change recommendation in daily life. Second, partners bear witness to suffering of their partner. In the acute phase and during hospitalization they want to stay close by the patient, feel urged to call the patient back to life and sooth the patient in turmoil. In the recovery phase, the partner of a couple help each other to narrate the illness story in acknowledging the grief and rage the patient or the partner experience due to the onset of illness. Third, both partners modulate the mood and climate in the relationship by reassuring each other and providing hope for the future, confirming their connectedness and resisting moods of fear and despair.
The study provides an insight in couples' patterns of dealing with experiences after the onset of cardiac disease and their caring for each. These findings are new in allowing a comprehensive picture of couple life worlds and health care professional as well as concerned couples inform themselves. The findings can be used to develop educational programs and intervention for couples' counseling. It can be concluded that interventions have to be tailored toward the caring practices and the couples' patterns in order to be supportive for couples and to acknowledge that their love for each other is taken for granted but makes the difference in adjusting to cardiac illness demands.
To a few, love hurts. But to most of us, love heals!
(April 18, 2006 issue)
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