By Denise Williams | News & Views

Gayla Oakley, RN, CCRP, MAACVPR has always advised her staff at the Boone County Health Center (BCHC) in Albion, Nebraska, to “treat each cardiac rehab patient as if he or she were your parent.” But what about when a loved one actually does suffer a cardiac event and lands in your facility? What if that someone, as Gayla had the misfortune of experiencing, is your spouse? Are you more emotional? Is it better to treat them yourself, or to hand that responsibility off to someone who is less attached? Here’s how Gayla navigated a cardiac crisis that hit close to home:

Unexpected Twist

Married to Bob for 47 years, Gayla was well aware of her husband’s familial risk for cardiac problems. At just 50 years young, his father had died of heart disease. But by all accounts—including his doctor’s—Bob was doing everything right to prevent a similarly tragic outcome and, in fact, had already outlived his dad by nearly 20 years. Although he did have mild hypertension and diabetes, both conditions were well-controlled with low-dose medication. Meanwhile, under the watchful eye of Gayla, who is director of cardiology services and prevention at BCHC, Bob maintained a good diet plus a daily walking regimen. The trucking firm manager could often be found playing golf and splitting wood by hand.

So, it was only in the interest of routine preventive care that the couple arranged for Bob to have a stress test on a Tuesday last summer, about 10 years after his last screening. Gayla was present for the stress test and was more surprised than anyone when it was positive. Bob’s doctor conferred immediately with a cardiologist, who took one look at the results and decided to skip the next step—a nuclear stress test—and instead scheduled heart catheterization that Friday.

As a professional with nearly 50 years of medical experience, Gayla was caught off guard by the alarming turn of events but was not rattled. She knew what to expect—no need for hysteria, she told herself. But as a loving wife, she wasn’t prepared for the cardiologist to walk out after the heart cath and tell her that Bob needed four-vessel bypass surgery.

The prognosis only worsened. During the surgery prep, an ultrasound revealed that Bob’s right carotid was 100% blocked and would have to be corrected before performing the bypass.

Two weeks after a routine appointment, Bob was sporting a huge incision in his chest and neck where a cardiovascular team had performed life-saving surgery. Gayla knew once she saw the results of the stress tetst that a health challenge lay ahead, but she never guessed Bob’s journey would take the path that it did—leading him to 5 weeks of cardiac rehab at her own facility.

Keep Calm and Do Your Job

Gayla attributes her calm demeanor throughout her husband’s ordeal to her medical training, which she says kept her grounded and on task. “I just knew what happens, and what needed to be done,” Gayla reflects. “I think the nurse in you takes over—you go on autopilot and that training jumps right on in there. Then, when it’s all over, you’ve got time to develop where your other thoughts are going.”

Interestingly, the experience became a teachable moment for Gayla. Not only did she play an important role in getting Bob back to a healthy place, she also tapped into unique insight that promises to help make CR better for all patients coming through her program.

She noted, for example, that no one ever asked how she, Bob’s spouse, was holding up. That didn’t bother her—there may be an underlying presumption of health care professionals having built-in coping mechanisms, she suggests—but it did give her pause. “I knew what was going on and what to expect, but what about caregivers or other spouses, even children, who are up all night worrying if their loved one is going to be alive in the morning? I can’t imagine what somebody who doesn’t understand would go through if this chain of events (that happened to me) were to happen to them,” she explains. “Somebody needs to make sure they’re on the same page. I found that it’s something we really need to focus on more.”

Stepping aside and putting her full faith in her staff to manage Bob’s rehab, Gayla also seized the opportunity to observe processes from a different angle. When her husband’s perceived exertion didn’t match his exhaustion level, she recognized some behaviors and personality traits in Bob that helped explain the disconnect. This observation translated into ensuring her staff’s discussions with patients yielded a deeper understanding of what they’re thinking but not saying.

Early in her career when working in the emergency department in her hometown, Gayla remembers her greatest fear was meeting her husband—or one of her parents—at the doors to the ER under critical circumstances. Thankfully, that never happened, but the scenario with Bob last year was close. She managed it with grace, thanks in no small measure to her background and training.