Intended for healthcare professionals

Practice What Your Patient is Thinking

Running a marathon was easier than getting back to work

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4331 (Published 02 December 2020) Cite this as: BMJ 2020;371:m4331
  1. Chloe Sellwood
  1. chloe.sellwood{at}nhs.net

Chloe Sellwood explains how she found the cognitive and emotional recovery from a cardiac arrest harder than her physical rehabilitation.

Run til you drop

In February 2019 I decided to complete a running challenge called “Run til you drop.” It involved running the distance of the date (eg, 5 miles or km on the 5 Feb) every day in February. Half way through the month-long challenge I had a cardiac arrest. It was a complete surprise considering my high basic level of fitness. It was discovered that I’d had a congenital defect since birth, despite having no symptoms for the first 42 years of my life.

A month later I underwent open heart surgery to “unroof” an artery. The surgery went well and a couple of weeks later I had an implanted cardioverter defibrillator inserted. My greatest concern throughout was being able to return to running. Before my surgery I had run marathons often and used running to maintain physical and mental wellbeing.

Getting back to physical health

Six and a half weeks after my arrest I was discharged and began a formal cardiac rehabilitation programme. I also did my own extended version of the NHS “Couch to 5k” scheme to get back to running. After four months I managed to run a 10 km race and then completed a half-marathon. My fitness wasn’t quite where it was before the arrest, but I was still very pleased.

A post on Facebook about my experiences led to a fellow runner contacting me and sharing her cardiac journey; she recommended joining the Cardiac Athletes Facebook group. This global group of patients and clinicians was supportive as I continued to recover and learn from their perspectives.

Experiencing “pumphead”

Despite the improvements in my physical health I found that work was becoming harder as the weeks passed. I was becoming increasingly short tempered, frustrated, and intolerant of others. I started to realise that I was struggling with my short term memory. I would have a conversation with someone, often forgetting who I had spoken to about a topic or what I had said to a particular individual. I didn’t recall this being discussed as a side effect of my cardiac arrest, so I started to worry.

I posted a query into the Cardiac Athletes group and heard that many other people were experiencing these same symptoms. Realising that this was not an abnormal side effect of what I had experienced really helped to reassure me. It was described as “pumphead” by others in the group, and it included a range of emotional, behavioural, and cognitive changes or impairments that occurred in those who had spent time on a bypass machine.

Learning to cope

I’ve learnt how to manage my memory issues (frequently I’ll email myself so I don’t forget things) and I already feel it’s improving. Because I felt physically well so quickly, I was not expecting to encounter psychological challenges of any sort.

My initial fear had been that I wouldn’t be able to run. I hadn’t even worried about other long term impacts, so hadn’t realised this was something to be aware of. Support from other cardiac athletes has proved invaluable to my recovery, and not just with running.

What you need to know

  • Physical recovery and psychological recovery are quite separate. One may happen without the other or at different times

  • Understand patients’ personal and realistic goals that reflect their endurance/fitness baseline

  • Contrary to expectations, getting back to being physically active might be easier for some patients than getting back to work

Education into practice

  • How would you approach discussing a patient’s personal goals after a serious illness?

  • What resources could you share with someone who has had coronary bypass surgery?

  • How could you help a patient understand the potential differences in physical and psychological recovery?

Additional information

Footnotes

  • Competing interests: none declared.

  • Provenance and peer review: commissioned, based on an idea from the author; externally peer reviewed.

View Abstract